[60] Since the publication of the first edition of this lecture, I have heard of two cases, in one of which the fever did not come on till the twentieth, and in the other till the twenty-first day after the infection was communicated to the body. In some of these tedious cases, I have seen an inflammation and suppuration on the punctured part of the arm on the eighth day without any fever. Perhaps in these cases the inflammation and suppuration are only cuticular, and that the small-pox is taken from the matter which is formed by them. I am led here unwillingly to discuss the old question, Is it possible to have the small-pox in the natural way after inoculation?--In many of the cases supposed to be the small-pox from inoculation, it is probable the matter has been taken from the chicken-pox, which resembles the small-pox in many of its peculiarities, but in none more than that of leaving pits or marks on the skin. But there are certainly cases where there are the most irrefragable proofs of the infection implanted by inoculation being of a variolous nature, where the disease has been afterwards taken in the natural way. In these cases I would suppose the variolous matter produced only a topical or cuticular disease. We see something analogous to this in nurses who attend patients in the small-pox. But further, this topical or cuticular infection may be produced by art in persons who have had the small-pox in the natural way. Some years ago, I made a puncture on my left hand with a lancet moistened with variolous matter. On the eighth day an inflammation appeared on the place, accompanied by an efflorescence in the neighbourhood of it, which extended about two inches in every direction from the spot where the puncture was made. On the eleventh day I was surprised to find two pocks (if I may venture to call them such), the one on the outside of the fourth finger of my left hand, and the other on my forehead. They remained there for several days, but without filling with matter, and then dropped off, rather in the form of a soft wart, than of a common scab. Doctor Way of Wilmington repeated the same experiment upon himself, but with an issue to his curiosity more extraordinary than that I have just now related. On the eighth day after he had made a puncture on his hand, a pock appeared on the spot, which in the usual time filled with matter, from which he inoculated several children, who sickened at the usual time, and went through all the common stages and symptoms of the small-pox. It would seem from these facts, that it is necessary the small-pox should produce some impression upon the _whole_ system, in order to render it ever afterwards incapable of receiving an impression of a similar nature. A fever and an eruption therefore seem necessary for this purpose. As the inflammation of the arm on the eighth day is a sign of the _topical_