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 INAUGURAL DISSERTATION 
 
 ON THE 
 
 NATURE AND ORIGIN 
 
 OF 
 
 VACCINIA, or COW-POCK, 
 
 SUBMITTED TO THE PUBLIC EXAMINATION OF THE 
 
 FACULTY OF PHYSIC 
 
 UNaiia THE AUTHORITY OF THi: TRUSTEES OF COLUMBIA COLLECSi 
 IN THE STATE OF NEW-YORK, 
 
 The Right Rev. BENJAMIN MOORE, D.D. President; 
 
 FOR THE DEGREE OF 
 
 DOCTOR OF PHYSIC, 
 
 On the Sth Day of November, 1803. 
 
 BY SAMUEL SCOFIELD, 
 
 Citizen of the State of New- York. 
 
 A specific is discovered for that disease which has been the scourge 
 of Europe for a thousand years, and committed the most dreadful 
 ravages in every quarter of the world." 
 
 N EW-rO RK: 
 
 Printed by T. ^ J. Swords, Printers to the Faculty of Physi' 
 of Cclumbia CoUege. ^ 4 " 
 
 1803. 
 
^:^ 
 
 
 ■S2>.3j$ 
 
 
TO 
 
 " \^ALENTINE SEAMAN, M.D, 8(c, 
 
 WHOSE HUMANE AND PHILANTHROPIC EXERTIONS, 
 
 so CONSPICUOUSLY DISPLAYED 
 
 IN INTRODUCING AND CULTIVATING A FAMILIAR 
 
 KNOWLEDGE pF VACCINE INOCULATION 
 
 IN THIS CITY, 
 
 . - '■ HAVE JUSTLY ENTITLED HIM TO 
 
 THE GRATEFUL THANKS AND ESTEEM 
 
 '-^' OF HIS FELLOW CITIZENS; 
 
 AND 
 
 IfO WHOSE A'ri'ENriVE AND INStRUCflVE INFORMA'TlON 
 
 fHE AVfHOR IS JNDEBT'ED FOR fHE GREATER 
 
 PARI' OF HIS MEDICAL EDUCAT'ION, 
 
 THIS DISSERTATION 
 
 IS RESPECTFULLY INSCRIBED. 
 
*5 
 
 James WATSON, Esq. President; 
 GILBERT ASPINWALL, Vice-President; 
 THOMAS FRANKLIN, Treasurer; 
 ADRIAN HEGEMAN, Secretary; 
 
 AND TO 
 
 ROBERT BOWNE, WILLET SEAMAN, 
 
 JOHN KEESE, SAMUEL MILLER, 
 
 SAMUEL L. MITCHILL, JAMES ROBERTSON, 
 ANDREW COCK, THOMAS BUCKLEY, and 
 
 WILLIAM MOORE, ISAAC HICKS, Directors; 
 
 AND ALSO TO 
 
 VALENTINE SEAMAN, WRIGHT POST, and 
 EDWARD MILLER, SAMUEL BORROWE, 
 
 Medical Board of the 
 
 Nexv-Ycrk Institution for the Inoculation of the 
 
 Kine-Pock : 
 
 Gentlemen, 
 
 PERMIT me to tender you my grateful 
 and sincere acknowledgments for the polite attention 
 shown, and for the many services rendered me, during my 
 official capacity as Resident Surgeon to that Benevolent 
 Institution : And, with wishing that you may long con- 
 tinue your wise and judicious Guardianship over this Bene- 
 ficent Establishment, in v/hich you have so transcendently 
 signalized yourselves in the glorious cause of Humanity, 
 and more particularly as respects that of the poor and 
 needy of your ow^n city, I subscribe myself your much 
 obliged and humble servant, 
 
 SAMUEL SCOFIELD. 
 
INTRODUCTORY OBSERVATIONS. 
 
 J. HE subject to which I have devoted the following 
 pages is, I conceive, one of the most important that can 
 engage the attention of the medical practitioner or of the 
 public. It is not only intimately connected with the in- 
 terests and policy of States and Empires, but involves in 
 its consequences the health and happiness of all posterity. 
 
 Not more than five years have elapsed since the asto- 
 nishing effects of this inestimable blessing were made 
 known to the world, by its first great inoculator. Dr. 
 Jenner, in a work, entitled, ^' An Inquiry into the Causes 
 and Effects of the Variola Vaccina, a Disease discovered 
 in some of the Western Counties of England, particularly 
 Gloucestershire, and known by the Name of the CoW" 
 Foxr 
 
 Notwithstanding the era of this great and ever memo- 
 rable improvement in the science of medicine is fixed at 
 so advanced a period as the latter end of the eighteenth 
 century, its existence in the cow, and its capability of 
 being communicated from the cow to the human subject, 
 have been known, in some of the dairy countries of Eu- 
 rope, from time immemorial. In such of the European 
 countries, those persons to whom were committed the 
 affairs of the dairy were known frequently to contract 
 
m 
 
 ( vi" ) 
 
 very disagreeable and troublesome sores, from milking 
 such cows as happened to be labouring under this com-, 
 plaint; generally manifesting themselves in the part ex- 
 posed to the infection, as the hands and wrists. Persons 
 so infected were, in the course of their complaint, most 
 generally affected with a slight ephemeral fever, after the 
 subsidence of which, the ulcers in a short time cicatrized ; 
 and they were left in a state for ever after unsusceptible 
 of the small-pox, either by inoculation or contagion. 
 The truth of this is confirmed by the experience of ages. 
 But this knowledge, unfortunately for humanity, was 
 principally confined to the proprietors and domestics 
 of the dairy; it being well known by them, that the 
 existence of such a disease among their cows, if public, 
 greatly depreciated the value of their produce. At length, 
 however, the immortal Jenner, by finding it frequently 
 impracticable to communicate the small-pox to such as 
 were said to h^ve previously undergone cow-pock, turned 
 his attention towards it, and, by a long series of accurate 
 and impartial experiments, in transmitting the matter from 
 the cow to the human subject, by means of inoculation, 
 evinced, beyond all possibility of doubt, that the disease 
 thus induced was equally effectual in securing a person 
 from the variolous complaint, as that communicated 
 immediately from the cow by milking; and that the 
 matter was not in the least deprived of its prophylactic 
 virtue from having passed the ordeal of the human system. 
 Experience now fully warrants the assertion, that through 
 this medium the infection may be handed down to poste- 
 rity in an undegenerated state, and, contrary to the 
 opinion which Dr. Jenner first advanced, will supersede 
 the necessity of having frequent recourse to the original 
 stock, in order to keep up a constant supply of the genuine 
 matter. 
 
( i>^ ) 
 
 i^lthough the discovery of vaccine inoculation is of so 
 very recent a date, and notwithstanding the vast torrent 
 of opposition directed against it from almost every quarter, 
 its salutary influence has already extended into every 
 civilized nation of the world, and its beneficial effects are 
 now experienced even by the savage. Indeed, there is 
 not at present a single well-informed physician, either in 
 Europe or America, that pretends in the least to doubt o£ 
 its efEcacy in protecting the system against that loathsome 
 complaint the small-pox. It is computed that not less 
 than two millions of persons have already experienced the 
 happy effects resulting from this great and ever-memorable 
 improvement. A great proportion of the better informed 
 part of the community have already become sensible of 
 the vast benefits that would accrue to society In substitut- 
 ing the vaccine for variolous inoculation, and are now very 
 generally adopting the practice. 
 
 From the growing reput£.tIon of this invaluable disco= 
 very, we are warranted in asserting that it promises fair, 
 at no very distant period, to exterminate from the face of 
 the earth one of the most formidable and destructive 
 maladies to which mortality is heir ; and that, in time, the 
 small-pox will only be known from the devastations and 
 ravages which It has committed — circumstances which 
 the human mind will ever contemplate with horror. 
 
 This dreadful scourge of humanity is not only to be 
 dreaded in regard to Its fatality, but also in consequence 
 of the many incurable diseases which it not unfrequendj 
 produces; some of the most prominent of which I shall 
 take an opportunity of noticing in the following disser^ 
 tation. ' " ^ 
 
 B 
 
( X ) 
 
 The important discovery of vaccine inoculation I eon^ 
 ceive to stand unparalleled in the history of medicine. 
 What remuneration, what gratitude, then, is due to him 
 who put mankind in possession of this inestimable bles- 
 sing ! His signal and transcendent services will be handed 
 down, in the annals of time, to the latest ages, and poste- 
 rity will recognize the name of their great benefactor with 
 gratitude and esteem. 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 VACCINA, or CO TV-POCK. 
 
 1 HE Cow-pock is supposed^ by Dr. Jenner^ 
 to derive its origin from the horse. This singular 
 opinion will, no doubt^ appear very surprising 
 to many. In order, therefore, that the reader 
 may clearly understand upon what his belief is 
 predicated, I shall, previously to entering into an 
 investigation of the subject myself, give the opi- 
 nion entertained of it by our author in his own 
 words, in the following quotation from his works, 
 (See his Inquiry into the Causes and Effects of 
 the Variola Vaccine^, 8zc, p. 2 — 6.) 
 
 '^ There is a disease,'' says Dr. Jenner, ^^ 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 
 of the heel, accompanied, at its commencement, 
 with small cracks or fissures, from which issues 
 a limpid fluid, possessing properties of a very 
 peculiar kind. This fluid seems capable of gene- 
 rating a disease in the human body (after it has 
 
12 
 
 iindergone the modification I shall presently' 
 speak of,) which bears so strong a resemblance td 
 the small-pox, that I think it highly probable it 
 may be the source of that disease. 
 
 " In this dairy country a great num.ber of 
 cows are kept, and the office of milking is per= 
 formed indiscriminately by men and maid, ser- 
 vants. One of the former having been appointed 
 to apply dressings to the heels of a horse affected 
 with the malady I have mentioned, and not pay- 
 ing due attention to cleanliness, incautiously 
 bears his part in milking the cows^ with some of 
 the particles of the infectious matter adhering to 
 his fingers. When this is the case, it frequently 
 happens that a disease is communicated to the 
 C0WS3 and from the cows to the dairy maids, 
 which spreads through the farm till most of the 
 cattle and domestics feel its unpleasant conse- 
 quences. This disease has obtained the name 
 of Coiv-Pqx. 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 somewhat approaching 
 to livid, and are surrounded by an inflammation. 
 These pustules, unless a timely remedy be applied, 
 frequently degenerate into phagedenic ulcers, 
 which prove extremely troublesome. The ani- 
 mals become indisposed, and the secretion of 
 milk is much lessened. Inflamed spots now be- 
 gin to appear on different parts of the hands of 
 
•IB 
 
 the domestics employed in milking, and sornc- 
 times on the wrists, which run on to suppuration, 
 first assuming the appearance of small vesications 
 produced by a burn. Most commonly they ap- 
 pear about the joints of the fingers, and at their 
 extremities ; but whatever parts are affected, if 
 the situation will admit, these superficial suppu- 
 i-ations put on a circular form, with their edges 
 more elevated than their center, and of a colour 
 distantly approaching to blue. Absorption takes 
 place, and tumours appear in each axilla. The 
 system becomes affected; the pulse is quickened: 
 shiverings, succeeded by heat, general lassitude, 
 and pains about the loins and limbs, with vomit- 
 ing, come on. The head is painful, and the pa- 
 tient is now and then even affected with deli- 
 rium.* These symptoms, varying in their degrees 
 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 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 heed- 
 lessly rubbed or scratched with the patient's in- 
 
 * " It will appear in the sequel that these symptoms arise principally 
 
 Trom the irritation of the sores, and not from the primary action of the •■ 
 
 Vaccine virus upon the constitution." 
 
 Note of Dr.^-^nncr. 
 
14 
 
 fected fingers. No eruptions on the skin liaV^ 
 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 arms: they v/ere very minutej 
 of a vivid red colour^ and soon died away with- 
 out advancing to maturation; so that I cannot 
 determine whether they had any connection with 
 the preceding 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/' 
 
 In regard to this interesting subject, I shall 
 take the liberty of deviating from its worthy au- 
 thor. Sorry I am, however, to contest the opinion 
 of so eminent and learned a character; but can- 
 dour, and a firm persuasion of a contrary belief, 
 compel me to the disagreeable task. 
 
 The facts which I conceive greatly to militate 
 against Dr. Jenner's hypothesis are, 
 
 1. That the Cow-pock has been discovered in 
 the teats of American cows, and also in those of 
 several parts of Europe, where, it is known, the 
 cows and horses are never attended by the same 
 person. 
 
 It appears that Dr. Jenner has an opinion 
 that the disease is particularly confined to some 
 few counties 2*72 England, where there is, as he 
 says, a direct communication between the heels 
 of the horse and the teats of the cow, through 
 
15 
 
 rhe medium of the male domestics, who, after 
 having been employed in applying dressings to 
 the heels of a horse affected with grease, with- 
 out proper attention to cleanliness, incautiously 
 bear their part in milking the cows 3 and in this 
 manner, from some of the particles of the infec-? 
 tious matter having adhered to their fingers, they 
 communicate the disease to the cows ; and that 
 from the cows it is communicated to the maid- 
 servants, and in this way spreads through the 
 farm. From this it seems that Dr. Jenner lays 
 his chief stress on the circumstance, as he sup- 
 poses, of the disease not existing in any country 
 where this communication "is wanting. Now, 
 that the genuine Cow-pock has been discovered 
 on the teats of American cows, in several of the 
 different States, is an undeniable fact; and expe-^ 
 rience has proved that the matter affords effectual 
 security against the small-pox. And that the 
 office of milking is never performed by men that 
 are employed in applying dressings to Xh^ greasy 
 heels of a horse is equally certain. It is also 
 well known, that the Cow-pock has existed in 
 Ireland from time immemorial, where it is even 
 deemed a disgrace for a man to engage in milk^ 
 ing. In proof of which I shall relate the fol- 
 lowing anecdote, which Mr. Ring, in his treatise 
 on the Cow-pock, informs us was related to him 
 by Dr. Jenner himself. " Two peasants, who 
 lived on a nobleman's estate in Ireland^ having 
 
16 
 
 been compelled to milk the cows in the park^ 
 were considered, by their neighbours and fellow 
 servants, as utterly unfit for all society. Had 
 they committed murder, they might have found 
 some kind friend to speak to them and associate 
 with them; but they had been guilty of a much 
 greater crime, that of milking cows^ 
 
 One of Dr. Jenner's principal arguments in 
 support of his opinion, concerning the origin of 
 the Cow-pock, as advanced in his ^ Further Ob-f 
 3ervations on the Variolas Vaccinae,' is drawn 
 from the supposed " total absence of the disease 
 in Ireland and Scotland, where," he says, " the 
 men-servants are not employed in the dairy." 
 It appears from Mr. Ring, that the preceding 
 narrative was related by Dr. Jenner previous to 
 his knowledge of the existence of the disease in 
 these countries. ' Since this, however, we havQ 
 been informed, by men of the first respectability 
 in the medical profession, that the Cow-pock 
 has existed in Ireland for an undeterminate 
 length of time ; and that it has been long 
 known, among the common people of that 
 country, to prove effectual, when taken froni 
 the cow by milking, in preventing the small- 
 pox; instances of which are related of thirty ox 
 forty years standing: and there are not wanting 
 instances of persons voluntarily giving themselves 
 the disease, from a conviction that it would pre- 
 vent the small-pox. 
 
17 
 
 '■■' Doctor Lewis Sacco, of Milan/ in his treatise 
 on Cow-pock, informs us that he has di:covered 
 the real disease in the cows of Lombardy, where 
 the horses and the affairs of the dairy are never 
 attended to by the same person. And it has alsQ 
 been discovered in the Dutchy of Holstein. 
 
 Now, the existence of the disease in places 
 where it is certain there is not the necessary me-? 
 dium of conveyance, amounts to a direct proof, 
 as I conceive, that the Vaccina is not in any way 
 connected with or dependent on the grease. 
 
 2. It does not appear that Dr. Jenner, or any 
 of the advocates for his opinion, have, after nu- 
 merous and repeated experiments, succeeded in 
 securing the system against the effects of the 
 variolous virus, either with matter taken immcr 
 diately from the horse, or after it had undergone 
 that peculiar modification in the system of the 
 cow which, by Dr. Jenner, is deemed so essen- 
 tially requisite, in order that it should possess the 
 property of completely securing the constitutiou 
 against the effects of small-pox. 
 
 It is said, indeed, by Dr. Jenner, that a vete- 
 rinary surgeon has, at last, 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 denuded 
 surface. This is the only case he relates that 
 appears to cari-y with it the least degree of 
 proof that the Cow-pock derives its origii| 
 
18 
 
 from the matter of grease ; and even here it 
 seems very singular that we have not a more 
 fall history of the case given us, as it would 
 certainly be of the utmost consequence to have 
 an accurate description of the appearances of the 
 disease, and also what use was made of the 
 matter it afforded, and whether it imparted to 
 the human system the same security as the casual 
 Cow-pock. I apprehend, however, there were 
 never any trials instituted with this artificial 
 virus ; or, if there were, they must, no doubt, 
 have proved abortive, otherwise so important a 
 circumstance in support of the doctrine would 
 doubtless not have passed unobserved. 
 
 There are, it is true, several experiments re- 
 lated by Dr. Jenner, which, in some measure, 
 seem to favour his hypothesis. He informs us^ 
 in one of these, that he found it impracticable 
 to induce the small-pox in a person who, six 
 years previous to his inoculating him with va- 
 riolous matter, had been pretty severely indis^ 
 posed, owing to some sores, occasioned, at that 
 time, by the matter of grease. This person, it 
 is said, was inoculated repeatedly, and also ex- 
 posed to variolous contagion, but wthout pro^ 
 ducing any effect. To this case is annexed a 
 note, stating, as a remarkable fact, well known 
 to many, the frequent failure of attempts to com- 
 municate the small-pox, by inoculation, to black' 
 gmiths^ who in the country are farriers. 
 
19 
 
 Anotlier case Is adduced by Dr. Jenner^ to 
 prove the obscure appearance of small-pox after 
 the disease produced by the grease^ at least in 
 some instances. 
 
 In another he tells us that this cannot be 
 entirely relied on, until a disease has been gene- 
 rated, by morbid matter from the horse, on the 
 udder of the cow, and passed through this me- 
 dium to the human subject; for the person who 
 Was the subject of this case^ he informs us, took 
 the small-pox upwards of twenty years after- 
 wards. 
 
 In all these cases we see there is but one in 
 which the person was rendered unsusceptible of 
 the small-pox,- and this, it seems, was only of 
 six years standing : whereas there is one of them, 
 who, after twenty years had elapsed, was seized 
 with the variolous disease. Is it not, therefore, 
 probable, that the person who continued to re* 
 sist the small-pox only for the short space of six 
 years, might have become again subject to it, 
 after a lapse of thirty or forty? Certainly it is 5 
 and the more so, I think, as there is but this one 
 person, among the many adduced, who remained 
 unsusceptible of variolous action. 
 
 Suppose, for a minute, it be admitted, merely 
 for argument sake, that the equine virus possesses 
 the power of giving to the system complete 
 security against the small-pox. Would such a 
 fact go an)' length to prove its similarity to Cow- 
 
2D 
 
 pock? Certainly not. For It must be knov^^h td 
 every inoculator of experience, that it is fre- 
 quently impracticable to excite the small-pox in 
 the systems of those who, at the time of inocula- 
 tion, happen to be labouring under some peculiar 
 morbid affection, as eruptive complaints, &Ci 
 And have we not reason to suppose that there 
 are other morbid poison S3 which future expe^ 
 rience may prove capable of warding off the 
 effects of this terrible hydra the small-pox, and 
 perhaps of some more disagreeable malady? 
 The Small-pox and Vaccina, we well know^ 
 are capable, in a great measure^ if not entirely, 
 of mutually destroying the eifects of each 
 other, at least their constitutional effect : but 
 110 one, I presume, will from this contend for 
 the identity of the two diseases. It is also ren- 
 dered pretty certain, from experience, that the 
 action of Vaccina has the effect of rendering 
 sheep unsusceptible of a very fatal complaint^ 
 which prevails and is contagious among them, 
 called the rot^ and also of inducing a disease in 
 the canine species, which is succeeded by art 
 unsusceptibility of the hydrophobia s yet no one^ 
 I am fully persuaded, will imagine the least 
 analogy between these complaints. 
 
 Another very potent argument in favour of th6 
 one complaint not being produced by the other^ 
 is their perfect dissimilarity, as existing in these 
 two different species of animals. The truth of 
 
2i 
 
 this assertion, I am convinced, will appear at 
 once evident to every person who has had an 
 opportunity of examining them in their different 
 stages. It is said by those vv^ho are conversant 
 with the complaint, that the grease is produced 
 from horses standing a greal length of time in 
 foul stables; moreover, it seems to be confined 
 principally to the heels of the animal, evidencing 
 itself in the form of small fissures or cracks: 
 whereas the distempet to which the cow is sub- 
 ject manifests itself on the udder, assuming a 
 vesicular or pustulous form. Is it not probable 
 that, if these diseases were of an analogous na- 
 ture, there would be an identity of their appear- 
 ance, when affecting only different species of the 
 same common class of animals? And more than 
 this, the permanency of their very different situa- 
 tions in these animals certainly evince a very de- 
 cided difference in the nature of them. 
 
 The validity of Dr. Jenner's opinion relative 
 to the origin of Vaccina is supposed, by many, 
 to be completely confirmed by some experiments 
 lately made by a Dr. Loy, who tells us that, in 
 order to ascertain the truth of Dr. Jenner's asser- 
 tion, he had recourse to experiments; and he 
 informs us that he has been successful, in some 
 few of the great number he has made with the 
 matter of grease, in exciting a disease in the 
 human constitution which very much resembled 
 Vaccina, and which, in some instances, served 
 
as a complete security against the varioi6ii§ 
 complaint by inoculation. But in every case in 
 •which it appears to have been successful in pre- 
 venting variolous inoculation from having effect^ 
 the person was subjected to inoculation with 
 small-pox before the disease excited with the 
 matter of grease had^ by any means, completed 
 its progress. Some of them, it seems, were in- 
 oculated with small-pox on the sixth day of the 
 disease, others on the tenth, &c. I am fully 
 convinced that experiments like these are not to 
 be depended on, more especially when Dr. 
 Jenner tells us, that he has witnessed a case^ 
 where a person, after having received the in^ 
 fluence of grease, remained for twenty years 
 unsusceptible of the small-pox, and was theii 
 seized with this complaint: and it must be appa- 
 rent, I think, to every person at all acquainted 
 with the physiological laws of the animal ceco^ 
 nomy, that a morbid disposition would not so 
 soon become extinct from the system. Further^ 
 Dr. Jenner states that a cold and wet spring is 
 favourable to the production of both Cow-pock 
 vca^ grease; which is to say, that the former is 
 not dependent upon the latter, but that they are 
 both the common effect of certain physical 
 causes. 
 
 From what has been above adduced, I think 
 we may with propriety, and with every appear- 
 ance of truth, conclude, that the two diseases 
 
•23 
 
 are not only unlike in their nature and appear- 
 ence, but also in their effects: the one affording 
 a temporary and ineffectual security against the 
 small-pox, the other a permanent and effectual ; 
 the one peculiar to the cow, the other to the 
 Jiorse, 
 
 Of the principal discriminating and characteristic 
 Sj/mptoms and Marks of the inoculated Vac- 
 d?ia, together zvith its incidental Varieties; 
 and a jDescription of the spurious Complaint, 
 
 THIS disease, as communicated by inocula- 
 lion, much resembles, in its commencement, 
 the small-pox. At the end of the second or be- 
 ginning cf the third day, if the operation proves 
 successful, (2. e. forty-eight or sixty hours from the 
 time of inserting the virus) a small speck of in- 
 flammation generally manifests itself at the place 
 of inoculation; this, gradually and uniformly 
 increasing, for the most part in the course of the 
 third day, becomes much more conspicuous, and 
 most generally by the commencement of the 
 fourth, WQ may discover, by the feel, a minute 
 pimple, elevating itself somewhat above the 
 common surface of the skin, with a slight in- 
 flammation circumscribing its base. From this 
 time it gradually increases in magnitude, and hj 
 
24 
 
 the termination of the fifth or beginning of the 
 sixth day, begins to assume that characteristic 
 and specific appearance which, to the expe=^ 
 rienced eye, so obviously and so happily distin* 
 guishes it from that direful malady the small-pox. 
 These criteria, however, cannot, in every case, 
 as early as the fifth or sixth day, be so clearly 
 discerned by the naked eye. Hence the necessity 
 of using magnifying glasses in examining the 
 early stages of this complaint. The peculiar 
 visible features of Vaccina consist, principally, 
 in the perfectly regular margin and beautifully 
 circumscribed form of the vesicle; having its? 
 surface much flattened, with an evident and re- 
 markable depression in its center, of a darker 
 colour, giving it the appearance of elevated 
 edges; which is occasioned by the cuticle still 
 adhering in that spot to the true skin underneath. 
 Contrary to this, the small-pox pustule, by the 
 fifth or sixth day, begins to assum.e an irregular 
 angulated margin, and is altogether destitute of 
 that flattened surface and central depression 
 which so peculiarly characterise the genuine 
 Cow-pock vesicle. What more certainly, if pos- 
 sible, distinguishes the vaccine from the variolous 
 pock, is, that the former appears to be an entire 
 congeries of small vesiculae or cells, so that in 
 puncturing the common vesicle or membrane 
 surrounding them, it requires some time for the 
 virus to ooze out ; and when we have exhauste4 
 
25 
 
 it of all its contents, its magnitude appears very 
 little diminished : whereas the latter consists 
 merely of one common cavity, and upon making 
 a single puncture into it, its contents are imme- 
 diately and entirely evacuated, leaving no trace 
 of its existence behind, except the flaccid and 
 relaxed cuticle which had previously served to 
 contain the matter. It is peculiarly deserving of 
 notice, that the circumscribed appearance and 
 perfectly regular margin of the Cow-pock vesicle 
 are evident in all the latter stages of the disease, 
 even in the process of scabbing: while the small- 
 pox, in contra-distinction, becomes daily more 
 and more irregular, in consequence of the con- 
 fluence of the circumjacent pustules. 
 
 About the fifth or sixth day, and in some in- 
 stances as early as the fourth, the inoculated part 
 begins to change from the red pimple above 
 mentioned, assuming a vesiculated appearance, 
 containing a fluid, the colour of which, through 
 the cuticle, resembles very much that of whey, 
 being of a perfectly limpid consistence, and very 
 transparent. Its limpid consistency and transpa- 
 rency, however, are apt, from certain causes, to 
 undergo a considerable change, which we shall 
 take occasion hereafter to mention. It is at this 
 period that the virus possesses its greatest share 
 of activity, and, provided it can be obtained in 
 sufficient quantity, is most suitable for the pur-? 
 poses of vaccination 3 it being at this early stag© 
 
 D 
 
26 
 
 of the complaint, for the reason above mentioned, 
 less liable to fail in exciting the disease than if 
 delayed to a later day ; though from the sixth day 
 to the tenth is laid down, by Dr. Jenner, as the 
 most proper time for procuring it. During the 
 tim.e that intervenes between these two periods 
 the pustule is greatly augmented, so much so by 
 the tenth day, in the generality of well-marked 
 cases, as to acquire nearly the size of a half-dime; 
 the surface of the pock at the same time becom- 
 ing much more evidently flattened, in proportion 
 as it increases, so that sometimes, in a pock of the 
 above mentioned magnitude, its elevation above 
 the surface of the surrounding skin will scarcely 
 exceed the one-tenth of an inch : the genuine 
 vaccine vesicle is likewise always destitute of 
 that plump rotundity which is so invariable an 
 attendant on the variolous. 
 
 About the eight or ninth day, sometimes a 
 little earlier or later, according to circumstances, 
 the pock having attained to its acme, the consti- 
 tutional symptoms begin to manifest themselves, 
 first by pain in the inoculated part, extending 
 itself towards the axilla, the glands of which 
 now become swelled and painful, especially on 
 making any exertion with the arm. These symp- 
 toms having extended themselves thus far, the 
 whole system begins now to participate in the 
 affection, by association with the local part; 
 as evinced by the succeeding languor, drowsiness^, 
 
m 
 
 paleness, chilliness, flushes of heat, head-ache^ 
 fulness and pain of the eyes, with redness ; pain 
 of the limbs and back, loss of appetite, nausea, 
 and sometimes vomiting; increased fulness and 
 preternatural frequency of the pulse, thirst, white 
 tongue, and, in short, all the general symptoms 
 of fever. It is not, hov/ever, to be supposed 
 that these symptoms discover themselves in every 
 case; on the contrary, it frequently happens that 
 w^e are unable to perceive the least constitutional 
 indisposition: some of these, for the most part, 
 notwithstanding, make their appearance, con- 
 tinuing from a few hours to one, two, or three 
 days, according to the constitution of the patient, 
 together with many collateral circumstances; 
 then subsiding spontaneously without any dis- 
 agreeable consequence. The slight marginal in- 
 flammation which has remained permanent from 
 the first commencement of the vesicle beo^ins, 
 about the eighth or jiinlh day, sometimes rather 
 earlier or later, gradually to extend itself, very 
 moderately affecting the surrounding parts, till 
 about the iejith ox eleventh, when its increase be- 
 comes much more rapid; diffusing itself, in some 
 instances, to the distance of two or three inches 
 from its source, and sometimes, though rarely, 
 extending itself as high up as the shoulder and 
 as low down as the elbow. This it is that con- 
 stitutes the efflorescence or areola so much spoken 
 pf by authors^ and which is said, hj some, to be 
 
indicative of the constitutional affection, and by 
 many is considered as a pathognomonic symptom 
 of the complaint. 
 
 From this time the central depression of the 
 vesicle begins to assume a darker appearance, 
 which, extending itself gradually towards the 
 circumference, completes, in the course of four 
 or five days, that dark mahogany-coloured scab 
 which is so peculiarly characteristic of the true^ 
 disease. This scab, if it be minutely examined 
 in the first stages of its formation, will be found 
 very frequently to put on a stellated appearance, 
 having a number of small lines, like radii, shoot- 
 ing out from the center to the circumference, in 
 a curvilineal direction; with a corresponding 
 number of little sulci or furrows. From the 
 £rst commencement of the scabbing process to 
 its completion, the scab passes through all the 
 different grades of colour, from a light brown 
 to that of a dark mahogany, assuming, at last, 
 very much the colour and appearance of a tama- 
 rind stone; becoming, towards the latter stages 
 of vaccination, very thick and heavy, and daily 
 increasing in the intensity of its colour; and 
 gradually detaching itself, at its circumference, 
 from the surrounding parts, adheres, at length, 
 by nothing but its center; falling oif eventually 
 at different periods of time, though generally 
 in three or four weeks from that of inocula- 
 tion 3 leaving no trace of its existence behind> 
 
<29 
 
 except a superficial pit or depression in the 
 cuticle. 
 
 Thus does the Yaccine-pock, as it has occur- 
 red to me, complete its regular stages. Some va- 
 rieties, however, remain yet to be mentioned, 
 which I shall proceed to treat of in the follow- 
 ing order. 
 
 It sometimes happens, that, either from some 
 peculiar change in the qualities of the matter 
 Used for inoculation, or from some specific dis- 
 position of habit, the vaccine vesicle shall varj 
 in respect to its progress, and also its appear- 
 ances, through its different stages. These va- 
 rieties resolve themselves principally into the 
 three following heads: 1. In regard to the pro- 
 gress and appearances of the vesicle. 2. In re- 
 gard to the areola or efflorescence: and, 3. As 
 respects the scabbing process. 
 
 The standard or natural appearances of the 
 Cow-pock vesicle are those above related : in 
 some instances, however, notwithstanding every 
 precaution is used in the operation, as well as 
 in taking and preserving the infection, the disease 
 induced will deviate considerably from its natural 
 appearance. The virus, in some cases, after 
 its introduction under the cuticle, does not pro- 
 duce any evident change in the part for some 
 time, lying apparently in a dormant or latent 
 state for ten or fifteen days, when, either from 
 a second inoculation, or some other cause, it be* 
 
S6 
 
 comes roused into action, and proceeds oft 
 through its regular stages, assuming its natural 
 appearances; though its progress, in such cases, 
 is almost always much more rapid than usual. 
 Several instances of this nature I had an oppor^ 
 tunity of witnessing during my residence at the 
 New- York Institution for the Inoculation of the 
 Kine-pock. A case of the like nature also oc- 
 curred in the practice of a very respectable phy- 
 sician of this city, which, from its singularity, 1 
 deem Vi^ell worth mentioning. The virus, in this 
 case, after its insertion, had lain apparently in 
 an inactive state for several days, when, from 
 an inoculation with variolous matter, near the 
 place where the vaccine virus had been intro-- 
 duced, it was excited into action, and passed 
 regularly through its several stages, entirely su- 
 perseding the effects of variolous inoculation^ 
 although the latter had made some considerable 
 progress. This person, it may be observed, had 
 been repeatedly vaccinated by Dr. Waterhouse, 
 of Cambridge College, and by him was deemed 
 unsusceptible of the complaint. Sometimes the 
 vesicle is very tardy in its progress, and does not 
 arrive at maturity till the twelfth or fifteenth 
 day; it being very obvious, however, that the 
 operation had taken effect immediately after the 
 insertion of the virus. At other times, again, 
 the vesicle is premature, acquiring its acme as 
 early as the sixth or seventh day, with a forma- 
 
SI 
 
 tiDii of its areola proportionabiy soon. I have 
 obtained matter, which answered every purpose 
 of inoculation, as early as the fourth day. la 
 some cases the pock produced is unusually small. 
 But, notwithstanding all these varieties in respect 
 to its progress and size, the vesicle, if genuine, 
 still preserves its central depression, its circular 
 form, regular margin, and, in short, every cha* 
 racteristic and specific appearance. These ano- 
 malies, in all probability, result either from some 
 peculiar change in the matter made use of, or from 
 the system's being under the influence of some 
 morbid action. Some few cases I have seen, in 
 which there were from one to two or three pock 
 made their appearance in the vicinity of the local 
 one, exactly resembling it in every particular cir- 
 cumstance, though generally falling oiF rather 
 sooner. This, however, is by no means a com^ 
 mon occurrence; and when such pock do appear, 
 they are, in all probability, induced by the pa- 
 tient's infecting the part with his nails. 
 
 From what has been above said, it will be 
 seen that the vesicle is subject to great variation, 
 especially as regards its progress; and that, there- 
 fore, there can be no specific time fixed upon 
 for procuring the virus. I have, as before 
 stated, obtained it as early as the fourth day, 
 (ninety-six hours from the time of inoculation) 
 and succeeded perfectly well with it in produce 
 ing the real disease. In other cases, on the coa- 
 
32 
 
 trary, it has been impracticable to obtain any till 
 the tivelfth or fourteenth day. 
 
 It has been observed, in the foregoing pages, 
 that a slight marginal inflammation was present 
 from the earliest stage of the complaint, and that, 
 in general, this began to diffuse itself to the sur- 
 rounding parts about the ninth or tenth day, 
 forming what is called the efflorescence or areola. 
 It commonly happens that this inflammation does 
 not diffuse itself in the form of an areola till the 
 period above-mentioned: cases, however, have 
 occurred, in which it commenced its career as 
 early as the ffth or sixth day: in others, again, 
 it has not made its appearance till the tivelfth or 
 fourteenth I and sometimes, it is said, not at all. 
 
 The efflorescence, after it has commenced, ad- 
 vances very rapidly to its height, from which it 
 begins soon gradually to decline, first at its circum- 
 ference; and, in the course of one, two, or three 
 days at farthest, is almost entirely gone; being, 
 in general, succeeded by a desquamation of the 
 cuticle. Frequently, however, it begins first to 
 subside from around the base of the vesicle, 
 leaving between its circumference and the pock 
 an interval of uninflamed surface, and, gradually 
 advancing from this towards the confines of the 
 areola, completely disappears in the usual time. 
 Sometimes the areola subsides in such a manner 
 as to leave one circle of inflammation imme- 
 diately around the base of the pock, and another 
 
S3 
 
 externally, so as to constitute a distinct external 
 and internal areola. As the efflorescence differs 
 in respect to its time of appearance and mode of 
 declension, so also does it vary in its appearance 
 when formed. It has before been stated, that 
 it was naturally circumscribed and limited in its 
 extent, and uniform in its colour from the vesi? 
 cle to its border: these characters, however, iri 
 some instances, are varied, for it sometimes hap-? 
 pens that the areola, instead of exhibiting this 
 circumscribed and limited extent, assumes a stel« 
 lated appearance, not having its inflammation 
 uniformly diffused, even within its boundaries; 
 but having alternately a streak of inflamed and 
 uninflamed surface shooting out from the vesicle, 
 like radii from a center, and exhibiting no de- 
 finite boundary, 
 
 The efliorescenee varies also in point of dura» 
 tion, its usual time of continuance being froni 
 one to three days; though it frequently, either 
 from mechanical irritation, or from the natural 
 tendency of the disease, continues a much longer 
 time, 
 
 It also varies as to its intensity of colour, being 
 naturally that of a rose-pink; though in some 
 cases it is of the colour of the pink only, and in 
 0thers of a Vermillion. 
 
 Having mentioned the varieties that are oc- 
 casionally manifested in the vesicle and eflloresr 
 i:ence, I shall proceed to notice some of the mos^ 
 
 E 
 
34 
 
 usual that take place in the process of scabbhig, 
 The change of colour which is to be observed in 
 the center of the vesicle about the close of the 
 tenth day, indicates the commencement of this 
 process, and extends itself over the surface of 
 the pock in the course of two or three days ; 
 and the pock, at the same time, gradually har- 
 dening, the scab, for the most part, is completely 
 formed in ten days or two weeks from the time 
 of vaccination : from this time it begins gra- 
 dually to detach itself from the skin, at its cir- 
 cumference, and shortly falls off, leaving the 
 part in the state before memioned. It some-- 
 times happens, however, contrary to this natural 
 state of affairs, that the formation of the scab 
 commences at a much earlier period, and some- 
 times, again, is protracted far beyond its usual 
 time. It has, indeed, been known to commence 
 as early as the sixth or seventh day, and com-^ 
 plete itself proportionably soon: in other cases 
 it has not commenced till the seventeenth or 
 eighteenth, though in such it has been observed 
 to advance to a state of maturity much sooner. 
 As to the colour of the scab in the genuine com- 
 plaint, it seldom varies, assuming almost inva^ 
 riabiy that dark brown, chesnut, or mahogany- 
 coloured appearance, heretofore mentioned ; at^ 
 tended, most commonly, with a smoothly po- 
 lished and glossy surface. I have observed, how^ 
 ^yer, that in the dark skin of the African th^ 
 
-35 
 
 toldu^ IS more intense than in the skin of ail 
 iEuropean, being iniiuencedj probably, by the 
 colour of the rete-mucosum. The other charac- 
 ters of the disease^ as exhibited by the former, 
 are altogether synonymous with those of the 
 latter, except the aivola, which must, of course, 
 be invisible: its existence, nevertheless, is fully 
 evinced by that tumid hardness which is so in- 
 variable a concomitant of this local inflamma- 
 tion. 
 
 Having now, as accurately as I am able, de- 
 lineated the natural appearances of the genuine 
 Vaccina, and, with as much precision as the ex- 
 tent of my observations would permit, traced it 
 through its different anomalies, I proceed to men- 
 tion some of the most obvious and discriminating 
 characters of the spurious complaint. 
 
 When, from mismanagement in either taking 
 or preserving the genuine vaccine virus, a dete- 
 rioration of its natural and inherent properties is 
 induced, instead of producing that beautiful sym- 
 metry of appearances above described, it gives 
 rise to a disease not only totally unlike it in ap- 
 pearance, but one that is altogether dissimilar in 
 effect; which, instead of affording that perma- 
 nent and effectual security against the small-pox 
 ever attendant on the real complaint, is entirely 
 destitute of all prophylactic influence; conse- 
 quently, leaving the constitution in a state still 
 susceptible of the impression of variolous virus. 
 
The effect thus produced not answering the de* 
 sired expectation, has led many unwary and in- 
 attentive physicians to allege, that vaccine in- 
 t)culation was not succeeded by an unsuscepti- 
 bility of the constitution to variolous infection; 
 Hence vs^e see the necessitv of indefatigable and 
 reiterated experiments, in order to arrive at 
 truth, in conducting such novel and interesting 
 inquiries. 
 
 The vesicle, excited by spurious or impure 
 virus, is very readily distinguished, by every ex- 
 perienced eye^ from that which results from the 
 real. The effect of the former, when introduced 
 under the cuticle, is frequently to excite prema- 
 ture inflammation, attended, in many instances, 
 •with intolerable itching, (this symptom is also a 
 presage of its not having taken effect at all, /. e, 
 "when genuine matter is used), and rnany times 
 producing an elevation of the cuticle, and forming 
 k pimple of considerable magnitude in the course 
 of a few hours. This, however, is not always 
 the case: in sorrie instances its effects do not be^ 
 come apparent sooner than those induced by the 
 genuine virus. From this time the disease pro- 
 gresses through its different stages; not, however, 
 with that admirable and beautiful regularity 
 which characterizes the true disease. When^ 
 from impure virus having been made use of, the 
 spurious Cow-pock is induced, instead of pre*- 
 senting itself in the form of a regular and cir^ 
 
27 
 
 tumscr'ibed vesicle, it has the appearance of an 
 ill-conditioned creeping sore, seldom assuming 
 the pustulous or vesicular form ; and instead of 
 producing a scab of the usual kind, is attended 
 with a festering, light coloured, or yellow one, 
 being always less thick and heavy than that 
 succeeding the true disease. 
 
 What is still more strikingly different is, that 
 the scab succeeding the genuine vesicle appears 
 to be merely, as it were, laid on, or slightly ad- 
 hereing to the skin; has its superior surface very 
 level or plane, and its margin, or external cir- 
 cumference, is very considerably and abruptly ele- 
 vated above the common level of the surround- 
 ing parts: whereas the scab of the spurious has 
 considerable rotundity, is thickest in the middle, 
 little elevated above the surface, very light and 
 thin around its margin, gradually though irre- 
 gularly losing itself in the surrounding skin, and 
 frequently terminates in a disagreeable phage- 
 denic ulcer, difficult of cure. The spurious pock, 
 at the same time, has no regular areola or efflo- 
 rescence, but merely an inflammation surrounds 
 ing it, which frequently extends itself to a con- 
 siderable distance from the place of inoculation, 
 particularly when much irritated, putting on that 
 angry and fiery aspect so peculiarly characteristic 
 of phlegmonic or suppurative inflammation: 
 whereas the real pock is surrounded by an ery- 
 sipelatous inflammation. This inflammation i§ 
 
also much more permanent than the efflorescence 
 accompanying the true Vaccina; neither is it so 
 rapid in its accession or declension as the latter 
 naturally is. 
 
 The constitutional affection induced by this 
 complaint (especially if the local disease proceeds 
 to any great height) is generally more severe than 
 that which is attendant on the real disease. The 
 slight symptoms of fever that usually occur in 
 true Vaccina are here very much aggravated: 
 the patient, for the most part, is affected with 
 great pain and swelling in the axilla^ extreme 
 pain of the head, preternatural heat of the sur- 
 face, great pain in the bones and back, pulse 
 much more frequent and full than natural, white 
 tongue, nausea and vomitings great pain and 
 tension in the inoculated part, &c. Besides, 
 these symptoms have no stated or regular time 
 of coming on, but invade the system indiscrimi- 
 nately, as circumstances shall direct. 
 
 If the disease succeeding vaccination shall as^ 
 sume the above appearances, no one need for a 
 moment hesitate in pronouncing it to be spu- 
 rious; and we may, with boldness^ assert, that 
 it has not wrought that requisite change in the 
 system which is so indispensibly necessary in 
 order to secure it against the dire effects of va- 
 riolous poison. 
 
 After having thus briefly treated of the origin, 
 general appearances, and varieties of this extra- 
 
S9 
 
 ordinary complaint, I deem it necessary to offer 
 some few observations in regard to its method of 
 treatment. 
 
 From the foregoing description of this disease 
 I think it will appear very generally to require 
 more attention in nice discernmiCnt and discri- 
 mination, in order to detect its specific and cha- 
 racteristic marks, than in judging of medicines 
 proper to be prescribed. I believe it will be very 
 readily admitted, by every experienced practi- 
 tioner in this complaint, that there is scarcely 
 one case in ten in which the patient is so much 
 indisposed that a cooling purgative or two^ joined 
 with a little abstinence in diet and regimen, 
 will not relieve him. This, I can say, was the 
 ease during my residence at the Kine-Pock Insti- 
 tution of this city, which was one year, in which 
 time there were upwards of a hundred persons 
 w^ho experienced the salutary effects of vaccine 
 inoculation at that benevolent establishment, and 
 not one case in the whole number presented, 
 (notwithstanding they were generally of the more 
 indigent part of the community, consequently 
 very liable to be exposed to all the vicissitudes 
 of weather, and many of them, indeed, to labo- 
 rious exercises,) that required any thing more 
 than some mild and cooling cathartic. 
 
 The Cow- pock has been objected to, by many, 
 from an ill-founded idea that it is frequently pro- 
 4uctive of very sore arms. Some, indeed, allege 
 
40 
 
 that the ulcer subsequent to vaccination is muck 
 more inveterate and difficult of cure than that 
 induced by small-pox. This, hov^ever, I have 
 never found to be the case, and I am inclined to 
 believe that if the necessary attention be paid in 
 removing the too great mechanical irritation, a 
 great proportion of v^hich very frequently arises 
 from tight sleeves, and in giving the patient the 
 necessary injunctions not to scratch or irritate 
 the vesicle (which, by the bye, he is very much 
 disposed to do, ov^ing to the intolerable itching 
 which frequently accompanies the areola,) it will 
 be found a very seldom sequela of the true pock. 
 Sometimes, however, from inattention to the 
 above precautions, the scab is rubbed off, or the 
 vesicle very much irritated; in consequence of 
 which, violent inflammation not unfrequently 
 ensues, accompanied with great tumefaction, 
 which, in some instances, extends itself to a 
 considerable distance from the place of vac^ 
 cination, with great pain in the inoculated 
 part, extending towards the axilla; to which 
 very commonly succeed swelling and inflamma^ 
 tion of the axillary glands, restlessness, chills, 
 fever, anxiety, nausea, vomiting, head-ache, pain 
 of the back, &c. These symptoms, in the course 
 of two or three days, will generally disappear; 
 though, now and then, a case of greater violence 
 will protract itself, as alleged by some, to one, 
 two, and even three weeks, It is not common. 
 
41 
 
 however, to find a case so violent as not speedily to 
 yield to a gentle antiphlogistic treatment. Due 
 attention should also be paid to the local aifection^ 
 which, by this time, has commonly assumed the 
 appearance of a troublesome phagedenic ulcer. 
 When the disease shall have acquired such an 
 augmentation (which, indeed, it appears inca^ 
 pable of, except from great and repeated irrita^ 
 tion of the vaccinated part), it is highly requi^ 
 site that some active m.eans should be resorted to^ 
 in order to arrest its progress. This we find very 
 effectually answered by the application of the 
 unguentum citrinuni; care being taken, however^ 
 never to extend its use beyond the surface of the 
 ulcer, otherwise, if active, it will frequently cor-? 
 rode the skin, and by this means augment the 
 sore. The unguentum hydrarg. and the un^ 
 guent, precip. rubr. are frequently very service- 
 able in disposing the ulcer to heal. In milder 
 cases, the aq. lytharg. or Goulard's extract of 
 Saturn, diluted, v/ill generally prove eflfectual. 
 When the inflammation, pain and swelling shall 
 become greatly aggravated, an emollient poul° 
 tice will be found beneficial. If the inflamma- 
 tion and sweUing, at the same time, extend over 
 the arm, keeping the part wet with lead-water, 
 or even with cold Vv^ater simply, will be attended 
 with great advantage. These^ combined with 
 the exhibition of a smart purgative every day or 
 iwo, together with abstinence from animal food 
 
 F 
 
42 
 
 and ardent liquors, will generally effect a cure 
 in a short time, or so far alleviate the violence of 
 the symptoms, that any common dressing will 
 suffice. 
 
 The efflorescence, as has been observed, is 
 sometimes accompanied v^ith a very disagreeable 
 itching: by bathing the part in rectified spirits of 
 wine, or ardent spirits, this disagreeable symp- 
 tom is almost instantaneously relieved. 
 
 It has been recommended, and, indeed, prac^ 
 tised by some, in order to avoid the bad conse- 
 quences arising from irritation, &c. to destroy, 
 by means of the sulphuric acid, or some other 
 active caustic, the local pock, or vesicle, so soon 
 as it shall have produced its desired effect on 
 the constitution. But the great difficulty in 
 establishing a specific time when the disease 
 shall have succeeded in completely securing the 
 constitution from the influence of variolous in-^ 
 fection, will ever render this practice fallacious 
 and delusive. 
 
 Manner of preserving Vaccine Virus y and Method 
 of Vaccination. 
 
 THE virus of Vaccina being naturally of a very 
 perishable nature, it is highly requisite that every 
 physician who undertakes to inoculate with it 
 should be acquainted with the most effectual 
 
45 
 
 means of preserving it, for the longest time, ifi 
 its most active state; and more especially so for 
 those that reside in the country, where a failure 
 might be with difficulty supplied. 
 
 Most of the physicians who have practised 
 with vaccine virus have been in the habit 
 of securing it on the point of a lancet, not 
 Apprehending that the matter very speedily suf- 
 fered a decomposition thereby, from the action 
 which it exerts on the metal of the instrument. 
 It is well known, that all fluids containing a por- 
 tion of oxygen in their composition, on coming 
 in contact with iron or steel, very readily undergo 
 a decom.position, having the oxygen they hold as 
 a constituent part detached, and united to the 
 metal, reducing the latter to the state of an oxyd; 
 v/hich process, at the same time that it proves 
 destructive to the metal, also destroys the qua- 
 lities of the fluid. It therefore necessarily follows, 
 that, as the virus of Vaccina^ in common Vvdth 
 all other animal secretions, contains a quantity 
 of oxygen in its composition, on being subjected 
 to the same process, must undergo the same or 
 similar changes of its properties, which renders 
 it altogether unfit for use, being frequently, if 
 used, productive of a disease of a spurious nature^, 
 the bad consequences of which have been al- 
 ready sufficiently explained. In such cases the 
 physician is not o' !y foiled in his attempt to 
 produce the genuine complaint, but is, at the 
 
44 
 
 same time, deprived of the use of his instrument; 
 for there are very few lancets, after having had 
 infection preserved on them, that are fit for use 
 till after having passed the hands of the cutler. 
 The consequence of such improper practice is, 
 that the physician is continually labouring under 
 imnecessary expense, and his own reputation, to- 
 gether with that of the disease, are both very 
 rnaterially injured. The m.any difficulties and 
 embarrassments thus arising, are, I am convinced, 
 sufficient to deter any one, in future, from em- 
 ploying similar means for the preservation of 
 this precious fluid. 
 
 Another method, which by many has been had 
 
 frequent recourse to^ is the preservation of it on 
 
 cotton thread. But this mode, I am of opinion, 
 
 will be found not sufficiently economical, as h, 
 
 requires a large cjuantity of the virus properly to 
 
 imbue a small portion of thread. Besides the 
 
 foregoing objection, another presents itself of a 
 
 much more serious nature^ which is, that virus 
 
 so preserved is prone to run into the putrefactive 
 
 fermentation ; v/hich process, it is well known> 
 
 destroys the chemical combination of all bodies 
 
 subject to its action; consequently the virus, after 
 
 having undergone this change^ is entirely unfit 
 
 for use. 
 
 Another, and, as appears to m.e, the most eli^ 
 gible method that has been adopted for the pre- 
 servation of the virus, is by securing it between 
 
45 
 
 pieces of glass, or upon pieces of quill made 
 pointed at the end on which the matter is to be 
 collected. When it is to be preserved in the 
 former way, common window glass is to be made 
 use of, previously cut into square pieces of about 
 an inch each, so that they shall be smooth, and 
 in exact contact with each other. Having pro- 
 perly taken the above precautions, the vesicle 
 from whence the matter is to be obtained must 
 be repeatedly and gently punctured with a sharp 
 lancet, being cautious, at the same tim^e, not to 
 penetrate too deep, otherwise the serum from the 
 adjacent vessels is apt to be effused, which very 
 frequently deceives us, it being impossible to 
 discriminate this from the real virus; very shortly 
 after which the virus will begin gently to ooze 
 .out at each puncture, in form of transparent lim- 
 pid drops, very much resembling those of dew^ 
 provided none of the surrounding blood-vessels 
 are injured by the lancet. The matter thus col- 
 lected round the punctures is to be carefully 
 taken off on the point of a lancet, or any con- 
 venient instrument, and transferred to the sur- 
 face of one of the plates of glass on which it is 
 to be preserved; care must be taken, at the same 
 time, to confine it to a small spot upon the 
 center of the glass, about the size of a split pea. 
 After having been thus collected, it should be 
 suffered to dry in the common temperature of the 
 atmosphere, and should then be immediately se- 
 
4^ 
 
 cured by accurately placing the other bit cf gia&5 
 over it, and wrapping thera up in goId-beater^s 
 skiU;, or a piece of wetted bladder, in order to 
 secure it from the action of the external air. 
 
 Many have preferred pieces of quill or ivory 
 for preserving the matter on; and, from the very 
 little trouble, both in the preservation and ino- 
 culation, with matter thus kept, I think it much 
 the best of any that has been heretofore devised; 
 nothing more being necessary, when this mode 
 is had recourse to, than merely touching the 
 point of them with the virus, and permitting it 
 to dry thereon, as above directed. 
 
 Many other means have been used for pre- 
 serving vaccine matter. By some it is said to 
 retain its infectious power for an unlimited time, 
 if kept in dry hydrogen or nitrogen gas. Dr. 
 Pearson, of London, has recommended the pre- 
 serving it on platina lancets. But, whichever of 
 these ways is adhered to, it will always be found 
 necessary entirely to seclude it from the action of 
 air and of light, it having been lately discovered 
 that either of these agents is capable of decom- 
 posing it. 
 
 Vaccine inoculation has been frequently com- 
 plained of, and even objected to, by many, on 
 account of its frequent failure in exciting -the 
 complaint. Upon accurate and impartial observa- 
 tion, however, it will be discovered, for the most 
 part, to be ov/ing to mismanagement, or inat- 
 
tention on the part of the physician ^ for the 
 virus of Vaccina, I believe, if the necessary pre- 
 cautions be used, will take effect nineteen times 
 out of twenty. 
 
 On accurately investigating the causes of failure 
 in vaccine inoculation, we shall find them prin- 
 cipally to resolve themselves into the three fol- 
 lowing heads: 1. From a deterioration of the 
 virus; 2. From a peculiar disposition of habit, 
 whereby it is incapacitated to receive the im- 
 pression of the disease; and, 3. From the method 
 of introducing the matter. 
 
 The matter of Vaccina is, no doubt, frequently 
 rendered inert from some peculiar change wrought 
 on it while contained in the vesicle. This change 
 may be produced by some specific morbid action 
 of the vessels secreting it, which, as well as being 
 endowed with the power of elaborating and se- 
 creting the most noxious poisons, possess also the 
 faculty of rendering them inert and harmless- 
 That there is a certain change of the properties 
 of the virus immediately ensuing the formation of 
 the efflorescence or areola, is sufficiently evinced 
 from the frequent ineffectual attempts to pro- 
 duce the disease with virus procured after that 
 period, and from its almost uniformly inducing 
 a spurious complaint if it takes effect. It is, in- 
 deed, asserted by some, that matter taken at this 
 period has been known frequently to succeed in 
 producing the true disease. But, if we put cou> 
 
48 
 
 iidence in what Dr. Jenner says, It must be al- 
 lowed that such matter is productive of a spu- 
 rious complaint, thereby frequently misleading 
 the unwary and inexperienced practitioner. The 
 practice ought, therefore, without hesitation, to 
 be abolished -, and matter should never be used 
 after having, in any degree, lost its original trans- 
 parency or limpid consistency; which changes 
 are produced by other causes than that of its 
 own specific inflammation, as the peculiar ac- 
 tion of the vessels, that morbid state of them 
 immediately succeeding to mechanical irrita- 
 tion, &c. The properties of the matter are 
 also frequently destroyed from not preserving it 
 on such substances as are incapable of oxyda- 
 tion, and from not securing it properly from the 
 light. 
 
 All the above circumstances are evidently fre- 
 quent sources of failure in the new inoculation. 
 Hence the most scrutinizing and strict attention, 
 in regard to the matter we make use of, is re^ 
 quisite, if we \vish to preserve sacred our own 
 reputation and that of the disease. 
 
 The second cause of failure which has been 
 mentioned is predicated on the opinion that the 
 system may, at certain times, be so disposed as 
 to incapacitate it for the reception of vaccine im- 
 pression. For the truth of this position, no vac- 
 cinator w^ill require any further evidence than a 
 reference to his own practice. The same also 
 
49 
 
 .Qceurs in variolous, inoculation. That there is a 
 jaatural tendency or disposition in the constitu- 
 tion of some to counteract or entirely reject cer- 
 tain morbid impressions, is an incontrovertible 
 fact^ and that many morbid changes take place 
 in the system, which have the same or similar 
 eiFects, cannot for a moment be doubted. When 
 this incapacity of the system arises from the 
 former of these, it is probable that it is occasioned 
 by sorne peculiar physical arrangement or con- 
 struction of the coniponent particles of the body; 
 and when from the latter, by some morbid de- 
 rangement or alteration of them. It sometime^ 
 happens that, either from one or other of these 
 causes, the matter, after having been inserted 
 under the cuticle, shall remain in a dormant or 
 inactive state for several days, frequently not 
 ]ess than ten or fifteen, not even exhibiting, all 
 this time, the slightest grade of inflarnmation, 
 several instances of which are related in a former 
 part of this dissertation. 
 
 There was once a case of Cow-pock came 
 under my observation, in which the efflorescence 
 was entirely suspended for several days beyond 
 its usual time of appearance, by the supervention 
 of measles. 
 
 The last, and which is certainly not an unfre= 
 quent source of failure, I have noticed as arising 
 from the method of introducing the virus. If, 
 at the time of inoculation, there happens to be 
 
 G 
 
50 
 
 much mechanical irritation occasioned by intro^ 
 ducing the matter, the part becomes prematurely- 
 inflamed 3 and this inflammation being of a totally 
 different nature from that induced by the matter 
 itself, the effects of the latter are entirely coun- 
 teracted, notwithstanding it be ever so genuine. 
 This same cause, very often also, produces a fai- 
 lure, v^hen, from the w^ant of fresh matter, we are 
 under the necessity of using such as has been 
 preserved on cotton. In such cases the portion 
 of thread introduced acts as an extraneous body, 
 giving rise to an issue. Premature inflammation 
 affords us a criterion, whereby we can generally, 
 with a great degree of certainty, judge of the 
 success of the operation, and of the nature of 
 the disease induced. 
 
 From what has been above adduced, the foU 
 lowing very useful deductions naturally arise. 
 
 1. That vaccine virus, either for inoculation 
 or preservation, should always be taken pre- 
 vious to the formation of the efflorescence or 
 areola. 
 
 2. That we should always make use of the 
 most recent matter that can be obtained 3 and, 
 provided it be impracticable to procure it imme- 
 diately from the vesicle, we should prefer such as 
 has been preserved on those substances that are 
 incapable of oxydation. 
 
 3. That as little irritation should be made use 
 of, in its introduction, as can be dispensed with, 
 
5i 
 
 This, indeed, may be very little, as it is never 
 iiecessary to draw^ blood. 
 
 As it respects the mode of vaccine inocula^ 
 tion, there are but two principal ways that are 
 at present practised; namely, by puncture and 
 incision. 
 
 The former of these methods I deem prefer- 
 able in all cases, except where an infected thread 
 is used, and even here, I believe, it is more apt 
 to succeed than incision. Whichever of the 
 ways be made use of, it is necessary for us, in 
 the first place, to provide ourselves with a sharp 
 and clean lancet, being cautious, by all means, 
 not to use one that has been previously armed with 
 variolous virus j for very unpleasant consequences 
 have not unfrequently followed such improper 
 conduct. In making the puncture or incision, 
 we should endeavour, as much as possible, to 
 avoid drawing blood, for if we do, the operation 
 will be less likely to succeed, as the blood, most 
 probably, washes away the virus^ After having 
 made the puncture or incision, and carefully in- 
 troduced the matter, a piece of court or adhesive 
 plaster should be applied immediately over the 
 place, as it gives to the operation greater surety 
 of success. But, whether it arises wholly from 
 restraining the subsequent hemorrhage, or in 
 part from preventing the evaporation of the more 
 volatile and active properties of the matter, I do 
 not know; but probably from both. 
 
s 
 
 There should also be a preference as to tti^ 
 |)lace of inoculation. The part of the arm, ^bout 
 half way between the shoulder and elbow, near 
 the insertion of the deltoid niuscle, is that which 
 is pretty generally preferred zt present; and^ 
 from its being less exposed to the atmosphere^ 
 from there not being any joints or tendons in the 
 neighbourhood, and from its being less liable 
 to injury than almost any other part of the body^ 
 I conceive it to be by far the most proper for 
 the purpose^ 
 
 A Consideration of the Manner in tvhkh Vaccine 
 Virus acts on the Human Constitution, and of 
 the Effects it produces. 
 
 IT has long been laid dovvn as an incontro- 
 vertible fact in medicine, that whatever is ap* 
 plied either to the cuticular, pulmonary, or in^ 
 testinal surfaces, must^ in order to produce its 
 operation on the system, be taken up by the ab- 
 sorbents, and conveyed into the circulatory mass 
 of fluids, v/hether of a bland nutritious nature^ 
 or a violent corrosive poison. It is even sup^ 
 posed, by our best physiologists and physicians, 
 that this is the only rational manner of account- 
 ing for the operation of the most noxious agents^ 
 and, in short, of almost every medicine the 
 Materia Medica affords. 
 
5$ 
 
 This, however. Is a doctrine which I cannot, 
 at present, accede to, and one, the truth of 
 which I have for a long time doubted, as it 
 does not appear to nae possible that any such 
 noxious or extraneous bodies could be received 
 into so pure, uncontaminated, and mild a fluid 
 as the blood, which is intended solely for the 
 nourishment and warmth of the bodv, without 
 occasioning instantaneous death, or, at least, 
 without producing the most terrible commotion 
 and derangement of the system. 
 
 It is said that the small-pox matter, after its 
 introduction under the cuticle, is taken up and 
 conveyed into the circulation through the medium 
 of the absorbents. If this be the case, the mat- 
 ter must, of course, undergo the round of cir= 
 culation; consequently, owing to its stimulating 
 and poisonous qualities, the system must be ex- 
 cited into m.orbid or increased action, which ac- 
 tion, it is said, tends to throw out the matter on 
 the surface of the body, in form of eruptions. 
 
 Now, in order to prove the fallacy of this doc- 
 trine, it is only necessary to observe, that if it 
 were a mere expulsion of the matter absorbed, 
 there could not possibly be so large a quantity 
 thrown out on the skin as, in many instances'/ 
 there actually is; for the quantity inserted at the 
 time of inoculation is known to every one to be 
 in proportion infinitely small. Whence, then, 
 is the source of this large quantity of matter?: 
 
54 
 
 Surely, it would be very preposterous to suppose 
 that the small particle which enters the circula- 
 tion has the power of producing so large a quan- 
 tity, by assimilating the blood to its own nature. 
 
 Again : it is supposed, by many, that the 
 matter entering the circulation is not directly 
 expelled from the system ; but that, in conse- 
 quence of certain peculiar inherent properties, 
 it is capable of exciting a specific morbid action 
 of the sanguiferous system ; and that this specific 
 action disposes the secerning vessels of the skin 
 to take on tlie office of secreting variolous mat- 
 ter. This, it is true, appears to be a much more 
 plausible theory than the former ; but it is, I am 
 persuaded, not without many insurmountable 
 difficulties. By this mode of reasoning it is im- 
 possible to account for the long-continued circu- 
 lation, and consequent application of the matter 
 to the internal surface of the arterial, venous 
 and absorbent systems, without producing a 
 more immediate effect; it being uniformly found 
 that it is several days after inoculation before 
 any symptom of the complaint becomes appa- 
 rent. If, upon its introduction, it were imme- 
 diately taken up by the absorbents, it must ne- 
 cessarily, in a very short time, pass into the cir- 
 culation. Perhaps, however, this may be an- 
 swered by some, in saying that it remains in the 
 place where it was first inserted, until, by its 
 irritation, it shall have excited the vessels of this 
 
55 
 
 local part to secrete a certain quantity of virus; 
 and that it is then absorbed, and produces all 
 the subsequent phenomena. But, that so acrid 
 and irritating a poison as this should so long re- 
 main in contact with the tender and patulous 
 mouths of the absorbents, and should then be 
 taken up by them, seems quite paradoxical. I 
 should rather be inclined to suppose, that, after 
 it had induced this degree of morbid excitement 
 on their sensible extremities, it would be rejected 
 by them, instead of being absorbed. 
 
 Again : that so small a particle of matter as is 
 sufficient to produce Vaccina or small-pox should 
 be so infinitely divided as to be applied to the 
 internal surface of the heart, arteries, and all the 
 ramifications of the sanguiferous system, so as to 
 produce all the violent symptoms and phenomena 
 attendant on these diseases, particularly small-pox, 
 appears to me quite impossible. If this theory be 
 true, we must admit that of the divisibility of 
 matter ad hifinitum; for, if this be the fact, a par- 
 ticle of the virus must necessarily be applied to 
 every portion or particle of matter entering into 
 the constitution of the animal economy; which 
 theory, however clearly it may be proved by 
 mathematical demonstration, is, in a physical 
 sense, altogether incorrect and absurd. I can- 
 not, indeed, suppose it possible, that the matter 
 should so long remain in the circulatory mass of 
 fluids, without producing som.e sensible change 
 
56 
 
 in the functions of the system. And how it 
 should happen that any thing should pass through 
 the absorbents into the circulation, in propria 
 formay is impossible for me to conceive; it being 
 a fixed law in physiology^ I l^elieve, that no- 
 thing is capable of entering or passing through 
 the vessels of the human body, without having 
 first undergone an appropriate change, by the in- 
 fluence of living vascular action; or, in other 
 words, not without having been animalized, or 
 assimilated to the nature of the body. By the 
 agency of this peculiar action of parts, are all 
 the different secretions to be accounted for: and 
 upon what other principle than vascular influence 
 or action is the formation of the blood itself to 
 be explained? Further, it does not appear to 
 me reasonable to suppose, that a chemical agent, 
 so much disposed to act upon bodies, and so 
 liable to be acted on and decomposed by other 
 chemical bodies, as vaccine or variolous matter, 
 should exist in contact with such a combination 
 of chemical agents as the blood and other parts 
 of the system, without undergoing the common 
 effect of all such bodies. Is it not highly probable 
 that the portion of ferruginous matt'er existing 
 in the blood would as soon destroy the activity 
 of the virus while in, as out of the system ? It 
 is well known that vaccine, together with vario^ 
 lous, and all other morbid poisons, being by any 
 means deprived of their oxygen, become entirely 
 
inert and harmless. If, therefore, the activit)? 
 of vaccine and variolous matter depend, in so 
 intimate a manner, on the existence of oxygen 
 in their composition, it clearly follows, that, in 
 passing the routine of circulation, they must lose 
 their effects, as they there meet v^ath numerous 
 substances capable of depriving them of this 
 principle. From whence, then, can we derive 
 support for the theory of absorption? 
 
 If it be true that the matter of Vaccina must, 
 in order to produce the disease, be absorbed, 
 and pass through the circulating mass of fluids, 
 why are its effects in so great a measure concen- 
 trated in the place of inoculation, and how comes 
 it that there are not eruptions on the surface? 
 
 The above facts and observations are sufiicient, 
 I am persuaded, to expose the fallacy of the 
 doctrine of absorption, that is, as respects the 
 action of vaccine and variolous virus. I shall 
 now, in as concise and comprehensive a manner 
 as I am able, lay before the reader my own opi- 
 nion on the subject. 
 
 I believe it is a well established and almost 
 universally admitted fact in physiology, that there 
 is a remarkable and intimate connection, or sym- 
 pathy, existing between the surface of the body 
 and the stomach. This is, indeed, proven by 
 every day's experience. It has been observed, by 
 a very learned and sagacious physician, that the 
 skin niight very properly be considered a kind 
 
 H 
 
58 
 
 of second stomach, through the medium of which 
 we are enabled to communicate to the system 
 the effect or influence of almost every article in 
 medicine; and that, in time, it would probably 
 supersede the necessity of the internal exhibition 
 of very many nauseous and disagreeable reme- 
 dies. Modern practice teaches us, that opium, 
 ^camphor, nicotiana, mercury, emetic tartar, tere- 
 binthina^and many other medicines, prove equally 
 effectual w^hen applied to the surface as when ta- 
 ken internally. Hence we see that we are enabled 
 to purge, salivate, puke and sweat, by this mode 
 of administering medicines. No one, I appre- 
 hend, will attempt to explain the effects of these 
 medicines, when applied in this manner, upon 
 any other principle or theory than that of sym- 
 pathetic association. If this be the manner in 
 which medicines, when so applied, operate on 
 the system, are we not, by analogical reasoning,, 
 irresistibly led to conclude, that all morbid poi- 
 sons produce their effects in the same identical 
 way? Most clearly we are. 
 
 The interval of time that takes place between 
 the introduction of the virus, and the coming 
 on of the constitutional symptoms, is very satis- 
 factorily explained by this consent of parts, but 
 not by absorption. The manner in which this 
 circumstance is explained, by the former of these, 
 is, that the morbid topical action, induced by the 
 virus at the place of inoculation^ requires a cer- 
 
59 
 
 tarn time to accumulate sufficient force to affect 
 the stomach; and the stomach, after having re* 
 ceived this impression by sympathizing with the 
 skin of the arm, affects the heart and arteries, by 
 their secondarily sympathizing with this organ, 
 producing all the phenomena of the concomitant 
 fever, which is always in direct ratio with the de- 
 rangement of this viscus. And from the ready 
 sympathy of the stomach in some instances, and 
 in some particular idiosyncrasies, are the varieties 
 and different degrees of violence of the com- 
 plaint to be explained. The eruptions in the 
 small-pox are explained in this way : that the 
 variolous virus, from its producing, by the consent 
 of parts, a peculiar or specific irritation on the 
 heart and arteries, the secerning vessels of the skin 
 are thereby induced to assume that particular spe- 
 cies of action which affords the secretion of va- 
 riolous matter. Are not the operation of all mor- 
 bid poisons much more rationally explained upon 
 the principles of this theory than upon those o£ 
 absorption? And have we not reason to anti- 
 cipate the explanation of the operation of all 
 medicines upon the same principle? Certainly, 
 the operation of opium, bark, wine, volatile 
 alkali, arsenic, and a number of others, as be- 
 fore mentioned, are only explicable in this way. 
 
 Another fact, which very much invalidates 
 the theory of absorption, is, that Dr. Physick, 
 of Philadelphia, has proved, by various experi- 
 
m 
 
 iiiehts, that mercury, when administered for the 
 cure of syphilis, does not enter into the circula- 
 tion. 
 
 The antagonists of the sympathetic theory m_ay 
 probably urge this objection — that if the chyle is 
 taken up by the lacteals, medicines, in conse- 
 quence of their being taken into the stomach, 
 and actually mixed with this fluid, must also be 
 taken up at the same tinle. But the advocates 
 of this opinion will do well to recollect, that 
 the chyle is a bland, innocuous fluid, intended 
 solely for the nourishment and support of th^ 
 system; 
 
 Now, if this be the use to which the chyle is 
 destined, it is clear that, if it carried along with 
 it all the irritating and poisonous substances 
 taken into the stoniach, it would certainly be 
 very far from answering this purpose. Neither 
 does it appear to me reasonable to suppose, 
 that nature ever intended the lacteals, or any 
 part of the absorbent system, to take up or con- 
 vey any thing but their own appropriate fluids. 
 If they should, it would be contrary to the 
 laws of physiology, to suppose that such sub- 
 stances should pass on through them in propria 
 forma. I believe it is alniost uiiiversally admitted, 
 that the vessels themselves, by their own speci- 
 fic actions, form, or secrete the fluids which they 
 convey; consequently, if there ever is any thing 
 Absorbed or taken up by them, it must neces- 
 
61 
 
 sarily undergo that peculiar change, in ordeY 
 that it may pass on through them. Further: if 
 every thing that passes into the stomach and in- 
 testines was as readily absorhed and carried into 
 the circulation as the chyle, the blood must ne- 
 cessarily, in a very short time, become one of 
 the most heterogeneous and contaminated fluids 
 in nature. Bat, contrary to all this, we find it 
 to be one of the most mild, salutary, and nutri- 
 tious; composed invariably of a certain number 
 of constituent parts; never varying, either in 
 health or disease, except in its consistency and the 
 relative proportion of its constituent principles. 
 Again: if things were absorbed and carried into 
 the blood, we should certainly be enabled, by 
 experiments, to discover them; but notwith- 
 standino^ the vast number that have been insti- 
 tuted for this purpose, not the least particle of 
 extraneous matter has ever been detected in it. 
 
 To conclude this subject, I would beg leave 
 to ask the advocates for absorption, whether it 
 appears in any w^ay probable, or even possible, 
 agreeable to the laws of chemistry, that a sub- 
 stance should remain, for any length of time, 
 in so powerful a solvent and chemical agent as 
 the gastric juice, without having wrought upon 
 it some particular change ? 
 
 If the doctrine of sympathy, nervous con- 
 sent, or associated motion, whichever you may 
 please to term it, explains, in a satisfactory and 
 
^2 
 
 rational manner, all the phenomena, and if the 
 data upon which it is predicated be just, upon 
 the principles of philosophical induction, it is 
 certainly right to give this the preference to all 
 others. 
 
 Much more might easily be adduced in sup- 
 port of this theory, but the limits which I have 
 prescribed to this Dissertation will not permit. 
 
 To many it may appear an act of supereroga* 
 tion to offer any thing further respecting the be- 
 neficial effects of Vaccina. But the very illibe- 
 ral conduct and groundless opposition inculcated 
 and persisted in by many, induces me to make 
 the following observations. 
 
 The first and most imiportant advantage of 
 Vaccine inoculation is, that those persons who 
 have once regularly and truly passed through the 
 disease are rendered thereby for ever after un- 
 susceptible of the small-pox, either by inocula- 
 tion or contagion. In proof of this assertion I 
 might adduce numerous instances, upon the re- 
 spectable authorities of Jenner,Ring, Aikin,Pear- 
 'son, and many others w^ho have written on the 
 subject, of persons remaining completely secure 
 from the attack of small-pox, for ten, twenty, 
 thirty, forty, fifty, and even sixty years, after 
 having been infected with Cow-pock: but, in 
 order to save time, I shall beg leave to refer any 
 person desirous of becoming more particularly 
 informed on the subject, to the authors I have 
 
63 
 
 quoted, and also to the Medical and Physical 
 Journal of London, and to the Medical Reposi- 
 tory of New- York, where he will find a detail of 
 almost every thing that has transpired on the 
 subject. Of its protecting the system for one, 
 two, and even three years, against the effects 
 of small-pox, we have numerous instances in 
 our own city. 
 
 During my stay at the New-York Kine-pock 
 Institution, about one hundred and twenty or 
 thirty patients, as before stated, were inoculated 
 with Cow-pock, ten of which number, at the 
 request of the Medical Board, I, at the expira- 
 tion of the year, tested with the most active and 
 recent small-pox matter I could procure. The 
 virus alluded to was taken from the pustules of 
 a person labouring under a very full burthen of 
 them in the natural way; a sufficient quantity of 
 which, in the course of half an hour after it was 
 procured, was carefully inserted into both arms of 
 every one of the ten ; but they uniformly resisted 
 it; none of their inoculations exhibiting any 
 other appearance of their having succeeded than 
 a small red pimple, (and many of them not even 
 this) which, as is usual in such cases, altogether 
 disappeared, in a very short time, without the 
 least symptom of small-pox. Several of the other 
 patients have informed me that, since they had 
 undergone vaccination, they had been repeatedly 
 exposed to variolous contagion^, in its most viru- 
 
64 
 
 lent and concentrated form, but without the least 
 effect. One of them told me, some time in 
 May last, that he had slept, for several nights 
 successively, in the same bed with a person who 
 was labouring under the small-po^ in the natural 
 way, of a most malignant type, but had never 
 experienced any inconvenience from it. The 
 inflammation excited by the virus, in the cases 
 above stated, is an undoubted proof of its ac- 
 tivity. 
 
 Dr. Seaman, of this city, having very politely 
 favoured me with the perusal of his official re- 
 gister, I am enabled, by his consent, to exhibit 
 a statement of the number he has inoculated, 
 and of the success he has met with. It appears 
 that the number inoculated by him amounts to 
 two hundred and forty-two, (/. e, from the 22d 
 of May, 1801, till the 31st of August, 1802) 
 of which iifty-'eight have since undergone va- 
 riolous inoculation, some of them repeatedly, 
 but all with that uniform resistance that is ever 
 consequent upon real Vaccina. It may, perhaps, 
 be of importance to observe, that two of the 
 number were taken into a room where a person 
 was labouring under the casual sraall-pox, of a 
 very malignant type, and were exposed to it in 
 every way that could be devised: the pillow-case, 
 which was so stiff with matter as nearly to stand 
 erect, was even taken from under the head of thQ 
 infected person, warmed by the fire, and hel4 
 
63 
 
 under their noses ^ and they were made to put 
 their hands into the bed to him, but all without 
 effect. Such well authenticated cases as these, to 
 which might be added a thousand more, equally 
 Well attested, must certainly be sufficient to carry 
 full conviction to the most prejudiced mind. 
 
 To the prophylactic virtue of Vaccina may be 
 added another of almost equal importance : I 
 mean its salutary and effectual influence in the 
 removal of many inveterate and disagreeable 
 complaints. It is alleged by Dr. John Redmari 
 Coxe, of Philadelphia, and by many of the most 
 eminent vaccinators in Europe, that children of 
 weakly and debilitated constitutions frequently 
 have their health amazingly improved by passing 
 through the Cow-pock; so much so, in many 
 instances, as to acquire a healthy and robust 
 habit in a very short time. 
 
 In Duncan's Annals of Medicine, vol. i. lus- 
 trum 2, p. 327, there is a case related of a very 
 singular chronical affection of the arm, which^ 
 after a lengthy and ineffectual treatment, with 
 all the various medicines that could be devised^ 
 was, in a very short time, completely cured by 
 inoculation v/ith Vaccina. 
 
 In Turkey it is said to have proved effectual 
 in securing persons from the plague. 
 
 In France (as mentioned in a former part of 
 this dissertation) it has been successfully practised 
 in preventing the rot in sheep: and it is sup? 
 
 I ' 
 
m 
 
 posed, by Dr. Jenner, to produce a disease in 
 the canine species, which renders them unsus- 
 ceptible of hydrophobia. If this latter be the 
 case, does not analogical reasoning lead us to 
 the conclusion, that it may be productive of the 
 same, happy effect in the human species ? 
 
 These, it appears, are the great and import- 
 ant advantages arising from the mild and benig- 
 nant effects of Vaccina, which, in addition to its 
 gentle aspect, unites the double advantage of 
 giving to the system, security against that deadly- 
 foe, the small-pox, and of removing from it miany 
 obstinate diseases : while the small-pox, on the 
 contrary, although it is, by the present improved 
 mode of inoculation, in a great measure disarmed 
 of its terrors, in some instances proves fatal. 
 And although fewer deaths happen in an equal 
 number of persons who undergo the small-pox 
 now than formerly, yet it must be admitted that 
 the general prevalence of inoculation tends to 
 spread and multiply the disease itself; of which, 
 though its violence be miUch abated by the mo- 
 dern mode of treatment, the contagious quality 
 remains in full force. 
 
 It deserves also to be noticed, that notwith- 
 standing the fatality of the small-pox is very 
 much lessened by the improvement in modern 
 inoculation, the deaths induced by it are not in- 
 considerable : they are estimated at about one in 
 every three hundred throughout England, and at 
 
67 
 
 about one in every hundred in London; while 
 the loss in the natural small-pox is probably not 
 less than one in six. The same, no doubt, will 
 apply in this country. It has been ascertained, 
 by calculation, that not less than forty millions 
 of the human species fall victims to the fatal ra- 
 vages of this disease in every century ! 
 
 It has been asserted by many, that although 
 Vaccina, when conducted by skilful persons, may 
 prove efficacious in shielding the constitution 
 against the small-pox, its advantages over the lat- 
 ter were much depreciated on taking into conside- 
 ration the vast number of accidents and mistakes 
 that are liable to happen in it before the world 
 shall have become sufficiently acquainted with its 
 general laws. And they have from hence con- 
 cluded, that the Cow-pock, in the aggregate, was 
 rather an evil than a benefit to mankind. This, 
 however, is a very flimsy pretext, for it is certainly 
 much better to submit to temporary inconveni- 
 ence than to be for ever afflicted with such a 
 destructive evil as the small-pox. Nor ought it 
 to be overlooked, that mistakes have frequently 
 occurred in the inoculated variola ; and instances 
 are not wanting, in which persons supposed to 
 have passed through it by inoculation, have 
 caught it afterw^ards in the natural way. Several 
 such cases I myself have witnessed. 
 
 To the fatality of the small-pox may be added 
 the many irremediable affections which it fre- 
 
(jiiently leaves behind it in the system ; as 
 lameness, blindness, deafness, &;c. It must 
 be known to every experienced inoculator^ 
 that small-pox also calls into action the latent 
 seeds of scrophula and other strumous com- 
 plaints, of which there are many cases on record. 
 Another, and which is considered by many as an 
 imaginary evil of this disease, is the deformity 
 of the skin which it frequently induces, eveii 
 iinder the inoculated form. In the view of phi- 
 losophy and reason, this may indeed be said to 
 he an imaginary evil, unworthy of regard: but^ 
 imtil the world shall become peopled with phi- 
 losophers and wise men, mankind will shudder 
 at the contemplation of a disease Vv^hich robs the 
 most lovely part of creation of all their beauty. 
 
 Another important advantage which Vaccina 
 possesses over the small-pox, is its non-contagious 
 quality, being communicable in no other way 
 than by inoculation, or an absolute insertion of 
 the matter under the cuticle. Children that have 
 hever had the complaint may even sleep in the 
 same bed with those that are infected with it> 
 without experiencing the least inconvenience. 
 
 Why, then, upon an appreciation of all these 
 important advantages of Vaccina, is the public 
 mind so indifferent to its propagation? It is said 
 that, in Sicily, it is received with enthusiasm^ 
 and that an hospital has been already established, 
 by his Sicilian Majesty, for the inoculation of 
 
m 
 
 tlie poor. Institutions of a similar nature have 
 been established at Malta and Naples ; and we 
 are informed that vaccine inoculation has been 
 adopted throughout the papal dominions, in the 
 kingdom of Etruria, and in the Ligurian Republic. 
 Is it not surprising that the magistrates and 
 rulers of more enlightened nations do not follow 
 their laudable example ? Its progress, however, 
 like that of all other innovations, though ever 
 ^o well founded, must be slow, Vv^hen the pre- 
 judices and prepossessions of the public are to 
 be contended with. It is, nevertheless, esta- 
 blished upon the broad and immutable basis of 
 truth, which^ firm as the Newtonian rock, will 
 remain unshaken amidst the waste of ages; and 
 the superstructure erected thereon will afford an 
 asylum of protection, by recourse to which man- 
 kind will be enabled to rid themselves of a 
 monster ! 
 
 ^HE END, 
 
Date Due 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 :0 
 
 Sc32 
 
 1 -H.hi