The store-house of physical practice being a general treatise of the causes and signs of all diseases afflicting human bodies : together with the shortest, plainest and safest way of curing them, by method, medicine and diet : to which is added, for the benefit of young practicers, several choice forms of medicines used by the London physicians / by John Pechey ...

CHAP CXVIII. Of the regular Small-Pox.

THere are two sorts of them; either they are Distinct or Confluent.

The Distinct begin with a shivering and coldness, which is presently follow'd with excessive heat, a vio∣lent pain in the Head and Back, Vomiting, a great propensity to Sweat; I mean in grown Persons, for I never yet observed any such disposition in Children, either before or after they came out; a pain at the ca∣vity of the Breast, beneath the region of the Heart, if it be pressed with the Hand, dulness and sleepiness, especially in Children, and sometimes Convulsive Fits; and if these happen to them that have all their Teeth, I reckon the Small-Pox are at hand, which most com∣monly coming out a few Hours after, sufficiently an∣swer the Prognostication: For instance, if the Child has a Convulsive Fit in the Evening, as it usually hap∣pens, the Small-Pox appear the next Morning; and moreover I have very often observ'd, that when they come immediately after these Fits, they rise in large Pustles, and are mild and favourable, and seldom flux: And these for the most part were the Symptoms which accompanied this Disease at its beginning, and preceded the eruption of the Pustles. But here it is proper to acquaint you, that sometimes it happened so, that in a looser texture of the Blood, which is easily changed, the course of separation was passed over gra∣dually without any violent sickness, before the expul∣sion of the Matter discover'd it self, by the eruption of the Pustles.

The Distinct Small-Pox usually come out on the fourth day inclusively, and sometimes a little later, but rarely before, at which time, for the most part, the symptoms are very much abated, or totally vanish, and the Patient thinks himself very well; only grown Peo∣ple are so disposed to Sweat, that they can scarce be kept from it, though they have little or no Cloaths on them, which disposition does not leave them till the Pustles begin to ripen, and then it vanishes of its own accord: The eruption is after this manner, first Pim∣ples as big as small Pins heads here and there shew them∣selves, and first of all in the Face, Neck and Breast, and afterwards in the whole Body. At this time the Jaws are affected with a pain that increases as the Pu∣stles rise, which growing daily bigger and higher, in∣flame the neighbouring skin and Flesh; for about the eighth day from the first approach of the Sickness, which I always diligently observe in this Disease, the spaces between, that before were somewhat white, now begin to be red and swell more or less, according to the num∣ber of the Pustles, with a tensive and launcing pain of these Parts, which increasing, hourly occasions the Inflam∣mation and Swelling; so that in progress of this Disease the Eye-lids are so filled up and extended, that the Patient is sometimes depriv'd of Sight, and when they are thus Tumified, they shine and are like a Bladder blowed up; and if a greater number of Pustles besiege the Eyes at the first eruption, they sooner retire to their dark Mansions; next after the Face, the Hands and Fingers, swell more or less, according to the number of the Pustles: The Pustles that were smooth and red to this day, are now grown rough and somewhat white, which is indeed the first sign of their coming to maturi∣ty; moreover, they cast out by degrees a certain yel∣lowish Matter, in colour like a Hony-comb, and the in∣flammation of the Face and hands, when it is at height, causes a very florid Colour, not unlike a Damask-Rose, in the spaces between the Small-Pox. On the Eleventh the Tumour and Inflammation of the Face manifestly diminish, and on the Fourteenth or Fifteenth day totally vanish.

That sort of Small-pox which we call the Flux, has the same Symptoms with the Distinct, only they are more violent; the Sickness, the Vomiting, the Fever, and the Restlesness, rage more violently: Moreover, a Loosness sometimes precedes the Eruption, and conti∣nues a day or two after it. This sort comes out gene∣rally on the third day, sometimes before, scarce ever after it. But it is to be Noted, when some grievous Symptom afflicts the Patient before the eruption, as a most violent pain, sometimes in the region of the Loins, like a fit of the Stone; sometimes in the Side, like a Pleurisie, sometimes in the Limbs, like a Rheumatism; lastly in the Stomach, with violent Sickness and Vomit∣ing; In these cases I have observed the Small-pox to come out later than ordinary. And in the nex place, I must acquaint you, that the Fever and other symptoms molest the sick many days after the coming out of the Pustles. This sort comes out sometimes like an Erysi∣pelas, sometimes like the Measles, and as to the out∣ward appearance they cannot be distinguished by any but those that are very conversant in this Distemper; yet he that shall diligently consider the great difference as to the time of eruption in these Diseases, and other Circumstances which he may gather from the History of each of them, will easily be able to distinguish them. These do not rise so high as the Distinct, especially those in the Face; after the eighth day they begin to change into a duskish Colour.

There are two other Symptoms that attend the Flux-pox, which are as considerable as the Pustles or Swel∣ling, viz. Salivation in grown People, and a Loosness in Children. The first of these is so perpetual a Con∣comitant, that I never knew but one that had the Con∣fluent kind and was free from Salivation; but the lat∣ter, viz. a Loosness, does not so certainly vex Chil∣dren that have this sort. Sometimes Salivation disco∣vers it self at the first coming out, sometimes not till a day or two after; first the matter is thin and easily spit up, so that the sick foul a great many Cloaths in a nights time; but about the Eleventh day it is most com∣monly

more clammy, so that it is difficulty hawked up, the Sick is thirsty, and now and then coughs as he drinks.

A Loosness does not invade Children so soon, as spitting does old People; but at what time soever it comes, if it be not stopped by Art, it continues through the whole course of the Disease.

In both kinds of small Pox, the Fever is highest from the beginning to the eruption; after which it is more moderate, till the Pustles begin to ripen, and after∣wards it totally evanishes.

I have always observed, that when the disease was violent, the sick had, as it were, a Fit in the evening; and then the Symptoms raged more cruelty.

In the next place I will treat of the irregular Symp∣toms that happen in this disease, when it is unskilfully handled.

It is to be noted, therefore, that the irregular Symp∣toms that occur on the eight Day, in the distinct small Pox, and those that happen on the eleventh in the Flux, always reckoning from the first approach of the Disease, are of very great moment with respect either to the Life or Death of the patient; and, therefore, they ought to be exactly weighed; for it is manifest that the greatest part of those that die of either sort, die on the days above-mentioned.

When Sweat is promoted much by Cordials and hot Regimen, the Particles are eliminated, which should have served to elevate the Pustles, and to swell the Face on the Eight Day; and it appears flaccid and white, and the Sweat, which flowed freely to this day, now ceases of its own accord, nor it can it be raised again with the hottest Cordials: The patient is taken light∣headed of a sudden, with Anxiety, violent Sickness and restlessness, he makes Water often, but little at a time, and in the space of a very few hours, takes leave of his Friends, and repairs to his long home.

But in the Flux the Sick is in the greatest danger, and most commonly dies on the 11th Day; for the Salivation which hitherto preserved the Patient is wont to cease of its own accord at this time: Therefore, unless the swelling of the Face persists a little longer,

and that of the Hands now manifestly beginning sup∣plies it's place, the sick must necessarily perish: But it happens too often in this hot Disease, that the Cras••s of the blood being weakened, and broke by an over-hot Regimen, and being so highly inflamed, that it is no longer able to exterminate leasurely the inflammatory Particles, (to say nothing at present of those Mischiefs that are occasioned by sweat unseasonably forced) so that either the Face or Hands do not swell at all, or the Tumour vanishes with the Salivation.

There are yet other symptoms that happen at any time of the Disease, and belong as well to the distinct small Pox as the Flux. As a Frensie, a Coma and Purple Spots, which are most commonly the forerun∣ners of Death; and sometimes there is a bloody Urin, or Blood is cast up from the Lungs, both these Hemorrhages happen most commonly at the beginning of the Disease, before the Pustles come out; some∣times also there is a total suppression of Urine. There are also other symptoms that sometimes arise from a cause contrary to those above mention'd, when the Pa∣tient has been injured by violent Cold or excessive Bleeding, or by being over purg'd, viz. the Pustles fall of a sudden, and a Loosness supervenes, so that the Patient, if he be Adult, is in great danger; more∣over, the Tumour of the Face and Hands is repell'd on this account.

But the Symptoms that proceed from taking Cold very rarely occur, for what those do that are occasioned by too hot a Regimen.

As soon as the Signs of this Disease shew themselves, I keep the sick from the open Air, and forbid them the use of Wine and Flesh, and allow them small Beer gently warmed with a Tost for their ordinary Drink, and now and then permit them to drink as much of it as they will, I order them for their Victuals, Oatmeal and Barly Broaths, and rosted Apples, and other things, which are neither too hot nor cold, nor too hard to be digested; I forthwith prohibit a hot Regimen and the use of all manner of Cordials. On the fourth day I commit the sick to his Bed; and then if they come not out well, some gentle Cordial may be properly prescri∣bed,

at least for once, to drive out the Pustles. Among the Medicines for this purpose, those they call Paregoricks, such as liquid Laudanum, Diascordium, and the like, if they be mixed in a small quantity with some proper cordial Waters excell the rest: But it is to be noted, That if I am call'd to a strong young Man, who has besides given occasion to the Disease by excessive drinking of Wine, or any Spirituous Liquor whatsoever, I reckon it not sufficient for the restrain∣ing of the ebullition of the Blood, that he abstrain from his Bed and Cordials; unless, moreover, he be blooded in the Arm.

When the Pustles first come out, I then diligently consider whether they be of the distinct or confluent kind, because they differ exceedingly one from the other, though they agree as to some symptoms. If, therefore, from the bigness and paucity of the Pustles, and the slowness of their coming out, and from the vanishing of sickness and other symptoms, which tire the Patient after the eruption of the flux Pox, it ap∣pear that they are the distinct sort, I take care that the sick be refreshed with small Beer, Oatmeal and Barly-gruel, and the like. And if the small Pox be but few, and in Summer-time, and that very hot, I see no reason why the Patient should be kept stifled up in Bed, and why he may not rather rise a few hours every day, provided the inconveniencies of too much Cold or Heat may be prevented by the place and cloathing; but if either the cold season of the Year, or a large eruption of the Pustles, put the Patient under a ne∣cessity of keeping his Bed continually, I take care that he lie not hotter nor has more Cloaths on him than when he was in health, and that he have a Fire kindled only morning and evening, unless it be Winter; nor do 〈◊〉〈◊〉 require that he should be always fixed to one place, lest he sweat, which I confidently affirm cannot be promoted without great danger.

When the Disease is going off, it is proper to give three or four spoonfulls of Canary-Wine hot, or some other temperate Cordial Medicine. At the same time also, a little hotter and more Cordial-diet may be al∣lowed. For instance, Sugar-so••s, and Oatmeal-candie

and the like; nor is there need of any other thing at all in the distinct and gentle sort, if the Patient will suffer himself to be treated moderately in this method and diet, unless by change Restlessness, or Watchings, should now and then persuade the use of a Parego∣rick.

But if the small Pox Flux, the case is very hazar∣dous; for I reckon this sort is no less different from the other than the Plague is from this; though among the Vulgar, who take names and words for things, the cure of both is said to be the same; for towards the end of the disease the sick is in great danger, viz. on the 11th Day in the common Flux-pox, on the 14th Day in a worser sort, and the 17th Day in the worst sort: But sometimes, though rarely, one the 21st Day, the Fever, the Restlessness and other symptoms invad∣ing together, whereby the sick is generally destroyed, unless Art relieve him: Wherefore, seeing there is so much danger when they Flux, the Physician should en∣deavour all he can to hinder their Fluxing, by bleeding presently in the Arm, if there be the least suspicion of the Flux-pox, and by giving a Vomit afterwards, and by keeping the sick up till the 6th Day from the first sickness. Afterwards he must be put to Bed, and keep there to the end of the disease; but he must have no more Cloaths on, nor a greater fire in his Chamber than he used to have when he was well, and he must drink freely of small Beer or other cooling Liquors. But because, notwithstanding the sick frequently grows hot, lightheaded, and restless, I give an Ano∣dyne every Night, but a little earlier than is usual; because in this Disease, a fit of heat and restlessness comes almost every day towards the evening.

But, which is to be lamented, notwithstanding these things, and all other Physical Helps, the sick is very often seized on the 11th Day, or on some other of those Days, which we said, were most fatal in the various kinds of Flux-pox, with a violent Fever, difficulty of breathing, and restlessness, and dies suddenly. In this case nothing is more effectual than the taking away of ten or twelve ounces of Blood, and in the evening a large Anodine must be given, as before; and so

afterwards morning and evening, and sometimes oftener; for it is diligently to be noted, that in some the fury of the Disease is so high, that a very large dosed Anodyne cannot stop its force in 12 hours; in which case it is necessary to repeat the Anodyne every 6th or every 8th hour.

But because it happens often at the latter end of the Disease, that the Body is bound up so much, that the sick is like to be suffocated, and consequenrly is in great danger; in this I have given successfully an ounce and an half of Lenitive Electuary dissolved in four ounces of Succory-water or the like; which Draught gives some stools before night; but if it does not, an Anodyne must be given in the evening, and sooner, not∣withstanding the Purge, if great Restlessness or some considerable sickness threaten danger.

If, therefore, the Purge does not answer the first day, it must be repeated the next, and then it seldom fails, and in this manner Bleeding and Purging may be repeat∣ed by Intervals, as occasion requires. But it is to be noted, that the sick must not be purged till the 13th day or after, nor then, unless Bleeding has gone be∣fore. For spitting of Blood and a bloody Urine coming upon the small Pox, for both these Hemorraghes come sometimes at the beginning of the Disease: After bleed∣ing largely once, give an Anodyne.

Take of red Poppy water, two ounces, of liquid Lau∣danum, 14 drops, of distill'd Vinegar, three drachms, of Diacodium, half an ounce; make a Draught to be repeated every night at bed time.

Take of Troches of Lemnian Earth and of Bole-armen∣ick, each one drachm, of sealed Earth, Bloodstone, Dragon's-blood and red Coral prepared, each half a drachm, of Mastich and Gum-arabick, each one scruple; mingle them, make a fine Powder, whereof let him take half a drachm every third hour in a spoonful of syrup of Comfry, drinking upon it four or five spoonfuls of the following Julep.

Take of the Waters of Plantain and Oak-buds, each three ounces, of Cinnamon-water Hordeate, two ounces, of syrup of dried Roses, one ounce; make it a little acid with spirit of Vitriol.

Emulsions also of the four greater cold Seeds with white Popies do a great deal of good. But after the Hemorrhage is stopt, you must proceed according to the method described in the small Pox.

Great care must be taken that the Salivation con∣tinue according to the manner of it, from the begin∣ning to the 12th or 13th day; for if it quite stop before the 11th day, the Sick is in great danger: It may be much promoted by ordering the Sick to drink freely small Beer, or any other Liquor, which is neither heat∣ing nor provokes sweat.

In the next place the Loosness in Children must be permitted, because it evacuates the morbifick matter. At last, when the Pustles are crusty and hard, I use to anoint the Face often with Oyl of sweet Al∣monds.

If in the distinct small Pox the Face does not swell, I give an Anodyne presently; but if the Patient be light-headed and very sick, and makes Water often, but little at a time, he can be relieved no other way, Death being near at hand, than by giving Narcoticks freely, or by taking away a large quantity of Blood, and by exposing the Body to the Air; but I would not be so understood here as if in every Phrensy coming upon the small Pox, there being no Symptom more frequent, that I should advise Bleeding presently; but only in that which therefore happens, because the Face does not swell in the distinct kind, tho' there be a great number of Pustles.

If in the Flux-Pox the Spitle be so thick and clammy that the Sick is in danger of being suffocated, which happens often on the 11th day, a Gargarism must ne∣cessarly be prescibed, and must be ordered to be used often Day and Night: It may be made of small Beer or Barly-water, with Hony of Roses. Or, the follow∣ing may be used.

Take of the bark of Elm, six drachms, of Liquorice, half a drachm, of Raisins of the Sun ston'd number twenty, of red Roses, two pugils; boil them in a sufficient quantity of Water to a pint and an half: In the strained Liquor dissolve of simple Oxymel, and of Hony of Roses, each two ounces; mingle them, make a Gargarism.

But when the sick is in danger to be suffocated every moment, and is stupid, an ounce and an half of the Infusion of Crocus Metallorum must be given, for a less Dose will not work, by reason of the stupidity of the sick. But this Remedy does not always do the bu∣siness.

The Coma may be easily relieved by the help of a moderate Regimen.

For a Suppression of Urine, which sometimes afflicts young and brisk People, nothing does so well as taking the Sick out of Bed; and after he has walked twice or thrice cross the Room, by the assistance of the By-stand∣ers, he will presently make Water freely, and be much relieved thereby.

But the Symptoms arising from catching cold, or by Evacuations unduly used, whereby the small Pox are struck in, must be removed by Cordials, and an agree∣able Regimen; but they must not be continued after the Symptoms are gone off: The chief of these are a flatting of the Pustles, and a Loosness in the distinct small Pox; for in the Flux a depression of the Pustles is natural; nor is a Loosness dangerous in Children. In both these cases, a Cordial-potion made of distilled Waters, Diascordium, liquid Laudanum, and the like, is proper, not only to remove these Symptoms, but also at any time of the Disease, if the Sick com∣plain of a pain at the Heart, or of sickness. But to speak the truth, Symptoms of this kind are very rare, compared with those which owe their original to the other extream, which is more fatal, though less bla∣med.

When the Patient is mending, and the Pustles are falling off, after he has 〈◊〉〈◊〉 Meat a few days, namely, about

the 21st or 22d day, I think he ought to be blooded, if the Disease has been violent; and, after Bleeding, he must be purged three or four times.

But sometimes after the Sick has recovered of the Flux-Pox, and rises daily, he has great swellings in his Legs; but they either go off of themselves, or are ea∣sily cured after Bleeding and Purging, by the use of emollient and discutient Herbs boiled in Milk, as Mal∣lows, the leaves of Mullein, Elder, Bays, with the flow∣ers of Camomil and Melilot.

The distinct irregular small Pox of the years 1670, 1671 and 1672, differed from the general distinct small Pox in the following things: First, the Eruption was generally on the third day, and then in the process of the Disease the Pustles did not arrive to a due bigness; and towards the end, when they began to ripen, they seemed black.

Moreover, there was a salivation sometimes, though rarely, when there were very few Pustles: But the flux-Pox differed in many things from the other Flux-Pox; for they came out sometimes on the second, some∣times on the third day, in the form of a redish Tumour covering the whole Face, and thicker than an Erysipe∣las, and scarce any visible distance betwixt the Pustles, with a heap of almost infinite, red, angry Pimples run∣ning into one, and disguising the whole Body between the Pustles; especially in the Thighs appeared some little Bladders very conspicuous like a burn, and distended with clear Water, which flowed out plentifully, when the skin was broken, the Flesh underneath being black like a Mortification. But this dreadful symptom seldom happened.

The Fever, and all other symptoms which either preceded or accompanied this kind of small Pox were more violent than in other sorts of Pox, and had a greater Inflammation. The free use of the white Deco∣ction and Milk-water did a great deal of good in this sort.

The Flux of the Courses, which happens often to Wo∣men when they have this Disease, requires a free use of these Liquors, if they flow at an unusual time.

A Gentlewoman that had this black sort of Pox was seized with so large a Flux of the Courses at an unusual time, that the Women about her thought she had mis∣carried, and tho' this Symptom continued many days, yet I continually used the Milk-water through the whole course of the Disease.