The Harvard Classics Part 13

Some other instances have likewise been represented to me of the appearance of the disease, apparently marked with its characteristic symptoms, and yet that the patients have afterwards had the smallpox. On these cases I shall, for the present, suspend any particular remarks, but hope that the general observations I have to offer in the sequel will prove of sufficient weight to render the idea of their ever having had existence, but as cases of spurious cow-pox, extremely doubtful.

Ere I proceed let me be permitted to observe that truth, in this and every other physiological inquiry that has occupied my attention, has ever been the object of my pursuit, and should it appear in the present instance that I have been led into error, fond as I may appear of the offspring of my labours, I had rather see it perish at once than exist and do a public injury.

I shall proceed to enumerate the sources, or what appear to me as such, of a spurious cow-pox.

First: That arising from pustules on the nipples or udder of the cow; which pustules contain no specific virus.

Secondly: From matter (although originally possessing the specific virus) which has suffered a decomposition, either from putrefaction or from any other cause less obvious to the senses.

Thirdly: From matter taken from an ulcer in an advanced stage, which ulcer arose from a true cow pock.

Fourthly: From matter produced on the human skin from contact with some peculiar morbid matter generated by a horse.

On these subjects I shall offer some comments: First, to what length pustulous diseases of the udder and nipples of the cow may extend it is not in my power to determine; but certain it is that these parts of the animal are subject to some variety of maladies of this nature; and as many of these eruptions (probably all of them) are capable of giving a disease to the human body, would it not be discreet for those engaged in this investigation to suspend controversy and cavil until they can ascertain with precision what IS and what IS NOT the cow-pox?

For example: A farmer who is not conversant with any of these maladies, but who may have heard of the cow-pox in general terms, may acquaint a neighbouring surgeon that the distemper appears at his farm. The surgeon, eager to make an experiment, takes away matter, inoculates, produces a sore, uneasiness in the axilla, and perhaps some affection of the system. This is one way in which a fallacious idea of security both in the mind of the inoculater and the patient may arise; for a disease may thus have been propagated from a simple eruption only.

One of the first objects then of this pursuit, as I have observed, should be, to learn how to distinguish with accuracy between that peculiar pustule which is the true cow pock, and that which is spurious. Until experience has determined this, we view our object through a mist. Let us, for instance, suppose that the smallpox and the chicken-pox were at the same time to spread among the inhabitants of a country which had never been visited by either of these distempers, and where they were quite unknown before: what confusion would arise! The resemblance between the symptoms of the eruptive fever and between the pustules in either case would be so striking that a patient who had gone through the chicken-pox to any extent would feel equally easy with regard to his future security from the smallpox as the person who had actually pa.s.sed through that disease. Time and future observation would draw the line of distinction.

So I presume it will be with the cow-pox until it is more generally understood. All cavilling, therefore, on the mere report of those who TELL US they have had this distemper, and are afterwards found susceptible of the smallpox, should be suspended. To ill.u.s.trate this I beg leave to give the following history:

Sarah Merlin, of the parish of Eastington in this county, when about thirteen or fourteen years of age lived as a servant with farmer Clarke, who kept a dairy consisting of about eighteen cows at Stonehouse, a neighbouring village. The nipples and udders of three of the cows were extensively affected with large white blisters. These cows the girl milked daily, and at the time she a.s.sisted, with two others, in milking the rest of the herd. It soon appeared that the disease was communicated to the girl. The rest of the cows escaped the infection, although they were milked several days after the three above specified, had these eruptions on the nipples and udders, and even after the girl's hand became sore. The two others who were engaged in milking, although they milked the cows indiscriminately, received no injury. On the fingers of each of the girl's hands there appeared several large white blisters--she supposes about three or four on each finger.

The hands and arms inflamed and swelled, but no const.i.tutional indisposition followed. The sores were anointed with some domestic ointment and got well without ulcerating.

As this malady was called the cow-pox, and recorded as such in the mind of the patient, she became regardless of the smallpox; but, on being exposed to it some years afterwards she was infected, and had a full burthen.

Now had any one conversant with the habits of the disease heard this history, they would have had no hesitation in p.r.o.nouncing it a case of spurious cow-pox; considering its deviation in the NUMEROUS blisters which appeared on the girl's hands; their termination without ulceration; its not proving more generally contagious at the farm, either among the cattle or those employed in milking; and considering also that THE PATIENT FELT NO GENERAL INDISPOSITION, ALTHOUGH THERE WAS SO GREAT A NUMBER OF VESICLES.

This is perhaps the most deceptious form in which an eruptive disease can be communicated from the cow, and it certainly requires some attention in discriminating it. The most perfect criterion by which the judgment may be guided is perhaps that adopted by those who attend infected cattle. These white blisters on the nipples, they say, NEVER EAT INTO THE FLESHY PARTS like those which are commonly of a bluish cast, and which const.i.tute the TRUE COW-POX, but that they affect the skin only, quickly end in scabs, and are not nearly so infectious.

That which appeared to me as one cause of spurious eruptions, I have already remarked in the former treatise, namely, the transition that the cow makes in the spring from a poor to a nutritious diet, and from the udder's becoming at this time more vascular than usual for the supply of milk. But there is another source of inflammation and pustules which I believe is not uncommon in all the dairy counties in the west of England. A cow intended to be exposed for sale, having naturally a small udder, is previously for a day or two neither milked artificially nor is her calf suffered to have access to her. Thus the milk is preternaturally acc.u.mulated, and the udder and nipples become greatly distended. The consequences frequently are inflammation and eruptions which maturate.

Whether a disease generated in this way has the power of affecting the const.i.tution in any PECULIAR manner I cannot presume positively to determine. It has been conjectured to have been a cause of the true cow-pox, though my inquiries have not led me to adopt this supposition in any one instance; on the contrary, I have known the milkers affected by it, but always found that an affection thus induced left the system as susceptible of the smallpox as before.

What is advanced in my second position I consider also of very great importance, and I could wish it to be strongly impressed on the minds of all who may be disposed to conclude hastily on my observations, whether engaged in their investigation by experiments or not to place this in its clearest point of view (as the similarity between the action of the smallpox and the cow-pox matter is so obvious) it will be necessary to consider what we sometimes observe to take place in inoculation for the smallpox when imperfect variolous matter is made use of. The concise history on this subject that was brought forward respecting what I had observed in this neighbourhood [Footnote: Inquiry into the Causes and Effects of the Variolae Vaccinae, p.56 of the original article]. I perceive, by a reference since made to the Memoirs of the Medical Society of London, may be considered as no more than a corroboration of the facts very clearly detailed by Mr. Kite [Footnote: See an account of some anomalous appearances consequent to the inoculation of the smallpox, by Charles Kite, Surgeon, of Gravesend, in the Memoirs of the Medical Society of London, vol. iv, p. 114.]. To this copious evidence I have to add still more in the following communications from Mr. Earle, surgeon, of Frampton-upon-Severn, in this county, which I deem the more valuable, as he has with much candour permitted me to make them public:

"SIR:

"I have read with satisfaction your late publication on the Variolae Vaccinae, and being, among many other curious circ.u.mstances, particularly struck with that relating to the inefficacy of smallpox matter in a particular state, I think it proper to lay before you the following facts which came within my own knowledge, and which certainly tend to strengthen the opinions advanced in pages 56 and 57 of your treatise.

"In March, 1784, a general inoculation took place at Arlingham in this county. I inoculated several patients with active variolous matter, all of whom had the disease in a favourable way; but the matter being all used, and not being able to procure any more in the state I wished, I was under the necessity of taking it from a pustule which, experience has since proved, was advanced too far to answer the purpose I intended. Of five persons inoculated with this last matter, four took the smallpox afterwards in the natural way, one of whom died, three recovered, and the other, being cautioned by me to avoid as much as possible the chance of catching it, escaped from the disease through life. He died of another disorder about two years ago.

"Although one of these cases ended unfortunate, yet I cannot suppose that any medical man will think me careless or inattentive in their management; for I conceive the appearances were such as might have induced any one to suppose that the persons were perfectly safe from future infection. Inflammation in every case took place in the arm, and fever came on with a considerable degree of pain in the axilla. In some of their arms the inflammation and suppuration were more violent than is commonly observed when perfect matter is made use of; in one there was an ulcer which cast off several large sloughs. About the ninth day eruptions appeared, which died away earlier than common without maturation. From these circ.u.mstances I should suppose that no medical pract.i.tioner would scarcely have entertained a doubt but that these patients had been infected with a true smallpox; yet I must confess that some small degree of doubt presented itself to me at the speedy disappearance of the eruptions; and in order, as far as I could, to ascertain their safety, I sent one of them to a much older pract.i.tioner than myself. This gentleman, on hearing the circ.u.mstances of the case, p.r.o.nounced the patient perfectly secure from future infection.

"The following facts are also a striking proof of the truth of your observations on this subject:

"In the year 1789 I inoculated three children of Mr. Coaley, of Hurst farm in this county. The arms inflamed properly, fever and pain in the axillae came on precisely the same as in the former cases, and in ten days eruptions appeared, which disappeared in the course of two days. I must observe that the matter here made use of was procured for me by a friend; but no doubt it was in an improper state; for, from the similarity of these cases to those which happened at Arlingham five years before, I was somewhat alarmed for their safety, and desired to inoculate them again: which being permitted, I was particularly careful to procure matter in its most perfect state. All the children took the smallpox from this second inoculation, and all had a very full burthen. These facts I conceive strikingly corroborate your opinion relative to the different states of matter; for in both instances that I have mentioned it was capable of producing something strongly resembling the true smallpox, although it afterwards proved not to be so.

"As I think the communication of these cases is a duty I owe to the public, you are at liberty to make what use you please of this letter. I remain, &c.,

"John Earle.

"FRAMPTON-UPON SEVERN, GLOUCESTERs.h.i.+RE, November 10, 1798.

"P. S. I think it necessary to observe that I can p.r.o.nounce, with the greatest certainty, that the matter with which the Arlingham patients were inoculated was taken from a true smallpox pustule.

I took it myself from a subject that had a very full burthen."

Certain then it is that variolous matter may undergo such a change from the putrefactive process, as well as from some of the more obscure and latent processes of nature, as will render it incapable of giving the smallpox in such a manner as to secure the human const.i.tution from future infection, although we see at the same time it is capable of exciting a disease which bears so strong a resemblance to it as to produce inflammation and matter in the incised skin (frequently, indeed, more violent than when it produces its effects perfectly), swelling of the axillary glands, general indisposition, and eruptions. So strongly persuaded was the gentleman, whose practice I have mentioned in page 56 of the late treatise, that he could produce a mild smallpox by his mode of managing the matter, that he spoke of it as a useful discovery until convinced of his error by the fatal consequence which ensued.

After this ought we to be in the smallest degree surprised to find, among a great number of individuals who, by living in dairies, have been casually exposed to the cow-pox virus when in a state a.n.a.logous to that of the smallpox above described, some who may have had the disease so imperfectly as not to render them secure from variolous attacks? For the matter, when burst from the pustules on the nipples of the cow, by being exposed, from its lodgment there, to the heat of an inflamed surface, and from being at the same time in a situation to be occasionally moistened with milk, is often likely to be in a state conducive to putrefaction; and thus, under some modification of decomposition, it must, of course, sometimes find access to the hand of the milker in such a way as to infect him. What confusion should we have were there no other mode of inoculating the smallpox than such as would happen from handling the diseased skin of a person labouring under that distemper in some of its advanced and loathsome stages! It must be observed that every case of cow-pox in the human species, whether communicated by design or otherwise, is to be considered as a case of inoculation. And here I may be allowed to make an observation on the case of the farmer communicated to me by Dr. Ingenhousz. That he was exposed to the matter when it had undergone the putrefactive change is highly probable from the doctor's observing that the sick cows at the farm gave out an OFFENSIVE STENCH FROM THEIR UDDERS. However, I must remark that it is unusual for cattle to suffer to such an extent, when disordered with the cowpox, as to make a bystander sensible of any ill smell. I have often stood among a herd which had the distemper without being conscious of its presence from any particular effluvia. Indeed, in this neighbourhood it commonly receives an early check from escharotic applications of the COW LEECH. It has been conceived to be contagious without contact; but this idea cannot be well founded because the cattle in one meadow do not infect those in another (although there may be no other part.i.tion than a hedge) unless they be handled or milked by those who bring the infectious matter with them; and of course, the smallest particle imaginable, when applied to a part susceptible of its influence, may produce the effect. Among the human species it appears to be very clear that the disease is produced by contact only. All my attempts, at least, to communicate it by effluvia have hitherto proved ineffectual.

As well as the perfect change from that state in which variolous matter is capable of producing full and decisive effects on the const.i.tution, to that wherein its specific properties are entirely lost, it may reasonably be supposed that it is capable of undergoing a variety of intermediate changes. The following singular occurrences in ten cases of inoculation, obligingly communicated to me by Mr. Trye, Senior Surgeon to the Infirmary at Glocester, seem to indicate that the variolous matter, previously to its being taken from the patient for the intended purpose, was beginning to part with some of its original properties, or, in other words, that it had suffered a partial decomposition. Mr. Trye says: "I inoculated ten children with matter taken at one time and from the same subject. I observed no peculiarity in any of them previously to their inoculation, nor did any thing remarkable appear in their arms till after the decline of the disease. Two infants of three months old had erysipelas about the incisions, in one of them extending from the shoulders to the fingers' ends. Another infant had abscesses in the cellular substance in the neighbourhood of the incisions, and five or six of the rest had axillary abscesses. The matter was taken from the distinct smallpox late in its progress, and when some pustules had been dried. It was received upon gla.s.s and slowly dried by the fire. All the children had pustules which maturated, so that I suppose them all secure from future infection; at least, as secure as any others whom I have ever inoculated. My practice never afforded a sore arm before."

In regard to my former observation on the improper and dangerous mode of preserving variolous matter, I shall here remark that it seems not to have been clearly understood. Finding that it has been confounded with the more eligible modes of preservation, I will explain myself further. When the matter is taken from a fit pustule and properly prepared for preservation, it may certainly be kept without losing its specific properties a great length of time; for instance, when it is previously dried in the open air on some compact body, as a quill or a piece of gla.s.s, and afterwards secured in a small vial. [Footnote: Thus prepared, the cow-pox virus was found perfectly active, and possessing all its specific properties, at the end of three months.] But when kept several days in a state of moisture, and during that time exposed to a warm temperature, I do not think it can be relied upon as capable of giving a perfect disease, although, as I have before observed, the progress of the symptoms arising from the action of the imperfect matter bear so strong a resemblance to the smallpox when excited completely.

Thirdly. That the first formed virus, or what const.i.tutes the true cow-pox pustule, invariably possesses the power I have ascribed to it, namely, that of affecting the const.i.tution with a specific disease, is a truth that no subsequent occurrence has yet led me to doubt. But as I am now endeavouring to guard the public as much as possible against erroneous conclusions, I shall observe that when this pustule has degenerated into an ulcer (to which state it is often disposed to pa.s.s unless timely checked), I suspect that matter possessing very different properties may sooner or later be produced; and although it may have pa.s.sed that stage wherein the specific properties of the matter secreted are no longer present in it, yet when applied to a sore (as in the casual way) it might dispose that sore to ulcerate, and from its irritation the system would probably become affected; and thus, by a.s.suming some of its strongest characters, it would imitate the genuine cow-pox.

From the preceding observations on the matter of smallpox when decomposed it must, I conceive, be admitted that cow-pox matter in the state now described may produce a disease, the effects of which may be felt both locally and generally, yet that the disease thus induced may not be effectual in obviating the future effects of variolous contagion. In the case of Mary Miller, related by Mr. Kite in the volume above alluded to, it appears that the inflammation and suppuration of the inoculated arm were more than usually severe, although the system underwent no specific change from the action of the virus; which appears from the patient's sickening seven weeks afterwards with the natural smallpox, which went through its course. Some of the cases communicated by Mr. Earle tend further to confirm this fact, as the matter there manifestly produced ulceration on the inoculated part to a considerable extent.

Fourthly. Whether the cow-pox is a spontaneous disease in the cow, or is to be attributed to matter conveyed to the animal, as I have conceived, from the horse, is a question which, though I shall not attempt now fully to discuss, yet I shall digress so far as to adduce some further observations, and to give my reasons more at large for taking up an opinion that to some had appeared fanciful. The aggregate of these observations, though not amounting to positive proof, forms presumptive evidence of so forcible a kind that I imagine it might, on any other person, have made the same impression it did on me, without fixing the imputation of credulity.

First: I conceived this was the source, from observing that where the cow-pox had appeared among the dairies here (unless it could be traced to the introduction of an infected cow or servant) it had been preceded at the farm by a horse diseased in the manner already described, which horse had been attended by some of the milkers.

Secondly: From its being a popular opinion throughout this great dairy country, and from its being insisted on by those who here attend sick cattle.

Thirdly: From the total absence of the disease in Ireland and Scotland, where the men-servants are not employed in the dairies.

[Footnote: This information was communicated to me from the first authority.]

Fourthly: From having observed that morbid matter generated by the horse frequently communicates, in a casual way, a disease to the human subject so like the cow-pox that, in many cases, it would be difficult to make the distinction between one and the other. [Footnote: The sound skin does not appear to be susceptible of this virus when inserted into it, but, when previously diseased from little accidents, its effects are often conspicuous.]

Fifthly: From being induced to suppose, from experiments, that some of those who had been thus affected from the horse resisted the smallpox.

Sixthly: From the progress and general appearance of the pustule on the arm of the boy whom I inoculated with matter taken from the hand of a man infected by a horse; and from the similarity to the cow-pox of general const.i.tutional symptoms which followed.

[Footnote: This case (on which I laid no inconsiderable stress in my late treatise, as presumptive evidence of the fact adduced) seems to have been either mistaken or overlooked by those who have commented upon it. (See Case XVIII, p. 36.) The boy, unfortunately, died of a fever at a parish workhouse before I had an opportunity of observing what effects would have been produced by the matter of smallpox.]

I fear it would be trespa.s.sing too far to adduce the general testimony of our farmers in support of this opinion; yet I beg leave to introduce an extract of a letter on this subject from the Rev. Mr. Moore, of Chalford Hill, in this county:

"In the month of November, 1797, my horse had diseased heels, which was certainly what is termed the grease; and at a short subsequent period my cow was also affected with what a neighbouring farmer (who was conversant with the complaints of cattle) p.r.o.nounced to be the cow-pox, which he at the same time observed my servant would be infected with: and this proved to be the case; for he had eruptions on his hands, face, and many, parts of the body, the pustules appearing large, and not much like the smallpox, for which he had been inoculated a year and a half before, and had then a very heavy burthen. The pustules on the face might arise from contact with his hands, as he had a habit of rubbing his forehead, where the sores were the largest and the thickest.

"The boy a.s.sociated with the farmer's sons during the continuance of the disease, neither of whom had had the smallpox, but they felt no ill effects whatever. He was not much indisposed, as the disease did not prevent him from following his occupations as usual. No other person attended the horse or milked the cow but the lad above mentioned. I am firmly of opinion that the disease in the heels of the horse, which was a virulent grease, was the origin of the servant's and the cow's malady."

But to return to the more immediate object of this proposition.

From the similarity of symptoms, both const.i.tutional and local, between the cow-pox and the disease received from morbid matter generated by a horse, the common people in this neighbourhood, when infected with this disease, through a strange perversion of terms, frequently call it the cow-pox. Let us suppose, then, such a malady to appear among some of the servants at a farm, and at the same time that the cow-pox were to break out among the cattle; and let us suppose, too, that some of the servants were infected in this way, and that others received the infection from the cows. It would be recorded at the farm, and among the servants themselves wherever they might afterwards be dispersed, that they had all had the cow-pox. But it is clear that an individual thus infected from the horse would neither be for a certainty secure himself, nor would he impart security to others were they inoculated by virus thus generated. He still would be in danger of taking the smallpox. Yet were this to happen before the nature of the cowpox be more maturely considered by the public my evidence on the subject might be depreciated unjustly.

For an exemplification of what is here advanced relative to the nature of the infection when received directly from the horse see Inquiry into the Causes and Effects of the Variolae Vaccinae, pp.

27, 28, 29, 30, and p. 35; and by way of further example, I beg leave to subjoin the following intelligence received from Mr.

Fewster, Surgeon, of Thornbury, in this county, a gentleman perfectly well acquainted with the appearances of the cow-pox on the human subject: