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To Mr Michael Gardiner, on Inoculation

Lord Stonefield proposes to have his son Mr. Willie inoculated
this harvest, and as he is to be under your care his Lordship desires
me to give you my opinion concerning the best manner of ma¬
naging this matter. With regard to the ordinary practice I know
that I need not instruct you, and shall therefor say only what
relates to the particular patient, or to new and late improvements
in the general practice which you may not yet have had experience of.

I think he should not be inoculated for ten or twelve days

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after he goes to the country that you may be certain he has catched
no cold in changing quarters, and farther that the hot season may
be over.

During this time there is to be no change of the diet he has
been on for some time past, which is milk, grain and vegetables,
and entirely without animal food, and this diet is to be continued
during the whole course of the disease

In the time which is to pass before inoculation you may
purge him twice, giving one grain of Calomel over night and a
Senna infusion in the morning. The same purging is to be re¬
peated twice between the Inoculation and Sickening, and in both
cases the doses are to be given at the interval of three or four days.

The inoculation is better performed by a Lance whose point
has been dipt in a pustule than by a thread as formerly, but if
you cannot have the opportunity of preparing a lancet within a
few days before your intended inoculation, you must employ a
thread as usual. In employing the lancet if the matter upon it
happens to be dry, you must hold it a little over the steam of
warm water before you employ it. In employing it you have
only to insinuate it under the cuticle without going deeper, and
when you have withdrawn the Lancet you have only to press
down again the cuticle, and tie a bit of rag upon it which rather
does harm.

Every day both before and after inoculation, and every day
during the course of the disease your patient must walk
out or be carried out into the fresh air and be very much
in it. When rains or high wind renders it inconvenient for
him to be abroad the window of his chamber must be kept
open for the most part. In short he can hardly have too much fresh
air; but it is by no means necessary to expose him to a stream of
air or to any moisture, so that these ordinary causes of cold may still
be avoided. I say farther that before Inoculation and from thence to
the Sickening there is no occasion to seek for much cold, and therefor
to push him constantly out of the house, but it may be enough
to avoid heat, to keep his chamber cool, and to have him often

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abroad: when the weather is warm he may be cooler within doors than
abroad, and this minds to say that when he is abroad he must keep
out of the sun and avoid any exercise that may heat him. The less
exercise he takes the better. This is the management till he sickens
and when that happens there must be more pain taken to cool
him. If any fever appears if it is in the day time let him be carried
abroad to sit in the shade; and if there is a little stream of air to
fan him it is the better. If it rains or he is so sick as to be averse
to sit up let the window and even opposite windows be open, and
while he lies upon his bed if this does not cool him let him be
carried near to the window and held in the stream of air. This is to
be done also in the night time, and if it is fair without high wind
I think even in the night-time carrying the patient abroad into the
open air is safer than keeping him at a window. When by any of
these means the heat, delerium, or other symptoms of fever are much
abated, he is to be laid abed but he must not be immediately covered
with blankets but should be for some time with only a single sheet
upon him. Let this be observed that the fever is most liable to come
on in the Evening and forepart of the night, and therefor at this
time the cooling measures are most necessary; but that after two or
three o'Clock the fever usually declines, and both from this consi¬
deration and from the measures employed before, the patient
may be covered towards morning and especially during sleep
at this time. Upon the whole I think it is found from much
experience that external cold is the surest and generally a
safe means of moderating the eruptive fever, and in propor¬
tion of rendering the small pox few and of a good kind. I have
given you hints of the particular execution, but some part
of it must be left to your own discretion upon understanding
the general plan. I have only to add that these cooling practices
are especially necessary during the eruptive fever, and are to be
continued if the small pox should after all prove numerous
or be attended with any other infavourable circumstance. But
if upon eruption they are veery few and of a good kind, hardly
any measures at all are necessary, and the patient may go

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abroad or stay at home as in ordinary health, or as directed above
for the time before sickening. In case of any sharp fever at
eruption, besides the cooling I have spoken of it is also proper
the day after sickening to give such a dose of Calomel and
Physic as above mentioned, and this may be repeated during
the course of the disease, and once or twice after it. I have
thus given you my plan I hope fully enough; but if any
doubt or difficulties remain, you have still enough to have
them solved, and I shall be glad to hear from you, being
very much