SMALL-POX. 



pus J the other fymptoms of courfe improving in a fimilar 

 •Jcgree. 



Such is the general plan of cure which experience has 

 fandlioned in the fmall-pox. Bat in particular cafes parti- 

 cular fymptoms are very urgjcnt, modifying the character of 

 tlie difeafe, and requiring feme modification of the method 

 of treatment. 



Little can be done to controul effectually the fal'ivat'wn, 

 vhen that difcharge is exceffive, nor to rcftore it when it 

 iiddenly fublides. In the former cafe, and when the pa- 

 tient is in danger of fuffocation from the vifcidity of the 

 faliva, and the difficulty of difcharging it, the mouth and 

 throat may be frequently wafhed or fyringed with a gargle 

 containing oxymel, or fome of the mineral acids. And, 

 as the faliva often begins to thicken on the eleventh day, 

 Sydenham recommended a blifter (which has been often 

 found benelicial) to be apphed between the (houlders, on 

 the evening of the tenth day, by way of prevention. The 

 diarrhica, when it occurs fpontaneoufly, being by all writers 

 deemed rather falutary than injurious, fhould not be inter- 

 fered with. The Jkvelli/ig of the head, fcice, znA fauces, when 

 it is exceffive, is highly dangerous, and commonly accom- 

 panied by vifcidity or iuppreffion of the falivary difcharge. 

 The fteady purfuit of the antiphlogillic fyftem is the belt 

 preventive of this danger, and the free difcharge occafioned 

 by laxatives affords the befl means of drawing off the deter- 

 mination of the fluids to thofe parts. 



The head-ache and delirium, when violent and accompanied 

 with intolerance of light, and other phrenitic fymptoms, 

 mark the violence of the fever from the beginning, as well 

 as the too great fulnefs of the vcflels of the head, and 

 therefore demand, not only the moft rigid purfuit of the 

 antiphlogillic plan, the free admiffion of cool air, and aftive 

 purgation, but alio the particular application of cold to the 

 head ; the detraction of blood by leeches or cupping from 

 the temples or nucha ; or even general blood-letting. The 

 pediluvium is fometimes recommended for the purpofe of 

 relieving the head on the principle of revulfion ; but we 

 have more than once exprcfled our doubts both of the truth 

 of the hypothefis and of the advantages of the praftice. 

 When the determination to the head is fuch as to produce 

 aftual coma, during the eruptive fever, a moll dangerous 

 fmall-pox is to be apprehended ; and the cooling evacuating 

 meafures jull recommended fhould be carried as far as dif- 

 cretion and experience will juflify, and a bliller fltould be 

 applied to the nick. 



Inflammation of the throat is a common attendant on all 

 the varieties of Imall-pox, even the mildell ; but in the 

 latter it is flight, and eafily relieved by any acidulous and 

 mucilaginous gargle, fuch as an infufion of figs, acidulated 

 with lemon-juice, apple-tea, or lemonade. But the angina, 

 which accompanies the worll kinds of fmall-pox, is more 

 acute and obdinate, and from extending to the glottis, it 

 frequently produces a confiderable degree of hoarftnefs. It 

 is alfo iiicrealcd by tlie general inflammation ar.d t\miefac- 

 tion of the contiguous parts, and continue^ till thefe fubfide. 

 This fymptom is moderated by the antiplilogitlic regimen, 

 by blood-letting in inflammatory habits, and efpecially by 

 the early courle of laxatives, which contribute to prevent 

 and diminifh all the inflammatory fymptoms. 



Difficulty of breathing is an alarming fymptom in fmall- 

 pox, and feldom occurs except in the worfl kinds, and in 

 the lail ilage of the difeafe, efpecially when it is left to 

 nature, or improperly treated in the preceding periods. In 

 cafes where the chefl is narrow and contracted, or there is a 

 conflitutional predifpofition to dileafe in the lungn, this 

 fymptom may occur at an carhcr flage. Its appearance 



implies a threatening or prefent inflammation or peripneu» 

 mony, and requires more than any other fymptom the free 

 ufe of blood-letting, as well as the exhibition of cooling 

 purgatives, and the whole antiphlogillic plan. 



Some degree of fupprejfwn of urine not unfrequently takes 

 place in fevere cafes of fmall-pox, efpecially from bad ma- 

 nagement in the beginning of the difeafe ; it is commonly 

 attended by collivenefs, and is mofl efieftually relieved by 

 promoting the inteltinal difcharge, efpecially by laxative 

 glyflers. An immediate evacuation is fometimes produced, 

 as Sydenham remarked, by taking the patient out of bed, 

 and fupporting him expofed to the cool air in his fhirt, but 

 Hill more eft'ediually by placing his feet on a cold floor or 

 hearth, which commonly induces a fpeedy difpofition in the 

 bladder to contraft and expel its contents. 



It only remains that we allude to the means which have 

 been devifed to prevent the deformity which is too often 

 produced by fmall-pox by the pits which it leaves behind. 

 As the pits have been afcribed to the retention of the acrid 

 matter under the cuticle, and the confequent corrofion of 

 the true flvin ; fo it has been propofed to open the puftules, 

 in order to allow the ichor to be difcharged. (See Van 

 Swieten, Comment, ad Aph. 1402.) This plan, however, 

 has not proved fuccefsful, and the theory is probably er- 

 roneous. Others have propofed the covering of the face in 

 the laft Itage of the difeafe, to fecure it from the air, and 

 the ufe of fomentations at the fame time with warm milk, 

 and inundlions with unfalted butter, hog's-lard, or oil. Dr. 

 Walker, in his valuable work already often quoted, adopts 

 a fimilar method, but at a fomewhat earher period. He 

 maintains that the pits do not originate either from the acri- 

 mony of the contained matter, from ulceration, or from any 

 lofs of fubllance of the fliin ; but that they are, in faft, 

 merely imprejjions, made in the tender flcin by the preflure 

 of the hardened and deficcated puftules, or fcabs, as a 

 feal imprelfes melted wax. This, however, may be juftly 

 queftioned ; for the flcin, tender as it may be, is probably 

 not capable of receiving any imprcffions lo permanent, and 

 mult be partially ulcerated, and lofe a portion of its fub- 

 ftance by Houghing, under each hardening puftule. It is 

 true, however, that the face is chiefly hable to be pitted, 

 from the greater drying and hardening of the crowd of puf- 

 tules which cover it, and that this may probably be owing 

 to its greater expofure to the air. Whence the early pre- 

 vention of fuch expofure, and the foftening of the drying 

 puftules, certainly promife the beft fecurity againft fevere 

 pitting. About the tenth day of the difeafe, fometimes 

 fooner, according to the kind of fmall-pox, the apices of 

 the puftules on the face change colour, feel rough, and 

 begin to harden, efpecially about the movith and chin, which 

 are more chafed by the bed-clothes. At this time, there- 

 fore. Dr. Walker iprcad over the face a malk, of tine old 

 cambric, thinly fmcarcd with a mild liniment, compoled of 

 oil, fpennaceti, and a little wax. 'J'his mafk he renewed 

 three or four times in twenty-four hours, and fometimes 

 oftener, elpccially when urged by the patient, who gene- 

 rally felt an agreeable and refrefliing coolnefs for fome time 

 after each application. On removing the mafk, the f;icc 

 was gently touched with a ioft cambric handkerchief, and 

 expofed to the air for as fliort a time as poflible. By this 

 expedient, he affirms, the variolous matter is feen through 

 the tranfpari'nt mafk to be preferved in a ftate of fluidity as 

 long as it remains in lliat ftate on other parts of the body, 

 or until it is gradually difcliargfd by oozing out. The 

 maflc is to be continutd till the puftules are perfectly emp- 

 tied, which happens in the courfe of ten, twelve, or fifteen 

 days, and iu forac kinds of fmall-pox in a longer lime. Dr. 



Walker 



