INOCULATION. 



Vwcinc 



,.uion 



More mi- 

 ll lilt- prc- 

 ,>bscr- 

 vations call' 

 ed tur. 



Mode of 

 prosecuting 

 the inquiry. 



I.css im- 

 portant 

 laws ul cow 

 pox. 



It is not 

 spread by 

 eflluvia. 



pox, and is, in fact, reduced almost to nothing. What 

 more can be reasonably desired ? We do not expect 

 to provide an absolute security from all accidents." 



\Ve have already stated that, since the preceding 

 publication appeared, we have heard of a ca.>e of death 

 in the secondary fever of small-pox in a patient who 

 IKU! been vaccinated. If such occurrences should be 

 well authenticated, we must trust solely to the extreme 

 diminution of the gross risk as ascertained by observa- 

 tion, afterwards assisted by tabular statements. This 

 still 'continues decidedly favourable to vaccination, as 

 infinitely superior to the -preventive by which it was 

 preceded. 



hi order that this important subject may be duly im- 

 proved, the following requisites ought to he attended to. 

 The inquirer ouglrt to see numerous inoculations, and 

 his observations on the progress of the disease ought to 

 be strictly daily. He ought to inoculate with matter ta- 

 ken from -the vesicle at various periods of its progress, 

 all within the limits now acknowledged to be well 

 adapted for communicating an efficacious vaccination, 

 lie ought to ascertain the number of successive re- 

 productions in the human subject, to which the dif- 

 ferent specimens of matter which he uses owe their 

 origin since they proceeded from the cow. Classifi- 

 cations of patients ought to be founded on these and 

 other differences. Written accounts ought to be kept 

 of every circumstance, even the most minute, and ap- 

 parently trifling, in the past history of each patient, 

 and in the phenomena which occur during the progress 

 of the disease. The aspect of his subsequent diseases, 

 especially those of a contagious nature, as scarlatina 

 and measles, ought to be inquired into and noted where- 

 ever it is practicable, and comparisons made in this re- 

 spect between patients of different kinds. All this ought 

 to be done simultaneously by persons in different places, 

 each of whom ought to be ready to take a journey on the 

 shortest notice, in order to investigate occasional anoma- 

 lous appearances. To execute these objects on a large 

 scale, and to provide for them men whose faithful and 

 assiduous exertions can be relied on, till such time as 

 satisfactory conclusions can be drawn from ample state- 

 ments, might be a work of some difficulty. To secure 

 the daily attendance of the patients, or to visit them at 

 their own houses when they do not attend, and to note 

 down every occurrence in the most scrupulous manner, 

 is a task to which no man can be expected gratuitously 

 to submit, unless his fortune is independent, his time 

 completely at his command, his heart bent on the ob- 

 ject, and his resolution much firmer than his hopes are 

 definite. We do not see how it is practicable without 

 the provision of a fund for the express purpose ; and, 

 since we find that governments have shewn themselves 

 not averse to appropriate part of the revenues of nations 

 to the great object of preventing the contagion of small- 

 pox, it may not be useless to remark that their fu- 

 ture munificence will be best bestowed on those arrange- 

 ments for the attainment of the object which call for 

 the most laborious, and perhaps otherwise unattainable 

 exertions. 



We shall now give a brief view of some of the most 

 interesting collateral circumstances attending the cow- 

 pox. 



This disease is not capable of being disseminated by 

 volatile effluvia. In this respect it differs from the in- 

 oculated small-pox, and exhibits one important advan- 

 tage above the latter disease, that no contagious affec- 

 tion is by means of it diffused through a neighbour- 

 hood. 



Another circumstance is worthy of remark, that cow- Vaccine 

 pox, once occurring, does not give security against a fu- 

 ture attack of the same disease. On this point different \ 

 opinions have been entertained, and experiments have . K ., , 

 varied in the r results. It appears, on the whole, that the 

 by one attack of cow-pox, whether casual or as the con- pe rson - 

 sequence of inoculation, the susceptibility to the same 

 disease in future is only diminished. Milkers in the 

 dairy counties are, by passing once through it, gene- 

 rally able to resist the contagion in future ; sometimes 

 they receive it, but always in a much milder form. It 

 is important to keep this circumstance in mind, because 

 some have thoughtlessly trusted to the effects of a se- ' 

 cond vaccination, after the first had for som^ time run 

 its course, as a sufficient test of its efficacy. That is, 

 they have looked tor an absence of future t usceptibility 

 to vaccine influence in those cases which were worthy 

 of dependence. The influence of a previous attack of 

 small-pox has a similar virtue. It in a slight degree My occur 

 diminishes, but does not destroy the susceptibility of "*' smi ll 

 the constitution to cow-pox. P 03t - 



Some precautions are proper in conducting the vac- Precautions 

 cine inoculation. The choice of matter should be care- in P elfl) "n- 

 fully attended to It should be taken from a good vac- in * vacciu - 

 cine vesicle, in a healthy subject, from the 5th to the '" 

 9th day of the disease. It is most certain in its effects 

 when immediately inserted. If it is to be kept, it Choice and 

 should be allowed to dry. Some confine it, in order to preservation 

 preserve it in its original moist state. They arc not of ""*"" 

 aware that it is subjected to much greater change by 

 moisture than by exposure to the atmosphere. It may 

 be kept on glass, or on the point of a lancet, or on the 

 end of a small pointed p ece of ivory. Mr. Bryce has 

 suggested the employment of the crust, which, in its 

 central part, contains matter dried in an early stage of 

 the disease, and therefore perfectly pure and safe, and 

 from which the light coloured part round the margin 

 ought to be removed. Dried matter, in these different 

 forms, is convenient for transportation j when about 

 to be used, it must be moistened with water, either 

 cold, or of a blood heat ; but recent matter is always 

 preferable, and therefore ought to be secured in every 

 populous place, by regular weekly inoculations. 



The end of the third month t when the constitution vfost eTigi- 

 has acquired some firmness, and before it is subjected ble time for 

 to the disadvantages of the period of teething, is the theo l >era ' 

 most eligible time for the operation. In an adult in ll< 

 whom it has been neglected, it should be performed 

 when the constitution is in its soundest state ; when, 

 for example, no cutaneous disease is present, and in 

 females when there is no pregnancy, and when the ca- 

 lamenia are absent. But, when the contagion of small, 

 pox prevails in a neighbourhood, these di sad vantages 

 must be disregarded. 



With respect to the mode of insertion, the object kept Mode of in- 

 in view is, to secure the contact of the matter with, the 5ertion ' 

 culis vern. The operator, therefore, should delicately 

 raise the cuticle, without any effusion of blood if possi- 

 ble, and apply the matter to the doraded part. The 

 method of doing this, which Mr. Bryce has found most 

 certain of success, is, first to lay a drop of the matter 

 on the surface, and then make several light punctures 

 through this matter and the cuticle with the lancet. It 

 is then to be held exposed to the air, but not to an arti- 

 ficial fire, till it dries, and afterwards left to itself. 



The inoculator must now mark its course, whether Prognosis 

 it is conformable to that which we have briefly stated, aml medical 

 which is described by authors, and delineated in their tleatment * 

 plates. These last, however, afford but feeble assistance, 



