This fever takes its name from the small pustules or bladders which appear on the skin, resembling, in shape and size, the seeds of millet. The pustules are either red or white, and sometimes both are mixed together.
The whole body is sometimes covered with pustules; but they are generally more numerous where the sweat is most abundant, as on the breast, the back, &c. A gentle sweat, or moisture on the skin, greatly promotes the eruption; but, when the skin is dry, the eruption is both more painful and dangerous.
Sometimes this is a primary disease; but it is much oftener only a symptom of some other malady, as the small-pox, measles, ardent, putrid, or nervous fever, &c. In all these cases it is generally the effect of too hot a regimen or medicines.
The miliary fever chiefly attacks the idle and the phlegmatic, or persons of a relaxed habit. The young and the aged are more liable to it than those in the vigour and prime of life. It is likewise more incident to women than men, especially the delicate and the indolent, who, neglecting exercise, keep continually within doors, and live upon weak watery diet. Such females are extremely liable to be seized with this disease in child-bed, and often lose their lives by it.
CAUSES.——The miliary fever is sometimes occasioned by violent passions or affections of the mind; as excessive grief, anxiety, thoughtfulness, &c. It may likewise be occasioned by excessive watching, great evacuations, a weak watery diet, rainy seasons, eating too freely of cold, crude, unripe fruits, as plums, cherries, cucumbers, melons; &c. Impure waters, or provisions which have been spoiled by rainy seasons, long keeping, &c. may likewise cause miliary fevers. They may also be occasioned by the stoppage of any customary evacuation, as issues, setons, ulcers, the bleeding piles in men, or the menstrual flux in women, &c.
This disease in child-bed-women is sometimes the effect of great costiveness during pregnancy; it may likewise be occasioned by their excessive use of green trash, and other unwholesome things, in which pregnant women are too apt to indulge. But its most general cause is indolence. Such women as lead a sedentary life, especially during pregnancy, and at the same time live grossly, can hardly escape this disease in child-bed. Hence it proves extremely fatal to women of fashion, and likewise to those women in manufacturing towns, who, in order to assist their husbands, sit close within doors for almost the whole of their time. But among women who are active and laborious, who live in the country, and take sufficient exercise without doors, this disease is very little known.
SYMPTOMS.——When this is a primary disease, it makes its attack, like most other eruptive fevers, with a slight shivering, which is succeeded by heat, loss of strength, faintishness, sighing, a low quick pulse, difficulty of breathing, with great anxiety and oppression of the breast. The patient is restless, and sometimes delirious; the tongue appears white, and the hands shake, with often a burning heat in the palms; and in child-bed-women the milk generally goes away, and the other discharges stop.
The patient feels an itching or pricking pain under the skin, after which innumerable small pustules of a red or white colour begin to appear. Upon this the symptoms generally abate, the pulse becomes more full and soft, the skin grows moister, and the sweat, as the disease advances, begins to have a peculiar fœtid smell; the great load on the breast, and oppression of the spirits, generally go off, and the customary evacuations gradually return. About the sixth or seventh day from the eruption, the pustules begin to dry and fall off, which occasions a very disagreeable itching in the skin.
It is impossible to ascertain the exact time when the pustules will either appear or go off. They generally come out on the third or fourth day, when the eruption is critical; but, when symptomatic, they may appear at any time of the disease.
Sometimes the pustules appear and vanish by turns. When that is the case, there is always danger; but when they go in all of a sudden, and do not appear again, the danger is very great.
In child-bed-women the pustules are commonly at first filled with clear water, afterwards they grow yellowish. Sometimes they are interspersed with pustules of a red colour. When these only appear the disease goes by the name of a rash.
REGIMEN.——In all eruptive fevers, of whatever kind, the chief point is to prevent the sudden disappearing of the pustules, and to promote their maturation. For this purpose the patient must be kept in such a temperature, as neither to push out the eruption too fast, nor to cause it to retreat prematurely. The diet and drink ought therefore to be in a moderate degree nourishing and cordial; but neither strong nor heating. The patient’s chamber ought neither to be kept too hot nor cold; and he should not be too much covered with clothes. Above all, the mind is to be kept easy and cheerful. Nothing so certainly makes an eruption go in as fear, or the apprehension of danger.
The food must be weak chicken-broth with bread, panado, sago, or groat gruel, &c. to a gill of which may be added a spoonful or two of wine, as the patient’s strength requires, with a few grains of salt and a little sugar. Good apples roasted or boiled, with other ripe fruits of an opening cooling nature, may be eaten.
The drink may be suited to the state of the patient’s strength and spirits. If these be pretty high, the drink ought to be weak; as water-gruel, balm-tea, or the decoction mentioned below[85].
When the patient’s spirits are low, and the eruption does not rise sufficiently, his drink must be a little more generous; as wine-whey, or small negus, sharpened with the juice of orange or lemon, and made stronger or weaker as circumstances may require.
Sometimes the miliary fever approaches towards a putrid nature, in which case the patient’s strength must be supported with generous cordials, joined with acids; and, if the degree of putrescence be great, the Peruvian bark must be administered. If the head be much affected, the body must be kept open by emollient clysters[86].
MEDICINE.——If the food and drink be properly regulated, there will be little occasion for medicine in this disease. Should the eruption however not rise, or the spirits flag, it will not only be necessary to support the patient with cordials, but likewise to apply blistering plasters. The most proper cordial, in this case, is good wine, which may either be taken in the patient’s food or drink; and if there be signs of putrescence, the bark and acids may be mixed with wine, as directed in the putrid fever.
Some recommend blistering through the whole course of this disease; and where Nature flags, and the eruption comes and goes, it may be necessary to keep up a stimulus, by a continual succession of small blistering plasters; but we would not recommend above one at a time. If however the pulse should sink remarkably, the pustules fall in, and the head be affected, it will be necessary to apply several blistering plasters to the most sensible parts, as the inside of the legs and thighs, &c.
Bleeding is seldom necessary in this disease, and sometimes it does much hurt, as it weakens the patient, and depresses his spirits. It is therefore never to be attempted unless by the advice of a physician. We mention this, because it has been customary to treat this disease in child-bed-women by plentiful bleeding, and other evacuations, as if it were highly inflammatory. But this practice is generally very unsafe. Patients in this situation bear evacuations very ill. And indeed the disease seems often to be more of a putrid than of an inflammatory nature.
Though this fever is often occasioned in child-bed-women by too hot a regimen, yet it would be dangerous to leave that off all of a sudden, and have recourse to a very cool regimen, and large evacuations. We have reason to believe, that supporting the patient’s spirits, and promoting the natural evacuations, is here much safer than to have recourse to artificial ones, as these, by sinking the spirits, seldom fail to increase the danger.
If the disease proves tedious, or the recovery slow, we would recommend the Peruvian bark, which may either be taken in substance, or infused in wine or water, as the patient inclines.
The miliary fever, like other eruptive diseases, requires gentle purging, which should not be neglected, as soon as the fever is gone off, and the patient’s strength will permit.
To prevent this disease, a pure dry air, sufficient exercise, and wholesome food, are necessary. Pregnant women should guard against costiveness, and take daily as much exercise as they can bear, avoiding all green trashy fruits, and other unwholesome things; and when in child-bed, they ought strictly to observe a cool regimen.
This fever takes its name from a remission of the symptoms, which happens sometimes sooner, and sometimes later, but generally before the eighth day. The remission is commonly preceded by a gentle sweat, after which the patient seems greatly relieved, but in a few hours the fever returns. These remissions return at very irregular periods, and are sometimes of longer, sometimes of shorter duration; the nearer however that the fever approaches to a regular intermittent, the danger is the less.
CAUSES.——Remitting fevers prevail in low marshy countries abounding with wood and stagnating water; but they prove most fatal in places where great heat and moisture are combined, as in some parts of Africa, the province of Bengal in the East Indies, &c. where remitting fevers are generally of a putrid kind, and prove very fatal. They are most frequent in close calm weather, especially after rainy seasons, great inundations, or the like. No age, sex, or constitution, is exempted from the attack of this fever; but it chiefly seizes persons of a relaxed habit, who live in low dirty habitations, breathe an impure stagnating air, take little exercise, and use unwholesome diet.
SYMPTOMS.——The first symptoms of this fever are generally yawning, stretching, pain, and giddiness in the head, with alternate fits of heat and cold. Sometimes the patient is affected with a delirium at the very first attack. There is a pain, and sometimes a swelling, about the region of the stomach; the tongue is white, the eyes and skin frequently appear yellow, and the patient is often afflicted with bilious vomitings. The pulse is sometimes a little hard, but seldom full, and the blood, when let, rarely shews any signs of inflammation. Some patients are exceedingly costive, and others are afflicted with a very troublesome looseness.
It is impossible to describe all the symptoms of this disease, as they vary according to the situation, the season of the year, and the constitution of the patient. They may likewise be greatly changed by the method of treatment, and by many other circumstances too tedious to mention. Sometimes the bilious symptoms predominate, sometimes the nervous, and at other times the putrid. Nor is it at all uncommon to find a succession of each of these, or even a complication of them at the same time, in the same person.
REGIMEN.——The regimen must be adapted to the prevailing symptoms. When there are any signs of inflammation, the diet must be slender, and the drink weak and diluting. But when nervous or putrid symptoms occur, it will be necessary to support the patient with food and liquors of a more generous nature, such as are recommended in the immediately preceding fevers. We must however be very cautious in the use of things of a heating quality, as this fever is frequently changed into a continual by an hot regimen, and improper medicines.
Whatever the symptoms are, the patient ought to be kept cool, quiet, and clean. His apartment, if possible, should be large, and frequently ventilated by letting in fresh air at the doors or windows. It ought likewise to be sprinkled with vinegar, juice of lemon, or the like. His linen, bed-clothes, &c. should be frequently changed, and all his excrements immediately removed. Though these things have been recommended before, we think it necessary to repeat them here, as they are of more importance to the sick than practitioners are apt to imagine[87].
MEDICINE.——In order to cure this fever, we must endeavour to bring it to a regular intermission. This intention may be promoted by bleeding, if there be any signs of inflammation; but when that is not the case, bleeding ought by no means to be attempted, as it will weaken the patient and prolong the disease. A vomit however will seldom be improper, and is generally of great service. Twenty or thirty grains of ipecacuanha will answer this purpose very well; but, where it can be obtained, we would rather recommend a grain or two of tartar emetic, with five or six grains of ipecacuanha, to be made into a draught, and given for a vomit. This may be repeated once or twice at proper intervals, if the sickness or nausea continues.
The body ought to be kept open either by clysters or gentle laxatives, as weak infusions of senna and manna, small doses of the lenitive electuary, cream of tartar, tamarinds, stewed prunes, or the like; but all strong or drastic purgatives are to be carefully avoided.
By this course the fever in a few days may generally be brought to a pretty regular or distinct intermission, in which case the Peruvian bark may be administered, and it will seldom fail to perfect the cure. It is needless here to repeat the methods of giving the bark, as we have already had occasion frequently to mention them.
The most likely way to avoid this fever is to use a wholesome and nourishing diet, to pay the most scrupulous attention to cleanliness, to keep the body warm, to take sufficient exercise, and in hot countries to avoid damp situations, night air, evening dews, and the like. In countries where it is endemical, the best preventive medicine which we can recommend, is the Peruvian bark, which may either be chewed, or infused in brandy or wine, &c. Some recommend smoking tobacco as very beneficial in marshy countries, both for the prevention of this and intermitting fevers.
This disease, which originally came from Arabia, is now become so general, that very few escape it at one time of life or another. It is a most contagious malady; and has for many years proved the scourge of Europe.
The small-pox generally appear towards the spring. They are very frequent in summer, less so in autumn, and least of all in winter. Children are most liable to this disease; and those whose food is unwholesome, who want proper exercise, and abound with gross humours, run the greatest hazard from it.
The disease is distinguished into the distinct and confluent kind; the latter of which is always attended with danger. There are likewise other distinctions of the small-pox; as the crystalline, the bloody, &c.
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.
The good women, as soon as they see the small-pox begin to appear, commonly ply their tender charge with cordials, saffron, and marigold-teas, wine, punch, and even brandy itself. All these are given with a view, as they term it, to throw out the eruption from the heart. This, like most other popular mistakes, is the abuse of a very just observation, that when there is a moisture on the skin, the pox rise better, and the patient is easier, than when it continues dry and parched. But that is no reason for forcing the patient into a sweat. Sweating never relieves unless where it comes spontaneously, or is the effect of drinking weak diluting liquors.
Children are often so peevish, that they will not lie a-bed without a nurse constantly by them. Indulging them in this, we have reason to believe, has many bad effects both upon the nurse and child. Even the natural heat of the nurse cannot fail to augment the fever of the child, but if she too proves feverish, which is often the case, the danger must be increased[89].
Laying several children who have the small-pox in the same bed has many ill consequences. They ought if possible never to be in the same chamber, as the perspiration, the heat, the smell, &c. all tend to augment the fever, and to heighten the disease. It is common among the poor to see two or three children lying in the same bed, with such a load of pustules that even their skins stick together. One can hardly view a scene of this kind without being sickened by the sight. But how must the effluvia affect the poor patients, many of whom perish by this usage[90]!
A very dirty custom prevails among the lower class of people, of allowing children in the small-pox to keep on the same linen during the whole period of that loathsome disease. This is done lest they should catch cold; but it has many ill consequences. The linen becomes hard by the moisture which it absorbs, and frets the tender skin. It likewise occasions a bad smell, which is very pernicious both to the patient and those about him; besides, the filth and sordes which adhere to the linen being resorbed, or taken up again into the body, greatly augment the disease.
A patient should not be suffered to be dirty in an internal disease, far less in the small-pox. Cutaneous disorders are often occasioned by nastiness alone, and are always increased by it. Were the patient’s linen to be changed every day, it would greatly refresh him. Care indeed is to be taken that the linen be thoroughly dry. It ought likewise to be put on when the patient is most cool.
So strong is the vulgar prejudice in this country, notwithstanding all that has been said against the hot regimen in the small-pox, that numbers still fall a sacrifice to that error. I have seen poor women travelling in the depth of winter, and carrying their children along with them in the small-pox, and have frequently observed others begging by the way-side, with infants in their arms covered with the pustules; yet I could never learn that one of these children died by this sort of treatment. This is certainly a sufficient proof of the safety at least, of exposing patients in the small-pox to the open air. There can be no reason however for exposing them to public view. It is now very common in the environs of great towns to meet patients in the small-pox on the public walks. This practice, however well it may suit the purposes of boasting inoculators, is dangerous to the citizens, and contrary to the laws of humanity and sound policy.
The food in this disease ought to be very light, and of a cooling nature, as panado, or bread boiled with equal quantities of milk and water, good apples roasted or boiled with milk, and sweetened with a little sugar, or such like.
The drink may be equal parts of milk and water, clear sweet whey, barley-water, or thin gruel, &c. After the pox are full, butter-milk, being of an opening and cleansing nature, is a very proper drink.
MEDICINE.——This disease is generally divided into four different periods, viz. the fever which precedes the eruption, the eruption itself, the suppuration, or maturation of the pustules, and the secondary fever.
It has already been observed, that little more is necessary during the primary fever than to keep the patient cool and quiet, allowing him to drink diluting liquors, and bathing his feet frequently in warm water. Though this be generally the safest course that can be taken with infants, yet adults of a strong constitution and plethoric habit sometimes require bleeding. When a full pulse, a dry skin, and other symptoms of inflammation render this operation necessary, it ought to be performed; but, unless these symptoms are urgent, it is safer to let it alone; if the body is bound, emollient clysters may be thrown in.
If there is a great nausea or inclination to vomit, weak camomile-tea or lukewarm water may be drank, in order to clean the stomach. At the beginning of a fever, Nature generally attempts a discharge, either upwards or downwards, which, if promoted by gentle means, would tend greatly to abate the violence of the disease.
Though every method is to be taken during the primary fever, by a cool regimen, &c. to prevent too great an eruption; yet after the pustules have made their appearance, our business is to promote the suppuration, by diluting drink, light food, and, if Nature seems to flag, by generous cordials. When a low, creeping pulse, faintishness, and great loss of strength, render cordials necessary, we would recommend good wine, which may be made into negus, with an equal quantity of water, and sharpened with the juice of orange, the jelly of currants, or the like. Wine-whey, sharpened as above, is likewise a proper drink in this case; great care however must be taken not to overheat the patient by any of these things. This, instead of promoting, would retard the eruption.
The rising of the small-pox is often prevented by the violence of the fever; in this case the cool regimen is strictly to be observed. The patient’s chamber must not only be kept cool, but he ought likewise frequently to be taken out of bed, and to be lightly covered with clothes while in it.
Excessive restlessness often prevents the rising and filling of the small-pox. When this happens, gentle opiates are necessary. These however ought always to be administered with a sparing hand. To an infant, a tea-spoonful of the syrup of poppies may be given every five or six hours till it has the desired effect. An adult will require a table-spoonful in order to answer the same purpose.
If the patient be troubled with a strangury, or suppression of urine, which often happens in the small-pox, he should be frequently taken out of bed, and, if he be able, should walk across the room with his feet bare. When he cannot do this, he may be frequently set on his knees in bed, and should endeavour to pass his urine as often as he can. When these do not succeed, a tea-spoonful of the sweet spirits of nitre may be occasionally mixed with his drink. Nothing more certainly relieves the patient, or is more beneficial in the small-pox, than a plentiful discharge of urine.
If the mouth be foul, and the tongue dry and chapped, it ought to be frequently washed, and the throat gargled with water and honey, sharpened with a little vinegar or currant jelly.
During the rising of the small-pox, it frequently happens that the patient is eight or ten days without a stool. This not only tends to heat and inflame the blood, but the fæces, by lodging so long in the body, become acrid, and even putrid; from whence bad consequences must ensue. It will therefore be proper, when the body is bound, to throw in an emollient clyster every second or third day, through the whole course of the disease. This will greatly cool and relieve the patient.
When petechiæ, or purple, black, or livid spots appear among the small-pox, the Peruvian bark must immediately be administered in as large doses as the patient’s stomach can bear. For a child, two drachms of the bark in powder may be mixed in three ounces of common water, one ounce of simple cinnamon-water, and two ounces of the syrup of orange or lemon. This may be sharpened with the spirits of vitriol, and a table-spoonful of it given every hour. If it be given to an adult in the same form, he may take at least three or four spoonfuls every hour. This medicine ought not to be trifled with, but must be administered as frequently as the stomach can bear it; in which case it will often produce very happy effects. I have frequently seen the petechiæ disappear, and the small-pox, which had a very threatening aspect, rise and fill with laudable matter, by the use of the bark and acids.
The patient’s drink ought likewise in this case to be generous, as wine or strong negus acidulated with spirits of vitriol, vinegar, the juice of lemon, jelly of currants, or such like. His food must consist of apples roasted or boiled, preserved cherries, plums, and other fruits of an acid nature.
The bark and acids are not only necessary when the petechiæ or putrid symptoms appear, but likewise in the lymphatic or crystalline small-pox, where the matter is thin, and not duly prepared. The Peruvian bark seems to possess a singular power of assisting Nature in preparing laudable pus, or what is called good matter; consequently it must be beneficial both in this and other diseases, where the crisis depends on a suppuration. I have often observed where the small-pox were flat, and the matter contained in them quite clear and transparent, and where at first they had the appearance of running into one another, that the Peruvian bark, acidulated as above, changed the colour and consistence of the matter, and produced the most happy effects.
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].
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.
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.
The present method of inoculating in Britain is to make two or three slanting incisions in the arm, so superficial as not to pierce quite through the skin, with a lancet wet with fresh matter taken from a ripe pustule; afterwards the wounds are closed up, and left without any dressing. Some make use of a lancet covered with the dry matter; but this is less certain, and ought never to be used unless where fresh matter cannot be obtained: when this is the case, the matter ought to be moistened by holding the lancet for some time in the steam of warm water[94].
Indeed, if fresh matter be applied long enough to the skin, there is no occasion for any wound at all. Let a bit of thread, about half an inch long, wet with the matter, be immediately applied to the arm, midway between the shoulder and the elbow, and covered with a piece of the common sticking-plaster, and kept on for eight or ten days. This will seldom fail to communicate the disease. We mention this method, because many people are afraid of a wound; and doubtless the more easily the operation can be performed, it has the greater chance to become general. Some people imagine, that the discharge from a wound lessens the eruption; but there is no great stress to be laid upon this notion; besides, deep wounds often ulcerate, and become troublesome.
We do not find that inoculation is at all considered as a medical operation in those countries from whence we learned it. In Turkey it is performed by the women, and in the East Indies by the Brachmins or priests. In this country the custom is still in its infancy; we make no doubt, however, but it will soon become so familiar, that parents will think no more of inoculating their children, than at present they do of giving them a purge.
No set of men have it so much in their power to render the practice of inoculation general as the clergy, the greatest opposition to it still arising from some scruples of conscience, which they alone can remove. I would recommend it to them not only to endeavour to remove the religious objections which weak minds may have to this salutary practice, but to enjoin it as a duty, and to point out the danger of neglecting to make use of a mean which Providence has put in our power for saving the lives of our offspring. Surely such parents as wilfully neglect the means of saving their children’s lives, are as guilty as those who put them to death. I wish this matter were duly weighed. No one is more ready to make allowance for human weakness and religious prejudices, yet I cannot help recommending it, in the warmest manner, to parents, to consider how great an injury they do their children, by neglecting to give them this disease in the early period of life.
The numerous advantages arising from the inoculation of the small-pox have been pretty fully pointed out by the learned Dr. M‘Kenzie, in his History of Health[95]. To those mentioned by the Doctor we shall only add, that such as have not had the small-pox in the early period of life, are not only rendered unhappy, but likewise in a great measure unfit for sustaining many of the most useful and important offices. Few people would chuse even to hire a servant who had not had the small-pox, far less to purchase a slave who had the chance of dying of this disease. How could a physician or a surgeon, who had never had the small-pox himself, attend others under that malady? How deplorable is the situation of females, who arrive at mature age without having had the small-pox! A woman with child seldom survives this disease: and if an infant happen to be seized with the small-pox upon the mother’s breast, who has not had the disease herself the scene must be distressing! If she continue to suckle the child, it is at the peril of her own life; and if she wean it, in all probability it will perish. How often is the affectionate mother forced to leave her house, and abandon her children, at the very time when her care is most necessary? Yet should parental affection get the better of her fears, the consequences would often prove fatal. I have known the tender mother and her sucking infant laid in the same grave, both untimely victims to this dreadful malady. But these are scenes too shocking even to mention. Let parents who run away with their children to avoid the small-pox, or who refuse to inoculate them in infancy, consider to what deplorable situations, they may be reduced by this mistaken tenderness!
As the small-pox is now become an epidemical disease in most parts of the known world, no other choice remains but to render the malady as mild as possible. This is the only manner of extirpation now left in our power; and though it may seem paradoxical, the artificial method of communicating the disease, could it be rendered universal, would amount to nearly the same thing as rooting it out. It is a matter of small consequence, whether a disease be entirely extirpated, or rendered so mild as neither to destroy life nor hurt the constitution; but that this may be done by inoculation, does not now admit of a doubt. The numbers who die under inoculation hardly deserve to be named. In the natural way, one in four or five generally dies; but by inoculation not one of a thousand. Nay, some can boast of having inoculated ten thousand without the loss of a single patient.
I have often wished to see some plan established for rendering this salutary practice universal; but am afraid I shall never be so happy. The difficulties indeed are many; yet the thing is by no means impracticable. The aim is great; no less than saving the lives of one-fourth part of mankind. What ought not to be attempted in order to accomplish so desirable an end?
The first step towards rendering the practice universal, must be to remove the religious prejudices against it. This, as already observed, can only be done by the clergy. They must not only recommend it as a duty to others, but likewise practise it on their own children. Example will ever have more influence than precept.
The next thing requisite is to put it in the power of all. For this purpose we would recommend it to the Faculty to inoculate the children of the poor gratis. It is hard that so useful a part of mankind should by their poverty be excluded from such a benefit.
Should this fail, it is surely in the power of any State to render the practice general, at least as far as their dominion extends. We do not mean that it ought to be enforced by a law. The best way to promote it would be to employ a sufficient number of operators at the public expence to inoculate the children of the poor. This would only be necessary till the practice became general; afterwards custom, the strongest of all laws, would oblige every individual to inoculate his children to prevent reflections.
It may be objected to this scheme, that the poor would refuse to employ the inoculators: this difficulty is easily removed. A small premium to enable mothers to attend their children while under the disease, would be a sufficient inducement; besides, the success attending the operation would soon banish all objections to it. Even considerations of profit would induce the poor to embrace this plan. They often bring up their children to the age of ten or twelve, and when they come to be useful, they are snatched away by this malady, to the great loss of their parents, and detriment of the public.
The British legislature has of late years shewn great attention to the preservation of infant lives, by supporting the foundling hospital, &c. But we will venture to say, if one-tenth part of the sums laid out in supporting that institution, had been bestowed towards promoting the practice of inoculation of the small-pox among the poor, that not only more useful lives had been saved, but the practice ere now rendered quite universal in this island. It is not to be imagined what effect example and a little money will have upon the poor; yet, if left to themselves, they would go on for ever in the old way, without thinking of any improvement. We only mean this as a hint to the humane and public-spirited. Should such a scheme be approved, a proper plan might easily be laid down for the execution of it.
But as public plans are very difficult to bring about, and often, by the selfish views and misconduct of those intrusted with the execution of them, fail of answering the noble purposes for which they were designed; we shall therefore point out some other method by which the benefits of inoculation may be extended to the poor.
There is no doubt but inoculators will daily become more numerous. We would therefore have every parish in Britain to allow one of them a small annual salary for inoculating all the children of the parish at a proper age. This might be done at a very trifling expence, and it would enable every one to enjoy the benefit of this salutary invention.
Two things chiefly operate to prevent the progress of inoculation. The one is a wish to put the evil day as far off as possible. This is a principle in our nature; and as inoculation seems rather to be anticipating a future evil, it is no wonder mankind are so averse to it. But this objection is sufficiently answered by the success. Who in his senses would not prefer a lesser evil to-day to a greater to-morrow, provided they were equally certain?
The other obstacle is the fear of reflections. This has very great weight with the bulk of mankind. Should the child die, they think the world would blame them. This they cannot bear. Here lies the difficulty; and till that be removed, inoculation will make but small progress. Nothing however can remove it but custom. Make the practice fashionable, and all objections will soon vanish. It is fashion alone that has led the multitude since the beginning of the world, and will lead them to the end. We must therefore call upon the more enlightened part of mankind to set a pattern to the rest. Their example, though it may for some time meet with opposition, will at length prevail.
I am aware of an objection to this practice from the expence with which it may be attended: this is easily obviated. We do not mean that every parish ought to employ a Sutton or a Dimsdale as inoculators. These have by their success already recommended themselves to crowned heads, and are beyond the vulgar reach; but have not others an equal chance to succeed? They certainly have. Let them make the same trial, and the difficulties will soon vanish. There is not a parish, and hardly a village in Britain, destitute of some person who can bleed. But this is a far more difficult operation, and requires both more skill and dexterity than inoculation.
The persons to whom we would chiefly recommend the performance of this operation are the clergy. Most of them know something of medicine. Almost all of them bleed, and can order a purge, which are all the qualifications necessary for the practice of inoculation. The priests among the less enlightened Indians perform this office, and why should a Christian teacher think himself above it? Surely the bodies of men, as well as their souls, merit a part of the pastor’s care; at lead the greatest Teacher who ever appeared among men seems to have thought so.
Should all other methods fail, we would recommend it to parents to perform the operation themselves. Let them take any method of communicating the disease they please; provided the subjects be healthy, and of a proper age, they will seldom fail to succeed to their wish. I have known many instances even of mothers performing the operation, and never so much as heard of one bad consequence. A planter in one of the West India islands is said to have inoculated, with his own hand, in one year, three hundred of his slaves, who, notwithstanding the warmth of the climate, and other unfavourable circumstances, all did well. Common mechanics have often, to my knowledge, performed the operation with as good success as physicians. We do not however mean to discourage those who have it in their power, from employing people of skill to inoculate their children, and attend them while under the disease, but only to shew, that where such cannot be had, the operation ought not upon that account to be neglected.
Instead of multiplying arguments to recommend this practice, I shall just beg leave to mention the method which I took with my own son, then an only child. After giving him two gentle purges, I ordered the nurse to take a bit of thread which had been previously wet with fresh matter from a pock, and to lay it upon his arm, covering it with a piece of sticking-plaster. This remained on six or seven days, till it was rubbed off by accident. At the usual time the small-pox made their appearance, and were exceedingly favourable. Surely this, which is all that is generally necessary, may be done without any skill in medicine.
We have been the more full upon this subject because the benefits of inoculation cannot be extended to society by any other means than making the practice general. While it is confined to a few, it must prove hurtful to the whole. By means of it the contagion is spread, and is communicated to many who might otherwise never have had the disease. Accordingly it is found that more die of the small-pox now than before inoculation was introduced; and this important discovery, by which alone more lives might be saved than by all the endeavours of the Faculty, is in a great measure lost by its benefits not being extended to the whole community[96].
The spring and autumn have been usually reckoned the most proper seasons for inoculation, on account of the weather being then most temperate; but it ought to be considered that these are generally the most unhealthy seasons of the whole year. Undoubtedly the best preparation for the disease is a previous good state of health. I have always observed that children in particular are more sickly towards the end of spring and autumn than at any other time of the year. On this account, as well as for the advantage of cool air, I would propose winter as the most proper season for inoculation; though, on every other consideration, the spring would seem to be preferable.
The most proper age for inoculation is between three and five. Many approve of inoculating on the breast, and where no circumstances forbid this practice, I have no objection to it. Children, however, are more liable to convulsions at this time than afterwards; besides, the anxiety of the mother or nurse, should the child be in danger, would not fail to heighten it by spoiling the milk.
Children who have constitutional diseases must nevertheless be inoculated. It will often mend the habit of body; but ought to be performed at a time when they are most healthy. Accidental diseases should always be removed before inoculation.
It is generally thought necessary to regulate the diet for some time before the disease be communicated. In children, however, great alteration in diet is seldom necessary, their food being commonly of the most simple and wholesome kind, as milk, water-pap, weak broths, bread, light pudding, mild roots, and white meats.
But children who have been accustomed to a hotter diet, who are of a gross habit, or abound with bad humours, ought to be put upon a spare diet before they are inoculated. Their food should be of a light cooling nature, and their drink whey, butter-milk, and such like.
We would recommend no other medicinal preparation but two or three mild purges, which ought to be suited to the age and strength of the patient. The success of inoculators does not depend on the preparation of their patients, but on their management of them while under the disease. Their constant care is to keep them cool, and their bodies gently open, by which means the fever is kept low, and the eruption greatly lessened. The danger is seldom great when the pustules are few; and their number is generally in proportion to the fever which precedes and attends the eruption. Hence the chief secret of inoculation consists in regulating the eruptive fever, which generally may be kept sufficiently low by the methods mentioned above.
The regimen during the disease is in all respects the same as under the natural small-pox. The patient must be kept cool, his diet should be light, and his drink weak and diluting, &c. Should any bad symptoms appear, which is seldom the case, they must be treated in the same way as directed in the natural small-pox. Purging is not less necessary after the small-pox by inoculation than in the natural way, and ought by no means to be neglected.
The measles appeared in Europe about the same time with the small-pox, and have a great affinity to that disease. They both came from the same quarter of the world, are both infectious, and seldom attack the same person more than once. The measles are most common in the spring season, and generally disappear in summer. The disease itself, when properly managed, seldom proves fatal; but its consequences are often very troublesome.
CAUSE.——This disease, like the small-pox, proceeds from infection, and is more or less dangerous according to the constitution of the patient, the season of the year, the climate, &c.
SYMPTOMS.——The measles, like other fevers, are preceded by alternate fits of heat and cold, with sickness, and loss of appetite. The tongue is white, but generally moist. There is a short cough, a heaviness of the head and eyes, drowsiness, and a running at the nose. Sometimes indeed the cough does not come before the eruption has appeared. There is an inflammation and heat in the eyes, accompanied with a defluxion of sharp rheum, and great acuteness of sensation, so that they cannot bear the light without pain. The eye-lids frequently swell so as to occasion blindness. The patient generally complains of his throat; and a vomiting or looseness often precedes the eruption. The stools in children are commonly greenish; they complain of an itching of the skin, and are remarkably peevish. Bleeding at the nose is common, both before and in the progress of the disease.
About the fourth day, small spots, resembling flea-bites, appear, first upon the face; then upon the breast, and afterwards on the extremities: these may be distinguished from the small pox by their scarcely rising above the skin. The fever, cough, and difficulty of breathing, instead of being removed by the eruption as in the small pox, are rather increased; but the vomiting generally ceases.
About the sixth or seventh day from the time of sickening, the measles begin to turn pale on the face, and afterwards upon the body; so that by the ninth day they entirely disappear. The fever; however, and difficulty of breathing, often continue, especially if the patient has been kept upon too hot a regimen. Petechiæ, or purple spots, may likewise be occasioned by this error.
A violent looseness sometimes succeeds the measles; in which case the patient’s life is in imminent danger.
Such as die of the measles generally expire about the ninth day from the invasion, and are commonly carried off by a peripneumony, or inflammation of the lungs.
The most favourable symptoms are a moderate looseness, a moist skin, and a plentiful discharge of urine.
When the eruption suddenly falls in, and the patient is seized with a delirium, he is in the greatest danger. If the measles turn too soon of a pale colour, it is an unfavourable symptom, as are also great weakness, vomiting, restlessness, and difficulty of swallowing. Purple or black spots appearing among the measles are very unfavourable. When a continual cough, with hoarseness, succeeds the disease, there is reason to suspect an approaching consumption of the lungs.
Our business in this disease is to assist Nature, by proper cordials, in throwing out the eruption, if her efforts be too languid; but when they are too violent they must be restrained by evacuations, and cool diluting liquors, &c. We ought likewise to endeavour to appease the most urgent symptoms, as the cough, restlessness, and difficulty of breathing.
REGIMEN.——The cool regimen is necessary here as well as in the small-pox. The food too must be light, and the drink diluting. Acids however do not answer so well in the measles as in the small-pox, as they tend to exasperate the cough. Small beer likewise, though a good drink in the small-pox, is here improper. The most suitable liquors are decoctions of liquorice with marsh-mallow roots and sarsaparilla, infusions of linseed, or of the flowers of elder, balm-tea, clarified whey, barley-water, and such like. These, if the patient be costive, may be sweetened with honey; or, if that should disagree with the stomach, a little manna may occasionally be added to them.
MEDICINE.——The measles being an inflammatory disease, without any critical discharge of matter, as in the small-pox, bleeding is commonly necessary, especially when the fever runs high, with difficulty of breathing, and great oppression of the breast. But if the disease be of a mild kind, bleeding may be omitted[97].
Bathing the feet and legs frequently in lukewarm water both tends to abate the violence of the fever, and to promote the eruption.
The patient is often greatly relieved by vomiting. When there is a tendency this way, it ought to be promoted by drinking lukewarm water, or weak camomile-tea.
When the cough is very troublesome, with dryness of the throat, and difficulty of breathing, the patient may hold his head over the steam of warm water, and draw the steam into his lungs.
He may likewise lick a little sperma-ceti and sugar-candy pounded together; or take now and then a spoonful of the oil of sweet almonds, with sugar-candy dissolved in it. These will soften the throat, and relieve the tickling cough.
If at the turn of the disease the fever assumes new vigour, and there appears great danger of suffocation, the patient must be bled according to his strength, and blistering-plasters applied, with a view to prevent the load from being thrown on the lungs, where if an inflammation should fix itself, the patient’s life will be in imminent danger.
In case the measles should suddenly disappear, it will be necessary to pursue the same method which we have recommended when the small-pox recede. The patient must be supported with wine and cordials. Blistering-plasters must be applied to the legs and arms, and the body rubbed all over with warm flannels. Warm poultices may likewise be applied to the feet and palms of the hands.
When purple or black spots appear, the patient’s drink should be sharpened with spirits of vitriol; and if the putrid symptoms increase, the Peruvian bark must be administered in the same manner as directed in the small-pox.
Opiates are sometimes necessary, but should never be given except in cases of extreme restlessness, a violent looseness, or when the cough is very troublesome. For children, the syrup of poppies is sufficient. A tea-spoonful or two may be occasionally given, according to the patient’s age, or the violence of the symptoms.
After the measles are gone off, the patient ought to be purged. This may be conducted in the same manner as directed in the small-pox.
If a violent looseness succeeds the measles, it may be checked by taking for some days a gentle dose of rhubarb in the morning, and an opiate over night; but if these do not remove it, bleeding will seldom fail to have that effect.
Patients recovering after the measles should be careful what they eat or drink. Their food for some time ought to be light, and in small quantities, and their drink diluting, and rather of an opening nature, as butter-milk, whey, and such like. They ought also to beware of exposing themselves too soon to the cold air, lest a suffocating catarrh, an asthma, or a consumption of the lungs, should ensue.
Should a cough, with difficulty of breathing, and other symptoms of a consumption, remain after the measles, small quantities of blood may be frequently let at proper intervals, as the patient’s strength and constitution will permit. He ought likewise to drink asses milk, to remove to a free air, if in a large town, and to ride daily on horseback. He must keep close to a diet consisting of milk and vegetables; and lastly, if these do not succeed, let him remove to a warmer climate[98].
The scarlet fever is so called from the colour of the patient’s skin, which appears as if it were tinged with red wine. It happens at any season of the year, but is most common towards the end of summer; at which time it often seizes whole families; children and young persons are most subject to it.
It begins like other fevers, with coldness and shivering, without any violent sickness. Afterwards the skin is covered with red spots, which are broader, more florid, and less uniform than the measles. They continue two or three days, and then disappear; after which the cuticle, or scarf-skin, falls off.
There is seldom any occasion for medicine in this disease. The patient ought however to keep within doors, to abstain from flesh, strong liquors, and cordials, and to drink freely of cool diluting liquors. If the fever runs high, the body must be kept gently open by emollient clysters, or small doses of nitre and rhubarb. A scruple of the former, with five grains of the latter, may be taken thrice a-day, or oftener, if necessary.
Children and young persons are sometimes seized at the beginning of this disease with a kind of stupor and epileptic fits. In this case the feet and legs should be bathed in warm water, a large blistering-plaster applied to the neck, and a dose of the syrup of poppies given every night till the patient recovers[99].
The scarlet fever however is not always of so mild a nature. It is sometimes attended with putrid or malignant symptoms, in which case it is always dangerous. In the malignant scarlet fever the patient is not only affected with coldness and shivering, but with languor, sickness, and great oppression, to these succeed excessive heat, nausea and vomiting, with a soreness of the throat; the pulse is extremely quick, but small and depressed; the breathing frequent and laborious; the skin hot, but not quite dry; the tongue moist, and covered with a whitish mucus; the tonsils inflamed and ulcerated. When the eruption appears, it brings no relief: on the contrary, the symptoms generally grow worse, and fresh ones come on, as purging, delirium, &c.
When this disease is mistaken for a simple inflammation, and treated with repeated bleedings, purging and cooling medicines, it generally proves fatal. The only medicines that can be depended on in this case are cordials and antiseptics, as the Peruvian bark, wine, snake-root, and the like. The treatment must be in general similar to that of the putrid fever, or of the malignant ulcerous sore throat[100].
When a continual, remitting, or intermitting fever is accompanied with a frequent or copious evacuation of bile, either by vomit or stool, the fever is denominated bilious. In Britain the bilious fever generally makes its appearance about the end of summer, and ceases towards the approach of winter. It is most frequent and fatal in warm countries, especially where the soil is marshy, and when great rains are succeeded by sultry heats. Persons who work without doors, lie in camps, or who are exposed to the night air, are most liable to this kind of fever.
If there are symptoms of inflammation at the beginning of this fever, it will be necessary to bleed, and to put the patient upon the cool diluting regimen recommended in the inflammatory fever. The saline draught may likewise be frequently administered, and the patient’s body kept open by clysters or mild purgatives. But if the fever should remit or intermit, bleeding will seldom be necessary. In this case a vomit may be administered, and, if the body be bound, a gentle purge; after which the Peruvian bark will generally complete the cure.