wishes, all poffible means are to be employed to throw the morbific humour on the fkin; with which intention every thing is to be done in this cafe, which we have propofed in treating of the fimple fort. But yet each fpecies of the malignant fort requires a peculiar confideration.

Whereas, in the cryftalline fort, the water of the puftules can never be brought to a laudable fuppuration; it ought to be carried off by thofe paffages in the body, which are naturally adapted to the fecretion of the thinner fluids. Now, I have faid above, that there is a great correfpondence between the skin and the kidneys. Therefore, while the thinneft parts of this water are made to tranfpire through the skin, the groffer parts ought to be drawn off through the urinary paffages, by diuretic medicines. Of this tribe there is nothing better than nitre, and that may be administered three or four times a-day, in fuch quantities as may not offend the ftomach, to wit, a scruple or half a drachm, diffolved in fmall wine, which is the only fort that agrees with this disease till towards the end'; when it may be proper to allow the patient a little Canary, (Dr Sydenham's favourite liquor), or any other foft and generous wine to support his ftrength. But while nitre is thus taken, it will be right to interpofe thofe medicines which cherish the heart, and promote the flux of the humour into the puftules: fuch as Raleigh's cordial, or the cordial confection; the bezoardic powder, fometimes with a little faffron; and the plain spirit of hartshorn. Befides thefe, on the fifth or fixth day of the eruption, blifters are to be applied between the fhoulders, and to the arms and legs for which purpose, the blistering epithem is

moft

moft convenient, as its foft confiftence enables it to reach the skin between the puftules, and ftick to it. For by this discharge of the ferofities, the fever, which increases, when there is no farther derivation of humours to the skin, is feasonably prevented.

I know indeed, that most of our phyficians apply this remedy earlier, and even on the first days of the disease, in every malignant finall-pox: but there is just reason to fear, that the great commotion raised in the blood by the acrimony of the flies might be an obstacle to the due propulfion of the humour into the beginning puftules.

The warty fmall-pox is more dangerous than the cryftalline; because the matter of the disease, being too thick, can neither fuppurate, nor pafs off by urine. Wherefore it is neceffary to use the utmost endeavours to take off the fever, and to provoke fweat, in order to digeft the morbid humour, by the cordial medicines aforementioned. And blisters ought to be applied in this cafe likewife. But the Arabian physicians pronounced this fort of the disease to be always fatal *.

Laftly, that fort which I have called the bloody fmall-pox, requires peculiar attention. Now, in this fort, if there is any room for phyfic, thofe medicines. bid faireft for fuccefs, which, by their ftypticity, thicken the blood in fome meafure, and fo check it, that it cannot break through even the smallest arteries. The best of this kind are the Peruvian bark, alum, and that fpirit which is called oil of vitriol, Now, thefe are to be ufed alternately in this manner. A drachm of the bark may be given every fixth hour; * See Rhazes's treatife annexed, chap. viii.

and,

and, three hours after, a proper quantity of alum. It will be a very powerful medicine, if thus compounded. Melt three parts of alum on the fire, with one part of that infpiffated juice, which is improperly named dragon's blood: when the mass is grown cold, reduce it to a powder; a fcruple of which, made into a bolus with conferve of red rofes, will be a proper dofe. The most convenient manner of giving the oil of vitriol, is in the tincture of rofes; five or fix fpoonfuls whereof may be taken feveral times in the day. And befides, the patient's common drink may be acidulated with it; efpecially if purple or black fpots appear interfperfed among the puftules. And this medicine will be of great fervice, not only in the bloody, but in all the other forts likewife, accompanied with thefe fpots. This one thing more I will add, that I have experienced the use of blifters to be fafe enough in this cafe, when a delirium requires their application. I have indeed feen fome patients recover by this method, who had difcharged large quantities of blood by the urinary canal at the time of the eruption of the pustules; but it is worthy of notice, that, in all thefe, the difeafe terminated in fome confiderable evil. For they were tortured, either with boils breaking out in many parts of the body, or with glandular fwellings under the ears or armpits, which were not eafily brought to fuppuration. I likewife remember the cafe of a young man, one of whose ton fils was destroyed by a gangrenous ulcer which was very troublesome to cure. Thus upon the whole it is manifeft, that it is extremely difficult to clear the mafs of blood of this poifon; and that a perfect recovery is not to be procured without a fuppuration,

either in its due courfe of time, or in the laft ftage of the distemper.

But in every fort of this difeafe, it is proper to open the body on the decline, that is, on the ninth or tenth day from the eruption; because a putrid fever generally comes on about this time, while the puftules are drying; or upon the fubfidence of the fwelling of the inflamed fkin, where there is no fuppuration; which fever cannot be taken off with equal fafety by any other means. But gentle cathartics alone are to be employed in this cafe, fuch as I have advifed before the eruption of the puftules.

This whole affair I formerly explained and illustra ted with proper examples, in my letter to Dr Freind *; and that gentleman likewife abundantly confirmed it afterwards, by the authorities of ancient and modern phyficians. So that whofoever refufes his affent to this practice, muft refolve not to fee at noon-day. All fevers have their certain periods; and where the poisonous matter has once infected the humours, the putrid fuel of the difeafe can hardly be thrown out of the body early enough. And indeed, when this rule is not observed, we daily fee the diftemper followed immediately by a hectic fever, attended with a cough, fpitting of purulent matter, fhortnefs of breath, and other symptoms of the lungs being affected.

But I muft obferve in this place, that, however beneficial purging may be at this time; yet, if the body happens to be too loofe, either from the natural state of the inteftines, or by frequent clyfters, this

Vid. Freind commentar. vii. ad Hippocrat. de morbis popularibus. Et epift. de purgantibus in fecunda variolarum febre adhibend.

VOL. II.

S

remedy

remedy becomes lefs neceffary, or at leaft may be poftponed for fome days. For great regard is to be paid to the patient's ftrength, which the length of the illnefs has more or lefs impaired.

Moreover, it is requifite to be very circumspect, whether there be any remains of the purulent matter lurking under the withered fkin of the puftules; for this is fometimes fo manifeftly the cafe, that though the fcabs appear dry and hard; yet, upon fome of them breaking here and there, there iffues forth very fœtid matter. In this circumftance, the body is not to be purged, but rather to be fupported by proper diet, until the matter is all come away; which I have feen continue running to the twenty-fourth day of the difeafe, and yet the patient recovered. I fhall never

forget the cafe of a certain young man of a very robuft conftitution, who had fo dreadful a fort of the confluent small-pox, that when the puftules fhould have ripened, his whole face was become black and dry; and, in short, thoroughly mortified. As the cafe feemed quite defperate, I ordered incifions to be made to the quick in many places, and fomentations of a decoction of emollient and warm plants, with the addition of camphorated fpirit of wine, to be applied to the parts: whereupon there followed a difcharge of matter from the incifions of fo offenfive a smell, that none of the attendants could bear to stay in the room; and having at the fame time promoted this discharge by proper digeftives, and duly purged him, he at length recovered. But his mangled face bore the Jafting marks of the malignity of the diftemper, and of the goodness of the cure.

In fine, it will be of ufe at this time to take away

fome