New Observations on Inoculation/Chapter 3
On the Treatment.
THE object of inoculation is to give the small-pox with as little prejudice to health as possible, or, in other words, to bring on as slight a disorder as we can.
What has been said on preparation and insertion, tends directly to that end; but the subject before us is still more closely connected with it, and consequently must be the most important part of our enquiries.
Indeed, if the patient is healthy; if he has lastly, not been hurt any preparation the insertion has been well performed; the ensuing disorder will almost infallibly be favourable, whatever pains may be taken by art to render it dangerous, either by neglecting the means of mitigating, or by substituting such as must increase, it.
But though not dangerous, the disorder may be more severe to some people; and it would be both unreasonable and inhuman not to afford them all the helps which may abate it, and remove the very suspicion of danger; and the more so, as, of all acute disorders, of which the small-pox is one, none perhaps will admit of such effectual, and yet simple and natural helps.
Four periods are distinguishable in the inoculated small-pox. The first is that of insertion; the second, that of local eruption; the third, that of the fever; and the fourth, that of the general eruption.
The first period lasts from the time of insertion to the first visible effect of the infectious matter, which shews itself by a slight inflammation at the place of insertion.
The second extends from the first effect upon the part, to that upon the whole animal system, or the first feverish symptoms.
The local inflammation at the place of insertion, is a real eruption of one or more variolous pustules, of the same nature with those that appear in other parts of the body when the eruption begins. Sometimes there is a red spot, or a cluster of spots, like flea-bites, which afterwards rise into real pustules. Sometimes a single pimple appears, having the little orifice for its center; and at other times it is a cluster or group of pustules, like the confluent small-pox.
Hence it appears, that the venom acts first upon that part where it was applied, and there produces a variolous, eruption, as it does in other parts.
When, instead of a puncture, an incision is made, the eruption appears both upon, and round about it; and brings on that inflammation, which is esteemed a sign that the infection has taken effect. But as this incision, and the treatment of it, prevent the variolous humor from shewing itself under a pustular appearance, inoculators have not sufficiently attended to the nature of this inflammation, or to the period of this local eruption.
The third period takes place from the beginning of the fever to the general eruption. Indeed, the first sensible effect of the venom upon the whole frame, is not commonly a fever, but a pain at the groin, axillæ or loins, and a heaviness in the head; but as these sometimes fail, are always slight, and are soon followed by the fever, which is the only constant symptom of the variolous ferment acting upon the whole animal system, the first appearance of this fever fixes the beginning; arid its cessation, when the eruption begins, the end of this period.
The fourth takes in the whole time of the general eruption to the falling off of the scabs.
This eruption once come out, the fever goes off, as do all the other symptoms of the foregoing period; those which now succeed are no longer the effect of the immediate action of the virus, which spent itself by the eruption, but are owing to the inflammation and suppuration of the pustules. Each of these is a small inflammatory tumor. When there is a large crop, and the whole body is covered with them, their inflammation and suppuration must of course bring on a fever, with all the symptoms incident to inflammatory disorders. These would equally take place, were a patient's body covered with such a breaking-out, though of another nature, and from a different cause.
When the pustules are few, the inflammation and suppuration have very little effect, when there are none at all, this last period of inoculation does not exist, and the disorder ends with the eruptive fever.
The description of these four periods plainly shews the progress of nature in inoculation. The matter applied by insertion produces the small-pox upon the spot; this local eruption then acts upon the whole body, and brings on the general disorder.
The animal system is by no means affected in the two first stages of inoculation; and therefore no alteration need be made in the patient's usual way of living, and no treatment is requisite during that time. But in the two last periods, the patient is really ill, and must conform to such rules as may lessen his disorder.
But though these last periods constitute what is called the disease of the small-pox, that appellation really takes in two disorders, distinct from each other, as well in their nature and their cause, as in their symptoms and duration. The one is the effect of the immediate action of the venom; the other of the inflammation and suppuration of the pustules. The first is nervous; the second inflammatory.
It is necessary to observe, that the local inflammation and suppuration, which preceded the first stage of the real disorder, and sometimes are prolonged and even increased during its progress, combine their effects with those, which arise from the universal variolous affection. This remark is the more important, as it points out the most essential difference between the natural and artificial disorder.
Inoculation shews that the part, where the matter is applied, is constantly the first affected, and is more so than any other. This part becomes the feat of an eruption, and consequently of inflammation.
In the natural way, the venom dispersed in the air is mostly conveyed by respiration into the lungs, or by deglutition into the stomach. That part of these internal organs which first received the infection, must be affected in the same manner as the external part is by inoculation. But an eruption and inflammation, which affect the animal œconomy but little, if at all, when produced upon the skin of the arm or hand, must be of the utmost consequence when they take place in organs whose action is so necessary to life. Their influence extends over all other parts, and they are of such a nature, that an inflammation upon the least spot of them often brings on an universal inflammation of the whole.
The symptoms of the small-pox, when it is violent, indicate that the seat is in the stomach or lungs; and dissection constantly shews the cause of death to have been an eruption in these viscera, like that which appears outwardly.
An eruption and inflammation, though ever so slight, either in the lungs or stomach, must produce effects, which being combined with those of the virus, will in this first period render the: disorder inflammatory, which it could not otherwise have been. Accordingly, in the natural small-pox, so early as the second or third day of the fever, the pulse, heat, &c. indicate an internal inflammation, and the blood is fizy as it is in inflammations of the lungs. But in the artificial small-pox, as the local inflammation is always slight, especially if the insertion has been well performed, and as it does not affect a delicate organ essential to life, it may be considered as next to nothing; and consequently the fever, and other symptoms incident to this period, are only occasioned by the immediate and hidden working of the venom, without the intervention of other causes. Hence we observe, during this stage of inoculation, none of those inflammatory symptoms which seldom fail to show themselves in the natural disorder.
Having now explained the nature and difference of these two last stages, which are properly the small-pox, I shall proceed to the treatment; and begin by the rules to be observed during the first, viz. from the appearance of the fever to the eruption. These rules are the more important as the two periods always correspond. It is universally allowed, that the higher the fever is, the fuller the eruption will be. When that once appears, it must have its course; the business of art is therefore to check it beforehand, by endeavouring to mitigate the disorder in the first stage, whence depends the degree of it in the second.
Our rules are simple, easy, and equally applicable to the natural and artificial small-pox.
RULE I.Fresh and cool air is to be respired.
The least attention to the phenomena of this disorder will convince us, that its process tends to assimilate part of our liquids to the primary variolous atom applied to any part of the body, either by inoculation or natural contagion. The result of this process is an eruption, the matter of which is exactly like that of the first applied atom. The reproduction therefore, and the multiplication of this atom, or the assimilation of our humors with the variolous matter, constitute the essence of this disorder.
Now, as the whole danger is known to consist in this assimilation, or in the quantity of pustules; the object of the treatment ought to be the reducing of it. The free admission of cool air fully answers this purpose; for as heat is the most powerful and universal agent in nature in propagation, vegetation, fermentation, and in general in every process where one substance is to be converted into another; so cold must check and retard the assimilation of our humors with the variolous matter, as it checks the growth of a plant, or the fermentation of a body.
Other reasons might be alledged to explain the salutary effects of cool air in this disorder; but reasonings are needless, where experience is so sure a guide.
In all countries, and at all times, it has been found that cool air is the most powerful antidote against this disorder; and hot air, on the contrary, the chief cause of fatal accidents too commonly observed in it.
I might quote the observations of the most famous physicians, who taught this doctrine, and to theirs join my own; but it will be sufficient to appeal to Sydenham, that oracle in physic, especially with regard to the small-pox. Read the works of that great man, and you will find, that whenever he treats of this distemper, he insists upon the necessity of breathing fresh air. Compare his various writings, and even the several editions he published, and you will be sensible that he was led to this opinion, not by reasoning or prejudice, but by degrees, and a long train of experiments.
The best writers since his time have added but little to what he said; but one and all confirmed his doctrine as to the benefit of fresh air. Some indeed went farther and asserted that the cooler the air, the better it is. They were induced to think so from some desperate cases in the small-pox, where the patient, thought to be dead, revived upon being exposed to the cold and open air, in the depth of winter.
The great success of inoculation in some parts of England, for these two or three last years, is by several eminent physicians ascribed chiefly to the courage of inoculators, who ventured farther than Sydenham himself; and the event seems to warrant even excess in this article; Of this the following fact, related by professor Monro, is a sufficient proof. One hundred and twelve persons were inoculated in the depth of winter, in some of the most northern islands of Scotland, where there was hardly fuel enough to dress victuals; several of the patients, during the whole course of the disorder, went out bare-footed upon the ice and snow, and not one of them died.
By quoting this instance of boldness, I do not pretend to advise the imitation of it; but this I dare affirm, with that assurance which intimate conviction alone can give, that every thing is to be feared from the heat of the air and little or nothing from cold; that a physician may safely have recourse even to excess of cold in a confluent and dangerous small-pox; and that many a one who dies of the natural disorder, after having been thoroughly nursed and covered up in bed in a hot and close room, would have escaped, had he been so lucky as to be seized with it in the open fields, and had crept into the meanest hut, which could hardly afford a shelter from the inclemency of the winter.
What I have now been saying relates to the natural, rather than to the artificial small-pox. This last is so mild of itself, that, when nothing is done to render it dangerous, seemingly harsh means need never be used. I only desire that every patient under inoculation avoid both excesses of heat and cold; that they breathe a cool air; and that their own sensations be the measure of this temperature. Let them act in this respect as if they were in health, and consulted their conveniency alone in the choice of their air. The heat of their body, increased by the disorder, will, it is true, encrease their desire of cool air; and such a degree of cold as would be rather disagreeable in health, will be extremely grateful in the small-pox. But this very desire is the voice of nature, and the relief, which immediately follows the gratifying of it, shews that this voice is not deceitful.
I cannot help observing, that every physician must know this to be the doctrine of Sydenham, Boerhaave, and all the great masters of our art. Not one of them would dare to avow the contrary opinion in print; and yet how many suffer their patients to be stifled up in hot rooms, and debarred from the benefit of cool air, merely in compliance with vulgar prejudice, founded on a mistaken notion that heat drives the humors toward the skin, that cold repels them, and consequently that warmth is beneficial, and cold hurtful in the small-pox?
Now, though this popular error can have no abettors among physicians, yet, lest any should inadvertently be led astray, it may be worth our while to refute it.
1.It is contradicted by experience, which is above all reasonings.
2.It rests upon vague and confused notions, and falls to the ground as soon as we come to a definition of the words used to express it.
3.The hot air taken in by the breath is so far from driving the humors outward, that it rather carries them more forcibly to the internal parts, and especially to the lungs, by dilating the pulmonary blood-vessels; whereas cold contracts the diameter of those trunks, and forces the humors towards the external parts.
4.When the eruption is compleated, and the pustules have once appeared, the cold surrounding air of the atmospheres never strikes them in. This has been observed by many physicians, and may be so by all, as well as by myself. On the contrary, the eruption is always most copious in those parts, which are most exposed to the air, viz. the face and hands, even in the coldest weather.
5.If cold did really drive back the pustules, it would be an advantage in a disorder, where the danger arises from their number. Hence, in some cases, pustules are often seen to disappear soon after the eruption; and this phenomenon, when attended with no bad symptom, is looked upon by skilful physicians as a sign that the disorder is very slight.
6.What induces people to imagine that pustules which disappear do really strike in, and that the humor which was to have filled them, is driven back towards the internal parts, and brings on the terrible symptoms sometimes attending this disorder, and even death itself, is, that the vanishing of the pustules is often the consequence of a fatal turn of the distemper. But the effect is here mistaken for the cause. When life is immediately attacked by some internal enemy such as an eruption on the lungs or stomach, too great an inflammation of these parts, too copious a suppuration, a mortification, &c, nature, sinking under this attack, is unable to carry on the external eruption, and the pustules disappear of course. But the threatening symptoms always go before; and the dissection of the bodies after death shews that the causes, which brought it on, began long before the sinking of the pustules.
In any other distemper, the discharge of an issue, of a blister, of a wound, or of an ulcer stops, when death draws near. We might just as well say, that the suppression of this discharge was the cause of death, as that the striking in of the pustules is so in the small-pox.
How absurd then is the doctrine which these few observations overthrow; but to how many thousands has it not proved fatal!
RULE II.The patient's mind must be diverted as much as possible.
Strange as this rule may appear, it is of the utmost importance. We all know what influence the affections of the soul have upon the disorders of the body; and in none is this so conspicuous as in the small-pox. From the apprehensions of the patient, his fate is often pronounced; hence great care is commonly taken to conceal from him the nature of his ailment; and many people decline inoculation, from a persuasion that they should not be terrified by the natural small-pox; so well is every one convinced that fear constitutes the greatest danger of this disorder.
If we examine things narrowly, and analyse the sensations of the mind in the first period we shall find some other feelings, which cannot come under the denomination of fear. A dejection will be observed, a sadness, an uneasiness and anxiety; these symptoms more or less apparent, seem to indicate that the active principle which presides over our preservation, is threatened with some imminent danger, and as it were feels the presence and influence of a cause ready to attack health and life in a manner the more alarming, as it shews itself less by external signs. Indeed as to the pain, or heat, the hardness or quickness of the pulse, by which we commonly judge of the intenseness of other disorders, they are very far from keeping pace with the lowness of spirits, weariness and uneasiness, so often observable in this. Now these symptoms, and their disproportion with the former, are the principal signs of pestilential distempers, among which the small-pox may be ranked; and it is chiefly by this difference that a skilful physician presently distinguishes the variolous fever from all others. May it not, at the same time, afford an additional proof, that all these disorders have their seat in the nerves, which of all other organs are most immediately connected with the soul?
The existence of these feelings being thus proved, our business must be to excite their opposites by means of amusement.
I was always struck with the resemblance of the earliest symptoms of this disorder with those of the sea-sickness. The anxiety, nausea, weariness, dejection, head-ach, are in both cases the same, and only differ in point of duration. It even happens sometimes, when a person is long and violently sick at sea, that some small degree of fever will appear at times, and the pulse shall be heavy and intermittent, as in the first period of the small-pox.
Sea-faring people know that dissipation is the best remedy for, and even a preservative against, these complaints. They advise such as are apt to be sick to keep upon deck, and to help in the working of the ship. I have many a time seen people violently sea-sick, instantly relieved by some strong impression on their mind. A ship passing by, the sight of land, any object that strikes unexpectedly, will in a moment perform a compleat cure.
Neither this comparison, however, nor all my preceding reasonings, would so strongly convince me of the truth and utility of the rule before us, as the facts which I have been witness to.
I have seen children in the first period, left to themselves in bed, suffering all the anxieties of this state; and at once have observed all their ills to vanish, as soon as their attention was drawn off to an amusing tale, or to a pleasing toy. This amendment was still more perfect if they were taken up, and enticed to walk about, to dance, to play, and if moderate exercise was added to the recreation of the mind. I aver that, whenever I have managed my inoculated patients in this manner, by keeping them out of bed, and contriving to divert and keep them in constant motion, they have slipped through this period, and hardly have known they were sick. I will not take upon me to determine whether this efficacy of exercise, during that period, is altogether owing to the diversion of the mind, to its increasing and facilitating the secretions, or to any other cause; but certain it is, that it constantly gives relief, and never has any bad effect.
It is easy to divert and amuse children; but how to manage with grown people, is by far a more difficult task. They require more interesting objects, and the choice can only be determined by the knowledge of their taste, and by particular circumstances. In general, one may recommend any moderate exercise attended with some diversion of the mind; such as walking, riding, &c. I say attended with diversion; for a man, who only walks to comply with the prescription of his physician, will be much sooner tired than one who is upon a hunting-match.
General directions cannot be given on this subject; those who have the care of the patients, and the patients themselves, are the best judges of what is most proper in each particular case. By their prudent management, they will be astonished to see a disorder, which would have been severe, if the patient had been nursed and kept in bed, turn out a mere trifle.
Some of the inoculators, who have succeeded so wonderfully in various parts of England, make their patients walk out in the fields, as soon as the fever comes on; they oblige them to go themselves and pump the water they are to drink, and constantly expose them to the open air in all weathers and at all seasons, not only during the feverish, but throughout the eruptive, state.
The two rules here laid down, contain all that is material in the management of the first period. Fresh air and amusement will greatly alleviate the illness, and prevent all bad symptoms.
But to be still more explicit in an affair of such importance, I shall specify some farther directions, included in, and flowing from, the two foregoing rules.
1. The cool air which is inspired ought, if possible, to be free, and constantly renewed.
2. The drink should be cool, and pleasant to the taste. Cool, for the same reasons with the air; pleasant, to present the sickness and reachings so common in this disorder.
3. The palate of the patent may in general be trusted to for the quantity and quality of the food. The call of nature is a truer and safer guide than any directions. If the patient loaths his food, it is a sign he does not want it; if, on the other hand, his appetite should be but a false craving, he will soon be satisfied.
4. The cloathing and bed-covering ought to be the same as in health.
5. The patient must not be allowed to lie in bed except at the hours of sleep.
These directions, which ought to be observed from the beginning of the fever to the end of the eruption, are dictated by nature, and confirmed by experience.
What does nature call for, by that inward heat, thirst, anxiety, retching, heaviness, lowness of spirits, uneasiness, which attend the first period? What; but free and open air, cool and pleasant liquors, entertaining objects, &c.?
Does not experience confirm the same thing? What set of men come off best in the small-pox? The lower-class, undoubtedly; the poor country people, who, left to the care of nature, blindly follow her dictates.
Particular observations may be still more convincing; let any one therefore alternately follow our rules, and those which are commonly practised; and first try them upon the inoculated small-pox, as being so mild in itself, that some little errors in the management can hardly make it very dangerous or mortal.
But I would not be misunderstood. When I propose trying the rules commonly practised, I am far from meaning what is too often done in the natural small-pox, when, under the notion of throwing out the variolous humour, driving it to the skin, drawing it down to the legs, removing it from the nobler parts, and easing the stomach of those humours which occasion anxieties and retchings, the poor patient is covered up warm in bed, in a hot close room, vomited, bled, blistered, and plied with cordials, apozems, &c. This indeed would be enough to make even inoculation fatal. By common practice I mean that, which is generally followed by the wisest and most humane inoculators, and which consists in treating this disorder as they would any gentle fever of much the same duration, though of a different nature. A patient would in that case be kept in bed, in a room moderately warm; fed with broth, eggs, milk-porridge, and allowed any of the cooling and aperitive drinks.
Let this method, I say, and mine be tried upon two different patients, and I will warrant the success of this double experiment to be such, that the latter will be thought preferable, even to the natural small-pox; and we shall shudder to think how much the ills that nature sends us may be aggravated by mismanagement, a worse evil than those which it pretends to cure.
Although the observance of the above rules may alone suffice to render the inoculated small-pox always mild and absolutely safe, yet I will not omit mentioning two helps, which art might afford to concur to the same end.
The first is the use of antispasmodics, the efficacy of which has been experienced by the ablest practitioners, and I may say by myself. I have constantly found their effect to be easy, without any bad consequence. I observed that they might safely be given in larger doses in this distemper than in any other, or even in health; and their effect afforded me a farther demonstration, that the nerves are of all the organs the most affected in the small-pox. But these remedies must only be used in the first period, and not after the eruption.
The second expedient is new, and I only propose it as a hint deserving of farther experiments.
By a constant law of nature, the local eruption at the place of insertion breaks out at least three days before the fever; and the later the fever comes on, the milder the disorder will generally be. Hence I concluded that the cause, which immediately acted upon the whole of the animal system, was by no means the matter which had been inserted, but that which was contained in the pustules of the first eruption. I therefore thought, that if any means could be contrived to retard the action of this matter, the disorder might prove slighter, and that cold applied to these pustules might answer this purpose.
Accordingly I desired two of my patients inoculated in the hand, to hold it in cold water as often and as long as possible, from the first appearances of the local eruption to that of the fever. In both cases the fever came on; but only the sixth day after, it was hardly perceptible, and lasted but four or five hours.
I am sensible that two facts are not sufficient to establish a general rule; as other causes may have influenced the event. But by repeating and varying this experiment, useful discoveries may be made, and more attention will be paid to this topical eruption, and its relation with the general one.
Be that as it will, an inoculated patient, treated according to the foregoing rules, during the first period, will have hardly any fever in the next, and certainly a very slight eruption and perhaps none at all.
In the first case, the inflammation and suppuration of a few pustules will not sensibly affect the animal œconomy, nor bring on the suppurative fever, which is the necessary consequence of a large crop, nor any of those dreadful symptoms, which attend the confluent sort. In short, the second period will be no illness at all; the patient is quite well as soon as the eruption appears.
He is surely no less so in the second case, when there is no general eruption; for the variolous infection having spent itself in the pustules that first came out at the place of insertion, these can no longer act upon the rest of the body, but are a sure sign that inoculation has produced its whole effect.
It has indeed been questioned, whether a patient who had but very few pustules, or only one, has had the small-pox as truly as one who has been very full, and whether he is equally safe from catching it.
He certainly had it, since the characteristic of the small-pox, that from which it is denominated in all languages, and by which it is distinguished from all other diseases, is the variolous eruption, not the number of pustules. He is equally safe from a return; for no reason can be alledged why we should have the small-pox but once, that will not equally hold good for one as for ten thousand pustules.
The instances, true or false, of a return are given out as having happened after a severe, as well as after a slight, small-pox. If a single pustule is no security, why should two, or a hundred? Or how many will be requisite? Were the probability of being safe from catching the small-pox again proportioned to the quantity of the eruption, inoculation, together with the rules given for the management of it, would be highly absurd; since both the rules and the practice, being intended to lessen the crop, would thereby tend to lessen the probability of never having it again.
A more palpable argument of this truth may be drawn from the very nature and course of the disorder. The inoculated small-pox is the ultimate effect of the variolous particle, which was applied to the skin. Now he, who has one pustule, undergoes an application to his skin of all the matter contained in the pustule; he is, in effect, inoculated on the spot, where the pustule is, and that much more powerfully than by the bare insertion of the atom of matter. The contents of this pustule being derived from the patient's own body, are more intimately united to it, in greater quantity, and for a longer time, than the particle inserted by inoculation, therefore a subject, after having once undergone the action of the variolous atom, was still liable to a fresh infection, his own pustule would inoculate him; this second infection would bring forth a third; and this a fourth; and so on, till he had exhausted the whole stock, or fell a victim to such a load of infection.
A man covered with variolous pustules, has all over his body a stratum of the very same matter, an atom of which gave him the small-pox a few days before, and the smallest particle of which will inoculate another, if applied to his skin, or, if conveyed with the air into his lungs, may give him a mortal small-pox. Yet this man, so thoroughly coated with the venom, finds no alteration in his health when the suppuration is over, but what proceeds from his past illness; and the matter he is still covered with has no farther power over him.
Suppose a body of such a nature as to be set on fire by a single spark; if, after having seen it in a blaze, you should observe it surrounded with flames, yet neither burnt nor so much as heated by them, would you not fay that it is become incombustible? In like manner, when you have seen the smallest variolous atom by its bare application, infecting a human body, and afterwards behold the same body covered with the same kind of matter, and not in the least affected by it, will you not conclude that it is no longer susceptible of infection, and, if I may so fay, that it is become invariolable?
This property of the variolous matter so active the first time it is applied to a human body and so inert as to the same body, when it has produced its effect, and been propagated and multiplied, ought always to be kept in view, if we would understand any thing of the hitherto unknown nature of this strange disorder.
This indeed is not our present object; and it may suffice for our purpose to conclude, that whoever has one pock is in the same case with one that has a full crop; each has had his share; and if the disorder can attack the same subject but once, both will for ever remain equally free.
But notwithstanding the obviousness of this truth, many people, accustomed to judge more from their own argumentations than from facts, will hardly be brought to believe that one pustule has the same effect as ten thousand. Though approves of inoculation in general, the bulk of mankind will be afraid of a copious eruption, and uneasy after a sparing one.
In order to satisfy these, it were to be wished, that inoculation could be so managed as to procure an eruption sufficient to remove all apprehensions of a return, and yet so moderate as not to endanger the patient.
The rules, which I have laid down, are intended to lessen the number of pustules; those which I have been opposing, tend to increase it. If two subjects presented themselves alike in health and disposition, I am apt to think might engage to give the one but few pustules, perhaps but one, and to the other a very full crop, if not a confluent small-pox.
In order to produce an eruption neither too small nor too great, a middle course should be steered between the two methods. But it is no easy matter to find out this middle way; nor can any exact rule be prescribed, so as neither to go beyond, nor fall short of, the mark. By keeping to the usual way of preparing, or of inserting, or of treating, or else to all three, the operator may bring on more pustules than the patient would have had, if left to nature; but then he may possibly raise a fuller crop than he wished for, perhaps something worse; and on the other hand, some patients may chance to be so well disposed by nature, that in spite of physical art they may have no small-pox, but at the place of insertion.
If one was absolutely bent upon giving a certain number of pustules, I could propose one way, though I must own I would not do it myself, and that is, to make the insertion with a needle, in twenty, thirty, or fifty places; then you would be sure of one pustule at least at each puncture, and probably of many more in other parts.
This method is the least dangerous think of, in compliance with common prejudice; but for my part, I cannot think a physician, merely to humour his patients, is at liberty to do them more harm than is necessary; and they, who will act at that rate, are less scrupulous than myself.
To be serious; I am satisfied that, notwithstanding the doubts which may arise as to the sufficiency of a single pustule, every wise man will run the venture of this inconveniency, and embrace the method here laid down. He can but be inoculated again, if he has any scruples; and by this experiment, he will find that one pustule is a sufficient security against any new infection, as has appeared in England, where this trial has often been made.
Again it may be asked, whether one can, indeed, have the small-pox but once? This question has been much canvassed, and perhaps not yet-fully decided; but its being a matter of debate, shews that the case of a relapse, if real, is exceedingly rare; and those who pretend to say that it is frequent, and yet make no scruple of exposing themselves to the infection, either say what they do not think, or do not think of what they say. For my own part I declare, I have never seen a true small-pox twice in the same person; and were it true that a very small number of people are liable to catch it again, I still believe that inoculation, rightly managed, would preserve the far greater part of those who fall victims to the natural small-pox, and consequently must be judged a most important discovery for the good of mankind.
- It might, for instance, be said, that of all the bodily organs, the nerves are most particularly attacked in this disorder, and that cold is the most powerful specific in all nervous affections. This begins to be understood in some parts of Europe, and will be more so in time, as the weakness of these organs seems daily to increase in the polished part of the human species.
- I could have wished our author had specified what antispasmodics he meant.