f 
 
 LETTER 
 
 FROM 
 
 DOCTOR EDWARD JENNER, 
 
 TO 
 
 / 
 
 WILLIAM DILLWYN, Esq. 
 
 ON 
 
 THE EFFECTS OF VACCINATION, 
 
 IN 
 
 Preserving from the Small-Pox . 
 
 TO WHICH ARE ADDED 
 
 SUNDRY DOCUMENTS RELATING TO VACCINATION, 
 
 t 
 
 referred to and accompanying the letter. 
 
 PUBLISHED BY THE PHILADELPHIA VACCINE SOCIETY. 
 William Fry, Printer. 
 
 1818. 
 
INTRODUCTION. 
 
 THE importance of the following Letter, lately received 
 from London, has induced the Philadelphia Vaccine Society 
 to publish it in its present form. The communication was made 
 in answer to the enquiry of one of our fellow citizens, who was 
 desirous of knowing Dr. Jenner’s opinion of his truly inte¬ 
 resting discovery, after it had stood the test of twenty years’ 
 experience. The friends of humanity will, no doubt, be highly 
 gratified by this additional confirmation of the security to be 
 obtained against the ravages of the Small-Pox, one of the most 
 loathsome and desolating of all diseases. 
 
LETTER 
 
 
 To Wm. Dillwyn, Esq. High am Lodge, Walthamstow , 
 
 Essex. 
 
 Dear Sir, 
 
 It is a curious and most delightful fact, that while the dis¬ 
 putations you allude to are here and there going on among 
 individuals, with regard to the efficacy of Vaccination, the 
 small-pox is flying before it in all directions. In a wide dis¬ 
 trict around me, embracing the most populous part of the 
 county of Gloucester, which abounds with manufactories, the 
 small-pox is scarcely ever heard of; and if it does happen to 
 appear from infection brought by the wandering pauper, it 
 either finds itself insulated, or is rendered incapable of spread¬ 
 ing, by giving immediately the vaccine security to those within 
 its atmosphere who may happen to remain unprotected. In 
 these few words, sir, I think I have answered the main part, of 
 your letter; but I will add a few more; and you have my full 
 consent to transmit, what I say, to your friends either on this 
 or the other side of the Atlantic. Wherever Vaccination has 
 been universally practiced, there the small-pox ceases to ex¬ 
 ist. It matters not how wide the district or how populous the 
 city, the result is, and, from the nature of things, must be the 
 same. There is scarcely any part of the civilized world that 
 cannot bear testimony to the truth of this position. For ex¬ 
 tent of territory, we may turn our eyes to our possessions in 
 the East, and to various parts of South America; and to 
 towns and cities, many of the most conspicuous in Europe. 
 As a cheering document, with regard to the extinction of the 
 small-pox throughout a kingdom, I shall take the liberty of 
 enclosing the report from Sweden.* Now, as the good sense 
 of the Swedes directed them to employ Vaccination for bring¬ 
 ing about this great event, why should not Britain avail her¬ 
 self of this great gift, and employ it in a similar way? Here 
 the Boon is distributed with a partial and sparing hand, and 
 consequently the small-pox still exists in several parts of our 
 island. However, I have the happiness to say, that since the 
 
 * See Appendix, No. I. 
 
4 
 
 first promulgation of my discovery, in the year 1798, the 
 deaths by small-pox in the British realms, according to the 
 best estimate 1 can form, are reduced from more than 40,000, 
 to less than 6,000. The metropolis, for the last ten or twelve 
 years, exhibited a reduction of about one half only; but during 
 the last two years, Vaccination has been more extensively 
 practiced than ever, both from the benevolence of private in¬ 
 dividuals of the Faculty, and the public institutions; and this 
 year promises a far greater reduction in the number of deaths 
 than any that has preceded it. You may, perhaps, at the India 
 House, have acquaintances who will furnish you with copies of 
 their reports from Calcutta, Bombay and Madras. A copy of 
 one of these I have enclosed, that it may be seen with what 
 vigour the new inoculation was prosecuted in a country too 
 distant for the approach of prejudice. In the island of Ceylon, 
 the ravages were dreadful, although many efforts had been 
 made to lessen its fatality by variolous inoculation. This, 
 wherever it was practised, produced a spreading of the dis¬ 
 ease, and made a bad matter worse; so that the people would 
 have nothing to do with it. But after a little time, they took 
 to the Vaccine very readily; and by referring to Dr. Christie’s 
 publication on the subject, which you may find at any of the 
 medical booksellers, you will observe that the small-pox be¬ 
 came totally extinct. However, in spite of glaring facts of 
 this description, I must candidly acknowledge, I am not at all 
 surprised, that both in our country and in other parts of the 
 world, a partial prejudice should now and then lift up its head. 
 It is called into existence, not from any thing faulty in the 
 principle of Vaccination,but from a wrong and injudicious ap¬ 
 plication of that principle. For example, a child or a family of 
 children, may be in such a state, that the action of the vaccine 
 fluid when applied to the skin, shall be either wholly or par¬ 
 tially resisted. It may either produce no effect at all, or it may 
 produce pustules, varying considerably in their rise, progress, 
 and general appearances, from those which have been desig¬ 
 nated by the term correct. It was about the year 1804, that I 
 was fortunate enough to discover the general cause of these 
 deviations, and no sooner was it fully impressed on my mind, 
 than I published it to the world. Though all may have access 
 to the paper* with the greatest facility, yet few, very few in¬ 
 deed, among those who vaccinate, have paid any attention to 
 it; yet I am confident, from a review of the practice on an im- 
 
 * See Appendix, No. III. 
 
5 
 
 mense scale, and through a period of more than twenty years, 
 that it is a matter which has a greater claim on our attention, 
 than any one thing besides connected with Vaccination—in¬ 
 deed I may say than every other thing. What I allude to is a 
 coincident eruptive state of the skin, principally bearing what 
 we call the herpetic or irritative character. If we vaccinate a 
 child under its influence, we are apt to create confusion. The 
 pustule will participate in the character of the herpetic blotch, 
 and the two thus become blended, forming an appearance that 
 is neither vaccine nor herpetic; but the worst of it is, that the 
 patient does not receive that perfect security from small-pox 
 infection, which is given b the perfect pustules. It by no 
 means always happens that the appearance of an eruption of 
 this, or any other description, prevents security; but it is so 
 commonly the case, that I cannot too much enforce the neces¬ 
 sity for rigid attention in the inoculator, whenever a child is 
 presented to him for vaccination, under such circumstances. 
 If the case admits of no delay, these irritative affections of the 
 skin should be removed at once; which may be done with ease, 
 and the most perfect safety, when they are not very numerous 
 and of long standing; medicine in that case may be necessary 
 in conjunction with an application. Bat on this subject I need 
 not enlarge, as it is more particularly spoken of in the paper 
 referred to. However, I may now just say, that the applica¬ 
 tion I make use of for destroying these eruptions, is the un- 
 guentum h drargyri nitrati of the last London Dispensatory. 
 
 One word more with respect to prejudice. How frequently 
 have we seen, in a variety of the public prints, paragraphs of 
 this description— u A gentleman’s family, consisting of three 
 or four or half a dozen children, were vaccinated by an emi¬ 
 nent surgeon, and all went through the disease in the most 
 satisfactory manner, and were pronounced safe; yet, on being 
 exposed to the infection of the small-pox, they all had the 
 disease, but happily they all recovered.” Here, sir, the mind 
 becomes entangled with a false association. The public con¬ 
 ceive, that an eminent surgeon must be a perfect master of this 
 little branch of our art; but it often happens that he has not 
 stooped to look at any thing beyond its outline; and when de¬ 
 viations arise in the progress of the pustules, to that extent 
 which I have pointed out as momentous, they pass by without 
 attracting any particular attention. 
 
 Pray excuse me—I find myself spinning out my letter into 
 an essay’, and at last was like to have forgotten the most im¬ 
 portant part of your inquiry; namely, “ whether I myself hadr 
 
6 
 
 not renounced my opinion of the efficacy of Vaccination.” 
 This question has been often put to me—why? I cannot con¬ 
 ceive. It came not long since, through a medical friend of 
 mine in London, from a very respectable lady in the country, 
 whose children had been vaccinated. I know not how to give 
 you more complete satisfaction on this point, than by a quota¬ 
 tion from the letter written to my medical friend in reply. 
 
 “ The ghost that has appeared to Mrs. C. has taken an 
 annual stalk over the country for these ten years past. I find 
 no great difficulty in laying it; but I cannot give it final repose; 
 the phantom will rise again in spite of me. If you will look 
 over your records relating to Vaccination in Ireland, you will 
 find, by one of the annual reports distributed by Dr. Labatt, 
 that this spirit appeared in Dublin not many years since, and 
 made many furious menaces, disturbing the tranquillity of 
 some of the inhabitants of that fair city. There you will see a 
 letter of mine written to the doctor, so much in point with 
 regard to Mrs. C.’s enquiry, that really I cannot add any thing 
 to it, as my opinion of the powers of Vaccination is precisely 
 the same now as it was then. Indeed, if it had wanted strength 
 at that time, it has since obtained it most abundantly. I beg 
 then that you will let Mrs. C. know, my confidence in the effi¬ 
 cacy of the Vaccine , to guard the constitution from the small¬ 
 pox , is not in the least diminished. That exceptions to the 
 general rule have appeared, and that they will sometimes ap¬ 
 pear, I am ready to admit. They have happened after small¬ 
 pox inoculation; and by the same rule, as the two diseases are 
 so similar, should they not happen after the Vaccine ?” 
 
 Believe me, dear sir, with great respect, 
 
 Your obt. and faithful servant, 
 
 EDW. JENNER. 
 
 Berkeley, Glostersfiire, 
 19th August, 1818. 3 
 
APPENDIX. 
 
 No. I. 
 
 Copy of a Letter from the President of the National Vaccine 
 
 Establishment, to Lord Sidmouth, dated 15th July, 1814; 
 
 enclosing, Report on the State of Vaccination in Sweden. 
 
 N. V. E. Leicester Square, 15th July, 1814. 
 
 My Lord, 
 
 The Board of the National Vaccine Establishment have 
 received the enclosed Report, “ On the state of Vaccination 
 in Sweden,” since they had the honour of communicating to 
 your Lordship their Report of the State of Vaccination, du¬ 
 ring the Year 1813, and they respectfully desire that it may be 
 submitted to the Honourable the House of Commons, in or¬ 
 der that it may be printed, and subjoined as an Appendix to 
 their Report. 
 
 (Signed) J. LATHAM, President. 
 
 Jas. Hervey, M. D. 
 
 Registrar. 
 
 To the Right Honourable Lord Viscount Sidmouth, 
 
 &c. &c. &c. 
 
 REPORT OF THE STATE OF VACCINATION IN SWEDEN. 
 
 (Translated from the original in Swedish.) 
 
 On the fourteenth of January, 1814, Mr. Macmichael, an 
 English Gentleman, attended the Royal College of Health, in 
 Stockholm, and delivered to the College a copy of the Report 
 of the National Vaccine Establishment in London, 
 dated 22d of April, 1813, and presented to Lord Sidmouth, 
 Secretary of State for the Home Department; at the same 
 time he requested that a short Account of the progress of 
 Vaccination in Sweden, and of the measures which had been 
 adopted for its promotion, might be communicated to him, for 
 the information of the British Parliament. 
 
 The Royal College had particular satisfaction in receiving 
 Mr. Macmichael, and undertook to comply with his request, 
 so much the more readily, as it had the pleasure of numbering 
 among its honorary Members the respectable name of Dr. 
 Jenner, for whom it was reserved to demonstrate, by the most 
 decisive experiments, the protective power of the Cow-Pox 
 against the most terrible and destructive contagion of the 
 Small-Pox; a pestilence, which by means of this blessed dis¬ 
 covery, must certainly be ultimately extirpated from the face 
 of the earth. 
 
8 
 
 It was to be expected, from the excellent arrangements 
 which the Kings of Sweden had adopted for somevvhat more 
 than half a century, in every department of Medical Science, 
 that the incomparable discovery o( Doctor Jenner, like the In¬ 
 oculation for the Small Pox at a former period,* should not 
 only become an object of the most accurate investigation, but 
 also, when approved by experience, be generally introduced 
 and promoted by rewards and established regulations. 
 
 The Medical Practitioners of Sweden, who had already 
 been informed, from the time of Dr. Jenner’s first discovery, 
 by means of a constant correspondence with the learned in 
 other countries, of the expectations which were entertained of 
 the success of experiments made with the Cow Pox, had great 
 pleasure in learning that one of their colleagues, Dr. Gahn, a 
 Member of the Royal College, had, towards the end of 1799, 
 procured some Vaccine Matter, and obtained the most satis¬ 
 factory result from inoculating with it. Another Swedish 
 Physician, now Professor of Medicine, Dr. Rosenskold, print¬ 
 ed, in 1801, a small pamphlet, entitled, “ To the Public oq 
 the Cow-Pox;” and performed Vaccination with success, 
 in several parishes in Skane. About the same time the un¬ 
 dersigned also published a more detailed account, with colour¬ 
 ed figures, under the title, u The Small-Pox may be extirpa¬ 
 ted;” and this Essay was distributed to all the Churches in 
 the Kingdom. 
 
 The Government, already attentive to the inestimable ad¬ 
 vantage, which the Inoculation of the Cow-Pox seemed to 
 promise, directed the College to examine Dr. Jenner’s disco¬ 
 very with the greatest accuracy; for which the proper means 
 were immediately afforded : and the College was ordered, 
 after collecting the results, to present its Report to the King. 
 
 This Report, which fully confirmed the excellence of the 
 Jennerian discovery, occasioned the salutary law, which was 
 first enacted in 1803, by which Vaccination was established 
 throughout the Kingdom; and the College was commanded 
 to promote its adoption by all possible means. The King was 
 pleased to appropriate 900 dollars, spec, banco, to be divided 
 into Premiums, which were to be distributed among such Me- 
 
 * It is remarkable, that the celebrated Dr. David Schultzenheim, who 
 was appointed as long-ago as 1754, by the States of the Kingdom, to inquire 
 into Sutton and Dimsdale’s Mode of Inoculating the Small Pox in England, 
 
 now the President of the Royal College of Health, and has been the most 
 instrumental, by means of his powerful influence, in promoting the most sa, 
 lutary measure, for the introduction of Vaccination. 
 
 4 
 
9 
 
 dical men as could exhibit the greatest number of vaccinated 
 persons. 
 
 A particular regulation was made for the Metropolis, im¬ 
 posing a fine of Three Dollars on any one, who should fail to 
 announce to the Medical Officer of the district, the appearance 
 of the contagion of the Small Pox: and in every such case, 
 the person infected was to be carried to the Small-Pox Hos¬ 
 pital: where every measure was adopted for his being proper¬ 
 ly nursed; and the same precautions have been continued to 
 the present time. 
 
 It was long a question, Whether new-born Children could 
 be vaccinated with success, and whether the Matter taken 
 from them might be employed with as much security as if 
 taken from Adults? 
 
 This doubt has been altogether removed; and in the Gene¬ 
 ral Lying-io-Hospital all the children are now vaccinated 
 within nine days from the time of their birth: so that, by 
 means of this progressive Vaccination, fresh matter remains 
 constantly in existence. 
 
 The want of a sufficient supply of Vaccine Matter for the 
 extensive provinces of the Kingdom, was long an obstacle to 
 the universality of Vaccination in Sweden. This obstacle no 
 longer exists: since the Royal College of Health, in conse¬ 
 quence of the humble representations which it made to the 
 King, obtained the adoption of a very effectual measure for 
 this purpose, in the appointment of a particular Establishment 
 for the general regulation of Vaccination throughout the King¬ 
 dom, which took place in the year 1812. 
 
 This Establishment consists of a Director, and several in¬ 
 spectors of the Stations for Vaccination in the Provinces. The 
 Director is a Member of the Royal College of Health, whom 
 the King has graciously commanded to receive and examine 
 all reports, to answer all enquiries, to conduct the distribution 
 of Vaccine Matter, which is delivered, free of postage, to all 
 persons who apply for it; and lastly, to report to the College 
 every thing relating to Vaccination that requires further regu¬ 
 lation, and to propose to it, as proper persons to receive rewards, 
 all those who appear to be the most deserving. He has also 
 the immediate inspection of all the Medical men, who are ap¬ 
 pointed to conduct the business of the Stations, established in ' 
 almost every Province; the progressive Vaccination perform¬ 
 ed at these Stations being calculated to maintain a constant 
 supply of fresh Matter, which is also distributed, free of post¬ 
 age, to those who require it; and their proceedings being re¬ 
 gistered in proper Catalogues and Journals. 
 
 B 
 
10 
 
 In Stockholm, three several Stations of this kind have been 
 appointed, whence fresh Matter may always be procured with 
 certainty, if it happen to be wanting in any particular Pro¬ 
 vince. 
 
 The Archbishops, Bishops, and the whole of the Clergy 
 throughout the kingdom, having, from the time of the happy dis¬ 
 covery of Vaccination, embraced it with the most distinguished 
 zeal; and many of this respectable body having not only em¬ 
 ployed the most effectual means for the removal of vulgar preju¬ 
 dice against it, but having even actually practised Vaccination 
 themselves; the King, assured of the continued exertions of 
 the Clergy in the same cause, was pleased to direct, that every 
 Minister should superintend the progress of Vaccination with¬ 
 in his parish: and should be empowered to call to his assist¬ 
 ance one or more Inspectors of Vaccination, according to 
 circumstances, for the purpose of causing all Children t<* be 
 properly vaccinated within the first year after their birth, and 
 keeping proper documents of the performance of the operation. 
 In each Parish or District, there must be an accredited Vacci¬ 
 nator, whose duty is to perform Vaccination, and to give a Re¬ 
 port of his proceedings to the Royal College of Health. 
 
 The College has also published, by the King’s command, a 
 Book of Instructions for Vaccinators and Inspectors of Vac¬ 
 cination, which has been distributed gratis to all the Churches 
 in the Kingdom. This Treatise, adapted to the use of the 
 Public, affords an accurate knowledge of the true and false 
 Cow-Pox; of the varieties which most frequently occur in it; 
 and of the cutaneous diseases, which occur so often in Swe¬ 
 den, very nearly resembling the Small-Pox. 
 
 For the more effectual encouragement of the practice of 
 Vaccination, the King has been graciously pleased to appoint 
 rewards of two different kinds, Pecuniary Premiums, and Ho¬ 
 norary Medals. The latter are distributed, commonly in Sil¬ 
 ver, but sometimes iu Gold, to those who have particularly 
 distinguished themselves. In all cases, those who have deserv¬ 
 ed rewards, are humbly pointed out to the King, by the Col¬ 
 lege ol Health; and his Majesty has reserved to himself the 
 right of assigning the proportions in which those rewards shall 
 be distributed. It is also in the King’s name, and with a cer¬ 
 tain degree of publicity, that these marks of his approbation 
 are bestowed. 
 
 For the honour of the Medical Profession in Sweden, it 
 must not be forgotten, that although Inoculation for the Small- 
 Pox was one of the most lucrative branches of their pri- 
 
11 
 
 vate practice, and has been entirely superseded by the sim¬ 
 ple process of Vaccination, no one individual of the profes¬ 
 sion has raised any obstacles against the Cow-Pox; but every 
 one has contributed to its advancement, by giving advice, in¬ 
 formation, and assistance, to the utmost of his ability. No 
 single publication has appeared to call in question its high im¬ 
 portance,* and its superiority to Variolous Inoculation; which 
 has been entirely discontinued ever since the year 1802, rather 
 by a tacit and universal consent, than in consequence of any 
 Royal prohibition. 
 
 It may therefore be asserted, that the Small-Pox, that equal¬ 
 ly disgusting and destructive pestilence, which for many ages 
 continued annually to send out of the world an immense num¬ 
 ber of young Children, is now, through the influence of Dr. 
 Jenner’s inestimable discovery, so perfectly extirpated in Swe¬ 
 den, that it never can become epidemic, even if at any time, 
 notwithstanding all the orders and all the vigilance employed 
 for its exclusion, the infection should make its appearance. 
 Such, in the last twelve years, has been the effect of the King’s 
 wise and humane attention, of the unanimity and disinterested¬ 
 ness of the Medical Profession, of the patriotic zeal of the 
 Clergy, of the good examples so promptly exhibited by the 
 upper classes, and of the progress of information and civiliza¬ 
 tion in the lower. 
 
 The undersigned, who has drawn up this short account, at 
 the request of the Royal College of Health, has also the ho¬ 
 nour of sending with it, in the name of the college, a Copy of 
 the Book of Instructions, and an impression in Silver of the 
 Honorary Medal, which was struck by the King’s command, 
 under the direction of the College, and which is distributed in 
 the King’s name for the promotion of Vaccination. 
 
 FR. HEDIN, M. D. 
 
 First Physician to the King, Medical Counsellor, 
 &c. &c. 
 
 Stockholm, 10th February, 1814. 
 
 * The answer which the undersigned returned the 1st November, 1801, 
 to a Letter addressed to him, by the Vaccine Committee of the Society of 
 Medicine, at Paris, and which is inserted in the second Report of that Com¬ 
 mittee, cannot justly be considered as a Publication of this kind. It was 
 not quite three Months after this time, that, having acquired perfect confi¬ 
 dence from inoculating a Cow, with the Cow-Pox, and transferring the ope¬ 
 ration to the human subject, be published the before-mentioned Essay, en¬ 
 titled, “ The Small-Pox may be extirpated.” 
 
No. II. 
 
 Supplement to the Madrid Gazette , of the 14 th October , 1806.* 
 
 On Sunday, the 7th of September last, Dr. Francis Xavier 
 Balmis, Surgeon Extraordinary to the King, had the honour 
 of kissing his Majesty’s hand, on occasion of his return from 
 a voyage round the world, executed with the sole object of 
 carrying to all the possessions of the Crown of Spain, situated 
 beyond the seas, and to those of several other nations, the in¬ 
 estimable gift of Vaccine Inoculation. His Majesty has inquir¬ 
 ed, with the liveliest interest, in all that materially related to 
 the expedition, and learned with the utmost satisfaction, that 
 its result has exceeded the most sanguine expectations that 
 were entertained at the time of the enterprize. 
 
 This undertaking had been committed to the diligence of 
 several Members of the Faculty, and subordinate persons, 
 carrying with them twenty-two children, who had never under¬ 
 gone the Small Pox, selected for the preservation of the pre¬ 
 cious fluid, by transmitting it successively from one to another, 
 during the course of the voyage. The expedition set sail from 
 Corunna, under the direction of Balmis, on the 30th of Novem¬ 
 ber, 1803. It made the first stoppage at the Canary Islands, 
 the second at Porto Rico, and the third at the Caracas. On 
 leaving that Province, by the port of La Guayra, it was divided 
 into two branches: one part sailing to South America, under 
 the charge of the Subdirector Don Francis Salvani; the other, 
 with the Director Balmis on board, steering for the Havanah, 
 and thence for Yucatan. There a subdivision took place: the 
 Professor Francis Pastor proceeding from the port of Sisal, to 
 that of villa Hermosa, in the province of Tobasca, for the pur¬ 
 pose of propagating Vaccination in the district of Ciudad 
 Real of Chiapa, and on to Goatemala, making a circuit of four 
 hundred leagues, through a long and rough road, comprising 
 Oaxaca; while the rest of the expedition, which arrived with¬ 
 out accident at Vera Cruz, traversed not only the Vice-royal¬ 
 ty of New Spain, but also the interior provinces; whence it was 
 to return to Mexico, which was the point of re-union. 
 
 * This shows with what ardor the Spaniards disseminated Vaccination. 
 It subsequently appeared, by documents received from various parts of South 
 .America, that this embassy had been the means of subduing the Small-pox 
 in most of the Provinces belonging to the King of Spain on that continent. 
 
 Doctor Jenner. 
 
13 
 
 This precious preservative against the ravages of the Small 
 Pox has already been extended through the whole of North 
 America, to the coasts of Sonora and Sinaloa, and even to the 
 Gentiles and Neophites of High Pimeria. In each capital a 
 Council has been instituted, composed of the Principal Au¬ 
 thorities, and the most zealous members of the Faculty, charg¬ 
 ed with the preservation of this invaluable specific, as a sa¬ 
 cred deposit, for which they are accountable to the King and 
 to posterity. 
 
 This being accomplished, it was the next care of the Direc¬ 
 tor to carry this part of the expedition from Africa to Asia, 
 crowned with the most brilliant success, and, with it, the com¬ 
 fort of Humanity. Some difficulties having been surmounted, 
 he embarked in the port of Acapulco for the Philippine Isl¬ 
 ands; that being the point at which, if attainable, it was origi¬ 
 nally intended that the undertaking should be terminated. 
 
 The bounty of Divine Providence having vouchsafed to se¬ 
 cond the great and pious designs of the King, Balmis happily 
 performed the vpyage in little more than two months: carry¬ 
 ing with him, from New Spain, twenty-six children, destined 
 to be vaccinated in succession, as before; and as many of them 
 were infants, they were committed to the care of the Matron 
 of the Foundling Hospital at La Corunna, who, in this, as 
 well as the former voyages, conducted herself in a manner to 
 merit approbation. The expedition having arrived at the Phil¬ 
 ippines, and propagated the specific in the islands subject to 
 his Catholic Majesty, Balmis, having concluded his philan¬ 
 thropic commission, concerted with the Captain General the 
 means of extending the beneficence of the King, and the glory 
 of his august name, to the remotest confines of Asia. 
 
 In point of fact, the Cow-pox has been disseminated through 
 the vast Archipelago of the Visayan Islands, whose Chiefs, 
 accustomed to wage perpetual war with us, have laid down 
 their arms, admiring the generosity of an enemy, who confer¬ 
 red upon them the blessings of health and life, at the time 
 when they were labouring under the ravages of an epidemic 
 Small-Pox. The principal persons of the Portuguese colonies, 
 and of the Chinese empire, manifested themselves no less be¬ 
 holden, when Balmis reached Macao and Canton; in both 
 which places he accomplished the introduction of fresh virus, 
 in all its activity, by the means already related: a result, which 
 the English on repeated trials, had failed to procure, in the 
 various occasions when they brought out portions of matter 
 
14 
 
 in the ships of their East India Company, which lost their effi¬ 
 cacy on the passage, and arrived inert. 
 
 After having propagated the Vaccine at Canton, as far as 
 possibility and the political circumstances of the empire would 
 permit, and having confided the further dissemination of it to 
 the Physicians of the English factory at the above-mentioned 
 port, Balmis returned to Macao, and embarked in a Portu¬ 
 guese vessel for Lisbon; where he arrived on the 15th Au¬ 
 gust. In the way he stopped at St. Helena, in which, as in 
 other places, by dint of exhortation and perseverance, he pre¬ 
 vailed upon the English to adopt the astonishing antidote, 
 which they had undervalued for the space of more than 
 eight years, though it was a discovery of their nation, and 
 though it was sent to them by Jenner himself. 
 
 Of that branch of the expedition which was destined for 
 Peru, it is ascertained that it was shipwrecked in one of the 
 mouths of the River de la Magdalena; hut having derived im¬ 
 mediate succour from the natives, from the Magistrates adja¬ 
 cent, and from the Governor of Carthagena, the Subdirector, 
 the three Members of the Faculty who accompanied him, and 
 the children, were saved, with the fluid in good preservation, 
 which they extended in that port, and its province, with acti¬ 
 vity and success. Thence it was carried to the isthmus of Pa¬ 
 nama, and persons properly provided with all necessaries, un¬ 
 dertook the long and painful navigation of the River de la 
 Magdalena: separating, when they reached the interior, to 
 discharge their commission in the towns of Teneriffe, Mom- 
 pox, Ocana, Socorro, San Gil y Medellin, in the valley of Cu- 
 cuta, and in the cities of Pamplona, Giron, Tunja, Velez, and 
 other places in the neighbourhood, until they met at Santa Fe: 
 leaving every where suitable instructions for the Members of 
 the Faculty, and in the more considerable towns, regulations 
 conformable to those rules which the Director had prescribed 
 for the preservation of the virus; which the Viceroy affirms to 
 have been communicated to fifty thousand persons without 
 one unfavourable result. Towards the close of March, 1805, 
 they prepared to continue their journey in separate tracks, for 
 the purpose of extending themselves, with the greater facility 
 and promptitude, over the remaining districts of the Vice¬ 
 royalty, situated in the road of Popayan, Cuenca, and Quito, 
 as far as Lima. In the August following they reached Guaya¬ 
 quil. 
 
 The result of this expedition has been, not merely to spread 
 the Vaccine among all people, whether friends or enemies; 
 
15 
 
 among Moors, among Visayans, and among Chinese; but also 
 to secure to posterity, in the dominions of his Majesty, the 
 perpetuity of so great a benefit; partly by means of the Central 
 Committees that have been established, as well as by the dis¬ 
 covery which Balmis made of an indigenous matter in the cows 
 of the valley of Atlixco, near the city of Puebla de los Ange¬ 
 les; in the neighbourhood of that of Valladolid de Mechoa- 
 can, where the Adjutant Antonio Gutierrez found it; and in 
 the district of Calabozo, in the province of Caracas, where 
 Don Carlos de Pozo, Physician of the residence, found it. 
 
 A multitude of observations, which will be published with¬ 
 out delay, respecting the developement of the Vaccine in va¬ 
 rious climes, and respecting its efficacy, not merely in prevent¬ 
 ing the Natural Small-Pox, but in curing simultaneously other 
 morbid affections of the human frame, will manifest hofr im¬ 
 portant to humanity will prove the consequences of an expedi¬ 
 tion, which has no parallel in history. 
 
 Though the object of this undertaking was limited to the 
 communication of the Vaccine in every quarter; to the instruc¬ 
 tion of Professors, and to the establishment of regulations, 
 which might serve to render it perpetual,—nevertheless, the 
 Director has omitted no means of rendering his services bene¬ 
 ficial, at the same time, to agriculture and the Sciences. He 
 brings with him a considerable collection of exotic plants. He 
 has caused to be drawn the most valuable subjects in Natural 
 History. He has amassed much important information; and, 
 among other claims to the gratitude of his country, not the 
 least consists in having imported a valuable assemblage of 
 trees and vegetables, in a state to admit of propagation; and 
 which, being cultivated in those parts of the Peninsula that 
 are most congenial to their growth, will render this expedition 
 as memorable in the annals of Agriculture, as in those of Me¬ 
 dicine and Humanity. It is hoped that the Subdirector and 
 his coadjutors, appointed to carry these blessings to Peru, will 
 shortly return by way of Buenos-Ayres, after having accom¬ 
 plished their journey through that Vice-royalty, the Vice-roy¬ 
 alty of Lima, and the districts of Chili and Charcas; and that 
 they will bring with them such collections and observations as 
 they have been able to acquire, according to the instructions 
 given by the Director, without losing sight of the philanthro¬ 
 pic commission which they received from his Majesty in the 
 plenitude of his zeal for the welfare of the human race. 
 
 
No. III. 
 
 To the Editors of the Medical and Physical Journal. 
 
 Gentlemen, 
 
 Those herpetic affections which so frequently appear 
 among the children of the poor, and which are evidently 
 contagious, often prevent the vaccine virus from producing 
 its correct action. The skin, although it be apparently sound 
 at the point of insertion, is nevertheless so influenced by the 
 disease, as frequently to baffle all our efforts to produce a cor¬ 
 rect pustule, and consequently to secure the constitution from 
 the contagion of the small-pox. The eruptions I allude to, 
 for the most part, correspond with those of the Second Order 
 of Cutaneous Diseases described by the ingenious Dr. Wil- 
 lan, under the term Psoriasis Diffusa .* The face, the eye¬ 
 lids, the tender skin behind the ears, and particularly the scalp, 
 are the parts most commonly affected; but the limbs and body 
 not unfrequently exhibit the same appearances. As far as I 
 have been able to observe, it is more common among the lower 
 classes of society in the country than in London. It is not 
 uncommon to see it pass through a village school, assuming a 
 variety of characters, according to the state of the constitution 
 of the child affected with it. I do not mean to say, that the 
 pustulef is always imperfect, and not effective, when the ino¬ 
 culated patient has this malady; on the contrary, it is some¬ 
 times perfectly correct, and much more frequently so when it 
 has been of long standing, than when in its recent state; and 
 what is remarkable, the disease is then (when of long duration) 
 sometimes swept entirely away. I have noticed this impedi¬ 
 ment to the perfect formation and progress of the vaccine pus¬ 
 tule, in my general correspondence, for more than two years 
 past, and conceive it to be a more frequent source of the spu¬ 
 rious pustule than any other, or indeed than all the rest united. 
 Dr. Marcet inserted some hints I communicated to him on 
 this head, in your Journal, for May, 1803, but I believe they 
 have not been much attended to. 
 
 In my Paper of Instructions for Vaccine Inoculation, pub- 
 
 * The labours of Dr. Willan in this rugged field of science, all should ac¬ 
 knowledge with thankfulness and gratitude. 
 
 f Having in my former Treatises used the term pustule , I make choice of it 
 now, lest it should create confusion; though, perhaps, not so appropriate as 
 
 tiock or vesicle. 
 
17 
 
 Mshed some years back, I have endeavoured to guard the 
 inoculator from being deceived by false appearances, by the 
 following observations. 
 
 “ The vaccine fluid is liable, from causes apparently trifling, 
 to undergo a decomposition. In this state it. sometimes pro¬ 
 duces what has been denominated the spurious pustule; that is, 
 a pustule,or an appearance on the arm not possessing the charac¬ 
 teristic marks of the genuine pustule. Anomalies assuming dif¬ 
 ferent forms may be excited, according to the qualities of the 
 virus applied, or the state of the person inoculated; but bv far 
 the most frequent variety or deviation from the perfect pus¬ 
 tule, is that which arrives at maturity and finishes its progress, 
 much within the time limited by the true. Its commencement 
 is marked by a troublesome itching; and it throws out a pre¬ 
 mature efflorescence, sometimes extensive, but seldom circum¬ 
 scribed, or of so vivid a tint as that which surrounds the pus¬ 
 tule completely organized; and (which is more characteristic 
 of its degeneracy than the other symptoms) it appears more 
 like a common festering produced by a thorn or any other 
 small extraneous body sticking in the skin, than a pustule ex¬ 
 cited by the vaccine virus. It is generally of a straw colour, 
 and when punctured, instead of the colourless, transparent 
 fluid of the perfect pustule, its contents are found to be opaque. 
 A little practice in vaccine inoculation, attentively conducted, 
 impresses on the mind the perfect character of the vaccine 
 pustule; therefore, when a deviation arises,, of whatever kind 
 it may be, common prudence points out the necessity of re¬ 
 inoculation.” The deviation, when it arises from the cuticular 
 disease I am speaking of, generally corresponds with that 
 above recited. I might have added, that if the pustule is not 
 much disturbed in its course by scratching, it commonly ter¬ 
 minates in a scab of a pale brown or amber colour, and soft in 
 its texture, compared with that produced by the true vaccine 
 pustule. I have abundant testimony to prove, that the fluid 
 taken from a spurious vaccine pustule thus excited, is capable 
 of propagating and perpetuating its like. Indeed, the vaccine 
 fluid, even in a pustule going through its course perfectly, if 
 taken in its far advanced stages, is capable of producing va¬ 
 rieties, which will be permanent if we continue to vaccinate 
 from it. I mention the subject briefly now; but it is my inten¬ 
 tion (as it embraces a wide field) to enlarge upon it, and some 
 others connected with vaccination, when circumstances will 
 permit me. Medical practitioners should be particularly cir¬ 
 cumspect when they inoculate those who have cuticular dis- 
 
 C 
 
18 
 
 eases. The danger of insecurity would be at once obviated, if 
 on the appearance of an irregular pustule, the disease wer to 
 be subdued by proper applications, and the patient then re-ino¬ 
 culated. I shall select a case, to show the efficacy of this mode 
 of proceeding. 
 
 A family, consisting of five fine healthv-looking children, 
 were inoculated by me at Cheltenham in the autumn of 1803 
 with fluid virus taken immediately from a proper vaccine pus¬ 
 tule. On examining the punctures on the fifth day, I found, 
 that on the left arm of one of the children, the pustule was ad¬ 
 vancing too rapidly. It was of an irregular form, contained al¬ 
 ready an opaque fluid, and was surrounded by an efflorescence 
 of a dusky red colour to the extent of one-third part of an inch. 
 Such an intolerable itching was excited, that the boy (who was 
 only three years old) could not be prevented from rubbing it. 
 This appearance led me to an examination; and on the child’s 
 head I observed an herpetic blotch not much larger in circum¬ 
 ference than a shilling. The hair around the part was stiffened 
 by the concreted ichor oozing from the sore, which had made 
 its appearance about ten days. No eruption showed itself in 
 any other part of the body. The pustule was repeatedly broken 
 by the child’s scratching and rubbing it; and the inflammation 
 on the arm, which began to spread so early, on the eighth and 
 ninth day became very extensive. T he child, at the same time, 
 was hot and restless. A soft, amber-coloured scab* now began 
 to form; but this being rubbed off, the part ulcerated and heal¬ 
 ed slowly, leaving a cicatrix deeper and larger than in ordina¬ 
 ry cases. The disease on the scalp was now quickly subdued 
 by the use of tar ointment; and at the expiration of six weeks 
 from its commencement, the inoculation was repeated, when 
 the pustule went through all its proper stages with perfect re¬ 
 gularity. The rest of the children inoculated at the same time, 
 went through the cow-pox in the ordinary way, without any 
 irregular appearance. 
 
 I have selected this case, to show how slight a local appear¬ 
 ance may produce a change in the state of the skin, at a dis¬ 
 tance from it. I cannot call it a general change in every case, 
 as I have sometimes found a correct pustule on one arm, and a 
 spurious pustule on the other; indeed, I have sometimes found 
 the perfect and imperfect pustule on the same arm, within two 
 
 * It may be remarked, that purulent matter cannot form a scab so hard and 
 compact as limpid matter. Hence arises the difference between the vario¬ 
 lous and the vaccine scab. It accounts too for the varicellous scab being com¬ 
 monly harder than the variolous. 
 
19 
 
 inches of each other, when the virus inserted was taken the 
 same instant from the same perfect pustule. It happens that I 
 more frequently detect the disease by the appearance of the 
 arm, than previously to inoculation. Parental fondness is 
 often mismanaged, and induces mothers to conceal eruptive 
 complaints on their children. 
 
 These are the constitutions which sometimes show a few 
 wandering pustulous eruptions after Vaccine inoculation; and 
 so peculiarly irritable is the skin when influenced by herpes, 
 that the smallest wound, a slight scratch, or the pricking of a 
 pin, for example, commonly produces inflammation, and slight, 
 superficial suppuration. 
 
 The preceding year I inoculated another child at Chelten¬ 
 ham, whose face was involved in one general thick incrusta¬ 
 tion. She had been in this state, without any material varia¬ 
 tion, upwards of two years, during which time many applica¬ 
 tions had been used to no purpose. The scalp partook, in some 
 degree, of the same kind of disease; but the body and limbs 
 were free from it, except when any of the acrid fluid, oozing 
 from fissures in the crust, chanced to fall upon the neck or 
 breast; it then invariably produced, for a time, a similar ap¬ 
 pearance. On vaccinating this child by a single puncture in 
 each arm, the pustules went through their course correctly. 
 On their decline, the incrustation began to be less coherent, 
 and to drop off; and at the expiration of a fortnight, the face 
 was smooth, no vestige of the disease remaining, except a 
 slight inflammation of the eye-lids. 
 
 Cases of this sort have become familiar; Mr.-Ring has given 
 several in his very copious Treatise on the Cow-pox; and they 
 have been mentioned by other authors, both here and on the 
 Continent. 
 
 I have in like manner sometimes seen papulous eruptions, 
 which have long proved troublesome, speedily swept away. 
 
 This I think may be accounted for. The vaccine virus, a 
 few days after its insertion, begins to act upon the constitution. 
 It is then manifest, from a new appearance which these erup¬ 
 tions put on, commonly that of increased inflammation, that a 
 new action has been excited in them. The original morbid ac¬ 
 tion therefore becomes deranged and is destroyed, and conse¬ 
 quently the disease is conquered. I have seen many instances 
 where pre-existing pimples have been converted into vaccine 
 pocks, which have kept pace with those on the arms in their 
 progressive changes. 
 
 Seeing that the skin, when disposed to reject the ordinary 
 
20 
 
 action of the variolous virus, rejects the vaccine also, I shall 
 just observe; it occurs to me as probable, that its herpetic 
 state, at the time of inoculation, has been the chief source of 
 those failures, which many practitioners have witnessed in 
 inoculating for the small-pox: for in many instances where, on 
 subsequent exposure to infection, the disease has been taken, 
 it has been found that the process of inflammation and suppu¬ 
 ration on the arms had gone to a greater extent than in ordi¬ 
 nary cases, that the symptomatic affections were clearly mark¬ 
 ed, and that even eruptions, though small and seldom maturat¬ 
 ing, have appeared. But as the state of the arm became a se¬ 
 condary object in inoculating for the small-pox, our solicitude 
 being directed to what appeared of far more consequence, the 
 number of pustules, I almost despair of obtaining much infor¬ 
 mation on this point. , 
 
 I shall conclude this paper by observing, that although the 
 Vaccine Inoculator does not inflict a severe disease, but,on the 
 contrary, produces a mild affection scarcely meriting that term, 
 yet, nevertheless, he should be extremely careful to obtain a 
 just and clear conception of this important branch of medical 
 science. He should not only be acquainted with the laws and 
 agencies of the vaccine virus on the constitution, but with 
 those of the variolous also, as they often interfere with each 
 other. 
 
 A general knowledge of the subject is not sufficient to ena¬ 
 ble or to warrant a person to practice Vaccine Inoculation; 
 he should possess a particular knowledge; and that which I 
 would wish strongly to inculcate, as the great foundation of 
 the whole, is an intimate acquaintance with the character of 
 the true and genuine vaccine pustule. The spurious pustule 
 would then be readily detected, whatever form it might as¬ 
 sume; and errors known no htore. 
 
 I am, &c. 
 
 EDWARD JENNER. 
 
 Berkeley, July 15, 1804, 
 
 t