278 
PATHOLOGY. 
naces red ; the fever ceafing when' the eruption is com¬ 
plete. 
Fhe natural fmall-pox begins with fenfibility to cold, 
fhivering, languor, feverifhnefs, difturbed deep, pain of 
the head and of the back, vomiting, and tendernefs of 
rlie epigaftrium under prell'ure. In adults, there is a 
ftrong tendency to perfpiration ; in infants, ftupor, and 
fits fmilar to thofe of epilepfy, fometimes occur about 
fhe third day, but there is no tendency to perfpiration. 
On the fourth day, the eruption generally appears on the 
face, and perhaps on the neck andbreaft; it extends 
gradually during the enfuing day, and becomes general 
over the furface of the body. The febrile fymptoms 
abate on the appearance of the eruption. On the fourth 
and fifth days, the puftules are fmall, hard, and globu¬ 
lar, red and painful, feparate anddiftinft from each other, 
with nearly colourlefs interftices. They enlarge gradu¬ 
ally until the eighth day, when they contain a little yel- 
lowifh fiiiid, and the interftices become red. From this 
day the puftules increafe in breadth, and have a fmall pit 
in their centre, until the eleventh, when they become 
mere rounded, and are encircled by rings of rofe-co- 
loured inflammation, which coalefce when the eruption 
is numerous. About the eighth day, there is frequently 
a flow of faliva, the integuments of the face are apt to 
become fwollen, the eyes are often clofed, and the eye¬ 
lids diftended like a bladder. This tumefa&ion gradual¬ 
ly declines; it is much abated, and the puftules are fully 
diftended, about the eleventh day, when a degree of fwel- 
ling is fometimes obferved about the hands and feet, 
which, in its turn, fubfides gradually; about the fame 
time too, the tendency to perfpiration diminifhes, or 
ceafes, fpontaneoufly. The puftules break, the fluid 
partly ifiues, and at length dries and forms a fcab, the 
cuticle becoming fhrivelled ; a procefs which is completed 
on the face about the fifteenth day. In a few days more, 
the fcabs feparate, leaving the fubjacent part of a brown- 
ifh-red colour, and often pitted. The fluid in the puf¬ 
tules fituated on the arms and hands, is fometimes ab- 
ferbed, and the cuticle falls down in a flaccid ftate. 
£. V. confluens, confluent fmall-pox, is attended with 
febrile fymptoms of a more ferious kind, refembling thofe 
of Emprefma maligna, and exacerbating towards even¬ 
ing. There are frequently coma, delirium; vomiting, 
and fometimes diarrhoea; a frequent, feeble, pulfe; there 
is lefs tendency to perfpiration; the appearance of the 
eruption induces lefs, and lefs permanent, relief; and 
the fever refumes its violence about the ftxth day. The 
eruption appears early, on the third day. It is preceded, 
or attended, in many inftances, by exanthema. The 
puftules are more numerous on the face; fmaller, and 
lefs hard and eminent; during a flouer and lefs marked 
progrefs, their diameters enlarge; they do not retain 
the circular and orbicular form, but aflfume an irregular 
figure, remain flat, and coalefce, fo that frequently the 
face feems covered with one extended and continuous 
puftule. The interftices are pale and flaccid, and with¬ 
out the rofe-coloured inflammation obferved in V. dif- 
creta. The contained fluid becomes opaque and brown- 
iftt, but does not afl'ume the yellow, confiftent, and pu¬ 
rulent, appearance. The puftules at length break, the 
Cuticle flirivels up, the enclofed fluid ifiues ; dark brown 
fcabs' are formed, feparate flowly, and leave deep 
pits. The tumefa&ion of the face, and the falivation, 
t ake place earlier, and are more conliderable, than in V.. 
difereta ; they abate, and the hands tumefy, about the 
feventh day. In infants, diarrhoea fometimes occurs ; 
and there is no falivation. On the general furface the 
puftules are more diftinft; but they are lefs prominent, 
and the enclofed matter lefs confiftent, than in the former 
variety. The febrile fymptoms are mitigated on the ap¬ 
pearance of the eruption, but again become more vio¬ 
lent, and conftitute what is termed the fecondary fever 
in this difeafe. 
y. V. inferta, inoculated fmall-pox : produced by ino¬ 
culation ; orange-coloured areola: about the punfture; 
pain in the axilla about the feventh day ; difeafe for the 
mod part mild ; and the purulent difeharge fometimes 
confined to the punctured part. 
• S. Degener, horn-pock, or cryftalline pock : pimples 
imperfectly fuppurating; ichorous or horny, and femi- 
tranfparent. 
- Now as to the treatment of fmall-pox. Since it ap¬ 
pears very evident, that the danger and violence of the 
fymptoms are nearly in proportion to the quantity of the 
eruption ; which is again much connected with the de¬ 
gree of fever that accompanies and precedes it; the firft: 
indication is, to moderate the eruptive fever. 
In the cafe of inoculated fmall-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 medi¬ 
cines if the habit be full, the body may be brought into 
a lefs inflammatory ftate, and thus rendered lefs fufeep- 
tible of violent inflammatory difeafe. But, in the cafual 
fmall-pox, we have commonly no warning of the malady, 
until the eruptive fever actually commences; nor, when 
it has already begun, can we be certain, from any pecu¬ 
liar fymptoms, that it is any thing but an ordinary fe¬ 
ver; uniefs it occurs in perfons who, not having pre- 
vioufly undergone the difeafe, have been notorioufly ex- 
pofed to the infeftion. It is fortunate, however, that 
our inability to diftinguifh the fever which is about to 
uftier in the fmall-pox from common inflammatory fever, 
is of no moment; fince the fame remedies are the moft 
appropriate in both cafes. According to the degree of 
violence with which the fever commences, the activity of 
the meafures for moderating it will be various. If the 
fymptoms are not fevere, the patient may be recommend¬ 
ed 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 difeard ani¬ 
mal food, and adopt that of a cooling nature, vegetable 
"decodfions, acidulous fruits, and diluent drinks, fuch as 
plain cold water, lemonade, whey, &c. All his drinks 
fhould be given cold ; and the bo'ivels fhould be freely 
opened by fome cooling purgative, as by the neutral 
falts, with a little calomel. If thefe meafures are adequate 
to keep down the fever, ar.d if, at the fame time, the 
eruption appears early, and in fmall numbers, the fafety 
of the patient may be confidered as afeertained ; and no 
farther treatment, except a continuance of the antiphlo- 
giftic fyftem, is neceflary. 
Where the fever comes on, however, with great vio¬ 
lence, manifefted by a quick hard pulfe, intenfe heat, 
and thirft, a flufhed countenance, inflamed eyes, fevere 
head-ache, quick and opprefled refpiration, with deli¬ 
rium, very active meafures fhould be immediately adopt¬ 
ed, especially in plethoric habits. In perfons of this de- 
feription, the firft objefl would be to let fome blood, the 
quantity of which mull be determined by a confideration 
of the violence of the fymptoms. At the fame time, the 
cooling plan muft be adopted to the fulleft extent in re- 
fpeft to the apartment, which fhould be freely ventilated 
by the admiflion of the external air, through open win¬ 
dows and doors, and to the bed, which fhould be a 
mattrafs, and as lightly covered as the feafon and the 
feelings w ill permit. If the fkin is intenfely hot and dry, 
much benefit will be obtained, in the moil: expeditious 
manner, by fponging the furface occafionally with cold 
water, or even by the ufe of the cold affufion. An active 
purgative will alfo contribute to relieve inflammatory ac¬ 
tion, and fhould be fpeedily adminiftered, and repeated 
according to circumftances. 
If, however, thefe falutary meafures have been omitted, 
or have proved inadequate to prevent a numerous erup¬ 
tion, efpecially upon the face; if the puftules are not 
diftinft ; and particularly, if, on the fifth day, the fever 
does not fuffer a confiderable remiflion ; the difeafe will 
a ftill 
