CAUSES.——The small-pox is commonly caught by infection. Since the disease was first brought into Europe, the infection has never been wholly extinguished, nor have any proper methods, as far as I know, been taken for that purpose; so that now it has become in a manner constitutional. Children who have overheated themselves by running, wrestling, &c. or adults after a debauch, are most apt to be seized with the small-pox.
SYMPTOMS.——This disease is so generally known, that a minute description of it is unnecessary. Children commonly look a little dull, seem lifeless and drowsy for a few days before the more violent symptoms of the small-pox appear. They are likewise more inclined to drink than usual, have little appetite for solid food, complain of weariness, and, upon taking exercise, are apt to sweat. These are succeeded by slight fits of cold and heat in turns, which, as the time of the eruption approaches, become more violent, and are accompanied with pains of the head and loins, vomiting, &c. The pulse is quick, with a great heat of the skin, and restlessness. When the patient drops asleep, he wakes in a kind of horror, with a sudden start, which is a very common symptom of the approaching eruption; as are also convulsion-fits in very young children.
About the third or fourth day from the time of sickening, the small-pox generally begin to appear; sometimes indeed they appear sooner, but that is no favourable symptom. At first they very nearly resemble flea-bites, and are soonest discovered on the face, arms, and breast.
The most favourable symptoms are a slow eruption, and an abatement of the fever as soon as the pustules appear. In a mild distinct kind of small-pox the pustules seldom appear before the fourth day from the time of sickening, and they generally keep coming out gradually for several days after. Pustules which are distinct, with a florid red basis, and which fill with thick purulent matter, first of a whitish, and afterwards of a yellowish colour, are the best.
A livid brown colour of the pustules is an unfavourable symptom; as also when they are small and flat, with black specks in the middle. Pustules which contain a thin watery ichor are very bad. A great number of pox on the face is always attended with danger. It is likewise a very bad sign when they run into one another.
It is a most unfavourable symptom when petechiæ, or purple, brown, or black spots are interspersed among the pustules. These are signs of a putrid dissolution of the blood, and shew the danger to be very great. Bloody stools or urine, with a swelled belly, are bad symptoms; as is also a continual strangury. Pale urine and a violent throbbing of the arteries of the neck are signs of an approaching delirium, or of convulsion-fits. When the face does not swell, or falls before the pox come to maturity, it is very unfavourable. If the face begins to fall about the eleventh or twelfth day, and at the same time the hands and feet begin to swell, the patient generally does well; but when these do not succeed to each other, there is reason to apprehend danger. When the tongue is covered with a brown crust, it is an unfavourable symptom. Cold shivering fits coming on at the height of the disease are likewise unfavourable. Grinding of the teeth, when it proceeds from an affection of the nervous system, is a bad sign; but sometimes it is occasioned by worms, or a disordered stomach.
REGIMEN.——When the first symptoms of the small-pox appear, people are ready to be alarmed, and often fly to the use of medicine, to the great danger of the patient’s life. I have known children, to appease the anxiety of their parents, bled, blistered, and purged, during the fever which preceded the eruption of the small-pox, to such a degree, that Nature was not only disturbed in her operation, but rendered unable to support the pustules after they were out; so that the patient, exhausted by mere evacuations, sunk under the disease.
When convulsions appear, they give a dreadful alarm. Immediately some nostrum is applied, as if this were a primary disease; whereas it is only a symptom, and far from being an unfavourable one, of the approaching eruption. As the fits generally go off before the actual appearance of the small-pox, it is attributed to the medicine, which by this means acquires a reputation without any merit[[88]].
All that is, generally speaking, necessary during the eruptive fever, is to keep the patient cool and easy, allowing him to drink freely of some weak diluting liquors; as balm-tea, barley-water, clear whey, gruels, &c. He should not be confined to bed, but should sit up as much as he is able, and should have his feet and legs frequently bathed in lukewarm water. His food ought to be very light; and he should be as little disturbed with company as possible.
Much mischief is done at this period by confining the patient too soon to his bed, and plying him with warm cordials or sudorific medicines. Every thing that heats and inflames the blood increases the fever, and pushes out the pustules prematurely. This has numberless ill effects. It not only increases the number of pustules, but likewise tends to make them run into one another; and when they have been pushed out with too great violence, they generally fall in before they come to maturity.