The arcola surrounding the vaccine vesicle is, I think, at its
  greatest height about the eleventh or twelfth day after vaccination,
  if the lymph used has been genuine.

  5th.  Does small-pox prevail there?

  6th.  Does small-pox prevail there after vaccination?

Small-pox prevails occasionally, and there are instances of its having occurred even in a confluent form after vaccination:  one genuine instance of this kind came under my notice in the year 1824, in the person of a liberated African girl, of about sixteen years of age; vaccination had been performed in this case, by the late Dr. Nicol, Deputy Inspector of Hospitals, and was considered satisfactory; the case proved confluent; the secondary fever was accompanied by a severe diarrhoea, which carried off the patient about the thirteenth day.  Another well authenticated instance of the same fact, occurred in the early part of the present year, in the family of a respectable Nova Scotian settler; other cases of a similar nature have been reported by the inhabitants; but I do not consider that, in these cases, the proofs of a pure previous vaccine disease have been satisfactorily established; when vaccination has been carried on for some time, from the same stock of lymph, the disease is apt to degenerate and become spurious, from which cause we require a frequent renewal of lymph from England, in order to keep it in continuous and successful operation; the spurious disease, on the fifth day, generally shews itself in the form of a small globated papula; on the eighth day, it presents sometimes an ash-coloured pustule, containing purulent matter; at other times, and less frequently, a brown-coloured scale, having a small quantity of purulent matter under it, capable of producing, by innoculation, a disease similar to itself; the great prevalence of a disease among the negro population, called “craw craw,” is considered as materially influencing that change in the properties of the pure vaccine lymph, which has been just noticed:  that apathy and indolence of which I have already accused the negro population, leads them to consider the appearance of disease in the arm, after vaccination, as the test of safety from small-pox, great as the difficulty sometimes is, in getting them to bring forward their children for vaccination, it is still greater to procure the examinations in its progress and maturation; the mere appearance of disease in the arm, is supposed to carry along with it immunity from small-pox; and, on the occurrence of the epidemic at an after period, it may be easily foreseen how wretchedly and how fatally this confidence in the spurious disease may be misplaced; I, therefore, do not consider, that, in all the cases spoken of among the inhabitants, as cases of small-pox occurring after vaccination, there existed satisfactory proofs of the patient having previously undergone the genuine vaccine disease; yet, I am sorry to say, that from such occurrences as these, vaccination has rather lost ground in the opinion of the negro population.

  7th.  Is small-pox an increasing malady?