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oculation has derived some advantage from the choice of the matter employed in it; but, from what has been observed in 595, it must appear very doubtful if any choice be necessary, or can be of any benefit in determining the state of the disease.
612. It has been supposed by some, that inoculation has an advantage, by introducing a small portion only of the contagious matter : but this rests upon an uncertain foundation. It is not known what quantity is introduced by the common infection, and it may be a small quantity only. Although it were larger than that thrown in by inoculation, it is not ascertained that the circums stance of quantity would have any effect. A certain quantity of ferment may be necessary to excite fermentation in a given mass; but that quantity given, the fermentation and assimilation are extended to the whole mass; and we do not find that a greater quantity than is just necessary, either increases the activity of the fermentation, or more certainly secures the assimilation of the whole. In the case of the small-pox, a considerable difference in the quantity of contagious matter introduced, has not discovered any effect in modifying the disease.
613. Purging has the effect of diminishing the activity of the sanguiferous system, and of obviat. iêng its inflammatory state: It is therefore pros bable, that the frequent use of cooling purgatives is a practice attending inoculation which may be of considerable advantage; and, probably, it is also useful by diminishing the determination to the skin. It appears to me, that mercurials and antimonials, as they are commonly managed, are use. ful only as they make a part of the purging course.
614. It is probable, that the state of the small. pox depends very much upon the state of the eruptive fever, and particularly upon moderating the inflammatory state of the skin; and; therefore, it is probable, that the measures taken for moder: ating the eruptive fever and inflammatory state of the skin, afford the greatest improvement which has been made in the practice of inoculation. The tendency of purging, and the use of acids for this purpose, is sufficiently obvious; and upon the same grounds, we should suppose, that blood-letting might be useful; but probably this has been omita ted, for the same reason that perhaps might have led to the omission of other remedies also ; which is, that we have found a more powerful and ef. fectual one in the application of cold air, and the use of cold drink. Whatever doubts or difficulties our theory might present to us on this subject; they may be entirely neglected, as the practice of Indos: tan had long ago, and the practice of this country has lately, by a large and repeated experience, as:
certained the safety and efficacy of this remedy: and as it may and can be more certainly employed with · the practice of inoculation, than it can be in cases
of common infection, it must give a singular ad vantage to the former, ' !
· 615. After the eruption, when a few pimples only have appeared on the face, the continuing the application of cold air, and the employment of purgatives, has indeed been the practice of many inoculators: but, I think, these practices cannot be said to give any peculiar advantages to inoculation; for when the state of the eruption is determined, when the number of pustules is very small, and the fever has entirely ceased, I hold the safety of the disease to be absolutely ascertained, and the fur. ther use of remedies entirely superfluous. In such cases, I judge the use of purgatives to be not only unnecessary, but that they may be often hurtful.
616. I have thus considered the several cir. cumstances and practices accompanying inoculation, and have endeavoured to ascertain the utility and importance of each. Upon the whole, I hope I have sufficiently ascertained the general utility and great advantage of this practice, especially consist. ing in this, that if certain precautions, preparations, and remedies, are of importance, all of them can be employed with more certainty in the practice of inoculation, than in the case of common infection. • It remains now, that I should offer some remarks on the conduct of the small-pox, as received by infection, or even when, after inoculation, the symptoms shall prove violent. The latter sometimes happens, although every precaution and remedy have been employed. The cause of this is not well known; but it appears to be commonly owing to a disposition of the fluids to putrescency, But, however this may be, it will appear, that not only in the case of common infection, but even in that of inoculation, there may be occasion for studying the conduct of this disease, in all its poss sible varying circumstances.
617. When, from the prevailing of small-pox as an epidemic, and more especially when it is known that a person not formerly affected with the disease has been exposed to the infection, if such person should be seized with the symptoms of fever, there can be little doubt of its being an attack of the small-pox; and therefore he is to be treated in every respect as if the disease had been received by inoculation. He is to be freely exposed to a cool air, to be purged, and to have cooling acids given liberally:
618. If these measures moderate the fever, nothing more is necessary : but if the nature of the fever attacking a person be uncertain ; or if, with suspicions of the small-pox, the symptoms of the fever be violent ; or even if, knowing the disease to be small-pox, the measures mentioned (597) shall not moderate the fever sufficiently; it will be proper to let some blood: and this will be more especially proper, if the person be an adult, of a plethoric habit, and accustomed to full living.
619. In the same circumstances, we judge it will be always proper to give a vomit, as useful in the commencement of all fevers, and more especial, ly in this, where a determination to the stomach appears from pain and spontaneous vomiting.
620. It frequently happens, especially in infants, that, during the eruptive fever of the small.pox, convulsions occur. Of these, if only one or two fits appear in the evening preceding the eruption, they give a favourable prognostic of a mild disease, and require no remedy; but if they occur more early, and be violent and frequently repeated, they are very dangerous, and require a speedy remedy. For this purpose, bleeding is hardly ever of service; blistering always comes too late; and the only remedy I have found effectual, is an opiate given in a large dose.
621. These are the remedies necessary during the eruptive fever; and if, upon the eruption, the pimples upon the face be very few and distinct, the disease is no further of any danger, requires