SMALL-POX. 



BO importance ; and we know not how fmall a quantity is 

 received when infeftion is communicated in the cafual way. 

 But it is very obvious, that, by avoiding the caufes of an 

 inflammatory diathefis, by leflening this condition when it 

 exifts, by (hunning the concurrence of other difeafes with 

 the fmall-pox, and by choofing the proper feafon and time 

 of life, we gain many advantages ; and probably thefe were 

 the principal advantages which inoculation poflefled. 



Seat of the Small-pox. — It has been a fubjeft of much 

 difpute, though eafily determined by obfervation, whether 

 the pL-.ftules of the fmall-pox affeft the vifcera and other 

 internal parts. The moil refpeftable teilimony in favour 

 of their exiftence internally, is that of Wrilberg, in the 

 New Gottingen Commentaries, vol. Ixvi : but fome others 

 have alfo maintained that they had feen the puftules, upon 

 difleftion, upon the internal organs. There is no doubt, 

 however, that fuch obfervations have originated in miftake. 

 For all the difleftions made by recent and more accurate 

 anatomilts have demonftrated, that, beyond the exteniion of 

 the cuticle, no variolous puftules ever arife. Cotunnius, an 

 Italian profeflbr of anatomy, didefted above forty perfons, 

 who died of fmall-pox, for the exprefs purpofe of afcertain- 

 ing what parts or organs were inveiled with the puftules. 

 Thefe examinations were condufted with great attention 

 and accuracy, and in the prefence of a number of Undents : 

 and the refult was, that, though the mouth, tongue, palate, 

 and top of the pharynx, were often full of puftules, and in 

 fome few cafes the internal membrane of the trachea was 

 inflamed, and exhibited fome efFufion ; yet not the leaft 

 veftige of puftules was found upon any of the internal parts, 

 even in the oefophagns. " Etcnim quod fpeftat interiores 

 partes, — certe non vifcus, non membrana, non glandula, 

 non pars demum interior ulla fuit, quae in tot exemplis 

 apparuerit puftulata." (Cotun. de Sedibus Variolarum, 

 ^ xxxix.) The truth is, as we have already obferved, the 

 puftules are little cutaneous abfceffes, the refult of inflam- 

 mation in the flcin alone, and not depofitories of contagious 

 matter diftilling from the blood. 



Diagnqfis. — It is not eafy, in general, to diftinguifli the 

 fever, which is about to uflier in the fmall-pox, from 

 common fimple fever, or from fome other febrile difeafes ; 

 fince its early fymptoms are not materially different from 

 thefe. It may be prefumed to be variolous fever, when the 

 fmall-pox is a prevailing epidemic, provided the individual 

 has not undergone the difeafe ; and efpecially if he may 

 have been in circumftances which rendered the communi- 

 cation of infeftion probable, or if his expofure to it were 

 well afcertained. On children, the occurrence of a con- 

 vulfive fit, on the evening of the fecond, or on the third 

 day, will lead to a fufpicion that the fmall-pox is about to 

 appear. In all cafes, however, this doubt will commonly 

 be cleared up by the fourth day, when the fmall-pox will 

 have appeared. 



It is not eafy to confound the eruption of fmall-pox 

 with any other febrile eruption, except the chicken-pox, 

 which, indeed, has not been demonftrated as a dillinft 

 difeafe more than fifty or fixty years. It had been called 

 iiariola fpur'i,!, lajlard fmall-pox ; and even Dr. Heberden, 

 who has the merit of having given the firft clear defcription 

 of the chicken-pox, (fee Medical Tranfaftions of the Col- 

 lege of Phyficians, vol. i. p. 433.) ftill applied the term 

 'variola to it ; calling it variola pujtlla. See his Commen- 

 tarii de Morbis, cap. 96. 



The eruption of fmall-pox is flower and of longer duration 

 than that of chicken-pox, the latter being commonly com- 

 pleted in three days, and being covered with flight brown 

 fcabs on the fifth day, at which time the fmall-pox is at 



the height of fuppuration. The inflammation round the 

 chicken-pox is very fmall, and the contents of them do not 

 f«em to be owing to fuppuration, as in fmall-pox, but rather 

 to what is extravafated immediately under the cuticle by 

 the ferous veficles of the fl<in, as in a common blifter ; whence 

 this fluid appears in a veficle on the fecond day, and, upon 

 the cuticle being broken, is prefently fucceeded by a flight 

 fcab. On the third and fourth days, the flirivelled or 

 wrinkled ftate of the veficles which remain entire, and the 

 radiating furrows of others, the ruptured tops of which 

 have been clofed by a flight incrullation, fully charafterife 

 the chicken-pox, and diftinguifli its eruption from the firm 

 and durable puftules of fmall-pox. Another circumftance is 

 alfo to be added to the diagnofis of thefe two difeafes. 

 If the whole eruption of chicken-pox on the face, breaft, 

 and limbs, be infpefted on the fifth or fixth day, every 

 gradation of the progrefs of the veficles will appear at the 

 iame time, which cannot take place in the flow and regu- 

 lated progrefs of the fmall-pox. (See WiUan on Vaccine 

 Inoculation, p. 95.) We have already noticed the dif- 

 ference in the fenfation excited by touching the early erup- 

 tion of the two difeafes with the point of the finger, pointed 

 out by the laft-named author. 



Since the introduction of the praftice of vaccination, which 

 maybe deemed oneof the greateft benefits ever conferred upon 

 mankind by any individual, the diagnofis between fmall-pox 

 and chicken-pox has, however, been rendered a httle more 

 difficult. For in feveral cafes in which the fmall-pox has 

 occurred in perfons who had undergone the cow-pox (and 

 we have feen that even fmall-pox and mealies are not always 

 fecurities againft themfelves), a mitigated and modified fmall- 

 pox has commonly enfued, of a veficular charafter, or of a 

 fmall horny appearance, which has not gone through the 

 ufual ftages ; but, inftead of proceeding to full fuppuration, 

 has begun to fubfide and dry away on the fixth day from 

 the commencement of the eruption. It requires confider- 

 able attention, therefore, to difcriminate between this variety 

 of mitigated fmall-pox and the chicken-pox ; and decifion 

 cannot always be obtained without the experiment of in- 

 oculation with the matter of the puftules. The inipreffion 

 under the finger, the form, and regular progrefs of the fmall- 

 pox, nay be generally recognized, however, up to the fixth 

 day, by careful obfervation. 



Treatment of Small-pox. — Until the year 1798, when Dr. 

 Jenner immortalized his name by the announcement of his 

 great difcovery of the properties of the cow-pox, no means 

 of prevention could be fuggefted to any individual, by which 

 he could avoid or proteft himfelf from the fmall-pox. In 

 all large towns, and efpecially fince the introduftion of the 

 praftiee of inoculation, a conftant colleftion of contagion 

 fubfilted, which operated upon every one who vifited them, 

 even for a ftiort time, from their more infulated fituations 

 in the country, if they remained fufceptible of the difeafe. 

 A preventive, however, is now difcovered, and every one 

 may be i-endered fecure from the influence of this baneful 

 contagion. (See Cow-pox.) At prefent, however, this 

 valuable preventive is not yet univerfally adopted, and the 

 fmall-pox has carried off^ in this metropolis, during the 

 year which has juft terminated (iSijI, no lefs than one 

 hundred and twenty-nine perfons. We have ftill, there- 

 fore, occafion to ftudy the beft mode of treating the dif- 

 eafe, under the different forms which it aflumes, when it 

 occurs in the cafual way. 



From a view of the hiftory of the difeafe, as above de- 

 tailed, it appears very evident, that the danger and violence 

 of the fymptoms are nearly in proportion to the quantity of 

 the eruption } which is again much conneded with the de- 

 gree 



