Part 3
In some of the preceding cases I have noticed the attention that was paid to the state of the variolous matter previous to the experiment of inserting it into the arms of those who had gone through the Cow-pox. This I conceived to be of great importance in conducting these experiments, and were it always properly attended to by those who inoculate for the Small-pox, it might prevent much subsequent mischief and confusion. With the view of enforcing so necessary a precaution, I shall take the liberty of digressing so far as to point out some unpleasant facts, relative to mismanagement in this particular, which have fallen under my own observation.
A Medical Gentleman (now no more), who for many years inoculated in this neighbourhood, frequently preserved the variolous matter intended for his use, on a piece of lint or cotton, which, in its fluid state was put into a vial, corked, and conveyed into a warm pocket; a situation certainly favourable for speedily producing putrefaction in it. In this state (not unfrequently after it had been taken several days from the pustules) it was inserted into the arms of his patients, and brought on inflammation of the incised parts, swellings of the axillary glands, fever, and sometimes eruptions. But what was this disease? Certainly not the Small-pox; for the matter having from putrefaction lost, or suffered a derangement in its specific properties, was no longer capable of producing that malady, those who had been inoculated in this manner being as much subject to the contagion of the Small-pox, as if they had never been under the influence of this artificial disease; and many, unfortunately, fell victims to it, who thought themselves in perfect security. The same unfortunate circumstance of giving a disease, supposed to be the Small-pox, with inefficaceous variolous matter, having occurred under the direction of some other practitioners within my knowledge, and probably from the same incautious method of securing the variolous matter, I avail myself of this opportunity of mentioning what I conceive to be of great importance; and, as a further cautionary hint, I shall again digress so far as to add another observation on the subject of Inoculation.
Whether it be yet ascertained by experiment, that the quantity of variolous matter inserted into the skin makes any difference with respect to the subsequent mildness or violence of the disease, I know not; but I have the strongest reason for supposing that is either the punctures or incisions be made so deep as to go _through_ it, and wound the adipose membrane, that the risk of bringing on a violent disease is greatly increased. I have known an inoculator, whose practice was "to cut deep enough (to use his own expression) to see a bit of fat," and there to lodge the matter. The great number of bad Cases, independent of inflammations and abscesses on the arms, and the fatality which attended this practice was almost inconceivable; and I cannot account for it on any other principle than that of the matter being placed in this situation instead of the skin.
It was the practice of another, whom I well remember, to pinch up a small portion of the skin on the arms of his patients and to pass through it a needle, with a thread attached to it previously dipped in variolous matter. The thread was lodged in the perforated part, and consequently left in contact with the cellular membrane. This practice was attended with the same ill success as the former. Although it is very improbable that any one would now inoculate in this rude way by design, yet these observations may tend to place a double guard over the lancet, when infants, whose skins are comparatively so very thin, fall under the care of the inoculator.
A very respectable friend of mine, Dr. Hardwicke, of Sodbury in this county, inoculated great numbers of patients previous to the introduction of the more modern method by Sutton, and with such success, that a fatal instance occurred as rarely as since that method has been adopted. It was the doctor's practice to make as slight an incision as possible _upon_ the skin, and there to lodge a thread saturated with the variolous matter. When his patients became indisposed, agreeably to the custom then prevailing, they were directed to go to bed and were kept moderately warm. Is it not probable then, that the success of the modern practice may depend more upon the method of invariably depositing the virus in or upon the skin, than on the subsequent treatment of the disease?
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 Small-pox 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 Small-pox 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 phænomena which it now exhibits. Its connection with the Small-pox 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[4]. 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 Small-pox, 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 Small-pox; 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 Small-pox, 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-dairy maid who never had been infected with either the Cow-pox or the Small-pox, 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 Small-pox, 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 Sarsenet lived as a dairy maid 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 tumors in the axillæ, nor any general indisposition. On being afterwards casually exposed to variolous infection, she had the Small-pox in a mild way.--Hannah Pick, another of the dairy maids who was a fellow-servant with Elizabeth Sarsenet 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 Small-pox 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 maid servant, were infected by the cows. The man servant had previously gone through the Small-pox, 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 these 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[5], 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.
FINIS.
[Footnote 1: It is very easy to procure pus from old sores on the heels of horses. This I have often inserted into scratches made with a lancet, on the sound nipples of cows, and have seen no other effects from it than simple inflammation.]
[Footnote 2: See Case IX.]
[Footnote 3: My friend Dr. Hicks, of Bristol, who during the prevalence of this distemper was resident at Gloucester, and Physician to the Hospital there, (where it was seen soon after its first appearance in this country) had opportunities of making numerous observations upon it, which it is his intention to communicate to the Public.]
[Footnote 4: 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.]
[Footnote 5: See Note in Page 7.]
_ERRATA._
Page 5, Line 4, after the word _shiverings_ insert _succeeded by heat_. Line 16, for _needlessly_ read _heedlessly_.
---- 24, Last line but one, for _sore_ read _tumour_.
---- 40, Line 12, for _Macklove_ read _Marklove_.
---- 41, Note--for _scepticus_ read _septicus_.
---- 60, Last line, for _moderate_ read _modern_.
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Transcriber's note
For this e-text, all the errors in the original book's "Errata" section have been corrected, as well as the following:
Introductory letter: "C. H PARRY" corrected to "C. H. PARRY".
Introduction: Inserted "to" after "But this disease is not".
Case XX: "begining" corrected to "beginning".
Conclusions: Added full-stop after "on the subject of Inoculation".
The following archaic spellings of words were used in the original book and have been retained: head-ach; concuring; delinated.