Zoonomia; Or, the Laws of Organic Life, Vol. II

by Erasmus Darwin

The distinct small-pox is attended with sensitive fever only, when very mild, as in most inoculated patients; or with sensitive irritated fever, when the disease is greater: the danger in this kind of small-pox is owing either to the tumor and soreness of the throat about the height, or eighth day of the eruption; or to the violence of the secondary fever. For, first, as the natural disease is generally taken by particles of the dust of the contagious matter dried and floating in the air, these are liable to be arrested by the mucus about the throat and tonsils in their passage to the lungs, or to the stomach, when they are previously mixed with saliva in the mouth. Hence the throat inflames like the arm in inoculated patients; and this increasing, as the disease advances, destroys the patient about the height.

Secondly, all those upon the face and head come out about the same time, namely, about one day before those on the hands, and two before those in the trunk; and thence, when the head is very full, a danger arises from the secondary fever, which is a purulent, not a variolous fever; for as the matter from all these of the face and head is reabsorbed at the same time, the patient is destroyed by the violence of this purulent fever; which in the distinct small-pox can only be abated by venesection and cathartics; but in the confluent small-pox requires cordials and opiates, as it is attended with arterial debility. See Sect. XXXV. 1. and XXXIII. 2. 10.

When the pustules on the face recede, the face swells; and when those of the hands recede, the hands swell; and the same of the feet in succession. These swellings seem to be owing to the absorption of variolous matter, which by its stimulus excites the cutaneous vessels to secrete more lymph, or serum, or mucus, exactly as happens by the stimulus of a blister. Now, as a blister sometimes produces strangury many hours after it has risen; it is plain, that a part of the cantharides is absorbed, and carried to the neck of the bladder; whether it enters the circulation, or is carried thither by retrograde movements of the urinary branch of lymphatics; and by parity of reasoning the variolous matter is absorbed, and swells the face and hands by its stimulus.

Variola confluens. The confluent small-pox consists of numerous pustules, which appear on the third day of the fever, flow together, are irregularly circumscribed, flaccid, and little elevated; the fever continuing after the eruption is complete; convulsions do not precede this kind of small-pox, and are so far to be esteemed a favourable symptom.

The confluent small-pox is attended with sensitive inirritated fever, or inflammation with arterial debility; whence the danger of this disease is owing to the general tendency to gangrene, with petechiæ, or purple spots, and hæmorrhages; besides the two sources of danger from the tumor of the throat about the height, or eleventh day of the eruption, and the purulent fever after that time; which are generally much more to be dreaded in this than in the distinct small-pox described above.

M. M. The method of treatment must vary with the degree and kind of fever. Venesection may be used in the distinct small-pox early in the disease, according to the strength or hardness of the pulse; and perhaps on the first day of the confluent small-pox, and even of the plague, before the sensorial power is exhausted by the violence of the arterial action? Cold air, and even washing or bathing in cold water, is a powerful means in perhaps all eruptive diseases attended with fever; as the quantity of eruption depends on the quantity of the fever, and the activity of the cutaneous vessels; which may be judged of by the heat produced on the skin; and which latter is immediately abated by exposure to external cold. Mercurial purges, as three grains of calomel repeated every day during the eruptive fever, so as to induce three or four stools, contribute to abate inflammation; and is believed by some to have a specific effect on the variolous, as it is supposed to have on the venereal contagion.

It has been said, that opening the pock and taking out the matter has not abated the secondary fever; but as I had conceived, that the pits, or marks left after the small-pox, were owing to the acrimony of the matter beneath the hard scabs, which not being able to exhale eroded the skin, and produced ulcers, I directed the faces of two patients in the confluent small-pox to be covered with cerate early in the disease, which was daily renewed; and I was induced to think, that they had much less of the secondary fever, and were so little marked, that one of them, who was a young lady, almost entirely preserved her beauty. Perhaps mercurial plasters, or cerates, made without turpentine in them, might have been more efficacious, in preventing the marks, and especially if applied early in the disease, even on the first day of the eruption, and renewed daily. For it appears from the experiments of Van Woensel, that calomel or sublimate corrosive, triturated with variolous matter, incapacitates it from giving the disease by inoculation. Calomel or sublimate given as an alterative for ten days before inoculation, and till the eruptive fever commences, is said with certainty to render the disease mild by the same author. Exper. on Mercury by Van Woensel, translated by Dr. Fowle, Salisbury.

Variola inoculata. The world is much indebted to the great discoverer of the good effects of inoculation, whose name is unknown; and our own country to Lady Wortley Montague for its introduction into this part of Europe. By inserting the variolous contagion into the arm, it is not received by the tonsils, as generally happens, I suppose, in the natural small-pox; whence there is no dangerous swelling of the throat, and as the pustules are generally few and distinct, there is seldom any secondary fever; whence those two sources of danger are precluded; hence when the throat in inoculated small-pox is much inflamed and swelled, there is reason to believe, that the disease had been previously taken by the tonsils in the natural way.—Which also, I suppose, has generally happened, where the confluent kind of small-pox has occurred on inoculation.

I have known two instances, and have heard of others, where the natural small-pox began fourteen days after the contagion had been received; one of these instances was of a countryman, who went to a market town many miles from his home, where he saw a person in the small-pox, and on returning the fever commenced that day fortnight: the other was of a child, whom the ignorant mother carried to another child ill of the small-pox, on purpose to communicate the disease to it; and the variolous fever began on the fourteenth day from that time. So that in both these cases fever commenced in half a lunation after the contagion was received. In the inoculated small-pox the fever generally commences on the seventh day, or after a quarter of a lunation; and on this circumstance probably depends the greater mildness of the latter. The reason of which is difficult to comprehend; but supposing the facts to be generally as above related, the slower progress of the contagion indicates a greater inirritability of the system, and in consequence a tendency to malignant rather than to inflammatory fever. This difference of the time between the reception of the infection and the fever in the natural and artificial small-pox may nevertheless depend on its being inserted into a different series of vessels; or to some unknown effect of lunar periods. It is a subject of great curiosity, and deserves further investigation.

When the inoculated small-pox is given under all the most favourable circumstances I believe less than one in a thousand miscarry, which may be ascribed to some unavoidable accident, such as the patient having previously received the infection, or being about to be ill of some other disease. Those which have lately miscarried under inoculation, as far as has come to my knowledge, have been chiefly children at the breast; for in these the habit of living in the air has been confirmed by so short a time, that it is much easier destroyed, than when these habits of life have been established by more frequent repetition. See Sect. XVII. 3. Thus it appears from the bills of mortality kept in the great cities of London, Paris, and Vienna, that out of every thousand children above three hundred and fifty die under two years old. (Kirkpatrick on Inoculation.) Whence a strong reason against our hazarding inoculation before that age is passed, especially in crowded towns; except where the vicinity of the natural contagion renders it necessary, or the convenience of inoculating a whole family at a time; as it then becomes better to venture the less favourable circumstances of the age of the patient, or the chance of the pain from toothing, than to risk the infection in the natural way.