Chapter III: Part 3

13th. The fever, pain in the side, cough, and difficulty of expectoration, being again increased, I ordered a vesicatory to the side, and some oxymel of squills in a pectoral mixture.

14th. The fever and pain of the side were abated, and he had obtained some little sleep, which was however much disturbed by sudden startings. The skin at the incisions had an unusual appearance, not easily to be described; and instead of being inflamed, as it usually is, where the progress of the infection is favourable, and not interrupted by some extraordinary accident, it was of a pale hue.

15th. He had rested ill, and the cough was so troublesome, that I ordered more blood to be taken, and the medicines to be continued. The incisions this day looked like pustules irregularly shaped, and a fluid appeared under the cuticle.

16th. All symptoms were more moderate; two pustules were discovered in the face, and those at the incisions seemed tending to maturation.

17th. All complaints much easier; the pustules at the incisions were more elevated, and had matter in them; but the others were but little advanced, and looked pale.

18th. He was in all respects so much better, that he ventured to ride out on horse-back, and I was released from my attendance; nor did I see him afterwards till he called at my house in good health on the 5th of July. But he then informed me, that in the afternoon of the 19th of June, the day after I took my leave of him, he had been extremely hot and feverish; was relieved on the 20th from all feverish symptoms, and discovered a great number of pustules, which rose, filled, and ripened without any further illness; so that he did not think it necessary to send me any notice of them. Looking in his face, I saw about thirty marks of small-pox, which confirmed the truth of his report.

I have also since received a very satisfactory account that many pustules in his face and other parts which came out after the time I saw him, stayed a proper time, and maturated completely.

CASE XVIII.

A middle-aged man, on the sixth day after he had been inoculated, complained of pain in his head and back, and had a slight degree of fever. These complaints remained till the 8th, when there appeared some eruptions on the face, which I took to be variolous: but it is to be noted, that having lived pretty freely, his face was very red and full of pimples; and neither the preparation nor medicines had much altered that appearance; so that it was no easy matter to distinguish between those which were habitual to him, and the fresh ones. The arm at this time was very considerably inflamed, as is usual about the time of eruption.

On the 9th he was perfectly well, and no more eruptions shewed themselves.

Having had several patients, who undoubtedly passed through the distemper with no more illness than this man had felt, and sometimes even without any eruption, I really thought that the affair was over.

On the 10th he took a laxative draught, eat a piece of mutton, and drank some ale. On the afternoon of the same day I found him complaining of a pain in his head, which he thought was occasioned by his venturing abroad during the operation of the purge. He had now more fever than at any other time before; however, as he averred that his complaints were such as he usually felt from a slight cold, I did not apprehend any thing more.

On the 11th in the morning he was still much indisposed, and had rested ill. In the evening of the same day I found him much better, but he said there were more pustules on his back. These I did not see.

Next morning I found he was gone to a friend’s house, having left word that he was quite well, and that I should hear from him if there was occasion.

On the 14th I was desired to visit him, when I found a moderate number of fresh pustules on the face and limbs, and in such forwardness, that I was convinced they had been out ever since his removal; which indeed was confirmed by the account he gave me: these maturated kindly, and he remains in good health.

CASE XIX.

A gentleman’s son in perfect health, between four and five years of age, on the third day after inoculation voided a long round worm alive, after having taken on the preceding night a dose of mercurial physick. No signs of worms had hitherto been observed in him; and he afterwards seemed to be quite well, till the symptoms which usually precede the small-pox came on.

After a very moderate illness, an eruption of about twenty pustules succeeded, and all complaints then ceased; so that on the 4th day after the eruption, I proposed, and was permitted, to discontinue my visits for the present. I called again however on the 6th day, and found him well as usual, and at play, the pustules being then nearly maturated.

I was informed, however, that in the night of the 4th day, he had been hot, feverish, and restless; was very well the day following, and hot again at night, but in a lesser degree; so that this slight illness did not then give the least alarm. But on the 7th day, early in the morning, I was called up to visit him as soon as possible, and was informed that in the beginning of the night he grew extremely hot and delirious, and soon became stupid, drowsy, and senseless; in which condition I found him, grating his teeth, with convulsive motions about the mouth.

The pustules were at this time quite ripe, and looked, as they always had done, extremely well. His pulse was very quick, though the heat was now moderate, and the respiration free and easy; but he was so comatose, as not to be roused, even so much as to open his eyes, by any disturbance that could be given.

In this alarming situation I desired the assistance of the physician, who on other occasions had usually attended the family. At our consultation, which soon followed, it was agreed, that as the small-pox were very few in number, had always looked well, and were now completely maturated, the present symptoms must be occasioned by worms, or some irritating cause in the bowels.

With this view a dose of rhubarb and calomel was immediately prescribed and exhibited, though we were obliged to open the mouth by force, and this not without some difficulty. The operation of this medicine was accelerated by a clyster, and a large fœtid slimy stool, followed by some smaller liquid ones, was procured that afternoon.

The child, however, seemed to be almost totally insensible during this time, nor did he yet appear to be in any respect relieved by these evacuations: blisters therefore were successively applied to the back, head, and legs, and sinapisms to the feet; leeches were likewise fixed to the temples, and rhubarb with calomel, after some little interval, again directed; tin medicines being given between whiles.

By these means, though not till a considerable quantity of slimy and extremely offensive fæces had been discharged, some signs of amendment appeared. But the child still remained in some degree comatose till the fifth day from this attack; after which the progress of amendment was very quick, and in two or three days he got quite well, and has so continued.

CASE XX.

In May 1776, I was desired to visit a considerable farmer, aged 68, to give my advice for a complaint in his legs.

About two years before he had been seized with a numbness and coldness in both legs and thighs, which it was apprehended would end in a palsy. For this disorder he took many medicines, and both his legs were blistered, by which he found relief; but from this time the legs were affected with troublesome itching and burning pains, attended with a sharp serous discharge through innumerable excoriations. These complaints destroyed his rest, and made him unhappy.

After relating this case, he told me, that as almost every body in the neighbourhood, who had not had the small-pox, was either under inoculation or preparing for it, he could scarcely expect to escape the infection, and had therefore a strong desire to be inoculated; and that his wife of the same age with himself, was likewise desirous of it.

This proposal induced me to examine the present condition of his legs more strictly. They were now, he said, in their best state; that is, not so full of pain as usual; they were dry and scurfy. His face was likewise scurfy, and of a settled deep red colour; the consequence, as he told me, of a repeated Erysipelas in it, and not of any intemperance.

Upon considering the case, and reflecting that the preparatory course of diet and medicine would probably amend the condition of his legs, I encouraged him to pursue his intention; and both he and his wife, after a fortnight’s preparation, were inoculated on the third of June.

On the 9th both made some slight complaints; and on the 12th the wife grew better, on the appearance of a very few distinct pustules, which maturated afterwards in the most favourable manner. But the man still complained of pain and weariness till the 13th, when he grew easier in that respect, and felt a smarting pain in his legs, which were very red, and had several pustules on them. Towards evening they grew more painful, more swelled, and a further eruption was discernable, though not easy to be distinguished, by reason of their diseased state.

He slept very little this night; but on the 14th I found him free from fever, and pretty well in all respects, except the pain in his legs; on which, and under the hams, a great number of distinct, but almost coherent pustules appeared. There were several also in the neck and face, but very few on the body or arms. He had all along been advised not to stir much, but had taken greater liberties of walking about than I had allowed.

15th. He had not slept a minute during the night. I found him up and walking about the house, complaining much of pain, but saying that in other respects he was well; but he was now rather cool than warm, his pulse very low, his aspect languid, the colour of the face inclined to livid and pale, and he complained of faintness and sickness. I could not avoid being alarmed. The legs also were swelled considerably, but not inflamed. I therefore ordered him instantly to bed; and as the tension was great, applied a cataplasm of bread and milk (being what was nearest at hand) all over each leg, and directed the following medicine to be taken as soon as possible.

℞ Mithrid. Ʒss. Decoct. Cort. Peruv. ℥ij. Tinct. Cort. Peruv.
simpl. Ʒij. M. f. haust. quam primum sumend. & sexta quaque hora
repetendus.

℞ Sal. Absinth. Ʒj. succ. Limon. ℥jss. Decoct. Cort. Per. ℥vi.
Tinct. Cort. Per. simpl. ℥jss. Syr. é Cort. Aur. ℥ss. M. f.
mixtura, cujus capiat Coch. iv. horis intermediis.

In the evening his pulse was raised, he was easier, and rested about an hour.

16th. In the morning, after he had rested some hours in the night, he was easier, warmer, and the pulse better.

17th. After a good night he found himself free from complaints, and from this time every circumstance went on favourably; the pocks maturated on the 7th day; his legs however were both considerably ulcerated for a fortnight after, but then soon healed. He remains at present in good health, and feels less uneasiness from his legs than he did before the inoculation.

CASE XXI.

A middle-aged woman was inoculated, May 15, 1765. She began to complain on the 23d; the fever and other symptoms were very moderate. On the 26th an eruption, distinct in kind, small in number, shewed itself; all the eruptive symptoms ceased, and she seemed perfectly well.

On the 29th she complained that her throat was sore, felt stiff, and swelled; but as this is not unusual, little regard was paid to it.

30th. She rested ill, her throat was worse, and it now gave her great pain to swallow. She had also been taken with a shivering fit, succeeded by fever. On inspecting the throat I could not perceive one pustule there, but the uvula and tonsils were very much swelled and inflamed. An acidulated gargle was directed, and a lenitive purge, which in the evening had operated thrice; the gargle had been frequently used, but the difficulty of swallowing was greatly increased, insomuch that she could get nothing down; the fever too was rather increased. Further help could not now be expected from internals; for upon making the trial, liquids returned through the nose. I directed a blister to be applied to the throat, and that she should frequently gargle with warm pectoral drink.

31st. She had not slept a minute, being disturbed, whenever she attempted it, with such sudden startings as made her afraid to sleep. The feverish heat was not very great, the pulse extremely quick, and all the liquids she attempted to swallow still came through the nose. She could not lie down in bed, and therefore sat up in an easy chair the greatest part of the night.

The pustules, which in the face did not exceed twenty, and very few appeared elsewhere, advanced to maturation kindly, without receiving the least check from this adventitious illness. Her speech was so much affected as scarce to be understood. She informed me, however, that she was subject to an illness of this kind; and had once narrowly escaped with her life, but had never been so bad before. I directed twelve ounces of blood to be taken from the arm, and that the sublingual veins should be pricked. But no relief seemed to be derived from any of these measures; and upon inspecting the throat again, the glands, uvula, and fauces were very much inflamed and distended. The tonsils were then lanced pretty deep, and a good deal of blood being discharged, the swelling of the parts subsided, so as to admit her to swallow, though with difficulty, a little pectoral drink, and afterwards few spoonfuls of milk pottage.

June 1st. She had rested but very little, though exceeding drowsy, and worn out for want of sleep; for the sudden startings, upon closing her eyes, still remained, though not in so great a degree as the preceding night; but she had swallowed some liquids, though with great difficulty. The feverish heat was not very great, the pulse quick and more feeble.

On inspecting the throat towards noon, the swelling, though somewhat abated, was still considerable enough to prevent much being swallowed.

In this dangerous situation the operation that had administered some relief was repeated, and other parts of the tonsils and fauces, which had not been wounded before, were now lanced pretty deep; a large quantity of blood was discharged, the parts collapsed, and in less than an hour she was able to swallow liquids; after which she got some refreshing sleep, recovered fast, and is now in good health. The pustules, notwithstanding this illness, advanced very kindly to maturation, and turned on the 7th day from the eruption.

CASE XXII.

A healthy middle-aged man, rather of a corpulent habit, was inoculated, had a slight cold fit (on the 5th day inclusive after the operation) which lasted but a very short time, and was not succeeded by either fever or complaint of any kind.

His arms at that time shewed certain signs of the infection having succeeded, which continued advancing to the 9th day, when the inflammations about the incisions appeared considerably spread, and were surrounded with confluent clusters of very small pustules. In other respects he was perfectly well, and felt not the least stiffness or pain in the axilla, or elsewhere; insomuch that he began to be uneasy least he should have no appearance of small-pox.

On the 10th several small pimples were to be seen on the forehead, which I should have thought small-pox, if he had not at this time been quite well, brisk, and hearty, without having felt any previous complaint.

On the 11th in the morning many more were to be seen on the face, limbs, and body, so that he might be said to be very full. I now examined him again very strictly, and could not find that he had been in the least ill; and on inquiring how he had slept, he answered, Never better; for he went to bed about ten, and did not wake till near seven in the morning. The eruption, on a close inspection, had such an appearance as would have made me pronounce it the small-pox of an unfavourable kind, if it had been preceded or attended by any feverish or other complaints; but I must confess, that even at this time I supposed it was only an inoffensive rash, as the patient was then, and had been, intirely free from any complaint.

All this day he continued perfectly well, had walked out of his own accord into the fields, and in the evening asserted that he never had been easier or better in all his life; though, as he confessed to me afterwards, he had been in some company where he smoked his pipe, and drank his share of a quart of ale. Still the pustules remained, and increased in number, though not in size; and nothing but the consideration of his having had none of the complaints which usually precede even the slightest kind of small-pox, kept me in any doubt whether they were the small-pox or not.

The next morning, being the 12th, the attending nurse told me that he had passed a very restless night, with much complaint of pain in his head and back; and I found him very uneasy, with great heat, a quick pulse, and very full of a small sort of small-pox indisputably.

These complaints coming on at this unusual time made me apprehensive of the consequences. I gave him directly calom. gr. iij. tart. emet. gr. 1/8, and advised him to get up and go into the air, but not to fatigue himself too much. I also directed that after two hours he should take a purging draught. [It is to be observed that he had had stools every day regularly; and remaining perfectly well, had taken no medicine for some time.] I called on him again about two, and found him walking about the house, when he said he was better, for that the physick had worked him five times very sufficiently, and each time he had been abroad to the privy, though it rained pretty smartly.

I saw him again in the evening, and then he made but little complaint of pain in either head or back; but was almost incessantly seized with a short tickling cough, and complained of his throat being sore. He then took another pill of the same kind as that in the morning.

Early the next day, the 13th, the nurse informed me that he had been very restless the whole night; had put on his cloaths and came down stairs, but was now gone into bed again, in hopes of getting a little rest. On going into his room I found him almost dressed again, complaining that he had an almost constant irritation in the throat, and finding it impossible to get any sleep, was therefore coming down stairs. I enjoined him, however, to keep within doors.

About one I saw him again; he had had two stools, and was better. His cough remained somewhat troublesome, and his throat grew sore.

In the evening I found him in good spirits, with a regular quiet pulse, and he had one more purging stool. I ordered another pill of the same kind to be taken at going to bed, and a bason of small white wine whey after it; also an oily mixture to be taken occasionally, to relieve his cough and the tickling sensation in the throat.

The 14th in the morning he had some comfortable rest, and felt himself refreshed; his cough had been much better, so that he had taken but once of the oily mixture. This day he had three stools from his pill; and the small-pox had advanced in an unexpectedly kind manner.

From this time nothing material happened; the cough left him, and his throat gave him no trouble.

The pustules filled with good matter in a shorter time than I ever saw such a number of so small a sort, and many were brown on the 17th day, being the 7th from the first appearance.

On the 19th he took a purge, and was perfectly well.

To these cases many others of a similar nature might be added. But by several unforeseen delays, not in my power to prevent, I have been obliged to trespass so much already on the patience of those who wished to see some account of this practice, that I shall only mention a few, which, by a partial or untrue relation, might possibly be construed to the disadvantage of inoculation; though when the particular facts are candidly exhibited, every just occasion of prejudice will undoubtedly be removed.

During the autumn of the last year the chin-cough was epidemick at Hertford; and as the winter approached, the small-pox also broke out in many places; and almost every child, who before had the chin-cough, and was seized with the natural small-pox, died of a confluent kind. This calamity fell severely among the poor of this place, many of whom earnestly entreated me to inoculate their families; but this was scarcely possible, unless some necessary provision could be obtained for them from the parishes to which they belonged; I therefore acquainted the clergymen of the respective parishes, that if proper care was taken that necessaries were not wanting, I would freely inoculate and attend all such as I thought were proper subjects.

Both the gentlemen approved the design; but after a short consultation with their parishioners, the affair was put off, the parish officers alledging that they could not provide proper places.

That such a design had been in agitation soon became known, and a number of poor people were continually soliciting me to inoculate them and their children at all events, promising to provide for themselves to the utmost of their power. Some had the disease already in their families. It was so much in the neighbourhood of others, that they were in daily fear of taking the infection, and their distress on this occasion was great. Women with children at their breasts, in want of all necessaries, yet solicitous for the safety of their offspring, pressed me to inoculate them and their children with an importunity not to be described. I acquainted them with the danger attending the infant state; but reasons availing nothing, I yielded to inoculate all who had not the chin-cough, or any other dangerous illness, though against my opinion and inclination, almost against my determined resolution. Amongst a very great number of such subjects of all ages and constitutions, and where some might reasonably be presumed to have taken the infection in the natural way, I expected some disagreeable events would happen; but the probability of saving the lives of many preponderated. The following however are the only cases that border on the unfortunate; and the reader will, if skilful and candid, easily place them to the right account.

A mother and three children (one of them at the breast) were inoculated. The children had then the chin-cough; but this was carefully concealed from me, as I had refused all under such circumstances. The youngest, of about five months old, had only five or six pustules in the face, and not more elsewhere proportionably. She lived past the crisis; but the cough remained violent, and she was much enfeebled, and died as children do who perish by the chin-cough, and without any one circumstance of danger that could be supposed to proceed from inoculation.

Another weakly child, about five months old, I had persuaded the mother to wean, in order that she herself might be inoculated. During the preparation this woman fell ill of a fever, as supposed; but on visiting her, I found the confluent small-pox appearing, and that the child had lain with her constantly. I was earnestly solicited to inoculate this infant, in order to give it a better chance, which with great reluctance I yielded to; it had a very small number of distinct pustules, and passed through the disease safely; but not being reconciled to any food but the breast, it died soon after, languishing for want of proper sustenance.

Another unfortunate subject was also a child at the breast, one of eight children, who with the father and mother were inoculated together. On the third day from the inoculation this child was seized with a fever, which, from the symptoms, I suspected arose from worms. I gave it a grain of calomel; a large worm was voided the next day, and the child was seemingly better; but the fever returned at night, and continued without remission in such a manner as to be very dangerous in itself, and prevented any distinction of the eruptive symptoms: at length a confluent kind appeared, though the number was not great; the bad symptoms were not alleviated by the eruption, and the child died early in the disease.

All these cases happened since the introduction and first chapter were written; and have confirmed my opinion, that it is better, both on account of the subject and the reputation of the practice, to defer inoculating children till they are about two years old.

It seems not improper likewise to mention the following case; which, if the whole truth is not related, may possibly afford matter of cavil against inoculation.

A short, thick-set, middle-aged man was seized with the usual symptoms on the eighth day after inoculation. The eruption was favourable, the crop moderate, the pustules large and distinct, and no peculiar care was either required or observed. The pock maturated in seven days; after which he took two purges, and had fixed the day for his return to London.

Two days before his intended journey I found him in the morning sitting by the fire, with his hand upon his head. Upon inquiring the reason, he answered, My head feels very queer to-day: a person in company added, that he had made too free with mutton the day before: but this he denied. He did not however seem much indisposed; he had taken a purge, and I expected he would be relieved by its operation.

Next morning he told me he had had a good night’s sleep, and was perfectly well; nevertheless, two hours after he fell down suddenly in a fit, and senseless. In this condition I found him about six in the evening, and so he continued till the night of the following day, when he expired, perfectly apoplectic, in spite of every means we could attempt for his relief.

CASES of the natural Small-pox, treated in the preceding Method.

CASE XXIII.

One morning about ten I was desired to visit a poor man in a fever. Two days before, in the evening, he had been seized with a shivering fit, which was then supposed to be the ague; he soon grew extremely hot, with pain in his head, back, and loins, which continued till I saw him, the 24th of October: he had kept his bed, had scarce any sleep, his heat great, pulse strong and quick, and the pain in his loins very severe. This man had applied to me to be inoculated a little before he was taken ill, on account of the small-pox being very much in his neighbourhood; but he had not as yet taken any preparatory steps. I made no doubt but he was now attacked with this disease, and from the severity of the symptoms expected it would prove of the confluent kind. As he lived near me, and I could easily attend to every circumstance, I determined to try how far the cooling method might be beneficial in treating the natural small-pox.

I found it very difficult to persuade him to rise out of bed, as he thought himself utterly unable to support himself, notwithstanding he was on other occasions a resolute man. Assuring him however that I would not attend him, unless he would comply, he promised to use his utmost endeavours. I left him to put this advice in practice, and ordered him to a carpenter’s yard about one hundred yards distance, where I promised to meet him.

In about a quarter of an hour I found he had reached the place of appointment, by the assistance of a neighbour, and was sitting on a bench, complaining of great weakness, and pain in his loins; which he described, by saying he felt as if he was cutting in two; but allowed that his head was easier since he had been in the air. Finding that he had had a stool the preceding day, but none since, I gave him a pill, containing about six grains of calom. and 1/8 gr. of emet. tartar, immediately; and as he complained of great thirst, I permitted him to drink half a pint of cold water after it. I advised him not to sit, but to endeavour to walk about a little, though ever so slowly; this he attempted, but went almost double. At this time the weather was not very cold, but there was a pretty brisk wind, with small rain.

About a quarter of an hour after, I saw him again. He had resolutely persisted in following my directions, and said his head was greatly relieved, but the pain in his back and loins was much the same. His pulse was now much altered; instead of being full and strong as before, it was low, but quick, and the heat on the skin greatly abated. As he seemed much fatigued, I did not insist on his keeping abroad longer, but permitted him to go home, desiring him to refresh himself, but not to pull off his cloaths, or go into bed.

At two o’clock I saw him again; his pill had then worked twice; he seemed fatigued and faint, but was abroad, for he said the air refreshed him, and his head was easier in the air than within, so that as soon as he was a little rested he came out by choice. The pain in his loins still remained very grievous, but his head was much easier; and his back and loins became less painful towards evening. I allowed him to go to bed about seven; but being desirous of observing the full effect of this kind of treatment, I ordered no medicine.

25th. Had but little rest, and his complaints nearly the same as when he went to bed. His pulse was now raised, and more full than in the evening, and the degree of heat greater than over night. A few small pustules were now beginning to shew themselves on his face; I directed a purging draught of infusion of sena and manna, quickened with jalap; advised him to get out of bed, and venture again into the air. This he did: by two o’clock the purge had worked thrice, and he was freer from the pain in his back and loins: more pustules now appeared in the face, but scarce any on the limbs. He had hitherto taken nothing since his first seizure, but tea with milk, sage and balm tea, loathing all other nourishment. He persisted in keeping out the greatest part of the afternoon; and at seven went to bed, when I found the pulse more calm and regular, and as his complaints were less violent, he began to think of nourishment.

26th. I saw him at seven in the morning; he had slept but little, had one purging stool in the night, and felt himself low and languid; his pulse was now even, full, and regular, and his heat moderate. Many more pustules were out in the face, though but few on the limbs, and his complaints of pain in the head and back went off. He took milk pottage with some appetite, and spent the greatest part of the day abroad.

At three in the afternoon I saw him, and was told, that lying down in the bed he had fallen asleep, and waked almost choked with blood; that he had vomited up a considerable quantity, which doubtless had been swallowed, as he was found bleeding at the nose. From what I could learn, the whole scarcely exceeded six or eight ounces. He complained of faintness, and said his pains were removed. I ordered him to drink the pectoral decoction, acidulated with a mixture of equal quantities of sweet and weak spirit of vitriol. The number of pustules continued increasing slowly on the face and other parts.

Late in the evening I saw him again; two more purging stools had followed; he complained of being very faint and low, and feared he should have no rest.

I now thought it proper to give him an anodyne cordial, and therefore ordered mithrid. [ounce]ss. which he took immediately. By the help of this he passed a very refreshing comfortable night, and thought himself quite well. The eruption was now completed; the small-pox might be properly called distinct: though full in the face, he had only a moderate number of a large sort on all the other parts; and he went through the succeeding stages without any difficulty.

CASE XXIV.

A young woman, who was servant in a house where a child had the small-pox in the natural way, determined to stay there and take her chance.

December 25th, 1765, I was desired to see her. She had been taken with a cold fit the preceding afternoon, which was succeeded by a fever, and the usual symptoms attending the eruption, but in a severe manner. I found her in bed, making great complaints of pain in her head, back, and loins; her pulse strong, quick, and full; a flushing red colour in the face, and the fever very high.

With much difficulty I prevailed upon her to get up; ordered her to drink some cold water, and go abroad into the air, though it was a very frosty morning, with sleet. At one o’clock I called again, and found her then below stairs walking about. The heat was much abated, her complexion pale, the pulse small and quick, and all her complaints considerably abated.

The account I received from her, and the persons who attended her, was, that upon first going into the air, she was so feeble, that the nurse, and another to assist, could scarce support her, and it was with much difficulty that she could walk with this assistance; that she drank a glass of cold water from the pump, and before she had been abroad many minutes found herself much easier, and had remained so ever since. It now rained pretty hard, which had obliged her to come in; but she said if her complaints returned, she would certainly go out again, be the weather ever so bad, and in this resolution I encouraged her.

On the 26th, about eleven in the morning, I visited her again, found she had passed a pretty good night, and had felt no remarkable uneasiness; she had been abroad several times the preceding day, to which she imputed the ease she enjoyed. Two pustules of a distinct kind were now out on the face, and she had the disease in a very favourable manner, without the least bad symptom during the progress, or any ill consequence afterwards.

CASE XXV.

Jan. 3d, 1766.] A healthy young man was inoculated in company with four of his neighbours. On the sixth, presuming that none of them would be ill, I went to London on business. Returning on the 7th in the afternoon, I was met by a servant, who informed me that this man had been taken ill on the 5th in the afternoon, had continued very bad ever since, and now had something broke out, which was suspected to be the small-pox, and that I was desired to visit him immediately: this I complied with, and found him in bed, complaining much of pain in his head, back, and loins, with great heat. Some small pustules were out on his face, which I perceived to be the small-pox; this was at five in the evening, and much about forty-eight hours from the first seizure.

The weather was at this time exceeding cold, and it froze very hard. I ordered him out of bed immediately, to drink a glass of cold water, and to get some assistance, and walk abroad in the air. Upon inquiry I found he had passed without a stool the whole day. Five grains of calomel in a pill were ordered to be taken immediately. He rested but little this night, and next morning a great many more pustules were out in the face, sufficient to shew a disposition to flux. As this pill produced no manifest effect, I ordered sal. glaub. [dram]vi. dissolved in water gruel to be taken immediately. The vehemence of the fever and other symptoms were scarcely moderated by this eruption.

Notwithstanding the medicine and the severity of the weather, I desired he would get on his cloaths, and go into the air as much as he could possibly bear; and in the evening ordered him to be carried in a chaise to the house provided for him in case he had been ill from inoculation. I examined the incisions carefully, but there were not the least signs of the infection having succeeded, either by discolouration, hardness, or any alteration on the skin, nor could he recollect that they had itched, or given him the least uneasiness.

In the evening he came to the house as ordered, but was so very feeble and full of complaints, that it was with great difficulty he was got to his room. Upon inquiry I found he had vomited up the salts soon after taking them, and had only one costive stool; he had complied with my orders about getting into the air several times in the day, though with great difficulty. His complaints of thirst, pain in the head and back, were at this time very great. I directed him to sit with his feet in warm water for a short time, and, on going into bed, to take a few spoonfuls of a laxative mixture, which was to be repeated till he had stools.

9th. He had been delirious in the night, but rested a little towards the morning; the number of pustules was now considerably increased. This day he had three stools from his purging mixture, by which he was relieved, and bore sitting up better.

10th. He passed the night easy, but without sleep. He was very full in the face, but had a smaller number on the body and limbs. No complaint, deserving notice, happened during the progress to maturation. He sat up a part of every day to the eighth from the eruption, when, being blind, and very sore, he kept in bed: they turned on the eleventh, and he recovered perfectly.

It was remarkable in this case, that the inoculated parts never shewed the least signs of infection; nor did a greater number of pustules appear near them than might have been expected if nothing had been done; nor is there to be seen the least mark where the inoculation was performed, though in all other inoculated patients who have had the disease, even in the slightest manner, there constantly remains a scar.

It appeared, on inquiry, that this man had been, for a considerable time before, in a constant intercourse with families in the small-pox; and there seems not to be the least doubt but his was the natural disease.

CASE XXVI.

A young woman was seized with a fever, and the usual symptoms. The next day an eruption appeared, which gave some suspicion of the small-pox: on the third day more spots were discovered, but she was not relieved. The disorder was now supposed to be an inflammatory fever, attended with a rash; and as she was extremely delirious, a blister had been applied about two hours before I first saw her. The face was extremely full of very small pustules, which indeed were the small-pox, and there was a considerable number on the neck and limbs; but notwithstanding this eruption, the fever was very high, and the degree of heat so excessive, that I scarce ever felt a person hotter; she was so far sensible as to complain of great pain in her head, stomach, and loins, though very delirious and extremely restless. She was at an inn much used by carriers, and it was highly improper she should remain there. In her present situation I was sensible it might appear very hazardous to move her; but it was evident that the small-pox would be confluent. I judged from the violence of the symptoms the disease would be dangerous, and the event doubtful, and was therefore desirous of trying how far the same method and remedies, which were used so successfully in the inoculated small-pox, as well as in some cases of the natural disease, would avail in this. The necessity of removing the patient afforded me a good opportunity, without any imputation of rashness. I therefore proposed her being taken down stairs into a parlour under the room where she then lay, while I was present, and ready to assist, if the fatigue should be too much for her; this was consented to; the women assisted in getting her cloaths on, which she seemed much pleased with, being then delirious. She was altogether unable to stand, and was therefore brought down by three persons in the same manner as if she had been dead. She was then placed in a chair, but had not even strength to hold herself upright, but was supported in that posture by the women about her.

The fatigue of moving, and change of posture, occasioned a faintness, in which she lost all colour, and the pustules for a time disappeared; upon this, the chair was leaned quite back, the bed was brought down, and laid on the floor, she was placed on it with her cloaths on, and eagerly drank a glass of cold water. Her colour soon returned; the pustules appeared as before; but she was considerably cooled, and her pulse, though it retained the quickness, was not near so strong. I stayed with her about half an hour, during which time she was more sensible, and not so restless, but seemed languid and tired. I ordered the window to be opened, the room to be kept cool, and gave her three grains of calomel, tart. emet. gr. 1/8, in a pill, and directed a purging draught to be taken as soon as it could be procured, and as there seemed no occasion for the blister, it was taken off.

I saw her next morning at a house to which she had been removed at a small distance, and found her almost free from complaints; she had rested moderately well, and was perfectly sensible. Those about her dated her amendment from the time when the purge (which had procured three stools) began to operate.

She was however extremely full all over of a very small confluent kind; yet these inflamed and maturated in a very favourable manner. From the minutest observation I could make, it seemed to me that by this management the number in the face was less than when I first saw her, consequently that some pustules were repressed after they had appeared.

CASE XXVII.

In the beginning of June 1766, a young woman was taken with a shivering fit, succeeded by a fever, and the symptoms that usually precede the small-pox, in a very violent degree: these were attended with such general weakness, that in a few hours after the seizure she was obliged to go to bed, where she soon became delirious, and afterwards insensible, her urine passing involuntarily; in this condition I first saw her about forty hours after she was taken ill. The heat was excessive, her pulse extremely quick, but not strong, and a few small eruptions appeared on the face, sufficient to ascertain the distemper. Upon raising her up she did not make the least effort to support herself, and therefore was permitted to lie down, and as the room was small, the window was set open. Five grs. of calomel were with great difficulty got down; and an infusion of sena and manna being prepared, the person attending was desired to give a little and often, till she had a stool.

It was very improper that she should remain in the house where she was, on account of the family; yet there was no possibility of moving her in her present condition. Next morning I was informed she had remained in the same stupid way the whole night, but was now rather better, and had spoke more sensibly, had two stools, and vomited up some bilious matter. The heat was still great, the pulse quick, and many small confluent pustules were out on the face and other parts: this was the third day of her illness. I advised her being got out of bed, and the windows to be kept open; but was in doubt whether she had strength enough to be taken into the open air.

In the evening the eruption was increased considerably in number; and she was so much eased of her complaints, as to bear being removed in a cart to a house in the neighbourhood, where I gave her calomel three grains, emetic tartar one eighth of a grain.

She had some rest this night, but the fever continued; and not having had any more stools, she was ordered to take a laxative potion of inf. of sena and manna. She had three stools before evening, and all her complaints abated. She was very full all over of a very confluent kind.

This young woman sat up the greatest part of several days after she was quite blind, by her own choice; and I do not recollect ever seeing one with so large a crop of pustules, who went through the disease so easily; for she made no complaint but of soreness, nor took any medicine but a few drops of thebaic tincture at bed-time, towards the crisis.

CASE XXVIII.

A poor man about 35 years of age, who had gone through the preparatory course, came to my house in company with several more, in order to be inoculated. As soon as he came into the room, I perceived he was ill, and on inquiring he told me, that about two hours before he had been taken with a fit of the ague, and that his head, back, and loins were in great pain. Feeling his pulse, I found a good deal of fever, his skin was also very hot. I knew the small-pox was in his neighbourhood; and thence concluded he was seized with this distemper. I advised him to keep abroad in the air as much as possible, and directed a pill of the kind already mentioned at night, and a purging draught the following morning.

These operated four or five times, and he persisted in obeying my orders; the fever and other complaints were not so high as to give any great alarm; he had a pretty large number of a distinct pock, and went through the distemper very well.

CASE XXIX.

About three in the afternoon I visited a middle-aged man, who after two days illness had an eruption, which the neighbours suspected to be the small-pox; I found him in bed, very hot, and in a sweat; his pulse quick, full, and strong; his face pretty full of small-pox, which had begun to appear in the morning. I received the usual account of the preceding symptoms, which had been pretty severe, and he still made great complaints of pains in his head, back, and loins; I immediately gave him a pill, containing cal. gr. v. tart. emet. gr. 1/8, which I had taken with me upon a presumption that I might want it: I also insisted on his getting up, and going abroad into the air, notwithstanding the sweat he was in, which it was my intention to restrain. I met with the usual difficulty in getting this advice complied with; however he was assisted, came down stairs, and went abroad, being supported by his wife; for he seemed very weak, and had not been out of his bed for two days before. As he complained of great thirst, I gave him a glass of cold water, and stayed about half an hour to see the effect of this treatment; he was at first very faint and sick, and vomited up some bilious matter, but not the pill he had lately taken; after this, while I stayed he said his head was better, and allowed he was refreshed by the air. I desired him to continue abroad as much as he could, and when he found himself tired, to go in and lie down a little; but as soon as he was able, to get out again, and if thirsty, to drink as much cold water as he pleased. I then took my leave, ordering a purging draught to be taken as soon as he received it, which I concluded would be at least three or four hours from that time.

Next morning, on visiting him, I was told that the purge had operated four times, that he found himself considerably relieved, both in his head and back, and had rested better than any time since he had been taken ill. The eruption proceeded slowly; but many more pustules now appeared in his face, and other parts, than before; he kept abroad, and his complaints continued wearing off. Next morning I found him quite easy; he was pretty full of a distinct pock, and from this time all went on well, without having occasion to take any more medicines.

POSTSCRIPT.

Many instances might be produced of unjust charges against Inoculation, alledged by those who have opposed the practice: but I should not at this time, and in this country, where the prejudices are pretty well removed, publish any case of the following kind, if the inadvertence of a translator had not made it necessary, in defence of my own character.

Dr. Baylies, an ingenious and learned English physician, had been called from Dresden to Berlin, in 1774, to inoculate some families of persons of condition; and the King of Prussia so far approved the practice, as to appoint him his physician.

After the most perfect success with several patients, a child who had been inoculated by him, was, about two months after, seized with a distemper which proved mortal, and the physicians who attended, asserted that the child died of the small-pox.

In vindication of his own character, and the practice of Inoculation, Dr. Baylies had the case of this child stated, and copies of it were transmitted to Dr. Watson, Dr. Archer, and myself, requesting our separate opinions.[7]

[7] Our opinions were essentially the same, but I neither thought it right to take the liberty, nor would it be of any importance to the matter in question to insert those of the other gentlemen.

The ungenerous treatment Dr. Baylies met with in this, and other respects, induced him to publish a tract on the occasion, in French, in which our opinions were inserted; and he was so obliging as to send me one of them.[8]

[8] Memoire concernant l’etat de l’Inoculation de la petite Verole à Berlin, &c.--A Dresde 1776.

I was greatly surprized to find what I had written, so erroneously translated, as to misrepresent my meaning in a most essential point. I therefore wrote to Dr. Baylies, and complained of the injury, requesting that he would endeavour to do me justice, in the manner he thought most effectual.

Notwithstanding this was generously complied with by Dr. Baylies, as far as he was able, I have reason to think, that some of the first copies are dispersed, and remain uncorrected; which I hope will be deemed a sufficient reason for publishing the following correspondence.

CASE.