"My neighbour, Mr. Hicks, having mentioned your wish to be informed of the progress of the inoculation here for the cow-pox, and he also having taken the trouble to transmit to you my minutes of the cases which have fallen under my care, I hope you will pardon the further trouble I now give you in stating the observations I have made upon the subject. When first informed of it, having two children who had not had the smallpox, I determined to inoculate them for the cow-pox whenever I should be so fortunate as to procure matter proper for the purpose. I was, therefore, particularly happy when I was informed that I could procure matter from some of those whom you had inoculated. In the first instance I had no intention of extending the disease further than my own family, but the very extensive influence which the conviction of its efficacy in resisting the smallpox has had upon the minds of the people in general has rendered that intention nugatory, as you will perceive, by the continuation of my cases enclosed in this letter, [Footnote: Doctor Marshall has detailed these cases with great accuracy, but their publication would now be deemed superfluous.—E.J.] by which it will appear that since the 22d of March I have inoculated an hundred and seven persons; which, considering the retired situation I resided in, is a very great number. There are also other considerations which, besides that of its influence in resisting the smallpox, appear to have had their weight; the peculiar mildness of the disease, the known safety of it, and its not having in any instance prevented the patient from following his ordinary business. In all the cases under my care there have only occurred two or three which required any application, owing to erysipelatous inflammation on the arm, and they immediately yielded to it. In the remainder the constitutional illness has been slight but sufficiently marked, and considerably less than I ever observed in the same number inoculated with the smallpox. In only one or two of the cases have any other eruptions appeared than those around the spot where the matter was inserted, and those near the infected part. Neither does there appear in the cow-pox to be the least exciting cause to any other disease, which in the smallpox has been frequently observed, the constitution remaining in as full health and vigour after the termination of the disease as before the infection. Another important consideration appears to be the impossibility of the disease being communicated except by the actual contact of the matter of the pustule, and consequently the perfect safety of the remaining part of the family, supposing only one or two should wish to be inoculated at the same time.
"Upon the whole, it appears evident to me that the cow-pox is a pleasanter, shorter, and infinitely more safe disease than the inoculated smallpox when conducted in the most careful and approved manner; neither is the local affection of the inoculated part, or the constitutional illness, near so violent. I speak with confidence on the subject, having had an opportunity of observing its effects upon a variety of constitutions, from three months old to sixty years; and to which I have paid particular attention. In the cases alluded to here you will observe that the removal from the original source of the matter had made no alteration or change in the nature or appearance of the disease, and that it may be continued, ad infinitum (I imagine), from one person to another (if care be observed in taking the matter at a proper period) without any necessity of recurring to the original matter of the cow.
"I should be happy if any endeavours of mine could tend further to elucidate the subject, and shall be much gratified is sending you any further observations I may be enabled to make.
"I have the pleasure to subscribe myself,
"Dear sir, etc.,
"JOSEPH H. MARSHALL
"EASTINGTON, GLOUCESTERSHIRE, April 26, 1799."
The gentleman who favoured me with the above account has continued to prosecute his inquiries with unremitting industry, and has communicated the result in another letter, which at his request I lay before the public without abbreviation.
Dr. Marshall's second letter:
"DEAR SIR:
"Since the date of my former letter I have continued to inoculate with the cow-pox virus. Including the cases before enumerated, the number now amounts to four hundred and twenty-three. It would be tedious and useless to detail the progress of the disease in each individual—it is sufficient to observe that I noticed no deviation in any respect from the cases I formerly adduced. The general appearances of the arm exactly corresponded with the account given in your first publication. When they were disposed to become troublesome by erysipelatous inflammation, an application of equal parts of vinegar and water always answered the desired intention. I must not omit to inform you that when the disease had duly acted upon the constitution I have frequently used the vitriolic acid. A portion of a drop applied with the head of a probe or any convenient utensil upon the pustule, suffered to remain about forty seconds, and afterwards washed off with sponge and water, never failed to stop its progress and expedite the formation of a scab.
"I have already subjected two hundred and eleven of my patients to the action of variolous matter, but EVERY ONE RESISTED IT.