Jenner centenary number.

  • British Medical Association
Date:
1896
Catalogue details

Licence: Public Domain Mark

Credit: Jenner centenary number. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    Journal states that this book was sold in thousands. Its second edition was published in 1801, and the plate to that edition is dated October 10th, 1800. There could be no pos- sibility of any medical man who chose to look at any of these plates failing to note the differences between vaccina- tion as shown by Aikin and others and inoculated small-pox as known from everyday experience. In 1802, as a frontis- piece to a work published by Pearson, entitled An Examina- tion of the Report to the House of Commons, there is a plate giving side by side at successive dates the course both of vaccination and small-pox inoculation. In 1801 the Society of Medicine in Paris published a plate showing the local results of the matter that had been taken to Paris by Wood- ville himself, after that which had been originally supplied by Pearson had died out. This visit of Woodville’s to Paris was made in July, 1800, after he had become aware of the faultiness of his proceedings in April, 1799. This French plate of 1801 was reproduced in 1840 in a Memoir on Re- vaccination published in Paris. The vesicles shown are typical of vaccinia and give no suggestion of variola- tion. Indeed, I have met with no evidence in the history of (inoculation that any such vesicles as were pourtrayed by Jenner, Aikin, and others, had ever before been seen or heard ■of as a result of any inoculative process. The appearances ■shown in the plates in question were those of vaccinia as we still know it. No such plates had ever before been published, because no such disease had ever before been known, and the very existence of the plates is proof of the nature of the inocu- lative material that was being used. We thus have on record not merely the written descrip- tion but a delineation of the actual appearance of vaccinia as known to Jenner and Pearson and Woodville. A plate by Ballhorn and Stromeyer, published in Germany, also shows, though not so explicitly as the others, the contrast between vaccinia and variola. Ring’s Treatise on Cow-pox, in 1803, •contained a series of similar illustrations. Kirtland’s Coloured Drawings. None of these plates, however, are at all equal in detail and elaboration to those which are published in the British Medical Journal to-day. These drawings of Kirtland’s do not seem ever to have been reproduced, and no doubt the •cost would make it almost impossible to publish them at the time. Kirtland’s plates are themselves so eloquent that it is almost an act of supererogation to attempt to describe what ■is so well depicted. They show vaccination and variolation day by day from the second to the sixteenth day, both in- clusive. Up till the fifth day the difference appears to be merely in degree of size and inflammation. Both are circular and both are growing, but on the fifth day there is just an ■indication of the nature of the difference which is about to develop itself. At the variolated spot there is an appreciable beginning of an areola, and close to the vesicle two very small vesicles or satellites have just made their appearance. On the following day (the sixth) there are two or three more supernumerary vesicles. On the seventh day all have coal- esced so as to make a single irregularly-shaped figure, and the surrounding redness is much increased. By this time also the vesicle has become a pustule, yellowish at and near the margin, and bluish in the centre. On the eighth day this sore has extended its borders, and a new group of satellites has appeared around it. On the ninth day there is an addi- tion to the satellites, but the striking feature is the deepen- ing of the areola. In the centre the colour is becoming darker. On these last two days two little vesicles, becoming pustular, have established themselves outside the general areola. All this time the vaccine vesicle has been pursuing its course as we know it to do in the present day. The circu- lar form is retained throughout; there are no satellites, and on the ninth day the areola somewhat resembles that of the variolous inoculation of the sixth day. On the tenth day there is shown a decided change on the variolated arm. Instead of scattered satellites there is a broad circle of con- fluent vesicles surrounding the original spot. On the eleventh day these have become yellower in hue, the areola has again extended, and round the confluent circle there are new satel- lites ; but in addition the general eruption has begun to show itself on the arm and forearm, the eruption at this time con- sisting of red papules, which on the twelfth day are vesicular at the apex, and have become pustular by the fourteenth day. By the fifteenth day the areola surrounding each of these pustules of the general eruption has disappeared. Umbilica- tion is not so clearly indicated by Kirtland in these eruptive pustules as might have been expected. With regard to the congeries of supernumerary pustules surrounding the inocu- lated spot, on the eleventh and twelfth day they are shown with a central punctated depression, but by the thirteenth day the “bridle” has given way underneath, the umbilica- tion has gone, and we have instead a globular appearance. On the fourteenth day the globules are much enlarged and distended, and their yellow colour has at one part of the circle a tendency to darkening into brown, and here also the pus- tules are contracting rather than distended. The centre of the original inoculation is also getting darker, and in the heart of it there is just an indication of a crust. The surrounding inflammation has certainly not extended since the twelfth day, but is rather moving towards diminution. By the fifteenth day there is obvious decadence of the whole process ; the areola is rapidly disappearing, the pustules are much darker, there is considerable incrustation, especially at the part which had shown this tendency on the previous day, and the centre also is darker. The series of plates closes with the sixteenth day. The pustules have lost their separate existence, the surrounding areola has disappeared excepting for a narrow line just at the edge of the circle, and there is a general contraction of the affected area. One could almost have wished that the plates had been continued for a day or two longer so as to show whether the red line at the base of the crusts on one side is merely a remainder of the areola, or whether there is here a tendency to a separation of the crust and the leaving of an ulcer to heal by granulation from the base and margins. It is unnecessary to follow in detail the course of the vaccine inoculation. The same appearances can be seen at the present time by any medical man who watches the course of one of his own cases. The vaccination of 1802 is identical with the vaccination of 1896, and there is cultivation neither upwards nor downwards. The appearances of small-pox inoculation being such as are recorded by Kirtland and Pearson and others, it is simply impossible to suppose that medical men, knowing what small-pox inoculation was like—knowing it to be as we have it depicted by Kirtland and others—and knowing, further, from Jenner and Aikin and the Medical and Physical Journal, etc., what vaccinia was like, could readily blunder between the two. It is impossible to account for the capacity for error of particular individuals, and here and there a mis- take no doubt occurred; but such exceptions weigh nothing with regard to the general question as to whether the material used for vaccination in the early years was cow-pox or small- pox. r The Chromographic reproductions of George Kirtland s coloured drawings of vaccinia and inoculated variola will be found facing this page.]
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