It is generally necessary, after the small-pox are gone off, to purge the patient. If however the body has been open through the whole course of the disease, or if butter-milk and other things of an opening nature have been drank freely after the height of the small-pox, purging becomes less necessary; but it ought never wholly to be neglected.
For very young children, an infusion of senna and prunes, with a little rhubarb, may be sweetened with coarse sugar, and given in small quantities till it operates. Those who are farther advanced must take medicines of a sharper nature. For example, a child of five or six years of age may take eight or ten grains of fine rhubarb in powder over night, and the same quantity of jalap in powder next morning. This may be wrought off with fresh broth or water-gruel, and may be repeated three or four times, five or six days intervening between each dose. For children further advanced, and adults, the dose must be increased in proportion to the age and constitution[[92]].
When imposthumes happen after the small-pox, which is not seldom the case, they must be brought to suppuration as soon as possible, by means of ripening poultices; and when they have been opened, or have broke of their own accord, the patient must be purged. The Peruvian bark and a milk diet will likewise be useful in this case.
When a cough, a difficulty of breathing, or other symptoms of a consumption, succeed to the small-pox, the patient must be sent to a place where the air is good, and put upon a course of asses milk, with such exercise as he can bear. For further directions in this case, see the article Consumptions.
OF INOCULATION.
Though no disease, after it is formed, baffles the powers of medicine more effectually than the small-pox, yet more may be done before-hand to render this disease favourable than any one we know, as almost all the danger from it may be prevented by inoculation. This salutary invention has been known in Europe above half a century; but, like most other useful discoveries, it has till of late made but slow progress. It must however be acknowledged, to the honour of this country, that inoculation has met with a more favourable reception here, than among any of our neighbours. It is still however far from being general, which we have reason to fear will be the case, as long as the practice continues in the hands of the faculty.
No discovery can be of general utility, while the practice of it is kept in the hands of a few. Had the inoculation of the small-pox been introduced as a fashion, and not as a medical discovery, or had it been practiced by the same kind of operators here, as it is in those countries from whence we learned it, it had long ago been universal. The fears, the jealousies, the prejudices, and the opposite interests of the faculty, are, and ever will be, the most effectual obstacles to the progress of any salutary discovery. Hence it is that the practice of inoculation never became in any measure general, even in England, till taken up by men not bred to physic. These have not only rendered the practice more extensive, but likewise more safe, and by acting under less restraint than the regular practitioners, have taught them that the patient’s greatest danger arose, not from the want of care, but from the excess of it.
They know very little of the matter, who impute the success of modern inoculators to any superior skill, either in preparing the patient or communicating the disease. Some of them indeed, from a sordid desire of engrossing the whole practice to themselves, pretend to have extraordinary secrets or nostrums for preparing persons for inoculation, which never fail of success. But this is only a pretence calculated to blind the ignorant and inattentive. Common sense and prudence alone are sufficient both in the choice of the subject and management of the operation. Whoever is possessed of these may perform this office for his children whenever he finds it convenient, provided they be in a good state of health.
This sentiment is not the result of theory, but of observation. Though few physicians have had more opportunities of trying inoculation in all its different forms, so little appears to me to depend on those, generally reckoned important circumstances, of preparing the body, communicating the infection by this or the other method, &c. that for several years past I have persuaded the parents or nurses to perform the whole themselves, and have found that method followed with equal success, while it is free from many inconveniences that attend the other[[93]].
The small-pox may be communicated in a great variety of ways with nearly the same degree of safety and success. In Turkey, from whence we learned the practice, the women communicate the disease to children, by opening a bit of the skin with a needle, and putting into the wound a little matter taken from a ripe pustule. On the coast of Barbary they pass a thread wet with the matter through the skin between the thumb and fore-finger; and in some of the states of Barbary, inoculation is performed by rubbing in the variolous matter between the thumb and fore-finger, or on other parts of the body. The practice of communicating the small-pox, by rubbing the variolous matter upon the skin, has been long known in many parts of Asia and Europe, as well as in Barbary, and has generally gone by the name of buying the small-pox.