A healthy middle-aged man, rather of a corpulent habit, was inoculated, had a slight cold fit (on the 5th day inclusive after the operation) which lasted but a very short time, and was not succeeded by either fever or complaint of any kind.
His arms at that time shewed certain signs of the infection having succeeded, which continued advancing to the 9th day, when the inflammations about the incisions appeared considerably spread, and were surrounded with confluent clusters of very small pustules. In other respects he was perfectly well, and felt not the least stiffness or pain in the axilla, or elsewhere; insomuch that he began to be uneasy least he should have no appearance of small-pox.
On the 10th several small pimples were to be seen on the forehead, which I should have thought small-pox, if he had not at this time been quite well, brisk, and hearty, without having felt any previous complaint.
On the 11th in the morning many more were to be seen on the face, limbs, and body, so that he might be said to be very full. I now examined him again very strictly, and could not find that he had been in the least ill; and on inquiring how he had slept, he answered, Never better; for he went to bed about ten, and did not wake till near seven in the morning. The eruption, on a close inspection, had such an appearance as would have made me pronounce it the small-pox of an unfavourable kind, if it had been preceded or attended by any feverish or other complaints; but I must confess, that even at this time I supposed it was only an inoffensive rash, as the patient was then, and had been, intirely free from any complaint.
All this day he continued perfectly well, had walked out of his own accord into thefields, and in the evening asserted that he never had been easier or better in all his life; though, as he confessed to me afterwards, he had been in some company where he smoked his pipe, and drank his share of a quart of ale. Still the pustules remained, and increased in number, though not in size; and nothing but the consideration of his having had none of the complaints which usually precede even the slightest kind of small-pox, kept me in any doubt whether they were the small-pox or not.
The next morning, being the 12th, the attending nurse told me that he had passed a very restless night, with much complaint of pain in his head and back; and I found him very uneasy, with great heat, a quick pulse, and very full of a small sort of small-pox indisputably.
These complaints coming on at this unusual time made me apprehensive of the consequences. I gave him directly calom. gr. iij. tart. emet. gr.1⁄8,and advised him to get up and go into the air, but not to fatigue himself too much. I also directedthat after two hours he should take a purging draught. [It is to be observed that he had had stools every day regularly; and remaining perfectly well, had taken no medicine for some time.] I called on him again about two, and found him walking about the house, when he said he was better, for that the physick had worked him five times very sufficiently, and each time he had been abroad to the privy, though it rained pretty smartly.
I saw him again in the evening, and then he made but little complaint of pain in either head or back; but was almost incessantly seized with a short tickling cough, and complained of his throat being sore. He then took another pill of the same kind as that in the morning.
Early the next day, the 13th, the nurse informed me that he had been very restless the whole night; had put on his cloaths and came down stairs, but was now gone into bed again, in hopes of getting a little rest. On going into his room I found him almost dressed again, complaining that he had an almost constant irritation in the throat, and finding it impossible to get any sleep, wastherefore coming down stairs. I enjoined him, however, to keep within doors.
About one I saw him again; he had had two stools, and was better. His cough remained somewhat troublesome, and his throat grew sore.
In the evening I found him in good spirits, with a regular quiet pulse, and he had one more purging stool. I ordered another pill of the same kind to be taken at going to bed, and a bason of small white wine whey after it; also an oily mixture to be taken occasionally, to relieve his cough and the tickling sensation in the throat.
The 14th in the morning he had some comfortable rest, and felt himself refreshed; his cough had been much better, so that he had taken but once of the oily mixture. This day he had three stools from his pill; and the small-pox had advanced in an unexpectedly kind manner.
From this time nothing material happened; the cough left him, and his throat gave him no trouble.
The pustules filled with good matter in a shorter time than I ever saw such a number of so small a sort, and many were brown on the 17th day, being the 7th from the first appearance.
On the 19th he took a purge, and was perfectly well.
To these cases many others of a similar nature might be added. But by several unforeseen delays, not in my power to prevent, I have been obliged to trespass so much already on the patience of those who wished to see some account of this practice, that I shall only mention a few, which, by a partial or untrue relation, might possibly be construed to the disadvantage of inoculation; though when the particular facts are candidly exhibited, every just occasion of prejudice will undoubtedly be removed.
During the autumn of the last year the chin-cough was epidemick at Hertford; and as the winter approached, the small-pox also broke out in many places; and almostevery child, who before had the chin-cough, and was seized with the natural small-pox, died of a confluent kind. This calamity fell severely among the poor of this place, many of whom earnestly entreated me to inoculate their families; but this was scarcely possible, unless some necessary provision could be obtained for them from the parishes to which they belonged; I therefore acquainted the clergymen of the respective parishes, that if proper care was taken that necessaries were not wanting, I would freely inoculate and attend all such as I thought were proper subjects.
Both the gentlemen approved the design; but after a short consultation with their parishioners, the affair was put off, the parish officers alledging that they could not provide proper places.
That such a design had been in agitation soon became known, and a number of poor people were continually soliciting me to inoculate them and their children at all events, promising to provide for themselvesto the utmost of their power. Some had the disease already in their families. It was so much in the neighbourhood of others, that they were in daily fear of taking the infection, and their distress on this occasion was great. Women with children at their breasts, in want of all necessaries, yet solicitous for the safety of their offspring, pressed me to inoculate them and their children with an importunity not to be described. I acquainted them with the danger attending the infant state; but reasons availing nothing, I yielded to inoculate all who had not the chin-cough, or any other dangerous illness, though against my opinion and inclination, almost against my determined resolution. Amongst a very great number of such subjects of all ages and constitutions, and where some might reasonably be presumed to have taken the infection in the natural way, I expected some disagreeable events would happen; but the probability of saving the lives of many preponderated. The following however are the only cases that border on the unfortunate; and the reader will, if skilful and candid, easily place them to the right account.
A mother and three children (one of them at the breast) were inoculated. The children had then the chin-cough; but this was carefully concealed from me, as I had refused all under such circumstances. The youngest, of about five months old, had only five or six pustules in the face, and not more elsewhere proportionably. She lived past the crisis; but the cough remained violent, and she was much enfeebled, and died as children do who perish by the chin-cough, and without any one circumstance of danger that could be supposed to proceed from inoculation.
Another weakly child, about five months old, I had persuaded the mother to wean, in order that she herself might be inoculated. During the preparation this woman fell ill of a fever, as supposed; but on visiting her, I found the confluent small-pox appearing, and that the child had lain with her constantly. I was earnestly solicited to inoculate this infant, in order to give it a better chance, which with great reluctance I yielded to; it had a very smallnumber of distinct pustules, and passed through the disease safely; but not being reconciled to any food but the breast, it died soon after, languishing for want of proper sustenance.
Another unfortunate subject was also a child at the breast, one of eight children, who with the father and mother were inoculated together. On the third day from the inoculation this child was seized with a fever, which, from the symptoms, I suspected arose from worms. I gave it a grain of calomel; a large worm was voided the next day, and the child was seemingly better; but the fever returned at night, and continued without remission in such a manner as to be very dangerous in itself, and prevented any distinction of the eruptive symptoms: at length a confluent kind appeared, though the number was not great; the bad symptoms were not alleviated by the eruption, and the child died early in the disease.
All these cases happened since the introduction and first chapter were written; and have confirmed my opinion, that it is better, both on account of the subject and the reputation of the practice, to defer inoculating children till they are about two years old.
It seems not improper likewise to mention the following case; which, if the whole truth is not related, may possibly afford matter of cavil against inoculation.
A short, thick-set, middle-aged man was seized with the usual symptoms on the eighth day after inoculation. The eruption was favourable, the crop moderate, the pustules large and distinct, and no peculiar care was either required or observed. The pock maturated in seven days; after which he took two purges, and had fixed the day for his return to London.
Two days before his intended journey I found him in the morning sitting by the fire, with his hand upon his head. Upon inquiring the reason, he answered, My head feels very queer to-day: a person in company added, that he had made too free with mutton the day before: but this he denied. He did not however seem much indisposed; he had taken a purge, and I expected he would be relieved by its operation.
Next morning he told me he had had a good night’s sleep, and was perfectly well; nevertheless, two hours after he fell down suddenly in a fit, and senseless. In this condition I found him about six in the evening, and so he continued till the night of the following day, when he expired, perfectly apoplectic, in spite of every means we could attempt for his relief.
Onemorning 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. and1⁄8gr.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 theair 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.
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.
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 thewhole 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 andlimbs. 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.
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 evidentthat 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 shelost 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.
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.
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.
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 daysbefore. 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 keptabroad, 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.
Manyinstances might be produced of unjust charges against Inoculation, alledged by those who have opposed the practice: but I should not at this time, and in this country, where the prejudices are pretty well removed, publish any case of the following kind, if the inadvertence of a translator had not made it necessary, in defence of my own character.
Dr. Baylies, an ingenious and learned English physician, had been called from Dresden to Berlin, in 1774, to inoculate some families of persons of condition; and the King of Prussia so far approved the practice, as to appoint him his physician.
After the most perfect success with several patients, a child who had been inoculated by him, was, about two months after, seized with a distemper which proved mortal, and the physicians who attended, asserted that the child died of the small-pox.
In vindication of his own character, and the practice of Inoculation, Dr. Baylies had the case of this child stated, and copies of it were transmitted to Dr. Watson, Dr. Archer, and myself, requesting our separate opinions.7
The ungenerous treatment Dr. Baylies met with in this, and other respects, induced him to publish a tract on the occasion, in French, in which our opinions were inserted; and he was so obliging as to send me one of them.8
I was greatly surprized to find what I had written, so erroneously translated, asto misrepresent my meaning in a most essential point. I therefore wrote to Dr. Baylies, and complained of the injury, requesting that he would endeavour to do me justice, in the manner he thought most effectual.
Notwithstanding this was generously complied with by Dr. Baylies, as far as he was able, I have reason to think, that some of the first copies are dispersed, and remain uncorrected; which I hope will be deemed a sufficient reason for publishing the following correspondence.
Augustus de Blumenthal, a healthy child, five years old, on the 21st of November 1774, was inoculated with matter taken from an inoculated patient, who was loaded with the small-pox, and is greatly marked by it. On the 11th and succeeding days from the operation, the fever and eruptions regularly followed. The pustules appeared on different parts over his whole body, were more numerous than they generally are from inoculation, and maturated, dried, and fell off as they ought to do, and as well as those of his brothers and sister, who were inoculated at the same time, and treated in the same manner from the beginning of the fever, till the disease was over. He was then repeatedly purged, as is usual in suchcases, and continued well for above six weeks afterwards; making no complaints till the last day of January 1775, when, while he was at dinner, he complained of being cold, yet afterwards amused himself at play with his companions, and in the evening said that his legs were very weak.
Wednesday the 1st of February, and 2d day of the illness, he arose in good humour, at noon he eat with appetite, but less so at night: during the whole day, at times, he complained more or less of weakness and uneasiness in his legs, sometimes walked about, and sometimes lay down on the sopha, and the succeeding night was restless and uneasy.
Thursday the 2d day of the month, and 3d of the disease, a physician was called, who, finding his pulse agitated, gave it as his opinion, that there was something mixed in his blood which ought not to be there, though he could not say what; and in the evening, to allay the agitation, prescribed him some powders.
Friday, Saturday, and Sunday, the 4th, 5th, and 6th of the month, and 5th, 6th, and 7th of the illness, he shewed great lowness and dejection of spirits, had great weakness in his legs, complained of giddiness, and was embarrassed in his head; yet nevertheless, he had some, though but little, stomach to his food, and during all these three days, a slight looseness, the discharges by which were of a green colour.
Monday the 7th of the month, and 8th of the disease, a large round worm came from him, and he eat with good appetite, though the disorder so increased, that he was confined to his bed, and in the evening became delirious; for the relief of which, a blistering plaister was applied between his shoulders.
Tuesday the 8th of the month, and 9th of the disease, his pulse in the morning was thought to be better; but in the evening the disorder increased, he was again delirious, and blisters were applied to thecalves of his legs. In this condition, being drowsy and watchful by turns, at uncertain and irregular times, sometimes answering questions with propriety, and at other times irrationally, he continued from Tuesday till Saturday the 12th of the month, and 13th of the disease, when in the evening, the surgeon in giving him a glyster, perceived some small red spots like flea-bites, to appear on his posteriors, but made no mention of it at that time. At midnight the physician again visited his patient, and found him excessively red and delirious, with every appearance of a violent impetus of blood to his head, and with involuntary contractions or drawings in the muscles of his arms and legs, upon which he ordered the surgeon to apply four leeches behind the ears. While they were drawing, a slight red ebullition was observed upon the neck, which after bleeding disappeared, and the child lay two hours quiet; but then the uneasiness returned, and before morning he was three times alternately affected with accessions of cold and heat, and had cramps and drawings inhis arms and legs, like those before described.
Sunday the 13th of the month, and 14th of the disease, in the morning his anxiety and restlessness perfectly left him, and in the course of the day, the delirium so diminished, that about nine in the evening he was quite sensible; when the surgeon being ordered to repeat the glyster, observed that the small red spots which he had before taken notice of, without mentioning, were some of them increased in magnitude to the size of lentils.
Monday the 14th of the month, and 15th of the illness, early in the morning the attendant physician again examined the eruptions, and said that he not only found their number great, but that many of them on the back were broke and subsided while there were others under the skin perceptible to the touch; and a very few on the face and neck, though flat, were round and reddish in their circumference, and white on their tops,so resembling eruptions of the small-pox, that he suspected the distemper could be no other: to put the matter out of doubt, the physician, that had inoculated the child, was called in; who, when he came, observed two or three flat eruptions on the face, to be round, edged with a reddish colour, and whitish on the top, as is above described; but on uncovering the body, and examining the rest, the chief of which were situated on the back, he looked on them to have more the appearance of burns or scalds than the small-pox. They were of irregular forms, like flaccid and transparent vesicles, implete with a reddish watry fluid, with a visible blackness underneath. He could not from their appearance, considered from the time of their eruption, and the early fluidity of their contents after they appeared, see any reason to think them at all variolous, especially as the child had so evidently had the disease from inoculation under his own eyes.
Tuesday the 15th of the month, and 16th of the disease, the physician, who hadinoculated the child, called again to see him, when he was informed, that he had totally lost all power of swallowing, and that it was suspected to arise from pustules in the throat. He then went to the child’s bedside, when he not only found many of the before described bladdery eruptions broken, and their water discharged, but all those that were not so, more flaccid and empty than the day before.
Wednesday the 16th of the month, and 17th of the disease, there was very little or no observable change in the morning from the circumstances which had attended the preceding day; yet some glimmering hope was conceived of the child’s recovery; but about two in the afternoon, the melancholy scene was closed by an easy death.
Thursday the 17th of the month, and the morrow after the child’s death, the physician that had inoculated the child called again, to inquire of the father if any thing more, that was material, had been observed between the time he had last seenthe child, and the hour of his death, when he told him that there had not, but that since his death the corpse had been inspected and opened, in the presence of four eminent gentlemen of the faculty in Berlin, and that it had been reported to him as follows.
That the external spots, which had been covered with the before described bladders, had many of them a blackish, or gangrenous appearance under the skin; while others that were extremely small, round and flat, seemed to have in them a small quantity of unconcocted matter.
That on one out of the four places on the arms, in which the infection had been inserted in the inoculation, there was found adhering a small dry scab.
That the throat was perfectly free from any pustulary appearance; and that all the viscera were quite sound, and shewed no sign of any disease, either external or internal.
But that on opening the skull, there were, in the lower and back part of the head, four ounces of extravasated water or serum, except which, nothing deviated from a healthy and natural state.
Query. Was the disease above described, the natural small-pox? The effect of any variolous matter left in the blood, in consequence of the previous inoculation? Or, were the pustulary eruptions, which shewed themselves on the 12th day of the disease, a critical discharge of a putrid or other kind of fever?
London, April 11, 1775.
S I R,
IHAVEcarefully perused the case you have communicated to me, and am of opinion, that the disease you have described was not the small-pox.
The cold fit which preceded the other complaints, is what usually happens at the commencement of the small-pox in common with other fevers; with this exception, I do not find one symptom during the whole illness, that corresponds with the well known progress of that disease.
The eruptions (on which I presume the suspicion of the small-pox was founded) differed from that distemper in every essential point, viz. The time and manner of their appearance; the parts they occupied; and their form and progress. Neither am I of opinion that the disease was the effect of any variolous matter left in the blood, in consequence of the previous inoculation.
That the natural and inoculated small-pox, as well as other diseases which form critical discharges on the skin, may sometimes be succeeded by boils or breakings out, is well known; but these follow very soon, are free from danger, and easily cured by gentle purges. Now in the case before me, I find the patient passed through the inoculated disease, in a regular, complete, and satisfactory manner, and continued well for six weeks after, making no complaint:after which he was seized with a disease that I have not the least doubt was a fever of the putrid kind; but I do not think that the pustulary eruptions can with propriety be deemed critical, as they did not terminate the disease; I rather esteem them to have been marks or tokens of great malignity and danger.
In the course of my whole practice, which it is well known has been extensive, I never knew a single instance of any one having the natural small-pox, after having been inoculated; nor have I ever known any person to have the disease a second time in the natural way.
I shall not pretend to decide on what may have happened to others; but what I have said is true, so far as relates to my own experience.
The report of the gentlemen who opened the body, affords no material information.
The appearance of the spots, is such as might be reasonably expected on any person who died of a malignant fever. Dry scabs frequently remain on the inoculated parts, for some months after the disease.
T. DIMSDALE.
To Dr. Baylies, Physician andPrivy-Counsellor to his PrussianMajesty at Berlin.
London, March 10, 1777.
Dear Sir,
PLEASEto accept my thanks for a very polite letter and a book, both which I received from my learned friend, Dr. Watson. But I am greatly chagrined to find, on the perusal of the French translation of my answers to the queries, that by the insertion of words, not to be found in what I wrote, not only the sense of my answer is perverted, but I am made tospeak what is not true, and to give an opinion contrary to my own sentiments, and the experience of every one in the least acquainted with the small-pox.
What follows will convince you, Sir, that my complaint is well founded, and I confide in your honour, for taking the most effectual steps to prevent the injury my character would sustain, if the mistake should not be rectified.
You will please to observe, that at the conclusion of the case transmitted to me, there were three queries, to each of which I gave distinct answers. The third query is: “Or were thepustulary eruptionsthat shewed themselves on the 12th day of the disease, a critical discharge of a putrid, or other kind of fever?” In my answer, having first remarked that the patient passed through the inoculated disease in a regular manner, I say in reply to the above-mentioned query.
“After which he was seized with a disease, that I have not the least doubt was a fever of the putrid kind; but I do not think thatthe pustulary eruptionscan with propriety be deemed critical, asthey did not terminatethe disease: I rather esteem them to have been marks or tokens of great malignity and anger.”
The French translation stands thus.
Q. “Ou les pustules qui ont paru le 12me jour de la maladie ont elles été l’evacuation critique d’une fievre putride, ou d’une autre espece de fievre?”
Reponse. “Ce n’est qu’au bout de ce tems qu’il a été attaqué d’une maladie, que je crois, sans balancer, avoir été une espece de fievre putride. Il ne faut cependant pas, selon moi, considererles pustules de la petite vérole, comme une crise, parcequ’elle ne leve pasla maladie; au contraire je les regarde comme les marques d’une grande malignité et d’un grand danger, ouse trouve le patient.”
The perusal of the above will certainly satisfy you of the justness of my complaint, and I shall wait with impatience for your answer, which I make no doubt will be such as is consistent with your honour and character.
It gives me real concern to find, on reading the book you favoured me with, that you meet with such opposition in the practice of inoculation, notwithstanding it is so apparently beneficial to mankind; and particularly, that gentlemen of the first rank in the medical profession, should find it so difficult to divest themselves of unreasonable prejudices: but in the end truth will prevail.
I am, Sir,Your most obedient humble servant,
T. DIMSDALE.
A Copy.
Berlin, 24th March, 1777.
Dear Sir,
YOURkind letter of the 10th instant, for which I owe you the greatest obligation, arrived here by the last post; and I am truly grieved to find so material a perversion and misrepresentation of your just opinion on the case of young Blumenthal, as is made in the French translation of it. In apology for which, I have only to say, that as I am not sufficiently master of the French to publish in that language, I put my English manuscript into the hands of a gentleman, an intimate friend, who is distinguishedly eminent for his knowledge, both of French and English, and who was formerly, for some time, a most eminent preacher, in London, to the French refugees; so that I had no doubt of his capacity or attention to do the whole justice, and therefore trusted it to him, with a most strict injunction, whatever liberties he took in other parts, to be particularlyexact in translating the letters, and quotations, without varying the sense of them in any part, for the sake of being florid. And as this gentleman lives in Dresden, where the book was printed, and not at Berlin, I left it to him to complete it, without any controul, whereby, till I received your letter, I had not the least knowledge of the fault you so justly complain of having been committed; and you may, Sir, be very certain, that if I had, I should not have sent an exemplary of it to you, in hopes of its passing unobserved. Hence I trust, that you will be fully convinced, it was quite unintentional; and in order to make you the utmost reparation, and prevent any injury to your judgment, in the opinion of the public, from the error committed, I beg leave to inform you, that as yet the French edition of the book has not been published in this country, and that none of them have been disposed of, except a few I have distributed gratis to my friends, to all of whom I will next week send a fresh printed leaf, which is now in the press, of the pages No. 51, and 52, wherein the fault is fully corrected, and which you shall be sure to have in a post or two after you receive this. I have the pleasure to add, that in the German translation, which has been sometime published, and which are all sold, the error has not been committed, and the translation of your letter is literal and exact. And as both the German and French are but translations of the original, further to secure the whole from being misunderstood, if you think that the pamphlet is sufficiently interesting, and worthy of being printed in English, I will send the manuscript by the first opportunity to London, and order it to be printed under the inspection of any person you shall recommend to me for that purpose. Flattering myself, that this answer to your last, will be fully satisfactory to you,
I am, with the most true esteem and respect,
Dear Sir,
Your most obliged,
And most obedient humble servant,
WILLIAM BAYLIES.