Chapter VII: Part 7

[43] Another very good Purge, in this Kind of Rheumatism, may also be
compounded of the best Gum Guiacum in Powder from 30 to 40 Grains;
dissolved in a little Yolk of a fresh Egg; adding from 6 to 10
Grains of Jallap powdered, and from 3 to 5 Grains of powdered
Ginger, with as much plain or sorrel Water, as will make a purging
Draught for a stronger or weaker grown Patient. Should the Pains
frequently infest the Stomach, while the Patient continues costive,
and there is no other Fever than such a small symptomatic one, as
may arise solely from Pain, he may safely take, if grown up, from
30 to 45 Drops of the volatile Tincture of Gum Guiacum, in any
diluting Infusion, that may not coagulate or separate the Gum. It
generally disposes at first to a gentle _Diaphoresis_ or Sweat, and
several Hours after to one, and sometimes to a second Stool, with
little or no Griping. _K._

Sec. 182. When general Remedies have been used, and the Disorder still continues, Recourse should be had to such Medicines, as are available to restore Perspiration; and these should be persisted in for a considerable Time. The Pills No. 18, with a strong Infusion of Elder Flowers, have often succeeded in this Respect: and then after a long Continuance of diluting Drinks, if the Fever is entirely subdued; if the Stomach exerts its Functions well; the Patient is no ways costive; if he is not of a dry Habit of Body; and the Part affected remains without Inflammation, the Patient may safely take the Powder No. 29, at Night going to Bed, with a Cup or two of an Infusion of _Carduus benedictus_, or the blessed Thistle, and a Morsel of Venice Treacle of the Size of a Hazel Nut, or a Filberd. This Remedy brings on a very copious Sweating, which often expells the [44] Disease. These Sweats may be rendered full more effectual, by wrapping up the affected Part in a Flanel dipt in the Decoction No. 27.

[44] Gum Guaiacum, given from six to ten Grains Morning and Night, is
often very successful in these Cases. It may be made into Pills or
Bolusses with the Rob of Elder, or with the Extract of Juniper. _E.
L._

Sec. 183. But of all these Pains, the Sciatica is one of the most tedious and obstinate. Nevertheless I have seen the greatest Success, from the Application of seven or eight Cupping-Glasses on the tormented Part; by which, without the Assistance of any other Remedy, I have cured, in a few Hours, Sciaticas of many Years standing, which had baffled other Remedies. Blisters, or any such stimulating Plaisters, as bring on a Suppuration and Discharge from the afflicted Part, contribute also frequently to the Cure; tho' less effectually than Cupping, which should be repeated several Times. Green Cere-cloth, commonly called Oil-cloth, (whether the Ingredients be spread on Taffety or on Linen) being applied to the diseased Part, disposes it to sweat abundantly, and thus to discharge the sharp Humour which occasions the Pain. Sometimes both these Applications, but especially that spread on Silk (which may be applied more exactly and closely to the Part, and which is also spread with a different Composition) raise a little Vesication on the Part as Blisters do. A Plaister of Quicklime and Honey blended together has cured inveterate Sciaticas. Oil of Eggs has sometimes succeeded in such Cases. A Seton has also been successfully made in the lower Part of the Thigh. Finally some Pains, which have not yielded to any of these Applications, have been cured by actual burning, inflicted on the very Spot, where the most violent Pain has been felt; except some particular Reason, drawn from an anatomical Knowlege of the Part, should determine the Surgeon not to apply it there. The Scull or Head should never be cauterized with a burning Iron.

Sec. 184. The hot Baths of _Bourbon_, _Plombiers_, _Aix-la-Chapelle_ and many others are often very efficacious in these chronical Pains: notwithstanding I really think, there is no rheumatic Pain that may not be cured without them. The common People substitute to these a Bath made of the Husk of Grapes, after their Juice is expressed, which cures some by making them sweat abundantly. Cold Baths however are the best to keep off this Disease; but then they cannot always be safely ventured on. Many Circumstances render the Use of them impracticable to particular Persons. Such as are subject to this chronical Rheumatism, would do very well to rub their whole Bodies every Morning, if they could, but especially the afflicted Parts, with Flanel. This Habit keeps up Perspiration beyond any other Assistance; and indeed sometimes even increases it too much. It would be serviceable too, if such Subjects of this cruel Disease wore Flanel all over their Skin, during the Winter.

After a violent Rheumatism, People should long be careful to avoid that cold and moist Air, which disposes them to relapse.

Sec. 185. Rheumatic People have too frequent a Recourse to very improper and hurtful Medicines, in this Distemper, which daily produce very bad Consequences. Such are spirituous Medicines, Brandy, and Arquebusade Water. They either render the Pain more obstinate and fixed, by hardening the Skin; or they repell the Humour to some inward Part. And Instances are not wanting of Persons who have died suddenly, from the Application of Spirit of Wine upon the Parts, that were violently afflicted with the Rheumatism. It also happens sometimes that the Humour, having no Outlet through the Skin, is thrown internally on the Bone and affects it. A very singular Fact occurred in this Respect, an Account of which may be serviceable to some Persons afflicted with the Disease. A Woman at Night was chaffing the Arm of her Husband, who had the Rheumatism there, with Spirit of Wine; when a very lucky Accident prevented the Mischief she might have occasioned by it. The Spirit of Wine took Fire from the Flame of the Candle she made use of, and burned the diseased Part. It was drest of Course, and the Suppuration that attended it, entirely cured the Rheumatism.

Sharp and greasy Unctions or Ointments produce very bad Effects, and are equally dangerous. A _Caries_, a Rottenness of the Bones, has ensued upon the Use of a Medicine called, The Balsam of Sulphur with Turpentine. I was consulted in 1750, three Days before her Decease, about a Woman, who had long endured acute rheumatic Pains. She had taken various Medicines, and, among the rest, a considerable Quantity of a Ptisan, in which Antimony was blended with some purging Medicines, and a greasy spirituous Balsam had been rubbed into the Part. The Fever, the Pains, and the Dryness of the Skin soon increased; the Bones of the Thighs and Arms became carious: and in moving the Patient no more than was necessary for her Relief and Convenience, without taking her out of her Bed, both Thighs and one Arm broke. So dreadful an Example should make People cautious of giving or applying Medicines inconsiderately, even in such Diseases, as appear but trifling in themselves. I must also inform the Readers, there are some rheumatic Pains, which admit of no Application; and that almost every Medicine aggravates them. In such Cases the afflicted must content themselves with keeping the Parts affected from the Impressions of the Air, by a Flanel, or the Skin of some Animal with the Fur on.

It is also more advisable sometimes to leave a sufferable and inveterate Pain to itself, especially in old or weakly People, than to employ too many Medicines, or such violent ones, as should affect them more importantly than the Pains did.

Sec. 186. If the Duration of the Pains fixed in the same Place, should cause some Degree of Stiffness in the Joint affected, it should be exposed twice a Day to the Vapour of warm Water, and dried well afterwards with hot Linen: then it should be well chaffed, and lastly touched over with Ointment of Marsh-mallows. Pumping, if superadded to this Vapour, considerably increases its Efficacy. I directed, for a Case of this Sort, a very simple Machine of white Tin, or Lattin, which combined the Application of the Steam and the Pump.

Sec. 187. Very young Children are sometimes subject to such violent and extended Pains, that they cannot bear touching in any Part, without excessive Crying. We must be careful to avoid mistaking these Cases, and not to treat them like Rheumatisms. They sometimes are owing to Worms, and go off when these have been discharged.

__Chapter XII.__

_Of the Bite of a mad Dog._

__Sect.__ 188.

Men may contract the particular and raging Symptom, which is very generally peculiar to this Disease from this Cause, and even without any Bite; but this happens very rarely indeed. It is properly a Distemper belonging to the canine _Genus_, consisting of the three Species of Dogs, Wolves, and Foxes, to whom only it seems inherent and natural; scarcely ever arising in other Animals, without its being inflicted by them. Whenever there occurs one of them who breeds it, he bites others, and thus the Poison, the Cause of this terrible Disease, is diffused. Other Animals besides the canine Species, and Men themselves being exposed to this Accident, do sometimes contract the Disease in all its Rage and Horror: though it is not to be supposed, that this is always an unfailing Consequence.

Sec. 189. If a Dog who used to be lively and active, becomes all at once moapish and morose; if he has an Aversion to eat; a particular and unusual Look about his Eyes; a Restlessness, which appears from his continually running to and fro, we may be apprehensive he is likely to prove mad; at which very Instant he ought to be tied up securely, that it may be in our Power to destroy him as soon as the Distemper is evident. Perhaps it might be even still safer to kill him at once.

Whenever the Malady is certain, the Symptoms heighten pretty soon. His Aversion to Food, but especially to Drink, grows stronger. He no longer seems to know his Master, the Sound of his Voice changes; he suffers no Person to handle or approach him; and bites those who attempt it. He quits his ordinary Habitation, marching on with his Head and his Tail hanging downwards; his Tongue lolling half out, and covered with Foam or Slaver, which indeed not seldom happens indifferently to all Dogs. Other Dogs scent him, not seldom at a considerable Distance, and fly him with an Air of Horror, which is a certain Indication of his Disease. Sometimes he contents himself with biting only those who happen to be near him: while at other Times becoming more enraged, he springs to the right and left on all Men and Animals about him. He hurries away with manifest Dread from whatever Waters occur to him: at length he falls down as spent and exhausted; sometimes he rises up again, and drags himself on for a little Time, commonly dying the third, or, at the latest, on the fourth Day after the manifest Appearance of the Disease, and sometimes even sooner.

Sec. 190. When a Person is bit by such a Dog, the Wound commonly heals up as readily, as if it was not in the least poisonous: but after the Expiration of a longer or shorter Term, from three Weeks to three Months; but most commonly in about six Weeks, the Person bitten begins to perceive, in the Spot that was bit, a certain dull obtuse Pain. The Scar of it swells, inflames, bursts open, and weeps out a sharp, foetid, and sanious, or somewhat bloody Humour. At the same Time the Patient becomes sad and melancholy: he feels a kind of Indifference, Insensibility, and general Numbness; an almost incessant Coldness; a Difficulty of breathing; a continual Anguish, and Pains in his Bowels. His Pulse is weak and irregular, his sleep restless, turbid, and confused with Ravings; with starting up in Surprize, and with terrible Frights. His Discharges by Stool are often much altered and irregular, and small cold Sweats appear at very short Intervals. Sometimes there is also a slight Pain or Uneasiness in the Throat. Such is the first Degree of this Disease, and it is called by some Physicians the dumb Rage, or Madness.

Sec. 191. Its second Degree, the confirmed or downright Madness, is attended with the following Symptoms. The Patient is afflicted with a violent Thirst, and a Pain in drinking. Soon after this he avoids all Drink, but particularly Water, and within some Hours after, he even abhors it. This Horror becomes so violent, that the bringing Water near his Lips, or into his Sight, the very Name of it, or of any other Drink; the Sight of Objects, which, from their Transparence, have any Resemblance of Water, as a Looking Glass, _&c._ afflicts him with extreme Anguish, and sometimes even with Convulsions. They continue however still to swallow (though not without violent Difficulty) a little Meat or Bread, and sometimes a little Soup. Some even get down the liquid Medicines that are prescribed them, provided there be no Appearance of Water in them; or that Water is not mentioned to them, at the same Time. Their Urine becomes thick and high-coloured, and sometimes there is a Suppression or Stoppage of it. The Voice either grows hoarse, or is almost entirely abolished: but the Reports of the bitten barking like Dogs are ridiculous and superstitious Fictions, void of any Foundation; as well as many other Fable, that have been blended with the History of this Distemper. The Barking of Dogs however is very disagreeable to them. They are troubled with short _Deliriums_ or Ravings, which are sometimes mixed with Fury. It is at such times that they spit all around them; that they attempt also to bite, and sometimes unhappily effect it. Their Looks are fixed, as it were, and somewhat furious, and their Visage frequently red. It is pretty common for these miserable Patients to be sensible of the Approach of their raging Fit, and to conjure the Bystanders to be upon their Guard. Many of them never have an Inclination to bite. The increasing Anguish and Pain they feel become inexpressible: they earnestly wish for Death; and some of them have even destroyed themselves, when they had the Means of effecting it.

Sec. 192. It is with the Spittle, and the Spittle only, that this dreadful Poison unites itself. And here it may be observed, 1, That if the Wounds have been made through any of the Patient's Cloaths, they are less dangerous than those inflicted immediately on the naked Skin. 2, That Animals who abound in Wool, or have very thick Hair, are often preserved from the mortal Impression of the Poison; because in these various Circumstances, the Cloaths, the Hair, or the Wool have wiped, or even dried up, the Slaver of their Teeth. 3, The Bites inflicted by an infected Animal, very soon after he has bitten many others, are less dangerous than the former Bites, because their Slaver is lessened or exhausted. 4, If the Bite happens in the Face, or in the Neck, the Danger is greater, and the Operation of the Venom is quicker too; by Reason the Spittle of the Person so bit is sooner infected. 5, The higher the Degree of the Disease is advanced, the Bites become proportionably more dangerous. From what I have just mentioned here it may be discerned, why, of many who have been bitten by the same Sufferer, some have been infected with this dreadful Disease, and others not.

Sec. 193. A great Number of Remedies have been highly cried up, as famous in the Cure of this Disease; and, in _Swisserland_ particularly, the Root of the Eglantine or wild Rose, gathered at some particular times, under the favorable Aspects of the Moon, and dried with some extraordinary Precautions. There is also the Powder of _Palmarius_ of calcined Egg Shells, that of the _Lichen terrestris_, or Ground Liverwort, with one third Part of Pepper, a Remedy long celebrated in _England_; Powder of Oyster-Shells; of Vervain; bathing in Salt Water; St. Hubert's Key, _&c. &c._ But the Death of a Multitude of those who have been bitten, notwithstanding their taking the greatest Part of all these boasted Antidotes; and the Certainty of no one's escaping, who had been attacked with the high raging Symptom, the _Hydrophobia_, have demonstrated the Inefficacy of them all, to all _Europe_. It is incontestable that to the Year 1730, not a single Patient escaped, in whom the Disease was indisputably manifest; and that every Medicine then employed against it was useless. When Medicines had been given before the great Symptom appeared, in some of those who took them, it afterwards appeared, in others not. The same different Events occurred also to others who were bitten, and who took not the least Medicine; so that upon the whole, before that Date, no Medicine seemed to be of any Consequence. Since that Time, we have had the Happiness to be informed of a certain Remedy, which is Mercury, joined to a few others.

Sec. 194. In short there is a Necessity for destroying or expelling the Poison itself, which Mercury effects, and is consequently the Counter-poison of it. That poison produces a general Irritation of the Nerves; this is to be removed or asswaged by Antispasmodics: so that in Mercury, or Quicksilver, joined to Antispasmodics, consists the whole that is indicated in the Cure of this Disease. There really have been many Instances of Persons cured by these Medicines, in whom the Distemper had been manifest in its Rage and Violence; and as many as have unfortunately received the Cause of it in a Bite, should be firmly persuaded, that in taking these Medicines, and using all other proper Precautions, they shall be entirely secured from all its ill Consequences. Those also in whom the Rage and Fury of this Distemper is manifest, ought to use the same Medicines, with entire [45] Hope and Confidence, which may justly be founded on the many Cures effected by them. It is acknowledged however, that they have proved ineffectual in a few Cases; but what Disease is there, which does not sometimes prove incurable?

[45] This Advice is truly prudent and judicious; Hope, as I have
observed on a different Occasion, being a powerful, though
impalpable, Cordial: and in such perilous Situations, we should
excite the most agreeable Expectations we possibly can in the
Patient; that Nature, being undepressed by any desponding
melancholy ones, may exert her Functions the more firmly, and
co-operate effectually with the Medicines, against her internal
Enemy. _K._

Sec. 195. The very Moment after receiving the Bite, is it happens to be in the Flesh, and if it can safely be effected, all the Part affected should be cut [46] away. The Ancients directed it to be cauterized, or burnt with a red hot Iron (meer Scarification being of very little Effect) and this Method would very probably prove effectual. It requires more Resolution, however, than every Patient is endued with. The Wound should be washed and cleansed a considerable Time with warm Water, with a little Sea-Salt dissolved in it. After this into the Lips and Edges of the Wound, and into the Surface of the Part all about it, should be rubbed a Quarter of an Ounce of the Ointment No. 28; and the Wound should be dressed twice daily, with the soft lenient Ointment No. 29, to promote Suppuration; but that of No. 28 is to be used only once a Day.

[46] I knew a brave worthy Gentleman abroad, who above forty Years past
thus preserved his Life, after receiving the Bite of a large
Rattle-Snake, by resolutely cutting it and the Flesh surrounding it
out, with a sharp pointed Penknife.--Perhaps those who would not
suffer the Application of the actual Cautery, that is, of a red hot
Iron (which certainly promises well for a Cure) might be persuaded
to admit of a potential Cautery, where the Bite was inflicted on a
fleshy Part. Though even this is far from being unpainful, yet the
Pain coming on more gradually, is less terrifying and horrid. And
when it had been applied quickly after, and upon the Bite, and kept
on for 3 or 4 Hours, the Discharge, after cutting the _Eschar_,
would sooner ensue, and in more Abundance, than that from the
actual Cautery; the only Preference of which seems to consist in
its being capable perhaps of absorbing, or otherwise consuming, all
the poisonous _Saliva_ at once. This Issue should be dressed
afterwards according to our Author's Direction; and in the gradual
healing of the Ulcer, it may be properly deterged by adding a
little Praecipitate to the Digestive. Neither would this interfere
with the Exhibition of the _Tonquin_ Powder No. 30, nor the
antispasmodic _Bolus_ No. 31, if they should be judged necessary.
And these perhaps might prove the most certain Means of preventing
the mortal Effects of this singular animal Poison, which it is so
impossible to analyze, and so extremely difficult to form any
material Idea of; but which is not the Case of some other Poisons.
_K._

In point of Regimen, the Quantity of Nourishment should be less than usual, particularly in the Article of [47] Flesh: he should abstain from Wine, spirituous Liquors, all Sorts of Spices and hot inflaming Food. He should drink only Barley-Water, or an Infusion of the Flowers of the Lime-tree. He should be guarded against Costiveness by a soft relaxing Diet, or by Glysters, and bathe his Legs once a Day in warm Water. Every third Day one Dose of the Medicine No. 30 should be taken; which is compounded of Mercury, that counterworks the Poison, and of Musk which prevents the Spasms, or convulsive Motions. I confess at the same Time that I have less Dependance on the Mercury given in this Form, and think the rubbing in of its Ointment considerably more efficacious, which I should hope may always prevent the Fatality of this dreadful, surprizing Disease. [48]

[47] It seems not amiss to try the Effects of a solely vegetable Diet
(and that perhaps consisting more of the acescent than alcalescent
Herbs and Roots) in this Disease, commencing immediately from the
Bite of a known mad Dog. These carnivorous Animals, who naturally
reject all vegetable Food, are the only primary Harbingers or
Breeders of it; though they are capable of transmitting it by a
Bite to graminivorous and granivorous ones. The Virtue of Vinegar
in this Disease, said to have been accidentally discovered on the
Continent, seems not to have been hitherto experienced amongst us;
yet in Case of such a morbid Accident it may require a Tryal; tho'
not so far, as to occasion the Omission of more certainly
experienced Remedies, with some of which it might be improper. _K._

[48] The great Usefulness of mercurial Frictions, we may even say, the
certain Security which they procure for the Patients, in these
Cases, provided they are applied very soon after the Bite, have
been demonstrated by their Success in _Provence_, at _Lyons_, at
_Montpellier_, at _Pondacherry_, and in many other Places. Neither
have these happy Events been invalidated by any Observations or
Instances to the contrary. It cannot therefore be too strongly
inculcated to those who have been bitten by venomous Animals, to
comply with the Use of them. They ought to be used in such a
Quantity, and after such a Manner, as to excite a moderate
Salivation, for fifteen, twenty, or even thirty Days. _E. L._
Though this Practice may justly be pursued from great Caution, when
no Cautery had been speedily applied to, and no such Discharge had
been obtained from, the bitten Part; yet wherever it had, this long
and depressing Salivation, I conceive, would be very seldom
necessary; and might be hurtful to weak Constitutions. _K._

Sec. 196. If the raging Symptom, the Dread of Water, has already appeared, and the Patient is strong, and abounds with Blood, he should, 1, be bled to a considerable Quantity, and this may be repeated twice, thrice, or even a fourth Time, if Circumstances require it.

2, The Patient should be put, if possible, into a warm Bath; and this should be used twice daily.

3, He should every Day receive two, or even three of the emollient Glysters No. 5.

4, The Wound and the Parts adjoining to it should be rubbed with the Ointment No. 28, twice a Day.

5, The whole Limb which contains the Wound should be rubbed with Oil, and be wrapped up in an oily Flanel.

6, Every three Hours a Dose of the Powder No. 30, should be taken in a Cup of the Infusion of Lime-tree and Elder Flowers.

7, The Prescription No. 31, is to be given every Night, and to be repeated in the Morning, if the Patient is not easy, washing it down with the same Infusion.

8, If there be a great Nauseousness at Stomach, with a Bitterness in the Mouth, give the Powder No. 35, which brings up a copious Discharge of glewy and bilious Humours.

9, There is very little Occasion to say any thing relating to the Patient's Food, in such a Situation. Should he ask for any, he may be allowed Panada, light Soup, Bread, Soups made of farinaceous or mealy Vegetables, or a little Milk.

Sec. 197. By the Use of these Remedies the Symptoms will be observed to lessen, and to disappear by Degrees; and finally Health will be re-established. But if the Patient should long continue weak, and subject to Terrors, he may take a Dose of the Powder No. 14, thrice a Day.

Sec. 198. It is certain that a Boy, in whom the raging Symptom of This Disease had just appeared, was perfectly cured, by bathing all about the wounded Part with Sallad-Oil, in which some Camphire and Opium were dissolved; with the Addition of repeated Frictions of the Ointment No. 28, and making him take some _Eau de luce_ with a little Wine. This Medicine, a Coffee-Cup of which may be given every four Hours, allayed the great Inquietude and Agitation of the Patient; and brought on a very plentiful Sweat, on which all the Symptoms vanished.

Sec. 199. Dogs may be cured by rubbing in a triple Quantity of the same Ointment directed for Men, and by giving them the Bolus No. 33. But both these Means should be used as soon as ever they are bit. When the great Symptom is manifest, there would be too much Danger in attempting to apply one, or to give the other; and they should be immediately killed. It might be well however to try if they would swallow down the Bolus, on its being thrown to them.

As soon as ever Dogs are bit, they should be safely tied up, and not let loose again, before the Expiration of three or four Months.

Sec. 200. A false and dangerous Prejudice has prevailed with Regard to the Bites from Dogs, and it is this--That if a Dog who had bit any Person, without being mad at the Time of his biting, should become mad afterwards, the Person so formerly bitten, would prove mad too at the same Time. Such a Notion is full as absurd, as it would be to affirm, that if two Persons had slept in the same Bed, and that one of them should take the Itch, the Small-Pocks, or any other contagious Disease, ten or twelve Years afterwards, that the other should also be infected with that he took, and at the same Time too.

Of two Circumstances, whenever a Person is bit, one must certainly be. Either the Dog which gives the Bite, is about to be mad himself, in which Case this would be evident in a few Days; and then it must be said the Person was bitten by a mad Dog: Or else, that the Dog was absolutely sound, having neither conceived, or bred in himself, nor received from without the Cause, the Principle, of Madness: in which last Case I ask any Man in his Senses, if he could communicate it. No Person, no Thing imparts what it has not. This false and crude Notion excites those who are possessed with it to a dangerous Action: they exercise that Liberty the Laws unhappily allow them of killing the Dog; by which Means they are left uncertain of his State, and of their own Chance. This is a dreadful Uncertainty, and may be attended with embarrassing and troublesome Consequences, independant of the Poison itself. The reasonable Conduct would be to secure and observe the Dog very closely, in Order to know certainly whether he is, or is not, mad.

Sec. 201. It is no longer necessary to represent the Horror, the Barbarity and Guilt of that cruel Practice, which prevailed, not very long since, of suffocating Persons in the Height of this Disease, with the Bed-cloaths, or between Matrasses. It is now prohibited in most Countries; and doubtless will be punished, or, at least ought to be, even in those where as yet it is not.

Another Cruelty, of which we hope to see no repeated Instance, is that of abandoning those miserable Patients to themselves, without the least Resource or Assistance: a most detestable Custom even in those Times, when there was not the least Hope of saving them; and still more criminal in our Days, when they may be recovered effectually. I do again affirm, that it is not very often these afflicted Patients are disposed to bite; and that even when they are, they are afraid of doing it; and request the Bystanders to keep out of their Reach: So that no Danger is incurred; or where there is any, it may easily be avoided by a few Precautions.

__Chapter XIII.__

_Of the Small-Pocks._

__Sect.__ 202.

The Small-Pocks is the most frequent, the most extensive of all Diseases; since out of a hundred Persons there are not more than [49] four or five exempted from it. It is equally true however, that if it attacks almost every Person, it attacks them but once, so that having escaped through it, they are always secure from [50] it. It must be acknowleged, at the same Time, to be one of the most destructive Diseases; for if in some Years or Seasons, it proves to be of a very mild and gentle Sort, in others it is almost as fatal as the Plague: it being demonstrated, by calculating the Consequences of its most raging, and its gentlest Prevalence, that it kills one seventh of the Number it attacks.

[49] As far as the Number of inoculated Persons, who remained entirely
uninfected (some very few after a second Inoculation) has enabled
me, I have calculated the Proportion naturally exempted from this
Disease, though residing within the Influence of it, to be full 25
in 1000. See Analysis of Inoculation, Ed. 2d. P. 157. Note *. _K._

[50] It has sometimes been observed (and the Observation has been such,
as not to be doubted) that a very mild distinct Small-Pocks has
sometimes invaded the same Person twice: But such Instances are so
very rare, that we may very generally affirm, those who have once
had it, will never have it again. _E. L._----In Deference to a few
particular Authorities, I have also supposed such a repeated
Infection. (Analysis of Inoculation, Ed. 2d. P. 43.) though I have
really never seen any such myself; nor ever heard more than two
Physicians affirm it, one at _Versailles_, and another in _London_;
the last of whom declared, he took it upon the Credit of a Country
Physician, thoroughly acquainted with this Disease, and a Witness
to the Repetition of it. Hence we imagine the Editor of this Work
at _Lyons_ might have justly termed this Re-infection _extremely_
rare, which would have a Tendency to reconcile the Subjects of the
Small-Pocks, more generally, to the most salutary Practice of
Inoculation. Doubtless some other eruptive Fevers, particularly,
the Chicken Pocks, Crystals, _&c._ have been often mistaken for the
real Small-Pocks by incompetent Judges, and sometimes even by
Persons better qualified, yet who were less attentive to the
Symptoms and Progress of the former. But whoever will be at the
Pains to read Dr. _Paux' Parallele de la petite verole naturalle
avec l'artificielle_, or a practical Abstract of Part of it in the
Monthly Review. Vol. XXV. P. 307 to 311, will find such a just,
clear and useful Distinction of them, as may prevent many future
Deceptions on this frequently interesting Subject. _K._

Sec. 203. People generally take the Small-Pocks in their Infancy, or in their Childhood. It is very seldom known to attack only one Person in one Place: its Invasions being very generally epidemical, and seizing a large Proportion of those who have not suffered it. It commonly ceases at the End of some Weeks, or of some Months, and rarely ever appears again in the same Place, until four, five or six Years after.

Sec. 204. This Malady often gives some Intimation of its Approach, three or four Days before the Appearance of the Fever, by a little Dejection; less Vivacity and Gaiety than usual; a great Propensity to sweat; less Appetite; a slight Alteration of the Countenance, and a kind of pale livid Colour about the Eyes: Notwithstanding which, in Children of a lax and phlegmatic Constitution, I have known a moderate Agitation of their Blood, (before their Shivering approached) give them a [51] Vivacity, Gaiety, and a rosy Improvement of their Complexion, beyond what Nature had given them.

[51] The same Appearances very often occur in such Subjects by
Inoculation, before actual Sickening, as I have observed and
instanced, Ed. 1st. P. 62, Ed. 2. P. 75, 76. _K._

Certain short Vicissitudes of Heat or Coldness succeed the former introductory Appearances, and at length a considerable Shivering, of the Duration of one, two, three or four Hours: This is succeeded by violent Heat, accompanied with Pains of the Head, Loins, Vomiting, or at least with a frequent Propensity to vomit.

This State continues for some Hours, at the Expiration of which the Fever abates a little in a Sweat, which is sometimes a very large one: the Patient then finds himself better, but is notwithstanding cast down, torpid or heavy, very squeamish, with a Head-ach and Pain in the Back, and a Disposition to be drowsy. The last Symptom indeed is not very common, except in Children, less than seven or eight Years of Age.

The Abatement of the Fever is of small Duration; and some Hours after, commonly towards the Evening, it returns with all its Attendants, and terminates again by Sweats, as before.

This State of the Disease lasts three or four Days; at the End of which Term, and seldom later, the first Eruptions appear among the Sweat, which terminates the Paroxysm or Return of the Fever. I have generally observed the earliest Eruption to appear in the Face, next to that on the Hands, on the fore Part of the Arms; on the Neck, and on the upper Part of the Breast. As soon as this Eruption appears, if the Distemper is of a gentle Kind and Disposition, the Fever almost entirely vanishes: the Patient continues to sweat a little, or transpire; the Number of Eruptions increases, others coming out on the Back, the Sides, the Belly, the Thighs, the Legs, and the Feet. Sometimes they are pushed out very numerously even to the Soles of the Feet; where, as they increase in Size, they often excite very sharp Pain, by Reason of the great Thickness and Hardness of the Skin in these Parts.

Frequently on the first and second Day of Eruption (speaking hitherto always of the mild Kind and Degree of the Disease) there returns again a very gentle Revival of the Fever about the Evening, which, about the Termination of it, is attended with a considerable and final Eruption: though as often as the Fever terminates perfectly after the earliest Eruption, a very distinct and very small one is a pretty certain Consequence. For though the Eruption is already, or should prove only moderate, the Fever, as I have before said, does not totally disappear; a small Degree of it still remaining, and heightening a little every Evening.

These Pustules, or Efflorescences, on their first Appearance, are only so many very little red Spots, considerably resembling a Flea-bite; but distinguishable by a small white Point in the Middle, a little raised above the rest, which gradually increases in Size, with the Redness extended about it. They become whiter, in Proportion as they grow larger; and generally upon the sixth Day, including that of their first Eruption, they attain their utmost Magnitude, and are full of _Pus_ or Matter. Some of them grow to the Size of a Pea, and some still a little larger; but this never happens to the greatest Number of them. From this Time they begin to look yellowish, they gradually become dry, and fall off in brown Scales, in ten or eleven Days from their first Appearance. As their Eruption occurred on different Days, they also wither and fall off successively. The Face is sometimes clear of them, while Pustules still are seen upon the Legs, not fully ripe, or suppurated: and those in the Soles of the Feet often remain much longer.

Sec. 205. The Skin is of Course extended or stretched out by the Pustules; and after the Appearance of a certain Quantity, all the Interstices, or Parts between the Pustules, are red and bright, as it were, with a proportionable Inflation or Swelling of the Skin. The Face is the first Part that appears bloated, from the Pustules there first attaining their utmost Size: and this inflation is sometimes so considerable, as to look monstrous; the like happens also to the Neck, and the Eyes are entirely closed up by it. The Swelling of the Face abates in Proportion to the scabbing and drying up of the Pustules; and then the Hands are puffed up prodigiously. This happens successively to the Legs, the Tumour or Swelling, being the Consequence of the Pustules attaining their utmost Size, which happens by Succession, in these different Parts.

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 [52] 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.

[52] 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 [53] 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.