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

VARIOLOUS matter is a peſtilen⯑tial virus ^* ſui generis, that, upon reception into the body, takes its ſeat in, and contaminates, that heterogeneous^† [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 [3]putrid effluviae do; but has not power of the more pure, globular, and perfect part of the blood and juices, if the other he⯑terogeneous corrupted part does not very much abound, and the conſtitution is ca⯑pable 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 ſtimu⯑late 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, tem⯑perance, 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, re⯑laxed, or due tone of the fibres, and the reigning conſtitution of the air, or the [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 pro⯑bably ever remain among thoſe wonder⯑ful 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 ſto⯑mach, 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 how⯑ever that way, viz. to the ſurface of the [6]ſkin^* by one general and powerful effort. When therefore the matter to be ſo expelled is not abundant, nature per⯑forms 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 pe⯑riod of eruption, which is a general cri⯑terion, whereby to judge of the mildneſs, or malignity of the diſeaſe.

When the eruption is compleated, na⯑ture 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 matu⯑ration, [7]which, when fully compleated, is the criſis of the diſeaſe. And the puſ⯑tules, having attained that degree of per⯑fection, by degrees harden and fall off, which terminates it.

In the natural ſmall-pox then, the va⯑riolous 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 natu⯑ral ſmall-pox, are thoſe of greatly leſſen⯑ing, nay, often of eradicating, not only [8]acquired, but hereditary ſcurvy, tranſ⯑mitted 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 inca⯑pable of being ſecreted, by the emuncto⯑ries of the body; not even by the action of a fever. In this diſeaſe it is deter⯑mined to the ſurface of the body, and, in a peculiar manner, eliminated and diſ⯑charged. 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 con⯑ſequence of which, with regard to the beneficial effects of health, to the per⯑ſons 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 attend⯑ing 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 ef⯑fluviae 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 de⯑termination is made of the matter, to⯑wards the wound, whereat it was re⯑ceived, [11]and alſo to the ſkin. Hereby is perverted that powerful and uniform de⯑termination 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 na⯑tural diſeaſe, conſiſts in reducing the ex⯑pulſive 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 attend⯑ing the wound beforehand, or any other cauſe.

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

If there is any tolerable ſtrength in the perſon, and the juices are not extraordi⯑narily 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 occa⯑ſions 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 occaſi⯑oned [13]therein, or eroſions of the veſſels brought on, by diſeaſed, acrimonious hu⯑mours, never properly diſcharged.

In women obſtruction of the menſes happens from the ſame cauſe, and ſtru⯑mous tumours in the glands of the breaſt are occaſioned, which degenerate into cancers, at a certain period. Theſe hap⯑pen, 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 remem⯑bred, 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 al⯑ways co-operates with it.

Now, though I am moſt ready to ac⯑knowledge, that inoculation is not to be conſidered as the ſole cauſe of many of the diſorders, which I have known ſoon [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 in⯑ſtrumental, 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 conſequen⯑ces 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 [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 ope⯑rations, and aiming at a knowledge and power ſuperior to that of the great Diſ⯑poſer of things; who does not view things in that partial, contracted light we do; but looks forward, and has, I am of opi⯑nion, 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 mor⯑tality of the ſmall-pox; and what me⯑thods will bring it neareſt to the ſtandard of nature, in the natural diſeaſe of the diſtinct kind.

THOUGH I cannot approve of in⯑oculation in the manner I could wiſh; it ſhall not be ſaid I am not wil⯑ling to lend aſſiſtance, from what know⯑ledge I have therein, to bring it towards the beſt ſtate, it is capable of attaining.

The beſt that can be ſaid of inocula⯑tion 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 [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 me⯑dicine, as to overcome, in a good mea⯑ſure, the prediſpoſing cauſe, viz. tena⯑cious, 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 prepa⯑ration, 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 ineffica⯑cious, are often bad, as they leave the humours too viſcid, and the body too op⯑preſſed, for the morbid matter to be well ſeparated from the blood. Which diſpo⯑ſition, 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-menti⯑oned.

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 expel⯑ling [19]the diſeaſe. To which cauſe, with the heavy clog upon nature from the uſe of too much viſcid diet, and the repul⯑ſion 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 te⯑nacious, and thereby hinder the ſepara⯑tion from the blood; and that the former may be in ſtate ſufficient, to give a lively and effectual impulſe to the morbid mat⯑ter, and to ſupport the patient in the en⯑ſuing diſeaſe.

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

CALOMEL, according to the pre⯑diction 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 univer⯑ſally 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 communi⯑cated 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; [22]and going out daily, except in bad wea⯑ther.

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 chil⯑dren, 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 toge⯑ther, and then purged off with Glauber ſalt, repeating it at due diſtances, is pre⯑ferable 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 diſ⯑eaſe, 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 ne⯑ceſſary, 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 teſtimo⯑nies, it cannot be juſtly ſaid, that mer⯑curials have not an extraordinary uſe in preparation; and, as on the other, it has been objected, very juſtly, by Mr. Brom⯑field, that by the preſent uſe of them, in large doſes, attended with a very lower⯑ing regimen, without ſufficient regard paid to the conſtitution of the patient, [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 ap⯑pearances above deſcribed, and the coming of the puſtules kindly to matu⯑rity, 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 [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 tranſ⯑mitted 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 ſe⯑cretion, and has probably received an in⯑creaſe 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 [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 man⯑ner 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 there⯑fore adviſeable? Air has a repellent action upon the ſurface of the body, as [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 con⯑ſequence? 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 [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 in⯑flammation of the lungs, and obſtinate in⯑termittents, 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 [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 treat⯑ment 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 con⯑fluent ſmall-pox, in violent and dange⯑rous caſes. They undoubtedly leſſen the putridity conſequent in the following ſtages; and may, under judicious ma⯑nagement, 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 in⯑oculated [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 in⯑diſcrimate 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 en⯑thuſiaſm of modern phyſic! and to its account may be fairly ſet, thoſe conſe⯑quences before enumerated, as attendant on imperfect depuration of the blood.