The Harvard Classics Part 15

These are not brought forward as uncommon occurrences, but as exemplifications of the human system's susceptibility of the variolous contagion, although it has been previously sensible of its action.

Happy is it for mankind that the appearance of the small-pox a second time on the same person, beyond a trivial extent, is so extremely rare that it is looked upon as a phaenomenon! Indeed, since the publication of Dr. Heberden's paper on the Varicellae, or chicken-pox, the idea of such an occurrence, in deference to authority so truly respectable, has been generally relinquished.

This I conceive has been without just reason; for after we have seen, among many others, so strong a case as that recorded by Mr.

Edward Withers, Surgeon, of Newbury, Berks, in the fourth volume of the Memoirs of the Medical Society of London (from which I take the following extracts), no one, I think, will again doubt the fact.

"Mr. Richard Langford, a farmer of West Shefford, in this county (Berks), about fifty years of age, when about a month old had the smallpox at a time when three others of the family had the same disease, one of whom, a servant man, died of it. Mr. Langford's countenance was strongly indicative of the malignity of the distemper, his face being so remarkably pitted and seamed as to attract the notice of all who saw him, so that no one could entertain a doubt of his having had that disease in a most inveterate manner." Mr. Withers proceeds to state that Mr.

Langford was seized a second time, had a bad confluent smallpox, and died on the twenty-first day from the seizure; and that four of the family, as also a sister of the patient's, to whom the disease was conveyed by her son's visiting his uncle, falling down with the smallpox, fully satisfied the country with regard to the nature of the disease, which nothing short of this would have done; the sister died.

"This case was thought so extraordinary a one as to induce the rector of the parish to record the particulars in the parish register."

It is singular that in most cases of this kind the disease in the first instance has been confluent; so that the extent of the ulceration on the skin (as in the cow-pox) is not the process in nature which affords security to the const.i.tution.

As the subject of the smallpox is so interwoven with that which is the more immediate object of my present concern, it must plead my excuse for so often introducing it. At present it must be considered is a distemper not well understood. The inquiry I have inst.i.tuted into the nature of the cow-pox will probably promote its more perfect investigation.

The inquiry of Dr. Pearson into the history of the cow-pox having produced so great a number of attestations in favour of my a.s.sertion that it proves a protection to the human body from the smallpox, I have not been a.s.siduous in seeking for more; but as some of my friends have been so good as to communicate the following, I shall conclude these observations with their insertion.

Extract of a letter from Mr. Drake, Surgeon, at Stroud, in this county, and late Surgeon to the North Gloucester Regiment of Militia:

"In the spring of the year 1796 I inoculated men, women, and children to the amount of about seventy. Many of the men did not receive the infection, although inoculated at least three times and kept in the same room with those who actually underwent the disease during the whole time occupied by them in pa.s.sing through it. Being anxious they should, in future, be secure against it, I was very particular in my inquiries to find out whether they ever had previously had it, or at any time been in the neighbourhood of people labouring under it. But, after all, the only satisfactory information I could obtain was that they had had the cow-pox. As I was then ignorant of such a disease affecting the human subject, I flattered myself what they imagined to be the cow-pox was in reality the smallpox in a very slight degree. I mentioned the circ.u.mstance in the presence of the officers, at the time expressing my doubts if it were not smallpox, and was not a little surprised when I was told by the Colonel that he had frequently heard you mention the cow-pox as a disease endemial to Gloucestershire, and that if a person were ever affected by it, you supposed him afterwards secure from the smallpox. This excited my curiosity, and when I visited Gloucestershire I was very inquisitive concerning the subject, and from the information I have since received, both from your publication and from conversation with medical men of the greatest accuracy in their observations, I am fully convinced that what the men supposed to be cow-pox was actually so, and I can safely affirm that they effectually resisted the smallpox."

Mr. Fry, Surgeon, at Dursley in this county, favours me with the following communication:

"During the spring of the year 1797 I inoculated fourteen hundred and seventy-five patients, of all ages, from a fortnight old to seventy years; amongst whom there were many who had previously gone through the cow-pox. The exact number I cannot state; but if I say there were nearly thirty, I am certainly within the number.

There was not a single instance of the variolous matter producing any const.i.tutional effect on these people, nor any greater degree of local inflammation than it would have done in the arm of a person who had before gone through the smallpox, notwithstanding it was invariably inserted four, five, and sometimes six different times, to satisfy the minds of the patients. In the common course of inoculation previous to the general one scarcely a year pa.s.sed without my meeting with one or two instances of persons who had gone through the cow-pox, resisting the action of the variolous contagion. I may fairly say that the number of people I have seen inoculated with the smallpox who, at former periods, had gone through the cow-pox, are not less than forty; and in no one instance have I known a patient receive the smallpox, notwithstanding they invariably continued to a.s.sociate with other inoculated patients during the progress of the disease, and many of them purposely exposed themselves to the contagion of the natural smallpox; whence I am fully convinced that a person who had fairly had the cow-pox is no longer capable of being acted upon by the variolous matter.

"I also inoculated a very considerable number of those who had had a disease which ran through the neighbourhood a few years ago, and was called by the common people the swine-pox, not one of whom received the smallpox. [Footnote: This was that mild variety of the smallpox which I have noticed in the late Treatise on the Cow-Pox (p. 233).]

"There were about half a dozen instances of people who never had either the cow-or swine-pox, yet did not receive the smallpox, the system not being in the least deranged, or the arms inflamed, although they were repeatedly inoculated, and a.s.sociated with others who were labouring under the disease; one of them was the son of a farrier."

Mr. Tierny, a.s.sistant Surgeon of the South Gloucester Regiment of Militia, has obliged me with the following information:

"That in the summer of the year of 1798 he inoculated a great number of the men belonging to the regiment, and that among them he found eleven who, from having lived in dairies, had gone through the cow-pox. That all of them resisted the smallpox except one, but that on making the most rigid and scrupulous enquiry at the farm in Gloucestershire, where the man said he lived when he had the disease, and among those with whom, at the same time, he declared he had a.s.sociated, and particularly of a person in the parish, whom he said had dressed his fingers, it most clearly appeared that he aimed at an imposition, and that he never had been affected with the cow-pox." [Footnote: The public cannot be too much upon their guard respecting persons of this description.] Mr. Tierny remarks that the arms of many who were inoculated after having had the cow-pox inflamed very quickly, and that in several a little ichorous fluid was formed.

Mr. Cline, who in July last was so obliging at my request as to try the efficacy of the cow-pox virus, was kind enough to give me a letter on the result of it, from which the following is an extract:

"My DEAR SIR:

"The cow-pox experiment has succeeded admirably. The child sickened on the seventh day, and the fever, which was moderate, subsided on the eleventh. The inflammation arising from the insertion of the virus extended to about four inches in diameter, and then gradually subsided, without having been attended with pain or other inconvenience. There were no eruptions.

"I have since inoculated him with smallpox matter in three places, which were slightly inflamed on the third day, and then subsided.

"Dr. Lister, who was formerly physician to the Smallpox Hospital, attended the child with me, and he is convinced that it is not possible to give him the smallpox. I think the subst.i.tuting the cow-pox poison for the smallpox promises to be one of the greatest improvements that has ever been made in medicine; and the more I think on the subject, the more I am impressed with its importance.

"With great esteem

"I am, etc., "HENRY CLINE.

"Lincoln's Inn Fields, August 2, 1798."

From communications, with which I have been favoured from Dr.

Pearson, who has occasionally reported to me the result of his private practice with the vaccine virus in London, and from Dr.

Woodville, who also has favoured me with an account of his more extensive inoculation with the same virus at the Smallpox Hospital, it appears that many of their patients have been affected with eruptions, and that these eruptions have maturated in a manner very similar to the variolous. The matter they made use of was taken in the first instance from a cow belonging to one of the great milk farms in London. Having never seen maturated pustules produced either in my own practice among those who were casually infected by cows, or those to whom the disease had been communicated by inoculation, I was desirous of seeing the effect of the matter generated in London, on subjects living in the country. A thread imbrued in some of this matter was sent to me, and with it two children were inoculated, whose cases I shall transcribe from my notes.

Stephen Jenner, three years and a half old.

3d day: The arm shewed a proper and decisive inflammation.

6th: A vesicle arising.

7th: The pustule of a cherry colour.

8th: Increasing in elevation. A few spots now appear on each arm near the insertion of the inferior tendons of the biceps muscles.

They are very small and of a vivid red colour. The pulse natural; tongue of its natural hue; no loss of appet.i.te or any symptom of indisposition.

9th: The inoculated pustule on the arm this evening began to inflame, and gave the child uneasiness; he cried and pointed to the seat of it, and was immediately afterwards affected with febrile symptoms. At the expiration of two hours after the seizure a plaster of ung. hydrarg. fort, was applied, and its effect was very quickly perceptible, for in ten minutes he resumed his usual looks and playfulness. On examining the arm about three hours after the application of the plaster its effects in subduing the inflammation were very manifest.

10th: The spots on the arms have disappeared, but there are three visible in the face.

11th: Two spots on the face are gone; the other barely perceptible.

13th: The pustule delineated in the second plate in the Treatise on the Variolae Vaccinae is a correct representation of that on the child's arm as it appears at this time.

14th: Two fresh spots appear on the face. The pustule on the arm nearly converted into a scab. As long as any fluid remained in it it was limpid.

James Hill, four years old, was inoculated on the same day, and with part of the same matter which infected Stephen Jenner. It did not appear to have taken effect till the fifth day.

7th: A perceptible vesicle: this evening the patient became a little chilly; no pain or tumour discoverable in the axilla.

8th: Perfectly well.

9th: The same.

10th: The vesicle more elevated than I have been accustomed to see it, and a.s.suming more perfectly the variolous character than is common with the cow-pox at this stage.

11th: Surrounded by an inflammatory redness, about the size of a shilling, studded over with minute vesicles. The pustule contained a limpid fluid till the fourteenth day, after which it was incrusted over in the usual manner; but this incrustation or scab being accidentally rubbed off, it was slow in healing.

These children were afterwards fully exposed to the smallpox contagion without effect.

Having been requested by my friend, Mr. Henry Hicks, of Eastington, in this county, to inoculate two of his children, and at the same time some of his servants and the people employed in his manufactory, matter was taken from the arm of this boy for the purpose. The numbers inoculated were eighteen. They all took the infection, and either on the fifth or sixth day a vesicle was perceptible on the punctured part. Some of them began to feel a little unwell on the eighth day, but the greater number on the ninth. Their illness, as in the former cases described, was of short duration, and not sufficient to interrupt, but at very short intervals, the children from their amus.e.m.e.nts, or the servants and manufacturers from following their ordinary business.

Three of the children whose employment in the manufactory was in some degree laborious had an inflammation on their arms beyond the common boundary about the eleventh or twelfth day, when the feverish symptoms, which before were nearly gone off, again returned, accompanied with increase of axillary tumour. In these cases (clearly perceiving that the symptoms were governed by the state of the arms) I applied on the inoculated pustules, and renewed the application three or four times within an hour, a pledget of lint, previously soaked in aqua lythargyri acetati [Footnote: Goulard's extract of Saturn.] and covered the hot efflorescence surrounding them with cloths dipped in cold water.

The next day I found this simple mode of treatment had succeeded perfectly. The inflammation was nearly gone off, and with it the symptoms which it had produced.

Some of these patients have since been inoculated with variolous matter, without any effect beyond a little inflammation on the part where it was inserted.

Why the arms of those inoculated with the vaccine matter in the country should be more disposed to inflame than those inoculated in London it may be difficult to determine. From comparing my own cases with some transmitted to me by Dr. Pearson and Dr.

Woodville, this appears to be the fact; and what strikes me as still more extraordinary with respect to those inoculated in London is the appearance of maturating eruptions, In the two instances only which I have mentioned (the one from the inoculated, the other from the casual, cow-pox) a few red spots appeared, which quickly went off without maturating. The case of the Rev. Mr. Moore's servant may, indeed, seem like a deviation from the common appearances in the country, but the nature of these eruptions was not ascertained beyond their not possessing the property of communicating the disease by their effluvia.

Perhaps the difference we perceive may be owing to some variety in the mode of action of the virus upon the skin of those who breathe the air of London and those who live in the country. That the erysipelas a.s.sumes a different form in London from what we see it put on in this country is a fact very generally acknowledged. In calling the inflammation that is excited by the cow-pox virus erysipelatous, perhaps I may not be critically exact, but it certainly approaches near to it. Now, as the diseased action going forward in the part infected with the virus may undergo different modifications according to the peculiarities of the const.i.tution on which it is to produce its effect, may it not account for the variation which has been observed?