II. To mitigate troublesome and alarming symptoms.
The fever which produces the eruption is generally of the inflammatory kind. It sometimes, therefore, comes on with the symptoms of great heat, preceded with chilliness, and determination to the head and breast, and a full hard pulse. The remedies proper in this case are,
1. Blood-letting. The quantity to be drawn must be regulated by the violence of the symptoms, the constitution, habits, and even country of the patient, and by the season of the year. I have never found more than one bleeding, to the quantity of twelve or fourteen ounces, necessary in any stage or degree of the eruptive fever of the small-pox by inoculation.
2. Cool air is of the utmost consequence in the eruptive fever. The use of this remedy in fevers marks an æra, not only in the management of the small-pox, but in medicine. The degrees of cold should always be increased in proportion to the violence of the fever. Stove-rooms, so common in this country, should be carefully avoided. The more we oblige our patients to sit up and walk in the open air, the better. Even in those cases where they languish most for the bed, they should be encouraged rather to lie upon, than under the bed-clothes. Children should be stript of flannel petticoats that come in contact with their skins; and even clouts should be laid aside, if possible without great inconvenience, and at any rate they should be often removed. Great and obvious as the advantages of cold air appear to be in the eruptive fever, it has sometimes been used to an excess that has done mischief. There are few cases where a degree of cold below fifty of Fahrenheit's thermometer is necessary in this stage of the small-pox. When it has been used below this, or where patients have been exposed to a damp atmosphere some degrees above it, I have heard of inflammations of an alarming nature being produced in the throat and breast.
3. The bowels, more especially of children, should be kept open with gentle laxatives. And,
4. Cool subacid drinks should be plentifully used until the eruption be completed.
Sometimes the small-pox comes on with a fever the reverse of that which we have described. The heat is inconsiderable, the pulse is weak, and scarcely quicker than ordinary, and the patient complains of but slight pains in the back and head. Here the treatment should be widely different from that which has been mentioned when the fever is of the inflammatory kind. Bleeding in this case is hurtful, and even cool air must be admitted with caution. The business of the physician in this case is to excite a gentle action in the sanguiferous system, in order to produce the degree of fever which is necessary to the eruption of the pock. For this purpose he may recommend the use of warm drinks, and even of a warm bed with advantage. If the eruption delay beyond the third day, with all the circumstances of debility that have been mentioned, I have frequently ordered my patients to eat a few ounces of animal food, and to drink a glass or two of wine, with the most desirable success. The effects of this indulgence are most obvious where the weakness of the fever and the delay of the eruption in children, have made it necessary to allow it to mothers and nurses.
The small-pox by inoculation so seldom comes on with the symptoms of what is called a malignant fever, that little need be said of the treatment proper in such cases. I shall only observe, that the cold regimen in the highest degree, promises more success in these cases than in any others. I have repeatedly been told, that when the small-pox appears confluent among the Africans, it is a common practice for mothers to rub their children all over with pepper, and plunge them immediately afterwards into a spring of cold water. This, they say, destroys a great part of the pock, and disposes the remainder to a kindly suppuration. From the success that has attended the use of the cold bath in malignant fevers in some parts of Europe[61], I am disposed to believe in the efficacy of the African remedy.
The fever generally lasts three days, and the eruption continues for a similar length of time, counting the last day of the fever, as the first day of the eruption. But this remark is liable to many exceptions. We sometimes observe the eruption to begin on the first, and often on the second day of the fever; and we sometimes meet with cases in which a second eruption comes on after the fever has abated for several days, and the first eruption considerably advanced in its progress towards a complete suppuration. This is often occasioned by the application of excessive cold or heat to the body, or by a sudden and premature use of stimulating drinks, or animal food.
I come now to treat of the best method of mitigating troublesome and alarming symptoms.