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 than49four 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 alwayssecure from50it. 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.§ 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 thosewho 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.§ 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 a51Vivacity, Gaiety, and a rosy Improvement of their Complexion, beyond what Nature had given them.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, verysqueamish, 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 aboutthe 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 ofPusor 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.§ 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.§ 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.§ 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 aMistake, such Pustules being almost constantly52imaginary. 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.§ 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, orstrikes 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 considerableStuporor Drowsiness, vanish immediately after this Bleeding.§ 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 isthe 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 greatStuporor 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.§ 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 fromJurat, 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.§ 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 generalhere. 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.§ 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 PtisanNº. 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 BalmTea, 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 clear53Water. 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 someButtermilkmay 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 perfectlyscabbed on the greater Part of his Face, with the PrescriptionNº. 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.§ 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 aDelirium, 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§ 36.5. He is to be restrained to the PtisansNº. 2or4; 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 MixtureNº. 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,§ 212.§ 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 the54Body very open. Forthis Purpose,aan Ounce ofCatholiconshould be added to the Glysters; or they might be simply made of Whey, with Honey, Oil and Salt.bGive the Patient three times every Morning, at the Interval of two Hours between each, three Glasses of the PtisanNº. 32.cPurge himaftertwo Days, with the PotionNº. 23, but on that Day he must not take the PtisanNº. 32.2. He must, if the Distemper be very violent, take a double Dose of the MixtureNº. 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 tocleanse 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.§ 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.§ 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 ofPusis 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 thatRelaxation; 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 thatPus, which would soon be driedup 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 a55general 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 Matteritself, and the great Tension and Stiffness of the Skin.§ 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 BaronHaller, 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, ofCynoglossumor 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,56when the Blood-vesselsare 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.§ 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 InfusionNº. 12pretty hot, and should be blistered on the fleshy Part of the Legs. This is a veryembarrassing 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.§ 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 Hospitals57are 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.§ 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 aChild 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.58The 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 Note11, 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 ofsound 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 inflammatory59Viscidity or Thickness. It removes all Obstructions in theViscera, 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 theOperation 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.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 truestLove 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 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 than49four 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 alwayssecure from50it. 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.§ 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 thosewho 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.§ 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 a51Vivacity, Gaiety, and a rosy Improvement of their Complexion, beyond what Nature had given them.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, verysqueamish, 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 aboutthe 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 ofPusor 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.§ 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.§ 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.§ 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 aMistake, such Pustules being almost constantly52imaginary. 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.§ 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, orstrikes 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 considerableStuporor Drowsiness, vanish immediately after this Bleeding.§ 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 isthe 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 greatStuporor 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.§ 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 fromJurat, 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.§ 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 generalhere. 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.§ 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 PtisanNº. 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 BalmTea, 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 clear53Water. 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 someButtermilkmay 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 perfectlyscabbed on the greater Part of his Face, with the PrescriptionNº. 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.§ 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 aDelirium, 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§ 36.5. He is to be restrained to the PtisansNº. 2or4; 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 MixtureNº. 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,§ 212.§ 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 the54Body very open. Forthis Purpose,aan Ounce ofCatholiconshould be added to the Glysters; or they might be simply made of Whey, with Honey, Oil and Salt.bGive the Patient three times every Morning, at the Interval of two Hours between each, three Glasses of the PtisanNº. 32.cPurge himaftertwo Days, with the PotionNº. 23, but on that Day he must not take the PtisanNº. 32.2. He must, if the Distemper be very violent, take a double Dose of the MixtureNº. 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 tocleanse 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.§ 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.§ 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 ofPusis 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 thatRelaxation; 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 thatPus, which would soon be driedup 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 a55general 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 Matteritself, and the great Tension and Stiffness of the Skin.§ 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 BaronHaller, 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, ofCynoglossumor 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,56when the Blood-vesselsare 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.§ 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 InfusionNº. 12pretty hot, and should be blistered on the fleshy Part of the Legs. This is a veryembarrassing 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.§ 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 Hospitals57are 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.§ 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 aChild 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.58The 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 Note11, 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 ofsound 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 inflammatory59Viscidity or Thickness. It removes all Obstructions in theViscera, 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 theOperation 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.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 truestLove 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.
Of the Small-Pocks.
Sect.202.
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 than49four 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 alwayssecure from50it. 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.
§ 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 thosewho 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.
§ 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 a51Vivacity, Gaiety, and a rosy Improvement of their Complexion, beyond what Nature had given them.
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, verysqueamish, 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 aboutthe 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 ofPusor 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.
§ 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.
§ 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.
§ 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 aMistake, such Pustules being almost constantly52imaginary. 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.
§ 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, orstrikes 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 considerableStuporor Drowsiness, vanish immediately after this Bleeding.
§ 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 isthe 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 greatStuporor 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.
§ 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 fromJurat, 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.
§ 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 generalhere. 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.
§ 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 PtisanNº. 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 BalmTea, 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 clear53Water. 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 someButtermilkmay 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 perfectlyscabbed on the greater Part of his Face, with the PrescriptionNº. 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.
§ 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 aDelirium, 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§ 36.
5. He is to be restrained to the PtisansNº. 2or4; 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 MixtureNº. 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,§ 212.
§ 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 the54Body very open. Forthis Purpose,aan Ounce ofCatholiconshould be added to the Glysters; or they might be simply made of Whey, with Honey, Oil and Salt.bGive the Patient three times every Morning, at the Interval of two Hours between each, three Glasses of the PtisanNº. 32.cPurge himaftertwo Days, with the PotionNº. 23, but on that Day he must not take the PtisanNº. 32.
2. He must, if the Distemper be very violent, take a double Dose of the MixtureNº. 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 tocleanse 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.
§ 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.
§ 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 ofPusis 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 thatRelaxation; 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 thatPus, which would soon be driedup 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 a55general 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 Matteritself, and the great Tension and Stiffness of the Skin.
§ 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 BaronHaller, 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, ofCynoglossumor 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,56when the Blood-vesselsare 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.
§ 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 InfusionNº. 12pretty hot, and should be blistered on the fleshy Part of the Legs. This is a veryembarrassing 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.
§ 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 Hospitals57are 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.
§ 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 aChild 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.58
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 Note11, 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 ofsound 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 inflammatory59Viscidity or Thickness. It removes all Obstructions in theViscera, 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 theOperation 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.
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 truestLove 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.