SMALL-POX. 



pouch or pocket, and applicable to any puttule or puftular 

 difeafe, were appropriated early to this formidable malady ; 

 and the epithet yma// was fubfequently added to dillinguifh 

 it from a Itill more recent difeafe, the lues venerea, to which 

 the fame appellation was applied. 



Several varieties of the fmall-pox have been noticed by 

 different writers, but they may be all included under the two 

 principal forms, which were fo ably pointed out by Syden- 

 ham, and which fince his time have been commonly recog- 

 nized under the appellations of the diJlinB and the conjluent 

 fmall-pox. Although originating from the fame contagion, 

 and not differing from each other effentially, they exhibit a 

 different feries of fymptoms, purfue a fomewhat different 

 courfe, and require a different mode of treatment, and there- 

 fore it is convenient to treat of them feparately. 



I. Of the Dift'ma Small-Pox :—VartoU Difcrette.—ln this 

 form of the difeafe, the eruptive fever is moderate, and not 

 eafily dillinguifhcd from an ordinary attack of common in- 

 flammatory fever. It generally begins about mid-day, with 

 a chillinefs and Ihivering, accompanied by a confiderable lan- 

 guor and drowfinefs, which are foon followed by a great 

 heat, pains in the head and back, ficknefs at the (tomach, 

 with a forenefs or preflure in that part, and in adults, efpe- 

 cially if they are kept in bed, with a great difpofition to 

 perfpiration. In children the iweating does not occur ; but 

 they are liable to frequent ftartings from their flumbers, and 

 on the third day are fometimes affefted with one or two fits 

 ofconvulfion. Sydenham confidered this fymptom as rather 

 favourable ; having obferved that it was commonly fuc- 

 ceeded by an eruption of a large and mild fmall-pox. On 

 the evening of the third, or the morning of the fourth day, 

 the eruption appears, and gradually incrcafes during the 

 fourth and fifth days, arifing firil on tiie face, and fucceflively 

 on the inferior parts, fo as to be completed over the whole 

 body on the lall-mentioned day. With the appearance of 

 the eruption, the febrile fymptoms abate, and nearly or alto- 

 gether ceafe on the following day, with the completion of 

 the eruption. This appears firft in fmall red fpots, fcarcely 

 eminent, but wliich, by degrees, riie into minute pimples, 

 which are feparate and di'linft from each other, and gene- 

 rally not very numerous. The day after their appearance, 

 a fmall veficle, containing a clear or flightly whey-coloured 

 fluid, fhews itfelf on each of the fpots. For two days thefe 

 veficles increafe in breadth only, and tliere is a fmall depref- 

 fion in their centre. As they extend, they continue to be 

 furrounded with an exaftly circular inflamed margin, which, 

 when the pullules are numerous, covers the greater part of 

 the intervening fkin, and diffufes fomewhat of a damaflc hue 

 over the fpaces between the puflulcs. Under the touch they 

 are hard, and rather painful, and give the imprefiion of fmall 

 round Iceds under the cuticle to the finger ; a circumflance 

 which tends to di(lingui(h them from the veficles of chicken- 

 pox, which feel like fmall feeds flattened by prellure. 



About the eighth day, the eruption is elevated into fphe- 

 roidal puftules; andif thefe are numerous, the incrcafcof their 

 fize and the fuUntfs of the furrounding parts occafioii a con- 

 fiderable fwelling of the whole face, and efpecially of the eye- 

 lids, which are fo dillendcd as entirely to clofc the eyes, and 

 often fhinc hke an inflated bladder. Sometimes, where nume- 

 rous pultules fix upon the eye-lids, the blindnefs comes on be- 

 fore the eighth day. The eruption now aflumes a whiter ap- 

 pearance; for, as the difeafe proceeds, the matter in t lie puftules 

 becomes by degrees more opaque, and at length, as the fuppu- 

 ration increafes, of a yellovvifli colour. A fimilar progrefs is 

 obferved in the hands, but a little later ; lo that when the face 

 is becoming rough and yellow, the extremities are becoming 

 fmoother and whiter. On the eleventh day the Iwelling of 



the face is much abated, and the inflammation diminiftied : 

 the puftules are now at their height, and fecm quite full. 

 On the top of each a darker fpot appears ; and at tliis place 

 the puftule, on the eleventh day or foon after, is fpontancoufiy 

 broken, and a portion of the matter oozes out ; in confe- 

 quence of which the puftule is (hnvelled and fubfides, while 

 the matter oozing out dries, and forma a cruft upon its fur- 

 face. Sore^etimes very little of the matter oozes out, but 

 remains in the puftule, becoming tluck, and even forming a 

 hard little fcab. After foine days, generally about the four- 

 teenth or fifteenth, both the crufts and the hardened puftules 

 fall off, leaving the (Icin on the points which they covered of 

 a brown red colour ; and it is only after many days that 

 thefe red marks are effaced. The diftinft fmall-pox feldom 

 leaves any pits in the flvin ; but in fome cafes, where the 

 matter of the puftules has been more liquid, the crufts formed 

 by it are later in falling off, and the points which they 

 covered undergo fome degree of ulceration, which partially 

 deftroys the fubftance of the fkin, and produces a fmall ex- 

 cavation or pit. Sydenham and CuUen afcribe this erro- 

 neoufly to the defquamation which enfues. 



As the eruption is fucceffive, fo the maturation on the 

 body and extremities follows the fame courfe as above de- 

 fcribed, but a little later. On the tenth and eleventh days, 

 as the fwelling of the face fubfides, a fwelling arifes in the 

 hands and feet, which again fubfides, as the puftules come to 

 maturity. In the puftules of the hands and arms, indeed, 

 the matter is frequently abfoibed ; fo that at the height of 

 the difeafe, thefe puftules appear as empty veficles. 



When the puftules on the face are numerous, fome degree 

 of feverilhnefs appears on the tenth and eleventh days, but 

 it ceafes again after the puftules are fully maturated, or con- 

 tinues only in a very flight degree till the laft puftules on the 

 feet have finifhed their courfe. In the diftindl fmall-pox 

 this fecondary fever is never confiderable, and feldom con- 

 tinues longer than the period juft mentioned. Under the 

 fame circumftances, an abundant crop of puftules on the 

 face, fome uneafinefs in the throat, and a hoarfenefs of voice, 

 occur about the fixth or feventh day, and a tliin fluid is 

 poured out from the mouth. Thefe fymptoms increafe with 

 the fwelhng of the face ; and the difchargcs from the mouth 

 and throat becoming thicker and more vifcid, are more dif- 

 ficultly ejected. Some difficulty of fwallowing alfo oc- 

 curs ; fo that liquids taken in to be fwallowed are fre- 

 quently rejefted, or thrown out by the nofe. But all thefe 

 affedtions of the fauces abate as the fwelling of the face 

 fubfides. 



Some varieties of the diftinft fmall-pox have been defcribed 

 by different authors under fpccific appellations, fuch as the 

 contiguous, X.\k coherent, X.\\e luarty, &c. fmall-pox (fee Walk- 

 er's Inquiry into the Small-pox, chap. viii. and Roe's Trea- 

 tife on the Natural Small-pox, chap. i. ) ; but thefe are merely 

 more violent degrees of the difeafe, p.irtaking more or lefs 

 of thecharafterof the confluent fpecies, and requiiing to be 

 treated accordingly. 



2. Of the Confluent Small-pox. — This form of the fmall-pox 

 follows a fimilar courfe with the preceding fpecies, but the 

 fymptoms of every ftage are more violent, and feveral of the 

 circumftances are alfo different. Tlie eruptive fever elpecially 

 is much more violent ; the pulfe is more frequent, (harp, 

 and contrafted ; the liead-ache, and the pain and anxiety at 

 the pra:cordia, the ficknefs and vomiting, arc more fevere ; 

 the coma is more confiderable, and there is frequently a de- 

 lirium. In adults tiiere is lefs dilpofition to perfpiration 

 than in the other fpecies, and fometimes a diarrhoea occurs ; 

 and in children epileptic fits are frequent on the firll days 

 of tlie difeafe, and fometimes prove fatal before any eruption 



appears,. 



