2 M E D I 



Practice. Small-pox is always produced by its own specific con- 

 l..-,-.^ tagion ; and when once the individual has gone through 

 Treatment jj, e dj seas e ) j n however slight a degree, ne is secured 

 from any future attack. Upon this fact is founded the 

 practice of inoculation ; for we learn, that where a por- 

 tion of the matter is inserted under the cuticle, it will 

 communicate a much milder disease than one that is re- 

 ceived in the usual way, which is probably by the lungs. 

 \Ve are, however, totally unable to explain the cause of 

 this difference. The relation which the fever bears to 

 the eruption, or the degree in which one is to be regard- 

 ed as the cause of the other, is a point that has given 

 rise to much speculation. According to the humoral 

 pathology, the eruption was thought to afford a remark- 

 able example of the critical discharge of an offending 

 matter from the system; and, proceeding upon this 

 principle, the great object of the practitioner was sup- 

 posed to be, to promote this discharge ; a system which 

 led to a practice precisely the reverse of the true one, 

 and which must no doubt have proved highly destruc- 

 tive. In what way the fever operates, or what is the 

 proximate cause of the disease, we know not ; but it 

 appears that the eruption is the consequence of the fe- 

 ver, and that, whatever diminishes the fever diminishes 

 the eruption, and at the same time lessens the violence 

 and danger of the disease. Our general plan of treat- 

 ment is accordingly founded upon this principle, to di- 

 minish the febrile action of the earlier stages by the ge- 

 neral application of the antiphlogistic plan, especially by 

 purgatives and by external cold, and in some cases, 

 where the inflammatory tendency is considerable, by 

 blood-letting. In the distinct variety this may be re- 

 garded as comprehending the whole of the treatment ; 

 for it would appear, that all direct attempts to act upon 

 the eruption, except so far as we can subdue the fever, 

 are at least useless, if not positively injurious. Tonics 

 and stimulants are seldom indicated, or only in conse- 

 quence of some unusual occurrence ; and when the dis- 

 ease has run through its course, the powers of the con- 

 stitution soon return to their accustomed standard. 

 of the con- In the confluent Small-pox we have a much more for- 

 midable disease to combat, and one which, unfortunate- 

 ly, but too often baffles all our endeavours. From its 

 very commencement it exhibits symptoms that have so 

 much of the typhous appearance, as almost to deter us 

 from the use of any active antiphlogistic treatment, and 

 even purgatives and cool air appear to produce a dan- 

 gerous shock to the oppressed and languid powers of 

 life. Still, however, they afford the only rational means 

 of relief ; but they must be pursued with caution, and 

 under the constant inspection of some person who is 

 well qualified to judge of their effects. The circum- 

 stance wliich renders the practice, in this variety of the 

 complaint, so critical, is, that when, from any cause, 

 the eruption suddenly disappears an effect which some- 

 times ensues from the sudden application of cold to the 

 Mirfiicf, or from the operation of a brisk purgative, the 

 vital powers become suddenly oppressed in so great a 

 degree, as to threaten the immediate extinction of life. 

 When e suspect this to be the case, we are to apply 

 external warmth, and to administer moderate doses of 

 f-timulants ; but this is to be done with caution, lest in 

 this way we exasperate the violence of the febrile 

 aitmn. Sometimes, without any obvious cause, this 

 deficiency of action ensues, when we are immediately 

 to have recourse to the tame means with those men- 

 tioned above. When the symptoms of variola assume 

 the decided typhous type, and" especially in the secon- 

 lary fever, it has been generally conceived that wine, 

 bark, and other stimulants and tonics, are the appro. 





CINE. 



priate remedies. We doubt how far this can be de- Practice, 

 pended upon as a general mode of treatment ; but we 'Ir' 

 apprehend that we are, in these cases, to proceed very 

 much upon the same plan wliich has been already re- 

 commended in the latter stages of other malignant fe- 

 vers, of prescribing very much to obviate or palliate 

 particular symptoms ; bearing in mind, that we have 

 to contend, on the one hand, with a tendency to febrile 

 excitement, and, on the other, with the state of ex- 

 haustion, which generally succeeds the former, when 

 it has been violent and long protracted. There is often, 

 in confluent Small-pox, a state of restlessness, or extreme 

 agitation, which is found to be alleviated by opium; 

 and although we do not expect any benefit to be de- 

 rived from sudorifics, we conceive that gentle diapho- 

 retics are often productive of great relief to the sensa- 

 tions, and, by removing a source of irritation, conspire 

 with opiates in procuring sleep. One of the most dis- 

 tressing effects of confluent Small-pox, is the injury 

 which it leaves to the constitution generally, or to par- 

 ticular organs, of which the eyes are the most apt to 

 suffer, so as not unfrequently to produce the complete 

 loss of sight. 



SECT. XX. Vaccinia. Cotv-Pox. 



The singular affection of Vaccinia has become an ob- Vaccinii, 

 ject of great attention, in consequence of the remark, 

 able property which it possesses of protecting the con- 

 stitution from the attacks of Variola ; and as it is, un- 

 der all its forms, a comparatively mild disease, and like- 

 wise possesses the peculiar advantage of being commu- 

 nicated only by absolute contact, it forms the means of 

 securing the individual, without spreading any danger- 

 ous infection through the community at large. 



The characteristics of Vaccinia are to produce a ve- 

 sicle of a circular form, with a depression in the centre, 

 which makes its appearance in three or four days after 

 the insertion of the matter under the cuticle. On the 

 eighth day it becomes filled with a transparent watery 

 lymph ; which, about the tenth or eleventh, is convert- 

 ed into a dark coloured scab, and falls off, leaving a 

 permanent mark on the part. Although the constitu- 

 tion receives so important a change by the disease, yet 

 the general febrile affection is almost too slight to be 

 observable; and, xcept in some extraordinary cases, 

 the only medical treatment which it requires is the ex- 

 hibition of a purgative at its termination. It was not 

 to be expected, that so great an innovation in practice 

 should be generally received without opposition ; but, 

 whatever may have been the motives of the parties 

 concerned, the results of all the controversies that have 

 been carried on have been very fortunate ; for we have, 

 by their means, had an opportunity of viewing the sub- 

 ject ijf.der every possible form, so as to arrive at a de- 

 gree of well-grounded confidence, which could not 

 otherwise have been obtained It is admitted, that 

 there are cases where Small-pox has succeeded to Cow- 

 pox ; but they are of very rare occurrence ; perhaps 

 not more so than a second attack of Small-pox, of which 

 a few unequivocal cases are upon record : and it has, 

 moreover, appeared, that the Small-pox which follows 

 Cow-pox, has had its virulence so mitigated, as to be 

 nearly without danger. \Ve may farther add, that the 

 accounts which were, at one period, so industriously 

 propagated, of loathsome eruptions succeeding to Cow- 

 pox, are now considered to be altogether without foun- 

 dation. 



\ aricella, or Chicken pox, is a complaint which ex- Varicella, 

 hibits the characters of a true Exanthema, but is so mild 



