The Present Method of Inoculating for the Small-Pox

7th. In the morning he was much in the same state, only weaker. I prescribed a salt of wormwood mixture, with Mindererus’s spirit, an oily mixture for his cough, and one grain of emetic tartar mixed with 10 grains of compound powder of crabs claws, to be taken in the evening.

8th. He had four stools in the night, sweated pretty well, and got some sleep; but he coughed much, breathed with difficulty, expectorated some thin frothy phlegm, and complained of great pain in his breast and side. Eight ounces of blood were directed to be taken away; the antimonial powder was repeated, with an addition of one grain of calomel; and he was directed to drink frequently a cup-full of pectoral decoction, to a quart of which was added one ounce and a half of Mindererus’s spirit.

9th. The blood taken away yesterday was very fizy, the pain in the breast and side much abated, but the cough very troublesome, and the expectorated phlegm streaked with blood. The inoculated parts were now discoloured, shewed evident signs of infection, and that we should soon have the small-pox to encounter together with the peripneumonic disorder.

10th. Very restless all the night, coughed much, and with great difficulty expectorated brown viscid phlegm. The bleeding was repeated, and the use of the antimonial powder and other medicines continued; which had every day procured some stools, and supported a constant breathing sweat.

11th. The blood was still found fizy, and the fever, cough, difficulty of respiration and of expectoration were increased. The progress of infection in the arm was slow, but shewed, however, that the eruptive fever would soon come on; and I was apprehensive that it would be so confounded with the peripneumonic disorder, as to cause much perplexity. I determined nevertheless to attempt to relieve the latter by whatever means I could, and wait the event; and therefore ordered more blood to be taken, a blistering plaister to be applied between the shoulders, and a small quantity of gum ammoniacum to be added to his pectoral medicines. In the evening I was informed that all the troublesome symptoms were considerably abated.

It must here be noted, that all the company, who had been inoculated at the same time, were now ill, and most of them had some eruptions.

12th. He had had more rest; but though most of his complaints were relieved, yet the fever still continued, and he expectorated with difficulty some very dark-brown phlegm, so that no alteration was made in his medicines.

The appearance on the incisions spread, but did not look as usual when the eruptive complaints are begun.

13th. The fever, pain in the side, cough, and difficulty of expectoration, being again increased, I ordered a vesicatory to the side, and some oxymel of squills in a pectoral mixture.

14th. The fever and pain of the side were abated, and he had obtained some little sleep, which was however much disturbed by sudden startings. The skin at the incisions had an unusual appearance, not easily to be described; and instead of being inflamed, as it usually is, where the progress of the infection is favourable, and not interrupted by some extraordinary accident, it was of a pale hue.

15th. He had rested ill, and the cough was so troublesome, that I ordered more blood to be taken, and the medicines to be continued. The incisions this day looked like pustules irregularly shaped, and a fluid appeared under the cuticle.

16th. All symptoms were more moderate; two pustules were discovered in the face, and those at the incisions seemed tending to maturation.

17th. All complaints much easier; the pustules at the incisions were more elevated, and had matter in them; but the others were but little advanced, and looked pale.

18th. He was in all respects so much better, that he ventured to ride out on horse-back, and I was released from my attendance; nor did I see him afterwards till he called at my house in good health on the 5th of July. But he then informed me, that in the afternoon of the 19th of June, the day after I took my leave of him, he had been extremely hot and feverish; was relieved on the 20th from all feverish symptoms, and discovered a great number of pustules, which rose, filled, and ripened without any further illness; so that he did not think it necessary to send me any notice of them. Looking in his face, I saw about thirty marks of small-pox, which confirmed the truth of his report.

I have also since received a very satisfactory account that many pustules in his face and other parts which came out after the time I saw him, stayed a proper time, and maturated completely.

CASE XVIII

A middle-aged man, on the sixth day after he had been inoculated, complained of pain in his head and back, and had a slight degree of fever. These complaints remained till the 8th, when there appeared some eruptions on the face, which I took to be variolous: but it is to be noted, that having lived pretty freely, his face was very red and full of pimples; and neither the preparation nor medicines had much altered that appearance; so that it was no easy matter to distinguish between those which were habitual to him, and the fresh ones. The arm at this time was very considerably inflamed, as is usual about the time of eruption.

On the 9th he was perfectly well, and no more eruptions shewed themselves.

Having had several patients, who undoubtedly passed through the distemper with no more illness than this man had felt, and sometimes even without any eruption, I really thought that the affair was over.

On the 10th he took a laxative draught, eat a piece of mutton, and drank some ale. On the afternoon of the same day I found him complaining of a pain in his head, which he thought was occasioned by his venturing abroad during the operation of the purge. He had now more fever than at any other time before; however, as he averred that his complaints were such as he usually felt from a slight cold, I did not apprehend any thing more.

On the 11th in the morning he was still much indisposed, and had rested ill. In the evening of the same day I found him much better, but he said there were more pustules on his back. These I did not see.

Next morning I found he was gone to a friend’s house, having left word that he was quite well, and that I should hear from him if there was occasion.

On the 14th I was desired to visit him, when I found a moderate number of fresh pustules on the face and limbs, and in such forwardness, that I was convinced they had been out ever since his removal; which indeed was confirmed by the account he gave me: these maturated kindly, and he remains in good health.

CASE XIX

A gentleman’s son in perfect health, between four and five years of age, on the third day after inoculation voided a long round worm alive, after having taken on the preceding night a dose of mercurial physick. No signs of worms had hitherto been observed in him; and he afterwards seemed to be quite well, till the symptoms which usually precede the small-pox came on.

After a very moderate illness, an eruption of about twenty pustules succeeded, and all complaints then ceased; so that on the 4th day after the eruption, I proposed, and was permitted, to discontinue my visits for the present. I called again however on the 6th day, and found him well as usual, and at play, the pustules being then nearly maturated.

I was informed, however, that in the night of the 4th day, he had been hot, feverish, and restless; was very well the day following, and hot again at night, but in a lesser degree; so that this slight illness did not then give the least alarm. But on the 7th day, early in the morning, I was called up to visit him as soon as possible, and was informed that in the beginning of the night he grew extremely hot and delirious, and soon became stupid, drowsy, and senseless; in which condition I found him, grating his teeth, with convulsive motions about the mouth.

The pustules were at this time quite ripe, and looked, as they always had done, extremely well. His pulse was very quick, though the heat was now moderate, and the respiration free and easy; but he was so comatose, as not to be roused, even so much as to open his eyes, by any disturbance that could be given.

In this alarming situation I desired the assistance of the physician, who on other occasions had usually attended the family. At our consultation, which soon followed, it was agreed, that as the small-pox were very few in number, had always looked well, and were now completely maturated, the present symptoms must be occasioned by worms, or some irritating cause in the bowels.

With this view a dose of rhubarb and calomel was immediately prescribed and exhibited, though we were obliged to open the mouth by force, and this not without some difficulty. The operation of this medicine was accelerated by a clyster, and a large fœtid slimy stool, followed by some smaller liquid ones, was procured that afternoon.

The child, however, seemed to be almost totally insensible during this time, nor did he yet appear to be in any respect relieved by these evacuations: blisters therefore were successively applied to the back, head, and legs, and sinapisms to the feet; leeches were likewise fixed to the temples, and rhubarb with calomel, after some little interval, again directed; tin medicines being given between whiles.

By these means, though not till a considerable quantity of slimy and extremely offensive fæces had been discharged, some signs of amendment appeared. But the child still remained in some degree comatose till the fifth day from this attack; after which the progress of amendment was very quick, and in two or three days he got quite well, and has so continued.

CASE XX

In May 1776, I was desired to visit a considerable farmer, aged 68, to give my advice for a complaint in his legs.

About two years before he had been seized with a numbness and coldness in both legs and thighs, which it was apprehended would end in a palsy. For this disorder he took many medicines, and both his legs were blistered, by which he found relief; but from this time the legs were affected with troublesome itching and burning pains, attended with a sharp serous discharge through innumerable excoriations. These complaints destroyed his rest, and made him unhappy.

After relating this case, he told me, that as almost every body in the neighbourhood, who had not had the small-pox, was either under inoculation or preparing for it, he could scarcely expect to escape the infection, and had therefore a strong desire to be inoculated; and that his wife of the same age with himself, was likewise desirous of it.

This proposal induced me to examine the present condition of his legs more strictly. They were now, he said, in their best state; that is, not so full of pain as usual; they were dry and scurfy. His face was likewise scurfy, and of a settled deep red colour; the consequence, as he told me, of a repeated Erysipelas in it, and not of any intemperance.

Upon considering the case, and reflecting that the preparatory course of diet and medicine would probably amend the condition of his legs, I encouraged him to pursue his intention; and both he and his wife, after a fortnight’s preparation, were inoculated on the third of June.

On the 9th both made some slight complaints; and on the 12th the wife grew better, on the appearance of a very few distinct pustules, which maturated afterwards in the most favourable manner. But the man still complained of pain and weariness till the 13th, when he grew easier in that respect, and felt a smarting pain in his legs, which were very red, and had several pustules on them. Towards evening they grew more painful, more swelled, and a further eruption was discernable, though not easy to be distinguished, by reason of their diseased state.

He slept very little this night; but on the 14th I found him free from fever, and pretty well in all respects, except the pain in his legs; on which, and under the hams, a great number of distinct, but almost coherent pustules appeared. There were several also in the neck and face, but very few on the body or arms. He had all along been advised not to stir much, but had taken greater liberties of walking about than I had allowed.

15th. He had not slept a minute during the night. I found him up and walking about the house, complaining much of pain, but saying that in other respects he was well; but he was now rather cool than warm, his pulse very low, his aspect languid, the colour of the face inclined to livid and pale, and he complained of faintness and sickness. I could not avoid being alarmed. The legs also were swelled considerably, but not inflamed. I therefore ordered him instantly to bed; and as the tension was great, applied a cataplasm of bread and milk (being what was nearest at hand) all over each leg, and directed the following medicine to be taken as soon as possible.

℞ Mithrid. Ʒss. Decoct. Cort. Peruv. ℥ij. Tinct. Cort. Peruv. simpl. Ʒij. M. f. haust. quam primum sumend. & sexta quaque hora repetendus.

℞ Sal. Absinth. Ʒj. succ. Limon. ℥jss. Decoct. Cort. Per. ℥vi. Tinct. Cort. Per. simpl. ℥jss. Syr. é Cort. Aur. ℥ss. M. f. mixtura, cujus capiat Coch. iv. horis intermediis.

In the evening his pulse was raised, he was easier, and rested about an hour.

16th. In the morning, after he had rested some hours in the night, he was easier, warmer, and the pulse better.

17th. After a good night he found himself free from complaints, and from this time every circumstance went on favourably; the pocks maturated on the 7th day; his legs however were both considerably ulcerated for a fortnight after, but then soon healed. He remains at present in good health, and feels less uneasiness from his legs than he did before the inoculation.

CASE XXI

A middle-aged woman was inoculated, May 15, 1765. She began to complain on the 23d; the fever and other symptoms were very moderate. On the 26th an eruption, distinct in kind, small in number, shewed itself; all the eruptive symptoms ceased, and she seemed perfectly well.

On the 29th she complained that her throat was sore, felt stiff, and swelled; but as this is not unusual, little regard was paid to it.

30th. She rested ill, her throat was worse, and it now gave her great pain to swallow. She had also been taken with a shivering fit, succeeded by fever. On inspecting the throat I could not perceive one pustule there, but the uvula and tonsils were very much swelled and inflamed. An acidulated gargle was directed, and a lenitive purge, which in the evening had operated thrice; the gargle had been frequently used, but the difficulty of swallowing was greatly increased, insomuch that she could get nothing down; the fever too was rather increased. Further help could not now be expected from internals; for upon making the trial, liquids returned through the nose. I directed a blister to be applied to the throat, and that she should frequently gargle with warm pectoral drink.

31st. She had not slept a minute, being disturbed, whenever she attempted it, with such sudden startings as made her afraid to sleep. The feverish heat was not very great, the pulse extremely quick, and all the liquids she attempted to swallow still came through the nose. She could not lie down in bed, and therefore sat up in an easy chair the greatest part of the night.

The pustules, which in the face did not exceed twenty, and very few appeared elsewhere, advanced to maturation kindly, without receiving the least check from this adventitious illness. Her speech was so much affected as scarce to be understood. She informed me, however, that she was subject to an illness of this kind; and had once narrowly escaped with her life, but had never been so bad before. I directed twelve ounces of blood to be taken from the arm, and that the sublingual veins should be pricked. But no relief seemed to be derived from any of these measures; and upon inspecting the throat again, the glands, uvula, and fauces were very much inflamed and distended. The tonsils were then lanced pretty deep, and a good deal of blood being discharged, the swelling of the parts subsided, so as to admit her to swallow, though with difficulty, a little pectoral drink, and afterwards few spoonfuls of milk pottage.

June 1st. She had rested but very little, though exceeding drowsy, and worn out for want of sleep; for the sudden startings, upon closing her eyes, still remained, though not in so great a degree as the preceding night; but she had swallowed some liquids, though with great difficulty. The feverish heat was not very great, the pulse quick and more feeble.

On inspecting the throat towards noon, the swelling, though somewhat abated, was still considerable enough to prevent much being swallowed.

In this dangerous situation the operation that had administered some relief was repeated, and other parts of the tonsils and fauces, which had not been wounded before, were now lanced pretty deep; a large quantity of blood was discharged, the parts collapsed, and in less than an hour she was able to swallow liquids; after which she got some refreshing sleep, recovered fast, and is now in good health. The pustules, notwithstanding this illness, advanced very kindly to maturation, and turned on the 7th day from the eruption.

CASE XXII

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.