SOME REASONS GIVEN AGAINST AN OPINION THAT A person infected with the Small-Pox may be cured by Antidote without incurring the Distemper:
WITH An attempt to explain the manner of the propagation and eruption of the Small-pox from the practice of Inoculation; and why this distemper, taken, by common infection, in the natural way, proves so much more fatal than that which is given by Inoculation.
BY THOMAS FREWEN, M. D.
LONDON: Printed for J. WILKIE, at the Bible, in St. Paul's Church-Yard.
MDCCLIX.
TO THE ROYAL SOCIETY.
IN the following pages are contained some reasons why the contagious poison of the Small-pox, received into the human body, cannot be extinguished, or expelled by any Antidote, or other means than what nature effects in producing the distemper. I have also endeavoured to explain the manner [Page vi]of the propagation and eruption of the Small-pox from the practice of inoculation; and why this distemper, taken, by common infection, in the natural way, proves so much more fatal than that which is given by inoculation.
The reasons that have induced me to present you with this short account from the press, were by no means owing to a consciousness of my having cleared up these matters to any degree of [Page vii]certainty; but because I do not remember to have seen any thing of this kind attempted before; and in hopes that my endeavours may be the means of employing the thoughts of others to explain these laws of Nature to a greater degree of perfection.
These inducements have encouraged me in this Address to your learned Society; to which the World will ever be indebted for the improvement of Art and Science; [Page viii]and I hope they may be admitted, as a necessary apology, for this presumption.
Some reasons why the Contagion of the Small-Pox, received into the human body, cannot be extinguished or expelled by any Antidote, or other means than what Nature effects in producing the distemper.
THAT most celebrated Professor, the learned Dr. Boerhaave, was of opinion that there is to be found out, in Nature, such a kind of medicine as would have the specific power of extinguishing, or eradicating the Contagion of the Small-pox, from a body infected, without permitting any eruption of the pustules; in the manner that other poisons are cured by [Page 2]peculiar Antidotes *. Some other Physicians, also, revering the sentiment of this great man, have pretended to support the same opinion.
But, as no improvements have yet appeared to have been made, at least nothing material has been advanced, by the advocates for this enquiry, notwithstanding the Doctor gave his reasons for his opinion, and explained his suggestions as far as he could, it is probable, therefore, that the unsurmountable obstacles which have arisen from the consideration of this contagious venom, and the different manner of it's operations, have, hitherto, discouraged all the attempts that may have been since made towards [Page 3]the discovery. And, indeed, I am inclined to think, that, had the Doctor written on this particular subject, after the practice of inoculation grew to be so much used in Europe, as it now is, he would, from the new discovery of the operation of this morbific taint, have established opposite reasons to an opinion, which, many years ago, he thought uncontrovertable. For so conspicuous in experiment, as this is, could never have escaped his sagacious observation; which proves that the least particle of variolous pus, containing the very seeds of contagion, by enflaming and corroding an external solid part, produceth a kind of Carbuncle; whereby the natural operation of this contagious infection is demonstrated to the greatest degree of certainty, [Page 4]and silences all hypothetical notions of its contaminating the fluids only, by explaining (as I shall endeavour to do more hereafter) that the morbific effluvia of this disease received by inspiration, in the ordinary way of infection, by inflaming and corroding, in like manner, such internal parts as are more immediately subservient to the vital purposes, are therefore more likely to be productive of the most dangerous consequences.
The method, however, given, for attaining to the knowledge of this discovery, is, after the infection of the Small-pox is taken, to prevent inflammation, so that a suppurated matter may not ensue: and this is proposed to be effected, by treating the distemper, like other inflammatory cases, in the beginning; [Page 5]and giving such correcting medicines, as, by gently diluting and dissolving the blood, may carry off the cause by the convenient outlets; and so cure the disease, while in it's first state, without coming to suppuration.
For this purpose the Doctor mentions a preparation of Mercury and Antimony, brought to a great degree of penetrability, and rendered intirely destitute of all Acrimony by dissolution, from whence, he says, there ariseth almost such a kind of medicine, and by which he hath seen some good effects.
The Aethiops Mineralis hath been likewise proposed as a specific medicine, for the same intention, by Dr. Lobb, who hath given some instances of the Small-pox being, [Page 6]in his judgment, prevented by the timely use of it. But as there have been frequent examples of people escaping this distemper, who had been supposed to be in the greatest danger of taking it; it is not improbable but that some of these may have been attributed, by mistake, to such preventive means as had been used on those occasions.
Dr. Cheyne also hath pronounced that the best Antidote in nature against the Small-pox, and the Plague itself, is Aethiops Mineralis and Cinnabaris Antimonii, taken, made up into boluses, twice or three times a day, and washed down with Orange Whey. Of the efficacy of which, he says, he has had some successful experience. For the confluent Small-pox, he [Page 7]adds, is but a miniature of the Plague, and both are curable in good habits.
Many more writers (some of which are of great eminence) have touched also upon this matter, as the sentiment of Boerhaave, but without presuming any further; well knowing that an affair of this nature can admit of no alternative, and that it is to no manner of purpose to pretend to defend by argument what cannot be sufficiently warranted by experience. For such particularities in opinion have been oftentimes ridiculed, in men of learning, as the effects of mere whim and chimera.
But the character of Boerhaave is too sacred for reflection, as he certainly had no design to impose on the judgment of others by a [Page 8]prediction of this sort, which was grounded, probably, on such Speculations in Chemistry as are not easily to be explained on mechanical principles.
Dr. Mead *, however, could not pass over this opinion of his learned friend without wondering how he could be induced to hope that some time or other a specific Antidote would be found against the contagious poison of the Small-pox; that is, by which it would be so thoroughly destroyed, that, tho'it had been received into the body, it could not produce the disease. For, continues he, the elements of things are so certain, and so well established by the permanent laws of Nature; that whosoever would endeavour to change them, would [Page 9]act like those Philosophers by fire (as they stile themselves) who labour hard to transmute the baser metals into gold; and when continual disappointments have convinced them of the vanity of their hopes, actually extract gold out of the purses of the ignorant and credulous by the fumes of their charcoal *.
In an affair of this kind, it is undoubtedly the safest and truest way to consult nature herself, as a divine principle, diffused throughout the creation, acting in all bodies by certain properties which are productive of certain effects. And we may consider her in a vast variety of senses, as she doth nothing in vain; attempts always to preserve [Page 10]herself; cures all diseases; and acts upon unerring rules in all her ways. Hence we observe in Fevers, particularly those of the eruptive kinds, the most surprising commotions and conflicts, which serve to throw off the morbific matter by various ways, for the relief of the Patient; and, in these cases, especially, she is to be nicely observed, and followed with the greatest care; because any counteracting means would obstruct her first design, and make her proceed upon other different principles, which would consequently beattended with very different effects.
It ought to be considered, therefore, whether a specific antidote against the contagious taint of the Small-pox (if such an one were discoverable) would not be likely [Page 11]to do more hurt than good, by preventing a distemper, which, perhaps, was intended by nature, as Dr. Gilchrist observes, for a drain to clear the constitution of some gross humours, which, if not carried off in this way, would bring on other diseases. The same Gentleman supports this opinion by observing that those Children who had had the Small-pox by inoculation in Scotland were uncommonly healthy; which he supposes to be owing to this cause, that the Fever in the Small-pox, communicated in the infant state, not only destroys or expells the latent seeds of diseases, before they are, by time and accidents, perfected, and put into action; but causes such an alteration of the humours as may make them less susceptible of any morbid [Page 12]impressions: And the vessels being so accustomed, before they become rigid, to certain motions and extensions, the body is rendered, ever after, more passive to the impulses of any subsequent distemper. This, he maintains, is agreeable to experience; for one who has suffered an acute illness will bear sickness better than another, who never had the like distemper, and be less overcome by it *.
Hippocrates calls nature the great physican; and our judicious Sydenham says, that a disease is nothing more than an effort of nature to throw off the morbific matter for the health of the patient; which Dr. Mead has observed to be no [Page 13]where more particularly verified than in those envenomed Fevers, in which the violence of the distemper breaks out on the Skin either in the form of pustules, carbuncles, or bubos. And hence it seems pretty plain that no art can abrogate the law of nature, by the prevention of those kind of diseases which happen from contagion.
Those corpuscular effluvia of the Small-pox, or particles which fly off from distempered bodies, and, mixing with the juices of others, occasion the same disease, are produced from a matter differing from all other poisons, and liable to cause inflammation in a greater or lesser degree, according to the constitutional state and condition of those that receive them: and some miserable cases of the Small-pox [Page 14]have shewed us instances where the whole texture of the blood has been so broken and dissolved, that the crassamentum, after it had stood a while to become cold, could but just hold together. Yet, notwithstanding, there have been some instances where this poison hath given so little disturbance, as scarcely to introduce any perceivable lentor on the blood, at least not enough to obstruct it in the capillary Vessels: And we have several times remarked where it has been applied by inoculation, that if it had not been for it's immediate action on a solid part, it would have proved insufficient even to show the characteristick marks of the Small-pox.
Therefore it is not altogether improbable but that this contagious venom may operate by various [Page 15]ways; sometimes by coagulating the blood; at others by dissolving it; and sometimes by corroding the solid parts themselves: And this may be owing, perhaps, to such natural causes as are not within the reach of human penetration. Which considerations, notwithstanding the deference I pay to Dr. Boerhaave's extraordinary merit and abilities, have induced me to question, even, the bare possibility of such a discovery. But, to go on.
The Doctor intimates that the bite of the Scorpion, which was formerly supposed to be certain death, is now cured by the application of the bruised Scorpion, or the oil of it, and concludes that all poisons have their antidotes; and, therefore, why may not a specific medicine be found out of such a [Page 16]nature, that, being diffused all the body over, after the variolous infection is received, may introduce contrary properties, and thereby extinguish the distemper in the beginning, before those effects are produced which must, otherwise, necessarily follow? For what Physician, says he, in a Pleurisy, Quinsy, &c. would wait for a cure by suppuration, when daily experience convinces us that these distempers are regularly cured without it? and why may not the inflammation be carried off, as well, in the first stage of the Small-pox, as in other inflammatory diseases, and so prevent its coming to suppuration at all?
To this, it may be said, that the general method of cure in Pleurisies, Quinsies, and other inflammatory [Page 17]distempers, which are neither contagious, nor of the eruptive kinds, proves insufficient to prevent the return of them, as often as the sudden changes and alterations of the weather, different seasons of the year, and many other accidental causes may happen to produce them. But, it is not so, in regard to the Small-pox; a disease which is propagated by it's own contagion only, without any other antecedent cause; and where a determinate length of time brings on every thing according to it's stated periods; so that nature, in doing her part, is a most certain guide to the Physician for the doing of his. Besides it is evident that the venom of this distemper can infect us but once; insomuch that that pabulum in our bodies, [Page 18]which is productive of this disease, being totally taken up by the contagion it hath received, is thereby expunged and eradicated, so that there remains nothing, afterwards, on which this morbific matter can have any further effect. And, indeed, in this sense, it may be truly said that the Small-pox is it's own antidote, by protecting all that undergo it from any future attack.
It may be granted how extreamly difficult it is to clear the mass of blood of this poison; yet it is most certainly true that Nature endeavours, with all her might, at the expulsion of it in the most perfect manner; that is, by forcing the morbid matter, as much as possible, to the pustules *: And [Page 19]any interruption must prove of dangerous consequence, lest the humours should be impeded in their circulatory motion, and fall into an intestine one, and grow putrid; which is frequently the case after too large evacuations, or excessive heat; where there is such a scarcity of spirits, that the solids do not vibrate sufficiently to keep the fluids in their due velocity.
This plainly indicates the hurtfulness of too great evacuations in the beginning of the Small-pox; and shews the Physician's part to be only to assist, by following nature; and not going before her.
The Measles are an inflammatory fever of the eruptive kind; whose pustules never arrive to a purulent state like those of the Small-pox; and they are cured by [Page 20]bleeding, and cooling medicines: but, I believe, it was never yet seen that these remedies could prevent their eruption, tho' made use of ever so soon after taking in the nfection.
There have been some instances in the Small-pox, where spontaneous hemorrhages, or other repeated bleedings have seemed to alter the nature of the distemper in some degree, by making that prove kindly, which would, probably, have fallen out otherwise, for want of those evacuations; but, I am persuaded, there never was any one proof of the contagion being wholly carried off that way, without some eruption of the pustules: so that it seems evident, even to a demonstration, that Nature, after a removal of the load that oppresses [Page 21]her, must be left to do her part in her own way, by causing suppuration, in a greater or lesser degree, as there happens to be occasion for it; in order to free the body from the corrupted state of the blood and humours arising from the contagious taint of this disease.
Moreover it is certain that the whole animal body, at all times before it has passed through the Small-pox, is, in every part alike, liable to receive the morbose, or infecting taint, and so propagate the disease. We know, also, that the least particle of the morbific matter, applied to any part of the body, will cause the Small-pox to be produced as effectively as a much greater quantity could be capable of doing it. And it is evident, from common experience, that all [Page 22]mankind, as well those who come of parents that have had the Small-pox, as those that have not, are alike liable to it; so that we may conclude the pabulum of this distemper to be a part of the human nature, conceived in the first rudiments of generation; and therefore not to be extinguished by any art, or other means, than it's own natural destroyer, the Small-pox itself; which only can render the body more perfect, by eradicating this one natural principle of mortality, and thereby giving it a security, for ever, against any further attack from this great evil.
The contagion of the Small-pox previously considered in a pestilential sense, the true manner of it's operation on human bodies, as it may be best known from the experiment [Page 23]of inoculation, seems sufficient to furnish more matter for the Physician and Philosopher than could possibly have been advanced without it. Insomuch that the discovery of a specific medicine to prevent the burning of a Caustic, or even Fire itself, may as well be expected, as to destroy the power of variolous contagion, when taken either in the natural way, or applied by inoculation. Most certain, therefore, it is, that no discovery of this kind, so seemingly repugnant to the laws of Nature, can ever be ascribed to human invention.
An attempt to explain the manner of the propagation and eruption of the Small-pox, from the practice of inoculation: And why this distemper, taken by common infection, in the natural way, proves so much more fatal than that which is given by inoculation.
THE main business of natural Philosophy, as Sir Isaac Newton observes, is to argue from Phenomena, without feigning Hypotheses, and to deduce causes from effects till we come to the very first cause. Therefore it ought to be the study of Physicians to consider well the various and subtile methods which Nature useth in producing diseases; and this can be known in general only by the different [Page 25]symptoms that occur to individuals in all cases. For her progress is undoubtedly slower or faster according to the different methods she takes in expelling the morbific cause, so that the morbid particles, being separated by her own action, may be discharged in her own way.
When a body, therefore, becomes contaminated by a contagious taint, it may be of the greatest use to know by what means it so happened; as the mode of nature, in her method of extricating the morbific matter, differs, probably, in great measure according to the different manner of receiving it: insomuch that the danger or safety of the patient may depend greatly on the primary communication of this matter either to an external or [Page 26]an internal part. And this opinion hath been confirmed by many observations of the Small-pox produced by inoculation, where the distemper hath been remarkably great from a multitude of the pustules, as well as the condition of them; which have gone off, by that preventive means, without any great uneasiness; whereas the same, in the natural way, are usually attended with a very high Fever, Delirium, and other dangerous contingencies, owing probably to imperceptible effluvia conveyed, at first, to the Lungs, Heart, Brain, &c.
But for a further explanation of this matter, by an enquiry into the different methods that nature pursues in communicating the Small-pox both by common infection, and [Page 27]the artificial experiment of inoculation, we shall the better form a judgment, agreeable to her own elements and principles, by her own rules and indications. And, in order thereto, it is manifestly certain, that, the air being infected with the venom of this distemper, the morbific particles, contained therein, are received into the human body by inspiration; and they act, wherever they happen to fall, by an irresistable power, like fire unextinguishable, until they have utterly subdued that pabulum in the body which was susceptible of this contaminating taint, and so propagated the disease: for thus it is we are secured from having the Small-pox a second time. But the causes of it's destructive malignity may be more than the nicest observation [Page 28]can discover. And, indeed, the mode of Nature, from this theory alone, seems to be too intricate and perplexing for human understanding; insomuch that the nature of the morbific matter, from whatever different kind of the Small-pox it may happen to come, is certainly the same, and plainly makes no difference in the nature of the disease. The difference of constitutions, therefore, it may reasonably be supposed, is the principal cause of the different kinds of the Small-pox. And, these principles being generally admitted, I think it evident, therefore, as far as it can be demonstrated from experience, that a different manner in giving the infection (I mean that of inoculation) manifestly produceth a different effect. And this, I make [Page 29]not the least doubt, would unexceptionably appear upon the trial, if it was possible to meet with two persons of exactly the same age and constitution, by communicating, to each of them, the same contagious taint, by the different ways of infection. But, for want of this, let us examine further, by pursuing the mode of nature, also, under the experiment of inoculation, and see what new discovery will arise to give an additional light to this matter.
By this method of trial it is evident that the smallest portion of the variolous pus, applied, by a slight incision, to any part of the body, acts in the manner of a caustic, by inflaming and corroding the part; insomuch that the continuity, after some days, is destroyed; [Page 30]and an ulceration caused from the separation of the eschar: And the taint of this infection, being infused into the blood, is conveyed, by means of the circulation, throughout the whole animal body; and touching every where on it's proper pabulum, like a spark of fire among particles of Sulphur, or Nitre, in a certain length of time it doth it's office, by exciting feverish symptoms, which regularly go off in a diaphoresis; whereby the salt serum of the blood, so impregnated, is driven out by the glands of the skin; and then the pores, being properly enlarged, let out the fiery pustules on the surface; which seems to be the true manner of the propagation and eruption of the Small-pox.
From this experiment we may reasonably suppose that the morbific effluvia of this distemper, received by inspiration also, produce the same kind of phenomenon in the natural way; and that these venomous particles, happening to fall on the vital parts, by inflaming and corroding the same, in like manner, are so commonly attended with their fatal effects; for instance, on the Lungs, Brain, &c.; where it is impossible for nature to help herself, or be furnished with any assistance to her relief. And this may occasion, which we daily see, high fevers, delirium, shortness of breath, the most surprising struggles and conflicts, and sudden changes in the Small-pox.
It may be supposed, also, that an infinite number of the virose [Page 32]particles, contained in the infected air, may be drawn in by the breath and nostrils at the same time; and so conveyed by the divarication of the Trachaea to the Lungs; and also by the olfactory nerves, or their fibrillae, to the most delicate texture of the brain, whereby a multitude of different parts may receive the contagious effect at the same instant of time; which, by pervading the innermost recesses of the whole animal compages, may so break and destroy the continuity of parts of moment, as to render a dissolution of the whole frame unavoidable. And that particular species of the Small-pox, in which the texture of the blood is so absolutely broken, that it dischargeth itself by every outlet of the body; and, stagnating in the small cuticular [Page 33]vessels, produceth black, gangrenous spots, all the surface over, is but too melancholy a proof of the truth of this hypothesis, from the sudden and untimely destruction that it usually brings upon the patient.
Inoculation explains also the reasonableness of this opinion: for if the morbific matter be applied to ever so many place, it will have the same effect in every one; by occasioning so many corroding Carbuncles, if they may be so called; which, the more they are, the more likely they will be to increase the [...], or the contagious infection of the blood and spirits: and, for this reason, I have wholly given up an opinion I had espoused some years ago; from a supposition that discharges from more inoculated places than one would be of advantage [Page 34]to the patient, by carrying off a greater quantity of the humours of the body, by means of those drains; and so, consequently, would be likely to prevent such feverish disorders and complaints, as might, otherwise, arise in the course of the Small-pox. But experience hath plainly shown this kind of doctrine to be erroneous; and convinced me, that the application of the virose matter, to one part only, is much safest and best; and, indeed, the corrosion of any one part, caused by the application of variolous matter, is a sufficient proof of its taking effect, and doing all that this contagion can do; even tho' there may happen to be scarce any febril symptoms produced from it, or so much as a perfectly distinguished pustule of the Small-pox: for the [Page 35]ulcerated part being cicatrised, will remain, beyond all dispute, as certain a mark of security to the patient, as if the skin had received the impressions of having undergone this distemper in ever so great a degree. And truly, if it were not so, several persons, under my own care, who had no pustulary eruptions, must have taken the Small-pox, from those who were their companions and bed-fellows in the distemper, by the ordinary way of infection; which the experience of such trials plainly convinced me they could not. From these cases, therefore, it seems reasonable to suppose, that this kind of artificial carbuncle, caused by the inoculation, was alone capable of extricating from the human nature the first principles of this distemper.
From what hath been already advanced, it seems pretty certain that these first principles of the Small-pox, being susceptible of the contagion to the most distant extremities, are diffused, in all parts alike, throughout the whole animal body; the principal caution, therefore, requisite to be observed by Physicians, in regard to those in whom this matter is to be applied, is to consider well their different constitutions and temperaments, as they are of themselves naturally productive of the different kinds of the Small-pox. For it is, I believe, a generally received opinion that the contagious venom of this disease is in it's own nature the same, and differs only according to the different bodies it is infused into. In some, for instance, [Page 37]we see that this poison applied can produce no more than it's own variolous carbuncle, or a very few of the pustules at most, and those of the shortest duration; whereas, in others, it is manifest that the different fluids become more contaminated, and, therefore, consequently produce other different degrees of the Small-pox: and wherever the lymphatick vessels are corroded by the variolated acrimony, being more than can be transpired by the pores of the skin, it occasions a suffusion of the lympha itself, and so consequently produceth a confluence of the Small-pox; and this happening commonly in a greater degree on the head and face, is undoubtedly owing to the great force of the circulation of the blood, which, carrying [Page 38]with it a variolated power, causes the effects above mentioned. The ventricles of the brain also, from the same morbose cause, are usually so affected as to occasion delirium, in the same manner probably, that the effluvia of strong drink and spirits affect the brain in drunkenness: for thus it is that the blood, having received any morbific taint, purifies itself in the circulation, by throwing off it's heterogeneous particles by the common emunctories which nature hath provided, as far as the animal faculties, under a morbid state are capable of accomplishing it.
Those principles in our nature, which are susceptible of the contagion of the Small-pox, tho' they are not, I believe, as I have before observed, liable to undergo a change, [Page 39]by any power of medicine, sufficient to prevent the influence of variolous infection; yet experience convinceth us (if we can be so convinced) that the manner of propagating the distemper produceth a very different effect: and there can be no occasion to enforce the truth of this opinion by argument, since God's Providence hath appeared, in the success of inoculation, so much in favour of that practice *.