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+The Project Gutenberg eBook, An Inquiry into the Causes and Effects of the
+Variolae Vaccinae, by Edward Jenner
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: An Inquiry into the Causes and Effects of the Variolae Vaccinae
+       A Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of the Cow Pox
+
+
+Author: Edward Jenner
+
+
+
+Release Date: July 15, 2009  [eBook #29414]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+
+***START OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND
+EFFECTS OF THE VARIOLAE VACCINAE***
+
+
+E-text prepared by K. Nordquist, Michael Roe, Carl Hudkins, and the
+Project Gutenberg Online Distributed Proofreading Team
+(http://www.pgdp.net) from page images generously made available by the
+Posner Memorial Collection, Carnegie Mellon University Libraries
+(http://posner.library.cmu.edu/Posner/)
+
+
+
+Note: Project Gutenberg also has an HTML version of this
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+      See 29414-h.htm or 29414-h.zip:
+      (http://www.gutenberg.org/files/29414/29414-h/29414-h.htm)
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+      (http://www.gutenberg.org/files/29414/29414-h.zip)
+
+
+      Images of the original pages are available through
+      the Posner Memorial Collection, Carnegie Mellon
+      University Libraries. See
+      http://posner.library.cmu.edu/Posner/books/book.cgi?call=614.4_J54I_1798
+
+
+
+
+
+AN
+_INQUIRY_
+INTO
+THE CAUSES AND EFFECTS
+OF
+THE VARIOLÆ VACCINÆ.
+
+
+PRICE 7s. 6d.
+
+
+
+
+AN
+_INQUIRY_
+INTO
+THE CAUSES AND EFFECTS
+OF
+THE VARIOLÆ VACCINÆ,
+A DISEASE
+DISCOVERED IN SOME OF THE WESTERN COUNTIES OF ENGLAND,
+PARTICULARLY
+_GLOUCESTERSHIRE_,
+AND KNOWN BY THE NAME OF
+THE COW POX.
+
+
+BY EDWARD JENNER, M.D. F.R.S. &c.
+
+              ----QUID NOBIS CERTIUS IPSIS
+  SENSIBUS ESSE POTEST, QUO VERA AC FALSA NOTEMUS.
+
+                                        LUCRETIUS.
+
+London:
+PRINTED, FOR THE AUTHOR,
+BY SAMPSON LOW, Nº. 7, BERWICK STREET, SOHO:
+AND SOLD BY LAW, AVE-MARIA LANE; AND MURRAY AND HIGHLEY, FLEET STREET.
+
+1798.
+
+
+
+
+  TO
+  _C. H. PARRY, M.D._
+  AT BATH.
+
+
+  _My dear friend_,
+
+In the present age of scientific investigation, it is remarkable that
+a disease of so peculiar a nature as the Cow Pox, which has appeared
+in this and some of the neighbouring counties for such a series of
+years, should so long have escaped particular attention. Finding the
+prevailing notions on the subject, both among men of our profession
+and others, extremely vague and indeterminate, and conceiving that
+facts might appear at once both curious and useful, I have instituted
+as strict an inquiry into the causes and effects of this singular
+malady as local circumstances would admit.
+
+The following pages are the result, which, from motives of the most
+affectionate regard, are dedicated to you, by
+
+  Your sincere Friend,
+  EDWARD JENNER.
+
+  Berkeley, Gloucestershire,
+  June 21st, 1798.
+
+
+
+
+AN INQUIRY, _&c. &c._
+
+
+The deviation of Man from the state in which he was originally placed
+by Nature seems to have proved to him a prolific source of Diseases.
+From the love of splendour, from the indulgences of luxury, and from
+his fondness for amusement, he has familiarised himself with a great
+number of animals, which may not originally have been intended for
+his associates.
+
+The Wolf, disarmed of ferocity, is now pillowed in the lady's lap[1].
+The Cat, the little Tyger of our island, whose natural home is the
+forest, is equally domesticated and caressed. The Cow, the Hog, the
+Sheep, and the Horse, are all, for a variety of purposes, brought
+under his care and dominion.
+
+There is a disease to which the Horse, from his state of
+domestication, is frequently subject. The Farriers have termed it
+_the Grease_. It is an inflammation and swelling in the heel, from
+which issues matter possessing properties of a very peculiar kind,
+which seems capable of generating a disease in the Human Body (after
+it has undergone the modification which I shall presently speak of),
+which bears so strong a resemblance to the Small Pox, that I think it
+highly probable it may be the source of that disease.
+
+In this Dairy Country a great number of Cows are kept, and the office
+of milking is performed indiscriminately by Men and Maid Servants.
+One of the former having been appointed to apply dressings to the
+heels of a Horse affected with _the Grease_, and not paying due
+attention to cleanliness, incautiously bears his part in milking the
+Cows, with some particles of the infectious matter adhering to his
+fingers. When this is the case, it commonly happens that a disease is
+communicated to the Cows, and from the Cows to the Dairy-maids, which
+spreads through the farm until most of the cattle and domestics feel
+its unpleasant consequences. This disease has obtained the name of
+the Cow Pox. It appears on the nipples of the Cows in the form of
+irregular pustules. At their first appearance they are commonly of a
+palish blue, or rather of a colour somewhat approaching to livid, and
+are surrounded by an erysipelatous inflammation. These pustules,
+unless a timely remedy be applied, frequently degenerate into
+phagedenic ulcers, which prove extremely troublesome[2]. The animals
+become indisposed, and the secretion of milk is much lessened.
+Inflamed spots now begin to appear on different parts of the hands of
+the domestics employed in milking, and sometimes on the wrists, which
+quickly run on to suppuration, first assuming the appearance of the
+small vesications produced by a burn. Most commonly they appear about
+the joints of the fingers, and at their extremities; but whatever
+parts are affected, if the situation will admit, these superficial
+suppurations put on a circular form, with their edges more elevated
+than their centre, and of a colour distantly approaching to blue.
+Absorption takes place, and tumours appear in each axilla. The system
+becomes affected--the pulse is quickened; and shiverings succeeded by
+heat, with general lassitude and pains about the loins and limbs,
+with vomiting, come on. The head is painful, and the patient is now
+and then even affected with delirium. These symptoms, varying in
+their degrees of violence, generally continue from one day to three
+or four, leaving ulcerated sores about the hands, which, from the
+sensibility of the parts, are very troublesome, and commonly heal
+slowly, frequently becoming phagedenic, like those from whence they
+sprung. The lips, nostrils, eyelids, and other parts of the body, are
+sometimes affected with sores; but these evidently arise from their
+being heedlessly rubbed or scratched with the patient's infected
+fingers. No eruptions on the skin have followed the decline of the
+feverish symptoms in any instance that has come under my inspection,
+one only excepted, and in this case a very few appeared on the arms:
+they were very minute, of a vivid red colour, and soon died away
+without advancing to maturation; so that I cannot determine whether
+they had any connection with the preceding symptoms.
+
+Thus the disease makes its progress from the Horse to the nipple of
+the Cow, and from the Cow to the Human Subject.
+
+Morbid matter of various kinds, when absorbed into the system, may
+produce effects in some degree similar; but what renders the Cow-pox
+virus so extremely singular, is, that the person who has been thus
+affected is for ever after secure from the infection of the Small
+Pox; neither exposure to the variolous effluvia, nor the insertion of
+the matter into the skin, producing this distemper.
+
+In support of so extraordinary a fact, I shall lay before my Reader a
+great number of instances[3].
+
+[Footnote 1: The late Mr. John Hunter proved, by experiments, that
+the Dog is the Wolf in a degenerated state.]
+
+[Footnote 2: They who attend sick cattle in this country find a
+speedy remedy for stopping the progress of this complaint in those
+applications which act chemically upon the morbid matter, such as the
+solutions of the Vitriolum Zinci, the Vitriolum Cupri, &c.]
+
+[Footnote 3: It is necessary to observe, that pustulous sores
+frequently appear spontaneously on the nipples of Cows, and instances
+have occurred, though very rarely, of the hands of the servants
+employed in milking being affected with sores in consequence, and
+even of their feeling an indisposition from absorption. These
+pustules are of a much milder nature than those which arise from that
+contagion which constitutes the true Cow Pox. They are always free
+from the bluish or livid tint so conspicuous in the pustules in that
+disease. No erysipelas attends them, nor do they shew any phagedenic
+disposition as in the other case, but quickly terminate in a scab
+without creating any apparent disorder in the Cow. This complaint
+appears at various seasons of the year, but most commonly in the
+Spring, when the Cows are first taken from their winter food and fed
+with grass. It is very apt to appear also when they are suckling
+their young. But this disease is not to be considered as similar in
+any respect to that of which I am treating, as it is incapable of
+producing any specific effects on the human Constitution. However, it
+is of the greatest consequence to point it out here, lest the want of
+discrimination should occasion an idea of security from the infection
+of the Small Pox, which might prove delusive.]
+
+
+
+
+_CASE I._
+
+
+JOSEPH MERRET, now an Under Gardener to the Earl of Berkeley, lived
+as a Servant with a Farmer near this place in the year 1770, and
+occasionally assisted in milking his master's cows. Several horses
+belonging to the farm began to have sore heels, which Merret
+frequently attended. The cows soon became affected with the Cow Pox,
+and soon after several sores appeared on his hands. Swellings and
+stiffness in each axilla followed, and he was so much indisposed for
+several days as to be incapable of pursuing his ordinary employment.
+Previously to the appearance of the distemper among the cows there
+was no fresh cow brought into the farm, nor any servant employed who
+was affected with the Cow Pox.
+
+In April, 1795, a general inoculation taking place here, Merret was
+inoculated with his family; so that a period of twenty-five years had
+elapsed from his having the Cow Pox to this time. However, though the
+variolous matter was repeatedly inserted into his arm, I found it
+impracticable to infect him with it; an efflorescence only, taking on
+an erysipelatous look about the centre, appearing on the skin near
+the punctured parts. During the whole time that his family had the
+Small Pox, one of whom had it very full, he remained in the house
+with them, but received no injury from exposure to the contagion.
+
+It is necessary to observe, that the utmost care was taken to
+ascertain, with the most scrupulous precision, that no one whose case
+is here adduced had gone through the Small Pox previous to these
+attempts to produce that disease.
+
+Had these experiments been conducted in a large city, or in a
+populous neighbourhood, some doubts might have been entertained; but
+here, where population is thin, and where such an event as a person's
+having had the Small Pox is always faithfully recorded, no risk of
+inaccuracy in this particular can arise.
+
+
+
+
+_CASE II._
+
+
+SARAH PORTLOCK, of this place, was infected with the Cow Pox, when a
+Servant at a Farmer's in the neighbourhood, twenty-seven years
+ago[1].
+
+In the year 1792, conceiving herself, from this circumstance, secure
+from the infection of the Small Pox, she nursed one of her own
+children who had accidentally caught the disease, but no
+indisposition ensued.--During the time she remained in the infected
+room, variolous matter was inserted into both her arms, but without
+any further effect than in the preceding case.
+
+[Footnote 1: I have purposely selected several cases in which the
+disease had appeared at a very distant period previous to the
+experiments made with variolous matter, to shew that the change
+produced in the constitution is not affected by time.]
+
+
+
+
+_CASE III._
+
+
+JOHN PHILLIPS, a Tradesman of this town, had the Cow Pox at so early
+a period as nine years of age. At the age of sixty-two I inoculated
+him, and was very careful in selecting matter in its most active
+state. It was taken from the arm of a boy just before the
+commencement of the eruptive fever, and instantly inserted. It very
+speedily produced a sting-like feel in the part. An efflorescence
+appeared, which on the fourth day was rather extensive, and some
+degree of pain and stiffness were felt about the shoulder; but on the
+fifth day these symptoms began to disappear, and in a day or two
+after went entirely off, without producing any effect on the system.
+
+
+
+
+_CASE IV._
+
+
+MARY BARGE, of Woodford, in this parish, was inoculated with
+variolous matter in the year 1791. An efflorescence of a palish red
+colour soon appeared about the parts where the matter was inserted,
+and spread itself rather extensively, but died away in a few days
+without producing any variolous symptoms[1]. She has since been
+repeatedly employed as a nurse to Small-pox patients, without
+experiencing any ill consequences. This woman had the Cow Pox when
+she lived in the service of a Farmer in this parish thirty-one years
+before.
+
+[Footnote 1: It is remarkable that variolous matter, when the system
+is disposed to reject it, should excite inflammation on the part to
+which it is applied more speedily than when it produces the Small
+Pox. Indeed it becomes almost a criterion by which we can determine
+whether the infection will be received or not. It seems as if a
+change, which endures through life, had been produced in the action,
+or disposition to action, in the vessels of the skin; and it is
+remarkable too, that whether this change has been effected by the
+Small Pox, or the Cow Pox, that the disposition to sudden cuticular
+inflammation is the same on the application of variolous matter.]
+
+
+
+
+_CASE V._
+
+
+MRS. H----, a respectable Gentlewoman of this town, had the Cow Pox
+when very young. She received the infection in rather an uncommon
+manner: it was given by means of her handling some of the same
+utensils[1] which were in use among the servants of the family, who
+had the disease from milking infected cows. Her hands had many of the
+Cow-pox sores upon them, and they were communicated to her nose,
+which became inflamed and very much swoln. Soon after this event Mrs.
+H---- was exposed to the contagion of the Small Pox, where it was
+scarcely possible for her to have escaped, had she been susceptible
+of it, as she regularly attended a relative who had the disease in so
+violent a degree that it proved fatal to him.
+
+In the year 1778 the Small Pox prevailed very much at Berkeley, and
+Mrs. H---- not feeling perfectly satisfied respecting her safety (no
+indisposition having followed her exposure to the Small Pox) I
+inoculated her with active variolous matter. The same appearance
+followed as in the preceding cases--an efflorescence on the arm
+without any effect on the constitution.
+
+[Footnote 1: When the Cow Pox has prevailed in the dairy, it has
+often been communicated to those who have not milked the cows, by the
+handle of the milk pail.]
+
+
+
+
+_CASE VI._
+
+
+It is a fact so well known among our Dairy Farmers, that those who
+have had the Small Pox either escape the Cow Pox or are disposed to
+have it slightly; that as soon as the complaint shews itself among
+the cattle, assistants are procured, if possible, who are thus
+rendered less susceptible of it, otherwise the business of the farm
+could scarcely go forward.
+
+In the month of May, 1796, the Cow Pox broke out at Mr. Baker's, a
+Farmer who lives near this place. The disease was communicated by
+means of a cow which was purchased in an infected state at a
+neighbouring fair, and not one of the Farmer's cows (consisting of
+thirty) which were at that time milked escaped the contagion. The
+family consisted of a man servant, two dairymaids, and a servant boy,
+who, with the Farmer himself, were twice a day employed in milking
+the cattle. The whole of this family, except Sarah Wynne, one of the
+dairymaids, had gone through the Small Pox. The consequence was, that
+the Farmer and the servant boy escaped the infection of the Cow Pox
+entirely, and the servant man and one of the maid servants had each
+of them nothing more than a sore on one of their fingers, which
+produced no disorder in the system. But the other dairymaid, Sarah
+Wynne, who never had the Small Pox, did not escape in so easy a
+manner. She caught the complaint from the cows, and was affected with
+the symptoms described in the 5th page in so violent a degree, that
+she was confined to her bed, and rendered incapable for several days
+of pursuing her ordinary vocations in the farm.
+
+March 28th, 1797, I inoculated this girl, and carefully rubbed the
+variolous matter into two slight incisions made upon the left arm. A
+little inflammation appeared in the usual manner around the parts
+where the matter was inserted, but so early as the fifth day it
+vanished entirely without producing any effect on the system.
+
+
+
+
+_CASE VII._
+
+
+Although the preceding history pretty clearly evinces that the
+constitution is far less susceptible of the contagion of the Cow Pox
+after it has felt that of the Small Pox, and although in general, as
+I have observed, they who have had the Small Pox, and are employed in
+milking cows which are infected with the Cow Pox, either escape the
+disorder, or have sores on the hands without feeling any general
+indisposition, yet the animal economy is subject to some variation in
+this respect, which the following relation will point out:
+
+In the summer of the year 1796 the Cow Pox appeared at the Farm of
+Mr. Andrews, a considerable dairy adjoining to the town of Berkeley.
+It was communicated, as in the preceding instance, by an infected cow
+purchased at a fair in the neighbourhood. The family consisted of the
+Farmer, his wife, two sons, a man and a maid servant; all of whom,
+except the Farmer (who was fearful of the consequences), bore a part
+in milking the cows. The whole of them, exclusive of the man servant,
+had regularly gone through the Small Pox; but in this case no one who
+milked the cows escaped the contagion. All of them had sores upon
+their hands, and some degree of general indisposition, preceded by
+pains and tumours in the axillæ: but there was no comparison in the
+severity of the disease as it was felt by the servant man, who had
+escaped the Small Pox, and by those of the family who had not, for,
+while he was confined to his bed, they were able, without much
+inconvenience, to follow their ordinary business.
+
+February the 13th, 1797, I availed myself of an opportunity of
+inoculating William Rodway, the servant man above alluded to.
+Variolous matter was inserted into both his arms; in the right by
+means of superficial incisions, and into the left by slight punctures
+into the cutis. Both were perceptibly inflamed on the third day.
+After this the inflammation about the punctures soon died away, but a
+small appearance of erysipelas was manifest about the edges of the
+incisions till the eighth day, when a little uneasiness was felt for
+the space of half an hour in the right axilla. The inflammation then
+hastily disappeared without producing the most distant mark of
+affection of the system.
+
+
+
+
+_CASE VIII._
+
+
+ELIZABETH WYNNE, aged fifty-seven, lived as a servant with a
+neighbouring Farmer thirty-eight years ago. She was then a dairymaid,
+and the Cow Pox broke out among the cows. She caught the disease with
+the rest of the family, but, compared with them, had it in a very
+slight degree, one very small sore only breaking out on the little
+finger of her left hand, and scarcely any perceptible indisposition
+following it.
+
+As the malady had shewn itself in so slight a manner, and as it had
+taken place at so distant a period of her life, I was happy with the
+opportunity of trying the effects of variolous matter upon her
+constitution, and on the 28th of March, 1797, I inoculated her by
+making two superficial incisions on the left arm, on which the matter
+was cautiously rubbed. A little efflorescence soon appeared, and a
+tingling sensation was felt about the parts where the matter was
+inserted until the third day, when both began to subside, and so
+early as the fifth day it was evident that no indisposition would
+follow.
+
+
+
+
+_CASE IX._
+
+
+Although the Cow Pox shields the constitution from the Small Pox, and
+the Small Pox proves a protection against its own future poison, yet
+it appears that the human body is again and again susceptible of the
+infectious matter of the Cow Pox, as the following history will
+demonstrate:
+
+William Smith, of Pyrton in this parish, contracted this disease when
+he lived with a neighbouring Farmer in the year 1780. One of the
+horses belonging to the farm had sore heels, and it fell to his lot
+to attend him. By these means the infection was carried to the cows,
+and from the cows it was communicated to Smith. On one of his hands
+were several ulcerated sores, and he was affected with such symptoms
+as have been before described.
+
+In the year 1791 the Cow Pox broke out at another farm where he then
+lived as a servant, and he became affected with it a second time; and
+in the year 1794 he was so unfortunate as to catch it again. The
+disease was equally as severe the second and third time as it was on
+the first[1].
+
+In the spring of the year 1795 he was twice inoculated, but no
+affection of the system could be produced from the variolous matter;
+and he has since associated with those who had the Small Pox in its
+most contagious state without feeling any effect from it.
+
+[Footnote 1: This is not the case in general--a second attack is
+commonly very slight, and so, I am informed, it is among the cows.]
+
+
+
+
+_CASE X._
+
+
+SIMON NICHOLS lived as a servant with Mr. Bromedge, a gentleman who
+resides on his own farm in this parish, in the year 1782. He was
+employed in applying dressings to the sore heels of one of his
+master's horses, and at the same time assisted in milking the cows.
+The cows became affected in consequence, but the disease did not shew
+itself on their nipples till several weeks after he had begun to
+dress the horse. He quitted Mr. Bromedge's service, and went to
+another farm without any sores upon him; but here his hands soon
+began to be affected in the common way, and he was much indisposed
+with the usual symptoms. Concealing the nature of the malady from Mr.
+Cole, his new master, and being there also employed in milking, the
+Cow Pox was communicated to the cows.
+
+Some years afterwards Nichols was employed in a farm where the Small
+Pox broke out, when I inoculated him with several other patients,
+with whom he continued during the whole time of their confinement.
+His arm inflamed, but neither the inflammation nor his associating
+with the inoculated family produced the least effect upon his
+constitution.
+
+
+
+
+_CASE XI._
+
+
+WILLIAM STINCHCOMB was a fellow servant with Nichols at Mr.
+Bromedge's Farm at the time the cattle had the Cow Pox, and he was
+unfortunately infected by them. His left hand was very severely
+affected with several corroding ulcers, and a tumour of considerable
+size appeared in the axilla of that side. His right hand had only one
+small sore upon it, and no tumour discovered itself in the
+corresponding axilla.
+
+In the year 1792 Stinchcomb was inoculated with variolous matter, but
+no consequences ensued beyond a little inflammation in the arm for a
+few days. A large party were inoculated at the same time, some of
+whom had the disease in a more violent degree than is commonly seen
+from inoculation. He purposely associated with them, but could not
+receive the Small Pox.
+
+During the sickening of some of his companions, their symptoms so
+strongly recalled to his mind his own state when sickening with the
+Cow Pox, that he very pertinently remarked their striking similarity.
+
+
+
+
+_CASE XII._
+
+
+The Paupers of the village of Tortworth, in this county, were
+inoculated by Mr. Henry Jenner, Surgeon, of Berkeley, in the year
+1795. Among them, eight patients presented themselves who had at
+different periods of their lives had the Cow Pox. One of them, Hester
+Walkley, I attended with that disease when she lived in the service
+of a Farmer in the same village in the year 1782; but neither this
+woman, nor any other of the patients who had gone through the Cow
+Pox, received the variolous infection either from the arm or from
+mixing in the society of the other patients who were inoculated at
+the same time. This state of security proved a fortunate
+circumstance, as many of the poor women were at the same time in a
+state of pregnancy.
+
+
+
+
+_CASE XIII._
+
+
+One instance has occurred to me of the system being affected from the
+matter issuing from the heels of horses, and of its remaining
+afterwards unsusceptible of the variolous contagion; another, where
+the Small Pox appeared obscurely; and a third, in which its complete
+existence was positively ascertained.
+
+First, THOMAS PEARCE, is the son of a Smith and Farrier near to this
+place. He never had the Cow Pox; but, in consequence of dressing
+horses with sore heels at his father's, when a lad, he had sores on
+his fingers which suppurated, and which occasioned a pretty severe
+indisposition. Six years afterwards I inserted variolous matter into
+his arm repeatedly, without being able to produce any thing more than
+slight inflammation, which appeared very soon after the matter was
+applied, and afterwards I exposed him to the contagion of the Small
+Pox with as little effect[1].
+
+[Footnote 1: It is a remarkable fact, and well known to many, that we
+are frequently foiled in our endeavours to communicate the Small Pox
+by inoculation to blacksmiths, who in the country are farriers. They
+often, as in the above instance, either resist the contagion
+entirely, or have the disease anomalously. Shall we not be able now
+to account for this on a rational principle?]
+
+
+
+
+_CASE XIV._
+
+
+Secondly, Mr. JAMES COLE, a Farmer in this parish, had a disease from
+the same source as related in the preceding case, and some years
+after was inoculated with variolous matter. He had a little pain in
+the axilla, and felt a slight indisposition for three or four hours.
+A few eruptions shewed themselves on the forehead, but they very soon
+disappeared without advancing to maturation.
+
+
+
+
+_CASE XV._
+
+
+Although in the two former instances the system seemed to be secured,
+or nearly so, from variolous infection, by the absorption of matter
+from sores produced by the diseased heels of horses, yet the
+following case decisively proves that this cannot be entirely relied
+upon, until a disease has been generated by the morbid matter from
+the horse on the nipple of the cow, and passed through that medium to
+the human subject.
+
+Mr. ABRAHAM RIDDIFORD, a Farmer at Stone in this parish, in
+consequence of dressing a mare that had sore heels, was affected with
+very painful sores in both his hands, tumours in each axilla, and
+severe and general indisposition. A Surgeon in the neighbourhood
+attended him, who, knowing the similarity between the appearance of
+the sores upon his hands and those produced by the Cow Pox, and being
+acquainted also with the effects of that disease on the human
+constitution, assured him that he never need to fear the infection of
+the Small Pox; but this assertion proved fallacious, for, on being
+exposed to the infection upwards of twenty years afterwards, he
+caught the disease, which took its regular course in a very mild way.
+There certainly was a difference perceptible, although it is not easy
+to describe it, in the general appearance of the pustules from that
+which we commonly see. Other practitioners, who visited the patient
+at my request, agreed with me in this point, though there was no room
+left for suspicion as to the reality of the disease, as I inoculated
+some of his family from the pustules, who had the Small Pox, with its
+usual appearances, in consequence.
+
+
+
+
+_CASE XVI._
+
+
+SARAH NELMES, a dairymaid at a Farmer's near this place, was infected
+with the Cow Pox from her master's cows in May, 1796. She received
+the infection on a part of the hand which had been previously in a
+slight degree injured by a scratch from a thorn. A large pustulous
+sore and the usual symptoms accompanying the disease were produced in
+consequence. The pustule was so expressive of the true character of
+the Cow Pox, as it commonly appears upon the hand, that I have given
+a representation of it in the annexed plate. The two small pustules
+on the wrists arose also from the application of the virus to some
+minute abrasions of the cuticle, but the livid tint, if they ever had
+any, was not conspicuous at the time I saw the patient. The pustule
+on the fore finger shews the disease in an earlier stage. It did not
+actually appear on the hand of this young woman, but was taken from
+that of another, and is annexed for the purpose of representing the
+malady after it has newly appeared.
+
+
+
+
+_CASE XVII._
+
+
+The more accurately to observe the progress of the infection, I
+selected a healthy boy, about eight years old, for the purpose of
+inoculation for the Cow Pox. The matter was taken from a sore on the
+hand of a dairymaid[1], who was infected by her master's cows, and it
+was inserted, on the 14th of May, 1796, into the arm of the boy by
+means of two superficial incisions, barely penetrating the cutis,
+each about half an inch long.
+
+[Illustration]
+
+On the seventh day he complained of uneasiness in the axilla, and on
+the ninth he became a little chilly, lost his appetite, and had a
+slight head-ach. During the whole of this day he was perceptibly
+indisposed, and spent the night with some degree of restlessness, but
+on the day following he was perfectly well.
+
+The appearance of the incisions in their progress to a state of
+maturation were much the same as when produced in a similar manner by
+variolous matter. The only difference which I perceived was, in the
+state of the limpid fluid arising from the action of the virus, which
+assumed rather a darker hue, and in that of the efflorescence
+spreading round the incisions, which had more of an erysipelatous
+look than we commonly perceive when variolous matter has been made
+use of in the same manner; but the whole died away (leaving on the
+inoculated parts scabs and subsequent eschars) without giving me or
+my patient the least trouble.
+
+In order to ascertain whether the boy, after feeling so slight an
+affection of the system from the Cow-pox virus, was secure from the
+contagion of the Small-pox, he was inoculated the 1st of July
+following with variolous matter, immediately taken from a pustule.
+Several slight punctures and incisions were made on both his arms,
+and the matter was carefully inserted, but no disease followed. The
+same appearances were observable on the arms as we commonly see when
+a patient has had variolous matter applied, after having either the
+Cow-pox or the Small-pox. Several months afterwards, he was again
+inoculated with variolous matter, but no sensible effect was produced
+on the constitution.
+
+Here my researches were interrupted till the spring of the year 1798,
+when from the wetness of the early part of the season, many of the
+farmers' horses in this neighbourhood were affected with sore heels,
+in consequence of which the Cow-pox broke out among several of our
+dairies, which afforded me an opportunity of making further
+observations upon this curious disease.
+
+A mare, the property of a person who keeps a dairy in a neighbouring
+parish, began to have sore heels the latter end of the month of
+February 1798, which were occasionally washed by the servant men of
+the farm, Thomas Virgoe, William Wherret, and William Haynes, who in
+consequence became affected with sores in their hands, followed by
+inflamed lymphatic glands in the arms and axillæ, shiverings
+succeeded by heat, lassitude and general pains in the limbs. A single
+paroxysm terminated the disease; for within twenty-four hours they
+were free from general indisposition, nothing remaining but the sores
+on their hands. Haynes and Virgoe, who had gone through the Small-pox
+from inoculation, described their feelings as very similar to those
+which affected them on sickening with that malady. Wherret never had
+had the Small-pox. Haynes was daily employed as one of the milkers at
+the farm, and the disease began to shew itself among the cows about
+ten days after he first assisted in washing the mare's heels. Their
+nipples became sore in the usual way, with blueish pustules; but as
+remedies were early applied they did not ulcerate to any extent.
+
+[Footnote 1: From the sore on the hand of Sarah Nelmes.--See the
+preceding case and the plate.]
+
+
+
+
+_CASE XVIII._
+
+
+JOHN BAKER, a child of five years old, was inoculated March 16, 1798,
+with matter taken from a pustule on the hand of Thomas Virgoe, one of
+the servants who had been infected from the mare's heels. He became
+ill on the 6th day with symptoms similar to those excited by Cow-pox
+matter. On the 8th day he was free from indisposition.
+
+There was some variation in the appearance of the pustule on the arm.
+Although it somewhat resembled a Small-pox pustule, yet its
+similitude was not so conspicuous as when excited by matter from the
+nipple of the cow, or when the matter has passed from thence through
+the medium of the human subject.--(See Plate, No. 2.)
+
+[Illustration]
+
+This experiment was made to ascertain the progress and subsequent
+effects of the disease when thus propagated. We have seen that the
+virus from the horse, when it proves infectious to the human subject
+is not to be relied upon as rendering the system secure from
+variolous infection, but that the matter produced by it upon the
+nipple of the cow is perfectly so. Whether its passing from the horse
+through the human constitution, as in the present instance, will
+produce a similar effect, remains to be decided. This would now have
+been effected, but the boy was rendered unfit for inoculation from
+having felt the effects of a contagious fever in a work-house, soon
+after this experiment was made.
+
+
+
+
+_CASE XIX._
+
+
+WILLIAM SUMMERS, a child of five years and a half old was inoculated
+the same day with Baker, with matter taken from the nipples of one of
+the infected cows, at the farm alluded to in page 35. He became
+indisposed on the 6th day, vomited once, and felt the usual slight
+symptoms till the 8th day, when he appeared perfectly well. The
+progress of the pustule, formed by the infection of the virus was
+similar to that noticed in Case XVII., with this exception, its being
+free from the livid tint observed in that instance.
+
+
+
+
+_CASE XX._
+
+
+From William Summers the disease was transfered to William Pead a boy
+of eight years old, who was inoculated March 28th. On the 6th day he
+complained of pain in the axilla, and on the 7th was affected with
+the common symptoms of a patient sickening with the Small-pox from
+inoculation, which did not terminate 'till the 3d day after the
+seizure. So perfect was the similarity to the variolous fever that I
+was induced to examine the skin, conceiving there might have been
+some eruptions, but none appeared. The efflorescent blush around the
+part punctured in the boy's arm was so truly characteristic of that
+which appears on variolous inoculation, that I have given a
+representation of it. The drawing was made when the pustule was
+beginning to die away, and the areola retiring from the centre. (See
+Plate, No. 3.)
+
+[Illustration]
+
+
+
+
+_CASE XXI._
+
+
+April 5th. Several children and adults were inoculated from the arm
+of William Pead. The greater part of them sickened on the 6th day,
+and were well on the 7th, but in three of the number a secondary
+indisposition arose in consequence of an extensive erysipelatous
+inflammation which appeared on the inoculated arms. It seemed to
+arise from the state of the pustule, which spread out, accompanied
+with some degree of pain, to about half the diameter of a six-pence.
+One of these patients was an infant of half a year old. By the
+application of mercurial ointment to the inflamed parts (a treatment
+recommended under similar circumstances in the inoculated Small-pox)
+the complaint subsided without giving much trouble.
+
+HANNAH EXCELL an healthy girl of seven years old, and one of the
+patients above mentioned, received the infection from the insertion
+of the virus under the cuticle of the arm in three distinct points.
+The pustules which arose in consequence, so much resembled, on the
+12th day, those appearing from the insertion of variolous matter,
+that an experienced Inoculator would scarcely have discovered a shade
+of difference at that period. Experience now tells me that almost the
+only variation which follows consists in the pustulous fluids
+remaining limpid nearly to the time of its total disappearance; and
+not, as in the direct Small-pox, becoming purulent.--(See Plate, No.
+4.)
+
+
+
+
+_CASE XXII._
+
+
+From the arm of this girl matter was taken and inserted April 12th
+into the arms of John Marklove one year and a half old,
+
+  Robert F. Jenner, eleven months old,
+  Mary Pead, 5 years old, and
+  Mary James, 6 years old.
+
+[Illustration]
+
+Among these Robert F. Jenner did not receive the infection. The arms
+of the other three inflamed properly and began to affect the system
+in the usual manner; but being under some apprehensions from the
+preceding Cases that a troublesome erysipelas might arise, I
+determined on making an experiment with the view of cutting off its
+source. Accordingly after the patients had felt an indisposition of
+about twelve hours, I applied in two of these Cases out of the three,
+on the vesicle formed by the virus, a little mild caustic, composed
+of equal parts of quick-lime and soap, and suffered it to remain on
+the part six hours[1]. It seemed to give the children but little
+uneasiness, and effectually answered my intention in preventing the
+appearance of erysipelas. Indeed it seemed to do more, for in half an
+hour after its application, the indisposition of the children
+ceased[2]. These precautions were perhaps unnecessary as the arm of
+the third child, Mary Pead, which was suffered to take its common
+course, scabbed quickly, without any erysipelas.
+
+[Footnote 1: Perhaps a few touches with the lapis septicus would have
+proved equally efficacious.]
+
+[Footnote 2: What effect would a similar treatment produce in
+inoculation for the Small-pox?]
+
+
+
+
+_CASE XXIII._
+
+
+From this child's arm matter was taken and transferred to that of J.
+Barge, a boy of seven years old. He sickened on the 8th day, went
+through the disease with the usual slight symptoms, and without any
+inflammation on the arm beyond the common efflorescence surrounding
+the pustule, an appearance so often seen in inoculated Small-pox.
+
+After the many fruitless attempts to give the Small-pox to those who
+had had the Cow-pox, it did not appear necessary, nor was it
+convenient to me, to inoculate the whole of those who had been the
+subjects of these late trials; yet I thought it right to see the
+effects of variolous matter on some of them, particularly William
+Summers, the first of these patients who had been infected with
+matter taken from the cow. He was therefore inoculated with variolous
+matter from a fresh pustule; but, as in the preceding Cases, the
+system did not feel the effects of it in the smallest degree. I had
+an opportunity also of having this boy and William Pead inoculated by
+my Nephew, Mr. Henry Jenner, whose report to me is as follows: "I
+have inoculated Pead and Barge, two of the boys whom you lately
+infected with the Cow-pox. On the 2d day the incisions were inflamed
+and there was a pale inflammatory stain around them. On the 3d day
+these appearances were still increasing and their arms itched
+considerably. On the 4th day, the inflammation was evidently
+subsiding, and on the 6th it was scarcely perceptible. No symptom of
+indisposition followed.
+
+To convince myself that the variolous matter made use of was in a
+perfect state, I at the same time inoculated a patient with some of
+it who never had gone through the Cow-pox, and it produced the
+Small-pox in the usual regular manner."
+
+These experiments afforded me much satisfaction, they proved that the
+matter in passing from one human subject to another, through five
+gradations, lost none of its original properties, J. Barge being the
+fifth who received the infection successively from William Summers,
+the boy to whom it was communicated from the cow.
+
+     *     *     *     *     *
+
+I shall now conclude this Inquiry with some general observations on
+the subject and on some others which are interwoven with it.
+
+Although I presume it may be unnecessary to produce further testimony
+in support of my assertion "that the Cow-pox protects the human
+constitution from the infection of the Small-pox," yet it affords me
+considerable satisfaction to say, that Lord Somerville, the President
+of the Board of Agriculture, to whom this paper was shewn by Sir
+Joseph Banks, has found upon inquiry that the statements were
+confirmed by the concuring testimony of Mr. Dolland, a surgeon, who
+resides in a dairy country remote from this, in which these
+observations were made. With respect to the opinion adduced "that the
+source of the infection is a peculiar morbid matter arising in the
+horse," although I have not been able to prove it from actual
+experiments conducted immediately under my own eye, yet the evidence
+I have adduced appears sufficient to establish it.
+
+They who are not in the habit of conducting experiments may not be
+aware of the coincidence of circumstances necessary for their being
+managed so as to prove perfectly decisive; nor how often men engaged
+in professional pursuits are liable to interruptions which disappoint
+them almost at the instant of their being accomplished: however, I
+feel no room for hesitation respecting the common origin of the
+disease, being well convinced that it never appears among the cows
+(except it can be traced to a cow introduced among the general herd
+which has been previously infected, or to an infected servant),
+unless they have been milked by some one who, at the same time, has
+the care of a horse affected with diseased heels.
+
+The spring of the year 1797, which I intended particularly to have
+devoted to the completion of this investigation, proved, from its
+dryness, remarkably adverse to my wishes; for it frequently happens,
+while the farmers' horses are exposed to the cold rains which fall at
+that season that their heels become diseased, and no Cow-pox then
+appeared in the neighbourhood.
+
+The active quality of the virus from the horses' heels is greatly
+increased after it has acted on the nipples of the cow, as it rarely
+happens that the horse affects his dresser with sores, and as rarely
+that a milk-maid escapes the infection when she milks infected cows.
+It is most active at the commencement of the disease, even before it
+has acquired a pus-like appearance; indeed I am not confident whether
+this property in the matter does not entirely cease as soon as it is
+secreted in the form of pus. I am induced to think it does cease[1],
+and that it is the thin darkish-looking fluid only, oozing from the
+newly-formed cracks in the heels, similar to what sometimes appears
+from erysipelatous blisters, which gives the disease. Nor am I
+certain that the nipples of the cows are at all times in a state to
+receive the infection. The appearance of the disease in the spring
+and the early part of the summer, when they are disposed to be
+affected with spontaneous eruptions so much more frequently than at
+other seasons, induces me to think, that the virus from the horse
+must be received upon them when they are in this state, in order to
+produce effects: experiments, however, must determine these points.
+But it is clear that when the Cow-pox virus is once generated, that
+the cows cannot resist the contagion, in whatever state their nipples
+may chance to be, if they are milked with an infected hand.
+
+Whether the matter, either from the cow or the horse will affect the
+sound skin of the human body, I cannot positively determine; probably
+it will not, unless on those parts where the cuticle is extremely
+thin, as on the lips for example. I have known an instance of a poor
+girl who produced an ulceration on her lip by frequently holding her
+finger to her mouth to cool the raging of a Cow-pox sore by blowing
+upon it. The hands of the farmers' servants here, from the nature of
+their employments, are constantly exposed to those injuries which
+occasion abrasions of the cuticle, to punctures from thorns and such
+like accidents; so that they are always in a state to feel the
+consequences of exposure to infectious matter.
+
+It is singular to observe that the Cow-pox virus, although it renders
+the constitution unsusceptible of the variolous, should,
+nevertheless, leave it unchanged with respect to its own action. I
+have already produced an instance[2] to point out this, and shall now
+corroborate it with another.
+
+Elizabeth Wynne, who had the Cow-pox in the year 1759, was inoculated
+with variolous matter, without effect, in the year 1797, and again
+caught the Cow-pox in the year 1798. When I saw her, which was on the
+8th day after she received the infection, I found her affected with
+general lassitude, shiverings, alternating with heat, coldness of the
+extremities, and a quick and irregular pulse. These symptoms were
+preceded by a pain in the axilla. On her hand was one large pustulous
+sore, which resembled that delinated in Plate No. 1.
+
+It is curious also to observe, that the virus, which with respect to
+its effects is undetermined and uncertain previously to its passing
+from the horse through the medium of the cow, should then not only
+become more active, but should invariably and completely possess
+those specific properties which induce in the human constitution
+symptoms similar to those of the variolous fever, and effect in it
+that peculiar change which for ever renders it unsusceptible of the
+variolous contagion.
+
+May it not, then, be reasonably conjectured, that the source of the
+Small-pox is morbid matter of a peculiar kind, generated by a disease
+in the horse, and that accidental circumstances may have again and
+again arisen, still working new changes upon it, until it has
+acquired the contagious and malignant form under which we now
+commonly see it making its devastations amongst us? And, from a
+consideration of the change which the infectious matter undergoes
+from producing a disease on the cow, may we not conceive that many
+contagious diseases, now prevalent among us, may owe their present
+appearance not to a simple, but to a compound origin? For example, is
+it difficult to imagine that the measles, the scarlet fever, and the
+ulcerous sore throat with a spotted skin, have all sprung from the
+same source, assuming some variety in their forms according to the
+nature of their new combinations? The same question will apply
+respecting the origin of many other contagious diseases, which bear a
+strong analogy to each other.
+
+There are certainly more forms than one, without considering the
+common variation between the confluent and distinct, in which the
+Small-pox appears in what is called the natural way.--About seven
+years ago a species of Small-pox spread through many of the towns and
+villages of this part of Gloucestershire: it was of so mild a nature,
+that a fatal instance was scarcely ever heard of, and consequently so
+little dreaded by the lower orders of the community, that they
+scrupled not to hold the same intercourse with each other as if no
+infectious disease had been present among them. I never saw nor heard
+of an instance of its being confluent. The most accurate manner,
+perhaps, in which I can convey an idea of it is, by saying, that had
+fifty individuals been taken promiscuously and infected by exposure
+to this contagion, they would have had as mild and light a disease as
+if they had been inoculated with variolous matter in the usual way.
+The harmless manner in which it shewed itself could not arise from
+any peculiarity either in the season or the weather, for I watched
+its progress upwards of a year without perceiving any variation in
+its general appearance. I consider it then as a _variety_ of the
+Small-pox[3].
+
+In some of the preceding cases I have noticed the attention that was
+paid to the state of the variolous matter previous to the experiment
+of inserting it into the arms of those who had gone through the
+Cow-pox. This I conceived to be of great importance in conducting
+these experiments, and were it always properly attended to by those
+who inoculate for the Small-pox, it might prevent much subsequent
+mischief and confusion. With the view of enforcing so necessary a
+precaution, I shall take the liberty of digressing so far as to point
+out some unpleasant facts, relative to mismanagement in this
+particular, which have fallen under my own observation.
+
+A Medical Gentleman (now no more), who for many years inoculated in
+this neighbourhood, frequently preserved the variolous matter
+intended for his use, on a piece of lint or cotton, which, in its
+fluid state was put into a vial, corked, and conveyed into a warm
+pocket; a situation certainly favourable for speedily producing
+putrefaction in it. In this state (not unfrequently after it had been
+taken several days from the pustules) it was inserted into the arms
+of his patients, and brought on inflammation of the incised parts,
+swellings of the axillary glands, fever, and sometimes eruptions. But
+what was this disease? Certainly not the Small-pox; for the matter
+having from putrefaction lost, or suffered a derangement in its
+specific properties, was no longer capable of producing that malady,
+those who had been inoculated in this manner being as much subject to
+the contagion of the Small-pox, as if they had never been under the
+influence of this artificial disease; and many, unfortunately, fell
+victims to it, who thought themselves in perfect security. The same
+unfortunate circumstance of giving a disease, supposed to be the
+Small-pox, with inefficaceous variolous matter, having occurred under
+the direction of some other practitioners within my knowledge, and
+probably from the same incautious method of securing the variolous
+matter, I avail myself of this opportunity of mentioning what I
+conceive to be of great importance; and, as a further cautionary
+hint, I shall again digress so far as to add another observation on
+the subject of Inoculation.
+
+Whether it be yet ascertained by experiment, that the quantity of
+variolous matter inserted into the skin makes any difference with
+respect to the subsequent mildness or violence of the disease, I know
+not; but I have the strongest reason for supposing that is either the
+punctures or incisions be made so deep as to go _through_ it, and
+wound the adipose membrane, that the risk of bringing on a violent
+disease is greatly increased. I have known an inoculator, whose
+practice was "to cut deep enough (to use his own expression) to see a
+bit of fat," and there to lodge the matter. The great number of bad
+Cases, independent of inflammations and abscesses on the arms, and
+the fatality which attended this practice was almost inconceivable;
+and I cannot account for it on any other principle than that of the
+matter being placed in this situation instead of the skin.
+
+It was the practice of another, whom I well remember, to pinch up a
+small portion of the skin on the arms of his patients and to pass
+through it a needle, with a thread attached to it previously dipped
+in variolous matter. The thread was lodged in the perforated part,
+and consequently left in contact with the cellular membrane. This
+practice was attended with the same ill success as the former.
+Although it is very improbable that any one would now inoculate in
+this rude way by design, yet these observations may tend to place a
+double guard over the lancet, when infants, whose skins are
+comparatively so very thin, fall under the care of the inoculator.
+
+A very respectable friend of mine, Dr. Hardwicke, of Sodbury in this
+county, inoculated great numbers of patients previous to the
+introduction of the more modern method by Sutton, and with such
+success, that a fatal instance occurred as rarely as since that
+method has been adopted. It was the doctor's practice to make as
+slight an incision as possible _upon_ the skin, and there to lodge a
+thread saturated with the variolous matter. When his patients became
+indisposed, agreeably to the custom then prevailing, they were
+directed to go to bed and were kept moderately warm. Is it not
+probable then, that the success of the modern practice may depend
+more upon the method of invariably depositing the virus in or upon
+the skin, than on the subsequent treatment of the disease?
+
+I do not mean to insinuate that exposure to cool air, and suffering
+the patient to drink cold water when hot and thirsty, may not
+moderate the eruptive symptoms and lessen the number of pustules;
+yet, to repeat my former observation, I cannot account for the
+uninterrupted success, or nearly so, of one practitioner, and the
+wretched state of the patients under the care of another, where, in
+both instances, the general treatment did not differ essentially,
+without conceiving it to arise from the different modes of inserting
+the matter for the purpose of producing the disease. As it is not the
+identical matter inserted which is absorbed into the constitution,
+but that which is, by some peculiar process in the animal economy,
+generated by it, is it not probable that different parts of the human
+body may prepare or modify the virus differently? Although the skin,
+for example, adipose membrane, or mucous membranes are all capable of
+producing the variolous virus by the stimulus given by the particles
+originally deposited upon them, yet I am induced to conceive that
+each of these parts is capable of producing some variation in the
+qualities of the matter previous to its affecting the constitution.
+What else can constitute the difference between the Small-pox when
+communicated casually or in what has been termed the natural way, or
+when brought on artificially through the medium of the skin? After
+all, are the variolous particles, possessing their true specific and
+contagious principles, ever taken up and conveyed by the lymphatics
+unchanged into the blood vessels? I imagine not. Were this the case,
+should we not find the blood sufficiently loaded with them in some
+stages of the Small-pox to communicate the disease by inserting it
+under the cuticle, or by spreading it on the surface of an ulcer? Yet
+experiments have determined the impracticability of its being given
+in this way; although it has been proved that variolous matter when
+much diluted with water, and applied to the skin in the usual manner,
+will produce the disease. But it would be digressing beyond a proper
+boundary, to go minutely into this subject here.
+
+At what period the Cow-pox was first noticed here is not upon record.
+Our oldest farmers were not unacquainted with it in their earliest
+days, when it appeared among their farms without any deviation from
+the phænomena which it now exhibits. Its connection with the
+Small-pox seems to have been unknown to them. Probably the general
+introduction of inoculation first occasioned the discovery.
+
+Its rise in this country may not have been of very remote date, as
+the practice of milking cows might formerly have been in the hands of
+women only; which I believe is the case now in some other dairy
+countries, and, consequently that the cows might not in former times
+have been exposed to the contagious matter brought by the men
+servants from the heels of horses[4]. Indeed a knowledge of the
+source of the infection is new in the minds of most of the farmers in
+this neighbourhood, but it has at length produced good consequences;
+and it seems probable from the precautions they are now disposed to
+adopt, that the appearance of the Cow-pox here may either be entirely
+extinguished or become extremely rare.
+
+Should it be asked whether this investigation is a matter of mere
+curiosity, or whether it tends to any beneficial purpose? I should
+answer, that notwithstanding the happy effects of Inoculation, with
+all the improvements which the practice has received since its first
+introduction into this country, it not very unfrequently produces
+deformity of the skin, and sometimes, under the best management,
+proves fatal.
+
+These circumstances must naturally create in every instance some
+degree of painful solicitude for its consequences. But as I have
+never known fatal effects arise from the Cow-pox, even when impressed
+in the most unfavourable manner, producing extensive inflammations
+and suppurations on the hands; and as it clearly appears that this
+disease leaves the constitution in a state of perfect security from
+the infection of the Small-pox, may we not infer that a mode of
+Inoculation may be introduced preferable to that at present adopted,
+especially among those families, which, from previous circumstances
+we may judge to be predisposed to have the disease unfavourably? It
+is an excess in the number of pustules which we chiefly dread in the
+Small-pox; but, in the Cow-pox, no pustules appear, nor does it seem
+possible for the contagious matter to produce the disease from
+effluvia, or by any other means than contact, and that probably not
+simply between the virus and the cuticle; so that a single individual
+in a family might at any time receive it without the risk of
+infecting the rest, or of spreading a distemper that fills a country
+with terror. Several instances have come under my observation which
+justify the assertion that the disease cannot be propagated by
+effluvia. The first boy whom I inoculated with the matter of Cow-pox,
+slept in a bed, while the experiment was going forward, with two
+children who never had gone through either that disease or the
+Small-pox, without infecting either of them.
+
+A young woman who had the Cow-pox to a great extent, several sores
+which maturated having appeared on the hands and wrists, slept in the
+same bed with a fellow-dairy maid who never had been infected with
+either the Cow-pox or the Small-pox, but no indisposition followed.
+
+Another instance has occurred of a young woman on whose hands were
+several large suppurations from the Cow-pox, who was at the same time
+a daily nurse to an infant, but the complaint was not communicated to
+the child.
+
+In some other points of view, the inoculation of this disease appears
+preferable to the variolous inoculation.
+
+In constitutions predisposed to scrophula, how frequently we see the
+inoculated Small-pox, rouse into activity that distressful malady.
+This circumstance does not seem to depend on the manner in which the
+distemper has shewn itself, for it has as frequently happened among
+those who have had it mildly, as when it has appeared in the contrary
+way.
+
+There are many, who from some peculiarity in the habit resist the
+common effects of variolous matter inserted into the skin, and who
+are in consequence haunted through life with the distressing idea of
+being insecure from subsequent infection. A ready mode of dissipating
+anxiety originating from such a cause must now appear obvious. And,
+as we have seen that the constitution may at any time be made to feel
+the febrile attack of Cow-pox, might it not, in many chronic diseases
+be introduced into the system, with the probability of affording
+relief, upon well-known physiological principles?
+
+Although I say the system may at any time be made to feel the febrile
+attack of Cow-pox, yet I have a single instance before me where the
+virus acted locally only, but it is not in the least probable that
+the same person would resist the action both of the Cow-pox virus and
+the variolous.
+
+Elizabeth Sarsenet lived as a dairy maid at Newpark farm, in this
+parish. All the cows and the servants employed in milking had the
+Cow-pox; but this woman, though she had several sores upon her
+fingers, felt no tumors in the axillæ, nor any general indisposition.
+ On being afterwards casually exposed to variolous infection, she had
+the Small-pox in a mild way.--Hannah Pick, another of the dairy maids
+who was a fellow-servant with Elizabeth Sarsenet when the distemper
+broke out at the farm was, at the same time infected; but this young
+woman had not only sores upon her hands, but felt herself also much
+indisposed for a day or two. After this, I made several attempts to
+give her the Small-pox by inoculation, but they all proved fruitless.
+From the former Case then we see that the animal economy is subject
+to the same laws in one disease as the other.
+
+The following Case which has very lately occurred renders it highly
+probable that not only the heels of the horse, but other parts of the
+body of that animal, are capable of generating the virus which
+produces the Cow-pox.
+
+An extensive inflammation of the erysipelatous kind, appeared without
+any apparent cause upon the upper part of the thigh of a sucking
+colt, the property of Mr. Millet, a farmer at Rockhampton, a village
+near Berkeley. The inflammation continued several weeks, and at
+length terminated in the formation of three or four small abscesses.
+The inflamed parts were fomented, and dressings were applied by some
+of the same persons who were employed in milking the cows. The number
+of cows milked was twenty-four, and the whole of them had the
+Cow-pox. The milkers, consisting of the farmer's wife, a man and a
+maid servant, were infected by the cows. The man servant had
+previously gone through the Small-pox, and felt but little of the
+Cow-pox. The servant maid had some years before been infected with
+the Cow-pox, and she also felt it now in a slight degree: But the
+farmer's wife who never had gone through either of these diseases,
+felt its effects very severely.
+
+That the disease produced upon the cows by the colt and from thence
+conveyed to those who milked them was the _true_ and not the
+_spurious_ Cow-pox[5], there can be scarcely any room for suspicion;
+yet it would have been more completely satisfactory, had the effects
+of variolous matter been ascertained on the farmer's wife, but there
+was a peculiarity in her situation which prevented my making the
+experiment.
+
+Thus far have I proceeded in an inquiry, founded, as it must appear,
+on the basis of experiment; in which, however, conjecture has been
+occasionally admitted in order to present to persons well situated
+for such discussions, objects for a more minute investigation. In the
+mean time I shall myself continue to prosecute this inquiry,
+encouraged by the hope of its becoming essentially beneficial to
+mankind.
+
+  FINIS.
+
+[Footnote 1: It is very easy to procure pus from old sores on the
+heels of horses. This I have often inserted into scratches made with
+a lancet, on the sound nipples of cows, and have seen no other
+effects from it than simple inflammation.]
+
+[Footnote 2: See Case IX.]
+
+[Footnote 3: My friend Dr. Hicks, of Bristol, who during the
+prevalence of this distemper was resident at Gloucester, and
+Physician to the Hospital there, (where it was seen soon after its
+first appearance in this country) had opportunities of making
+numerous observations upon it, which it is his intention to
+communicate to the Public.]
+
+[Footnote 4: I have been informed from respectable authority that in
+Ireland, although dairies abound in many parts of the Island, the
+disease is entirely unknown. The reason seems obvious. The business
+of the dairy is conducted by women only. Were the meanest vassal
+among the men, employed there as a milker at a dairy, he would feel
+his situation unpleasant beyond all endurance.]
+
+[Footnote 5: See Note in Page 7.]
+
+
+
+
+_ERRATA._
+
+
+  Page 5, Line 4, after the word _shiverings_ insert _succeeded by
+      heat_.
+          Line 16, for _needlessly_ read _heedlessly_.
+
+  ---- 24, Last line but one, for _sore_ read _tumour_.
+
+  ---- 40, Line 12, for _Macklove_ read _Marklove_.
+
+  ---- 41, Note--for _scepticus_ read _septicus_.
+
+  ---- 60, Last line, for _moderate_ read _modern_.
+
+
+
+
+
+     *     *     *     *     *
+
+
+
+
+Transcriber's note
+
+
+For this e-text, all the errors in the original book's "Errata"
+section have been corrected, as well as the following:
+
+Introductory letter: "C. H PARRY" corrected to "C. H. PARRY".
+
+Introduction: Inserted "to" after "But this disease is not".
+
+Case XX: "begining" corrected to "beginning".
+
+Conclusions: Added full-stop after "on the subject of Inoculation".
+
+The following archaic spellings of words were used in the original
+book and have been retained: head-ach; concuring; delinated.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND
+EFFECTS OF THE VARIOLAE VACCINAE***
+
+
+******* This file should be named 29414-8.txt or 29414-8.zip *******
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+<body>
+<h1>The Project Gutenberg eBook, An Inquiry into the Causes and Effects of the
+Variolae Vaccinae, by Edward Jenner</h1>
+<pre>
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at <a href = "http://www.gutenberg.org">www.gutenberg.org</a></pre>
+<p>Title: An Inquiry into the Causes and Effects of the Variolae Vaccinae</p>
+<p>       A Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of the Cow Pox</p>
+<p>Author: Edward Jenner</p>
+<p>Release Date: July 15, 2009  [eBook #29414]</p>
+<p>Language: English</p>
+<p>Character set encoding: ISO-8859-1</p>
+<p>***START OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND EFFECTS OF THE VARIOLAE VACCINAE***</p>
+<p>&nbsp;</p>
+<h4>E-text prepared by K. Nordquist, Michael Roe, Carl Hudkins,<br />
+    and the Project Gutenberg Online Distributed Proofreading Team<br />
+    (<a href="http://www.pgdp.net/c/">http://www.pgdp.net</a>)<br />
+    from page images generously made available by<br />
+    the Posner Memorial Collection, Carnegie Mellon University Libraries<br />
+    (<a href="http://posner.library.cmu.edu/Posner/">http://posner.library.cmu.edu/Posner/</a>)</h4>
+<p>&nbsp;</p>
+<table border="0" style="background-color: #ccccff;" cellpadding="10">
+  <tr>
+    <td valign="top">
+      Note:
+    </td>
+    <td>
+      Images of the original pages are available through
+      the Posner Memorial Collection, Carnegie Mellon
+      University Libraries. See
+      <a href="http://posner.library.cmu.edu/Posner/books/book.cgi?call=614.4_J54I_1798">
+      http://posner.library.cmu.edu/Posner/books/book.cgi?call=614.4_J54I_1798</a>
+	</td>
+  </tr>
+</table>
+<p>&nbsp;</p>
+<hr class="full" />
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+
+<h1>
+<a name="chapter1"></a>
+AN<br />
+<i>INQUIRY</i><br />
+INTO<br />
+THE CAUSES AND EFFECTS<br />
+OF<br />
+THE VARIOL&AElig; VACCIN&AElig;.<br />
+</h1>
+<p class="headingcenter">
+PRICE 7s. 6d.
+<a name="preface1"></a><span class="pagenum">[Pg i]</span>
+</p>
+<h1>
+<a name="chapter2"></a>
+AN<br />
+<i>INQUIRY</i><br />
+INTO<br />
+THE CAUSES AND EFFECTS<br />
+OF<br />
+THE VARIOL&AElig; VACCIN&AElig;,<br />
+A DISEASE<br />
+DISCOVERED IN SOME OF THE WESTERN COUNTIES OF ENGLAND,<br />
+PARTICULARLY<br />
+<i>GLOUCESTERSHIRE</i>,<br />
+AND KNOWN BY THE NAME OF<br />
+THE COW POX.<br />
+</h1>
+<p class="headingcenter">
+BY EDWARD JENNER, M.D. F.R.S. &amp;c.
+</p>
+<p class="quotecenter">
+&mdash;QUID NOBIS CERTIUS IPSIS<br />
+SENSIBUS ESSE POTEST, QUO VERA AC FALSA NOTEMUS.
+</p>
+<p class="quoteright">
+LUCRETIUS.
+</p>
+<p class="headingcenter">
+London:<br />
+PRINTED, FOR THE AUTHOR,<br />
+BY SAMPSON LOW, N&#176;. 7, BERWICK STREET, SOHO:<br />
+AND SOLD BY LAW, AVE-MARIA LANE; AND MURRAY AND HIGHLEY, FLEET STREET.<br />
+</p>
+<p class="headingcenter">
+1798.
+<a name="preface3"></a><span class="pagenum">[Pg iii]</span>
+</p>
+<h2>
+<a name="chapter3"></a>
+TO<br />
+<i>C. H.<a name="tr1"></a> PARRY, M.D.</i><br />
+AT BATH.<br />
+</h2>
+<p>
+<i>My dear friend</i>,<br />
+</p>
+<p>
+In the present age of scientific
+investigation, it is remarkable that a disease of so
+peculiar a nature as the Cow Pox, which has appeared
+in this and some of the neighbouring
+counties for such a series of years, should so long
+have escaped particular attention. Finding the
+prevailing notions on the subject, both among men
+of our profession and others, extremely vague and
+indeterminate, and conceiving that facts might appear
+<a name="preface4"></a><span class="pagenum">[Pg iv]</span>
+at once both curious and useful, I have instituted
+as strict an inquiry into the causes and effects
+of this singular malady as local circumstances would
+admit.
+</p>
+<p>
+The following pages are the result, which, from
+motives of the most affectionate regard, are dedicated
+to you, by
+</p>
+<p class="letterright">
+Your sincere Friend,<br />
+EDWARD JENNER.<br />
+</p>
+<p>
+Berkeley, Gloucestershire,<br />
+June 21st, 1798.<br />
+<a name="page1"></a> <span class="pagenum">[Pg 1]</span>
+</p>
+<h2>
+<a name="chapter4"></a>
+AN
+INQUIRY,
+<i>&amp;c. &amp;c.</i>
+</h2>
+<p>
+The deviation of Man from the state in which
+he was originally placed by Nature seems to have
+proved to him a prolific source of Diseases. From
+the love of splendour, from the indulgences of
+luxury, and from his fondness for amusement, he
+has familiarised himself with a great number of
+animals, which may not originally have been intended
+for his associates.
+<a name="page2"></a> <span class="pagenum">[Pg 2]</span>
+</p>
+<p>
+The Wolf, disarmed of ferocity, is now pillowed
+in the lady's lap<a name="ref_1_1"></a><a href="#footnote_1_1" class="fnref">[1]</a>. The Cat, the little Tyger of our
+island, whose natural home is the forest, is equally
+domesticated and caressed. The Cow, the Hog, the
+Sheep, and the Horse, are all, for a variety of
+purposes, brought under his care and dominion.
+</p>
+<p>
+There is a disease to which the Horse, from his
+state of domestication, is frequently subject. The
+Farriers have termed it <i>the Grease</i>. It is an inflammation
+and swelling in the heel, from which issues
+matter possessing properties of a very peculiar kind,
+which seems capable of generating a disease in the
+Human Body (after it has undergone the modification
+which I shall presently speak of), which bears so strong
+a resemblance to the Small Pox, that I think it highly
+probable it may be the source of that disease.
+<a name="page3"></a> <span class="pagenum">[Pg 3]</span>
+</p>
+<p>
+In this Dairy Country a great number of Cows
+are kept, and the office of milking is performed
+indiscriminately by Men and Maid Servants. One
+of the former having been appointed to apply
+dressings to the heels of a Horse affected with <i>the
+Grease</i>, and not paying due attention to cleanliness,
+incautiously bears his part in milking the Cows,
+with some particles of the infectious matter adhering
+to his fingers. When this is the case, it
+commonly happens that a disease is communicated
+to the Cows, and from the Cows to the Dairy-maids,
+which spreads through the farm until most of the
+cattle and domestics feel its unpleasant consequences.
+This disease has obtained the name of
+the Cow Pox. It appears on the nipples of the
+Cows in the form of irregular pustules. At their
+first appearance they are commonly of a palish blue,
+or rather of a colour somewhat approaching to
+livid, and are surrounded by an erysipelatous inflammation.
+<a name="page4"></a> <span class="pagenum">[Pg 4]</span>
+These pustules, unless a timely remedy
+be applied, frequently degenerate into phagedenic
+ulcers, which prove extremely troublesome<a name="ref_1_2"></a><a href="#footnote_1_2" class="fnref">[2]</a>.
+The animals become indisposed, and the
+secretion of milk is much lessened. Inflamed spots
+now begin to appear on different parts of the hands
+of the domestics employed in milking, and sometimes
+on the wrists, which quickly run on to suppuration,
+first assuming the appearance of the small
+vesications produced by a burn. Most commonly
+they appear about the joints of the fingers, and
+at their extremities; but whatever parts are affected,
+if the situation will admit, these superficial
+suppurations put on a circular form, with their
+edges more elevated than their centre, and of a
+<a name="page5"></a> <span class="pagenum">[Pg 5]</span>
+colour distantly approaching to blue. Absorption
+takes place, and tumours appear in each axilla.
+The system becomes affected&ndash;the pulse is quickened;
+and shiverings <a name="err1"></a>succeeded by heat,  with general lassitude and
+pains about the loins and limbs, with vomiting,
+come on. The head is painful, and the patient is
+now and then even affected with delirium. These
+symptoms, varying in their degrees of violence,
+generally continue from one day to three or four,
+leaving ulcerated sores about the hands, which, from
+the sensibility of the parts, are very troublesome,
+and commonly heal slowly, frequently becoming
+phagedenic, like those from whence they sprung.
+The lips, nostrils, eyelids, and other parts of the
+body, are sometimes affected with sores; but these
+evidently arise from their being <a name="err2"></a>heedlessly  rubbed
+or scratched with the patient's infected fingers.
+No eruptions on the skin have followed the decline
+of the feverish symptoms in any instance that has
+<a name="page6"></a> <span class="pagenum">[Pg 6]</span>
+come under my inspection, one only excepted, and
+in this case a very few appeared on the arms: they
+were very minute, of a vivid red colour, and soon
+died away without advancing to maturation; so that
+I cannot determine whether they had any connection
+with the preceding symptoms.
+</p>
+<p>
+Thus the disease makes its progress from the
+Horse to the nipple of the Cow, and from the Cow
+to the Human Subject.
+</p>
+<p>
+Morbid matter of various kinds, when absorbed
+into the system, may produce effects in some degree
+similar; but what renders the Cow-pox virus so
+extremely singular, is, that the person who has been
+thus affected is for ever after secure from the infection
+of the Small Pox; neither exposure to the
+variolous effluvia, nor the insertion of the matter
+into the skin, producing this distemper.
+<a name="page7"></a> <span class="pagenum">[Pg 7]</span>
+</p>
+<p>
+In support of so extraordinary a fact, I shall lay
+before my Reader a great number of instances<a name="ref_1_3"></a><a href="#footnote_1_3" class="fnref">[3]</a>.
+</p>
+<p class="footnote">
+<a name="footnote_1_1"></a><a href="#ref_1_1">1</a>: The late Mr. John Hunter proved, by experiments, that the Dog is the Wolf
+in a degenerated state.
+</p>
+<p class="footnote">
+<a name="footnote_1_2"></a><a href="#ref_1_2">2</a>: They who attend sick cattle in this country find a speedy remedy for stopping
+the progress of this complaint in those applications which act chemically upon
+the morbid matter, such as the solutions of the Vitriolum Zinci, the Vitriolum
+Cupri, &amp;c.
+</p>
+<p class="footnote">
+<a name="footnote_1_3"></a><a href="#ref_1_3">3</a>: It is necessary to observe, that pustulous sores frequently appear spontaneously
+on the nipples of Cows, and instances have occurred, though very rarely, of the
+hands of the servants employed in milking being affected with sores in consequence,
+and even of their feeling an indisposition from absorption. These pustules are
+of a much milder nature than those which arise from that contagion which constitutes
+the true Cow Pox. They are always free from the bluish or livid tint so
+conspicuous in the pustules in that disease. No erysipelas attends them, nor do they
+shew any phagedenic disposition as in the other case, but quickly terminate in a scab
+without creating any apparent disorder in the Cow. This complaint appears at
+various seasons of the year, but most commonly in the Spring, when the Cows
+are first taken from their winter food and fed with grass. It is very apt to appear
+also when they are suckling their young. But this disease is not <a name="tr2"></a>to be considered as
+similar in any respect to that of which I am treating, as it is incapable of producing
+any specific effects on the human Constitution. However, it is of the greatest consequence
+to point it out here, lest the want of discrimination should occasion an idea
+of security from the infection of the Small Pox, which might prove delusive.
+<a name="page9"></a> <span class="pagenum">[Pg 9]</span>
+</p>
+<h2>
+<a name="chapter5"></a>
+<i>CASE I.</i>
+</h2>
+<p>
+JOSEPH MERRET, now an Under Gardener to the
+Earl of Berkeley, lived as a Servant with a Farmer near
+this place in the year 1770, and occasionally assisted in
+milking his master's cows. Several horses belonging to the
+farm began to have sore heels, which Merret frequently
+attended. The cows soon became affected with the Cow
+Pox, and soon after several sores appeared on his hands.
+Swellings and stiffness in each axilla followed, and he was
+so much indisposed for several days as to be incapable of
+pursuing his ordinary employment. Previously to the appearance
+of the distemper among the cows there was no
+fresh cow brought into the farm, nor any servant employed
+who was affected with the Cow Pox.
+</p>
+<p>
+In April, 1795, a general inoculation taking place here,
+Merret was inoculated with his family; so that a period of
+twenty-five years had elapsed from his having the Cow Pox
+<a name="page10"></a> <span class="pagenum">[Pg 10]</span>
+to this time. However, though the variolous matter was
+repeatedly inserted into his arm, I found it impracticable to
+infect him with it; an efflorescence only, taking on an
+erysipelatous look about the centre, appearing on the skin
+near the punctured parts. During the whole time that his
+family had the Small Pox, one of whom had it very full,
+he remained in the house with them, but received no injury
+from exposure to the contagion.
+</p>
+<p>
+It is necessary to observe, that the utmost care was taken
+to ascertain, with the most scrupulous precision, that no one
+whose case is here adduced had gone through the Small Pox
+previous to these attempts to produce that disease.
+</p>
+<p>
+Had these experiments been conducted in a large city, or
+in a populous neighbourhood, some doubts might have
+been entertained; but here, where population is thin, and
+where such an event as a person's having had the Small Pox
+is always faithfully recorded, no risk of inaccuracy in this
+particular can arise.
+<a name="page11"></a> <span class="pagenum">[Pg 11]</span>
+</p>
+<h2>
+<a name="chapter6"></a>
+<i>CASE II.</i>
+</h2>
+<p>
+SARAH PORTLOCK, of this place, was infected with
+the Cow Pox, when a Servant at a Farmer's in the neighbourhood,
+twenty-seven years ago<a name="ref_2_1"></a><a href="#footnote_2_1" class="fnref">[1]</a>.
+</p>
+<p>
+In the year 1792, conceiving herself, from this circumstance,
+secure from the infection of the Small Pox, she
+nursed one of her own children who had accidentally
+caught the disease, but no indisposition ensued.&ndash;During
+the time she remained in the infected room, variolous
+matter was inserted into both her arms, but without any
+further effect than in the preceding case.
+<a name="page12"></a> <span class="pagenum">[Pg 12]</span>
+</p>
+<p class="footnote">
+<a name="footnote_2_1"></a><a href="#ref_2_1">1</a>: I have purposely selected several cases in which the disease had appeared
+at a very distant period previous to the experiments made with variolous
+matter, to shew that the change produced in the constitution is not affected by
+time.
+</p>
+<h2>
+<a name="chapter7"></a>
+<i>CASE III.</i>
+</h2>
+<p>
+JOHN PHILLIPS, a Tradesman of this town, had the
+Cow Pox at so early a period as nine years of age. At the
+age of sixty-two I inoculated him, and was very careful in
+selecting matter in its most active state. It was taken from
+the arm of a boy just before the commencement of the
+eruptive fever, and instantly inserted. It very speedily
+produced a sting-like feel in the part. An efflorescence
+appeared, which on the fourth day was rather extensive,
+and some degree of pain and stiffness were felt about the
+shoulder; but on the fifth day these symptoms began to
+disappear, and in a day or two after went entirely off,
+without producing any effect on the system.
+<a name="page13"></a> <span class="pagenum">[Pg 13]</span>
+</p>
+<h2>
+<a name="chapter8"></a>
+<i>CASE IV.</i>
+</h2>
+<p>
+MARY BARGE, of Woodford, in this parish, was inoculated
+with variolous matter in the year 1791. An efflorescence
+of a palish red colour soon appeared about the
+parts where the matter was inserted, and spread itself rather
+extensively, but died away in a few days without producing
+any variolous symptoms<a name="ref_3_1"></a><a href="#footnote_3_1" class="fnref">[1]</a>. She has since been repeatedly
+employed as a nurse to Small-pox patients, without experiencing
+any ill consequences. This woman had the Cow
+Pox when she lived in the service of a Farmer in this parish
+thirty-one years before.
+<a name="page14"></a> <span class="pagenum">[Pg 14]</span>
+</p>
+<p class="footnote">
+<a name="footnote_3_1"></a><a href="#ref_3_1">1</a>: It is remarkable that variolous matter, when the system is disposed to reject
+it, should excite inflammation on the part to which it is applied more speedily
+than when it produces the Small Pox. Indeed it becomes almost a criterion by
+which we can determine whether the infection will be received or not. It seems
+as if a change, which endures through life, had been produced in the action, or
+disposition to action, in the vessels of the skin; and it is remarkable too, that
+whether this change has been effected by the Small Pox, or the Cow Pox, that
+the disposition to sudden cuticular inflammation is the same on the application of
+variolous matter.
+</p>
+<h2>
+<a name="chapter9"></a>
+<i>CASE V.</i>
+</h2>
+<p>
+MRS. H&mdash;, a respectable Gentlewoman of this town,
+had the Cow Pox when very young. She received the
+infection in rather an uncommon manner: it was given by
+means of her handling some of the same utensils<a name="ref_4_1"></a><a href="#footnote_4_1" class="fnref">[1]</a> which
+were in use among the servants of the family, who had the
+disease from milking infected cows. Her hands had many
+of the Cow-pox sores upon them, and they were communicated
+to her nose, which became inflamed and very much
+swoln. Soon after this event Mrs. H&mdash; was exposed to
+the contagion of the Small Pox, where it was scarcely
+possible for her to have escaped, had she been susceptible of
+it, as she regularly attended a relative who had the disease
+in so violent a degree that it proved fatal to him.
+<a name="page15"></a> <span class="pagenum">[Pg 15]</span>
+</p>
+<p>
+In the year 1778 the Small Pox prevailed very much at
+Berkeley, and Mrs. H&mdash; not feeling perfectly satisfied
+respecting her safety (no indisposition having followed her
+exposure to the Small Pox) I inoculated her with active
+variolous matter. The same appearance followed as in the
+preceding cases&ndash;an efflorescence on the arm without any
+effect on the constitution.
+</p>
+<p class="footnote">
+<a name="footnote_4_1"></a><a href="#ref_4_1">1</a>: When the Cow Pox has prevailed in the dairy, it has often been communicated
+to those who have not milked the cows, by the handle of the milk
+pail.
+</p>
+<h2>
+<a name="chapter10"></a>
+<i>CASE VI.</i>
+</h2>
+<p>
+It is a fact so well known among our Dairy Farmers,
+that those who have had the Small Pox either escape the
+Cow Pox or are disposed to have it slightly; that as soon as
+the complaint shews itself among the cattle, assistants are
+procured, if possible, who are thus rendered less susceptible
+of it, otherwise the business of the farm could scarcely go
+forward.
+</p>
+<p>
+In the month of May, 1796, the Cow Pox broke out at
+Mr. Baker's, a Farmer who lives near this place. The
+<a name="page16"></a> <span class="pagenum">[Pg 16]</span>
+disease was communicated by means of a cow which was
+purchased in an infected state at a neighbouring fair, and
+not one of the Farmer's cows (consisting of thirty) which
+were at that time milked escaped the contagion. The
+family consisted of a man servant, two dairymaids, and a
+servant boy, who, with the Farmer himself, were twice a
+day employed in milking the cattle. The whole of this
+family, except Sarah Wynne, one of the dairymaids, had
+gone through the Small Pox. The consequence was, that
+the Farmer and the servant boy escaped the infection of the
+Cow Pox entirely, and the servant man and one of the maid
+servants had each of them nothing more than a sore on one
+of their fingers, which produced no disorder in the system.
+But the other dairymaid, Sarah Wynne, who never had
+the Small Pox, did not escape in so easy a manner. She
+caught the complaint from the cows, and was affected with
+the symptoms described in the 5th page in so violent a
+degree, that she was confined to her bed, and rendered
+incapable for several days of pursuing her ordinary vocations
+in the farm.
+<a name="page17"></a> <span class="pagenum">[Pg 17]</span>
+</p>
+<p>
+March 28th, 1797, I inoculated this girl, and carefully
+rubbed the variolous matter into two slight incisions made
+upon the left arm. A little inflammation appeared in the
+usual manner around the parts where the matter was inserted,
+but so early as the fifth day it vanished entirely
+without producing any effect on the system.
+</p>
+<h2>
+<a name="chapter11"></a>
+<i>CASE VII.</i>
+</h2>
+<p>
+Although the preceding history pretty clearly
+evinces that the constitution is far less susceptible of the
+contagion of the Cow Pox after it has felt that of the Small
+Pox, and although in general, as I have observed, they who
+have had the Small Pox, and are employed in milking cows
+which are infected with the Cow Pox, either escape the
+disorder, or have sores on the hands without feeling any
+general indisposition, yet the animal economy is subject to
+some variation in this respect, which the following relation
+will point out:
+<a name="page18"></a> <span class="pagenum">[Pg 18]</span>
+</p>
+<p>
+In the summer of the year 1796 the Cow Pox appeared at
+the Farm of Mr. Andrews, a considerable dairy adjoining
+to the town of Berkeley. It was communicated, as in the
+preceding instance, by an infected cow purchased at a fair
+in the neighbourhood. The family consisted of the Farmer,
+his wife, two sons, a man and a maid servant; all of whom,
+except the Farmer (who was fearful of the consequences),
+bore a part in milking the cows. The whole of them, exclusive
+of the man servant, had regularly gone through the
+Small Pox; but in this case no one who milked the cows
+escaped the contagion. All of them had sores upon their
+hands, and some degree of general indisposition, preceded
+by pains and tumours in the axill&aelig;: but there was no comparison
+in the severity of the disease as it was felt by the
+servant man, who had escaped the Small Pox, and by those
+of the family who had not, for, while he was confined to
+his bed, they were able, without much inconvenience, to
+follow their ordinary business.
+<a name="page19"></a> <span class="pagenum">[Pg 19]</span>
+</p>
+<p>
+February the 13th, 1797, I availed myself of an opportunity
+of inoculating William Rodway, the servant man above alluded
+to. Variolous matter was inserted into both his arms;
+in the right by means of superficial incisions, and into the left
+by slight punctures into the cutis. Both were perceptibly
+inflamed on the third day. After this the inflammation
+about the punctures soon died away, but a small appearance
+of erysipelas was manifest about the edges of the incisions
+till the eighth day, when a little uneasiness was felt for the
+space of half an hour in the right axilla. The inflammation
+then hastily disappeared without producing the most
+distant mark of affection of the system.
+<a name="page20"></a> <span class="pagenum">[Pg 20]</span>
+</p>
+<h2>
+<a name="chapter12"></a>
+<i>CASE VIII.</i>
+</h2>
+<p>
+ELIZABETH WYNNE, aged fifty-seven, lived as a
+servant with a neighbouring Farmer thirty-eight years ago.
+She was then a dairymaid, and the Cow Pox broke out
+among the cows. She caught the disease with the rest of
+the family, but, compared with them, had it in a very
+slight degree, one very small sore only breaking out on the
+little finger of her left hand, and scarcely any perceptible
+indisposition following it.
+</p>
+<p>
+As the malady had shewn itself in so slight a manner,
+and as it had taken place at so distant a period of her life, I
+was happy with the opportunity of trying the effects of
+variolous matter upon her constitution, and on the 28th of
+March, 1797, I inoculated her by making two superficial
+incisions on the left arm, on which the matter was cautiously
+rubbed. A little efflorescence soon appeared, and a tingling
+<a name="page21"></a> <span class="pagenum">[Pg 21]</span>
+sensation was felt about the parts where the matter
+was inserted until the third day, when both began to
+subside, and so early as the fifth day it was evident that no
+indisposition would follow.
+</p>
+<h2>
+<a name="chapter13"></a>
+<i>CASE IX.</i>
+</h2>
+<p>
+Although the Cow Pox shields the constitution from
+the Small Pox, and the Small Pox proves a protection
+against its own future poison, yet it appears that the human
+body is again and again susceptible of the infectious matter
+of the Cow Pox, as the following history will demonstrate:
+</p>
+<p>
+William Smith, of Pyrton in this parish, contracted this
+disease when he lived with a neighbouring Farmer in the
+year 1780. One of the horses belonging to the farm had
+sore heels, and it fell to his lot to attend him. By these
+means the infection was carried to the cows, and from the
+cows it was communicated to Smith. On one of his hands
+<a name="page22"></a> <span class="pagenum">[Pg 22]</span>
+were several ulcerated sores, and he was affected with such
+symptoms as have been before described.
+</p>
+<p>
+In the year 1791 the Cow Pox broke out at another farm
+where he then lived as a servant, and he became affected
+with it a second time; and in the year 1794 he was so
+unfortunate as to catch it again. The disease was equally
+as severe the second and third time as it was on the first<a name="ref_5_1"></a><a href="#footnote_5_1" class="fnref">[1]</a>.
+</p>
+<p>
+In the spring of the year 1795 he was twice inoculated,
+but no affection of the system could be produced from the
+variolous matter; and he has since associated with those who
+had the Small Pox in its most contagious state without
+feeling any effect from it.
+<a name="page23"></a> <span class="pagenum">[Pg 23]</span>
+</p>
+<p class="footnote">
+<a name="footnote_5_1"></a><a href="#ref_5_1">1</a>: This is not the case in general&ndash;a second attack is commonly very slight,
+and so, I am informed, it is among the cows.
+</p>
+<h2>
+<a name="chapter14"></a>
+<i>CASE X.</i>
+</h2>
+<p>
+SIMON NICHOLS lived as a servant with Mr. Bromedge,
+a gentleman who resides on his own farm in this
+parish, in the year 1782. He was employed in applying
+dressings to the sore heels of one of his master's horses, and
+at the same time assisted in milking the cows. The cows
+became affected in consequence, but the disease did not
+shew itself on their nipples till several weeks after he had
+begun to dress the horse. He quitted Mr. Bromedge's
+service, and went to another farm without any sores upon
+him; but here his hands soon began to be affected in the
+common way, and he was much indisposed with the usual
+symptoms. Concealing the nature of the malady from Mr.
+Cole, his new master, and being there also employed in
+milking, the Cow Pox was communicated to the cows.
+<a name="page24"></a> <span class="pagenum">[Pg 24]</span>
+</p>
+<p>
+Some years afterwards Nichols was employed in a farm
+where the Small Pox broke out, when I inoculated him
+with several other patients, with whom he continued
+during the whole time of their confinement. His arm
+inflamed, but neither the inflammation nor his associating
+with the inoculated family produced the least effect upon
+his constitution.
+</p>
+<h2>
+<a name="chapter15"></a>
+<i>CASE XI.</i>
+</h2>
+<p>
+WILLIAM STINCHCOMB was a fellow servant with
+Nichols at Mr. Bromedge's Farm at the time the cattle had
+the Cow Pox, and he was unfortunately infected by them.
+His left hand was very severely affected with several corroding
+ulcers, and a tumour of considerable size appeared
+in the axilla of that side. His right hand had only one
+small sore  upon it, and no <a name="err3"></a>tumour discovered itself in the
+corresponding axilla.
+<a name="page25"></a> <span class="pagenum">[Pg 25]</span>
+</p>
+<p>
+In the year 1792 Stinchcomb was inoculated with variolous
+matter, but no consequences ensued beyond a little
+inflammation in the arm for a few days. A large party
+were inoculated at the same time, some of whom had the
+disease in a more violent degree than is commonly seen
+from inoculation. He purposely associated with them, but
+could not receive the Small Pox.
+</p>
+<p>
+During the sickening of some of his companions, their
+symptoms so strongly recalled to his mind his own state
+when sickening with the Cow Pox, that he very pertinently
+remarked their striking similarity.
+<a name="page26"></a> <span class="pagenum">[Pg 26]</span>
+</p>
+<h2>
+<a name="chapter16"></a>
+<i>CASE XII.</i>
+</h2>
+<p>
+The Paupers of the village of Tortworth, in this county,
+were inoculated by Mr. Henry Jenner, Surgeon, of Berkeley,
+in the year 1795. Among them, eight patients presented
+themselves who had at different periods of their lives
+had the Cow Pox. One of them, Hester Walkley, I attended
+with that disease when she lived in the service of a Farmer
+in the same village in the year 1782; but neither this
+woman, nor any other of the patients who had gone
+through the Cow Pox, received the variolous infection
+either from the arm or from mixing in the society of the
+other patients who were inoculated at the same time. This
+state of security proved a fortunate circumstance, as many
+of the poor women were at the same time in a state of
+pregnancy.
+<a name="page27"></a> <span class="pagenum">[Pg 27]</span>
+</p>
+<h2>
+<a name="chapter17"></a>
+<i>CASE XIII.</i>
+</h2>
+<p>
+One instance has occurred to me of the system being
+affected from the matter issuing from the heels of horses,
+and of its remaining afterwards unsusceptible of the variolous
+contagion; another, where the Small Pox appeared
+obscurely; and a third, in which its complete existence was
+positively ascertained.
+</p>
+<p>
+First, THOMAS PEARCE, is the son of a Smith and
+Farrier near to this place. He never had the Cow Pox;
+but, in consequence of dressing horses with sore heels at
+his father's, when a lad, he had sores on his fingers which
+suppurated, and which occasioned a pretty severe indisposition.
+Six years afterwards I inserted variolous matter into
+his arm repeatedly, without being able to produce any thing
+more than slight inflammation, which appeared very soon
+<a name="page28"></a> <span class="pagenum">[Pg 28]</span>
+after the matter was applied, and afterwards I exposed him
+to the contagion of the Small Pox with as little effect<a name="ref_6_1"></a><a href="#footnote_6_1" class="fnref">[1]</a>.
+</p>
+<p class="footnote">
+<a name="footnote_6_1"></a><a href="#ref_6_1">1</a>: It is a remarkable fact, and well known to many, that we are frequently
+foiled in our endeavours to communicate the Small Pox by inoculation to
+blacksmiths, who in the country are farriers. They often, as in the above
+instance, either resist the contagion entirely, or have the disease anomalously.
+Shall we not be able now to account for this on a rational principle?
+</p>
+<h2>
+<a name="chapter18"></a>
+<i>CASE XIV.</i>
+</h2>
+<p>
+Secondly, Mr. JAMES COLE, a Farmer in this parish,
+had a disease from the same source as related in the preceding
+case, and some years after was inoculated with
+variolous matter. He had a little pain in the axilla, and
+felt a slight indisposition for three or four hours. A few
+eruptions shewed themselves on the forehead, but they very
+soon disappeared without advancing to maturation.
+<a name="page29"></a> <span class="pagenum">[Pg 29]</span>
+</p>
+<h2>
+<a name="chapter19"></a>
+<i>CASE XV.</i>
+</h2>
+<p>
+Although in the two former instances the system seemed
+to be secured, or nearly so, from variolous infection, by the
+absorption of matter from sores produced by the diseased
+heels of horses, yet the following case decisively proves
+that this cannot be entirely relied upon, until a disease
+has been generated by the morbid matter from the horse on
+the nipple of the cow, and passed through that medium to
+the human subject.
+</p>
+<p>
+Mr. ABRAHAM RIDDIFORD, a Farmer at Stone in
+this parish, in consequence of dressing a mare that had sore
+heels, was affected with very painful sores in both his
+hands, tumours in each axilla, and severe and general
+indisposition. A Surgeon in the neighbourhood attended
+him, who, knowing the similarity between the appearance
+of the sores upon his hands and those produced by the
+<a name="page30"></a> <span class="pagenum">[Pg 30]</span>
+Cow Pox, and being acquainted also with the effects of
+that disease on the human constitution, assured him that he
+never need to fear the infection of the Small Pox; but this
+assertion proved fallacious, for, on being exposed to the
+infection upwards of twenty years afterwards, he caught
+the disease, which took its regular course in a very mild
+way. There certainly was a difference perceptible, although
+it is not easy to describe it, in the general appearance of the
+pustules from that which we commonly see. Other practitioners,
+who visited the patient at my request, agreed with
+me in this point, though there was no room left for suspicion
+as to the reality of the disease, as I inoculated some of his
+family from the pustules, who had the Small Pox, with its
+usual appearances, in consequence.
+<a name="page31"></a> <span class="pagenum">[Pg 31]</span>
+</p>
+<h2>
+<a name="chapter20"></a>
+<i>CASE XVI.</i>
+</h2>
+<p>
+SARAH NELMES, a dairymaid at a Farmer's near this
+place, was infected with the Cow Pox from her master's
+cows in May, 1796. She received the infection on a part
+of the hand which had been previously in a slight degree
+injured by a scratch from a thorn. A large pustulous sore
+and the usual symptoms accompanying the disease were
+produced in consequence. The pustule was so expressive
+of the true character of the Cow Pox, as it commonly
+appears upon the hand, that I have given a representation
+of it in the annexed plate. The two small pustules on the
+wrists arose also from the application of the virus to some
+minute abrasions of the cuticle, but the livid tint, if they
+ever had any, was not conspicuous at the time I saw the
+patient. The pustule on the fore finger shews the disease in
+an earlier stage. It did not actually appear on the hand of
+<a name="page32"></a> <span class="pagenum">[Pg 32]</span>
+this young woman, but was taken from that of another,
+and is annexed for the purpose of representing the malady
+after it has newly appeared.
+</p>
+<p>
+<a name="plate1"></a>
+<a href="images/i-p-032a.jpg"><img src="images/t-p-032a.jpg" width="437" height="247" alt="Plate 1" /></a>
+</p>
+<h2>
+<a name="chapter21"></a>
+<i>CASE XVII.</i>
+</h2>
+<p>
+The more accurately to observe the progress of the
+infection, I selected a healthy boy, about eight years old,
+for the purpose of inoculation for the Cow Pox. The
+matter was taken from a sore on the hand of a dairymaid<a name="ref_7_1"></a><a href="#footnote_7_1" class="fnref">[1]</a>,
+who was infected by her master's cows, and it was inserted,
+on the 14th of May, 1796, into the arm of the boy by
+means of two superficial incisions, barely penetrating the
+cutis, each about half an inch long.
+<a name="page33"></a> <span class="pagenum">[Pg 33]</span>
+</p>
+<p>
+On the seventh day he complained of uneasiness in the
+axilla, and on the ninth he became a little chilly, lost his
+appetite, and had a slight head-ach. During the whole of
+this day he was perceptibly indisposed, and spent the night
+with some degree of restlessness, but on the day following
+he was perfectly well.
+</p>
+<p>
+The appearance of the incisions in their progress to a
+state of maturation were much the same as when produced
+in a similar manner by variolous matter. The
+only difference which I perceived was, in the state of the
+limpid fluid arising from the action of the virus, which
+assumed rather a darker hue, and in that of the efflorescence
+spreading round the incisions, which had more of an erysipelatous
+look than we commonly perceive when variolous
+matter has been made use of in the same manner; but the
+whole died away (leaving on the inoculated parts scabs and
+subsequent eschars) without giving me or my patient the
+least trouble.
+<a name="page34"></a> <span class="pagenum">[Pg 34]</span>
+</p>
+<p>
+In order to ascertain whether the boy, after feeling so
+slight an affection of the system from the Cow-pox virus,
+was secure from the contagion of the Small-pox, he was
+inoculated the 1st of July following with variolous matter,
+immediately taken from a pustule. Several slight punctures
+and incisions were made on both his arms, and the matter
+was carefully inserted, but no disease followed. The same
+appearances were observable on the arms as we commonly
+see when a patient has had variolous matter applied, after
+having either the Cow-pox or the Small-pox. Several months
+afterwards, he was again inoculated with variolous matter,
+but no sensible effect was produced on the constitution.
+</p>
+<p>
+Here my researches were interrupted till the spring of the
+year 1798, when from the wetness of the early part of the
+season, many of the farmers' horses in this neighbourhood
+were affected with sore heels, in consequence of which the
+Cow-pox broke out among several of our dairies, which
+afforded me an opportunity of making further observations
+upon this curious disease.
+<a name="page35"></a> <span class="pagenum">[Pg 35]</span>
+</p>
+<p>
+A mare, the property of a person who keeps a dairy in
+a neighbouring parish, began to have sore heels the latter
+end of the month of February 1798, which were occasionally
+washed by the servant men of the farm, Thomas
+Virgoe, William Wherret, and William Haynes, who in
+consequence became affected with sores in their hands,
+followed by inflamed lymphatic glands in the arms and
+axillæ, shiverings succeeded by heat, lassitude and general
+pains in the limbs. A single paroxysm terminated the
+disease; for within twenty-four hours they were free from
+general indisposition, nothing remaining but the sores on
+their hands. Haynes and Virgoe, who had gone through
+the Small-pox from inoculation, described their feelings as
+very similar to those which affected them on sickening with
+that malady. Wherret never had had the Small-pox.
+Haynes was daily employed as one of the milkers at the
+farm, and the disease began to shew itself among the cows
+about ten days after he first assisted in washing the mare's
+heels. Their nipples became sore in the usual way, with
+blueish pustules; but as remedies were early applied they
+did not ulcerate to any extent.
+</p>
+<p class="footnote">
+<a name="footnote_7_1"></a><a href="#ref_7_1">1</a>: From the sore on the hand of Sarah Nelmes.&ndash;See the <a href="#chapter20">preceding case</a> and
+the <a href="#plate1">plate</a>.
+</p>
+<h2>
+<a name="page36"></a> <span class="pagenum">[Pg 36]</span>
+<a name="chapter22"></a>
+<i>CASE XVIII.</i>
+</h2>
+<p>
+JOHN BAKER, a child of five years old, was inoculated
+March 16, 1798, with matter taken from a pustule on the
+hand of Thomas Virgoe, one of the servants who had been
+infected from the mare's heels. He became ill on the 6th
+day with symptoms similar to those excited by Cow-pox
+matter. On the 8th day he was free from indisposition.
+</p>
+<p>
+There was some variation in the appearance of the pustule
+on the arm. Although it somewhat resembled a Small-pox
+pustule, yet its similitude was not so conspicuous as when
+excited by matter from the nipple of the cow, or when the
+matter has passed from thence through the medium of the
+human subject.&ndash;(See<a href="#plate2"> Plate, No. 2</a>.)
+</p>
+<p>
+<a name="plate2"></a>
+<a href="images/i-p-036a.jpg"><img src="images/t-p-036a.jpg" width="314" height="430" alt="Plate 2" /></a>
+</p>
+<p>
+This experiment was made to ascertain the progress and
+subsequent effects of the disease when thus propagated.
+<a name="page37"></a> <span class="pagenum">[Pg 37]</span>
+We have seen that the virus from the horse, when it proves
+infectious to the human subject is not to be relied upon as
+rendering the system secure from variolous infection, but
+that the matter produced by it upon the nipple of the cow
+is perfectly so. Whether its passing from the horse through
+the human constitution, as in the present instance, will
+produce a similar effect, remains to be decided. This would
+now have been effected, but the boy was rendered unfit
+for inoculation from having felt the effects of a contagious
+fever in a work-house, soon after this experiment was made.
+</p>
+<h2>
+<a name="chapter23"></a>
+<i>CASE XIX.</i>
+</h2>
+<p>
+WILLIAM SUMMERS, a child of five years and a half
+old was inoculated the same day with Baker, with matter
+taken from the nipples of one of the infected cows, at the
+farm alluded to in page 35. He became indisposed on the
+6th day, vomited once, and felt the usual slight symptoms
+till the 8th day, when he appeared perfectly well. The
+progress of the pustule, formed by the infection of the virus
+<a name="page38"></a> <span class="pagenum">[Pg 38]</span>
+was similar to that noticed in Case XVII., with this exception,
+its being free from the livid tint observed in that instance.
+</p>
+<h2>
+<a name="chapter24"></a>
+<i>CASE XX.</i>
+</h2>
+<p>
+From William Summers the disease was transfered to
+William Pead a boy of eight years old, who was inoculated
+March 28th. On the 6th day he complained of pain in the
+axilla, and on the 7th was affected with the common symptoms
+of a patient sickening with the Small-pox from inoculation,
+which did not terminate 'till the 3d day after the
+seizure. So perfect was the similarity to the variolous
+fever that I was induced to examine the skin, conceiving
+there might have been some eruptions, but none appeared.
+The efflorescent blush around the part punctured in the
+boy's arm was so truly characteristic of that which appears
+on variolous inoculation, that I have given a representation
+of it. The drawing was made when the pustule was <a name="tr3"></a>beginning
+to die away, and the areola retiring from the centre.
+(See <a href="#plate3">Plate, No. 3</a>.)
+</p>
+<p>
+<a name="plate3"></a>
+<a href="images/i-p-038a.jpg"><img src="images/t-p-038a.jpg" width="425" height="467" alt="Plate 3" /></a>
+</p>
+<h2>
+<a name="page39"></a> <span class="pagenum">[Pg 39]</span>
+<a name="chapter25"></a>
+<i>CASE XXI.</i>
+</h2>
+<p>
+April 5th. Several children and adults were inoculated
+from the arm of William Pead. The greater part of them
+sickened on the 6th day, and were well on the 7th, but in
+three of the number a secondary indisposition arose in consequence
+of an extensive erysipelatous inflammation which
+appeared on the inoculated arms. It seemed to arise from
+the state of the pustule, which spread out, accompanied
+with some degree of pain, to about half the diameter of a
+six-pence. One of these patients was an infant of half a year
+old. By the application of mercurial ointment to the
+inflamed parts (a treatment recommended under similar
+circumstances in the inoculated Small-pox) the complaint
+subsided without giving much trouble.
+</p>
+<p>
+HANNAH EXCELL an healthy girl of seven years old,
+and one of the patients above mentioned, received the
+<a name="page40"></a> <span class="pagenum">[Pg 40]</span>
+infection from the insertion of the virus under the cuticle of
+the arm in three distinct points. The pustules which arose
+in consequence, so much resembled, on the 12th day, those
+appearing from the insertion of variolous matter, that an
+experienced Inoculator would scarcely have discovered a
+shade of difference at that period. Experience now tells me
+that almost the only variation which follows consists in the
+pustulous fluids remaining limpid nearly to the time of its
+total disappearance; and not, as in the direct Small-pox,
+becoming purulent.&ndash;(See <a href="#plate4">Plate, No. 4</a>.)
+</p>
+<p>
+<a name="plate4"></a>
+<a href="images/i-p-040a.jpg"><img src="images/t-p-040a.jpg" width="430" height="444" alt="Plate 4" /></a>
+</p>
+<h2>
+<a name="chapter26"></a>
+<i>CASE XXII.</i>
+</h2>
+<p>
+From the arm of this girl matter was taken and inserted
+April 12th into the arms of John <a name="err4"></a>Marklove one year and a
+half old,
+</p>
+<p>
+Robert F. Jenner, eleven months old,<br />
+Mary Pead, 5 years old, and<br />
+Mary James, 6 years old.<br />
+<a name="page41"></a> <span class="pagenum">[Pg 41]</span>
+</p>
+<p>
+Among these Robert F. Jenner did not receive the infection.
+The arms of the other three inflamed properly and
+began to affect the system in the usual manner; but being
+under some apprehensions from the preceding Cases that a
+troublesome erysipelas might arise, I determined on making
+an experiment with the view of cutting off its source.
+Accordingly after the patients had felt an indisposition of
+about twelve hours, I applied in two of these Cases out of
+the three, on the vesicle formed by the virus, a little mild
+caustic, composed of equal parts of quick-lime and soap,
+and suffered it to remain on the part six hours<a name="ref_8_1"></a><a href="#footnote_8_1" class="fnref">[1]</a>. It seemed
+to give the children but little uneasiness, and effectually
+answered my intention in preventing the appearance of
+erysipelas. Indeed it seemed to do more, for in half an
+hour after its application, the indisposition of the children
+ceased<a name="ref_8_2"></a><a href="#footnote_8_2" class="fnref">[2]</a>. These precautions were perhaps unnecessary as
+<a name="page42"></a> <span class="pagenum">[Pg 42]</span>
+the arm of the third child, Mary Pead, which was suffered
+to take its common course, scabbed quickly, without any
+erysipelas.
+</p>
+<p class="footnote">
+<a name="footnote_8_1"></a><a href="#ref_8_1">1</a>: Perhaps a few touches with the lapis <a name="err5"></a>septicus would have proved equally
+efficacious.
+</p>
+<p class="footnote">
+<a name="footnote_8_2"></a><a href="#ref_8_2">2</a>: What effect would a similar treatment produce in inoculation for the Small-pox?
+</p>
+<h2>
+<a name="chapter27"></a>
+<i>CASE XXIII.</i>
+</h2>
+<p>
+From this child's arm matter was taken and transferred
+to that of J. Barge, a boy of seven years old. He sickened
+on the 8th day, went through the disease with the usual
+slight symptoms, and without any inflammation on the arm
+beyond the common efflorescence surrounding the pustule,
+an appearance so often seen in inoculated Small-pox.
+</p>
+<p>
+After the many fruitless attempts to give the Small-pox to
+those who had had the Cow-pox, it did not appear necessary,
+nor was it convenient to me, to inoculate the whole of
+those who had been the subjects of these late trials; yet I
+thought it right to see the effects of variolous matter on
+some of them, particularly William Summers, the first of
+these patients who had been infected with matter taken
+<a name="page43"></a> <span class="pagenum">[Pg 43]</span>
+from the cow. He was therefore inoculated with variolous
+matter from a fresh pustule; but, as in the preceding
+Cases, the system did not feel the effects of it in the
+smallest degree. I had an opportunity also of having this boy
+and William Pead inoculated by my Nephew, Mr. Henry
+Jenner, whose report to me is as follows: &quot;I have inoculated
+Pead and Barge, two of the boys whom you lately infected
+with the Cow-pox. On the 2d day the incisions were inflamed
+and there was a pale inflammatory stain around them.
+On the 3d day these appearances were still increasing and their
+arms itched considerably. On the 4th day, the inflammation
+was evidently subsiding, and on the 6th it was scarcely
+perceptible. No symptom of indisposition followed.
+</p>
+<p>
+To convince myself that the variolous matter made use
+of was in a perfect state, I at the same time inoculated a
+patient with some of it who never had gone through the
+Cow-pox, and it produced the Small-pox in the usual
+regular manner.&quot;
+<a name="page44"></a> <span class="pagenum">[Pg 44]</span>
+</p>
+<p>
+These experiments afforded me much satisfaction, they
+proved that the matter in passing from one human subject to
+another, through five gradations, lost none of its original
+properties, J. Barge being the fifth who received the infection
+successively from William Summers, the boy to whom
+it was communicated from the cow.
+<a name="page45"></a> <span class="pagenum">[Pg 45]</span>
+</p>
+<hr />
+<p>
+I shall now conclude this Inquiry with some
+general observations on the subject and on
+some others which are interwoven with it.
+</p>
+<p>
+Although I presume it may be unnecessary to
+produce further testimony in support of my assertion
+&quot;that the Cow-pox protects the human constitution
+from the infection of the Small-pox,&quot; yet
+it affords me considerable satisfaction to say, that
+Lord Somerville, the President of the Board of
+Agriculture, to whom this paper was shewn by
+Sir Joseph Banks, has found upon inquiry that the
+statements were confirmed by the concuring  testimony
+of Mr. Dolland, a surgeon, who resides in
+a dairy country remote from this, in which these
+observations were made. With respect to the
+opinion adduced &quot;that the source of the infection
+<a name="page46"></a> <span class="pagenum">[Pg 46]</span>
+is a peculiar morbid matter arising in the horse,&quot;
+although I have not been able to prove it from
+actual experiments conducted immediately under
+my own eye, yet the evidence I have adduced
+appears sufficient to establish it.
+</p>
+<p>
+They who are not in the habit of conducting
+experiments may not be aware of the coincidence
+of circumstances necessary for their being managed
+so as to prove perfectly decisive; nor how often men
+engaged in professional pursuits are liable to interruptions
+which disappoint them almost at the
+instant of their being accomplished: however,
+I feel no room for hesitation respecting the common
+origin of the disease, being well convinced
+that it never appears among the cows (except it
+can be traced to a cow introduced among the
+<a name="page47"></a> <span class="pagenum">[Pg 47]</span>
+general herd which has been previously infected,
+or to an infected servant), unless they have been
+milked by some one who, at the same time, has
+the care of a horse affected with diseased heels.
+</p>
+<p>
+The spring of the year 1797, which I intended
+particularly to have devoted to the completion of
+this investigation, proved, from its dryness, remarkably
+adverse to my wishes; for it frequently
+happens, while the farmers' horses are exposed to
+the cold rains which fall at that season that their
+heels become diseased, and no Cow-pox then
+appeared in the neighbourhood.
+</p>
+<p>
+The active quality of the virus from the horses'
+heels is greatly increased after it has acted on the
+nipples of the cow, as it rarely happens that the
+<a name="page48"></a> <span class="pagenum">[Pg 48]</span>
+horse affects his dresser with sores, and as rarely
+that a milk-maid escapes the infection when she
+milks infected cows.  It is most active at the
+commencement of the disease, even before it has
+acquired a pus-like appearance; indeed I am not
+confident whether this property in the matter does
+not entirely cease as soon as it is secreted in the
+form of pus.  I am induced to think it does
+cease<a name="ref_9_1"></a><a href="#footnote_9_1" class="fnref">[1]</a>, and that it is the thin darkish-looking
+fluid only, oozing from the newly-formed cracks
+in the heels, similar to what sometimes appears
+from erysipelatous blisters, which gives the disease.
+Nor am I certain that the nipples of the cows are
+at all times in a state to receive the infection. The
+appearance of the disease in the spring and the
+<a name="page49"></a> <span class="pagenum">[Pg 49]</span>
+early part of the summer, when they are disposed
+to be affected with spontaneous eruptions so much
+more frequently than at other seasons, induces me
+to think, that the virus from the horse must be
+received upon them when they are in this state, in
+order to produce effects: experiments, however,
+must determine these points. But it is clear that
+when the Cow-pox virus is once generated, that
+the cows cannot resist the contagion, in whatever
+state their nipples may chance to be, if they are
+milked with an infected hand.
+</p>
+<p>
+Whether the matter, either from the cow or the
+horse will affect the sound skin of the human
+body, I cannot positively determine; probably
+it will not, unless on those parts where the cuticle
+is extremely thin, as on the lips for example.
+<a name="page50"></a> <span class="pagenum">[Pg 50]</span>
+I have known an instance of a poor girl who
+produced an ulceration on her lip by frequently
+holding her finger to her mouth to cool the raging
+of a Cow-pox sore by blowing upon it. The
+hands of the farmers' servants here, from the
+nature of their employments, are constantly exposed
+to those injuries which occasion abrasions
+of the cuticle, to punctures from thorns and such
+like accidents; so that they are always in a state
+to feel the consequences of exposure to infectious
+matter.
+</p>
+<p>
+It is singular to observe that the Cow-pox virus,
+although it renders the constitution unsusceptible
+of the variolous, should, nevertheless, leave it
+unchanged with respect to its own action. I have
+<a name="page51"></a> <span class="pagenum">[Pg 51]</span>
+already produced an instance<a name="ref_9_2"></a><a href="#footnote_9_2" class="fnref">[2]</a> to point out this,
+and shall now corroborate it with another.
+</p>
+<p>
+Elizabeth Wynne, who had the Cow-pox in the
+year 1759, was inoculated with variolous matter,
+without effect, in the year 1797, and again caught
+the Cow-pox in the year 1798. When I saw her,
+which was on the 8th day after she received the
+infection, I found her affected with general lassitude,
+shiverings, alternating with heat, coldness
+of the extremities, and a quick and irregular
+pulse. These symptoms were preceded by a pain
+in the axilla. On her hand was one large pustulous
+sore, which resembled that delinated in Plate
+No. 1.
+<a name="page52"></a> <span class="pagenum">[Pg 52]</span>
+</p>
+<p>
+It is curious also to observe, that the virus,
+which with respect to its effects is undetermined
+and uncertain previously to its passing from the
+horse through the medium of the cow, should then
+not only become more active, but should invariably
+and completely possess those specific properties
+which induce in the human constitution
+symptoms similar to those of the variolous fever,
+and effect in it that peculiar change which for
+ever renders it unsusceptible of the variolous contagion.
+</p>
+<p>
+May it not, then, be reasonably conjectured, that
+the source of the Small-pox is morbid matter of a
+peculiar kind, generated by a disease in the horse,
+and that accidental circumstances may have again
+and again arisen, still working new changes upon
+<a name="page53"></a> <span class="pagenum">[Pg 53]</span>
+it, until it has acquired the contagious and malignant
+form under which we now commonly see it
+making its devastations amongst us? And, from a
+consideration of the change which the infectious
+matter undergoes from producing a disease on the
+cow, may we not conceive that many contagious
+diseases, now prevalent among us, may owe their
+present appearance not to a simple, but to a compound
+origin? For example, is it difficult to
+imagine that the measles, the scarlet fever, and the
+ulcerous sore throat with a spotted skin, have all
+sprung from the same source, assuming some
+variety in their forms according to the nature of
+their new combinations? The same question will
+apply respecting the origin of many other contagious
+diseases, which bear a strong analogy to each
+other.
+<a name="page54"></a> <span class="pagenum">[Pg 54]</span>
+</p>
+<p>
+There are certainly more forms than one,
+without considering the common variation between
+the confluent and distinct, in which the
+Small-pox appears in what is called the natural
+way.&ndash;About seven years ago a species of Small-pox
+spread through many of the towns and
+villages of this part of Gloucestershire: it was
+of so mild a nature, that a fatal instance was
+scarcely ever heard of, and consequently so little
+dreaded by the lower orders of the community,
+that they scrupled not to hold the same intercourse
+with each other as if no infectious disease had been
+present among them. I never saw nor heard of
+an instance of its being confluent. The most
+accurate manner, perhaps, in which I can convey
+an idea of it is, by saying, that had fifty individuals
+been taken promiscuously and infected
+<a name="page55"></a> <span class="pagenum">[Pg 55]</span>
+by exposure to this contagion, they would have
+had as mild and light a disease as if they had
+been inoculated with variolous matter in the
+usual way. The harmless manner in which
+it shewed itself could not arise from any peculiarity
+either in the season or the weather, for I
+watched its progress upwards of a year without
+perceiving any variation in its general appearance.
+I consider it then as a <i>variety</i> of the Small-pox<a name="ref_9_3"></a><a href="#footnote_9_3" class="fnref">[3]</a>.
+</p>
+<p>
+In some of the preceding cases I have noticed
+the attention that was paid to the state of the
+<a name="page56"></a> <span class="pagenum">[Pg 56]</span>
+variolous matter previous to the experiment of
+inserting it into the arms of those who had gone
+through the Cow-pox. This I conceived to be
+of great importance in conducting these experiments,
+and were it always properly attended to by
+those who inoculate for the Small-pox, it might
+prevent much subsequent mischief and confusion.
+With the view of enforcing so necessary a precaution,
+I shall take the liberty of digressing so
+far as to point out some unpleasant facts, relative
+to mismanagement in this particular, which
+have fallen under my own observation.
+</p>
+<p>
+A Medical Gentleman (now no more), who
+for many years inoculated in this neighbourhood,
+frequently preserved the variolous matter intended
+for his use, on a piece of lint or cotton, which, in
+<a name="page57"></a> <span class="pagenum">[Pg 57]</span>
+its fluid state was put into a vial, corked, and
+conveyed into a warm pocket; a situation certainly
+favourable for speedily producing putrefaction
+in it. In this state (not unfrequently after
+it had been taken several days from the pustules)
+it was inserted into the arms of his patients, and
+brought on inflammation of the incised parts,
+swellings of the axillary glands, fever, and sometimes
+eruptions. But what was this disease? Certainly
+not the Small-pox; for the matter having
+from putrefaction lost, or suffered a derangement
+in its specific properties, was no longer capable
+of producing that malady, those who had been
+inoculated in this manner being as much subject
+to the contagion of the Small-pox, as if
+they had never been under the influence of this
+artificial disease; and many, unfortunately, fell
+<a name="page58"></a> <span class="pagenum">[Pg 58]</span>
+victims to it, who thought themselves in perfect
+security. The same unfortunate circumstance of
+giving a disease, supposed to be the Small-pox,
+with inefficaceous variolous matter, having occurred
+under the direction of some other practitioners
+within my knowledge, and probably from the same
+incautious method of securing the variolous matter,
+I avail myself of this opportunity of mentioning
+what I conceive to be of great importance;
+and, as a further cautionary hint, I shall again
+digress so far as to add another observation on the
+subject of Inoculation.<a name="tr4"></a>
+</p>
+<p>
+Whether it be yet ascertained by experiment,
+that the quantity of variolous matter inserted into
+the skin makes any difference with respect to the
+subsequent mildness or violence of the disease, I
+<a name="page59"></a> <span class="pagenum">[Pg 59]</span>
+know not; but I have the strongest reason for
+supposing that is either the punctures or incisions
+be made so deep as to go <i>through</i> it, and wound
+the adipose membrane, that the risk of bringing
+on a violent disease is greatly increased. I have
+known an inoculator, whose practice was &quot;to
+cut deep enough (to use his own expression) to see
+a bit of fat,&quot; and there to lodge the matter. The
+great number of bad Cases, independent of inflammations
+and abscesses on the arms, and the fatality
+which attended this practice was almost inconceivable;
+and I cannot account for it on any
+other principle than that of the matter being placed
+in this situation instead of the skin.
+</p>
+<p>
+It was the practice of another, whom I well
+remember, to pinch up a small portion of the skin
+<a name="page60"></a> <span class="pagenum">[Pg 60]</span>
+on the arms of his patients and to pass through it
+a needle, with a thread attached to it previously
+dipped in variolous matter. The thread was
+lodged in the perforated part, and consequently
+left in contact with the cellular membrane. This
+practice was attended with the same ill success as
+the former. Although it is very improbable that
+any one would now inoculate in this rude way by
+design, yet these observations may tend to place a
+double guard over the lancet, when infants, whose
+skins are comparatively so very thin, fall under
+the care of the inoculator.
+</p>
+<p>
+A very respectable friend of mine, Dr. Hardwicke,
+of Sodbury in this county, inoculated great
+numbers of patients previous to the introduction
+of the more <a name="err6"></a>modern  method by Sutton, and with
+<a name="page61"></a> <span class="pagenum">[Pg 61]</span>
+such success, that a fatal instance occurred as
+rarely as since that method has been adopted. It
+was the doctor's practice to make as slight an incision
+as possible <i>upon</i> the skin, and there to lodge
+a thread saturated with the variolous matter.
+When his patients became indisposed, agreeably
+to the custom then prevailing, they were directed
+to go to bed and were kept moderately warm. Is
+it not probable then, that the success of the modern
+practice may depend more upon the method of
+invariably depositing the virus in or upon the skin,
+than on the subsequent treatment of the disease?
+</p>
+<p>
+I do not mean to insinuate that exposure to cool
+air, and suffering the patient to drink cold water
+when hot and thirsty, may not moderate the eruptive
+symptoms and lessen the number of pustules;
+<a name="page62"></a> <span class="pagenum">[Pg 62]</span>
+yet, to repeat my former observation, I cannot
+account for the uninterrupted success, or nearly so,
+of one practitioner, and the wretched state of the
+patients under the care of another, where, in both
+instances, the general treatment did not differ
+essentially, without conceiving it to arise from the
+different modes of inserting the matter for the
+purpose of producing the disease. As it is not the
+identical matter inserted which is absorbed into the
+constitution, but that which is, by some peculiar
+process in the animal economy, generated by it,
+is it not probable that different parts of the human
+body may prepare or modify the virus differently?
+Although the skin, for example, adipose membrane,
+or mucous membranes are all capable of
+producing the variolous virus by the stimulus given
+by the particles originally deposited upon them,
+<a name="page63"></a> <span class="pagenum">[Pg 63]</span>
+yet I am induced to conceive that each of these
+parts is capable of producing some variation in
+the qualities of the matter previous to its affecting
+the constitution. What else can constitute the
+difference between the Small-pox when communicated
+casually or in what has been termed the
+natural way, or when brought on artificially
+through the medium of the skin? After all, are
+the variolous particles, possessing their true specific
+and contagious principles, ever taken up and conveyed
+by the lymphatics unchanged into the blood
+vessels? I imagine not. Were this the case,
+should we not find the blood sufficiently loaded
+with them in some stages of the Small-pox to communicate
+the disease by inserting it under the
+cuticle, or by spreading it on the surface of an
+ulcer? Yet experiments have determined the impracticability
+<a name="page64"></a> <span class="pagenum">[Pg 64]</span>
+of its being given in this way; although
+it has been proved that variolous matter
+when much diluted with water, and applied to the
+skin in the usual manner, will produce the disease.
+But it would be digressing beyond a
+proper boundary, to go minutely into this subject
+here.
+</p>
+<p>
+At what period the Cow-pox was first noticed
+here is not upon record. Our oldest farmers were
+not unacquainted with it in their earliest days,
+when it appeared among their farms without any
+deviation from the ph&aelig;nomena which it now exhibits.
+Its connection with the Small-pox seems
+to have been unknown to them. Probably the
+general introduction of inoculation first occasioned
+the discovery.
+<a name="page65"></a> <span class="pagenum">[Pg 65]</span>
+</p>
+<p>
+Its rise in this country may not have been of
+very remote date, as the practice of milking cows
+might formerly have been in the hands of women
+only; which I believe is the case now in some
+other dairy countries, and, consequently that the
+cows might not in former times have been exposed
+to the contagious matter brought by the men servants
+from the heels of horses<a name="ref_9_4"></a><a href="#footnote_9_4" class="fnref">[4]</a>. Indeed a knowledge
+of the source of the infection is new in the
+minds of most of the farmers in this neighbourhood,
+but it has at length produced good consequences;
+and it seems probable from the precautions
+they are now disposed to adopt, that the
+<a name="page66"></a> <span class="pagenum">[Pg 66]</span>
+appearance of the Cow-pox here may either be
+entirely extinguished or become extremely rare.
+</p>
+<p>
+Should it be asked whether this investigation is
+a matter of mere curiosity, or whether it tends to
+any beneficial purpose? I should answer, that
+notwithstanding the happy effects of Inoculation,
+with all the improvements which the practice has
+received since its first introduction into this
+country, it not very unfrequently produces deformity
+of the skin, and sometimes, under the best
+management, proves fatal.
+</p>
+<p>
+These circumstances must naturally create in
+every instance some degree of painful solicitude
+for its consequences. But as I have never known
+fatal effects arise from the Cow-pox, even when
+<a name="page67"></a> <span class="pagenum">[Pg 67]</span>
+impressed in the most unfavourable manner, producing
+extensive inflammations and suppurations
+on the hands; and as it clearly appears that this
+disease leaves the constitution in a state of perfect
+security from the infection of the Small-pox, may
+we not infer that a mode of Inoculation may be
+introduced preferable to that at present adopted,
+especially among those families, which, from
+previous circumstances we may judge to be predisposed
+to have the disease unfavourably? It is an
+excess in the number of pustules which we chiefly
+dread in the Small-pox; but, in the Cow-pox, no
+pustules appear, nor does it seem possible for the
+contagious matter to produce the disease from
+effluvia, or by any other means than contact, and
+that probably not simply between the virus and
+the cuticle; so that a single individual in a family
+<a name="page68"></a> <span class="pagenum">[Pg 68]</span>
+might at any time receive it without the risk of
+infecting the rest, or of spreading a distemper that
+fills a country with terror. Several instances have
+come under my observation which justify the
+assertion that the disease cannot be propagated by
+effluvia. The first boy whom I inoculated with
+the matter of Cow-pox, slept in a bed, while the
+experiment was going forward, with two children
+who never had gone through either that disease or
+the Small-pox, without infecting either of them.
+</p>
+<p>
+A young woman who had the Cow-pox to a
+great extent, several sores which maturated having
+appeared on the hands and wrists, slept in the same
+bed with a fellow-dairy maid who never had been
+infected with either the Cow-pox or the Small-pox,
+but no indisposition followed.
+<a name="page69"></a> <span class="pagenum">[Pg 69]</span>
+</p>
+<p>
+Another instance has occurred of a young
+woman on whose hands were several large suppurations
+from the Cow-pox, who was at the same
+time a daily nurse to an infant, but the complaint
+was not communicated to the child.
+</p>
+<p>
+In some other points of view, the inoculation
+of this disease appears preferable to the variolous
+inoculation.
+</p>
+<p>
+In constitutions predisposed to scrophula, how
+frequently we see the inoculated Small-pox, rouse
+into activity that distressful malady. This circumstance
+does not seem to depend on the manner in
+which the distemper has shewn itself, for it has as
+frequently happened among those who have had it
+mildly, as when it has appeared in the contrary way.
+<a name="page70"></a> <span class="pagenum">[Pg 70]</span>
+</p>
+<p>
+There are many, who from some peculiarity in
+the habit resist the common effects of variolous
+matter inserted into the skin, and who are in consequence
+haunted through life with the distressing
+idea of being insecure from subsequent infection.
+A ready mode of dissipating anxiety originating
+from such a cause must now appear obvious. And,
+as we have seen that the constitution may at any
+time be made to feel the febrile attack of Cow-pox,
+might it not, in many chronic diseases be
+introduced into the system, with the probability
+of affording relief, upon well-known physiological
+principles?
+</p>
+<p>
+Although I say the system may at any time be
+made to feel the febrile attack of Cow-pox, yet I
+have a single instance before me where the virus
+<a name="page71"></a> <span class="pagenum">[Pg 71]</span>
+acted locally only, but it is not in the least probable
+that the same person would resist the action
+both of the Cow-pox virus and the variolous.
+</p>
+<p>
+Elizabeth Sarsenet  lived as a dairy maid at Newpark
+farm, in this parish. All the cows and the servants
+employed in milking had the Cow-pox; but
+this woman, though she had several sores upon
+her fingers, felt no tumors in the axillæ, nor any
+general indisposition.  On being afterwards casually
+exposed to variolous infection, she had the
+Small-pox in a mild way.&ndash;Hannah Pick, another
+of the dairy maids who was a fellow-servant with
+Elizabeth Sarsenet when the distemper broke out
+at the farm was, at the same time infected; but
+this young woman had not only sores upon her
+hands, but felt herself also much indisposed for a
+<a name="page72"></a> <span class="pagenum">[Pg 72]</span>
+day or two. After this, I made several attempts
+to give her the Small-pox by inoculation, but
+they all proved fruitless. From the former Case
+then we see that the animal economy is subject to
+the same laws in one disease as the other.
+</p>
+<p>
+The following Case which has very lately occurred
+renders it highly probable that not only the
+heels of the horse, but other parts of the body of
+that animal, are capable of generating the virus
+which produces the Cow-pox.
+</p>
+<p>
+An extensive inflammation of the erysipelatous
+kind, appeared without any apparent cause upon
+the upper part of the thigh of a sucking colt, the
+property of Mr. Millet, a farmer at Rockhampton,
+a village near Berkeley.  The inflammation continued
+<a name="page73"></a> <span class="pagenum">[Pg 73]</span>
+several weeks, and at length terminated in
+the formation of three or four small abscesses. The
+inflamed parts were fomented, and dressings were
+applied by some of the same persons who were
+employed in milking the cows. The number of
+cows milked was twenty-four, and the whole of
+them had the Cow-pox. The milkers, consisting
+of the farmer's wife, a man and a maid servant,
+were infected by the cows. The man servant had
+previously gone through the Small-pox, and felt
+but little of the Cow-pox. The servant maid had
+some years before been infected with the Cow-pox,
+and she also felt it now in a slight degree: But the
+farmer's wife who never had gone through either
+of these diseases, felt its effects very severely.
+<a name="page74"></a> <span class="pagenum">[Pg 74]</span>
+</p>
+<p>
+That the disease produced upon the cows by the
+colt and from thence conveyed to those who
+milked them was the <i>true</i> and not the <i>spurious</i>
+Cow-pox<a name="ref_9_5"></a><a href="#footnote_9_5" class="fnref">[5]</a>, there can be scarcely any room for
+suspicion; yet it would have been more completely
+satisfactory, had the effects of variolous matter been
+ascertained on the farmer's wife, but there was a
+peculiarity in her situation which prevented my
+making the experiment.
+</p>
+<p>
+Thus far have I proceeded in an inquiry,
+founded, as it must appear, on the basis of experiment;
+in which, however, conjecture has
+been occasionally admitted in order to present to
+persons well situated for such discussions, objects
+<a name="page75"></a> <span class="pagenum">[Pg 75]</span>
+for a more minute investigation. In the mean
+time I shall myself continue to prosecute this
+inquiry, encouraged by the hope of its becoming
+essentially beneficial to mankind.
+</p>
+<p class="footnote">
+<a name="footnote_9_1"></a><a href="#ref_9_1">1</a>: It is very easy to procure pus from old sores on the heels of horses. This I
+have often inserted into scratches made with a lancet, on the sound nipples of
+cows, and have seen no other effects from it than simple inflammation.
+</p>
+<p class="footnote">
+<a name="footnote_9_2"></a><a href="#ref_9_2">2</a>: See <a href="#chapter13">Case IX</a>.
+</p>
+<p class="footnote">
+<a name="footnote_9_3"></a><a href="#ref_9_3">3</a>: My friend Dr. Hicks, of Bristol, who during the prevalence of this distemper
+was resident at Gloucester, and Physician to the Hospital there,
+(where it was seen soon after its first appearance in this country) had opportunities
+of making numerous observations upon it, which it is his intention to communicate
+to the Public.
+</p>
+<p class="footnote">
+<a name="footnote_9_4"></a><a href="#ref_9_4">4</a>: I have been informed from respectable authority that in Ireland, although
+dairies abound in many parts of the Island, the disease is entirely unknown. The
+reason seems obvious. The business of the dairy is conducted by women only.
+Were the meanest vassal among the men, employed there as a milker at a dairy,
+he would feel his situation unpleasant beyond all endurance.
+</p>
+<p class="footnote">
+<a name="footnote_9_5"></a><a href="#ref_9_5">5</a>: See <a href="#footnote_1_3">Note</a> in Page 7.
+</p>
+<p class="finis">
+FINIS.
+<a name="page77"></a> <span class="pagenum">[Pg 77]</span>
+</p>
+<h2>
+<a name="chapter28"></a>
+<i>ERRATA.</i>
+</h2>
+<table summary="errata">
+<tr><td>Page 5, </td> <td><a href="#err1">Line  4</a>, </td> <td>after the word <i>shiverings</i> insert <i>succeeded by heat</i>.</td></tr>
+<tr><td></td><td><a href="#err2">Line 16</a>, </td><td>for <i>needlessly</i> read <i>heedlessly</i>.</td></tr>
+<tr><td>&mdash; 24, </td><td><a href="#err3">Last line but one</a>, </td><td>for <i>sore</i> read <i>tumour</i>.</td></tr>
+<tr><td>&mdash; 40, </td><td><a href="#err4">Line 12</a>, </td><td>for <i>Macklove</i> read <i>Marklove</i>.</td></tr>
+<tr><td>&mdash; 41, </td><td><a href="#err5">Note</a>&ndash;</td><td>for <i>scepticus</i> read <i>septicus</i>.</td></tr>
+<tr><td>&mdash; 60, </td><td><a href="#err6">Last line</a>, </td><td>for <i>moderate</i> read <i>modern</i>.</td></tr>
+</table>
+<div class="trnote">
+<h2>
+<a name="chapter29"></a>
+Transcriber's Note
+</h2>
+<p>
+For this e-text, all the errors in the original book's &quot;Errata&quot; section
+have been corrected, as well as the following:
+</p>
+<table summary="notes">
+<tr><td><a href="#tr1">Introductory letter</a>: </td><td>&quot;C. H PARRY&quot; corrected to &quot;C. H. PARRY&quot;.</td></tr>
+<tr><td><a href="#tr2">Introduction</a>: </td><td>Inserted &quot;to&quot; after &quot;But this disease is not&quot;.</td></tr>
+<tr><td><a href="#tr3">Case XX</a>: </td><td>&quot;begining&quot; corrected to &quot;beginning&quot;.</td></tr>
+<tr><td><a href="#tr4">Conclusions</a>: </td><td>Added full-stop after &quot;on the subject of Inoculation&quot;.</td></tr>
+</table>
+<p>
+The following archaic spellings of words were used in the original book
+and have been retained:  head-ach; concuring; delinated.
+</p>
+</div>
+
+<p>&nbsp;</p>
+<p>&nbsp;</p>
+<hr class="full" />
+<p>***END OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND EFFECTS OF THE VARIOLAE VACCINAE***</p>
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+The Project Gutenberg eBook, An Inquiry into the Causes and Effects of the
+Variolae Vaccinae, by Edward Jenner
+
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+
+
+
+Title: An Inquiry into the Causes and Effects of the Variolae Vaccinae
+       A Disease Discovered in Some of the Western Counties of England, Particularly Gloucestershire, and Known by the Name of the Cow Pox
+
+
+Author: Edward Jenner
+
+
+
+Release Date: July 15, 2009  [eBook #29414]
+
+Language: English
+
+Character set encoding: ISO-646-US (US-ASCII)
+
+
+***START OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND
+EFFECTS OF THE VARIOLAE VACCINAE***
+
+
+E-text prepared by K. Nordquist, Michael Roe, Carl Hudkins, and the
+Project Gutenberg Online Distributed Proofreading Team
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+
+
+
+
+
+AN
+_INQUIRY_
+INTO
+THE CAUSES AND EFFECTS
+OF
+THE VARIOLAE VACCINAE.
+
+
+PRICE 7s. 6d.
+
+
+
+
+AN
+_INQUIRY_
+INTO
+THE CAUSES AND EFFECTS
+OF
+THE VARIOLAE VACCINAE,
+A DISEASE
+DISCOVERED IN SOME OF THE WESTERN COUNTIES OF ENGLAND,
+PARTICULARLY
+_GLOUCESTERSHIRE_,
+AND KNOWN BY THE NAME OF
+THE COW POX.
+
+
+BY EDWARD JENNER, M.D. F.R.S. &c.
+
+              ----QUID NOBIS CERTIUS IPSIS
+  SENSIBUS ESSE POTEST, QUO VERA AC FALSA NOTEMUS.
+
+                                        LUCRETIUS.
+
+London:
+PRINTED, FOR THE AUTHOR,
+BY SAMPSON LOW, No. 7, BERWICK STREET, SOHO:
+AND SOLD BY LAW, AVE-MARIA LANE; AND MURRAY AND HIGHLEY, FLEET STREET.
+
+1798.
+
+
+
+
+  TO
+  _C. H. PARRY, M.D._
+  AT BATH.
+
+
+  _My dear friend_,
+
+In the present age of scientific investigation, it is remarkable that
+a disease of so peculiar a nature as the Cow Pox, which has appeared
+in this and some of the neighbouring counties for such a series of
+years, should so long have escaped particular attention. Finding the
+prevailing notions on the subject, both among men of our profession
+and others, extremely vague and indeterminate, and conceiving that
+facts might appear at once both curious and useful, I have instituted
+as strict an inquiry into the causes and effects of this singular
+malady as local circumstances would admit.
+
+The following pages are the result, which, from motives of the most
+affectionate regard, are dedicated to you, by
+
+  Your sincere Friend,
+  EDWARD JENNER.
+
+  Berkeley, Gloucestershire,
+  June 21st, 1798.
+
+
+
+
+AN INQUIRY, _&c. &c._
+
+
+The deviation of Man from the state in which he was originally placed
+by Nature seems to have proved to him a prolific source of Diseases.
+From the love of splendour, from the indulgences of luxury, and from
+his fondness for amusement, he has familiarised himself with a great
+number of animals, which may not originally have been intended for
+his associates.
+
+The Wolf, disarmed of ferocity, is now pillowed in the lady's lap[1].
+The Cat, the little Tyger of our island, whose natural home is the
+forest, is equally domesticated and caressed. The Cow, the Hog, the
+Sheep, and the Horse, are all, for a variety of purposes, brought
+under his care and dominion.
+
+There is a disease to which the Horse, from his state of
+domestication, is frequently subject. The Farriers have termed it
+_the Grease_. It is an inflammation and swelling in the heel, from
+which issues matter possessing properties of a very peculiar kind,
+which seems capable of generating a disease in the Human Body (after
+it has undergone the modification which I shall presently speak of),
+which bears so strong a resemblance to the Small Pox, that I think it
+highly probable it may be the source of that disease.
+
+In this Dairy Country a great number of Cows are kept, and the office
+of milking is performed indiscriminately by Men and Maid Servants.
+One of the former having been appointed to apply dressings to the
+heels of a Horse affected with _the Grease_, and not paying due
+attention to cleanliness, incautiously bears his part in milking the
+Cows, with some particles of the infectious matter adhering to his
+fingers. When this is the case, it commonly happens that a disease is
+communicated to the Cows, and from the Cows to the Dairy-maids, which
+spreads through the farm until most of the cattle and domestics feel
+its unpleasant consequences. This disease has obtained the name of
+the Cow Pox. It appears on the nipples of the Cows in the form of
+irregular pustules. At their first appearance they are commonly of a
+palish blue, or rather of a colour somewhat approaching to livid, and
+are surrounded by an erysipelatous inflammation. These pustules,
+unless a timely remedy be applied, frequently degenerate into
+phagedenic ulcers, which prove extremely troublesome[2]. The animals
+become indisposed, and the secretion of milk is much lessened.
+Inflamed spots now begin to appear on different parts of the hands of
+the domestics employed in milking, and sometimes on the wrists, which
+quickly run on to suppuration, first assuming the appearance of the
+small vesications produced by a burn. Most commonly they appear about
+the joints of the fingers, and at their extremities; but whatever
+parts are affected, if the situation will admit, these superficial
+suppurations put on a circular form, with their edges more elevated
+than their centre, and of a colour distantly approaching to blue.
+Absorption takes place, and tumours appear in each axilla. The system
+becomes affected--the pulse is quickened; and shiverings succeeded by
+heat, with general lassitude and pains about the loins and limbs,
+with vomiting, come on. The head is painful, and the patient is now
+and then even affected with delirium. These symptoms, varying in
+their degrees of violence, generally continue from one day to three
+or four, leaving ulcerated sores about the hands, which, from the
+sensibility of the parts, are very troublesome, and commonly heal
+slowly, frequently becoming phagedenic, like those from whence they
+sprung. The lips, nostrils, eyelids, and other parts of the body, are
+sometimes affected with sores; but these evidently arise from their
+being heedlessly rubbed or scratched with the patient's infected
+fingers. No eruptions on the skin have followed the decline of the
+feverish symptoms in any instance that has come under my inspection,
+one only excepted, and in this case a very few appeared on the arms:
+they were very minute, of a vivid red colour, and soon died away
+without advancing to maturation; so that I cannot determine whether
+they had any connection with the preceding symptoms.
+
+Thus the disease makes its progress from the Horse to the nipple of
+the Cow, and from the Cow to the Human Subject.
+
+Morbid matter of various kinds, when absorbed into the system, may
+produce effects in some degree similar; but what renders the Cow-pox
+virus so extremely singular, is, that the person who has been thus
+affected is for ever after secure from the infection of the Small
+Pox; neither exposure to the variolous effluvia, nor the insertion of
+the matter into the skin, producing this distemper.
+
+In support of so extraordinary a fact, I shall lay before my Reader a
+great number of instances[3].
+
+[Footnote 1: The late Mr. John Hunter proved, by experiments, that
+the Dog is the Wolf in a degenerated state.]
+
+[Footnote 2: They who attend sick cattle in this country find a
+speedy remedy for stopping the progress of this complaint in those
+applications which act chemically upon the morbid matter, such as the
+solutions of the Vitriolum Zinci, the Vitriolum Cupri, &c.]
+
+[Footnote 3: It is necessary to observe, that pustulous sores
+frequently appear spontaneously on the nipples of Cows, and instances
+have occurred, though very rarely, of the hands of the servants
+employed in milking being affected with sores in consequence, and
+even of their feeling an indisposition from absorption. These
+pustules are of a much milder nature than those which arise from that
+contagion which constitutes the true Cow Pox. They are always free
+from the bluish or livid tint so conspicuous in the pustules in that
+disease. No erysipelas attends them, nor do they shew any phagedenic
+disposition as in the other case, but quickly terminate in a scab
+without creating any apparent disorder in the Cow. This complaint
+appears at various seasons of the year, but most commonly in the
+Spring, when the Cows are first taken from their winter food and fed
+with grass. It is very apt to appear also when they are suckling
+their young. But this disease is not to be considered as similar in
+any respect to that of which I am treating, as it is incapable of
+producing any specific effects on the human Constitution. However, it
+is of the greatest consequence to point it out here, lest the want of
+discrimination should occasion an idea of security from the infection
+of the Small Pox, which might prove delusive.]
+
+
+
+
+_CASE I._
+
+
+JOSEPH MERRET, now an Under Gardener to the Earl of Berkeley, lived
+as a Servant with a Farmer near this place in the year 1770, and
+occasionally assisted in milking his master's cows. Several horses
+belonging to the farm began to have sore heels, which Merret
+frequently attended. The cows soon became affected with the Cow Pox,
+and soon after several sores appeared on his hands. Swellings and
+stiffness in each axilla followed, and he was so much indisposed for
+several days as to be incapable of pursuing his ordinary employment.
+Previously to the appearance of the distemper among the cows there
+was no fresh cow brought into the farm, nor any servant employed who
+was affected with the Cow Pox.
+
+In April, 1795, a general inoculation taking place here, Merret was
+inoculated with his family; so that a period of twenty-five years had
+elapsed from his having the Cow Pox to this time. However, though the
+variolous matter was repeatedly inserted into his arm, I found it
+impracticable to infect him with it; an efflorescence only, taking on
+an erysipelatous look about the centre, appearing on the skin near
+the punctured parts. During the whole time that his family had the
+Small Pox, one of whom had it very full, he remained in the house
+with them, but received no injury from exposure to the contagion.
+
+It is necessary to observe, that the utmost care was taken to
+ascertain, with the most scrupulous precision, that no one whose case
+is here adduced had gone through the Small Pox previous to these
+attempts to produce that disease.
+
+Had these experiments been conducted in a large city, or in a
+populous neighbourhood, some doubts might have been entertained; but
+here, where population is thin, and where such an event as a person's
+having had the Small Pox is always faithfully recorded, no risk of
+inaccuracy in this particular can arise.
+
+
+
+
+_CASE II._
+
+
+SARAH PORTLOCK, of this place, was infected with the Cow Pox, when a
+Servant at a Farmer's in the neighbourhood, twenty-seven years
+ago[1].
+
+In the year 1792, conceiving herself, from this circumstance, secure
+from the infection of the Small Pox, she nursed one of her own
+children who had accidentally caught the disease, but no
+indisposition ensued.--During the time she remained in the infected
+room, variolous matter was inserted into both her arms, but without
+any further effect than in the preceding case.
+
+[Footnote 1: I have purposely selected several cases in which the
+disease had appeared at a very distant period previous to the
+experiments made with variolous matter, to shew that the change
+produced in the constitution is not affected by time.]
+
+
+
+
+_CASE III._
+
+
+JOHN PHILLIPS, a Tradesman of this town, had the Cow Pox at so early
+a period as nine years of age. At the age of sixty-two I inoculated
+him, and was very careful in selecting matter in its most active
+state. It was taken from the arm of a boy just before the
+commencement of the eruptive fever, and instantly inserted. It very
+speedily produced a sting-like feel in the part. An efflorescence
+appeared, which on the fourth day was rather extensive, and some
+degree of pain and stiffness were felt about the shoulder; but on the
+fifth day these symptoms began to disappear, and in a day or two
+after went entirely off, without producing any effect on the system.
+
+
+
+
+_CASE IV._
+
+
+MARY BARGE, of Woodford, in this parish, was inoculated with
+variolous matter in the year 1791. An efflorescence of a palish red
+colour soon appeared about the parts where the matter was inserted,
+and spread itself rather extensively, but died away in a few days
+without producing any variolous symptoms[1]. She has since been
+repeatedly employed as a nurse to Small-pox patients, without
+experiencing any ill consequences. This woman had the Cow Pox when
+she lived in the service of a Farmer in this parish thirty-one years
+before.
+
+[Footnote 1: It is remarkable that variolous matter, when the system
+is disposed to reject it, should excite inflammation on the part to
+which it is applied more speedily than when it produces the Small
+Pox. Indeed it becomes almost a criterion by which we can determine
+whether the infection will be received or not. It seems as if a
+change, which endures through life, had been produced in the action,
+or disposition to action, in the vessels of the skin; and it is
+remarkable too, that whether this change has been effected by the
+Small Pox, or the Cow Pox, that the disposition to sudden cuticular
+inflammation is the same on the application of variolous matter.]
+
+
+
+
+_CASE V._
+
+
+MRS. H----, a respectable Gentlewoman of this town, had the Cow Pox
+when very young. She received the infection in rather an uncommon
+manner: it was given by means of her handling some of the same
+utensils[1] which were in use among the servants of the family, who
+had the disease from milking infected cows. Her hands had many of the
+Cow-pox sores upon them, and they were communicated to her nose,
+which became inflamed and very much swoln. Soon after this event Mrs.
+H---- was exposed to the contagion of the Small Pox, where it was
+scarcely possible for her to have escaped, had she been susceptible
+of it, as she regularly attended a relative who had the disease in so
+violent a degree that it proved fatal to him.
+
+In the year 1778 the Small Pox prevailed very much at Berkeley, and
+Mrs. H---- not feeling perfectly satisfied respecting her safety (no
+indisposition having followed her exposure to the Small Pox) I
+inoculated her with active variolous matter. The same appearance
+followed as in the preceding cases--an efflorescence on the arm
+without any effect on the constitution.
+
+[Footnote 1: When the Cow Pox has prevailed in the dairy, it has
+often been communicated to those who have not milked the cows, by the
+handle of the milk pail.]
+
+
+
+
+_CASE VI._
+
+
+It is a fact so well known among our Dairy Farmers, that those who
+have had the Small Pox either escape the Cow Pox or are disposed to
+have it slightly; that as soon as the complaint shews itself among
+the cattle, assistants are procured, if possible, who are thus
+rendered less susceptible of it, otherwise the business of the farm
+could scarcely go forward.
+
+In the month of May, 1796, the Cow Pox broke out at Mr. Baker's, a
+Farmer who lives near this place. The disease was communicated by
+means of a cow which was purchased in an infected state at a
+neighbouring fair, and not one of the Farmer's cows (consisting of
+thirty) which were at that time milked escaped the contagion. The
+family consisted of a man servant, two dairymaids, and a servant boy,
+who, with the Farmer himself, were twice a day employed in milking
+the cattle. The whole of this family, except Sarah Wynne, one of the
+dairymaids, had gone through the Small Pox. The consequence was, that
+the Farmer and the servant boy escaped the infection of the Cow Pox
+entirely, and the servant man and one of the maid servants had each
+of them nothing more than a sore on one of their fingers, which
+produced no disorder in the system. But the other dairymaid, Sarah
+Wynne, who never had the Small Pox, did not escape in so easy a
+manner. She caught the complaint from the cows, and was affected with
+the symptoms described in the 5th page in so violent a degree, that
+she was confined to her bed, and rendered incapable for several days
+of pursuing her ordinary vocations in the farm.
+
+March 28th, 1797, I inoculated this girl, and carefully rubbed the
+variolous matter into two slight incisions made upon the left arm. A
+little inflammation appeared in the usual manner around the parts
+where the matter was inserted, but so early as the fifth day it
+vanished entirely without producing any effect on the system.
+
+
+
+
+_CASE VII._
+
+
+Although the preceding history pretty clearly evinces that the
+constitution is far less susceptible of the contagion of the Cow Pox
+after it has felt that of the Small Pox, and although in general, as
+I have observed, they who have had the Small Pox, and are employed in
+milking cows which are infected with the Cow Pox, either escape the
+disorder, or have sores on the hands without feeling any general
+indisposition, yet the animal economy is subject to some variation in
+this respect, which the following relation will point out:
+
+In the summer of the year 1796 the Cow Pox appeared at the Farm of
+Mr. Andrews, a considerable dairy adjoining to the town of Berkeley.
+It was communicated, as in the preceding instance, by an infected cow
+purchased at a fair in the neighbourhood. The family consisted of the
+Farmer, his wife, two sons, a man and a maid servant; all of whom,
+except the Farmer (who was fearful of the consequences), bore a part
+in milking the cows. The whole of them, exclusive of the man servant,
+had regularly gone through the Small Pox; but in this case no one who
+milked the cows escaped the contagion. All of them had sores upon
+their hands, and some degree of general indisposition, preceded by
+pains and tumours in the axillae: but there was no comparison in the
+severity of the disease as it was felt by the servant man, who had
+escaped the Small Pox, and by those of the family who had not, for,
+while he was confined to his bed, they were able, without much
+inconvenience, to follow their ordinary business.
+
+February the 13th, 1797, I availed myself of an opportunity of
+inoculating William Rodway, the servant man above alluded to.
+Variolous matter was inserted into both his arms; in the right by
+means of superficial incisions, and into the left by slight punctures
+into the cutis. Both were perceptibly inflamed on the third day.
+After this the inflammation about the punctures soon died away, but a
+small appearance of erysipelas was manifest about the edges of the
+incisions till the eighth day, when a little uneasiness was felt for
+the space of half an hour in the right axilla. The inflammation then
+hastily disappeared without producing the most distant mark of
+affection of the system.
+
+
+
+
+_CASE VIII._
+
+
+ELIZABETH WYNNE, aged fifty-seven, lived as a servant with a
+neighbouring Farmer thirty-eight years ago. She was then a dairymaid,
+and the Cow Pox broke out among the cows. She caught the disease with
+the rest of the family, but, compared with them, had it in a very
+slight degree, one very small sore only breaking out on the little
+finger of her left hand, and scarcely any perceptible indisposition
+following it.
+
+As the malady had shewn itself in so slight a manner, and as it had
+taken place at so distant a period of her life, I was happy with the
+opportunity of trying the effects of variolous matter upon her
+constitution, and on the 28th of March, 1797, I inoculated her by
+making two superficial incisions on the left arm, on which the matter
+was cautiously rubbed. A little efflorescence soon appeared, and a
+tingling sensation was felt about the parts where the matter was
+inserted until the third day, when both began to subside, and so
+early as the fifth day it was evident that no indisposition would
+follow.
+
+
+
+
+_CASE IX._
+
+
+Although the Cow Pox shields the constitution from the Small Pox, and
+the Small Pox proves a protection against its own future poison, yet
+it appears that the human body is again and again susceptible of the
+infectious matter of the Cow Pox, as the following history will
+demonstrate:
+
+William Smith, of Pyrton in this parish, contracted this disease when
+he lived with a neighbouring Farmer in the year 1780. One of the
+horses belonging to the farm had sore heels, and it fell to his lot
+to attend him. By these means the infection was carried to the cows,
+and from the cows it was communicated to Smith. On one of his hands
+were several ulcerated sores, and he was affected with such symptoms
+as have been before described.
+
+In the year 1791 the Cow Pox broke out at another farm where he then
+lived as a servant, and he became affected with it a second time; and
+in the year 1794 he was so unfortunate as to catch it again. The
+disease was equally as severe the second and third time as it was on
+the first[1].
+
+In the spring of the year 1795 he was twice inoculated, but no
+affection of the system could be produced from the variolous matter;
+and he has since associated with those who had the Small Pox in its
+most contagious state without feeling any effect from it.
+
+[Footnote 1: This is not the case in general--a second attack is
+commonly very slight, and so, I am informed, it is among the cows.]
+
+
+
+
+_CASE X._
+
+
+SIMON NICHOLS lived as a servant with Mr. Bromedge, a gentleman who
+resides on his own farm in this parish, in the year 1782. He was
+employed in applying dressings to the sore heels of one of his
+master's horses, and at the same time assisted in milking the cows.
+The cows became affected in consequence, but the disease did not shew
+itself on their nipples till several weeks after he had begun to
+dress the horse. He quitted Mr. Bromedge's service, and went to
+another farm without any sores upon him; but here his hands soon
+began to be affected in the common way, and he was much indisposed
+with the usual symptoms. Concealing the nature of the malady from Mr.
+Cole, his new master, and being there also employed in milking, the
+Cow Pox was communicated to the cows.
+
+Some years afterwards Nichols was employed in a farm where the Small
+Pox broke out, when I inoculated him with several other patients,
+with whom he continued during the whole time of their confinement.
+His arm inflamed, but neither the inflammation nor his associating
+with the inoculated family produced the least effect upon his
+constitution.
+
+
+
+
+_CASE XI._
+
+
+WILLIAM STINCHCOMB was a fellow servant with Nichols at Mr.
+Bromedge's Farm at the time the cattle had the Cow Pox, and he was
+unfortunately infected by them. His left hand was very severely
+affected with several corroding ulcers, and a tumour of considerable
+size appeared in the axilla of that side. His right hand had only one
+small sore upon it, and no tumour discovered itself in the
+corresponding axilla.
+
+In the year 1792 Stinchcomb was inoculated with variolous matter, but
+no consequences ensued beyond a little inflammation in the arm for a
+few days. A large party were inoculated at the same time, some of
+whom had the disease in a more violent degree than is commonly seen
+from inoculation. He purposely associated with them, but could not
+receive the Small Pox.
+
+During the sickening of some of his companions, their symptoms so
+strongly recalled to his mind his own state when sickening with the
+Cow Pox, that he very pertinently remarked their striking similarity.
+
+
+
+
+_CASE XII._
+
+
+The Paupers of the village of Tortworth, in this county, were
+inoculated by Mr. Henry Jenner, Surgeon, of Berkeley, in the year
+1795. Among them, eight patients presented themselves who had at
+different periods of their lives had the Cow Pox. One of them, Hester
+Walkley, I attended with that disease when she lived in the service
+of a Farmer in the same village in the year 1782; but neither this
+woman, nor any other of the patients who had gone through the Cow
+Pox, received the variolous infection either from the arm or from
+mixing in the society of the other patients who were inoculated at
+the same time. This state of security proved a fortunate
+circumstance, as many of the poor women were at the same time in a
+state of pregnancy.
+
+
+
+
+_CASE XIII._
+
+
+One instance has occurred to me of the system being affected from the
+matter issuing from the heels of horses, and of its remaining
+afterwards unsusceptible of the variolous contagion; another, where
+the Small Pox appeared obscurely; and a third, in which its complete
+existence was positively ascertained.
+
+First, THOMAS PEARCE, is the son of a Smith and Farrier near to this
+place. He never had the Cow Pox; but, in consequence of dressing
+horses with sore heels at his father's, when a lad, he had sores on
+his fingers which suppurated, and which occasioned a pretty severe
+indisposition. Six years afterwards I inserted variolous matter into
+his arm repeatedly, without being able to produce any thing more than
+slight inflammation, which appeared very soon after the matter was
+applied, and afterwards I exposed him to the contagion of the Small
+Pox with as little effect[1].
+
+[Footnote 1: It is a remarkable fact, and well known to many, that we
+are frequently foiled in our endeavours to communicate the Small Pox
+by inoculation to blacksmiths, who in the country are farriers. They
+often, as in the above instance, either resist the contagion
+entirely, or have the disease anomalously. Shall we not be able now
+to account for this on a rational principle?]
+
+
+
+
+_CASE XIV._
+
+
+Secondly, Mr. JAMES COLE, a Farmer in this parish, had a disease from
+the same source as related in the preceding case, and some years
+after was inoculated with variolous matter. He had a little pain in
+the axilla, and felt a slight indisposition for three or four hours.
+A few eruptions shewed themselves on the forehead, but they very soon
+disappeared without advancing to maturation.
+
+
+
+
+_CASE XV._
+
+
+Although in the two former instances the system seemed to be secured,
+or nearly so, from variolous infection, by the absorption of matter
+from sores produced by the diseased heels of horses, yet the
+following case decisively proves that this cannot be entirely relied
+upon, until a disease has been generated by the morbid matter from
+the horse on the nipple of the cow, and passed through that medium to
+the human subject.
+
+Mr. ABRAHAM RIDDIFORD, a Farmer at Stone in this parish, in
+consequence of dressing a mare that had sore heels, was affected with
+very painful sores in both his hands, tumours in each axilla, and
+severe and general indisposition. A Surgeon in the neighbourhood
+attended him, who, knowing the similarity between the appearance of
+the sores upon his hands and those produced by the Cow Pox, and being
+acquainted also with the effects of that disease on the human
+constitution, assured him that he never need to fear the infection of
+the Small Pox; but this assertion proved fallacious, for, on being
+exposed to the infection upwards of twenty years afterwards, he
+caught the disease, which took its regular course in a very mild way.
+There certainly was a difference perceptible, although it is not easy
+to describe it, in the general appearance of the pustules from that
+which we commonly see. Other practitioners, who visited the patient
+at my request, agreed with me in this point, though there was no room
+left for suspicion as to the reality of the disease, as I inoculated
+some of his family from the pustules, who had the Small Pox, with its
+usual appearances, in consequence.
+
+
+
+
+_CASE XVI._
+
+
+SARAH NELMES, a dairymaid at a Farmer's near this place, was infected
+with the Cow Pox from her master's cows in May, 1796. She received
+the infection on a part of the hand which had been previously in a
+slight degree injured by a scratch from a thorn. A large pustulous
+sore and the usual symptoms accompanying the disease were produced in
+consequence. The pustule was so expressive of the true character of
+the Cow Pox, as it commonly appears upon the hand, that I have given
+a representation of it in the annexed plate. The two small pustules
+on the wrists arose also from the application of the virus to some
+minute abrasions of the cuticle, but the livid tint, if they ever had
+any, was not conspicuous at the time I saw the patient. The pustule
+on the fore finger shews the disease in an earlier stage. It did not
+actually appear on the hand of this young woman, but was taken from
+that of another, and is annexed for the purpose of representing the
+malady after it has newly appeared.
+
+
+
+
+_CASE XVII._
+
+
+The more accurately to observe the progress of the infection, I
+selected a healthy boy, about eight years old, for the purpose of
+inoculation for the Cow Pox. The matter was taken from a sore on the
+hand of a dairymaid[1], who was infected by her master's cows, and it
+was inserted, on the 14th of May, 1796, into the arm of the boy by
+means of two superficial incisions, barely penetrating the cutis,
+each about half an inch long.
+
+[Illustration]
+
+On the seventh day he complained of uneasiness in the axilla, and on
+the ninth he became a little chilly, lost his appetite, and had a
+slight head-ach. During the whole of this day he was perceptibly
+indisposed, and spent the night with some degree of restlessness, but
+on the day following he was perfectly well.
+
+The appearance of the incisions in their progress to a state of
+maturation were much the same as when produced in a similar manner by
+variolous matter. The only difference which I perceived was, in the
+state of the limpid fluid arising from the action of the virus, which
+assumed rather a darker hue, and in that of the efflorescence
+spreading round the incisions, which had more of an erysipelatous
+look than we commonly perceive when variolous matter has been made
+use of in the same manner; but the whole died away (leaving on the
+inoculated parts scabs and subsequent eschars) without giving me or
+my patient the least trouble.
+
+In order to ascertain whether the boy, after feeling so slight an
+affection of the system from the Cow-pox virus, was secure from the
+contagion of the Small-pox, he was inoculated the 1st of July
+following with variolous matter, immediately taken from a pustule.
+Several slight punctures and incisions were made on both his arms,
+and the matter was carefully inserted, but no disease followed. The
+same appearances were observable on the arms as we commonly see when
+a patient has had variolous matter applied, after having either the
+Cow-pox or the Small-pox. Several months afterwards, he was again
+inoculated with variolous matter, but no sensible effect was produced
+on the constitution.
+
+Here my researches were interrupted till the spring of the year 1798,
+when from the wetness of the early part of the season, many of the
+farmers' horses in this neighbourhood were affected with sore heels,
+in consequence of which the Cow-pox broke out among several of our
+dairies, which afforded me an opportunity of making further
+observations upon this curious disease.
+
+A mare, the property of a person who keeps a dairy in a neighbouring
+parish, began to have sore heels the latter end of the month of
+February 1798, which were occasionally washed by the servant men of
+the farm, Thomas Virgoe, William Wherret, and William Haynes, who in
+consequence became affected with sores in their hands, followed by
+inflamed lymphatic glands in the arms and axillae, shiverings
+succeeded by heat, lassitude and general pains in the limbs. A single
+paroxysm terminated the disease; for within twenty-four hours they
+were free from general indisposition, nothing remaining but the sores
+on their hands. Haynes and Virgoe, who had gone through the Small-pox
+from inoculation, described their feelings as very similar to those
+which affected them on sickening with that malady. Wherret never had
+had the Small-pox. Haynes was daily employed as one of the milkers at
+the farm, and the disease began to shew itself among the cows about
+ten days after he first assisted in washing the mare's heels. Their
+nipples became sore in the usual way, with blueish pustules; but as
+remedies were early applied they did not ulcerate to any extent.
+
+[Footnote 1: From the sore on the hand of Sarah Nelmes.--See the
+preceding case and the plate.]
+
+
+
+
+_CASE XVIII._
+
+
+JOHN BAKER, a child of five years old, was inoculated March 16, 1798,
+with matter taken from a pustule on the hand of Thomas Virgoe, one of
+the servants who had been infected from the mare's heels. He became
+ill on the 6th day with symptoms similar to those excited by Cow-pox
+matter. On the 8th day he was free from indisposition.
+
+There was some variation in the appearance of the pustule on the arm.
+Although it somewhat resembled a Small-pox pustule, yet its
+similitude was not so conspicuous as when excited by matter from the
+nipple of the cow, or when the matter has passed from thence through
+the medium of the human subject.--(See Plate, No. 2.)
+
+[Illustration]
+
+This experiment was made to ascertain the progress and subsequent
+effects of the disease when thus propagated. We have seen that the
+virus from the horse, when it proves infectious to the human subject
+is not to be relied upon as rendering the system secure from
+variolous infection, but that the matter produced by it upon the
+nipple of the cow is perfectly so. Whether its passing from the horse
+through the human constitution, as in the present instance, will
+produce a similar effect, remains to be decided. This would now have
+been effected, but the boy was rendered unfit for inoculation from
+having felt the effects of a contagious fever in a work-house, soon
+after this experiment was made.
+
+
+
+
+_CASE XIX._
+
+
+WILLIAM SUMMERS, a child of five years and a half old was inoculated
+the same day with Baker, with matter taken from the nipples of one of
+the infected cows, at the farm alluded to in page 35. He became
+indisposed on the 6th day, vomited once, and felt the usual slight
+symptoms till the 8th day, when he appeared perfectly well. The
+progress of the pustule, formed by the infection of the virus was
+similar to that noticed in Case XVII., with this exception, its being
+free from the livid tint observed in that instance.
+
+
+
+
+_CASE XX._
+
+
+From William Summers the disease was transfered to William Pead a boy
+of eight years old, who was inoculated March 28th. On the 6th day he
+complained of pain in the axilla, and on the 7th was affected with
+the common symptoms of a patient sickening with the Small-pox from
+inoculation, which did not terminate 'till the 3d day after the
+seizure. So perfect was the similarity to the variolous fever that I
+was induced to examine the skin, conceiving there might have been
+some eruptions, but none appeared. The efflorescent blush around the
+part punctured in the boy's arm was so truly characteristic of that
+which appears on variolous inoculation, that I have given a
+representation of it. The drawing was made when the pustule was
+beginning to die away, and the areola retiring from the centre. (See
+Plate, No. 3.)
+
+[Illustration]
+
+
+
+
+_CASE XXI._
+
+
+April 5th. Several children and adults were inoculated from the arm
+of William Pead. The greater part of them sickened on the 6th day,
+and were well on the 7th, but in three of the number a secondary
+indisposition arose in consequence of an extensive erysipelatous
+inflammation which appeared on the inoculated arms. It seemed to
+arise from the state of the pustule, which spread out, accompanied
+with some degree of pain, to about half the diameter of a six-pence.
+One of these patients was an infant of half a year old. By the
+application of mercurial ointment to the inflamed parts (a treatment
+recommended under similar circumstances in the inoculated Small-pox)
+the complaint subsided without giving much trouble.
+
+HANNAH EXCELL an healthy girl of seven years old, and one of the
+patients above mentioned, received the infection from the insertion
+of the virus under the cuticle of the arm in three distinct points.
+The pustules which arose in consequence, so much resembled, on the
+12th day, those appearing from the insertion of variolous matter,
+that an experienced Inoculator would scarcely have discovered a shade
+of difference at that period. Experience now tells me that almost the
+only variation which follows consists in the pustulous fluids
+remaining limpid nearly to the time of its total disappearance; and
+not, as in the direct Small-pox, becoming purulent.--(See Plate, No.
+4.)
+
+
+
+
+_CASE XXII._
+
+
+From the arm of this girl matter was taken and inserted April 12th
+into the arms of John Marklove one year and a half old,
+
+  Robert F. Jenner, eleven months old,
+  Mary Pead, 5 years old, and
+  Mary James, 6 years old.
+
+[Illustration]
+
+Among these Robert F. Jenner did not receive the infection. The arms
+of the other three inflamed properly and began to affect the system
+in the usual manner; but being under some apprehensions from the
+preceding Cases that a troublesome erysipelas might arise, I
+determined on making an experiment with the view of cutting off its
+source. Accordingly after the patients had felt an indisposition of
+about twelve hours, I applied in two of these Cases out of the three,
+on the vesicle formed by the virus, a little mild caustic, composed
+of equal parts of quick-lime and soap, and suffered it to remain on
+the part six hours[1]. It seemed to give the children but little
+uneasiness, and effectually answered my intention in preventing the
+appearance of erysipelas. Indeed it seemed to do more, for in half an
+hour after its application, the indisposition of the children
+ceased[2]. These precautions were perhaps unnecessary as the arm of
+the third child, Mary Pead, which was suffered to take its common
+course, scabbed quickly, without any erysipelas.
+
+[Footnote 1: Perhaps a few touches with the lapis septicus would have
+proved equally efficacious.]
+
+[Footnote 2: What effect would a similar treatment produce in
+inoculation for the Small-pox?]
+
+
+
+
+_CASE XXIII._
+
+
+From this child's arm matter was taken and transferred to that of J.
+Barge, a boy of seven years old. He sickened on the 8th day, went
+through the disease with the usual slight symptoms, and without any
+inflammation on the arm beyond the common efflorescence surrounding
+the pustule, an appearance so often seen in inoculated Small-pox.
+
+After the many fruitless attempts to give the Small-pox to those who
+had had the Cow-pox, it did not appear necessary, nor was it
+convenient to me, to inoculate the whole of those who had been the
+subjects of these late trials; yet I thought it right to see the
+effects of variolous matter on some of them, particularly William
+Summers, the first of these patients who had been infected with
+matter taken from the cow. He was therefore inoculated with variolous
+matter from a fresh pustule; but, as in the preceding Cases, the
+system did not feel the effects of it in the smallest degree. I had
+an opportunity also of having this boy and William Pead inoculated by
+my Nephew, Mr. Henry Jenner, whose report to me is as follows: "I
+have inoculated Pead and Barge, two of the boys whom you lately
+infected with the Cow-pox. On the 2d day the incisions were inflamed
+and there was a pale inflammatory stain around them. On the 3d day
+these appearances were still increasing and their arms itched
+considerably. On the 4th day, the inflammation was evidently
+subsiding, and on the 6th it was scarcely perceptible. No symptom of
+indisposition followed.
+
+To convince myself that the variolous matter made use of was in a
+perfect state, I at the same time inoculated a patient with some of
+it who never had gone through the Cow-pox, and it produced the
+Small-pox in the usual regular manner."
+
+These experiments afforded me much satisfaction, they proved that the
+matter in passing from one human subject to another, through five
+gradations, lost none of its original properties, J. Barge being the
+fifth who received the infection successively from William Summers,
+the boy to whom it was communicated from the cow.
+
+     *     *     *     *     *
+
+I shall now conclude this Inquiry with some general observations on
+the subject and on some others which are interwoven with it.
+
+Although I presume it may be unnecessary to produce further testimony
+in support of my assertion "that the Cow-pox protects the human
+constitution from the infection of the Small-pox," yet it affords me
+considerable satisfaction to say, that Lord Somerville, the President
+of the Board of Agriculture, to whom this paper was shewn by Sir
+Joseph Banks, has found upon inquiry that the statements were
+confirmed by the concuring testimony of Mr. Dolland, a surgeon, who
+resides in a dairy country remote from this, in which these
+observations were made. With respect to the opinion adduced "that the
+source of the infection is a peculiar morbid matter arising in the
+horse," although I have not been able to prove it from actual
+experiments conducted immediately under my own eye, yet the evidence
+I have adduced appears sufficient to establish it.
+
+They who are not in the habit of conducting experiments may not be
+aware of the coincidence of circumstances necessary for their being
+managed so as to prove perfectly decisive; nor how often men engaged
+in professional pursuits are liable to interruptions which disappoint
+them almost at the instant of their being accomplished: however, I
+feel no room for hesitation respecting the common origin of the
+disease, being well convinced that it never appears among the cows
+(except it can be traced to a cow introduced among the general herd
+which has been previously infected, or to an infected servant),
+unless they have been milked by some one who, at the same time, has
+the care of a horse affected with diseased heels.
+
+The spring of the year 1797, which I intended particularly to have
+devoted to the completion of this investigation, proved, from its
+dryness, remarkably adverse to my wishes; for it frequently happens,
+while the farmers' horses are exposed to the cold rains which fall at
+that season that their heels become diseased, and no Cow-pox then
+appeared in the neighbourhood.
+
+The active quality of the virus from the horses' heels is greatly
+increased after it has acted on the nipples of the cow, as it rarely
+happens that the horse affects his dresser with sores, and as rarely
+that a milk-maid escapes the infection when she milks infected cows.
+It is most active at the commencement of the disease, even before it
+has acquired a pus-like appearance; indeed I am not confident whether
+this property in the matter does not entirely cease as soon as it is
+secreted in the form of pus. I am induced to think it does cease[1],
+and that it is the thin darkish-looking fluid only, oozing from the
+newly-formed cracks in the heels, similar to what sometimes appears
+from erysipelatous blisters, which gives the disease. Nor am I
+certain that the nipples of the cows are at all times in a state to
+receive the infection. The appearance of the disease in the spring
+and the early part of the summer, when they are disposed to be
+affected with spontaneous eruptions so much more frequently than at
+other seasons, induces me to think, that the virus from the horse
+must be received upon them when they are in this state, in order to
+produce effects: experiments, however, must determine these points.
+But it is clear that when the Cow-pox virus is once generated, that
+the cows cannot resist the contagion, in whatever state their nipples
+may chance to be, if they are milked with an infected hand.
+
+Whether the matter, either from the cow or the horse will affect the
+sound skin of the human body, I cannot positively determine; probably
+it will not, unless on those parts where the cuticle is extremely
+thin, as on the lips for example. I have known an instance of a poor
+girl who produced an ulceration on her lip by frequently holding her
+finger to her mouth to cool the raging of a Cow-pox sore by blowing
+upon it. The hands of the farmers' servants here, from the nature of
+their employments, are constantly exposed to those injuries which
+occasion abrasions of the cuticle, to punctures from thorns and such
+like accidents; so that they are always in a state to feel the
+consequences of exposure to infectious matter.
+
+It is singular to observe that the Cow-pox virus, although it renders
+the constitution unsusceptible of the variolous, should,
+nevertheless, leave it unchanged with respect to its own action. I
+have already produced an instance[2] to point out this, and shall now
+corroborate it with another.
+
+Elizabeth Wynne, who had the Cow-pox in the year 1759, was inoculated
+with variolous matter, without effect, in the year 1797, and again
+caught the Cow-pox in the year 1798. When I saw her, which was on the
+8th day after she received the infection, I found her affected with
+general lassitude, shiverings, alternating with heat, coldness of the
+extremities, and a quick and irregular pulse. These symptoms were
+preceded by a pain in the axilla. On her hand was one large pustulous
+sore, which resembled that delinated in Plate No. 1.
+
+It is curious also to observe, that the virus, which with respect to
+its effects is undetermined and uncertain previously to its passing
+from the horse through the medium of the cow, should then not only
+become more active, but should invariably and completely possess
+those specific properties which induce in the human constitution
+symptoms similar to those of the variolous fever, and effect in it
+that peculiar change which for ever renders it unsusceptible of the
+variolous contagion.
+
+May it not, then, be reasonably conjectured, that the source of the
+Small-pox is morbid matter of a peculiar kind, generated by a disease
+in the horse, and that accidental circumstances may have again and
+again arisen, still working new changes upon it, until it has
+acquired the contagious and malignant form under which we now
+commonly see it making its devastations amongst us? And, from a
+consideration of the change which the infectious matter undergoes
+from producing a disease on the cow, may we not conceive that many
+contagious diseases, now prevalent among us, may owe their present
+appearance not to a simple, but to a compound origin? For example, is
+it difficult to imagine that the measles, the scarlet fever, and the
+ulcerous sore throat with a spotted skin, have all sprung from the
+same source, assuming some variety in their forms according to the
+nature of their new combinations? The same question will apply
+respecting the origin of many other contagious diseases, which bear a
+strong analogy to each other.
+
+There are certainly more forms than one, without considering the
+common variation between the confluent and distinct, in which the
+Small-pox appears in what is called the natural way.--About seven
+years ago a species of Small-pox spread through many of the towns and
+villages of this part of Gloucestershire: it was of so mild a nature,
+that a fatal instance was scarcely ever heard of, and consequently so
+little dreaded by the lower orders of the community, that they
+scrupled not to hold the same intercourse with each other as if no
+infectious disease had been present among them. I never saw nor heard
+of an instance of its being confluent. The most accurate manner,
+perhaps, in which I can convey an idea of it is, by saying, that had
+fifty individuals been taken promiscuously and infected by exposure
+to this contagion, they would have had as mild and light a disease as
+if they had been inoculated with variolous matter in the usual way.
+The harmless manner in which it shewed itself could not arise from
+any peculiarity either in the season or the weather, for I watched
+its progress upwards of a year without perceiving any variation in
+its general appearance. I consider it then as a _variety_ of the
+Small-pox[3].
+
+In some of the preceding cases I have noticed the attention that was
+paid to the state of the variolous matter previous to the experiment
+of inserting it into the arms of those who had gone through the
+Cow-pox. This I conceived to be of great importance in conducting
+these experiments, and were it always properly attended to by those
+who inoculate for the Small-pox, it might prevent much subsequent
+mischief and confusion. With the view of enforcing so necessary a
+precaution, I shall take the liberty of digressing so far as to point
+out some unpleasant facts, relative to mismanagement in this
+particular, which have fallen under my own observation.
+
+A Medical Gentleman (now no more), who for many years inoculated in
+this neighbourhood, frequently preserved the variolous matter
+intended for his use, on a piece of lint or cotton, which, in its
+fluid state was put into a vial, corked, and conveyed into a warm
+pocket; a situation certainly favourable for speedily producing
+putrefaction in it. In this state (not unfrequently after it had been
+taken several days from the pustules) it was inserted into the arms
+of his patients, and brought on inflammation of the incised parts,
+swellings of the axillary glands, fever, and sometimes eruptions. But
+what was this disease? Certainly not the Small-pox; for the matter
+having from putrefaction lost, or suffered a derangement in its
+specific properties, was no longer capable of producing that malady,
+those who had been inoculated in this manner being as much subject to
+the contagion of the Small-pox, as if they had never been under the
+influence of this artificial disease; and many, unfortunately, fell
+victims to it, who thought themselves in perfect security. The same
+unfortunate circumstance of giving a disease, supposed to be the
+Small-pox, with inefficaceous variolous matter, having occurred under
+the direction of some other practitioners within my knowledge, and
+probably from the same incautious method of securing the variolous
+matter, I avail myself of this opportunity of mentioning what I
+conceive to be of great importance; and, as a further cautionary
+hint, I shall again digress so far as to add another observation on
+the subject of Inoculation.
+
+Whether it be yet ascertained by experiment, that the quantity of
+variolous matter inserted into the skin makes any difference with
+respect to the subsequent mildness or violence of the disease, I know
+not; but I have the strongest reason for supposing that is either the
+punctures or incisions be made so deep as to go _through_ it, and
+wound the adipose membrane, that the risk of bringing on a violent
+disease is greatly increased. I have known an inoculator, whose
+practice was "to cut deep enough (to use his own expression) to see a
+bit of fat," and there to lodge the matter. The great number of bad
+Cases, independent of inflammations and abscesses on the arms, and
+the fatality which attended this practice was almost inconceivable;
+and I cannot account for it on any other principle than that of the
+matter being placed in this situation instead of the skin.
+
+It was the practice of another, whom I well remember, to pinch up a
+small portion of the skin on the arms of his patients and to pass
+through it a needle, with a thread attached to it previously dipped
+in variolous matter. The thread was lodged in the perforated part,
+and consequently left in contact with the cellular membrane. This
+practice was attended with the same ill success as the former.
+Although it is very improbable that any one would now inoculate in
+this rude way by design, yet these observations may tend to place a
+double guard over the lancet, when infants, whose skins are
+comparatively so very thin, fall under the care of the inoculator.
+
+A very respectable friend of mine, Dr. Hardwicke, of Sodbury in this
+county, inoculated great numbers of patients previous to the
+introduction of the more modern method by Sutton, and with such
+success, that a fatal instance occurred as rarely as since that
+method has been adopted. It was the doctor's practice to make as
+slight an incision as possible _upon_ the skin, and there to lodge a
+thread saturated with the variolous matter. When his patients became
+indisposed, agreeably to the custom then prevailing, they were
+directed to go to bed and were kept moderately warm. Is it not
+probable then, that the success of the modern practice may depend
+more upon the method of invariably depositing the virus in or upon
+the skin, than on the subsequent treatment of the disease?
+
+I do not mean to insinuate that exposure to cool air, and suffering
+the patient to drink cold water when hot and thirsty, may not
+moderate the eruptive symptoms and lessen the number of pustules;
+yet, to repeat my former observation, I cannot account for the
+uninterrupted success, or nearly so, of one practitioner, and the
+wretched state of the patients under the care of another, where, in
+both instances, the general treatment did not differ essentially,
+without conceiving it to arise from the different modes of inserting
+the matter for the purpose of producing the disease. As it is not the
+identical matter inserted which is absorbed into the constitution,
+but that which is, by some peculiar process in the animal economy,
+generated by it, is it not probable that different parts of the human
+body may prepare or modify the virus differently? Although the skin,
+for example, adipose membrane, or mucous membranes are all capable of
+producing the variolous virus by the stimulus given by the particles
+originally deposited upon them, yet I am induced to conceive that
+each of these parts is capable of producing some variation in the
+qualities of the matter previous to its affecting the constitution.
+What else can constitute the difference between the Small-pox when
+communicated casually or in what has been termed the natural way, or
+when brought on artificially through the medium of the skin? After
+all, are the variolous particles, possessing their true specific and
+contagious principles, ever taken up and conveyed by the lymphatics
+unchanged into the blood vessels? I imagine not. Were this the case,
+should we not find the blood sufficiently loaded with them in some
+stages of the Small-pox to communicate the disease by inserting it
+under the cuticle, or by spreading it on the surface of an ulcer? Yet
+experiments have determined the impracticability of its being given
+in this way; although it has been proved that variolous matter when
+much diluted with water, and applied to the skin in the usual manner,
+will produce the disease. But it would be digressing beyond a proper
+boundary, to go minutely into this subject here.
+
+At what period the Cow-pox was first noticed here is not upon record.
+Our oldest farmers were not unacquainted with it in their earliest
+days, when it appeared among their farms without any deviation from
+the phaenomena which it now exhibits. Its connection with the
+Small-pox seems to have been unknown to them. Probably the general
+introduction of inoculation first occasioned the discovery.
+
+Its rise in this country may not have been of very remote date, as
+the practice of milking cows might formerly have been in the hands of
+women only; which I believe is the case now in some other dairy
+countries, and, consequently that the cows might not in former times
+have been exposed to the contagious matter brought by the men
+servants from the heels of horses[4]. Indeed a knowledge of the
+source of the infection is new in the minds of most of the farmers in
+this neighbourhood, but it has at length produced good consequences;
+and it seems probable from the precautions they are now disposed to
+adopt, that the appearance of the Cow-pox here may either be entirely
+extinguished or become extremely rare.
+
+Should it be asked whether this investigation is a matter of mere
+curiosity, or whether it tends to any beneficial purpose? I should
+answer, that notwithstanding the happy effects of Inoculation, with
+all the improvements which the practice has received since its first
+introduction into this country, it not very unfrequently produces
+deformity of the skin, and sometimes, under the best management,
+proves fatal.
+
+These circumstances must naturally create in every instance some
+degree of painful solicitude for its consequences. But as I have
+never known fatal effects arise from the Cow-pox, even when impressed
+in the most unfavourable manner, producing extensive inflammations
+and suppurations on the hands; and as it clearly appears that this
+disease leaves the constitution in a state of perfect security from
+the infection of the Small-pox, may we not infer that a mode of
+Inoculation may be introduced preferable to that at present adopted,
+especially among those families, which, from previous circumstances
+we may judge to be predisposed to have the disease unfavourably? It
+is an excess in the number of pustules which we chiefly dread in the
+Small-pox; but, in the Cow-pox, no pustules appear, nor does it seem
+possible for the contagious matter to produce the disease from
+effluvia, or by any other means than contact, and that probably not
+simply between the virus and the cuticle; so that a single individual
+in a family might at any time receive it without the risk of
+infecting the rest, or of spreading a distemper that fills a country
+with terror. Several instances have come under my observation which
+justify the assertion that the disease cannot be propagated by
+effluvia. The first boy whom I inoculated with the matter of Cow-pox,
+slept in a bed, while the experiment was going forward, with two
+children who never had gone through either that disease or the
+Small-pox, without infecting either of them.
+
+A young woman who had the Cow-pox to a great extent, several sores
+which maturated having appeared on the hands and wrists, slept in the
+same bed with a fellow-dairy maid who never had been infected with
+either the Cow-pox or the Small-pox, but no indisposition followed.
+
+Another instance has occurred of a young woman on whose hands were
+several large suppurations from the Cow-pox, who was at the same time
+a daily nurse to an infant, but the complaint was not communicated to
+the child.
+
+In some other points of view, the inoculation of this disease appears
+preferable to the variolous inoculation.
+
+In constitutions predisposed to scrophula, how frequently we see the
+inoculated Small-pox, rouse into activity that distressful malady.
+This circumstance does not seem to depend on the manner in which the
+distemper has shewn itself, for it has as frequently happened among
+those who have had it mildly, as when it has appeared in the contrary
+way.
+
+There are many, who from some peculiarity in the habit resist the
+common effects of variolous matter inserted into the skin, and who
+are in consequence haunted through life with the distressing idea of
+being insecure from subsequent infection. A ready mode of dissipating
+anxiety originating from such a cause must now appear obvious. And,
+as we have seen that the constitution may at any time be made to feel
+the febrile attack of Cow-pox, might it not, in many chronic diseases
+be introduced into the system, with the probability of affording
+relief, upon well-known physiological principles?
+
+Although I say the system may at any time be made to feel the febrile
+attack of Cow-pox, yet I have a single instance before me where the
+virus acted locally only, but it is not in the least probable that
+the same person would resist the action both of the Cow-pox virus and
+the variolous.
+
+Elizabeth Sarsenet lived as a dairy maid at Newpark farm, in this
+parish. All the cows and the servants employed in milking had the
+Cow-pox; but this woman, though she had several sores upon her
+fingers, felt no tumors in the axillae, nor any general indisposition.
+ On being afterwards casually exposed to variolous infection, she had
+the Small-pox in a mild way.--Hannah Pick, another of the dairy maids
+who was a fellow-servant with Elizabeth Sarsenet when the distemper
+broke out at the farm was, at the same time infected; but this young
+woman had not only sores upon her hands, but felt herself also much
+indisposed for a day or two. After this, I made several attempts to
+give her the Small-pox by inoculation, but they all proved fruitless.
+From the former Case then we see that the animal economy is subject
+to the same laws in one disease as the other.
+
+The following Case which has very lately occurred renders it highly
+probable that not only the heels of the horse, but other parts of the
+body of that animal, are capable of generating the virus which
+produces the Cow-pox.
+
+An extensive inflammation of the erysipelatous kind, appeared without
+any apparent cause upon the upper part of the thigh of a sucking
+colt, the property of Mr. Millet, a farmer at Rockhampton, a village
+near Berkeley. The inflammation continued several weeks, and at
+length terminated in the formation of three or four small abscesses.
+The inflamed parts were fomented, and dressings were applied by some
+of the same persons who were employed in milking the cows. The number
+of cows milked was twenty-four, and the whole of them had the
+Cow-pox. The milkers, consisting of the farmer's wife, a man and a
+maid servant, were infected by the cows. The man servant had
+previously gone through the Small-pox, and felt but little of the
+Cow-pox. The servant maid had some years before been infected with
+the Cow-pox, and she also felt it now in a slight degree: But the
+farmer's wife who never had gone through either of these diseases,
+felt its effects very severely.
+
+That the disease produced upon the cows by the colt and from thence
+conveyed to those who milked them was the _true_ and not the
+_spurious_ Cow-pox[5], there can be scarcely any room for suspicion;
+yet it would have been more completely satisfactory, had the effects
+of variolous matter been ascertained on the farmer's wife, but there
+was a peculiarity in her situation which prevented my making the
+experiment.
+
+Thus far have I proceeded in an inquiry, founded, as it must appear,
+on the basis of experiment; in which, however, conjecture has been
+occasionally admitted in order to present to persons well situated
+for such discussions, objects for a more minute investigation. In the
+mean time I shall myself continue to prosecute this inquiry,
+encouraged by the hope of its becoming essentially beneficial to
+mankind.
+
+  FINIS.
+
+[Footnote 1: It is very easy to procure pus from old sores on the
+heels of horses. This I have often inserted into scratches made with
+a lancet, on the sound nipples of cows, and have seen no other
+effects from it than simple inflammation.]
+
+[Footnote 2: See Case IX.]
+
+[Footnote 3: My friend Dr. Hicks, of Bristol, who during the
+prevalence of this distemper was resident at Gloucester, and
+Physician to the Hospital there, (where it was seen soon after its
+first appearance in this country) had opportunities of making
+numerous observations upon it, which it is his intention to
+communicate to the Public.]
+
+[Footnote 4: I have been informed from respectable authority that in
+Ireland, although dairies abound in many parts of the Island, the
+disease is entirely unknown. The reason seems obvious. The business
+of the dairy is conducted by women only. Were the meanest vassal
+among the men, employed there as a milker at a dairy, he would feel
+his situation unpleasant beyond all endurance.]
+
+[Footnote 5: See Note in Page 7.]
+
+
+
+
+_ERRATA._
+
+
+  Page 5, Line 4, after the word _shiverings_ insert _succeeded by
+      heat_.
+          Line 16, for _needlessly_ read _heedlessly_.
+
+  ---- 24, Last line but one, for _sore_ read _tumour_.
+
+  ---- 40, Line 12, for _Macklove_ read _Marklove_.
+
+  ---- 41, Note--for _scepticus_ read _septicus_.
+
+  ---- 60, Last line, for _moderate_ read _modern_.
+
+
+
+
+
+     *     *     *     *     *
+
+
+
+
+Transcriber's note
+
+
+For this e-text, all the errors in the original book's "Errata"
+section have been corrected, as well as the following:
+
+Introductory letter: "C. H PARRY" corrected to "C. H. PARRY".
+
+Introduction: Inserted "to" after "But this disease is not".
+
+Case XX: "begining" corrected to "beginning".
+
+Conclusions: Added full-stop after "on the subject of Inoculation".
+
+The following archaic spellings of words were used in the original
+book and have been retained: head-ach; concuring; delinated.
+
+
+
+***END OF THE PROJECT GUTENBERG EBOOK AN INQUIRY INTO THE CAUSES AND
+EFFECTS OF THE VARIOLAE VACCINAE***
+
+
+******* This file should be named 29414.txt or 29414.zip *******
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