The Present Method of Inoculating for the Small-Pox

CASES of the natural Small-pox, treated in the preceding Method

CASE XXIII

One morning about ten I was desired to visit a poor man in a fever. Two days before, in the evening, he had been seized with a shivering fit, which was then supposed to be the ague; he soon grew extremely hot, with pain in his head, back, and loins, which continued till I saw him, the 24th of October: he had kept his bed, had scarce any sleep, his heat great, pulse strong and quick, and the pain in his loins very severe. This man had applied to me to be inoculated a little before he was taken ill, on account of the small-pox being very much in his neighbourhood; but he had not as yet taken any preparatory steps. I made no doubt but he was now attacked with this disease, and from the severity of the symptoms expected it would prove of the confluent kind. As he lived near me, and I could easily attend to every circumstance, I determined to try how far the cooling method might be beneficial in treating the natural small-pox.

I found it very difficult to persuade him to rise out of bed, as he thought himself utterly unable to support himself, notwithstanding he was on other occasions a resolute man. Assuring him however that I would not attend him, unless he would comply, he promised to use his utmost endeavours. I left him to put this advice in practice, and ordered him to a carpenter’s yard about one hundred yards distance, where I promised to meet him.

In about a quarter of an hour I found he had reached the place of appointment, by the assistance of a neighbour, and was sitting on a bench, complaining of great weakness, and pain in his loins; which he described, by saying he felt as if he was cutting in two; but allowed that his head was easier since he had been in the air. Finding that he had had a stool the preceding day, but none since, I gave him a pill, containing about six grains of calom. and 1⁄8 gr. of emet. tartar, immediately; and as he complained of great thirst, I permitted him to drink half a pint of cold water after it. I advised him not to sit, but to endeavour to walk about a little, though ever so slowly; this he attempted, but went almost double. At this time the weather was not very cold, but there was a pretty brisk wind, with small rain.

About a quarter of an hour after, I saw him again. He had resolutely persisted in following my directions, and said his head was greatly relieved, but the pain in his back and loins was much the same. His pulse was now much altered; instead of being full and strong as before, it was low, but quick, and the heat on the skin greatly abated. As he seemed much fatigued, I did not insist on his keeping abroad longer, but permitted him to go home, desiring him to refresh himself, but not to pull off his cloaths, or go into bed.

At two o’clock I saw him again; his pill had then worked twice; he seemed fatigued and faint, but was abroad, for he said the air refreshed him, and his head was easier in the air than within, so that as soon as he was a little rested he came out by choice. The pain in his loins still remained very grievous, but his head was much easier; and his back and loins became less painful towards evening. I allowed him to go to bed about seven; but being desirous of observing the full effect of this kind of treatment, I ordered no medicine.

25th. Had but little rest, and his complaints nearly the same as when he went to bed. His pulse was now raised, and more full than in the evening, and the degree of heat greater than over night. A few small pustules were now beginning to shew themselves on his face; I directed a purging draught of infusion of sena and manna, quickened with jalap; advised him to get out of bed, and venture again into the air. This he did: by two o’clock the purge had worked thrice, and he was freer from the pain in his back and loins: more pustules now appeared in the face, but scarce any on the limbs. He had hitherto taken nothing since his first seizure, but tea with milk, sage and balm tea, loathing all other nourishment. He persisted in keeping out the greatest part of the afternoon; and at seven went to bed, when I found the pulse more calm and regular, and as his complaints were less violent, he began to think of nourishment.

26th. I saw him at seven in the morning; he had slept but little, had one purging stool in the night, and felt himself low and languid; his pulse was now even, full, and regular, and his heat moderate. Many more pustules were out in the face, though but few on the limbs, and his complaints of pain in the head and back went off. He took milk pottage with some appetite, and spent the greatest part of the day abroad.

At three in the afternoon I saw him, and was told, that lying down in the bed he had fallen asleep, and waked almost choked with blood; that he had vomited up a considerable quantity, which doubtless had been swallowed, as he was found bleeding at the nose. From what I could learn, the whole scarcely exceeded six or eight ounces. He complained of faintness, and said his pains were removed. I ordered him to drink the pectoral decoction, acidulated with a mixture of equal quantities of sweet and weak spirit of vitriol. The number of pustules continued increasing slowly on the face and other parts.

Late in the evening I saw him again; two more purging stools had followed; he complained of being very faint and low, and feared he should have no rest.

I now thought it proper to give him an anodyne cordial, and therefore ordered mithrid. ℥ss. which he took immediately. By the help of this he passed a very refreshing comfortable night, and thought himself quite well. The eruption was now completed; the small-pox might be properly called distinct: though full in the face, he had only a moderate number of a large sort on all the other parts; and he went through the succeeding stages without any difficulty.

CASE XXIV

A young woman, who was servant in a house where a child had the small-pox in the natural way, determined to stay there and take her chance.

December 25th, 1765, I was desired to see her. She had been taken with a cold fit the preceding afternoon, which was succeeded by a fever, and the usual symptoms attending the eruption, but in a severe manner. I found her in bed, making great complaints of pain in her head, back, and loins; her pulse strong, quick, and full; a flushing red colour in the face, and the fever very high.

With much difficulty I prevailed upon her to get up; ordered her to drink some cold water, and go abroad into the air, though it was a very frosty morning, with sleet. At one o’clock I called again, and found her then below stairs walking about. The heat was much abated, her complexion pale, the pulse small and quick, and all her complaints considerably abated.

The account I received from her, and the persons who attended her, was, that upon first going into the air, she was so feeble, that the nurse, and another to assist, could scarce support her, and it was with much difficulty that she could walk with this assistance; that she drank a glass of cold water from the pump, and before she had been abroad many minutes found herself much easier, and had remained so ever since. It now rained pretty hard, which had obliged her to come in; but she said if her complaints returned, she would certainly go out again, be the weather ever so bad, and in this resolution I encouraged her.

On the 26th, about eleven in the morning, I visited her again, found she had passed a pretty good night, and had felt no remarkable uneasiness; she had been abroad several times the preceding day, to which she imputed the ease she enjoyed. Two pustules of a distinct kind were now out on the face, and she had the disease in a very favourable manner, without the least bad symptom during the progress, or any ill consequence afterwards.

CASE XXV

Jan. 3d, 1766.] A healthy young man was inoculated in company with four of his neighbours. On the sixth, presuming that none of them would be ill, I went to London on business. Returning on the 7th in the afternoon, I was met by a servant, who informed me that this man had been taken ill on the 5th in the afternoon, had continued very bad ever since, and now had something broke out, which was suspected to be the small-pox, and that I was desired to visit him immediately: this I complied with, and found him in bed, complaining much of pain in his head, back, and loins, with great heat. Some small pustules were out on his face, which I perceived to be the small-pox; this was at five in the evening, and much about forty-eight hours from the first seizure.

The weather was at this time exceeding cold, and it froze very hard. I ordered him out of bed immediately, to drink a glass of cold water, and to get some assistance, and walk abroad in the air. Upon inquiry I found he had passed without a stool the whole day. Five grains of calomel in a pill were ordered to be taken immediately. He rested but little this night, and next morning a great many more pustules were out in the face, sufficient to shew a disposition to flux. As this pill produced no manifest effect, I ordered sal. glaub. Ʒvi. dissolved in water gruel to be taken immediately. The vehemence of the fever and other symptoms were scarcely moderated by this eruption.

Notwithstanding the medicine and the severity of the weather, I desired he would get on his cloaths, and go into the air as much as he could possibly bear; and in the evening ordered him to be carried in a chaise to the house provided for him in case he had been ill from inoculation. I examined the incisions carefully, but there were not the least signs of the infection having succeeded, either by discolouration, hardness, or any alteration on the skin, nor could he recollect that they had itched, or given him the least uneasiness.

In the evening he came to the house as ordered, but was so very feeble and full of complaints, that it was with great difficulty he was got to his room. Upon inquiry I found he had vomited up the salts soon after taking them, and had only one costive stool; he had complied with my orders about getting into the air several times in the day, though with great difficulty. His complaints of thirst, pain in the head and back, were at this time very great. I directed him to sit with his feet in warm water for a short time, and, on going into bed, to take a few spoonfuls of a laxative mixture, which was to be repeated till he had stools.

9th. He had been delirious in the night, but rested a little towards the morning; the number of pustules was now considerably increased. This day he had three stools from his purging mixture, by which he was relieved, and bore sitting up better.

10th. He passed the night easy, but without sleep. He was very full in the face, but had a smaller number on the body and limbs. No complaint, deserving notice, happened during the progress to maturation. He sat up a part of every day to the eighth from the eruption, when, being blind, and very sore, he kept in bed: they turned on the eleventh, and he recovered perfectly.

It was remarkable in this case, that the inoculated parts never shewed the least signs of infection; nor did a greater number of pustules appear near them than might have been expected if nothing had been done; nor is there to be seen the least mark where the inoculation was performed, though in all other inoculated patients who have had the disease, even in the slightest manner, there constantly remains a scar.

It appeared, on inquiry, that this man had been, for a considerable time before, in a constant intercourse with families in the small-pox; and there seems not to be the least doubt but his was the natural disease.

CASE XXVI

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.