Small Pox Complexly considered.

In the accidental Contagion, from Infection re­ceived to Sickening, are 18 to 21 Days; from Observations which I made in several Families; and as to the Town in general, we may recol­lect, that about the Middle of June, 1721, E­ruptions appearing in many Houses, the Watches which had been appointed to prevent its Spread­ing, [Page 10] were discontinued; in the next Parcel of De­cumbents, the Eruptions appeared about the 7th and 8th of July; and in the End of July, and Beginning of August it spread much. The Change and Full of the Moon may more or less dispose Bo­dies to receive the Infection; but Sickening and Eruptions do happen in all Times of the Moon: In Southerly close Weather the Infection is most susceptible. In the Small Pox received by Incision the Patient sickens the 5th 6th or 7th Day, and af­ter 1, 2, 3, or sometimes 4 Days, the Eruptions begin.

There are vast Varieties of the genuine Small Pox; but in general, the sooner the several Stadia are accomplished, the more benign; and most fre­quently, the Danger is in Proportion to the Num­ber of the Pustules: There are some Exceptions were a Distinct Sort has been very malignant, and even attended with Purples, Mr. F —'s Indian Peter, &c. From the Quantity and Nature of the Pustules in the Face we generally judge of the more or less Violence of the Distemper. H. P— aet. 13, Face and Extremities confluent, but scarce any Pu­stules in the Trunk of here Body; she died 11th from Eruption.

To form a general Idea of this Distemper, we must take the distinct plump Kind as a Standard. It may be described thus; begins with the com­mon Symptoms of a Fever, but more particular­ly is attended with Pain in the Head, Back and Loins, and about the Region of the Stomach, weep­ing Eyes, Sore Throat. Vomitings, Dosedness, Startings, and in Children sometimes Convulsions. The End of the 3 d, or Beginning of the 4 th Day, the Small Pox Pustules begin to appear distinct; 5 th they grow round and enlarge their Bases of a lively red, 6 th Day they come to a Point, 7 th the Points or Apices turn white, 8 th they turn yellow, 9 th they are full of lau­dable [Page 11] digested Pus, 10 th they begin to crust or scab, 12 th they are dry Scabs, and Appetite returned.

We may comprehend all the Varieties of Small Pox under these. 1. A distinct dry Sort, being the most favourable of all; yet sometimes with consi­derable Apparatus Symptoms; they are few, not large, Bases scarce inflamed, small Digestion, being hard with a little white Point; 5th or 6th Day from Eruption they begin to dry away, and gra­dually vanish, leaving only a Freckle behind them, but no Redness; I have seen Indians with this Kind. 2. A distinct plump Kind, already described as the Standard. 3. The Cohaerent, or small fre­quent Sort; they are not exactly round, pointed and vivid; but sessile and depressed, the Symptoms do not intirely cease upon Eruption, but after some Time they intermit until the Stadium of Maturation, then arises a Fever, &c. 4. The Con­fluent, they appear sooner than the 4th Day, or are retarded by some violent Symptom later; their first Appearance is frequently Erisypilas like, and and at last appear of on Ash-coloured Crust or white Skin, &c. 6. To these add the Small Pox with interspersed Petechiae brown or red, with Vesiculae miliares, or small Blisters full of a limpid or bluish Serum, and with Purple Spots from the black to the more diluted Purples, and Haemorrha­ges, which are more mortal than the Plague it sef.

Some general Directions for the Regimen in the Course of the Small Pox.

1. Let not Numbers be pent up in one Room, which can scarce contain Air enough for the Main­tainance of Health in one single Person, especially if kept from Communication with the free exter­nal [Page 12] Air; for the Spring of the inspired Air is the continued Cause of the Circulation in our Bodies. 2. Where the Design of Nature is obvious, and her Intentions right, we ought not to disturb Nature by Medicines. 3. In this or any other acute Distem­per, Nature or the Spirits ought not to be disturb'd by Noise or Confabulation. 4. Where Medicines are required, we are not to insist on any Medicine that continues to be disagreeable to the Stomach. 5. In this Distemper any violent Symptom appearing must be immediately obviated; Delays here are dan­gerous: But we are to expect in this as in most other acute Distempers, that the Symptoms should have a Sort of Exacerbation towards Night. 6. Let not your Mixtures be too much compounded, that you may be the more certain of the Effects of the several Ingredients. 7. The Belly is not to be kept soluble. It is observ'd by every Body, that in the Small Pox (Dr. Friend's Cases excepted) Opening of the Body by Catharticks, however mild, confounds the Course of Nature, and gives the Small Pox Fever a Determination to the Bow­els of bad Consequence: The Body sometimes bound up for two Weeks, without any Inconve­niency only the Pain of a labouring Stool at last, shows that this Distemper does not allow of Na­ture's being disturb'd in her Office: If there hap­pens in any of the Stadiums any undue Evacuation or Colliquation, use moderate Astringents, Opiats, and mild Cordials. 8. Avoid Grief, Study, intense Thinking, and the like; they hinder Perspiration, and all other Tendencies to the Surface or ad extra of the Body.

In the malignant Kinds, a Fever accompanies all the Stadia; the Absence or Presence of the Fe­ver in the three last Stadia, Diliria, Vigilae, Stu­por profundus, Subsultus tendinum, are always prin­cipal [Page 13] Indications of Safety or Danger. In this, as in all acute Diseases, we ought to observe the Pa­tient's Pulse, Tongue, Urine, Breathing, as also the Eyes, Temper of the Skin, and Posture of laving. The best Pulse is the strong, full, equal, and slow; the nearer it approaches these the better. Be­cause of the Continuation of the Membrane which invests the Tongue, with that of the Stomach and Intestines, Physicians judge of the inward Temper of the Body by the Aspect of the Tongue. In all Eruptive Fevers, the Urine settles from the Begin­ning; Urine pretty high coloured with Contents is best, thin clear and pale is bad; where Sus­pensions follow a laudable Sediment Nature is in Danger; large Quantity of Urine, especially if without any considerable Thirst, is always a good Symptom. Respiration is most to be attended to of all Symptoms; just upon the Crisis it may be magna & celeris, and yet salutary.

Dr. Sydenham is much extolled from introducing Opiats into the Management of this Distemper. Dr. Morton says, without the Use of Laudanum not much is to be done in the Cure of the Small Pox. It is certain that Inquietudes, Watchings, Deliria and the like, so exhaust the Spirits in this Distemper, that they make the Use of Ano­dynes unavoidable. Opiats relax the Skin, and give a proper Determination ad extra; Laudanum in that Sort of Small Pox which is accompanied with a Salivation, &c. concocts the Spittle, and promotes the Swelling of the Face and Hands. Discretion however is required in their Use; for where the Blood is languid, they leave the Pa­tient more languid and faint, Tongues drier, Pulse weaker, gravitative Headakes, and the like: The indifferent Use of Narcoticks fix the faeculent Hu­mours, and occasion Pittings and Scars. The Testa­cea [Page 14] ought to supyly the Place of Opiats in Chil­dren; for they moderate the inordinate Commo­tion of the Blood more kindly and salutarily.

Vesicatories by their Stimulus increase the Oscil­lation of all the Fibres, and squeeze out the im­pacted Contents. In Comatoes Cases the most ge­nerous Alexipharmicks without Vesicatories, do not rouse the Spirits. Epispasticks, by their Stimulus, not only attenuate and derive the Humour to the Parts, but also discharge them: Translations of morbid Matter from one Part to another, is some­times of the greatest Service, especially where it has a Discharge: All critical Evacuations are of this Nature. When Symptoms threaten the Brain, Vesicatories are of excellent Use, not neglecting suppedanea irritantia, live Animals, and the like, to the Soles of the Feet.

Let the Patient drink plentifully of diluting Li­quors; for there is something Caustick and acri­monious in the Infection. Herb Teas much used In this Country, I cannot recommend; they seem to wash away that soft mellow Moisture of the Mouth and Throat, and do frequently rather oc­casion than alleviate Thirst: The more mellow Diluents I always found to answer better, as Bar­ley Water, thin Water Gruel, Sack Whey, Vin. Ca­narin. ad medias coct. as the Patient's Temper and Condition may require. After Eruption in all their Drinks and medicinal Mixtures give Sp. Vitriol, Sp. Sulph. per camp, Sp. Nitr [...]d. they keep the great Effervescence of the Blood under, and as Sydenham says of the Sp Vitriol. are a Sort of Specifick against the variolous Putrefaction or Foeculency, shorten the Stadiums, prevent Pitting, and are a Succedaneum to U. S.

As for Preservatives against the Small Pox Infec­tion, we know of none really such, excepting Fly­ing [Page 15] from the Place where it rages. Some Consti­tutions, and in some Seasons or Times, are more or less susceptible of it. Towards Prevention may conduce, the keeping the Mind chearful, and the the Body healthful. When the Vessels are im­pregnated with rich Food, and generous Liquors (I do not extend this to Crapula and Ebriety, which are Violence done to Nature) we are less liable to receive the Injuries of the circumambi­ent Air, as in catching cold, Epidemical contagious Distempers, &c. because the Excretories of Per­spiration are full, and in a State of emptying, not imbibing; thus the Poor suffer most in Times of a Plague

Preparatories.

1. The best Preparative for the Small Pox, is to keep the Mind as chearful, and the Body as health­ful as we can. 2. Proper Evacuations, U. S. in the Plethorick, vigorous, and youthful, and in those who have accustomed themselves to U. S. Sydenham's young Man who had been frequently blooded for Rheumatick Pains, was too much low­ered; Purging in gross full Habits, but the Cathar­ticks ought to be given some considerable Time before the Infection is received, lest they should weaken and dissipate the Spirits too much. 3. I found gentle Mercurials, as is AEthiop's Mineral, procured frequently a favourable Small Pox in Chil­dren. 4. Issues, especially in Children, by their Vent and Derivation are found beneficial.

Avoid violent Exercise when Small Pox is ex­pected. I. C— from thence had a few Purples, and narrowly escaped. The Patient ought not to be kept too low in his Diet, lest the Eruption should [Page 16] not proceed so well. All Fevers when not distract­ed by Anxiety perform their Course best; this is reckoned one of the Reasons why the Small Pox is most favourable to Children.

Apparatus.

Of all Distempers this especially requires Ad­vice in the Apparatus, because on this depend all the other Stadia, altho' it is too common not to send for Advice until the Eruption. Unless you see some Exanthemata praenuncia, or Fore-runners of the Small Pox, (especially when the Small Pox first enters a Town,) which sometimes appear the first Day of Seisure, be cautious how you foretel the Small Pox before Eruption; frequently in the Beginning the Feverish Symptoms are so gene­ral, that we cannot say the Small Pox are to fol­low, but by Conjecture, from the Decumbent's having never had them, and that he has lately been exposed to the Infection. In the Beginning of any Fever, v. g. of a Pleuritick Fever, we cannot posi­tively say it is Pleuritick, before we observe the Determination to the Pleura.

Seeing there are such very different Varieties, and sometimes contrary Indications in the follow­ing Stages, in some the Spirits to be lowered, in others the Spirits to be raised, &c. how Emiri­cally do they act (the Care of a discreet Nurse on­ly is much more safe) who in the first Stage, or Apparatus, indifferently tread the same Path, Blood-letting, or Alexipharmicks, or Emeticks, or Opiats, &c. to all. We ought not, by Alexi­pharmicks, to set Nature in a more violent Flame and Rage; neither are we by U. S. and other Evacuations, to depress the Spirits; but we ought [Page 17] to study Nature, and when all seems to be in a re­gular Course, tending to its proper Periods in due Time, we are not to disturb Nature with Medi­cines, but direct to a sutable Regimen, and a na­tural Temperature, with a thin and spare Diet,

This Apparatus, or first Fever, is attended with some or all of the following Symptoms of Fevers in general, Chilliness, Shiverings, Horripulations, Yawning, Stretching, Giddiness; then Heat, Thirst, with Tongue foul or dry; Pulse stronger, quicker, unequal; a deficent Spittle, Loss of Appetite, Nau­sea and Vomiting,; Pains in the Head, Back, and Loins; Inquietudes, or Comatoes Affections: Besides these, in Eruptive Fevers, particularly in the Small Pox, there is a certain Oppression circa cordis regionem, Sneezings, Coughs, Asthmatick Breathings, Hoarseness, Sore Throat, Weeping or Splendor of the Eyes, Dosedness, and sometimes in Children Convulsions.

In Eruptive Fevers (in other Fevers such Symp­toms only happen towards their fatal End) the Apparatus Symptoms are mostly nervosi generis, viz. Oppression at the Breast, Asthmatick Breathings, Vo­mitings, Deliria, Comas, Lumbagos, tendinum Sub­sultus, Insultus Epileptici in Children. Notwith­standing this dismal Catalogue of Symptoms in some Constitutions, the Conflict between Nature and the Distemper is with so little Violence, as not to be sensible before the Eruption point it out; in others very few of these Symptoms are sensible, In some Constitutions with very malig­nant Kinds, the Symptoms are mild; the Necrosis being so very intense, Nature is so oppressed from the Beginning as not to be capable of any Lucta or Struggle with the Distemper, as was the Case of many who died with Purples and Hoemorrhages. In some Constitutions, violent Symptoms in the [Page 18] Beginning are not always followed by a bad Kind, providing that Weakness of the Pulse, and a lan­guid Eruption do not concur. Mr. F— began with a strangled tumified Countenance, a Diarrhaea and Profluvium, threatning Purples; she had a distinct Kind, and did well. Several Children had violent Convulsions, but a favourable Kind of Small Pox soon appeared.

Prognosticks. From the Intenseness and Conti­nuance of the Horripulation, we judge of the Ha­zard in all Fevers; in some rare Cases, the Necro­sis is so Pestilence like, that this Symptom does not happen. A Bar cross the Chest (as they ex­press it) with involuntary Sighings, Anxiety, De­jection of Spirits and Despondency, great Com­plaints of the Throat, violent fixed Spasmodick Pains, in Back, Sides, Loins, Bowels, &c. are bad Symptoms; and according to their Intenseness ge­nerally speaking, the more violent Small Pox does follow. Dolor versatilis of Sides, Limbs, &c. are not so bad. A strangled boufi Countenance, with a Diarrhaea, frequently prognosticate Purples and Hoemorrhages. A dry Tongue, quick but weak vacillating Pulse, Urine clear thin and pale, in­tense Coma, are bad Signs. Voiding of Urine in­voluntary, or inscious (where there is no other violent Symptom) in the Apparatus, is no bad Symptom. H. P— aet. 18, M. R— aet. 15, had favourable Small Pox Notwithstanding the Vio­lence of other Symptoms, if there be a true fe­verish Heat, a strong and equal Pulse, Urine high coloured, with Contents, they indicate well the Strength of Nature.

Where the Symptoms are any ways considera­ble, let the Patient immediately upon Seizure be put to Bed, but not with too many Cloaths. The Temper is not to be lowered too much by catch­ing [Page 19] Cold, U. S. or any unnecessary Evacuation, so as to produce a late, imperfect, unequal, or se­cond Crop, which are of bad Consequence; nei­ther ought it to be raised by Cordials, and a hot Regimen, to drive the Humours into a Separati­on more than was design'd by Nature, i. e. a con­fluent, or very full Kind; as we are not to expect a kind Sort of Small Pox until the 4th Day, why should we endeavour to drive them sooner? The Blood may be thus so harrassed as not to allow of any regular Separation, but occasion an Erysi­pelas like, or very unequal, or tardive Sort, which are the worst Kinds. Emollient Cataplasms, especi­ally in Children, to the Feet, have been obser­ved manifestly to alleviate the Symptoms, and sometimes to sollicite the variolous Matter more plentifully that Way, to the Relief of the other Parts.

Blood letting in the Beginning, without any Exception, would be always useful, if the Small Pox were a simple inflammatory Case, and not complicated with some deleterious Miasma, which requires Strength of Nature to subsist under. Where there is a Plethora, U. S. is requisite to ease Nature of its Load, that it may the better perform its Office. In Athletick Habits, Wine­bibbers, those accustomed to U. S. it is advisable, to prevent a too great Assimulation of variolose Matter. In violent Vomitings, violent spasmodick Pains of any Kind, intense Coma, or Convulsions threatning some Apoplectick Symptom, especially if the Pulse be strong, U. S. is necessary, and af­terwards an Emetick, (in some Cases Anodynes) Vesicatories, a cool Regimen, and plentifully to dilute. Excepting in these, and the like Cases, U. S disturbs the Course of Nature, and a good Succedaneum for it is, a cool Method and Regi­men. [Page 20] In all Depressions, and Obstructions, if U. S. does not relieve, in confirms them, by lessening the Force of Circulation.

Vomiturition in the Apparatus is from the Scene being in the nervous System; most Affections of the Nerves, v. g. Hysterical and Hypocondriacal Paroxysms, Concussions of the Brain, Nephritick Pains, &c. occasion Vomiting; so that reaching to vomit does not always signify a foul Stomach. This Symptom ought to be left to it self, unless there be Suspicion of a foul Stomach, then an E­metick is of use to clean the Stomach, and pre­vent Foeculenies being carried into the Blood al­ready morbid: In some Cases, by a universal Horripulation and Concussion, Vomiting conduces to render the Circulation more free. Let your Emeticks be gentle, not violent, lest they may dissipate and put the Oeconomy of the Spirits in too great a Hurry, and so divert the Eruption. My Emetick was generally Sal Vitriol. which oc­casions no great Dissipation of Spirits, it is easily kept within Bounds, by its Astringency it streng­thens the Stomach; it ought not to be forced downwards by too large Quantities of Drink, but rather repeat small Doses of the Salt.

Where the Symptoms threaten the Brain, apply Vesicatories. We are to take Notice that a Stu­por is peculiar to this Distemper, and is not of bad Consequence, unless it turns to an intense Coma. In Childrens Convulsions and Comatoes Affections preceeding Eruption, if violent, don't glyster, nor confound Nature by Evacuations, but blister and give moderate Cordials. Vigiliae and Deliria are in this Distemper worse Symptoms, because they waste and confound the Spirits; when the Pulse is strong, U. S. and Vesicatories are good, but espe­cially Opiats ( Sydenham will ever be celebrated [Page 21] for his introducing Opiats in the Cure of this Distemper) are essentially requisite and unavoida­ble.

A Diarrhaea, especially if attend with Gripings, in this, and all other Fevers, (a few excepted where it is critical) confound the Courfe of Na­ture, and must be moderated by Opiats, which will not retard the Eruption so much as the Pur­ging would have done.

Eruption.

The End of the 3 d or Beginning of the 4 th Day the best Sort appeared with us, An. 1721; so much as the Eruption anteverts the 4th Day, or is re­tarded beyond it, so much greater the Danger; either from the Violence of the Fever, or hot Regimen, in the first Cafe; for the more violent and hasty any Inflammation is in its Course, the Danger of a subsequent Gangrene is the more to be apprehended. Dr. Huxham says, that An. 1724, 1725, there was in Plymouth an anomalous Small Pox, that appeared in less than 24 Hours after Seizure, and was always of the fluxed Kind: The other Case of being retarded, is from a too cool Regimen, officious Bleeding, catching cold, or some considerable Evacuation.

The more universal the Appearance is at first, the more perfect and more benign is the Crisis; the more gradual, especially with new Sprouts in the Interstices, the more imperfect is the Crisis, and the Distemper is the more malignant. F. S— aet. 22, no violent Complaint in Apparatu, 1st and 2d Day of Eruption came out like a distinct good Sort, but the 3d Day came out infinite Multitudes of a small Purplish Pox, he died 17th of Seizure. [Page 22] W. W— aet. 25, violent Pain at his Stomach, and dull, was U. S. in Apparatu, the Eruption very slow and languid, so as not to appear in the Ex­tremities until the 3d or 4th of Eruption, a di­stinct, but frequent sessile Kind; he spit, and swell'd well, died 14th of Seizure. Mr. H—r, aet. 30, a few Purples, with Haemorrhagia narium, the Pox in his Face had the regular Course of the con­fluent Kind, but in his Extremities, at the Time of his Death, being 14th of Seizure, the Pustules had scarce begun to maturate. Mrs. Y— aet. 20, just having given over Suckling, violent Pain in her Back, and Reachings, was brought from an adja­cent Island to Boston, 2d of Seizure some Appear­ance of Small Pox, and after 3 or 4 Days more a Sort of second Crop, reddish, with some watery Blisters interspersed, she did not spit, a continued Nausea and Delirium, died 16th of Seizure. B. I— aet. 1, by catching cold the Eruption is checked, and after two Days came out a second Crop, of a very unequal crude Kind, she died soon.

The Eruptions appearing in the Extremities be­fore they appear in the Face, presage ill, as in ma­ny of the Purple Cases, being from a stifled Fever; for the Circulation being freer in the Extremities, the Eruptions come out there more kindly.

If there attends the Eruption a profuse Sweating, Ptyalism, Menstruatio tempore non debito, Diar­rhaea, &c. they are bad Symptoms; because they denote much of a Colliquation, and divert Na­ture from her principal Work. Sweating is a Sepa­ration of a different Nature from that of the Small Pox; and therefore by Reason of its Di­version it is not to be encouraged; a gentle Breath­ing and Relaxation of the external Habit, solicites the Eruption, and is good. A Diarrhaea torminosa (unless from an habitual Colick, as in Mr. L—'s [Page 23] Negroe Caesar) even in Children is no good Symp­tom; with us it frequently attended the Erup­tion in Children, and might be sometimes a Com­plication with that Looseness incident to Children in the Autumn, or from Worms. In violent Co­lick Pains emollient Glysters may be allowed, but with Discretion.

Upon the Eruption the Throat complains. The Ptyalism begins with the Eruption.

A Christalline Small Pox is a Colliquation, and therefore not good. Looseness with a very hot Temper presage a confluent Sort. The Confluent Sort appear sooner than the 4th Day, or by some violent Symptom are retarded until after the 4th Day; the Symptoms continue after Eruption; they make their first Appearance Erysipelas like.

Strong Diaphoreticks in any Fever, administred before a perfect Concoction of the morbifick Mat­ter, carry the Humours crude into the Brain, oc­casioning Deliria, Comas, Convulsions; they likewise dissipate and expend the smooth Lympha of the Blood. Opiats in some Cases, administred with Discretion, by their relaxing Quality, conduce to the Eruption of the Small Pox; it has been a ge­nerally received Opinion, that they check all Se­cretions, but in partu dissicili, & Lochiorum fluxu impedito, the modern Physicians find nothing more serviceable.

In the Winter Small Pox, Coughs, and Sore Throats, are great Complaints; they occasion Want of Rest, and Sleep, and exhaust the Spi­rits; therefore if very troublesome, give Ano­dynes with Discretion, and a light Pectoral De­coction for their common Drink; guard the Chops with Flannels.

[Page 24]The Eruption Period admits of no Evacuation, excepting perhaps U. S. in some Cases where the Fever continues to be very high.

Maturation.

After 3 Days Inflammation the Pustules begin to digest; where the Eruption was protracted, in the same Manner the Digestion is protracted; first in the Face and Neck, afterwards gradually in the Trunk and Extremities, the lower Ex­tremities being last: The Duration of the Period of Maturation in bad Kinds is very uncertain, (it is reckoned to continue until the Declension begins) especially when accompanyed with a Sa­livation, and Swellings, and may be protracted to 10 or 12 Days, the longer always the worse: Where Nature is very low, and no Succedaneum happens, the Fever and other bad Symptoms may continue to the 18th Day before there is a per­fect Maturation.

A round, florid, and turgid Pox is the Standard of Goodness. A turgid Pox, with florid Intersti­ces, from white becoming yellowish, promise well in all Kinds: The frequent small, but distinct Sort called the Cohaerent, if they be nearly round, after 3, 4, or 5 Days of Maturation, the Patient may do well without Spitting; if they are very close, in the Maturation they enlarge their Bases so much as to flow together; with a protracted Matura­tion, they continue depressed and watery some Time before they turn yellowish, and are saved by a Ptyalism, Swelling of Face and Hands, and sometimes by a Diabetical Profluvium. A few, without Spitting or Purging, in a true confluent Sort, did well. After Eruption is compleated, [Page 25] if there appear in the Interstices several miliary Blisters or Pustules, some filled with a limpid Serum, others of a dark red, it is generally an ill Symptom, but some survive it. In the Matu­ration and Declension, some small Eruptions some­times appear in the Interstices, and dry away a­gain the same Day, without any Thing bad to be apprehended.

Frequently the Pustules ripening inflame the whole Habit, and occasion Inquietudes; the Pa­tient becomes hotter, and Pulse higher, which disturb Nature in her Course; this is called the Second, or Maturation Fever: Here Paragoricks (beginning the 6th Day) are as much a Speci­fick as the Cortex Peruv. in Intermittents. Some­times U. S. is required. Sometimes a Salivation, with Swellings of Face and Hands, or Diabetical Profluvium, put off the Return of the Violence of the Fever. Women frequently have a Profluvium Mensium, 1st or 2d Day of Maturation, even tem­pore non debito, but it goes off gradually in a Day or two. A difficult Swallowing, if only from the Small Pox in the Throat, or Fauces, is tedious, but not a mortal Symptom; a Vesicatory to the Nape of the Neck is of Use. When any Subsi­dence of Pox, or Swellings of Face, &c. happen too soon, give Alexipharmicks (I do not mean Spirituous Cordials, which are apt to raise febrile Effervescences of bad Consequence) as Vin. Cana­rin. ad med. coct. Theriaca, Rad. Serp. Virgin, Be­zoar, Lap. Contrayer v, &c. Vesicatories also must be used to rouse the Spirits.

Salivation does not belong to a good Kind, and is only a Succedaneum; I observed that in some, tho' very full, without any considerable Spitting or Swelling, the Distemper had its Course more kindly and safely, than in others who from a kind [Page 26] of malignant Colliquation, spit profusely, and swell very much; where it is Nature's last Resource, it is very uncertain in the Event; W. W— aet. 25, dies 11th of Eruption, after having spit freely, with Face and Hands at his Exit well swelled. It frequently begins with the Eruption, and ought not to decline until about the 11th of Illness; it is at first thin, but afterwards thick and ropy, and therefore requires Diluents plentifully; if too tough and choky, use Gargles made of Barley-Water, decoct. Rad. Alth. and the like, with Mel. Rosar, Syrup Violar, Oxymel, &c. If Suffocation is feared, or if the Phlegm seem to lay low, give gentle Emeticks; I have given Cinabar. Nativ, and have ventured small Doses of Calomel in a slow viscid tough Salivation with some Benefit: I can­not recommend it but to the Discreet, it fuseth too much, the Distemper it self being colliquative, it may occasion a Tabid Inanition. If any febrile Efflorescence divert its Course, we must have Re­gard to the Fever. Swellings of Face and Hands, sometimes Scroti & Preputii, or diabetical Proflu­viums, come on as Subsidaries to the Salivation in its Declension; at the Time when we are to expect the Swelling of the Hands, Epispasticks to the Wrists may sollicite the Humours thither, and the running of these Blisters sometimes sup­plies the Defect of Spitting. As the Eruptions on the Hands are later than those on the Face, so are their Swellings. In cold Weather Saliva­tion does not go on so kindly as at other Times. Purging sometimes must be used to supply a defi­cient Salivation.

Continued Nauseas a bad Sign. Sudden Chil­liness, Shiverings, Diarrhaea, Vigiliae pertinaces, De­liria, and other violent Symptoms, not to be laid by Opiats, portend a sudden Dissolution: If with [Page 27] the incipient Maturation the Pox begin to dry, excepting in the most benign small dry distinct Sort, Death is at the Door; or if in a protracted Maturation, they begin at any Time to dry be­fore they are filled with Pus, so far as the Species of the Pox will allow, it is a bad Symptom. Pu­stules flaccid, or containing a watery Lymph, or Purplish Sanies, are bad; of a hard livid stran­gled Colour, signify that Nature declines; sessile, dry, depressed, subsiding in the Center, or turn­ing white, are very malignant; Interstices livid, or pale, are bad.

Desquammation.

The Absence of Symptoms, with a craving Ap­petite, are good Signs; the Return, or Increase of a Fever are bad. Scarce any (Purples and Hae­morrhages excepted, who die in all Stadia, accor­ding to the Degree of their pestiferous Malignity) die but in the Declension; but this Period does sometimes begin with the first of Maturation, or at any Time of the Maturation protracted, but not perfected.

In the Turning, the more the Scab approaches to a Bees Wax yellow Colour, the more benign. In the Cohaerent, which at length arrive to a com­pleat Maturation, even with Spittings and Swel­lings, the Declension is equally favourable as in the Distinct, only the Patient complains more of be­ing faint. In some Constitutions, altho' the Pu­stules be large, distinct, and not frequent, this Pe­riod was longer than usual (especially if Opiats are much used) with a cadaverous Stench, and leaving deep Pits, Mrs. F— aet. 30. This last Sta­dium, with a sanious Scab returning fresh and [Page 28] fresh, may be protracted to many Days, with a most tedious Expectoration of viscid Phlegm, and remaining Hecktick Heat. Generally speaking, af­ter a protracted Maturation, assisted by Salivation and Swellings, the Pox do not begin to decline until the 13th or 14th Day; some are not out of Danger until the 21st; T. I— aet. 14, in a con­fluent Kind, a Diarrhaea protracted the Course of the Distemper; a few not until the 24th Day. D. L— aet. 19, in the Apparatus a violent Lumba­go, and Haemorrhagia narium & uteri, intensely confluent, Declension attended with aguish Parox­ysms, and Hecktical Heats.

When the Pus is reabsorbed by the circulating Fluid, or when the dry inseparable Crusts return the Foeculency into the Mass of Blood, happens a third Fever (the first is in the Apparatus, called Eruptive Fever, the second is in the Maturation, from the Inflammation of the Phlegmones) being of a putrid Kind, and kills some the 11th, 14th, 17th, 21st, 24th Day of Illness, being Critical Days; if Blisters are thought requisite, let them be ap­plied the Night preceeding the Critical Days, and not delayed until the Fever rises, because they add to the Heat and Effervescence of the Blood. This putrid Fever requires immediate U. S. then cool­ing gentle Catharticks, especially if the Incrustation is such that the Matter is too thick to be further absorb'd; for the Guts, besides the Inconveniencies of being stuffed with Impurities, some Part of their foeculent Contents re-enter by the Lacteals, and are a Pabulum to the Fever. As a late Au­thor well observes, upon a Retrocession of Swel­lings, or any unlucky Translation upon the Vi­tals, it is easier directly to solicite the Intestines to a Discharge than the Salival Glands, or Uri­nary Ducts. Sometimes a Diarrhaea is a useful Succe­daneum to a Salivation in Children.

[Page 29]Where Nature languishes, the Pustules subside. In the Confluent, if 9th of Eruption the Face subsides, but Pox does not grow rough, 10th comes a putrid Heat and Nausea, and 11th, being 14th of Illness, they die. Sometimes the Patient to Appearance is in a fair Way, but of a sudden grows dull, then hot, then sickish, and soon dies; Mrs. S— aet. 25. Many in the Confluent Sort die of meer Weakness, without any Delirium or considerable Fever; W. H— Esq. Where the Pox turns to an Ash-colour or white, then it is bad. A Hecktick Heat, Eyes suddenly opening from the subsiding of the Face, a bad Omen. Scabs brown­ish and blackish are Signs of Sphacelation; where full of Splits and Cracks, are in Danger. A flat brownish Crust on the Face, with anhelosa respi­ratio, and Deliriums at Times, altho' Temper and Pulse seem promising, prognosticate Death; Mr. M—'s Daughter died 14th of Eruption. Turning too soon, with a dark black Crust, but no rough Scab, next Day came Stools and Urine inscious I. B— aet. 15: Some dry, burnt like, crusty Scabs on the Chin, Nose, or Lips, too soon, a bad Omen, signifying a Hecktick Heat, and Death 11th or 12th of Eruption; Mrs. C—, M. B—. When the Small Pox begins to scab reddish, rough and purulent, always a bad Omen, M. T—'s Beard, Mrs. E—'s Maid's Nose. Sanious Eructations in­stead of Pus, are very bad.

A Diabetical Profluvium, or Micturition, soon after Turning, are bad Symptoms; Mrs. S— dies 14th of Illness, with a putrid Heat and Nausea, Swellings in good Order. M. T— a full distinct Kind, in Coughing his Water flows from him involuntary, dies 9th of Eruption, Hands well swelled. Mr. R— full of a distinct Sort, after 6 Hours of a Peripneumoniack Paroxysm, dies 9th of [Page 30] Eruption with a Micturition. Mrs. E—'s Maid af­ter two Days Obstruction of Urine, had all Eva­cuations involuntary for two Days, and then dies. The 12th or 13, a Micturition, and Dysury, fol­lowed by a Quantity of turbid Urine, with Sedi­ment, is good; but if thin and limpid, and in small Quantities, with a Delirium Tremor & Subsultus, Death soon follows.

A Delirium, a dyspnaea or anhelosa respiratio, are bad Signs, but are sometimes relieved by U. S. A short and weak Inspiration are Fore-runners of Death; but a difficult suspiriosa respiratio not so always, sometimes proceeding from being stuffed with Phlegm, and is removed by a gentle Puke. In the End of the Distemper, when violent, the Patient is sometimes so weak, that for some short Time a Delirium, or rather Foolishness, continues from Inanition. A cold Respiration is generally a mortal Sign, signifying some internal Gangrene; T. N— aet. 21, is an Exception, after a violent Delirium of many Days (at other Times upon the least Disorder subject to febrile Effervescen­cies) in the Declension had frigida respiratio, a Stammering which continued ever after, and a Pa­ralitick Weakness in one Arm, of which he soon recovered. T. J— aet. 14, had Convulsions 17th of Eruption (a Confluent Kind) and next Day be­gan to recover; these might proceed from Breast Milk, and some Milk Punch administred to him unadvisedly, rather than from the Distemper. A Twitching, a trembling Motion of the lower Jaw and Hands, involuntary Urine, Tongue in a con­tinued Motion, picking the Cloaths of the Bed with the Fingers, are reckoned mortal Symptoms. D. L. aet. 19, is an Exception; she began to re­cover 24th of Illness in the worst Sort of Con­fluents.

[Page 31]A strong Vibration of the Carotide Arteries is generally a mortal Symptom. In the End (from Inanition) when the Supply of Spirits to the Muscles and to their Antagonists begin to fail, the Consequence is Tremblings and Twitchings, with a weak and interrupted Pulse, and Difficulty of swallowing from a Palsy of the Oesophagus. Many inflammatory Distempers as well as this, towards their fatal End, when the Spirits are quite exhausted by the Lucta, much abate in all the violent Symptoms, and the Patient has a Sort of Euthanasia, and says he is much better, but soon dies.

The Confluent Small Pox, with an Erysipelas Efflorescence, which begin to dry the Beginning of Maturation, with a dry Tongue, small and quick Puse, Subsultus tendinum, &c. are mortal. As the yellowish Colour is almost always salutary, little black Specks and Pits are the reverse, proceeding a fervori intenso. Itching of the Pustules denotes the Caustick Acrimony of the Matter, and is a bad Sign, either leaving deep Pits, or if by Mismanage­ment it recede, must soon demolish the delicate Texture of the Vitals.

Weakness and Nauseas in the Declension do not allow of Opiats, but a Cordial Regimen, v. g. some cordial acidulated Julep, or for the poorer Sort some weak Punch. When the Putrid Fever intermits, or considerably remits, the Cortex Peruv. sometimes answers after a sutable cordial Cathar­tick, as is the Tinctur. sacra. When the Pustules subside, and the Interstices turn pale, the Spitting declines too fast, or Tumours of Face and Hands abate, give Paragoricks and moderate Cordials, but nothing spirituous to rise Effervescencies; Mrs. P: had Vin. Canarin. ad medias coct. Therica Venet, with pulv. rad. Serp. Virginian. In the Apparatus [Page 32] she was brought to Bed 6 Weeks before her Time, Pox confluent in her Face, began to recover the 12th of Eruption, had subsequent versatile Rheumatick Pains and aedematous Legs, but by the Use of the free Air, and Riding, soon was well. T. J. in the Confluent Kind, with a Diarrhaea in the Declension, had Vin. rubr. Galic. ad medias coct. began to recover 18th of Eruption, had sub­sequent Boils, &c.

Suffocations; if Hysterical, which are not uncom­mon to Women in the Confluent Small Pox, use Antihystericks; if from the Glands of the Fauces tumified, use acidulated Gargles and Vesicatories to the Nape of the Neck. In Urinary Obstructions, use sutable Diureticks, and alter their Posture. In troublesome Infarctions of the Nose, use Tents dipt in Butter, Ol. Oliv, Amyd. d. or inject some emollient Mixture with Mel. Rosar.

A sharp Sanies, and corrosive Ichor, lodged, and at Times gleeting from under the Scabs, occasion Pittings and Scars, which are not easily prevented. A protracted Maturation, with a subsidiary Sali­vation, are most apt to pit; fretting putrid fe­verish Heat is sometimes allayed by the Cortex Peruv. covering the Parts with greased Rags retains the Halitus, oily Leniments stop the Pores, Acu­puncture admits the external Air too soon: fo­ment with warm Milk, which destroys the Acrimony.

Relicks and Consequential Ails.

Most of the Varieties of the Small Pox, after the Patient is recovered thereof, require no other Medicine than to be duly purged; and the more violent the Distemper, the greater is the Necessity [Page 33] for Cathartick [...] ▪ After the Stadia are all over, the Body having been long bound, and no Sign of a Stool, first clear the primae viae by solliciting with Suppositories, or give Emollient Glysters and Lenitives, which open the Body without any Di­sturbance; afterwards use strong Catharticks, which may cleanse the whole Habit. Let the Temper and Appetite be restored before we use these strong Catharticks (excepting some Cordial Pur­ges early in the Declension of some of the Cohae­rent and Confluent Kinds) lest you may thereby rouse and enrage some of the reliquiae, and bring on a Flux by determining that Way.

After the Small Pox, some have Pthysical Coughs, Hectick Heats, Opthalmies, aedematous Swellings in the Legs, Whitloes, Furunculi or small Boils, glan­dular Tumors. Mrs. F— aet. 20, had an Anchylo­sis in the Cubitus Articulation of both Arms; T. N— remained with a Stammering, from the Violence of the Distemper upon these Nerves. The Scropu­lous Habits run the greatest Risque of Consequen­tial Ails.

A remaining Cough (which happens especially in the Winter Season) may bring on a Pthisis, and therefore is not to be neglected: Begin with U. S. endeavour to thicken and digest the Ca­tarrh, and allay its Sharpness, use sutable Anti­hecticks, but especially Change of Air.

If a Hectick Disposition remain after the Small Pox, begin by U. S. and then a few convenient Catharticks; the Cortex Peruv. administred with Discretion is of Use, riding in a free Air, and a Milk Diet; Milk new drawn from the Cow has a peculiar healing Balsam, which it expends every Moment after it is taken from the Cow, as some Mineral Waters do after their being taken from their Fountain.

[Page 34]In Opthalmies let Blood, give some Doses of Cinabar or Calomel, use Medicines as if the Case was Scrophulous, wash the Eyes with warm Milk, a Cinabarine Suffitus is good. Beware of drying astringent Collyriums or Eye.waters, for by the imprudent Use of these I observed the Humours of the Eye thickned, and the Sight lost in several.

For Oedematous Swellings use spirituous Fotus's and Riding.

The Spring of the Glands having suffered much, the Small Pox leaves scropulous and other glandular Swellings. Boils, glandular, strumous or any other Swellings, if possible, are to be brought to Sup­puration, fearing a Translation upon the Lungs, or any other noble Part; they are therefore upon their Appearance to be encouraged by some sim­ple Poultis, or Fotus, Empl. Diachyl. cum. g. and the like.

Mr. P — who by Way of Amusement applied himself much to Chymistry in England, told me, that his Wife having suffered much in her Face, from a very bad Kind of Small Pox; by the Use of a Mask made of Lead beat thin, the Inside smear­ed with dissolved Sperma Ceti, and a very small Matter of crude Mercury, became almost as beau­tiful as before the Small Pox.

Purples and Hoemorrhages.

Vesiculae miliares, Petechiae, Maculae purpureae, and Haemorrhages, are Degrees of that colliquative and Caustick Infection which is more fatal than the Plague it self. This Article cannot be called Practical, because such Decumbents are not (or scarce) to be saved, the Constitution of the Per­son being only in Fault, and not any particular [Page 35] Incident; but as it seldom happens in Europe, that such Numbers and Varieties of Purples and Haemorrhages are to be seen at the same Time in one Place, I thought it might be acceptable to the curious. Even in this Place, last Small Pox Time, An. 1702, only 3 in these Circumstances were observed, as I was well informed by John Clark, Esq late a noted Practitioner in Boston.

Purple Spots appear in the Apparatus and Erup­tion Periods, the Petechiae generally appear late; both discover themselves first on the Breast, Neck, and Arms. Miliary Blisters and Petechiae, their Increase in Number of Dimensions portend ill, their Decrease are somewhat promising, being Signs of a more or less Intenseness of the Caustick Affection, some few recovered; with Purple Spots and Haemorrhages scarce any surviv'd; the three Cases that came to my Knowledge were not pro­perly such in the Nature of the Distemper; Mr. D—'s Indian Boy, aet. 13, with a confluent Kind, his few and small pale Spots, considering the In­dian Complexion, are rather to be reckoned Pete­chiae; I. C— aet. 19, confluent Small Pox, his few Purples were the Effects of violent Exercise just before Decumbiture; Capt: T—'s Negroe Man's bloody Urine was from a Blow cross the Loins some short Time before, he had the Confluent Sort. Dr. Sydenham gives an Instance of a Patient of Dr. Goodale's, An. 1691, in a continued (but not Small Pox) Fever with brownish Spots on his Neck, Breast, and Arms, attended with bloody Urine, cured; which he reckons a Prodigy in Medicine, and the greatest Cure he ever did know. Dr. Morton never knew but one recover, a Patient of Dr. Slare's, in July, 1692, a sanguine Woman, aet. 20, with a few Petechiae and bloody Urine, by Spitting, and a very unusual Swelling [Page 36] of Face and Hands saved. Dr. Huxham says, that in the malignant Small Pox at Plymouth, An. 1724, 1725, he knew but one Person that surviv'd Pur­ple Spots; some died 5th or 6th Day, some dwin­dled till the 10th or 11th Day; he heard of none who had bloody Urine.

Some Families Blood is more apt to be fused by the Small Pox Infection than others, as I in­stanced before. Purple and black Spots are Indices of a begun Mortification; the cadaverous Stench of the Breath and Stools in many of them, is a plain Sign of an inward Gangrenous Disposition: Hae­morrhages declare the Consistance of the Blood and Texture of the Solids dissolved. The Degrees of Spots are, black the most malignant, purple, blue, red, brown, dusky, with their greater or smaller Dimensions. Purple Spots, if they increase in Numbers or Dimensions, denunciate some impend­ing Haemorrhage, and soon after the Catastrophe. E. G— aet. 18, by generous Alexipharmicks his Purples increased to Millions, soon after bloody Stools, and dies next Day.

Some few have miliary Blisters or Purple Spots, with a large distinct crude Kind mali moris; Mr. F—'s Indian, aet. 25; Mr. C—'s Indian, aet. 15, they died the 14th Day.

Purples have generally a strangled Countenance, and an Erisypelas like Small Pox, especially if Hae­morrhages are to follow, frequently a profuse Sali­vation. The Symptoms in the most intense Kind of Purples, are only Suspiria, and great Dejection of Spirits, without any violent Symptom. Capt. C—'s Indian Woman, aet. 45, had the first Day Erisypelas like Eruptions in Arms and Hands, dies the 3d Day with Purples, bloody Stools, bloody Spittle, and vomiting Blood, The milder Sort are attended with spasmodick Pains in the Breast, Back, &c.

[Page 37]Alexipharmicks, or Emeticks, or Vesicatories, used in Purples, soon bring a Hoemorrhage and Death by several Days too premature, as I could instance in many. By U. S. and a cool Regimen (Milk and Water for their Drink) I protracted the Lives of some to the 14th Day.

In the Year 1721, we had in Boston 5989 ill of the Small Pox, whereof died 844; of these up­wards of 80 (that is 1 in 10) died with Purple Spots and Haemorrhages, whereof 65 came to my Knowledge (not including I. C—'s Purples, Capt. T [...]' [...] Negroe's bloody Urine, and Mr. D—'s Indian Boy's Petechiae) and whose Cases I committed to Writing. The Varieties of their Cases at length cannot be inserted in an Abstract, but for the Contemplation of the curious I shall reduce them thus; Of White Persons died 16 Men, 24 Women, 18 Children, (all under 14 aet. I call Children) 7 Indians, no Negroes; of the Women 7 were preg­nant, whereof 3 at their full Time were brought to Bed, 3 suffered Abortion at 5 or 6 Months; 1. Mrs. L. 5 or 6 Months gone with Child, had a confluent Sort with a few Spots, and in the Beginning of Maturation a violent Haemorrhage at the Nose, dies the 17th without Proflavium or Abortion.

In these 65 Cases, 20 had Purples only without Haemorrhages; one D. I. aet. 15, had no Purples, but Spittle and Urine dilutely tinctur'd with Blood; the 44 following, besides Purples had Haemorrhages, viz. bloody Urine 6, Profluvium (I mean mulie­bre) 5, bloody Spittle 11, Haemorrhage at the Nose 2, bloody Stools 1, Urine and Spittle 1, U­rine Stools and Spittle 1, Urine Spittle and Pro­fluvium 1, Urine and at the Nose Spittle and Stools 1, Profluvium and at the Nose 1, Profluvium and Spittle 2, Stools and at the Nose 2, Stools and [Page 38] Spittle 3, Stools and Vomiting 3, Stools Spittle and Vomiting 1, Vomiting and by the Pores of the Skin under the Nose, and at the Corners of the Eyes 1, at the Gums and Mouth 1, Mrs. W.'s Indian Woman, 6th of Illness suddenly seized with all Sorts of Haemorrhages, soon dies wallowing in her Blood.

These 65 died at various Periods, reckoning from the Beginning of their Illness. With Purples only, dies fourth Day of Illness 2, fifth Day 5, sixth Day 1, seventh Day 1, ninth Day 4, eleventh Day 2, fourteenth Day 3, seventeenth Day 2. With Haemorrhages only, the eighth Day 1: With Pur­ples and Haemorrhages, the third Day dies 1, fourth Day 6, fifth Day 6, sixth Day 12, seventh Day 6, ninth Day 5, tenth Day 1, eleventh Day 1, twelfth Day 1, thirteenth Day 2, fourteenth Day 2, se­venteenth Day 1, being only a Haemorrhage at the Nose, which did not continue:

Hence we may learn that no Ages nor Sex are exempted from Purples and Haemorrhages. Mrs. C. was 60 aet. Capt. C.'s Child 6 Months old. 2. Of the various Races or Species of Mankind, if we may so express it, the American Indians are the most liable to them, and the African Negroes the least; altho' in the Year 1721 our Negroe Slaves were ten Times the Number of our Indian, (the Province having discouraged the Importation of Spanish Indians, because of their valetudinary state of Health) there died 7 Indians, but not one Negroe with these dismal Symptoms. 3. Preg­nant Women are in some Danger of Purples and Haemorrhages.