cursorily examined into the testimonies in its favour. That article, however, has been written for more than three years from the present time: in the course of which period vaccination has been tried upon a much more extended scale, and its effects have been examined with still closer precision, and we are happy to add, with more philosophical coolness. One of the best papers that has been given to the world by the French Imperial Institute is an article upon this subject, drawn up by three of its brightest ornaments, M. M. Berthollet, Percy and Halle, and read August 17, 1812. It has since been published, on account of its national, or rather its universal, importance in the Moniteur, and we cannot forbear presenting our readers with the following translation of that part of it which chiefly examines and replies to the general observations which in different countries have been advanced in opposition to it. These observations are put in the form of six successive queries; each of which receives its proper answer. I. Do the fever and the general eruption which follow the inoculation for the small-pox, but do not appear after vaccination, constitute a necessary purification of the system, the want of which may lead to dangerous consequences?

II. Do the facts observed demonstrate that the cow-pox, introduced into the system, is of such a nature as to produce eruptions, or accidents, which ought to be ascribed to the difficulty, the imperfection, or the want of eruptions?

III. Is the virus introduced by vaccination of such a nature as to produce immediately, that is, during the development of the natural effects of vaccination, fatal accidents?

The first two of these queries are answered in the affirmative; the third in the negative. We must pass by the train of argument, though highly ingenious and conclusive, in order to notice, in a somewhat detailed manner, the three questions by which these are succeeded, and which are of considerably more practical importance.

IV. Is the virus introduced by vaccination of such a nature as to produce, even after its operation has terminated favourably, diseases, more or less severe, and which may even prove fatal ? The solution of this question is difficult, because our investigation is of necessity interrupted by, a great number of uncertainties.

It is certainly difficult to establish, that a virus, introduced into the body, and capable of rendering it inaccessible to the small-pox contagion, has not the power of producing any other change which can affect the health. Such a consequence can only be the result of a number of observations, so great, that its disproportion with the contrary observations must prevent us from ascribing them to any thing else but causes absolutely unconnected with the introduction of the virus,

But the observations in support of a contrary opinion must be equally difficult to obtain. If a disease appear after vaccination, in order to show that it can be ascribed to no other cause, are ought to know what was the state of the subject before vaccination, and whether his constitutional or hereditary temperament did not prepare him for those maladies which have taken place. We must be able to show that after vacination he has not been exposed to causes capa

ble of producing these diseases. We ought likewise to inquire whether the source from which the cow-pox matter was derived was infected with any foreign ferment. And finally, as in all ages and all circumstances of life various dis eases appear which cannot be assigned to any known cause, those which succeed vaccination ought, in order to be ascribed to it, to show such a character of affinity with each other as to indicate their common origin, and offer in their development a connexion more or less sensible with the primitive effects of vaccination to which they succeed

It is therefore requisite to admit, in opposition to the advantages ascribed to vaccination, those observations only which are well authenticated, and the details of which are sufficiently complete to enable us to appreciate their value.

Nevertheless, if the number of facts alleged were very considerable, as it would be impossible in such a case to ascribe them to mere accident, they would in a great measure supply the place of exact observations, and would produce a certain degree of probability in their favour.

By attending to all these particulars we shall endeavour to give an answer to the question proposed.

We shall begin with the observations which have been given as proofs that there exists diseases which owe their origin to vaccination.

Among those that have been published, or that have come to our knowledge, there are very few which, considered separately, have the character of exact observation; and not one possesses the conditions necessary to fix the rela tion of the malady noticed to the previous vaccination.

Out of eleven observations that have been particularly communicated to us, and which, from the precision with which the facts were announced, as well as the nature of the evidence of those who communicated them, seemed to deserve particular attention, we have had it in our power to verify seven. All of these seven were formally and authentically denied by ocular witnesses, most assiduous, and consequently best acquainted with the facts, either from situation, or the interest which attached them to the children who were the subject of these observations. We can only suppose that the persons, who communicated to us these observations, persons well informed, and without any motive to deceive, were led into error by false reports concerning things which they had not been able to see with their own eyes After this it was natural for us to suspect the authenticity of the other facts which had come to our knowledge by the same means, though we had it not in our power to verify them by actual inquiry.

A fact reported to the medical society of Grenoble has been mentioned, and it is advanced in the work of M. Chappon, as a proof of the bad effects of vaccination. A child after vaccination had the face covered with pimples, which were succeeded by scabs that gave the face a hideous appearance. This was followed by an anasarca, and the case ended fatally. Notwithstanding the want of details in this case, it is easy to perceive in it that eruption so familiar to infants, and known by the vulgar name of croute laiteuse (crusta lactea). Its appearance after vaccination does not prove that it had any thing in

common with it. We frequently see the suppression of such eruptions produce very severe symptoms without the presence of vaccination, commonly either in the head or the organs of respiration.

The little exactness in the other observations which we might examine, renders it impossible to admit them as proofs in a discussion like the present.

We have met with strangers to the art of medicine, especially parents, who have assured us that their children, after having been carefully and successfully vaccinated, experienced several inconveniences, sometimes eruptions, sometimes a weakness of health to which they had not been subject before vaccination. These symptoms in some cases obliged them to have recourse to blisters and issues in order to remove them. It was impossible for us to make ourselves so well acquainted with the origin of these facts as to be able to judge how far the allegations were well founded; but without rejecting them altogether, we may say that all the children, and even adults, that we have had an opportunity of vaccinating ourselves, or that we have seen vaccinated, never exhibited any such symptom.

There is a circumstance which we observe frequently, and to which we ought to attend particularly, while discussing the present question. We often see an accidental impression, an emotion, a fall, occasion the development of a disease, to the nature of which that occasional cause is obviously a stranger. The small-pox itself often appears after such accidents, and in other cases they have occasioned violent fevers or other maladies to which a disposition seems to have pre-existed, and only required an occasion to call it into action. Is it not also possible, that in circumstances which we can neither determine nor foresce, vaccination may give occasion to the appearance of a malady without being its cause, and thus bring about what any other commotion would have done, experienced at the same time? In that case there would be nothing in such diseases connected with vaccination, or proceeding from the cow-pox virus.

Since then there is not one of the observations, collected hitherto, which can of itself serve as a proof of the opinion which we are examining, it remains for us to see whether taken collectively their number is such, compared with that of the cases whose history is known, as to give some solidity to the objection.

The collections to which we have had recourse already, in order to give an answer to the other questions, will still furnish us with numerous facts to satisfy this.

The correspondence of Paris, besides the facts which we have noticed above, furnishes the following: erysipelas in the arm in the proportion of one case to 10,000; suppurations continuing in the cow-pox, in the proportion of one to 10,000; and these are only local accidents, particular to the parts on which the inoculation was performed. As to general accidents they have only been observed when from particular objects the number of punctures has been very much increased, as when they have amounted to 30, 40, 50, or even to 60. These accidents have been fever and convulsions, which did not in any instance terminate fatally. The cases collected by the society of Paris are all such as have exhibited the characteristic progress of

true cow-pox, an observation of more importance than has always been supposd.

The facts furnished by the Bibliotheque Britannique afford us the following results. We shall notice those only which have been announced with so much precision as to give us an exact idea of the case.

In 1800 M. Odier announced at Geneva that out of 1500 persons vaccinated not one accident had occurred.

Dr. Anderson writes, in 1804, from Madras, to the Jennerian Society of London, that the number of vaccinations performed by the British and Indian physicians on English, Portuguese, Brahmin, Malabar, Gentoo, Mahometan, Half-cast, Pariah, Maratta, Canadian, and Rajaput subjects, amounted to 145,818; and that in none of these cases had a single accident been observed. This enumeration was made in 1803, and published in 1804 by the government of Madras.

In 1803 the Jennerian Society of London, in consequence of rumours propagated respecting vaccination, as if it occasioned various dreadful diseases till that time unknown, was induced to make an exact examination. The result of this, comprehended in twenty-two paragraphs, gives in paragraph twenty-one the following statement: the disease produced by vaccination is in general slight, and without bad consequences. The cases contrary to this conclusion are in small number, compared with the total number of cases, and may very naturally be ascribed to the constitution, or the peculiar disposition of the individuals who have exhibited the exceptions.

In 1807 the Society of Surgeons in London published another report, more precise; and in which they show the greatest reserve with respect to the consequences to be drawn from the results obtained. We have already said, in speaking of the eruptions following vaccination, that there were only sixty-six examples of them among 164,361 persons vaccinated; twenty-four erysipelatous affections only were observed out of the number sixty-six: and among these we must reckon the only three deaths which followed vaccination, and which have already been noticed. All this is the result of the answer of 426 correspondents, whose testimony was solicited by a circular letter.

In another place mention is made of the same erysipelatous cases, probably comprehended under the twenty-four which have been just mentioned. The disease is ascribed to the too great depth of the incisions, by means of which the cow-pox matter had been pushed too far below the skin, instead of being introduced between it and the epidermis. Other observations may give some probability to this presumption, which we shall not attempt to examine here.

At Aleppo, the English consul, Mr. Barker, has succeeded in familiarizing the people to vaccination: 600 were vaccinated in 1805, without observing a single disagreeable accident to follow.

In 1803 the Spanish government undertook the noble and generous enterprise of sending out an expedition, which terminated in 1806. The sole object of this expedition was to convey to all their American and Asiatic possessions the new means of preserving the colonies against the ravages of the small-pox.

A certain number of children was embarked, who were to be vaccinated successively during the voyage. In this manner the cow-pox virus

was transported to the Canaries, to Porto Rico, to the Caraccas, to Guatimala, to New Spain, to the Philippine islands, to Macao, to Canton, to the islands of Visaye, where a hostile nation was so struck with this act of generosity on the part of the Spaniards as immediately to lay down their arms. The colonists of St. Helena, who had hitherto refused the cow-pox matter from their own countrymen, received it from the Spaniards. The provinces of Terrafirma, of Carthagena, of Peru, &c. likewise received the cow-pox matter, which was even found indigenous near Puebla-de-los-Angeles, not far from Valladolid, and in the Caraccas. The viceroy of New Spain has attested that out of 50,000 individuals vaccinated in his government not a single unfavourable accident had come to his knowledge.

At Echaterinoslaff, the Duke of Richelieu, governor of the Crimea, assures us that out of 7065 individuals vaccinated in six months, not a single accident intervened, except one, in which the small-pox appeared the day after vaccination.

Finally, in 1810, M. Ćurioni, minister of the interior at Milan, wrote to M. Sacco that as far as his information went, not a single instance had occurred of small-pox appearing upon individuals that had been vaccinated, and no disease whatever had followed the process.

It appears to us that the small number of unfavourable observations which have been collected, and among which we must not include those not well authenticated, and which depend upon assertions destitute of proof, disappear entirely before such a mass of facts.

V.-Supposing that inoculation for the smallpox has the advantage of sometimes favouring the cure of certain chronical diseases, is this advantage peculiar to it, and ought it to ensure it a preference over vaccination?

This question does not present fewer difficulties than the preceding.

In speaking of the diseases, the origin of which has been referred to vaccination, we might have observed that the same reproach had been thrown against the small-pox, and that not without some reason. Not to mention former authors suspected of partiality, we shall satisfy ourselves with referring to the authors of the Bibliotheque Britannique, who have given some instances. Other facts of an opposite nature have been alleged, showing that inoculation is an epoch of an advantageous change in the constitution, by the cessation of various infirmities, and the confirmation of the health and constitution of the person inoculated.

These advantages have been ascribed either to the perfection of the eruption, and the regularity of the general commotion which accompanies it, or regarded as the effect of the suppurations prolonged in the place where the inoculation was performed; a phenomenon which has been imitated by means of a supplementary suppuration, induced by blisters when the circumstances of the case seemed to require it. It has been conceived that these evacuations destroyed the causes of the diseases formerly existing, and in the midst of which the small-pox had made its appearance.

Observers will not consider it as a contradiction to say that a commotion excited by the introduction of the matter of small-pox may pro

duce results that seem diametrically opposite to each other. These effects do not appear contradictory, but because they vary according to the disposition and the strength of the subjects who receive the virus, and according as the essential phenomena of the malady, which this virus occasions, take place with more or less violence, regularity, or perfection. The fact exists. The only conclusion, which in our opinion can be drawn, is that these effects depend upon general laws, which it is not our business here to explain, and that they must not be regarded as a specific property, which, if it did exist, could not give birth to consequences so different.

We must, nevertheless, acknowledge, that however striking the observations may be, they do not lead to a striking demonstration. Hence, when any person says that inoculation favours the cure of a particular disease, we must restrict the proposition to mean nothing more than a simple expression of the particular fact observed. A person was afflicted with a chronic disease, from the knowledge of the character and progress of which we could not expect a speedy cure. This person was inoculated, and soon after the cure took place in a manner quite unexpected. Such is the fact. To draw as a consequence that the inoculation was the cause of the cure, it would be necessary that analogous instances had either always, or at least very frequently, occurred; otherwise the coincidence may have been entirely accidental.

Examples are given of obstinate, even hereditary ulcers, of cachexy, scurvy, eruptions, &c. cured in consequence of inoculation. The character of those who have attested these facts We readily admit them; but to prove that these does not permit us to call them in question. advantages ought to establish a preference for inoculation with the small-pox matter over vaccination, it would be at least necessary to prove that vaccination has not been followed by equally fortunate consequences; but the very contrary fact results from the observations collected by the correspondence of Paris, and from several cases announced in the works extracted by the authors of the Bibliotheque Britannique. The variety of facts announced by the correspondence of Paris is so great that it might even lead to some scepticism. We shall therefore only notice those relations which are given by persons entitled to draw our attention, and those the details of which contain some interesting particulars. Without attempting to draw any consequences from them, we shall simply present a short statement.

Mr. Richard Dunning, of Plymouth, in a work published in London in 1800, entitled Some Observations on Vaccination, &c. when speaking of the effects of vaccination on the health, says, that he has generally observed the health improved by vaccination, and he gives two instances: the first a young girl, daughter of a consumptive father, subject to vomiting, and continually labouring under oppression, with a cadaverous aspect spotted with livid blotches. After a for. tunate and successful vaccination, she in a few months recovered the best possible state of health. The second example was a child two years of age, naturally delicate, recovering from an inflammation of the breast, but still pale, very feeble, and oppressed. This child, after vaccination, speedily recovered strength, acquired a good habit of body, a free respiration, and an

excellent state of health. M. Maunoir, of Geneva, on this occasion adds another instance: a child, whose arm was covered with dartrous eruptions, which inflamed during the influence of the cow-pox inoculation, and assumed the appearance of as many cow-pocks. After the vaccination was over this child got quit of the eruption entirely. The same person affirms that he has observed, even after false vaccination, a sensible improvement in the health of delicate infants.

Šimilar results have been announced in the Spanish expedition, with an intention to publish

them.

Dr. Sacco, in his treatise Della Vaccinazione (Milan, 1809), affirms, that when vaccinating infants affected with palsy in the arms or lower extremities, troubled with chronic diseases of the glands, &c. he made a great number of punctures on purpose, to the amount of thirty or forty: that some of these patients were perfectly cured, and that the health of others was considerably improved.

M. Barrey, of Besançon, observes that vaccination had been performed, in 1804, in three villages belonging to his department, on 141 infants under twelve years of age, constituting more than one half of all the children under that age in the place. In 1809 no fewer than 134 of these children enjoyed perfect health, seven alone having died of different diseases; but of the children that had not been vaccinated no fewer than forty-six were dead, though no small-pox had visited the country during the period. If under this last number be only included the children that existed in 1804, and not those born between that period and 1809, we must conclude that vaccination had rendered the children less susceptible of other diseases; but M. Barrey's observation is not sufficiently precise to enable us to estimate its importance.

The facts contained in the correspondence of Paris present themselves in a much greater number. If we refuse to admit all these cures to be owing to vaccination, we shall at least allow the coincidence of the cures with vaccination. Even in that case the great number of facts must produce at least a suspicion that vaccination had a useful effect in these cases, and give us a cer, tainty that at least it was not injurious,

The names of the observers, the places where the observations were made, the kind of observations, are marked with precision in the notes which have been put into our hands. A considerable number enter into details, both respect ing the phenomena and the methods employed; the number of punctures made in order to induce a more considerable commotion, and to render it more general and more efficacious.

We ought to remark here more particularly the maladies which affect the organs and functions which belong to the lymphatic system. On that account we shall begin with them. Fourteen observers have given a great number of examples of the crusta lactea disappearing after vaccina, tion; sometimes after a suppuration of the cowpox continued for twenty-seven days. Seven observers have sent a great number of observations, two of which are accompanied with details, stating the termination of dartrous affections spread over different parts of the body, and especially the arms, after vaccination. In one of these cases the cure was preceded by a violent inflammation round the cow-pox, and by a suppuration kept up for a month. Eighteen ob, VOL. XI.-PART II.

servers have given an account of chronic and obstinate opthalmias in scrofulous children cured by vaccination. Eight of these observations are detailed. In several cases the punctures made amounted to fifteen or twenty. Some were made iu the nape of the neck. In most of them the suppurations were long continued; sometimes they were succeeded by blisters: but in every one of the cases the same means had been employed before vaccination without any effect. Twelve observers have given numerous facts relative to the termination of scrofula after vaccination, Eight of these are detailed. In one the scrofula was complicated with opthalmia. Sixteen punc. tures were made in the limbs. On the seventh day the child opened its eyes, and was capable of bearing the light. The inflammation of the punctures was violent: the inguinal glands subsided, the scrofulous tumours disappeared, and the cure was complete; but it was thought proper to endeavour to render it still more secure by a cautery performed on one of the limbs. In another case the scrofulous tumours were open, they discharged an unhealthy pus, and the flesh was pale and fungous. During the progress of the cow-pox the edges of the ulcers became red, and the flesh firm; the suppuration became less abun dant, and less watery; much of the humours was drawn to the vaccinated arm; the scrofulous tumours healed in the course of a month; the cowpox continued to suppurate during three months, and then the cure was complete,

Since the introduction of vaccination into the department of Mount Blanc, M. Carou, physician of Annecy, affirms that the number of scrofulous diseases has sensibly diminished; and M. Bacon, physician at Falaise, that in the hospital for children, formerly filled with scrofulous cases, no such disease is now to be found. Four observers sent various observations, five of which are very detailed, and have for their objects eases of rickets, not indeed cured, but modified in a remarkable manner, and the progress of which was either stopped, or sensibly retarded, by vac. cination. The power of walking recovered, strength increased, and the solidity of station re-established, were the most sensible effects that resulted; and in these cases the numerous punctures along the spines were the means by which they flattered themselves with having obtained success. Three observers have spoken of the tinea capitis. One of the observations is de tailed, and gives an account of a tinea of a yellow colour, yielding a copious yellow humour, of the consistence of honey. Twelve punctures were made upon the head itself. When the vaccinal crusts fell off, the crusts of the tinea dried up, fell off, and the cure was complete observers furnish numerous facts respecting vac cination performed on patients labouring under nervous disorders, Five of these are detailed. A megrim which continually tortured a young man of fourteen years of age, for several years, vanished after the suppuration of the cow-pox, Daily convulsions, during ten months, in a child of twenty months, which had not been alleviated by medicine, became less violent during the progress of vaccination, and afterwards disappeared altogether, Various convulsive diseases, three of which were epileptic, were suspended during the progress of the cow-pox. Afterwards they continued to recur, but at longer intervals. Three of them, one of which was hereditary, ceased ale together. In one that had convulsions every

Five

day, the vaccination was performed during sleep, because it would have brought on a fit if the patient had been awake. The epilepsy disappeared the ninth day after the vaccination. In him, who was afflicted with an hereditary epilepsy, and who was cured, vaccination was performed by incision, and the pustules were con verted into an ulcer. Ten observers furnish various observations, four of which are detailed, and relate to periodical and obstinate fevers, such as quartans, double tertians, and quotidians. They were cured by vaccination. Two quotidians, with which young men of twentyeight were afflicted, had lasted for ten months; a double tertian, in a child of three years, had lasted three months. They ceased after vaccination. In four persons afflicted with intermittents, and vaccinated, the cow-pox appeared only upon one, and he alone was cured.

Several other observers, to the number of fourteen, have furnished various remarkable facts respecting different other diseases. In an infant, a year old, a palsy of the left arm, which had lasted two months, disappeared a month after vaccination, performed by making six punctures in the diseased arm. A great number of violent coughs have been suspended, moderated, or cured. The consequences of suppressed measles, namely, a dry cough, fever, and diarrhoea, were cured by a cow-pox induced by twenty punctures, during the suppuration of which a strong fever and miliary eruption occurred. A violent pain in the joint of the left thigh, with which a child of nine years of age was afflicted, with a threatening of spontaneous luxation of the limb, was treated by means of eighteen punctures round the diseased joint. Sixteen pox, the aureolas of which were confluent, occasioned fever, and then suppurated. Soon after the pain of the joint disappeared, and the cure was complete. A white 'swelling of the knee in a child of eight years of age, and a deafness which had increased for eighteen months in a child of six years of age, were both cured by vaccination.

Such are the facts which we have collected respecting the diseases existing at the time of vaccination, and cured by that process. We have noticed those only which are related with preci'sion. We do not think that they ought to be always considered as cures due to vaccination. Separately taken, we do not see in them any thing else than a coincidence between the time of cure and vaccination; but taken collectively, we think that the number of facts, and the circumstances accompanying those which we have particularly noticed, give at least a presumption in favour of vaccination, more than sufficient to counterbalance the facts which have been alleged in favour of the small-pox, in what way soever that disease is communicated. We acknowledge, at the same time, that a comparison between vaccination and inoculation for the small-pox, in this point of view, cannot be fairly made, because a much greater number of cases of the former than of the latter have been given to the public. Vaccination, under the special protection of go ́vernment, has become the object of a regular and active correspondence, in which few facts have escaped observers, only in danger of being led astray by their zeal. Inoculation, on the other hand, but little favoured by government, was become the object of enterprises, in which a spirit of cupidity was much more prevalent than a spirit of observation."

It will be asked, perhaps, whether, if we admit an equality of advantages in favour of vaccination and inoculation, considered as a remedy for different diseases, it would not be of advantage to preserve the inoculation for the smallpox as a means of utility in certain situations.

We answer, that in such a comparison we ought not to leave out the dangers of a contagion, subtile and persevering like that of the small-pox, compared with the virus of the cowpox, which can only be communicated immediately, because the least alteration destroys its properties. We ought also to reckon for something the hope at present entertained of being able to destroy the small-pox altogether. Could houses for inoculation, though established under the care of the police, be subjected to laws so severe, and to a sequestration so exact, as to prevent completely the spreading of the smallpox from them, something might be said in its favour; but whoever considers the nature of man, and the state of society, must be convinced of the impossibility of securing any such object. In our opinion, even admitting vaccination and inoculation to be equally efficacious in removing other diseases, the balance in favour of vaccination is so strong that it is impossible to hesitate one moment about preferring it.

VI-How far can we depend upon the preservative efficacy of the cow-pox, compared with the same advantage resulting from the small-pox, natural or inoculated? What consequences follow from this, properly considered, in the one or the other virus?

Nobody disputes the power of the cow-pox to preserve from the small-pox: and this question, which at the commencement was the most important of all, has now become only secondary to various others that have been put, and most of which we think we have already answered. At the same time, to this question must be referred a variety of other particulars of considerable interest, such, for example, as the distinction between the true and false cow-pox, the eruptions that have been confounded with the small-pox, the changes introduced in the bills of mortality by the introduction of the cow-pox, the hopes of destroying the small-pox, or of driving it out of the civilized world.

The idea of the faculty of preserving from the small-pox divides itself into two questions. One may be thrus stated: Will an individual, after being vaccinated, if he be placed in a situation proper to produce the small-pox, and which usually produces it, continue exempt from that disease? The solution of this question can only be obtained by a multitude of experiments; and that solution will give, then, not absolute certainty, but degrees of probability proportional to the number of experiments undertaken to resolve the question.

The other question is this: Is it impossible for a vaccinated person to be infected with the smallpox? Experience cannot decide, in the affirmative, the question when thus stated; but a single observation is sufficient to decide it in the negative. If that observation does not exist, the question must continue insoluble; because, in order to resolve it, we must be acquainted with the nature of the virus of small-pox and of cowpox, with all the circumstances which are capable of excluding or producing contagion, and with the peculiar dispositions which prevent men from