Paul Bourget - "Cosmopolis, v3"

Georgina Pell Curtis - "The Interdependence of Literature"

Sir Samuel White Baker - "In the Heart of Africa"

George Eliot - "The Mill on the Floss"

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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




I shall here take the opportunity of thanking Dr. Marshall and
those other gentlemen who have obligingly presented me with the
result of their inoculations; but, as they all agree in the same
point as that given in the above communication, namely, the
security of the patient from the effects of the smallpox after
the cow-pox, their perusal, I presume, would afford us no
satisfaction that has not been amply given already. Particular
occurrences I shall, of course, detail. Some of my correspondents
have mentioned the appearance of smallpox-like eruptions at the
commencement of their inoculations; but in these cases the matter
was derived from the original stock at the Smallpox Hospital.

I have myself inoculated a very considerable number from the
matter produced by Dr. Marshall's patients, originating in the
London cow, without observing pustules of any kind, and have
dispersed it among others who have used it with a similar effect.
From this source Mr. H. Jenner informs me he has inoculated above
an hundred patients without observing eruptions. Whether the
nature of the virus will undergo any change from being farther
removed from its original source in passing successively from one
person to another time alone can determine. That which I am now
employing has been in use near eight months, and not the least
change is perceptible in its mode of action either locally or
constitutionally. There is, therefore, every reason to expect
that its effects will remain unaltered and that we shall not be
under the necessity of seeking fresh supplies from the cow.

The following observations were obligingly sent me by Mr. Tierny,
Assistant Surgeon to the South Gloucester Regiment of Militia, to
whom I am indebted for a former report on this subject:

"I inoculated with the cow-pox matter from the eleventh to the
latter part of April, twenty-five persons, including women and
children. Some on the eleventh were inoculated with the matter
Mr. Shrapnell (surgeon to the regiment) had from you, the others
with matter taken from these. The progress of the puncture was
accurately observed, and its appearance seemed to differ from the
smallpox in having less inflammation around its basis on the
first days--that is, from the third to the seventh; but after
this the inflammation increased, extending on the tenth or
eleventh day to a circle of an inch and a half from its centre,
and threatening very sore arms; but this I am happy to say was
not the case; for, by applying mercurial ointment to the inflamed
part, which was repeated daily until the inflammation went off,
the arm got well without any further application or trouble. The
constitutional symptoms which appeared on the eighth or ninth day
after inoculation scarcely deserved the name of disease, as they
were so slight as to be scarcely perceptible, except that I could
connect a slight headache and languor, with a stiffness and
rather painful sensation in the axilla. This latter symptom was
the most striking--it remained from twelve to forty-eight hours.
In no case did I observe the smallest pustule, or even
discolouration of the skin, like an incipient pustule, except
about the part where the virus has been applied.

"After all these symptoms had subsided and the arms were well, I
inoculated four of this number with variolous matter, taken from
a patient in another regiment. In each of these it was inserted
several times under the cuticle, producing slight inflammation on
the second or third day, and always disappearing before the fifth
or sixth, except in one who had the cow-pox in Gloucestershire
before he joined us, and who also received it at this time by
inoculation. In this man the puncture inflamed and his arm was
much sorer than from the insertion of the cow-pox virus; but
there was no pain in the axilla, nor could any constitutional
affection be observed.

"I have only to add that I am now fully satisfied of the efficacy
of the cow-pox in preventing the appearance of the smallpox, and
that it is a most happy and salutary substitute for it. I remain,
etc.,

"M. J. TIERNY."

Although the susceptibility of the virus of the cow-pox is, for
the most part, lost in those who have had the smallpox, yet in
some constitutions it is only partially destroyed, and in others
it does not appear to be in the least diminished.

By far the greater number on whom trials were made resisted it
entirely; yet I found some on whose arm the pustule from
inoculation was formed completely, but without producing the
common efflorescent blush around it, or any constitutional
illness, while others have had the disease in the most perfect
manner. A case of the latter kind having been presented to me by
Mr. Fewster, Surgeon, of Thornbury, I shall insert it:

"Three children were inoculated with the vaccine matter you
obligingly sent me. On calling to look at their arms three days
after I was told that John Hodges, one of the three, had been
inoculated with the smallpox when a year old, and that he had a
full burthen, of which his face produced plentiful marks, a
circumstance I was not before made acquainted with. On the sixth
day the arm of the boy appeared as if inoculated with variolous
matter, but the pustule was rather more elevated. On the ninth
day he complained of violent pain in his head and back,
accompanied with vomiting and much fever. The next day he was
very well and went to work as usual. The punctured part began to
spread, and there was the areola around the inoculated part to a
considerable extent.

"As this is contrary to an assertion made in the Medical and
Physical Journal, No. 8, I thought it right to give you this
information, and remain,
"Dear sir, etc.,
"J. FEWSTER."

It appears, then, that the animal economy with regard to the
action of this virus is under the same laws as it is with respect
to the variolous virus, after previously feeling its influence,
as far as comparisons can be made between the two diseases.

Some striking instances of the power of the cow-pox in suspending
the progress of the smallpox after the patients had been several
days casually exposed to the infection have been laid before me
by Mr. Lyford, Surgeon, of Winchester, and my nephew, the Rev. G.
C Jenner. Mr. Lyford, after giving an account of his extensive
and successful practice in the vaccine inoculation in Hampshire,
writes as follows:

"The following case occurred to me a short time since, and may
probably be worth your notice. I was sent for to a patient with
the smallpox, and on inquiry found that five days previous to my
seeing him the eruption began to appear. During the whole of this
time two children who had not had the smallpox, were constantly
in the room with their father, and frequently on the bed with
him. The mother consulted me on the propriety of inoculating
them, but objected to my taking the matter from their father, as
he was subject to erysipelas. I advised her by all means to have
them inoculated at that time, as I could not procure any
variolous matter elsewhere. However, they were inoculated with
vaccine matter, but I cannot say I flattered myself with its
proving successful, as they had previously been so long and still
continued to be exposed to the variolous infection.
Notwithstanding this I was agreeably surprised to find the
vaccine disease advance and go through its regular course; and,
if I may be allowed the expression, to the total extinction of
the smallpox."

Mr. Jenner's cases were not less satisfactory. He writes as
follows:

"A son of Thomas Stinchcomb, of Woodford, near Berkeley, was
infected with the natural smallpox at Bristol, and came home to
his father's cottage. Four days after the eruptions had appeared
upon the boy, the family (none of which had ever had the
smallpox), consisting of the father, mother, and five children,
was inoculated with vaccine virus. On the arm of the mother it
failed to produce the least effect, and she, of course, had the
smallpox, [Footnote: Under similar circumstances I think it would
be advisable to insert the matter into each arm, which would be
more likely to insure the success of the operation.--E. J.] but
the rest of the family had the cow-pox in the usual way, and were
not affected with the smallpox, although they were in the same
room, and the children slept in the same bed with their brother
who was confined to it with the natural smallpox; and
subsequently with their mother.

"I attended this family with my brother, Mr. H. Jenner."

The following cases are of too singular a nature to remain
unnoticed.

Miss R--, a young lady about five years old, was seized on the
evening of the eighth day after inoculation with vaccine virus,
with such symptoms as commonly denote the accession of violent
fever. Her throat was also a little sore, and there were some
uneasy sensations about the muscles of the neck. The day
following a rash was perceptible on her face and neck, so much
resembling the efflorescence of the scarlatina anginosa that I
was induced to ask whether Miss R--had been exposed to the
contagion of that disease. An answer in the affirmative, and the
rapid spreading of the redness over the skin, at once relieved me
from much anxiety respecting the nature of the malady, which went
through its course in the ordinary way, but not without symptoms
which were alarming both to myself and Mr. Lyford, who attended
with me. There was no apparent deviation in the ordinary progress
of the pustule to a state of maturity from what we see in
general; yet there was a total suspension of the areola or florid
discolouration around it, until the scarlatina had retired from
the constitution. As soon as the patient was freed from this
disease this appearance advanced in the usual way. [Footnote: I
witnessed a similar fact in a case of measles. The pustule from
the cow-pock virus advanced to maturity, while the measles
existed in the constitution, but no EFFLORESCENCE appeared around
it until the measles had ceased to exert its influence.]

The case of Miss H--R--is not less interesting than that of her
sister, above related. She was exposed to the contagion of the
scarlatina at the same time, and sickened almost at the same
hour. The symptoms continued severe about twelve hours, when the
scarlatina-rash shewed itself faintly upon her face, and partly
upon her neck. After remaining two or three hours it suddenly
disappeared, and she became perfectly free from every complaint.
My surprise at this sudden transition from extreme sickness to
health in great measure ceased when I observed that the
inoculated pustule had occasioned, in this case, the common
efflorescent appearance around it, and that as it approached the
centre it was nearly in an erysipelatous state. But the most
remarkable part of this history is that, on the fourth day
afterwards, so soon as the efflorescence began to die away upon
the arm and the pustule to dry up, the scarlatina again appeared,
her throat became sore, the rash spread all over her. She went
fairly through the disease with its common symptoms.

That these were actually cases of scarlatina was rendered certain
by two servants in the family falling ill at the same time with
the distemper, who had been exposed to the infection with the
young ladies.

Some there are who suppose the security from the smallpox
obtained through the cow-pox will be of a temporary nature only.
This supposition is refuted not only by analogy with respect to
the habits of diseases of a similar nature, but by
incontrovertible facts, which appear in great numbers against it.
To those already adduced in the former part of my first treatise
[Footnote: See pages 217, 218, 219, 221, 223, etc.] many more
might be adduced were it deemed necessary; but among the cases I
refer to, one will be found of a person who had the cow-pox
fifty-three years before the effect of the smallpox was tried
upon him. As he completely resisted it, the intervening period I
conceive must necessarily satisfy any reasonable mind. Should
further evidence be thought necessary, I shall observe that,
among the cases presented to me by Mr. Fry, Mr. Darke, Mr.
Tierny, Mr. H. Jenner, and others, there were many whom they
inoculated ineffectually with variolous matter, who had gone
through the cow-pox many years before this trial was made.

It has been imagined that the cow-pox is capable of being
communicated from one person to another by effluvia without the
intervention of inoculation. My experiments, made with the design
of ascertaining this important point, all tend to establish my
original position, that it is not infectious except by contact, I
have never hesitated to suffer those on whose arms there were
pustules exhaling the effluvia from associating or even sleeping
with others who never had experienced either the cow-pox or the
smallpox. And, further, I have repeatedly, among children, caused
the uninfected to breathe over the inoculated vaccine 'pustules
during their whole progress, yet these experiments were tried
without the least effect. However, to submit a matter so
important to a still further scrutiny, I desired Mr. H. Jenner to
make any further experiments which might strike him as most
likely to establish or refute what had been advanced on this
subject. He has since informed me "that he inoculated children at
the breast, whose mothers had not gone through either the
smallpox or the cow-pox; that he had inoculated mothers whose
sucking infants had never undergone either of these diseases;
that the effluvia from the inoculated pustules, in either case,
had been inhaled from day to day during the whole progress of
their maturation, and that there was not the least perceptible
effect from these exposures." One woman he inoculated about a week
previous to her accouchement, that her infant might be the more
fully and conveniently exposed to the pustule; but, as in the
former instances, no infection was given, although the child
frequently slept on the arm of its mother with its nostrils and
mouth exposed to the pustule in the fullest state of maturity. In
a word, is it not impossible for the cow-pox, whose ONLY
manifestation appears to consist in the pustules CREATED BY
CONTACT, to produce ITSELF by effluvia?

In the course of a late inoculation I observed an appearance
which it may be proper here to relate. The punctured part on a
boy's arm (who was inoculated with fresh limpid virus) on the
sixth day, instead of shewing a beginning vesicle, which is usual
in the cow-pox at that period, was encrusted over with a rugged,
amber-coloured scab. The scab continued to spread and increase in
thickness for some days, when, at its edges, a vesicated ring
appeared, and the disease went through its ordinary course, the
boy having had soreness in the axilla and some slight
indisposition. With the fluid matter taken from his arm five
persons were inoculated. In one it took no effect. In another it
produced a perfect pustule without any deviation from the common
appearance; but in the other three the progress of the
inflammation was exactly similar to the instance which afforded
the virus for their inoculation; there was a creeping scab of a
loose texture, and subsequently the formation of limpid fluid at
its edges. As these people were all employed in laborious
exercises, it is possible that these anomalous appearances might
owe their origin to the friction of the clothes on the newly
inflamed part of the arm. I have not yet had an opportunity of
exposing them to the smallpox.

In the early part of this inquiry I felt far more anxious
respecting the inflammation of the inoculated arm than at
present; yet that this affection will go on to a greater extent
than could be wished is a circumstance sometimes to be expected.
As this can be checked, or even entirely subdued, by very simple
means, I see no reason why the patient should feel an uneasy hour
because an application may not be absolutely necessary. About the
tenth or eleventh day, if the pustule has proceeded regularly,
the appearance of the arm will almost to a certainty indicate
whether this is to be expected or not. Should it happen, nothing
more need be done than to apply a single drop of the aqua
lythargyri acetati [Footnote: Extract of Saturn.] upon the
pustule, and, having suffered it to remain two or three minutes,
to cover the efflorescence surrounding the pustule with a piece
of linen dipped in the aqua lythargyri compos. [Footnote: Goulard
water. For further information on this subject see the first
Treatise on the Var. Vac., Dr. Marshall's letters, etc.] The
former may be repeated twice or thrice during the day, the latter
as often as it may feel agreeable to the patient.

When the scab is prematurely rubbed off (a circumstance not
unfrequent among children and working people), the application of
a little aqua lythargyri acet. to the part immediately coagulates
the surface, which supplies its place, and prevents a sore.

In my former treatises on this subject I have remarked that the
human constitution frequently retains its susceptibility to the
smallpox contagion (both from effluvia and contact) after
previously feeling its influence. In further corroboration of
this declaration many facts have been communicated to me by
various correspondents. I shall select one of them.

"DEAR SIR:

"Society at large must, I think, feel much indebted to you for
your Inquiries and Observations on the Nature and Effects of the
Variolae Vaccinae, etc., etc. As I conceive what I am now about
to communicate to be of some importance, I imagine it cannot be
uninteresting to you, especially as it will serve to corroborate
your assertion of the susceptibility of the human system of the
variolous contagion, although it has previously been made
sensible of its action. In November, 1793, I was desired to
inoculate a person with the smallpox. I took the variolous matter
from a child under the disease in the natural way, who had a
large burthen of distinct pustules. The mother of the child being
desirous of seeing my method of communicating the disease by
inoculation, after having opened a pustule, I introduced the
point of my lancet in the usual way on the back part of my own
hand, and thought no more of it until I felt a sensation in the
part which reminded me of the transaction. This happened upon the
third day; on the fourth there were all the appearances common to
inoculation, at which I was not at all surprised, nor did I feel
myself uneasy upon perceiving the inflammation continue to
increase to the sixth and seventh day, accompanied with a very
small quantity of fluid, repeated experiments having taught me it
might happen so with persons who had undergone the disease, and
yet would escape any constitutional affection; but I was not so
fortunate; for on the eighth day I was seized with all the
symptoms of the eruptive fever, but in a much more violent degree
than when I was before inoculated, which was about eighteen years
previous to this, when I had a considerable number of pustules. I
must confess I was now greatly alarmed, although I had been much
engaged in the smallpox, having at different times inoculated not
less than two thousand persons. I was convinced my present
indisposition proceeded from the insertion of the variolous
matter, and, therefore, anxiously looked for an eruption. On the
tenth day I felt a very unpleasant sensation of stillness and
heat on each side of my face near my ear, and the fever began to
decline. The affection in my face soon terminated in three or
four pustules attended with inflammation, but which did not
maturate, and I was presently well.
"I remain, dear sir, etc.,
"THOMAS MILES."

This inquiry is not now so much in its infancy as to restrain me
from speaking more positively than formerly on the important
point of scrophula as connected with the smallpox.

Every practitioner in medicine who has extensively inoculated
with the smallpox, or has attended many of those who have had the
distemper in the natural way, must acknowledge that he has
frequently seen scrophulous affections, in some form or another,
sometimes rather quickly shewing themselves after the recovery of
the patients. Conceiving this fact to be admitted, as I presume
it must be by all who have carefully attended to the subject, may
I not ask whether it does not appear probable that the general
introduction of the smallpox into Europe has not been among the
most conductive means in exciting that formidable foe to health?
Having attentively watched the effects of the cow-pox in this
respect, I am happy in being able to declare that the disease
does not appear to have the least tendency to produce this
destructive malady.

The scepticism that appeared, even among the most enlightened of
medical men when my sentiments on the important subject of the
cow-pox were first promulgated, was highly laudable. To have
admitted the truth of a doctrine, at once so novel and so unlike
any thing that ever had appeared in the annals of medicine,
without the test of the most rigid scrutiny, would have bordered
upon temerity; but now, when that scrutiny has taken place, not
only among ourselves, but in the first professional circles in
Europe, and when it has been uniformly found in such abundant
instances that the human frame, when once it has felt the
influence of the genuine cow-pox in the way that has been
described, is never afterwards at any period of its existence
assailable by the smallpox, may I not with perfect confidence
congratulate my country and society at large on their beholding,
in the mild form of the cow-pox, an antidote that is capable of
extirpating from the earth a disease which is every hour
devouring its victims; a disease that has ever been considered as
the severest scourge of the human race!




THE CONTAGIOUSNESS OF PUERPERAL FEVER
BY
OLIVER WENDELL HOLMES


INTRODUCTORY NOTE


Oliver Wendell Holmes was born in Cambridge, Massachusetts,
August 29, 1809, and educated at Phillips Academy, Andover, and
Harvard College. After graduation, he entered the Law School, but
soon gave up law for medicine. He studied first in Boston, and
later spent two years in medical schools in Europe, mainly in
Paris. On his return he began to practise in Boston, but in two
years he was appointed professor of anatomy at Dartmouth College,
a position which he held from 1838 to 1840, when he again took up
his Boston practise. It was soon after this, in 1843, that he
published his essay on the "Contagiousness of Puerperal Fever,"
his only contribution of high distinction to medical science.
From 1847 to 1882 he was Parkman professor of anatomy and
physiology in the Harvard Medical School. He died in Boston,
October 7, 1894.

In spite of the importance of the paper here printed, Holmes's
reputation as a scientist was overshadowed by that won by him as
a wit and a man of letters. When he was only twenty-one his "Old
Ironsides" brought him into notice; and through his poetry and
fiction, and the sparkling talk of the "Breakfast Table" series,
he took a high place among the most distinguished group of
writers that America has yet produced.




THE CONTAGIOUSNESS OF PUERPERAL FEVER

Note.--This essay appeared first in 1843, in The New England
Quarterly Journal of Medicine, and was reprinted in the "Medical
Essays" in 1855.


In collecting, enforcing and adding to the evidence accumulated
upon this most serious subject, I would not be understood to
imply that there exists a doubt in the mind of any well-informed
member of the medical profession as to the fact that puerperal
fever is sometimes communicated from one person to another, both
directly and indirectly. In the present state of our knowledge
upon this point I should consider such doubts merely as a proof
that the sceptic had either not examined the evidence, or, having
examined it, refused to accept its plain and unavoidable
consequences. I should be sorry to think, with Dr. Rigby, that it
was a case of "oblique vision"; I should be unwilling to force
home the argumentum ad hominem of Dr. Blundell, but I would not
consent to make a question of a momentous fact which is no longer
to be considered as a subject for trivial discussions, but to be
acted upon with silent promptitude. It signifies nothing that
wise and experienced practitioners have sometimes doubted the
reality of the danger in question; no man has the right to doubt
it any longer. No negative facts, no opposing opinions, be they
what they may, or whose they may, can form any answer to the
series of cases now within the reach of all who choose to explore
the records of medical science.

If there are some who conceive that any important end would be
answered by recording such opinions, or by collecting the history
of all the cases they could find in which no evidence of the
influence of contagion existed, I believe they are in error.
Suppose a few writers of authority can be found to profess a
disbelief in contagion,--and they are very few compared with
those who think differently,--is it quite clear that they formed
their opinions on a view of all the facts, or is it not apparent
that they relied mostly on their own solitary experience? Still
further, of those whose names are quoted, is it not true that
scarcely a single one could, by any possibility, have known the
half or the tenth of the facts bearing on the subject which have
reached such a frightful amount within the last few years? Again,
as to the utility of negative facts, as we may briefly call
them,--instances, namely, in which exposure has not been followed
by disease,--although, like other truths, they may be worth
knowing, I do not see that they are like to shed any important
light upon the subject before us. Every such instance requires a
good deal of circumstantial explanation before it can be
accepted. It is not enough that a practitioner should have had a
single case of puerperal fever not followed by others. It must be
known whether he attended others while this case was in progress,
whether he went directly from one chamber to others, whether he
took any, and what, precautions. It is important to know that
several women were exposed to infection derived from the patient,
so that allowance may be made for want of predisposition. Now, if
of negative facts so sifted there could be accumulated a hundred
for every one plain instance of communication here recorded, I
trust it need not be said that we are bound to guard and watch
over the hundredth tenant of our fold, though the ninety and nine
may be sure of escaping the wolf at its entrance. If any one is
disposed, then, to take a hundred instances of lives, endangered
or sacrificed out of those I have mentioned, and make it
reasonably clear that within a similar time and compass TEN
THOUSAND escaped the same exposure, I shall, thank him for his
industry, but I must be permitted to hold to my own practical
conclusions, and beg him to adopt or at least to examine them
also. Children that walk in calico before open fires are not
always burned to death; the instances to the contrary may be
worth recording; but by no means if they are to be used as
arguments against woollen frocks and high fenders.