SMALL-POX. 



trree of fever that accompaniej and precedes it. The firft 

 indication, therefore, is, to moderate the eruptive fever. 



In the cafe of inoculated fmjU-pox, this procefs may be 

 commenced in the interval between the infertion of the 

 matter and the beginning of the diforder, that is, feveral 

 days previous to the origin of the fever ; when, by a light 

 and cooling diet, and by the ufe of laxative medicines, if 

 the habit be full, the body may be brought into a lefs in- 

 flammatory ftate ; and thus rendered lefs fufceptible of vio- 

 lent inflammatory diieafe. But in the cafual fmall-pox, we 

 have commonly no warning of the malady, until the 

 eruptive fever aftually commences ; nor, when it has already 

 begun, can we be certain, from any peculiar fymptoms, that 

 it is any thing but an ordinary fever ; unlefs it occurs in 

 perfons who, not having previoufly undergone the difeafe, 

 have been notorioufly cxpofed to the infeftion. It is fortu- 

 nate, however, that our inability to dillinguifh the fever 

 which is about to uflier in the fmall-pox from common in- 

 flammatory fever, is of no moment ; fince the fame reme- 

 dies are the moll appropriate in both cafes. The older prafti- 

 tioners, indeed, mifled by their h\imoral hypothefes, about 

 a fermentation in the blood, a llruggle of the conftitution 

 to rid itfelf of the fcum and dregs that were feparated, and 

 a falutary effort to difcharge them by the flcin, which was 

 fuppofed to be manifelt in the pullules, unfortunately took 

 an oppofite view of the fubjeft. They thought it neceflary 

 to afiitl and encourage the fever, and very dangerous to re- 

 prefs it ; and therefore they excluded the cool air, kept the 

 patient in a hot bed, and adminiftered warm drinks and cor- 

 dial medicines. The pernicious influence of this praftice 

 (which was extended to all febrile complaints) was firft de- 

 tefted by the fagacity of our great countryman, Sydenham, 

 in fpite of the hypothetical doitrines, in which he had him- 

 felf been educated ; and his prophecy, that, after his death, 

 liis opinion and praftice would prevail, has been amply veri- 

 fied. In faft it is now univerfally admitted, that the more 

 the previous fever is moderated, the more all the enfuing 

 fymptoms will be mitigated. According to the degree of 

 violence with which the fever commences, the aftivity of the 

 meafures for moderating it will be various. If the fymp- 

 toms are not fevere, the patient may be recommended not 

 to keep his bed, but to remain, according to the advice of 

 Sydenham, in a cool apartment, having the benefit of cool 

 air ; and at the fame time to difcard animal food, and adopt 

 that of a cooling nature, vegetable decoftions, acidulous 

 fruits, and diluent drinks, luch as plain cold water, lemonade, 

 whey, &c. All his drinks (liould be given cold ; and the 

 bowels rtiould be freely opened by fome cooling purgative, 

 as by the neutral falts, with a little calomel. If thefe mea- 

 fures are adequate to keep down the fever, and if, at the 

 fame time, the eruption appears early, and in fmall numbers, 

 the lafcty of the patient may be confidered as afcertained ; 

 and no farther treatment, except a continuance of the anti- 

 phlogillic (yftem, is neceflary. The praftice of continuing 

 to give purgatives as the eruption declines, appears to be al- 

 together unneceflary, and may in fome cafes be hurtful ; 

 and it leems to be continued rather in compliance with the 

 exploded hypothefis of feparating the contagious matter 

 from the blood, than from any rational inference of expe- 

 rience. 



Where the fever comes on, however, with great violence, 

 manifelting early its charafter, by a quick, hard pulfe, in- 

 tenfe heat, and thirft, a flufhed countenance, inflamed eyes, 

 fevere head-ache, a quick and oppreffcd rrfpiration, with de- 

 lirium, efpecially in adult perfons, and in thofe of vigorous 

 or pletiioric habits, very adlivc meafures fliould be imme- 

 diately adopted. In perfons of the latter defcriptioii, the 



firft objeiS would be to let fome blood, the quantity 

 of which mull be determined by a confideration of the 

 patient's age, conftitution, and habits of life, and of 

 the violence of the fymptoms. At the fame time, al. 

 though he cannot obey Sydenham's injunftion of fitting 

 up, the cooling plan muft be adopted to the fulleft ex- 

 tent in refpeft to his apartment, which fliould be freely 

 ventilated by the admiffion of the external air, through 

 open windows and doors, and to his bed, which fliould be 

 a mattrafs, and as lightly covered as the feafon and his feel- 

 ings will permit. If the fkin is intcnfely hot and dry, much 

 benefit will be obtained, in the moll expeditious manner, by 

 fponging the furface occafionally with cold water, or even 

 by the ufe of the cold afl^ufion. We have known feveral 

 inftances, in which this fever, not being fufpefted to be 

 the variolous fever, was treated by the cold aftufion, with 

 the moll decided alleviation of the fever, and of the fub- 

 fequent eruption. The benefits of this praftice in fear- 

 let fever, even during tlie extenfion of the eruption over 

 the whole flcin, are now generally acknowledged by all phy- 

 ficians who have witneiled the falutary and rapid change 

 which it produces, both in the feelings and in the malady of 

 the patient; being, in fa<3:,the moft efficacious phyfical agent, 

 as well as the moft expeditious and grateful, that the whole 

 art of medicine is poflefled of ; and the only expedient fully 

 entitled to the commendation of the ancient empiric, that of 

 curing " cito, tuto, et jucundc." It is, in truth, but the 

 perfeilion of the cooling iyftem recommended by Syden- 

 ham ; and when united with cool air, cool drinks, and light 

 coverings, it affords the moil certain means of controlling 

 the inflammatory fever. 



An aftive purgative will alfo contribute to relieve inflam- 

 matory adlion, and (hould be fpeedily adminiftered, and re- 

 peated according to circumllances. Diaphoretics are alfo 

 recommended, and if they are not of a Ilimulating kind, 

 they may be given with advantage : but the moft effeftual 

 mode of inducing perfpiration is by reducing the dry and 

 burning heat of the flcin, by cool air and waftiing. 



If, however, thefe falutary meafures have been omitted, 

 or have proved inadequate to prevent a numerous eruption, 

 efpecially upon the face ; if the puftules are not diftinft ; 

 and particularly, if, on the fifth day, the fever docs not fuf- 

 fer a confiderable remiflion ; the difeafe will ftiU require a 

 great deal of attention. It will ftill be neceflary to avoid 

 heat and a heating regimen, and to continue to admit the 

 free accefs of cool air, although the more aftive applica- 

 tions of cold, by fponging or aff^ufion with water, need 

 not be continued. The beneficial influence of cool and frefli 

 air, indeed, at all periods of the difeafe, is very manifeft ; 

 and in order to imprefs this truth more ftrongly, it may not 

 be improper to relate a cafe or two, from among many that 

 have been recorded, to fliew the extent of that influence, 

 even in the later ftages. Sir George Baker, in his «' En- 

 quiry into the Merits of a Method for inoculating the 

 Small-pox, &c." obfcrves, " The hiltory recorded by Sy- 

 denham, of a young man at Briftol, who owed his recovery 

 to his being laid out on a table, as if dead, is fuffi- 

 ciently known. To this hiftory there is a great refemblance 

 in a cafe which is mentioned by Dr. Kirkpatrick, ai having 

 happened in Carolina. Mr. Benjamin Marych had a violent 

 natural confluent fmall-pox in the liot weather. His at- 

 tendants tliought him dead ; upon which the (aflies were im- 

 mcdi.itcly fct open, and a frefli quantity of air, or poflibly 

 a wind, rufliing in, produced a frefli relpiration and motion 

 in the pcrfon who was thought dead. When this was ob- 

 ferved, they went to put them down again. The patient 

 who faw it, and was fpeechlefs, but fcnfiblc of tlie alteration 

 Y 2 and 



