CASE XXII.
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 the fields, 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 directed that 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, was therefore 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 almost every 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 themselves to 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 small number 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.