18 21.3 
yourown practice coincide with mine? 
That is to say, whether the vaccine 
vesicles, under these contingent cir¬ 
cumstances, go through their course 
with the same regularity as when the 
skin is free from diseases of this de¬ 
scription ? 
Secondly , Whether, on the other 
hand, such individuals are more liable 
to resist the legitimate action of vaccine 
lymph when inserted into the arms, 
than those who ore free from such 
eruptive affections ? 
Thirdly , Whether you have met with 
cases of small-pox, or what has been 
termed the varioloid disease, after vac¬ 
cination; and if so, whether in such 
cases you ascertained those deviations 
at the time of vaccination in the pro¬ 
gress of the pustules on the arms, which 
I have described as liable to take place 
when the skin is affected with herpetic 
and other eruptions ? 
As you may not have the paper be¬ 
fore you to which I here allude, nor the 
short series which followed it, I will 
point out the periods of their publica¬ 
tion, and where they are to be found. 
The first was published in the Medical 
and Physical Journal, No. 66, for Au¬ 
gust, 1804, and gives an outline of the 
subject, of some extent. It points out 
the fact, that a single serous blotch 
upon the skin, existing during the 
progress of the vaccine vesicles on the 
arms, may occasion such irregularity 
and deviation from correctness, that 
Vaccination under such circumstances 
cannot be perfectly depended on. 
I have found abrasions of the cuticle 
to produce the same effect ; such, for 
example, as we find in the nurseries of 
the opulent, as well as the cottages of 
the poor, behind the ears, and upon 
many other parts where the cuticle is 
thin. Happily we find no irregularity 
in the vaccine vesicle in an unconta¬ 
minated skin ; but we find it if the skin 
is beset with these herpetic blotches, 
or even simple serous oozings from an 
abraded cuticle. It is not to be consi¬ 
dered as of less consequence when oc¬ 
cupying a small space ; a speck behind 
the ear which might be covered by a 
split pea, being capable of disordering 
the progress of the vaccine vesicle. 
Dandriffe may be considered as a ma¬ 
lady of this glass, the incrustation on 
the scalp being formed from excoriation 
beneath; and however slight, for there 
is every gradat ion between a thin scurfy 
layer of a dirt-looking substance, or 
even patches of this thin crust, and 
307 
Tinea itself. However fortunately for 
the safety of the vaccine practice, and 
fortunately too for the ease of the prac¬ 
titioner, all these affections of the skin 
may be removed with very little trou¬ 
ble.* Sore eyelids are also impediments 
to constitutional vaccination. 
The second paper relating to this 
subject was given by the late Dr. 
Willan, in answer to the following 
interrogatory, addressed to me by him- 
self:| X4 What are the changes pro¬ 
duced in the vesicle, when a person is 
affected during vaccination with the 
shingle^, the vesicular ringworm, or 
impetigo ?” 
To this question I made a full, and 
I believe, a satisfactory reply. Its 
purport will be shewn by quoting a 
few sentences from it. 44 To answer 
this question in its fullest extent, would 
lead me through a wide field of obser¬ 
vation, which I mean to go over at a 
future time ; but the following answer 
may probably convey to you as much 
information upon the subject as you 
may now require. Vaccination, under 
the circumstances you mention, usually 
produces a striking deviation from the; 
perfect character of the vaccine vesicle 
at some period or other of its pro¬ 
gress, but more frequently in its 
early than in its declining stages; 
indeed, it is commonly perceptible 
in a day or two after inoculation. It 
would be difficult, perhaps impossible, 
without the aid of drawings, to give a 
correct description of the varieties 
which an heipetic state of the skin 
is capable of producing, from those 
trifling deviations which prove no im¬ 
pediment to the vaccine security, up 
to that point of imperfection in the 
vesicle, which affords no security at 
all. Perhaps I commit an error in 
* The most effectual application which 
I know for subduing these cuticular dis¬ 
eases, that produce impediment, is the 
Unguentum Hydrargyri Nitratis, as much 
lowered with Unguentum Cetacei, or any 
other bland ointment, as the irritability of 
the subject may require. The dandriffe 
demands a double process—the first con¬ 
sists in removing the incrustation, the 
second in subduing the oozing. There are 
skins that will not well bear unctuous ap¬ 
plications; the desiccative lotions may 
then be made use of two or three times 
a-day; such as those prepared with the 
sulphate of zinc or superacetate of lead, 
&c. 
f It was published in the year 1806, in 
his Treatise on Vaccine Inoculation. 
saving 
Dr. Jennet's Circular to the Profession. 
