The Present Method of Inoculating for the Small-Pox

Consequences of this Method of Inoculation

I Shall now consider the consequences that follow this very cool and repelling method, and how far the patient’s future state of health may be affected by a practice so new, and opposite to all established theory.

I need not say how much it has been thought right, in most or all eruptive complaints, especially in the small-pox, to forward, by every gentle means, the efforts of nature in producing an eruption; and on the contrary, how dangerous to check it, either by cold air, cold drink, or any considerable evacuations; or that the use of warm diluents, therefore, and the lying in bed, especially if the fever and symptoms run high, or at least confining to the house, have been generally approved and recommended for the purpose. But when a practice so foreign to this, and almost totally different, is inculcated, it is no wonder if men’s minds are alarmed, and those evils expected that were supposed to be the unavoidable consequences of it.

Experience, however, and instances of so many thousands succeeding by this method, without any considerable bad effects from it, either immediate or remote, are irresistible arguments for its support and justification, and the best proof of its utility and safety. I have said, without any considerable bad effects; for in reality I have seen none that deserve that name, if compared with what sometimes follow the natural small-pox, or frequently happen after the old method of inoculation.

Every one who has had any share in this practice according to the common or old methods, will allow, that after passing through the disease in a very favourable manner, their patients (children especially) were frequently liable to abscesses in the axilla and other parts, tedious ophthalmies, and troublesome ulcerations in the place of insertion; which though they could not be foreseen or prevented, yet frequently gave more pain and vexation to the patients, and trouble to the operator, than the disease itself had done: whereas on inquiry into the fate of those who have been treated in the cool way, or this new method, I can say, that in more than 1500 there has been only one who has had so much as a boil in the axilla; and that was in a child who had an issue in the same arm, and which was at that time dried up: and I have only seen two very small superficial boils in others near the place of insertion; and these seemed rather to be occasioned by an irritation from the discharge, than from any other cause, and were all soon healed with very little trouble.

In a few instances also there has been a slough in the incised part, which has made a sore of short duration; but not one instance of an ulcer of any continuance. Such little breakings out too, and scabs, as are frequently known to succeed the mild natural small-pox, sometimes, though rarely, happen to those inoculated this way; and as they are of the same little consequence, are generally cured by the same method of a few gentle purges.

With regard to ophthalmies from this kind of practice, I have never had an example of one truly deserving that name; the coats of the eye have been a little inflamed in a very few, but they soon became clear, without any means used for that purpose. And I know but two cases where I thought the inflammation great enough to require bleeding, and not one where a blister was necessary. So that these complaints, heretofore so frequent and grievous, seem by this new method to be much reduced: a circumstance which, if it does not amount to a proof, admits at least of a fair conjecture, that the state of health is better here, than where those remains of putridity are so evidently existing in the habit.

Discoveries in physic, as in every other science, are in their infancy liable to censure and opposition; and as the present system of inoculation is of so extraordinary a kind, it would not be strange if a greater portion of both than usual should fall to its share. Accordingly, since no charge of fatality during the disease, nor instances of bad effects soon after the recovery, can be produced, recourse has been had to other measures to calumniate and discredit the practice. It would be tedious to enter into a detail of the many false and ridiculous reports that have been spread against it. In general, the constitution is said to be injured, and the dreadful effects are to appear at some distant period; but at what time, or what kind of disease, nobody pretends to determine. To these general accusations it cannot be expected I should give other than a general answer; which is, that from the strictest observation and inquiry I have been able to make, those who have been inoculated in this way, have continued to enjoy as good a state of health as their neighbours; nay, many of them have thought their constitutions better after the process than before.

But it seems as if these opposers expected that inoculation should not only free the inoculated from the small-pox, and any early bad effects, but must preserve them too from all other disorders through the rest of their lives. To such I can say nothing; but if others, who are more reasonable, require further satisfaction as to the consequences of this method, I must desire them to make inquiry of those who have been inoculated under my direction.

Another charge against this method of inoculation is, that some have had the distemper afterwards in the natural way. What I have said under the head of anomalous small-pox, will I believe sufficiently account for the appearances which have occasioned these false reports; and if that does not satisfy, I can only add this positive declaration, that nothing of the kind has ever happened to any patient inoculated by me; and I firmly believe, no one has ever had, or can have, the distemper a second time, either in the natural way or from inoculation.

The Effects of this Treatment applied to the natural Small-Pox

The very great relief which persons under inoculation experience from fresh air, cold water, and evacuations by stool, during the fever preceding eruption, soon determined me to make trial how far the like treatment might be useful to those who might be seized with the small-pox in the natural way; more especially in such cases, where, from the violence of the symptoms, a confluent kind was justly to be apprehended.

But opportunities of making experiments of this sort in a satisfactory manner are rare. First, because a physician, or even medical assistance of any kind, is not often called in till the eruption shews itself; when it is too late to expect all the good effects that might be hoped for, from an earlier trial of this method: and secondly, because the first attack of the small-pox is so much like the beginning of some other fevers as not easily to be distinguished; though a diligent attention to the symptoms, will generally, if we are called in time, enable us to form a pretty certain prognostic. For if the attack of the cold fit be pretty severe, and the subsequent fever unusually high; if a nausea and vomiting succeed, together with great pains in the head, back, and loins, especially in the last; if a delirium, great restlessness, disagreeable taste in the mouth, and a peculiar fœtid smell in the breath, or even if several of these symptoms are observed, the small-pox may with great reason be expected; and if upon inquiry, which should always be made, it appears that the patient has been in the way of infection, there will be little reason to doubt it.

It may be objected, that notwithstanding the closest attention and inquiry, symptoms of the like nature may precede fevers of other kinds; to which I answer, that some such cases, though few, have happened; and the treatment I am about to recommend has been practised not only without prejudice to the patient, but manifestly to his benefit.

But waving for the present all considerations respecting the treatment of fevers in general, I shall only relate what has occurred to me in respect to the natural small-pox.

In several instances where I have been concerned, and where the symptoms and other concurring circumstances induced me to think the small-pox was at hand, I have directed the like management as I recommend to inoculated patients⁵.

I have been called also to others at the time of eruption, where some pustules having already appeared, made the matter clear; and in every case of this kind, I have endeavoured to get the sick person into the open air, have generally given the mercurial and antimonial pill, and directed a laxative to be taken some hours after it, in order to procure three or four stools; and this method I have more particularly enjoined, and sometimes repeated, where the kind has appeared to be bad, and where little or no relief has been found from the partial eruption; the symptoms continuing to be such as portended great danger. I have followed the same method during every part of the eruptive fever, intending thereby to abate its violence, to check the eruption, and prevent the conflux, and consequently the danger⁶.

The success attending this practice has hitherto exceeded my expectations; though it must be confessed, that as the symptoms run much higher in the natural, than they are found to do in the inoculated disease, the relief has not been so considerable; and I have found it extremely difficult to persuade such whose complaints have been very severe, to quit their beds, and attempt to go abroad: indeed the exceeding feeble state they are sometimes in, sufficiently shews that great resolution is requisite to put this in practice.

Among those who have been treated in this manner under my own care and inspection, not one has died, and the number amounts to about 40. Some of the most remarkable cases will be subjoined, which will more satisfactorily explain the practice, and demonstrate its success.

The immediate sensible effects of going into the open air, are, a very great abatement of heat upon the whole surface of the skin, which, though but just before intensely hot, generally in a short time feels not much warmer than that of a person in health: the pulse, from being very strong, full, and quick, becomes less hard and full, but continues quick; and I have sometimes observed it to intermit; which, however alarming it may seem, is not a dangerous symptom.

The pain in the head is always relieved, but that in the back and loins does not abate in proportion: and although it costs no little pain and trouble to persist in moving abroad under such circumstances, attended for the most part with great lassitude, yet the patients are sensible of the benefits they receive; and entertaining a good opinion of the usefulness of the practice, commonly behave with great resolution; and, what is very encouraging, in general think themselves stronger.

Upon going within doors to rest themselves, the pain in the head grows worse, but is again relieved as soon as they return into the air.

The effects of the medicines are usually these:

If there has been much sickness at stomach, a vomiting frequently happens soon after the pill: this the patients should promote by drinking plentifully of some warm diluents; and till the fatigue occasioned by it is over, they certainly ought not to go abroad.

By this operation, and the stools which succeed, the feverish and internal heat, the thirst, sickness, and pains, are for the most part considerably abated. The patients commonly complain of being very low and faint after these evacuations; but the most urgent symptoms being alleviated thereby, a disposition to receive nourishment hourly increases. They are then allowed to drink thin mutton or chicken broth, milk pottage, or tea, as the most grateful and refreshing cordial sustenance they can take. Sleep likewise now most commonly comes on spontaneously. But they are permitted to enjoy this refreshment by day upon the bed only; for I always dissuade them from going into it till night.

From the foregoing account it appears, that the fever preceding eruption, and the most grievous symptoms accompanying it, are often greatly mitigated by this practice; and I will here add, that the eruption is most certainly retarded, that is, it does not appear so soon after the attack of the disease, nor come out so precipitately when it has begun to appear, as it seemed likely to have done if the natural progress had not been interrupted; an effect, which, however dangerous it may have been thought, may be produced with the utmost safety, and clearly shews the utility of the practice. For it is evident from experience, that the later the eruption shews itself after the beginning of the disease, and the slower it comes out, the more mild and favourable is the subsequent disorder. And I am of opinion, that the eruption is not only retarded and protracted by this method, but likewise that it is in some degree repressed; having had strong reasons to apprehend, in several instances, that the number of pustules, which appeared at first, were by such repression actually diminished; and those that remained seemed larger, and of a milder kind.

What has hitherto been said on the subject, relates only to the disease in its eruptive state, which is certainly a very interesting period; but that which follows is not less so, though not always attended to so much as it deserves: for when the eruption is completed, the symptoms abate, the patients seem relieved, and often to such a degree, that both they, and their attendants, flatter themselves with hopes of a happy event, and think it unnecessary to apply for any medical assistance; yet with all these hopeful appearances, the number and kind of the small-pox are frequently such, as would make a judicious practitioner apprehensive of much danger in the subsequent stages.

And where the practitioners themselves may see reason to doubt of the event, yet few or none of them have attempted, I believe, to do much towards preventing the danger; for, unless some pressing symptoms call for immediate relief, it is the general practice to wait till maturation comes on, and brings with it such a train of dreadful complaints, as are more than enough to employ, and too often baffle the best abilities.

In this neglected interval, from the eruption being completed, to the accession of the fever of maturation, and its concomitants (an interval which, in point of duration, is very different in different constitutions and kinds of small-pox); I will venture in general to recommend the same mercurial antimonial medicine as was prescribed in the eruptive fever, to be repeated at proper intervals, till the maturation advances; at which time it must certainly be discontinued: and these circumstances can be regulated only by those who attend, according to the urgency of the symptoms, and the strength of the patients: a cupful of the following apozem should, if necessary, be now-and-then taken after the mercurial medicine; often enough to procure three or four stools a day, especially if the patient is costive.

Take cream of tartar, two drachms; of manna, one ounce; dissolve them in one quart of barley water, or the pectoral drink.

How far it may be safe or advisable for the patients to venture out into the open air during this stage of the disease, I will not yet pretend to say; but they will certainly be both refreshed and invigorated, by being kept out of bed as much as they can bear, without being over-fatigued; and by fresh air let in sometimes through an open window.

As the violence of the eruptive fever, with its attendant complaints, must necessarily exhaust the strength and spirits, both should in this interval be recruited, by as much proper nourishment (such as has been mentioned in the former part of this chapter) as can be taken down without offending the stomach; and also, if occasion requires, with medicines of a cordial and anodyne quality: for this is the time to recover as much strength as possible, in order to be better able to encounter and bear the pain and fever, which will most certainly happen, as the state of maturation advances.

Medicines, except what have been already mentioned, seem at this time unnecessary; and they would interfere with, and prevent the true relish for, food.

But for the best method of treating the small-pox in its most dangerous stage, I mean that of maturation, I must refer to the several learned and eminent practitioners who have professedly written upon the subject, whose opinions and practice I neither pretend to correct or amend. I shall however take the liberty to recommend one medicine to be used in that stage of the disease, which I have found to abate heat, and allay thirst, in such a manner as to afford a very pleasing refreshment.

Take of the weak spirit of vitriol one part, of the sweet spirit of vitriol two parts; mix. Of this the quantity of half an ounce may be added to a quart, or perhaps three pints, of barley water, or the pectoral drink, or any other diluent, and to be drank of at pleasure.

I have at present nothing farther to recommend; but what has been said will I presume be sufficient, with the cases annexed (in which the method will be more plainly described) to justify farther trials of the cooling, repelling, and evacuating practice in the beginning, at least, of the natural small-pox, till the eruption is completed; especially where the physician has an opportunity of making the trial before the eruption appears, and can be pretty certain, or has good reason to conclude, that his patient’s disorder is variolous. And the more violent the symptoms are in this stage of the disease, the more we should be induced to employ the means which have been attended with so much success, in the same stage of the disease after inoculation.

But it may be asked, if I was called to a patient in a bad confluent small-pox, and finding the eruption completed, whether in such a case I should venture to give and continue the use of the alterative and purgative medicine; and advise the patient to go out, if he can bear it, into the open air in cold weather, or direct air to be let in through a window even while the mercurial purge may be operating.

Before I give a direct answer to this question, let me first ask the most experienced practitioner, whether he knows any method of cure which may in bad cases be safely relied on, to avert the impending danger, and save his patients? The too well known fatality of all kinds of small-pox, very clearly proves that he does not, and that no such method has yet been discovered. And if this be the case, surely a bold, and even hazardous practice, is very justifiable towards any such unhappy patients, who lie as it were under sentence of a cruel death, not to be prevented by what are called the regular and usual methods. But still it may be urged, that no impending danger, however great, can sufficiently justify the trial of any hazardous experiment, unless supported by some degree of reason or experience. Happy, indeed, it is, when we have these two guides before us; but when they are separated, the latter is certainly most to be relied on, and her I have endeavoured hitherto to follow.

For in the practice of inoculation experience has taught me, that after as well as before the eruption, persons may safely take mercurial purges, and go out during their operation (though I have seldom advised any to do so) into the cold air, in inclement weather, without suffering the least harm or subsequent ill consequence from it. And by this experience I was led, though with great caution, to try whether the same practice might not be safely employed in the cure of the natural small-pox, as well as the inoculated; nor have the trials been unsuccessful: for though among the patients I have treated in this manner, some had confluent sorts, yet were the complaints unusually moderate throughout the whole progress of the disease, and the maturation was completed, without such troublesome and alarming symptoms and events as might be expected under any other known method of treatment; nor did any secondary fever ensue.

I would not, however, be understood to entertain so good an opinion of this method, as to insinuate that it will save all who have the bad confluent kind; too many of these are incurable; but I am not without hopes, that it may give a chance of recovery, hitherto untried, to many: and even if this alterative and evacuating course in the early part of the disease should not succeed, so as to avert the approaching danger, I think there is great reason to suppose that nourishment, cordials, and opiates, which may be wanted in the state of maturation, will be administered with more advantage and security after it, than if that method had not been previously taken.

It seems necessary, however, to declare, that nothing which has been said is meant to relate to practice in the bleeding or purple small-pox; though very cold repellent methods may perhaps deserve to be tried in these hitherto fatal cases, provided it can be done early; but the mercurial evacuating course seems quite improper.

Upon the whole, what has been said on the natural small-pox, must wait the award of time and experience, the only tests of the utility of any practice; for I have lived long enough to have seen several instances where very ingenious and well-meaning men have been greatly mistaken, by relying too much on the first impressions made by a few successful experiments.