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eteellent state of health. M. Maunoir, of Ge- servers have given an account of chronic kid Deva, on this occasion adds another instance: obstinate opthalmias in scrofulous children cured child, whose arm was covered with dartrous by vaccination. Eight of these observations are eroptions, which inflamed during the influence detailed. In several cases the parctures made of the cow-pos inoculation, and assumed the ap- amounted to Afreen or twenty. Some were made pearance of as many cow-pocks. After the vac- in the Bape of the neck. In most of them the cination was over this child got quit of the erup- suppurations were long continued; sometimes tion entirely. The same person affirms that he has they were succeeded by blisters: but in every one ebserved, even after false vaccination, a sensible of the cases the same means had been employed improvement in the health of delicate infants. before vaccination without any effect. Twelve
Similar results have been announced in the observers have given numerous facts relative to Spanish expedition, with an intention to publish the termination of scrofula after vaccination. them,
Eight of these are detailed. In one the scrofula Dr. Sacco, id his treatise Della Vaccinazione was complicated with opthalmia. Sixteen punc(Milan, 1809), affirms, that when vaccinating in- tures were made in the limbs. On the seventh fants affected with palsy in the arms or lower ex- day the child opened its eyes, and was capable tremities, troubled with chronic diseases of the of bearing the light. The inflammation of the glands, &e. he made a great number of punctures punctures was violent: the inguinal glands subon purpose, to the amount of thirty or forty: that sided, the scrofulous tumours disappeared, and some of these patients were perfectly cured, and the cure was complete; but it was thought proper that the bealth of others was considerably im to endeavour to render it still more secure by a prored.
cautery performed on one of the limbs. In anM. Barrey, of Besançon, observes that vacci- other case the scrofulous tumours were open, they zation had been performed, in 1804, in three discharged an unhealthy pus, and the Aesh was villages belonging to his department, on 141 in- pale and fungous. During the progress of the fauts under twelve years of age, constituting more cow-pox the edges of the ulcers became red, and than one half of all the children under that age the flesh frm; the suppuration became less abunin the place. In 1809 no fewer thao 134 of these dant, and less watery; much of the humours was children enjoyed perfect health, seven alone drawn to the vaccinated arm; the scrofulous tuhaving died of different diseases; but of the mours bealed in the course of a month; the cowe children that had not been vaccidated no fewer pox continued to suppurate during three months, than forty-six were dead, though no small-pox and then the cure was complete. had visited the country during the period. If
Since the introduction of vaocination into the under this last number be only included the department of Mount Blanc, M. Carov, pbysi. children that existed in 1804, and not those bora cian of Annecy, affirms that the pumber of scrobetween that period and 1809, we must conclude fulous diseases has sensibly diminished; and M. that vaccination had rendered the children less Bacon, physician at Falaise, that in the hospital Fusceptible of other diseases; but M. Barrey's for children, formerly filled with scrofulous cases, observation is not sufficiently precise to enable us no such disease is now to be found. Four oba to estimate it importance.
servers sent various observations, five of which The facts contained in the correspondence of are very detailed, and have for their objects cases Paris present themselves in a much greater num- of rickets, not indeed cured, but modified in a ber. If we refuse to admit all these cures to be remarkable manner, and the progress of which owing to vaccination, we shall at least allow the was either stopped, or sensibly retarded, by vac coincidence of the cures with vaccination. Even çination. The power of walking recovered, in that case the great number of facts must pro- strength increased, and the solidity of station duce at least a suspicion that vaccination had a re-established, were the most sensible effects that useful effect in these cases, and give us a cere resulted; and in these cases the numerous punctainty that at least it was not injurious.
tures along the spines were the means by which The names of the observers, the places where they dattered themselves with haviog obtained the observations were made, the kind of obser- success. Three observers have spoken of the rations, are marked with precision in the notes tinea capitis. One of the observations is de which have been put into our hands. A consi- tailed, and gives an account of a linea of a yel. derable number enter into details, both respecto low colour, yielding a copious yellow bumour, ing the phenomena and the methods employed; of the consistence of honey. Twelve punctures the number of punctures made in order to induce were made upon the head itself. When the vace a more considerable commotion, and to render it cinal crusts fell off, the crusts of the tinea dried more general and more efficacious.
up, fell off, and the cure was complete. Five We ought to remark here more particularly the observers furnish numerous facts respecting vacmaladies which affect the organs and functions cination performed og patients labouring under which belong to the lymphatic system. On that nervous disorders. Five of these are detailed. account we shall begin with them. Fourteen A megrin which continually tortured a young observers have given a great number of examples man of fourteen years of age, for several years, of the crusta lactea disappearing after vaccina. vanished after the suppuration of the cow-pox. tion; sometimes after a suppuration of the cow. Daily convulsions, during ten months, in a child pox continued for twenty-seven days. Seven of twenty months, which had not been alleviated observers have sent a great number of observan by medicine, became less violent during the protions, two of which are accompanied with
details, gress of vaccination, and afterwards disappeared stating the termination of dartrous affections altogether. Various convulsive diseases, three spread over different parts of the body, and of wbich were epileptic, were suspended during Especially the arms, after vaccination. In one of the progress of the cow-pox. Afterwards they these cases the cure was preceded by a violent continued to recur, but at longer intervals. Three infatamnation round the cow.pox, and by a sup. of them, one of which was hereditary, ceased ab puration kept up for a month, Eighteen obe together. Is one that had convulsious every VOL. XI.-PÅRT U.
day, the vaccination was performed during sleep, It will be asked, perliaps, whether, if we ad. because it would have brought on a fit if the mit an equality of advantages in favour of vacpatient had been awake. The epilepsy disap- cination and inoculation, considered as a remedy peared the ninth day after the vaccination. In for different diseases, it would not be of advanhim, who was afflicted with an hereditary epi- tage to preserve the inoculation for the smalle lepsy, and who was cured, vaccination was per- pox as a means of utility in certain situations. formed by incision, and the pustules were con- We answer, that in such a comparison we verted into an ulcer. Ten observers furnish va- ought not to leave out the dangers of a contirious observations, four of which are detailed, gion, subtile and persevering like that of the and relate to periodical and obstinate fevers, small-pox, compared with the virus of the cowsuch as quartans, double tertians, and quoti- pox, which can only be communicated immedians. They were cured by vaccination. Two diately, because the least alteration destroys its quotidiaus, with which young men of twenty- properties. We ought also to reckon for someeight were alllicted, had lasted for ten months; a thing the hope at present entertained of being double tertian, in a child of three years, had able to destroy the small-pox altogether. Could lasted three months. They ceased after vacci- houses for inoculation, though established under nation. In four persons afflicted with intermit. the care of the police, be subjected to laws so tents, and vaccinated, the cow-pox appeared only severe, and to a sequestration so exact, as to upon one, and he alone was cured.
prevent completely the spreading of the smallSeveral other observers, to the number of pox from them, something might be said in its fourteen, have furnished various remarkable facts favour; but whoever considers the nature of man, respecting different other diseases. In an infant, and the state of society, must be convinced of a year old, a palsy of the left arm, which had the impossibility of securing any such object. lasted two months, disappeared a month after In our opinion, even admitting vaccination and vaccination, performed by making six punctures inoculation to be equally efficacious in removing in the diseased arm. A great number of violent other diseases, the balance in favour of vaccinacoughs have been suspended, moderated, or tion is so strong that it is impossible to hesitate cured. The consequences of suppressed measles, one moment about preferring it. namely, a dry cough, fever, and diarrhæa, were eured by a cow-pox induced by twenty punce
VI -How far can we depend upon the preser. tures, during the suppuration of which a strong vative efficacy of the cow-pox, compared with the fever and miliary eruption occurred. A violent same advantage resulting from the small-pox, pain in the joint of the left thigh, with which a natural or inoculated? What consequences fol. child of nine years of age was afflicted, with a low from this, properly considered, in the one or threatening of spontaneous luxation of the limb, the other virus? was treated by means of eighteen punctures round Nobody disputes the power of the cow.pox to the disensed joint. Sixteen pox, the aureolas of preserve from the small-pox: and this question, which were confluent, occasioned fever, and then which at the commencement was the most imsuppurated. Soon after the pain of the joint portant of all, has now become only secondary to disappeared, and the cure was complete. A white various others that have been put, and most of swelling of the knee in a child of eight years of which we think we have already answered. At age, and a deafness which had increased for the same time, io this question must be referred eighteen months in a child of six years of age, a variety of other particulars of considerable inwere both cured by vaccination.
terest, such, for example, as the distinction be. Such are the facts which we have collected re- tween the true and false cow-pox, the eruptions specting the diseases existing at the time of vac- ihat have been confounded with the small-pox, cination, and cured by that process. We have the changes introduced in the bills of mortality noticed those only which are related with preci- by the introduction of the cow-pox, the hopes of sion. We do not think that they ought to be destroying the small.po.x, or of driving it out of always considered as cures due to vaccination. the civilized world. Separately taken, we do not see in them any The idea of the faculty of preserving from the thing else than a coincidence between the time small-pox divides itself into two questions. of cure and vaccination; but taken collectively, One may be thus stated: Will an individual, after we think that the number of facis, and the cir- being vaccinated, if he be placed in a situation cumstances accompanying those which we have proper to produce the small-pox, and which particularly noticed, give at least a presumption usually produces it, continue exempt from that in favour of vaccination, more than suicient to disease The solution of this question can only counterbalance the facts which have been alleged be obtained by a multitude of experimenis; and in favour of the small-pox, in what way soever that solution will give, then, not absolute certhat disease is communicated. We acknowledge, tainty, but degrees of probability proportional at the same time, that a comparison between to the number of experiments undertaken to vaccination and inoculation for the small-pox, in resolve the question. this point of view, cannot be fairly made, because The other question is this: Is it impossible for a much greater pumber of cases of the former a vaccinated person to be infected with the smallthan of the latter have been given to the publie. pox? Experience cannot decide, in the affirma. Vaccination, under the special protection of go- tive, the question when thus stated; but a single vernment, bas become the objeci of a regular and observation is sufficient to decide it in the negaactive corn spondence, in which few facts have live. If that observation does not exist, the escaped observers, only in danger of being led question must continue insoluble; because, in astray by their zeal. Inoculation, on the other order to resolve it, we must be acquainted with hand, but little favoured by government, was the nature of the virus of small-pox and of cow. become the object of enterprises, in which a pox, with all the circumstances which are capable spirit of cupidity was much more prevalent iban of excluding or producing contagion, and witte spirit of observation.
the peculiar dispositions which prevent men from
contracting it: all of them things absolutely un- whenor the eighth eighty-eight; when onthe ninth, known to us.
eighty-five; when on the tentli, eighty; when on We must therefore confine ourselves to the the eleventh, fifty; and when on the iwelsh, only first of these questions, and inquire into wliat from ten to fifteen. Besides this, the longer time confidence we may repose in the preservative elapses before the matter be extracted from a pock, power of the cow-pox. Such is the nature of the more likely is the pock to suppurate, and be the question to be resolved. We thought it ne- converted into an ulcer. M. Sacco recommends, essary to fix its nature with precision, before likewise, in order to be more certain of the effiproceeding to collect, as we have done with the cacy of the matter, to avoid opening the pock too other questions, the positive elements of its solu- near the centre where the puncture was made, tioa. Let us establish, in the first place, the but to take the matter from as nearly as possible nature of the facts which ought to constitute the outer edge of the pock, where it is more unithese elements.
formly pure and limpid. Notwithstanding the It is obvious, in the first place, that we ought various ingenious modes that have been contrivto exclude all those in which the characters of ed to transport the matter from one place to anthe cow.pox have not been ascertained. Some other, the most certain method of vaccinating, persons have considered the difference between when it can be done, is to take the matter out of the true and false cow-pox as a subtilly; but we one arm, and immediately introduce it into anLaswer, that when the characters, taken from the other. epoch of development of the form and appear
A second order of facts which ought to be exance of the pock, of the nature of the humour cluded from the comparison, consists in observacontained in it, of the manner of its desiccation, tions of eruptive diseases, distinguished by the and of the mark which remains after it has name of the small-pox, but which from their dropped off, are so distinct from each other, as in characters belonged evidently to the chicken-pox, the true and false cow-pox: when to this differ- or to some anomalous eruption, which have but á ence is joined the determination of the circum- faint resemblance in form to the small-pox, but stances upon which the failure of vaccination are in other respects quite different. Such erupusually depends, as, for example, the too late tions show themselves every day upon children period at which the virus has been taken, the who have had the small-pox; and when they changes in the cow-pock which have occasioned appear before that disease, they do not prevent the mixture of pus with the true limpid liquor it from infecting the patient. An attentive ob of the cow-pock-when these circumstances have server can easily distinguish such eruptions. been accurately observed, no farther ambiguity The small-pox have a regular progress which reuains, and the distinction between the two cannot be mistaken; and when they are confluent kinds of pock is perfectly established, and may they can be still confounded with other eruptions, be easily determined.
which are usually exempt from all danger, and This difference was established in consequence even from severe illness. Every observation of errors committed in the first experiments. At then, which does not give us the essential chaParis we were in possession of the false cow-pox racters by which the small-pox is distinguished matter, and were not acquainted with the effects from other eruptive diseases, and in which we of the true till Dr. Woodville made a journey to do not find the fever of the commencement of the France, and naturalized among us the true disease, the eruption, the suppuration, the fever matter. At Geneva false cow-pox matter im- of intumescence which accompanies it, and the posed upon the physicians, and disappointed desiccation-every such observation cannot come their bopes during twenty-one months, till, in into comparison with the observations in favour May, 1800, the virus sent by Dr. Pearson suc- of the present question. ereded completely.
There is a third order of facts which cannot The different characters of the true and false be admitted into the comparison of which we cow-pox matter have been already pointed out in speak; we mean those cases in which a true the report inserted in the fifth volume of the small-pox makes its appearance during the time Physical and Mathematical Memoirs of the In- of vaccination, at an epoch when we inust supstitute. They have been repeatedly published pose that the infection was caught before the by the central committee of the society of Paris; cow-pox could exert its preventive powers. This they are described in several parts of the Biblio- point has been discussed in the first report to the theque Britannique, and in various other publi- Institute. We have already, in the memoir, cations. Dr. Sacco has given at the end of his given several examples of it, in speaking of the work very good plates, where both the true and eruptions and diseases ascribed to the cow-por. the false cow-pock are represented.
On this point Dr. Sacco has made some curious Besides this, Dr. Sacco, endeavouring to fix experiments, to determine the precise time when the time when the cow-pox may be usefully com- the small-pox may still appear after vaccination. municated, has determined by experiment the Supposing the cow.pox to appear on the third relation between the probability of success, and day after the puncture, the inoculation for the the successive days in which the virus has been small-pox performed between the first and fifth collected. According to his observations, sup- day occasions the appearance of the small-pox posing that the cow.pock begins to appear on the between the seventh and eleventh day. Inocuthird day, as usually bappens, the success may lation performed on the sixth or seventh day be considered as certain if the virus be taken occasioned a slight inflammation of the part between the fifth and eighth day, reckoning from punctured, without any general eruption. Eiiher the time of the puncture; or between the third no pox appeared over the punctures, or if they and sixth day, reckoning from the appearance of did they speedily dried up.
Inoculation pero the pock. He found that when the matter was formed from the eighth to the eleventh day protaked on the sixth day from the appearance of duced a slight alteration at the place of the the pock, out of 100 punctures, ninety-five suc- puncture, seldom a pnek, or at least it very cdiceeded; 'when on the sevenib, ninety-two; ly dried up. Inoculation with small-pox inatler being performed on sixteen infants between the has been vaccinated to be afflicted with the small. elevenih and thirteenth day after vaccination, pox. Nor indeed ought we to look for any such three of them only exhibited a slight redness at impossibility, as it has been well ascertained not the place of the puncture, while the thirteen to bold, even after inoculation, with the matter others had po symptoms wlialever. If the forma- of small-pox. tion of the cow-pock be later than the third day, But what degrees of probability do these obas hapnens sometimes, in that case the possibility servations leave, tbat vaccination will be a preof the small.pox infection will be extended to a servative from small-pox? We may obtain it by time proportionally longer.
comparing the number of individuals who have These details appeared to us necessary, in taken the small.pox after vaccination with the order to show to what degree of exactness ob- whole number vaccinated, and wbo have not servations on the preservative power of the cow- caught the infection, though repeatedly exposed pox have been carried, and to show that the dis- to it. Another base of this evaluation is the tinctions to which these researches have given number of counter experiments made, either by origin are far from being, as some persons wish inoculation, or by placing persons that have been us to believe, subtilties and subterfuges invented vaccinated in contact with those that are aflicted to excuse the want of success.
with the small-pox. Now in applying the remarks that have been If we take the result of the correspondence of made to the alleged observations of small-pox the central committee of Paris, the seven obserappearing after vaccination, if we exclude all vations a'ove-mentioned, supposing them all those wbich want the conditions necessary for exact, are to be opposed to no fewer than rendering them credilable, we find very little 2,671,662 cases of vaccination. If it be objected which can come in competition with the facts on that these seven observations, the only ones with the other side. There are, however, some, which the committee were acquainted, are in all against which it is difficult to start any plausible probability not the only ones which have occurred objection. The Jennerian Society of London in the empire, we answer, that even these seren evidently admit the existence of such, in articles are not altogether free from uncertainty; and nine, ten, eleven, fourteen, and fifteen, of their that the 2,671,662 vaccinations mentioned by the report. The College of Surgeons of London say, committee are far from being the whole number that out of 16,438 cases of vaccination there hitherto performed in France. These two nomwere fifty-six, that is, one in 3,000, where it was bers, being the whole obtained by the same means, insufficient to act as a preservative from the are very fairly comparable with each other. small-pox. But they bave not informed us They give us the ratio of 1 to 381,666. what was the immediate effect of these vaccina. With respect to counter-experiments, they are tions, and to what circumstances their insuffie of three kinds; those made by inoculating ciency could be ascribed. The authors of the with small-poxvirus; those resulting from Bibliotheque Britannique have inserted in their coming in contact with infected persons ; work a leiter from London, dated 5th August, those resulting from the reports of epidemic 1811, stating that the national cow-pos establish- small pox in villages, from which very few ment in London had published two cases of persons escape. The accounts transmitted to small.pox occurring after a most successful vac- the committee present 640 individuals put to the cination. “ These cases,” says the letter, test of inoculation; 680 persons living with inwell ascertained, and admitted on the part of the dividuals afflicted with the small-pox, and in establishment. But they publish, at the same contact with them, yet escaping the disease, while time, three cases of natural small-pox occurring every other person took it; and 4312 who in the twice in the same individual, after an interval of midst of epidemics affecting whole villages eseleven years.”
caped the general contagion : making in all 5352 The correspondence of the central committee individuals that remained free from the conof Paris contains some similar examples. Six tagion, in circumstances either artificial or observations were communicated by men well natural, in which they ought, had it not been for informed, and free from prejudice; but they vaccination, to have been atlicted with the diswere not accompanied with details sufficient to remove all uncertainty. Two of these announced Similar results have been obtained in all other small-pox appearing in the midst of an epidemic countries of Europe. small-pox, which afficted Beauvais in the autumn From all these facts, it is impossible not to of 1810. But the children in whom this disease conclude that the probability that vaccination appeared had been vaccinated when the cow-pox will preserve from the small-pox is as strong as was first introduced into France; and as no de- that inoculation with small-pox virus itself will tails are given, it is very possible that the disease prove efficacious; or that the small-pox will not communicated was the false cow-pox, at that recur a second tiine in the same individual: for it time so common in this country. All the other appears to us unreasonable, or at least premature, children, vaccinated in the same place, and at to conclude that small-pos will recur after the later periods, continued exempt from the small- one oftener than the other. pox. There is a fact, which was verified by If to these observations we join those wbich several members of the committee, and we vure are their natural consequence, and which bave selves saw the infant covered with a very nu. been attested by physicians and magistrales, both merous, but favourable small-pox, on the 7th in France and in other countries, that small-pos December, 1806, This child, called Emma epidemies have been stopped in their progress by Kerouenne, lived in the old street of the Temple, vaccination ; that they have been excluded from No. 93, and had been successfully vaccinated on those villages where vaccination had been gene. the 21th March, 1804, by M. Lanne, physician in rally practised ; that these epidemics, which used Rue Français, who had preserved an account of to return at stated periods, bave ceased to appear the vaccination, and its progress. It is therefore at their usual epochs; that several villages have evident that it is not impossible for a child that ceased to know the small-pos, and that it ban