SECTION I.
Of the nature of variolous matter, its seat in, and effects on the blood.

VARIOLOUS matter is a pestilen­tial virus ^* sui generis, that, upon reception into the body, takes its seat in, and contaminates, that heterogeneous^† [Page 2]part of the blood and juices, which is viscid; especially that which, by reason of taking unwholesome, or too much animal food, or any kind of high living, or by being retained long in the vessels, without being assimilated into a good and perfect state, is become putrescent; or tenacious and acrimonious, and therefore strictly scorbutieal.

This taint in the humours may be either hereditary or acquired, and, it may be safely said, is almost always both. It serves for a nidus, wherein the variolous matter rests; and which it by degrees heats and corrupts, in the manner other [Page 3]putrid effluviae do; but has not power of the more pure, globular, and perfect part of the blood and juices, if the other he­terogeneous corrupted part does not very much abound, and the constitution is ca­pable of expelling it.

When the above described matter is so corrupted by the variolous virus, and, as it were, changed into its own nature; the subtle effluviae arising therefrom stimu­late the nerves, and rouze up that system, in proportion to the strength it has, or as the peccant matter may more or less abound, to endeavour at its expulsion.

When the matter then to be expelled, either by reason of natural health, tem­perance, or the power of preparation, is small, the disease is of the distinct kind; when large, of the confluent. And these, together with the effect a too rigid, re­laxed, or due tone of the fibres, and the reigning constitution of the air, or the [Page 4]climate, may have, seem to be the real causes, which occasion the variety in this disease; which does not arise from any difference in the variolous matter itself; as is abundantly proved by numberless instances, of persons receiving the most favourable small-pox, from the worst kinds thereof.

The above well accounts, why some persons are not liable, to take the small-pox, at all times; if it happens there is no heterogeneous corruptible matter in the body, at the time, for the effluviae to lodge in. As to the reason, why persons have the small-pox, or any such pestilential disorder but once; it is at present only resolvable, into the will of that merciful Providence, who presides over us. The cause of which will pro­bably ever remain among those wonder­ful arcana, which human penetration may admire at a distance, but cannot search into.

SECT. II.
Of the process of the disease in the natural small-pox, and its frequent beneficial effects, in those who recover.

WHEN the morbid effluviae from the corrupted matter above described, begin to be predominant, they irritate and distend the nerves, and bring on the known symptoms of the disease; pain in the head and back, sickness at the sto­mach, and an universal languor, &c. All the powers of the body rise to expel this dreadful enemy, and a fever commences: whereby the morbid matter is in some measure attenuated; but great part of it being still incapable of being secreted, by the general outlets of the body, and in particular by perspiration; yet withal too irritating and dangerous, to be retained any longer within; is determined how­ever that way, viz. to the surface of the [Page 6]skin^* by one general and powerful effort. When therefore the matter to be so expelled is not abundant, nature per­forms this with more ease, and by a more gradual expulsion; when it predominates, if the strength is good, the attempt is more violent. Hence arises, some cases, depending on extraordinary weakness of the nerves, and viscidity of the juices, excepted, that usual difference in the pe­riod of eruption, which is a general cri­terion, whereby to judge of the mildness, or malignity of the disease.

When the eruption is compleated, na­ture still carries on her work, by a farther gra [...]ual attenuation and determination, of any remaining matter in the blood, to the pustules; bringing on hereby their matu­ration, [Page 7]which, when fully compleated, is the crisis of the disease. And the pus­tules, having attained that degree of per­fection, by degrees harden and fall off, which terminates it.

In the natural small-pox then, the va­riolous effluviae having taken full effect on the viscid, scorbutic, putrescent matter above described, as not having been drawn off by any partial discharge beforehand, nor its determination changed, the efforts of the constitution in expelling it, are powerful, uniform and regular, at least in good habits; and above all, natural: and, whatever we may pretend, nature is most perfect in her operations, when the obstacles to be surmounted are not very great; and all good physic depends upon a knowledge, and observance of her laws.

The good effects, attending the natu­ral small-pox, are those of greatly lessen­ing, nay, often of eradicating, not only [Page 8]acquired, but hereditary scurvy, trans­mitted through preceding generations. An affair of great consequence to the health and well-being of succeeding ones! and this by a method, whereby alone it can be discharged. It is often got to such a degree of tenacity, as to be inca­pable of being secreted, by the emuncto­ries of the body; not even by the action of a fever. In this disease it is deter­mined to the surface of the body, and, in a peculiar manner, eliminated and dis­charged. Health succeeds, and that often to a degree inexperienced before.

Hereby nature has a chance of being restored to a state of perfection, in some measure adequate to its first state, with respect to purity of the blood. The con­sequence of which, with regard to the beneficial effects of health, to the per­sons themselves, and their posterity, I leave to the judicious to determine.

It cannot indeed be denied, that this disease sometimes makes dreadful havock, in those bodies, in whom, the before-mentioned viscid, putrescent, scorbutic matter predominates, especially in hot climates, and in constitutions of the air productive of putrid disorders; when, by reason of abounding untoward matter and the putrescence thereby occasioned, or when, on account of great weakness, nature cannot bring about, her main work, the maturation of the pustules. Nor that, when the disease does not prove fatal, there are wanting instances of imperfect recovery, where she does thus meet with such obstacles, that she cannot surmount. These are however no contradiction of the original rectitude of those laws, whereby the disease acts. And wise indeed must he be, who can find out any, respecting the reception and expulsion of diseases, superior, on the whole, to those which are original.

SECT. III.
Of the process of the disease by inoculation, the imperfect depuration generally attend­ing it, and the effects and diseases that frequently follow.

IN this method, the matter is indeed absorbed into the blood, by a wound made in the skin; but undoubtedly it is soon after also received in, by the breath likewise. For how is it possible, the ef­fluviae of matter so contagious, which is also again discharged by the wound, and by which, the disease may, in the same manner, be communicated to others, should not be received in by the breath of the person, out of whose arm it issues?

Be that as it may; the effort of nature, in expelling it, is here twofold. A de­termination is made of the matter, to­wards the wound, whereat it was re­ceived, [Page 11]and also to the skin. Hereby is perverted that powerful and uniform de­termination of the matter of the disease, after one manner only, as in the natural small-pox. And certainly, the apparent difference, of inoculation, from the na­tural disease, consists in reducing the ex­pulsive fever in the former, under that which would take place in the latter, in the same body, with the same quantity of heterogeneous, unhealthful matter, to be discharged; whether it arises, from thus baffling the effort of nature, by the double determination above-mentioned, the inflammation and discharge attend­ing the wound beforehand, or any other cause.

The general consequence is imperfect depuration, even though the pustules that appear maturate kindly; which, notwith­standing the person recovers, is productive of many bad consequences.

If there is any tolerable strength in the person, and the juices are not extraordi­narily viscid, the first and most usual are imposthumations; or a tendency of diseased serous and lymphatic humours to the skin^*, which often degenerates into a most obstinate scorbutic disorder there.

If nature is not able to relieve herself in this way, scorbutic opthalmics ensue, which often endanger the sight; or the matter falls upon the lungs, and occa­sions obstructions in the glands of that organ, which by degrees end in a tabes; especially towards that critical term of life, when diseases of that kind are apt to take place, in young persons. In others a spitting of blood comes on, from the increased heat and rarefaction occasi­oned [Page 13]therein, or erosions of the vessels brought on, by diseased, acrimonious hu­mours, never properly discharged.

In women obstruction of the menses happens from the same cause, and stru­mous tumours in the glands of the breast are occasioned, which degenerate into cancers, at a certain period. These hap­pen, where the matter described is apt to lye dormant, as it is generally inclined to do in weak, relaxed constitutions; and therefore, in children, I have known the king's evil succeed: for let it be remem­bred, that tho' relaxation of the glands be now considered, as the chief cause of that dreadful malady; viscidity is often a predisposing cause to relaxation, and al­ways co-operates with it.

Now, though I am most ready to ac­knowledge, that inoculation is not to be considered as the sole cause of many of the disorders, which I have known soon [Page 14]consequent, or could reasonably trace, therefrom; yet, I cannot, without flying in the face of my reason, but remark, that it must at least be considered as in­strumental, by preventing the beneficial effects of a disease, so salutary in its nature in general, to those who recover from it.

These objections therefore lye against inoculation; even tho' the patients may have been treated after the most judicious manner. I have known these consequen­ces happen, in those, who have been under the treatment of persons, of great reputed skill in this branch, as well as in my own patients. And so sensible I am of the bad effects of imperfect depuration of tenacious acrid matter, and especially that which is transmitted, that I will venture to declare, any disorder may arise therefrom, even, from a simple eruption on the skin, to the king's evil, cancers, consumption of the lungs, or the slow [Page 15]nervous fever and atrophy; in which the subtle diseased effluviae attack and prey upon the first principles of life.

Sorry I am to say it, and I wish I may be mistaken; but these appear to me to be the consequences of disturbing and perverting the order of nature in her ope­rations, and aiming at a knowledge and power superior to that of the great Dis­poser of things; who does not view things in that partial, contracted light we do; but looks forward, and has, I am of opi­nion, ordered every disease, in regard to the manner of its reception and expulsion, so as to be best on the whole, and for the benefit of his creatures.

SECT. IV.
How far inoculation may be considered, as a succedaneum necessary to prevent the mor­tality of the small-pox; and what me­thods will bring it nearest to the standard of nature, in the natural disease of the distinct kind.

THOUGH I cannot approve of in­oculation in the manner I could wish; it shall not be said I am not wil­ling to lend assistance, from what know­ledge I have therein, to bring it towards the best state, it is capable of attaining.

The best that can be said of inocula­tion is, that it is a means of preventing the mortality of the small-pox, which appears to be a very good plea for its use, when, on account of an unfavourable state of the air, we see numbers falling, on all sides of us, a sacrifice to its most [Page 17]fatal effects. But that it can be equal, in its beneficial effects, to the natural disease, in those who recover, unless it possibly may, in some cases, take a more natural turn, is, I apprehend, in its own nature, impossible. The laws of diseases were given with them, and the nearer we keep to those laws, on the safer ground do we tread.

Inoculation will be brought nearest, in its good effects, to the natural disease, by so preparing the body, by diet and me­dicine, as to overcome, in a good mea­sure, the predisposing cause, viz. tena­cious, acrid matter, to the bad effects the disease may have, without impairing the strength, or the least that is possible. This is dividing the two extremes of no preparation at all, or of one which has but little efficacy; and of another, which brings down the strength.

By a gradual, proper, alterative prepa­ration, the blood will be reduced into such a state, by lessening and attenuating any tenacious humours therein, that the matter of the disease will be more easily separated from it; and by preserving also the strength, the effort of expulsion will be more lively and effectual.

No preparation, or one that is ineffica­cious, are often bad, as they leave the humours too viscid, and the body too op­pressed, for the morbid matter to be well separated from the blood. Which dispo­sition, if it should not occasion any bad symptoms, during the disease, will be in great danger of shewing itself afterwards, in the bad consequences before-menti­oned.

Too much preparation, and violent doses of mercurials, are bad on the other hand, as thereby the strength is impaired, which is the chief instrument in expel­ling [Page 19]the disease. To which cause, with the heavy clog upon nature from the use of too much viscid diet, and the repul­sion of the matter of the disease by cold air, are to be attributed the agues and putrid fevers, I have frequently observed consequent upon the modern method.

In the matter of preparation therefore, regard is to be had to the constitution of the person, both in respect of the solids and fluids; that the latter be not too te­nacious, and thereby hinder the separa­tion from the blood; and that the former may be in state sufficient, to give a lively and effectual impulse to the morbid mat­ter, and to support the patient in the en­suing disease.

SECT. V.
Of the best method of preparation, both before the natural and inoculated small-pox.

CALOMEL, according to the pre­diction of the great Boerhaave, is the grand corrector, not of the variolous virus, but of that predisposing cause, which occasions its most dreadful effects, and the basis of the medicines now in use.

This, were it not now almost univer­sally known, I might have some right to determine; having seen the extraordinary effects of it, in a practice commencing so early as the year 1739, a period perhaps not many have a pretence to date from. I am therefore clear, that Dr. Ruston is right, in his experimental observations on Sutton's medicines; which is however, I believe, in general, not doubted.

The method was at first tried on three young persons, who afterwards received the small-pox, in the natural way, and had a favourable distinct kind, succeeded by an uninterrupted state of health, for several years after recovery.

It was afterwards confined within the narrow limits of the persons own friends and patients, who first made use of it, and became the more confined, for want of that enterprizing and daring spirit, which characterizes the modern race of inoculators. It was however communi­cated to several not long after.

Calomel and calx of antimony, joined with cream of tartar and purgatives of the brisker kind, as jalap and scammony, were given as an alterative, in very small doses every morning, so as to move the bowels once daily, for a fortnight or three weeks before the natural disease; abstaining, at the same time, from flesh, and fermented, and other strong liquors; [Page 22]and going out daily, except in bad wea­ther.

This method I have seen attended with very great success. It was made use of in preparation before the natural small-pox, in which it scarce ever failed of giving a distinct sort, when the regimen prescribed with it was regularly persisted in.

Its beneficial effects before inoculation, are also extraordinary, and I still think it one of the best that can be used for chil­dren, and young persons; but that small doses of calomel joined with emetic tartar, or a preparation of antimony like James's powder, taken two or three nights toge­ther, and then purged off with Glauber salt, repeating it at due distances, is pre­ferable for adults; especially those of a robust constitution, and in the warmer seasons of the year^*.

In patients to be inoculated, I never continued the method longer than to the time of inoculation; which I thought most eligible, as it gave nature time to recruit, before the appearance of the dis­ease, and for the heat and disturbance, occasioned by the mercurials, to subside. The original method however was to continue the medicines to the time of seizure; which may be in some cases ne­cessary, when persons are not so strict, in the observance of regimen, as they ought to be.

Let it be here observed, that, as on the one hand, by this and other testimo­nies, it cannot be justly said, that mer­curials have not an extraordinary use in preparation; and, as on the other, it has been objected, very justly, by Mr. Brom­field, that by the present use of them, in large doses, attended with a very lower­ing regimen, without sufficient regard paid to the constitution of the patient, [Page 24]the strength is often too much depressed, and nature rendered unable to expel the disease, and perfect the maturation; that this method is a medium between both: and that a distinct pox by inoculation, expelled with ease, and coming kindly to maturation, as in the natural disease, is the almost infallible consequence of the use of it.

SECT. VI.
Of the general necessity of physical helps after inoculation, and which are the best of that kind.

NOtwithstanding the favourable ap­pearances above described, and the coming of the pustules kindly to matu­rity, yet from consequences which have followed, I am fully assured, that the work is not generally so well done, as in the natural way; and that though the [Page 25]enemy should lye dormant, and seem quiet for a while; yet that, if he is not thoroughly conquered, he will certainly rise again, and commit dreadful havock and devastation.

Let it be here remembered, that trans­mitted and acquired scurvy, when joined to hereditary and acquired weakness, is to the body, what original sin is to the soul, and will not fail sooner or later to destroy it.

Means may be used to keep off and ward the blow. In the present case, issues continued in the inoculated parts, according to the old method, above all things will assist nature, and drain off any remaining matter, which is unfit for se­cretion, and has probably received an in­crease of acrimony, from the variolous virus. To these should be joined, the alterative method used in preparation for a short time; or crude antimony or some [Page 26]of its preparations with Aethiops mineral, and a course of purging mineral waters; at least in such cases, as give reason to suspect, that there is any scorbutical taint remaining behind.

SECT. VII.
Of the good and bad effects of cold air, and other antiseptics, and the reasonable man­ner of using them; with some remarks on the present prevailing and peculiar method.

IT must be allowed, that air is one of the greatest preservatives of the blood and juices from putrescence, while life subsists; but does it thence follow, that the promiscuous use of it, in so free a manner, in all cases, in all seasons, and in all periods of this disease, is there­fore adviseable? Air has a repellent action upon the surface of the body, as [Page 27]well as is endued with a preservative power. Therefore such indiscriminate and extraordinary use of it, as is too common with some, savours but too strongly of empiricism, to say no worse of it.

Is there nothing to be done, but, after a slight fever, to check nature in the beginning of her work, by cold air and antiseptics, and set aside maturation, her second intention, as a matter of no con­sequence? or is it possible mankind should be arrived at such total darkness of the understanding, in this, as is apprehended, most enlightened age, as to suppose they can trifle with and oppose original laws, without smarting severely for it?—This is not copying after the great father of physic, nor agreeable to his rules. For though it is the proper business of physic, to relieve nature, when oppressed, and lessen her efforts, when too violent; I do ask all who pretend to lay the least claim [Page 28]to medical erudition, if any thing can be substituted with equal propriety, in the place of those known crises, whereby diseases are terminated?

The seeming recovery from the small-pox, is by no means a proof sufficient; unless it can be likewise proved, that there is no other disease that can be fatal. I have myself known putrid purgings, putrid fevers with sore throats, with in­flammation of the lungs, and obstinate in­termittents, following hard upon the heels of a celebrated method: Arising, I have the weakness to apprehend, from the rarified, putrid matter of the small-pox, unexpelled by maturation; the oppressive load upon nature, from viscid diet, joined with the relaxation brought on by large doses of mercurials.

I hope Dr. Dimsdale will not take it amiss, if I say, that the case he has so candidly related, in his treatise on the [Page 29]small-pox, page 137, of the man who died of an apoplexy, upon recovery from inoculation, most probably arose from matter unexpelled, determined to and affecting the head; though under a treat­ment more judicious, than what I have above recited.

The public is greatly indebted to that gentleman, for communicating the good effects air and mercurial purges may have, in repressing the first fever of the con­fluent small-pox, in violent and dange­rous cases. They undoubtedly lessen the putridity consequent in the following stages; and may, under judicious ma­nagement, be a great means of preserving life.

The necessity also of circulating air through the chambers of the sick, in all stages of the disease, as well as of taking them, at times, out of bed, according to Sydenham's method; of even letting in­oculated [Page 30]persons walk about the house in the warm season of the year; and indeed all methods of using air, agreeable to right reason and experience, are also abundantly apparent. But surely the in­discrimate use of it, in such degree, as is common, in all cases, in all stages of the disease, and in all seasons of the year, in this climate, is an extreme, which may be too justly stiled the madness and en­thusiasm of modern physic! and to its account may be fairly set, those conse­quences before enumerated, as attendant on imperfect depuration of the blood.