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who was confined to it with the natural smallpox; and subsequently with their mother.

"I attended this family with my brother, Mr. H. Jenner." The following cases are of too singular a nature to remain unnoticed.

Miss R, a young lady about five years old, was seized on the evening of the eighth day after inoculation with vaccine virus, with such symptoms as commonly denote the accession of violent fever. Her throat was also a little sore, and there were some uneasy sensations about the muscles of the neck. The day following a rash was perceptible on her face and neck, so much resembling the efflorescence of the scarlatina anginosa that I was induced to ask whether Miss Rhad been exposed to the contagion of that disease. An answer in the affirmative, and the rapid spreading of the redness over the skin, at once relieved me from much anxiety respecting the nature of the malady, which went through its course in the ordinary way, but not without symptoms which were alarming both to myself and Mr. Lyford, who attended with me. There was no apparent deviation in the ordinary progress of the pustule to a state of maturity from what we see in general; yet there was a total suspension of the areola or florid discolouration around it, until the scarlatina had retired from the constitution. As soon as the patient was freed from this disease this appearance advanced in the usual way.

The case of Miss H— R— is not less interesting than that of her sister, above related. She was exposed to the contagion of the scarlatina at the same time, and sickened almost at the same hour. The symptoms continued severe about twelve hours, when the scarlatina-rash shewed itself faintly upon her face, and partly upon her neck. After remaining two or three hours it suddenly disappeared, and she became perfectly free from every complaint. My surprise at this sudden transition from extreme sickness to health in great measure ceased when I observed that the inoculated pustule had occasioned, in this case, the common efflorescent

I witnessed a similar fact in a case of measles. The pustule from the cow-pock virus advanced to maturity, while the measles existed in the constitution, but no efflorescence appeared around it until the measles had ceased to exert its influence.

appearance around it, and that as it approached the centre it was nearly in an erysipelatous state. But the most remarkable part of this history is that, on the fourth day afterwards, so soon as the efflorescence began to die away upon the arm and the pustule to dry up, the scarlatina again appeared, her throat became sore, the rash spread all over her. She went fairly through the disease with its common symptoms.

That these were actually cases of scarlatina was rendered certain by two servants in the family falling ill at the same time with the distemper, who had been exposed to the infection with the young ladies.

Some there are who suppose the security from the smallpox obtained through the cow-pox will be of a temporary nature only. This supposition is refuted not only by analogy with respect to the habits of diseases of a similar nature, but by incontrovertible facts, which appear in great numbers against it. To those already adduced in the former part of my first treatise' many more might be adduced were it deemed necessary; but among the cases I refer to, one will be found of a person who had the cow-pox fifty-three years before the effect of the smallpox was tried upon him. As he completely resisted it, the intervening period I conceive must necessarily satisfy any reasonable mind. Should further evidence be thought necessary, I shall observe that, among the cases presented to me by Mr. Fry, Mr. Darke, Mr. Tierny, Mr. H. Jenner, and others, there were many whom they inoculated ineffectually with variolous matter, who had gone through the cow-pox many years before this trial was made.

It has been imagined that the cow-pox is capable of being communicated from one person to another by effluvia without the intervention of inoculation. My experiments, made with the design of ascertaining this important point, all tend to establish my original position, that it is not infectious except by contact. I have never hesitated to suffer those on whose arms there were pustules exhaling the effluvia from associating or even sleeping with others who never had experienced either the cow-pox or the smallpox. And, further, I have repeatedly, among children, caused the uninfected to breathe

See pages 217, 218, 219, 221, 223, etc.

over the inoculated vaccine pustules during their whole progress, yet these experiments were tried without the least effect. However, to submit a matter so important to a still further scrutiny, I desired Mr. H. Jenner to make any further experiments which might strike him as most likely to establish or refute what had been advanced on this subject. He has since informed me "that he inoculated children at the breast, whose mothers had not gone through either the smallpox or the cow-pox; that he had inoculated mothers whose sucking infants had never undergone either of these diseases; that the effluvia from the inoculated pustules, in either case, had been inhaled from day to day during the whole progress of their maturation, and that there was not the least perceptible effect from these exposures. One woman he inoculated about a week previous to her accouchement, that her infant might be the more fully and conveniently exposed to the pustule; but, as in the former instances, no infection was given, although the child frequently slept on the arm of its mother with its nostrils and mouth exposed to the pustule in the fullest state of maturity. In a word, is it not impossible for the cow-pox, whose only manifestation appears to consist in the pustules created by contact, to produce itself by effluvia? In the course of a late inoculation I observed an appearance which it may be proper here to relate. The punctured part on a boy's arm (who was inoculated with fresh limpid virus) on the sixth day, instead of shewing a beginning vesicle, which is usual in the cow-pox at that period, was encrusted over with a rugged, amber-coloured scab. The scab continued to spread and increase in thickness for some days, when, at its edges, a vesicated ring appeared, and the disease went through its ordinary course, the boy having had soreness in the axilla and some slight indisposition. With the fluid matter taken from his arm five persons were inoculated. In one it took no effect. In another it produced a perfect pustule without any deviation from the common appearance; but in the other three the progress of the inflammation was exactly similar to the instance which afforded the virus for their inoculation; there was a creeping scab of a loose texture, and subsequently the formation of limpid fluid at its edges. As these people were all employed in laborious.

exercises, it is possible that these anomalous appearances might owe their origin to the friction of the clothes on the newly inflamed part of the arm. I have not yet had an opportunity of exposing them to the smallpox.

In the early part of this inquiry I felt far more anxious respecting the inflammation of the inoculated arm than at present; yet that this affection will go on to a greater extent than could be wished is a circumstance sometimes to be expected. As this can be checked, or even entirely subdued, by very simple means, I see no reason why the patient should feel an uneasy hour because an application may not be absolutely necessary. About the tenth or eleventh day, if the pustule has proceeded regularly, the appearance of the arm will almost to a certainty indicate whether this is to be expected or not. Should it happen, nothing more need be done than to apply a single drop of the aqua lythargyri acetati upon the pustule, and, having suffered it to remain two or three minutes, to cover the efflorescence surrounding the pustule with a piece of linen dipped in the aqua lythargyri compos. The former may be repeated twice or thrice during the day, the latter as often as it may feel agreeable to the patient.

When the scab is prematurely rubbed off (a circumstance not unfrequent among children and working people), the application of a little aqua lythargyri acet. to the part immediately coagulates the surface, which supplies its place, and prevents a sore.

In my former treatises on this subject I have remarked that the human constitution frequently retains its susceptibility to the smallpox contagion (both from effluvia and contact) after previously feeling its influence. In further corroboration of this declaration many facts have been communicated to me by various correspondents. I shall select one of them.

66 'DEAR SIR:

Society at large must, I think, feel much indebted to you for your Inquiries and Observations on the Nature and Effects of the Variola Vaccinæ, etc., etc. As I conceive

8 Extract of Saturn.

9 Goulard water. For further information on this subject see the first Treatise on the Var. Vac., Dr. Marshall's letters, etc.

what I am now about to communicate to be of some importance, I imagine it cannot be uninteresting to you, especially as it will serve to corroborate your assertion of the susceptibility of the human system of the variolous contagion, although it has previously been made sensible of its action. In November, 1793, I was desired to inoculate a person with the smallpox. I took the variolous matter from a child under the disease in the natural way, who had a large burthen of distinct pustules. The mother of the child being desirous of seeing my method of communicating the disease by inoculation, after having opened a pustule, I introduced the point of my lancet in the usual way on the back part of my own hand, and thought no more of it until I felt a sensation in the part which reminded me of the transaction. This happened upon the third day; on the fourth there were all the appearances common to inoculation, at which I was not at all surprised, nor did I feel myself uneasy upon perceiving the inflammation continue to increase to the sixth and seventh day, accompanied with a very small quantity of fluid, repeated experiments having taught me it might happen so with persons who had undergone the disease, and yet would escape any constitutional affection; but I was not so fortunate; for on the eighth day I was seized with all the symptoms of the eruptive fever, but in a much more violent degree than when I was before inoculated, which was about eighteen years previous to this, when I had a considerable number of pustules. I must confess I was now greatly alarmed, although I had been much engaged in the smallpox, having at different times inoculated not less than two thousand persons. was convinced my present indisposition proceeded from the insertion of the variolous matter, and, therefore, anxiously looked for an eruption. On the tenth day I felt a very unpleasant sensation of stillness and heat on each side of my face near my ear, and the fever began to decline. The affection in my face soon terminated in three or four pustules attended with inflammation, but which did not maturate, and I was presently well.

“I remain, dear sir, etc.,

"THOMAS MILES."

I

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