In the courfe of my practice, the latter end of February and in March following, I distinctly recollect four cafes, in which I first faw eruptions from the vaccine inoculation, refembling fo much thofe of the fmall-pox, that I fhould not have hefitated to confider them as belonging to this disease, if I had not excited them by a different poifon from the variolous. I observed, however, at that time, fome appearances of thefe eruptions different from thofe which ufually occur in the finall-pox. Almost all these eruptions, in the stage of deficcation, afforded hining, fmooth, black, or reddish-brown fcabs; very few of them having previously fuppurated. Finding, in feveral inftances, that the matter from the inoculated puftule of these patients produced a fimilar eruptive diforder, and alfo the fame being the event in the practice of two or three of my correfpondents, whom I had furnished with matter from the above eruptive cafes, I, from that time, avoided using matter from the cafes in which fuch eruptions appeared. After this precaution, no cruptive cafes refembling the finall-pox, but certainly eruptions, in number from a fingle one to about a dozen, which were large, red, hard pimples, with little or no lymph, and never with any pus, occurred in probably one cafe out of twenty or thirty. Thefe fpots, fo unlike the fmall-pox, gave. no trouble, and were of fuch a fhort duration, that when I fpeak of cruptions I do not include them in the account; I in-clude thofe only in which the eruptions refembled the small-pox: nor do I reckon among the eruptive cafes, thofe in which, in a few inftances, a rash broke out about the 14th day after inoculation, and which was as troublesome as the Urticaria. My experience then, with refpect to the cafes of eruptions, being diminithed in number, by avoiding inoculation with matter of fimilar eruptive cafes, coincides with Dr. Woodville's, and confirms what he has already fo ufefully communicated to the public.. It was obvious to fufpect, on the first occurrence of the eruptive cafes, that variolous matter in an obferved way, but from the fources which could not even be conjectured, had been introduced into the conftitution inftead of the vaccine poifon. This conjecture, in fpite of the cleareft evidence of fenfe refpecting the nature of the matter ufed, received feme counte nance from the non-appearance of eruptions as above ftated; but from the occurrence of fuch cafes in the practice of other Inoculators in the last autumn and this winter, I now think it very unreasonable to doubt any longer, that, either on account of peculiar ftates of the human animal economy, or on account of fome co-operating agents, the genuine vaccine poifon does occafionally produce a certain variety of the cowpock, characterized by the appearance of puftules like thofe of of the variola. I have good evidence alfo to fhew, that even in the hands of thofe very Inoculators, who, a little time ago, would not allow that the vaccine poifon could produce eruptions, fuch cafes have lately occurred. In the month of October laft I inoculated a child, two years of age, with the vaccine poifon. The original matter which, had produced this matter, I took from the cow in March last; fince which time the vaccine difeafe had been excited by it, in my hands, in a great number of patients. The vaccine difeafe took place with the ufual appearances in the inoculated part, and affected the whole conftitution in the ordinary manner; but a few eruptions broke out on the fecond or third day, after a flight fever; they were, however, only the red large pimples aforementioned, and, of courfe, not at all like the finall-pox.. Mr. Keate carried matter from this child to Brighthelmftone, where Mr. Barrett inoculated two children, who took the disease, and from one of thefe Mr. Keate inoculated three children. They all had the ufual fever about the eighth day, and all had a number of eruptions except one, who had only five or fix, and thofe dried on the fifth day. This last cafe was probably that which Mr. Keate informed me had in the inoculated part the genuine vaccine puftule; but in all the others, Mr. Barrett obferved, that in the inoculated part the puftule was ragged at the edges, and flat, moft refembling the variolous puftule, Matter from thefe patients was sent to Petworth, where Mr. Andre informs me, he inoculated with it fourteen children. They all took the difeafe, and had eruptions like the variolous. Three children at the breaft had from three to twelve puftules, the remaining eleven children had from fifty to feveral hundred eruptions. The ftate of the arms, and the characters of the puftules of the inoculated part are not mentioned. None of the above patients died; nor is any mention made by Mr. Keate, Mr. Barrett, and Mr. Andre, even of any apprehenfion of danger. I add, that about a month ago, Dr. Thornton fent the cafe with cruptions, produced by matter which I originally took from the cow. According then to experience, we draw thefe conclufions: Ift, That in certain conftitutions, or under the circumstances of certain co-operating agents, the vaccine poifon produces a difeafe refembling the finall-pox; and, of courfe, the puftule in the inoculated part is very different from that of the vaccine. pock ordinarily occurring, and the eruptions refemble very much, if not exactly, fome varieties of the fmalt-pox. 2d. That in fome inftances thefe eruptions have occurred, although the inoculated part exhibited the genuine vaccine puftule. 02 3d. That 3d. That the matter of fuch eruptive cafes, whether taken from the inoculated part, or from other parts, produces univerfally, or at leaft generally, fimilar eruptive cafes; and has not, I believe, been feen to go back, by paffing through different conftitutions to the ftate in which it produces, what is called the genuine vaccine disease. 4th. That eruptions of a different appearance from variolous ones, fometimes occur in the true cow-pock. Now, whether the vaccine poifon, when it produces these cafes resembling the fmall-pox, really becomes by compofition or decompofition, variolous matter, is undetermined. If this fhould be found to be the cafe by future experiments, still we muft confider the two poifons as of diftinctly different species, on account of the different characters of the puftule in the fmall-pox and cow-pock: although, as juft faid, by the combination of fome other fubftance with the cow-pock poifon, or by the feparation of fome one of the conftituent ingredients of the poifon, the variolous may be produced. To illustrate this theory, let it be confidered, that magnefia and fulphate of magnefia are different fpecies of fubftances, although they agree in fome of their principal effects on the human conftitution, and in fome other properties; but, by the union of magnesia with fulphuric acid, it becomes fulphate of magnesia: or, the illuftration may be given converfely. As, then, we have dif tinct denominations for thefe two fubftances, fo we ought to have them for the two poisons, and the two different diseased ftates they produce, namely, the cow-pock and the small-pox. Accordingly, Dr. Odier, of Geneva, whofe powers as a Dia letician, and whofe acuteness as a Philologer, I can attest from the period of his academical ftudies, has "baptized" (to ufe the term of Dr. De Carro) the new difeafe, la vaccine, or vaccina; rejecting, as abfurd, the name of the English, variola vaccine. But, to return to the immediate question under difcuffion; granting, that variolous-like eruptions are liable to be produced by the inoculation of the cow-pock; what difference ought this accident to make in our eftimate of the value of the new practice, from the estimate made on the fuppofition, that no fuch eruptions would occur? I apprehend the value is hereby depreciated, but not to fuch a degree as to create any reafonable apprehenfions of the failure of the vaccine inoculation, in fuperfeding and finally extinguishing the small-pox : becaufe, 1. If the precaution be taken of avoiding inoculation with matter from eruptive cafes, as far as I have feen, not above one one cafe with variolous-like eruptions will be produced among two hundred inftances of inoculated cow-pock. 2. These eruptive cafes, as far as I have obferved, are not more severe than the ordinary kinds of inoculated finall-pox. 3. I have feen no disfiguration of the fkin from this variety of cow-pock; but I think it just to acknowledge, that from the experience I have had, no Practitioner can answer for fuch cafes not occurring in any inftance; and, as danger is always in proportion to the number of eruptions, which number, no perfon can pretend to limit; it is evident, that the chance of life during this disease is leffened, although but a very little. Provided this ftatement be made to the patient, it does not appear to me, that the fact of the liability to eruptions ought to impede the progress of the vaccine inoculation; but if, on the contrary, the patient be affured that such eruptions will not occur, there is good ground for the practice falling into difcredit, or at leaft, with reafon, for many perfons being difcontented. After this representation of an unfavourable part of the history of the cow-pock, it is confolatory to be able to counterpoife it with fome new facts, which, like that of the eruptions, have been difcovered in the courfe of further experience. It now appears, that a perfon who has had the fmallpox, is not fufceptible of the cow-pock by inoculation;* nor is a perfon fufceptible of the conftitutional affection from the cow-pock poifon more than once. On the whole, then, we have gained, perhaps, as much as we have loft, fince the publication of the original account. And, unless fome new adverfe facts fhall be difcovered, and confiding that the public will adopt a method which is manifeftly to their intereft, the change effected in medical practice will be fo eminently memorable, that the introduction of the vaccine inoculation must become an epoch in the biftory of phyfic. To the Editors of the Medical and Phyfical Journal. GENTLEMEN, IN your Journal for the prefent month, I obferve an extract from a paper fent you by Dr. Pearfon, on the appearance of pufules The cafes of milkers, with chopt hands, being repeatedly affected with fores from the cow-pock poison, applied in milking, whether they had undergone the fmall-pox or not, probably occafioned the error of the conclusion here alluded to. puftules refembling the fmall-pox in the vaccine inoculation. When I have had an opportunity of perufing this paper, I may probably request the favour of you to give room to fome comments upon it; in the mean time, it may be proper to remark, that from the commencement of my inoculation with the vaccine virus to the prefent day, no puftules, fimilar to the variolous, have in any one inftance appeared. I have seen rafhes, and fometimes (though very rarely) I have obferved a few fcattered pimples about the body; indeed, it has often appeared fingular to me, on reflecting how frequently local cuticular inflammation and irritation (whether arifing fpontaneously, or from the application of acid substances) occafion fuch appearances, that they fhould have occured fo feldom. Time will develope the mystery before us; at prefent, I very much fufpect, that where variolous puftules have appeared, variolous matter has occafioned them. The many obfcure ways by which it may effect the system, must be too obvious to require explanation. Berkeley, Jan. 13, 1800. I remain, GENTLEMEN, To the Editors of the Medical and Phyfical Journal. GENTLEMEN, THE fuccefs which attended the ufe of the opiate friction in feveral cafes related by Mr. Ward, of Manchester, induced me to try it in the following, wherein it was attended with the moft beneficial effects. If you think it worthy a place in your valuable Journal, you are at liberty to infert it. I remain, GENTLEMEN,' Deal, Dec. 22, 1799... Your very humble fervant, THO. DOCKER, Surgeon to the Forces. JOHN BAYLIS, of the Third Regiment of Guards, was received into the Military Hofpital at this place, from Holland, as a venereal patient. Upon examination, I found a confiderable fphacelation in the groin, from a bubo which had been opened fom |