AN ACCOUNT Of the SUCCESS of Inoculating the Small-Pox; In a LETTER to Dr.
WILLIAM WHITAKER.
By THO. NETTLETON, M. D.
LONDON:
Printed by S. PALMER, for J. BATLEY, at the
Dove
in
Pater-Noster-Row.
1722.
(
Price
4 d. )
ADVERTISEMENT.
ALL Persons concern'd in the Practice of Inoculating the Small-Pox, are desired to keep a Register of the Name, Age and Habitation of every Person inoculated, the Manner of the Operation, the Days of sickening and of the Eruption, the Sort of Small-Pox that is produced, and the Event.
Where the true Small-Pox is not produced by Inoculation, it will be of Use to take particular Notice, whether the Patient had any other Kind of Eruption, what Symptoms preceded or attended it, whether the Incisions inflam'd and run, and for what Time their Running continued.
In Case any Person shall happen to die after Inoculation, either in the Course of the Small-Pox, or after they are gone off, it is desired that a particular Relation of the Case may be made, and attested, if it be judg'd necessary, by the nearest Relations of the Party deceas'd, or by other credible Persons, that were Witnesses to the Fact.
They are intreated to send these Accounts, or an Extract from them, comprehending all Persons inoculated from the Beginning to the End of the Years 1727 and 1728 to Dr.
Scheuchzer,
M. D. and F. R. S. at Sir
Hans Sloane
's, Bart. in
Great Russel-street
by
Bloomsbury-Square,
some Time in
January,
or at farthest in
February
next, that so the Result of them may be publish'd early in the Spring.
Nov.
8. 1728.
SIR,
H AVING too often found, with no small Grief and Trouble, how little the Assistance of Art can avail in many Cases of the Small-Pox, I was induced to try the Method of Incision or Inoculation, which came so well recommended by several Physicians from
Turkey,
and which had also been lately practised at
London.
This I thought was sufficient to justify the Attempt; and what Success it hath met with, I have here sent, according to your Desire, a faithful Account of, and of every thing that has been done or observ'd here relating to that Affair, that might be worth your Notice.
IT was in
December
last that I first began to put this Method in practice, and finding it to succeed beyond my Expectation in the first Instance, I was encourag'd to repeat it upon some others; and afterwards several seeing with how much Ease these got thro' the Distemper, were desirous to have the same done to themselves, or to their Children; so that there are now upwards of Forty here, who have receiv'd the Small-Pox by Inoculation, who are all, through God's Blessing, in very good Health.
WHAT was done by way of Preparation, was chiefly Purging with Rhubarb, for Children, and sometimes Vomiting, very rarely Bleeding; tho' that may be sometimes necessary; and many have had no Preparation at all: But I always found, as far as I was able to judge, that those whose Bodies were prepared, especially by Vomiting, had more favourable Symptoms than others in the same Circumstances where that was omitted.
THE Method which I always took in the Operation, was to make two Incisions, one in the Arm, and another in the opposite Leg; I believe it is not very material whether the Incisions be large or small, but I commonly found that when they were made pretty large (in grown Persons ¾ of an Inch in Length, proportionably less in Children, and so deep as to cut thro' the Skin in the middle of the Incision) the Quantity of Matter discharged afterwards at those places, was greater; and the more plentiful that Discharge, the more easy the rest of the Symptoms generally are; and they are also by this means the best secured from any ill Consequence afterwards.
AT first I collected some of the Matter from the Pustules of one who had the Small-Pox of the natural sort, into a Shell or a Viol, and infus'd two or three Drops of it into the Wound; but finding it sometimes to be very troublesom and difficult to get any Quantity of the Matter; and observing also that the least imaginable will be sufficient for the purpose, I generally take small Pledgetts of Cotton, and ripping the Pustules when they are ripe with the Point of a Lancet, roll the Pledgetts over them till they have imbib'd some of the Moisture; I put one of these upon each Wound, covering them with any common Plaister 'till the next Day, when I commonly take away both the Cotton and the Plaister, leaving the Wound to itself, only covering it with a slight Linnen Roller to defend it from the Air. I have sometimes rub'd the Pledgett only once over the Wound, without binding it on, which I found to answer the End as well; and from some other Observations I have made, I have been surpriz'd to see the Small-Pox produced this way, when I was very well assured, the Quantity of Matter receiv'd into the Vessels cou'd not amount to the Hundreth Part of a Grain.
THE Persons inoculated have not been confin'd to any Regimen, only to keep themselves moderately warm; and those who were grown up to live very temperate and regular, to keep their Minds easy and compos'd, and to use proper Means to drive away all Fear and Concern. Some have been obliged, from the time of the Inoculation, to abstain from Flesh, and all strong Liquors; but I found afterwards that the Eruption did not proceed so well, when they were obliged to live too low; perhaps, in warmer Climates, where they are not so much accustom'd to live upon Flesh, such Abstinence may be necessary; but here I find it best to let them cat and drink as usual, tho' something more sparingly, 'till the Fever begins to rise, and then, but not before, we enjoin such a Regimen as is usual in like Cases.
THE first thing that occurr'd after the Incision, was the Inflammation of the Wounds, which commonly happen'd about the fourth Day, when they began to appear very red round about, and to grow a little sore and painful; in about two Days more they began to digest and run; in some they begin to run sooner, and the Quantity discharged is much greater than in others. I generally found, that in those who discharged most this way, the Fever was more slight, and the Small-Pox fewer; tho' I have known some do very well, when these Places have only appear'd very red, but have not run at all, as it usually happens when the Incision is made so superficial as not to cut thro' the Skin.
ABOUT the seventh Day, the Symptoms of the Fever begin to come on, which are the very same that we always observe in the Small-Pox of the distinct Kind in the natural Way; a quick Pulse, great Heat and Thirst, Pain in the Head and Back, and about the Region of the Stomach, Vomiting, Dosedness, Startings, and sometimes Convulsions. All were not seized with these Symptoms, nor in the same Degree or Continuance; some began on the seventh Day, and continued ill without any Remission 'till after the eleventh; many not 'till the eighth or ninth Day; and the Fever in these was more moderate, with great Intermissions; but some have scarce had any Illness at all: During all this time the Places of Incision continued to be very sore, and swell very much, so as to appear large and deep, and to discharge a great deal of Matter.
ON the tenth Day the Small-Pox most commonly did appear, sometimes on the ninth, and sometimes not 'till the eleventh; but I never found that any Difference of Age, Constitution, or any other Cause, ever made them vary above one Day from the tenth. The Number was very different, in some not above ten or twenty, most frequently from fifty to two Hundred, and some had more than cou'd well be numbred, but never of the Confluent sort: Their Appearance was the same with those of the distinct Kind; they commonly come out very round and florid, and many times rise as large as any I have observed of the natural sort, going off with a yellow Crust or Scab, as usual; tho' it sometimes happens, especially when the Sores discharge a very great Quantity of Matter, that they are both few in Number, and do not rise to any Bulk; but having made their Appearance for four or five Days, they waste insensibly away.
AFTER the Small-Pox comes out, the feverish Symptoms gradually abate; and when the Eruption is compleated they usually cease, without any second Fever, or any farther Trouble in any respect.
WHILE the Pustules were rising, and for some time after they were gone, the Sores continued to swell, and to run very much; the longer they did so, the better; but they never fail'd to heal up, without any Trouble, after a certain Time.
I very rarely saw occasion for any Medicines in the course of the Distemper, only sometimes, when the Symptoms run very high, I gave a gentle Anodyne, to be repeated as Occasion should require; and once or twice I thought it necessary to Blister. After the Small-Pox is gone, they have always been Purged twice or thrice, and sometimes let Blood, which is all that has been usually done.
IT has happen'd in one Instance or two, that the Symptoms in the Distemper have been worse than usual; and some few, after the Small-Pox were gone off, have been subject to other Indispositions; of all which I shall give you a particular Account.
THE first that was inoculated,
Tho. Thorp
's Son of
Hallifax.
a Boy about a Year and half old, began to be ill on the eighth Day, and had a brisk Fever for about two Days; when the Pustules began to appear, they were but few in Number, and rose very large; the Child was soon well, and continu'd so for about three Weeks, when being carry'd out, and kept a long time in the cold, he fell into a feverish Disorder, accompany'd with a Cough, and was ill for four or five Days; after that time it went off, and he has ever since been in very good Health.
THE second was a Girl of two Years old,
Jer. Turner
's Daughter.
in a Family where they had formerly bury'd their Children successively of the Small-Pox, and this they fear'd might undergo the same Fate. The Fever came on about the seventh Day, and she continu'd very ill 'till the tenth; on which Day about Noon she had a strong convulsive Fit; towards Evening the Pustules appeared, and the Child grew better; and tho' she had more in Number than usual, yet she grew well as soon as they were fully come out, and has continu'd so ever since.
THE eighth and ninth were in a Family where they had four Children, none of whom had had the Small-Pox.
Mr.
John Sympson
's Children.
I was call'd to the eldest, who was seized in the common way with the most Malignant sort I ever saw, attended with the worst Symptoms that could be; so that he dy'd on the fourth Day, all full of Purple and Livid Spots. The Parents were very desirous that any Means might be used to preserve the rest; but here I was in great Doubt and Perplexity what Part to act. I knew very well, that if I should venture to make the
Incision,
whatever should happen would be charged upon that; and it was not improbable but some of them might have already taken the Infection; in which case it was very uncertain what the Event might be. On the other hand, if it was omitted, I thought it probable they might all dye, the Contagion which was got amongst 'em being of such a destructive Nature: Wherefore I was willing to run the risque of my Reputation, rather than that the Children should all perish. They were therefore all three Inoculated the Day before the eldest died, after having told the Parents that I cou'd not answer for the Consequence, in case they had already catch'd the Infection; which wou'd be known if any of them fell ill before the seventh Day. According as we fear'd, one of them began on the second Day, much after the same manner with the eldest; and the Small-Pox came out on the third Day, or rather an universal Redness all over the Skin, interspers'd with many purple Spots. There were none of these Spots near the Places of Incision, which began to swell a little (as usual) about the fourth Day, and the Small-Pox did rise a little more about those places than elsewhere; but Nature was too much oppress'd with the Violence of the Distemper; and tho' she continu'd longer than her Brother, and was not Delirious as he was, yet she dyed on the seventh Day. I did not reckon this Child in the Number of those who receiv'd the Small-Pox by Inoculation; for I thought there was sufficient reason to conclude that she had taken the Infection before; but of this we must leave all Persons to judge as they please; I only give you a Relation of Facts The other two continu'd well 'till the eighth Day, when they both fell ill together; the Small-Pox came out on the tenth, of a very good Sort, tho' more in Number than some others had; and they both got very easily thro' the Distemper without any Indisposition since. It was observable that the Elder of these Children two days before the Eruption, had many red Spots which appear'd upon him, very much like those of the other two Children, which changed in them to Purples afterwards; which the Mother was very much concern'd at, fearing they would prove the same in this: But when the Small-Pox came out, these Spots grew gradually less, and at last quite disappear'd. The other Child had been very subject to Convulsions for a long time when young, and it was afflicted with the same very much from the time that the Fever came on 'till the Small-Pox appear'd.
THE twenty seventh, was a married Gentlewoman aged about twenty six, who got very well thro' the Distemper, but about a Week after, was seiz'd with a very great Coldness and Shivering, which were follow'd by a Burning-heat, with a violent Pain and disorder in her Head, which continu'd for several Hours: She had about two Years ago an intermitting Fever, which I took this to be a Paroxism of, and expected its return; but she felt no more of it, and has ever since continu'd in good Health.
OF her two Sons who were both Inoculated about the same time, the Younger got thro' the Distemper with a great deal of Ease; the Small-Pox being few, and the Symptoms very slight: But the Elder (a Boy about five Years old) fared quite otherwise. The Symptoms before the Eruption were more than usually severe, especially the Vomitting; the Pustules appear'd at the usual time, but more numerous than ordinary; and when the Eruption was finished, the Fever did not cease as it has done in every instance but this: On the fifth day after he was seiz'd, the swelling of his Face began, which was follow'd by a Pain and Swelling in his Throat, and a Salivation, which continuing 'till the cleventh day, were succeeded by a swelling in his Hands and Feet, the usual Symptoms of the Distinct sort when they are very full; and tho' there appear'd some little Signs of Malignity, yet he got thro' the Distemper without any Danger, but with much more Pain and Trouble than any of the rest have endured. After the Small-Pox were gone off, we found a hard Swelling upon his Shoulder, which disabled him for some time from moving his Arm; but by the use of some common Applications, that is in a great measure gone. In this Family, the only Child they had before these, dyed of the Small-Pox, of a very malignant Sort; and this Boy was of an ill Habit of Body, and has had many dangerous Illnesses.
THE twenty third was a Girl about nine Months old:
Mr.
Is. Hansoo
's Daughter.
In this Child, about a Fortnight after she was well of the Small-Pox, the Mother discover'd that one of her Thighs was a little swell'd, which was painful to her for some time, and made her unwilling to move that Part: Some of the Inguinal Glands were also swell'd; but these went off in a few Days, there only remaining a Hardness above the Knee, which also disappear'd in a short time, without coming to Suppuration.
THE thirty seventh was a Girl,
Mr.
Jo. Haigh
's Daughter.
six Years of Age; she got very easily thro' the Distemper; but before the Small-Pox were gone, we found a small Tumour upon the Muscles of the Loins, which ripen'd very speedily, and was open'd and heal'd up in a very short time. Her Sister, a young Woman about eighteen, had also a Swelling of the same Kind in her Leg, but it lay something deeper, and gave her a great deal of Pain for three or four Days; afterwards it dischar'd a great Quantity of Matter, and was heal'd without any farther Trouble.
ALL the rest, excepting these I have mention'd, got very well thro' the Distemper, without any manner of Trouble, or Hazard, or any ill Consequence afterwards. Whether those slight Indispositions which some have been subject to afterwards, were owing to the Incision, I have not been able to judge; but I presume, what they have endured in the course of the Distemper, and what has follow'd after, is not to be put in the Ballance with what is undergone in the common way, by those who are thought to come off very well: And if this Method were more generally practised, 'tis probable some Means would be found out to prevent even these subsequent Disorders, which are no more frequent, nor near so bad as those which follow the natural Sort.
IN two Instances the Inoculation had no Effect; the Reaof which in
Michacel Bland
's Daughter.
one was, because the Child had the Small-Pox before; in the
Wm. Clark
's Son.
other, the Matter was taken whenthe Pustules were wither'd, and almost gone, and that little Moisture which they contain'd, I suppose, had lost its Virtue: The Boy to whom it was made use of was no way affected, the Places of Incision did not at all Inflame and swell, as usual, nor did any Pustules appear, but about a Fortnight after, he was seized with the Distemper in the common way, and did very well.
SOME of those who have been Inoculated that are grown up, have afterwards attended others in the Small-Pox; and it has often happen'd, that in Families where some Children have been Inoculated, others have been afterwards seiz'd in the common way; and they have laid together in the same Bed all the time; but we never found that ever any had the Distemper twice; neither is there any reason to suppose it possible, there being no Difference that can be observed betwixt the Natural and the Artificial Sort, (if we may be allow'd to call them so) but only that the latter have commonly fewer. There is one Observation which I have made, (tho' I wou'd not yet lay any creat Stress upon it;) that in Families where any have been Inoculated, those who were afterwards seized, never had an ill Sort of Small-Pox, but always recover'd very well.
THUS, Sir, I have given you a short and plain Account of what has occurr'd to me, concerning this Method of Inoculation. 'Tis not any Pains or Care I have taken in writing this Letter, will make it acceptable to you; for I am sensible it is deficient in every Respect, but a faithful History of Matters of Fact. I could have Inoculated a much greater Number than I have done, if I would have press'd it; but I only took such as desired it of themselves; being cautious of persuading any body to it; because I had no Authority hereabouts to support me. I know not whether I shall have an Opportunity of doing much more this way at present, the Small-Pox being in a great measure gone from this Town and Country; but I have already seen so much of it, that I should never be afraid of its Success.
THERE is only one thing more which I am oblig'd to mention, and which I wou'd rather have pass'd over in silence, and that is, the vigorous Opposition it has met with from many honest well-meaning Persons, who cannot but fancy it is an unlawful and unwarrantable Practice: They have gain'd a great Majority on their Side here, as well as in other Places where it has been practised; I only wish, that as they act upon a Principle of Conscience, they wou'd have been less busy in raising and spreading false and groundless Reports, whereby this Matter has been much mis-represented, and many entertaining a wrong Notion of it, have been deterr'd from making use of this Method for themselves or their Children, who have since unhappily been taken off by the Small-Pox. But when this Affair it set in a true Light, and found to be always safe and effectual, I believe all the Objections raised against it will fall of course. It would be of the greatest moment, that the World should know more fully what you think of it in Town, and how you have found it to succeed. 'Tis commonly objected here, that it is not approved of in
London;
but if those Gentlemen who have justly gain'd the greatest Honour and Reputation in our Profession, should, by finding it successful, see Cause to declare publickly in its Favour, that would be the greatest Means to forward it in the Country, and soon reconcile People to a Method, which I believe has no where been put in practice with any other Aim, than to do some Service to Mankind; for which reason I doubt not but these Lines, tho' writ in haste, will be acceptable to you, from,
Sir,
Your sincere Friend, and humble Servant,
THO. NETTLETON.
Hallifax,
Apr. 3. 1
22: