A Treatise upon the Small-Pox. Blackmore Richard Doddridge

proceeding from an immoderate and irregular Exaltation of the sulphurous or fiery Ingredients in its Composition. Inflammatory are such, as are attended ordinarily with painful Swellings or ​Eruptions in the solid Parts, when the active Principles of the Blood, by a vigorous Effort, not only resist the Progress of the Fever, but wholly or in part, disengage the Matter of it, and breaking off its Complication force it to lodge in the solid Parts either external or internal. If the Seeds of the Fever, which are cast out in part from the Blood, by reason of their crude and indigested State, are uncapable of breathing through the Pores of the Skin, but are caught and entangled in the small Strainers which they are unapt to pass; this Settlement at first, by the continual Supplies, and Accession of new Forces, is gradually augmented in Breadth and Size. If the Matter of the Disease be lodged on the Joints, accompanied with a threading painful Swelling, it produces an acute Rheumatism; if any where on the Surface of the Body, which happens most frequently in the Face, the Effect is an Erysipelas or St. Anthony's Fire; but if the Matter intercepted in its Passage is stop’d and confin’d in the Glands, and breaks out on the Skin in small Spots at first, which afterwards by Degrees encrease, it lays the Foundation of the Meazles or Small-Pox; and if it appears in a red Eruption, diffus’d in wider Patches on the Skin, it becomes a Scarlet Fever: But if the noxious Matter is discharg’d upon the Muscles of the Throat, it proves a Quinsy, or a painful Swelling of the Tosills; if on the internal Skin of the Chest or Thorax, a ​Pleurisy; if on the Lungs a Peripneumony; if on the Liver, Kidney, Bladder or Guts, it produces hot painful Swellings, which by Degrees often ulcerate, and sometimes mortify.

      The Reason of naming this kind of Fever Inflammatory, is taken from the Custom of Surgeons, who call the Tumours of the Body Inflammations, which accompanied with Redness, Pain, and Heat, proceed by Degrees to Digestion and Maturation: So Boils, Phlegmons, painful scorbutick red Swellings, are term’d Inflammations; and therefore acute Rheumatisms, St. Anthony's Fire, the Meazles, Scarlet Fevers, and the Small-Pox, that are attended with Symptoms of the like Nature, I call Inflammatory; for this Name does not arise from the feverish Disorder of the Blood; which notwithstanding it is excessively hot and boiling, yet it cannot in simple and malignant Fevers be said to be inflam’d; for if any Fever upon that account may be called Inflammatory, then all others likewise may be so denominated, since the Effect of all Sorts of this Disease is excessive Heat; and then the Distinction of Inflammatory Fevers would be unreasonable and impertinent. That Distinction therefore depends not upon the Symptoms which accompany the Fever in the fluid, but in the solid Parts of the Body.

      A malignant Fever, the third Species above-mentioned, does not only by the excessive ​Power and licentious Encroachments of the fiery Particles upon the other Principles, break the Order and Oeconomy of Nature, in which a healthful State or Confutation is founded, but causes likewise that Disunion and Ruin of some Parts of the Blood, in which Corruption, or Putrefaction does consist. And this is the essential Difference, that constitutes and distinguishes this from all Fevers of another Nature and Denomination; and of this I have discoursed at large in a former Writing, where I made an imperfect Division of Fevers, that is only into simple and malignant, which however was sufficient for the Subject I had then in hand. But it must be here observed, that sometimes the inflammatory Fevers are likewise malignant, by the Accession of noxious and putrid Particles, which they meet with in the Blood. And as this is evident in the worst Kind of Small-Pox, so it often falls out in the Meazles, Scarlet Fevers, acute Rheumatisms, and other Distempers of this Nature, which by the Adhæsion of ill-condition’d putrid Matter, become hazardous, and frequently of fatal Consequence.

      The Small-Pox, the Subject of this Discourse, belongs to the second Division, which may be thus describ’d. The Small-Pox is an Inflammatory Fever, accompanied by an Eruption or breaking out of small red Spots, like Flea-bites, that by degrees encrease, and ripening like little Boils, grow full of ​Matter, and at length, but not in less than in ten Days after the first Assault, compleat their Course. The intrinsick Nature and Properties that distinguish and diversify this from other inflammatory Fevers, consist in the peculiar Figure and Size of the Matter of it, that make it uncapable of being disengaged and separated from the Blood by any other Strainers, or by any other Way, than that before described; and therefore the active Principles of the Blood are, by their natural Oeconomy, necessarily determined to take this one Way, of casting off the unsound Parts for the Preservation of the whole. But what that peculiar Figure, Structure, and Disposition are, cannot be discovered by the sharpest Sight; for this, like other intrinsick essential Differences, that constitute any one Sort or Species of Things, and separate and distinguish it from all others, lying not within the Compass of human Understanding, disappoint our most diligent Enquiries, and triumph over the Endeavours of the acutest Philosopher. We must be contented in this, as in all other Diseases, to understand the Cause by the Effect, and essential Principles by their Symptoms, as we know the internal Nature of the Tree by its peculiar Fruits; and therefore I shall enter upon a fuller and more particular Description of the Small-Pox, that I may shew the Properties and Qualities by which it is discriminated from other inflammatory Fevers.

      ​This, like all other Fevers, is introduced into the Body by a cold Fit and Shiverings, or Rigours, which after an Hour or more disappear, and are succeeded by an inordinate Heat, and a disturb’d Pulse, both which are soon accompanied with great Pains, sometimes in the Head, sometimes in the Side, sometimes in the Limbs, but much more frequently in the Back, where often they are very acute and scarce sufferable; attended with great Sickness and violent Vomitings, which so nearly resemble a Fit of the Stone, that sometimes the Physician, imposed upon by the Similitude of Symptoms, has pronounced it to be that grievous Distemper. When the enormous Pain in the Back happens at the beginning, it always presages a mortal or very doubtful Event; for the dangerous Nature of the Small-Pox may be foreseen by the Violence of the Symptoms. By this Account of the first Assault of the Small-Pox, before any Eruption appears upon the Skin, it is evident, that the animal Spirits bear the first Onset, and receive the first Impression of the Enemy’s Force; which is still more manifest, by observing that Lightness of Head, or Suspension of Reason and Reflection, often goes before the breaking out of the Distemper in Spots.