THE METHOD Of Practice in the Small Pox, With Observations on the Way of Inoculation. Taken from a Manuscript Of the late Dr. NATHANAEL WILLIAMS, Of BOSTON in N. E.
Published for the Common Advantage, more especially of the Country Towns, who may be visited with that Distemper.
BOSTON: Printed and Sold by S. KNEELAND, in Queenstreet opposite the Prison. MDCCLII.
PREFACE.
FOR the Sake of Those who live at a Distance and knew not the Author of the following Tracts, I would observe; That he had his Education at Harvard-College, and studied Chymistry and Physick, under his Uncle the Learned Dr. James Oliver of Cambridge; one of the most esteemed Physicians in his Day; who had a singular Help in the Art of Chymistry by the ingenious Dr. Lodowick a German, who was also accounted an excellent Physician, and the most skilful Chymist that ever came into these Parts of America. And Dr. Williams lived and practiced in Boston with great Success and Reputation for near thirty seven Years, to the Time of his Death, which was on Jan. 10. 1737, 8, in the 63d Year of his Age.
He was well vers'd in the most valued Authors, especially those who wrote on Experimental Cases, carefully comparing them with his own Observations. He made the Case of his Patients as his own: and where he apprehended Danger, applied himself with great Concern and Diligence, and seem'd to bear them on his Mind continually. In some Cases he has consulted with Dr. Mead, and other principal Physicians in England for Advice and Help.
In every thing he was exceeding Cautious; especially in the Preparation of his more important Medicines for his own Practice, that he might more surely judge of their Operations: And his established Character for Piety, Skill and Caution, made his Patients entirely satisfied in all his Managements.
[Page] It was his Method to reduce to Writing the more remarkable Cases with the various Symptoms occuring, and the Course he took; that he might form his own Practice in like Cases afterwards. And by this Means we are favoured with the following Tracts; which appear to be wrote with great Judgment and Conciseness; tho' without the least Thought of their being ever published.
The former Part seems to have been drawn up for some special Friend, by Way of Direction; the latter is a more particular Account of his own Practice, in which the Prescriptions are here rendred into English for their being of more extensive Use.
I hope this will suffice to recommend them to those who were not acquainted with him: for as to those who knew him, I apprehend it needless.
In the little Knowledge I have of Physical Authors and of this Distemper, I cannot but judge these small Tracts of great Value. And as my divine and merciful MASTER declared, that He came not to destroy Men's Lives, but to save them; and in tender Pity to all about Him, and a perfect Consistence with his saving Office, employed his Power to heal their bodily as well as spiritual Maladies: I cannot but judge it consistent with my Imitation of Him, to promote the Publishing this excellent Method of Healing, and recommend it to all around me. And in Hopes of its being a Mean in his Hand of saving the Lives of many, especially in our Country Towns, as well as in This where the Physicians have not now Time to attend all the Sick; I humbly commit it to his sovereign Blessing.
General RULES to be observed.
1. WHen the Air is infected and Danger arises from thence—
Let those that are liable to the Distemper live temperate in all Things: * for nothing more exposes to it or makes it more mortal than Intemperance.
To guard against the Infection and render the Distemper more favourable when it seizes; Let a Scruple of Brimstone very finely powder'd be taken twice a Day; first in the Morning, and about six o'Clock at Night, in a Spoonful of Water; and drink after it 40 Drops of Elixir Proprietatis in a Glass of Water, or any generous Wine; or where that † can't be obtain'd, let a Glass of Cyder with Rue and Gentian steep'd in it be taken in its Stead.
2. When the Symptoms of the Small Pox appear (which are very various, Pains in the Head, Back, Limbs, Stomach, Belly, Sickness &c. with a Fever, which always accompanies what ever other Symptoms there are.)
If now there be any Signs of a foul Stomach, or its being clogg'd with Phlegm; Let there be a Vomit given as soon as may be before the Eruption or Appearance of the Pock. When it has done working, let something Cordial be given, as Mint-water sweetned with Syrup of Saffron; or a Toast and Canary Wine.
[Page 2] Let the Blood be now well diluted with some small Tea made of Baum, Sage, or any other temperate Herb; which let be sweetned with Syrup of Saffron, & given 3 or 4 Times a Day 'till the Pock is all out. Small Beer with a Toast, or Fair Water with a Toast, may be allowed now and then, if desir'd.
To bring out the Pock, it is necessary that there be some Fever which must carefully be minded: If too high, it must be suppressed, and nothing must be allowed but what is cooling; if too low, it must be raised by warm Cordials, 'till the Heat of the Flesh be something beyond what is common: but yet great Care must be taken that it be not raised too high. A moist Skin is best, but profuse Sweats are destructive, and to be checked, by keeping the Hands out of Bed, and lessening the Bed Cloaths. Let the Throat be early guarded by a Plaistor of Paracelsus, or a Saffron Stay. If before Eruption (or any Time after) the Person be Delirious or Raving; apply a large Blister to the Nape of the Neck; and strong Attractives to the Soles of the Feet of Salt Beef, or Salt Mackrill, or Beef Kidneys.
If there happen a FLUX, before Eruption (or at any other Time;) Let it be immediately stop'd by a Drahm of Diascordiam in Mint-Water; which may be repeated once in six Hours, if Need be.
If excessive Vomiting happen now or at any other Time; give Venice Treacle a Drahm in Mint-Water, or hot Wine if very violent, if Mint-Water with Syrup of Saffron will not stop it. However, if it be moderate, it may be serviceable; and therefore not to be stop'd too soon. The same may be said of Bleeding at the Nose.
3. When the Eruption is over, which is generally in 3, or 4 Days at farthest;—Let the same Rules be observed about the Drink as before. The Fever ought now to cease: but yet a natural Warmth must be maintained, and the Government of the Person be accordingly; otherwise the Pock will not fill; which is the Thing now to be expected.
If the Pock do not grow and fill by the forementioned Regimen; Let a handful of Sheeps-Dung be steeped in hot Water 3 or 4 Hours, and then strain'd off, and be given to the Quantity [Page 3] of 3 or 4 Spoonfuls every 3 Hours: this continue, 'till the Maturation of the Pock, if Need be.
If they strike in; apply Blisters to the Wrists and Ankles, and give the temperate Cordials as oft as needful, to make them appear again: a Glass of Canary with Saffron in it, or two Scruples of Venice-Treacle in Mint-water.
If the Throat be sore; gargle it with Water sweetned with Honey of Roses; or hold in the Mouth a little Conserve of Roses made a little tart with Spirit of Vitriol; or a little Syrup of Black-berries, or Srawberries, or Mulberries.
If the Urine be stop'd, as it many Times is; Let the Person be raised up: and if that do not answer, let him take a Decoction of Pompion and Parsley-Seed for his Drink, 'till he be relieved.
Let the Food be Oatmeal-Caudle, Milk-porrage, Sack-whey; the one or the other, according as the Fever allows.
If there be a Flux or loose Body; boil'd Rice may be eaten, and the Water of it drank: or the white Decoction made of Burnt-Hartshorn and Bisket, of each an Ounce boil'd in two Quarts of Water, 'till a Pint be consumed; let the Dregs be poured out with the rest in a Vessel wherein it is kept; and when it is drank, let it always be stirred up 'till it looks thick like Milk.
4. When they come to turn, which is on the 7th or 9th Day commonly after Eruption; Let Cordials be often given, and a more cordial Diet be allowed.
If the Phlegm be tough or viscid, and Raising stop'd; Let it be thinned by a little Syrup of Vinegar made with Honey; or a Syrup of Urine, made with two Spoonfuls of Urine and one of Honey, with a little Nutmeg.
If there be any Signs of an approaching Fever upon the Turning of the Pock, or the Person be delirious; Let there be strong Attractives to the Feet, and a Blister to the Neck, and Arms also if Need be; which must be kept, running, 'till the Danger is over.
If the secondary Fever arises; it must be treated like a common putrid Fever. The Balsam of Fennel in Fountain Water excels here.
[Page 4] When the Pock is thoroughly turned; the Body may be kept open with a loosning Diet of Plumb-porrage, &c. If a Fever arises or is heightned for want of a Stool; a Suppositor or Clister may be us'd of Milk & Sugar.
Cold chilly Fits with Sickness and Faintness often happen at the Turning; which must carefully be watched and speedily relieved, by something Cordial; as Toast & Wine; or Elixir Proprietatis in a Glass of Canary Wine.
5. After the Pock is dried away and the Strength recruited; Let the Body be well purged; 3 or 4 Times at least, at due Intervals, after the Confluent Sort; once or twice may suffice after the Distinct.
Some more general RULES.
A Cold Regimen in a flegmatic Constitution and where native Heat is wanting, often proves fatal; tho' in a sanguine Constitution, where innate Heat is strong, it is necessary. Many are lost by not observing this Difference.
Bleeding in some Cases may be necessary; but let it be directed by a judicious Physician, and never else admitted. Opiates are also to be under the same Direction.
Too many Medicines often do much Hurt. More People are lost thro' a preposterous Use of needless Remedies, than thro' the Force of the Disease.
A Looseness happening before the Suppuration of the Pustules, must be stop'd; but after, may be allowed.
Medical Observations on the SMALL-POX. Anno 1730.
THE Method I took in treating this Distemper; and which I found most successful, was as follows:
I advised my Patients, for whom I thought I should be concerned, to Temperance in all Things, as the best Preparation for the Small-Pox; and to take Morning & Evening 20 or 30 Drops of my Small-Pox Drops; * or where those will not go down, 30 or 40 Drops of Elixir Proprietatis This Method I found in many Instances both this Year & in 1721, very successful to render the Distemper favourable. Those who were constant in taking it, I observed escaped a long Time before they were seized, and had generally the most favourable Sort and many escaped it altogether without any Complaint, tho' greatly exposed. I found also a Scruple of Flower of Brimstone, in Milk or any Vehicle, to answer this End very well, taken once, or twice a Day.
Before the Eruption.
When the Symptoms of this Distemper appeared, if they were favourable, I did little or nothing, but advised to dilute the Blood with some small Tea of Baum, or what pleased the Appetite; and keep to a Diet of Water-Gruel for Food; Milk one Part, and Water three Parts, boil'd together for Drink; and wait for the Eruption: which if it appeared not the third Day. I endeavoured to promote, with this Mixture,
Syrup of Saffron 1 Ounce, Treacle Water half an Ounce, Carduus Water 2 Ounces, mixt, 3 or 4 Spoonfuls for a Dose: To be repeated once in six Hours; observing in the mean time to drink plentifully of small Tea or Milk and Water.
If there were any Signs of a foul Stomach; I gave a Vomit as soon as I had Opportunity, before the Eruption: and I scrupled not to give it even when the Eruption was made, where the Signs of Foulness were manifest. For want of the Help [Page 6] of this, I found great Danger arising, and a Necessity often times to give it, even at the very Height of the Distemper. I never gave any but Ipecacuanha, for fear of over-working, and weakning my Patient; who had now a dangerous Distemper to go thro', that required the greatest Strength to carry him thro'.
If there were great Fulness of Blood, Aptness to Bleed at the Nose. or Blood over-heat with Drinking, or its Passages obstructed with taking Cold; in these Cases I opened a Vein, and took away 8 or 10 Ounces of Blood: This I found a good Preparatory.
In Case of Delirium or obstructed Menses; I chose to bleed in the Feet.
After the Bleeding was over, I endeavoured to promote a Breathing with some small Tea; which much facilitated the Eruption.
Sometimes before the Eruption, I have found excessive Vomiting: This I endeavoured to carry off by a Vomit, if there appeared any Symptoms of Foulness of the Stomach: if not, I endeavoured to settle it by an Anodyne in some Alexipharmic Julep, viz.
Mint Water, Black Cherry Water, of each 2 Oz. Epidemic Water, Syrup of Saffron, of each half an Oz. Liquid Laudanum 15 Drops, more or less, according to the Age of the Patient; 3 or 4 Spoonfuls for a Dose, and repeated if Occasion required. This often answered the Intention of Nature: which was now strugling with the Malignity fix'd upon the Nerves of the Stomach, and threw it out to the Skin, which was the Thing aimed at.
If there were a Coma or Delirium, or Raving, if there were no Signs of Overfulness of the Blood, or Humours of the Body, or Foulness of the Stomach; I now judged these Symptoms to arise from the variolous Matter fixed on the Nerves; and did little to remove them, but only diluted the Blood, and gave some gentle Alexipharmic: and if they remained obstinate. I applied Attractives to the Feet; and Blisters to the Wrists and Ankles; and if Need required, behind the Ears: This I found most commonly to succeed.
[Page 7] A Purging has happened sometimes before the Eruption: which I was always very cautious of stopping, notwithstanding the common Practice to the contrary. For where I have found this, I generally found the Confluent Sort to follow, especially in Children. I therefore rather chose to carry it off, with Rubarb in small Doses repeated; a third Part of a Dose in Powder, repeated every six Hours, in a little Syrup of Saffron, or the same Part of a Dose in Infusion, sweetned with the same Syrup. However, if it caused Coldness in the extream Parts (and was very severe) or any great Faintness; I endeavoured to check it by Oil of Cinnamon; or if that would not answer, with an Anodyne in some Alexipharmic Julep. The Mixture I used was, viz.
Mint-water 2 Oz. Diascord: one Drahm, Syrup Saffron 1 Oz. mixt, to be repeated every six Hours, if Occasion. And the Diet, the white Decoction, with Cloves, Cinnamon and Nutmegs with it, as the Patient liked best.
Bleeding at the Nose often happened, and that to a very great Degree. This I endeavoured not to stop 'till it fainted the Patient. I have found great Damage ensue upon stopping it too soon. I endeavoured to cool the Blood by cooling Teas, Milk & Water &c, which was now ordinarily over-heat; and lay warm Attractives to the Feet, which would often be very cold at this Time. I never did bleed to turn the Blood, but always found the Method above-mentioned to succeed.
Convulsion-Fits often happen, in Children especially.—If there were any manifest Signs of Foulness of the Stomach and Fulness of Blood, I both bled them, and after that gave a Vomit; after which was over, I applied Blisters and Attractives, and ordered some Alexipharmic Julep to be repeated as the Symptoms called for. If the Fever was high; I endeavoured to lower it by Milk and Water, Water with a Toast in it, Small Beer &c: if too low, I raised it by some generous Alexipharmic. Here I have found Anodynes necessary and very successful, after proper Evacuations, given in some Alexipharmic Julep. To a Child of [Page 8] two Years old after bleeding and vomiting, I gave Powder of Contrayerva Root 5 Grains, Black Cherry-Water 1 Oz. Syrup of Saffron half an Oz. Liquid Laudanum 4 Drops, often, with good Success. This both composed the Spirits which were now enraged, settled the over tension of the Fibres, and threw off the variolous Matter to the Skin. This I have found succeed, even when the Limbs have been left stiff and could not be bent without breaking, when the Fit seemed to be over.
When the Eruption is made.
I Was careful to observe what State the Fever was in: whether there was enough to carry on the Maturation, or too much to hinder, or precipitate it; and accordingly applied.
Some were so hot, as to allow of nothing that was the least Cordial, but called for the most temperate cooling Regimen.
These I treated with Milk and Water, which I allowed and perswaded them to drink plentifully of; and Panada, or Water-Gruel for their Food. This for the most Part ripened and filled the Pustules. If it did not, I gave Gascoign Powder, Morning and Night, in a little Carduus-Water, sweetned with Syrup of Saffron, or a little Epidemic W ater, diluted with Carduus-water, and sweetned with some cooling Syrup, as Strawberries &c.
Others were apt to grow cold, and want a Fever. These I treated with a Julep of Carduus Water, 4 Oz. Syrup of Saffron 1 Oz. Treacle Water, or Epidemic Water, half an Oz. Contrayerva Stone two Drams, mixt: of this I gave a Spoonful every Morning till the Warmth came on and the Pock appeared bright and full, and so continued as this Intention required: Being careful in the mean Time to dilute the Blood with good Store of Drink. Here I allowed Sack-whey, Wine and Water, and now and then a little Phlip. I found a Drink made of Sheeps Dung boiled in Water to answer well here: This drank plentifully, filled the Pustules, and raised the Swelling, and carried on the Maturation to Expectation.
[Page 9] I found a Necessity of observing this Difference in treating my Patients. I observed many to die in keeping to the cooling Method without allowing them Cordials at due Intervals, as is now the common Method in Imitation of Dr. Sydenham; and this even in the distinct Sort of Pock.
As to the Confluent—I found a Necessity of watching this carefully and varying as the Symptoms directed. If I saw it coming; I endeavoured to cleanse the Body well both upwards and downwards as soon as I could, and bled them also if there were proper Indications for it. If a Purging attended it at the Beginning or Progress; I endeavoured only to suppress and moderate it, and not wholly to check it. In the Beginning I gave Rubarb in small Doses every six Hours, which answered well, and ordered the white Decoct: for Food. I ordered for Drink, Milk and Water: and if the Fever was high, a Julep of Syrup of Elderberries well acidulated with Spirit of Vitriol, and Spirit of Vitriol in all their Drink.
If a Cordial was wanted, or the Pustules did not fill well; I ordered Powder of Gascoign, Morning and Night, or oftner if Need required, in some temperate Vehicle; being careful in the mean Time to dilute and temper the Blood with good Store of Liquid; nothing answered which Intention like Milk and Water in great Quantities. This cooling, diluting Method kept from Delirium and Raving; and followed closely, was the best Remedy to cure it. Bleeding I never found succeed after the Eruption was thoroughly made, even in Distraction it self; but sunk the Spirits and Pustules too; and I ever found it difficult to save Life after it.
If the Pustules seem to strike in; I have found a Decoction of Snake-root, sweetned with Syrup of Saffron given hot, to answer well. If that does not answer immediately; I orordered Blisters to the Wrists and Ankles, and a Julep of the Contrayerva-Stone in Carduus Water, Syrup of Saffron, and Epidemic Water, to be followed every two Hours 'till the Intention was answered. In the mean Time, diluting the Blood well with some temperate Liquors, as the Heat and Temper of the Person required.
[Page 10] If the Throat be sore with the Pock, I found a Saffron-Stay, or a Plaister of Paracelsus imbued with Oil of Mint, to relieve much. A Spoonful of the following Julep help in the Mouth & gradually swallowed, has been very serviceable; viz. Hysop-Water or common Water, three Ounces; Syrup of Elderberries, Strawberries, Mulberries, or Honey of Roses, two Oz; Spirit of Vitriol, so much as to make it very tart, mixt. If very much stuffed with Phlegm, I have applied a Blister to the Nape of the Neck, and sometimes given a Vomit, to save Life at any Time of the Pock.
I have found great Advantage in an open Body, one Stool in a Day in the whole Course of the Distemper; contrary to the common Observation, in any Sort, especially the Confluent: and when there has been a great Load of Humours, have promoted it by a Suppositor, or loosening pectoral Decoction; tho' not by Purges. Sometimes I have allowed them to eat Figs and Raisins, which both brought on the ripening of the Pustules and kept the Body open sufficiently.
In raving Distraction, I have found Applications to the Feet, with strong Attractives, Blisters, and a cooling, diluting Diet taken plentifully, to answer best. Bleeding I never found to succeed here; except there were plain Indications for it from over fulness of Blood, and some Stagnation from taking Cold. If the Pustules filled well, I was not over-busy with Remedies; but I have found it to cease of it self, when the Pock had turned.
The Pock turning.
When the Pock is ripe and begins to turn, great Care must be taken to prevent the second Fever. A loose Body is of great Service here, in every Sort of Pock. I therefore early ordered a Suppositor or Clister. If this answered not, I gave a Pectoral Decoction with good Success. The Hierapicra has been very serviceable where it could be taken. And this I continued as often as I saw a Fever inclining to rise. However I took Care to guard the Vitals by repeated Doses of fixed or volatile Cordials, as the Symptoms required.
[Page 11] If upon the Turning they were much oppressed in the Breast, or stuffed with Phlegm in the Organs of Respiration; I have found a Vomit to succeed, of Ipecacuanha or Vinum Emeticum and Pectoral Syrup, diluted with Hysop Water, with a Blister to the Nape of the Neck. After this, the Pectoral Decoction, and that with a little Sena, to make it more purging, if Need require.
Cold chilly Fits are very apt to come at the Turning; which are prevented by a Cordial duly repeated, especially Gascoign-Powder, and helped by a Cordial given immediately when they come.
If the second Fever arise, if it be attended with great Oppression and Difficulty of Breathing, and Stagnation of the Blood; I have found Bleeding succeed; but not else. If it be moderate, a loose Body suffices; if not, Blisters and Purges of the gentle Sort have carried it off best, with a cooling, diluting Diet; not forgetting to intermix a Cordial fix'd or volatile, as the Symtoms called for.
In the Purples, Petechiae, and Indigo Pock; I have found the aforesaid Rules to be most serviceable. The most smoothing, diluting Diet, and large Quantities of them, answer best: not forgetting Cordials, especially fix'd Bezoardics; without which the most cooling Regimen signifies but little. Bleeding I have found of no Service here; except the common Indications for it were apparent. I have seen it repeated to a third Time, but to no Advantage, but apparently hastned the Death of the Patient. Many have lived to the 9th Day, that have but few Remedies used; and some have recovered to a Surprize, that have been given over; tho' it has been very rare.
Mrs. H. recovered of the Purple Sort in the Use of diluting Diet and great Quantities of Elixir Proprietatis.
Mrs. R. recovered of the Indigo Pock in the Use of the diluting Diet, with Syrup of Saffron, Treacle-Water, and Carduus-Water, and Morning and Night a Dose of Gascoign Powder. I opened one of the Indigo Pock with a Lancet, found congealed hardned Blood, a quarter of an Inch deep: I dare not proceed deeper with it for fear of an Haemorage. I [Page 12] generally found the Pulse much depressed; and sometimes but few Complaints, the Patients commonly thinking themselves well 'till Death came on.
As to Anodynes; I have found them absolutely necessary, and very serviceable to subdue the great Pain & Fever that arises from thence from the Smart of the Pock. These I seldom gave, 'till the Pustules were thoro'ly out, and they began to complain of Soreness and Restlesness thereby; except in Case of Convulsions, and then not 'till due Evacuations have been made. A swelling of the Face commonly followed it; and it would raise this Swelling when no other Remedies would. It often took away a Delirium & Raving, & composed the Patient to rest. I ordinarily gave them but once in 24 Hours at Night; tho' sometimes in great Restlesness have given them oftner; and in the Confluent Sort, once in eight Hours. I commonly mix'd them in some cordial Julep, according to the Temper and Circumstances of the Patient. In great Stuffage of the Lungs & Breast, I gave them in some pectoral Mixture: Tho' sometimes they checked the Salivation in the Confluent Sort, yet it returned soon with diluting Diet.
As to purging the Body after the Small-Pox; I have found it generally necessary. For want of it, many break out in Boils &c.
I have found a Vomit more serviceable than a Purge. For want of it, many times Purges, tho' very strong, work not at all: tho' on the same Persons the same Purge would work much in a much less Dose.
If the Patient was weak, I began with Rubarb or Pill Ruffi: and then after some Time, gave Jallap or Pill Cochiae Minor.
Small Pox by Inoculation. in 1730.
I Entred upon it with the utmost Caution, and was careful to use it by the best Rules I could find prescribed.
As to the Matter I made use of; I endeavoured to take it of a wholsome Person, of a favourable distinct Sort of Pock, well ripe, white, and of a due Consistence, and without Smell. This, as long as it would keep thus, I made use of; having kept it in the Month of March a Fortnight, and us'd it with as good Success as any just taken. I always kept it in a cool Place, contrary to the common Precepts about it, to keep it warm 'till it was used. When I could get it from an inoculated Person I chose it; having by Experience found it to yield the most favourable Pock. I have used the third Produce with the best Effect.
If the Patient was very full of Blood and liv'd intemperately; I bled him before the Incision was made. And if there were any Signs of Foulness at the Stomach or Bowels; I vomited, or purged them, and ordered them Temperance in Eating and Drinking. Meat I allowed of the easiest Digestion, but once a Day, and that in Moderation. Strong Drink I forbad, save a Glass of Wine at Meals. Above all, I charged them to keep out of the Way of receiving the Infection in the common Way as much as possible.
I made the Incisions in each Arm only, and not in a Legg; having observed great Inconvenience to arise from an Incision made in the Leg by the Humours falling down into it.
I made the Incision not in the upper Side of the Arm, where Issues are made; having found great Inconvenience by that Method: for this Way, a Pond was made after a while, which contained the Matter 'till it was dressed; so that the Orifice was made much larger, and a Sinus often produced where the Humours were very sharp.
I therefore chose to make it in the lower Part of the Arm above the Elbow; where the Matter vented itself as [Page 14] soon as it was made, and remained not in a Body in the Place of Incision. This Way I found they run more freely, and yet corroded the Flesh not so much.
I chose not to dress my Patients Incisions my self, for fear of carrying the Infection to them, 'till they began to complain of the Symptoms of the Small-Pox; but directed them to dress them themselves, or some Body else for them that would no Ways endanger them. I took Care not to bind the Roller too hard; having found a Tumour to arise often upon too strict a Bandage, which needed Poulticing with white Bread and Milk to abate it.
I saw no Need of making the Incisions large or deep, or putting much of the Matter in; having found upon Trial, the least Incisions if deep enough to make the Blood come, to answer as well as the largest; and the very least Part of Matter to answer as well as a great deal.
I have found two Incisions in grown Persons to answer much better than one only. I observed those that had but one, had the most Pock, and the most troublesome Symptoms of Pains. Swellings &c. Tho' in Infants, I have found one to answer very well.
The first Dress was with a simple Diachylon Plaister. When the Incision was made, I carefully laid a Bit of Lint imbibed well with the Matter, over or in the Incision: and having put the Plaister over it, I bound it on, and let it lie 24 Hours; and then took off the Plaister and Lint, and having wiped the Plaister clean, laid it on again, throwing away the Lint; and so continued to dress daily till the third or fourth Day, when the Incision began to open and be a little inflamed; and then I dressed it with a Pledget arm'd with Basilicon laid over the Incision, and the same Plaister laid over it. This I found the best Dress; it both draw'd and digested, and kept the Arm easy.
When the Incisions were much inflamed, I found nothing so effectual as a Poultice of white Bread & Milk apply'd warm, and renewed twice a Day, and oftner if Need called for it. Sometimes when it was apt to breed a Fungus, I dress'd it with Liniment: Areaei, which answered well.
[Page 15] If the Incisions are not dressed twice a Day at least, and sometimes three Times; when they come to run much, they are very apt to be much inflamed; and I have seen a Mortification soon gather. When the Incisions do not run well; I fear a troublesome and full Pock, and have often seen many Swellings to arise about the Arm especially; which if taken in Time would quickly yield to a Poultice of white Bread and Milk better than any Thing else; and when those are gone, others to arise and create much Trouble.
I always observed the Incisions to run much at the Turning, and more now than at any Time else.
I never endeavoured to stop the Running of the Incisions by Restringents; but continued in the Dress of Basilicon or Liniment: Areaei, with the Plaister over it; and with this Dress I encouraged them to Dress, 'till they run exceedingly.
When there appeared a large Sinus all round under the Skin; be not forward to cut it, but dress it carefully by filling it full of fresh white Break and Milk. This I have seen cure a very large one, in which I could carry my Finger clear round half an Inch under the Skin. If it must be cut, dress it with a little Liniment: with a few Grains of Mercurius Dulcis, and wash it with Lime Water.
I found the more the Incisions run, the more favourable the Pock and all the Symptoms were. I therefore encouraged the Running as much as I could: but not by corrosive, pungent Plaisters, as Hat [...]ase but only by Basilicon, Liniment: Areaei, Cabbage-Leaf &c.
The most troublesome Symptoms of Fever, Coma, and Tumours in the Arms and Glandulus Parts, was in a Negro Girl; whose Incision run but very little. I gave little or no Medicine, 'till the Symptoms of the Small Pox appeared, but Elixir Proprietatis, which I order'd to be drank often in Water; and to abstain from Meat; and to live upon a smoothing, diluting Diet.
When I saw the Spmptoms of the Small Pox beginning, I was very watchful to observe them. If the Fever, Pains, and Sickness were favourable; I chose to do nothing, but leave the Work to Nature. If the Fever was very high; I chose to lower it with a cooling diluting Diet, of Milk and Water, Water with a Toast in it, &c.
[Page 16] I never yet saw a Necessity of Bleeding any of my Patients, but one; who had taken cold, and thereby fix'd a great Pain in his Side. Neither did I ever observe any Advantage by Bleeding, but the contrary. The Pock was retarded, and the Patient much weakned.
If the Fever continued 'till the third Day of Complaint, and no Eruption appeared; I applied Blisters, which answered for the most Part to draw forth the Pock, and abate the Fever; and if Need required, Attractives to the Feet. If there were any Signs of Foulness of the Stomach, I gave a Vomit of Ipecacuanha.
Sometimes Convulsions arose in Children before the Eruption, which went off themselves, or with Blisters & Attractives to the Feet. Sometimes they lay comatous and restless, which I relieved by Blisters & Alexipharmic Julep [...] to drive out the Pustules. When once the Eruption was made, the troublesome Symptoms went off for the most Part. However I endeavoured by some gentle Alexipharmic Julep to forward the Growth and Ripening of the Pock. I found little Need of Anodynes: tho' if they were very sore and restless, I always gave them. If they were very full of the Pock, I treated them in all Respects as in the common Small Pox.
The most of my Patients were very favourably dealt with: more than 50 out of 65; were sitting up and walking about the Room soon after the Eruption was well made.
But one died that I inoculated: which was a Child 8 Weeks old, and under the Disadvantage of losing a full Breast, and put to one that was very disagreable before to the Child, and now much more so by the Distress of the Nurse (who was the Mother) not only with that Child but with three more Children in the same Room. The Pock had its Course favourably enough; appear'd the 9th Day, and turned the 15th: but the Bowels fill'd daily with Wind, for want of proper Nourishment, and at length threw the Child into Convulsions, of which it died on the 22d. Two more were very full but not dangerous. One had a flat Pock; which was also full, and did not turn 'till the ninth Day; followed with hard Tumours in the Arms for many Days, which were all dissipated with the white Bread Poultice only.