The nature of inoculation explained, and its merits stated: in an essay, intended to supply what appeared still wanting to clear up that subject. ...

THE Nature of Inoculation EXPLAINED, AND Its MERITS Stated; IN An ESSAY, intended to ſupply what appeared ſtill wanting to clear up that Subject.

AND WHEREIN The Nature of the Difference, between Inoculation and the Natural Small-Pox, is fully ſhewn; all Extremes in Opinion or Practice are avoided; and the true Uſe and beſt Manner of Preparation, from a Knowledge and Experience therein, of an earlier Date than what any, who have written on the Subject, pretend to, are declared; with a View to the general Good.

To which is added, AN APPENDIX, CONTAINING Some Thoughts on the firſt Appearance of the SMALL-POX in the World, and an ADDRESS to INOCULATORS and Others.

Quamvis, Scaeva, ſatis per te tibi conſulis, & ſcis, — Diſce docendus adhuc, quae cenſet amiculus: ut ſi Caecus iter monſtrare velit, tamen aſpice, ſi quid Et nos, quod cures proprium feciſſe, loquamur. HOR.

LONDON: Printed for B. LAW, in Ave-mary-Lane; and JOHN DALE, at Coleſhill.

M DCC LXIX.

PREFACE.

AS burleſque writing has of late taken place of ſober enquiry, on the ſubject of inoculation; I doubt not its merits are ſo fully aſcertained and eſtabliſhed, in the opinion of ſome, as not to ſtand in need of farther examination. Some there are however who think otherwiſe. If I perchance ſhould be of that number, may I be ſuffered a little in my folly; eſpecially if, at the ſame time, I declare my ſentiments candidly and honeſtly, and endeavour to explain its nature more fully, than I find is already done to my hands, by any author. And let the gentlemen of wit take this friendly caution with them, To take care that, in the uſe of talents, allowed at beſt to be but dangerous, they do not unwarily ſtumble upon ſubjects, too important for their application. Let it be alſo conſidered, that it is but a mean and illiberal employment, to be the retailers of low jeſts. Can any thing equal the native beauty and dignity of truth, in her moſt ſimple dreſs? ſhe is, in fact, a moſt delicate miſtreſs, that muſt be wooed in her own way, and will not bear being laughed at and jeered to her face. For a while then raillery apart from diſquiſitions in phyſic, for that is a part of truth.

The weakneſs and depravity of human judgment is in nothing more conſpicuous, than the tendency it has of running into erroneous extremes. The bad effects of this unhappy propenſity of carrying our prejudices, for favourite opinions and practice, too far, phyſic, in common with other ſubjects, has often felt; and it appears plainly to me, that the ſhort-ſightedneſs, whereby we examine only things preſent, and which is a grand cauſe of error in general, contributes not a little to our forming an erroneous judgment, in the matter before us. However, in enquiries after truth, a ſubject which diſclaims all imperfect notions, or partial repreſentations, it is neceſſary the mind, under ſafe guidance, ſhould take into its view, if poſſible, the whole that relates to a ſubject, and examine every thing with the deepeſt and moſt fixed attention.

Tho' ſeveral ſenſible and judicious writers ſeem to entertain very ſanguine hopes, concerning the preſent method of inoculation, to whom, and to whoſe writings, I wiſh to pay all due deference; though, I hope, I alſo wiſh well to all methods, which truly conduce to the health and preſervation of mankind, as well as have long known the importance of proper preparation, both before the natural, and inoculated ſmall-pox: yet ſorry I am to ſay, I am obliged to conſider the preſent reigning mode, on the whole; as one of thoſe dangerous extremes, which will be productive of bad conſequences, to the health of this, and ſucceeding generations. I muſt alſo, upon the principles and experience, hereafter to be laid down, go yet farther, and declare I am far from being ſo well fatisfied about inoculation in general, as not to be aware, that it is a ſubject, which has never been well cleared up; that, tho' it is become pretty univerſal in England, it ſtill wants the concurrence of many of the eminent in the profeſſion, and of more of thoſe abroad; the unprejudiced opinion of any of which, if happily ſuch are to be found, I think, deſerves to be attended to.

There is ſomewhat of original rectitude, or its contrary, in moſt things, which diſcovers itſelf, to an impartial obſerver, at firſt ſight. This teſtimony inoculation apparently wants, in an eminent degree; or it had become long ſince univerſal. And tho' the main argument, its preſent ſucceſs, be ſtrong in its favour; it is not infallible upon the principles and experience laid down in the following pages. I heartily wiſh I may be miſtaken in my opinion, and that inoculation really may be that uſeful and ſalutary practice, I believe, many eminent in the profeſſion, and others out of it, judge it to be. However, as that opinion is founded on obſervation and experience, and a long and cloſe attention to the reaſon of things; till inoculation ſhall happily ſtand upon a better foundation, than preſent, perhaps tranſient ſucceſs, I cannot help retaining it.

I am, at the ſame time, fully ſenſible, how ill ſuch ſentiments agree, with the notions entertained by the patrons of inoculation; eſpecially by the warmer advocates for the preſent method. Nothing therefore ſhould have induced me publickly to declare them, but the ſtrongeſt perſuaſion of their truth; and an opinion, that it is the duty of a writer to declare truth, or the beſt apprehenſions he has of it. I have therefore herein delivered my ſentiments to the conſideration of thoſe, who, being perſons of due temper, will coolly hear reaſon, on every ſide of an argument; and who, having alſo ability to trace back effects to cauſes, and to inveſtigate diſeaſes in their very principles and ſource, are the only perſons qualified to judge; who, being endued with aſſiduity and application, will diligently obſerve not only preſent effects, but remoter conſequences; and who, being alſo men of integrity and candour, will faithfully communicate ſuch obſervations. By ſuch, and ſuch only, can the jarring opinions, relative to this ſubject, be at length determined. For my own part, my obſervations have been very unfavourable to it, at leaſt in the light I have conſidered them. As it appears undeniably clear to me, that if inoculation, or any other cauſe, is capable of increaſing hereditary or acquired ſcurvy, when alſo conjoined with the uſe of violent doſes of mercurials, the preſent too common and pernicious uſe of warm relaxing liquors, or any ſpecies of intemperance which enfeebles the body; they will not fail to promote a decay, and a falling off, in this and each ſucceeding generation, from the priſtine health and vigour of their anceſtors.

THE NATURE of INOCULATION EXPLAINED, &c.

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

VARIOLOUS matter is a peſtilential virus Tho' this is a matter apparently beyond doubt, from the very nature of the diſeaſe, and eſpecially its effects in the confluent kind; it is ſurprizing to find that few writers have been of this opinion, except Rhazes, the late Dr. Mead, and the preſent Dr. Ruſton. ſui generis, that, upon reception into the body, takes its ſeat in, and contaminates, that heterogeneousI am ſorry I cannot agree with Dr. Ruſton, in opinion, that the variolous matter is apt to infect perfectly aſſimilated juices; as then the heat and irritation, occaſioned by mercurial medicines, would be pernicious. Their action upon heterogeneous matter, better accounts for the good effects of preparation thereby; as they are known to diſcharge ſuch matter from the body. Beſides, were the more perfect juices in general tainted, nature would have no reſource left, whereby to ſeparate the diſeaſed humours from the body. 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 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 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 ſkinIt may be here obſerved, that miliary fevers ariſe from the ſame ſtate of the humours without infection, and the ſame incapacity in nature to diſcharge them; wherefore antimonials and calomel, in ſuch caſes, lay the baſis of a cure. 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, 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 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, 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 ſkinI am far from thinking with ſome gentlemen, who practiſe inoculation, that it is good to avoid either of theſe conſequences, in caſes where it happens that nature has not properly relieved herſelf, by the preceding diſeaſe., 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 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 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 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 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 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; 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 yearThis perfectly anſwers to Boerhaave's notion of the medicine, likely to correct, as he apprehended, the variolous virus..

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, 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 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 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 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 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 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 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.

THE APPENDIX.

IT is pretty univerſally agreed, that the ſmall-pox did not make its appearance very early in the world, as neither Hippocrates nor Celſus take any notice of it. If this is the caſe, and moſt probable it appears; as I will not allow that things of that kind happen in the world by chance, I cannot help forming this inference; that, at the time of its firſt appearance, there was a real neceſſity for it, either in a phyſical or moral ſenſe, and moſt probably in both.

The former neceſſity could be occaſioned by nothing elſe, than the increaſing corruption of tranſmitted or acquired ſcurvy or impurity of the blood, and its miſchievous effects, ariſing from intemperance; and the latter, by degeneracy of manners.

In regard to the former, it is humbly conceived, that the moſt wiſe and merciful Diſpoſer of things, would not have laid this ſevere ſcourge upon intemperance, without having ſtill farther therein a merciful view, in the reſtoration and preſervation of the human ſyſtem to future ages, in that ſtate of perfection, it is ſtill ſeen, in a wonderful manner, capable of attaining in many inſtances; conſidering the many removes which have happened from that purity of blood, and that ſtrength which were original.

That the ſmall-pox, among other cauſes, has had a great ſhare in this miraculous preſervation and reſtoration, whereby the humam ſyſtem has been capable, like the phoenix, of often riſing again, as it were, out of its own aſhes, is not to be doubted. To this end, providence has appointed laws of an infallible propriety, reſpecting the manner of the reception and expulſion of diſeaſes; wherewith, ſo far as men co-operate, they proceed right; as they reſiſt, wrong. In the foregoing pages, I have already conſidered the matter of hereditary and acquired impurity of the blood, and what the ſmall-pox has to do with it; at leaſt, in the natural way.

The latter is perhaps a ſubject of too delicate a nature to touch upon, and may alſo appear foreign to the preſent purpoſe. Suffice it therefore to ſay, that, though it is certainly right to alleviate and take off any of the ſevere effects of diſeaſes, ſo far at leaſt as we can do it to good purpoſe; it is undoubtedly a great error, that the ſmall-pox is now conſidered, as the only bugbear in the whole liſt of diſeaſes, which, if people can but get over, they think they are ſafe. Whereas the mortality, attending the ſmall-pox, makes but a ſmall part in the general devaſtation occaſioned by diſeaſes. It is certainly wrong to inſtil into and encourage ſuch notions, in young minds. Temperance is the ſureſt guard againſt the bad effects of diſeaſes in general, and of this in particular; for without regimen, preparation itſelf would avail but little.

Permit me now to addreſs ſome very peculiar inoculators.

Let it be laid down as a fundamental rule for all honeſt men to proceed by, never to perſuade any one into the uſe of inoculation. For, as the conſequence is to them and theirs, it ought to be their own act, and they ſhould be ſatisfied in their own minds, that what they are doing is right. This will be a ſure means of avoiding reflections afterwards, and prevent that uneaſineſs I have been witneſs to, even where a celebrated method has been ſucceeded by diſagreeable conſequences.

Much leſs let any preſume to declare, there is no danger attending even the beſt methods, as long as they would claim a pretence to believe, that we are in the hands of providence. It alſo well deſerves ſerious conſideration, how far it may be right and humane, to turn patients looſe, and thereby drive all people into the uſe of a method, in a manner, whether they will or not.

Let me alſo join with Mr. Bromfield in deſiring, that if they have, at any time, found their method wrong, they would take the hint, alter it, and have regard not only to preſent, but future conſequences. For, whether it is allowed or no, the following of putrid fevers, &c. on the heels of any method, is a ſhrewd ſign of its inſufficiency and inefficacy. It, in fact, requires more judgment, than ſome are perhaps aware of, ſo to order things unnatural, as to anſwer the great purpoſes of the Author of nature.

If any thing herein written ſhall appear too harſh, or ſeem too hard to be digeſted by our frail nature; let it be attributed to that honeſt and generous warmth, which is due to ſubjects of an important kind. Let it alſo be remembered, that, out of regard to the lives of my fellow-creatures, I have allowed of inoculation, as a ſuccedaneum to prevent the mortality of the ſmall-pox, under proper reſtrictions, good management, and a reſpect to future conſequences; though, I declare, I am not clear in my own mind, that it will be attended with good in general. For, if lingering evils be of all evils the worſt, the point is nice to decide on, and of weighty concern. That I have communicated a method, which, notwithſtanding the baſis of it is now pretty univerſally known, has a peculiarity belonging to it, in the manner of adminiſtration, that brings the effects of inoculation, neareſt to thoſe of the diſtinct natural kind, of any thing yet made known; and injures the ſtamina leſs, than the common method of adminiſtering mercurials.

As I plead a long and pretty conſiderable experience, though not ſo extenſive as that of ſome others, as well as a ſtrict attention paid to the ſubject, and a faithful relation of facts; let theſe pages be turned over and again, before any one raſhly declares againſt what is therein contained. If people are determined to ſtick to their own ſhortſighted views, had any one the knowledge of the whole truth of this ſubject, it would not avail.

For my own part, having long revolved in my mind the ſentiments, ariſing from reaſon and experience, herein contained, it would be juſt neither to myſelf or 〈1 page duplicate〉〈1 page duplicate〉 others, totally to ſuppreſs them. Therefore, as the time now is of thoroughly examining this important ſubject, I have with fidelity declared them. And I heartily wiſh that method may take place, which will moſt conduce to the general good; which undoubtedly will be the caſe, if men will proceed upon firm and ſtable principles.

FINIS.