Smallpox, a very common disease among children, which also attacks adults in all ages, is common in France, England, and other countries.

This disease appears on the skin, which it covers with pustules; its origin is uncertain, we have not found that they mentioned it before the Arab physicians. It strongly resembles measles, so that it is difficult to distinguish the two during the first three days.

Both come from an impure blood loaded with putrid miasma; the causal agent of measles is more acrid and subtle, warmer and more bilious; we claim that both do not return once we have had them, but experience demonstrates the contrary in France. As for the way by which this disease is produced, some, like Olaeus, would like that we demonstrate its cause with birth and that [smallpox] does not show itself until it has had the occasion to develop; adding that almost all men have smallpox and that there cannot be one in a thousand who escape it.

Drake compares smallpox to the leprosy of the Arabs, and claims that it is a temporary and critical leprosy caused by a saline serum, which arouses a fever by means of which the blood is purified.

There are two species of smallpox , distinct and confluent. In the first, the pustules are separated and one by one; in the second, the pustules are touching, and are crammed together in a way that they can only form one scab.

Mr. Sydenham observes that distinct and regular smallpox starts by a shaking and coldness followed by a great warmth, a headache and backache, vomiting, drowsiness and often epileptic fits; the eruptions usually arrive the fourth day. The pustules appear first on the face, secondly on the neck, then on the chest; at the beginning they are reddish, then they increase and whiten by degree, the eleventh day the swelling and inflammation of the face vanish, and the pustules begin to fade, around this time is the end of the critical and dangerous period; then the pustules begin to dry out, and near the fifteenth day, they appear to diminish and begin to fall off, and so we believe that there is no longer any danger.

Distinct smallpox follows this turn of events, unless it arises in the pathways of the stomach or other symptoms upset the ordinary course of the disease.

Confluent smallpox has the same symptoms, but by a degree more violent. The pustules appear normally on the third day, not separated as in the previous case, but into each other and at the end they appear as one small whitish film over all the skin, and all over the body, and above all the head is considerably swollen; next this film becomes blackish. This type of smallpox is accompanied in adults by salivation and by diarrhea in children, salivation often starts immediately after eruption, but diarrhea comes later. This type of smallpox is much more dangerous, it is usually complicated by purpura and anthrax, and it often carries away the ill on the eleventh day.

This disease is epidemic, begins in spring, increases towards the summer, and slows down towards autumn, and starts anew toward the beginning or middle, and the end of the following winter.

It is divided, according to Mr. Morton, into four stages: 1st The preparation known as its incubation or fermentation ; this is the first stage of the infection.

2nd The eruption which lasts four days, like the first stage and when the pustules push out continually, starting with on the face, secondly the neck, next the chest and finally all over the body; it should be noted that the eruptions are on the inside as well as on the outside.

3rd Suppuration or the spots widening, rising, whitening and coming to a head, and then filling with pus, and becoming covered by a scab more or less dirty and dull.

4th The drying out or the pustules shriveling and subsiding, drying out, falling off, and leaving in their place a superficial and red cavity which stays a long time after all the symptoms have disappeared.

There are four degrees of malignancy: 1st when the pustules are universally confluent and crammed; 2nd exceptionally confluent; 3rd distinct, but very small and consistent, bordered by black or a vivid and inflamed red; 4th when the pustules are distinct, but with a petechial eruption, purpura or the eruption which accompanies military fever. [1]

Causes : as this disease attacks all ages of men and women, children and the elderly, and it occurs in different countries at once, it appears that smallpox comes by contagion, and that it is gained by communication with a person who had it previously. Pathways which serve to communicate this kind of contagion are the air, which is loaded with it and carries it into the mouth, nose and lungs, esophagus, stomach, intestines, and during the same period the contagion does not yet have much of a venomous side, but it instigates it in our humors, by using raw, undigested humors or corruption therein, and this venom can keep a long time without manifesting itself.

The remote cause will be therefore an infection which is transmitted to us or which has developed in us. Nobody knows of what it consists, it has at the least a lot of similarity to our humors and the lymph that separates in the glands of the skin; is this a similar humor to leprosy? Is this a virus that we carry from birth; that is what we cannot decide.

The occasional causes can be: 1st some alteration or change in the air, since smallpox comes more frequently towards spring, and as elsewhere it is in Europe more epidemic and more fatal during particular times and above all towards the spring.

2nd Fear that becomes so overwhelming that it is not easy to express; it is only by too much experience, which is the effect of passions on the body and our humors. Fear caused smallpox in some individuals who found it without thinking of it or expecting it in the places where there were sick attacked by smallpox .

3rd By indigestion, undigested humors, rot of the first pathways, the use of overly hot broths, which alkalize and putrefy, or constitute the blood.

All these causes suffice to determine an adverse causal agent to produce its effect and to grow.

Symptoms . Once this germ has appeared, it is followed by the subsequent signs: horror, shivering, an acute and inflammatory fever, blazing and continual warmth, glistening, sparkling and tearful eyes; different pains which attack the head, back, and extremities and especially the stomach; because there occurs some cardialgia, weakness, nausea, vomiting, which above all is ordinary with children, anxiety, numbness, drowsiness, slumber.

These symptoms are compounded by others which belong to different diseases, such as side pain, cough, spitting out blood, restricted breathing, trembling and convulsive, a stupor with an awkward position of the head, jerks in the tendons, bloating in the lower abdomen, hardness in its different regions, an inflammatory colic, suppression of urine, tenesmus, other times diarrhea and dysentery take up the part and stop the eruption or make the venom return inside when it had already gone out through the skin’s pores.

Prognosis . The earlier smallpox appears in the spring and the more the air is disposed to promote the disease, the more dangerous it becomes.

2nd Confluent [smallpox] is as dangerous in children as in adults; and more in the latter than in the former. But the danger is much greater if there is suppression of the urine, nausea, delirium, patches of the purpura, crystallin, [2] bloody urine.

3rd Phthialism or sudden stopping of salivation, and not returning within 24 hours, marks a great danger; but it occurs only in confluent [smallpox] and again in adults. In this type the patient is not out of danger before the 20th day.

4th If the smallpox is distinct, round, and large so that pustules fill and grow into a point at the tip; if the vomiting, headache, and fever cease or diminish significantly after the eruption; if moreover the patient has peace of mind and is without apprehension, the danger is ordinarily passed around the tenth day. Convulsions are very dangerous.

In general when smallpox follows some debauchery or excess, be it of liqueurs, food, or otherwise, it is very dangerous and lethal for the average individual.

Treatment . Feelings are strongly divided on this matter. The common person wants us to give cordials in order to help the eruption; sensible physicians, such as Boerhaave and others, look at this disease as inflammatory and want us to treat it as such. But this treatment must vary according to the type, stages, and degrees that we have distinguished in smallpox . On this basis we must recall what we have said in discussing eruptive fevers.

In the first stage, which is that of incubation or fermentation, one should generally bleed in order to relax and loosen the skin and to aid the eruption; but one should bleed less than in an ordinary inflammation. One should subsequently order an emetic or a purgative for the purpose of evacuating the primary pathways, or slightly purging enemas.

Drink will be thinning, moist; broths will be light and slightly nourishing in order to not raise the fever. See Inflammation.

In the second stage, we will help the eruption with a light tisane of black salsify, lentils, white swallow-wort, or otherwise, or diluted wine, or staghorn gruel.

The manner [of the patient] will be tempered: the patient will take heavier broths.

In the third stage, we will aid suppuration by continuing the same diet; we will let out even more through the skin by using light diaphoretics.

Finally at the end we will push with stronger sudorifics: the food will be more substantial. We can then divert part of the humor through the stools.

One should purge after the scabs have fallen, or when they begin to fall, and do so repeatedly, in order to prevent the reflux of the purulent matter to the inside. We will use detersive, balsamic, and fortifying tisanes; we will prescribe detersive liniments to be placed on the pustules, or a simple anointing with a rose salve, or an ordinary ointment.

The best way to prevent the spots from widening is to not touch them or to prick them slightly in order to evacuate the pus, so that it does not corrode the skin underneath the scabs.

We absolutely cannot give general rules on the treatment of smallpox ; as its cause is unknown to us, we cannot in this respect treat it only by empiricism: the symptoms only give us some indications. We see the ill perish after bleeding; we see a lot who recover without bleeding, or other preparations.

Mr. Friend and others are for bleeding; the Germans bleed slightly. Alsaharavius in the first stage of smallpox recommended bleeding just until weakness and blackout. Mr. Lister had found that in malignant smallpox the blood is excessively pale and powdery, of the sort that the limpest feather could easily divide its corpuscles.

Etmuller says that we should have on top of it all a particular attention to the breath, respiration, and the voice; and that when these two things are good, it is a good sign. He adds that horse manure is an excellent medicine in that it causes a sweat and safeguards the throat.

The common person is prejudiced that all drinks must be red because of the heat that he claims is alone necessary in this disease.

Some authors have proposed mercurials in the beginning by establishing a parallel between syphilis and smallpox .

Inoculation . Brought to us from the Indies and Mingrelia, [3] one other method to treat smallpox is inoculation . It consists of giving smallpox by communicating its venom to a patient by making the pus from a smallpox pustule enter by some opening made in the skin or by placing in the nose a quite considerable grain of the germ: then we treat the patient methodically. See Inoculation.

Chickenpox . [4] This disease has a lot in common with true smallpox ; but it is much milder, more superficial. One observes the four stages like in the real one, although less marked. Those who deny that you can have this disease [5] two times say that chickenpox comes from a failure of sufficient eruption of smallpox ; by which means there still remains enough causal agent to produce a new eruption and that true smallpox destroys the glands and tissue of the skin when it is abundant, which prevents it from returning. This cause cannot occur when smallpox is poor, and we only see some specks which come out here and there.

It is commonly thought therefore that the latter is caused by the remains of the causal agent of smallpox which could not come to light, or which did not have enough strength not having found the intermittent causes vigorous enough to produce true smallpox . This matter being in the blood, either from birth, or a contagious interaction, remains there and does not produce its effects as much as on another occasion, finding a lack of the causes that aid its development and elevation. The particular force of temperament, the commendable quality of humors that will make the tips of the virus dulled or oppressed, so that they will lose their vigor. If therefore a cause of smallpox , but weakened or less energetic, exists in the blood it could on the occasion of air or a light fermentation in the humors produce some mild effects or complete the elimination of the virulent humor not competed the first time; it will separate from the blood and appear under the form of chickenpox .

It will happen therefore that a person who will have had true smallpox , could still have chickenpox ; and that others who never will have had the first, will however have the second. The treatment of chickenpox must be the same as for the real [smallpox], with some minor differences. Thus we will bleed less, purge less, we will prescribe a less strict diet. See True Smallpox.

Chickenpox, as well as the other, often leave after-effects or unpleasing consequences; whereupon it should be noted that it comes during an imperfect elimination of an overly abundant humor that burst onto different parts [of the body], as occurs in some people who are left blind, others are crippled, fall into phthisis or the doldrums. See these articles .

The true way to prevent all these disorders is to aid nature and to complete what it cannot do alone, I mean that one must use purgatives, aperitifs, mercury pastilles, baths, sudorifics, mineral waters, milk, and finally all the recommended aids in order to divert imminent consumption, or chronic diseases of which we fear the after-effects and length. See Chronic. See Phthsis.

Milk cut with sudorifics, exercise, change of air, and finally healthy foods, with a proper diet, will be excellent prophylactics against imminent phthisis following smallpox , or a badly treated [smallpox], or a returning [smallpox], or one which will go out badly.

Notes

1. Millet is the term used to designate the particular eruption of marks which occurs during an episode of military fever.

2. A skin condition defined by transparent blisters, sometimes clustered together and surrounded by a red circle.

3. A principality in western Georgia, also known as Samegrelo or Odishi, that remained independent until 1803 when it was subjected to the rule of the Russian Empire.

4. I have translated petite vérole volante as chickenpox. This is a commonly accepted translation, although other scholars have argued that petite vérole volante was in fact another pox disease closely related to smallpox that no longer exists in the modern era. Based on modern germ theory, chickenpox and smallpox, although both pox diseases, are not classified as belonging to the same disease family.

5. Smallpox. During the eighteenth century, the question of whether or not an individual could have smallpox more than once became a central issue in tumultuous debate in Europe over inoculation and the prevention of smallpox.