I Take the Liberty at last of pub­lishing these few Pages, and giving them the Ornament of prefixing your Name to them. If there be any Thing that is Valuable in them in my own Estimation, it is contain'd in these two Particulars, the [Page 2]kind Opinion you are pleas'd to have of them, and the Good I hope they may be instrumental of in the Disease of which they treat.

With all Submission I proceed to speak of the following Disease, viz. the Small-Pox, that is, of the Method I have taken in the curing of it. In which I shall be very short, as to the Definitions, Signs, Diog­nosticks, or other [...]; such Parts having been very copiously treated of by many great Authors, and in almost every Bodies Hands. The chief Stress of what I humbly propose, depending upon Histo­rical Instances, and Matters of Fact: Not but it will be allow'd, and it frequently happens, that the Success of Medicines and their various and multiform manner of Use and Application, has given light into the Nature and Indoles of Diseases; as the Ef­fect of several Parts of an Animal in Food or Medicine, hath been made use of to ex­plain their Nature, and even exemplify the Parts of which they may consist; which may be seen in our two Famous Professors Dr. Glisson and Dr. Willis, the first in his [Page 3] Anatomia, Cap. vi. the other in many places of his Anima Brutorum; as also in Sir George Ent, Dr. Morton, and several others; so that Physiology and Practice thus attended to, may be observ'd to illustrate each other. And here, Sir, I must again beg your Par­don, that I shall be forced to place before you Cramben Recoctam, having already troubled you very much, with many of the Particulars I must here recount. But before I can come to them, I must speak to a General or two: The first of which is as to the general Regimen to be used, the Cold or the Hot, as they are generally and vulgarly distinguish'd.

For the First, Dr. Sydenham and his Fol­lowers strenously appear against the uni­versal Practice of those that preceded him, as well as his Contemporaries; and I may say, against Nature her self: For tho' we may find interspers'd in their reciting the Pharmaceutica, sometimes what will seem to countenance the Cold Regimen, (in which the Countries and Climates where they practis'd might probably be a great Inducement) yet it is very plain, that they chiefly depended on Alexipharmicks and the warm Method. Amatus Lusitanus, who was as bold, I think, as any one in the Use of the Refrigeria, yet has in a Scho­lium these Words, Quod variolarum & Mor­billorum ad Cutem eruptio, quaedam a Na­tura [Page 4]non solum constituta, sed destinata Cri­sis sit: Consequens erit cum Hippocrate & Galeno asseverare; quod quando Natura eam conficere tentat, tunc Medicus Materiam fluere dispositam condensare, aut a viâ sua cohilere non debet; sed Magis ipsam dispo­nere, ut per eam viam incedat per quam Na­tura expellere Conatur; juxta illud Hippoc. Quo Natura maxime vergit per loca confe­rentia, eo ducere. I must confess, this Scho­lium is hardly to be reconcil'd with his Practice, either in the Precedent, or fol­lowing Curatio; in this last, he tells us, that being sent for to a Boy blind for Three Days of the Small-Pox, which he mentions as an extraordinary Occurrence, he imme­diately fell to washing and other Applica­tions to his Eyes, and with great Pleasure acquaints his Reader, ex tenebris Puer ipse revocatus. This would be mad Practice in England, whatever it was in Tuscany; but this I mention to shew, how little (as I said before) is to be depended on Cases Historically only related: And that in dif­ferent Climates, it is not the discordant Opinions Physicians maintain against each other; but there is a Necessity for that very Reason to take Measures somewhat dif­ferent. Reverius declares for the Alexi­pharmicks, and the warm Regimen, Primo ut Aeger in loco Calidiusculo detineatur, quo Pori Cutis aperiantur, & variolarum Erup­tio [Page 5]adjuvetur, &c. I forbear quoting that celebrated Practiser at length, that I may be as little troublesome as possible, and be­ing of no great Consequence to the Rea­ders I chiefly intend this for. The same Thing might be repeated out of all the Au­thors of any Consideration, or Antiquity, which would be as Nauseous, as it would be Endless. The Mischief which has arisen is this; that in Practice, while there have been Endeavours used towards an Inprove­ment, some have advanc'd from a Genial necessary Warmth to almost actual Fire; and instead of keeping the cold destructive Air out, have perfectly suffocated the poor Patients, by letting them have none at all; making at the same Time such vast Fires (whatever be the Temper of the Air, or of the Sick Person) which cause Faintings with other Irregularities coincident with it. And on the other Hand, I shall take the Liberty to say, that the Reformers have started so far out of that Method, in order to distin­guish themselves by their new Discoveries in disavowing the Warm Regimen; that one would think there's no being Cool or Refreshing for the Patient without Freez­ing. Let me therefore beg leave to follow the Celebrated Dr. Morton, whose Practice is Regular and Rational, and whose Suc­cess was Answerable. He positively de­clares for the Warm; and both throughout [Page 6]his Precedent Rationale, as well as in the subsequent Histories, reprehends the con­trary Proceeding; which he deliberately confutes, and descends even to mention the Materia made use of in the Cold Re­gimen; such as Spiritus vitrioli, Decoctum Album, Diacodium, and the like; nay, he says, that he was inform'd Dr. Sydenham himself had towards the latter Part of his Life gone off from that Opinion. Be that as it will, he was in the wrong, as Dr. Mor­ton thought, and will appear more to be so, if we take but very little Pains to con­sider the Aetiology of the Disease it self, or the Operations of Nature under it. For what is it that Nature is doing, or how can she perform that visible Diaploresis, (if I may so call the Eruption) but by a Warmth somewhat higher than her con­stant Tenor; so that she acts her self in the Alexipharmick way; and that must be­yond Contradiction be the right. Could we either substitute any other Discharge to carry off by it with safety the repell'd Morbid Humours, or if ever a Sudorifick, or Expulsive Operation (of that kind) could be perform'd, without the Constitution be­ing somewhat more than commonly warm; there would be room to say something; but when this can never be, which must be confess'd by all, there will need but very little Argument or Persuasion, to direct us [Page 7]which of the two Regimens ought to be chosen. And yet, notwithstanding the apparency of the Case, there are still some so blindly devoted to the following that otherwise great Man; and even notwith­standing their own ill Success, they go on in a supine, fatal Bigotry, and Dependance on his Word; and think that Sydenham's Name is sufficient to shelter, and justify their own Inattention to Nature herself. Insomuch that I have heard it (with some Pain) affirm'd, that Diacodium was the Pa­nacea, which would do every Thing, and that nothing could be done well without it: That it was in the Small-Pox, like the Cortex in intermitting Fevers, &c. and however diversified the Disease might be, it has been, upon the ill Success of the first, doubled and trebled, and given the Patient without the least Guard. Diacodium is questionless sometimes a proper, as it is a Pacifick Medicine. But suppose we meet with a Comatose sleepy Disposition in the Beginning, and it should attend the Distemper in the other Stages, which in Flegmatick Pituitose Habits is very fre­quent; must we still proceed to give this Roapy Opiat? Why, yes, if we believe the Sophistry above, and which I have known pursued as long as Nature has lasted. But enough of this unwelcome Subject.

The next General I shall trouble you with is Blood-letting. Tho' indeed, I think it ought not to be term'd a General, it being impossible, but that it must be de­structive in many Cases, and I believe very dubious in its Success in any. There is a Question, Sir, I have wanted long to be resolv'd, and is as difficult to state, I believe as to resolve. I have in debating occasi­onally, whether Bleeding were generally good in the Small-Pox, heard it affirm'd, that it certainly was, if timely administer'd: The same Affirmation I have under the Hands of some Men Eminent in Practice; we find it likewise in many celebrated Au­thors already extant among us. As to the Time, it is agreed as soon as possible, at least before the Eruption is in any Measure perform'd; the Reasons alledg'd are, that it gives some remission to the excruciating Pains, and even diminishes the Morbid Mat­ter; so that the Enemy being weaken'd, Nature must be the better enabled to with­stand the remaining Force. Before I come to expostualte on the Particulars, give me leave to suggest, First, that it may be fre­quently observ'd, that the Small-Pox in some Families is very signally, and as it were Hereditarily Fatal. This we find both Dr. Sydenham and Dr. Morton have observ'd, and granted. Suppose then, Secondly, That in one Family Three Children of the [Page 9]same Father and Mother should be treated in the Sydenhamian Way: The first is blooded, has the benign, distinct sort of the Small-Pox, and does well. The next after the same manner is Blooded, has the Confluent, malign sort, and dies. The Third under the same Administration of Bleeding, upon which appear the Maculae Nigrae, Lividae, Purpureae, &c. and Na­ture under so miserable a Prostration of Spi­rits, that she quite gives up the Conten­tion; and yet for any Thing that could be seen or apprehended, this last might have been the distinct kind, which as Histories are two to one. Such Events as these ought certainly to put us to a stand; and for the Truth of the Facts, I can produce undeniable Evidence; but wave it here, be­cause I would not revive the Grief of those, who make but too severe Remarks upon the Proceeding. What Measures therefore, Good Sir, must we take? Will the taking of Blood away, alter the Indoles of the Di­sease from the Malignant or Confluent kind, to the Benign and Discreet sort; if so, it ought in all Subjects, and on all Occasions to be used; and this is what they mean, by saying it will lessen the Quantity, or for my Part I know not what to make on't: But if this be difficult and uncertain, nay, I will say impossible to make apparent; then they put Persons on a very great Ha­zard, [Page 10]who make use of such dangerous Methods by weakening Nature, and in no respect lessening the Disease: Which Charge, how­ever severe and heavy, must in the general be confess'd to be true. For here, by the way, I must take so much Liberty, strongly to presume, that the kind of the Disease, in respect to its degree, is determin'd upon the first imparting of the Contagion: Tho' out of doubt, the Disposition the Blood and other Juices of the Body are in at that Time, does strongly dispose to one or the other; such as was before said, the inhe­rent Crasis of the Blood and Spirits, in re­spect to the Parents we are Descendants of, violent Exercise, hard Drinking, or other crapulous Disorders, and the like; which not only expose us the sooner to the re­ceiving the Infection (as is vulgarly and truly express'd) but the Poisonous Mias­mata of the Disease, are immediate­ly imparted to every Particle of the Fluids, being thus made susceptible of them; and thus the Confluent kind of the Small-Pox is form'd, and as I said, determin'd, before it is possible to adminster any Re­medy. So that except by Bleeding we can undertake to change the very Indoles of the Disease, even after it is form'd, tho' not render'd Visible, which I believe is im­possible; we shall be in Danger of adding to the Disease, and abstracting from the [Page 11]Strength of the Patient. For 'twill hardly ever be found, that the taking of Blood away, can restore it, from a Fusion to its natural Crasis, that is, the Sphaerical red Parts, to their just Magnitude, and the rest, of what Denomination soever, to their Natural Size, Figure, and Cohesion ^*. By the Loss of Blood, 'tis well known, that the Mass is attenuated; and for that very Reason is Phlebotomy administred in many Instances, as in Pleurisies, the Malacia, &c. that so there may be more room for the Heart in its Pulses, to dash and toss, as it were, the Blood, by which Action the Lentor or too cohaesive Parts may be divi­ded into smaller Portions. To this I must add, that Haemorrhages, from whatever Part they flow, are not occasion'd, at least very rarely, from a Plethora simply so call'd, or from the Strength and Force of the Pulse; for then the most robust Ani­mals, and those that use the most violent Exercise, would be most liable to them, either Man or Beast; which is hardly ever observable: But most frequently from the Prava Diathesis of the Blood it self in the Loosening of its Texture; so that in pas­sing the Capillaries, it is as it were perco­lated through 'em, or render'd so keen, that [Page 12]it breaks, and, as it were, eats through. For a Confirmation of which, I appeal to Dr. Lower's Book de Corde. And where such Symptoms attend the Beginning of the Small-Pox, Bleeding is seldom, I believe I might say never, of any Service. But Blisters are of excellent Use, which is the next General.

Two Questions therefore, I think, arise from these few last Periods.

• First, Whether the Indoles, that is, the Sort or Kind of the Small-Pox be de­termin'd in each individual Person up­on the very first Attack of the In­fection.
• Secondly, Whether it be possible by any Administration, especially Bleeding, to make any Alteration or Mutation from Bad to Good, from the Conflu­ent to the Discrete Kind.

You see, Sir, my Opinion by what has been already said, which I very humbly submit to better Judgments.

At the End of the precedent Paragraph I have said, that Blisters are good in re­moving, or putting a Stop to that mischie­vous Symptom, namely, the Haemorrhages that frequently attend the Beginnings of the Small-Pox. These sometimes appear, even before any other Signs, and prevent [Page 13]the Struggle Nature generally makes to throw off the Disease from the Center to the Peripheria ^*. Sometimes Bleeding at the Nose, Spitting of Blood, or an immo­derate Flux of the Menses, appear just at the Eruption; by which Nature in that ne­cessary Effort is so debilitated, that she can't perform, nor go through that Task; and then the Enemy again retires to the Vitals, and acts all imaginable Mischief. I am well aware what Botallus and many others say, that the Loss of Blood will not produce the Effect here charg'd; but I must desire to be excus'd, from resigning my Sense and Reason; both which I must do, should I make any Doubt of the retiring of the poisonous Particles of this Disease; when upon the Loss of Blood, I see the Humours secreted from the Blood disappear, and a visible Paleness spread in its stead, both on the Face, and all over the Body, which no one can deny, who has made any Number of regular Observations. But to return to Blisters. These Bleedings, as I said before, being occasion'd by the dissol­vent Pestilential Particles in the Serum of the Blood, breaking and dividing the Red Globules into a preternatural Smalness, and by that putting the Blood into a Fusion, [Page 14]forces it through the Capillary Branches of the Blood-Vessels: But the Blisters drawing off Part of this Saline, Deleterious Serum, by abating its Quantity, the Globules afore­said are at Liberty to attract each other, and by that means to form themselves in­to their genial and natural Size; and so the Symptom ceases: For I have had frequent Occasion to observe in Persons that have been seiz'd with the most violent Effusion of Blood, that as soon as the Serum has be­gun to fill the Blister-Bladder, the Bleeding has constantly ceased. And thus even the Quantity of the peccant Matter may be said to be diminish'd. But where Persons are averse to Blisters, as too frequently they are, we need not be entirely at a Loss, nor have recourse to that desperate Expedient of Phlebotomy; for I do assure you the Powder does it as certainly, and after a manner (as I suppose) much like the Blisters; for by very soon procuring a Dia­phoresis, the morbid Matter is brought to the Exteriors, and by Sweat the Deleterious Serum lessen'd.

And here, by the way, give me Leave to say, with great Submission, that I take the Blood to be the first Nidus of the con­tagious Particles, and not the Spirits, as Dr. Morton asserts; for as the Matter which fills the Blisters, and also what fills the Pustles of the Small-Pox, are Secretions [Page 15]directly from the Blood; it is but reasonable, I think, to conclude, that the Fomes or Pena is there for both. Besides, as the Spirits are form'd from the finer Parts of the Blood, and constantly receive their Sup­ply and Restoration from that Magazine; so it is but natural to conclude, (till the contrary can be demonstrated) that what Detriment, Labefaction, or Pollution soever they receive, must be communicated the same way. As to the Quickness of its Com­munication, that can be no Objection to any one, that considers the Pulse of the Heart and Arteries, and the Motion of the Blood in them; so that it requires but a very few Minutes, after the receiving of the Infectious Lentor into the Blood, before it may by stopping in the fine Capillaries of the Meninges, Brain, and Spinal Mar­row, give Occasion to all those violent Or­gasms exercis'd, and communicated through the whole Systasis Nervosa; and which, while loosely carry'd in the Rivus of the Blood, has little Opportunity of exerting those excruciating and dolorous Sensations. And farther still, it may be made almost a daily Observation, that Persons having been conversant in Places infected, have remov'd to others free of the Disease; yet after many Days the Insults of the Disease have begun upon the Nerves, which is a pretty plain Instance. But this by the by. How­ever, [Page 16]when we come to consider the Di­stemper once form'd as Physicians, the Spirits have their Share, and suffer violent­ly; and except we consider the Blood and Spirits in this complex View, we shall ne­ver discover the true curative Indications; which is what I come now to speak of, and shall do it in a very few Words.

Without repeating what has been already said, the Oppression of the Spirits, the Diathesis the Blood is then in, and the Na­ture of the Disease, shew, I think, the Ne­cessity of Proceeding in the Alexipharmick Way, by promoting a general Diapheresis in a gentle manner, by such Medicines as will invigorate the Nerves and Spirits, by fitting them for, as well as putting them upon Action; and at the same time pro­mote a Sudoriferous Perspiration over the whole Body: So that Neurotick, Volatil, Cephalick Medicines, mix'd with Anodines, and such as will cause Sweat without an Inflamation, (all which is to be obtain'd by a Right proceeding, and the Alexipharma­con here proposed) is, and must surely be acknowledg'd to be the regular Way and Means of assisting Nature in this Exigency. I have often wonder'd to find so few of that Class of Medicines, call'd Cephalicks, in the Materia of Dr. Morton, who proceeds on such Principles in affirming the first At­tacks to be made upon the Nerves, and [Page 17]their Propagines; for want of which, many of the noblest Alexipharmicks are render'd not only ineffectual, but hurtful, by doing nothing else than inflaming the Blood, and scorching the Vitals, such as Saffron, Rad. Serpent. &c. The like Mischief may be charg'd upon Opiates simply given, with­out the Guard of Volatil Medicines to at­tend them; which stop and impede Nature in the Discharge; and instead of procuring that gentle Requies and Refreshment of Sleep, so absolutely necessary in the Small-Pox, cause horrible Deliriums, Convulsions, &c. But that I may give you no farther Trouble, I proceed now to lay before you the Series of the Cure, a Method I have (by God's Blessing) found more than com­monly successful.

As soon as there is any Suspicion of the Small-Pox, let the Person attack'd go imme­diately to Bed, and endeavour, if possible, to get some Sleep: Towards the attaining of which, let there be kept the profoundest Silence; (which is a Rule to be observ'd through the whole Course of the Disease:) For it is hardly to be imagin'd, what inexpres­sible Disadvantages sick Persons labour un­der, and what Symptomatick Mischiefs they heap upon themselves, by striving (as they call it) against the Disease: By going into the Air, they sometimes repel the mor­bid Humours to the Vitals; which may be [Page 18]done even before there be any visible Ap­pearance of them upon the Surface of the Body. Others by Exercise, Diversion, hard Drinking, and the like, thinking to divert, greatly increase the Disease. Which can be of no Advantage in the Beginning of any Fever, but in this does often prove perni­cious. Let the Patient be cover'd with as many Cloaths as may reasonably be sup­pos'd will produce such a Warmth, as is natural, acceptable, and pleasant in the Winter, and no farther. If the Pains and unquiet Tossings be such, that no Rest can be obtain'd without Help; at the End of Twelve Hours from the first Attack, and not sooner without apparent Necessity, let the following Draught be taken.

And let it be repeated every Eight Hours. But if there be violent Symptoms, such as Bleeding at the Nose or Mouth, Fluxus Mensium immodicus vel praematurus, excru­ciating Pains, Watching, or the like, it may be repeated every Six or every Four Hours. The precedent Dose is fitted for Adult Persons: But for Children of one, two, or three Years old, five Grains is suf­ficient; and to be repeated according to the [Page 19]Age and Strength of the Patient, or the Quantity each time given. The Vehicle above-mention'd is what I generally make use of; but the Powder may be given in a little Syrup, small Sack-Whey, or any thing else, except Diacodium. If the sick Per­sons are able, let them be help'd out of Bed once every Day; but in this, let their own Desires, join'd with common Prudence, be the Rule; for no other can be set.

The next thing to be consider'd, is the Quantity of Liquids to be allow'd. I am not for such large Quantities of Malted Liquors, I mean Small Beer, as is generally in present Practice admitted; neither am I totally for denying them. But a Decoction of Figs with some Cochineel, and inspirited with some small Portion of right good Ca­nary, I permit in good Plenty almost to the Patient's Choice. As, ‘℞ Ficuum Pinginum lbss Cochinel. ʒss. coqr. in aq. Fontan. s. q. ad lbij sub fi­nem addendo Vini Canarij ℥iiij plùs minusvè Bulliant semel tum adde Syr. de Rubo Ideo ℥ss fiat Apozema & refrigeratum libat ad Libitum.’ This Liquor exceeds any that I have known made use of; for it keeps the Throat and Passages of the Lungs free and open, gent­ly promotes the Eruption; at the same time [Page 20]that it exhilerates the Spirits, and abates the Thirst: And I have not among some Hundreds met with any one Person, but was pleas'd with it. For in Small Beer, there is generally in Fevers a most unwel­come Clamminess succeeding the drinking of it.

When the Eurption is perfected, so that the first Symptoms are abated, the Draught above-mention'd need be repeated but every Night at the Hour of Rest; nor even then if there be a Natural Propensity to sleep, and the Small-Pox, be of the mild distinct Kind, (yet I always advise to have it in promptu); but in the Confluent Kind I think it ought to be taken every twenty­four Hours at least, through the whole Course of the Disease. When the time of Maturation, or according to the Vulgar Idiom, the filling and ripening of the Pustles commences; which according to Dr. Mor­ton, may be reckon'd to begin about three Days after the total Eruption; the foresaid Draught is certainly necessary to be taken twice every Twenty-four Hours: And then I do very much recommend the drinking of large Quantities of what we call Milk-Porridge, made after this Manner: The Oatmeal being finely fifted may be boil'd in a due Quantity of Water for Half an Hour, or very little more, then add a Third Part of New Milk, and just give it [Page 21]one Boil so as to mix it well together, and 'tis enough. This I order sometimes to be taken Hot as Tea or Coffee, thus taken it will keep the Passages of the Throat clear; and frequently as I have observ'd, will make the Scabs of the Small-Pox, which are en­gag'd in the Passages scale off, and come away. At other Times to drink a good Draught of the same very near Cold, and sometimes to be taken warm as Food. This smooth mild Pabulum cloaths, and indeed does as it were digest the Ichorous Serum of the Blood, to which Diathesis in the con­fluent Kind it is very much disposed, and supplies it with a soft Chylose Matter, wherewith to fill the Pustles. It likewise supplies the Salivation, where it happens with a proper Fluid, gently raises it when it abates, and keeps up the necessary Tume­sactions of the Extremities. It may be also a reasonable Means to prevent any Tabid or Consumptive Dispositions, which are here frequently founded: And I have always ob­serv'd the Patients very soon recover their Strength, who have plentifully taken of this simple innocent Food. In the mean time, the Decoction of the Figs is not to be omitted being sometimes taken.

Thus, Sir, am I come to the last Stage, the Crisis and Declination of the Disease, which is attended with less or more Diffi­culty, according as the Precedent have [Page 22]been treated; and in which I have found little trouble, where I have had the Op­portunity of directing its setting out; and even still are the Alexipharmicks to be used, tho' at greater Distances, so that I recom­mend the same Draught every Night, then every other Night, and so to be left off. I confess at this time, too frequently appears the direful Symptons in the confluent Kind, and require the utmost Penetration to find out Means to assist Nature, that she may defend her self against this last Assault. As for Bleeding, I hope, such Adventrous Un­dertakings are quite out of Thought. And really, Sir, I have not been able to collect any great Advantage even from Blisters as commonly directed, that is on any other Part of the Body except the Head; for at this time the chief Intention is to stimulate Nature in her several Offices to act the re­maining Part with some Vigor. Neither have I found there has been any reason to boast of the good Consequences, though the Blisters have had their common Effect; for there having been so vast an Expence of Juices already, there is apt to follow Deli­quiums, and a great Prostration of Spirits upon this second additional Discharge; but Blisters on the Head, from whose Office we expect little more than to excite and stir up the remaining Force, are, and have been of excellent Use. Nay, Sir, I have made use, [Page 23]I do assure you, of actual Fire upon the Head, and visibly, under God, deliver'd two Persons who were in the very Article, when all was thrown up, and others had withdrawn themselves, and nothing but Death expected every Moment. But where the Use of this, by reason of its seeming Severity, should be deny'd the Physician, instead of it I advise, that after as much Hair of the Head can be taken off, as the present Urgency will admit of (tho' I always order that to be done at the beginning of the Disease) then to fill a Broad, Thin, Linnen Bag, with bruised Cantharides, and having dipp'd it into boiling Vinegar, to lay it almost scalding Hot upon the Head. This, I confess, I never had occasion to make Tryal of but once, and then 'twas with evident Success, the Person being now living, but especial Care must be taken to see the Bag keeps warm, for if it turn cold it may prove mischievous.

Having thus far spoken of the Small Pox, in regard to Persons that may be Patients under it, in an indifferent and general Man­ner; I now intreat your Permission, Good Sir, to speak of Women with Child, who are afflicted with that Disease, singularly, and in a Place by themselves; their Condi­tion having been always look'd on as full of Hazard upon many Accounts; and for whose Sake chiefly you have all this Trou­ble, [Page 24]and the present Publication (if it may be so) is made to the World. Not but that the Distemper is the same in every respect that regards it self, and must be generally so treated. But the sad Fatality which so commonly attends these poor People at that time; the considering that Two Lives are included in one Individual, and therefore that one Fate must attend them, and both be sav'd or lost together; with other Cir­cumstances, which too often go along with it, that it most frequently happens on a Woman's first Pregnancy; so that the Ex­pectations of a Family on one Side are cer­tainly extinct, and sometimes it hath fallen out that both have been.

These and other moving Incidents put me upon the utmost Stress of considering their Cases, with the greatest and most heedful Attention I was Master of. And I do here, and ever must with all the Grati­tude of my Soul, acknowledge and adore the Divine Goodness on these poor Endea­vours; and which I hope are agreeable to the Proceedure of Nature, and the Ars Medica, by what follows.

Here I must again inculcate, as I must on all Occasions, that the strict Enquiry in­to the Animal Oeconomy is and has been the just, regular, and only Means for dis­covering useful Remedies; at least the proper Way of rendring any of the Parti­culars [Page 25]of the Materia Medica rationally, and therefore as constantly successful as the Strength of the Disease, or the Weakness of Humanity will admit of. Thus Dr. Her­man Grabe puts it into a Kind of exempla­ry Method; and in distinct Chapters tells us, what Ways we are to take, if ever we intend or desire to make any commendable Discoveries in Chirurgery or Pharmacy; and therefore proposes to our Imitation, the Examples of the most considerable Physiolo­gists of the Time he liv'd in, or a little be­fore it; beginning at our Great Country­man Dr. Harvey, and instances in many Particulars, what Light the Knowledge of the Circulation of the Blood has given to the Pathology of Diseases, and the Secrets that may be disclosed from the Observa­tions thereon. He proceeds afterward to the Discoveries made by Bartholine, Whar­ton, Steno, Sylvius, and Willis; and seve­rally hinting, what useful Inventions have been, and still may be made for the Good of Mankind by following their Pattern, which he presses very earnestly to all the Practisers in that noble Art. And here I beg you will indulge me so far, to affirm to you, that if there be any thing valuable in what I now lay before you, it is owing to the considering the Parts of a Gravid Fe­male more intimately than ordinary, at the Time when these Parts of the Kingdom [Page 26]were [...] with the Small-Pox. And find­ing so little Encouragement; and on the contrary, so much Forbiddance in the Suc­cess of the common Procedure, either in Books or Observation; there seem'd to me to be a Kind of tacit Demand made by the tender Sex upon all the Practisers in the Science, to have their Case peculiarly consider'd.

To speak first in general, and to consider, that Nature is then intent upon the great Work of propagating and perpetuating her­self in the Species: And that this is a Task the most arduous in its Performance of all natural Functions, is sufficiently observable from the great Turn, and, as it were, Re­volution made in the Constitution. Not to entertain you with the shocking Expres­sions of the Act of Generation, though really observable enough, but the Conse­quences of it. Upon the first setting out of the Primordia of Conception, the Men­ses are intercepted; so that the Blood, Spi­rits, Lymph, and the whole Genus fluidum of the System take a new Turn; and this not purely for the Nutrition of the but just conceiv'd Faetus, which it does not, nor is it possible it should receive the thousandth Part, but for many other Uses and Reasons, and for this general one amongst the rest, because she would not admit of any Avoca­tion, or Interruption in this so great an [Page 27]Undertaking. And we almost always see, that Miscarriages (not to speak of the Loss of the Embryo, which however ought to be consider'd, and seems to be a Duty im­ply'd in our Oaths) are incomparably more full of Danger, and ruinous, even to the Health of the Mother, than natural and timely Births. And this, I suppose, no one will put me upon proving, when Na­ture, and every Day's Experience, manifests it to the most superficial Observation. But when to this is added, the violent Insults of a little less than Pestilential Fever; when she is forced from this her grand Intention, call'd off and diverted to contend with what is so frequently too strong of it self, and which God in his merciful Administra­tion and Providence has so order'd, that human Nature is rarely, if ever, more than once in each Individual subjected to it. When to these general Disadvantages, so considerable a Part of the Mother, as the Foetus, when of any Magnitude, must be accounted, is in Danger, if not timely pre­vented, of being torn from her; by which so great an Effusion of Blood, and other Fluids, such an Exhaustion of Spirits must immediately follow: What Intenseness of Thought and Sedulity must these Conside­rations raise in every one, that desires, or intends to make himself serviceable in his Employ, to which he has assign'd himself, [Page 28]and is, as it were, elected? Upon such like Observations as these, I thought my self excusable, if I took a Method somewhat pe­culiar, to prevent, if possible, that which might be otherwise destructive of the Mo­ther and Offspring; and without this be­ing done, every Day's sad Experience suf­ficiently shews, that both must generally be lost together. To detain you therefore no longer; As soon as ever I have been call'd to a Woman with Child, and there has been Reason to believe she would be seiz'd with the Small-Pox; as by the usual Symptoms in the Person her self, or the Place where she lives being visited, together with her own Fears and Apprehensions be­ing strongly employ'd or affected; in such a Case, without staying for the appearing of any other Sign, to make the Diagnostick certain, I always give something to prevent Miscarriage; and in this, I dare presume you, Sir, will agree with me, that I am regularly discharging my Duty, because such Administration can have no Male-Tendency: Besides, the Lucta is so great, the Convulsion frequently so violent, at the same time that the poisonous Miasmata are making their Insults upon the Internals be­fore the Eruption, that the Placenta is in great Danger of being very much loosen'd, if not immediately torn and divided from the Mother; upon which, all the Symptoms [Page 29]before recited, and many more, must be exasperated. And under this Oppression, while Nature is held in this unhappy Di­lemma of attending one or the other, either to expel the Disease, or preserve the Em­bryo, and is not able to perform both; du­ring the Hesitation, both Mother and Child are in the most eminent Danger of being lost: Immediately therefore I order the following Bolus and Draught.

After this has been taken about Two Hours, I then order the Alexipharmick Draught before-mention'd. In which you see, I regard both the Pregnancy of the Mother, as well as endeavour to get the Enemy at the same time remov'd to that convenient Distance from the Vitals, that we may with some tolerable Safety parly with him. The Bolus and Draught against Abortion, I certainly repeat at the End of four Hours after taking the first; but then [Page 30]omit it for twelve Hours, except some pe­culiar Reasons from the Patient oblige me to repeat it sooner. The Signs of an ap­proaching Miscarriage, and that of the na­tural Birth being so very like, and Women being so abundantly sensible of the Particu­larities in that Case, I need not take up any room here in reciting them: Upon which Occasions and Informations, I repeat the Bolus and Draught every three, four, or five Hours, as Need shall require; the Per­sen herself being kept in Bed in the most quiet Disposition and Posture that is possible, till these threatning Signs abate. For at this time I am so intent on tying, as it were, all things fast in the Communication be­tween the Mother and Foetus, that in truth I think nothing safe, or like to be so, till that great Point is secur'd; and that the foremention'd Bolus, or the Rad. Tormentil. (in what Form the Physician shall think fit, or the Prtient can best take it) will do; at least I never yet knew it fail. But still I would have the Decoction of Figs before spoken of, in proper Intervals freely used (and likewise the Alexipharmick Draught sometimes) as being what will dilute the Fervency of the Blood, and help to break and divide the morbid and peccant Matter from it, and is a good Diaphoretick besides. After this, I generally repeat the two Me­dicines against Abortion once every Twen­ty [Page 31]four Hours, as there is Opportunity, so as not to interfere with the Medicines ne­cessary to bring forward the general Disease. But however, when that is near the State, and grows towards a Crisis, I never omit giving it twice at least in Twenty four Hours. After that is over, I withdraw those restringent Medicines to once in that Time: Then to once in Two natural Days; and then to once in three or four Days. But if the Disease be of the mildest Kind, then neither this, nor any other Medicine, directed to what Intention soever, need be so frequently repeated. But if it be of the Confluent, or even of the Cohaerent Kind, if we keep not upon the Guard, we shall be in Danger of being surprized; for in such Kind of Fevers that are, or are near like Pestilential, there is such Relaxation, or, may I not call it, a Dissolution in all the Juices, and also in the internal Membranes, that they too frequently fall, as it were, in sunder; and thus sometimes disappoint us in our most confident and sanguine Expecta­tion. When the Crisis is pass'd, and all the Symptoms much abated, and Nature un­der a sensible Alleviation and Refreshment, we may with Reason believe the Patient out of Danger, consider'd singly in the Mother; so that the Embryo ought now to be our pe­culiar Regard. As soon therefore as it is manifest that it may be done without Ha­zard, [Page 32]I would have the inferior Intestines empty'd of the Faeces by the common do­mestick Clister of Milk and Sugar. The same may be repeated the next Day; and then intermitting a Day, it may be again made use of, if the Strength of the Patient will admit of it. But I do positively de­clare against any purging Medicine being taken at the Mouth by Women with Child; because it puts the Child into the utmost Danger of being expell'd before its time: Of which, with Permission, I shall give you Two pretty plain Instances.

A Gentlewoman of this Town, who had the Small-Pox in the mildest manner ima­ginable, so that there was little or no Oc­casion for any Assistance on any respect whatever, was (tho' with Child) treated at the latter End, as in common Cases, with purging Medicines, by which (in her own Opinion, and also in that of most about her) she miscarry'd. Again:

Mrs. Snow, a Gentlewoman who was most severely handled, as by her Case here­after recited appears, upon her Recovery from the utmost Danger, was so prepossess'd with the Necessity of being purg'd after such a Disease, that notwithstanding all I could say, would not be prevail'd with, but purg'd she would be. I order'd her nothing else but

℞ Mannae, Sal Cathartic. Glauberaa. ℥ss. [Page 33]to be taken in Gruel; by which she had Five moderate Stools: Yet even this caused in the Child such tremulous, fluttering and disorder'd Motions, and in her self such parturient Pains, that without waiting to know whether the Purge had finish'd its full Operation, I was necessitated to give the Draught and Bolus against Abortion: Upon which she was abundantly convinced, and desir'd she might have no more Purges. Neither indeed had she any more, nor any one else with whom I was concern'd, who were with Child, any thing of that Kind, but the Clister before-mentioned, till after the Time of their Delivery. They and their Children are all alive, and in perfect Health, (Mrs. Dove being long since safely deliver'd.) And more I think I need not urge. I only therefore beg your Patience for one Word more of Comfort to Women with Child. And pardon, I intreat you, good Sir, any seeming Vanity in it. As I have laid their Case, as well as I can, be­fore you, I may with some Assurance, as well as Pleasure, say, that thus consider'd, their Condition is even not so dangerous as other Women: For it is observ'd by Au­thors, and may be so very often in our own Practice, that the Proceeding and Advance of the Disease, and its Cure, is interrupted by the Menstruation of Female Patients, even in their timely and regular manner; [Page 34]and is enumerated ^* as one singular Disad­vantage in their Case, and is much worse when (as it frequently happens) it appears before its Time. For a Confirmation of what I now say, I refer my self to Dr. Mor­ton's Historical Observations in the 9th, 18th, 36th, 37th, 41st, 52d Histories of Puretology. And for the unhappy Events subsequent on Abortions, the 43d and 44th Histories of the same Author are sufficient Testimonies. I shall add but this one gene­ral Observation more, on which it cannot but be imagin'd I must reflect with some Satisfaction, that during the Continuance of the Small-Pox in these Parts, there was not one Person with Child, for whom I was consulted, whom I treated not in the Me­thod above describ'd; and not one of them but is now alive, and so are their Children: Except Mrs. Withnoe's, which liv'd above a Fortnight, and then I believe died on the first Insults of the Small-Pox; there being a Necessity, by reason of the weak Condition of the Mother, and other Disorders of the Family, to keep it constantly in a Room, where Three others lay miserably afflicted of the Confluent Sort of Small-Pox. And I can't learn from the strictest Enquiry I have made, that any escap'd that were not [Page 35]thus dealt withal; but both miscarried and died, except the Gentlewoman before hin­ted at, who only miscarry'd upon her being purg'd after the Disease.

After what has been said, I shall take Leave to lay before you some Historical Cases: Which I hope, Sir, will not only seem excusable, but necessary, and even incumbent on me; that so any Person may be satisfied, that shall think fit to enquire into the Truth of the Relations from the Persons themselves.