?.<*f&h&u - a 5 • „'*> g 1 ? . m* -A V* *J ^ f*<^ te* "i** *- fv* ,. J^fc* ./A* smxjl,Q^oQrooi>Di)0^&OQrOQrO&OUD Surgeon General's Office '^Ift 4» £vl N«f to ba i,;wr;^j&*#**.» ''«*i. 3 J §fe ^fec^e'on, ....¥. No. / I: AN ESSAY htU4,k ON THE ExPEDlENCB*\Ot ' NOCULATION ^fi "*.■<■$ ■'■ y--[ AND " »*. 2*&? Seafons mod [ro$er for iU HVMBLY INSCRIBED Zta Inhabitants of Philadelphia, Br LAUGHLIN MACLEANE, M. D* Ef /e rat wxjxta vi —- < of all the Symptoms of a Diforder taken toge- rrognoflie.^ £ ^ ' * 6 Miafmata. • <• --noxious, hurtfull Particles. Attenuants —— S Medicines which render the Humors of the Bo- £ dy thinner. Vifcidity......—-Toughnefs; Gluinefs. Epidemic.------—Common among the Peop!e, univerfal. Endemif,.--------Peculiar to a particular Place, or People. *. /• r» •/• j S Accidental, not depending on the Qualities of ^'MH'jthe5oilorair. * . Pituitous.--------Watery; Phlegmatic, {much the fame as Vifcidity ; fometimes it fig- nifies Clamminefs, Ropynefs. C An imaginary fubtile Element, generally • fup- JEther.-------< pofed a purer fort of Air, featcd above our C Atmofphere. M -f A fubtile Air or Breath, (not that of the Aura. < T . t Lungs.) Firfi pa^s' ^ -are in Anatomy the Stomach and Guts. Antacids.---■-----Contrary to, prone to deftroy, Acids. prophylaxis. > -.-preVention, Prefervative. Prophylaclic. 5 r _ , ,. .- C That Temperament of Body peculiar to any Ma» Idiofyncrafy,-*—-^ arifmg from his own particular ftru&ure. Panacea. [6J Panacea '—----A Remedy for all Diforders, an univerfal Cure. Empirical.-----—Belonging to a Quack. Stimulants._____S Men : for the *r>*re Prudent and Vav.',:'- tntious always decline meddling ,o'th a tWinfs which dees not pertain (9 them, and which therefore it cannot ie cx'-t:t-d they fhoulauni.erii.tn-i; As f$r thole Qui non d'uiicere quid fit jcirt, ntiUnui ttiSibi mn arrogant fcienti- am. QWiNTiLiAH. i vide Aristotil. Politic ?• Cap. if. Hbrodot. Lik. a: Cap. S-. t "J not it: "J, urtho'it might bring great Light upon Diforders, yet h couhl induce few to cultivate the Science, becaufe the Phyfician i.inrielf mioht ftarve while he was ftudying how to make others Jive,-----The more modern Divifion'into the three Profeflions, Medical, Surgical, and Pharmaceutical, has maintained its Ground'long, *and is like!,- to do fo, as it is foandrJ 6n the mutual Advantage of b-jth Parties, as well the Sons of jE(:u!ai:i'uam ^jifi".? K-vit nrtrn? in hac Sr excrceat, faid Circro on a much 'lefsdnterefting Occafion, than one wherein the Life and Dc;.th of Millions are concerned. I beg pardon for this long Di'iTdkon, butas the Health of the Public is lo nearly in- terefted°in the Subject, an Apo'ogy for it is the lefs neceffary, there being few, very few, Medicines';; which, when taken into the Habit even by the moft heahhy, do not either manifcft Injury or Service to the Constitution.-—But to return,! fhall be-in with the Opinion of the accurate Hiixbam, who fo eminendy fupp nts thd Fame and Dignity of his Profeilicn; in his incomparable Lhay ort 1 >.'v,-rs, a work of immenfe Value, and which cannot be too often per rieJ, as, in it, He has fo judicioufly corrected the few Errors of .the renowf ed Sydenham, who in'fome cafes pu'.hecl the ratienrd Method of Phyfic, which he had happily rellored, a little too far, a fate, as already obferved, not uncommon to the beft of things; In his Effay on Fevers, I fay," he has thefe Words, t(. Innumerable '• IrJhnc^ bowe/er have now fuftkiently evinced the great Succefs " and Advantage of this Method, Inoculafcon, and, granting all ei iiit Prejudice and,Party have faid againft'it, the Danger in the •( n-i'uai v.-y is . at leaft'ten to one, of what it is in this.^t " Tu» ITa7.=-;d in this Method, fays Doctor Netthicn who was k! one of the firft and moft judicious Inoculators, is very inconfi- " derable, and in Proportion to that in the ordinary way, by acci- -• dental Contagion, fo fmall, that it ought not to deter any Body *k from making ufe of it." fl Doctor Shaw, Phyii'i.m in ordinary to his Majefty, in liist :-;w f'r. etife of Phyfic, nublifhed at a Time when Inoculation had veu into LV;route, " by (as hirnteii expieflcs it) fome Errors in the " Choice £ lie dices nthtum xc?> fetnper AZgritfrodefl, nr-rt Jemper fanis. (>£ ls. L b. 2. Caw. j. *l£?ii -v:;te: in pty>' ?fj.( in':dm:, (i a Medico impcrlto; A/< d':n-> e (is in*- f ■•■ :kn «?.fcii/i:ii iti-rmm Pirjpiratio divert *fJtot anti* km SSaMctor. iicct. u Aphor ' 47. T P.K/. i j v. % i'h.'icjcpr). Itiin'aSi. No. }70. L »3 J f' Choice of the Subject, fome in the management afterwards, and Ci fome untoward Accidents in'the Diftemper itfelf," neverthelefs beftows on it the following Character; * " The Small-pox given "by Inoculation appear to be the diftinct kind, the Symptoms • " here being generally light and favourable ; the Puftules'few and " not apt to pit or mark the Face ; and the Danger little thro' the " whole courfe of the diftemper." The Sentiments of Doctor Rutherford on this Head as taken from his own Mouth in his Clinical Lectures for the year 1753 tho' "comprifed in few Words are, with me at leaft,of the greateft weight, " Above thirty years, fays he, has Inoculation been practifed in " this Ifland (Britain) and with good Succefs, for few or none " have died of it, where the Experiment was fairly tried, that is to '* fay, where the Patients Blood was jn a proper State, and Him- " felf free from any other Difeafe."—---My Obligations to this great Mar. as my Preceptor in the healing Art, require, fince I Have had occafion to mensem, him, that I flop here, to pay him the Tribute of an unfeigned Gratitude ; a Tribute due to his Worthy particularly from his Pupils, who can never fufficiently acknow- ledge the Advantages they have reaped from his Labours, above all from his excellent Inftitution of Clinical Lectures, where they daily faw him put in Practice on numberlefs Patients the falutary Precepts which he had before taught them in his practical Clafs, If great Abilities conftitute, if a tender Heart and extenfive Charity adorn, the Real Phyfician, no man ever deferved the Title better, no man ever graced the Science more. The great Doctor Mead in. his Treatife on the Small-Pox has a» intire Chapter on the Advantages of Inoculation, to which, as being too long for infertion here I refer the Reader. But the ftrongeft Argument in favour of Inoculation is drawn from Facts, an Argument which admits of no Reply, and againft which all Realoning would be vain and abfurd.---By this Argu- ment chiefly, nay almoft folely, did the celebrated Doctor Jurin ob- viate all the Cavils of the hrft Oppofers of the Variolous Infition; ■proving evidently, by his ingenious Tables, and the Inferences na- turailv deduced from them, " that, nearly one fourteenth Part of ■' ali' that are born die of the Small-pox ;" if not faved by Inocu- lation._____But as all ftill-born and abortive Children were included - in the Bills of Mortality, upon which thefe Tables were formed, flnd as many Thouiands die without ever having the Small-poA-, v.O.iVUtilOUa K* Vol. J- Ti£(t 158- [ i4l Convulfions, Teething, Rickets, &c. being obferved to carry off Children to the Number of 386 out of every 1000 in the Bills of Mortality ; If the fame Proportion fhould ftill continue, that was obferved in thefe Tables, calculated for forty two years before Ino- culation was known, and eighteen Months after it was practifed, in England, for fo foon after did Doctor Jurin write, we muft ex- pect; " That of Perfons of all Age, taken ill of the natural Small- " pox there muft die of this Diftemper, one in five or fix, or two u in eleven.'" " That of Perfons of all Ages inoculated without Regard to the " Healthinefs or Unhealthinefs of the Subject, as was practifed in «' New-England, on the firft Knowledge of the Method, there will " die only one i n Sixty." " That of Perfons inoculated with the fame Caution in the " Choice of the Subjects, as had been ufed in England by thev fe- " veral Operators one with another; (fome of whom however were " not very proper as will appear from the Tables) there will die " only one in Ninety one." " But if thofe two Perfons hereafter mentioned in the Third ** Table, were allowed to have died of other Ace-dents or Di- " feafes, then, we fhall have Reafon "to think, as far as any " Judgment can be made from our Experience in England, that, " provided proper Caution were ufed, None at all will die of Ino- " culation, as we are informed is the Cafe in Turky, where out of " many Thoufands, that in the Space of forty Years, had been " inoculated in and about Confiantinople, by one Greek Woman, " not fo much as one Perfon mifcarried. This, Doctor Le Due u afferted, who was a Native of Confiantinople, and had been him- " felf inoculated there under the Care of his Father an Eminent " Phyfician in that City." For a further Account of this Matter fee the 374th No. of the Philofophical Tranfactions; The Tables, to illuftrate the Infe- rences, 1 have inferred here. Tabl^. [ «s J TABLE I. Years Total No. of Died of the Small-pox. Burials i In all In rooo | ■————_. .________ 1 1 ,..... 1667 15842 1196 75 1668 17278 1987 JI5 1669 *9432 95* 49 1670 20198 1465 73 1671 15729 696 44 1672 18230 1116 61 1673 17504 «53 49 1674 21201 2507 118 '■'"t 17244 997 5» 1676 18732 359 '9 1677 19067 1678 88 1678 20678 1798 87 167; 21730 1967 91 i6Se 21053 689 33 1681 23971 2982 125 1682 20691 1408 68 1683 20587 2096 102 1684 23202 156 7 1685 23222 2496 107 1686 22609 1062 47 20 Years 398200 28459 7»* Each Year' f at a < ► 19910 1423 Medium ' \ TABLE H 'ears 1701 1702 1703 1704 *7°5 1706 1707 1708 1709 [1710 1711 1712 '7'3 1714 1715 1716 171? 1718 1719 1720 1721 1722 22 Years Each Year at a Medium 42 Years Each Year in 42 at a Medium . I I 10 j T A B L E II. Total No. of | Died of the Small-pox. Burials In all In 1000 i 20471 1059 53 \----..... 1 19481 37* 16 20720 898 43 22684 1501 66 22097 1095 5° 19847 721 36 21600 1078 5° 2 I 291 1687 79 .2l8O0 1024 47 2462O 3138 127 I9833 9*5 46 2II98 J943 9z 2IOJ7 1614 77 26569 2810 106 22232 *P57 48 24436 2427 99 23446 2211 94 ■ 26523 1884 7* 28347 3229 114 25454 1440 57 26142 2375 91. 25750 2167 36620 84 72 .*•.... » 505598 •. 22982 1665 72 903798 65079 72 ■■ 21519 1550 1 " TABLE III. E 17 J TABLE III. Inoculated by Doctor NittLten. 61 Claudius Amy and, Efqr. Sergeant Surgeon ij Mr. Maitland, Surgeon 57 Doctor Dozer, 4 Mr. irejnujij, Surgeon 3 The Reverend Mr. fohnfon 3 Doctor Brady, 4 Mr, Smith, Surgeon ~) ,_ „,. , „ Mr. Dymar, Apothecary $ at C T'fler 13 Mr. Walter, Apothecary ntGofpsrt 3 A Woman at Leicejler 8 Doftor Williams,, at Haverford Wcfl 8 Doctor ivf«o& at ifr,//^/ ' 1 ..... In all 182 Out of this Number the Oppofers of Inoculation affirm that two Perfons died of the Inoculated Small-pox; The Favourers of this Practice maintain, that their Death was occafioned by other Cau- fes. * The Reverend Mr. Mathers Account from Bofton, March 10, 1721, was " that of near 300 inoculated there, 5 or 6 died upon " it or after it, but from other Difeafes and Accidents, chiefly " from having taken, the Infection the common way by Infpiration, " previous to the Tranfplantation. J . Having now ftrengthened myfelf by the Opinion of Men emi- nent in their Profeflion, I fhall more boldly endeavour to anfwer the Objections of thofe who oppofe this Practice of Inoculation. Thefe may be reduced to the following Heads, to which for Me- thods fake I fhall reply in order. C It * By the Accounts of the Hofpitalfor Inoculation in London, it appears that no more die of Inoculation under proper Management than 1 in i?o. Andfurely the Danger ma) be eflimated greater in a crouded ncify Hojpita', than in well aired* private Rooms. But the ci-ut'i:,; Succefs which has at- tended this Operation in Antie.ua, while the Inaction has been fo malignant and fatal here, might, without any further Argument, convince any unpreju- diced Reajoner of the Utility of the Method, and the Obligation which every conscientious Parent lies under of praclifing it for the Good of his Children ; for if lam well informed, and I receive my Intelligence jnm a Gentleman ir. this City of known Honour and Veracity, above ten Thoufand Perfons have been this Sealon inoculated iv that (mall I far. i; in which Number the Propor- tion of thofe who diedofthe Dijorder was to that of the Survivors, at one t$ tiglr kunMd. * la Philofoph.Tr jnl»a. No. 347- [ r8 J It is objected i, That the Difordcr railed by Infition is not the Identical Small- pox. "ft. That in Cofequence of this the Small-Pox may be caught after Recovery from the Operation. JH, That it is Prefumption to inflict this, or any other Diftemper. TV. That our Fate is already.decreed, and therefore Inoculation, if not finfull, muft at leaft be unprofitable. V» That in cafe of bad Succefs, Remorfe muft occafion very great unhappinefs. VI.And th'at the Seeds of other Diforders may be introduced with the variolous Matter. Tl. The two firft were the earlieft Objections againft the variolous Infition, and are fo much connected, that one being overthrown, the other muft fall of courfe ; to fave Time and , Words I fhall therefore confider them together. When Inoculation firft came in vogue thefe were terrible Objections to it, and deterred many, be-> caufe they were a Matter, not of Reafon, but of Eperience ; which alone could prove their Infufhciency, all Reafonings a priori being dangerous in Medicine: but now they have loft fo much Ground that they fcarcely deferve a ferious anfwer, after almoft forty Years Practice, in which there has not been found the fmalleft Deviation of the Symptoms from their ufual Appearance in the or< , dinary Seizure of the Diftemper, when equally mild, or equally fe-. vere; nor can the moft prejudiced Enemies of this Method, pro- duce one unexceptionable Inftance of a genuine Attack of the vari- olous Fever after Recovery from the Small-pox by Inoculation, nor one finifter Accident immediately dependent on it. Which I think fufficiently demonftrates that Infition produces the real Small-Pox, and that Perfons inoculated are no more liable to a fecond Vift- tation of this Difeafe than thofe who have had it in the natural manner.-----One or two Relations, it is true, have been given of Perfons having the Small-Pox after Inoculation, but they were found on Enquiry to be ill-grounded, and no more than every day happened to People very converfant with the Sick in this Diforder ; for Nurfcs who handle variolous Patients may be faid to have the Small pox often, if the Appearance and Suppuration of a few Puf- tujts on thofe P^rts which come into frequent Contact with the Sick, [ 19] Sick, but without a fever or any ill Symptoms, may be called the Small-pox. And this is all that could ever be proved to befall a- ny Perlons after Inoculation, and that only Two Or Three out of many Thoufands.......A remarkable Inftance of this Sort happened to myfelf. The firft Perfon I Inoculated had a larger Number of the Pocks, and of a worfe kind than I could have wifhed; Uneafy, leaft I fhould mifcarry in my very firft Attempt, and the more fo as the Perfon afflicted was very dear to me, I was particularly affiduous in my Attendance, fcarce ftirring from the Room, but in order to fleep, and trufting very little to any one, fo that I almoft performed the Office of a Nurfe myfelf. / The confequence was that about the time when my Patient was out of Danger, Puftules began to ap- pear on my Hands and Arms, and fuppurating with a confiderablc degree of Inflammation went regularly thro' all the Stages of the natural Difeafe, without any apparent Fever, but not without Pain :; And if this happened to me who have had the Diforder in as fevere a manner naturally, as moft People who have recovered from it, having loft two Brothers, befide one rendered lame, by it, at the very time when I narrowly efcaped Death myfelf, it may well have been the Cafe with One or Two of the Inoculated, who were fo mildly handled by the Diforder as to leave it uncertain whether they had taken the Infection or not.—^r-I had the Curiofity to keep fome of the matter of thefe Puftules, which came to fo extra- ordinary a head on myfelf, to try whether it would communicate the Diftemper in the way of Inoculation, but could find Nobody willing to rifk the Experiment, fo that there yet remains Room for doubt with me, whether fuch matter can convey the Small-pox, but I am rather inclined to believe it will; tho' I freely acknow- ledge my utter Ignorance as to the Caufe why the blood will not receive a fever after the firft Infection. This Ignorance however is of the lefs moment, as fuch Knowledge would not contribute to the real Improvement of the Art.----The firft Caufe of the Diforder itfelf is equally unknown, and what has hitherto efcaped the Pene- tration of the moft fubtile Phyficians, is likely to. remain always a fecret to me : Befides it has ever been my Opinion that there is fome thing not a little imprudent in the Inveftigation of all firft Caufes; which are placed many Degrees above human Comprehen- fion.......They who have dared to conjecture any thing concerning Matters fo profound and uncertain, differ widely among themielves: fome blaming I know not what Pollution of the Blood, while we continue in the Womb; fome accufing certain morbid Affections and peculiar Acrimonies of the Fluids; while others more plaufibly alled^e, that in different Climates while the fame Caufes conftantly act, Various Diforders are produced {sv^iot) proper to thefe Climates, which Diforders afterwards may be propagated by C 2 infection. [ 20] Infection. Put for my part I am not afhamed to own that here a- gain I know nothing of the Matter; and provided I know the fe- cond and proximate Caufes, I think I know all that is ufefull, or can inlhuct me in the Cure of Diforders; further Infight into thefe Matters pertains more, if it pertains to any body, to the Philofo- rher than the Phyfician. /JLThe chief Argument urged againft Inoculation by fcrupulous Perfons, is from Confidence. It is Prefumption, fay they, to tempt the Almighty by inflicting Diftempers without his Permiflion. So fay I; but the great Succefs of the Practice not only fhows the Per- miflion of God for, but his immediate Bleffing on our Endeavours, by the extraordinary Recovery of fo many more in this, than in the natural way, as it is called, of the Difeafe. To prove their Affer- tion it will be ncceflary for them to fhew, that this Method is dif- pleafing to God ; but this I am apt to think, they will find no very eafy Matter. If even as many Perfons died of the Small-pox by I- noculation as without it, we might have reafon to conjecture, that our Practice was not only difpleaiing to God, but punifhed by him, as in that cafe the many Advantages of Preparation, Youth, Confi- dence, &c. which we have manifeftly in our favour cannot defend us from his Wrath : They might then fay, that the Sins of the Fa- thers were vifited on their Children and we fhould all be more rea- dy to acquiefce, and to defift from a Practice againft which God had, fo plainly, manifefted his Difpleafure. But if on the other hand we may, with equal Authority, conclude, that the ufe of thefe fecond Means is pleafmg to our Creator, and bleffed by him, with the moft extraordinary Marks of his Favour, as our Succefs war- rants, may we not very fairly retort this Argument of Prefumption I and certainly not to ufe the Means put in our power, but fupinely to expect all Blefiings to be poured on us, without; the leaft Effort on our Part, argues Prefumption in a double Senfe.-----Much of t>i;s Nature are the Obje&iofts made to the ufe of Mr. Franklins In- vention for defending Us from the fatal Effects of Lightning; cer- tainly an Invention of the moft fignal Benefit to Mankind, whether we confider it as reflecting our Perfons, our Buildings, our Fleets or our Magazines; and yet fuch is our Superftition or Sloth, or Prefumption. not to call it wcrfe, that wc reap very little Advan- tage fiom it; fcarce One in a Thoufand, I might fay ten Thou- fands, feeming to underftand the Importance of fo noble a Difco- very. I might here argue, I hope without any Imputation of Irre- ligion, that God having fubjected the Works of his Creation to fettled Laws. Deviations from thofe Laws will feldom take Place; in other Words, we will feldom, or never, find any unfteadinefs in ■^h Caufes ana Effects as come within the Coirpafs of our Under- ftanding. [ 21 ] ftanding. Thus Lightning, under the Regulation of thefe general Laws, being always obferved to ftrike the higheft Buildings, as Steeples, the loftieft Trees as Oaks, will be ever obferved to do the fame. Mr. Franklin regarding this, and finding that the electric fire tended more to pafi. thro' certain Species of Matter, than o- thcrs, for on what Suppoution elfe fhall we account for the melting of Swords while the Scabbards which contained them have re- mained uninjured, happily took the Hint, and by difcovering what Subftances were the moft proper to attrad and convey this de. ftroying fire, by placing thefe attracting Subftances higher, and con- tinuing, them lower, than the Subftances to be defended, He fell upon the moft rational Method of Safety that could well be devifed againft the electric Stroke. And, I again venture to repeat it, He who doth not avail himfelf of thefe means of Security, but relyeth on his own Sufficiency or Obftinacy, is the Perfon guilty of Pre- fumption, and by it the moft likely to offend God, who hath, in a great meafure, left the Means of our own Safety to our own Saga- city, and will therefore be pleafed with our honeft Endeavours to attain that End. Let us not then neglect the moft obvious means of our Prefervation in the natural Courfe-of Things, but let us, at the fame time reft contented and affured, that when it fhall pleafe God to inflict his Punifhment on us, by the Stroke of Fire, of a Difeafe or of any other Inftrument of his Wrath, all our Endeavours can be no Obftacle to his Will; nor let us ever defign them as fuch. IKThe Advocates for Predeftination* reject the Cuftom of Inocu- lation, becaufe, fay they, if it be decreed that We fhall perifh by the Small -Pox, our Endeavours can be of no avail to reverie this Decree. It is neither my Defign, nor Talent, to enter into or re- concile Metaphyfical Points of Controverfy, efpecially one con- cerning which the World hath ever been, and is ever likely to be, fo much divided. But this I beg leave to offer, that, provided there be a Decree in the Cafe, I can very well conceive this Decree to be conditional, without implying any, the leaft, Contradiction. What I mean is moft'eafily explained by an Example, as for in- ftance, may it not be decreed that I fhall have Succefs, (in reco- vering we fhall fuppofe from a Diforder) provided I make ufe of the Means which are put in my Power for that End, but that I fhall not fucceed in cafe I neglect thefe Means......If Example is ftronoer than Precept, with thefe Oppofers of Inoculation, I could recoiv.mend that of the Inhabitants of Bofton as very worthy of Imi- tation, who rv.iinte.in Predeftination as firmly and practice Inocu- lation as univerially as any People under the Sun; the Havock made by the natural attack of the Small-Pox forcing them into, and their great Succefs continuing them in, a method fo falutary. [«] V^ It is a very common Objection of Parent?, that, did their Chil- dren die by Inoculation they could never forgive themfelves. This Argument fpecious as it may appear is not only frivolous to the laft degree, but conclufive againft itfelf. Becaufe the Danger being ten to one in the Natural way, Parents, in cafe their Children die of the Small-Pox, have ten times the Reafon never to pardon them- felves, for not giving them the chance of furviving the Diforder by the help of Inoculation. Befides when any Action is done thro' an intire Conviction, that it is not only juft but expedient, Want of Succefs can never deferve, tho' it too often.meets with, Ctmfure. Vt Others, and indeed with more Shew of Reafon, are averfc from Inoculation, through fears of introducing the Fomes of other Diforders into the Habit, along with the Variolous Matter; and fuch perhaps as could not be driven out again, but might, if en- tailed on Foiterity, be worfe not only than the Difeafe here fpoken of, but than Death itfelf; the Kings-Evil (as it is called) for in,- ftance. Cn account of thefe Fears, it was that, fome Perfons have recommended the giving of the Infection'by the Nofe, a Method certainly attended with Confequences more to be dreaded than thofe againft which it was defigned to guard. To thefe it may be anfwered, that provided the requifite care be taken in chuiing a proper Pock, and from a healthy Subject, very little, if any, Hazard will be run on this Score. What is a Phyfician good for, or why do we employ him, if we do not judge him capable of diftinguifhing a healthy Conftitution from an un- found one ? It may be objected, that it is no very eafy, if not an impoffible, matter, to make this Diftinction in a Perfon ill of the Small-pox. To this I reply that, a prudent Phyfician will chufe his Peck from a Patient whom he has known in Health, if pof- lible ; where this cannot be done, he will enquire from Perfons whom he can confide in: Befides as the propereft Subject from whom the variolous Infection can be taken, is one who hath nei- ther a great Load of die Pox, nor is much oppreffed by the Dif- order ; any different cutaneous Difeafe will be eafily difcovered. But the Difeafe, which is thus particularly alarming is of a Nature not fo be concealed, nor difguifed, and when very vifible Marks do not betray it to die Knowledge of the moft ignorant, the Habit of Ecdy, nay the very Eyes of the Perfon affected feldcm fail to difcover it to fhe more fkilfull. Further it is my Opinion that ftru- mous Diforders cannot be caught by Contagion, nor communicated but by hereditary Taint. For though a Man, or Woman may, and in general do, hand down this Evil to their Children, yet we never find that they infect each other, there being no inftance of a- ny [ *n uy Man or Woman being hurted by fleepiqg in the fame bed whh their Spoufes, though One of the Two were fcrophulous even to the laft degree. For thefe Reafons then, I imagine that all terrors on this head are groundlefs, in as much as this Diforder depends on fome imme- diate fault in our own Structure, either firft ariiing in ourfelves or derived to us from faulty Parents. And this I take to be the Caufe why we fo feldom fucceed in the Cure of the Evil; the Fault not lying fo much in bad Juices, as in faulty Glands, which cannot fe- parate good Juices. It is true we may palliate the Malady by thinning the Humours, and correcting their Acrimony, thus pro- curing them an eafier pafiage through the vitiated Organs; but as foon as we ceafe from our Palliatives, fo foon will the Difeafe re- cover its former Virulence, the Original Caufe remaining un- altered. And this Opinion may be very well reconciled with all the Stages of this Diftemper, I ever faw ; whether its Attacks re- mained partial or became univerfal, happened fooner in Life or la- ter, continued invariable or remitted.-------As to Difeafes of lefs moment, fuch as cutaneous Diforders, provided they fhould be in- troduced into the Blood by means of the Pock, they would either be expelled along with the enfuing Malady, or might be conquered afterwards by proper Medicines. But in my Opinion there is little Danger of this: for the variolous Virus feems to me, to be of a Nature too fubtile to mix with other Matter, and appears rather capable of deftroyihg, all inferior degrees of Infection, than a pro- per Vehicle for its Conveyance : to which thbught I am the more inclined by having frequently obferved the Itch carried off by tha Small-pox, as well when the Difeafe was very mild, as when it was remarkably fevere......This is corroborated by a fimilar Ob- fervation mentioned in the Philofophical Tranfactions ; * " Thofe " that have had ugly Ulcers long runaing upon them have had " them healed up. Some very feeble, crazy, confumptive People, " upon this Tranfplantation, have grown healthy, and got rid of " their former Maladies." The Method propofed for avoiding thefe Inconveniencies, by conveying the Infection through the Organs of fmelling, appears too full of danger, to be countenanced by any prudent Perfon; for by thefe means we introduce the very fubtileft Effluvia of the pocky Matter, and thofe alone, into Parts the moft delicate, and moft im- mediately neceffary for Life, to wit, the Brain, Nerves, and Or. cans of Refpiration. After fuch Practice have, we not reafon to ex- • pe& • No. 379. [ *4l pect Deliria, Convulfions, Suffocations, and the word of Syr.;: toms ? But what do we gain by fuch Practice r Truly very little. For this is the very Manner by which the DiK-afe atcacks us in the natural way, and one of the greateft Caufes of its Fatality: for this Reafon chiefly do the Symptoms run higher in the Natural than Artificial Small-pcx, if I may ufe the Exprefilon ; and for this Rea- fon are Convulfions more frequent in the one than in the other.—— It may not be improper here to obferve that moft Phyficians agree in drawing a good Prognofis from Convulfions, J when they feize young Patients, and that early after the Attack of this Diforder, on the contrary, they allow that nothing can indicate more Danger when they hapf en late, or to Perfons grown up, but they do not fo well agree in afligning Reafdns for thefe Prognoftics.-----The Doc- trin« is good, becaufe we have it confirned by the beft Mafter, Ex- perience, which therefore makes the Knowledge of the Caufe of lefa Moment, if any thing can be called of little Moment, which may ferve to inftruct us in, and regulate our Practice.------To me* it feems probable that the Nerves being in a particular manner op- preifed by die offending Miafmata received by Infection, Nature in- duces thefe Convulfions* and the fubfequent Encreafe of the Fever, as the moft effectual Method of throwing them from the Nerves in.-? to the Circulation of the Blood, for their utter Expulfion, and that the Nerves of Children being more tender than thofe of Adults, they will not only be irritated to expell the Poifon on a fmaller at- tack, but will, by yielding more, fuffer lefs Damage from its vio lence. f—^-—-But when Convulfions happen late the Difeafe has got t hrJitioiaiv oi fa- tal: for here the Convulfion is the Effect, nota partial " Caufe, of theFeyer; and an Encreafe of the Caufe can never remove, but mail rather augment, the Effqct.------Befides when Convulfions happen early in a Diforder, they often proceed from a Sympathy of the Parts, as when an acrid Matter offend^the Stomach, Thefe a Vomit fpeedily removes; oftener from Repletion and Crudity of the Humours, and tbidh the Fever,- by attenuating the 'Juices, and expelling the peccant Matter, feldom fails to overcome ; but when they make their attack late in the Difeafe, they proceed, for the moft part, .from Vifcidity and want of Moifture, which Vices the Fever will hourly eucicafe, by conftandy waitir.? the thinner parts of the Fluids. Having thus, in as brief a manner as I could, endeavoured to prove the Advantages of Inoculation, by obviating the Objections againft it, It remains now that I fay a few Words on the Seafons moft proper for putting it in Execution, the Knowledge of which is fo effentially neceffary to found Practice, that Nothing can be fati- onally performed without it. TheiIe is not perhaps a more difficult Pointin the whole Prac- tice of Medicine, nor one lefs attended to, than to determine wjth accuracy on the Seafon of the Year and Habit of the Patient, moft likely to promife Succefs in this Undertaking. *------And the ftric- teft Regard to the Temper of the Air is in an efpecial manner ne- ceffary for every one who would confult either the Safety of his Pa- tient or his own Reputation ; feeing that we never fail to find the reigning Epidemic manifeftly conjoined with the fubfequent Di- feafe, whenever we bring oh the Small pox imprudently, that is on an unfit Subject at an unfit Time. As I have all along ftriven to enforce whatever I advance by the beft Authority, whoever is at the Pains to confult the Writings of Sydenham, Mead, Huxham, Hoffman, Wintringham, Ramazzini, &c. will find the reafonablenefs of this Affertion; their Works univerfally teaching us that the pre- vailing Epidemic of the Seafon, whether Fever, JPlux, Quir.iy, or D whatever nihilperuiciofius........Scire namque I'eet ejus modi Eijtit:ur,, fi modo cura- titur, humect at at ione?n pofcerc. C J" whatever it was, almoft always fymptomatically fupervened the cur-- fcry Diforders of the Year, efpecially the Meafles and Small-pox; '' Upon the whole then, fays Huxham, it is evident that the previous '* Stiite of the Body and Difpofition of the. Humors greatly r;«rt- '* tribute to determine the Quantity, and Quality of the Small-pofc. ---This may be very nqych owing to that peculiar State of'the Air " inducing fuch and fuch Qualities into the Solids and Fluids,- " which render them liable to fuch and fuch peculiar Fevers; for " we find one Conftitution of the Atmofphere difpofeth to infiam- " matory Fevers, another to the flow nervous, remittents, inter- " mittents &c. and a third to the putrid, malignant or. petechial. " New when the Contagion co-incides and co-operates with fuch '• or fuch a Conftitution, it will be productive of fuch or fuch a " kind of Small-pox, or rather of fuch or fuch a kind of Fever ■« with the Small po>:------Indeed 1 think I have frequently ob- '•' fervsd the common Epidemic Fever manifeftly concurring with1 " the Smallpox, and that the Variolous Contagion only diveifified- *' the Difsafe-r or rather the Epidemic'-Fever was'co-incident- with '' the Small po.v c# the fame Subject. This Was the Cafe very of- " ten intheYt'irs 1740, 1741, and 1745, When a violent Eph- " demic Fever of the Peftilential kind raged here (Plymouth) chief- " ly r.mong the Soldiers, Sailors, and PrifoneBi, who had com- *' monly the moft evident-Symptoms of the malignant Fever with' " the Small-pox, which therefore proved exceeding fatal among " them; whereas je.r.ny Perfons in the Neighbourhood, that had' '* no Communication with the Hofpitals, and were otherwife tole* ** raliy healthy, had a very favourable kind.'' Air being fo immediately neceffary to the Lire of all Animals,' that no-Creature, almoft, can livellum deprived of it, even for a few Minutes, certainly the different States of its Temperament, whether morbid or found, are of the greateft Confequence to Health, and fhould be ftudied, not only diligently but indefati- jeab!y, by every Perfon, who propofes to reach any Excellency in the Art of healing, or preventing Diforders. And'this Practice is-' as o'd as Hippflcratcr, witnefs his intire valuable Books CTf Epi- civmirs: nay to fuch ;i length did this, great Father of Phyfic pufh hi.-, Relearches into the different Conftitutious of the Atmofphere, ti ..at he deduced not only the different Diftempers incident to Man- kind in different Climates, but their very Manners and Difpofitions, frsm the Variations of Air peculiar to Each. And he who does not well confider the Confequences that will arife, not only from ihe fecrct and inexplicable Changes incident to the Conftitution of this fluid, but alfo from the more obvious Mutations in its Gra- vity, Ekdtiehy, Mcifture, Drynefi., Heat, Cohmd>, and other fenfible [ 27 3 ifenftble Qualities, will ever b.e deficient as well in difcovering the Caufes of acute, and even chronic, Difeafes, as in accounting for hi* v.nnt of Succefs in their Treatment. Eum recle cnraturum effe, .dicimt, quern prima origo Caufe nonfefe'le- rit.---■—iSIuiu, JEjlimatio Caicfcc fa;pe morbum fohdt. Celsus in Pr«fat. But let ns hear Sydenham, who can fpeak more to the Purpofe on this head than I can prefume to do, " If one were .to examine all " the Branches of Phyfic, nothing perhaps would appear fo fur- " prizing as the different and perfectly diffimilar face of epidemic " Difeafes, which do not fo much relate to, and depend upon, the " various Seafons of the fame Year, as upon the different Confti- " tution, of different Years. And this manifeft Diverfity of thefe " 'Difeafes ftill furtner appears, not only from their proper and pe- " culiar Symptoms, but alfo from the different Method of Curs " they refpectively require. Plence it is clear, that thefe Diftem- " pers, tho' to lefs accurate Obfervers they may feem to agree in •" -their external face, and certain Symptoms, in common, are, in " reality, of very .different and diffimilar Natures; and thefe kind:] " of Difeafes differ fo extremely, that the fame Method which <: cures in the middle of the Year, may poftibly prove deftructive at " the Conclufion of it." %-----This Doctrine is confirmed by Hux- ham whofe Authority I cannot too often induce ; " Different Con- " ftitutions of the Air, fays he, hrive different Effects on the moll " healthy, much more on the Sick and Weak, and of courfe on f Difeafes. It hath been long obferved that one Conftitution of th- " Atmofphere promotes, another retards the Progrefs of epidemic " Diforders, particularly of the Small-pox ; which at one time be- " gin in the remoteft Corner of a Town or City, and foon ravage " the whole, at another are carried into the very heart of them, and «•' yet prefendy ceafe. The Plague itfelf is commonly flopped by a " Change of Air, from hot and moift, to cold and dry. The very «« ftate ^of the Blood greatly depends on the precedent and prefent f* Conftitution of the Air, and it hath been proved that the Conta- <: gion has different Effects on different States of the Blood.-----A " due Confideration therefore of the prefent and preceding Conftitu- " tion of the Air, is of no fmall Import in our Method of Cure." f But a particular Regard to-the Conftitution of the Air can in no Country be more neceffarv than in this; for as the Extremes of Heat an«i Cold are felt here pretty violently, We may be faid to live by D 2 turns £ Swan's Sydenham. P. 4*. t £% on Fevers. P-3e 14+. [28] turns in very different Climates; * And thefe Changes from very hot to very cold and the contrary, are oftentimes fo fudden as to render this the cafe, not only in the fame week, but frequently in the fame day. Hence a rife the Agues, Fluxes, Pleurifies, and other Autum- nal || epidemic Diforders, to which the lower Sort of People cfpccially are fo much expofed, as they never fail to encreafe the Caufes of thefe Diftempers, by frequent Heats and fudden Coolings, to which, alfo the baneful Cuftom of drinking Ample cold water, when warm, does not a little contribute:-----Whoever confiders the immediate and fenfible Effects, not to mention the more remote and abftrufe, on which endemic and epidemic Dineafes feem to depend, of Heat and Cold, not only on human Bodies but on all Modifications of Matter whatever, will readily acknowledge the different Treatment, which Diforders called by the fame Name will require under different Cir- cumftances : for in reality thefe Diforders are far from being the fame, but as different as the Treatment which they require. And in thus prefcribing not for the Names, but the Nature of Difeafes doe« the Diftincticn lie between the real Phyfician and the Quack. It is the Office of thje Air which we infpire to cool the immoderate fervour of the Blood ; and to contribute to its Supply, by agitating and blending the Chyle with it in the Lungs : Thus at once prefer- ving the Circulation and preventing Putrefaction. Hence the Influ- ence which the change of Seafons has on the Health of all Animals. —--—By the Summer's Heat the Fibres are relaxed, the Texture of the Blood is loofened, and^he Strength of the Veffels is dimininhed. Heat expands every thing, even'Iron, much more then our Hu- mours; but the Rarefaction of the Blood, and the Relaxation of the Veffels leffen the Momentum of the circulating Fluids; Hence Strength and the natural Secretions fail. Wh en the Temperature of the Air is hot and moift, the Compa- ges of the iribies is almoft refolved ; for to relax is the Property of both * Si aeri aflivofrigus l^e-^jcr.iat. ilia die. fnppopta eadem biqendi, LI- htrt.-. e, tertiam ptrtcmcirc'ter Pert •.'irationis exire prohibit, qua nip fiat fenjibilis. facile aa Putredin'e?nvel Cichcxiam d'fponit. Prchib.ta Peripiratiofncia ab improvija frigiMtate, magisnocet 'Dibili- tw a-.i.ru. a fenfim prohibit a, Si G.rpora tkrepente trx-isjirant::? ab acre call do in frigt'dum, la-duntur, eu'aredaumur majoris Ponacris, ip.->f,vpar ft; apuyaoin catidum, Udun- tw. fiur.t enirn nunoris Roboris.. S. S..n«or. Se.'t. z. Vphor, 9. 11. 12. || £>' tqgiv upntrtv ojcv in< aa/VnV tfwYfW or'i y.iv -a^xS-, ct£ rh- Epidemic in Prole^omen." % Aer cenopor convert it infenfibilem Pcrfpirationcm in icho'rem? qui re- tent us, et Minds ncn re Joint us, 7:10gua ex parte in Cachexiam faceffere jolet. 6. iaauor. Ssi\. z. Aph. 6. t -o ] iScmething [ritiiiov) of Hi/pirates, is, whether it he the At cid (o much talked of and foiictle underftood by Sylvius and Others, the ^Ether hinted at by Sir Ifaac Nsivton and embraced by Doctor J\.ocw/o>.\ the celebrated Electric Aura, or neither of all thefe, I do jiot pretend to fay ; But I fay that it is indifpenfhh'y our Bufinefs co obferve all Changes in the Difpofition of the Ajr tending to produce or banilh Epidemic Diforders, and to reguhte pur Pra^ice,accord- ingly. I have perhaps faid fo anuch on this Article cl" the Air, that to isake myfelf thoroughly underftood, it may ie«rm requifite I fhould fay more; hut as I have already trefpaffed, both on the Patience of the Reader, and my prefent Defign, I-fhall draw to a Conclufion with a few practical Remarks, deduced from the foregoing Doctrine. -----X The fafeft Times to inoculate feem to be after the Difeafe has ceafed or before it has commenced to rage naturally ; for in the firft cafe, the Air no longer continues, andinthelaft, hasttot yet begun, to favour its Attack : In thefe Cafes, if we may roafon a priori, the Danger feems, caeteris paribus, next to None. On the other hand the unfafeft Time is manifeftly during the Violence of the Diftemper, and if ever 1 would advife againft Inoculation it fhoujd be during fuch an Epidemic Conftitution of the Air, for if there is the leaft Room to tax us with Prefumption, it certainly is when we bring the Diforder on a Perfon improperly prepared ; and for due Preparation a health- full Air is, perhaps, the moft requifite Article.-----It is our Bufinefs then in fuch a Dilemma to remove out of the Sphere of Contagion, and even this muft be done with the greateft Caution imaginable, as all Changes are to be brought about by Degrees : f This want of Caution, joined to Fear, I take to be the Caufe why People who ti- morcufly fly from epidemic Difeafes, efpecially the Small-pox, are h apt to catch them immediately on their Removal from the Place in- fected ; for as the Seeds of this Diftemper are thought to be connate with u'i, this fudden Change of Air and Hurry of Spirits mav eafily and readily bring them into Action ; Nor need we have recourfe, in accounting for it, to Sympathy, or that Power which the Mind is al- io1/, ed by many * to have of affecting the Body conformably to what it ± i-lovbus_ m. vet.'tvr fdrlolarumeft utflurfwum Epidepiicut, : c h. Recheiehe ce ia verite. Tom. 1. Li v. 2. Chap. 7 [S'J j- feels in Imagination. But where this Remov;d is impi a&icabie, either on account of this Conftitution of the Atmofphere being very general and wide extended, or that our Circumftances or other Af- fairs will not allow of it, it is evidently our Bufinefs to prepare our- fclvcs for, and await the regular Attack ; guarding with care againft all Intemperance in Food, J Fatigue, Watching, Study, &c. nei- ther indulging Cares, nor harbouring Fears, all which are ever f-Hind not only to favour the Violence, but haften the Approach, of this Difeafe. And this Method is certainly very agreeable to Rea- fon ; for we are not certain, though the Infedion fhould be very ge- neral, that we fhall be feized by it this Bout, but we are pretty fure, that if we bring it on fo untimeoufly, we fhall run a great Rifk from the noxious Temperament of the Air.----This Practice is fupported by the' beft Authority ; among Others Doctor Huxham is " perfuaded that if Perfons regularly prepared were to receive the "variolous Contagion in a natural way, far the greater Part of " them would have them in a mild manner; for undoubtedly a ve- " ry bad fort of Small-Pox many times arifes from an overfullnefs " of Blood, A'crimony of the Humors, or great Loads of foul " Matter in the firft Paffage*; and very frequently Errors are com- " mitted in Diet, Exercife &c. after the Infection is firft taken, " which often prove of fatal Confequence in the Event. From "thefe thofe that are inoculated are, or fhould be, guarded, and? " hence the great iuccefs of that Operation." But if any Conftitution of the Air is attended in the general by a favourable kindhof Pox, no time can be more proper than this for Inoculation ; and the golden Opportunity fhould be watched- with' the greateft care, and embraced wkh the greateft Alacrity. The intermediate Seafons are, before the Advance, and during-' y the Decline of any Conftitution of the Air tending to bring on the Diforder; the Danger being always greater in Proportion as we ad- Vance nearer to, or recede lefs'from the State of the Difeafe, or that Point of Time when it hath attained f*the greateft Violence, and from which by the natural Courfe of things it muft immediately de-- dine. Times ? Qui cemedit magisqaam oportet, alitor mimts quamoportet. S. Sandor.-Sect. 7. Afhor, j<^ Mazis meet v.imi us Animi affeclus, warn nimius Corporis Mot us. 6 Sea.^.Aphor. <£, Sonr.io folito bteviore fewfer alicfuid Ferfpir.it ionis probibctur, quod id ft feqwuit.ii ditbus Pitniore t't>ip.r,itio>n co>n»i>:iS:ir,imTninet febri's P trim- Um. $etf. 4- Aphor. 3<* L 32 J Times abfolutely improper and on no account to be relied crt are, at, and for fome time after, the f Summer and V> inter Solfti- ces.------But here it muft be noted, that, the Heighth of Sum- mer is a much more dangerous Seafon for Inoculation than the Ex- tremity of Winter, as Heat tends to induce the Diforder epidemi- cally, but Cold has the contrary Effect; So that in Winter the Hazard arifes from the Rigour of the Seafon alone, whereas in Summer the Danger is doubled by the Vehemence of the Heat and Difpofition of the Air. Nothing can be worfe calculated for promifing Succefs in Ino- culation than the prepofterous Method, which too many give into; of preparing all their Patients for the Small-Pox after one and the fame Manner; nor can any thing be more offenfive to common Senfe. Some bold Spirits bleed, purge and vomit all that come in their way ; fome pretend to do Miracles by Abfortents (fweetning Powders as they are called ;) Others on every occafion fly to Prepa- rations of Mercury: And Many are wonderfully fond of the Bark. ----— Thefe various Methods can be only proper or improper at Circumftances require or forbid their ufe. Mercury however and Abfortents are the moft general Noftrums ; the indifcriminate ufe of the former has already been taken notice of in a * Quotation to which I refer the Reader, I fhall therefore confine myfelf now to the Confideration of the latter. Absob bent Powders are quacked without Rliime or Reafon, to ufe a homely Phrafe, not only on Children but on Patients of all A- ges, all Tempers, and all Conftitutions, in order to prepare thent for fubfequent Inoculation. What is the C.onfequence ? Where A- cidities abound, thefe infipid Earths are very ufefull; where the Habit of Body is already found, not only thefe but all otherMedicines are detrimental; J but where ever, as is very often the- Cafe, efpe- cially with Adults, the Humours are inclined to Putrefaction, they are abfolute deftruction. Harris was a very great Man, he did great Good by thefe very Medicines to many Infants, bat a favou- rite Notion will lead even the greateft aftray, and it is very certain that f Sahberrimum Per eft, prsxime deinde abhoc by ems, ptriculofior AZfias, Autumnus longe periculpffimus Tttnpeftdtibus verecptittae a wales junt. five jrigida pve calid* : Pefjima qua; variant maxime j Quo fit ut Autumnus Plurimos opprimat. C e L s L i r>. 2 r Ev p$ivo7raoa onwards d,i vvaot, x.ea ■S-cva.juS'i'earca to nrWay tig i&inis——lxtque xjptf- rare Midi cum oportet qua fit Mgri Nature, humidum magis an magis ptcutii Corpus pt, validi Nervi an infirmi, frequens Valetudo an rara, eaque cum til. vehemens effe fokt anlenis, brevis »nlonga.—"~*lson eadem omnibus e- tiamin pmilibus Capbusopitulantur.———-Hippocrates dixit mederi, opor- tere communia et propria intuentem. Ce l s u s. in Prsfac. Ante tmnia fcire convent t Naturam Corporis ; quia alii graciles, alii obeft funt i alii calldi. a.ii frigidiores : aliihumidi, alii pcciores ; alios adHric- ta alios re[oluts Alvurexercet ■——Raro §}m(piam non aliquam partem im- becillem babct.— •■ Quod contra confuetudinem eft nocet, feumolle feu durum, Csesus Lib. i.Cap. 3. » Omne Auxillum Corporis aut demit ailquam materiam aut adjicit, aut ew- cat aut reprimit. asit refrigerataut calefacit, aut durat aut mollit. ---In tnlttendo Sanguine r.on tarn annos Medicus numerari, qiam Vires Mjrotaritit afiirnare dtba.- — Aivut p vthementius fluit, aut fapius ducicur bominem ' infirmas. CeisUS. LiL. 2. Cap. 9. 10. 12* 18. Natura *tpust;ar;t( 7iiJ.ilZUc.'ciaaproficit.---Ex toto non fie Pueriut yiri dtrari nebent. Cslsvs. Lip. 3. Cap. 1. 7. L 35 J every Page almoft of his Works, of which fee a Specimen below, and continues yet the Opinion of all thofe who deferve beft of the World in the Profeffion. And He that would excel' not only in thefe, but all Branches pertaining to Medicine muft be daily con- verfant with the Writings of the Ancients, as well as the Moderns. Such a Man will feldom find himfelf at a Lofs for particular Rules on particular Occafions; And he who undertakes the Care of the Health and Lives of the Public without refolving to undergo this Fatigue moft faithfully, will never, Idhould think, bring his Con- fcience to acquit him of the Crime of Arrogance, or fomething much worfe, though he may conceal his Idlenefs from the Know- ledge of the World, ♦' As for thofe, fays the good Huxham, who " will neither read nor reafon, but practife by Rote, and prefcribe " at a Venture, I muft ferioufly advife them to perufe the fixth " Commandment." Th ere is no lefs reafon to complain of a dangerous Samenefs in the Cure of the Small-Pox, than in the Preparation for them; ef- pecially among the lower People, with whom it is a maxim that nothing more is requifite for the cure of this Diforder, than, a good Nurfe, a flice of Bacon for the throat, and Milk-Punch, or the like to keep the Pox from the Heart as they term it. But I will venture to fay that there is no Diforder whatever in which there are furer Grounds for the Phyfician to proceed on, nor one wherein he will find more occafions to vary his Medicines; for though the Caufe of the Difeafe be utterly unknown, and its Effects in general very different and variable, yet when we come to confider thefe Ef- fects with regard to the particular Species of the Pox, and Habit of the Patient, we will find them quite regular and conftant, and may draw a furer Prognofis, and have plainer Indications, perhaps in this, than in any other Diftemper. But I was amazed to find the following Paragraph in a Paper worthy of Admiflion into the Phi- lofophical Tranfa&ions; ° About the feventli day, fays Mr. New- " man, f the Patient feels the ufual Symptoms of the Small-pox " coming upon him, and he is now managed as in an ordinary " putrid fever; If he cannot hold up he goes to Bed; if his Head " achs too much we put the common Poultice to his feet; if he bet " very fick at Stomach we give him a gentle Vomit; yea we com- " monly do thefe things almoft of Courfe, whether we find the Pa- " tient want them or not, and we reckon the fooner we do thefe ** things the better." If this be not downright Quackery, I would he glad to know what Quackery is. But to return to what I blam- ed, chiefly among thrlower People, I fhall mention one Error for t No. 37©« [ 3M all; It is a Practice almojkmnivcrfal, (and which to omit they would efteem a-kin to Murder) to give Spirits, Brandy, Saffron, and the like, Cordials as they call them, to promote the Eruption of the Puftules ; and that without once confidering whether the Fe- ver be high or low, the Patient young or old, weak or ftrong. Thefe People do not difcover that this treatment is Death unlefs the Fever be really too low, which is not often, though fometimes, the cafe ; and whe'u the fever is tpo high, the Circulation of the Blood is fo. rapid that little or nothing can be fecreted from it or thrown into the Capillaries, and of Confequence the Eruption, inftead of being promoted, muft be vaftly retarded : Here the Indication is, to leflen the fever, by, bleeding, cooling, diluting, fubacid Drinks; bathing the Extremities in warm emollient Liquor., which open the Pores and draw a flux to the Parts, by the Rarefaction which they occafion, in the Veffels of the Limbs to which they are ap- plied, &e. and not to heighten it abfurdly by Cordials, which by preventing the Eruption, oftentimes occafion Death before the fifth or fixth day.-—-When indeed the Pulfe is languid, the Oppreffion on the Spirits great, and the Countenance pale, cordial warm Me- dicines, and Blifters, are not only proper, but indifpenfably necef- Vary,' to affift Nature in driving the Diforder from the Vitals to the Extremities. But I am going beyond my Purpofe. Th e Symptoms attending the Small-pox by Infition being exact- ly fimilar to thofe arifing from the natural Difeafe, but infinitely milder, the very fame Remedies, when any Medicines are requifite, which are indicated in the one, are, in correfponding Circumftan- ces, proper in the other. For the intire curative part of this Dif- temper, I therefore refer the Reader to the excellent Writings of Sydenham, Freind, Mead, and efpecially Huxham; from which lafl I muft however infert one practical Caution, becaufe I have ob- ferved it too often neglected, fince I have had accefs to the Sick in this Diforder ; I mean the infernal Practice of bliftering by Rote, whether there be an Indication for it or not: Treating of putrid ma- lignant Fevers this excellent Author goes on thus ; " What I have " faid of volatile Alcalious Salts leads me to a Reflection on the " promifcuous ufe of Blifters in thefe Fevers, which by Some are " efteemed the only Anchor of Hope in fuch dangerous Cafes; " but I think they are many times too haftily and improperly ap- " plied, efpecially in the Beginning, when the Fever runs high, " and doth not demand a further Stimulant; for the Action of the " Cantharidcs is not merely on the Skin, but affects the whole ner- " vous and vafcular Syftem : Now when the Irritations and Vibra- " tions are already too great, as frequently happens in the Begin- " ning of iuch Fevers, they are very injudicioufly applied. Befides " the [37 J f< the Salts of thefe Flies operate much in the fame manner as the «< volatile alcali Salts, and certainly tend to promote the Diftb- « lution and confequently Putrefaftion of the Blood. It is true in- " deed Nature may fometimes want a Spur, nay often doth, parti- « cularly towards the Decline of thefe Fevers, when the Solids *' grow torpid, the Circulation languid, the Spirits effete and the " Sick comatofe : here Blifters muft be applied, and are of exceed-' " ing great ufe, at whatever time of the Fever fuch a train of <' Symptoms comes on.---But in the above circumftances I have " very many times feen very pernicious Effects attend their too ear- " ly Application; as obftinate Pervigilium, Delirium, Suppreffion !* of the Urine, Tremors, Subfultus. f &c." There is one thing more, which I hope I fhall be excufed for mentioning, as no Writer, that I know of, has taken fufficient no- tice of it: It is far alfo from being foreign to my Defign, as it re- fpects not only the Preparation of Children for the Small-pox, and the Completion of their Cure after them, but their very Health at all times ; I mean the bad Cuftom of putting young Children to fleep with old Folks : It is very certain that the Growth and Strength of Children muft be much impaired by fuch Treatment, for elderly Perfons, whofe Integuments are become dry and fpongy, will imbibe a great deal of moifture from thefe young and fappy Bedfellows, and that in Proportion to the greater age of the one, and the tenderer Years and Conftitution of the other, which confe- quently muft greatly diminifh the radical Heat and Pith of the litde innocent Sufferers; Many a Child has died tabid for no other rea- fon, and I myfelf have feen two or three refcued from dying Mar- tyrs to the Health of their aged Nurfes, when their very Vitals were almoft extracted. J This Cuftom then being prejudicial at all times, muft be additionally fo after the Small-pox, for all Patienta are for fome time after their Recovery from this Diftemper inclined to be hectic, and have more need under thefe Circumftances of re- ceiving Nourifhment, than of parting with the fmall Stock of im- poverifhed Fluids which the Diforder has left them. This Method of external Nutrition was very well known fome thoufand Years ago, as appears from the Cafe of David and the Damfel, * and'I wonder it has not met with more Regard from the Cultivators of Medicine fince. A" t Hu x H a m Effay on Pevers, page ut £ Tain copiofa eft Corporis Exhalatio in Dormi'entibus, ut non fobtm Mgti turn lam's cubant es, JedSani inter St btnas -vti inalas Diffofit tones Sibi invi. tern eommunicent. ' _ S. Santlor. Sfi<2.4. A. it. * 1. Kings. Chap. 1. v. 4. [ 3« 1 As a Recapitulation of the whole I fhall conclude with the foMoWt kng Allegory, which I hope will be found juft and of eafy Applica. tion. In a certain Ifland of India, fays the Per/tan Hiftorian Zadi, lived a People called V AR IOLAR II, long were they highin the favouT of ORO MJZES who fhowered on them all manner of temporal Bleflings. As long as they liftened to the Dictates of Virtue, un- 4er whofe immediate Care ORO MJZES had placed them, they retained their Purity of Manners, and Age and Sicknefs were un- |cnown among them ; but no fooncr did they hearken to the Infinu- ations of Vice, a Stranger whom ARRIMANIUS, envying their felicity, had fent in from a neighbouring Nation to corrupt them, than they began openly to difobey the Mandates of Virtue, banifhing Wisdom, Sobriety, Exercise, and Simplicity, her favourite Servants, and preferring in their Stead, Folly, Intemperance, Sloth and Sensuality, the Minifters of Vice. ORO MAZ E S imaged at this Ingratitude, refolved that in their Practices they fhould find their Punifhment, and recalled Virtue, permitting Vice and his Train, who had thus crept in, to fettle among them. The Malice of thefe Fiends was moft amaz- ing, for no fooner could a Woman conceive in any part of the If- land, than one or other of them was fure, by Stratagem, Force, or otherwife, to gain Admiffion to her Bed, and beget a fpurious If- fue, to be born at the fame Inftant with her natural Offspring, and to continue its mortal Foe ; there being fcarce an Inftance, in ma, ny Centuries, of any Infant coming into the World without fuch a monftrous Brother, whofe unnatural Enmity Death alone could ter- minate ; and one of the Tv/o never failed to fall into the firft Com- bat, which happened frequently even in the Cradle. This Progeny of Vice, and his Companions, were called VA RIO LJE, and did not in the leaft degenerate from their Sires, in a particular Manner bearing envious Rancour againft the Fair, whofe Beauty upbraided their Deformity; infomuch that, though otherwife arrant Cowards thefe fpitefull Imps would fuffer .Death, at any time, with pleafure, fo they could but rob their a- miable Sifters of their Youth and Beauty, let their Share of thefe be ever fo fmall. The VARIO L JE were, from the verv Womb, crafty and infidious, ever unwilling to engage on an equal footing, but flily waiting all Opportunities of taking their haplefs unfufpecting Bre- thren at a Difadvantage. Th* I 39 J l The Havock committed by thefe mercilefs Savages was a£ length fo terrible, and thefe unhappy Iflanders were become fo completely wretched, fuch as gained the Victory remaining for the moft part maimed and deformed, for an eafy Conqueft was feldom known, and their Scars, contrary to the Rules of War were far from . being held honourable, being Brands to remind them of the Happinefs which they had forfeited, that OROMAZES took Compaffion on their miferable Condition, and fent down the Nymph HTG IE INE to their Affiftance. She it was who firft taught them to be brave and feek the Ene- my, if not through Courage, which they feemed to have forgot, at leaft through Policy ; telling them that no Paflion was fo fervile as Fear, confequently none of which Men ought fo much to be a- fhamed ; that She knew Cowardice alone occafion the Lofs of ma- ny a Victory, and not unfrequently baffle all her Aid, where other- wife fhe could forefee but little Danger. She alfo inftructed them, further than they had yet known, in the Nature of their Enemy, and their own Power; making it appear that the VAR10 LJE had this Peculiarity in their favour, that, ceteris paribus, the lon- ger they deferred their Attack, the Match became every day more Unequal, their Strength encreafing amazingly with their Years: on the other hand fhe difcovered to the V ARIOLARII, certain Preparations which were friendly to them, but deadly to the Foe, inftru&ing them in the Times fitting for an Attack, and furnifliing them alfo with new and proper Arms for the Fight, againft which She forefaw the VARIOLJE had little Dexterity to defend themfelves. At the fame time advifing Parents, to prepare their Children according to her Directions, and force the Enemy upon them, without obferving any Points of Honour with Rafcals who avowedly picqued themfelves on Deceit and Treachery. HTGIEINE, notwithftanding her whole Endeavours were bent to ferve this wretched People, found yet too many of them ready to oppofe her, Pufillanimity fwayed Some, Superftition by- affed Others, a lucky Efcape from the Foe weighed with many, and not a few, fhame to tell, among her outwardly profefled Friends, were fecretly bribed by the Enemy. The Confequences however, fays Zadi, were, that they who liftened to HTGIEINE al- moft always gained the Battle ; They who difobeyed her, feldom efcaped with Life, fekWmer without Maim. So that at length the the Salutary Effects of her Meafures left her few to oppofe them, and they who did, fcarce ever failed to repent it. FINIS. froflfcript. SI foC E the foregoing Effay has been committed to the Prefs, t have had the Pleafurc of perufing two Pieces on the fame Sub- ject; the one a regular Treatife in French by Doctor Tifot of Mont- pelier, the other an Academical Difcourfe by Dodor Thompfon, for- m rly Phyfician here. 1 have had the Satisfaction to find that, iri general, what I have advanced is agreeable to the Sentiments of both thefe Gentlemen; but as my Plan, as well as Argument, is fomewhat different from either of Theirs, though tending to pro- mote the fame Caufe, I have been perfuaded not to fupprefs my Copy. There have alfo been two or three other Pieces lately pu- blilhed on the fame Subjeft, in different Languages, but thefe I have not had the good fortune yet to have feen; Errdta. Pagfc4. Notes, for ko,S fauiac, read, xdi SWcsr. Page 7. Notes for auferre, read, auferri. Page 9. line 11. for fo, read, to. Page to line 18; for refpectt, read.refpeas. Page n. N^tes, for irallniusj read, nulhus. Page 17. line 32. for, fhall more, read, fhall the more. Page 24. Notes, line 2. for dfmi^irrear, read, *reodiv,jea c E^S •> ...V