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New Observations on Inoculation/An Account of a Series of Experiments/Account

< New Observations on Inoculation‎ | An Account of a Series of Experiments

AN

 

ACCOUNT

 

OF A

 

SERIES of EXPERIMENTS

 

IN

 

INOCULATION.

 

HAVING for several years been one of the physicians of the Foundling Hospital, where all the children are directed to be inoculated; and where inoculation, under the conduct and direction of the physicians, has been, practised ever since its establishment; and being therefore in a situation of superintending every year the inoculation of some hundreds, I have given no small degree of attention to this mode of introducing the small-pox.

The success of inoculation at the hospital has been such, as no practitioners need be ashamed of. Very great success has likewise attended inoculation in many parts of this kingdom: even though it has of late descended into very illiberal[1] hands; such as, in other diseases scarce any one would dare to confide in. But among these last, I do not mean to include a certain family, who have practised inoculation with great success. They have deserved well; not only on account of some real improvements they have made in this process, but also for the confidence they have excited in the public, from which vast numbers have been inoculated, who otherwise would not.

Some inoculators depend, or at least seem to depend, upon the effect of certain nostrums, the composition of which they endeavour industriously to conceal. These consist chiefly of a mercurial preparation, given before and after the punctures are made; purging pills, and some doses of purging salts. They chuse the matter should be inserted in its ichorous or watery state. The medicines just now mentioned, with abstinence from animal food and heating liquors, a strict vegetable diet, not lying in bed more than usual, and cool and open air, constitute the chief part of their regimen, in most cafes, during the preparation and course of the disease.

A practitioner in the west of England, besides preparing his patients, by bleeding some, and purging all, directs them to lie in bed and sweat freely, during the eruptive state of the disease, and until the eruption is complete.

They are then permitted to walk about at large, and are under very little confinement during the remainder of the distemper.

A very ingenious and eminent physician, who has long practised inoculation largely with great success, and has published a valuable treatise upon this subject, directs both antimonial and mercurial medicines, during the preparation. He recommends that the variolous matter be inserted in its crude state; but he has informed me, since the publication of this work, that his doubts then remained, whether much depended upon the condition of the matter, at the time of inoculation.

I was very desirous of knowing what it was, in the whole regimen, that chiefly contributed to lessen the disease; particularly, what share the kind of variolous matter had in the success: whether it depended upon its being taken from the natural or inoculated small-pox; and then, whether in its watery, or in its purulent state. It would be a desirable thing likewise when the variolous matter inserted every other circumstance was the same to observe what effect mercurial medicines or purges had, when given preparatory. Nothing hitherto had been done in a comparative view, which, while practitioners continue in the same track, cannot be expected. An investigation of this sort therefore, which very few physicians are in a situation of making, I considered as of no small importance. I resolved, therefore, to put in practice several of the methods that had been used with success, together with some others which promised to be equally secure; to the end that if any one method was by experience found to answer better than the others, it might be adopted.

I had found, though the same preparation had used for several years was continued, yet that keeping the patients less in bed, and more exposed to the cool and open air, the disease was less severe; the variolous pustules were fewer in number, insomuch that they were very rarely blind: to say nothing, that at the end of the distemper they were less enfeebled. I determined to try, therefore, what medicines of different kinds, under the same regimen, would produce: besides, as lord Bacon suggests, Inveniendum est, quid natura faciat, vel ferat: It was proper also to be informed of what nature unassisted, not to say undisturbed, would do for herself This was not to be done, but where a number of persons of both sexes were inoculated at the same time and place, in the same manner, with the same variolous matter, and observing equally the same regimen. The only difference then was to consist in their medical treatment.

October 12, 1767, I directed thirty-one persons to be inoculated. Their ages, as well as those of the subsequent observations, were from six to eleven or twelve. Ten were girls, and twenty-one boys. They were all inoculated with variolous matter, taken in its ichorous or watery state, from a person who had the disease in what is called the natural way. Each had two slight punctures in the left arm, made with the point of a lancet, dipped in, and slightly moistened with, this matter; and no plaster was put over them. The lancet, in making these punctures, was obliquely directed, that the matter might be inserted between the cuticle and skin. They had all abstained from animal food ten days before the punctures were made, which they did likewise during the course of the disease. Their diet was milk, and divers preparations of vegetables; and their drink water, with toasted bread in it, except now and then a draught of wine whey, when necessary. If any of them coughed to a degree worth taking notice of, they drank infusion of raisins. When the weather was favourable, they were, both during the preparation and course of the disease, frequently in the open air. Hitherto in every particular the treatment was the same; if therefore, any difference should arise during the course of the subsequent disease, it must be accidental or constitutional, and not owing to diet or difference in their general regimen.

Of these thirty-one persons, five boys and five girls, by way of preparation, took a powder, consisting of twelve grains of jalap and four of calomel. This powder was taken twice before the insertion of the variolous matter, and once after. No other medicine was used as preparatory.

Of the five boys, four had the small-pox in a very slight degree; of the fifth, the punctures inflamed but little; and though he was inoculated a second time twelve days after, he had no eruption. The second punctures continued red several days; but neither sickness nor pustules succeeded. One only of these boys was in the least disordered during the whole course of the disease, and he complained of the head-ach, for a day or two preceding the eruption. These boys had only fifty-four pustules among them; about fourteen each.

Of the five girls, four had the eruption without any previous or attendant disorder. The punctures of the fifth inflamed, and had large red margins; an argument of the contagion having taken place; and were succeeded by only two pustules, which were so very small, and dried away on the second day after their appearance, that I could not depend upon them as variolous. She was therefore sixteen days after inoculated again; but these punctures healed very soon, and nothing succeeded. The four girls had only eighteen pustules among them; not five to each.

The most that any boy had was twenty-five, the least had four. The most that any girl had was six, the least had three.

It must here be observed, that in this and the subsequent account, the pustules were numbered by the attendants when they were nearest maturity, in every part of the body, the scalp excepted; where, on account of the hair, their number could not be ascertained. The pustules arising from the punctures and about them were reckoned among the others.

Five boys and five girls under the same regimen with the former, took each of them two purges of infusion of sena and syrup of roses, before the punctures were made, and one four days after. No other medicine was used as preparatory. Not one of these complained of sickness, or other disorder, during the whole course of the disease. Eight of them had variolous pustules. One of the girls, though the punctures inflamed, had no eruption. She was then inoculated again, but the second punctures were not visible after a day or two. One of the boys had likewise the punctures inflamed to a considerable degree, but no eruption followed. These eight had sixty-six pustules among them, of whom one, who had most, had thirty. Two of the girls had only two pustules each. At a medium, each had little more than eight pustules.

Eleven boys under the same circumstances with the former, were inoculated without any medical preparation. Of these, previous to the eruption, five complained of head-ach, two of which were slightly feverish. One of these last, though the punctures inflamed, and had a large red margin round them two inches in diameter, had no eruption; and when punctured a second time, a fortnight after, it had no effect. Another, who had no feverish symptoms, though the punctures inflamed, had no eruption, and was inoculated a fortnight after without effect. The other nine went through the disease perfectly well, and had among them two hundred and eighty-eight pustules; which, reduced to a medium, is thirty-two each. It is here to be observed, that one of these had near two hundred pustules; and three of the others only seven among them.

Except three purges at the decline of the disease, and what was considered as preparatory, none of these thirty-one persons took any medicine during the course of it.

November 1, fourteen boys and nine girls were inoculated under the same continuance of vegetable diet, and abstinence from animal food as the former. Those before mentioned were inoculated with variolous matter, in its thin or ichorous state, from the pustules of the natural small-pox: but these were infected with purulent matter taken from the pustule of the inoculated small-pox. Of these, four boys and four girls took each of them thrice, as in the former inoculation, four grains of calomel without any addition: as it might be presumed that in the former manner of giving it, this mercurial preparation had not its full effect, on account of its being joined with, and carried off hastily by, a purging medicine; it was therefore left to itself, and it generally went off gently by stool. Each of these eight had variolous pustules. Three of the girls and one of the boys had a sickness and slight head-ach before the eruption; the last, during this sickness, voided five worms by stool. The number of pustules among the eight amounted to five hundred and seventy-six, viz. seventy-two to each. Of these, one girl had four hundred and forty pustules; but she was no otherwise disordered during the whole illness, than with a flight head-ach, without feverish heat, on the two days preceding the eruption. One boy had only seven pustules.

At the same time with the former, in the same manner, and with the same matter, four boys and four girls were inoculated. These took no mercurial preparation, but only two doses of infusion of sena and syrup of roses twice before the punctures were made, and once after. Of these eight, one boy only complained of an head-ach one day, which went off upon the eruption of the pustules. They all had variolous eruptions. The number among these eight amounted to two hundred and fifteen; nearly twenty-nine to each. Of these, that patient who had most, had sixty-four; the least three. One of these boys, who had eighteen pustules, after they were ripe and in a state of decline, had an imposthumation under his chin, which broke of itself, under a pultice of bread and milk, and healed in a few days. The above sixteen, as well those who took calomel during the preparation, as those who took the other purging physic, had also three doses of infusion of sena and syrup of roses when the disease was over. No other medicine was taken.

The remaining six boys and one girl, who were under the same circumstances likewise oculated at this time, took no medicine, either preparatory, during the course of the disease, or after it; except their abstaining from animal food; they were treated in the manner recommended by the ingenious Dr. Gatti, who sometime since inoculated a considerable number at Paris, and whom I frequently saw while he was in London. Two of the boys complained of a slight head-ach the day before the eruption; they all had variolous pustules; and the number among them amounted to one hundred and twenty-five, not quite eighteen to each. He who had most, had sixty, the least, two: the girl had only three. Though none of these, as I before mentioned, took any purging medicine, at the decline, or after the disease; they, nevertheless, continued perfectly well. In about twenty days from the punctures being made, not to mention here that each puncture generally became a variolous pustule, and maturated always before the rest, the external inflammation attendant on them had entirely subsided, and nothing remained on the punctured parts but a dry scale, which easily came off of itself.

I before mentioned, that in the first of the two above recited inoculations, the variolous matter was taken from the natural small-pox when in a watery state: in the second, the matter made use of was from the inoculated small-pox, when purulent. On November 24, twenty were inoculated under the same circumstances of diet, cool air, and every thing else; the variolous matter was that from inoculation, and in its perfectly concocted state. It was taken from the inside of the hand of a strong hard-skinned boy, where two or three pustules remained after they were dry. The matter was perfectly white, and as viscid as cream. I was desirous of being informed, whether the effects of this would be different from what had been first employed, either in the punctures or eruptions. Of this number, ten were boys, and ten girls. Fifteen of these had been twelve days without animal food, before the punctures were made; five were inoculated after only three days abstinence. They took no medicine, either preparatory, or during the course of the disease. Of these, one boy and one girl, though the punctures inflamed and were turgid, had no eruption; and when fresh punctures were made a fortnight after, they did not inflame, and were scarce visible the third day after they were made. The boy was one of those who had abstained three days only from animal food.

The other eighteen had variolous pustules. Five of the boys and two of the girls complained of head-ach and sickness of stomach before the eruption; the rest had no complaints. The number of pustules among them amounted to one thousand and twenty; not quite fifty-seven each. The greatest number either of them had was two hundred and sixty; the least had only two, exclusive of those occasioned by the punctures. Three had only four pustules each. He that had the greatest number, was not one of those who had been three days only from animal food. The pustules among these four amounted to two hundred and ninety-three; something more than seventy-three to each: though one of these had only four pustules. She who had most, had one hundred and sixty-eight.

The whole eighteen went through the disease without any thing worthy of remark, except one of the boys, who had been three days only kept from animal food. Though he had ninety-three pustules, he became somewhat feverish two days after the maturation of the pustules. This was followed by a painful inflammatory swelling upon the shoulder, which disappeared intirely in a few days, upon the application of a common pultice, and taking some purges of infusion of sena.

The punctures of all those in the former inoculation dried away, as I before mentioned, in a few days after the maturation of the pustules; though the patients, some of them, took no purging medicine after the decline of the disease: but in the last inoculation, where matter highly concocted was employed, in four of the boys and three of the girls, the punctures remained turgid and red, after the variolous pustules were dried away. To these, and to these only some purges were given; during the taking of which, the punctures healed and scaled off. Neither of these, were of the number of those who had, prior to their being punctured, abstained three days only from animal food.

Of the seventy-four persons, whose histories I have here related, though inoculated with variolous matter in different states; though prepared in so different a manner; and a great many no otherwise prepared than by abstinence from animal food; not one of them was disordered enough, during the whole process, to occasion the lead anxiety for the event. Not one of them had, from the pustules being upon the eyelids or near them, their eyes closed a single day; none continued in bed an hour longer than they would have been in their best health. None of them had any tumour under the armpit, much less an abscess there, which in the former method of inoculating was too often seen. No plaster was used to any of them, as I had long since found it to answer no other purpose than to disguise the appearance of the punctures. As in a few of them, half a dozen perhaps, the punctures spread, and were sore about the time, or soon after the maturation, a pultice of bread and milk, answered effectually every purpose of outward application.

When it did not rain, or the weather was otherwise unfit, they were out every day, during the whole process, in a field near the infirmary where they were inoculated, where no other persons were admitted.

There did not happen to any of these, what I have sometimes observed in delicate adults and weakly children when under inoculation, viz. that after the febrile state has been over, and the eruption been complete, by keeping the patient cool, and not permitting them to continue in bed, the pustules have not proceeded towards maturation, but seemed at a stand. At the same time, the patient has been languid, restless, and attended with frequent vomitings. Under these circumstances, confinement in bed, somewhat warmer than in health, appropriated cordial medicines, wine whey, and, occasionally, if the bowels are lax, an anodyne, have been of great use. From this alteration of treatment these symptoms have gone off, and the pustules have then ripened kindly. When cases of this sort occur, which do not frequently, it is obvious to a sagacious practitioner, what ought to be done.

The greatest number of pustules that, in the three inoculations, either of the boys had on his face, was twenty-seven: two had twenty each; all the rest under that number. The greatest number upon the face of either of the girls was forty; another had thirty; a third twenty-nine; none of the others had twenty, many none at all; far the greatest number, fewer than ten.

Of the twenty last inoculated, where no preparatory purges were given, and where matter highly concocted was inserted, it was strikingly observable, not only to myself, but to some experienced physicians and others, who did me the honour of attending me during the course of these inquiries, that the pustules were larger, and maturated more perfectly than in the first inoculation. In both the former inoculations especially when either calomel or purges were given as preparatory, in many of the patients the matter scarce ripened perfectly; the pustules were small, watery and frequently dried away without maturating: but it. must be remembered, whatever might be the more powerful effect of variolous concocted matter, that to these last were given no preparatory purges.

Upon reviewing what has been before laid down, it appears, that out of seventy-four, the whole sixty-two persons, who in consequence of inoculation had variolous pustules, had among them in number, two thousand three hundred and sixty-two; somewhat more than thirty-eight to each: an inconsiderable number indeed! as physicians daily see in one limb only of an adult person, labouring under the coherent, not to say confluent natural small-pox, a greater quantity of variolous matter than was found in all these persons put together.

The remaining twelve, though they had no eruption, I consider as having, in all probability gone through the disease; as the punctures of almost all of them were inflamed and turgid many days. When this happens, and no plaister has been applied, though neither febrile symptoms-nor pustules supervene, it is an argument of the variolous matter having infected the punctures. If after these, other punctures are made without effect, the variolous poison seems to have exerted its utmost power in the former punctures; and the small pox is no longer to be dreaded.

But to return; of those inoculated with the ichor of the natural small-pox,

Pustules at a medium.
Four boys, prepared with jalap and calomel, had, at a medium,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
14 each.
Of these, the boy who had most pustules had 25, the least 4.
 
Four girls with the same,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5 each.
Of these, the girl who had most had 6, the least 3.
 
Four boys and four girls with infusion of sena,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
8 each.
Of these, the greatest number were 30, the least 2; none of the rest had 10.
 
Eleven without medical preparation,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
32 each.
Of these, the most were 200, the least 1.
 

Inoculated with purulent variolous matter from Inoculation.

Pustules at a medium.
Four boys and four girls with calomel only,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
72 each.
Of these, the most were 440, the least 7.
 
Four boys and four girls with infusion of sena,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
29 each.
Of these, the most were 64, the least 3.
 
Six boys and one girl without medical preparation,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
18 each.
Of these, the most were 60, the least 2.
 

With highly concocted matter from inoculation without medical preparation.

Pustules at a medium.
Nine boys and nine girls had,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
57 each.
Of these, the most were 260, the least 1.
 
Of these, four were inoculated after three days abstinence only from animal food: these had,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
73 each.
The greatest number was 168, the least 4.
 

The twelve, who, though inoculated the second time, had no eruption, continued with the others during the whole course, in order to observe whether they would be infected by the natural contagion; but nothing ensued.

As the degree of violence in the small-pox is, cæteris paribus, as the number of pustules; by these relations it appears, that the smallest number of pustules were produced, when the variolous matter in its ichorous or watery state was inserted by puncture, and the patient had taken previously purges, in which the mercurial preparation did not seem to contribute any thing to the lessening of the number of pustules; as those, who took the infusion of sena, and no mercurial preparation, came off as well. The pustules of the eight who took jalap and calomel, amounted, at a medium, to nine and 1/2 each; of the eight who took fusion of sena, the pustules, at a medium, were eight to each. One of the eleven boys, who, under the same circumstances, except previous purges, had two hundred pustules, raises the medium of the others to thirty-two each though one of these had but one pustule, and the next greatest in number had only thirty-six.

Of those eight, where purulent matter from inoculation was inserted, and calomel without purging medicine previously given, one had four hundred and forty pustules; a quantity almost double to that of any one of the whole number, who are the subject of this enquiry. The next greatest is forty-two; the least only seven. Of these the medium is seventy-two; a number more than double that of those, who in the former inoculation took no preparatory purging medicine at all; and nine times as many as those, who in the former inoculation took infusion of sena only. This experiment, as far it extends, is not in favour of the mercurial alterative, previous to inoculation. The medium of those eight who took infusion of sena, is twenty-nine each; much less than half the preceding number: and of the seven inoculated without medical preparation, the medium is eighteen, that is, one-fourth of the number only of those who took the mercurial medicine.

Of the eighteen, where matter in its most concocted state from inoculation was inserted, and no medical preparatory given to each, the medium was fifty-seven to each; which is the highest number, except those who had taken the mercurial medicine.

Of those who were inoculated with only three days abstinence from animal food, the medium of the four was seventy-three; which is one more to each than those who had taken the calomel. Of these, however, one had but four pustules.

I here must remark, that from many trials I had heretofore made, and from the relation of others highly worthy of credit, I had long entertained doubts of the efficacy of mercurials, quatenus mercurials, lessening the quantity, and consequently the danger of the small-pox. I mean, here, what is usually called the alterative property of mercurial medicines, and not what depends upon their purging quality.

Such is the state of the facts, from which every person is at liberty to make such deductions as he may think they will admit of. To me it appears, that after ten or twelve days abstinence from animal food and heating liquors, the person being in other respects in good health, it is of no very great importance with what kind of variolous matter he is inoculated; as in every one of the histories before mentioned, though the treatment was so different, the small-pox was so slight as scarce to deserve the name of a disease. It should seem, however, from the result of these; that after a few previous gentle purges, in which mercurial preparations have no part, and the variolous matter being inserted in its watery state, that the supervening eruptions will be fewest in number, and the disease the slightest. Ichorous or watery variolous matter, therefore, I should chuse to employ.

If, indeed, particularly in children, there should be symptoms which indicated worms or foul bowels, I should certainly direct calomel with jalap, or with whatever other purging medicine was exhibited, previous to inoculation: and this not so much with a view of lessening the number of variolous pustules, as that of more effectually clearing the bowels of their morbid contents.

The general expediency of repeated purging at the decline and after the disease, when conducted in this manner, seems to depend entirely upon the state of the punctures, the sores succeeding them, and other indications at the time. The secure side is that of gently, and not violent, purging. If no plaster has been applied, the punctures rarely give any trouble. Particular care must be taken likewise, that, after so long an abstinence from animal food, the patients be, when the pustules are dried away, restored to it by degrees. Those of the younger sort especially, as their appetites are generally pretty keen, if left to their own discretion, would eat too much: and whatever happens afterwards, though apparently the effect only of too hasty an ingurgitation of animal food, would be attributed to the remains of the variolous matter lurking in the habit and not sufficiently carried off.

It should seem also, that when highly concocted variolous matter is inserted, the supervening pustules are larger, more in number, and maturate the most perfectly; and that the sores attendant upon the punctures are disposed to keep longer open.

We may deduce likewise, that in general far more than any previous preparation depends upon the patient's constitutional fitness for the reception of the variolous poison at the time of inoculation. This is evinced by the great latitude in the number of pustules of those, where the disease was produced, when the regimen, diet, physic, and variolous matter were precisely the same.

From what combination of causes may arise this constitutional fitness for receiving the variolous infection, is reserved for more acute physiologists than myself to determine.

It need not here be observed, that the small-pox, when the contagion is received in what is called the natural way, is frequently one of the most fatal diseases, that infest mankind. By what means the intensity of it is lessened the disease becomes milder by inoculation; whether it arises from the variolous virus being absorbed by the lymphatics upon the surface of the body, and not received in the first instance either into the lungs by respiration, or with the saliva or aliment into the stomach, is not intended to be discussed in this place. By computation from our bills of mortality, at a medium, out of every thousand who die of all diseases put together, we find that about eighty are destroyed by the small-pox; a twelfth part and half of the whole number of deaths. Sometimes the proportion is higher, as in the last year 1767: it then amounted to a tenth part, and about one third.[2] In the year 1752, which is the highest comparative number[3] I find, it amounted to a fifth, and somewhat more than a half. Whatever art can do, therefore, to avert this destruction, to prevent a cruel death to many, and deformity to more, is of high importance. This, I flatter myself, inoculation, when practised more generally than even in England at present, particularly in the country, under proper political, as well as medical regulations, will in a great measure do; and of this the most essential parts seem to be, the insertion of ichorous variolous matter by small puncture; a well regulated vegetable diet before, and during the whole[4] process of inoculation; and the avoiding of heated rooms and heated liquors, particularly in the inflammatory state of the disease. These, to me, appear the principal points. The boasted effects of the medical nostrums of several inoculators, at however an extravagant price the possessors may rate them, are, in my opinion, very little to be regarded. The preceding histories bear testimony that much is not wanted; and if these are not deemed sufficiently numerous, we have many hundreds more to produce in corroboration of that testimony. It is well known that no persons place much value upon nostrums in physic, except those, whose knowledge in medical matters lies in a very small compass. The most valuable nostrum of all, I apprehend, is not to do too much: and I say this from the conviction I have, of the mischiefs I have seen, and believed to be owing to the effect of mercurials, and too frequent preparatory and other purgings, administered too liberally by some inoculators, in delicate habits. These, therefore, a prudent practitioner may avoid, and direct those medicines only, the utility of which experience has justified.

I hold it as a truth, and I am not singular in my opinion, that inoculation, practised by any person whatever, in any manner yet devised, and any time, carries with it, in general, less danger to the patient than the natural small pox, under the direction of the most able and experienced physician. Whatever, therefore, can contribute to the perfection of this salutary practice, deserves the most serious enquiry. What has been the result of my experience, I here, without reserve, communicate to the public.

The small-pox, in its mild and distinct state, is seldom, except among persons of distinction, an object of the care of physicians in London, out of hospitals. They are most frequently consulted in the worst state of the worst kind of the disease; when it is of too considerable a magnitude to admit of much as it is well known relief from the medical art that the averting the danger attendant upon the maturation and decline of the small-pox, depends very much upon its treatment during the febrile and eruptive state of it. The vexations and discouragements which the excellent Sydenham met with, in. his practice in the confluent small-pox, mortified him not a little, and occasioned him to say, in his letter[5] to Dr. Cole, Quâ de causâ accedente insuperabili τῶν πωλλῶν prejudicio, bene mecum agi putarem, si nunquam deinceps ad variolis laborante accerserer.

Within these last ten years, there have died of the small-pox, in the compass of the bills of mortality only, twenty-three thousand three hundred and eight persons.[6] Had this number been inoculated under advantageous circumstances, it will not be too much to say, that the thousands had been preserved, and a portion only of the fractional parts been destroyed by this disease. Of these, how many died under inoculation we are not informed. It were a desirable thing to be known. The deaths by inoculation ought to make a distinct article in the bills of mortality. In great numbers inoculated some will die, whoever may conduct the process: but as many inoculators endeavour industriously to conceal the deaths in this practice, and are desirous of attributing them to any cause rather than the small-pox, it would not be easy to procure the real numbers.

It may be no small degree of satisfaction to those who have been inoculated, and have had the small-pox in a very flight manner, to be informed, that besides those above mentioned, who were inoculated a second time without effect, I have had some scores punctured a second time, where there has been only one pustule; or where without pustules the punctures.

There died of the fmall-pox from 1701 to 1710, 12548 persons. This number is greatly enhanced by the number 3138 dying of the small-pox in the last of those years. In the year 1702, there died of this disease, only 311; though the general deaths were 19481.

General deaths from 1701 to 1710,214611

from 1758 to 1767,223497

have been turgid or inflamed, when no plaster has been applied. This was done, in order to ascertain the reality of the variolous poison having exerted ail its power. In no one instance, within my cognisance, a subsequent eruption has ever happened; nor have the punctures the second time put on the appearance they did at first; but have always healed as such slight punctures usually do, when no variolous matter has been inserted.

Notwithstanding what I have before advanced, I am no advocate for very early inoculation, where the contagion may be in great measure avoided, as in country places. I do not recommend it, until the body has acquired a certain degree of strength, and the disorders attending infancy are over. When I say this, it well known, that numbers have been inoculated successfully in the earliest time of their lives; but it is likewise as well known, that several have died at that period, where great attention has been paid to them, and no medical assistance been wanting. I therefore in this state never, advise it, except in cases where there high probability of the infants receiving it by contagion; and I am of opinion, as has been already mentioned, that inoculation at any time carries with it more security than having the small-pox by natural contagion. A few months since, where a child of three years old had the natural small-pox in a severe manner, there was an infant of only seven weeks old. This the parents refused to remove out of the house, though I much pressed them to it. They were determined, that this infant should take its chance from its brother's contagion. They had no objection to its being inoculated, as I thought that method the most secure. It was accordingly inoculated from its brother, and had about twenty pustules, and passed very well through the small-pox; though on the two day preceding the eruption it was considerably disordered, to the no small anxiety both of the parents and myself. If infants have but little of the disease, they go through it well; but if they have much, which no practitioner can assure himself they will not, their powers of life are scarce sufficient to struggle with it, and the conflict dangerous. The assistance of the medical art, in this situation, extends not very far. After three years old, the danger of inoculating is but little. In several parts of London, and in populous manufacturing towns, where several families live in one house, when the contagion is prevalent, there then remains, in my opinion, no doubt of the expediency of inoculating even early; as the incurring some little degree of danger is justifiable, when a much greater is impending.

  1. A livery-servant, belonging to a friend of the author's, left his master's service, not a great while since, to practise inoculation.
  2. The general deaths were
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    22612
    By the small-pox
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    2188
  3. Died in 1752,
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    20485
    By the small-pox
    . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    3538
  4. This rule may now and then admit of an exception in weakly and delicate habits, in which, after the febrile process is over and the eruption well formed, if the patient is very languid, some light broth, and even a mouth full or two of chicken, may be indulged with advantage; but this must be directed with caution.
  5. Dissertatio Epistolaris ad Gulielmum Cole, M.D.
  6. This number is almost double to that of the first ten years of the present century, though the general deaths at that period do not fall much short of those of the last ten years.