Part 22

This Practice which I had heard of, and even suggested to myself, but never seen actually enterprized, seems so very rational as highly to deserve a fair Trial in the confluent Degrees of the Small-Pocks [for in the distinct it can scarcely be necessary] wherein every probable Assistance should be employed, and in which the most potent Medicines are very often unsuccessful. We have but too many Opportunities of trying it sufficiently; and it certainly has a more promising Aspect than a Practice so highly recommended many Years ago, of covering all the Pustules (which is sometimes the whole Surface of the Patient) in Melilot, or suppose any other suppurating, Plaister; which will effectually prevent all Perspiration, and greatly increase the Soreness, Pain and Embarrassment of the Patient, at the Height of the Disease. I can conceive but one bad Consequence that might possibly sometimes result from the former; but this (besides the Means that may be used to avert it) is rather remote, and so uncertain, until the Trial is repeatedly made, that I think it ought not to be named, in Competition with the Benefits that may arise from it in such Cases, as seem, otherwise, too generally irrecoverable. K.

Sec. 217. In the Treatment of this Disease, I have said nothing with Respect to Anodynes, or such Medicines as procure Sleep, which I am sensible are pretty generally employed in it, but which I scarcely ever direct in this violent Degree of the Disease, and the Dangers of which Medicine in it I have demonstrated in the Letter to Baron Haller, which I have already mentioned. For which Reason, wherever the Patient is not under the Care and Direction of a Physician, they should very carefully abstain from the Use of Venice Treacle, Laudanum, Diacodium, that is the Syrup of white Poppies, or even of the wild red Poppy; Syrup of Amber, Pills of Storax, of Cynoglossum or Hounds-tongue, and, in one Word, of every Medicine which produces Sleep. But still more especially should their Use be entirely banished, throughout the Duration of the secondary Fever, when even natural Sleep itself is dangerous. One Circumstance in which their Use may sometimes be permitted, is in the Case of weakly Children, or such as are liable to Convulsions, where Eruption is effected not without Difficulty. But I must again inculcate the greatest Circumspection, in the Use of such Medicines, whose Effects are fatal, when the Blood-vessels are turgid or full; whenever there is Inflammation, Fever, a great Distension of the Skin; whenever the Patient raves, or complains of Heaviness and Oppression; and when it is necessary that the Belly should be open; the Urine plentifully discharged; and the Salivation be freely promoted.

The Use of Opiates in this Disease undoubtedly requires no Small Consideration, the great Sydenham himself not seeming always sufficiently guarded in the Exhibition of them; as far as Experience since his Day has enabled Physicians to judge of this Matter. In general our Author's Limitations of them seem very just; though we have seen a few clear Instances, in which a light Raving, which evidently arose from Want of Sleep (joined to some Dread of the Event of the Disease by Inoculation) was happily removed, with every other considerable Complaint, by a moderate Opiate. In sore and fretful Children too, under a large or middling Eruption, as the Time gained to Rest is taken from Pain, and from wasting their Spirits in Crying and Clamour, I have seen Suppuration very benignly promoted by Diacodium. But in the Crisis of the secondary Fever in the confluent or coherent Pock, when there is a morbid Fulness, and Nature is struggling to unload herself by some other Outlets than those of the Skin, which now are totally obstructed (and which seems the only Evacuation, that is not restrained by Opiates) the giving and repeating them then, as has too often been practised, seems importantly erroneous; for I think Dr. Swan has taken a judicious Liberty of dissenting from the great Author he translates, in forbidding an Opiate, if the Spitting abates, or grows so tough and ropy, as to endanger Suffocation. As the Difference of our Oeconomy in the Administration of Physic from that in Swisserland, and Dr. Tissot's just Reputation may dispose many Country Practitioners to peruse this Treatise, I take the Liberty of referring such Readers, for a Recollection of some of my Sentiments of Opiates, long before the Appearance of this Work in French, to the second Edition of the Analysis from P. 94 to 97, &c. K.

Sec. 218. If Eruption should suddenly retreat, or strike in, heating, soporific, spirituous and volatile Remedies should carefully be avoided: but the Patient may drink plentifully of the Infusion No. 12 pretty hot, and should be blistered on the fleshy Part of the Legs. This is a very embarrassing and difficult Case, and the different Circumstances attending it may require different Means and Applications, the Detail and Discussion of which are beyond my Plan here. Sometimes a single Bleeding has effectually recalled Eruption at once.

Sec. 219. The only certain Method of surmounting all the Danger of this Malady, is to inoculate. But this most salutary Method, which ought to be regarded as a particular and gracious Dispensation of Providence, can scarcely be attainable by, or serviceable to, the Bulk of the People, except in those Countries, where Hospitals are destined particularly for Inoculation. In these where as yet there are none, the only Resource that is left for Children who cannot be inoculated at home, is to dispose them happily for the Distemper, by a simple easy Preparation.

That I have long since had the Honour of agreeing with our learned Author, in this Consideration for the Benefit of the Body of the People, which is the Benefit of the State, will appear from p. 288 of Analys. Ed. 1st. and from p. 371, 372 of the Second. K.

Sec. 220. This Preparation consists, upon the whole, in removing all Want of, and all Obstructions to, the Health of the Person subject to this Disease, if he have any such; and in bringing him into a mild and healthy, but not into a very robust and vigorous, State; as this Distemper is often exceedingly violent in this last.

It is evident, that since the Defects of Health are very different in different Bodies, the Preparations of them must as often vary; and that a Child subject to some habitual Disorder, cannot be prepared in the same Method with another who has a very opposite one. The Detail and Distinctions which are necessary on this important Head, would be improper here, whether it might be owing to their unavoidable Length; or to the Impossibility of giving Persons, who are not Physicians, sufficient Knowlege and Information to qualify them for determining on, and preferring, the most proper Preparation in various Cases. Nevertheless I will point out some such as may be very likely to agree, pretty generally, with Respect to strong and healthy Children.

The Substance of this Section flows from the Combination of an excellent Understanding with great Experience, mature Reflection, and real Probity; and fundamentally exposes both the Absurdity of such as universally decry any Preparation of any Subject previous to Inoculation, (which is said to be the Practice of a present very popular Inoculator in Paris) and the opposite Absurdity of giving one and the very same Preparation to all Subjects, without Distinction; though this was avowed to have been successfully fully practised in Pensylvania, some Years since; which the Reader may see Analys. Ed. 2d, from p. 329 to 331 and the Note there. K.

The first Step then is an Abatement of their usual Quantity of Food. Children commonly eat too much. Their Limitation should be in Proportion to their Size and Growth, where we could exactly ascertain them: but with Regard to all, or to much the greater Number of them, we may be allowed to make their Supper very light, and very small.

Their second Advantage will consist in the Choice of their Food. This Circumstance is less within the Attainment of, and indeed less necessary for, the common People, who are of Course limited to a very few, than to the Rich, who have Room to make great Retrenchments on this Account. The Diet of Country People being of the simplest Kind, and almost solely consisting of Vegetables and of Milk-meats, is the most proper Diet towards preparing for this Disease. For this Reason, such Persons have little more to attend to in this Respect, but that such Aliments be sound and good in their Kind; that their Bread be well baked; their Pulse dressed without Bacon, or rancid strong Fat of any sort; that their Fruits should be well ripened; that their Children should have no Cakes or Tarts, [But see Note , P. 40, 41.] and but little Cheese. These simple Regulations may be sufficient, with Regard to this Article of their Preparation.

Some Judgment may be formed of the good Consequences of their Care on these two Points, concerning the Quantity and Quality of the Childrens Diet, by the moderate Shrinking of their Bellies; as they will be rendered more lively and active by this Alteration in their living; and yet, notwithstanding a little less Ruddiness in their Complexion, and some Abatement of their common Plight of Body, their Countenances, upon the whole, will seem improved.

The third Article I would recommend, is to bathe their Legs now and then in warm Water, before they go to Bed. This promotes Perspiration, cools, dilutes the Blood, and allays the Sharpness of it, as often as it is properly timed.

The fourth Precaution, is the frequent Use of very clear Whey. This agreeable Remedy, which consists of the Juices of Herbs filtred through, and concocted, or as it were, sweetened by the Organs of a healthy Animal, answers every visible Indication (I am still speaking here of sound and hearty Children). It imparts a Flexibility, or Soupleness to the Vessels; it abates the Density, the heavy Consistence and Thickness of the Blood; which being augmented by the Action of the poisonous Cause of the Small-Pocks, would degenerate into a most dangerous inflammatory Viscidity or Thickness. It removes all Obstructions in the Viscera, or Bowels of the lower Cavity, the Belly. It opens the Passages which strain off the Bile; sheaths, or blunts, its Sharpness, gives it a proper Fluidity, prevents its Putridity, and sweetens whatever excessive Acrimony may reside throughout the Mass of Humours. It likewise promotes Stools, Urine and Perspiration; and, in a Word, it communicates the most favourable Disposition to the Body, not to be too violently impressed and agitated by the Operation of an inflammatory Poison: And with Regard to such Children as I have mentioned, for those who are either sanguine or bilious, it is beyond all Contradiction, the most effectual preparatory Drink, and the most proper to make them amends for the Want of Inoculation.

There may certainly be an inflammatory Acrimony or Thinness, as well as Thickness of the Blood; and many medical Readers may think a morbid Fusion of the red Globules to be a more frequent Effect of this Contagion, than an increased Viscidity of them. See Analys. Ed. 2d. p. 75 to 83. But this Translation, conforming to the Spirit of its Original, admits very little Theory, and still less Controversy, into its Plan. K.

I have already observed, that it may also be used to great Advantage, during the Course of the Disease: but I must also observe, that however salutary it is, in the Cases for which I have directed it, there are many others in which it would be hurtful. It would be extremely pernicious to order it to weak, languishing, scirrhous, pale Children, subject to Vomitings, Purgings, Acidities, and to all Diseases which prove their Bowels to be weak, their Humours to be sharp: so that People must be very cautious not to regard it as an universal and infallible Remedy, towards preparing for the Small-Pocks. Those to whom it is advised, may take a few Glasses every Morning, and even drink it daily, for their common Drink; they may also sup it with Bread for Breakfast, for Supper, and indeed at any Time.

If Country People will pursue these Directions, which are very easy to observe and to comprehend, whenever the Small-Pocks rages, I am persuaded it must lessen the Mortality attending it. Some will certainly experience the Benefit of them; such I mean as are very sensible and discreet, and strongly influenced by the truest Love of their Children. Others there are Alas! who are too stupid to discern the Advantage of them, and too unnatural to take any just Care of their Families.

_Chapter XIV._

Of the Measles.

_Sect._ 221.

The Measles, to which the human Species are as generally liable, as to the Small-Pocks, is a Distemper considerably related to it; though, generally speaking, it is less fatal; notwithstanding which, it is not a little destructive in some Countries. In Swisserland we lose much fewer, immediately in the Disease, than from the Consequences of it.

It happens now and then that the Small-Pocks and the Measles rage at the same Time, and in the same Place; though I have more frequently observed, that each of them was epidemical in different Years. Sometimes it also happens that both these Diseases are combined at once in the same Person; and that one supervenes before the other has finished its Course, which makes the Case very perilous.

Sec. 222. In some Constitutions the Measles gives Notice of its Approach many Days before its evident Invasion, by a small, frequent and dry Cough, without any other sensible Complaint: though more frequently by a general Uneasiness; by Successions of Shivering and of Heat; by a severe Head-ach in grown Persons; a Heaviness in Children; a considerable Complaint of the Throat; and, by what particularly characterizes this Distemper, an Inflammation and a considerable Heat in the Eyes, attended with a Swelling of the Eye-lids, with a Defluxion of sharp Tears, and so acute a Sensation, or Feeling of the Eyes, that they cannot bear the Light; by very frequent Sneezings, and a Dripping from the Nose of the same Humour with that, which trickles from the Eyes.

The Heat and the Fever increases with Rapidity; the Patient is afflicted with a Cough, a Stuffing, with Anguish, and continual Reachings to vomit; with violent Pains in the Loins; and sometimes with a Looseness, under which Circumstance he is less persecuted with Vomiting. At other times, and in other Subjects, Sweating chiefly prevails, though in less Abundance than in the Small-Pocks. The Tongue is foul and white; the Thirst is often very high; and the Symptoms are generally more violent than in the mild Small-Pocks.

At length, on the fourth or fifth Day, and sometimes about the End of the third, a sudden Eruption appears and in a very great Quantity, especially about the Face; which in a few Hours is covered with Spots, each of which resembles a Flea-bite; many of them soon joining form red Streaks or Suffusions larger or smaller, which inflame the Skin, and produce a very perceivable Swelling of the Face; whence the very Eyes are sometimes closed. Each small Spot or Suffusion is raised a little above the Surface, especially in the Face, where they are manifest both to the Sight and the Touch. In the other Parts of the Body, this Elevation or Rising is scarcely perceivable by any Circumstance, but the Roughness of the Skin.

The Eruption, having first appeared in the Face, is afterwards extended to the Breast, the Back, the Arms, the Thighs and Legs. It generally spreads very plentifully over the Breast and the Back, and sometimes red Suffusions are found upon the Breast, before any Eruption has appeared in the Face.

The Patient is often relieved, as in the Small-Pocks, by plentiful Discharges of Blood from the Nose, which carry off the Complaints of the Head, of the Eyes, and of the Throat.

Whenever this Distemper appears in its mildest Character, almost every Symptom abates after Eruption, as it happens in the Small-Pocks; though, in general, the Change for the better is not as thoroughly perceivable, as it is in the Small-Pocks. It is certain the Reachings and Vomitings cease almost entirely; but the Fever, the Cough, the Head-ach continue; and I have sometimes observed that a bilious Vomiting, a Day or two after the Eruption, proved a more considerable Relief to the Patient than the Eruption had. On the third or fourth Day of the Eruption, the Redness diminishes; the Spots, or very small Pustules, dry up and fall off in very little branny Scales; the Cuticle, or superficial Skin also shrivels off; and is replaced by one succeeding beneath it. On the ninth Day, when the Progress of the Malady has been speedy, and on the eleventh, when it has been very slow, no Trace of the Redness is to be found; and the Surface immediately resumes its usual Appearance.