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  conderable —> considerable
  rhubard —> rhubarb
  therfore —> therefore
  smoaked —> smoked
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  choaked —> choked
  wereat —> were at
  inculation —> inoculation
  throngh —> through
  anamalous —> anomalous

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                                  THE
                            PRESENT METHOD
                                  OF
                              INOCULATING
                                FOR THE
                              SMALL-POX.

                          To which are added,

               Some Experiments, instituted with a View
            to discover the Effects of a similar Treatment
                       in the NATURAL SMALL-POX.

                       By THOMAS DIMSDALE, M. D.

                    The SEVENTH EDITION, Corrected.

                                LONDON:

                Printed by JAMES PHILLIPS, George-Yard,
                            Lombard-Street;

               And Sold by W. OWEN, in Fleet-Street; and
               CARNAN and NEWBERY, in-St. Paul’s Church
                                 Yard.

                              MDCCLXXIX.




                                TO THE

                      Royal College of Physicians

                                  IN

                                LONDON,

                      This Treatise is inscribed,

                        With all due Deference

                             and Respect,

                                  BY

                              THE AUTHOR.




INTRODUCTION.

Of the Age, Constitution, and Season of the Year proper for Inoculation.

Of the Preparation.

Of Infection.

Of the Progress of Infection.

OF ANOMALOUS SYMPTOMS AND APPEARANCES.

Consequences of this Method of Inoculation.

The Effects of this Treatment applied to the natural Small-Pox.

CONCLUSION.

CASES.

CASES of the natural Small-pox, treated in the preceding Method.

POSTSCRIPT.

CASE.




INTRODUCTION.


From the time that I entered into the practice of medicine, and saw the
danger to which the generality of those who had the small-pox in the
natural way were exposed, I could not but sincerely wish, with every
sensible person of the faculty, that Inoculation might become general.

A considerable share of employment in this branch of my profession
has for upwards of twenty years occurred to me; and altho’ I have
been so fortunate as not to lose a patient under inoculation, except
one child, about fourteen years ago, who after the eruption of a few
distinct pustules died of a fever, which I esteemed wholly independent
of the small-pox, yet I must acknowledge that in some cases the
symptoms have cost me not a little anxiety for the event.

Nor have the subsequent effects of this practice always been so
favourable as one could wish; and tho’ far from equalling those which
too often follow the natural small-pox; either in respect to difficulty
or number, yet they sometimes gave no small uneasiness to the operator.

It cannot likewise, it ought not to be concealed, that some of the
inoculated have died under this process, even under the care of very
able and experienced practitioners. But this number is so small, that,
when compared with the mortality attending the natural small-pox, it is
reduced almost to a cypher.

These circumstances, however, tended to discourage the operation in
some degree. Practitioners were cautious of urging a process, of whose
event they could not be certain: and parents, who were sensible enough
to observe, that though the chance was greatly in their favour, yet a
blank might cast up against them, engaged in it with hesitation.

Humanity, as well as a wish to promote the honour and advantage of the
art I profess, made me ever attentive to the improvement of this part
of my employment. Dissatisfied with the common methods, I had carefully
attended to the circumstances that seemed to contribute to the good or
ill success of this practice, in the course of my own business, as well
as to the best information I could get of the success of others.

Many facts had induced me to think that regimen, preparation, and
management would do much: that as the disease was of an inflammatory
kind, a cooling regimen must certainly for the most part be reasonable.
Some faint essays were made to try how far this sentiment might be
just. But those who are the best acquainted with the first aphorism of
Hippocrates, will be the first in justifying a cautious procedure,
where the object is no less than the life of an individual.

In this situation I first heard, and with the utmost satisfaction,
that in some parts of the nation, a new and more successful method
of inoculating was discovered, than had hitherto been practised. The
relators gave incredible accounts of the success; which was the more
marvellous, as the operators were chiefly such, as, by report, could
lay but little claim to medical erudition.

Knowing that improvements, which would do honour to the most elevated
human understandings, are sometimes stumbled upon by men of more
confined abilities; and that in medicine, as well as in every other
circumstance in life, it is our duty to avail ourselves as much as
possible of all discoveries tending to the common benefit, I embraced
every _just opportunity_ of informing myself of facts, circumstances,
and events, that either public fame, or more precise relations,
brought to me. I use the term _just opportunity_, because, if I am not
misinformed, endeavours have been used, inconsistent with equity and
candour, to rob those who are intitled to our gratitude for assisting
us in this important process, of that share of private emolument which
is their due, let their title to the discovery be ever so paradoxical.

To expose patients, even in the inoculated small-pox, to all weathers,
was a thing unheard of. To permit them through the whole progress
of the disease to go abroad, and follow their usual vocations, and
that they should neither suffer any present evil, nor experience any
disagreeable consequences, was still more surprizing; yet an infinite
number of instances have confirmed all this; and some of these
instances will appear in the sequel of this performance.

The design of this treatise is to bring the practice still one step
nearer to perfection, and lessen the ravages of a distemper, which is
not a native of Britain, but, like the plague, has been imported from
a foreign country, and demands the exertion of all the powers we are
possessed of, either to exterminate it from amongst us, which perhaps
is not practicable, or to render it less unsafe, if not wholly without
difficulty or danger.

The following directions for this purpose, are the result of an
extensive practice: and if a strong persuasion of the truth of what he
writes, founded on repeated trials and impartial observations, should
have led the author to express himself in a very sanguine manner, the
future experience of others, he trusts, will be his justification.

    Hertford, 1. Nov.
    1766.




Of the AGE, CONSTITUTION, and SEASON of the Year proper for INOCULATION.


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