A TREATISE OF THE SMALL-POX: Addreſs'd in a Letter to the very Learned Dr. JOHN BATEMAN, Fellow and Elect, and late Preſident of the Royal College of Phyſicians.

I Take the Liberty at laſt of pub⯑liſhing theſe few Pages, and giving them the Ornament of prefixing your Name to them. If there be any Thing that is Valuable in them in my own Eſtimation, it is contain'd in theſe two Particulars, the [2]kind Opinion you are pleas'd to have of them, and the Good I hope they may be inſtrumental of in the Diſeaſe of which they treat.

With all Submiſſion I proceed to ſpeak of the following Diſeaſe, viz. the Small-Pox, that is, of the Method I have taken in the curing of it. In which I ſhall be very ſhort, as to the Definitions, Signs, Diog⯑noſticks, or other [...]; ſuch Parts having been very copiouſly treated of by many great Authors, and in almoſt every Bodies Hands. The chief Streſs of what I humbly propoſe, depending upon Hiſto⯑rical Inſtances, and Matters of Fact: Not but it will be allow'd, and it frequently happens, that the Succeſs of Medicines and their various and multiform manner of Uſe and Application, has given light into the Nature and Indoles of Diſeaſes; as the Ef⯑fect of ſeveral Parts of an Animal in Food or Medicine, hath been made uſe of to ex⯑plain their Nature, and even exemplify the Parts of which they may conſiſt; which may be ſeen in our two Famous Profeſſors Dr. Gliſſon and Dr. Willis, the firſt in his [3] Anatomia, Cap. vi. the other in many places of his Anima Brutorum; as alſo in Sir George Ent, Dr. Morton, and ſeveral others; ſo that Phyſiology and Practice thus attended to, may be obſerv'd to illuſtrate each other. And here, Sir, I muſt again beg your Par⯑don, that I ſhall be forced to place before you Cramben Recoctam, having already troubled you very much, with many of the Particulars I muſt here recount. But before I can come to them, I muſt ſpeak to a General or two: The firſt of which is as to the general Regimen to be uſed, the Cold or the Hot, as they are generally and vulgarly diſtinguiſh'd.

For the Firſt, Dr. Sydenham and his Fol⯑lowers ſtrenouſly appear againſt the uni⯑verſal Practice of thoſe that preceded him, as well as his Contemporaries; and I may ſay, againſt Nature her ſelf: For tho' we may find interſpers'd in their reciting the Pharmaceutica, ſometimes what will ſeem to countenance the Cold Regimen, (in which the Countries and Climates where they practis'd might probably be a great Inducement) yet it is very plain, that they chiefly depended on Alexipharmicks and the warm Method. Amatus Luſitanus, who was as bold, I think, as any one in the Uſe of the Refrigeria, yet has in a Scho⯑lium theſe Words, Quod variolarum & Mor⯑billorum ad Cutem eruptio, quaedam a Na⯑tura [4]non ſolum conſtituta, ſed deſtinata Cri⯑ſis ſit: Conſequens erit cum Hippocrate & Galeno aſſeverare; quod quando Natura eam conficere tentat, tunc Medicus Materiam fluere diſpoſitam condenſare, aut a viâ ſua cohilere non debet; ſed Magis ipſam diſpo⯑nere, ut per eam viam incedat per quam Na⯑tura expellere Conatur; juxta illud Hippoc. Quo Natura maxime vergit per loca confe⯑rentia, eo ducere. I muſt confeſs, this Scho⯑lium is hardly to be reconcil'd with his Practice, either in the Precedent, or fol⯑lowing Curatio; in this laſt, he tells us, that being ſent for to a Boy blind for Three Days of the Small-Pox, which he mentions as an extraordinary Occurrence, he imme⯑diately fell to waſhing and other Applica⯑tions to his Eyes, and with great Pleaſure acquaints his Reader, ex tenebris Puer ipſe revocatus. This would be mad Practice in England, whatever it was in Tuſcany; but this I mention to ſhew, how little (as I ſaid before) is to be depended on Caſes Hiſtorically only related: And that in dif⯑ferent Climates, it is not the diſcordant Opinions Phyſicians maintain againſt each other; but there is a Neceſſity for that very Reaſon to take Meaſures ſomewhat dif⯑ferent. Reverius declares for the Alexi⯑pharmicks, and the warm Regimen, Primo ut Aeger in loco Calidiuſculo detineatur, quo Pori Cutis aperiantur, & variolarum Erup⯑tio [5]adjuvetur, &c. I forbear quoting that celebrated Practiſer at length, that I may be as little troubleſome as poſſible, and be⯑ing of no great Conſequence to the Rea⯑ders I chiefly intend this for. The ſame Thing might be repeated out of all the Au⯑thors of any Conſideration, or Antiquity, which would be as Nauſeous, as it would be Endleſs. The Miſchief which has ariſen is this; that in Practice, while there have been Endeavours uſed towards an Inprove⯑ment, ſome have advanc'd from a Genial neceſſary Warmth to almoſt actual Fire; and inſtead of keeping the cold deſtructive Air out, have perfectly ſuffocated the poor Patients, by letting them have none at all; making at the ſame Time ſuch vaſt Fires (whatever be the Temper of the Air, or of the Sick Perſon) which cauſe Faintings with other Irregularities coincident with it. And on the other Hand, I ſhall take the Liberty to ſay, that the Reformers have ſtarted ſo far out of that Method, in order to diſtin⯑guiſh themſelves by their new Diſcoveries in diſavowing the Warm Regimen; that one would think there's no being Cool or Refreſhing for the Patient without Freez⯑ing. Let me therefore beg leave to follow the Celebrated Dr. Morton, whoſe Practice is Regular and Rational, and whoſe Suc⯑ceſs was Anſwerable. He poſitively de⯑clares for the Warm; and both throughout [6]his Precedent Rationale, as well as in the ſubſequent Hiſtories, reprehends the con⯑trary Proceeding; which he deliberately confutes, and deſcends even to mention the Materia made uſe of in the Cold Re⯑gimen; ſuch as Spiritus vitrioli, Decoctum Album, Diacodium, and the like; nay, he ſays, that he was inform'd Dr. Sydenham himſelf had towards the latter Part of his Life gone off from that Opinion. Be that as it will, he was in the wrong, as Dr. Mor⯑ton thought, and will appear more to be ſo, if we take but very little Pains to con⯑ſider the Aetiology of the Diſeaſe it ſelf, or the Operations of Nature under it. For what is it that Nature is doing, or how can ſhe perform that viſible Diaploreſis, (if I may ſo call the Eruption) but by a Warmth ſomewhat higher than her con⯑ſtant Tenor; ſo that ſhe acts her ſelf in the Alexipharmick way; and that muſt be⯑yond Contradiction be the right. Could we either ſubſtitute any other Diſcharge to carry off by it with ſafety the repell'd Morbid Humours, or if ever a Sudorifick, or Expulſive Operation (of that kind) could be perform'd, without the Conſtitution be⯑ing ſomewhat more than commonly warm; there would be room to ſay ſomething; but when this can never be, which muſt be confeſs'd by all, there will need but very little Argument or Perſuaſion, to direct us [7]which of the two Regimens ought to be choſen. And yet, notwithſtanding the apparency of the Caſe, there are ſtill ſome ſo blindly devoted to the following that otherwiſe great Man; and even notwith⯑ſtanding their own ill Succeſs, they go on in a ſupine, fatal Bigotry, and Dependance on his Word; and think that Sydenham's Name is ſufficient to ſhelter, and juſtify their own Inattention to Nature herſelf. Inſomuch that I have heard it (with ſome Pain) affirm'd, that Diacodium was the Pa⯑nacea, which would do every Thing, and that nothing could be done well without it: That it was in the Small-Pox, like the Cortex in intermitting Fevers, &c. and however diverſified the Diſeaſe might be, it has been, upon the ill Succeſs of the firſt, doubled and trebled, and given the Patient without the leaſt Guard. Diacodium is queſtionleſs ſometimes a proper, as it is a Pacifick Medicine. But ſuppoſe we meet with a Comatoſe ſleepy Diſpoſition in the Beginning, and it ſhould attend the Diſtemper in the other Stages, which in Flegmatick Pituitoſe Habits is very fre⯑quent; muſt we ſtill proceed to give this Roapy Opiat? Why, yes, if we believe the Sophiſtry above, and which I have known purſued as long as Nature has laſted. But enough of this unwelcome Subject.

The next General I ſhall trouble you with is Blood-letting. Tho' indeed, I think it ought not to be term'd a General, it being impoſſible, but that it muſt be de⯑ſtructive in many Caſes, and I believe very dubious in its Succeſs in any. There is a Queſtion, Sir, I have wanted long to be reſolv'd, and is as difficult to ſtate, I believe as to reſolve. I have in debating occaſi⯑onally, whether Bleeding were generally good in the Small-Pox, heard it affirm'd, that it certainly was, if timely adminiſter'd: The ſame Affirmation I have under the Hands of ſome Men Eminent in Practice; we find it likewiſe in many celebrated Au⯑thors already extant among us. As to the Time, it is agreed as ſoon as poſſible, at leaſt before the Eruption is in any Meaſure perform'd; the Reaſons alledg'd are, that it gives ſome remiſſion to the excruciating Pains, and even diminiſhes the Morbid Mat⯑ter; ſo that the Enemy being weaken'd, Nature muſt be the better enabled to with⯑ſtand the remaining Force. Before I come to expoſtualte on the Particulars, give me leave to ſuggeſt, Firſt, that it may be fre⯑quently obſerv'd, that the Small-Pox in ſome Families is very ſignally, and as it were Hereditarily Fatal. This we find both Dr. Sydenham and Dr. Morton have obſerv'd, and granted. Suppoſe then, Secondly, That in one Family Three Children of the [9]ſame Father and Mother ſhould be treated in the Sydenhamian Way: The firſt is blooded, has the benign, diſtinct ſort of the Small-Pox, and does well. The next after the ſame manner is Blooded, has the Confluent, malign ſort, and dies. The Third under the ſame Adminiſtration of Bleeding, upon which appear the Maculae Nigrae, Lividae, Purpureae, &c. and Na⯑ture under ſo miſerable a Proſtration of Spi⯑rits, that ſhe quite gives up the Conten⯑tion; and yet for any Thing that could be ſeen or apprehended, this laſt might have been the diſtinct kind, which as Hiſtories are two to one. Such Events as theſe ought certainly to put us to a ſtand; and for the Truth of the Facts, I can produce undeniable Evidence; but wave it here, be⯑cauſe I would not revive the Grief of thoſe, who make but too ſevere Remarks upon the Proceeding. What Meaſures therefore, Good Sir, muſt we take? Will the taking of Blood away, alter the Indoles of the Di⯑ſeaſe from the Malignant or Confluent kind, to the Benign and Diſcreet ſort; if ſo, it ought in all Subjects, and on all Occaſions to be uſed; and this is what they mean, by ſaying it will leſſen the Quantity, or for my Part I know not what to make on't: But if this be difficult and uncertain, nay, I will ſay impoſſible to make apparent; then they put Perſons on a very great Ha⯑zard, [10]who make uſe of ſuch dangerous Methods by weakening Nature, and in no reſpect leſſening the Diſeaſe: Which Charge, how⯑ever ſevere and heavy, muſt in the general be confeſs'd to be true. For here, by the way, I muſt take ſo much Liberty, ſtrongly to preſume, that the kind of the Diſeaſe, in reſpect to its degree, is determin'd upon the firſt imparting of the Contagion: Tho' out of doubt, the Diſpoſition the Blood and other Juices of the Body are in at that Time, does ſtrongly diſpoſe to one or the other; ſuch as was before ſaid, the inhe⯑rent Craſis of the Blood and Spirits, in re⯑ſpect to the Parents we are Deſcendants of, violent Exerciſe, hard Drinking, or other crapulous Diſorders, and the like; which not only expoſe us the ſooner to the re⯑ceiving the Infection (as is vulgarly and truly expreſs'd) but the Poiſonous Miaſ⯑mata of the Diſeaſe, are immediate⯑ly imparted to every Particle of the Fluids, being thus made ſuſceptible of them; and thus the Confluent kind of the Small-Pox is form'd, and as I ſaid, determin'd, before it is poſſible to adminſter any Re⯑medy. So that except by Bleeding we can undertake to change the very Indoles of the Diſeaſe, even after it is form'd, tho' not render'd Viſible, which I believe is im⯑poſſible; we ſhall be in Danger of adding to the Diſeaſe, and abſtracting from the [11]Strength of the Patient. For 'twill hardly ever be found, that the taking of Blood away, can reſtore it, from a Fuſion to its natural Craſis, that is, the Sphaerical red Parts, to their juſt Magnitude, and the reſt, of what Denomination ſoever, to their Natural Size, Figure, and Coheſion ^*. By the Loſs of Blood, 'tis well known, that the Maſs is attenuated; and for that very Reaſon is Phlebotomy adminiſtred in many Inſtances, as in Pleuriſies, the Malacia, &c. that ſo there may be more room for the Heart in its Pulſes, to daſh and toſs, as it were, the Blood, by which Action the Lentor or too cohaeſive Parts may be divi⯑ded into ſmaller Portions. To this I muſt add, that Haemorrhages, from whatever Part they flow, are not occaſion'd, at leaſt very rarely, from a Plethora ſimply ſo call'd, or from the Strength and Force of the Pulſe; for then the moſt robuſt Ani⯑mals, and thoſe that uſe the moſt violent Exerciſe, would be moſt liable to them, either Man or Beaſt; which is hardly ever obſervable: But moſt frequently from the Prava Diatheſis of the Blood it ſelf in the Looſening of its Texture; ſo that in paſ⯑ſing the Capillaries, it is as it were perco⯑lated through 'em, or render'd ſo keen, that [12]it breaks, and, as it were, eats through. For a Confirmation of which, I appeal to Dr. Lower's Book de Corde. And where ſuch Symptoms attend the Beginning of the Small-Pox, Bleeding is ſeldom, I believe I might ſay never, of any Service. But Bliſters are of excellent Uſe, which is the next General.

Two Queſtions therefore, I think, ariſe from theſe few laſt Periods.

• Firſt, Whether the Indoles, that is, the Sort or Kind of the Small-Pox be de⯑termin'd in each individual Perſon up⯑on the very firſt Attack of the In⯑fection.
• Secondly, Whether it be poſſible by any Adminiſtration, eſpecially Bleeding, to make any Alteration or Mutation from Bad to Good, from the Conflu⯑ent to the Diſcrete Kind.

You ſee, Sir, my Opinion by what has been already ſaid, which I very humbly ſubmit to better Judgments.

At the End of the precedent Paragraph I have ſaid, that Bliſters are good in re⯑moving, or putting a Stop to that miſchie⯑vous Symptom, namely, the Haemorrhages that frequently attend the Beginnings of the Small-Pox. Theſe ſometimes appear, even before any other Signs, and prevent [13]the Struggle Nature generally makes to throw off the Diſeaſe from the Center to the Peripheria ^*. Sometimes Bleeding at the Noſe, Spitting of Blood, or an immo⯑derate Flux of the Menſes, appear juſt at the Eruption; by which Nature in that ne⯑ceſſary Effort is ſo debilitated, that ſhe can't perform, nor go through that Task; and then the Enemy again retires to the Vitals, and acts all imaginable Miſchief. I am well aware what Botallus and many others ſay, that the Loſs of Blood will not produce the Effect here charg'd; but I muſt deſire to be excus'd, from reſigning my Senſe and Reaſon; both which I muſt do, ſhould I make any Doubt of the retiring of the poiſonous Particles of this Diſeaſe; when upon the Loſs of Blood, I ſee the Humours ſecreted from the Blood diſappear, and a viſible Paleneſs ſpread in its ſtead, both on the Face, and all over the Body, which no one can deny, who has made any Number of regular Obſervations. But to return to Bliſters. Theſe Bleedings, as I ſaid before, being occaſion'd by the diſſol⯑vent Peſtilential Particles in the Serum of the Blood, breaking and dividing the Red Globules into a preternatural Smalneſs, and by that putting the Blood into a Fuſion, [14]forces it through the Capillary Branches of the Blood-Veſſels: But the Bliſters drawing off Part of this Saline, Deleterious Serum, by abating its Quantity, the Globules afore⯑ſaid are at Liberty to attract each other, and by that means to form themſelves in⯑to their genial and natural Size; and ſo the Symptom ceaſes: For I have had frequent Occaſion to obſerve in Perſons that have been ſeiz'd with the moſt violent Effuſion of Blood, that as ſoon as the Serum has be⯑gun to fill the Bliſter-Bladder, the Bleeding has conſtantly ceaſed. And thus even the Quantity of the peccant Matter may be ſaid to be diminiſh'd. But where Perſons are averſe to Bliſters, as too frequently they are, we need not be entirely at a Loſs, nor have recourſe to that deſperate Expedient of Phlebotomy; for I do aſſure you the Powder does it as certainly, and after a manner (as I ſuppoſe) much like the Bliſters; for by very ſoon procuring a Dia⯑phoreſis, the morbid Matter is brought to the Exteriors, and by Sweat the Deleterious Serum leſſen'd.

And here, by the way, give me Leave to ſay, with great Submiſſion, that I take the Blood to be the firſt Nidus of the con⯑tagious Particles, and not the Spirits, as Dr. Morton aſſerts; for as the Matter which fills the Bliſters, and alſo what fills the Puſtles of the Small-Pox, are Secretions [15]directly from the Blood; it is but reaſonable, I think, to conclude, that the Fomes or Pena is there for both. Beſides, as the Spirits are form'd from the finer Parts of the Blood, and conſtantly receive their Sup⯑ply and Reſtoration from that Magazine; ſo it is but natural to conclude, (till the contrary can be demonſtrated) that what Detriment, Labefaction, or Pollution ſoever they receive, muſt be communicated the ſame way. As to the Quickneſs of its Com⯑munication, that can be no Objection to any one, that conſiders the Pulſe of the Heart and Arteries, and the Motion of the Blood in them; ſo that it requires but a very few Minutes, after the receiving of the Infectious Lentor into the Blood, before it may by ſtopping in the fine Capillaries of the Meninges, Brain, and Spinal Mar⯑row, give Occaſion to all thoſe violent Or⯑gaſms exercis'd, and communicated through the whole Syſtaſis Nervoſa; and which, while looſely carry'd in the Rivus of the Blood, has little Opportunity of exerting thoſe excruciating and dolorous Senſations. And farther ſtill, it may be made almoſt a daily Obſervation, that Perſons having been converſant in Places infected, have remov'd to others free of the Diſeaſe; yet after many Days the Inſults of the Diſeaſe have begun upon the Nerves, which is a pretty plain Inſtance. But this by the by. How⯑ever, [16]when we come to conſider the Di⯑ſtemper once form'd as Phyſicians, the Spirits have their Share, and ſuffer violent⯑ly; and except we conſider the Blood and Spirits in this complex View, we ſhall ne⯑ver diſcover the true curative Indications; which is what I come now to ſpeak of, and ſhall do it in a very few Words.

Without repeating what has been already ſaid, the Oppreſſion of the Spirits, the Diatheſis the Blood is then in, and the Na⯑ture of the Diſeaſe, ſhew, I think, the Ne⯑ceſſity of Proceeding in the Alexipharmick Way, by promoting a general Diaphereſis in a gentle manner, by ſuch Medicines as will invigorate the Nerves and Spirits, by fitting them for, as well as putting them upon Action; and at the ſame time pro⯑mote a Sudoriferous Perſpiration over the whole Body: So that Neurotick, Volatil, Cephalick Medicines, mix'd with Anodines, and ſuch as will cauſe Sweat without an Inflamation, (all which is to be obtain'd by a Right proceeding, and the Alexipharma⯑con here propoſed) is, and muſt ſurely be acknowledg'd to be the regular Way and Means of aſſiſting Nature in this Exigency. I have often wonder'd to find ſo few of that Claſs of Medicines, call'd Cephalicks, in the Materia of Dr. Morton, who proceeds on ſuch Principles in affirming the firſt At⯑tacks to be made upon the Nerves, and [17]their Propagines; for want of which, many of the nobleſt Alexipharmicks are render'd not only ineffectual, but hurtful, by doing nothing elſe than inflaming the Blood, and ſcorching the Vitals, ſuch as Saffron, Rad. Serpent. &c. The like Miſchief may be charg'd upon Opiates ſimply given, with⯑out the Guard of Volatil Medicines to at⯑tend them; which ſtop and impede Nature in the Diſcharge; and inſtead of procuring that gentle Requies and Refreſhment of Sleep, ſo abſolutely neceſſary in the Small-Pox, cauſe horrible Deliriums, Convulſions, &c. But that I may give you no farther Trouble, I proceed now to lay before you the Series of the Cure, a Method I have (by God's Bleſſing) found more than com⯑monly ſucceſsful.

As ſoon as there is any Suſpicion of the Small-Pox, let the Perſon attack'd go imme⯑diately to Bed, and endeavour, if poſſible, to get ſome Sleep: Towards the attaining of which, let there be kept the profoundeſt Silence; (which is a Rule to be obſerv'd through the whole Courſe of the Diſeaſe:) For it is hardly to be imagin'd, what inexpreſ⯑ſible Diſadvantages ſick Perſons labour un⯑der, and what Symptomatick Miſchiefs they heap upon themſelves, by ſtriving (as they call it) againſt the Diſeaſe: By going into the Air, they ſometimes repel the mor⯑bid Humours to the Vitals; which may be [18]done even before there be any viſible Ap⯑pearance of them upon the Surface of the Body. Others by Exerciſe, Diverſion, hard Drinking, and the like, thinking to divert, greatly increaſe the Diſeaſe. Which can be of no Advantage in the Beginning of any Fever, but in this does often prove perni⯑cious. Let the Patient be cover'd with as many Cloaths as may reaſonably be ſup⯑pos'd will produce ſuch a Warmth, as is natural, acceptable, and pleaſant in the Winter, and no farther. If the Pains and unquiet Toſſings be ſuch, that no Reſt can be obtain'd without Help; at the End of Twelve Hours from the firſt Attack, and not ſooner without apparent Neceſſity, let the following Draught be taken.

And let it be repeated every Eight Hours. But if there be violent Symptoms, ſuch as Bleeding at the Noſe or Mouth, Fluxus Menſium immodicus vel praematurus, excru⯑ciating Pains, Watching, or the like, it may be repeated every Six or every Four Hours. The precedent Doſe is fitted for Adult Perſons: But for Children of one, two, or three Years old, five Grains is ſuf⯑ficient; and to be repeated according to the [19]Age and Strength of the Patient, or the Quantity each time given. The Vehicle above-mention'd is what I generally make uſe of; but the Powder may be given in a little Syrup, ſmall Sack-Whey, or any thing elſe, except Diacodium. If the ſick Per⯑ſons are able, let them be help'd out of Bed once every Day; but in this, let their own Deſires, join'd with common Prudence, be the Rule; for no other can be ſet.

The next thing to be conſider'd, is the Quantity of Liquids to be allow'd. I am not for ſuch large Quantities of Malted Liquors, I mean Small Beer, as is generally in preſent Practice admitted; neither am I totally for denying them. But a Decoction of Figs with ſome Cochineel, and inſpirited with ſome ſmall Portion of right good Ca⯑nary, I permit in good Plenty almoſt to the Patient's Choice. As, ‘℞ Ficuum Pinginum lbſs Cochinel. ʒſs. coqr. in aq. Fontan. ſ. q. ad lbij ſub fi⯑nem addendo Vini Canarij ℥iiij plùs minuſvè Bulliant ſemel tum adde Syr. de Rubo Ideo ℥ſs fiat Apozema & refrigeratum libat ad Libitum.’ This Liquor exceeds any that I have known made uſe of; for it keeps the Throat and Paſſages of the Lungs free and open, gent⯑ly promotes the Eruption; at the ſame time [20]that it exhilerates the Spirits, and abates the Thirſt: And I have not among ſome Hundreds met with any one Perſon, but was pleas'd with it. For in Small Beer, there is generally in Fevers a moſt unwel⯑come Clammineſs ſucceeding the drinking of it.

When the Eurption is perfected, ſo that the firſt Symptoms are abated, the Draught above-mention'd need be repeated but every Night at the Hour of Reſt; nor even then if there be a Natural Propenſity to ſleep, and the Small-Pox, be of the mild diſtinct Kind, (yet I always adviſe to have it in promptu); but in the Confluent Kind I think it ought to be taken every twenty⯑four Hours at leaſt, through the whole Courſe of the Diſeaſe. When the time of Maturation, or according to the Vulgar Idiom, the filling and ripening of the Puſtles commences; which according to Dr. Mor⯑ton, may be reckon'd to begin about three Days after the total Eruption; the foreſaid Draught is certainly neceſſary to be taken twice every Twenty-four Hours: And then I do very much recommend the drinking of large Quantities of what we call Milk-Porridge, made after this Manner: The Oatmeal being finely fifted may be boil'd in a due Quantity of Water for Half an Hour, or very little more, then add a Third Part of New Milk, and juſt give it [21]one Boil ſo as to mix it well together, and 'tis enough. This I order ſometimes to be taken Hot as Tea or Coffee, thus taken it will keep the Paſſages of the Throat clear; and frequently as I have obſerv'd, will make the Scabs of the Small-Pox, which are en⯑gag'd in the Paſſages ſcale off, and come away. At other Times to drink a good Draught of the ſame very near Cold, and ſometimes to be taken warm as Food. This ſmooth mild Pabulum cloaths, and indeed does as it were digeſt the Ichorous Serum of the Blood, to which Diatheſis in the con⯑fluent Kind it is very much diſpoſed, and ſupplies it with a ſoft Chyloſe Matter, wherewith to fill the Puſtles. It likewiſe ſupplies the Salivation, where it happens with a proper Fluid, gently raiſes it when it abates, and keeps up the neceſſary Tume⯑ſactions of the Extremities. It may be alſo a reaſonable Means to prevent any Tabid or Conſumptive Diſpoſitions, which are here frequently founded: And I have always ob⯑ſerv'd the Patients very ſoon recover their Strength, who have plentifully taken of this ſimple innocent Food. In the mean time, the Decoction of the Figs is not to be omitted being ſometimes taken.

Thus, Sir, am I come to the laſt Stage, the Criſis and Declination of the Diſeaſe, which is attended with leſs or more Diffi⯑culty, according as the Precedent have [22]been treated; and in which I have found little trouble, where I have had the Op⯑portunity of directing its ſetting out; and even ſtill are the Alexipharmicks to be uſed, tho' at greater Diſtances, ſo that I recom⯑mend the ſame Draught every Night, then every other Night, and ſo to be left off. I confeſs at this time, too frequently appears the direful Symptons in the confluent Kind, and require the utmoſt Penetration to find out Means to aſſiſt Nature, that ſhe may defend her ſelf againſt this laſt Aſſault. As for Bleeding, I hope, ſuch Adventrous Un⯑dertakings are quite out of Thought. And really, Sir, I have not been able to collect any great Advantage even from Bliſters as commonly directed, that is on any other Part of the Body except the Head; for at this time the chief Intention is to ſtimulate Nature in her ſeveral Offices to act the re⯑maining Part with ſome Vigor. Neither have I found there has been any reaſon to boaſt of the good Conſequences, though the Bliſters have had their common Effect; for there having been ſo vaſt an Expence of Juices already, there is apt to follow Deli⯑quiums, and a great Proſtration of Spirits upon this ſecond additional Diſcharge; but Bliſters on the Head, from whoſe Office we expect little more than to excite and ſtir up the remaining Force, are, and have been of excellent Uſe. Nay, Sir, I have made uſe, [23]I do aſſure you, of actual Fire upon the Head, and viſibly, under God, deliver'd two Perſons who were in the very Article, when all was thrown up, and others had withdrawn themſelves, and nothing but Death expected every Moment. But where the Uſe of this, by reaſon of its ſeeming Severity, ſhould be deny'd the Phyſician, inſtead of it I adviſe, that after as much Hair of the Head can be taken off, as the preſent Urgency will admit of (tho' I always order that to be done at the beginning of the Diſeaſe) then to fill a Broad, Thin, Linnen Bag, with bruiſed Cantharides, and having dipp'd it into boiling Vinegar, to lay it almoſt ſcalding Hot upon the Head. This, I confeſs, I never had occaſion to make Tryal of but once, and then 'twas with evident Succeſs, the Perſon being now living, but eſpecial Care muſt be taken to ſee the Bag keeps warm, for if it turn cold it may prove miſchievous.

Having thus far ſpoken of the Small Pox, in regard to Perſons that may be Patients under it, in an indifferent and general Man⯑ner; I now intreat your Permiſſion, Good Sir, to ſpeak of Women with Child, who are afflicted with that Diſeaſe, ſingularly, and in a Place by themſelves; their Condi⯑tion having been always look'd on as full of Hazard upon many Accounts; and for whoſe Sake chiefly you have all this Trou⯑ble, [24]and the preſent Publication (if it may be ſo) is made to the World. Not but that the Diſtemper is the ſame in every reſpect that regards it ſelf, and muſt be generally ſo treated. But the ſad Fatality which ſo commonly attends theſe poor People at that time; the conſidering that Two Lives are included in one Individual, and therefore that one Fate muſt attend them, and both be ſav'd or loſt together; with other Cir⯑cumſtances, which too often go along with it, that it moſt frequently happens on a Woman's firſt Pregnancy; ſo that the Ex⯑pectations of a Family on one Side are cer⯑tainly extinct, and ſometimes it hath fallen out that both have been.

Theſe and other moving Incidents put me upon the utmoſt Streſs of conſidering their Caſes, with the greateſt and moſt heedful Attention I was Maſter of. And I do here, and ever muſt with all the Grati⯑tude of my Soul, acknowledge and adore the Divine Goodneſs on theſe poor Endea⯑vours; and which I hope are agreeable to the Proceedure of Nature, and the Ars Medica, by what follows.

Here I muſt again inculcate, as I muſt on all Occaſions, that the ſtrict Enquiry in⯑to the Animal Oeconomy is and has been the juſt, regular, and only Means for diſ⯑covering uſeful Remedies; at leaſt the proper Way of rendring any of the Parti⯑culars [25]of the Materia Medica rationally, and therefore as conſtantly ſucceſsful as the Strength of the Diſeaſe, or the Weakneſs of Humanity will admit of. Thus Dr. Her⯑man Grabe puts it into a Kind of exempla⯑ry Method; and in diſtinct Chapters tells us, what Ways we are to take, if ever we intend or deſire to make any commendable Diſcoveries in Chirurgery or Pharmacy; and therefore propoſes to our Imitation, the Examples of the moſt conſiderable Phyſiolo⯑giſts of the Time he liv'd in, or a little be⯑fore it; beginning at our Great Country⯑man Dr. Harvey, and inſtances in many Particulars, what Light the Knowledge of the Circulation of the Blood has given to the Pathology of Diſeaſes, and the Secrets that may be diſcloſed from the Obſerva⯑tions thereon. He proceeds afterward to the Diſcoveries made by Bartholine, Whar⯑ton, Steno, Sylvius, and Willis; and ſeve⯑rally hinting, what uſeful Inventions have been, and ſtill may be made for the Good of Mankind by following their Pattern, which he preſſes very earneſtly to all the Practiſers in that noble Art. And here I beg you will indulge me ſo far, to affirm to you, that if there be any thing valuable in what I now lay before you, it is owing to the conſidering the Parts of a Gravid Fe⯑male more intimately than ordinary, at the Time when theſe Parts of the Kingdom [26]were [...] with the Small-Pox. And find⯑ing ſo little Encouragement; and on the contrary, ſo much Forbiddance in the Suc⯑ceſs of the common Procedure, either in Books or Obſervation; there ſeem'd to me to be a Kind of tacit Demand made by the tender Sex upon all the Practiſers in the Science, to have their Caſe peculiarly conſider'd.

To ſpeak firſt in general, and to conſider, that Nature is then intent upon the great Work of propagating and perpetuating her⯑ſelf in the Species: And that this is a Task the moſt arduous in its Performance of all natural Functions, is ſufficiently obſervable from the great Turn, and, as it were, Re⯑volution made in the Conſtitution. Not to entertain you with the ſhocking Expreſ⯑ſions of the Act of Generation, though really obſervable enough, but the Conſe⯑quences of it. Upon the firſt ſetting out of the Primordia of Conception, the Men⯑ſes are intercepted; ſo that the Blood, Spi⯑rits, Lymph, and the whole Genus fluidum of the Syſtem take a new Turn; and this not purely for the Nutrition of the but juſt conceiv'd Faetus, which it does not, nor is it poſſible it ſhould receive the thouſandth Part, but for many other Uſes and Reaſons, and for this general one amongſt the reſt, becauſe ſhe would not admit of any Avoca⯑tion, or Interruption in this ſo great an [27]Undertaking. And we almoſt always ſee, that Miſcarriages (not to ſpeak of the Loſs of the Embryo, which however ought to be conſider'd, and ſeems to be a Duty im⯑ply'd in our Oaths) are incomparably more full of Danger, and ruinous, even to the Health of the Mother, than natural and timely Births. And this, I ſuppoſe, no one will put me upon proving, when Na⯑ture, and every Day's Experience, manifeſts it to the moſt ſuperficial Obſervation. But when to this is added, the violent Inſults of a little leſs than Peſtilential Fever; when ſhe is forced from this her grand Intention, call'd off and diverted to contend with what is ſo frequently too ſtrong of it ſelf, and which God in his merciful Adminiſtra⯑tion and Providence has ſo order'd, that human Nature is rarely, if ever, more than once in each Individual ſubjected to it. When to theſe general Diſadvantages, ſo conſiderable a Part of the Mother, as the Foetus, when of any Magnitude, muſt be accounted, is in Danger, if not timely pre⯑vented, of being torn from her; by which ſo great an Effuſion of Blood, and other Fluids, ſuch an Exhauſtion of Spirits muſt immediately follow: What Intenſeneſs of Thought and Sedulity muſt theſe Conſide⯑rations raiſe in every one, that deſires, or intends to make himſelf ſerviceable in his Employ, to which he has aſſign'd himſelf, [28]and is, as it were, elected? Upon ſuch like Obſervations as theſe, I thought my ſelf excuſable, if I took a Method ſomewhat pe⯑culiar, to prevent, if poſſible, that which might be otherwiſe deſtructive of the Mo⯑ther and Offspring; and without this be⯑ing done, every Day's ſad Experience ſuf⯑ficiently ſhews, that both muſt generally be loſt together. To detain you therefore no longer; As ſoon as ever I have been call'd to a Woman with Child, and there has been Reaſon to believe ſhe would be ſeiz'd with the Small-Pox; as by the uſual Symptoms in the Perſon her ſelf, or the Place where ſhe lives being viſited, together with her own Fears and Apprehenſions be⯑ing ſtrongly employ'd or affected; in ſuch a Caſe, without ſtaying for the appearing of any other Sign, to make the Diagnoſtick certain, I always give ſomething to prevent Miſcarriage; and in this, I dare preſume you, Sir, will agree with me, that I am regularly diſcharging my Duty, becauſe ſuch Adminiſtration can have no Male-Tendency: Beſides, the Lucta is ſo great, the Convulſion frequently ſo violent, at the ſame time that the poiſonous Miaſmata are making their Inſults upon the Internals be⯑fore the Eruption, that the Placenta is in great Danger of being very much looſen'd, if not immediately torn and divided from the Mother; upon which, all the Symptoms [29]before recited, and many more, muſt be exaſperated. And under this Oppreſſion, while Nature is held in this unhappy Di⯑lemma of attending one or the other, either to expel the Diſeaſe, or preſerve the Em⯑bryo, and is not able to perform both; du⯑ring the Heſitation, both Mother and Child are in the moſt eminent Danger of being loſt: Immediately therefore I order the following Bolus and Draught.

After this has been taken about Two Hours, I then order the Alexipharmick Draught before-mention'd. In which you ſee, I regard both the Pregnancy of the Mother, as well as endeavour to get the Enemy at the ſame time remov'd to that convenient Diſtance from the Vitals, that we may with ſome tolerable Safety parly with him. The Bolus and Draught againſt Abortion, I certainly repeat at the End of four Hours after taking the firſt; but then [30]omit it for twelve Hours, except ſome pe⯑culiar Reaſons from the Patient oblige me to repeat it ſooner. The Signs of an ap⯑proaching Miſcarriage, and that of the na⯑tural Birth being ſo very like, and Women being ſo abundantly ſenſible of the Particu⯑larities in that Caſe, I need not take up any room here in reciting them: Upon which Occaſions and Informations, I repeat the Bolus and Draught every three, four, or five Hours, as Need ſhall require; the Per⯑ſen herſelf being kept in Bed in the moſt quiet Diſpoſition and Poſture that is poſſible, till theſe threatning Signs abate. For at this time I am ſo intent on tying, as it were, all things faſt in the Communication be⯑tween the Mother and Foetus, that in truth I think nothing ſafe, or like to be ſo, till that great Point is ſecur'd; and that the foremention'd Bolus, or the Rad. Tormentil. (in what Form the Phyſician ſhall think fit, or the Prtient can beſt take it) will do; at leaſt I never yet knew it fail. But ſtill I would have the Decoction of Figs before ſpoken of, in proper Intervals freely uſed (and likewiſe the Alexipharmick Draught ſometimes) as being what will dilute the Fervency of the Blood, and help to break and divide the morbid and peccant Matter from it, and is a good Diaphoretick beſides. After this, I generally repeat the two Me⯑dicines againſt Abortion once every Twen⯑ty [31]four Hours, as there is Opportunity, ſo as not to interfere with the Medicines ne⯑ceſſary to bring forward the general Diſeaſe. But however, when that is near the State, and grows towards a Criſis, I never omit giving it twice at leaſt in Twenty four Hours. After that is over, I withdraw thoſe reſtringent Medicines to once in that Time: Then to once in Two natural Days; and then to once in three or four Days. But if the Diſeaſe be of the mildeſt Kind, then neither this, nor any other Medicine, directed to what Intention ſoever, need be ſo frequently repeated. But if it be of the Confluent, or even of the Cohaerent Kind, if we keep not upon the Guard, we ſhall be in Danger of being ſurprized; for in ſuch Kind of Fevers that are, or are near like Peſtilential, there is ſuch Relaxation, or, may I not call it, a Diſſolution in all the Juices, and alſo in the internal Membranes, that they too frequently fall, as it were, in ſunder; and thus ſometimes diſappoint us in our moſt confident and ſanguine Expecta⯑tion. When the Criſis is paſs'd, and all the Symptoms much abated, and Nature un⯑der a ſenſible Alleviation and Refreſhment, we may with Reaſon believe the Patient out of Danger, conſider'd ſingly in the Mother; ſo that the Embryo ought now to be our pe⯑culiar Regard. As ſoon therefore as it is manifeſt that it may be done without Ha⯑zard, [32]I would have the inferior Inteſtines empty'd of the Faeces by the common do⯑meſtick Cliſter of Milk and Sugar. The ſame may be repeated the next Day; and then intermitting a Day, it may be again made uſe of, if the Strength of the Patient will admit of it. But I do poſitively de⯑clare againſt any purging Medicine being taken at the Mouth by Women with Child; becauſe it puts the Child into the utmoſt Danger of being expell'd before its time: Of which, with Permiſſion, I ſhall give you Two pretty plain Inſtances.

A Gentlewoman of this Town, who had the Small-Pox in the mildeſt manner ima⯑ginable, ſo that there was little or no Oc⯑caſion for any Aſſiſtance on any reſpect whatever, was (tho' with Child) treated at the latter End, as in common Caſes, with purging Medicines, by which (in her own Opinion, and alſo in that of moſt about her) ſhe miſcarry'd. Again:

Mrs. Snow, a Gentlewoman who was moſt ſeverely handled, as by her Caſe here⯑after recited appears, upon her Recovery from the utmoſt Danger, was ſo prepoſſeſs'd with the Neceſſity of being purg'd after ſuch a Diſeaſe, that notwithſtanding all I could ſay, would not be prevail'd with, but purg'd ſhe would be. I order'd her nothing elſe but

℞ Mannae, Sal Cathartic. Glauberaa. ℥ſs. [33]to be taken in Gruel; by which ſhe had Five moderate Stools: Yet even this cauſed in the Child ſuch tremulous, fluttering and diſorder'd Motions, and in her ſelf ſuch parturient Pains, that without waiting to know whether the Purge had finiſh'd its full Operation, I was neceſſitated to give the Draught and Bolus againſt Abortion: Upon which ſhe was abundantly convinced, and deſir'd ſhe might have no more Purges. Neither indeed had ſhe any more, nor any one elſe with whom I was concern'd, who were with Child, any thing of that Kind, but the Cliſter before-mentioned, till after the Time of their Delivery. They and their Children are all alive, and in perfect Health, (Mrs. Dove being long ſince ſafely deliver'd.) And more I think I need not urge. I only therefore beg your Patience for one Word more of Comfort to Women with Child. And pardon, I intreat you, good Sir, any ſeeming Vanity in it. As I have laid their Caſe, as well as I can, be⯑fore you, I may with ſome Aſſurance, as well as Pleaſure, ſay, that thus conſider'd, their Condition is even not ſo dangerous as other Women: For it is obſerv'd by Au⯑thors, and may be ſo very often in our own Practice, that the Proceeding and Advance of the Diſeaſe, and its Cure, is interrupted by the Menſtruation of Female Patients, even in their timely and regular manner; [34]and is enumerated ^* as one ſingular Diſad⯑vantage in their Caſe, and is much worſe when (as it frequently happens) it appears before its Time. For a Confirmation of what I now ſay, I refer my ſelf to Dr. Mor⯑ton's Hiſtorical Obſervations in the 9th, 18th, 36th, 37th, 41ſt, 52d Hiſtories of Puretology. And for the unhappy Events ſubſequent on Abortions, the 43d and 44th Hiſtories of the ſame Author are ſufficient Teſtimonies. I ſhall add but this one gene⯑ral Obſervation more, on which it cannot but be imagin'd I muſt reflect with ſome Satisfaction, that during the Continuance of the Small-Pox in theſe Parts, there was not one Perſon with Child, for whom I was conſulted, whom I treated not in the Me⯑thod above deſcrib'd; and not one of them but is now alive, and ſo are their Children: Except Mrs. Withnoe's, which liv'd above a Fortnight, and then I believe died on the firſt Inſults of the Small-Pox; there being a Neceſſity, by reaſon of the weak Condition of the Mother, and other Diſorders of the Family, to keep it conſtantly in a Room, where Three others lay miſerably afflicted of the Confluent Sort of Small-Pox. And I can't learn from the ſtricteſt Enquiry I have made, that any eſcap'd that were not [35]thus dealt withal; but both miſcarried and died, except the Gentlewoman before hin⯑ted at, who only miſcarry'd upon her being purg'd after the Diſeaſe.

After what has been ſaid, I ſhall take Leave to lay before you ſome Hiſtorical Caſes: Which I hope, Sir, will not only ſeem excuſable, but neceſſary, and even incumbent on me; that ſo any Perſon may be ſatisfied, that ſhall think fit to enquire into the Truth of the Relations from the Perſons themſelves.