Page:Encyclopædia Britannica, Ninth Edition, v. 24.djvu/39

Rh VACCINATION 25 on the whole better than the cowpox vesicle of the period. But the real practical application of this idea was reserved for Badcock, a dispensing chemist at Brighton. It does not appear that any authentic or fully detailed account of Badcock s experiments lias been published ; l but he thus summarized the results some forty years later (Pall Mall Gazette, Jan. 23, 1880): &quot;By careful and repeated experiments 1 produced, by the inoculation of the cow with smallpox, a benign lymph of a non - infectious and highly protective character. My lymph has now been in use at Brighton for forty years, and is at the present time the principal stock of lymph employed there, being that exclusively used by the public vaccinators.&quot; At Boston, U.S., the same kind of lymph was raised and put in use in 1852. But at Attleborough, Mass., the same experiment had in 1836 led to disaster. Smallpox was inoculated on a cow s udder, and the product used to vaccinate about fifty persons. The result was an epidemic of smallpox, a panic, and the suspension of business. 2 On the face of it this method was simply variolating the cow (on a mucous membrane if the hairless or shaven skin failed) and inoculating the human subject with that curiously disguised smallpox matter. However, it was thought necessary to hold an experimental inquiry upon it, and in 1865 a commission of the Lyons Society of Medicine reported that, &quot;in vaccinating according to the method of Thiele and Ceely, we are merely practis ing the old inoculation, rendered uniformly benign, it may be, by the care taken to inoculate only the first product (T accident primitif), but preserving for certain all its risks in respect to contagion.&quot; 3 A negative result was come to by Klein in 1879, in an inquiry for the Local Government Board, wherein he had Ceely s cooperation. In 1879 the Irish Local Government Board prevented the use of similar variolous lymph by threatening to prosecute under the Act making the inoculation of smallpox penal. Notwithstanding the common sense of the case, and these experimental proofs, the official view taken by the medical department in 1857, that Thiele, Ceely, and Badcock had established the correctness of Jenner s doctrine of variola; vaccinre, is still held very tenaciously by the profession. It is too simple and attractive to be soon given up ; but perhaps the best way to get rid of it is to state in plain terms what cowpox itself really is. Natural Although there is no difficulty in drawing up a complete history natural history of cowpox, thanks to the laborious and exact studies of Ceely, yet the attention has been so much diverted to side issues that the facts to be stated in this section will come before most readers with the aspect of novelty. The other original authorities besides Ceely are .Tenner himself, Pearson (who collected information by circular in the months following Jenner s Inquiry], Bous- quet (1836), Estlin (1838), and Crookshank (1888). The Wiirtemberg inquiry, published by Hering (Stuttgart, 1839), is made up of very indifferently authenticated or incomplete statements, which have not the same value as the rest, and are at variance with them on the most essential points. Its ori- Cowpox as an infective disease arises in cow-houses here gination. an( j there, and at wide intervals of time, out of a common physiological or constitutional eruption of some particular cow, usually a heifer in her first milk, very often in the spring season or at some other crisis of the year or of the animal s life-history. It never arises except in milch cows ; it occurs nowhere in the cow but on the teats, or, by in fection, on adjoining parts of the udder. All the characters by which we know it distinctively as cowpox are associated with the fact of milking, or with the inevitable traction on teats that are the subject of an otherwise unimportant eruption. The primary disorder, as Ceely describes it, is an eruption of a few pimples, the size of a vetch or larger, hard and solid at first, but at length slightly vesiculated on the summit. It is only rarely that a series of events ensues on this basis which constitute cowpox as we know it ; they ensue in some one animal out of many in the same byre, and years may elapse before the event happens again. The pimples on the teats are made to bleed by what Ceely calls &quot;the merciless manipulations of the milkers&quot;; the blood forms crusts, which are dislodged every six hours ; and indurated ulcers form on the sites of the original pimples. of cow- pox - Jiost. Med. and Surf/. Journ., 1860, p. 77. 3 Vaccine et Variole, Paris, 1865, p. 101. The process being thus made inveterate owing to the in- Its in cessant interference of the milker s hands, it becomes com- fective municable to the other cows. The milkers can usually proper point out some one cow in which the disease began ; and it spreads slowly through a byre, taking sometimes as long as three months to go the round of all the animals. An animal already infected at one or more places on its teats may become infected at other places on the teats and body of the udder, either by the traction of milking or by the contact of parts when the cow is lying down. The ulcers heal sometimes slowly, sometimes more quickly ; they may heal under crusts, or as open sores ; induration and rounding of the edges are distinctive, along with much thickening of the base. The scars are also in durated, rounded arid elevated at the edges, and smooth or puckered on the surface ; they are often as large as a walnut. It is not easy to see a vesicular stage of the disease even in the cows infected from the initial spontane ous case ; and Ceely had for the most part to be content with the coagulated matter of crusts to vaccinate with. The process is, in fact, bound up from first to last in the most intimate and essential manner with the operation of milking. Cowpox &quot; undisturbed by the milker s hands &quot; has no existence in the originating cow ; it is the persistent irritation that makes it a pox. It is communicable, also, to the hands of the milkers themselves, and by their filthy hands to their faces. Jenner mentions a good many such cases ; Pearson has collected several ; and Ceely gives three in very full detail. As in the inoculated venereal pox, the Progress infection proceeds for a time under the skin, making a ( tlie bluish -white vesicle ; it eats away the tissues round the margin, where the fluid makes the skin bulge out into the characteristic tumid ring. After the fourteenth day the vesicle will have become an eschar, the average size of a sixpenny piece, which comes away and leaves a sore. The open sore is a regular part of the infection in the milker s hand. Various regions of the face get infected by contact from the hands : Jenner mentions the case of &quot;a poor girl who produced an ulceration on her lip by frequently holding her finger to her mouth to cool the raging of a cowpox sore by blowing upon it&quot;; another of Jenner s cases had the sore on the wing of the nose ; one of Ceely s cases had an ulcer on the temple three-quarters of an inch long ; in a case observed by Crookshank there was a very large vesicle and subsequent sore over the left cheek-bone. The local infection is accompanied by con stitutional disturbance, more or less severe, including head ache, pains in the loins, vomiting, and sometimes delirium. The axillary glands become painful, usually about the fourth day, and remain hard for some time. Eruptions occurred, but there is very little said about them. As might have been expected, the effects of experimental Human - infection with cowpox matter were the same as the ac- lzedcow cidental. They are spoken of as the effects of &quot; primary p&amp;lt; lymph,&quot; that is to say, lymph direct from the cow s teats or from the milker s sore hand, or in the earlier removes from these sources. Jenner s experience of primary lymph was very much the same as Bousquet s, Estlin s, and Ceely s forty years later. Woodville s, on the other hand, was exceptionally reassuring ; 4 had it not been so, it is not likely that cowpoxing on the large scale would ever have survived the initial discouragements entailed by the use of primary lymph. The process on the child s arm was on the whole the same as on the milker s hand, allowing for the more deliberate mode of inoculation and for different texture of the skin. The vesicle grew to a great size up to the four- 4 But Addington (On (he Inoculation of (he Cowpox, Birmingham, 1801), who got his lymph from Woodville, was not equally fortunate : of eleven cases at the beginning of his series five ended in ulceration , after that the cases all ended in a &quot;dry scab.&quot; XXIV. 4
 * See Hodgson, Brit. Med. Journ., 26th November 1881.