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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 convulfions, upon the appearance of the difeafe, fome evacuation ought to be made which may be fafely effected by leeches applied to the temples, or behind the ears. Likewife, if blood cannot be drawn from the arm, in most young fubjects either of the jugulars may be opened without inconvenience...

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That regard is to be had to the patient's ftrength of what age foever, is manifeft to all. But the weakness is feldom fo great, as not to bear fome lofs of blood, unless it be after fome extraordinary evacuations. Nor is the pulfe to be overmuch depended on in this cafe for it often happens, that the thickness of the blood prevents the fecretion of the ufual quantity of animal fpirits, in the brain, and that the vital fluid is not propelled from the heart with due force; in which cafe, by removing the oppreffion, the patient's ftrength is obferved even to increafe, with the bleeding.

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

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of the puftules, if the patient be not too weak, that it forwards it confiderably: and for the very fame reafon, that in large abfceffes, when there is too great a fulness, and the heat too intenfe, the fuppuration is brought on quicker and better by taking away some blood.

I have often obferved, when in the beginning a vast number of fmall puftules foreboded a disease of the worfe kind, that the face of affairs was fo remarkably changed upon one or two bleedings, that the puftules increafed in fize, and diminished in number, (the greatnefs of the difeafe thus giving way to the greatnefs of the remedy), by which means nature acquired fufficient ftrength to expel the noxious humour. For it is most certainly true, that nature labours at the expulfion of the poison in the most perfect manner, that is, endeavours to make the puftules fill up as much as poffible; and for that end the requires every thing to be quiet within the body, and always abhors confusion. And indeed, the reason why the confluent fmall-pox is worse than the diftinct fort, is not, becaufe the matter of the disease is more abundant in the former than in the latter, but because it is not pushed out in a proper manner. For upon a ftrict examination we generally find, that the greater quantity is discharged in the diftin&t fort.

Now, to conclude this head, fuch is the benefit of large and reiterated bleeding, that it is obferved to prevent thofe evils which often attend the disease: as a delirium, convulfions, difficulty of breathing, and the like. For the diffection of dead bodies fhews, that the infection is not confined to the exterual parts of the body, but feizes on the internal parts alfo.

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alfo. For I myself have feen fubjects, in which the lungs, brain, liver, and inteftines were thick be fet with puftules. Nor have I the leaft doubt, but that those fudden deaths which fometimes happen towards the end of the difeafe, when there feemed to be no room left for fear, are occafioned 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 prognoftic, than this of which we are treating. Upon the whole, there is no time of the disease, wherein it may not be neceffary 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 fays, that he never faw a patient recover who had had this symptom *. But 1 can pofitively declare, that I have had better fortune; having recovered many who had been feized with a delirium at that time, by drawing blood immediately, and then throwing in a clyfter.

After taking away as much blood as is requifite, it is proper to purge the body; which may be done with fafety enough, any time before the eruption of the puftules. But the purge muft be of the gentle kind; fuch as the infufion of fena with manna, or manna alone, especially for children. For no difturb

But firft a vomit

ance is to be raifed in the body. fhould be given, if there happens to be any collec

* Epist. de quibufdam variolarum generibus.

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tion of phlegm or bile in the ftomach, or the ftomach to be loaded with food unfeasonably taken.

As foon 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 fuffer it to grow languid.

It was a wife faying of Afclepiades, that he made ufe of the fever for its own cure *: whereby he meant, that the fever is to be regulated in such a manner, that itself may throw off whatever is noxious to the body. Wherefore the true intention in this cafe, is, to keep the inflammation of the blood within due bounds, and at the fame time to affift the expulfion of the morbific matter through the fkin. For both which purposes a medicine, which I have experienced to be ufeful, is a powder compofed of two parts of the bezoardic powder, and one part of purified nitre; and fometimes 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 effervefcence 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 draughts containing half an ounce of juice of lemons, with one fcruple of falt of wormwood.

Now, concerning thofe medicines which ease pain, and procure fleep, in this fevere difeafe, thefe are not *Celf. lib. iii. cap. iv.

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to be used over-haftily: for all anodynes in fome meafure obftruct the feparation of the morbid humour from the blood, unlefs the pain happens to be exceffive 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 puftules be completed; but after that narcotics may be administered with fafety. Thus it will be right to give the patient a dofe of the thebaic tincture, or diacodion, every evening, especially if he be a youth or an adult perfon; for thefe medicines agree not fo well with infants. And fometimes, in cafes of very great inquietude, the dofe is to be repeated in the morning. For the fuppuration of the matter ftagnating in the puftules, is forwarded by quiet and fleep. But if, towards the end of the difcafe, the patient happens to be feized with a fhortness of breath, or danger of choking from vifcid flime, thefe medicines are to be entirely prohibited. In the mean time, if the patient is coftive, which is generally the cafe, and the fever continues, the body is to be opened with a clyfter every fecond or third day.

It may be needlefs to obferve, that if this method is proper in the diftinct fmall-pox, it will be found more neceffary ftill in the confluent, which is attended with greater fear and danger.

From the fimple I now pafs to the malignant finallpox, of which I have already established three forts, to wit, the cryftalline, the warty, and the bloody.

Now, this obfervation holds good in all kinds of the disease, that the more the puftules tend to fuppuration, the greater are the hopes of recovery; and therefore, when that does not go on according to our

wishes,

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