Читать книгу The Present Method of Inoculating for the Small-Pox - Dimsdale Thomas - Страница 2

Before I proceed to describe the regimen and preparatives, it may not be improper to mention what has occurred to me in respect to the most suitable age and constitution for inoculation; and likewise what seasons seem to be more or less favourable for the practice.

In regard to age; where it is left to my choice, I decline inoculating children under two years old. I know the common practice is against me in this particular; but my reasons for rejecting such are founded on observation and experience. I have, indeed, lately inoculated many under this age, at the pressing entreaties of their parents, and they have all done well. But it must be considered, that young children are exposed to all the hazards of dentition, fevers, fluxes, convulsions, and other accidents, sufficiently difficult in themselves to manage in such tender subjects; insomuch that scarce two in three of all that are born, live to be two years old, as is demonstrable from the Bills of Mortality.

Besides, convulsive paroxysms often accompany the variolous eruptive fever in children; and though generally looked upon in no unfavourable light, as often preceding a distinct kind of small-pox, yet they are at all times attended with some degree of danger; nay, some, it is well known, have expired under them; while others, who have struggled through with great difficulty, have been so debilitated, and their faculties so impaired, that the effects have been perceptible during the remaining part of their lives.

And even admitting the eruption to be favourable, and not attended with any such alarm, yet should a larger number of pustules than usual appear, or any untoward symptom happen, and require medical help, the unhappy sufferer is much too young to be prevailed on to take unpalatable medicines, or submit to other necessary measures, by persuasions, menaces, or bribes. I have often been present at afflicting scenes of this nature; and have reason to think that many children have died of the small-pox in the natural way, merely from the impossibility of prevailing upon them to comply with what was proper, in cases where little or no danger was discoverable, either from the number or species of the pustules, the degree of fever, or any other apparent cause.

It must likewise be taken into consideration, that young children have usually a larger share of pustules from inoculation, than those who are advanced a little farther in life; and that under this circumstance many have died; and the proportion of these, so far as I can learn, is too great to encourage a continuance in the inoculation of young children: so that it seems most prudent to wait till this dangerous period be over, especially as its duration is so short, that the danger of their receiving the small-pox therein in the natural way is very little; and it is at this time much more easy to preserve them from it, than when they are left more to themselves, and may be more in the way of infection. But children above this period may be inoculated more freely; nor does there appear any reason to exclude healthy adults of any age; persons of seventy having passed through this process with the utmost ease, and without occasioning the least painful apprehension for the event.

In respect to constitution, greater liberties may be taken than have heretofore been judged admissible: persons afflicted with various chronic complaints, of scrophulous, scorbutic, and arthritic habits; persons of unwieldy corpulency, and of intemperate and irregular lives, have all passed through this disease, with as much ease and safety as the most temperate, healthy, and regular. But those who labour under any acute or critical diseases, or their effects, are obviously unfit and improper subjects. So likewise are those where there are evident marks of corrosive acrimonious humours, or where there is a manifest debility of the whole frame, from inanition, or any other cause: all these should be treated in a proper manner previous to the introduction of this disease. Constitutions disposed to frequent returns of intermittents, seem likewise justly exceptionable; especially as the preparatory regimen may in some habits increase this tendency. I have known, however, instances of severe ague fits attacking persons between the insertion of the matter and the eruption of the pock, and even during maturation; when the Peruvian bark has been given liberally and with success; the principal business, in the mean time, suffering no injury or interruption.

Among the circumstances generally considered as more or less propitious to inoculation, the season of the year has hitherto been deemed a matter of some importance. Spring and autumn, for the most part, have been recommended, as being the most temperate seasons; the cold of winter, and the summer heats, having been judged unfavourable for this process. But experience does not justify these opinions; for according to the best observation I have been able to make, inoculated persons have generally had more pustules in spring than at any other time of the year; and epidemic diseases being commonly most frequent in autumn, especially fluxes, intermittents, and ulcerated sore throats (all which are liable to mix more or less with the small-pox) the autumn, upon this account, does not seem to be the most favourable season in general.

My opinion is, that considering the surprizing and indisputable benefits arising at all times to patients in the small-pox, from the free admission of fresh cool air and evacuations (which will appear from some cases hereafter subjoined) we may safely inoculate in all seasons, provided care be taken to screen the patients as much as possible from heat in summer, and to prevent them from keeping themselves too warm, and too much shut up, as they are naturally disposed to do, from the weather in winter. And it is well known, that many have been inoculated in the depth of winter, and some during the greatest heat in summer, without suffering any injury or inconvenience from either.

When seasons, however, are marked with any peculiar epidemics, of such a kind especially as may render a mild disease more untractable, it may perhaps be most prudent not to inoculate while such diseases are prevalent.

An eminent physician of my acquaintance in London, at that time in considerable business, informed me that in the year 1756 the small-pox were very rife, in the summer of that year especially. That in most of them the throat was so much affected, that about the seventh day from the eruption, when they ought to have taken liquors in abundance, they could not swallow a drop. The ptyalism was in the mean time copious; and the kind being for the most part confluent, they died on the tenth or eleventh day; and those who sunk under this distemper (who were by much the majority) all suffered from this cause. This instance is only given to shew the necessity of regarding the general state of epidemics when we go into this operation; and to excite those who are friends to this most beneficial discovery, to use every means in their power to provide against a single instance of ill success.