Читать книгу: «The Present Method of Inoculating for the Small-Pox», страница 7

POSTSCRIPT

Many instances might be produced of unjust charges against Inoculation, alledged by those who have opposed the practice: but I should not at this time, and in this country, where the prejudices are pretty well removed, publish any case of the following kind, if the inadvertence of a translator had not made it necessary, in defence of my own character.

Dr. Baylies, an ingenious and learned English physician, had been called from Dresden to Berlin, in 1774, to inoculate some families of persons of condition; and the King of Prussia so far approved the practice, as to appoint him his physician.

After the most perfect success with several patients, a child who had been inoculated by him, was, about two months after, seized with a distemper which proved mortal, and the physicians who attended, asserted that the child died of the small-pox.

In vindication of his own character, and the practice of Inoculation, Dr. Baylies had the case of this child stated, and copies of it were transmitted to Dr. Watson, Dr. Archer, and myself, requesting our separate opinions.⁷

The ungenerous treatment Dr. Baylies met with in this, and other respects, induced him to publish a tract on the occasion, in French, in which our opinions were inserted; and he was so obliging as to send me one of them.⁸

I was greatly surprized to find what I had written, so erroneously translated, as to misrepresent my meaning in a most essential point. I therefore wrote to Dr. Baylies, and complained of the injury, requesting that he would endeavour to do me justice, in the manner he thought most effectual.

Notwithstanding this was generously complied with by Dr. Baylies, as far as he was able, I have reason to think, that some of the first copies are dispersed, and remain uncorrected; which I hope will be deemed a sufficient reason for publishing the following correspondence.

CASE

Augustus de Blumenthal, a healthy child, five years old, on the 21st of November 1774, was inoculated with matter taken from an inoculated patient, who was loaded with the small-pox, and is greatly marked by it. On the 11th and succeeding days from the operation, the fever and eruptions regularly followed. The pustules appeared on different parts over his whole body, were more numerous than they generally are from inoculation, and maturated, dried, and fell off as they ought to do, and as well as those of his brothers and sister, who were inoculated at the same time, and treated in the same manner from the beginning of the fever, till the disease was over. He was then repeatedly purged, as is usual in such cases, and continued well for above six weeks afterwards; making no complaints till the last day of January 1775, when, while he was at dinner, he complained of being cold, yet afterwards amused himself at play with his companions, and in the evening said that his legs were very weak.

Wednesday the 1st of February, and 2d day of the illness, he arose in good humour, at noon he eat with appetite, but less so at night: during the whole day, at times, he complained more or less of weakness and uneasiness in his legs, sometimes walked about, and sometimes lay down on the sopha, and the succeeding night was restless and uneasy.

Thursday the 2d day of the month, and 3d of the disease, a physician was called, who, finding his pulse agitated, gave it as his opinion, that there was something mixed in his blood which ought not to be there, though he could not say what; and in the evening, to allay the agitation, prescribed him some powders.

Friday, Saturday, and Sunday, the 4th, 5th, and 6th of the month, and 5th, 6th, and 7th of the illness, he shewed great lowness and dejection of spirits, had great weakness in his legs, complained of giddiness, and was embarrassed in his head; yet nevertheless, he had some, though but little, stomach to his food, and during all these three days, a slight looseness, the discharges by which were of a green colour.

Monday the 7th of the month, and 8th of the disease, a large round worm came from him, and he eat with good appetite, though the disorder so increased, that he was confined to his bed, and in the evening became delirious; for the relief of which, a blistering plaister was applied between his shoulders.

Tuesday the 8th of the month, and 9th of the disease, his pulse in the morning was thought to be better; but in the evening the disorder increased, he was again delirious, and blisters were applied to the calves of his legs. In this condition, being drowsy and watchful by turns, at uncertain and irregular times, sometimes answering questions with propriety, and at other times irrationally, he continued from Tuesday till Saturday the 12th of the month, and 13th of the disease, when in the evening, the surgeon in giving him a glyster, perceived some small red spots like flea-bites, to appear on his posteriors, but made no mention of it at that time. At midnight the physician again visited his patient, and found him excessively red and delirious, with every appearance of a violent impetus of blood to his head, and with involuntary contractions or drawings in the muscles of his arms and legs, upon which he ordered the surgeon to apply four leeches behind the ears. While they were drawing, a slight red ebullition was observed upon the neck, which after bleeding disappeared, and the child lay two hours quiet; but then the uneasiness returned, and before morning he was three times alternately affected with accessions of cold and heat, and had cramps and drawings in his arms and legs, like those before described.

Sunday the 13th of the month, and 14th of the disease, in the morning his anxiety and restlessness perfectly left him, and in the course of the day, the delirium so diminished, that about nine in the evening he was quite sensible; when the surgeon being ordered to repeat the glyster, observed that the small red spots which he had before taken notice of, without mentioning, were some of them increased in magnitude to the size of lentils.

Monday the 14th of the month, and 15th of the illness, early in the morning the attendant physician again examined the eruptions, and said that he not only found their number great, but that many of them on the back were broke and subsided while there were others under the skin perceptible to the touch; and a very few on the face and neck, though flat, were round and reddish in their circumference, and white on their tops, so resembling eruptions of the small-pox, that he suspected the distemper could be no other: to put the matter out of doubt, the physician, that had inoculated the child, was called in; who, when he came, observed two or three flat eruptions on the face, to be round, edged with a reddish colour, and whitish on the top, as is above described; but on uncovering the body, and examining the rest, the chief of which were situated on the back, he looked on them to have more the appearance of burns or scalds than the small-pox. They were of irregular forms, like flaccid and transparent vesicles, implete with a reddish watry fluid, with a visible blackness underneath. He could not from their appearance, considered from the time of their eruption, and the early fluidity of their contents after they appeared, see any reason to think them at all variolous, especially as the child had so evidently had the disease from inoculation under his own eyes.

Tuesday the 15th of the month, and 16th of the disease, the physician, who had inoculated the child, called again to see him, when he was informed, that he had totally lost all power of swallowing, and that it was suspected to arise from pustules in the throat. He then went to the child’s bedside, when he not only found many of the before described bladdery eruptions broken, and their water discharged, but all those that were not so, more flaccid and empty than the day before.

Wednesday the 16th of the month, and 17th of the disease, there was very little or no observable change in the morning from the circumstances which had attended the preceding day; yet some glimmering hope was conceived of the child’s recovery; but about two in the afternoon, the melancholy scene was closed by an easy death.

Thursday the 17th of the month, and the morrow after the child’s death, the physician that had inoculated the child called again, to inquire of the father if any thing more, that was material, had been observed between the time he had last seen the child, and the hour of his death, when he told him that there had not, but that since his death the corpse had been inspected and opened, in the presence of four eminent gentlemen of the faculty in Berlin, and that it had been reported to him as follows.

That the external spots, which had been covered with the before described bladders, had many of them a blackish, or gangrenous appearance under the skin; while others that were extremely small, round and flat, seemed to have in them a small quantity of unconcocted matter.

That on one out of the four places on the arms, in which the infection had been inserted in the inoculation, there was found adhering a small dry scab.

That the throat was perfectly free from any pustulary appearance; and that all the viscera were quite sound, and shewed no sign of any disease, either external or internal.

But that on opening the skull, there were, in the lower and back part of the head, four ounces of extravasated water or serum, except which, nothing deviated from a healthy and natural state.

Query. Was the disease above described, the natural small-pox? The effect of any variolous matter left in the blood, in consequence of the previous inoculation? Or, were the pustulary eruptions, which shewed themselves on the 12th day of the disease, a critical discharge of a putrid or other kind of fever?

London, April 11, 1775.

S I R,

I HAVE carefully perused the case you have communicated to me, and am of opinion, that the disease you have described was not the small-pox.

The cold fit which preceded the other complaints, is what usually happens at the commencement of the small-pox in common with other fevers; with this exception, I do not find one symptom during the whole illness, that corresponds with the well known progress of that disease.

The eruptions (on which I presume the suspicion of the small-pox was founded) differed from that distemper in every essential point, viz. The time and manner of their appearance; the parts they occupied; and their form and progress. Neither am I of opinion that the disease was the effect of any variolous matter left in the blood, in consequence of the previous inoculation.

That the natural and inoculated small-pox, as well as other diseases which form critical discharges on the skin, may sometimes be succeeded by boils or breakings out, is well known; but these follow very soon, are free from danger, and easily cured by gentle purges. Now in the case before me, I find the patient passed through the inoculated disease, in a regular, complete, and satisfactory manner, and continued well for six weeks after, making no complaint: after which he was seized with a disease that I have not the least doubt was a fever of the putrid kind; but I do not think that the pustulary eruptions can with propriety be deemed critical, as they did not terminate the disease; I rather esteem them to have been marks or tokens of great malignity and danger.

In the course of my whole practice, which it is well known has been extensive, I never knew a single instance of any one having the natural small-pox, after having been inoculated; nor have I ever known any person to have the disease a second time in the natural way.

I shall not pretend to decide on what may have happened to others; but what I have said is true, so far as relates to my own experience.

The report of the gentlemen who opened the body, affords no material information.

The appearance of the spots, is such as might be reasonably expected on any person who died of a malignant fever. Dry scabs frequently remain on the inoculated parts, for some months after the disease.

T. DIMSDALE.

To Dr. Baylies, Physician and

Privy-Counsellor to his Prussian

Majesty at Berlin.

London, March 10, 1777.

Dear Sir,

PLEASE to accept my thanks for a very polite letter and a book, both which I received from my learned friend, Dr. Watson. But I am greatly chagrined to find, on the perusal of the French translation of my answers to the queries, that by the insertion of words, not to be found in what I wrote, not only the sense of my answer is perverted, but I am made to speak what is not true, and to give an opinion contrary to my own sentiments, and the experience of every one in the least acquainted with the small-pox.

What follows will convince you, Sir, that my complaint is well founded, and I confide in your honour, for taking the most effectual steps to prevent the injury my character would sustain, if the mistake should not be rectified.

You will please to observe, that at the conclusion of the case transmitted to me, there were three queries, to each of which I gave distinct answers. The third query is: “Or were the pustulary eruptions that shewed themselves on the 12th day of the disease, a critical discharge of a putrid, or other kind of fever?” In my answer, having first remarked that the patient passed through the inoculated disease in a regular manner, I say in reply to the above-mentioned query.

“After which he was seized with a disease, that I have not the least doubt was a fever of the putrid kind; but I do not think that the pustulary eruptions can with propriety be deemed critical, as they did not terminate the disease: I rather esteem them to have been marks or tokens of great malignity and anger.”

The French translation stands thus.

Q. “Ou les pustules qui ont paru le 12me jour de la maladie ont elles été l’evacuation critique d’une fievre putride, ou d’une autre espece de fievre?”

Reponse. “Ce n’est qu’au bout de ce tems qu’il a été attaqué d’une maladie, que je crois, sans balancer, avoir été une espece de fievre putride. Il ne faut cependant pas, selon moi, considerer les pustules de la petite vérole, comme une crise, parce qu’elle ne leve pas la maladie; au contraire je les regarde comme les marques d’une grande malignité et d’un grand danger, ouse trouve le patient.”

The perusal of the above will certainly satisfy you of the justness of my complaint, and I shall wait with impatience for your answer, which I make no doubt will be such as is consistent with your honour and character.

It gives me real concern to find, on reading the book you favoured me with, that you meet with such opposition in the practice of inoculation, notwithstanding it is so apparently beneficial to mankind; and particularly, that gentlemen of the first rank in the medical profession, should find it so difficult to divest themselves of unreasonable prejudices: but in the end truth will prevail.

I am, Sir,

Your most obedient humble servant,

T. DIMSDALE.

A Copy.

Berlin, 24th March, 1777.

Dear Sir,

YOUR kind letter of the 10th instant, for which I owe you the greatest obligation, arrived here by the last post; and I am truly grieved to find so material a perversion and misrepresentation of your just opinion on the case of young Blumenthal, as is made in the French translation of it. In apology for which, I have only to say, that as I am not sufficiently master of the French to publish in that language, I put my English manuscript into the hands of a gentleman, an intimate friend, who is distinguishedly eminent for his knowledge, both of French and English, and who was formerly, for some time, a most eminent preacher, in London, to the French refugees; so that I had no doubt of his capacity or attention to do the whole justice, and therefore trusted it to him, with a most strict injunction, whatever liberties he took in other parts, to be particularly exact in translating the letters, and quotations, without varying the sense of them in any part, for the sake of being florid. And as this gentleman lives in Dresden, where the book was printed, and not at Berlin, I left it to him to complete it, without any controul, whereby, till I received your letter, I had not the least knowledge of the fault you so justly complain of having been committed; and you may, Sir, be very certain, that if I had, I should not have sent an exemplary of it to you, in hopes of its passing unobserved. Hence I trust, that you will be fully convinced, it was quite unintentional; and in order to make you the utmost reparation, and prevent any injury to your judgment, in the opinion of the public, from the error committed, I beg leave to inform you, that as yet the French edition of the book has not been published in this country, and that none of them have been disposed of, except a few I have distributed gratis to my friends, to all of whom I will next week send a fresh printed leaf, which is now in the press, of the pages No. 51, and 52, wherein the fault is fully corrected, and which you shall be sure to have in a post or two after you receive this. I have the pleasure to add, that in the German translation, which has been sometime published, and which are all sold, the error has not been committed, and the translation of your letter is literal and exact. And as both the German and French are but translations of the original, further to secure the whole from being misunderstood, if you think that the pamphlet is sufficiently interesting, and worthy of being printed in English, I will send the manuscript by the first opportunity to London, and order it to be printed under the inspection of any person you shall recommend to me for that purpose. Flattering myself, that this answer to your last, will be fully satisfactory to you,

I am, with the most true esteem and respect,

Dear Sir,

Your most obliged,

And most obedient humble servant,

WILLIAM BAYLIES.