Such is the usual progress of the disease: subsequent to vaccination, it is a mild and tractable disorder. It is right, however, to mention that small-pox has occurred even to the vaccinated in almost as severe a form as the confluent natural small-pox, and running its regular course unaltered or unmodified. Such instances, however, are extremely rare, and form the exceptions to the general rule; for "no reasonable doubt can be entertained, from the abundance of facts now before the world, that such modification is the law of the animal economy, and that the regular or natural progress is the exception."
MATERNAL MANAGEMENT.—The grand principle in the treatment of small-pox is to moderate and keep under the fever; and however the plans adopted by different medical men may vary in particular points to accomplish this purpose, they uniformly make this principle their chief aim and object. To carry out this intention, however, the medical adviser is greatly dependent upon the aid and assistance of a judicious parent, and without this it is impossible to hope for a successful issue to the case. A clear knowledge, therefore, of those points of general management in which in fact a great part of the above principle consists (few and simple as these directions are), it must be all-important for the mother to be acquainted with: for the rest, she must and ought to look to the medical man.
In the more rare and severe form of this disease, viz. the confluent small-pox, although in some instances it runs the same course as the milder form, the distinct or natural small-pox, still, usually, the constitutional symptoms are much more aggravated, and the medical and general treatment required will so much depend upon the character of the individual case, that we do not think it well to notice it here.
BED AND BED-ROOM.—It will not be necessary at first for the child to be confined to his bed, but generally about the third or fourth day he will gladly resort to it; and if he does not, it will be prudent to keep him there. He must not, however, be loaded with bed-clothes, but lightly covered; and the bed and body linen should be changed daily, if possible.
The bed-room should be capacious and well ventilated; fresh air frequently admitted; and if the season of the year permit, and there is no dampness of atmosphere, a window should be constantly open during the day: it is also desirable to keep the chamber darkened in all cases, as there is always a tendency to inflammation of the eyes.
If these directions are not regarded, and a great heat of the apartment is permitted, with abundance of bed-clothes heaped upon the child, the hot bath is used, and hot and stimulating regimen given (upon the old and erroneous notion of bringing out the eruption), the mildest case will inevitably be converted into one of the most severe and dangerous. Facts have abundantly shown that such measures invariably prove the most effectual means of exasperating the disease, and endangering life.
REGIMEN.—This must be most sparing. Cold water may be given whenever the child asks for it. Lemonade should form the common drink during the fever; and gruel, barley-water, and roasted apples are all else that is required during this period, and not until the disease is going off must any change be made in the diet.
The above period having arrived, mildly nutritious food should be given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or sago; to be followed in a few days by the wing of a chicken or a mutton chop; remembering always, that solid animal food must at first be given cautiously and sparingly. Wine or stimulants must be positively forbidden; unless, indeed, ordered by the medical man, for circumstances may arise which render them advisable.
The state of the bowels must be carefully attended to at this time.
THE ERUPTION.—In the natural and mild form of this disorder the pustules generally break from the sixth to the eighth day; dry scabs succeed; and in about nine or ten days the parts heal perfectly, requiring no treatment. In the more aggravated cases, however, in which the pustules are very numerous, running one into the other, and, bursting, discharge greatly, the whole surface of the body should be frequently and liberally dusted over with dried flour, or, what is better, starch powder. The sores in this instance are always tedious in healing, and followed by the well-known pits or marks: these arise from a loss of substance in the true skin, and occur more particularly on the face, from the great vascularity of this part causing the pustules to be more numerous here than elsewhere. It is a popular error to suppose that by wearing masks of fine linen or cambric illined with particular ointments, these scars or pits may be prevented: it is impossible to prevent them; and any local application, except a little cold cream or oil of almonds applied to the scabs when they harden, will prove more injurious than useful. The child's hands, however, should always be muffled to prevent its scratching or breaking the sores, for otherwise he will not be kept from thus attempting to allay the excessive itching which they occasion.