Advice to the people in general, with regard to their health

by S. A. D. Tissot

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

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

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

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

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

§ 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 a Mistake, such Pustules being almost constantly [⁵²] imaginary. It begins, most frequently, before the Eruption appears; if this Complaint is in a light Degree, it terminates upon the Eruption; and whenever it revives again in the Course of the Disease, it is always in Proportion to the Degree of the Fever. Hence we may infer it does not arise from the Pustules, but is owing to the Inflammation; and as often as it is of any considerable Duration, it is almost ever attended with another Symptom, the Salivation, or a Discharge of a great Quantity of Spittle. This Salivation rarely exists, where the Disease is very gentle, or the Patient very young; and is full as rarely absent, where it is severe, and the Patient is past seven or eight Years old: but when the Eruption is very confluent, and the Patient adult, or grown up, the Discharge is surprizing. Under these Circumstances it flows out incessantly, allowing the afflicted Patient no Rest or Respite; and often incommodes him more than any other Symptom of the Distemper; and so much the more, as after its Continuance for some Days, the Lips, the Inside of the Cheeks, the Tongue, and the Roof of the Mouth are entirely peeled or flead, as it were. Nevertheless, however painful and embarrassing this Discharge may prove, it is very important and salutary. Meer Infants are less subject to it, some of them having a Looseness, in Lieu of it: and yet I have observed even this last Discharge to be considerably less frequent in them, than a Salivation is in grown People.

§ 208. Children, to the Age of five or six Years, are liable to Convulsions, before Eruption: these however are not dangerous, if they are not accompanied with other grievous and violent Symptoms. But such Convulsions as supervene, either when Eruption having already occurred, suddenly retreats, or strikes in, according to the common Phrase; or during the Course of the Fever of Suppuration, are greatly more terrifying.