Classification of noun clauses: Object clause Subject clause Predictive clause Appositive clause.
MR. WAKLEY'S PENAL CLAUSE IN THE VACCINATION ACT
1
108 and of which the editor has for some time had the whole of my copy, stated that the scarlatinal dropsy, in two out of the three varieties which I consider it presents, arises from the direct action of the scarlatinal virus on the kidney, you will perhaps have no objection to insert the following quotations from my paper, to prove this statement. In tlie Medical Times for September 23rd, 1848, p. 333, the following occurs :-" I consider scarlatina to be a contagious eruptive fever, characterized by a uniform inflammatory action of the vessels of the skin, and of the mucous membranes of the alimentary canal, and of the urinary passages which terminates in desquamation of their epithelium." In proof of the statement that the kidneys are thus affected, I pointed ’, out (Oct. 7th, p. 371-2, and Oct. 14th, p. 6) that the urine of scarlatinal patients almost invariably contains albumen at some period or other of the eruptive disease, and that a large quantity of renal epithelium can ordinarily be detected during and subsequently to the eruptive stage, and also that other indications of superficial Innammation of the secreting part of the kidney are often present. In the number for Oct. 21st, p. 21-2, are the following para- graphs :- " From the microscopic and chemical examinations of the urine previously described, we are induced to think that the kidneys must be affected in a similar manner to the skin, in most, if not in all, cases of scarlatina. Thus the albumen and blood corpuscles, which are so frequently met with, are indica- tive of congestion of the vessels of the gland, in the same manner as the vessels of the cutis; the increased quantity of epithelial scales shows that desquamation of the mucous mem- brane of the tubes occurs as well as desquamation of the cuticle..... But in addition to the facts presented by the urine, the kidneys of those who die from scarlatina usually afford ir- refragable proof of having suffered from the virus. They are usually enlarged, dark-coloured, congested, and somewhat softened..... The following case, which occurred in April, 1844, affords strong confirmation of the correctness of this view :- " Master -,aged seven, had scarlatina about two years ago, (in 1842,) at which time he had severe cynanche, as well as the rash, but no subsequent dropsy..... About three weeks since he was exposed to the virus of scarlatina, without any apparent effect at the time. Some few days afterwards, slight cynanche parotidia supervened, which went away after a few days. On the nineteenth or twentieth day after the exposure, the face began to swell, then his extremities, and lastly his abdomen and scrotum. This swelling was attended with fever and paucity of urine, which was albuminous, high coloured, small in quantity, of high specific gravity, and con- tained some pus or mucus, and blood corpuscles, epithelial cells, and fibrinous cylinders." " Closely connected with, although not invariably dependent on, the renal disease, is the dropsy which follows an attack of scarlatina..... Of this disease, if it may be so called, there are three varieties-first, that in which the urine is non-albu- minous ; second, in which the urine is albuminous, and the disease arises from a congested or subacute inflammatory state of the kidney; and third, in which the urine is albuminous, but the kidney is in a state of acute inflammation. They had better, therefore, be divided into A, dropsy from debility, and B, dropsy from (a) renal derangement, and (b) from renal dis- organization." At p. 23, after alluding to the mode in which the secretions are formed by the nutrition and eventual rupture of the secreting cells, I state that " this increased nutrition and des- quamation of the (renal) epithelium is probably partly caused by the absorption of the septic poison, which constitutes the virus of scarlatina, and by its excretion from the system, partly through the agency of these cells." The last quotation that I will make is the following, (Oct. 28, p. 41,) which occurs under the head of treatment of the dropsy :- " Anything, therefore, which acts on the cells so as to cause increased action must cause increased nutrition, and an in- creased supply of blood to the organ. The cells must there- fore, under these circumstances, arrive at the full period of their existence at an earlier period than they otherwise would do, and must necessarily be cast off sooner than normal. It is therefore very evident, that if, as I believe, the virus of scarlatina produces this effect on the cells of the kidney, and thus induces the changes in the urine already described, that any means or medicine which aggravates this already-increased action must necessarily prove highly injurious." The above extracts prove that I have long believed that the kidneys are attacked more or less severely in all cases of scarlatina; that the desquamation of the renal epithelium is caused by the specific action of the scarlatinal virus; and lastly, that the subsequent dropsy in most cases results either from this action persisting for a certain period after the erup- tion has vanished, or from the great amount of disorganiz&- tion of the kidney induced by the primary attack. In either case I consider the dropsy to be caused by the direct action of the virus on the kidneys, and not from cold applied to the external surface. As previously stated in my definition of scarlatina, I con- sider the affection of the kidneys to constitute an essential part of the disorder; and believe, that if the kidneys are not involved in the primary attack, they are likely to become diseased, on any subsequent exposure to the virus, without the skin participating in the inflammatory action. The case related above, and others which I have since attended, form the basis of this belief. The only point, then, on which I differ from Dr. Miller is, that I do not consider the anaemia and swelling, in that variety of dropsy which is unattended by the presence of albumen, or of an increased quantity of renal epithelium in the urine, to be caused by renal disease. I remain, Sir, obediently yours, Commercial-road, July, 1849. J. W. TRIPE, M.D., M.R.C.S. &C. MR. WAKLEY’S PENAL CLAUSE IN THE VACCINATION ACT. To the Edit0?’ of THE LANCET. ’, SiR,—An attack made on Mr. Wakley, in THE LANCET of July 7th, for inserting a prohibition in the Vaccination Act of Inoculation for Small-pox, requires some notice, lest it may be considered that medical men tacitly consent to, and acknow- ledge the truth of, Mr. Fletcher’s remarks. I would first ob- serve, that the wisdom of this proceeding is fully shown in the case of your correspondent, who would, had he not been pre- vented by the fear of the law, have increased to an unknown extent, that most loathsome disease-small-pox. It is a gene- rally received axiom, that we are not to do evil that good may come; and in this instance more especially, it is very doubtful whether any good may be derived from allowing medical prac- titioners to inoculate children, and thereby spread the disease, no one can tell to what extent. Some surgeons still prefer inoculation to vaccination, and would therefore foster the pre- judices which do in some places exist against vaccination, and in favour of small-pox; and although it may sometimes be the case, as Mr. Fletcher has asserted, that those inoculated recover more speedily than those who take the small-pox naturally, yet it must be evident that there may be exceptions, and a conscientious medical man could not but accuse himself, if,. after having inoculated many successfully, and saved lives thereby, one fatal case should occur, one valuable life, per- haps, be sacrificed to his thoughtlessness in assisting to spread an intractable disease. And the matter does not end here. It is often the fact, that isolated cases of small-pox occur. If inoculation were legal, all those who preferred it would im- mediately be made certain of having the disease, which may, perhaps, last for months in a place whence it would speedily have been removed, but for this officious and hazardous inter- ference. I know that in many districts where vaccination used to be disliked, and not allowed, chiefly through the want of care on the part of the operator in the selection of children from whom the lymph was taken, there is now not one parent in fifty that refuses to have his child vaccinated, from being able to choose the subject from whom he would prefer his child to receive the infection, and from knowing, by the clear proofs which a medical man always can show such persons, that much good may be done, and that no harm can happen from such a trifling operation. By keeping up inoculation in ever so slight a degrae, the door is left open to bring small-pox into a place, whereas there is little doubt that if every infant, and every person when arrived at puberty, were to be vac- cinated properly, we should, in a few years time, never see small-pox, excepting perhaps an isolated case now and then. Agreeing entirely as I do with the concluding remarks of Mr. Fletcher, I can but express my regret that he, or any other medical man, should be found, who would in any way uphold the dangerous and not rarely fatal practice of inocula- tion.—I am, Sir, your obedient servant, Crewkeme, Somerset, July, 1849. G. F. W.
Transcript of MR. WAKLEY'S PENAL CLAUSE IN THE VACCINATION ACT
108
and of which the editor has for some time had the whole of mycopy, stated that the scarlatinal dropsy, in two out of the threevarieties which I consider it presents, arises from the directaction of the scarlatinal virus on the kidney, you will perhapshave no objection to insert the following quotations from mypaper, to prove this statement.In tlie Medical Times for September 23rd, 1848, p. 333, the
following occurs :-" I consider scarlatina to be a contagiouseruptive fever, characterized by a uniform inflammatoryaction of the vessels of the skin, and of the mucous membranesof the alimentary canal, and of the urinary passages whichterminates in desquamation of their epithelium." In proofof the statement that the kidneys are thus affected, I pointed ’,out (Oct. 7th, p. 371-2, and Oct. 14th, p. 6) that the urine ofscarlatinal patients almost invariably contains albumen at someperiod or other of the eruptive disease, and that a largequantity of renal epithelium can ordinarily be detected duringand subsequently to the eruptive stage, and also that otherindications of superficial Innammation of the secreting part ofthe kidney are often present.In the number for Oct. 21st, p. 21-2, are the following para-
graphs :-" From the microscopic and chemical examinations of
the urine previously described, we are induced to think thatthe kidneys must be affected in a similar manner to the skin,in most, if not in all, cases of scarlatina. Thus the albumen andblood corpuscles, which are so frequently met with, are indica-tive of congestion of the vessels of the gland, in the samemanner as the vessels of the cutis; the increased quantity ofepithelial scales shows that desquamation of the mucous mem-brane of the tubes occurs as well as desquamation of thecuticle..... But in addition to the facts presented by the urine,the kidneys of those who die from scarlatina usually afford ir-refragable proof of having suffered from the virus. They areusually enlarged, dark-coloured, congested, and somewhatsoftened..... The following case, which occurred in April,1844, affords strong confirmation of the correctness of thisview :-
" Master -,aged seven, had scarlatina about two yearsago, (in 1842,) at which time he had severe cynanche, as well asthe rash, but no subsequent dropsy..... About three weekssince he was exposed to the virus of scarlatina, without anyapparent effect at the time. Some few days afterwards, slightcynanche parotidia supervened, which went away after a fewdays. On the nineteenth or twentieth day after the exposure,the face began to swell, then his extremities, and lastly hisabdomen and scrotum. This swelling was attended withfever and paucity of urine, which was albuminous, highcoloured, small in quantity, of high specific gravity, and con-tained some pus or mucus, and blood corpuscles, epithelialcells, and fibrinous cylinders."
" Closely connected with, although not invariably dependenton, the renal disease, is the dropsy which follows an attack ofscarlatina..... Of this disease, if it may be so called, thereare three varieties-first, that in which the urine is non-albu-minous ; second, in which the urine is albuminous, and thedisease arises from a congested or subacute inflammatory stateof the kidney; and third, in which the urine is albuminous,but the kidney is in a state of acute inflammation. They hadbetter, therefore, be divided into A, dropsy from debility, andB, dropsy from (a) renal derangement, and (b) from renal dis-organization."At p. 23, after alluding to the mode in which the secretions
are formed by the nutrition and eventual rupture of thesecreting cells, I state that " this increased nutrition and des-quamation of the (renal) epithelium is probably partly causedby the absorption of the septic poison, which constitutes thevirus of scarlatina, and by its excretion from the system,partly through the agency of these cells."The last quotation that I will make is the following,
(Oct. 28, p. 41,) which occurs under the head of treatment ofthe dropsy :-
" Anything, therefore, which acts on the cells so as to causeincreased action must cause increased nutrition, and an in-creased supply of blood to the organ. The cells must there-fore, under these circumstances, arrive at the full period oftheir existence at an earlier period than they otherwise woulddo, and must necessarily be cast off sooner than normal. Itis therefore very evident, that if, as I believe, the virus ofscarlatina produces this effect on the cells of the kidney, andthus induces the changes in the urine already described, thatany means or medicine which aggravates this already-increasedaction must necessarily prove highly injurious."
The above extracts prove that I have long believed that the kidneys are attacked more or less severely in all cases ofscarlatina; that the desquamation of the renal epithelium iscaused by the specific action of the scarlatinal virus; andlastly, that the subsequent dropsy in most cases results eitherfrom this action persisting for a certain period after the erup-tion has vanished, or from the great amount of disorganiz&-tion of the kidney induced by the primary attack. In eithercase I consider the dropsy to be caused by the direct actionof the virus on the kidneys, and not from cold applied to theexternal surface.As previously stated in my definition of scarlatina, I con-
sider the affection of the kidneys to constitute an essentialpart of the disorder; and believe, that if the kidneys are notinvolved in the primary attack, they are likely to becomediseased, on any subsequent exposure to the virus, withoutthe skin participating in the inflammatory action. The caserelated above, and others which I have since attended, formthe basis of this belief.The only point, then, on which I differ from Dr. Miller is,
that I do not consider the anaemia and swelling, in thatvariety of dropsy which is unattended by the presence ofalbumen, or of an increased quantity of renal epithelium inthe urine, to be caused by renal disease.
I remain, Sir, obediently yours,Commercial-road, July, 1849. J. W. TRIPE, M.D., M.R.C.S. &C.
MR. WAKLEY’S PENAL CLAUSE IN THEVACCINATION ACT.
To the Edit0?’ of THE LANCET.
’, SiR,—An attack made on Mr. Wakley, in THE LANCET ofJuly 7th, for inserting a prohibition in the Vaccination Actof Inoculation for Small-pox, requires some notice, lest it maybe considered that medical men tacitly consent to, and acknow-ledge the truth of, Mr. Fletcher’s remarks. I would first ob-serve, that the wisdom of this proceeding is fully shown in thecase of your correspondent, who would, had he not been pre-vented by the fear of the law, have increased to an unknownextent, that most loathsome disease-small-pox. It is a gene-rally received axiom, that we are not to do evil that good maycome; and in this instance more especially, it is very doubtfulwhether any good may be derived from allowing medical prac- -.
titioners to inoculate children, and thereby spread the disease,no one can tell to what extent. Some surgeons still preferinoculation to vaccination, and would therefore foster the pre-judices which do in some places exist against vaccination, andin favour of small-pox; and although it may sometimes be thecase, as Mr. Fletcher has asserted, that those inoculated recovermore speedily than those who take the small-pox naturally,yet it must be evident that there may be exceptions, and aconscientious medical man could not but accuse himself, if,.after having inoculated many successfully, and saved livesthereby, one fatal case should occur, one valuable life, per-haps, be sacrificed to his thoughtlessness in assisting to spreadan intractable disease. And the matter does not end here.It is often the fact, that isolated cases of small-pox occur. Ifinoculation were legal, all those who preferred it would im-mediately be made certain of having the disease, which may,perhaps, last for months in a place whence it would speedilyhave been removed, but for this officious and hazardous inter-ference. I know that in many districts where vaccination usedto be disliked, and not allowed, chiefly through the want ofcare on the part of the operator in the selection of childrenfrom whom the lymph was taken, there is now not one parentin fifty that refuses to have his child vaccinated, from beingable to choose the subject from whom he would prefer hischild to receive the infection, and from knowing, by the clearproofs which a medical man always can show such persons,that much good may be done, and that no harm can happenfrom such a trifling operation. By keeping up inoculation inever so slight a degrae, the door is left open to bring small-poxinto a place, whereas there is little doubt that if every infant,and every person when arrived at puberty, were to be vac-cinated properly, we should, in a few years time, neversee small-pox, excepting perhaps an isolated case now andthen.Agreeing entirely as I do with the concluding remarks of
Mr. Fletcher, I can but express my regret that he, or anyother medical man, should be found, who would in any wayuphold the dangerous and not rarely fatal practice of inocula-tion.—I am, Sir, your obedient servant,Crewkeme, Somerset, July, 1849. G. F. W.
