that jurisprudence, is a highly profitable and glorious distinction among men-especially in an intellectual and free country. In our own land, it is the way to every thing desirable, and must ever be so-and though practical cleverness and dexterous empiricism may, with the help of good fortune, achieve much, there is no hope so solid as that bottomed upon an honest, thorough-paced knowledge of the science. It is better than talentbut it helps talent-it is fuel for its fires, a lamp to its feet, and a staff of strength in its right hand.

ART. VI.-1. History of the Natural and Modified Small-Pox, or of the Variolous and Varioloid Diseases, as they prevailed in Philadelphia, in the years 1823 and 1824. By JOHN K. MITCHELL, M. D. and JOHN BELL, M. D. Attending Physicians at the then Small-Pox Hospital. North-Amer. Med. and Surg. Journal, Vol. II.

2. Report of the Committee of the Philadelphia Medical Society, appointed to collect facts in relation to the occurrence of SmallPox, in 1827-1828. North-Amer. Med. and Surg. Journal, Vol. V.

3. Annual Report of the Medical Officers of the National Vaccine Establishment of Great-Britain, for 1829-1830.

WE have made reference, at the head of the present article, to some very important documents upon a subject which has, for a long time, disturbed, and still continues to agitate the public mind. Professional treatises abound of Small-pox, Varioloid diseases, and Vaccine, but these are not, and ought not to be satisfactory to the community. Couched in technica! language which is, in a certain degree, unintelligible to the general reader-filled with technical illustrations, which only serve to perplex and confound him-and dragging heavily through minute questions of technical detail, of which he cannot perceive the importance or even the relevancy, they are, by no means, fitted for promiscuous circulation. It cannot be doubted, that in a matter of this kind, where there is an evident, universal and pressing interest, the public have a right to call

upon the guardians of health-the physicians in whose hands they have placed their safety and their lives, for the results of their experience and observation. We had hoped to have been furnished by the members of our State Medical Society, with some document similar to those appealed to above, but have been disappointed.

Without any further preface, we shall proceed to a brief discussion of the several questions-of the identity of the variolous and varioloid diseases-of the value of the practice of inoculation-of vaccination, revaccination, &c.

One would imagine, on listening to the language held by the common people, and, indeed, by many physicians, that Smallpox or, as it is nosologically written, Variola, is a disease of such definite history and appearance, that it were easy to distinguish any possible variations, and to separate from it, with precision, every similar or "counterfeit presentment" of analogous character. Others would have you believe, that some change must have taken place in its history, and that the modifications or varieties now forced upon our attention are new, and must be accounted for under some modern system of explanation. Both these views of the matter are erroneous. Let any distinct picture be drawn of Small-pox, and let the cases as they are recorded in books, or as they successively occur in practice, be compared with it, and we do not hesitate to affirm, that the exceptions will be found to be nearly, if not quite as numerous as the confirmations of the rule.

This assertion is easily proved. Thus, for example; all writers describe the disease under the two general heads of distinct and confluent, (phrases referring to the number of pustules) taking care to specify that the difference between these two is in degree and not in nature. How vague any such distinction is we surely need not say. Where is the line to be drawn in cases which approach the point of division? But it is acknowledged that the mere number of pustules is not, after all, the sole cause of this difference in grade; their location, also, must be considered, for, says Sydenham, " this disease is not to be esteein'ed dangerous, because the body is full of pustules, but from the 'great number of them in the face, for, if that be exceeding full, though they are but few, and those of the distinct kind every where else, yet the patient is equally endangered, as if 'all the limbs were extremely full."

All the older writers speak of irregular forms of Small-pox. Sydenham is particular in detailing the varieties which the disease offered in the several years of its epidemic occurrence unVOL. VII. NO. 14.

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der his own notice. Licutaud speaks of a "spurious Smallpox," occasionally taken for the legitimate. Parr tells us that "the varieties of Small-pox are numerous." Others tell us of water pock, of wind-pock, stone-pock, &c. in almost unnumbered diversity. It was only among the English, and not by them, until the time of Heberden, that Varicella (Chicken-pox) was distinguished from Small-pox.* Morton, of the time of Sydenham, speaks of it as mild Small-pox. His contemporary must so have regarded it, if he met with it at all. And though Heberden, Willis, Rayer and M'Intosh talk very positively of the distinctions between the two, yet other writers have not been able to mark them so clearly. Thomson, for instance, maintains Varicella, in all its varieties, to be a modified Smallpox. And while Willan recognizes it only as presented in the serous or vesiculous form, Rayer acknowledges, that it occasionally assumes a pustulous condition. With regard to the grade, which is made the source of distinction between distinct and confluent Small-pox, it should be remembered that Ring has given us a case of confluent Chicken pox, and that M'Intosh has recorded two fatal cases, one in a child, the other in an adult. Heberden speaks of a malignant sort of Chicken-pox, in which "the continuance of the pain and fever, after the ' eruption, and the degree of both these, though there be not 'above twenty pustules, are, as far as I have seen, what never hap'pens in the Small-pox. Chicken-pox has been known to pit the skin, and modified Smali-pox often fails to do this. If we receive the diagnosis of M'Intosh, and others, who discern Chicken-pox by the succession of crops of pustules, what shall we say to Heberden's acknowledgment of his having seen four cases of its unequivocal occurrence in Small-pox? These are 'the only instances," he says, and his language is striking, "which have happened to me something like what is often talked of a second crop."

It seems to us, that the above observations, in making which, we have referred in preference to the older writers, exhibit plainly enough the difficulty of distinguishing Small-pox from its kindred affections, if their actual identity be not established. The term, Varioloid, is a new one, signifying such a resemblance or analogy, as we have here indicated. This appellation has become" familiar in our ear as household words," and is meant to denote generally the eruptive fevers above designated, which men are unwilling to acknowledge to be true Small-pox, and yet which are so nearly similar as to be with

*That is, by the profession; nurses and common people, had noted and named these varieties at least half a century before.

difficulty distinguished from it. Whether it be from any spontaneous change in the nature of the morbid action in which Variola consists, or whether it depend on the influence of external circumstances, it is alleged that the late epidemic affections of this kind, have exhibited certain modifications of symptom and history, which entitle them to be set apart from the well known and regular forms of ancient Small-pox by a peculiar and specific title, and the above term, Varioloid, has been chosen as significant, both of the resemblance and dissimilarity. It was first used by Thomson, in his "Account of the Varioloid epidemic," which prevailed at Edinburgh, in 1818. Cross gives an excellent history of a similar epidemic (which, however, he terms Small-pox) as occurring at Norwich. The same pestilence, it is asserted, raged about the same time in France, Italy and Germany, from which last source it was brought into America in 1818, making its first invasion in Baltimore, (Md.) and Lancaster, (Penn.) It was first noticed in Charleston in January, 1824, and proceeded slowly to infect individual after individual, until November, when it spread more extensively. During that winter, it seized considerable numbers, but scarcely prevailed at any time so widely as to deserve the appellation of epidemic, and, in almost every instance, could be traced to a direct communication. After its first introduction, too, into our city, it should be observed that there were repeated arrivals of infected vessels, bringing hither persons actually ill of Smallpox or Varioloid. Nor was it long confined to the cities on or near the sea-coast, but was conveyed to several points in the interior, spreading, wherever it was known to be introduced, a degree of terror proportioned to the anticipated evils which are always expected to follow in the train of a malady so loathsome and devastating. In the spring of 1826, it prevailed to a sufficient extent among us to be regarded with special attention, but its principal sway as an epidemic was developed in the winter of 1830-31, during which it invaded every quarter of our city, and, indeed, almost every family, attacking all classes of persons, respecting no measures of precaution, nor repelled by any imaginable prudence in avoiding exposure.

It is reasonable to ask, and the community has a right to know from physicians, who use the term, what are the specific and characteristic marks by which Varioloid is distinguished from Small-pox, if it be thus distinct. In entering upon this subject we are at once surrounded by all the elements of animated controversy, and even hot dispute, and while we proceed in the fulfilment of our duty to express our opinions, we shall do this as

briefly as is consistent with perspicuity, and with all deference to the authorities with whom we are at issue.

Varioloid has been assumed to differ essentially from Variola (Small-pox) because, first, it affects persons known to have previously passed through attacks of regular Small-pox; secondly, it affects persons previously vaccinated; and thirdly, it presents certain peculiarities of history and character, which serve as distinguishing marks.

The first of these alleged reasons is obviously of no force. It was long since observed that Small-pox sometimes failed to destroy the liability to its own recurrence, and instances of its repetition are to be found in all the old writers. "Petrus Borellus," says Heberden, "records the case of a 'woman who had this distemper seven times, and catching it 'again, died of the eighth attack." Dr. Oppert, of Berlin, relates the case of a girl, who, at six years of age, had coufluent Small-pox. Seventeen years after, she was again attacked, and died of the disease. A similar case is authentically stated to have occurred in this city. If it is replied, that these cases are too few in number, to affect the general rule, that Smallpox invades the constitution but once, we readily acknowledge the correctness of the assertion, and proceed to apply the inference to the case before us. During the prevalence of the late epidemic in Philadelphia, (call it Varioloid or Small-pox,) but sixteen persons are reported, by Drs. Bell and Mitchell, as attacked with it, who had previously had Small-pox. A similar list may be made out of cases of the same kind occurring here, while the pestilence prevailed among us, so limited in number, however, as to prove most conclusively, that Variola protects, at least in a certain degree, from Varioloid disease.

With regard to the second point mentioned above, it is only necessary to observe that no well informed physician of the present day, retains any confidence in the absolute preven tive power of vaccine against the invasion of Small-pox, however much he may be disposed to confide in its unfailing modifying influence. But of this, more hereafter.

Thirdly, the principal peculiarities which are supposed to characterize the Varioloid, and to offer specific marks by which we may discern it, are, so far as we have been able to collect, the following:

First, the eruption comes forth in successive crops.

Secondly, the pocks or pustules, when formed, are conoidal, without a central depression.

Thirdly, they are vesicular and not multicellular as in Small

pox.