276 Original Vaccine Pdck Institution. 



or five fatal cases have occurred from the affection of the 

 part inoculated ; although at the institution, and in our pri- 

 vate practice, we have bad no such cases ; and that sore 

 arms much less frequently occur than from variolous inocu- 

 lation is quite evident. 



'•' In conclusion : We find in our experience, both private 

 and public, the vaccine affection a much lees painful one 

 than the variolous inoculation, and in no instance * fatal — ■» 

 that it is not propagated by mere contact, or effluvia — that 

 it is never epidemical — that it produces insusceptibility of 

 the small-pox if well conducted, in perhaps 499 out of 500 

 cases — that by modes, hereafter to be explained, there is good 

 ground for believing that the practice may be so conducted 

 as to make the proportion of failures much less — that the 

 advantages arc on many accounts so great as to amply com- 

 pensate for the small sacrifice and trouble of a second ino- 

 culation — but lastlv, it ought to be constantly in view, that 

 the security against the small-pox cannot be absolutely ob- 

 tained unless inoculation be re-instituted ; and hence, that 

 for the future it does not seem justifiable to neglect to pro- 

 pose the second f inoculation in every instance ; audit is 

 further our duty to propose it, as a security for the past, also 

 to those who have been already vaccinated %." 



* In a case communicated, an infant died on the 10th day after inocula- 

 tion, with convulsive fits. — See Minute Book. 



f The second inoculation may be instituted either in four days or any 

 longer time after the first inoculation has taken effect. See Med. and Chi- 

 rurgical Review, vol. 12. — Med. and Surgical Journal of Edin. vol. 1. — TiU 

 loch's Philosophical Magazine, vol. 23. 



i Although at this time the appearances or circtimstances are unknown, 

 during the vaccine affection, which necessarily give security, and hence re- 

 inoculation must be provisionally resorted to ; yet, it is reasonable to expect 

 that hereafter the subject may be so far investigated as to determine the 

 question by one inoculation. 



Sole. — ft has been urged, that the evidence in this paper, at most, only proves* 

 that vaccination destroys the susceptibility of the smaH-pos for a limited 

 time: and hence that the second inoculation only affords a proof of the 

 time for which that unsusceptibility subsists. This may be, I think, justly 

 redargued. 1st. The failures afford only equivocal evidence of the alleged 

 temporary unsusceptibility. 2d. Such a temporary state is against analogy. 

 3d. There is no inconsiderable positive evidence of permanent unsu#- 

 «seutibility» 



The 



