CHAPTER XII.

OF THE SMALL-POX.

THIS disease, which originally came from Arabia, is now become so general, that very few escape it at one time of life or another. It is a most contagious malady, and has for many years proved the scourge of Europe.

The small-pox generally appears towards the spring. It is very frequent in summer, less so in autumn, and least of all in winter. Children are most liable to this disease; and those whose food is unwholesome, who want proper exercise, and abound with gross humours, run the greatest hazard from it.

The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the crystalline, the bloody, &c.

CAUSES.—The small-pox is generally caught by infection. Since the disease was first brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpose; so that now it has become in a manner constitutional. Children who have overheated themselves by running, wrestling, &c. or adults after a debauch, are most apt to be seized with the small-pox.

SYMPTOMS.—This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, and seem listless and drowsy for a few days before the more violent symptoms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, complain of weariness, and upon taking exercise, are apt to sweat. These are succeeded by slight fits of cold and heat by turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomitting, &c. The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion fits in very young children.

About the third or fourth day from the time of sickening, the small-pox generally begins to appear; sometimes indeed they appear sooner, but that is no favourable symptom. At first they very nearly resemble flea-bites, and are soonest discovered on the face, arms, and breast.

The most favourable symptoms are a slow eruption, and an abatement of the fever as soon as the pustules appear. In a mild distinct kind of small-pox, the pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules which are distinct, with a florid red basis, and which fill with thick purulent matter, first of a whitish, and afterwards of a yellowish colour, are the best.

A livid brown colour of the pustules is an unfavourable symptom; as also when they are small and flat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pocks on the side is always attended with danger. It is likewise a bad sign when they run one into another.

It is a most unfavourable symptom when petechiæ, or purple, brown, or black, spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and show the danger to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine, and a violent throbbing of the arteries of the neck, are signs of an approaching delirium, or of convulsion fits. When the face does not swell, or falls before the pocks come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well; but when these do not succeed each other there is reason to apprehend danger. When the tongue is covered with a brown crust, it is an unfavourable symptom. Cold shivering fits coming on at the height of the disease, are likewise unfavourable. Grinding of the teeth, when it proceeds from an affection of the nervous system, is a bad sign; but sometimes it is occasioned by worms, or a disordered stomach.

REGIMEN.—When the first symptoms of the smallpox appear, people are ready to be alarmed, and often fly to the use of medicine, to the great danger of the patient’s life. I have known children, to appease the anxiety of their parents, bled, blistered, and purged, during the fever which preceded the eruption of the small-pox, to such a degree, that Nature was not only disturbed in her operation, but rendered unable to support the pustules after they were out; so that the patient, exhausted by mere evacuations, sunk under the disease.

When convulsions appear, they give a dreadful alarm. Immediately some nostrum is applied, as if this were a primary disease; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit.^*

All that is, generally speaking, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He should not be confined to bed, but should sit up as much as he is able, and should have his feet and legs frequently bathed in lukewarm water. His food ought to be very light, and he should be as little disturbed with company as possible.

Much mischief is done at this period by confining the patient too soon in his bed, and plying him with warm cordials or sudorific medicines. Every thing that heats and inflames the blood increases the fever, and pushes out the pustules. This has numberless ill effects. It not only increases the number of pustules, but likewise tends to make them run into one another; and when they have been pushed out with too great violence, they generally fall in before they come to maturity.

The good women, as soon as they see the small-pox begin to appear, commonly ply their tender charge with cordials, saffron, and marigold teas, wine, punch, and even brandy itself. All these are given with a view, as they term it, to throw out the eruption from the heart. This, like most other popular mistakes, is the abuse of a very just observation—that when there is a moisture on the skin, the pocks rise better, and the patient is easier, than when it continues dry and parched. But that is no reason for forcing the patient into a sweat. Sweating never relieves, unless where it comes spontaneously, or it is the effect of drinking weak diluting liquors.

Children are often so peevish, that they will not lie in bed without a nurse constantly by them. Indulging them in this, we have reason to believe, has many bad effects both upon the nurse and child. Even the natural heat of the nurse cannot fail to augment the fever of the child; but if she too proves feverish, which is often the case, the danger must be increased.^*

Laying several children who have the small-pox in the same bed has many ill consequences. They ought if possible never to be in the same chamber, as the perspiration, the heat, smell, &c. all tend to augment the fever, and to heighten the disease. It is common among the poor to see two or three children lying in the same bed, with such a load of pustules, that even their skins stick together. One can hardly view a scene of this kind without being sickened by the sight; but how must the effluvia affect the poor patients, many of whom perish by this usage.

A very dirty custom prevails among the lower class of people, of allowing children in the small pox to keep on the same linen during the whole period of that loathsome disease. This is done lest they should catch cold, but it has many ill consequences. The linen becomes hard by the moisture which it absorbs, and frets the tender skin. It likewise occasions a bad smell, which is very pernicious both to the patient and those about him; besides, the filth and sordes which adhere to the linen being resorbed, or taken up again into the body, greatly augment the disease.

This sentiment is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inoculation in all its different forms, so little appears to me to depend upon these, generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, &c. that, for several years past, I have persuaded the parents or nurses to perform the whole themselves, and have found that method followed with equal success, while it is free from many inconveniences that attend the other.^*

The small-pox may be communicated in a great variety of ways, with nearly the same degree of safety and success. In Turkey, from whence we learned the practice, the women communicate the disease to children, by opening a bit of skin with a needle, and putting into a wound a little matter taken from a ripe pustule. On the coast of Barbary, they pass a wet thread with the matter through the skin between the thumb and fore-finger; and, in some of the states of Barbary, inoculation is performed by rubbing the variolous matter between the thumb and fore-finger, or on other parts of the body. The practice of communicating the small-pox, by rubbing the variolous matter upon the skin, has been long known in many parts of Asia and Europe, as well as in Barbary, and has generally gone by the name of buying the small-pox. This custom has long been prevalent in Wales.

The present method of inoculating in Britain is to make two or three slanting incisions in the arm, so superficial as not to pierce quite through the skin, with a lancet, wet with fresh matter taken from a ripe pustule; afterwards the wounds are closed up, and left without any dressing. Some make use of a lancet covered with the dry matter; but this is less certain, and ought never to be used, unless where fresh matter cannot be obtained: when this is the case, the matter ought to be moistened, by holding the lancet for some time in the steam of warm water.

Indeed, if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread about half an inch long, wet with the matter, be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of common sticking-plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease. We mention this method, because many people are afraid of a wound; and doubtless the more easily the operation can be performed, it has the greater chance to become general. Some people imagine that the discharge from a wound lessens the eruption; but there is no great stress to be laid on this notion; besides, deep wounds often ulcerate and become troublesome.

We do not find that inoculation is at all considered as a medical operation in those countries from whence we learned it. In Turkey it is performed by the women, and in the East Indies by the brahmins or priests. We make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, than at present they do of giving them a purge.

No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objections which weak minds may have to this salutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make use of a mean which providence has put in our power, for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children’s lives, are as guilty as those who put them to death. I wish this matter were duly weighed. No one is more ready to make allowance for human weakness and religious prejudices; yet I cannot help recommending it, in the warmest manner, to parents to consider how great an injury they do their children by neglecting to give them this disease in the early period of life.

Instead of multiplying arguments to recommend this practice, I shall beg leave to mention the method which I took with my own son, then an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rubbed off by accident. At the usual time the small-pox made their appearance, and were exceeding favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine.

The most proper age for inoculation is, between three and five. Many approve of inoculating on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more liable to convulsions at this time than afterwards; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the milk.

We would recommend no other medicinal preparation, but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the preparation of their patients, but on their management of them while under the disease. Their constant care is to keep them cool, and their bodies gently open, by which means the fever is kept low, and the eruption greatly lessened. The danger is seldom great when the pustules are few, and their number is generally in proportion to the fever which precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods above mentioned.

The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be light, and his drink weak and diluting, &c. Should any bad symptoms appear, which is seldom the case, they must be treated in the same way as directed for the natural small-pox. Purging is not less necessary after the small-pox by inoculation, than in the natural way, and ought by no means to be neglected.

The introduction of the Cow-pox, we find by experience, proves a complete and infallible preventive against the small-pox, and is doubtless an improvement of immense importance. The invention and promulgation of a discovery, which combines ease, safety, and simplicity, deserves the highest praise; and, patronised as it is by the most distinguished medical characters, we may fondly expect in its general adoption the complete abolition of a disease which has heretofore proved so fatal to mankind; so that in a few years time this loathsome disease will be no longer a dread to the human race.

* Convulsion fits are no doubt very alarming, but their effects are often salutary. They seem to be one of the means made use of by Nature for breaking the force of a fever. I have always observed a fever abated, and sometimes quite removed, after one or more convulsion fits. This readily accounts for convulsions being a favourable symptom in the fever which precedes the eruption of the small-pox, as every thing which mitigates this fever lessens the eruption.

* I have known a nurse, who had the small-pox before, so infected by lying constantly a-bed with a child in a bad kind of small-pox, that she had not only a great number of pustules which broke out all over her body, but afterwards a malignant fever, which terminated in a number of imposthumes or boils, and from which she narrowly escaped with her life. We mention this to put others on their guard against the danger of this virulent infection.

* A critical situation, too often to be met with, first put me upon trying this method. A gentleman who had lost all his children except one son, by the natural small-pox, was determined to have him inoculated. He told me his intention, and desired I would persuade the mother and grandmother, &c. of its propriety, but that was impossible; they were not to be persuaded: and either could not get the better of their fears, or were determined against conviction. It was always a point with me not to perform the operation without the consent of the parties concerned, I therefore advised the father, after giving his son a dose or two of rhubarb, to go to a patient who had the small-pox of a good kind, to open two or three of the pustules, taking up the matter with a little cotton, and as soon as he came home to take his son apart, and give his arm a slight scratch with a pin, afterwards to rub the place well with the cotton, and take no further notice of it. All this he punctually performed; and at the usual period the small-pox made their appearance, which were of an exceeding good kind, and so mild as not to confine the boy an hour to his bed. None of the other relations knew but that the disease had come in the natural way, till the boy was well.