Part 14 (2/2)
In this respect, as well as many others, a parallel may be drawn between this disease and the smallpox In the latter, the patient first feels the effect of what is called the absorption of the virus The symptoms then often nearly retire, when a fresh attack commences, different froress of the pustules through their different stages of h the application I have mentioned in the case of Mary Hearn proved sufficient to check the progress of ulceration and prevent any secondary symptoms, yet, after the pustule has duly exerted its influence, I should prefer the destroying it quickly and effectually to any other mode The term caustic to a tender ear (and I conceive none feel uardians of a nursery) , but every solicitude that er exist when it is understood that the pustule, in a state fit to be acted upon, is then quite superficial, and that it does not occupy the space of a silver penny [Footnote: I ress of the pustule because I am acquainted with their efficacy; probably ht answer the purpose quite as well, such as ents]
As a proof of the efficacy of this practice, even before the virus has fully exerted itself on the syste history:
By a reference to the treatise on the Variolae Vaccinae it will be seen that, in the month of April, 1798, four children were inoculated with the matter of cow-pox, and that in two of these cases the virus on the arm was destroyed soon after it had produced a perceptible sickening Mary Jaed seven years, one of the children alluded to, was inoculated in thewith fresh variolous matter, and at the same time was exposed to the effluvia of a patient affected with the sress of the infected arenerally observe when variolous matter has been inserted into the skin of a person who has not previously undergone either the cow-pox or the s there was infection in it, she was re those who had not had the s, froirl's ar her on the evening of the following day (the ninth) all I could learn from the woman who attended her was that she felt soht, but was not restless; and that in thethere was the faint appearance of a rash about her wrists This went off in a few hours, and was not at all perceptible to le eruption appeared, the skin having been repeatedly and carefully exaress to the end, through all the stages of inflahth day irl (Mary James) and inserted into the arms of her mother and brother (neither of whom had had either the se, the latter six
On the eighth day after the insertion the boy felt indisposed, and continued unwell two days, when a measles-like rash appeared on his hands and wrists, and was thinly scattered over his ar his body was marbled over with an appearance somewhat similar, but he did not complain, nor did he appear indisposed A few pustules now appeared, the greater part of which went aithout an to complain She was a little chilly and had a headache for two days, but NO PUSTULE APPEARED on the skin, nor had she any appearance of a rash
The family was attended by an elderly woman as a nurse, who in her infancy had been exposed to the contagion of the smallpox, but had resisted it This wohtest , two or three of which only maturated
From a solitary instance like that adduced of Mary James, whose constitution appears to have resisted the action of the variolous virus, after the influence of the cow-pox virus had been so soon arrested in its progress, no positive conclusion can be fairly drawn; nor from the history of the three other patients ere subsequently infected, but, nevertheless, the facts collectively
That one mild variety of the smallpox has appeared I have already plainly shewn; [Footnote: See Inquiry into the Causes and Effects of the Variolae Vaccinae, p 54 (of original article)], and by the means now mentioned we probably have it in our power to produce at will another
At the time when the pustule was destroyed in the arm of Mary James I was informed she had been indisposed about twelve hours; but I am now assured by those ith her that the space of time was much less Be that as it may, in cases of cow-pox inoculation I would not recommend any application to subdue the action of the pustule until convincing proofs had appeared of the patient's having felt its effects at least twelve hours No harer period to elapse before the application was made use of In short, it should be suffered to have as full an effect as it could, consistently with the state of the arm
As the cases of inoculation multiply, I am more andmerely from the primary action of the virus on the constitution, and that those symptoms which, as in the accidental cow-pox, affect the patient with severity, are entirely secondary, excited by the irritating processes of inflaular virus possesses an irritating quality of a peculiar kind, but as a single cow-pox pustule is all that is necessary to render the variolous virus ineffectual, and as we possess thethe irritation, should any arise, it becomes of little or no consequence
It appears then, as far as an inference can be drawn froress of cow-pox inoculation, that it is an accidental circumstance only which can render this a violent disease, and a circumstance of that nature which, fortunately, it is in the power of almost every one to avoid I allude to the communication of the disease from cows In this case, should the hands of the milker be affected with little accidental sores to any extent, every sore would become the nidus of infection and feel the influence of the virus; and the degree of violence in the constitutional symptoms would be in proportion to the number and to the state of these local affections Hence it follows that a person, either by accident or design, ht be so filled with these wounds froht sink under the pressure
Seeing that we possess thethe action of the soresviolent effects; and seeing, too, that these sores bear a resemblance to the se the hope that soe to counteract the fatal tendency of that disease, when it appears in this terrific fores of the disease thisexpectation of success I will not pretend now to determine I only throw out this idea as the basis of further reasoning and experiment
I have often been foiled in my endeavours to communicate the cow- pox by inoculation An inflammation will sometimes succeed the scratch or puncture, and in a few days disappear without producing any further effect Sometimes it will even produce an ichorous fluid, and yet the syste we know happens with the smallpox virus
Four or five servants were inoculated at a faruous to this place, last summer, with matter just taken from an infected cow A little inflammation appeared on all their ar a pustule; yet all these servants caught the disease within athe infected cows, and some of them had it severely At present no otherthe s the cow-pox; but it is probable this e We should imitate the casual co the smallest superficial incision or puncture on the skin, to produce a little scab, and then, re it, to touch the abraded part with the virus A small portion of a thread i the sht probably prove a successful way of giving the disease; or the cutisplaster, and the virus brought in contact with it In the cases just alluded to, where I did not succeed in giving the disease constitutionally, the experiment was made with matter taken in a purulent state froh contained in a s the smallpox perfectly? I suspect it is not Let us consider that it is always preceded by the limpid fluid, which, in constitutions susceptible of variolous contagion, is always infectious; and though, on opening a pustule, its contents iven quantity of the lih it would be imperceptible to the only test of our senses, the eye The presence, then, of this fluid, or its h pus, may at all times render active what is apparently MERE PUS, while its total absence (as in stale pustules) may be attended with the i too widely to go far into the doctrine of secretion, but as it will not be quite extraneous, I shall just observe that I consider both the pus and the lians established by nature to perfor these fluids may differ essentially in their anization of glandular bodies constitutes the difference in the qualities of the fluids secreted? Froement in the structure or, in other words, soland destined to create a mild, innoxious fluid, a poison of the land, which in its sound state secretes pure saliva,thrown into diseased action, produce a poison of the most destructive quality Nature appears to have nothe vascular parts of the body than she has in for blood vessels, and millions of these can be called into existence, when inflammation is excited, in a few hours [Footnote: Mr Home, in his excellent dissertation on pus and mucus, justifies this assertion]
In the present early stage of the inquiry (for early it certainly must be deemed), before we know for an absolute certainty how soon the virus of the cow-pox e in its specific properties, after it has quitted the li a pustule, it would be prudent for those who have been inoculated with it to submit to variolous inoculation No injury or inconvenience can accrue fro those who, from inoculation, have felt the smallpox in an unsatisfactory ht appear that I had not been too officious in offering a cautionary, hint in reco a second inoculation with matter in its ument's sake (not fro had the cow-pox should be found susceptible of the smallpox, would this invalidate the utility of the practice? For, waiving all other considerations, ill deny that the inoculated sh abstractedly it may be considered as har that in numberless instances proves baneful to the human frame
That in delicate constitutions it soenerally be subscribed to, as it is so obvious to common observation This consideration is important
As the effects of the smallpox inoculation on those who have had the cow-pox will be watched with the most scrupulous eye by those who prosecute this inquiry, itto their recollection some facts relative to the smallpox, which I must consider here as of consequence, but which hitherto seem not to have made a due impression
It should be remembered that the constitution cannot, by previous infection, be rendered totally unsusceptible of the variolous poison; neither the casual nor the inoculated smallpox, whether it produces the disease in a uish the susceptibility The skin, we know, is ever ready to exhibit, though often in a very liree, the effects of the poison when inserted there; and how frequently do we see, aion, eruptions, and these so like an eruption appear, or the sree of indisposition, upon the insertion of the variolous h the cow-pox,the peculiarities of the disease entleo, was inoculated for the s no pustules, or scarcely any constitutional affection that was perceptible, he was dissatisfied, and has since been repeatedly inoculated A vesicle has always been produced in the arht indisposition; this is by no means a rare occurrence It is probable that fluid thus excited upon the skin would always produce the sh the cow-pox many years before I once produced a vesication by the insertion of variolouswoman who had a h no constitutional effect was produced on the patient fro communication from Mr Fewster affords a still clearer elucidation of this fact Mr Fewster says: ”On the 3d of April, 1797, I inoculated Master H--, aged fourteen months, for the smallpox At the usual time he sickened, had a plentiful eruption, particularly on his face, and got well His nurseh the s much pitted with it She had used the child to sleep on her left ar his inoculation he had ot well she (the nurse) desired me to look at her face, which she said was very painful There was a plentiful eruption on the left cheek, BUT NOT ON ANY OTHER PART OF THE BODY, which went on to maturation
”On enquiry I found that three days before the appearance of the eruption she was taken with slight chilly fits, pain in her head and limbs, and some fever On the appearance of the eruption these pains went off, and now, the second day of the eruption, she complains of a little sore throat Whether the above symptoms are the effects of the smallpox or a recent cold I do not know
On the fifth day of the eruption I charged a lancet from two of the pustules, and on the next day I inoculated two children, one two years, the other four months old, with the matter At the same time I inoculated the mother and eldest sister with variolous matter taken from Master H-- On the fifth day of their inoculation ALL their arhth day the eldest of those inoculated froest on the eleventh They had both a plentiful eruption, from which I inoculated several others, who had the disease very favourably The mother and the other child sickened about the same time, and likewise had a plentiful eruption
”Soon after, a e sickened with the smallpox and had a confluent kind To be convinced that the children had had the disease effectually I took them to his house and inoculated them in both arms with matter taken from him, but without effect”