rooted prejudices, and the insinuations urged to shackle the universal
benefits of inoculation, and which pervade not only the ignorant mass
of the community, but also the generality of the medical profession
throughout Europe, would abundantly excuse and urge me to be more
diffuse on this interesting and litigated topick. But having, some
years ago, published a small Essay on Inoculation, and having now
nearly finished a general treatise on the natural and inoculated small
pox, I shall postpone the result of much reading and reflection to that
republication. An acquiescence in neutrality or indifference, where it
can be proved to mathematical demonstration that myriads of lives might
be preserved, which are now sacrificed, would, at least in a moral
sense, constitute an accessary in criminality.
Small pox, or variolæ, have been properly discriminated into several
species: the distinct and confluent, or benign and malign; the
crystalline, lymphatick, warty, petechial, and hemorrhagick; the
inoculated; the spurious. The principal differences between small
pox consist in the period of eruption, the number and form of the
pustules, the quantity and state of the fluid contained in them, and
the contumacious perseverance of the fever. The progress of variolous
fever has been divided into four stages, that preceding the eruption;
the eruption; the suppuration; and the exsiccation of the pustules.
The first visible effects of the contagion and fever are nausea,
vomiting, soreness at the stomach, drowsiness: before the eruption
infants are prone to startings, and some even to epileptic fits; adults
to sweats. The second stage of eruption is, from three to four days,
from the first attack, of small red spots or pimples on the skin,
resembling flea-bites, in number and quantity extremely various; from
one or more, multiplied to many hundreds. The eruption is commonly
first on the face, spreading gradually over the body and extremities,
and is compleated about the fifth or sixth day from the febrile
commencement: and on this eruption, the fever abates or subsides. In
the third stage of maturation the pimples increase daily in size; are
elevated into prominences inflamed at the base; and the suppuration is
compleated between the eighth and eleventh day from the first attack:
the pustules then detached from each other, have risen into small
boils, the size of peas or larger, turgid with pus, gradually becoming
opake, yellowish, and tenacious. In the fourth stage the pustules
shrivel or burst, oozing out part of their contents, and a superficial
incrustation is formed, which, after some days, together with the
shrivelled pustules, scales off, leaving the subjacent skin of a brown
red colour. This is the mild form of the disease; but we are next to
describe it under more dangerous and fatal forms.
In the Confluent small pox, the revolutions are the same, but the
symptoms more exasperated; the vomiting and the eruptive fever violent,
frequently with coma, or delirium. The eruption protrudes earlier;
on the second or third day, in congregated clusters, like measles,
and more numerous on the face; the fever does not then subside, but
increases towards the fifth or sixth day, and continues throughout the
disease. The swelling of the face is commonly earlier and more severe:
and both in confluent and distinct, when the pustules are numerous on
the face and fauces, there is soreness and inflammation of the throat,
hoarseness, and difficulty of swallowing; and about the eighth day,
the eye-lids are closed up with temporary blindness. On the face,
especially, the pustules are small, less elevated, coalescent; and it
is often covered with a universal flat vesicle: the fluid is whitish or
brownish, not yellow and tenacious, or of due maturation and concocted
purulency. The pustular interstices, if any, are pale and flaccid.
The facial intumescence subsides about the tenth or eleventh day:
and during these stages of fermentation and depuration, a salivation
commonly ensues, especially in adults; and in infants a diarrhœa. About
the fourth stage the fever, called secondary, is often renewed with
considerable vehemence, and with various duration and event. In the
latter stages the pustules excite intolerable itching of the skin, and,
if not prevented, incessant scratching and cutaneous denudation: the
breath, exhalations and excretions are then offensive to the smell. In
the mild distinct, the pustules commonly begin to dry on the ninth day,
and continue to the fourteenth in a process of exsiccation; but in the
confluent, this stage begins about the eleventh day.
The following are all unfavourable omens in small pox: Sudden and
premature eruption of pustules. In this first stage, infants,
especially before dentition, are sometimes snatched off in epileptick
fits. The more small pox appear in the confluent, or in the distinct
form, they are more or less perilous. It is only where the distinct
are crowded with pustules on the face; or accompanied with fever and
putrescency; or with pustules warty and lymphatick, that they are
dangerous. Or, a natural mild small pox may be rendered malignant
from confined air, heated room, and regimen. In the catalogue of
unfavourable symptoms, are the fever continuing pertinaceous; and with
putrescency it is still more dangerous: the pustules not sufficiently
filled and distended, hard, or warty, or not filled with maturated pus;
the top of the pustules depressed; pale interstices at their base;
sudden retrocession or subsidence of the pustules during the stage of
maturation: severe inflammation of the fauces; difficult deglutition;
severe pain at the stomach. The secondary fever arising commonly about
the recession and exsiccation of the pustules, or ebb of maturation,
is the most dangerous period of small pox. The variolous crisis then
is generally by diarrhœa, or turbid urine, or both conjointly, or by
salivation. It is evident that, as the cutaneous pores are blocked
up, the absorbed, and other floating pus, must be defecated by some
grosser excretory. Additional symptoms of alarm, especially in the
confluent, are, if the suppurating stage of the fever continues severe,
the salivation ceases, and the hands do not then swell. When the
putrescency is virulent, the disease sometimes proves fatal in a few
days; but in most cases on the eleventh, and sometimes not until the
fourteenth or seventeenth. Fatal symptoms of putrescency are petechiæ,
and bloody pustules; putrid urine and stools; tumid emphysematous
abdomen.
Inoculated Small Pox. Between seven and nine days, some slight fever
succeeded by an eruption of pustules; in general not numerous, and the
patients are very seldom confined to bed, or indisposed. In ninety-nine
cases out of an hundred, inoculation produces a distinct small pox,
void of danger. After inoculation from the maturated pustules of real
small pox, and the usual symptoms of impregnation, mankind are ever
after invulnerable by this contagion.
Chicken Pox. Bastard or spurious; and distinguished under the
apellation of petite verole volante, stein pox, and swain pox. They
are sometimes epidemick, but inoffensive; and have given rise to the
supposition of a person’s undergoing the natural small pox a second
time. The eruption forms very quickly into pustules, of which the
pus is not concocted, nor tenacious; and after three or four days,
incrustations.
_Measles._ Morbilli rubeola. From 100 to 120th part of the community
seem to be destroyed by measles. Morbillous mortality is to that of
small pox in the ratio of one to ten or twelve; and consequently may be
estimated at one of seventy-seven whom it attacks. Sydenham, long ago
observed, that measles, if judiciously treated, are attended with very
little danger; but he should at least have qualified the expression,
by adding immediate and considerable danger; for both immediately, and
in their future consequences, they are by no means so innocuous. Few
escape this exotick contagion, especially in childhood and in cities.
It attacks the same persons but once in life; and, with us, is said to
be most epidemick in winter.
Morbillous symptoms are fever, impaired appetite, heaviness of the
head and eyes, somnolency, catarrh, acrid defluxion from the fauces,
nose, and eyes, with hoarseness, sneezing, and lachrymation; short
dry cough, and some difficulty in respiration. Prior to the eruption,
there is generally anxiety about the breast, palpitation of the heart,
itching of the face, peevishness, and considerable fever. On the third
or fourth day there is an eruption of small red spots first on the
face, resembling the bites of ants or fleas, generally confluent and
entangled, and broad on the trunk and extremities; but not elevated
above the skin, nor rising into pustules, nor suppurating: the size
and shape various and irregular. About the sixth day the eruption on
the face begins to dry, and on the ninth, is totally obliterated with
desquamation of the cuticle. With the eruption the fever frequently
does not cease; and the cough and difficulty in respiration often
continue beyond the eruptive limits and cuticular desquamation. The
usual crisis is by scaling of the cuticle, turbid urine, or diarrhœa.
Unfavourable symptoms are, too sudden or too tardy eruption; pale or
yellow eruption; great debility; and above all, pulmonick inflammation.
The last in the train of morbillous evils and consequences are,
consumption, anasarca, ophthalmy. Sometimes, though rarely, measles
have been seen in accompanyment with other eruptive fevers, as small
pox, and gangrenous angina.
_Scarlet fever._ Febris scarlatina, ignis facer, scarlatina anginosa.
Its mortality in the London bills is added to the general febrile
heap. This contagious epidemick is most frequent in the infant and
adolescent age; it attacks families and schools about one time; and
the same person but once in life; and is said to be most frequent in
winter. It is generally accompanied with an anginous or ulcerous sore
throat, but not putrid. That genus or species of scarlet fever which
usually accompanies angina gangrenosa, and is extremely dangerous,
is hereafter described. The symptoms of simple scarlet are the usual
febrile precursors; on the second, third, or fourth day, an eruption
of broad irregular redness and spots; general or partial only over
the face, trunk, and extremities, and not elevated above the surface:
sometimes overspreading the face with a crimson colour. Concomitant
symptoms are, difficulty of swallowing, and uneasiness in the throat,
redness, tension, and sloughs: commonly also nausea, sickness at
the stomach, vomiting, vertigo, drowsiness, headach, difficulty of
breathing, anxiety. After three or four days more; that is, between
the sixth and ninth, the cutaneous eruption and redness disappears,
with desquamation of the cuticle, and harrassing pruriency. The usual
crisis is by sweats, urine, fetid stools, and exscreation of sloughs.
Sometimes, a few days after the cuticular desquamation, an anasarcous
swelling suddenly appears; and during the convalescent state, from
exposure to cold air, or neglect of cutaneous and other expurgation,
anasarca, hydrothorax or ascites have ensued.
There are two or three other febrile eruptions to which authors have
appropriated distinct names, but by which very few of the human race
are destroyed. These are febris urticata, bullosa, and pemphigodes. In
general, they consist of red spots and serous vesicles on different
parts of the skin, exciting heat and itching; the urticata resembling
blisters from the burning of nettles. Some of these are mobile,
receding and re-appearing, and prone to relapse. After a few days,
however, or at the utmost a few weeks, they vanish: and are not
contagious nor epidemick.
_Plague._ Pestis. This febrile demon cannot now be called one of the
mortal epidemicks of Europe, except in the south-east extremity,
inhabited by the Turks. The two greatest pestilences on record,
happened in the sixth and fourteenth centuries of our era; which, with
more barbarous havock than that of Goths or Saracens, overwhelmed
millions in three quarters of the globe in one indiscriminate massacre.
In London, before the general conflagration in 1666, of one half nearly
of the old city, the plague was very frequent: but since that event,
or at the most two or three years after, it has been exterminated and
banished from us. That fortunate disaster which consumed a magazine of
putrefaction; together with widened streets, ventilation, cleanliness,
and many other causes, have all contributed to the extinction of this
exotick incendiary. For it is well known, that pestilential miasma
has been preserved dormant many years in porous materials. From 1592
to 1665, the plague appears to have had annually more or less share
in the mortality of the British metropolis; and adding together the
different periods of its duration, amounts to twenty-five years. In
1665, which is the most furious pestilence in the London annals, the
deaths amounted to 100,000; but in the eight preceding years, to only
113. Registers, in other parts of Europe, prove, that this disease has
committed direful carnage since our emancipation. At Marseilles they
can enumerate twenty general plagues, which have successively laid
waste that populous city. Many other European cities and towns, during
the last and present century, and especially those bordering on the
Mediterranean, have, in a very short space of time, severely smarted by
pestilence, and have been nearly depopulated.
At present, in all the Mediterranean ports they are, from fatal
experience, scrupulously vigilant to guard, by a circumvallation of
alarm posts, against the pestilential infection, and the clandestine
entry of infected goods or merchandize. It rarely now gains admittance,
by stealth into any of the European ports; (Constantinople excepted) or
even if imported to our shores, the wise precautions and regulations,
enacted by Quarantines, soon check its irruption and progress. This
is a most interesting epoch and improvement in the police of modern
states; for the original institution and rough draft of which, about
300 years ago, we are indebted to the Venetians. The political
ordinances, however, enacted for the exclusion and suppression of
pestilential contagion, were, until the present century, extremely
erroneous and impolitick. Formerly, the plague in London, and in
most other European cities, where it was permitted to sojourn, was
rendered infinitely more terrifick and destructive by injudicious
legislative regulations; especially by the barbarous sacrifice, and
absurd policy of sick and sound immured together, with a forlorn motto
on their doors, until all were dead or recovered. This was an effectual
discouragement against an early alarm which, as in cases of fire, is of
the utmost importance. It is evident, by the London bills, that a mere
handful, at any time, died in the publick pest-house; consequently,
every corner of the city was polluted with infection.
True plague is now chiefly chained down to Constantinople, and to
Grand Cairo in Egypt, the two original, or at least one of the hotbeds
and volcanos of pestilence; to several of the maritime towns of Asia
and Africa situated on the Archipelago and Mediterranean; as Smyrna,
Aleppo, Tripoli, Tunis, Algiers, &c. In many of these cities the
pestilential miasma is hatched and accumulated into venomous malignity:
it is in some nearly an annual, or triennial epidemick. At this day,
plague almost solely wreaks its venom on the Mahometan nations, whose
prejudices and ignorance, rivetted by religious and predestinarian
absurdities, give licence and activity to its imperious domination.
From such implicit and enthusiastick submission to the tenets of the
Alcoran, joined to gross stupidity in science and philosophy, the
Mahometans are encouraged, defenceless and rash, to brave this most
malignant and terrible of the febrile host.
Fortunately for mankind, the pestilential contagion spreads to a very
small distance through the air, without some contact or adhesion to
infected goods and porous materials; or by personal communication and
intercourse of the sound with the diseased. The atmosphere is not
tainted to any considerable distance. A neighbour barricading himself
within his house, at a few yards distance from infection, may escape
unhurt. If pestilential contagion could be so suddenly and widely
scattered over a kingdom as epidemical influenza, the earth, in a few
months, would be converted into an enormous church-yard. It is not like
some other exotick poisons of the exanthematous order, after enduring
which once, mankind are rendered invulnerable: the plague, as well as
putrid fever, may attack the same person repeatedly. What proportion
die or recover, I cannot ascertain; and indeed the prophylactic
or preventitive, is infinitely the most important indication. Its
invariable characteristic features are buboes, carbuncles, and
petechiæ. The general progress of the symptoms are, great abasement of
strength and of spirits, apprehension of death, dejected countenance,
and wildness of the eyes; nausea, vomiting of bile; headach, giddiness,
delirium; weak irregular pulse; petechiæ, hæmorrhages; fetid breath
and excretions; buboes or boils in the inguinal, axillary, or jugular
lymphatick glands; and appearing early, or in the progress of the
disease; besides gangrenous carbuncles in different parts. According
to the virulence of the contagion, and other co-operating causes,
the disease may be fatal in a few hours, a few days, or in one, two,
or three weeks. The poison arrested in the lymphatic glands and
suppurating, is a favourable presage. Domestick animals, as quadrupeds
and fowls, are liable to the infection, and to be changed into carrion.
_Sweating Sickness_, ephemera sudatoria et elodes, cannot now be
considered as an epidemick cause of mortality. Somewhat more than 300
years ago, this singular contagious and vagrant disease burst out, for
the first time, in the army of Henry VII. in his return to England
from an expedition against France; and in four hours sickness, numbers
were exterminated: but by keeping warm in bed, under profuse sweats,
the dangerous whirlpool generally was escaped. The same infection was
imported into England at several subsequent intervals; but happily,
its greatest devastation was always of short duration; and this morbid
meteor has long since disappeared from our island, and from Europe. Its
symptoms were continued profuse sweats, extreme debility, fainting,
anxiety, restlessness, pain in the stomach, thirst, vertigo, quick
irregular pulse. Sometimes it was fatal in one day; and, if the sick
survived to the seventh, they generally recovered.
Of the predisposing and occasional _Causes_ of fevers, intermittent
and remittent, nervous and putrid, inflammatory, small-pox, measles,
scarlet, plague, sweating sickness. The principal causes of the
preceding genera of fevers may conveniently be presented at one view,
in abbreviation. We throw to one side all that specious romance and
sapient pomposity, strutting in the tinsel robes of proximate causes,
and merely attend to the predisponent and occasional. Because, after
diving and climbing as assiduously as many of our fellow-labourers in
search of those arcana, we experienced reiterated retrogradation; and,
as in metaphysicks, error supplanted by error. Neither do we attempt to
pry into those latent predispositions in the human organization, which
renders them susceptible to many various febrile impressions.
The predisposing and occasional causes of intermittent and remittent
fevers are, cloudy winter and autumn: northern morasses: noxious miasma
or emanation from morasses, from countries and soils low, damp, woody,
uncultivated, especially in warm climates, weather, and seasons:
atmosphere moist and hot: foggy atmosphere: unusual irregularity of the
seasons and atmosphere: unusual continuance of cold rainy weather:
damp night-air, especially in warm unhealthy climates: excessive heats:
burning zones and regions: sudden vicissitudes from heat to cold of
the seasons and weather: unusually excessive and long continued heats:
also damp weather, particularly when unusually warm for the season and
climate: damp ground-floors and habitations: damp sheets and beds:
sleeping in the open air, and on damp ground: sudden stoppage of
perspiration: bile depraved, redundant; septick miasma introduced from
without, or generated within the body: efforts of nature to disencumber
its functions and organs of some clogs or impurities. Perhaps rather
contributing as exciting causes are passions of mind, fatigue,
hardships, long watching, hunger, thirst, intoxication, venery,
interruption of the excretions, &c.
The predisposing and occasional causes of nervous and putrid fevers
are, many or perhaps all of the preceding causes: noxious miasma
or contagion, engendered from human effluvia in cities, jails,
hospitals, dirty, small, crowded houses and apartments, especially
in unventilated alleys and lanes; accumulation of corporeal filth
from want of cloathing, change of raiment, slothfulness; contagion
concentrated in porous materials, furniture, raiment, and houses:
cadaverous exhalations, effluvia from putrid carcasses of animals,
and from both animal and vegetable heaps in a state of fermentative
putrefaction: damp rainy seasons: bad harvest, and putrid grain; putrid
diet animal or farinaceous: improper medical treatment of remittent
fevers; corrupted bile, or other secerned and excreted fluids, noxious
in quantity or quality: profuse evacuation, immoderate venery,
desponding passions of mind, intemperance in food or drink, stoppage
of perspiration, &c. Of miliary fever the causes are, estuation, hot
regimen, and rooms, during fever or parturition, excessive evacuations,
weak constitutions, debility, depressing passions, moist air, wet
summer.
The predisposing and occasional causes of inflammatory fevers and diary
are, cold climate and winter: cold winds: change of seasons: heat of
the atmosphere: insolation: excessive labour, exercise, and fatigue:
violent passions of mind: long watching: cold drink when the body is
heated: intoxication with spirituous liquors: crude chyle: heating
stimulating diet: disordered stomach, plethora: excess of coagulable
lymph and its tenacity: menstrual, lacteal, hæmorrhoidal, arthritick:
warm baths; excruciating pain.
The predisposing and occasional causes of small pox, measles, scarlet
fever, and sweating sickness, are unknown, both as to their source and
nature: the two first are exotick leavens. Of plague: venomous effluvia
in certain hot climates, from putrid animal exhalations and filth, such
as the stagnant canals and reservoirs of putridity in the city of Grand
Cairo: putrid emanations from swarms of dead locusts. Predisposing
causes to pestilential infection are, long watching, hunger, poor diet,
intemperance, excess of venery, fatigue, terror, fear, debility, low
spirits, &c.