John Lothrop Motley - "History of the United Netherlands, 1586"

John Lothrop Motley - "History of the United Netherlands, 1588 89"

James Oliver Curwood - "Nomads Of The North"

William Henry Withrow - "Neville Trueman the Pioneer Preacher"

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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.

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Books: The Harvard Classics Volume 38

V >> Various >> The Harvard Classics Volume 38




"As I think the communication of these cases is a duty I owe to
the public, you are at liberty to make what use you please of
this letter. I remain, &c.,

"John Earle.

"FRAMPTON-UPON SEVERN, GLOUCESTERSHIRE, November 10, 1798.

"P. S. I think it necessary to observe that I can pronounce, with
the greatest certainty, that the matter with which the Arlingham
patients were inoculated was taken from a true smallpox pustule.
I took it myself from a subject that had a very full burthen."

Certain then it is that variolous matter may undergo such a
change from the putrefactive process, as well as from some of the
more obscure and latent processes of nature, as will render it
incapable of giving the smallpox in such a manner as to secure
the human constitution from future infection, although we see at
the same time it is capable of exciting a disease which bears so
strong a resemblance to it as to produce inflammation and matter
in the incised skin (frequently, indeed, more violent than when
it produces its effects perfectly), swelling of the axillary
glands, general indisposition, and eruptions. So strongly
persuaded was the gentleman, whose practice I have mentioned in
page 56 of the late treatise, that he could produce a mild
smallpox by his mode of managing the matter, that he spoke of it
as a useful discovery until convinced of his error by the fatal
consequence which ensued.

After this ought we to be in the smallest degree surprised to
find, among a great number of individuals who, by living in
dairies, have been casually exposed to the cow-pox virus when in
a state analogous to that of the smallpox above described, some
who may have had the disease so imperfectly as not to render them
secure from variolous attacks? For the matter, when burst from
the pustules on the nipples of the cow, by being exposed, from
its lodgment there, to the heat of an inflamed surface, and from
being at the same time in a situation to be occasionally
moistened with milk, is often likely to be in a state conducive
to putrefaction; and thus, under some modification of
decomposition, it must, of course, sometimes find access to the
hand of the milker in such a way as to infect him. What confusion
should we have were there no other mode of inoculating the
smallpox than such as would happen from handling the diseased
skin of a person labouring under that distemper in some of its
advanced and loathsome stages! It must be observed that every
case of cow-pox in the human species, whether communicated by
design or otherwise, is to be considered as a case of
inoculation. And here I may be allowed to make an observation on
the case of the farmer communicated to me by Dr. Ingenhousz. That
he was exposed to the matter when it had undergone the
putrefactive change is highly probable from the doctor's
observing that the sick cows at the farm gave out an OFFENSIVE
STENCH FROM THEIR UDDERS. However, I must remark that it is
unusual for cattle to suffer to such an extent, when disordered
with the cowpox, as to make a bystander sensible of any ill
smell. I have often stood among a herd which had the distemper
without being conscious of its presence from any particular
effluvia. Indeed, in this neighbourhood it commonly receives an
early check from escharotic applications of the COW LEECH. It has
been conceived to be contagious without contact; but this idea
cannot be well founded because the cattle in one meadow do not
infect those in another (although there may be no other partition
than a hedge) unless they be handled or milked by those who bring
the infectious matter with them; and of course, the smallest
particle imaginable, when applied to a part susceptible of its
influence, may produce the effect. Among the human species it
appears to be very clear that the disease is produced by contact
only. All my attempts, at least, to communicate it by effluvia
have hitherto proved ineffectual.

As well as the perfect change from that state in which variolous
matter is capable of producing full and decisive effects on the
constitution, to that wherein its specific properties are
entirely lost, it may reasonably be supposed that it is capable
of undergoing a variety of intermediate changes. The following
singular occurrences in ten cases of inoculation, obligingly
communicated to me by Mr. Trye, Senior Surgeon to the Infirmary
at Glocester, seem to indicate that the variolous matter,
previously to its being taken from the patient for the intended
purpose, was beginning to part with some of its original
properties, or, in other words, that it had suffered a partial
decomposition. Mr. Trye says: "I inoculated ten children with
matter taken at one time and from the same subject. I observed no
peculiarity in any of them previously to their inoculation, nor
did any thing remarkable appear in their arms till after the
decline of the disease. Two infants of three months old had
erysipelas about the incisions, in one of them extending from the
shoulders to the fingers' ends. Another infant had abscesses in
the cellular substance in the neighbourhood of the incisions, and
five or six of the rest had axillary abscesses. The matter was
taken from the distinct smallpox late in its progress, and when
some pustules had been dried. It was received upon glass and
slowly dried by the fire. All the children had pustules which
maturated, so that I suppose them all secure from future
infection; at least, as secure as any others whom I have ever
inoculated. My practice never afforded a sore arm before."

In regard to my former observation on the improper and dangerous
mode of preserving variolous matter, I shall here remark that it
seems not to have been clearly understood. Finding that it has
been confounded with the more eligible modes of preservation, I
will explain myself further. When the matter is taken from a fit
pustule and properly prepared for preservation, it may certainly
be kept without losing its specific properties a great length of
time; for instance, when it is previously dried in the open air
on some compact body, as a quill or a piece of glass, and
afterwards secured in a small vial. [Footnote: Thus prepared, the
cow-pox virus was found perfectly active, and possessing all its
specific properties, at the end of three months.] But when kept
several days in a state of moisture, and during that time exposed
to a warm temperature, I do not think it can be relied upon as
capable of giving a perfect disease, although, as I have before
observed, the progress of the symptoms arising from the action of
the imperfect matter bear so strong a resemblance to the smallpox
when excited completely.

Thirdly. That the first formed virus, or what constitutes the
true cow-pox pustule, invariably possesses the power I have
ascribed to it, namely, that of affecting the constitution with a
specific disease, is a truth that no subsequent occurrence has
yet led me to doubt. But as I am now endeavouring to guard the
public as much as possible against erroneous conclusions, I shall
observe that when this pustule has degenerated into an ulcer (to
which state it is often disposed to pass unless timely checked),
I suspect that matter possessing very different properties may
sooner or later be produced; and although it may have passed that
stage wherein the specific properties of the matter secreted are
no longer present in it, yet when applied to a sore (as in the
casual way) it might dispose that sore to ulcerate, and from its
irritation the system would probably become affected; and thus,
by assuming some of its strongest characters, it would imitate
the genuine cow-pox.

From the preceding observations on the matter of smallpox when
decomposed it must, I conceive, be admitted that cow-pox matter
in the state now described may produce a disease, the effects of
which may be felt both locally and generally, yet that the
disease thus induced may not be effectual in obviating the future
effects of variolous contagion. In the case of Mary Miller,
related by Mr. Kite in the volume above alluded to, it appears
that the inflammation and suppuration of the inoculated arm were
more than usually severe, although the system underwent no
specific change from the action of the virus; which appears from
the patient's sickening seven weeks afterwards with the natural
smallpox, which went through its course. Some of the cases
communicated by Mr. Earle tend further to confirm this fact, as
the matter there manifestly produced ulceration on the inoculated
part to a considerable extent.

Fourthly. Whether the cow-pox is a spontaneous disease in the
cow, or is to be attributed to matter conveyed to the animal, as
I have conceived, from the horse, is a question which, though I
shall not attempt now fully to discuss, yet I shall digress so
far as to adduce some further observations, and to give my
reasons more at large for taking up an opinion that to some had
appeared fanciful. The aggregate of these observations, though
not amounting to positive proof, forms presumptive evidence of so
forcible a kind that I imagine it might, on any other person,
have made the same impression it did on me, without fixing the
imputation of credulity.

First: I conceived this was the source, from observing that where
the cow-pox had appeared among the dairies here (unless it could
be traced to the introduction of an infected cow or servant) it
had been preceded at the farm by a horse diseased in the manner
already described, which horse had been attended by some of the
milkers.

Secondly: From its being a popular opinion throughout this great
dairy country, and from its being insisted on by those who here
attend sick cattle.

Thirdly: From the total absence of the disease in Ireland and
Scotland, where the men-servants are not employed in the dairies.
[Footnote: This information was communicated to me from the first
authority.]

Fourthly: From having observed that morbid matter generated by
the horse frequently communicates, in a casual way, a disease to
the human subject so like the cow-pox that, in many cases, it
would be difficult to make the distinction between one and the
other. [Footnote: The sound skin does not appear to be
susceptible of this virus when inserted into it, but, when
previously diseased from little accidents, its effects are often
conspicuous.]

Fifthly: From being induced to suppose, from experiments, that
some of those who had been thus affected from the horse resisted
the smallpox.

Sixthly: From the progress and general appearance of the pustule
on the arm of the boy whom I inoculated with matter taken from
the hand of a man infected by a horse; and from the similarity to
the cow-pox of general constitutional symptoms which followed.
[Footnote: This case (on which I laid no inconsiderable stress in
my late treatise, as presumptive evidence of the fact adduced)
seems to have been either mistaken or overlooked by those who
have commented upon it. (See Case XVIII, p. 36.) The boy,
unfortunately, died of a fever at a parish workhouse before I had
an opportunity of observing what effects would have been produced
by the matter of smallpox.]

I fear it would be trespassing too far to adduce the general
testimony of our farmers in support of this opinion; yet I beg
leave to introduce an extract of a letter on this subject from
the Rev. Mr. Moore, of Chalford Hill, in this county:

"In the month of November, 1797, my horse had diseased heels,
which was certainly what is termed the grease; and at a short
subsequent period my cow was also affected with what a
neighbouring farmer (who was conversant with the complaints of
cattle) pronounced to be the cow-pox, which he at the same time
observed my servant would be infected with: and this proved to be
the case; for he had eruptions on his hands, face, and many,
parts of the body, the pustules appearing large, and not much
like the smallpox, for which he had been inoculated a year and a
half before, and had then a very heavy burthen. The pustules on
the face might arise from contact with his hands, as he had a
habit of rubbing his forehead, where the sores were the largest
and the thickest.

"The boy associated with the farmer's sons during the continuance
of the disease, neither of whom had had the smallpox, but they
felt no ill effects whatever. He was not much indisposed, as the
disease did not prevent him from following his occupations as
usual. No other person attended the horse or milked the cow but
the lad above mentioned. I am firmly of opinion that the disease
in the heels of the horse, which was a virulent grease, was the
origin of the servant's and the cow's malady."

But to return to the more immediate object of this proposition.

From the similarity of symptoms, both constitutional and local,
between the cow-pox and the disease received from morbid matter
generated by a horse, the common people in this neighbourhood,
when infected with this disease, through a strange perversion of
terms, frequently call it the cow-pox. Let us suppose, then, such
a malady to appear among some of the servants at a farm, and at
the same time that the cow-pox were to break out among the
cattle; and let us suppose, too, that some of the servants were
infected in this way, and that others received the infection from
the cows. It would be recorded at the farm, and among the
servants themselves wherever they might afterwards be dispersed,
that they had all had the cow-pox. But it is clear that an
individual thus infected from the horse would neither be for a
certainty secure himself, nor would he impart security to others
were they inoculated by virus thus generated. He still would be
in danger of taking the smallpox. Yet were this to happen before
the nature of the cowpox be more maturely considered by the
public my evidence on the subject might be depreciated unjustly.
For an exemplification of what is here advanced relative to the
nature of the infection when received directly from the horse see
Inquiry into the Causes and Effects of the Variolae Vaccinae, pp.
27, 28, 29, 30, and p. 35; and by way of further example, I beg
leave to subjoin the following intelligence received from Mr.
Fewster, Surgeon, of Thornbury, in this county, a gentleman
perfectly well acquainted with the appearances of the cow-pox on
the human subject:

"William Morris, aged thirty-two, servant to Mr. Cox of
Almondsbury, in this county, applied to me the 2d of April, 1798.
He told me that, four days before, be found a stiffness and
swelling in both his hands, which were so painful it was with
difficulty he continued his work; that he had been seized with
pain in his head, small of the back, and limbs, and with frequent
chilly fits succeeded by fever. On examination I found him still
affected with these symptoms, and that there was a great
prostration of strength. Many parts of his hands on the inside
were chapped, and on the middle joint of the thumb of the right
hand there was a small phagedenic ulcer, about the size of a
large pea, discharging an ichorous fluid. On the middle finger of
the same hand there was another ulcer of a similar kind. These
sores were of a CIRCULAR form, and he described their first
appearance as being somewhat like blisters arising from a burn.
He complained of excessive pain, which extended up his arm into
the axilla. These symptoms and appearances of the sores were so
exactly like the cow-pox that I pronounced he had taken the
distemper from milking cows. He assured me he had not milked a
cow for more than half a year, and that his master's cows had
nothing the matter with them. I then asked him if his master had
a GREASY horse, which he answered in the affirmative, and further
said that he had constantly dressed him twice a day for the
[Footnote: HC--Vol.88] last three weeks or more, and remarked
that the smell of his hands was much like that of the horses's
heels. On the 5th of April I again saw him, and found him still
complaining of pain in both hands, nor were his febrile symptoms
at all relieved. The ulcers had now spread to the size of a
seven-shilling gold coin, and another ulcer, which I had not
noticed before, appeared on the first joint of the forefinger of
the left hand, equally painful with that on the right. I ordered
him to bathe his hands in warm bran and water, applied
escharotics to the ulcers, and wrapped his hands up in a soft
cataplasm. The next day he was much relieved, and in something
more than a fortnight got well. He lost his nails from the thumb
and fingers that were ulcerated."

The sudden disappearance of the symptoms in this case after the
application of the escharotics to the sores is worthy of
observation; it seems to show that they were kept up by the
irritation of the ulcers.

The general symptoms which I have already described of the cow-
pox, when communicated in a casual way to any great extent, will,
I am convinced, from the many cases I have seen, be found
accurate; but from the very slight indisposition which ensues in
cases of inoculation, where the pustule, after affecting the
constitution, quickly runs into a scab spontaneously, or is
artificially suppressed by some proper application, I am induced
to believe that the violence of the symptoms may be ascribed to
the inflammation and irritation of the ulcers (when ulceration
takes place to any extent, as in the casual cow-pox), and that
the constitutional symptoms which appear during the presence of
the sore, while it assumes the character of a pustule only, are
felt but in a very trifling degree. This mild affection of the
system happens when the disease makes but a slight local
impression on those who have been accidentally infected by cows;
and, as far as I have seen, it has uniformly happened among those
who have been inoculated, when a pustule only and no great degree
of inflammation or any ulceration has taken place from the
inoculation. The following cases will strengthen this opinion.

The cow-pox appeared at a farm in the village of Stonehouse, in
this county, about Michaelmas last, and continued gradually to
pass from one cow to another till the end of November, On the
twenty-sixth of that month some ichorous matter was taken from a
cow and dried upon a quill. On the 2d of December some of it was
inserted into a scratch, made so superficial that no blood
appeared, on the arms of Susan Phipps, a child seven years old.
The common inflammatory appearances took place in consequence,
and advanced till the fifth day, when they had so much subsided
that I did not conceive any thing further would ensue.

6th: Appearances stationary.

7th: The inflammation began to advance.

8th: A vesication, perceptible on the edges, forming, as in the
inoculated smallpox, an appearance not unlike a grain of wheat,
with the cleft, or indentation in the centre.

9th: Pain in the axilla.

10th: A little headache; pulse, 110; tongue not discoloured;
countenance in health.

11th, 12th: No perceptible illness; pulse about 100.

13th: The pustule was now surrounded by an efflorescence,
interspersed with very minute confluent pustules to the extent of
about an inch. Some of these pustules advanced in size and
maturated. So exact was the resemblance of the arm at this stage
to the general appearance of the inoculated smallpox that Mr. D.,
a neighbouring surgeon, who took some matter from it, and who had
never seen the cow-pox before, declared he could not perceive any
difference. [Footnote: That the cow-pox was a supposed guardian
of the constitution from the action of the smallpox has been a
prevalent idea for a long time past; but the similarity in the
constitutional effects between one disease and the other could
never have been so accurately observed had not the inoculation of
the cow-pox placed it in a new and stronger point of view. This
practice, too, has shewn us, what before lay concealed, the rise
and progress of the pustule formed by the insertion of the virus,
which places in a most conspicuous light its striking resemblance
to the pustule formed from the inoculated smallpox.] The child's
arm now shewed a disposition to scab, and remained nearly
stationary for two or three days, when it began to run into an
ulcerous state, and THEN commenced a febrile indisposition
accompanied with an increase of axillary tumour. The ulcer
continued spreading near a week, during which time the child
continued ill, when it increased to a size nearly as large as a
shilling. It began now to discharge pus; granulations sprang up,
and it healed. This child had before been of a remarkably sickly
constitution, but is now in very high health.

Mary Hearn, twelve years of age, was inoculated with matter taken
from the arm of Susan Phipps.

6th day: A pustule beginning to appear, slight pain in the
axilla.

7th: A distinct vesicle formed.

8th: The vesicle increasing; edges very red; no deviation in its
appearance at this time from the inoculated smallpox.

9th: No indisposition; pustule advancing.

10th: The patient felt this evening a slight febrile attack.

11th: Free from indisposition.

12th, 13th: The same.

14th: An efflorescence of a faint red colour extending several
inches round the arm. The pustule, beginning to shew a
disposition to spread, was dressed with an ointment composed of
hydrarg. nit. rub. and ung. cerce. The efflorescence itself was
covered with a plaster of ung. hydr. fort. In six hours it was
examined, when it was found that the efflorescence had totally
disappeared.

The application of the ointment with the hydr. nit. rub. was made
use of for three days, when, the state of the pustule remaining
stationary, it was exchanged for the ung. hydr. nit. This
appeared to have a more active effect than the former, and in two
or three days the virus seemed to be subdued, when a simple
dressing was made use of; but the sore again shewing a
disposition to inflame, the ung. hydr. nit. was again applied,
and soon answered the intended purpose effectually. The girl,
after the tenth day, when, as has been observed, she became a
little ill, shewed not the least symptom of indisposition. She
was afterwards exposed to the action of variolous; matter, and
completely resisted it. Susan Phipps also went through a similar
trial. Conceiving these cases to be important, I have given them
in detail: first, to urge the precaution of using such means as
may stop the progress of the pustule; and, secondly, to point out
(what appears to be the fact) that the most material
indisposition, or at least that which is felt most sensibly, DOES
NOT ARISE PRIMARILY FROM THE FIRST ACTION OF THE VIRUS ON THE
CONSTITUTION, BUT THAT IT OFTEN COMES ON, IF THE PUSTULE IS LEFT
TO CHANCE, AS A SECONDARY DISEASE. This leads me to conjecture,
what experiment must finally determine, that they who have had
the smallpox are not afterwards susceptible of the primary action
of the cow-pox virus; for seeing that the simple virus itself,
when it has not passed beyond the boundary of a vesicle, excites
in the system so little commotion, is it not probable the
trifling illness, thus induced may be lost in that which so
quickly, and oftentimes so severely, follows in the casual cow-
pox from the presence of corroding ulcers? This consideration
induces me to suppose that I may have been mistaken in my former
observation on this subject.

In this respect, as well as many others, a parallel may be drawn
between this disease and the smallpox. In the latter, the patient
first feels the effect of what is called the absorption of the
virus. The symptoms then often nearly retire, when a fresh attack
commences, different from the first, and the illness keeps pace
with the progress of the pustules through their different stages
of maturation, ulceration, etc. Although the application I have
mentioned in the case of Mary Hearn proved sufficient to check
the progress of ulceration and prevent any secondary symptoms,
yet, after the pustule has duly exerted its influence, I should
prefer the destroying it quickly and effectually to any other
mode. The term caustic to a tender ear (and I conceive none feel
more interested in this inquiry than the anxious guardians of a
nursery) may sound harsh and unpleasing, but every solicitude
that may arise on this account will no longer exist when it is
understood that the pustule, in a state fit to be acted upon, is
then quite superficial, and that it does not occupy the space of
a silver penny. [Footnote: I mention escharotics for stopping the
progress of the pustule because I am acquainted with their
efficacy; probably more simple means might answer the purpose
quite as well, such as might be found among the mineral and
vegetable astringents.]

As a proof of the efficacy of this practice, even before the
virus has fully exerted itself on the system, I shall lay before
my reader the following history:

By a reference to the treatise on the Variolae Vaccinae it will
be seen that, in the month of April, 1798, four children were
inoculated with the matter of cow-pox, and that in two of these
cases the virus on the arm was destroyed soon after it had
produced a perceptible sickening. Mary James, aged seven years,
one of the children alluded to, was inoculated in the month of
December following with fresh variolous matter, and at the same
time was exposed to the effluvia of a patient affected with the
smallpox. The appearance and progress of the infected arm was, in
every respect similar to that which we generally observe when
variolous matter has been inserted into the skin of a person who
has not previously undergone either the cow-pox or the smallpox.
On the eighth day, conceiving there was infection in it, she was
removed from her residence among those who had not had the
smallpox. I was now anxiously waiting the result, conceiving,
from the state of the girl's arm, she would fall sick about this
time. On visiting her on the evening of the following day (the
ninth) all I could learn from the woman who attended her was that
she felt somewhat hotter than usual during the night, but was not
restless; and that in the morning there was the faint appearance
of a rash about her wrists. This went off in a few hours, and was
not at all perceptible to me on my visit in the evening. Not a
single eruption appeared, the skin having been repeatedly and
carefully examined. The inoculated arm continued to make the
usual progress to the end, through all the stages of
inflammation, maturation, and scabbing.