8. If the heating regimen had been carried to excess, or other ill-judged treatment followed.
9. If the patient had met a chill at the outset, checking the eruption.
10. If the attack happen in summer.
11. If the attack happen during a variolous epidemic constitution of the air.
12. If the patient be pregnant or newly married.
13. If the patient be consumptive or syphilitic.
14. If the patient be apprehensive as to the result.
Morton having made the benign type the norm, made the medium type the commonest; and that was really true of the first great epidemic in London in his experience, in the years 1667-68. Sydenham says of it that the cases were more than he ever remembered to have seen, before or after: “nevertheless, as the disease was regular and of a mild type, it cut off comparatively few among the immense number of those who took it.” Pepys enters this epidemic under the date of 9 Feb. 1668: “It also hardly ever was remembered for such a season for the smallpox as these last two months have been, people being seen all up and down the streets newly come out after the smallpox.” Let us pause here for a moment to ask what Pepys may have meant by recognising the people all up and down the streets newly come out after the smallpox. Did he mean that they were pock-marked? We may answer the question by the testimony of Dr Fothergill for a correspondingly mild and extensive prevalence of smallpox in London some three generations later, which I shall take out of its order because it bears upon the question of pitting. His report for December 1751 is:[847]
“Smallpox began to make their appearance more frequently than they had done of late, and became epidemic in this month. They were in general of a benign kind, tolerably distinct, though often very numerous. Many had them so favourably as to require very little medical assistance, and perhaps a greater number have got through them safely than has of late years been known.” The January (1752) report is: “A distinct benign kind of smallpox continued to be the epidemic of this month; a few confluent cases, but rarely.” In February he writes: “Children and young persons, unless the constitution is very unfavourable, get through it very well; and the height to which the weekly bills are swelled ought to be considered, in the present case, as an argument of the frequency, not the fatality, of this distemper.” In June the type was still favourable: “Crowds of such whom we see daily in the streets without any other vestige than the remaining redness of a distinct pock.”
This was an epidemic such as Sydenham alleges that of 1667-68 to have been; and the vestiges of smallpox by which Pepys recognized those who were newly come out of the disease were probably the same that Fothergill saw in 1752.