10th. Eruption copious, and in confluent patches, with red bases, and flat vesicular summits. Has also aphthæ.
13th. Eruption confluent, in large white patches on face. Throat very sore.
15th. Dead at eight A. M.
Examination.—The stomach of a light colour, perfectly healthy. Folds and plaits of mucous membrane strongly marked. Mucous surface of trachea nearly healthy.
VIII. Infant, female, of a woman who died in the Alms House of varioloid disease, shortly after giving birth to this child. It is three weeks old; was admitted Sunday, 25th April, second day of the eruption. Dead on Thursday, 29th. The skin became livid after death..
Examination.—Pharynx inflamed, and the eruption on it extending all the way down the œsophagus, to near the cardiac orifice; the lining membrane being also in part destroyed. Stomach of a fine clear red, and beautifully injected to the minutest capillaries all over the mucous surface. Intestines, both large and small, red and injected.
The larynx has some eruption on its lining membrane. The trachea and bronchiæ nearly healthy; there being no eruption or secretion on their surface.
Doctor Darrach was present at the majority of the above detailed examinations, and kindly officiated at some of them. This gentleman, well known for his zeal in the study of comparative and morbid anatomy, made many interesting microscopical examinations of the various kinds of variolous pustules, and the corresponding changes in the cutaneous tissue, the results of which, we hope, he will make public.
Having thus freely described what we saw, we wish it were in our power to lay down next, for the benefit of those who come after us, a satisfactory method of treating small-pox. The hospital returns are not of such an encouraging nature as to make our self-love predominate over observation and experience, and lead us to inferences which might seem to sanction the utility of this or that medicine, or curative plan. We had to deal, it is true, with the worst portion of the community; persons of constitutions exhausted or perverted by excess of sensual indulgences, or by poverty, or both conjoined. In private and even dispensary practice, where the subjects were of a better physical and moral nature, we often saw the disease subside, and health return, after less attention to administer medical aid, or to supply other wants, than was exhibited at the hospital. We are, notwithstanding, sanguine enough to anticipate useful results from our attentive study of the symptoms of the disease, in connexion with that of the post mortem examinations, and to consider ourselves as in possession of lights to guide us with more certainty than before. Let us see how far a cautious analysis will tend to dispel old errors, and establish useful truths.
The gastric distress, and the associated uneasiness and pain in the head, back, and limbs, with evening exacerbations of fever, for the three days preceding the eruption, evince conclusively a disease to which the skin is a stranger, except by its usual sympathies of heat and coldness, moisture and dryness. The appearance of the tongue, the loss of appetite, thirst, nausea, and occasionally vomiting, are testimonies to the impeded function of the stomach in this first period, or that of precursory fever: and if to this we add the soreness of the fauces and pharynx, producing impeded deglutition, we cannot refuse our assent to the belief that the mucous surface, on which the preparatory process of digestion takes place, is mainly affected. The next leading symptom is the appearance of the eruption on the skin. The character of the disease is now fixed, and the physician feels himself compelled to respect the cutaneous inflammation, throughout its entire course, naturally enough regarding it as the disease itself, rather than the last link in the chain of morbid actions. To support the circulatory system at such a degree as shall enable the skin to secrete this new matter of small-pox, is nearly as much as he proposes to himself. But here arises a question of great practical moment. To what extent, if any, is the eruption a natural or necessary sequence of the previous symptoms or condition of the system. Perhaps in the existing state of medical science, we hardly dare reply positively to this question. This much we know, that there is no correspondence in general between the intensity of the precursory fever, and the copiousness of the after eruption. We are, moreover, well apprized of the fact of very many, who had been protected in earlier life by inoculation or vaccination, being seized with all the symptoms of the precursory fever of the small-pox, and remaining seriously indisposed for a few days, yet with very little eruption in some cases, and without any in others.