24 VACCINATION Histori- In this posture of affairs Woodville of the inoculation cal hospital, London, succeeded in January 1799 in starting sources & success j on o f arm-to-arm vaccinations from a London cow, which were exceptionally free from the ulcerative lymph, termination. From that source Jenner himself was sup plied with lymph in February, while more than two hundred practitioners both at home and abroad were sup plied some three weeks later. There was a quarrel with Woodville in due course, and an attempt to set up an authentic Jennerian lymph independent of the London stock. But the merits of this claim (which otherwise rests on the vague evidence of Marshall) may be judged of by the fact that Ring s application to Jenner in Sep tember 1799 for genuine lymph was answered by the latter with a supply of matter which was none other than Wood- ville s own stock, after six months use in the country. Woodville s stock was used all over the world down to 1836. By that time there were numerous complaints that the lymph was degenerating, and a widespread feeling that it was necessary to "go back to the cow." Apart from the numerous original cases of cowpox alleged to have been found in Wiirtemberg, the first new authentic source was the Passy cow of 1836. From the accidental vesicles on the milker s hand Bousquet, the director of vaccination in Paris, started a new stock, which partly superseded Woodville s lymph hitherto in use in France. In 1838 Estlin of Bristol, after several years vain en deavours, heard of original cowpox in Jenner s own parish of Berkeley (Gloucestershire), where the disease was so far forgotten that the milkers were for several days un aware that the vesicles on their hands had been contracted from cows. Estlin s new geniture is one of the most fully recorded in the history of vaccination. In the same year, and the two following years (1838-41), Ceely of Aylesbury found some half-dozen distinct occurrences of cowpox in the dairy-farms of his district, and cultivated lymph from them. His account of the natural history of cowpox in the cow, and of the effects of primary lymph when inocu lated on the human arm, is by far the most comprehensive and candid that has ever been given ; without it we should hardly have understood the real nature of cowpox. Bous quet, Estlin, and Ceely are the chief writers who have authentically described the establishment of new stocks of cowpox lymph since Woodville s original report of 1799. There are numerous other references, less detailed, to original cowpox in the cow, and to vaccinations therefrom, in England, on the Continent, and in the United States ; some of these came to light in the inquiry of the Epidemic- logical Society in 1852. One of the best -known cases of comparatively recent times is the Beaugency cow of 1866, which has been the source of much of the calf-lymph of the Dutch, Belgian, and other vaccine "farms." Another French case occurred in the Gironde in November 1881, and is described in the Bulletin of the Academy of Medi cine (p. 17, 1882). In England the editors of the Veter inarian inserted a notice in the number for August 1879, making a request to their readers for lymph " from vesicles on the teats of cows in cases of so-called natural cowpox." The only answer to it hitherto has been an intimation in June 1880 that there was a case of cowpox at Halstead in Essex, which was visited by Ceely and others and pro nounced by the former to be of the nature of eczema. In 1876 the disease was found at a farm near Reykjavik in Iceland, where it had never been seen before ; it was of the old type, producing sores on the milkers hands, and causing much alarm by its unfamiliar character. 1 1 Cowpox of the original ulcerating type still occurs, but is now hardly recognized as such. The inquiry into an outbreak of scarlet fever in December 1885, traced to a dairy at Hendon (Middlesex), elicited the fact that the inculpated cows, as well as seventy or eighty The so-called calf lymph is as remote from the cow as Calf ordinary humanized lymph ; it differs from the latter lymph, merely in the circumstance that the calf (on its shaven belly) becomes the vaccinifer, instead of the child, and that the cycle of the disease is very much abbreviated or contracted in the calf : the vesicles are distended with lymph about the fourth or fifth day, instead of the seventh or eighth, and are almost unattended by areolar redness and constitutional disturbance, the animal being able to support fifty to a hundred or more vesicles without the smallest inconvenience. On the child s arm the vesicles after calf-lymph are slower in development than in the calf, and are attended by areola, &c. Under the influence of theory, "vaccine" lymph has been got Anoma- frem two sources that have absolutely nothing to do with cowpox ; lous and, oddly enough, the matter from these sources lias been so sources managed as to produce correct vesicles on the child s arm. One of vac- source is the grease of the horse s hocks and the other is smallpox cine, itself. The grease of the horse was known to produce vesicles and sub- Grease sequent ulcers on the hands almost indistinguishable from those of of the accidental cowpox. There was also the tradition (which breaks horse. down when tested by facts) that accidental infection with the grease protected from smallpox. Jenner held that all "genuine" cowpox came from horse-grease ; and, after he had raised vaccine vesicles on the arms of children by matter from the cow s teats, he proceeded to try whether he could not raise the same kind of vesicle experi mentally by matter once removed from the horse s hocks. The experiment succeeded, just as the accident had done. The vesicle (represented in plate 2 of the Inquiry) ulcerated, and the boy died of what is vaguely termed a "fever" in one place and a "con tagious fever " in another. The same kind of inconsequent logic suggested the experiment of inoculating the matter of horse-grease upon the skin of the cow s teats, the object being to prove the identity of cowpox with the grease. That too succeeded in the hands of Loy of Whitby. Loy also inoculated children with the same matter, and raised vesicles on their arms, which were, of course, the same as the accidental vesicles (compared to the blister raised by a burn). Sacuo of Milan actually used the equine matter on a large scale, instead of cowpox matter ; and De Carro of Vienna "equinated" many persons in that city with lymph sent him by Sacco. Baron prints a memorandum of Jenner, dated 23d July 1813, relating to "equine virus which I have been using from arm to arm for these two months past, without observing the smallest deviation in the progress and appearance of the pustules from those produced by vaccine," and a second note, dated 17th May 1817, in which Jenner says he " took matter from Jane King (ecp.rine direct) for the National Vaccine Establishment. The pustules beautifully correct." This is not the place to enter upon the pathology of horse- grease ; and, as a matter of fact, equiuatiou has not been much practised on the whole. According to Jenner s own data, it was an occasional constitutional disease of the horse s hocks in wet seasons, which was communicable to the hands of men in the form of large whitish vesicles, ending in corroding and painful open sores (see the case reported to him by Fewster, op. cit., ed. 1800, p. 96). The other anomalous source of "vaccine "is human smallpox. Human Jenner having succeeded in passing off his doctrine that cowpox is small- smallpox of the cow, it occurred to some persons about forty years pox. after to prove the doctrine by experiment, the proof being to variolate the cow on the udder. This Avas accomplished in 1838, after much trouble, by Thiele in Kazan (Russia), who inoculated several thousands of persons with the variolous matter passed through the system of the cow." Within a few months of that experiment, the same thing was attempted by Ceely of Ayleslmry, who succeeded, after many failures, in raising a large variolous pock, not on the udder of the cow, but on the mucous membrane of the vulva. The first experiment with the matter of this pock was undesigned ; his assistant pricked his hand with the lancet which had just been dipped into the large pustule, and in due course had an attack of smallpox. Ceely persevered with his experiments (having meanwhile variolated another heifer at five places on the vulva), and in due time so "managed" his matter as to produce vesicles on the human arm (without general eruption on the skin), which were regarded at Cheltenham and other places as at two other farms, were affected with what the dairymen called "cowpox" (see Cameron, Trans. Epid. Soc., April 1886). A similar outbreak in November 1887, involving 160 cows and 7 milkers at four fnrms in Wiltshire, was clearly proved by Crookshank to be the his torical cowpox of Jenner and Ceely, by the evidence of identity in the sores on the cows teats and in the sores or vesicles on the milkers hands or faces, and by the production of correct vaccine vesicles in calves inoculated with lymph from a vesicle on the face of a milker
(Brit. Med. Journ., 17th December 1887 and 21st January 1888).