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blood of infants is generally too thick, and too much in quantity for the bulk of the body; and as they are oft-times feized with convulsions, upon the appearance of the disease, fome evacuation ought to be made : which may be safely effected by leeches applied to the temples, or behind the ears. Likewise, if blood cannot be drawn from the arın, in most young subjects either of the jugulars may be opened without inconvenience.

That regard is to be had to the patient's strength of what age foever, is manifest to all. But the weakness is seldom so great, as not to bear some loss of blood, unless it be after some extraordinary evacuations. Nor is the pulse to be overmuch depended on in this case : for it often happens, that the thickness of the blood prevents the fecretion of the usual quantity of animal spirits, in the brain, and that the vital Muid is not propelled from the heart with due force ; in which cafe, by removing the oppression, the patient's strength is observed even to increase with the bleeding.

But in what proportion blood is to be taken away, will be best determined by the vehemence of the disease. Many of our physicians imagine that they have done their duty, when they have ordered one bleeding, and are vastly, cautious of opening a vein at all, after the first appearance of the pustules, for fear of checking the eruption. But this is certainly an ill-timed caution; for in youths and adults it is often necessary to draw blood two or three times, only with an intermission of two or three days between each time. And indeed bloodletting is so far from being an obstacle to the eruption VOL. II. R

of

of the pustules, if the patient be not too weak, that it forwards it considerably : and for the very fame reason, that in large abscesses, when there is too great a fulness, and the heat too intense, the suppuration is brought on quicker and better by taking away some blood.

I have often observed, when in the beginning a vast number of small pustules foreboded a disease of the worfe kind, that the face of affairs was so remarkably changed upon one or two bleedings, that the pustules increased in fize, and diminished in number, (the greatness of the disease thus giving way to the greatness of the remedy), by which means nature acquired fufficient strength to expel the noxious humour. For it is most certainly true, that nature labours at the expulsion of the poison in the most perfect manner, that is, endeavours to make the puftules fill up as much as possible; and for that end she requires every thing to be quiet within the body, and always abhors confusion. And indeed, the reason why the confluent small-pox is worse than the distinct fort, is not, because the matter of the disease is more abundant in the former than in the latter, but because it is not pushed our in a proper manner. For upon a strict examination we generally find, that the greater quancity is discharged in the distinct fort,

Now, to conclude this head, fuch is the benefit of large and reiterated bleeding, that it is observed to prevent those evils which often attend the disease : as a delirium, convulsions, difficulty of breathing, and the like. For the dissection of dead bodies ihews, that the infection is not confined to the extersaal parts of the body, but feizes on the internal parts

also.

also. For I myself have seen subjects, in which the lungs, brain, liver, and intestines were thick beseľ with pustules. Nor have I the least doubt, but that those sudden deaths which sometimes happen towards the end of the disease, when there seemed to be no room left for fear, are occasioned by the efflux of the purulent matter from the bursted puftules on one or other of the nobler parts. Wherefore no fever is attended with more uncertain figns, on which to ground a fure prognostic, than this of which we are treating. Upon the whole, there is no time of the disease, wherein it may not be necessary to draw blood ; if the violence of the fever require it, and the patient appear able to bear it. For it is always better to try a doubtful remedy than none.

A frenzy, coming on the fourth day of the eruption, is justly esteemed of very bad omen ; infomuch that Dr Freind says, that he never saw a patient recover who had had this fymptom *. sitively declare, that I have had better fortune; having recovered many who had been seized with a delirium at that time, by drawing blood immediately, and then throwing in a clyfter.

After taking away as much blood as is requisite, it is proper to purge the body; which may be done with safety enough, any time before the eruption of the pustules. But the purge must be of the gentle kind; such as the infusion of sena with manna, or manna alone, especially for children. For no disturbance is to be raised in the body. But first a vomit thould be given, if there happens to be any collec

But I can po

* Epift. de quibufdam variolarum generibus.

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tion

tion of phlegm or bile in the stomach, or the stomach to be loaded with food upseasonably taken.

As soon as it is certain, that the eruption is near at hand, most physicians are of opinion, that it ought to be promoted, by all means. Yet we are to remember, that this is the proper work of nature; and therefore great care should be taken, neither to increase the motion of the blood over-much, nor suffer it to grow languid.

It was a wise saying of Asclepiades, that he made use of the fever for its own cure *: whereby he meant, that the fever is to be regulated in fuch a manner, that itself may throw off whatever is noxious to the body. Wherefore the true intention in this case, is, to keep the inflammation of the blood within due bounds, and at the same time to assist the expulfion of the morbific matter through the fkin. For both which purposes a medicine, which I have experienced to be useful, is a powder composed of two parts of the bezoardic powder, and one part of purificd nitre; and sometimes of equal parts of both. An adult may take half a drachm of this powder three or four times in a day, diminishing the quantity for children, in proportion to their age, And if the effervescence of the blood run very high, a proper quantity of spirit of vitriol may be added to the patient's drink. But if there be any keckings or retchings to vomit, they will be removed by drąughts containing half an ounce of juice of lemons, with one fcruple of falt of wormwood.

Now, concerning those medicines which ease pain, and procure sleep, in this fevere disease, these are not

* Cell. lib. iii. cap. iv.

to be used over-hastily : for all anodynes in some meafure obstruct the feparation of the morbid humour from the blood, unless the pain happens to be excessive : and moreover, if the violence of the fever has raised a delirium, they generally make it worfe. Wherefore it is not proper to employ them, until the eruption of the pustules be completed ; but after that narcotics may be administered with safety. Thus it will be right to give the patient a dose of the thebaic tincture, or diacodion, every evening, especially if he be a youth or an adult person ; for these medicines agree not so well with infants. And sometimes, in cases of very great inquietude, the dose is to be repeated in the morning. For the fuppuration of the matter stagnating in the puítules, is forwarded by quiet and fleep. But if, towards the end of the difease, the patient happens to be seized with a shortness of breath, or danger of choking from vifcid flime, these medicines are to be entirely prohibited. In the mean time, if the patient is costive, which is generally the case, and the fever continues, the body is to be opened with a clyster every second or third day.

It may be 'needless to observe, that if this method is proper in the distinct small-pox, it will be found more necessary still in the confluent, which is attended with greater fear and danger.

From the simple I now pass to the malignant finallpox, of which I have already established three forts, to wit, the crystalline, the warty, and the bloody.

Now, this observation holds good in all kinds of the disease, that the inore the pustules tend to suppuration, the greater are the hopes of recovery; and therefore, when that does not go on according to our

wishes,

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