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wishes, áll possible means are to be employed to throw the morbific humour on the skin ; with which intention every thing is to be done in this case, which we have proposed in treating of the simple fort. But yet each fpecies of the malignant fort requires a peculiar confideration.
Whereas, in the crystalline fort, the water of the puftules can never be brought to a laudable fuppuration ; it ought to be carried off by those passages in the body, which are naturally adapted to the secretion of the thinner fluids. Now, I have said above, that there is a great correspondence between the skin and the kidneys. Therefore, while the thinnest parts of this water are made to transpire through the skin, the grosser parts ought to be drawn off through the urinary passages, by diuretic medicines. Of this tribe there is nothing better than nitre, and that may be administered three or four times a day, in such quantities as may not offend the stomach, to wit, a scruple or half a drachm, dissolved in sinall 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 soft and generous wine to support his strength. But while nitre is thus taken, it will be right to interpose those medicines which cherish the heart, and promote the flux of the humour into the pustules" : such as Raleigh's cordial, or the cordial confection'; the bezoardic powder, fometimes with a little faffron; and the plain fpirit of hartshorn. Besides these, on the fifth or fixth day of the eruption, blisters are to be applied between the shoulders, and to the arms and legs : for which purpose, the blistering epithem is most convenient, as its soft consistence enables it to reach the skin between the pustules, and stick to it. For by this discharge of the serosities, the fever, which increases, when there is no farther derivation of hu. mours to the skin, is feafonably prevented.
I know indeed, that most of our physicians 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 fies might be an obstacle to the due propulsion of the humour into the beginning puftules.
The warty small-pox is more dangerous than the crystalline ; because the matter of the disease, being too thick, can neither fuppurate, nor pass off by urine. Wherefore it is necessary to use the utmost endeavours to take off the fever, and to provoke sweat, in order to digest the morbid humour, by the cordial medicines aforementioned. And blisters ought to be applied in this case likewise. But the Arabian physicians pronounced this fort of the disease to be always fatal *.
Lastly, that fort which I have called the bloody small-pox, requires peculiar attention. Now, in this fort, if there is any room for physic, those medicine3 bid fairert for success, which, by their ftypticity, thicken the blood in some measure, and fo check it, that it cannot break through even the finallest arteries. The best of this kind are the Peruvian bark, alum, and that spirit which is called oil of vitriol, Now, these are to be used alternately in this manner. A drachm of the bark may be given every sixth hour; * See Rhazes's treatise annexed, chap. viii.
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 inspisfated 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 conserve of red rofes, will be a proper dose. The most convenient manner of giving the oil of vitriol, is in the tincture of roses ; five or fix spoonfuls whereof may be taken several times in the day.
And besides, the patient's common drink may be acidulated with it; especially if purple or black fpots appear interspersed among the pustules. And this medicine will be of great service, not only in the bloody, but in all the other forts likewise, accompanied with these spots. This one thing more I will add, that I have experienced the use of blisters to be fafe enough in this case, when a delirium requires their application. I have indeed feen fome patients recover by this method, who had discharged 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 diseafe terminated in some considerable evil. For they were tortured, either with boils breaking out in many parts of the body, or with glandular swellings under the ears or armpits, which were not easily brought to suppuration. I likewife remember the case of a young man, one of whose tonfils 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 mass of blood of this poison ; and that a perfect recovery is not to be procured without a fuppuration,
either in its due course of time, or in the last stage of the distemper.
But in every fort of this disease, 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 pustules are drying ; or upon the subsidence of the swelling of the inflamed skin, where there is no fuppuration ; which fever cannot be taken off with equal safety by any other means. But gentle cathartics alone are to be employed in this case, such 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 likewise abundantly confirmed it afterwards, by the authorities of ancient and modern physicians. So that whosoever refuses his affent to this practice, must resolve not to see at noon-day. All fevers have their certain periods ; and where the poisonous matter has once infected the humours, the putrid fuel of the disease can hardly be thrown out of the body early enough. And indeed, when this rule is not observed, we daily see the diftemper followed immediately by a hectic fever, attended with a cough, spitting of purulent matter, hortness of breath, and other fymptoms of the lungs being affected.
But I must observe in this place, that, however beneficial purging may be at this time ; yet, if the body happens to be too loose, either from the natural state of the intestines, or by frequent clysters, this
* Vid. Freind commentar. vii. ad Hippocrat. de morbis popularibus. Et epift. de purgantibus in secunda variolarum febre adhibend. Vol. II.
remedy remedy becomes less necessary, or at least may be postponed for some days. For great regard is to be paid to the patient's strength, which the length of the illness has more or less impaired.
Moreover, it is requisite to be very circumspect, whether there be any remains of the purulent matter lurking under the withered skin of the pustules; for this is fometimes so manifestly the case, that though the fcabs appear dry and hard ; yet, upon some of them breaking here and there, there issues forth very fætid matter. In this circumstance, 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 disease, and yet the patient recovered. I shall never forget the case of a certain young man of a very robust constitution, who had fo dreadful a fort of the confluent small.pox, that when the pustules should have ripened, his whole face was become black and dry; and, in short, thoroughly mortified. As the case seemed quite desperate, I ordered incisions to be made to the quick in many places, and fomentations of a decoction of emollient and warm plants, with the addition of camphorated spirit of wine, to be applied to the parts: whereupon there followed a discharge of matter from the incisions of fo offensive a smell, that none of the attendants could bear to stay in the room; and having at the same time promoted this discharge by proper digestives, and duly purged him, he at length recovered. But his mangled face bore the Jasting marks of the malignity of the distemper, and of the goodness of the cure. In fine, it will be of use at this time to take away