MEDICAL AND PHILOSOPHICAL INTELLIGENCE.

VACCINATION.

We offer no apology in giving circulation to the following observations of Dr. Muter, of Battle, Sussex, on the Cow Pox Inoculation, which have appeared in some of the principal publications.-The subject is of great importance; and we trust the Doctor's remarks will dissipate whatever prejudices may have been ignorantly created.

"THAT a person having had the cow pox properly, is as permanently safe from small pox as though he had undergone that disease in the natural way, however severely, cannot admit of a doubt. It is established beyond all controversy; but I confess, it is too true, that small pox often occurs to such as have been vaccinated. To render vaccination, in every instance, absolutely and permanently successful, it is necessary, 1st. That the matter used be good, that is, taken at a proper period from a pustule which has gone through the regular stages. 2d. That the specific action be excited and completed, locally, and constitutionally, without interruption; then not a case in ten thousand will fail. But to be certain of all this requires great care, and not less skill. Every medical man, and no other, ought to vaccinate should frequently send for matter to one or other of the different institutions established on purpose to promote the interest of vaccination-for this plain reason, because he cannot depend upon what he borrows from another. He should likewise make himself master of the subject, and be able to say decidedly, this is a good or a bad pustule: here the patient is safe from small pox, or still liable to it. This can only be done at the end of two weeks, because that time is necessary to complete the formation, and absorption into the system of cow pox matter. But during this period the patient should be seen at least twice, in order to witness its proper stages. The causes of failure are concerns of the greatest importance, and should be placed in the most luminous point of view possible. Not only is the character of a medical man, but the life of the patient, at

stake; if he fails, the patient suffers from a loathsome and fatal disease, while the mistake ultimately recoils on himself. In many instances the way of a medical man with his patients is as the way of a ship on the sea, as the way of a serpent on a rock, trackless as the eagle's flight in the air, evanescent as the lightning's flash in the sky. The patient dies, and dead men tell no tales. Then who can judge where there is no evidence left upon which to determine; or, who can say, has the medical man done or not done his duty? In this instance, how, ever, all are competent to decide. Has the small pox occurred to a single patient he formerly vaccinated? if so, he has not done his duty, provided that he had an opportunity to see the case repeatedly afterwards. My medical brethren, think on the responsibility to which you and I are subject; and remember, that vaccination proves one of the most delicate tests of medical acumen and assiduity.

"I shall now point out a few of the more evident causes of the occasional failure of cow pox. 1st. There is often much difficulty in deciding positively, whether the patient has been perfectly and successfully vaccinated.-2d. Medical men are not sufficiently paid for vaccination, and it is attended with great loss of time always to see the patient sufficiently often.3d. They borrow cow pox matter from one another. This is always a cause of uncertainty,and often productive of infinite mischief. 4th. Parents are often careless, and neglect to have their children's cases properly inspected.-5th. The specific action is frequently disturbed by accident, the child rubbing off the head of the pustule before it is fully matured.-6th, Cow pox matter is sometimes taken from an arm a considerable time after the appearance of the areola.-7th. There is also a risk in taking it too soon.

"Mr. Hudson has with great propriety suggested a second vaccination in all doubtful cases. He has likewise pointed out unanswerable objections to a second inoculation with small pox. So far we agree; but I must declare, that I consider all fear groundless as to the deterioration of cow pox matter from frequent repetition. To conclude; I have vaccinated a great number every successive year, and, to the best of my knowledge, no patient vaccinated by me has hitherto caught the small pox. Indeed, this is no more than what may be accom

plished by every medical man, and every one who reflects on the accumulated evidence collected from every quarter of the globe, must admit that it is an indelible stain on the medical character to hear us publishing our own shame in reporting so many failures."-Leeds Mercury, February 7, 1818.

It appears by these very interesting observations, that the vaccine crust or scab, so generally used in the United States, is not commonly employed in Great Britain.-Editors.

Orfila and Majendie's Experiments on Morphium.

[From the London Medical Repository, for April 1818.]

THE fact that the narcotic principle of opium is morphium, an alkaline substance, sui generis, discovered by M. Sertuerner, is now pretty generally admitted; and although physicians in this country have not endeavoured to establish by experiments the effects of this substance on the animal economy, yet, many trials of it, both in its simple state, and in combination with various acids, have been made by various physiologists on the continent. The most celebrated of these experimenters are M. Orfila and M. Majendie, both of whom have published details to their experiments*, and it is now our ob ject to lay an abstract of these memoirs before our readers.

In the first M. Orfila purposes,-"1st, to establish that the aqueous extract of opium owes its medicinal properties to an alkali composed of oxygen, hydrogen, carbon, and azote; 2dly, to compare the effects of the aqueous extract of opium on the animal system, with those of morphium in its simple state, and in its state of combination with acids, with oils, and with alcohol; and, 3dly, to point out the method of treating symptoms indicative of poisoning by morphium."

Before entering upon the physiological part of his Essay, M. Orfila describes the physical and chemical properties of morphium, which we need not transcribe, and then details the method by which Robiquet orders it to be prepared, as the best process for procuring it. " Boil, for a quarter of an hour, a concentrated infusion of opium with a small quantity of mag

* Vide Nouveau Journ. de Médicine, et Chirurgie.—tom. i. p. 1.

nesia; a greyish precipitate will be produced, which appears to be a compound of morphium and a sub-meconate, with some colouring matter: wash it on a filter, and boil it with concentrated alcohol, which dissolves the morphium, and allows it to precipitate almost entirely as it cools. It is necessary to redissolve the morphium in concentrated alcohol, in order to ob tain it ina state of purity."

The first set of M. Orfila's experiments were intended to ascertain "the action of Morphium itself on the animal economy." In two experiments, that substance was introduced into the stomach of two dogs in the doses of two and five grains; and in a third experiment it was applied to the exposed cellular tissu on the thigh of a dog: vomiting, partial paralysis, and other symptoms of poisoning by opium were produced; but the animals rapidly recovered. From these experiments, M. Orfila, finding that morphium alone, owing to its little solubility in water, exercises but a feeble action on the 'animal economy, next tried it in combination with some acids.

The acid with which M. Orfila first combined it, was the acetic, diluted with water. Six grains of the acetate thus formed were introduced in the stomach of two dogs. In a short time the posterior extremities were paralysed; the animals seemed to be asleep, but were roused by the smallest noise; and, as if terrified, made fruitless efforts to escape; but as they fell in the attempt, they appeared instantly again asleep. The pupils were dilated, the pulse was slow, and the respiration labouring. At the end of eight hours they uttered a piercing cry; but on the following day all the symptoms diminished, and the animals gradually recovered their functions.

"Another dog was treated in the same manner, with six grains of the aqueous extract of opium dissolved in half an ounce of weak acetic acid. The posterior extremities became so enfeebled that the animal walked with difficulty; there was a slight tendency to sleep, but the respiration remained unaffected, and next day the animal appeared in perfect health.

Six grains of morphium dissolved in vinegar being injected into the cellular tissu in the thigh of a small dog, nearly the same symptoms were produced as when the acetate was introduced into the stomach; but the feebleness of the hind legs

did not altogether subside until the second day afterwards: and when twelve grains of the acetate were employed, the animal did not recover its ordinary state of health until the close of the fifth day. When six grains of the aqueous extract of opium dissolved in the acetic acid was injected into the thigh, in the same manner as the acetate of morphium, the symptoms subsided the next day; and on the third day, when the dose amounted to twelve grains.

Two grains of morphium, dissolved in water slightly acidulated with vinegar, were injected into the jugular vein of a stout dog. "The only symptom produced was paralysis of the posterior extremities; which terminated on the evening of the same day. On substituting two grains of the aqueous extract of opium for the morphium, no effect whatever was produced.

"One grain of morphium was dissolved in double the quantity of acidulated water, as in the former experiment; the effects produced were, at first, paralysis of the posterior extremities, and then drowsiness. These symptoms were augmented in a quarter of an hour; but they subsided in five hours, and on the following day the health of the animal was completely re-established. A dog of nearly the same size and strength was instantly killed, by the injection of two grains of morphium dissolved in acidulated water. Two grains of recently prepared aqueous extract, dissolved in the same quantity of acidulated water, and injected into the jugular vein of a robust dog, produced paralysis of the posterior extremities, drowsiness, and impeded respiration. These symptoms, however, subsided in an hour, and the animal walked with ease."

From these experiments M. Orfila has drawn the following conclusions: "1°, that morphium dissolved in acetic acid produces the same symptoms as the aqueous extract of opium; which inclines him to believe that the active ingredient of the extract is a salt analogous to the acetate: 2o, that the acetate of morphium exerts a more intense action on the animal economy than the same dose of the aqueous extract of opium. But it is necessary to reflect, that if twelve grains of the aqueous extract of opium does not occasion so violent an effect as twelve grains of morphium dissolved in vinegar, it is owing to that quantity of the extract containing, besides the morphium,