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DAVID BREWSTER, LL. D.
F. R. S. LOND. AND EDIN. AND M. R. I. A.
CORRESPONDING MEMBER OF THE ROYAL ACADEMY OF SCIENCES OF PARIS, AND OF THE ROYAL ACADEMY OF SCIENCES OF
WITH THE ASSISTANCE OF
GENTLEMEN EMINENT IN SCIENCE AND LITERATURE.
IN EIGHTEEN VOLUMES.
PRINTED FOR WILLIAM BLACKWOOD;
AND JOHN WAUGH, EDINBURGH; JOHN MURRAY; BALDWIN & CRADOCK;
SECT. XIX. Variola. Small Pox.
We now come to the second genus of the Pyrexia, the Exanthemata, diseases consisting of fever, upon which supervenes, at a certain period, a cutaneous eruption, characterized by specific symptoms, and continued during a certain length of time; they have also the peculiar property of occurring once only during the life of the individual, and they appear to be always produced by a specific contagion. The diseases to which the above characters strictly apply, are Variola, Vaccinia, Varicella, Scarlatina, and Rubeola.
The disease of Variola, or Small pox, which a century ago was scarcely less dreaded than the Plague itself, affords a memorable example of the triumph of the medical art over what appeared to be an inevitable evil attached to human existence. By the introduction of inoculation, the disease was rendered comparatively safe to the individual, and by the substitution of the vaccine for the variolous poison, this benefit has been extended to the community at large. Some time must be allow for the prejudices of mankind to subside, but we have every reason to hope that ultimately this destructive scourge will be banished from all civilized countries. According to the degree of violence with which Variola exists, it constitutes two varieties, which although evidently belonging to the same disease, and convertible into each other, differ essentially in their symptoms, and require different modes of treatment; from the peculiar appearances of the eruption, they have obtained the names of distinct and confluent.
The first invasion of Small-pox is marked by symptoms of general fever, which partakes of the inflammatory type, and is characterized by vomiting, and by pain upon pressing the region of the stomach. On the third or fourth day, the eruption begins to appear on the face, and in about two days is completed over the body. It appears in the form of small red points, which afterwards rise into pimples, and at length, by the fifth or sixth day, are converted into vesicles, containing a light yellow fluid. These vesicles are surrounded by an inflamed margin, so as to produce a considerable redness over the whole surface of the body, which is not actually occupied by the vesicles themselves; and all the soft parts, especially the face, is so much swelled,
VOL. XIV. PART 1.
that the eyelids are often completely closed. About the Practice. eleventh day, the fluid in the pustules becomes opaque, and of a yellower colour, and being now fully matured, the vesicles burst and shrivel up, and the inflammation gradually subsides, leaving red marks upon the skin, which, when the disease has become violent, are suc ceeded by pits or depressions, that are never afterwards obliterated. The pustules on the other parts of the body proceed in the same order with those on the face, but go through their successive stages a day or two later, and are generally attended with less inflammation.
In the distinct and less violent form of the disease, Confluent. the fever abates when the eruption is completed, and seldom returns in any considerable degree; but, in the confluent variety, what is called the secondary fever comes on at the period of maturation, which is often equally violent, and is indeed more to be dreaded than the first, or the eruptive fever. All the symptoms are more urgent in this variety, and come on at an earlier period, although at the same distance of time from each other; the pustules are more numerous, so as to run into each other, and form large patches of continuous suppuration, while, at the same time, they are less elevated than in the distinct kind, and have less inflammation round their margin. The fever is also of a different nature, exhibiting more of the typhous type, and the system in general seems to be more oppressed and torpid, and to be less capable of re-action. The prognosis of the disease depends very much upon the nature of the variety to which it inclines; for while, in the distinct Small-pox, we may generally hope for a favourable issue, the confluent is, for the most part, altogether be yond the reach of our remedies. What circumstance it is which produces the two varieties we know not: it depends, in a great degree, upon what may be called the prevailing character of the epidemic; in some the distinct, and in others the confluent, being much the most frequent; but we are not able to connect these differences in the nature of the epidemic with any external circumstances, or with any peculiar states of the constitution. We have sufficient evidence that it does not depend upon any specific difference in the nature of the contagious matter; because both the varieties are capable of being produced from the same source of infection.