When the eruption subsides suddenly, or, as the good women term it, when the small-pox strike in, before they have arrived at maturity, the danger is very great. In this case blistering-plasters must be immediately applied to the wrists and ancles, and the patient’s spirits supported with cordials.
Sometimes bleeding has a surprising effect in raising the pustules after they have subsided; but it requires skill to know when this is proper, or to what length the patient can bear it. Sharp cataplasms however may be applied to the feet and hands, as they tend to promote the swelling of these parts, and by that means to draw the humours towards the extremities.
The most dangerous period of this disease is what we call the secondary fever. This generally comes on when the small-pox begin to blacken, or turn on the face; and most of those who die of the small-pox are carried off by this fever.
Nature generally attempts, at the turn of the small-pox, to relieve the patient by loose stools. Her endeavours this way are by no means to be counteracted, but promoted, and the patient at the same time supported by food and drink of a nourishing and cordial nature.
If, at the approach of the secondary fever, the pulse be very quick, hard, and strong, the heat intense, and the breathing laborious, with other symptoms of an inflammation of the breast, the patient must immediately be bled. The quantity of blood to be let must be regulated by the patient’s strength, age, and the urgency of the symptoms.
But, in the secondary fever, if the patient be faintish, the pustules become suddenly pale, and if there be great coldness of the extremities, blistering plasters must be applied, and the patient must be supported with generous cordials. Wine and even spirits have sometimes been given in such cases with amazing success.
As the secondary fever is in great measure, if not wholly, owing to the absorption of the matter, it would seem highly consonant to reason, that the pustules, as soon as they come to maturity, should be opened. This is every day practiced in other phlegmons which tend to suppuration; and there seems to be no cause why it should be less proper here. On the contrary, we have reason to believe, that by this means the secondary fever might always be lessened, and often wholly prevented.
The pustules should be opened when they begin to turn of a yellow colour. Very little art is necessary for this operation. They may either be opened with a lancet or a needle, and the matter absorbed by a little dry lint. As the pustules are generally first ripe on the face, it will be proper to begin with opening these, and the others in course as they become ripe. The pustules generally fill again, a second or even a third time; for which cause the operation must be repeated, or rather continued as long as there is any considerable appearance of matter in the pustules.
We have reason to believe that this operation, rational as it is, has been neglected from a piece of mistaken tenderness in parents. They believe that it must give great pain to the poor child; and therefore would rather see it die than have it thus tortured. This notion however is entirely without foundation. I have frequently opened the pustules when the patient did not see me, without his being in the least sensible of it; but suppose it were attended with a little pain, that is nothing in comparison to the advantages which arise from it.
Opening the pustules not only prevents the resorption of the matter into the blood, but likewise takes off the tension of the skin, and by that means greatly relieves the patient. It likewise tends to prevent the pitting, which is a matter of no small importance. Acrid matter, by lodging long in the pustules, cannot fail to corrode the tender skin; by which many a handsome face becomes so deformed as hardly to bear a resemblance to the human figure[[91]].