Part 6

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.