Part 7

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.

Augustus de Blumenthal, a healthy child, five years old, on the 21st of November 1774, was inoculated with matter taken from an inoculated patient, who was loaded with the small-pox, and is greatly marked by it. On the 11th and succeeding days from the operation, the fever and eruptions regularly followed. The pustules appeared on different parts over his whole body, were more numerous than they generally are from inoculation, and maturated, dried, and fell off as they ought to do, and as well as those of his brothers and sister, who were inoculated at the same time, and treated in the same manner from the beginning of the fever, till the disease was over. He was then repeatedly purged, as is usual in such cases, and continued well for above six weeks afterwards; making no complaints till the last day of January 1775, when, while he was at dinner, he complained of being cold, yet afterwards amused himself at play with his companions, and in the evening said that his legs were very weak.

Wednesday the 1st of February, and 2d day of the illness, he arose in good humour, at noon he eat with appetite, but less so at night: during the whole day, at times, he complained more or less of weakness and uneasiness in his legs, sometimes walked about, and sometimes lay down on the sopha, and the succeeding night was restless and uneasy.

Thursday the 2d day of the month, and 3d of the disease, a physician was called, who, finding his pulse agitated, gave it as his opinion, that there was something mixed in his blood which ought not to be there, though he could not say what; and in the evening, to allay the agitation, prescribed him some powders.

Friday, Saturday, and Sunday, the 4th, 5th, and 6th of the month, and 5th, 6th, and 7th of the illness, he shewed great lowness and dejection of spirits, had great weakness in his legs, complained of giddiness, and was embarrassed in his head; yet nevertheless, he had some, though but little, stomach to his food, and during all these three days, a slight looseness, the discharges by which were of a green colour.

Monday the 7th of the month, and 8th of the disease, a large round worm came from him, and he eat with good appetite, though the disorder so increased, that he was confined to his bed, and in the evening became delirious; for the relief of which, a blistering plaister was applied between his shoulders.

Tuesday the 8th of the month, and 9th of the disease, his pulse in the morning was thought to be better; but in the evening the disorder increased, he was again delirious, and blisters were applied to the calves of his legs. In this condition, being drowsy and watchful by turns, at uncertain and irregular times, sometimes answering questions with propriety, and at other times irrationally, he continued from Tuesday till Saturday the 12th of the month, and 13th of the disease, when in the evening, the surgeon in giving him a glyster, perceived some small red spots like flea-bites, to appear on his posteriors, but made no mention of it at that time. At midnight the physician again visited his patient, and found him excessively red and delirious, with every appearance of a violent impetus of blood to his head, and with involuntary contractions or drawings in the muscles of his arms and legs, upon which he ordered the surgeon to apply four leeches behind the ears. While they were drawing, a slight red ebullition was observed upon the neck, which after bleeding disappeared, and the child lay two hours quiet; but then the uneasiness returned, and before morning he was three times alternately affected with accessions of cold and heat, and had cramps and drawings in his arms and legs, like those before described.

Sunday the 13th of the month, and 14th of the disease, in the morning his anxiety and restlessness perfectly left him, and in the course of the day, the delirium so diminished, that about nine in the evening he was quite sensible; when the surgeon being ordered to repeat the glyster, observed that the small red spots which he had before taken notice of, without mentioning, were some of them increased in magnitude to the size of lentils.

Monday the 14th of the month, and 15th of the illness, early in the morning the attendant physician again examined the eruptions, and said that he not only found their number great, but that many of them on the back were broke and subsided while there were others under the skin perceptible to the touch; and a very few on the face and neck, though flat, were round and reddish in their circumference, and white on their tops, so resembling eruptions of the small-pox, that he suspected the distemper could be no other: to put the matter out of doubt, the physician, that had inoculated the child, was called in; who, when he came, observed two or three flat eruptions on the face, to be round, edged with a reddish colour, and whitish on the top, as is above described; but on uncovering the body, and examining the rest, the chief of which were situated on the back, he looked on them to have more the appearance of burns or scalds than the small-pox. They were of irregular forms, like flaccid and transparent vesicles, implete with a reddish watry fluid, with a visible blackness underneath. He could not from their appearance, considered from the time of their eruption, and the early fluidity of their contents after they appeared, see any reason to think them at all variolous, especially as the child had so evidently had the disease from inoculation under his own eyes.

Tuesday the 15th of the month, and 16th of the disease, the physician, who had inoculated the child, called again to see him, when he was informed, that he had totally lost all power of swallowing, and that it was suspected to arise from pustules in the throat. He then went to the child’s bedside, when he not only found many of the before described bladdery eruptions broken, and their water discharged, but all those that were not so, more flaccid and empty than the day before.

Wednesday the 16th of the month, and 17th of the disease, there was very little or no observable change in the morning from the circumstances which had attended the preceding day; yet some glimmering hope was conceived of the child’s recovery; but about two in the afternoon, the melancholy scene was closed by an easy death.

Thursday the 17th of the month, and the morrow after the child’s death, the physician that had inoculated the child called again, to inquire of the father if any thing more, that was material, had been observed between the time he had last seen the child, and the hour of his death, when he told him that there had not, but that since his death the corpse had been inspected and opened, in the presence of four eminent gentlemen of the faculty in Berlin, and that it had been reported to him as follows.

That the external spots, which had been covered with the before described bladders, had many of them a blackish, or gangrenous appearance under the skin; while others that were extremely small, round and flat, seemed to have in them a small quantity of unconcocted matter.

That on one out of the four places on the arms, in which the infection had been inserted in the inoculation, there was found adhering a small dry scab.

That the throat was perfectly free from any pustulary appearance; and that all the viscera were quite sound, and shewed no sign of any disease, either external or internal.

But that on opening the skull, there were, in the lower and back part of the head, four ounces of extravasated water or serum, except which, nothing deviated from a healthy and natural state.

Query. Was the disease above described, the natural small-pox? The effect of any variolous matter left in the blood, in consequence of the previous inoculation? Or, were the pustulary eruptions, which shewed themselves on the 12th day of the disease, a critical discharge of a putrid or other kind of fever?

London, April 11, 1775.

SIR,

I have carefully perused the case you have communicated to me, and am of opinion, that the disease you have described was not the small-pox.

The cold fit which preceded the other complaints, is what usually happens at the commencement of the small-pox in common with other fevers; with this exception, I do not find one symptom during the whole illness, that corresponds with the well known progress of that disease.

The eruptions (on which I presume the suspicion of the small-pox was founded) differed from that distemper in every essential point, viz. The time and manner of their appearance; the parts they occupied; and their form and progress. Neither am I of opinion that the disease was the effect of any variolous matter left in the blood, in consequence of the previous inoculation.

That the natural and inoculated small-pox, as well as other diseases which form critical discharges on the skin, may sometimes be succeeded by boils or breakings out, is well known; but these follow very soon, are free from danger, and easily cured by gentle purges. Now in the case before me, I find the patient passed through the inoculated disease, in a regular, complete, and satisfactory manner, and continued well for six weeks after, making no complaint: after which he was seized with a disease that I have not the least doubt was a fever of the putrid kind; but I do not think that the pustulary eruptions can with propriety be deemed critical, as they did not terminate the disease; I rather esteem them to have been marks or tokens of great malignity and danger.

In the course of my whole practice, which it is well known has been extensive, I never knew a single instance of any one having the natural small-pox, after having been inoculated; nor have I ever known any person to have the disease a second time in the natural way.

I shall not pretend to decide on what may have happened to others; but what I have said is true, so far as relates to my own experience.

The report of the gentlemen who opened the body, affords no material information.

The appearance of the spots, is such as might be reasonably expected on any person who died of a malignant fever. Dry scabs frequently remain on the inoculated parts, for some months after the disease.

T. DIMSDALE.

To Dr. Baylies, Physician and Privy-Counsellor to his Prussian Majesty at Berlin.

London, March 10, 1777.

Dear Sir,

Please to accept my thanks for a very polite letter and a book, both which I received from my learned friend, Dr. Watson. But I am greatly chagrined to find, on the perusal of the French translation of my answers to the queries, that by the insertion of words, not to be found in what I wrote, not only the sense of my answer is perverted, but I am made to speak what is not true, and to give an opinion contrary to my own sentiments, and the experience of every one in the least acquainted with the small-pox.

What follows will convince you, Sir, that my complaint is well founded, and I confide in your honour, for taking the most effectual steps to prevent the injury my character would sustain, if the mistake should not be rectified.

You will please to observe, that at the conclusion of the case transmitted to me, there were three queries, to each of which I gave distinct answers. The third query is: “Or were the _pustulary eruptions_ that shewed themselves on the 12th day of the disease, a critical discharge of a putrid, or other kind of fever?” In my answer, having first remarked that the patient passed through the inoculated disease in a regular manner, I say in reply to the above-mentioned query.

“After which he was seized with a disease, that I have not the least doubt was a fever of the putrid kind; but I do not think that _the pustulary eruptions_ can with propriety be deemed critical, as _they did not terminate_ the disease: I rather esteem them to have been marks or tokens of great malignity and anger.”

The French translation stands thus.

Q. “Ou les pustules qui ont paru le 12me jour de la maladie ont elles été l’evacuation critique d’une fievre putride, ou d’une autre espece de fievre?”