SMALL-POX. 



and benefit, beckoned with his hand to prevent them ; and 

 by degrees entirely recovered." Another cafe of the fame 

 kind is related by a gentleman of great veracity and expe- 

 rience. " In the year 1736, a man who lived as fervant 

 with Mrs. Broderep, one of the daughters of archbilhop 

 Wake, in Great Ormond-itrect, had the confluent fmall- 

 pox ; and on the evening of the fifteenth or fixteenth day, 

 his life was entirely defpaired of. On the next morning, 

 when I went rather to enquire after liim than to vifit him, 

 the nurfe's report was, that he had grown worfe and worfe 

 till two or three o'clock in the morning, at which time he 

 ceafed to breathe, became infenfible and motionlefs, and ap- 

 peared to be abfolutely dead. About five or fix o'clock, 

 the body was removed and placed on a large table, near an 

 open window, with no covering except only a fhirt. No 

 fign of life appeared, but the body continued hotter than 

 is cummon after death. This heat, however, the nurfe at- 

 tributed to the weather. In this ftate he had remained about 

 an hour, when the nurfe heard a fort of figh, or faint 

 breathing ; and it was obferved that he had moved his arm 

 acrafs his ftomach. Being raifed up with fome difficulty, 

 he took a fpoonful of a cordial medicine, ordered for him 

 on the preceding day ; and as foon as he was able to fpeak, 

 hs faid the cold air was very refrefhing. Being carried back 

 to the bed, he fell into a fweat, and flept three or four 

 hours. About this time I faw him. His pulfe was now 

 equal and ftrong ; his refpiration better than it had been for 

 feveral days before ; and his fenfes perfett. The door and 

 windows were left open, and in a few days the man was 

 quite out of danger." (See fir G. Baker's EfTay, above 

 quoted; and Dr. Walker's work on Small-pox.) Thefe 

 fatts require no comment. They demonllrate the beneficial 

 influence of cool air at all periods of the dileafe. It is, 

 however, particularly beneficial at the period of which we 

 are now fpeaking, when a thick eruption is coming out, 

 and the fever does not remit. At this time the expofure to 

 cool air, with the other antiphlogiftic meafures, will often 

 greatly leflen the indiflinft crowd of puftules that is fpread- 

 ing over the face, and occafion a few regular ones to arife, 

 the head will lofe its confufion, and the breathing become 

 lefs opprefled. 



At this period of the difeafe, too, under the fame cir- 

 cumftances, it may be necefiary, in adult and plethoric fub- 

 jefts, to take away fome blood. This, however, feldom re- 

 quires to be repeated. But a cooling purgative fliould be 

 adminiftered and repeated, or aided by a frequent repetition 

 of laxative glyfters ; and the free ufe of diluent drinks 

 fliould be permitted. 



Moft writers from Sydenham downwards, and Boerhaave 

 and CuUen among the reil, have recommended the admi- 

 iiiftration of an opiate, every night, under this febrile condi- 

 tion, that continues after the eruption of confluent fmall-pox 

 has appeared. Sydenham, however, only gave it to patients 

 whofe age exceeded fourteen years : but Boerhaave and 

 CuUen fpecify the fifth day as the time for the commence- 

 ment of opiates, and mention no exception. It does not 

 appear, that modern experience has confirmed the views of 

 thefe great phyficians : indeed, when Sydenham fpeaks of 

 ufing opium or bleeding to effeft the fame purpofe, we are 

 unable to conjedlure what powers he afcribed to the former 

 retnedy. " Jam non aliis auxiliis (cuii in propinquo mors 

 fit) aegro fubveniri pofle autumo, quam vel narcolica affatim 

 exhibendo, vel fanguinan liberaliter extrahendo," &c. (Obf. 

 Medica:, feft. iii. cap. 2.) Dr. Walker has juftly animad- 

 verted on this praAice, which, however it may alleviate 

 reftlefsnefs and pain, in flight cafes, unaccompanied by 

 ECiite fever, is well known to accelerate the circulation, to 



harden the pulfe, to augment the heat and third, to increafc 

 delirium, to diminifh the fecretions ; in a word, to aggra- 

 vate all the fymptoms of inflammatory fever, while it fails 

 to produce the anticipated reft, or rather baniflies it more 

 cffeftually. Such we know to be the effetts of an opiate 

 in all the phlegmafis, or acute and vifceral inflammation ; as 

 well as in the atlive flages of common fever ; and we know 

 no circumltance in the early ftage of fmall-pox, which con- 

 ititutes any exception to this fatt, or which modifies the ordi- 

 nary operation of the medicine. A fteady purfuit of the anti- 

 phlogillic plan is a much more effeftual footherof the irrita- 

 tion which the patient fuffers. Sydenham and other writers 

 urge the impropriety of interfering with the ptyalifm, that 

 ufually occurs in confluent fmall-pox ioon after the eruption 

 is out, and deem the fuppreffion of it highly dangerous. 

 Yet the tendency of opium to leflen the fecretions is well 

 underftood : but the principal injury to be apprehended from 

 it is the excitement which it produces. In the later periods 

 of the dileafe, however, when the febrile excitement is low, 

 and much irritation is kept up by the hardening cralts, the 

 moderate ufe of opiates is to be recommended. 



The antiphlogiftic praftice, above recommended, fliould 

 be continued during the progrefs of the eruption to matura- 

 tion, unlefs fome particular fymptoms of failure of the ms 

 ■v'ltic fliould enfue. For in every cafe of fmall-pox, where 

 the eruption of pufl;ules is numerous, although fome abate- 

 ment of the fever is difcernible upon the complete eruption 

 of the fpots, yet there is feldom a perfeA remiffion of the 

 fever, the pulfe rarely defcending below 90 or 100 in the 

 minute. The ficondary fever, therefore, which occurs about 

 the eleventh day, upon the complete fuppuration of the 

 puftule?, or at Icait when thefe are perfectly full and 

 Stretched to their utmoft extent, whatever may be the nature 

 of the fluid which they contain, is rather an augmentation 

 of the exilling fever than a new fever. The origin of this 

 fever, in the opinion of Sydenham and moll of the writers 

 who followed him, was the re-abforption of the virus of the 

 pullules into the blood, as well as the retention of the or- 

 dinary perfpirable matter, which could not pafs ofi^ by the 

 (liin. Whence they recommended blood-letting, which, 

 they believed, was the molt effeftual mode of depurating 

 the blood thus contaminated, as the means of cure for this 

 fever. But not only was their theory very bad, (for furely 

 drawing a few ounces of blood from the circulating mais 

 could have no eff'efl in removing the corruption from that 

 which remained in the veflels,) but their praftice was often 

 injurious, by reducing the ftrength of tiie patient, at a time 

 when the powers of life were about to fail, and require all 

 poflible fupport. Dr. Freind had the merit of pointing out 

 the fuperior advantages of gentle purgatives in mitigating 

 the fecondary fever. The bowels fliould be gently but 

 ft;eadily opened, in all cafes, at the commencement of this 

 fever, provided no diarrhoea has occurred. According to 

 the ftate of the pulfe, and the appearance of the matter in 

 the eruptions, the ilrength of the patient, and other fymp- 

 toms, more or lefs of a cordial plan of treatment muft, how- 

 ever, be combined with the laxatives. Light liquid nourifti- 

 ment, with a little wine and water as drink, fliould be fre- 

 quently adminiftered ; and a decoAion or infufion of cia- 

 choHa, with the mineral acids and a flight aromatic, will be 

 given with advantage. If the difeafe put on a more malig- 

 nant charafter, with petechirc and hxmorrhages, the cordial 

 treatment muft be increafed both in quantity and ftrength ; 

 but the ftate of the bowels mult itill be regulated. Under 

 this cordial plan, the petechia will fometimes difappear ; 

 the empty veficles will become filled with matter ; and 

 the ichorous fluid of others be changed into white thick 



pus J 



