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calculated to remove plausible objections should be instituted, and stated with candour. Since evidence cannot be too much multiplied, where it can be procured, as in the present instance, in an easy, safe, and effectual way, it should be zcalously sought.

However improbable, and however contradictory to many well ascertained facts, we may consider the opinion entertained by the present author, on the inefficacy of Cow-pox in preventing Small-pox, after a certain period, we deem it right to leave the question which he agitates on this subject, to be decided by the additional evidence to which it has given rise; and we shall therefore now confine ourselves to a report of the cases from which his inferences are deduced.

The first case is that of a Child which was inoculated with variolous matter two years after having had Cow-pox. Seven days subsequent to the inoculation, six or seven eruptions appeared on the child's body, which did not suppurate, but in four days terminated in a warty scurf.

The second case is nearly similar to the first.-Eruptions occurred after exposure to variolous contagion, more than three years subsequently to successful vaccination. These eruptions remained about five days, and never suppurated.

Mr. G. appears to be extremely anxious to prove that these eruptions were actually, variolous: but to his conclusions we can by no means accede; and we think that he and his friends were by much too hasty in forming their opinions, when they ventured, in both cases, so soon after the appearance of the eruption, to give a decision on its nature. Considering the similarity between Chicken-pox and Small-pox, during the first few days of those complaints, we cannot regard it as being a proof of discretion, to hazard a judgment on a doubtful point where the evidence was so defective.

The third case is of more consequence; and, as it merits particular consideration, we shall give it in the author's own words:

In the latter end of January, eighteen hundred and one, I vaccinated an infant, the daughter of Mr. Luscombe, keeper of the gaol in Portsmouth. The progress of the arm was extremely regular, aud carried with it every mark of absorption. The child was restless, and somewhat feverish, about the eighth and ninth days. It seemed altogether as much indisposed as children of that age generally are.

Matter was taken from the pustule early on the ninth day, which I used on a child who had the disease nearly in the same manner; and has since been in situations, where it must have taken the Small Pox, if the constitution had been susceptible of receiving it. Mr. Meritt, of Portsmouth, likewise vaccinated a child with matter from the same

source.

source. The pustule, and consequent symptoms in this case, were equally well defined.

In fact I never entertained any doubt of its having properly taken effect; the arm shewing at the time, and until the present moment, marks of the pustule sufficiently strong and satisfactory. And it is perfectly in my recollection, that when some alarm was excited by the case of the marine at Haslar, somewhat more than a year after, the parents wishing to have her inoculated, I advised them to the contrary, saying, that if there were any efficacy in the Cow Pox, she never would suffer from the Small Pox, having undergone the disease so decidedly."

This opinion seemed to be verified, not only to my own satisfaction, but that of the friends, some time after. For on the tenth of April, eighteen hundred and three, I inoculated another of their children, which they chose rather to have done with variolous matter. The disease could not occur more favourable to my design of infecting the other child, if possible, than it did; as it produced near three hundred well maturated pustules.

By my desire, which met the wishes of the parents, the children were kept constantly together. They were alternately suffered to sleep in the same cradle. And when the cap was taken from the head of one, it was constantly put upon the other, the same cap being used through the whole of the contagious period of the disease, without any effect whatever.

On Monday the 13th ult. (Feb. 1804.) I was desired to call at the house, but being from home at the time, I did not go until the follow. ing morning. They then told me, that the child had the Small Pox. This I discredited, supposing it impossible, as she had so decidedly resisted infection before. I was surprized however to find their account correct, upwards of a hundred eruptions appearing in different parts of the face, body and extremities; several of which were pustular, and well advanced towards maturation.

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Not having been called early caough to witness the beginning and progress of the disease, I was the more particular in my inquiries. This I found was the fourth day of the eruption; she was taken ill on the Wednesday evening preceding, complaining of sickness, pain in the head and back, accompanied with considerable fever. On Thursday and part of Friday, she continued nearly the same. Supposing it to arise from cold, the mother was not alarmed, but gave her some diluting drink, and kept her in bed. About Friday noon she began to be better, but not totally free from fever. On Saturday morning she was perfectly recovered, but while she was dressing, a few eruptions were perceived in her face, neck and shoulders, but were not much attended to at the time. On Sunday the number increased, and still more came out on Monday morning. They now began to consider them as something more than pimples. For the first time they suspected Small Pox. In this they were justified, from variolous infection being in the school; two or three other children having taken it, one of which died, in a confinent sort under my care soon after. This induced them to send for me.'

Some

Some doubts were entertained with regard to the propriety of considering this as a genuine case of Small-pox, from the pustules going off on the 7th day but those doubts were removed by the appearance of variolous pustules in four cases which were inoculated from it. These pustules maturated, and, in three of the cases, went off on the 7th day, and in the fourth on the 9th day.

Another case, of a kind nearly similar to the last, is stated from the practice of a friend. Small-pox inoculation, one year after vaccination, produced on the 11th day an eruption of a few pustules, one only of which (on the arm) suppurated but from this pustule matter was taken, which produced Small-pox, as is stated, in a satisfactory manner. On this case, however, we would observe that the statement of it is not sufficiently particular, to make it an object of distinct consideration; and that it is besides not improbable that the pustule on the arm might have been produced by an unintentional touch of the lancet, during inoculation, and that it might thus have been a primary one.

To the third case, there seems to be no reasonable ground of objection; and we are therefore compelled to consider it as a distinct instance of Small-pox occurring after vaccine inoculation had taken effect. We are not disposed to doubt the accuracy of Mr. Goldson's report of this case, nor to consider him as likely to have erred in his conclusion, that the Cowpox inoculation had completely succeeded; and therefore, without entering farther into his views on the subject, we shall only remark that an occasional occurrence, such as that which we have now mentioned, can very little affect the value of vaccination. Several unquestionable instances are recorded, in which Small-pox has occurred a second time; and it cannot be expected that this may not also be the case with Cow-pox. The value which the latter possesses, as a preventive of Small-pox, must depend on the comparative frequency of such occurrences; and it is desirable that the attention of the candid practitioner should be directed to ascertain this very important point.

As we shall soon have occasion to lay before our readers, some experiments made with the view of ascertaining the truth of the author's hypothesis, that the Cow-pox only renders the body unsusceptible of Small-pox influence for a limited time, we shall now only observe that he appears to us to have acted with great propriety, in calling the attention of medical men to a farther investigation of this singular disease; which cannot but have a tendency to increase our knowlege of its na ture, and the laws by which it is governed, as well as to remove

those

those unfavourable impressions on the public mind, which partial and erroneous statements are so likely to create. Several minor particulars in this pamphlet we feel it unnecessary to notice.

ART. IV. An Answer to Mr. Goldson; proving that Vaccination
is a permanent Security against the Small-Pox. By John Ring,
Member of the Royal College of Surgeons in London. 8vo.
Is. 6d. Murray.

T

HIS is a very singular performance. The author has distinguished himself for his services in the cause of vaccination: but, in the present instance, he appears to us to have overlooked the interest of this noble discovery, and to have deviated from the path which candour and philosophy prescribe for the investigation of truth. The public may be amused, but will neither be instructed nor convinced, by misplaced attempts at wit and humour; while they will be inclined to suspect some concealed and radical defect in principle, where examination and inquiry do not receive every degree of encouragement. They have a right to expect, in a matter in which they are so deeply interested as the new inoculation, that their doubts and fears, however they may have been produced, should be satisfied and removed; and we cannot think that it will increase their estimation of Dr. Jenner's discovery, to hear the mode recommended by a respectable practitioner, for ascertaining some important particulars relating to it, treated with contempt and ridicule.

Yell.

Considering the ease and safety, with which Mr. Goldson's advice to inoculate with variolous matter some of the more early cow-pox patients, may be adopted, we cannot help expressing our surprise that so ready a method of removing the impression produced by the Portsmouth cases should not be deemed worthy of adoption by the present author. Mr. Ring, indeed, goes so far as to consider any such experiments as highly disgraceful; though we have no other reason assigned for the use of so harsh an epithet, than that he conceives them to be unnecessary. He admits, however, that such experiments were required at an early period of vaccine inoculation, in order to ascertain its utility; and he still considers it as justifiable to put patients to the test of variolation, at their own particular request, or that of their friends. Is not this to admit the propriety of satisfying doubts when doubts may have by any means been excited? and is it disgraceful to institute experiments on a large scale, to confirm the utility of vaccine inoculation, when such trials were extensively and safely REV. Nov. 1804.

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made

made in the infancy of the practice; and when we are told by the author himself that they are indispensible, consistently with the least regard to character, if patients require a test

their safety? Mr. Ring cannot surely regard the insertion of variolous matter, subsequently to successful vaccine inoculation, as attended with danger; otherwise, he could not, with any regard to humanity, authorize the employment of this test, even at the desire of patients or their friends, when he admits that to have recourse to such an experiment, with a conviction of its danger, is a crime. The inexpediency of ever inoculating with variolous matter, in order to determine whether the constitution has been rendered unsusceptible of small-pox, is but feebly supported by Mr. Ring. Not a particle of evidence in confirmation of his opinion is adduced from what has occurred since the introduction of cow-pox; though it is well known that, at one period, such a test was very frequently employed. Two cases, which occurred forty years ago, are, it is true, mentioned from Dr. Buchan, in which an eruption was produced by the insertion of variolous matter, in two persons who had gone through small-pox. In one of these cases, the eruption gave rise to a general mortification and to death, and in the other to a serious indisposition. The extreme rarity, however, of such occurrences, and the absence of any disadvantages produced by inoculation with small-pox matter, subsequently to cow-pox, would favour the supposition that there existed, in the cases adduced, a peculiarity of constitution which cannot affect our reasoning in ordinary circumstances. If we were even to grant that cases like those mentioned might in some very rare instances again happen, we should not be furnished with a good reason for omitting inoculation with variolous matter, in order to clear up any doubts which might remain unsatisfied with regard to the permanent efficacy of cow-pox.. We are bound to compare the probable evil with the probable good; and we ought not to hesitate between the very minute portion of danger arising from the use of the variolous test after vaccine inoculation, and the great advantages likely to be produced by silencing, in the mode which the objectors themselves propose, a very serious charge against vaccination.

Mr. Ring considers it to be a work of supererogation, to try such experiments, if they are even innocent;' when it is recollected what a vast number of persons have been vac cinated in this metropolis, and are daily exposed to the danger of catching the small-pox in the natural way, without receiving it.' The actual insertion of variolous matter must be admitted to be the most complete test of the constitution being safe; which, it is somewhat singular, Mr. Ring himself al

lows;

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