Part 5

Take compound powder of crabs claws, one scruple; emetic tartar, one grain.

This operated moderately by vomit, discharging some bile, and also twice by stool. The stomach was much relieved, but the rash remained, and put on so much the appearance of a confluent eruption, that I could scarce be satisfied it was not so, though I had seen in the same person but a few days before a smaller degree of the same rash. What made the case more doubtful was, that the fever still remained pretty high; and her head and back were not much relieved by this eruption. In this situation I did not think it adviseable to expose the patient to the open air, but directed only a saline mixture, with compound powder of crabs claws, and that she should keep her room, but not her bed.

On the 10th a few distinct pustules were to be distinguished, the rash began to look fainter, and the whole terminated in a very favourable distinct eruption, without any particular accident: the skin peeled off universally, as is not uncommon after a rash.

CASE XV.

A man aged 44, on the sixth day after inoculation, began to complain of pains in his head and back, and of being frequently very cold. These lasted with great severity, insomuch that he took the alterative pill, a purging draught, and kept much in the air till the 9th, when about ten pustules appeared, and his complaints ceased. These seemed likely to dry away without maturating, which is not unfrequently the case where there are very few.

On the 12th he took a purge; his arm remained considerably inflamed; but as he was very desirous of going to a relation’s house, where he proposed to be aired, I consented to it.

On the 16th I was told he had been much indisposed since his removal, and that he wished to see me.

On the 17th I visited him, and found a considerable number of pustules, to the amount of about 40, in the face, of true small-pox. The account he gave me was, that he found himself very ill on the evening after his removal, and that he perceived the pustules the next morning. This was on the 14th day from the inoculation, and the forwardness they were in agreed well with his account. His arm continued much inflamed, with many pustules near the incision.

CASE XVI.

A healthy young man was inoculated December the 6th, 1766. On the 11th and 12th he was cold and hot alternately, and complained of great pain in his head, back, and limbs.

The 13th he was much easier, but still felt pains in his head and back. The inoculated parts, which from the operation till this day I had no opportunity of seeing, shewed evident signs of infection; but the skin at the incision was pale, not elevated, nor did a thin fluid appear under the cuticle, as is usual when the progress of infection is favourable; neither had he felt much uneasiness about the incisions, or stiffness in the axilla.

14th. He was free from all complaints; the discolouration on the arm had spread wider, and two or three pustules were discovered near the place of insertion.

15th. Many pustules appeared in different parts, about one hundred.

16th. The pustules were properly advanced, and the man seemed to be perfectly well. But there were now some appearances in the arm which I was dissatisfied with: for the inoculated part was covered with a great number of very small pale-coloured confluent pustules; and the incision, instead of being elevated, was depressed, and of a livid colour in the middle: this sometimes happens, and denotes an eschar and ulceration at the conclusion of the disease.

17th. He was seized in the middle of the day with a shivering fit, succeeded by great heat and pain in the head, back, and limbs, which continued all the following night. He likewise felt considerable pain at the incision, and in the shoulder, extending to the axilla.

18th. In the morning he complained of great pain at the incision up to the shoulder and the axilla of one arm. The pulse was very quick, and the fever high. In this situation I made no doubt but there would be a second eruption, and therefore persuaded him to get up and go into the air, and directed an infusion of senna and manna to be taken immediately.

This operated four times, and he was considerably relieved of all his complaints; but fresh pustules now made their appearance on the face and other parts, to the amount of double the number at least of the first. From this time he remained quite free from fever, and every other complaint; the last pustules, as well as the first, maturating in the most favourable manner. But what is very remarkable, both crops of pustules ripened nearly about the same time; for the progress of those which came out first seemed to be retarded by the second eruptive fever, and the latter pustules advanced quicker than usual.

CASE XVII.

June 2d. Twenty-two persons were inoculated, who lodged at two neighbouring houses.

On the 4th in the evening one of them, a man aged 30, had a shivering fit, succeeded by fever, with pain in the head, back, and side, which continued all night.

5th. In the morning, when I first visited him, the pulse was very quick, full, and strong, and the former complaints remained; but I found him walking about the house. On inspecting the incisions, both were quite well; while those of every one of his associates, which I saw at the same time, shewed evident marks of infection.

This patient had been very much in the way of infection, and I suspected that he was going to have the small-pox in the natural way: I therefore directed the mercurial and antimonial pill to be taken at night, and that he should go into the air as much as he could bear, but not go into bed.

6th. In the morning I was informed that he had been sick and vomited, without having a stool: and that all his complaints remained, though not quite so violent. I prescribed half an ounce of Glauber’s salt, and half an ounce of manna, dissolved in water-gruel, to be taken immediately.

In the afternoon I found him in bed, but was told he had been in the air, and that the purge had operated four times. He was now disposed to sweat, and his pains were abated; but the fever remained as before, with a white dry tongue: he had a troublesome cough, difficult respiration, and great oppression at his stomach; but there was not the least sign of infection in the arm.

7th. In the morning he was much in the same state, only weaker. I prescribed a salt of wormwood mixture, with Mindererus’s spirit, an oily mixture for his cough, and one grain of emetic tartar mixed with 10 grains of compound powder of crabs claws, to be taken in the evening.

8th. He had four stools in the night, sweated pretty well, and got some sleep; but he coughed much, breathed with difficulty, expectorated some thin frothy phlegm, and complained of great pain in his breast and side. Eight ounces of blood were directed to be taken away; the antimonial powder was repeated, with an addition of one grain of calomel; and he was directed to drink frequently a cup-full of pectoral decoction, to a quart of which was added one ounce and a half of Mindererus’s spirit.

9th. The blood taken away yesterday was very fizy, the pain in the breast and side much abated, but the cough very troublesome, and the expectorated phlegm streaked with blood. The inoculated parts were now discoloured, shewed evident signs of infection, and that we should soon have the small-pox to encounter together with the peripneumonic disorder.

10th. Very restless all the night, coughed much, and with great difficulty expectorated brown viscid phlegm. The bleeding was repeated, and the use of the antimonial powder and other medicines continued; which had every day procured some stools, and supported a constant breathing sweat.

11th. The blood was still found fizy, and the fever, cough, difficulty of respiration and of expectoration were increased. The progress of infection in the arm was slow, but shewed, however, that the eruptive fever would soon come on; and I was apprehensive that it would be so confounded with the peripneumonic disorder, as to cause much perplexity. I determined nevertheless to attempt to relieve the latter by whatever means I could, and wait the event; and therefore ordered more blood to be taken, a blistering plaister to be applied between the shoulders, and a small quantity of gum ammoniacum to be added to his pectoral medicines. In the evening I was informed that all the troublesome symptoms were considerably abated.

It must here be noted, that all the company, who had been inoculated at the same time, were now ill, and most of them had some eruptions.

12th. He had had more rest; but though most of his complaints were relieved, yet the fever still continued, and he expectorated with difficulty some very dark-brown phlegm, so that no alteration was made in his medicines.

The appearance on the incisions spread, but did not look as usual when the eruptive complaints are begun.

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.