The predominancy and reign of inflammatory fever in northern latitudes, is in winter and spring, in cold climates and rigorous seasons, and where cold and moisture are combined. It commonly attacks the robust, strong, athletick, and those in the vigour of life: it is not contagious; and neither its remission nor exacerbation are conspicuous. Its assault is sudden and violent, with severe headach, quick laborious respiration, interrupted sleep and restlessness, or sometimes somnolency; sometimes delirium; but in general the mental functions are not greatly disordered, nor the muscular debility so great as in the nervous and putrid fevers: pulse accelerated, strong, full, and tense; commotion and throbbing of the temporal and carotid arteries; intense heat of the skin, dryness of the mouth, fauces, tongue, and nose; ingurgitation of drink with avidity; the urine somewhat crimson in tincture, and in small quantity; the belly generally costive; the blood drawn, forming a buffy incrustation on the contracted coagulum, complete its portrait. The natural crisis is various by nasal hemorrhage, by sweats, turbid urine, diarrhœa; and the duration of the fever from four to eleven days. The Febris Diaria of a few days continuance, is a sort of minor or infant species, an appendix of the inflammatory: it begins suddenly with nausea, vomiting, shivering, cold, headach, lassitude, heat of the skin, flushed face, restlessness, or disturbed sleep, strong quick pulse: and is rarely dangerous.
With respect to all the preceding confederate genera of fevers, we shall make the following general observation. In the preceding century, during the last thirty years, febrile mortality, by the London bills, is rated at 87,645: and the mortality of the present century is seen in the Chart. Formerly, in this metropolis and island, and probably throughout Europe, fevers seem to have been much more prevalent and fatal than at present: their essential nature and cure is now much better understood by physicians; and we are provided with far more powerful auxiliary remedies, and are more expert in their application. In this particular instance, modern medicine, especially of the century in which we live, is signalized, and may, without arrogance, claim triumphal honours. The supposed innumerable varieties of fevers, and from which perplexity Sydenham could not altogether extricate himself, is now disproved by repeated experience, and by the infallible efficacy of general remedies. It is, however, as yet impossible to fix any definite medium or average of mortality in the above genera of fevers, whether remittent, nervous, putrid, or inflammatory. We have modern authentick records, wherein, under judicious and skilful treatment, of 200 sick in remittent fevers only one died; and even in the nervous and putrid, the blanks were trifling compared to the prizes; whereas, under different and erroneous management, one half, and often the greatest part of the sick perished. The corroboration of these assertions may be seen in those learned authors, Lind, Millar, Robinson, Clarke, Lettsom, Sims, and others.
Throughout the intire morbid host of human foes, there is probably no such flagrant variation in the therapeutick barometer, or scale of mortality, as in that of the fevers hitherto described. Different curatory processes and remedies soon change the natural genus, symptoms, crisis, prognosticks, and event. No dangerous diseases almost whatsoever, are more successfully oppugnable under discreet medical regimen; and when entrusted to nature, from the days of Hippocrates to the present time, they have ever been extremely fatal. Sorry I am to add, that, perhaps in many instances, the errors and fatality of nature, have been less destructive than those of artificial and therapeutick mismanagement. Since the discovery of antimonials and Peruvian bark, few now, under skilful medical pilots, die, compared to the multitudes of sick: but still in the aggregate list of funerals, except perhaps pulmonary Consumptions, it may be doubted whether any other of the belligerent morbid foes commit such ravages amongst mankind.
Small Pox,
natural and inoculated. We have no vestiges, neither in history nor tradition, of this loathsome disease, nor of the measles, before the irruption of Mahomet and his followers from the Arabian deserts, about 1,300 years ago; and from whom this extraneous contagion was first transplanted into Europe. It is little more than 200 years since the exportation of this exotic poison to the American continent, where it had never before been seen nor heard of. The havock by this scourge of the human race, amounts, in London, to nearly a decimation of the inhabitants; or to about one tenth, or one twelfth. It is equally or oftener much more fatal throughout the torrid and frigid zones; and in the adult age is more violent than in childhood. It attacks the same person but once in life: had this not been the case, the human race must long since have been extinct. On a promiscuous average, one of every seven infected die of the natural disease; but under inoculation only 1 of 500. Besides, to the former deadly catalogue may be superadded a frightful train of mangled constitutions and countenances, of consumptions, abscesses, ulcers, opthalmias, blindness.
In every large metropolis, small pox is an annual epidemick. In country towns and open districts, its invasions are more distant; at uncertain intervals of some years, when numbers contiguous are attacked at the same time. In our climate, it is alledged to be most prevalent in spring and autumn. Very few of the human species escape the small pox, especially in populous cities and towns, wherein there is always lasting variolous fuel, or, lurking embers: a wooden horse with ferocious foes in ambuscade, tolerated within their walls, rioting in human slaughter, and infantile immolation. It might easily be demonstrated, that in London, and probably in all other large cities, variolous ravages are principally amongst children under five years of age. Without entering into any elaborate argumentation, or proofs of this assertion, the reader may, in some degree, be convinced, by only turning his eye to the first Chart, and to a small table of London mortality during ten years; wherein he will observe the trifling annual mortality in the interval between 5 and 20 years; before which last period, a mere handful of the native progeny of the metropolis can be supposed to have escaped an infection with which they are constantly enveloped. It is obvious that the total annual mortality by all diseases, inclusively, in London during this adolescent period of life of 15 years, is not equal to variolous carnage singly. As to inoculation, or artificial engrafting of the contagion, it is throughout the greatest part of Europe a modern practice of the present century, and is yet in its cradle. Even in the London small pox hospital, since its first institution, forty years ago, there have not been inoculated altogether 25,000.
The cruel carnage perpetrated by small pox throughout the earth; the rooted prejudices, and the insinuations urged to shackle the universal benefits of inoculation, and which pervade not only the ignorant mass of the community, but also the generality of the medical profession throughout Europe, would abundantly excuse and urge me to be more diffuse on this interesting and litigated topick. But having, some years ago, published a small Essay on Inoculation, and having now nearly finished a general treatise on the natural and inoculated small pox, I shall postpone the result of much reading and reflection to that republication. An acquiescence in neutrality or indifference, where it can be proved to mathematical demonstration that myriads of lives might be preserved, which are now sacrificed, would, at least in a moral sense, constitute an accessary in criminality.
Small pox, or variolæ, have been properly discriminated into several species: the distinct and confluent, or benign and malign; the crystalline, lymphatick, warty, petechial, and hemorrhagick; the inoculated; the spurious. The principal differences between small pox consist in the period of eruption, the number and form of the pustules, the quantity and state of the fluid contained in them, and the contumacious perseverance of the fever. The progress of variolous fever has been divided into four stages, that preceding the eruption; the eruption; the suppuration; and the exsiccation of the pustules. The first visible effects of the contagion and fever are nausea, vomiting, soreness at the stomach, drowsiness: before the eruption infants are prone to startings, and some even to epileptic fits; adults to sweats. The second stage of eruption is, from three to four days, from the first attack, of small red spots or pimples on the skin, resembling flea-bites, in number and quantity extremely various; from one or more, multiplied to many hundreds. The eruption is commonly first on the face, spreading gradually over the body and extremities, and is compleated about the fifth or sixth day from the febrile commencement: and on this eruption, the fever abates or subsides. In the third stage of maturation the pimples increase daily in size; are elevated into prominences inflamed at the base; and the suppuration is compleated between the eighth and eleventh day from the first attack: the pustules then detached from each other, have risen into small boils, the size of peas or larger, turgid with pus, gradually becoming opake, yellowish, and tenacious. In the fourth stage the pustules shrivel or burst, oozing out part of their contents, and a superficial incrustation is formed, which, after some days, together with the shrivelled pustules, scales off, leaving the subjacent skin of a brown red colour. This is the mild form of the disease; but we are next to describe it under more dangerous and fatal forms.
In the Confluent small pox, the revolutions are the same, but the symptoms more exasperated; the vomiting and the eruptive fever violent, frequently with coma, or delirium. The eruption protrudes earlier; on the second or third day, in congregated clusters, like measles, and more numerous on the face; the fever does not then subside, but increases towards the fifth or sixth day, and continues throughout the disease. The swelling of the face is commonly earlier and more severe: and both in confluent and distinct, when the pustules are numerous on the face and fauces, there is soreness and inflammation of the throat, hoarseness, and difficulty of swallowing; and about the eighth day, the eye-lids are closed up with temporary blindness. On the face, especially, the pustules are small, less elevated, coalescent; and it is often covered with a universal flat vesicle: the fluid is whitish or brownish, not yellow and tenacious, or of due maturation and concocted purulency. The pustular interstices, if any, are pale and flaccid. The facial intumescence subsides about the tenth or eleventh day: and during these stages of fermentation and depuration, a salivation commonly ensues, especially in adults; and in infants a diarrhœa. About the fourth stage the fever, called secondary, is often renewed with considerable vehemence, and with various duration and event. In the latter stages the pustules excite intolerable itching of the skin, and, if not prevented, incessant scratching and cutaneous denudation: the breath, exhalations and excretions are then offensive to the smell. In the mild distinct, the pustules commonly begin to dry on the ninth day, and continue to the fourteenth in a process of exsiccation; but in the confluent, this stage begins about the eleventh day.
The following are all unfavourable omens in small pox: Sudden and premature eruption of pustules. In this first stage, infants, especially before dentition, are sometimes snatched off in epileptick fits. The more small pox appear in the confluent, or in the distinct form, they are more or less perilous. It is only where the distinct are crowded with pustules on the face; or accompanied with fever and putrescency; or with pustules warty and lymphatick, that they are dangerous. Or, a natural mild small pox may be rendered malignant from confined air, heated room, and regimen. In the catalogue of unfavourable symptoms, are the fever continuing pertinaceous; and with putrescency it is still more dangerous: the pustules not sufficiently filled and distended, hard, or warty, or not filled with maturated pus; the top of the pustules depressed; pale interstices at their base; sudden retrocession or subsidence of the pustules during the stage of maturation: severe inflammation of the fauces; difficult deglutition; severe pain at the stomach. The secondary fever arising commonly about the recession and exsiccation of the pustules, or ebb of maturation, is the most dangerous period of small pox. The variolous crisis then is generally by diarrhœa, or turbid urine, or both conjointly, or by salivation. It is evident that, as the cutaneous pores are blocked up, the absorbed, and other floating pus, must be defecated by some grosser excretory. Additional symptoms of alarm, especially in the confluent, are, if the suppurating stage of the fever continues severe, the salivation ceases, and the hands do not then swell. When the putrescency is virulent, the disease sometimes proves fatal in a few days; but in most cases on the eleventh, and sometimes not until the fourteenth or seventeenth. Fatal symptoms of putrescency are petechiæ, and bloody pustules; putrid urine and stools; tumid emphysematous abdomen.