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happy to peruse his communications on one of the most important subjects, perhaps, ever brought under medical discus. sion; and we shall ever gratefully regard Dr. Jenner as the original writer.
Art. XII. Reports of a Series of Inoculations for the Variola Vaccina,
or Cow-pox ; with Remarks and Observations on this Disease, considered as a substitute for the Small-pox. By William Woodville, M. D. Physician to the Small-pox and Inoculation Hospitais. 8vo. pp. 155. 35. 6d. sewed. Phillips and Son. 1799. THE *HE publications which have hitherto appeared on this
subject contain satisfactory evidence with respect to certain facts, from which some important advantages in medical practice are calculable ; provided, however, that certain other facts, at present unestablished, do not prove, on farther research, to counterbalance those advantages, or that new facts do not arise which evince detriment. Yet, while we are aware of and duly report such unfavorable results from the prosecution of the inquiry, it is no more than bare justice to allow that the investigation may afford conclusions which exhibit additional advantages in practice. Much has been written on this subject, but it has principally consisted of unauthenticatcd reports and à priori unsound reasoning. Well attested and copious evidence was yet wanting, to enable the public to estimate the value of the new inoculation. The present work bears directly on this deficient point, viz. that of evidence; and the judgment, the industry, and the opportunities of the author, secured us from being disappointed in our expectations of much satisfaction from these reports.
Dr. Woodville says, 'I conceived it to be a duty that I owed to the public, in my official situation at the Inoculation Hospital, to embrace the first opportunity of carrying the plan into execution.' Not being able to procure vaccine inatter, he proceeded to try whether the disease could be actually excited by inoculating the nipples of cows with matter of grease ; in conformity to the opinion that the cow.pox originated in the grease. The numerous experiments made by the author, how
, ever, as well as by Professor Coleman, (of the Veterinary College,) in order to produce the disease in cows by the inoculation of the grease matter, and other equine morbid secretea Auids, proved unsuccessful. In a note, the curious fact is stațed, that, although the variolæ vaccine could not be produced in the cow's teats by the inoculation either of variolous matter, or of vaccine matter from the cow, Mr. Coleman did succeed in exciting the disease in this animal by inoculation of cow-pox matter from
the human subject. From these experiments, and other conclusive reasons here stated, Dr. Woodville proves the
error of Dr. Jenner with respect to the origin of the cow-pox in the grease of horses :--but this error is of no importance with respect to the practical advantages which are promised by other facts and observations.
At length, in January last, the cow-pox becoming epibootic (if we may be permitted to use the term) in a stable in Gray's. Inn Lane, matter was procured; by means of which the disease was propagated in the Small-pox Hospital ; and the consequent practice furnished the valuable statement of evidence contained in the present publication. It was thought of importance that this practice should be conducted openly, before several philosophical and professional men; and accordingly Lord Somerville, Sir Joseph Banks, Sir W. Watson, Drs. Simmons, Pearson, Willan, and others, attended at the cow. house above-mentioned, on the 24th January, to examine the sérvants and the cows then affected with the variola vaccina.
Dr. Woodville thinks it necessary, before he details his cases, to relate the local appearances arising from inoculation of the small-pox. The most curious of these observations is, that • the variolous matter first inserted, like other morbid poisons, is not capable of being immediately absorbed, but lodges in the skin, and there excites an inflammatory process, by which new matter producing the disease is generated,' In a note, it is subjoined, that the greater mildness of the inoculated than the casual small-pox depends upon this circumstance.'
Dr. Woodville then next relates the cases of 200 patients. inoculated with vaccine variolous matter between the 21st Ja-, nuary 1799, and the 18th March following. All of these from the oth of March, viz. 78, were inoculated for the small. pox (except two persons), after having gone through the cowpox, without producing any disease.'
In order to observe the progressive descent of the vaccine infection from patient to patient, as well as the magnitude of the disease which was excited by the inoculation, the account of the above 200 patients is also given in a table of 9 pages, containing 5 columns: 1, the name, 2. the years of age, 3. the months of age, 4. the number of days of illness, 5. the number of pustules. The original matter was taken from the cow, and from the milk-maid, Sarah Rice, who contracted the disease from the cow. This table comprehends all the cases originally intended for the present publication : but, from the delays occasioned by a concurrence of circumstances, the author took the advantage of making additions. Accordingly, another tabulated statement is given, of the same kind
as the former, in which are contained the results of above 303 additional cases,
These 500 cases give occasion to several remarks at the close of this valuable pamphlet; and we were anxious to compare
the appearances with those already described by others. First, we are not a little surprised on finding so great a proportion of pustular cases :
Indeed,' says the author, ' when I first observed a pustular cruption upon Buckland, Case 3d, the occurrence being wholly unexpected, I was not without apprehension that the lancet which was employed in his inoculation might have had some particles of variolous matter adhering to it. But this suspicion was soon removed ; for upon inquiry I found that all the lancets which I had used on the 21st January, were then made use of for the first time since they had been ground by the cutler.' (p. 137.)
2dly, A suspicion arose that the patients were variolated (as Dr.W.calls it) by the variolous inoculation, which was performed on the 5th day after the insertion of the vaccine matter, in order to secure them against the natural small-pox to which they were exposed in the Hospital; and hence, it was supposed, a hybrid disease was produced.
• But (says the Dr.) as the matter employed in the cow-pox ino-' culations was always taken before the constitution could be affected by the variolous matter, and during the time that both inoculations were merely local diseases, I apprehend its effects would be the same as if the variolous inoculation had not taken place, Nay, had this not been the case, but had several patients been inoculated with matter taken from the cow-pox tumour on the arm of Jane Collingridge, after both the inóculations were supposed to have affected the constitation for several days, neither facts nor analogy lead us to believe that the matter thus obtained would produce any other disease than that of its own species, or that its specific morbid quality would be changed by entering into combination with the virus of the small-pox, The general character of the tumour formed by the inoculation of the
different from that of the cow-pox, and though on the same day a person be inoculated in one arm with the matter of the cow.pox, and in the other with that of the small-pox, yet both .tumours preserve their respective characteristic appearances throughout the whole course of the disease. This is certainly a strong proof that the two diseases in respect to their local action continue separate and distinct.'
Twenty-eight patients were on the same day inoculated with a mixture of equal parts of the variolous and cow-pox matter, in order to see which disease would prevail, or whether an hybrid disease would be produced. The result was that, in most of the patients, the disease resembled the cow-pox; in the others, it more resembled the small-pox; but in none was there much indisposition, nor many pustules.
3dly, Matter sent into the country from the arm of Ann Bumpus, who had 310 suppurated pustules, produced the disease in 160 persons, without any maturated pustules : but this exemption from suppurated pustules did not depend on the air of the country, because one out of five of the above patients in the tables had such eruptions, who lived cight miles distance from London ; and, at a small village further frona London, 18 persons were inoculated with similar matter, in all of whom it produced pustules.
4thly, A strong proof that the suppurated pustules were those of the real cow-pox is afforded by the inoculation of a cow's teat with cow-pox matter from the human subject. A man servant caught the disease by milking this cow; and with the matter from this cow, the patients Streeton, Smith, and Meacock, were inoculated. Streeton had 300 suppurated pustules, Meacock had still more, and Smith had above 109 pustules,
5thly, The following nice observations, we think, should be repeatedly made, before the conclusion be admitted.
• If a person has casually received the infection of the small-pox, and be inoculated with variolous matter three or four days before the eruptive symptoms supervene, the inoculated part does not tumily, as in other cases, but becomes a simple pustule : on the contrary, if a person has been inoculated, and the progress of the inoculation be sa far advanced that the patient is within one day of the approach of the eruptive fever, and be then inoculated a second time, the tumour produced from the second inoculation will become nearly as exteusive as the first, and be in a state of suppuration a few hours after the fever commences. Hence it appears, that the process of variolation in the natural and in the inoculated small-pox is different.'
6thly. The number inoculated for the vaccine disease, by the author, amounted to about 600: but they could not all be included in the tables ; because, when they were printed, the disease was not far enough advanced to give the result :but, in judging of the degree of danger and the magnitude of the disease, it will be proper to take into the account the case of an infant at the breast, which died on the nth day after the vaccine inoculation. In this solitary fatal case, the local tumour was very inconsiderable, and the eruptive symptoms took place on the 7th day; when the child was attacked with tirs of the spasmodic kind, which recurred at short intervals with increased violence, and carried it off, after an eruption of 80 ør. 100 pustules. It appears, then, that one proved fatal out of 500 inoculated cases for the cow-pos; and the preceding tables shew that in other cases the disease was of. formidable severity: while, on the other hand, a very large proportion of the patients were scarcely disordered from the inoculation, and
had no pustules. About two-fifths had no pustules, and threefourths had no perceptible constitutional disorder :-but, says the author, if at an average one of 500 will die of the inoculated cow-pox, I confess I should not be disposed to introduce this disease in the Inoculation Hospital ; because, of 5000 cases of variolous inoculation, the number of deaths has not exceeded one in 600.-It will be obvious to men of good judgment, that the calculation of proportional mortality in the cow-pox is premature.
7thly, The disease appeared in general milder when the matter was used from those who had the disease mildly.
8thly, The conclusion, that the cow-pox and small-pox are only varieties of the same species of disease, appears still more unwarrantable than even that of the proportional mortality. The fact which led to this conclusion, however, merits farther scrutiny, to determine whether eruptive cases of the vaccine disease, resembling the small-pox, uniformly produce similar eruptive cases. We think that the contrary appears from the cases in this volume.
gthly, We are of opinion that the conclusion, from two cases only, that the vaccine disorder can be propagated by effluvia, stands in need of confirmation.
lothly, On the important point of persons taking the small pox after the vaccine infection, the author very well observes that the instances in the affirmative are defective, in not affording sufficient proof that the disease was really the cow-pox; while the instances, which go to prove that those who had undergone the genuine vaccine disease resisted the variolous infection, are decisive, and sufficiently numerous to establish the fact in a satisfactory manner. The number inoculated by Dr. W. for the small-pox, after the cow.pox, amounted to above 400. :: 11thly, Dr. W. observes, that we have been told that the cow-pox tumour produced erysipelatous inflammation and phagedenic ulceration; but the inoculated part has not ulcerated in any
of the cases which have been under my care ;' and nothing but slight inflammation ensued, which was easily subdued by aqua lithargyri acetati. We confess that the representation made of the use of caustics by Dr. Jenner, and of other means, to subdue the terrible local affection which is said to occasionally take place, always appeared to us chimerical; and the affection for which they were proposed seemed to have no existence. Dr. Woodville's extensive experience is conclusive on this point.
On the subject of the vaccine disease, we have undoubtedly received much information, as to its history, from the pam