A history of the variolous epidemic which occurred in Norwich, in the year 1819, and destroyed 530 individuals; with an estimate of the protection afforded by vaccination, and a review of past and present opinions upon chicken-pox and modified smallpox

Front matter

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YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

Preface

J- HE period which has elapsed since the introduction of Vaccination has created many fresh topics of inquiry After more than twenty years' trial of the practice, we have to examine what has happened in regard to the means by which it has been promoted, the number of individuals who have submitted to it, the protection really afforded, and the effects produced on the mortality from smallpox.

In respect to some of these subjects, it is possible that a few advantages may have arisen out of my very limited situation, which has enabled me to give, from my

VI own observation, an account of a greater part of the whole effects of a destructive variolous epidemic, than could have been furnished by an individual placed in a large metropolis. Did not this excuse occur to me, I should probably not venture to write upon a question, which has recently met with attention from men placed in the most eminent situations.

The facts which I have stated are contained mostly in the first part of the treatise, and for those I pledge myself. The arguments into which I have been led will chiefly be found in the second part, and if these should be objected to, or even refuted, I shall not be extremely mortified, as I have offered them (so far as I can judge of my own feelings) without prejudice or presumption, rather waiting the decision of others, when more evidence shall have been collected, than presuming to have uniformly established incontrovertible deductions of my own.

My warmest thanks are due to my prof esssional Brethren in Norwich, whose

VII liberality has so much extended my opportunities of gaining" information. To those Gentlemen in the County of Norfolk and Siiffolh, in several other parts of Great Britain, and on the Continent, who have favoured me with their correspondence and assistance, I am equally indebted. And I shall be amply recompensed for the little time and exertion I have bestowed upon the following pages, should the Medical Profession in general not deem them altogether useless and superfluous.

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Lately published by the same Author, and to be had of all Booksellers, — price 8s.

SKETCHES OF THE

Including remarks on the Hospital-practice, Lectures, Anatomical Schools and Museums, and exhibiting the state of medical Instruction in the French Metropolis, &c.

CHAPTER I. Of the Small-pox. 1 — 19

Former prevalence of small-pox in Norwich, 2. Origin of the epidemic of 1819, 3. Number of deaths produced byit, 5. Probable number who took the disease, 6. Register of 200 Cases of small-pox, 7. Proportion that resist smallpox, 8. Various Characters of the epidemic, 9. Worst effects of the epidemic, 10. Injudicious treatment amongst the poor, 11. Causes of the rapid and extensive spreading of the disease, 12. Causes of its cessation, 14. Small-pox in those who formerly resisted it, 1 5. Ditto in those supposed to have had it formerly 16. Ditto in those supposed to have had it lately, 17. Ditto after inoculated smallpox, 18.

CHAPTER II. Of the Cow-pox. 20—39

Early practice of vaccination in Norwich 20. Rewards for vaccination to the poor, 21. Pauper vaccination for six years preceding the epidemic, 23. Ditto in the year of the epidemic, 24. Public proceedings to promote it, 25. Unanimity of medical men in recommending it, 26. Discouragement of variolous inoculation, 27. Rewards for vaccination in 1819, 28. Register of 500 persons who applied to be vaccinated, 30. Proportion that resist vaccination, 32. Probable number of the vaccinated in Norwich, 33. Proportion of them affected by exposure to small-pox, 35. Examination of the scars left by cow-pox, 36. Variolous inoculation upon the vaccinated, 39. Present state of vaccination in Norwich, 39.

Chapter III

Of Small-pox and Cow-pox occurring together in the same Individual. 40 — 58.

Inoculated small-pox occurring with cow-pox, 40. Natural small-pox occurring with cow-pox, 41. Mistakes produced by the two diseases occurring together, 43. Periods at which small-pox may appear during cow-pox, 45. Reciprocal influence of the two diseases, 45. Small-pox appearing on the 10th day of vaccination, 47. Severe small-pox appearing on the 10th day of vaccination, 50. Ditto on the llth day of vaccination, 52. Fatal ditto on the 10th or llth day of vaccination, 54. Rules derived from the occurrence of the two diseases together, 55. They do not occur together in their usual intensity, 57.

CHAPTER IV. Of Small-pox after Cow-pox. 59 — 65

Distinct regular small-pox after cow-pox, 60. Severe small-pox after cow-pox, 60. Confluent small-pox after cow-pox, 61. Conclusions deduced from this case, 62. Petechial sinall-pox after cow-pox, 63. Conclusions from this case, 64. Reasons for relating these cases, 65.

Chapter V

Of the concomitant eruptive Diseases of the Epidemic Small-pox. 66—122.

Section I. Of the eruptive disease which chiefly attacked those who had neither passed through smallpox nor cow-pox --- -- _.. (J7_

XI

Petechial fever, 67. Dissection after death from this fever,

68. Contrast between petechial and variolous eruptions,

69. Probable cause of the petechial fever, 70. SECTION II. Of the eruptive disease which seems

to have occurred indiscriminately in those who had passed through small-pox or cow-pox, and those who had not had either of these disorders - - - 70.

Precursory symptoms of the disease, 71. Case of the disease detailed, 71. Varieties and characteristic mark of the disease, 72. Reasons for not assigning it to the variolous contagion, 74.

SECTION III. Of the eruptive diseases which chiefly occurred in those who had passed through the cow-pox - 75

These eruptions not strictly confined to the vaccinated, 75. Rash and sore throat, 76. Conoidal vesicular eruption, 76. Eruptions with indented pocks, 77. case I. A rash preceding the eruption of a few indented pocks, 77. II. Pearly and indented eruption, pustular upon the face, 80. III. Similar eruption with tumefaction of the face, 82. IV. Eruption leaving tubercular elevations, 84. V. Experiment by inoculation, 85. VI. Ditto, 87. VII. Ditto, 88. VIII. Numerous eruption of indented pocks, with a rash, 89. IX. Eruption of numerous pocks, a few only indented, 93. X. Eruption of indented pocks, pustular on the hands and face, 95. XI. Horny eruption, the contents of the pocks coagulating on the face, 96. XII. Indented pocks visible on the second day, 86. XIII. Eruption of indented pocks, a few attaining a large size, 98.

XIV. Most numerous eruption of indented pocks, 101.

XV. Similar eruption with fever of a typhiod character, 106.

XVI. Eruption with fever of a like kind, 113. General description of these eruptive diseases, 166. Precursory symptoms, 117. Situation and quantity of the eruption, 118. Period and manner of incrusting, 119. State of the throat and falling off of the scabs, 120. Variolous contagion the source of them, 121.

Chapter I

Of the distinctive Characters of the Small-pox. 125 — 140.

Preceding indisposition and coming out of the eruption, 126. Period of maturation and secondary fever, 127. Crimson areola and peculiar fetor, 128. The slough answering to each pock, 129. The scars left by small-pox, 130. An eruption protecting against a future attack, 130. Ditto giving rise to small-pox in others, 131. Varieties from inoculation of small-pox, 132. Pustular or vesicular character of an eruption determined by degree of inflammation, 135. Structure and progress of a variolous pock, 135. Remarks on the cellular structure of a pock. 136. Variations of the variolous eruption in different regions of the body, 138. No single rule for determining small-pox, 139.

Chapter II

A sketch of the History of Varicella. 141 — 172.

Eirst Period, from the earliest writings on the small-pox to the introduction into Europe of the practice of variolous inoculation - - - - - - 141.

Second Period, from the introduction of variolous inoculation to the discovery of vaccination - - - - 144.

third period, from the discovery of vaccination to the present time ----- - 155.

xm CHAPTER III.

Of modified Small-pox, and its classification with Variola and Varicella. 173—210.

Origin of modified small-pox, 174. Modified small-pox in France, 175. Ditto in Holland, 178. Ditto in the kingdom of Wirtemburg, 180. Usual progress of this eruption, 182. Importance of ascertaining the central depression, 184. A situation assigned to the eruptions which chiefly attacked the vaccinated during the epidemic in Norwich, 186. Severer complications of modified small-pox, 187. Mildest varieties of the disease, 188. Source of it, and effects of its contagion, 191. Proportion of the vaccinated who take modified small-pox, 192. Small degree of danger attending it, 193. Probable causes of its occurring, 194. Pei ods at which it may happen after vaccination, 198. Similarity of hornpock and modified small-pox, 199. Diagnosis of modified small-pox, 200. Objections to the term, 205. Proposals for classifying it with varicella, 206. Two species of varicella, 207.

Chapter IV

Of Variolous Inoculation and the means of discouraging it. 211—224.

Early progress and effects of this practice, 212. Its effects upon the mortality of small-pox in London, 213. Deaths in small-pox Hospital during inoculation and vaccination, 215. Difference in extents of the two practices, 215. Deaths from small-pox in Berlin during inoculation and vaccination, 216. Danger of variolous inoculation, 217. It does not always protect against small-pox, 218. Necessity for legislative interference, 219. Regulations proposed, 221. Circumstances to which inoculation should be restricted, 223.

XIV

Chapter V

Of Vaccination and the means of promoting it. 225 — 253.

Definition of the term, 225. Distinction between die real and practical efficacy of cow-pox, 226. Uniform progress of the disease, 226. Signs of constitutional effect, 227. Circumstances under which it is imperative to re-vaccinate, 223. Precautions in obtaining ichor, 229. Keeping a register of the vaccinated, 230. Method of vaccinating, 231. Care in watching the progress of the disease, 232. The reported failures do not affect the general practice, 233. Legislative measures to promote vaccination, 235. Greatextent of vaccination in Russia, 240. Laws to promote it in Denmark, 241. Its reception and propagation in the Prussian dominions, 242. Effects and extent of vaccination in the principality of Anspach, 245. Laws respecting vaccination in the kingom of Wirtemburg, 249. Concluding remarks, 251.

APPENDICES.

Appendix, No. I. Translation of Heim's paper on the diagnosis between Variola and Varicella ----- 257

Appendix, No. II. Result of a correspondence with Practitioners in the county of Norfolk and adjoining parts of the ccunty of Suffolk - - - _ _ . 264

Appendix, No. III. Abstract of a Report' of the vaccinations practised in France in 1816 - - - - - . 292