Chapter VIII: Part 8

[53] A Negro Girl, about five or six Years old, under a coherent Pock,
stole by Night out of the Garret where she lay, into a Kitchen out
of Doors, where she drank plentifully of cold Water. How often she
repeated these nightly cooling Potions I never could certainly
learn, though they occurred in my own House in _South-Carolina_ in
Summer. But it is certain the Child recovered as speedily as
others, whose Eruption was more distinct, and who drank
Barley-Water, very thin Rice or Indian Corn Gruel, Balm Tea, or the
like. In fact, throughout the Course of this Visitation from the
Small Pocks in _Carolina_ in 1738, we had but too many
Demonstrations of the fatal Co-operation of violent Heat with their
Contagion; and not a very few surprizing Instances of the salutary
Effects of being necessarily and involuntarily exposed to same very
cooling Accidents after Infection, and in some Cases after Eruption
too: which I then more particularly mentioned is a small
controversial Tract printed there. _K._

Sec. 213. But if the Fever should be strong, the Pulse hard, and the Pain of the Head and Loins should be violent, he must, 1. immediately lose Blood from the Arm; receive a Glyster two Hours after; and, if the Fever continues, the Bleeding must be repeated. I have directed a Repetition of it even to the fourth Time, within the two first Days, to young People under the Age of eighteen; and it is more especially necessary in such Persons as, with a hard and full Pulse, are also affected with a heavy Drowsiness and a _Delirium_, or Raving.

2. As long as the Fever continues violently, two, three, and even four Glysters should be given in the 24 Hours; and the Legs should be bathed twice.

3. The Patient is to be taken out of Bed, and supported in a Chair as long as he can tolerably bear it.

4. The Air of his Chamber should frequently be renewed, and if it be too hot, which it often is in Summer, in Order to refresh it, and the Patient, the Means must be employed which are directed Sec. 36.

5. He is to be restrained to the Ptisans No. 2 or 4; and if that does not sufficiently moderate the Fever, he should take every Hour, or every two Hours, according to the Urgency of the Case, a Spoonful of the Mixture No. 10; mixed with a Cup of Ptisan. After the Eruption, the Fever being then abated, there is less Occasion for Medicine; and should it even entirely disappear, the Patient may be regulated, as directed, Sec. 212.

Sec. 214. When, after a Calm, a Remission or Intermission of some Days, the Process of Suppuration revives the Fever, we ought first, and especially, to keep the [54] Body very open. For this Purpose, _a_ an Ounce of _Catholicon_ should be added to the Glysters; or they might be simply made of Whey, with Honey, Oil and Salt. _b_ Give the Patient three times every Morning, at the Interval of two Hours between each, three Glasses of the Ptisan No. 32. _c_ Purge him _after_ two Days, with the Potion No. 23, but on that Day he must not take the Ptisan No. 32.

[54] We must remember that Dr. _Tissot_ is treating _here_ of the higher
or confluent Degrees of this Disease; for in the distinct
Small-Pocks, it is common to find Persons for several Days without
a Stool, and without the least perceiveable Disorder for Want of
one (their whole Nourishment being very light and liquid) in which
Cases, while Matters proceeded well in all other Respects, there
seems little Occasion for a great Solicitude about Stools: But if
one should be judged necessary after four or five Days Costiveness,
accompanied with a Tightness or Hardness of the Belly, doubtless
the Glyster should be of the lenient Kind (as those directed by our
Author are) and not calculated to produce more than a second Stool
at the very most. Indeed, where there is Reason to apprehend a
strong secondary Fever, from the Quantity of Eruption, and a
previously high Inflammation, it is more prudent to provide for a
Mitigation of it, by a moderately open Belly, than to suffer a long
Costiveness; yet so as to incur very little Hazard of abating the
Salivation, or retarding the Growth or Suppuration of the Pustules,
by a Superpurgation, which it may be too easy to excite in some
Habits. If the Discharge by spitting, and the Brightness and
Quantity of Suppuration, have been in Proportion to the Number of
Eruptions; though the Conflict from the secondary Fever, where
these have been numerous, is often acute and high; and the Patient,
who is in great Anguish, is far from being out of Danger, yet
Nature pretty generally proves stronger than the Disease, in such
Circumstances. As the _Elect. Catholicon_, is little used, or made
here, the lenitive Electuary of our Dispensatory may be substituted
for it, or that of the _Edinburgh_ Dispensatory, which was
calculated particularly for Glysters. _K._

2. He must, if the Distemper be very violent, take a double Dose of the Mixture No. 10.

3. The Patient should be taken out of Bed, and kept up in a Room well aired Day and Night, until the Fever has abated. Many Persons will probably be surprized at this Advice; nevertheless it is that which I have often experienced to be the most efficacious, and without which the others are ineffectual. They will say, how shall the Patient sleep at this Rate? To which it may be answered, Sleep is not necessary, nay, it is hurtful in this State and Stage of the Disease. Besides, he is really unable to sleep: the continual Salivation prevents it, and it is very necessary to keep up the Salivation; which is facilitated by often injecting warm Water and Honey into his Throat. It is also of considerable Service to throw some up his Nostrils, and often thus to cleanse the Scabs which form within them. A due Regard to these Circumstances not only contributes to lessen the Patient's Uneasiness, but very effectually also to his Cure.

4. If the Face and Neck are greatly swelled, emollient Cataplasms are to be applied to the Soles of the Feet; and if these should have very little Effect, Sinapisms should be applied. These are a kind of Plaister or Application composed of Yeast, Mustard-flower, and some Vinegar. They sometimes occasion sharp and almost burning Pain, but in Proportion to the Sharpness and Increase of these Pains, the Head and Neck are remarkably relieved.

Sec. 215. The Eyelids are puffed up and swelled when the Disease runs high, so as to conceal the Eyes, which are closed up fast for several Days. Nothing further should be attempted, with Respect to this Circumstance, but the frequent moistening of them with a little warm Milk and Water. The Precautions which some take to stroke them with Saffron, a gold Ducat, or Rose-water are equally childish and insignificant. What chiefly conduces to prevent the Redness or Inflammation of the Eyes after the Disease, and in general all its other bad Consequences, is to be content for a considerable Time, with a very moderate Quantity of Food, and particularly to abstain from Flesh and Wine. In the very bad Small Pocks, and in little Children, the Eyes are closed up from the Beginning of the Eruption.

Sec. 216. One extremely serviceable Assistance, and which has not been made use of for a long Time past, except as a Means to preserve the Smoothness and Beauty of the Face; but yet which has the greatest Tendency to preserve Life itself, is the Opening of the Pustules, not only upon the Face, but all over the Body. In the first Place, by opening them, the Lodgment or Retention of _Pus_ is prevented, which may be supposed to prevent any Erosion, or eating down, from it; whence Scars, deep Pitts and other Deformities are obviated. Secondly, in giving a Vent to the Poison, the Retreat of it into the Blood is cut off, which removes a principal Cause of the Danger of the Small-Pocks. Thirdly, the Skin is relaxed; the Tumour of the Face and Neck diminish in Proportion to that Relaxation; and thence the Return of the Blood from the Brain is facilitated, which must prove a great Advantage. The Pustules should be opened every where, successively as they ripen. The precise Time of doing it is when they are entirely white; when they just begin to turn but a very little yellowish; and when the red Circle surrounding them is quite pale. They should be opened with very fine sharp-pointed Scissars; this does not give the Patient the least Pain; and when a certain Number of them are opened, a Spunge dipt in a little warm Water is to be repeatedly applied to suck up and remove that _Pus_, which would soon be dried up into Scabs. But as the Pustules, when emptied thus, soon fill again, a Discharge of this fresh Matter must be obtained in the same Manner some Hours after; and this must sometimes be repeated five or even six Times successively. Such extraordinary Attention in this Point may probably be considered as minute, and even trivial, by some; and is very unlikely to become a [55] general Practice: but I do again affirm it to be of much more Importance than many may imagine; and that as often as the Fever attending Suppuration is violent and menacing, a very general, exact and repeated opening, emptying, and absorbing of the ripened Pustules, is a Remedy of the utmost Importance and Efficacy; as it removes two very considerable Causes of the Danger of this Disease, which are the Matter itself, and the great Tension and Stiffness of the Skin.

[55] This Practice which I had heard of, and even suggested to myself,
but never seen actually enterprized, seems so very rational as
highly to deserve a fair Trial in the confluent Degrees of the
Small-Pocks [for in the distinct it can scarcely be necessary]
wherein every probable Assistance should be employed, and in which
the most potent Medicines are very often unsuccessful. We have but
too many Opportunities of trying it sufficiently; and it certainly
has a more promising Aspect than a Practice so highly recommended
many Years ago, of covering all the Pustules (which is sometimes
the whole Surface of the Patient) in Melilot, or suppose any other
suppurating, Plaister; which will effectually prevent all
Perspiration, and greatly increase the Soreness, Pain and
Embarrassment of the Patient, at the Height of the Disease. I can
conceive but one bad Consequence that might possibly sometimes
result from the former; but this (besides the Means that may be
used to avert it) is rather remote, and so uncertain, until the
Trial is repeatedly made, that I think it ought not to be named, in
Competition with the Benefits that may arise from it in such Cases,
as seem, otherwise, too generally irrecoverable. _K._

Sec. 217. In the Treatment of this Disease, I have said nothing with Respect to Anodynes, or such Medicines as procure Sleep, which I am sensible are pretty generally employed in it, but which I scarcely ever direct in this violent Degree of the Disease, and the Dangers of which Medicine in it I have demonstrated in the Letter to Baron _Haller_, which I have already mentioned. For which Reason, wherever the Patient is not under the Care and Direction of a Physician, they should very carefully abstain from the Use of Venice Treacle, Laudanum, _Diacodium_, that is the Syrup of white Poppies, or even of the wild red Poppy; Syrup of Amber, Pills of Storax, of _Cynoglossum_ or Hounds-tongue, and, in one Word, of every Medicine which produces Sleep. But still more especially should their Use be entirely banished, throughout the Duration of the secondary Fever, when even natural Sleep itself is dangerous. One Circumstance in which their Use may sometimes be permitted, is in the Case of weakly Children, or such as are liable to Convulsions, where Eruption is effected not without Difficulty. But I must again inculcate the greatest Circumspection, in the Use of such Medicines, whose Effects are fatal, [56] when the Blood-vessels are turgid or full; whenever there is Inflammation, Fever, a great Distension of the Skin; whenever the Patient raves, or complains of Heaviness and Oppression; and when it is necessary that the Belly should be open; the Urine plentifully discharged; and the Salivation be freely promoted.

[56] The Use of Opiates in this Disease undoubtedly requires no Small
Consideration, the great _Sydenham_ himself not seeming always
sufficiently guarded in the Exhibition of them; as far as
Experience since his Day has enabled Physicians to judge of this
Matter. In general our Author's Limitations of them seem very just;
though we have seen a few clear Instances, in which a light Raving,
which evidently arose from Want of Sleep (joined to some Dread of
the Event of the Disease by Inoculation) was happily removed, with
every other considerable Complaint, by a moderate Opiate. In sore
and fretful Children too, under a large or middling Eruption, as
the Time gained to Rest is taken from Pain, and from wasting their
Spirits in Crying and Clamour, I have seen Suppuration very
benignly promoted by _Diacodium_. But in the _Crisis_ of the
secondary Fever in the confluent or coherent Pock, when there is a
morbid Fulness, and Nature is struggling to unload herself by some
other Outlets than those of the Skin, which now are totally
obstructed (and which seems the only Evacuation, that is not
restrained by Opiates) the giving and repeating them then, as has
too often been practised, seems importantly erroneous; for I think
Dr. _Swan_ has taken a judicious Liberty of dissenting from the
great Author he translates, in forbidding an Opiate, if the
Spitting abates, or grows so tough and ropy, as to endanger
Suffocation. As the Difference of our Oeconomy in the
Administration of Physic from that in _Swisserland_, and Dr.
_Tissot's_ just Reputation may dispose many Country Practitioners
to peruse this Treatise, I take the Liberty of referring such
Readers, for a Recollection of some of my Sentiments of Opiates,
long before the Appearance of this Work in French, to the second
Edition of the Analysis from P. 94 to 97, _&c._ _K._

Sec. 218. If Eruption should suddenly retreat, or strike in, heating, soporific, spirituous and volatile Remedies should carefully be avoided: but the Patient may drink plentifully of the Infusion No. 12 pretty hot, and should be blistered on the fleshy Part of the Legs. This is a very embarrassing and difficult Case, and the different Circumstances attending it may require different Means and Applications, the Detail and Discussion of which are beyond my Plan here. Sometimes a single Bleeding has effectually recalled Eruption at once.

Sec. 219. The only certain Method of surmounting all the Danger of this Malady, is to inoculate. But this most salutary Method, which ought to be regarded as a particular and gracious Dispensation of Providence, can scarcely be attainable by, or serviceable to, the Bulk of the People, except in those Countries, where Hospitals [57] are destined particularly for Inoculation. In these where as yet there are none, the only Resource that is left for Children who cannot be inoculated at home, is to dispose them happily for the Distemper, by a simple easy Preparation.

[57] That I have long since had the Honour of agreeing with our learned
Author, in this Consideration for the Benefit of the Body of the
People, which is the Benefit of the State, will appear from p. 288
of Analys. Ed. 1st. and from p. 371, 372 of the Second. _K._

Sec. 220. This Preparation consists, upon the whole, in removing all Want of, and all Obstructions to, the Health of the Person subject to this Disease, if he have any such; and in bringing him into a mild and healthy, but not into a very robust and vigorous, State; as this Distemper is often exceedingly violent in this last.

It is evident, that since the Defects of Health are very different in different Bodies, the Preparations of them must as often vary; and that a Child subject to some habitual Disorder, cannot be prepared in the same Method with another who has a very opposite one. The Detail and Distinctions which are necessary on this important Head, would be improper here, whether it might be owing to their unavoidable Length; or to the Impossibility of giving Persons, who are not Physicians, sufficient Knowlege and Information to qualify them for determining on, and preferring, the most proper Preparation in various Cases. Nevertheless I will point out some such as may be very likely to agree, pretty generally, with Respect to strong and healthy Children. [58]

[58] The Substance of this Section flows from the Combination of an
excellent Understanding with great Experience, mature Reflection,
and real Probity; and fundamentally exposes both the Absurdity of
such as universally decry any Preparation of any Subject previous
to Inoculation, (which is said to be the Practice of a present very
popular Inoculator in _Paris_) and the opposite Absurdity of giving
one and the very same Preparation to all Subjects, without
Distinction; though this was avowed to have been successfully fully
practised in _Pensylvania_, some Years since; which the Reader may
see Analys. Ed. 2d, from p. 329 to 331 and the Note there. _K._

The first Step then is an Abatement of their usual Quantity of Food. Children commonly eat too much. Their Limitation should be in Proportion to their Size and Growth, where we could exactly ascertain them: but with Regard to all, or to much the greater Number of them, we may be allowed to make their Supper very light, and very small.

Their second Advantage will consist in the Choice of their Food. This Circumstance is less within the Attainment of, and indeed less necessary for, the common People, who are of Course limited to a very few, than to the Rich, who have Room to make great Retrenchments on this Account. The Diet of Country People being of the simplest Kind, and almost solely consisting of Vegetables and of Milk-meats, is the most proper Diet towards preparing for this Disease. For this Reason, such Persons have little more to attend to in this Respect, but that such Aliments be sound and good in their Kind; that their Bread be well baked; their Pulse dressed without Bacon, or rancid strong Fat of any sort; that their Fruits should be well ripened; that their Children should have no Cakes or Tarts, [But see Note [11], P. 40, 41.] and but little Cheese. These simple Regulations may be sufficient, with Regard to this Article of their Preparation.

Some Judgment may be formed of the good Consequences of their Care on these two Points, concerning the Quantity and Quality of the Childrens Diet, by the moderate Shrinking of their Bellies; as they will be rendered more lively and active by this Alteration in their living; and yet, notwithstanding a little less Ruddiness in their Complexion, and some Abatement of their common Plight of Body, their Countenances, upon the whole, will seem improved.

The third Article I would recommend, is to bathe their Legs now and then in warm Water, before they go to Bed. This promotes Perspiration, cools, dilutes the Blood, and allays the Sharpness of it, as often as it is properly timed.

The fourth Precaution, is the frequent Use of very clear Whey. This agreeable Remedy, which consists of the Juices of Herbs filtred through, and concocted, or as it were, sweetened by the Organs of a healthy Animal, answers every visible Indication (I am still speaking here of sound and hearty Children). It imparts a Flexibility, or Soupleness to the Vessels; it abates the Density, the heavy Consistence and Thickness of the Blood; which being augmented by the Action of the poisonous Cause of the Small-Pocks, would degenerate into a most dangerous inflammatory [59] Viscidity or Thickness. It removes all Obstructions in the _Viscera_, or Bowels of the lower Cavity, the Belly. It opens the Passages which strain off the Bile; sheaths, or blunts, its Sharpness, gives it a proper Fluidity, prevents its Putridity, and sweetens whatever excessive Acrimony may reside throughout the Mass of Humours. It likewise promotes Stools, Urine and Perspiration; and, in a Word, it communicates the most favourable Disposition to the Body, not to be too violently impressed and agitated by the Operation of an inflammatory Poison: And with Regard to such Children as I have mentioned, for those who are either sanguine or bilious, it is beyond all Contradiction, the most effectual preparatory Drink, and the most proper to make them amends for the Want of Inoculation.

[59] There may certainly be an inflammatory Acrimony or Thinness, as
well as Thickness of the Blood; and many medical Readers may think
a morbid Fusion of the red Globules to be a more frequent Effect of
this Contagion, than an increased Viscidity of them. See Analys.
Ed. 2d. p. 75 to 83. But this Translation, conforming to the Spirit
of its Original, admits very little Theory, and still less
Controversy, into its Plan. _K._

I have already observed, that it may also be used to great Advantage, during the Course of the Disease: but I must also observe, that however salutary it is, in the Cases for which I have directed it, there are many others in which it would be hurtful. It would be extremely pernicious to order it to weak, languishing, scirrhous, pale Children, subject to Vomitings, Purgings, Acidities, and to all Diseases which prove their Bowels to be weak, their Humours to be sharp: so that People must be very cautious not to regard it as an universal and infallible Remedy, towards preparing for the Small-Pocks. Those to whom it is advised, may take a few Glasses every Morning, and even drink it daily, for their common Drink; they may also sup it with Bread for Breakfast, for Supper, and indeed at any Time.

If Country People will pursue these Directions, which are very easy to observe and to comprehend, whenever the Small-Pocks rages, I am persuaded it must lessen the Mortality attending it. Some will certainly experience the Benefit of them; such I mean as are very sensible and discreet, and strongly influenced by the truest Love of their Children. Others there are Alas! who are too stupid to discern the Advantage of them, and too unnatural to take any just Care of their Families.

__Chapter XIV.__

_Of the Measles._

__Sect.__ 221.

The Measles, to which the human Species are as generally liable, as to the Small-Pocks, is a Distemper considerably related to it; though, generally speaking, it is less fatal; notwithstanding which, it is not a little destructive in some Countries. In _Swisserland_ we lose much fewer, immediately in the Disease, than from the Consequences of it.

It happens now and then that the Small-Pocks and the Measles rage at the same Time, and in the same Place; though I have more frequently observed, that each of them was epidemical in different Years. Sometimes it also happens that both these Diseases are combined at once in the same Person; and that one supervenes before the other has finished its Course, which makes the Case very perilous.

Sec. 222. In some Constitutions the Measles gives Notice of its Approach many Days before its evident Invasion, by a small, frequent and dry Cough, without any other sensible Complaint: though more frequently by a general Uneasiness; by Successions of Shivering and of Heat; by a severe Head-ach in grown Persons; a Heaviness in Children; a considerable Complaint of the Throat; and, by what particularly characterizes this Distemper, an Inflammation and a considerable Heat in the Eyes, attended with a Swelling of the Eye-lids, with a Defluxion of sharp Tears, and so acute a Sensation, or Feeling of the Eyes, that they cannot bear the Light; by very frequent Sneezings, and a Dripping from the Nose of the same Humour with that, which trickles from the Eyes.

The Heat and the Fever increases with Rapidity; the Patient is afflicted with a Cough, a Stuffing, with Anguish, and continual Reachings to vomit; with violent Pains in the Loins; and sometimes with a Looseness, under which Circumstance he is less persecuted with Vomiting. At other times, and in other Subjects, Sweating chiefly prevails, though in less Abundance than in the Small-Pocks. The Tongue is foul and white; the Thirst is often very high; and the Symptoms are generally more violent than in the mild Small-Pocks.

At length, on the fourth or fifth Day, and sometimes about the End of the third, a sudden Eruption appears and in a very great Quantity, especially about the Face; which in a few Hours is covered with Spots, each of which resembles a Flea-bite; many of them soon joining form red Streaks or Suffusions larger or smaller, which inflame the Skin, and produce a very perceivable Swelling of the Face; whence the very Eyes are sometimes closed. Each small Spot or Suffusion is raised a little above the Surface, especially in the Face, where they are manifest both to the Sight and the Touch. In the other Parts of the Body, this Elevation or Rising is scarcely perceivable by any Circumstance, but the Roughness of the Skin.

The Eruption, having first appeared in the Face, is afterwards extended to the Breast, the Back, the Arms, the Thighs and Legs. It generally spreads very plentifully over the Breast and the Back, and sometimes red Suffusions are found upon the Breast, before any Eruption has appeared in the Face.

The Patient is often relieved, as in the Small-Pocks, by plentiful Discharges of Blood from the Nose, which carry off the Complaints of the Head, of the Eyes, and of the Throat.

Whenever this Distemper appears in its mildest Character, almost every Symptom abates after Eruption, as it happens in the Small-Pocks; though, in general, the Change for the better is not as thoroughly perceivable, as it is in the Small-Pocks. It is certain the Reachings and Vomitings cease almost entirely; but the Fever, the Cough, the Head-ach continue; and I have sometimes observed that a bilious Vomiting, a Day or two after the Eruption, proved a more considerable Relief to the Patient than the Eruption had. On the third or fourth Day of the Eruption, the Redness diminishes; the Spots, or very small Pustules, dry up and fall off in very little branny Scales; the Cuticle, or superficial Skin also shrivels off; and is replaced by one succeeding beneath it. On the ninth Day, when the Progress of the Malady has been speedy, and on the eleventh, when it has been very slow, no Trace of the Redness is to be found; and the Surface immediately resumes its usual Appearance.

Sec. 223. Notwithstanding all which the Patient is not safe, except, during the Course of the Distemper, or immediately after it, he has had some considerable Evacuation; such as the Vomiting I have just mentioned; or a bilious Looseness; or considerable Discharges by Urine; or very plentiful Sweating. For when any of these Evacuations supervene, the Fever vanishes; the Patient resumes his Strength, and perfectly recovers. It happens sometimes too, and even without any of these perceivable Discharges, that insensible Perspiration expels the Relics of the poisonous Cause of this Disease, and the Patient recovers his Health. Yet it occurs too often, that this Venom not having been entirely expelled (or its internal Effects not having been thoroughly effaced) it is repelled upon the Lungs, where it produces a slight Inflammation. In Consequence of this the Oppression, the Cough, the Anguish, and Fever return, and the Patient's Situation becomes very dangerous. This Outrage is frequently less vehement, but it proves tedious and chronical, leaving a very obstinate Cough behind it, with many Resemblances of the Whooping-Cough. In 1758 there was an epidemic State of the Measles here extremely numerous, which affected great Numbers: Almost all who had it, and who were not very carefully and judiciously attended, were seized in Consequence of it with that Cough, which proved very violent and obstinate.

Sec. 224. However, notwithstanding this be the frequent Progress and Consequence of this Disease, when left entirely to itself, or erroneously treated, and more particularly when treated with a hot Regimen; yet when proper Care was taken to moderate the Fever at the Beginning, to dilute, and to keep up the Evacuations, such unhappy Consequences have been very rare.

Sec. 225. The proper Method of conducting this Distemper is much the same with that of the Small-Pocks.

1, If the Fever be high, the Pulse hard, the Load and Oppression heavy, and all the Symptoms violent, the Patient must be bled once or twice.

2, His Legs must be bathed, and he must take some Glysters: the Vehemence of the Symptoms must regulate the Number of each.

3, The Ptisans No. 3 or 4 must be taken, or a Tea of Elder and Lime-tree Flowers, to which a fifth Part Milk may be added.

4, The Vapour, the Steam of warm Water should also be employed, as very conducive to asswage the Cough; the Soreness of the Throat, and the Oppression the Patient labours under.

5, As soon as the Efflorescence, the Redness becomes pale, the Patient is to be purged with the Draught No. 23.

6, He is still to be kept strictly to his Regimen, for two Days after this Purge; after which he is to be put upon the Diet of those who are in a State of Recovery.

7, If during the Eruption such Symptoms supervene as occur [at the same Term] in the Small-Pocks, they are to be treated in the Manner already directed there.

Sec. 226. Whenever this Method has not been observed, and the Accidents described Sec. 223 supervene, the Distemper must be treated like an Inflammation in its first State, and all must be done as directed Sec. 225. If the Disease is not vehement, [60] Bleeding may be omitted. If it is of some standing in gross Children, loaded with Humours, inactive, and pale, we must add to the Medicines already prescribed the Potion No. 8, and Blisters to the Legs.

[60] Our Author very prudently limits this Discharge, and the Repetition
of it, in this Disease (Sec. 225) as an erroneous Excess of it has
sometimes prevailed. I have seen a very epidemical Season of the
Measles, where Bleeding was not indicated in one third of the
infected. And yet I have known such an Abuse of Bleeding in it,
that being repeated more than once in a Case before Eruption (the
Measles probably not being suspected) the Eruption was retarded
several Days; and the Patient, a young Lady of Condition, remained
exceeding low, faint and sickish; 'till after recruiting a very
little, the Measles appeared, and she recovered. In a Youth of a
lax Fibre, where the Measles had appeared, a seventh or eighth
Bleeding was ordered on a Stitch in the Side, supervening from
their too early Disappearance, and the Case seemed very doubtful.
But Nature continued very obstinately favourable in this Youth, who
at length, but very slowly, recovered. His Circulation remained so
languid, his Strength, with his Juices, so exhausted, that he was
many Weeks before he could sit upright in a Chair, being obliged to
make Use of a Cord depending from the Ceiling, to raise himself
erectly in his Seat. _K._

Sec. 227. It often happens from the Distance of proper Advice, that the Relics, the Dregs as it were, of the Disease have been too little regarded, especially the Cough; in which Circumstance it forms a real Suppuration in the Lungs, attended with a slow Fever. I have seen many Children in Country Villages destroyed by this Neglect. Their Case is then of the same Nature with that described Sec. 68 and 82, and terminates in the same Manner in a Looseness, (attended with very little Pain) and sometimes a very foetid one, which carries off the Patient. In such Cases we must recur to the Remedies prescribed Sec. 74, Article 3, 4, 5; to the Powder No. 14; and to Milk and Exercise. But it is so very difficult to make Children take the Powder, that it may be sometimes necessary to trust to the Milk without it, which I have often seen in such Situations accomplish a very difficult Cure. I must advise the Reader at the same Time, that it has not so compleat an Effect, as when it is taken solely unjoined by any other Aliment; and that it is of the last Importance not to join it with any, which has the least Acidity or Sharpness. Persons in easy Circumstances may successfully take, at the same Time, _Pfeffer_, [61] _Seltzer_, _Peterstal_, or some other light Waters, which are but moderately loaded with mineral Ingredients. These are also successfully employed in all the Cases, in which the Cure I have mentioned is necessary.

[61] Bristol Water will be no bad Substitute for any of these, in such
Cases. _K._

Sec. 228. Sometimes there remains, after the Course of the Measles, a strong dry Cough, with great Heat in the Breast, and throughout the whole Body, with Thirst, an excessive Dryness of the Tongue, and of the whole Surface of the Body. I have cured Persons thus indisposed after this Distemper, by making them breathe in the Vapour of warm Water; by the repeated Use of warm Baths; and by allowing them to take nothing for several Days but Water and Milk.

Before I take leave of this Subject, I assure the Reader again, that the contagious Cause of the Measles is of an extremely sharp and acrid Nature. It appears to have some Resemblance to the bilious Humour, which produces the _Erisipelas_, or St. Anthony's Fire; and thence it demands our particular Attention and Vigilance; without which very troublesome and dangerous Consequences may be apprehended. I have seen, not very long since, a young Girl, who was in a very languid State after the Measles, which she had Undergone three Years before: It was at length attended with an Ulceration in her Neck, which was cured, and her Health finally restored by _Sarsaparilla_ with Milk and Water.

Sec. 229. The Measles have been communicated by [62] Inoculation in some Countries, where it is of a very malignant Disposition; and that Method might also be very advantageous in this. But what we have already observed, with Respect to the Inoculation of the Small-Pocks, _viz._ That it cannot be extended to the general Benefit of the People, without the Foundation of Hospitals for that very Purpose, is equally applicable to the Inoculation of the Measles.

[62] The only Account I have read of this Practice, is in the learned
Dr. _Home's_ _Medical Facts and Experiments_, published in 1759,
which admits, that but nine out of fifteen of the Subjects of this
Practice took. Cotton dipt in the Blood of a Patient in the Measles
was inserted into the Arms of twelve; and three received the Cotton
into their Nostrils, after the Chinese Manner of infusing the
Small-Pocks; but of these last not one took, and one of those who
had taken, had the Measles again two Months after. We think the
sharp hot Lymph distilling from the inflamed Eyes of Persons in
this Disease, a likelier Vehicle to communicate it than the Blood,
especially the dry Blood, which was sometimes tried; since the
human _Serum_ seems the Fluid more particularly affected by it; and
this must have been evaporated when the Blood grew dry. A few
practical Strictures on this Work, and particularly on this
Practice described in it, appeared in the Monthly Review Vol. XXI.
P. 68 to 75. _K._

__Chapter XV.__

_Of the ardent or burning Fever._

__Sect.__ 230.

The much greater Number of the Diseases I have hitherto considered, result from an Inflammation of the Blood, combined with the particular Inflammation of some Part, or occasioned by some Contagion or Poison, which must be evacuated. But when the Blood is solely and strongly inflamed, without an Attack on any particular Part, this Fever, which we term hot or burning, is the Consequence.

Sec. 231. The Signs which make it evident are, a Hardness and Fulness of the Pulse in a higher Degree than happens in any other Malady; an excessive Heat; great Thirst; with an extraordinary Dryness of the Eyes, Nostrils, Lips, of the Tongue, and of the Throat; a violent Head-ach; and sometimes a Raving at the Height of the Paroxysm, or Increase of the Fever, which rises considerably every Evening. The Respiration is also somewhat oppressed, but especially at the Return of this Paroxysm, with a Cough now and then; though without any Pain in the Breast, and without any Expectoration, or coughing up. The Body is costive; the Urine very high coloured, hot, and in a small Quantity. The Sick are also liable to start sometimes, but especially when they seem to sleep; for they have little sound refreshing Sleep, but rather a kind of Drowsiness, that makes them very little attentive to, or sensible of, whatever happens about them, or even of their own Condition. They have sometimes a little Sweat or Moisture; though commonly a very dry Skin; they are manifestly weak, and have either little or no Smell or Taste.

Sec. 232. This Disease, like all other inflammatory ones, is produced by the Causes which thicken the Blood, and increase its Motion; such as excessive Labour, violent Heat, Want of Sleep, the Abuse of Wine or other strong Liquors; the long Continuance of a dry Constitution of the Air, Excess of every kind, and heating inflaming Food.

Sec. 233. The Patient, under these Circumstances, ought, 1, immediately to be put upon a Regimen; to have the Food allowed him given only every eight Hours, and, in some Cases, only twice a Day: and indeed, when the Attack is extremely violent, Nourishment may be wholly omitted.

2, Bleeding should be performed and repeated, 'till the Hardness of the Pulse is sensibly abated. The first Discharge should be considerable, the second should be made four Hours after. If the Pulse is softened by the first, the second may be suspended, and not repeated before it becomes sufficiently hard again, to make us apprehensive of Danger: but should it continue strong and hard, the Bleeding may be repeated on the same Day to a third Time, which often happens to be all the Repetitions that are necessary.

3, The Glyster No. 5 should be given twice, or even thrice, daily.

4, His Legs are to be bathed twice a Day in warm Water: his Hands may be bathed in the same Water. Linen or Flanel Cloths dipt in warm Water may be applied over the Breast, and upon the Belly; and he should regularly drink the Almond Milk No. 4 and the Ptisan No. 7. The poorest Patients may content themselves with the last, but should drink very plentifully of it; and after the Bleeding properly repeated, fresh Air and the plentiful Continuance of small diluting Liquors generally establish the Health of the Patient.

5, If notwithstanding the repeated Bleedings, the Fever still rages highly, it may be lessened by giving a Spoonful of the Potion No. 10 every Hour, till it abates; and afterwards every three Hours, until it becomes very moderate.

Sec. 234. Haemorrhages, or Bleedings, from the Nose frequently occur in this Fever, greatly to the Relief and Security of the Patient.

The first Appearances of Amendment are a softening of the Pulse, (which however does not wholly lose all its Hardness, before the Disease entirely terminates) a sensible Abatement of the Head-ach; a greater Quantity of Urine, and that less high coloured; and a manifestly approaching Moisture of the Tongue. These favourable Signs keep increasing in their Degree, and there frequently ensue between the ninth and the fourteenth Day, and often after a Flurry of some Hours Continuance, very large Evacuations by Stool; a great Quantity of Urine, which lets fall a palely reddish Sediment; the Urine above it being very clear, and of a natural Colour; and these accompanied with Sweats in a less or greater Quantity. At the same Time the Nostrils and the Mouth grow moist: the brown and dry Crust which covered the Tongue, and which was hitherto inseparable from it, peels off of itself; the Thirst is diminished; the Clearness of the Faculties rises; the Drowsiness goes off, it is succeeded by comfortable Sleep, and the natural Strength is restored. When Things are evidently in this Way, the Patient should take the Potion No. 23, and be put upon the Regimen of those who are in a State of Recovery. It should be repeated at the End of eight or ten Days. Some Patients have perfectly recovered from this Fever, without the least Sediment in their Urine.

Sec. 235. The augmenting Danger of this Fever may be discerned, from the continued Hardness of the Pulse, though with an Abatement of its Strength; if the Brain becomes more confused; the Breathing more difficult; if the Eyes, Nose, Lips and Tongue become still more dry, and the Voice more altered. If to these Symptoms there be also added a Swelling of the Belly; a Diminution of the Quantity of Urine; a constant Raving; great Anxiety, and a certain Wildness of the Eyes, the Case is in a manner desperate; and the Patient cannot survive many Hours. The Hands and Fingers at this Period are incessantly in Motion, as if feeling for something upon the Bed-Cloths, which is commonly termed, their hunting for Flies.

__Chapter XVI.__

_Of putrid Fevers._

__Sect.__ 236.

Having treated of such feverish Distempers, as arise from an Inflammation of the Blood, I shall here treat of those produced by corrupt Humours, which stagnate in the Stomach, the Guts, or other Bowels of the lower Cavity, the Belly; or which have already passed from them into the Blood. These are called putrid Fevers, or sometimes bilious Fevers, when a certain Degeneracy or Corruption of the Bile seems chiefly to prevail in the Disease.

Sec. 237. This Distemper frequently gives Notice of its Approach, several Days before its manifest Attack; by a great Dejection, a Heaviness of the Head; Pains of the Loins and Knees; a Foulness of the Mouth in the Morning; little Appetite; broken Slumber; and sometimes by an excessive Head-ach for many Days, without any other Symptom. After this, or these Disorders, a Shivering comes on, followed by a sharp and dry Heat: the Pulse, which was small and quick during the Shivering, is raised during the Heat, and is often very strong, though it is not attended with the same Hardness, as in the preceding Fever; except the putrid Fever be combined with an inflammatory one, which it sometimes is. During this Time, that is the Duration of the Heat, the Head-ach is commonly extremely violent; the Patient is almost constantly affected with Loathings, and sometimes even with Vomiting; with Thirst, disagreeable Risings, a Bitterness in the Mouth; and very little Urine. This Heat continues for many Hours, frequently the whole Night; it abates a little in the Morning, and the Pulse, though always feverish, is then something less so, while the Patient suffers less, though still greatly dejected.

The Tongue is white and furred, the Teeth are foul, and the Breath smells very disagreeably. The Colour, Quantity and Consistence of the Urine, are very various and changeable. Some Patients are costive, others frequently have small Stools, without the least Relief accruing from them. The Skin is sometimes dry, and at other Times there is some sensible Perspiration, but without any Benefit attending it. The Fever augments every Day, and frequently at unexpected irregular Periods. Besides that _great_ Paroxysm or Increase, which is perceivable in all the Subjects of this Fever, some have also other _less_ intervening ones.

Sec. 238. When the Disease is left to itself, or injudiciously treated; or when it proves more powerful than the Remedies against it, which is by no Means seldom the Case, the Aggravations of it become longer, more frequent and irregular. There is scarcely an Interval of Ease. The Patient's Belly is swell'd out like a Foot-ball; a _Delirium_ or Raving comes on; he proves insensible of his own Evacuations, which come away involuntarily; he rejects Assistance, and keeps muttering continually, with a quick, small, irregular Pulse. Sometimes little Spots of a brown, or of a livid Colour appear on the Surface, but particularly about the Neck, Back and Breast. All the Discharges from his Body have a most foetid Smell: convulsive Motions also supervene, especially in the Face; he lies down only on his Back, sinks down insensibly towards the Foot of the Bed, and picks about, as if catching Flies; his Pulse becomes so quick and so small, that it cannot be perceived without Difficulty, and cannot be counted. His Anguish seems inexpressible: his Sweats stream down from Agony: his Breast swells out as if distended by Fullness, and he dies miserably.

Sec. 239. When this Distemper is less violent, or more judiciously treated, and the Medicines succeed well, it continues for some Days in the State described Sec. 237, without growing worse, though without abating. None of these Symptoms however appear, described Sec. 238; but, on the contrary, all the Symptoms become milder, the Paroxysms, or Aggravations, are shorter and less violent, the Head-ach more supportable; the Discharges by Stool are less frequent, but more at once, and attended with Relief to the Patient. The Quantity of Urine is very considerable, though it varies at different Times in Colour and Consistence, as before. The Patient soon begins to get a little Sleep, and grows more composed and easy. The Tongue disengages itself from its Filth and Furriness, and Health gradually, yet daily, advances.

Sec. 240. This Fever seems to have no critical Time, either for its Termination in Recovery, or in Death. When it is very violent, or very badly conducted, it proves sometimes fatal on the ninth Day. Persons often die of it from the eighteenth to the twentieth; sometimes only about the fortieth; after having been alternately better and worse.

When it happens but in a light Degree, it is sometimes cured within a few Days, after the earliest Evacuations. When it is of a very different Character, some Patients are not out of Danger before the End of six Weeks, and even still later. Nevertheless it is certain, that these Fevers, extended to this Length of Duration, often depend in a great Measure on the Manner of treating them; and that in general their Course must be determined, some time from the fourteenth to the thirtieth Day.

Sec. 241. The Treatment of this Species of Fevers is comprized in the following Method and Medicines.

1, The Patient must be put into a _Regimen_; and notwithstanding he is far from costive, and sometimes has even a small Purging, he should receive one Glyster daily. His common Drink should be Lemonade, (which is made of the Juice of Lemons, Sugar and Water) or the Ptisan No. 3. Instead of Juice of Lemons, Vinegar may be occasionally substituted, which, with Sugar and Water, makes an agreeable and very wholesome Drink in these Fevers.

2, If there be an Inflammation also, which may be discovered by the Strength and the Hardness of the Pulse, and by the Temperament and Complexion of the Patient; if he is naturally robust, and has heated himself by any of the Causes described, Sec. 232, he should be bled once, and even a second Time, if necessary, some Hours after. I must observe however, that very frequently there is no such Inflammation, and that in such a Case, Bleeding would be hurtful.

3, When the Patient has drank very plentifully for two Days of these Liquids, if his Mouth still continues in a very foul State, and he has violent Reachings to vomit, he must take the Powder No. 34, dissolved in half a [63] Pot of warm Water, a [64] Glass of it being to be drank every half Quarter of an Hour. But as this Medicine vomits, it must not be taken, except we are certain the Patient is not under any Circumstance, which forbids the Use of a Vomit: all which Circumstances shall be particularly mentioned in the Chapter, respecting the Use of such Medicines, as are taken by way of Precaution, or Prevention. If the first Glasses excite a plentiful Vomiting, we must forbear giving another, and be content with obliging the Patient to drink a considerable Quantity of warm Water. But if the former Glasses do not occasion Vomiting, they must be repeated, as already directed until they do. Those who are afraid of taking this Medicine, which is usually called, the Emetic, may take that of No. 35, also drinking warm Water plentifully during its Operation; but the former is preferable, as more prevalent, in dangerous Cases. We must caution our Readers at the same Time, that wherever there is an Inflammation of any Part, neither of these Medicines must be given, which might prove a real Poison in such a Circumstance; and even if the Fever is extremely violent, though there should be no particular Inflammation, they should not be given.

[63] That is about two Ounces more than a Pint and a half of our
Measure.

[64] About three Ounces.

The Time of giving them is soon after the End of the Paroxysm, when the Fever is at the lowest. The Medicine No. 34 generally purges, after it ceases to make the Patient vomit: But No. 35 is seldom attended with the same Effect.

When the Operation of the Vomit is entirely over, the Sick should return to the Use of the Ptisan; and great Care must be taken to prohibit them from the Use of Flesh Broth, under the Pretext of working off a Purging with it. The same Method is to be continued on the following Days as on the first; but as it is of Importance to keep the Body open, he should take every Morning some of the Ptisan No. 32. Such, as this would be too expensive for, may substitute, in the room of it, a fourth Part of the Powder No. 34 in five or six Glasses of Water, of which they are to take a Cup every two Hours, beginning early in the Morning. Nevertheless, if the Fever be very high, No. 32 should be preferred to it.

4, After the Operation of the Vomit, if the Fever still continue, if the Stools are remarkably foetid, and if the Belly is tense and distended as it were, and the Quantity of Urine is small, a Spoonful of the Potion No. 10 should be given every two Hours, which checks the Putridity and abates the Fever. Should the Distemper become violent, and very pressing, it ought to be taken every Hour.

5, Whenever, notwithstanding the giving all these Medicines as directed, the Fever continues obstinate; the Brain is manifestly disordered; there is a violent Head-ach, or very great Restlessness, two blistering Plaisters No. 36 must be applied to the inside and fleshy Part of the Legs, and their Suppuration and Discharge should be continued as long as possible.

6, If the Fever is extremely violent indeed, there is a Necessity absolutely to prohibit the Patient from receiving the least Nourishment.

7, When it is thought improper, or unsafe, to give the Vomit, the Patient should take in the Morning, for two successive Days, three Doses of the Powder No. 24, at the Interval of one Hour between each: This Medicine produces some bilious Stools, which greatly abate the Fever, and considerably lessen the Violence of all the other Symptoms of the Disease. This may be done with Success, when the excessive Height of the Fever prevents us from giving the Vomit: and we should limit ourselves to this Medicine, as often as we are uncertain, what ever the Circumstances of the Disease and the Patient will admit of the Vomiting; which may thus be dispensed with, in many Cases.

8, When the Distemper has manifestly and considerably declined; the Paroxysms are more slight; and the Patient continues without any Fever for several Hours, the daily use of the purging opening Drinks should be discontinued. The common Ptisans however should be still made use of; and it will be proper to give every other Day two Doses of the Powder No. 24, which sufficiently obviates every ill Consequence from this Disease.

9, If the Fever has been clearly off for a long Part of the Day; if the Tongue appears in a good healthy State; if the Patient has been well purged; and yet one moderate Paroxysm of the Fever returns every Day, he should take four Doses of the Powder No. 14 between the End of one Return and the Beginning of the next, and continue this Repetition some Days. People who cannot easily procure this Medicine, may substitute, instead of it, the bitter Decoction No. 37. four Glasses of which may be taken at equal Intervals, between the two Paroxysms or Returns of the Fever.