CASE XVII.
June 2d. Twenty-two persons were inoculated, who lodged at two neighbouring houses.
On the 4th in the evening one of them, a man aged 30, had a shivering fit, succeeded by fever, with pain in the head, back, and side, which continued all night.
5th. In the morning, when I first visited him, the pulse was very quick, full, and strong, and the former complaints remained; but I found him walking about the house. On inspecting the incisions, both were quite well; while those of every one of his associates, which I saw at the same time, shewed evident marks of infection.
This patient had been very much in the way of infection, and I suspected that he was going to have the small-pox in the natural way: I therefore directed the mercurial and antimonial pill to be taken at night, and that he should go into the air as much as he could bear, but not go into bed.
6th. In the morning I was informed that he had been sick and vomited, without having a stool: and that all his complaints remained, though not quite so violent. I prescribed half an ounce of Glauber’s salt, and half an ounce of manna, dissolved in water-gruel, to be taken immediately.
In the afternoon I found him in bed, but was told he had been in the air, and that the purge had operated four times. He was now disposed to sweat, and his pains were abated; but the fever remained as before, with a white dry tongue: he had a troublesome cough, difficult respiration, and great oppression at his stomach; but there was not the least sign of infection in the arm.
7th. In the morning he was much in the same state, only weaker. I prescribed a salt of wormwood mixture, with Mindererus’s spirit, an oily mixture for his cough, and one grain of emetic tartar mixed with 10 grains of compound powder of crabs claws, to be taken in the evening.
8th. He had four stools in the night, sweated pretty well, and got some sleep; but he coughed much, breathed with difficulty, expectorated some thin frothy phlegm, and complained of great pain in his breast and side. Eight ounces of blood were directed to be taken away; the antimonial powder was repeated, with an addition of one grain of calomel; and he was directed to drink frequently a cup-full of pectoral decoction, to a quart of which was added one ounce and a half of Mindererus’s spirit.
9th. The blood taken away yesterday was very fizy, the pain in the breast and side much abated, but the cough very troublesome, and the expectorated phlegm streaked with blood. The inoculated parts were now discoloured, shewed evident signs of infection, and that we should soon have the small-pox to encounter together with the peripneumonic disorder.
10th. Very restless all the night, coughed much, and with great difficulty expectorated brown viscid phlegm. The bleeding was repeated, and the use of the antimonial powder and other medicines continued; which had every day procured some stools, and supported a constant breathing sweat.
11th. The blood was still found fizy, and the fever, cough, difficulty of respiration and of expectoration were increased. The progress of infection in the arm was slow, but shewed, however, that the eruptive fever would soon come on; and I was apprehensive that it would be so confounded with the peripneumonic disorder, as to cause much perplexity. I determined nevertheless to attempt to relieve the latter by whatever means I could, and wait the event; and therefore ordered more blood to be taken, a blistering plaister to be applied between the shoulders, and a small quantity of gum ammoniacum to be added to his pectoral medicines. In the evening I was informed that all the troublesome symptoms were considerably abated.
It must here be noted, that all the company, who had been inoculated at the same time, were now ill, and most of them had some eruptions.
12th. He had had more rest; but though most of his complaints were relieved, yet the fever still continued, and he expectorated with difficulty some very dark-brown phlegm, so that no alteration was made in his medicines.
The appearance on the incisions spread, but did not look as usual when the eruptive complaints are begun.
13th. The fever, pain in the side, cough, and difficulty of expectoration, being again increased, I ordered a vesicatory to the side, and some oxymel of squills in a pectoral mixture.
14th. The fever and pain of the side were abated, and he had obtained some little sleep, which was however much disturbed by sudden startings. The skin at the incisions had an unusual appearance, not easily to be described; and instead of being inflamed, as it usually is, where the progress of the infection is favourable, and not interrupted by some extraordinary accident, it was of a pale hue.
15th. He had rested ill, and the cough was so troublesome, that I ordered more blood to be taken, and the medicines to be continued. The incisions this day looked like pustules irregularly shaped, and a fluid appeared under the cuticle.
16th. All symptoms were more moderate; two pustules were discovered in the face, and those at the incisions seemed tending to maturation.
17th. All complaints much easier; the pustules at the incisions were more elevated, and had matter in them; but the others were but little advanced, and looked pale.
18th. He was in all respects so much better, that he ventured to ride out on horse-back, and I was released from my attendance; nor did I see him afterwards till he called at my house in good health on the 5th of July. But he then informed me, that in the afternoon of the 19th of June, the day after I took my leave of him, he had been extremely hot and feverish; was relieved on the 20th from all feverish symptoms, and discovered a great number of pustules, which rose, filled, and ripened without any further illness; so that he did not think it necessary to send me any notice of them. Looking in his face, I saw about thirty marks of small-pox, which confirmed the truth of his report.
I have also since received a very satisfactory account that many pustules in his face and other parts which came out after the time I saw him, stayed a proper time, and maturated completely.