Читать книгу The Present Method of Inoculating for the Small-Pox - Dimsdale Thomas - Страница 3

In directing the preparatory regimen, I principally aim at these points: to reduce the patient, if in high health, to a low and more secure state; to strengthen the constitution, if too low; to correct what appears vitiated, and to clear the stomach and bowels, as much as may be, from all crudities and their effects. With this view, I order such of my patients as constitute the first class, and who are by much the majority, to live in the following manner: to abstain from all animal food, including broths, also butter and cheese, and from all fermented liquors, excepting small beer which is allowed sparingly, and from all spices, and whatever possesses a manifest heating quality. The diet is to consist of pudding, gruel, sago, milk, rice-milk, fruit-pies, greens, roots, and vegetables of all the kinds in season, prepared or raw. Eggs, though not to be eaten alone, are allowed in puddings, and butter in pie-crust; the patients are to be careful that they do not eat such a quantity as to overload their stomachs, even of this kind of food. Tea, coffee, or chocolate are permitted for breakfast, to those who choose or are accustomed to them.

In this manner they are to proceed about nine or ten days before the operation; during which period, at nearly equal distances, they are directed to take three doses of the following powder, either made into pills, or mixed with a little syrup or jelly, at bed-time; and a dose of Glauber’s salt, dissolved in thin water-gruel, each succeeding morning.

The powder is composed of eight grains of calomel, the same quantity of the compound powder of crabs claws, and one eighth part of a grain of emetic tartar. Instead of emetic tartar, I have sometimes substituted two grains of precipitated sulphur of antimony. In order to facilitate the division of the doses, a large quantity is prepared at once, and great care taken that the mixture is well performed.

This quantity is usually sufficient for a healthy strong man; and the dose must be lessened for women or children, according to their age and strength, as well as for persons advanced in years.

The first dose is commonly ordered at the commencement of the course, the second, three or four days after, and the third, about the eighth or ninth day; and I choose to inoculate the day after the last dose has been taken. On the days of purging, broths are allowed, and the patients are desired to abstain from unprepared vegetables.

What has hitherto been said concerning the preparation, must be considered as proper only for the young or middle-aged, in a good state of health; but among those who are desirous of inoculation are often found tender, delicate, and weakly women, men of bad stamina, valetudinarians by constitution, by illness, or intemperance; also aged persons and children; and for these a very different treatment is directed; a milder course of medicine, rather of the alterative than purgative kind, is here preferable; and in many instances, an indulgence in some light animal food, with a glass or two of wine in case of lowness, is not only allowable, but necessary to support a proper degree of strength, especially in advanced age.

Children whose bowels are often tender, and ought not to be ruffled by strong purges, yet require a mild mercurial, and bear it well; besides emptying the bowels of crudities, it is a good security against worms and their effects, which are sometimes of themselves perplexing enough, and produce very alarming and even fatal disorders.

Indeed the particular state of health of every person entering upon the preparatory course, should be inquired into and considered. Inattention to this has, I am satisfied, done great mischief, and particularly the indiscreet use of mercurials, whereby a salivation has often been raised, to the risque of impairing good constitutions, and the ruin of such as were previously weak and infirm. The distinctions and treatment necessary, will be obvious to those who are acquainted with the animal œconomy and medical practice.

The time of menstruation has generally been the guide in respect to the inoculation of women; that the whole of the disease might be over within the menstrual period. This I commonly observe, when I can choose my time without any inconvenience, and inoculate soon after the evacuation ceases; though I have no reason to decline performing the operation at any time, as I can produce many examples in which no inconvenience has arisen, nor any difference been observable, when this circumstance has been disregarded.

Women with child have likewise been inoculated, and done well; yet some particular emergency should be pleaded in excuse for it in their situation, as it may be attended with some hazard. I have not inoculated any woman whom I knew to be pregnant; but some who concealed their pregnancy have been inoculated by me, who, I fancy, hoped for an event that did not happen, I mean miscarriages: one of these had a child born nine weeks after inoculation, at the full time, with distinct marks of the disease, though the mother had very few eruptions.