INOCULATION. 



tintil the fever comes on. All this timr, moderate cxercife 

 in the air is ftrongly recommended. In twenty-four hours 

 after the inocnlation, the operator can often diftingnifh whe- 

 ther or no the patient be infefted. He evei-)' day examines 

 the incition ; and from hence feems to prognofticate, with 

 fome degree of certainty, concerning the degree of the future 

 difeafe. In three days after the operation (provided that 

 it has fuccecdcd), there appears on the incifion a fpot like 

 a ika-bite, not as yet above tlie flcin. This fpot, by degrees, 

 rifes to a red pimple ; and then becomes a bladder full of 

 clear lymph. This advanceth to maturation like the vario- 

 lous puftules, but is the laft which falleth oiT. In proportion 

 as the difcolouration round the place of the incifion is 

 greater, the Icfs quantity of eruption is expefted. And, 

 therefore, whenever only a fmall difcoloured circle is ob- 

 ferved, purging medicines, more than ordinary, and more fre- 

 quently repeated, are held to be neceflary. 



" The preparatory diet is ftill continued. If the fever 

 remains fome hours without any tendency to perfpiration, 

 fome acid drops are adminiftered, the effidi of which is to 

 bring on a profufe fwcat ; but in fome cafes where the fever 

 is very high, a powder or pili, ftill more powerful, is given. 

 In general, during the burning heat of the fever, the inocu- 

 lator gives cold water. But the perfpiration beginning, he or- 

 ders warm balm-tea or thin water-gruel. As foon as the fweat 

 abates, the eruption having made its firll appearance, he 

 obliges every body to get up, to walk about the houfe, or 

 into the garden. From this time, to the *urn of the dif- 

 eafe, he gives milk gruel, nil Ubitiim. 



" On the day following the firlt appearance of the opaque 

 fpot on the puftules, to grown people he gives an ounce of 

 Glauber's purging fait. To children he gives a dofe of it 

 proportioned to their age. Then, if the eruption be fmall, 

 he allows them to cat a little boiled mutton, and toad and 

 butter, and to drink fmall beer. But in cafe of a large 

 eruption, he gives them, on the third day after their having 

 taken the firlt dofe, another dofe of the fame fait, and con- 

 fines them to the diet ordered during the preparation." 



Sir George, after reprefenting this as the praftice of Mr. 

 D. Sutton, afcribes its fuperior fuccefs to the free ufe of 

 cold air. Dr. Glafs, of Exeter, in a publication which ap- 

 peared fliortly after that of the preceding gentleman, im- 

 puted the advantages of the Suttonian method to the patient 

 being fweated ; while another author, Mr. Chandler, dif- 

 fered from both the former writers, and referred the chief 

 benefit of the plan to the infecting humour being taken in a 

 crude ftatc, " before it has been ultimately variolated by the 

 fucccedilig fever." Baron Dimfdale likewife thought, that 

 although the wliole procel's might have fome (hare in the 

 production of the fuccels, yet he believed the chief good 

 was owing to the method of inoculating with recent fluid 

 matter, and the management of the patients at the time of 

 the eruption. 



In November, 1766, baron Dimfdale publifhed his well 

 known work, entitled " The prefent Method of inoculating 

 for the Small-pox." The inftruftions contained in this 

 book have dcfervedly continued ever fince, almoil without 

 exception, to regulate the practice of inoculation. 



The baron, when the age is left to his choice, avoids in- 

 oculating children under two years of age. The fubjefts 

 confidered by him improper for the operation, are fuch as 

 labour under any acute or critical difeafes, or their cffeiSts ; 

 and alfo fuch as have evident marks of corrofive acrimonious 

 humours, or manifell debility. 



As for the moft eligible fcafon of the year, he thought, 

 that perfc 

 any 



Vol. XIX. 



intcrmittcnts, and ulcerated fore throats) being moft fre- 

 quent in the autumn, the baron did not look upon this as in 

 general the moft favourable feafon. But he was of opmion, 

 that we might fafely inoculate at all feafotis, provided care 

 were taken to fcreen the patients as much as poffible from 

 heat in fummer, and to prevent them from keepin" thcm- 

 felves too warm, and too much fnut up froin the weather 

 in winter. He thought it prudent, however, to avoid ino- 

 culation while any peculiar epidemic difeafes were preva- 

 lent. He recommended a preparatory regimen, fo as to 

 reduce the patient, if in high health, to a low and more 

 fecure Hate ; to ilrengthen the conftitution if too low, to 

 correet what appears vitiated ; and to clear the ftomach 

 and bowels as much as may be from all crudities and their 

 eftl'fts. Young or middle aged pcrfons, enjoying a good 

 (late of health, were ftriftly confined to a milk and vegeta- 



ble diet for 1 



ayp previous to the operation, during which 



erfons generally liad more puftules in the fpring than 

 ther time ; and epidemic difeafes (cfpecially luxes, 



period they were ordered to take the following powder three 

 times at bed-time, and a dofe of Glauber's fait each fuc- 

 ceeding morning. The powder was compofed of eight 

 grains of calomel, the fame quantity of compound powder 

 of crabs' claws, and ith of a grain of emetic tartar. For 

 women or children the dofe was lefl'cned, according to their 

 age and ftrenglli. For thofe wlio were of a tender delicate 

 conftitution, or valetudinarians, he preferibed a milder me- 

 dicine, and rather of the alterative than tlie purgative kind ; 

 indulging fome with light animal food, and in cafe of low- 

 nefs, with a glafs or two of wine. The baron preferred the 

 following method of inoculating. Tiie patient to be in- 

 fetled being in the Tame houle, and if no objedtion is made 

 to it, in the fame room with one who has the difeafe, a little 

 variolous matter is taken from the place of infertion, if the 

 fubje(it is under inoculation, or a pullule, if in the natural 

 way, on the point of a lancet, fo that both fides of the 

 point are moillened. With this lancet an incifion is made 

 in that part of the arm where iifues are ufually placed, 

 deep enough to pafs through the fcarf-flcin, and juft to 

 touch the Ikin itfelf, and in length as ftiort as poOible, not 

 more than one-eighth of an inch. The little wound being- 

 then ftretched open between the finger and thumb of the 

 operator, the incifion is moiftened with the matter by gently 

 touching it with the flat fide of the inL-ftcd lancet. Tlie 

 baron generally performed the operation in both arms, and 

 fometinies in two places in one arm, a little diltance from 

 each other. Neither plafter nor bandage is to be applied to 

 the inoculated part. The baron preferred ufing fuch mat- 

 ter as was taken during the eruptive fever, it being then in 

 his opinion endued with moft activity. When the difeafe 

 was to be communicated from an inoculated perfon, lie took 

 the matter, not from the fecondary puftules, but from tlie 

 place of inoculation. The fecond day after the operation, 

 ff the inoculated part is viewed with a lens, he fays, there 

 generally appears a kind of orange-coloured ftain about the 

 incifion, and tlie furrounding ilvin feems to contract. At 

 this time the baron ufed to prefcribe the following medicine 

 to be taken at bed-time : calomel and compound powder of 

 crabs' claws, of each three grains, emetic tartar ,',;th of a 

 grain. On the fourth or fifth day a hardnefs is perceptible 

 to the finger. The part itches and appears flightly inflamed. 

 He remarks, that a li'.tlc clear fluid may be feen under a 

 kind of veficatioii, the part refenibUng a fuperficial burn. 

 In general, about the fixth day fome pain and ftifitiefs are 

 felt in the arm-pit. Tiiis was regarded as a very defirablc 

 fymplom, a3 foreboding the near approach of tlie eruptive 

 fymptoms, and the favourable progrefs of the difeafe. 

 Sometimes on the feventh, more often on the eighth day, the 

 fymptams of the eruptive fever appear ; fuch as ilight 

 U remitting 



