A treatise on the cow-pox; containing an enumeration of the principal facts in the history of that disease; the method of communicating the infection by inoculation; and the means of distinguishing between the genuine and spurious cow-pox ..

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Preface

1 he Small-pox, one of the most severe and dangerous diseases to which mankind is subject, has descended, with undiminished violence, from generation to generation, ever since its introduction into Europe, more than a thousand years ago; and every effort hitherto made to extirpate this formidable disease, has failed of success.

' Many thousands annually fall victims to the Small-pox; and even when it does not prove fatal, it frequently produces painful and lingering complaints.

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It is often injurious to beauty, by the permanent pits and scars which it leaves on the face: it often destroys the sight, by the inflammation and scales which it induces on the eyes; and it sometimes terminates in swellings and ulcers, by which the strongest constitutions are gradually undermined, and ultimately ruined.

Inoculation has, indeed, rendered the Small-pox much less fatal ; but even inoculated Small-pox is frequently attended with fever, and with other alarming symptoms. It is this circumstance which has prevented the practice of inoculation for the Small- pox from becoming general among the lowerclasses of the people ; and there is cause to believe, that the practice of partial inoculation, though beneficial to the in-

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dividuals inoculated, has, on the whole, been injurious to mankind, by spreading the contagion to numbers who otherwise might have escaped the disease altogether.

Mankind are, therefore, infinitely indebted to Dr Jenner, for his zeal in introducing to public notice an easy, safe, and effectual method of preventing the Small-pox, by the substitution of another disease. This disease is known by the name of Cow-pox, and is now universally acknowledged to possess the singular property of producing a change in the human constitution, which enables it to resist the variolous contagion.

The facts which Dr Jenner has stated on the subject, have been investigated, and their accuracy ascertained ; the ex-

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periments which he has made, have been repeated times without number, and found to be accurate; and the concurring testimonies of many medical practitioners have confirmed his inferences. The Author of the following pages will not presume to say, that he has much new information to communicate; but having had extensive experience in the practice of Vaccine Inoculation, and wishing to do every thing in his power to render it general; he conceives, that a short account of the principal facts relating to the history of the Cow-pox, addressed to the Clergy of Scotland, who deservedly have great influence over the minds of the people, and who are much disposed to promote every object tending to the public good, will more effectually introduce

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the Vaccine Inoculation in this country, than any other measure that could be adopted.

With this view, he has stated every thing of importance that is generally known on this interesting subject. No circumstance is mentioned, as a fact, which is not confirmed by his own experience ; and, at the same time, he has carefully referred, in the most material points, to the original and best authorities, in order that they, into whose hands these pages shall fall, may have an opportunity to obtain the most complete information on a subject so interesting and important to mankind.

Since the first edition of this Treatise was published, the Author has had occasion to correspond with a number of very respectable clergymen and

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practitioners on the subject; and he is extremely happy to find, that the plan which he has adopted has met with general approbation, and that the Vaccine Inoculation continues to gain ground in almost every part of Scotland.

A great deal, however, still depends on the exertion of individuals; and daily experience convinces him more and more, that the support of the Clergy, collectively, is necessary to complete the ultimate success of the Cow-pox inoculation, which has been so happily introduced under the auspices of Dr Jenner.

Chapter I. Of The Casual Cow-pox

Page Sect. I. Of the Discovery of the Cow-pox, .... 1

Sect. II. Of the Origin and Appearance of the

Casual Cow-pox, 4

Chapter II. Of The Inoculated Cow-pox

Sect. I. Of the Method of Procuring the Virus

of Cow- Pox, and of prestrving it for Use,. . . 14 Sect. II. Manner of performing the Inoculation, 29 Sect. III. Of the Symptoms of the Inoculated Cow-pox, 37 ili CONTENTS.

Page Sect. IV. Means of distinguishing the Genuine

from the Spurious Cow-pox, 4-9

Sect. V. Means of ascertaining, whether a Patient has passed through the Genuine Cow-pox, 64 Sect. VI. Cases in which the Vaccine Inoculation

should be deferred, 76

Sect. VII. Of the Advantages of the Cow-pox

over the Small-pox, 86

Sect. VIII. Of the Advantages which might arise from the Clergy exerting their Influence in promoting Vaccination, 95

Conclusion, 112

Explanation of the Plates, 122

Apfendix, i . . 129

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TREATISE

ON THE

COW-POX.

CHAPTER I.

OF THE CASUAL COW-POX.

SECTION I. Of the Discovery of the Cow-pox

In the month of June 1798, Dr Jenner, Physician at Berkeley, in Gloucestershire, published an interesting account of experiments which he had made, for the purpose of investigating the nature of a disease known

A in that country by the name of the Cow-pox. — He had commenced his inquiries nearly twenty-two years before, but had not an opportunity of making any experiments on the subject, till the month of May 1796.

In the course of his inquiries, he found, that, in the spring and autumn months, particularly if the weather is rainy, an eruption of pustules, or rather of vesicles, appears on the teats and udders of cows, in the extensive dairies of the western counties of England; and that this eruption is communicated to the milkers, by the matter contained in the vesicles being rubbed on the hands and fingers when the skin is abraded.

Dr Jenner also found, that the common people of Gloucestershire had been long acquainted with this circumstance, — that they, who were thus infected with the Cow-pox, remained ever afterwards unsusceptible of the contagion of Small-pox.

Having ascertained the truth of this circumstance, he attempted to render the observation generally useful, by communicating the disease received accidentally by the milkers, to children who had never been infected with the Small-pox. This he successfully accomplished ; and the happy result of these experiments has facilitated the introduction of the inoculated Cow-pox into almost every corner of the world. To the rapid dissemination of this practice, Dr Jenner's judicious conduct materially contributed. — He did not publish his discoveries, till he had it in his power to announce the confirmation of them by ample experience ; thus precluding all doubt or dispute about them, howevernew and extraordinary they might appear.

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Section II

Of the Origin and Appearance of the Casual Cow-pox.

The udders of cows, during the time they are suckling their young, are subject to pustulous sores of different kinds, which are occasioned by the stinging of flies, by external injuries, or by allowing the milk to collect in too great quantity.

By handling these pustules, sores are some times communicated to the hands of the milkers, which excite a good deal of uneasiness in the parts affected, but are never accompanied with fever. They often leave ulcers, that do not heal readily, both in the cow and in the human subject; but none of these sores preserve the person from the contagion of the Small-pox.

There is another kind of pustule, however.

more resembling a vesicle, to which the teats of cows are liable, which assumes a very different appearance, and is produced by a different cause from any of those that I have mentioned; the fluid of this vesicle, when introduced into the human constitution, occasions a disease, that renders the person ever afterwards secure against an attack of Small-pox. This vesicle has been denominated the Cow-pox, and it seems to be produced in the following manner.

In the spring, after a severe winter, horses often become affected with a disease in the heels, which farriers call the Grease.

It appears at the roots of the hairs, in the form of small vesicles, containing an acrid fluid, which bursts out when the vesicles are compressed, in rubbing down the horse's legs.

At this time the horse is evidently hot and feverish, and if any of the matter is applied to an excoriated part of the fingers or hands of the grooms, sores are produced, which, are also accompanied with fever. These sores do not heal readily, and often remain open for several weeks.

If a person who is thus affected, or who has any of the infectious matter on his fingers, milks the cows, as is frequently done in^extensive dairies, vesicles of a particular appearance are soon observed on their teats.

These vesicles are at first of a pale blue or livid colour, with a depression in their centre, and are surrounded with an erysipelatous inflammation. They contain a transparent watery fluid, and the parts in their immediate vicinity become hard and inflamed. If care is not taken to prevent them from being rubbed, they burst, and give rise to a foul deep-eating ulcer, which is long of healing. Sometimes the cow appears to be sick, and yields less milk than usual ; but this is not a frequent occurrence.

If at this time any of the matter of the vesicle, or sore, touches the milkers, when the scarf skin has been previously scratched, or rubbed off, vesicles similar to those on the teat of the cow are produced in the course of a few days.

At first, small inflamed spots appear on the wrists, hands, and joints of the fingers. These soon become vesicles, which fill with a transparent watery fluid, and continue to increase for several days. On the fifth or sixth day from the commencement of the vesicles, they are found to contain a quantity of a bluish fluid ; are of a circular form , depressed in their centre, and elevated at their edges. Soon afterwards, their bases are surrounded with an inflamed ring or areola, which, in the space of a day or two, is sometimes two inches in diameter.

On the seventh or eighth day, symptoms of absorption take place ; tumours appear in the glands of the arm-pit; the pulse becomes quick ; the patient complains of sickness, anxiety, oppression, and frequent changes from heat to cold ; sometimes, although rarely, he is even delirious.

These symptoms are not always equally

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violent, but they continue in a certain degree for one, two, or three days ; and when they recede, are followed by ulcerated sores on the parts, very similar to those on the cow from which the infection was received.

It must be observed, however, that no vesicular eruption on the skin has ever been known in Cow-pox to follow the feverish symptoms, as in the Small-pox, if it be not on the spot at which the infection is communicated. This accounts for vesicles appearing occasionally on the nose, lips, eyelids, and other parts where the skin is extremely thin. They arise from the patient carelessly rubbing them with the infected lingers.*

" Thus, the disease makes its progress from the horse to the nipple of the cow, and from the cow to the dairy-maid." +

• See Jenner's Inquiry into the Causes and Effects of (he Variola; Vaccinae, p. 5.

t See Jenner's Inquiry, &c. p. 6.

When a person has gone through this disease, he is ever afterwards secure from the infection of the Small-pox.

In support of the opinion, that the matter of grease in horses produces the Cow-pox, when applied to the teat of the cow, Dr Jenner has mentioned a circumstance which is still more remarkable, — That the matter of grease itself occasions a disease, when the human body is inoculated with it, which prevents the person from being afterwards susceptible of the Small-pox contagion. *

Dr Jenner, indeed, relates the history of two cases, which seem to invalidate this position; but the difference of the event in these cases can be accounted for, on the supposition, that the matter of grease, with which the persons were first infected, was sufficiently acrid to produce an eruption, but had lost its specific anti-variolous quality, as in vari-

* See Jenner, Case of Thomas Pearce, p. 27, and of John Baker, p. S6.

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ous circumstances happens even with the vaccine matter itself.

Since the publication of these important facts, many experiments have been made, both in Great Britain and on the Continent, for the purpose of ascertaining, whether the Cow-pox was really produced by the matter of grease applied to the udders of cows, as asserted by Dr Jenner. Experiments on this subject have been made by Dr Woodville, Mr Simmons, and Mr Coleman,* all of which seem to refute Dr Jenner's opinion ; but, in the month of October 1801, Dr Loy of Whitby, in Yorkshire, published a set of experiments, which, as they appear to have been carefully conducted,and to be accurately and faithfully described, must, in the opinion of every unprejudiced inquirer, prove, that Dr Jenner was right in his conjectures; and shew, that a person who has been infected with the mat-

* See Reports of a Series of Inoculations for the Variolas Vaccinae, by W. Woodville, p. 7. See also Mr Simmons' Experiments; and Dr Pearson's Inquiry, p. 83.

THE COW-POX. U

ter of grease, is equally incapable of receiving the Small-pox contagion, as if he had had the genuine Cow-pox. Indeed, from the description which Dr Loy gives of the disease produced by inoculating with the matter of grease, one is induced to consider it as the same in every circumstance with the genuine Cow-pox. *

Dr Loy has also pointed out a probable reason for the result of his experiments being different from the account given of similar trials by Dr Woodville, Mr Coleman, and Mr Simmons, namely, that he employed the matter of grease taken from a horse on the seventh day from the appearance of the eruption, and at the very time when the animal laboured under a considerable degree of fever. It appears from Dr Loy's observations — 1. That the matter of grease taken at this time, produced a disease on the teats of cows, similar in every respect to the Cow-pox.

* See Loy, Account of some Experiments on the Origin of the Cow-pox, p. 20.— 26.

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2. That matter taken from the cows infected in this manner, and introduced into the human subject, produced a disease which preserved the patient from the contagion of Small-pox.

3. That a person inoculated with matter produced in cows in this manner, received the genuine Cow-pox from it, and passed regularly through the disease.

In the sixth volume of the Memoirs of the London Medical Society, there is a communication from Dr Jos. Head Marshall, which appears to me to afford additional evidence of the accuracy of Dr Jenner's observations.

Dr Marshall states, that he was called to visit a young woman who had four or five vaccine vesicles on the hand: she had received the infection from one of the cows, which having been restive one morning, had been milked by the farmer's son, who was in the habit of attending a horse with sore heels in the stable. In this instance, the farmer's son conveyed the matter of grease from the horse to the cow, on whom it produced the Cow-pox, and the cow communicated the infection to the dairy-maid.

The confirmation of these facts would he a matter of much importance in the history of the Cow-pox, as it would point out a method of procuring genuine active matter, should that which is now in use fail, in those countries where the casual Cow-pox, as affecting cows, is unknown.

It must, however, be acknowledged, that the experiments hitherto made on this curious and interesting point, are not so numerous as might be wished, from the difficulty of procuring the genuine matter of grease ; as it is supposed, that the constitutional affection in the human subject is produced by that matter only which is taken from the horse during the eruptive fever when he first becomes affected with the grease, which is said to endure only for a very short period. But there are strong grounds for thinking, that Dr Jenner's opinion will ultimately appear to be well founded.

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CHAPTER II.

OF THE INOCULATED COW-POX.

SECTION I.

Of the Method of Procuring the Virus of Cow- Pox, and of preserving it for Use.

In propagating the Cow-pox by inoculation, the matter must be taken at a certain stage of the vesicle, otherwise a spurious disease may be produced, that does not preserve the constitution from Small-pox, and yet may readily be mistaken for the genuine Cow-pox, by those who are not accurately acquainted with the appearances of this disease. To guard practitioners, and the public, therefore, against accidents of this kind, I shall mention the manner of obtaining and preserving the proper vaccine virus ; and, in a subsequent Section, shall point out the sources of that matter from which the spurious disease originates.

It ought to be held as an invariable rule, that Cow-pox matter should be taken from a vesicle on one of the days between the fifth and ninth inclusive from the inoculation ; for we commonly fail in producing the genuine disease, if the matter be not thin and limpid ; but after the ninth day it usually becomes thick and purulent, and it cannot often be procured sooner than the fifth.

The genuine vaccine disease has, no doubt, been produced by matter taken on the twelfth, or even the fourteenth day, from under the scab ; but more frequently a spurious pustule is induced when the matter is taken at this late period, by which the practice is brought into discredit. There is, however, no necessity for using matter in this state ; so that, although some have ventured to advise this measure, few who have had full opportunities of observing its effects will be inclined to adopt it. I mention this with more confidence, as I know that Dr Jenner is decidedly of the same opinion ; for he says, that the matter should be taken between the fifth and ninth days after inoculation, and at all events, never after the scab has begun to form. This Dr Jenner inculcated.to Dr Tierney, who has lately published an inaugural dissertation on the subject of Cow-pox. *

I ought, however, to mention here, that although it is unsafe to inoculate with matter taken after the ninth day, or from under the scab ; yet, that the same objections do not exist against the employment of a solution of the scab in water, for the purpose of inoculation. With regaid to the virus contained in the vesicle, it is generally contaminated

ON THE COW-POX. IT

with purulent matter, and of course improper for being used in inoculation, after the ninth day of the disease ; whereas the scab, or crust, as it seems to be composed of the transparent, active virus, which hardening daily, from the fourth to the eighth or ninth day, gradually assumes the form of a hard, semi-transparent, brownish crust, may be used with safety for inoculation, in the manner pointed out in page 22 of this Treatise.

A Cow-pox vesicle seems to be composed of a numerous assemblage of minute cells, each of them containing a small quantity of fluid, and not communicating with one another, as the cells of the cellular membrane do in the healthy state ; at least we are induced to adopt this opinion from observing, that when one, or even two or three punctures are made in a vesicle, they do not give vent to all the fluid which it contains.

One who is unacquainted with the structure of the Cow-pox vesicle, would, from this peculiarity, be induced to think, that the

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quantity of virus in it is very small ; but by puncturing the vesicle in various places, thiough its whole circumference, almost all the fluid will be discharged; and if we wait for half a minute, or a minute, more lymph will form in the vesicle, and more than it seemed originally to contain, will ooze out at the punctures. It appears, however, that the virus first taken is the strongest; and when a large quantity is subsequently discharged, it becomes proportionally weaker 5 so that we ought to make use of that only which flows immediately after the punctures are made.

This account of the structure of a Cow-pox vesicle was, so far as I know, first given in a letter published by Dr Cappe of York, in the York Herald, about seven years ago, and it seems to be accurate. For although Dr Willan, in his Treatise on Vaccine Inoculation, p. 9, says, the cells communicate with each other, yet after very minute examination, I am rather disposed to agree with Dr Cappe; and I think it is probable,

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that the communications between the cells of the cellular membrane, of which they are composed, are obliterated by the inflammation preceding the formation of the vesicle.

If the inoculation is to be performed in the course of a few days, or if the matter is to be sent to a short distance only, it may be taken on a lancet, by making one or two punctures in the vesicle, from which a sufficient quantity may be procured, and the pustule will not be deprived of virus for afterinoculations. A piece of tinfoil, gold-beaters leaf, or moistened bladder, should then be wrapped round the lancet, to prevent the matter from being injured by exposure to the air.

But when we wish to send the virus to a distance, or to preserve it in an active state for a longer period, various other and more effectual means may be employed for the purpose. Two or three punctures being made in the most turgid part of the vesicle, a good deal of the fluid which it contains will ooze out. This being collected on two thin plates of glass, each about an inch square, the two pieces should be laid close together when the matter is yet fluid, by which means, when the serous part of it has evaporated, the plates of glass will be agglutinated to each other.

On the pieces of glass being laid together, they should be covered with tinfoil, or moistened bladder, to keep them more firmly in contact, and that they may be more conveniently carried in the pocket, or transmitted in a letter.

This I consider as the easiest and best method of excluding the air, and consequently of preserving the virus in its most active state.

The virus may also be collected by soaking a piece of cotton-thread in it, and placing this between two plates of glass, which should be covered with moistened bladder or tinfoil ; or the thread may be inclosed in a small phial well corked, or in a glass-tube, or in a quill, which should afterwards be sealed with wax.

THE COW-POX. SI

Other methods have been advised for preserving Cow-pox virus in its active state ; one of these consists in having a small phial with a stopper, which reaches nearly to the bottom. The virus is spread on the stopper, and inclosed in the phial when fluid. This has been done, in the expectation that it will remain fluid for several weeks. It is an extremely convenient method of collecting and preserving the virus ; and answers the purpose of those who are in the daily habit of using it, better perhaps than any other. But, although we are thus enabled, almost to a certainty, to preserve the virus, for several days, in a fluid state, provided there is a sufficient quantity of it, and although it generally retains its active property during thatperiod, particularly in cold weather; yet even if it were to continue fluid for several weeks in warm weather, it is probable we should not find it of any use, as it would in all likelihood be decomposed by putrefaction, and thus its specific anti-variolous quality be destroyed ; so that I consider this mode of preserving virus as better adapted for daily, immediate, employment, than for conveying it to considerable distances, or for keeping the virus for a longer period than a few days.

For some years past, Mr Bryce informs me, that he and the other gentlemen of the Vaccine Institution in this place, have been accustomed to inoculate with a solution of the crust, or vaccine scab, in water; and by many experiments made for the purpose, have ascertained, that the disease is as readily communicated in this manner as if the inoculation were performed with recent fluid virus. When the crust is to be used, the outer parts of it are scraped off, and only that portion employed which is transparent, and of a hard horny consistence. The quantity intended to be used, is then put on a flat piece of glass, and being moistened with a drop of warm or cold water, is bruised with the flat side of the inoculating lancet, until a complete solution of a milkycoloured fluid is effected. The inoculation is then performed in the usual manner.

Mr Bryce, who discovered this mode of obtaining and preserving vaccine virus,* advises the crusts to be put into a small phial, with a well-ground glass stopper, as soon as they fall off, so that they may be secluded, as much as possible, from the action of the air.

The efficacy of a solution of the scab in warm water, in producing the genuine Cow-pox, is farther corroborated by Mr Shool bred, Superintendant of Vaccine Inoculation at Calcutta, who succeeded in producing perfect vesicles with a scab four months and a half old. f

Although I have repeatedly made use of the scab in inoculating, and have sometimes succeeded with it in producing the perfect

* See Practical Observations on the Inoculation of Cow-pox, by James Bryce, p. 128.

+ See Report on the State and Progress of Vaccine Inoculation in Bengal, during the year 1804, by John Shoolbred, Superintendant General of Vaccine Inoculation.

disease, yet my experience of it is too limited as yet to entitle me to recommend it in preference to any other mode of preserving the vaccine virus ; more especially as I have hitherto found, that, if the matter be properly preserved between two plates of glass, in a cold dry place, and the air carefully excluded from it, and the inoculation performed with due care, it will seldom fail, at least in climates where the temperature is the same as it is in this country.

I find also from the report for 1806, of the committee of the Central Vaccine Society, for the extinction of Small-pox in Paris, that in France and in Italy, they have not been so successful with a solution of the crust, in producing the disease, as the surgeons in this country and in the East Indies.* The method proposed by Mr Bretonneau, and re-

* See Report of the Committee of the Central Society for the Extinction of Small-pox in France, by the propogation of Cow-pox, read June 12, 1806, p. 86.

commended by the committee in Paris, for preserving the vaccine virus in its fluid and active state, is extremely ingenious, and I have no doubt of its answering the purpose completely. It consists in applying one extremity of a capillary tube to a vaccine vesicle open over its whole surface. The fluid matter rises in the tube, and when the latter is filled, both of its extremities are sealed with sealing-wax. When the matter preserved in one of these tubes is to be used, the sealing-wax is removed from its ends, one of which is introduced into another tube, rather wider and longer, and the other extremity is placed over a plate of glass. On blowing into the tube which incloses that which is filled with the fluid matter, the matter runs out on the plate of glass, and is then used for inoculation. The committee have used matter which was preserved for two months in this manner, with complete success ; they do not now employ any other method of transmitting it to their correspondents at a distance, who apply to them for fresh supplies less frequently than formerly, as they succeed more readily in communicating the disease with matter preserved in this manner.*

I have even produced the disease with matter kept for two months; and Dr De Carro mentions, that he succeeded with virus six months after he received it from Dr Pearson ; although the virus was sent on a piece of cotton-thread, inclosed only in a letter, from London to Vienna.

But the best method of preserving Cow-pox matter, and of propagating the disease, is to inoculate a few patients only at one time, and afterwards from these to inoculate others, thus keeping up a constant succession and supply of matter. Were this generally done, less risk would be incurred of producing the spurious disease, even if the matter should be taken at an improper stage of the vesicle ; and thus patients would very

* See Report, &c. p. 88.

THE COW-POX. 2T

rarely be attacked with the Small-pox, in consequence of the Cow-pox having failed.

In many of those cases, therefore, where the vaccine inoculation fails, the failure most commonly proceeds from the matter not being genuine, or not having been taken at a proper period of the vesicle ; or, if Dr Woodville's opinion is well founded, from some individuals not being susceptible of the Cow-pox contagion, which, he thinks, is the case with about one person in sixty.