Domestic Medicine - Chapters 21-24



CHAPTER XXI.
OF THE MILIARY FEVER.

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 
childbed, 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.

THIS disease in childbed-women is sometimes the effect of great 
costiveness during pregnancy; it may likewise be occasioned by 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 childbed. 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 
childbed 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 foetid 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 of 
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 symptomatical, 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 chearful. Nothing so certainly makes an eruption go in as 
fear, or the apprehension of danger.

THE food must be weak; chicken broth with bread, panada, sago, or goat-
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 
and cooling nature, may be eat.

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. Take two ounces of the 
shavings of hartshorn, and the same quantity of sarsaparilla, boil them in 
two English quarts of water. To the strained decoction add a little white 
sugar, and let the patient take it for his ordinary drink.

WHEN the patients spirits are low, and 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. In the commercium literarium for 
the year 1735, we have the history of an epidemical miliary fever, which 
raged at Strasburgh in the months of November, December, and January; from 
which we learn the necessity of a temperate regimen in this malady, and 
likewise that physicians are not always the first who discover the proper 
treatment of diseases. This fever made terrible havoc even among men of 
robust constitutions, and all medicine proved in vain. They were seized in 
an instant with shivering, yawning, stretching, and pains in the back, 
succeeded by a most intense heat; at the same time there was a great loss 
of strength and appetite. On the seventh or ninth day the miliary 
eruptions appeared, or spots like flea-bites, with great anxiety, a 
delirium, restlessness, and tossing in bed. Bleeding was fatal. While 
matters were in this unhappy situation, a midwife, of her own accord, gave 
to a patient, in the height of the disease, a clyster of rain-water and 
butter without salt, and for his ordinary drink a quart of spring water, 
half a pint of generous wine, the juice of a lemon, and six ounces of the 
whitest sugar, gently boiled till a scum arose, and this with great 
success; for the belly was soon loosened, the grievous symptoms vanished, 
and the patient was restored to his senses, and snatched from the jaws of 
death. This practice was imitated by others with the like happy effects.

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 fill 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 childbed-
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 chilldbed-wormen 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 avoid 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 childbed, they ought 
strictly to observe a cool regimen.



CHAPTER XXII.
OF THE REMITTING FEVER.

THIS fever takes its name from a remission of the symptoms, which happens 
sometimes sooner, and sometimes later, but commonly before the eighth day. 
The remission is generally preeceded 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 less.

CAUSES. - Remitting fevers prevail in low marshy countries abounding with 
wood and stagnated 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 frequently in close 
calm weather, especially after rainy seasons, great inundations, and 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 
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 dilirium 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 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 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 
llnen, 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. The 
ingenious Dr. Lind of Edinburgh, in his inaugural dissertation concerning 
the putrid remitting fever of Bengal, has the following observation: 
"Indusia, lodices, ac strangula, saepius sunt mutanda, ac aeri exponenda; 
foeces fordesque quam primum removendae; oportet etiam ut loca quibus 
aegri decumbunt sint salubria, et aceto conspersa; denique ut aegris cura 
quanta maxima prospiciatur. Compertum ego habeo, medicum haec sedulo 
observantem, quique ea exequi potest, multo magis aegris pro futurum, quam 
medicum peritiorem hisce commodis destitutum." - "The patient's shirt, bed-
clothes, and bedding, ought frequently to be changed, and exposed the air, 
and all his excretions immediately removed; the bed-chamber should be well 
ventilated, and frequently sprinkled with vinegar; in short, every 
attention should be paid to the patient. I can affirm, that a physician 
who puts these in practice will much oftener succeed than one who is even 
more skillful, but has not opportunity of using these means."

MEDICINE. - In order ot cure this fever, we must endeavor to bring it to a 
regular intermission. This intention may be promoted by bleeding, if there 
be any signs of inflammation; but when this 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 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 avoid this fever is to use a wholesome and nourishing 
diet, to pay the most scrupulous regard 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 in intermitting fevers.



CHAPTER XXIII.
OF THE THE SMALL-POX.

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 crystaIine, the bloody, &c.

CAUSES - The small-pox is commonly caught by infection. Since the disease 
was first brought to Europe, the infection has never been wholly 
extinguished; nor have any proper methods, so far as I know, been taken 
for that purpose; so that now it has become in a manner constitutional. 
Children who have over-heated themselves by running, wrestling, &c., or 
adults after a debauch, are most apt to be seized with a small-pox.

SYMPTOMS. - This disease is so generally known, that a minute description 
of it is unnecessary. Children commonly look a little dull, seem listless 
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 the 
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 watry 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 petechiae, or purple, brown, or 
black spots are inspersed among the pustules. These are signs of a 
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 stranguary. 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 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 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. Convulsion-fits are no doubt very 
alarming, but their effects are often salutary. They seem to be one of the 
means made use of by nature for breaking the force of a fever. I have 
always observed the fever abated, and sometimes quite removed, after one 
or more cunvulsion-fits. This readily accounts for convulsions being a 
favourable symptom in the fever which precedes the eruption of the small-
pox, as every thing that mitigates this fever lessens the eruption.

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 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 beore they come to maturity.

THE good women, as soon as they see the small-pox begin to appear, 
commonly ply their tender charge with codials, 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 
therre 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 off the child; 
but if she too proves feverish, which is offten the case, the danger must 
be increased. I have known a nurse, who had the small-pox before, so 
infected by lying constantly a-bed with a child in a bad kind of small-
pox, that she had not only a great number of pustules which broke out all 
over her body, but afterwards a malignant fever, which terminated in a 
number of impostumes or boils, and from which she narrowly escaped with 
her life. We mention this to put others upon their guard against the 
danger of this virulent infection.

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.

A VERY dirty custom dirty custom prevails amongst the lower class of 
people, of allowing children in the small-pox to keep on the same linen 
during the whole period of this loathsome disease. This is done lest they 
should catch cold; but it has many ill consequences. The linen comes hard 
by the moisture which it absobs, 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 sores which adhere to the linen 
being resorbed, or taken up again into the body, greatly augment the 
disease. This observation is likewise applicable to hospitals, work-
houses, &c. where numbers of children happen to have the small-pox at the 
same time. I have seen above forty childen cooped up in one apartment all 
the while they had this disease, without any of them being admitted to 
breathe the fresh air. No one can be at a loss to see the impropiety of 
such conduct. It ought to be a rule, not only in hospitals for the small-
pox, but likewise for other diseases, that no patient should be within 
sight or hearing of another. This is a matter to which too little regard 
is paid. In most hospitals and infirmaries, the sick, the dying, and the 
dead, are often to be seen in the same apartment.

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, nowithstanding 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 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 suqar, 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 stranguary, 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, sharpend 
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 faeces, 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 this 
disease. This will greatly cool and relieve the patient.

WHEN petechiae, or purple, black, or livid spots appear among the 
smallpox, 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 often produce very happy effects. I have 
frequently seen the petechiae 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 petechiae or putrid 
symptoms appear, but likewise in the lymphatic or chrystalline smallpox, 
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 sweIling of 
these parts, and by that means to draw the humours towards the extremities.

THE most dangeous 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 pustles 
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 he 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. Though this operation can never do harm, 
yet it is only necessary when the patient has a great load of small-pox, 
or when the matter which they contain is of so thin and acrid a nature, 
that there is reason to apprehend bad consequences from its being too 
quickly resorbed, or taken up again into the mass or circulating humours.

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 betwixt each dose. For children further advanced, 
and adults, the dose must be increased in proportion to the age and 
constititution. I have of late been of use, after the small-pox, to give 
one, two, three, four, or five grains of calomel, according to the age of 
the patient, over night, and to work it off next morning with a suitable 
dose of jalap.

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 these, 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 inconveniencies that attend the other. A critical situation, too 
often to be met with, first put me upon trying this method. A gentleman 
who had lost all his children except one son by the natural small-pox, was 
determined to have him inoculated. He told me his intention, and desired I 
would persuade the mother and grandmother, &c. of its propriety. But that 
was impossible. They were not to be persuaded, and either could not get 
the better of their fears, or were determined against conviction. It was 
always a point with me, not to perform the operation without the consent 
of the parties concerned. I therefore advised the father, after giving his 
son a dose or two of rhubarb, to go to a patient who had the small-pox of 
a good kind, to open two or three of the pustules, taking up the matter 
with a little cotton, and as soon as he came home to take his son apart, 
and give his arm a slight scratch with a pin, afterwards to rub the place 
well with the cotton, and take no further notice of it. All this he 
punctually performed; and at the usual period the small-pox made their 
appearance, which were of an exceeding good kind, and so mild as not to 
confine the boy an hour to his bed. None of the other relations knew but 
the disease had come in the natural way, till the boy was well.

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 forefinger, 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. 
Mr. TRONCHIN communicates this disease by a little bit of thread dipt in 
the matter, which he covers with a small blistering plaster. This method 
may no doubt be used with advantage in those cases where the patient is 
very much alarmed at the sight of any cutting instrument.

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 the arm, midway 
between the shoulder and 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 learn 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. McKenzie in his History 
of Health. "Many and great, says this humane author, are the dangers 
attending the natural infection, from all which the inoculation is quite 
secure. The natural infection may invade weak or distempered bodies, by no 
means disposed for its kindly reception. It may attack them at a season of 
the year either violently hot or intenseIy cold. It may be communicated 
from a sort of small-pox impregnated with the utmost virulence. It may lay 
hold upon people unexpectedly, when a dangerous sort is imprudently 
imported into a maritime place. It may surprise us soon after excesses 
committed in luxury, intemperance, or lewdness. It may likewise seize on 
the innocent after indispensable watchings, hard labour, or necessary 
journies. And is it a trivial advantage, that all these unhappy 
circumstances can be prevented by Inoculation? By inoculation numbers are 
saved from deformity as well as from death. In the natural small-pox, how 
often are the finest features, and the most beautiful complexions, 
miserably disfigured? Whereas inoculation rarely leaves any ugly marks of 
scars, even where the number of pustules on the face has been very 
considerable, and the symptoms by no means favourable. And many other 
grievous complaints, that are frequently subsequent to the natural sort, 
seldom follow the artificial. Does not inoculation also prevent those 
inexpressible terrors that perpetually harass persons who never had this 
disease, insomuch that when the small-pox is epidemical, entire villages 
are depopulated, markets ruined, and the the face of distress spread over 
the whole country? From this terror it arises, that justice is frequently 
postponed or discouraged, at sessions or assizes where the small-pox 
rages. Witnesses and juries dare not appear; and by reason of the 
necessary absence of some gentlemen, our honourable and useful judges are 
not attended with that reverence and splendor due to their office and 
merit. Does not inoculation, in like manner, prevent our brave sailors 
from being seized with this distemper on shipboard, where they must 
quickly spread the infection among such of the crew who never had it 
before, and. where they have scarce any chance to escape, being half 
stifled with the closeness of their cabins, and but very indifferently 
nursed? Lastly, with regard to the soldiery, the miseries attending these 
poor creatures, when attacked by the small-pox on a march, are 
inconceivable, without attendance, without lodgings, without any 
accommodation: so that one of three commonly perishes."

TO these 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 happens 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 continues to suckle the child, it is at the 
peril of her own life; and if she weans 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 has 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 to the Faculty to inoculate the children of the 
poor gratis. lt 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 maybe objected to this scheme, that the poor would refuse to employ the 
inoculators. This difficulty is easiIy 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 methods 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 tomorrow, 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 which pinches, 
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 sklll 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 least 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 staid 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. Sure 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 soclety 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. By a well-
laid plan for extending inoculation, more lives might be saved at a small 
expence, than are at present preserved by all the hospitals in England, 
which cost the public such an amazing sum.

THE spring and autumn have been usually reckoned the most proper seasons 
for inocculation, 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 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 betwixt 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 be 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 inoculatlon 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.



CHAPTER XXIV.
OF THE MEASLES.

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 
tears, 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. Petechiae, 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 fhe 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 loosness, 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 no 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 morbific matter, 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 opression of the breast. But if the disease be of a 
mild kind, bleeding may be omitted. I do not know any disease wherein 
bleeding is more necessary than in the measles, especially when the fever 
runs high; in this case I have always found it relieve the patient.

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 patients 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 occasionally be 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 permlt. 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. Attempts have 
been made to communicate the measles, as well as the small-pox, by 
inoculation, and we make no doubt but in time the practice may succeed. 
Dr. Home of Edinburgh says, he communicated the disease by the blood. 
Others have tried this method, and have not found it succeed. Some think 
the disease would be more certainly communicated by rubbing the skin of a 
patient who has the measles with cotton, and afterwards applying the 
cotton to a wound, as in the small-pox; while others recommend a bit of 
flannel which had been applied to the patient's skin, all the time of the 
disease, to be afterwards laid upon the arm or leg of the person to whom 
the infection is to be communicated. There is no doubt but this disease, 
as well as the small-pox, may be communicated various ways; the most 
probable, however, is either from cotton rubbed upon the skin, as 
mentioned above, or by introducing a little of the sharp humour which 
distils from the eyes of the patient into the blood. It is agreed on all 
hands that such patients as have been inoculated had the disease very 
mildly; we therefore wish the practice were more general, as the measles 
have of late become very fatal.


OF THE SCARLET FEVER.

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.

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. In the year 1774, during 
winter, a very bad species of this fever prevailed in Edinburgh. It raged 
chiefly among young people. The eruption was generally accompanied with a 
quinsey, and the inflammatory symptoms were so blended with others of a 
putrid nature, as to render the treatment of the disease very difficult. 
Many of the patients, towards the decline of the fever, were afflicted 
with large swellings of the submaxillary glands, and not a few had a 
suppuration in one or both ears.


OF THE BILIOUS FEVER.

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 or 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.

IN case of a violent looseness, the patient must be supported with chicken 
broth, jellies of hartshorn, and the like; and he may use the white 
decoction for his ordinary drink. See Appendix, White Decoction. If a 
bloody-flux should accompany this fever, it must be treated in the manner 
recommended under the article Dysentery.

WHEN there is a burning heat, and the patient does not sweat, that 
evacuation may be promoted by giving him, three or four times a-day, a 
table-spoonful of Mindererus's spirit mixed in a cup of his ordinary 
drink. See Appendix, Spirit of Mindererus.

IF the bilious fever be attended with the nervous, malignant, or putrid 
symptoms, which is sometimes the case, the patient must be treated in the 
same manner as directed under these diseases.

AFTER this fever, proper care is necessary to prevent a relapse. For this 
purpose the patient, especially towards the end of autumn, ought to 
continue the use of the Peruvian bark for some time after he is well. He 
should likewise abstain from all trashy fruits, new liquors, and every 
kind of flatulent aliment.