ART. I. Cases of Small Pox, subsequent to Vaccination, with Facts and Observations, read before the Medical Society, at Portsmouth, March 29, 1804: Addressed to the Dire tors of the Vaccine Institution. By WILLIAM GOLDSON, Member of the Royal College of Surgeons in London. pp. 71. THIS pamphlet has excited a considerable sensation, not only in the minds of the public at large, but among the most enlightened and judicious medical practitioners. It is indeed the most serious attack which the vaccine inoculation has hitherto experienced, but it is an attack which we feel confident may be repelled. Mr. Goldson, who we understand is a surgeon of respectability in the neighbour hood of Portsmouth, first employed the vaccine inoculation in the autumn of 1800, and from that time forward, seems to have generally adopted the practice, and to have fully acquiesced in the generally received opinion of its utility. His confidence in its efficacy was first shaken, by the supposed occurrence of small pox, in a marine who had been vaccinated by Mr. Richman, surgeon to the division of ma rines at Portsmouth, at the time when the practice was first introduced to that place. There was no reason to doubt that the man had experienced the proper vaccine affection, but after an interval of about two and a half years, he was inoculated by Mr. Richman with variolous matter, and a disease ensued, which, though presenting some irregular appearances, was, upon the whole, judged by a sufficient number of competent witnesses to be the genuine small-pox. This circumstance naturally excited a good deal of attention in the neighbourhood, and seems to have induced Mr. Goldson to put several children to the test of variolous inoculation, who had previously undergone vaccinations. The pamphlet contains an account of the result of some of those experiments, when a disease took place which was pronounced to be the true small-pox. The cases are the more striking, as Mr. Goldson himself had an opportunity of inspecting the progress of the previous vaccine disease, and from his account, which is considerably minute, it appears to have proceeded through its several stages without any irregularity or suspicious circumstance. The nature of the subsequent disease was determined principally by the duration and obvious appearance of the pustules, of which Mr. Goldson must be admitted to be a competent judge; and his opi nion was confirmed by that of other respectable practitioners, by whom the pa tients were inspected. There were some slight irregularities in the appearance of the eruption, which the author candidly states, but, in order, as was supposed, to remove every possibility of doubt, matter was taken from some of the pustules, and it was found to produce in other childrea an unequivocal small-pox. This appears to us a fair statement of the facts; how then, it wil be asked, are we to reconcile the experience of Mr. Goldson, with that of se many other medical men, who have met with results entirely dissimilar? His hypothesis is, that the casual cow-pox is an effectual preventative against the re currence of small-pox, but that artificial vaccination renders the system unsuscep tible of variolous contagion for a limited time only, probably not more than two cr three years. This supposition, though not very probable, is, it must be confessed, possible, and it becomes a matter of the highest importance to ascertain the truth or fallacy of an opinion, in which the lives of thousands are concerned. The objections to our author's deductions may, we think, with more propriety be stated in the three following articles, which, in our opinion, contain a complete answer to his arguments against vaccination. Before we conclude we shall remark, that, in our opinion, the present pamphlet displays marks of candour and liberality; and, as far as we can judge from appearances, its publication was produced by a desire to ascertain the truth, on a question in which the author conceived he had reason to dissent from the voice of the majority. We are indeed surprised at the want of informa tion which is manifested in some parts of the work, but we are fully disposed to acquit the author of any blame, except that which arises from ignorance. ART. II. An Answer to Mr. Goldson; proving that Vaccination is a permanent Security against the Small-pox. By JoнN RING, Member of the Royal College of Surgeons in London. pp. 43. SHORTLY after the publication of the preceding pamphlet, an answer was announced to it from the pen of Mr. Ring, a gentleman whose active zeal in promoting the vaccine inoculation would naturally lead him to repel every attempt to diminish its utility. Mr. Goldson's work was dedicated to the Jennerian Society, and he requested them to institute experiments in order to determine whether there be not a limited period to the preservative power of vaccination. Mr. Ring, however, informs us that "The society, however, fully convinced of the absurdity of such an hypothesis, have not thought it necessary to comply with his request." We must confess that on this occasion the conduct of the society has not proved worthy of the high opinion which has been formed of its respectability. Its express object is the extermination of the small-pox; but in what way can this be so effectually brought about, as by using every possible method to remove the objections which may still attach to the practice of vaccination? The effect of Mr. Goldson's pamphlet on the minds of the public was too considerable to be neglected, and his arguments, however futile, certainly did not involve so evident an absurdity, as to render them undeserving of examination or reply. It appears to us, on the contrary, that experiments of the kind suggested by Mr. Goldson, will prove the only effectual means of restoring the public confidence in the practice of vaccination; and we do not hesitate to assert, that they would be more satisfactory, than the most forcible and ingenious arguments which can be produced upon the subject. Mr. Ring, indeed, states, that, "When that society was first established, thousands of persons vaccinated by its own members, had been put to the test of variolous inoculation, and exposed to the infection of the small-pox in every form; yet none of them had caught the disease. Thousands, nay tens of thousands, are at this time exposed to the infection of the small-pox after vaccination, with impunity. "A considerable number of them were vaccinated four or five years ago, and many au All this we believe to be true; but these round assertions of thousands and tens of thousands, do not convey to the anxious and inquiring mind the same feeling of conviction, as would be produced by the accurate detail of a very few indivi dual cases. Until this is done, the adversary may still consider his defeat as imperfect. It appears that our thor had received information of the supposed failure of Mr. Goldson's vaccination, previous to the publication of the subject with the father of the child his pamphlet, and had corresponded on whose case is first recorded. From this information we think it evidently appears, that the disease produced in this child differed from small-pox, both in the appearance which the eruption assumed, and the period of its production. The suppuration in the inoculated part, and the general febrile affection of the system, were both premature, and the eruptions which were afterwards formed on the body wanted the characteristic of the variolous pustule. These circumstances induce us to agree with Mr. Ring, in referring the symptoms to that affection which is produced by vacciolous inoculation, in some persons who have undoubtedly before gone through the proper small-pox. Cases of this kind are related upon the best authority, and in some, the pustules have proceeded to full maturation, and the degree of con stitutional affection has even been more considerable than the majority of pactients experience during their first inoculation. This circumstance had been observed before the discovery of the vaccine inoculation, and has been pointedly insisted on by Dr. Jenner and others, in order to prevent that kind of mistake, into which we conceive that Mr. Goldson has fallen. The following remark is quoted by Mr. Ring from Dr. Jenner's Inquiry: "It should be remembered, that the constitution cannot by previous affection be rendered totally unsusceptible of the variolous poison: neither the casual, nor the inoculated small-pox, whether it produces the disease in a mild or in a violent way, can perfectly extinguish the susceptibility. The skin, we know, is ever ready to exhibit, though often in a very limited degree, the effects of the poison when inserted there; and how frequently do we see among nurses, when much exposed to the contagion, eruptions, and these, sometimes preceded by sensible illness! yet, should any thing like an eruption appear, or the smallest degree of indisposition, upon the insertion of the variolous matter on those who have gone through the cow-pox, my assertions respecting the peculiarities of the disease might be unjustly discredited." It is also decidedly established, that the matter generated in these pustules is capable of producing the perfect smallpox, a circumstance which materially weakens the evidence adduced by Mr. Goldson, to prove that the subsequent affection in his cases was the genuine variolous disease. The second, fourth, and fifth of Mr. Goldson's cases may be accounted for in the same manner with the first. With respect to the third, there can be no doubt that the child received the small-pox, after it had been supposed to be secured by vaccination. Are we then authorized to rely implicitly on Mr. Goldson's judgment as to the result of the vaccine inoculation? We should not, on light grounds, doubt the competency of a respectable practitioner to decide on this point, but it must be confessed, that there is ground for suspicion; when he informs us, that in no instance has he ever seen any approach to a spurious disease, we are almost irresistbly led to conclude, either that his experience must have been very limited, or that he had failed to make himself acquainted with the marks which discriminate the genuine cow-pock from the imperfect form of the disease. With respect to the case of the marine, inoculated by Mr. Richman, to which we referred in the preceding article, we think there is just ground for suspecting that the vaccine matter employed had either been taken from the subject at too late a period of the disease, or had suffered an alteration in its properties by the length of time which it remained on the lancet. As a reason for not trying the experiments suggested by Mr. Goldson, it is urged by our author, that the disease excited by a second inoculation with variolous matter, both in those who have previously had the cow-pox and the small-pox, is not unfrequently at tended with painful and distressing symptoms, and sometimes even with danger. There can be no doubt that an extensive suppuration in the inoculated part, a degree of constitutional affection, a few pustules on the other parts of the body, and a degree of swelling in the axillary glands, have occasionally been the consequence of the experiment. But these cases are rare, and we are inclined to think that the morbid symptoms have been in some instances unnecessarily aggravated by the great quantity of matter inserted, or some other circumstance attending the performance of the operation. It is, we confess, a choice of difficulties, but we think that the evil which might possibly result to a few individuals from experiments of this kind, infinitely less to be dreaded, than that the public confidence in the preservative powers of vaccination should be weakened. Mr. Goldson, in order to give some degree of probability to his supposition respecting the different effects produced on the system by the casual and the inoculated cow-pox, lays a good deal of stress upon the blue colour which he thinks always obtains in the pustule of the casual disease, but which is wanting in the pustule by inoculation. Mr. Ring, however, informs us, from the authority of Dr. Jenner himself, that this distinctive mark is by no means constantly to be observed; it is sometimes wanting in persons who have received the disease immediately from the cow, and is sometimes present in the pustules produced by the common in culation. With respect to Mr. Goldson's peculiar hypothesis, that the preservative power of the inoculated cow-pox ex tends for a limited period only, Mr. Ring is satisfied with the general kind of answer which we have quoted in the beginning of this article. To most persons such an answer may be satisfactory, but we still think that the objection was deserving of a more direct refutation. Mr. Ring's pamphlet displays evident marks of ability and acuteness, and, as far as argu ments can go, unsupported by experi ment, we think that he has been very successful in detecting the fallacy of Mr. Goldson's statement. We cannot dis miss this article without expressing our disapprobation of the insinuations which Mr. Ring throws out against the charac even were there good grounds for suspecting the purity of his motives, we think the cause of truth is more promoted by dispassionate reasoning, than by petulant declamation. ter of his adversary, and the motives which induced him to object to the vaccine inoculation. We believe that on this subject our author's zeal has led him to charge Mr. Goldson unjustly; and ART. III. Minutes of some Experiments to ascertain the permanent Security of Vaccination, against Exposure to the Small-pox; to which are prefixed some Remarks on Mr. Goldson's Pamphlet; with an Appendix, containing Testimonials and other Communications from many of the most respectable medical Men in this Neighbourhood. By RICHARD DUNNING, Surgeon, and Secretary to the Dock Jennerian Institution. pp. 120. THE second reply to Mr. Goldson's pamphlet which we shall notice is written by Mr. Dunning of Plymouth, a gentleman who, as well as Mr. Ring, was an early and zealous advocate of the vaccine inoculation. He remarks that "Mr. Goldson's pamphlet, I fear, is nuch too well written not to excite a very general interest, and, I lament to add, not to ccasion a vast deal of misery and distraction n many thousands of families; at the same ime I am most ready to admit, and I admit t with great satisfaction, that his observaions, &c. are written apparently with too nuch candour for me to doubt a moment his villingness fully to retract them, whenever e shall see occasion to do so. Indeed the vhole tenor of the pamphlet carries conviction o my mind, that the author is not a bigot, sho, if wrong, will not be convinced.". Our opinion, as we have already expressed, entirely coincides with that of Mr. Dunning. Though he conceives hat all our analogies directly oppose the hypothesis of Mr. Goldson, yet he confesses, that it is to facts alone that we must make our appeal; and he accordingly took an early opportunity of apply. ing the test of variolation, to children who had some time before received the vaccine disease. Before he enters upon the detail of his experiments, he informs us that he commenced the practice of vaccination in the latter end of the year 1799; since that time he has vaccinated more than a thousand subjects. "➖➖➖➖ many of whom have been subjected to variolation, and many constantly and fully exposed to casual infection of the variolous principle; and having never met with a single instance of subsequent small-pox among those subjects, nor known a case in the [ractice of any surgeon in this town or neigh bourhood; I should fail egregiously in my duty, were I not to take this and every pportunity to assert, and re-assert my enure belief, that the protection against the mall-pox which we obtain from the practice of vaccination is not casual, nor of a limited duration, but regular and permanent.” Our author notices the occurrence of the local eruptions, which will occasionally take place in nurses, or other persons particularly exposed to the contact of variolous matter, though they have before undergone the genuine small-pox, and he remarks that the same circumstance takes place in cow-pox. A vaccine pustule of considerable magnitude, may be produced upon the arm of a person who has previously gone through but the character of the pustule in these either the cow-pox or the small-pox; cases is somewhat different from its or dinary state; the appearance of the areola he considers as the principal mark of discrimination. Our author quotes some passages from Dr. Jenner (similar to those which we have already noticed in Mr. Ring's work) on the affection which is produced by a second variolous inoculation in some persons who have certainly gone through the small-pox. The obvious conclusion from these cases is, that vaccination offers the same advantage with variolous inoculation : they neither of them can prevent a topical affection from being produced, by the direct application of large quantities of matter to the body, but they afford a sufficient security against the reception of the small-pox by exposure to its contagion. Our author expresses his surprise at Mr. Goldson's assertion, that he has never seen any approach to the spuriouscow-pox. Many cases of this description, he says, have been seen at Plymouth, and he enumerates other instances of their occurrence. Indeed, he points out circumstances in some of Mr. Goldson's own cases, which render it doubtful whether they experienced the proper vaccine dis ease. The first of Mr. Dunning's experiments, of which we have an account, was performed about 3 years ago, upon a child of his own, who eight months before had been vaccinated. Variolous matter was inserted into the arm; an early and considerable local affection took place, but no constitutional effects were produced. The subjects of the second and third experiments were also two of Mr.Dunning's own children; the elder had undergone the variolous inoculation eleven years before, the younger had been vaccinated about three years. In both these cases a local affection ensued, but no constitutional disease The subject of the first experiment was exposed for some minutes, to the air of an apartment, fully affected with the contagion of the casual small-pox, but no trace of disease was produced. The result of this experiment is the more striking, as shortly after, the child received the contagion of scarlatina, and went through the disease with considerable severity; a strong presumption that its system was in a state fitted to receive the small-pox, had it not been rendered unsusceptible of it by the previous vaccination. The fifth experiment contains an account of a child who had been vaccinated in the year 1800; it was taken into a room which had been saturated many weeks with the small-pos, she shook the height of half-pox, and remained in the hands twice with the child full of it, and at room some minutes." Mr. Dunning's work concludes with several letters from respectable practi tioners in the neighbourhood of Piy mouth, containing either their testimony to the truth of the facts stated by him, or their concurrence in the doctrines advanced in his treatise. The work, as the author acknowledges, was composed in haste, and of this there are indeed evident marks. We think it, however, a valuable performance; the experiments, though not rumerous, are satisfactory, and the whole is written with the candid and liberal spirit, which ought always to accompany scientific investigation. ART. IV. A Statement of Evidence from Trials by Inoculation of variolous and ¶nccine Matter to judge of the Question-Whether or not a Person can undergo the Small-pox ater being affected by the Cow-pock. By the Physicians of the original Vaccine Pock Institution, established December, 1799. pp. 87. ALTHOUGH Mr. Goldson seems to have intended his publication to be im. mediately addressed to the governors of the Jennerian Society, yet the vaccinepock institution, over which Dr. Pearson presides, considered that they were equally called upon to answer the objections which it contained against the benefit to be derived from vaccination. This institution, indeed, presented them with peculiar advantages for this purpose; it was established in the year 1799, and there appears to have been accurate registers preserved of all the cases vaccinated since that time, a circumstance which is scarcely to be expected in the private practice of any individual. In the introduction we meet with some remarks on the operation of the matter taken in the latter periods of the disease, which is stated to differ from matter in the earlier stages, only in being less certain in producing its effect. It is remarked that the cases adverse to the vaccine inoculation may be di vided into four classes; 1st. Cases of the small-pox by inoenlation, in persons who had been supposed to have recently gone through the cow-pock. 2nd. Those who are asserted to have taken the small-pox on inoculation, ing in what is termed the natural way, i "3d. Instances of the small-pox superven 4th. Cases of the natural small-pox taling place at a more distant period af vaccination, i. e. in at least three or four years." With respect to the first class, the public seem now to acquiesce in the possibility of their occurrence: even Mr. Goldson himself admits, as a part ofb hypothesis, the temporary preservative effect of vaccination. With respect to the second supposition, before his pu cation, no one suspected that di any rence could exist between the effects recent vaccination, and of vaccinati performed at a more remote period. is contrary to all analogy and antece dent probability that the effect of th casual and the inoculated cow-p should differ in this remarkable partica lar; and it is admitted on all has that the casual disease affords a pe manent security. Still however it w conceived that the objections could onl |