George Barr McCutcheon - "The Purple Parasol"

Geneve L.A. Shaffer - "The Log of the Empire State"

Chamisso et. al. - "Peter Schlemihl etc."

Louis Antoine Fauvelet de Bourrienne - "Memoirs of Napoleon Bonaparte, v5"

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PHILADELPHIA, Pa. -- The Philadelphia literary world will celebrate the launch of two new players today, April 10th: Kay Square Press, a new publishing company focused on Philadelphia-area artists, their stories, and their art; and Kay Square's first release, 'With the Rich and Mighty: Emlen Etting of Philadelphia' (ISBN: 978-0-9815129-0-7), a critical biography by Kenneth C. Kaleta.

FlatSigned Press Alleges Don Imus Remarks Damage Legacy of President Gerald R. Ford
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Books: The Harvard Classics Volume 38

V >> Various >> The Harvard Classics Volume 38




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 smallpox 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 smallpox 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 smallpox 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. [Footnote:
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.] 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 smallpox, 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 smallpox; 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
smallpox, 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-dairymaid who never had been
infected with either the cow-pox or the smallpox, 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 smallpox 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 Sarfenet lived as a dairymaid 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 tumours in the axillae, nor any general
indisposition. On being afterwards casually exposed to variolous
infection, she had the smallpox in a mild way. Hannah Pick,
another of the dairymaids who was a fellow-servant with Elizabeth
Sarfenet 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 smallpox
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 maidservant, were
infected by the cows. The man-servant had previously gone through
the smallpox, 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 the 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, 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.




II

FURTHER OBSERVATIONS ON THE VARIOLA VACCINAE, OR COW-POX. 1799


Although it has not been in my power to extend the inquiry into
the causes and effects of the variolae vaccinae much beyond its
original limits, yet, perceiving that it is beginning to excite a
general spirit of investigation, I think it of importance,
without delay, to communicate such facts as have since occurred,
and to point out the fallacious sources from whence a disease
imitative of the true variolae vaccinae might arise, with the
view of preventing those who may inoculate from producing a
spurious disease; and, further, to enforce the precaution
suggested in the former treatise on the subject, of subduing the
inoculated pustule as soon as it has sufficiently produced its
influence on the constitution. From a want of due discrimination
of the real existence of the disease, either in the brute or in
the human subject, and also of that stage of it in which it is
capable of producing the change in the animal economy which
renders it unsusceptible of the contagion of the smallpox,
unpleasant consequences might ensue, the source of which,
perhaps, might not be suspected by one inexperienced in
conducting such experiments.

My late publication contains a relation of most of the facts
which had come under my own inspection at the time it was
written, interspersed with some conjectural observations. Since
then Dr. G. Pearson has established an inquiry into the validity
of my principal assertion, the result of which cannot but be
highly flattering to my feelings. It contains not a single case
which I think can be called an exception to the fact I was so
firmly impressed with--that the cow-pox protects the human body
from the smallpox. I have myself received some further
confirmations, which shall be subjoined. I have lately also been
favoured with a letter from a gentleman of great respectability
(Dr. Ingenhousz), informing me that, on making an inquiry into
the subject in the county of Wilts, he discovered that a farmer
near Calne had been infected with the smallpox after having had
the cow-pox, and that the disease in each instance was so
strongly characterized as to render the facts incontrovertible.
The cow-pox, it seems, from the doctor's information, was
communicated to the farmer from his cows at the time that they
gave out an offensive stench from their udders.

Some other instances have likewise been represented to me of the
appearance of the disease, apparently marked with its
characteristic symptoms, and yet that the patients have
afterwards had the smallpox. On these cases I shall, for the
present, suspend any particular remarks, but hope that the
general observations I have to offer in the sequel will prove of
sufficient weight to render the idea of their ever having had
existence, but as cases of spurious cow-pox, extremely doubtful.

Ere I proceed let me be permitted to observe that truth, in this
and every other physiological inquiry that has occupied my
attention, has ever been the object of my pursuit, and should it
appear in the present instance that I have been led into error,
fond as I may appear of the offspring of my labours, I had rather
see it perish at once than exist and do a public injury.

I shall proceed to enumerate the sources, or what appear to me as
such, of a spurious cow-pox.

First: That arising from pustules on the nipples or udder of the
cow; which pustules contain no specific virus.

Secondly: From matter (although originally possessing the
specific virus) which has suffered a decomposition, either from
putrefaction or from any other cause less obvious to the senses.

Thirdly: From matter taken from an ulcer in an advanced stage,
which ulcer arose from a true cow pock.

Fourthly: From matter produced on the human skin from contact
with some peculiar morbid matter generated by a horse.

On these subjects I shall offer some comments: First, to what
length pustulous diseases of the udder and nipples of the cow may
extend it is not in my power to determine; but certain it is that
these parts of the animal are subject to some variety of maladies
of this nature; and as many of these eruptions (probably all of
them) are capable of giving a disease to the human body, would it
not be discreet for those engaged in this investigation to
suspend controversy and cavil until they can ascertain with
precision what IS and what IS NOT the cow-pox?

For example: A farmer who is not conversant with any of these
maladies, but who may have heard of the cow-pox in general terms,
may acquaint a neighbouring surgeon that the distemper appears at
his farm. The surgeon, eager to make an experiment, takes away
matter, inoculates, produces a sore, uneasiness in the axilla,
and perhaps some affection of the system. This is one way in
which a fallacious idea of security both in the mind of the
inoculater and the patient may arise; for a disease may thus have
been propagated from a simple eruption only.

One of the first objects then of this pursuit, as I have
observed, should be, to learn how to distinguish with accuracy
between that peculiar pustule which is the true cow pock, and
that which is spurious. Until experience has determined this, we
view our object through a mist. Let us, for instance, suppose
that the smallpox and the chicken-pox were at the same time to
spread among the inhabitants of a country which had never been
visited by either of these distempers, and where they were quite
unknown before: what confusion would arise! The resemblance
between the symptoms of the eruptive fever and between the
pustules in either case would be so striking that a patient who
had gone through the chicken-pox to any extent would feel equally
easy with regard to his future security from the smallpox as the
person who had actually passed through that disease. Time and
future observation would draw the line of distinction.

So I presume it will be with the cow-pox until it is more
generally understood. All cavilling, therefore, on the mere
report of those who TELL US they have had this distemper, and are
afterwards found susceptible of the smallpox, should be
suspended. To illustrate this I beg leave to give the following
history:

Sarah Merlin, of the parish of Eastington in this county, when
about thirteen or fourteen years of age lived as a servant with
farmer Clarke, who kept a dairy consisting of about eighteen cows
at Stonehouse, a neighbouring village. The nipples and udders of
three of the cows were extensively affected with large white
blisters. These cows the girl milked daily, and at the time she
assisted, with two others, in milking the rest of the herd. It
soon appeared that the disease was communicated to the girl. The
rest of the cows escaped the infection, although they were milked
several days after the three above specified, had these eruptions
on the nipples and udders, and even after the girl's hand became
sore. The two others who were engaged in milking, although they
milked the cows indiscriminately, received no injury. On the
fingers of each of the girl's hands there appeared several large
white blisters--she supposes about three or four on each finger.
The hands and arms inflamed and swelled, but no constitutional
indisposition followed. The sores were anointed with some
domestic ointment and got well without ulcerating.

As this malady was called the cow-pox, and recorded as such in
the mind of the patient, she became regardless of the smallpox;
but, on being exposed to it some years afterwards she was
infected, and had a full burthen.

Now had any one conversant with the habits of the disease heard
this history, they would have had no hesitation in pronouncing it
a case of spurious cow-pox; considering its deviation in the
NUMEROUS blisters which appeared on the girl's hands; their
termination without ulceration; its not proving more generally
contagious at the farm, either among the cattle or those employed
in milking; and considering also that THE PATIENT FELT NO GENERAL
INDISPOSITION, ALTHOUGH THERE WAS SO GREAT A NUMBER OF VESICLES.

This is perhaps the most deceptious form in which an eruptive
disease can be communicated from the cow, and it certainly
requires some attention in discriminating it. The most perfect
criterion by which the judgment may be guided is perhaps that
adopted by those who attend infected cattle. These white blisters
on the nipples, they say, NEVER EAT INTO THE FLESHY PARTS like
those which are commonly of a bluish cast, and which constitute
the TRUE COW-POX, but that they affect the skin only, quickly end
in scabs, and are not nearly so infectious.

That which appeared to me as one cause of spurious eruptions, I
have already remarked in the former treatise, namely, the
transition that the cow makes in the spring from a poor to a
nutritious diet, and from the udder's becoming at this time more
vascular than usual for the supply of milk. But there is another
source of inflammation and pustules which I believe is not
uncommon in all the dairy counties in the west of England. A cow
intended to be exposed for sale, having naturally a small udder,
is previously for a day or two neither milked artificially nor is
her calf suffered to have access to her. Thus the milk is
preternaturally accumulated, and the udder and nipples become
greatly distended. The consequences frequently are inflammation
and eruptions which maturate.

Whether a disease generated in this way has the power of
affecting the constitution in any PECULIAR manner I cannot
presume positively to determine. It has been conjectured to have
been a cause of the true cow-pox, though my inquiries have not
led me to adopt this supposition in any one instance; on the
contrary, I have known the milkers affected by it, but always
found that an affection thus induced left the system as
susceptible of the smallpox as before.

What is advanced in my second position I consider also of very
great importance, and I could wish it to be strongly impressed on
the minds of all who may be disposed to conclude hastily on my
observations, whether engaged in their investigation by
experiments or not to place this in its clearest point of view
(as the similarity between the action of the smallpox and the
cow-pox matter is so obvious) it will be necessary to consider
what we sometimes observe to take place in inoculation for the
smallpox when imperfect variolous matter is made use of. The
concise history on this subject that was brought forward
respecting what I had observed in this neighbourhood [Footnote:
Inquiry into the Causes and Effects of the Variolae Vaccinae,
p.56 of the original article]. I perceive, by a reference since
made to the Memoirs of the Medical Society of London, may be
considered as no more than a corroboration of the facts very
clearly detailed by Mr. Kite [Footnote: See an account of some
anomalous appearances consequent to the inoculation of the
smallpox, by Charles Kite, Surgeon, of Gravesend, in the Memoirs
of the Medical Society of London, vol. iv, p. 114.]. To this
copious evidence I have to add still more in the following
communications from Mr. Earle, surgeon, of Frampton-upon-Severn,
in this county, which I deem the more valuable, as he has with
much candour permitted me to make them public:

"SIR:

"I have read with satisfaction your late publication on the
Variolae Vaccinae, and being, among many other curious
circumstances, particularly struck with that relating to the
inefficacy of smallpox matter in a particular state, I think it
proper to lay before you the following facts which came within my
own knowledge, and which certainly tend to strengthen the
opinions advanced in pages 56 and 57 of your treatise.

"In March, 1784, a general inoculation took place at Arlingham in
this county. I inoculated several patients with active variolous
matter, all of whom had the disease in a favourable way; but the
matter being all used, and not being able to procure any more in
the state I wished, I was under the necessity of taking it from a
pustule which, experience has since proved, was advanced too far
to answer the purpose I intended. Of five persons inoculated with
this last matter, four took the smallpox afterwards in the
natural way, one of whom died, three recovered, and the other,
being cautioned by me to avoid as much as possible the chance of
catching it, escaped from the disease through life. He died of
another disorder about two years ago.

"Although one of these cases ended unfortunate, yet I cannot
suppose that any medical man will think me careless or
inattentive in their management; for I conceive the appearances
were such as might have induced any one to suppose that the
persons were perfectly safe from future infection. Inflammation
in every case took place in the arm, and fever came on with a
considerable degree of pain in the axilla. In some of their arms
the inflammation and suppuration were more violent than is
commonly observed when perfect matter is made use of; in one
there was an ulcer which cast off several large sloughs. About
the ninth day eruptions appeared, which died away earlier than
common without maturation. From these circumstances I should
suppose that no medical practitioner would scarcely have
entertained a doubt but that these patients had been infected
with a true smallpox; yet I must confess that some small degree
of doubt presented itself to me at the speedy disappearance of
the eruptions; and in order, as far as I could, to ascertain
their safety, I sent one of them to a much older practitioner
than myself. This gentleman, on hearing the circumstances of the
case, pronounced the patient perfectly secure from future
infection.

"The following facts are also a striking proof of the truth of
your observations on this subject:

"In the year 1789 I inoculated three children of Mr. Coaley, of
Hurst farm in this county. The arms inflamed properly, fever and
pain in the axillae came on precisely the same as in the former
cases, and in ten days eruptions appeared, which disappeared in
the course of two days. I must observe that the matter here made
use of was procured for me by a friend; but no doubt it was in an
improper state; for, from the similarity of these cases to those
which happened at Arlingham five years before, I was somewhat
alarmed for their safety, and desired to inoculate them again:
which being permitted, I was particularly careful to procure
matter in its most perfect state. All the children took the
smallpox from this second inoculation, and all had a very full
burthen. These facts I conceive strikingly corroborate your
opinion relative to the different states of matter; for in both
instances that I have mentioned it was capable of producing
something strongly resembling the true smallpox, although it
afterwards proved not to be so.