Part 21

Sec. 206. Whenever there is a very considerable Eruption, the Fever is heightened at the Time of Suppuration, which is not to be wondered at; one single Boil excites a Fever: How is it possible then that some hundred, nay some thousand of these little Abscesses should not excite one? This Fever is the most dangerous Period, or Time of the Disease, and occurs between the ninth and the thirteenth Days; as many Circumstances vary the Term of Suppuration, two or three Days. At this painful and perilous Season then, the Patient becomes very hot, and thirsty: he is harrassed with Pain; and finds it very difficult to discover a favourable easy Posture. If the Malady runs very high, he has no Sleep; he raves, becomes greatly oppressed, is seized with a heavy Drowsiness; and when he dies, he dies either suffocated or lethargic, and sometimes in a State compounded of both these Symptoms.

The Pulse, during this Fever of Suppuration, is sometimes of an astonishing Quickness, while the Swelling of the Wrists makes it seem, in some Subjects, to be very small. The most critical and dangerous Time is, when the Swellings of the Face, Head and Neck are in their highest Degree. Whenever the Swelling begins to fall, the Scabs on the Face to dry [supposing neither of these to be too sudden and premature, for the visible Quantity of the Pustules] and the Skin to shrivel, as it were, the Quickness of the Pulse abates a little, and the Danger diminishes. When the Pustules are very few, this second Fever is so moderate, that it requires some Attention to discern it, so that the Danger is next to none.

Sec. 207. Besides those Symptoms, there are some others, which require considerable Attention and Vigilance. One of these is the Soreness of the Throat, with which many Persons in the Small-Pocks are afflicted, as soon as the Fever grows pretty strong. It continues for two or three Days; feels very strait and troublesome in the Action of Swallowing; and whenever the Disease is extremely acute, it entirely prevents Swallowing. It is commonly ascribed to the Eruption of Pustules in the Throat; but this is a Mistake, such Pustules being almost constantly imaginary. It begins, most frequently, before the Eruption appears; if this Complaint is in a light Degree, it terminates upon the Eruption; and whenever it revives again in the Course of the Disease, it is always in Proportion to the Degree of the Fever. Hence we may infer it does not arise from the Pustules, but is owing to the Inflammation; and as often as it is of any considerable Duration, it is almost ever attended with another Symptom, the Salivation, or a Discharge of a great Quantity of Spittle. This Salivation rarely exists, where the Disease is very gentle, or the Patient very young; and is full as rarely absent, where it is severe, and the Patient is past seven or eight Years old: but when the Eruption is very confluent, and the Patient adult, or grown up, the Discharge is surprizing. Under these Circumstances it flows out incessantly, allowing the afflicted Patient no Rest or Respite; and often incommodes him more than any other Symptom of the Distemper; and so much the more, as after its Continuance for some Days, the Lips, the Inside of the Cheeks, the Tongue, and the Roof of the Mouth are entirely peeled or flead, as it were. Nevertheless, however painful and embarrassing this Discharge may prove, it is very important and salutary. Meer Infants are less subject to it, some of them having a Looseness, in Lieu of it: and yet I have observed even this last Discharge to be considerably less frequent in them, than a Salivation is in grown People.

As Pustules are, and not very seldom, visible on the Tongue, and sometimes on the Roof, even to its Process called the Palate, which I have plainly seen; it seems not very easy to assign any insuperable Obstacle to the Existence of a few within the Throat; though this scarcely ever occurs, in the distinct Small-Pocks. Doubtless however, a considerable Inflammation of that Part will be as likely to produce the great Difficulty of Swallowing, as the Existence of Pustules there; which our learned Author does not absolutely reject, and consequently will forgive this Supposition of them; especially if he credits the ocular Testimony of Dr. Violante, cited in the Analysis, Ed. 2d. p 71. K.

Sec. 208. Children, to the Age of five or six Years, are liable to Convulsions, before Eruption: these however are not dangerous, if they are not accompanied with other grievous and violent Symptoms. But such Convulsions as supervene, either when Eruption having already occurred, suddenly retreats, or strikes in, according to the common Phrase; or during the Course of the Fever of Suppuration, are greatly more terrifying.

Involuntary Discharges of Blood from the Nose often occur, in the first Stage of this Distemper, which are extremely serviceable, and commonly lessen, or carry off, the Head-ach. Meer Infants are less subject to this Discharge; though they have sometimes a little of it: and I have known a considerable Stupor or Drowsiness, vanish immediately after this Bleeding.

Sec. 209. The Small-Pocks is commonly distinguished into two Kinds, the confluent and the distinct, such a Distinction really existing in Nature: but as the Treatment of each of them is the same; and as the Quantity or Dose of the Medicines is only to be varied, in Proportion to the Danger of the Patient (not to enter here into very tedious Details, and such as might exceed the Comprehension of many of our Readers; as well as whatever might relate particularly to the malignant Small-Pocks) I shall limit myself within the Description I have premised, which includes all the Symptoms common to both these Kinds of the Small-Pocks. I content myself with adding here, that we may expect a very confluent and dangerous Pock, is, at the very Time of seizure, the Patient is immediately attacked with many violent Symptoms; more especially if his Eyes are extremely quick, lively, and even glistening, as it were; if he vomits almost continually; if the Pain of his Loins be violent; and if he suffers at the same Time great Anguish and Inquietude: If in Infants there is great Stupor or Heaviness; if Eruption appears on the third Day, and sometimes even on the second: as the hastier Eruptions in this Disease signify the most dangerous Kind and Degree of it; and on the contrary, the slower Eruption is, it is the safer too; supposing this Slowness of the Eruption not to have been the Consequence of great Weakness, or of some violent inward Pain.

Sec. 210. The Disorder is sometimes so very mild and slight, that Eruption appears with scarcely any Suspicion of the Child's having the least Ailment, and the Event is as favourable as the Invasion. The Pustules appear, grow large, suppurate and attain their Maturity, without confining the Patient to his Bed, or lessening either his Sleep, or Appetite.

It is very common to see Children in the Country (and they are seldom more than Children who have it so very gently) run about in the open Air, through the whole Course of this Disease, and feeding just as they do in Health. Even those who take it in a somewhat higher Degree, commonly go out when Eruption is finished, and give themselves up, without Reserve, to the Voracity of their Hunger. Notwithstanding all this Neglect, many get perfectly cured; though such a Conduct should never be proposed for Imitation, since Numbers have experienced its pernicious Consequences, and several of these Children have been brought to me, especially from Jurat, who after such Neglect, in the Course of the mild and kindly Sort of this Distemper, have contracted Complaints and Infirmities of different Kinds, which have been found very difficult to subdue.

Sec. 211. This still continues to be one of these Distempers, whose Danger has long been increased by its improper Treatment, and especially by forcing the Patients into Sweats; and it still continues to be increased, particularly among Country People. They have seen Eruption appear, where the Patient sweats, and observed he found himself better after its Appearance: and hence they conclude that, by quickening and forcing out this Eruption, they contribute to his Relief; and suppose, that by increasing the Quantity of his Sweats, and the Number of his Eruptions, the Blood is the better cleared and purified from the Poison. These are mortal Errors, which daily Experience has demonstrated, by their tragical Consequences.

When the Contagion or Poison, which generates this Disease, has been admitted into the Blood, it requires a certain Term to produce its usual Effects: at which Time the Blood being tainted by the Venom it has received, and by that which such Venom has formed or assimilated from it, Nature makes an Effort to free herself of it, and to expell it by the Skin, precisely at the Time when every Thing is predisposed for that Purpose. This Effort pretty generally succeeds, being very often rather too rapid and violent, and very seldom too weak. Hence it is evident, that whenever this Effort is deficient, it ought not to be heightened by hot Medicines or Means, which make it too violent and dangerous: for when it already exceeds in this Respect, a further Increase of such Violence must render it mortal. There are but few Cases in which the Efforts of Nature, on this Occasion, are too languid and feeble, especially in the Country; and whenever such rare Cases do occur, it is very difficult to form a just and proper Estimation of them: for which Reason we should be very reserved and cautious in the Use of heating Medicines, which are so mortally pernicious in this Disease.

Wine, Venice Treacle, cordial Confections, hot Air, and Loads of Bed-cloths, annually sweep off Thousands of Children, who might have recovered, if they had taken nothing but warm Water: and every Person who is interested in the Recovery of Patients in this Distemper, ought carefully to prevent the smallest Use of such Drugs; which, if they should not immediately aggravate it to a fatal Degree, yet will certainly increase the Severity and Torment of it, and annex the most unhappy and tragical Consequences to it.

The Prejudice in this Point is so strongly rooted, that a total Eradication of it must be very difficult: but I only desire People would be convinced by their own Eyes, of the different Success of the hot Regimen, and of that I shall propose. And here indeed I must confess, I found more Attention and Docility, on this Point, among the Inhabitants of the City, and especially in the last epidemical spreading of the Small-Pocks, than I presumed to hope for. Not only as many as consulted me on the Invasion of it, complied exactly with the cooling Regimen I advised them; but their Neighbours also had Recourse to it, when their Children sickened: and being often called in when it had been many Days advanced, I observed with great Pleasure, that in many Houses, not one heating Medicine had been given; and great Care had been taken to keep the Air of the Patient's Chamber refreshingly cool and temperate. This encourages me to expect, that this Method hereafter will become general here. What certainly ought most essentially to conduce to this is, that notwithstanding the Diffusion or spreading of this Disease was as numerous and extensive as any of the former, the Mortality, in Consequence of it, was evidently less.

Sec. 212. At the very Beginning of the Small-Pocks (which may be reasonably suspected, from the Presence of the Symptoms I have already described; supposing the Person complaining never to have had it, and the Disease to prevail near his Residence) the Patient is immediately to be put on a strict Regimen, and to have his Legs bathed Night and Morning in warm Water. This is the most proper and promising Method to lessen the Quantity of Eruption in the Face and Head, and to facilitate it every where else on the Surface. Glysters also greatly contribute to abate the Head-ach, and to diminish the Reachings to vomit, and the actual Vomitings, which greatly distress the Patient; but which however it is highly absurd and pernicious to stop by any stomachic cordial Confection, or by Venice Treacle; and still more dangerous to attempt removing the Cause of them, by a Vomit or Purge, which are hurtful in the beginning of the Small-Pocks.

If the Fever be moderate, the Bathings of the Legs on the first Day of sickening, and one Glyster may suffice then. The Patient must be restrained to his Regimen; and instead of the Ptisan No. 1, 2, 4, a very young Child should drink nothing but Milk diluted with two thirds of Elder Flower or Lime-tree Tea, or with Balm Tea, if there be no perceivable Fever; and in short, if they have an Aversion to the Taste of them all, with only the same Quantity of good clear Water. An Apple coddled or baked may be added to it; and if they complain of Hunger, a little Bread may be allowed; but they must be denied any Meat, or Meat Broth, Eggs and strong Drink; since it has appeared from Observations frequently repeated, that Children who had been indulged with such Diet proved the worse for it, and recovered more slowly than others. In this early Stage too, clear Whey alone may serve them instead of every other Drink, the good Effects of which I have frequently been a Witness to; or some Buttermilk may be allowed. When the Distemper is of a mild Species, a perfect Cure ensues, without any other Assistance or Medicine: but we should not neglect to purge the Patient as soon as the Pustules are perfectly scabbed on the greater Part of his Face, with the Prescription No. 11, which must be repeated six Days after. He should not be allowed Flesh 'till after this second Purge; though after the first he may he allowed some well-boiled Pulse, or Garden-stuff and Bread, and in such a Quantity, as not to be pinched with Hunger, while he recovers from the Disease.

A Negro Girl, about five or six Years old, under a coherent Pock, stole by Night out of the Garret where she lay, into a Kitchen out of Doors, where she drank plentifully of cold Water. How often she repeated these nightly cooling Potions I never could certainly learn, though they occurred in my own House in South-Carolina in Summer. But it is certain the Child recovered as speedily as others, whose Eruption was more distinct, and who drank Barley-Water, very thin Rice or Indian Corn Gruel, Balm Tea, or the like. In fact, throughout the Course of this Visitation from the Small Pocks in Carolina in 1738, we had but too many Demonstrations of the fatal Co-operation of violent Heat with their Contagion; and not a very few surprizing Instances of the salutary Effects of being necessarily and involuntarily exposed to same very cooling Accidents after Infection, and in some Cases after Eruption too: which I then more particularly mentioned is a small controversial Tract printed there. K.

Sec. 213. But if the Fever should be strong, the Pulse hard, and the Pain of the Head and Loins should be violent, he must, 1. immediately lose Blood from the Arm; receive a Glyster two Hours after; and, if the Fever continues, the Bleeding must be repeated. I have directed a Repetition of it even to the fourth Time, within the two first Days, to young People under the Age of eighteen; and it is more especially necessary in such Persons as, with a hard and full Pulse, are also affected with a heavy Drowsiness and a Delirium, or Raving.

2. As long as the Fever continues violently, two, three, and even four Glysters should be given in the 24 Hours; and the Legs should be bathed twice.

3. The Patient is to be taken out of Bed, and supported in a Chair as long as he can tolerably bear it.

4. The Air of his Chamber should frequently be renewed, and if it be too hot, which it often is in Summer, in Order to refresh it, and the Patient, the Means must be employed which are directed Sec. 36.

5. He is to be restrained to the Ptisans No. 2 or 4; and if that does not sufficiently moderate the Fever, he should take every Hour, or every two Hours, according to the Urgency of the Case, a Spoonful of the Mixture No. 10; mixed with a Cup of Ptisan. After the Eruption, the Fever being then abated, there is less Occasion for Medicine; and should it even entirely disappear, the Patient may be regulated, as directed, Sec. 212.

Sec. 214. When, after a Calm, a Remission or Intermission of some Days, the Process of Suppuration revives the Fever, we ought first, and especially, to keep the Body very open. For this Purpose, a an Ounce of Catholicon should be added to the Glysters; or they might be simply made of Whey, with Honey, Oil and Salt. b Give the Patient three times every Morning, at the Interval of two Hours between each, three Glasses of the Ptisan No. 32. c Purge him after two Days, with the Potion No. 23, but on that Day he must not take the Ptisan No. 32.

We must remember that Dr. Tissot is treating here of the higher or confluent Degrees of this Disease; for in the distinct Small-Pocks, it is common to find Persons for several Days without a Stool, and without the least perceiveable Disorder for Want of one (their whole Nourishment being very light and liquid) in which Cases, while Matters proceeded well in all other Respects, there seems little Occasion for a great Solicitude about Stools: But if one should be judged necessary after four or five Days Costiveness, accompanied with a Tightness or Hardness of the Belly, doubtless the Glyster should be of the lenient Kind (as those directed by our Author are) and not calculated to produce more than a second Stool at the very most. Indeed, where there is Reason to apprehend a strong secondary Fever, from the Quantity of Eruption, and a previously high Inflammation, it is more prudent to provide for a Mitigation of it, by a moderately open Belly, than to suffer a long Costiveness; yet so as to incur very little Hazard of abating the Salivation, or retarding the Growth or Suppuration of the Pustules, by a Superpurgation, which it may be too easy to excite in some Habits. If the Discharge by spitting, and the Brightness and Quantity of Suppuration, have been in Proportion to the Number of Eruptions; though the Conflict from the secondary Fever, where these have been numerous, is often acute and high; and the Patient, who is in great Anguish, is far from being out of Danger, yet Nature pretty generally proves stronger than the Disease, in such Circumstances. As the Elect. Catholicon, is little used, or made here, the lenitive Electuary of our Dispensatory may be substituted for it, or that of the Edinburgh Dispensatory, which was calculated particularly for Glysters. K.

2. He must, if the Distemper be very violent, take a double Dose of the Mixture No. 10.

3. The Patient should be taken out of Bed, and kept up in a Room well aired Day and Night, until the Fever has abated. Many Persons will probably be surprized at this Advice; nevertheless it is that which I have often experienced to be the most efficacious, and without which the others are ineffectual. They will say, how shall the Patient sleep at this Rate? To which it may be answered, Sleep is not necessary, nay, it is hurtful in this State and Stage of the Disease. Besides, he is really unable to sleep: the continual Salivation prevents it, and it is very necessary to keep up the Salivation; which is facilitated by often injecting warm Water and Honey into his Throat. It is also of considerable Service to throw some up his Nostrils, and often thus to cleanse the Scabs which form within them. A due Regard to these Circumstances not only contributes to lessen the Patient's Uneasiness, but very effectually also to his Cure.

4. If the Face and Neck are greatly swelled, emollient Cataplasms are to be applied to the Soles of the Feet; and if these should have very little Effect, Sinapisms should be applied. These are a kind of Plaister or Application composed of Yeast, Mustard-flower, and some Vinegar. They sometimes occasion sharp and almost burning Pain, but in Proportion to the Sharpness and Increase of these Pains, the Head and Neck are remarkably relieved.

Sec. 215. The Eyelids are puffed up and swelled when the Disease runs high, so as to conceal the Eyes, which are closed up fast for several Days. Nothing further should be attempted, with Respect to this Circumstance, but the frequent moistening of them with a little warm Milk and Water. The Precautions which some take to stroke them with Saffron, a gold Ducat, or Rose-water are equally childish and insignificant. What chiefly conduces to prevent the Redness or Inflammation of the Eyes after the Disease, and in general all its other bad Consequences, is to be content for a considerable Time, with a very moderate Quantity of Food, and particularly to abstain from Flesh and Wine. In the very bad Small Pocks, and in little Children, the Eyes are closed up from the Beginning of the Eruption.

Sec. 216. One extremely serviceable Assistance, and which has not been made use of for a long Time past, except as a Means to preserve the Smoothness and Beauty of the Face; but yet which has the greatest Tendency to preserve Life itself, is the Opening of the Pustules, not only upon the Face, but all over the Body. In the first Place, by opening them, the Lodgment or Retention of Pus is prevented, which may be supposed to prevent any Erosion, or eating down, from it; whence Scars, deep Pitts and other Deformities are obviated. Secondly, in giving a Vent to the Poison, the Retreat of it into the Blood is cut off, which removes a principal Cause of the Danger of the Small-Pocks. Thirdly, the Skin is relaxed; the Tumour of the Face and Neck diminish in Proportion to that Relaxation; and thence the Return of the Blood from the Brain is facilitated, which must prove a great Advantage. The Pustules should be opened every where, successively as they ripen. The precise Time of doing it is when they are entirely white; when they just begin to turn but a very little yellowish; and when the red Circle surrounding them is quite pale. They should be opened with very fine sharp-pointed Scissars; this does not give the Patient the least Pain; and when a certain Number of them are opened, a Spunge dipt in a little warm Water is to be repeatedly applied to suck up and remove that Pus, which would soon be dried up into Scabs. But as the Pustules, when emptied thus, soon fill again, a Discharge of this fresh Matter must be obtained in the same Manner some Hours after; and this must sometimes be repeated five or even six Times successively. Such extraordinary Attention in this Point may probably be considered as minute, and even trivial, by some; and is very unlikely to become a general Practice: but I do again affirm it to be of much more Importance than many may imagine; and that as often as the Fever attending Suppuration is violent and menacing, a very general, exact and repeated opening, emptying, and absorbing of the ripened Pustules, is a Remedy of the utmost Importance and Efficacy; as it removes two very considerable Causes of the Danger of this Disease, which are the Matter itself, and the great Tension and Stiffness of the Skin.