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.