“Although one of these cases ended unfortunate, yet I cannot suppose that any medical man will think me careless or inattentive in their management; for I conceive the appearances were such as might have induced any one to suppose that the persons were perfectly safe from future infection.  Inflammation in every case took place in the arm, and fever came on with a considerable degree of pain in the axilla.  In some of their arms the inflammation and suppuration were more violent than is commonly observed when perfect matter is made use of; in one there was an ulcer which cast off several large sloughs.  About the ninth day eruptions appeared, which died away earlier than common without maturation.  From these circumstances I should suppose that no medical practitioner would scarcely have entertained a doubt but that these patients had been infected with a true smallpox; yet I must confess that some small degree of doubt presented itself to me at the speedy disappearance of the eruptions; and in order, as far as I could, to ascertain their safety, I sent one of them to a much older practitioner than myself.  This gentleman, on hearing the circumstances of the case, pronounced the patient perfectly secure from future infection.

“The following facts are also a striking proof of the truth of your observations on this subject: 

“In the year 1789 I inoculated three children of Mr. Coaley, of Hurst farm in this county.  The arms inflamed properly, fever and pain in the axillae came on precisely the same as in the former cases, and in ten days eruptions appeared, which disappeared in the course of two days.  I must observe that the matter here made use of was procured for me by a friend; but no doubt it was in an improper state; for, from the similarity of these cases to those which happened at Arlingham five years before, I was somewhat alarmed for their safety, and desired to inoculate them again:  which being permitted, I was particularly careful to procure matter in its most perfect state.  All the children took the smallpox from this second inoculation, and all had a very full burthen.  These facts I conceive strikingly corroborate your opinion relative to the different states of matter; for in both instances that I have mentioned it was capable of producing something strongly resembling the true smallpox, although it afterwards proved not to be so.

“As I think the communication of these cases is a duty I owe to the public, you are at liberty to make what use you please of this letter.  I remain, &c.,

“John Earle.

“Frampton-upon Severn, Gloucestershire, November 10, 1798.

“P.  S. I think it necessary to observe that I can pronounce, with the greatest certainty, that the matter with which the Arlingham patients were inoculated was taken from a true smallpox pustule.  I took it myself from a subject that had a very full burthen.”