except in the first or fimple stage of the diforder; but many cafes have a favourable ftate for the trial in their early period, and that opportunity may be feized with a proba bility of fuccefs. The operation is fimple, eafily executed, productive of but little pain, and attended with no kind of danger. Account of a Woman who had the Small Pox during Pregnancy, and who feemed to have communicated the fame Difeafe to the Fatus. By John Hunter, Efq. F. R. S. From the fame. Mr. Grant's Account. ON the 5th of December, 1776, Mrs. Ford had been feized with fhivering and the other common fymptoms of fever, to which were added great difficulty of breathing, and a very hard cough. Mr. Grant faw her on the 7th; and he took from her eight ounces of blood, and gave her a compofition of the faline mixture with spermaceti and magnesia every fix hours. This had operated by the 8th two or three times very gently, when most of the complaints were relieved; but the cough ftill fhaking her violently, bleeding feemed neceffary to be repeated, more particularly as he looked upon herself to be in the fixth month of her pregnancy. The medicine was continued without the magnefia. In the evening (viz. the 8th) the fmall pox appeared, which proved of a mild kind, and moderate in quantity. Its progrefs was rather flower than might have been expected; but the woman paffed through the disease in great fpirits, fitting up the greatest part of the day during the whole time, and taking only a paregoric at night, and, as occafion required, a little magnefia: thus the fymptoms were mitigated, and the cough at laft became very little troublesome. On the 25th fhe complained of a pain in her fide. Eight ounces of blood were taken away. The next day fhe was quite free from pain, and thought herself as well on the 27th as her particular fituation would admit of; after which he was not vifited by Mr. Grant till the 31ft, when the was in labour. Mr. Waftall's Letter on the fame Dec. 30, 1776, I was fent for to Mrs. Ford, a healthy woman, about twenty-two years of age, who was pregnant with her firit child. She had come out of the country about three months before. Soon after her arrival in town fhe was feized with the fmall pox, and had been under the care of Meffrs. Hawkins and Grant, who have favoured me with the particulars here annexed. I called upon her in the afternoon; the complained of violert griping pains in her bowels, darting down to the pubes. On examining I found the os tince a little dilated, with other symptoms of approaching labour. I fent her an anodoyne fpermaceti emulfion, and defired to be called if her pains increased. I was fent for. The labour advanced K 3 very very flowly; her pains were long and fevere; fhe was delivered of a dead child, with fome difficulty. Obferving an eruption all over the body of the child, and feveral of the pufules filled with matter, I examined them more particularly; and recollecting, that Dr. Leake, in his Introductory Lecture to the Practice of Midwifery, had obferved, that it might be neceffary to enquire, whether thofe adults who are faid totally to efcape the fmall pox have not been previously affected with it in the womb, I fent a note to Dr. Leake, and likewife to Dr. Hunter, in hopes of afcertaining a fact hitherto much doubted. Dr. Leake came the fame evening, and faw the child. Dr. Hunter came af terwards, with Mr. Cruickshanks, and examined it; alfo Mr. John Hunter and Mr. Falconer; who all concurred with me, that the eruption on the child was the fmall pox. Dr. Hunter thought the eruption fo like the fmall pox that he could hardly doubt; but faid, that in all other cafes of the fame kind, that he had met with, the child in utero had efcaped the contagion. Fom Mr. Grant's Notes. The eruption appeared on Mrs. Ford in the evening of the 8th of December, and he was delivered the 31st, that is, twenty-three days after the appearance of the erup cafe, with all its circumstances, has inclined me to confider it with fome attention. There can be no doubt but that the mother had the fmall pox, and that the eruption began to appear on the 8th of December: alfo, that it went through its regular ftages, and that on the 31ft, viz. twentythree days after the firft appearance of the eruption, the woman was delivered of the child, who is the fubject of this paper. Secondly, The distance of time when the had the fmall pox before delivery, joined with the stage of the difeafe in the child when born, which probably was about the fixth or feventh day of the eruption, viz. about fifteen or fixteen days after the beginning of the eruption on the mother, perfectly agrees with the poffibility of the infection's being caught from the mother. Thirdly, The external appearance of the puftules in the child was perfectly that of the small pox, as must have appeared from the relation given in Mr. Waftall's letter. Most of the pufules were diftin&t, but fome were blended or united at their bafe. The face had the greateft number; and thefe were in general the most indiftinct. They were fomewhat flattened with a dent in the middle *. So far were the leading circumftances and external appearances in favour of their being the variolous eruption; but although these leading circumstances and external appearances were incontrovertible, yet they were not an abfolute I endeavoured to take fome matter upon the point of two lancets; but not having an opportunity of making an experiment myfelf, I gave them to two gentlemen, who, I imagine, were afraid of inoculating with them. proof proof of this being the genuine fmall pox; therefore I must be allowed to confider this fubject a little further, and fee how far all the circumstances correfpond or are fimilar to the true fmall pox. In the fmall pox we have a previous fever, in place of which, in the prefent cafe, we have no information but that of the mother's having had the fmall pox within fuch a limited time as may favour the poffibility of infection in the womb ; may prefume, that the child muft have had confiderable fever preceding fuch an eruption, of whatsoever kind it was. In the fmall pox the eruption goes through pretty regular tages in its progrefs and declenfion, which circumftances we know nothing of in the prefent cafe; but even this fever, the eruptions, and their progrefs, are not abfolutely proofs that the diforder is the fmall pox when it is caught in the common and natural way: and in proof of this affertion it may be obferved, that practitioners every now and then are mistaken. It may be asked, what is the true characteristic of the fmall. pox that by which it differs from all other eruptions that we are acquainted with? The moft certain character of the fmall pox, that I know, is the formation of a flough, or a part becoming dead by the variolous inflammation; a circumftance which hitherto, I believe, has not been taken notice of. This was very evident in the arms of thofe who were inoculated in the old way, where the wounds were confiderable, and were dreffed every day; which mode of treatment kept them from fcabbing, by which means this procefs was eafily obferved; but in the prefent method of inoculation it is hardly obfervable: the fore being allowed to fcab, the flough and fcab unite and drop off together. The fame indiftin&tnefs attends the eruptions on the fkin; and in thofe patients who die of, or die while in, the difeafe, where we have an opportunity of examining them while the part is diftinct, this flough is very evident. This flough is the caufe of the pitt after all is cicatrized; for it is a real lofs of fubftance of the furface of the cutis: and in proportion to this flough is the remaining depreffion. The chicken pox comes the nearest in external appearance to the fmall pox; but it does not commonly produce a flough. As there is generally no lofs of fubftance in this cafe, there can be no pitt. But it fometimes happens, although but rarely, that there is a pitt in confequence of a chicken pock; then ulceration has taken place on the furface of the cutis, a common thing in fores. In the prefent cafe, befides the leading circumftances mentioned in the cafe of the mother, correfponding with the appearances on the child, and the external appearances themselves, we have in the fullest fenfe the third and real or principal character of the fmall pox, viz. the flough in every puftule; from all which, I think, we may conclude, that the child had caught the fmall pox in the K 4 womb; womb; ar at least a disease, the effects of which were fimilar to no other known disease. In opening the bodies of thofe who had either died of, or died while under, the small pox, I always examined carefully to fee whether any internal cavity, fuch as the afphagus, trachea, ftomach, inteftines, pleura, peritoneum, &c. had eruptions upon them or not, and never finding any in any of thofe cavities, I began to fufpect, that either the fkin itfelf was the only part of the body fufceptible of fuch a fimulus; or that the fkin was fubject to fome influence to which the other parts of the body were not fubject, and which made it alone fufceptible of the variolous fimulus. If from the firft caufe, I then concluded it must be an original principle in the animal economy. If from the fecond, I then fufpected, that external exposure was the cause; and I was the more led into this idea, from finding that these eruptions often attack the mouth and throat, two expofed parts; add to which, that we generally find the eruptions most on the expofed parts of the body, as the face, &c, With these ideas in my mind, I thought I faw the most favourable opportunity of clearing up this point. I therefore very attentively examined most of the internal cavities of this child; fuch as the peritoneum, pleura, trachea, inside of the fophagus, ftomach, intefines, &c. but obferved nothing uncommon. I have already obferved, that in this child the face and extremities were the fulleft, fimilar to what happens in common; from all which I may be allowed to draw this conclufion, that the fkin is the principal part which is fufceptible of the vario lous fimulus, and is not affected by any external influence whatever. The communication of the fmall pox to the child in the womb may be fuppofed to happen in two ways; one by infection from the mother, as is fuppofed in the above cafe; the other by the mother's having abforbed the fmall pox matter from fome other perfon, and the matter being carried to the child from the connection between the two, which we may fuppofe done with or without first affecting the mother. Teftimonies and opinions are various with refpect to these two facts. Boerhaave feems to have been led by his experience to think that fuch infection was not communicable: for we find that he attended a lady, who having, in the fixth month of her preg nancy, had the confluent small pox, brought forth at the regular period a child, who fhewed not the leaft veftige of his mother's disease. His commentator, however, Van Swieten, fupports a different opi, nion (fee his comment, vol. v.) He quotes a cafe from the Philofophical Transactions, vol. xxviii, No 337. p. 165, of a woman, who, having just gone through a mild fort of fmall pox, was, by means of a ftrong dofe of purging phyfic, thrown into a miscarriage, and brought forth a dead female child, whofe whole body was covered with variolous pufules full of ripe matter, but this hiftory is founded only on the relation of a midwife to a clergyman, and therefore not abfolutely abfolutely to be depended upon as accurately stated: however, it is more than probable, that there was a cafe as defcribed; and that there were really eruptions on the fkin of the child fimilar to the fmall pox. "fon afferted, that he difcovered “evident marks of the fmall pox, " which The must have gone "through in the womb; and "the fame physician pronounced, "that this child would be free "from future infection. After 46 Van Swieten likewife mentions" four years her brother was inowhat Mauriceau relates of him- "culated; and Dr. Watson obfelf. This author teftifies, that "tained permiffion of the parents he had often heard his father and to try the fame experiment on mother fay, that the latter, when "the girl. The operation was big with him, and very near her "performed on both children in time of delivery, had a painful" the fame manner; and the pus attendance on one of her children, who died of the fmall pox on the feventh day of the eruption; and that on the day following the death of this child, Mauriceau came into the world, bringing with him five or fix true puftules of the fmall pox. It does not appear, however, from this recital, whether or not Mauriceau paffed through life free from any pofterior infection; but admitting that this eruption of Mauriceau's was truly the mall. pox, yet I should very much doubt his having caught it from the child who died of it; as it fhould feem that the puftules of Mauriceau were of the fame date with thofe of the child who died. Van Swieten appeals to a more recent cafe, which had been reported to him by perfons of great credit, and is recorded in the Phil. Tranf. vol. xlvi. p. 235. "A woman, big with child, having herself long ago had the "fmall pox, very affiduoufly nurfed a maid fervant during "the whole process of this dif❝ease. At the proper time fhe "brought forth a healthy female child, in whose skin Dr. Wat "ufed in both cafes was taken "from the fame patient. The event, however, was different; for the boy had the regular "eruption, and got well; but "the girl's arm did not inflame "nor fuppurate, On the tenth day from the infertion of the matter, he turned pale fud"denly, was languid for two "days, and afterwards was very "well. In the neighbourhood of " the incifion there appeared a " puftule, like those puftules that 66 we fometimes obferve in perfons "who, having had the difeafe, " attend patients ill of the small "pox." 66 In the epiftles of T. Bartholinus, cent. ii. p. 682, there is the following history. "A poor woman, aged thirty-eight years, pregnant, and now near the time of delivery, was feized with the "fymptoms of the fmall pox, and "had a very numerous eruption. "In this ftate fhe was delivered "of a child, as full of variolous puftules as herself. The child "died foon after birth; the mo"ther three days afterwards." Van Swieten infers, that the mother and the child were in this cafe |