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.