VACCINATION. 



inftance of recovery under fo heavy an eruption attended by 

 fuch circumftances. It feemed, however, that the latter 

 ftages of the difeafe were pafled through more rapidly in 

 this cafe than ufual, and it may be a queftion whether this 

 extraordinary cireumftance, as well as the ultimate recovery 

 of Mr. Grofvenor, were not influenced by previous vacci- 

 nation. 



The Board of the National Vaccine Eftablifliment are of 

 opinion, that the cafe of the Hon. Robert Grofvenor was a 

 cafe of confluent fmall-pox : that the attack and progrefs 

 of the diforder were attended by fymptoms which almoft 

 invariably announce a fatal termination. But they obferve, 

 that the fwelling of the face, which is generally fo exceflive 

 as to clofe the eyes, and is confidered as a favourable fymp- 

 ton, v»as flighter than ufual ; that on the tenth day the 

 puftules began to dry upon the face, and that from that 

 time the difeafe paffcd with unufual rapidity through the 

 period when life is generally efteemed to be in the greateft 

 hazard. 



Thofe who are acquainted with the nature of the con- 

 fluent fmall-pox, are aware that this peculiarity cannot be 

 attributed to the effcA of medical treatment. 



In moil cafes of fmall-pox which have fucceeded to vac- 

 cination, the puftules have been obfervcd to dry more 

 rapidly, and the diforder has concluded at an earlier period 

 than ufual. 



If allowance be made for the relative periods in which 

 the confluent and diilinft fmall-pox complete their courfe, 

 the rapid progrefs towards recovery through the latter ftage 

 of confluent fmall-pox, as exhibited in the cafe of Mr. 

 Grofvenor, may be compared with the rapid deficcation of 

 the puftules in the diftindl and peculiarly mild form of the 

 diforder which is confidered as fmall-pox modified by vac- 

 cination. Both forms of the diforder proceed in the ufual 

 courfe, the one attended with violent, the other with mild 

 fymptoms, till they arrive near to the height, when they 

 appear to receive a check, and the recovery is unufually 

 rapid. 



From this correfpondence of circumftances, the Board are 

 induced to infer, that in the cafe of Mr. Grofvenor, which 

 has been more violent than any yet fubmitted to them, the 

 progrefs of the difeafe, through its latter ftage, and the 

 aonfequent abatement of fymptoms, were influenced by an 

 anti-variolous effect produced upon the conftitution by the 

 vaccine procefs. 



The occurrence of fmall-pox after vaccination, has been 

 forefeen and pointed out in the report on vaccination made 

 to parliament, by the College of Phyficians, in the year 

 1807, to which the Board are defirous of calling the atten- 

 tion of the public ; in which it is ilated, that, 



" The fecurity derived from vaccination againft the fmall- 

 pox, if not abfolutely perfect, is as nearly fo as can perhaps 

 be expefted from any human difcovery ; for amongft feveral 

 hundred thoufand cafes, with the refults of which the College 

 have been made acquainted, the number of alleged failures 

 has been furpriCngly fmall ; fo much fo, as to form cer- 

 tainly no reafonable objeftion to the general adoption of 

 vaccination ; for it appears that there are not nearly fo many 

 failures in a given number of vaccinated perfons, as there 

 are deaths in an equal number of perfons inoculated for the 

 fmall-pox. Nothing can more clearly demonftrate the fupe- 

 riority of vaccination over the inoculation of the fmall-pox 

 than this confideration ; and it is a moft important faft, 

 which has been confirmed in the courfe of this enquiry, that 

 in almoft every cafe in which the fmall-pox has fucceeded 

 vaccinatioii, whether by inoculation, or by cafual infedion, 

 the difeafe has varied much from its ordinary courfe ; it has 

 Vol.. XXXVI. 



neither been the fame in violence, nor in the duration of its 

 fymptoms; but has, with very few exceptions, been re- 

 markably mild, as if the fmall-pox had been deprived, by 

 the previous vaccine difeafe, of its ufual malignity." Re- 

 port of the College of Phyficians, p. 4. 



The peculiarities of certain conftitutions with regard to 

 eruptive fevers, form a curious fubjeft of medical hiftory. 

 Some individuals have been more than once affefted with 

 fcarlet fever and meafles ; others liave been through life ex- 

 pofed to the contagion of thcfc difeafes without effeft ; 

 many have refifted the inoculation and contagion of fmall- 

 pox for feveral years, and have afterwards become fufceptible 

 of the diforder, and fome have been twice affefted with fmall- 

 pox. 



Among fucli infinite varieties of temperament, it will not 

 appear extraordinary, that vaccination, though fo generally 

 fuccefsful, ftiould fometimes fail of rendering the human 

 conftitution unfufceptible of fmall-pox ; ofpecially fince it 

 has been found that in feveral inftances fmall-pox has oc- 

 curred to individuals over whom the fmall-pox inoculation 

 had appeared to have produced its full influence. Three in- 

 ftances of this kind have taken place within the laft month ; 

 and, in another inftance, the natural fmall-pox has occurred 

 a fecond time. See Report of the National Vaccine Efta- 

 bhfiiment, July 181 1. 



It has been imagined by fome, that although the human 

 conftitution is apparently fliielded from the aftion of fmall- 

 pox by having undergone the cow-pox, yet that this fecu- 

 rity may not be permanent ; but that, at the end of a certain 

 period of time, the perfon will again become fufceptible of 

 fmall-pox. This objeftion, however, muft now have little 

 weight; for Dr. Jenner himfelf inoculated with the virus of 

 fmall-pox, perfons who had been afl^efted with the cow-pox 

 twenty-five, twenty-feven, thirty-one, and fifty-three years 

 before ; but who had never been infefted with the fmall-pox, 

 and thefe he found completely refifted this difeafe. 



For further evidence and reafoning on this point, fee Ter- 

 mor's Refleftions on the Cow-pox ; Edin. Rev. No. XVII.; 

 and Bryce's Praftical Obf. on the Cow-pox. 



Experience has proved that, in certain inftances, the cow- 

 pox virus has merely a local aftion, and fuch cafes have been 

 miftaken for the regular conftitutional affeftion ; a thing 

 very likely to happen, when it is remembered that the ge- 

 neral ailment of the fyftem is feldom marked by any very 

 ftrong fymptoms ; and that, in the cafes alluded to, the 

 local appearances would purfue a regular progrefs. Yet, m 

 thefe circumftances, tlie patient is left unprotefted from an 

 attack of fmall-pox. As Mr. Bryce has pointed out, there- 

 fore, a certain tejl of the conjlitution being really affeElei in 

 every inoculation of cow-pox muft be a moft important defi- 

 deratum. Indeed, until there be demonftrated and generally 

 known fome unequivocal mark of a conftitutional affeftion, 

 which does conftantly occur during the courfe of cow-pox 

 when eff'eftual, and which may be as eafily diftinguiflied as 

 the fever and eruption confequent to the inoculation for fmall- 

 pox, this new inoculation ought never to be performed, ex- 

 cept by perfons well acquainted with every appearance of t;^ 

 ailment. For, as much as it is more difficult to diftinguijh 

 between the cow-pox and fome other affeftions, and alfo 

 clearly to afcertain the prefence of a conftitutional affeftion, 

 than to form a fimilar judgment in the inoculated fmall-pox, 

 the more does the cow-pox inoculation reqiiire attention to 

 every fymptom which may occur during its progrefs, m 

 order that mankind may reap every advantage which has been 

 promlfed from the general adoption of cow-pox as a pre- 

 ventive of fmall-pox. . 



Mr. Brvce has endeavoured to difcover a criterion ot the 

 ' , U patient 



