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of noticing the effects of a singular disease, and of viewing the progress of the most curious experiment that ever was recorded in the history of physiology.

"I remain, dear sir, etc.,

"JOSEPH H. MARSHALL."

"P.S. I should have observed that, of the patients I inoculated and enumerated in my letter, one hundred and twenty-seven were infected with the matter you sent me from the London cow. I discovered no dissimilarity of symptoms in these cases from those which I inoculated from matter procured in this country. No pustules have occurred, except in one or two cases, where a single one appeared on the inoculated arm. No difference was apparent in the local inflammation. There was no suspension of ordinary employment among the labouring people, nor was any medicine required.

"I have frequently inoculated one or two in a family, and the remaining part of it some weeks afterwards. The uninfected have slept with the infected during the whole course of the disease without being affected; so that I am fully convinced that the disease cannot be taken but by actual contact with the matter.

"A curious fact has lately fallen under my observation, on which I leave you to comment.

"I visited a patient with the confluent smallpox and charged a lancet with some of the matter. Two days afterwards I was desired to inoculate a woman and four children with the cow-pox, and I inadvertently took the vaccine matter on the same lancet which was before charged with that of smallpox. In three days I discovered the mistake, and fully expected that my five patients would be infected with smallpox; but I was agreeably surprised to find the disease to be genuine cow-pox, which proceeded without deviating in any particular from my former cases. I afterwards inoculated these patients with variolous matter, but all of them resisted its action.

"I omitted mentioning another great advantage that now occurs to me in the inoculated cow-pox; I mean the safety with which pregnant women may have the disease com

municated to them. I have inoculated a great number of females in that situation, and never observed their cases to differ in any respect from those of my other patients. Indeed, the disease is so mild that it seems as if it might at all times be communicated with the most perfect safety.”

I shall here take the oportunity of thanking Dr. Marshall and those other gentlemen who have obligingly presented me with the result of their inoculations; but, as they all agree in the same point as that given in the above communication, namely, the security of the patient from the effects of the smallpox after the cow-pox, their perusal, I presume, would afford us no satisfaction that has not been amply given already. Particular occurrences I shall, of course, detail. Some of my correspondents have mentioned the appearance of smallpox-like eruptions at the commencement of their inoculations; but in these cases the matter was derived from the original stock at the Smallpox Hospital.

I have myself inoculated a very considerable number from the matter produced by Dr. Marshall's patients, originating in the London cow, without observing pustules of any kind, and have dispersed it among others who have used it with a similar effect. From this source Mr. H. Jenner informs me he has inoculated above an hundred patients without observing eruptions. Whether the nature of the virus will undergo any change from being farther removed from its original source in passing successively from one person to another time alone can determine. That which I am now employing has been in use near eight months, and not the least change is perceptible in its mode of action either locally or constitutionally. There is, therefore, every reason to expect that its effects will remain unaltered and that we shall not be under the necessity of seeking fresh supplies from the cow.

The following observations were obligingly sent me by Mr. Tierny, Assistant Surgeon to the South Gloucester Regiment of Militia, to whom I am indebted for a former report on this subject:

"I inoculated with the cow-pox matter from the eleventh to the latter part of April, twenty-five persons, including

women and children. Some on the eleventh were inoculated with the matter Mr. Shrapnell (surgeon to the regiment) had from you, the others with matter taken from these. The progress of the puncture was accurately observed, and its appearance seemed to differ from the smallpox in having less inflammation around its basis on the first days-that is, from the third to the seventh; but after this the inflammation increased, extending on the tenth or eleventh day to a circle of an inch and a half from its centre, and threatening very sore arms; but this I am happy to say was not the case; for, by applying mercurial ointment to the inflamed part, which was repeated daily until the inflammation went off, the arm got well without any further application or trouble. The constitutional symptoms which appeared on the eighth or ninth day after inoculation scarcely deserved the name of disease, as they were so slight as to be scarcely perceptible, except that I could connect a slight headache and languor, with a stiffness and rather painful sensation in the axilla. This latter symptom was the most striking—it remained from twelve to forty-eight hours. In no case did I observe the smallest pustule, or even discolouration of the skin, like an incipient pustule, except about the part where the virus has been applied.

"After all these symptoms had subsided and the arms were well, I inoculated four of this number with variolous matter, taken from a patient in another regiment. In each of these it was inserted several times under the cuticle, producing slight inflammation on the second or third day, and always disappearing before the fifth or sixth, except in one who had the cow-pox in Gloucestershire before he joined us, and who also received it at this time by inoculation. In this man the puncture inflamed and his arm was much sorer than from the insertion of the cow-pox virus; but there was no pain in the axilla, nor could any constitutional affection be observed.

"I have only to add that I am now fully satisfied of the efficacy of the cow-pox in preventing the appearance of the smallpox, and that it is a most happy and salutary substitute for it. I remain, etc.,

"M. J. TIERNY."

Although the susceptibility of the virus of the cowpox is, for the most part, lost in those who have had the smallpox, yet in some constitutions it is only partially destroyed, and in others it does not appear to be in the least diminished.

By far the greater number on whom trials were made resisted it entirely; yet I found some on whose arm the pustule from inoculation was formed completely, but without producing the common efflorescent blush around it, or any constitutional illness, while others have had the disease in the most perfect manner. A case of the latter kind having been presented to me by Mr. Fewster, Surgeon, of Thornbury, I shall insert it:

"Three children were inoculated with the vaccine matter you obligingly sent me. On calling to look at their arms three days after I was told that John Hodges, one of the three, had been inoculated with the smallpox when a year old, and that he had a full burthen, of which his face produced plentiful marks, a circumstance I was not before made acquainted with. On the sixth day the arm of the boy appeared as if inoculated with variolous matter, but the pustule was rather more elevated. On the ninth day he complained of violent pain in his head and back, accompanied with vomiting and much fever. The next day he was very well and went to work as usual. The punctured part began to spread, and there was the areola around the inoculated part to a considerable extent. 'As this is contrary to an assertion made in the Medical and Physical Journal, No. 8, I thought it right to give you this information, and remain,

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"Dear sir, etc.,

"J. FEWSTER.”

It appears, then, that the animal economy with regard to the action of this virus is under the same laws as it is with respect to the variolous virus, after previously feeling its influence, as far as comparisons can be made between the two diseases.

Some striking instances of the power of the cow-pox in

suspending the progress of the smallpox after the patients had been several days casually exposed to the infection have been laid before me by Mr. Lyford, Surgeon, of Winchester, and my nephew, the Rev. G. C. Jenner. Mr. Lyford, after giving an account of his extensive and successful practice in the vaccine inoculation in Hampshire, writes as follows:

"The following case occurred to me a short time since, and may probably be worth your notice. I was sent for to a patient with the smallpox, and on inquiry found that five days previous to my seeing him the eruption began to appear. During the whole of this time two children who had not had the smallpox, were constantly in the room with their father, and frequently on the bed with him. The mother consulted me on the propriety of inoculating them, but objected to my taking the matter from their father, as he was subject to erysipelas. I advised her by all means to have them inoculated at that time, as I could not procure any variolous matter elsewhere. However, they were inoculated with vaccine matter, but I cannot say I flattered myself with its proving successful, as they had previously been so long and still continued to be exposed to the variolous infection. Notwithstanding this I was agreeably surprised to find the vaccine disease advance and go through its regular course; and, if I may be allowed the expression, to the total extinction of the smallpox."

Mr. Jenner's cases were not less satisfactory. He writes as follows:

"A son of Thomas Stinchcomb, of Woodford, near Berkeley, was infected with the natural smallpox at Bristol, and came home to his father's cottage. Four days after the eruptions had appeared upon the boy, the family (none of which had ever had the smallpox), consisting of the father, mother, and five children, was inoculated with vaccine virus. On the arm of the mother it failed to produce the least effect, and she, of course, had the smallpox," but the rest of the family had the cow-pox in the usual way, and were not affected with the smallpox, although they were in the same room, and the children slept in the same bed with their brother

"Under similar circumstances I think it would be advisable to insert the matter into each arm, which would be more likely to insure the success of the operation.-E. J.

(8) HC XXXVIII

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