A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8).
- James Copland
- Date:
- 1834-59
Licence: Public Domain Mark
Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
![ids, or dangerous affection of internal or vital or- gans, which more or less prominently mark the confluent and typhoid forms of the malady. The distinct small-pox presents in general the regular procession of the stages just distinguished. 13. A. The period of latency or incubation—-the precursor]/ stage—in small-pox, or the time which elapses from the inhalation of the infecting miasm, or the morbific leaven, until the appearance of the primary fever, has been ascertained with con- siderable precision on numerous occasions. In cases of inoculation the duration of the stage is rendered apparent; but in natural small-pox it is very commonly a matter of doubt. Dr. Greg- ory, who has directed his attention to this top- ic, states that a large accumulation of facts ena- bles him to fix this period at about twelve days, and that the extremes may be stated at ten and sixteen days. It has been, however, contended by several writers that circumstances may occa- sion much longer or much shorter periods of in- cubation than are here assigned, and my own ob- servation tends to confirm this opinion. A con- centrated effluvium or miasm from the infected ; a severe and prevalent epidemic ; a very suscep- tible, weak, or cachectic habit of body ; great fear of the disease, or dread of infection ; a warm, hu- mid, and close atmosphere ; and the respiration of air loaded with emanations from a number of small-pox cases, may somewhat shorten this pe- riod, and hasten the next or eruptive. On the oth- er hand, various circumstances may prolong this stage, and retard the appearance of the next, es- pecially a weak dose of the poison ; strong health and insusceptibility of the patient ; a dry, cold, and pure state of the air, or residence in a dry and bracing locality. In the former circumstan- ces, the period of incubation may possibly be shortened to seven or eight days, and in the lat- ter it may be prolonged even to twenty or twen- ty-one days ; but of these extreme ranges Dr. Gregory very strongly doubts, ten and sixteen days being the extremes, according to his obser- tion. The inoculated disease furnishes a more determinate duration, which is generally from seven to nine days. 14. The first days of this period are often pass- ed without much or obvious disorder; but in other cases some symptoms are experienced in- dicating a state of impaired health, especially lan- guor, lassitude, or malaise. When the disease is infected by a miasm floating in the air, or emana- ting from the sick, the patient sometimes experi- ences, at the time, an unpleasant and peculiar odour, generally attended by a feeling of sickness, giddiness, and of impending disease. When this feeling is strong, it is often accompanied by a state of alarm or dread, which seems to shorten this stage and to hasten on the next, and even to render the malady more severe. 15. B. The febrile stage, or that of invasion— the primary fever—supervenes upon the preced- ing period; or from the ninth to the thirteenth day from the time of infection, or from the sev- enth or eighth day from inoculation, the patient experiences rigors, followed or attended by fe- brile symptoms, especially acceleration of pulse, heat of skin, pains in the loins and limbs, rest- lessness, scanty and high-coloured urine, nausea, vomiting, &c, &c. In some cases, the rigors and heats alternate for some time, or during the first day ; but the latter generally soon follow on the former. On the second day the fever is at- tended by nausea and vomiting, and great depres- sion, with tenderness at the epigastrium on press- ure, and anxiety at the priEcordia] 1 he lassitude and torpor are often accompanied, in adults, with somnolency, headache, and sweats ; and in chi - dren, with faintness, sinking, or even with convul- sions, or eclampsia. Pain throughout the body, more especially in the head, back, loins, and limbs, is always experienced, and the pain at the epigastrium is often so severe as not to admit of the least pressure, or even the weight of the bed- clothes. In some cases the headache is attend- ed by stupor or delirium, especially in adults; and in children by sopor, or epileptic convul- sions ; in these, the face is hot and flushed, and the carotid and temporal arteries beat strongly, the tout-ensemble of the symptoms indicating great vascular reaction. Sydenham remarks, that when children, especially after dentition, arc seized with convulsions during the primary fever it is a sign of the speedy appearance of the erup- tion ; so that, supposing the convulsions to take place over night, a kindly small-pox may be ex- pected to appear in the morning. 16. In other cases, excessive prostration, with faintness or syncope, extreme anxiety at the prae- cordia, oppression at the chest, frequent sighing, and even dyspnoea, pallid countenance, coldness of the extremities, and feeble pulse, usher in the febrile stage, and take the place of rigors or chills, or follow immediately upon them. These symp- toms are indications of the depressing influence of the poisonous miasm on the organic functions, and of the inability of the vital energies to react sufficiently, or to develop a state of healthy ac- tion. In these cases, a confluent state of the dis- ease, or marked adynamia may be expected, with pulmonary congestion, &c. One or other of the foregoing groups of symptoms generally usher in the eruptive fever, and although neither of them can be considered as evidence of the nature of the incipient malady, still, the previous good health of the patient, the suddenness or severity of the seizure, the prevalence of variola in the vicinity, or prior exposure to infection, even although vac- cination or previous small-pox should have been undergone, ought to be viewed as very strong in- dications of the disease. Dr. Gregory justly re- marks, that the fact of prior vaccination should not throw the physician off his guard, for the in- itiatory fever is just as severe after vaccination as it is in the unvaccinated. 17. C. The Period of Eruption and Development. —Forty-eight hours elapse from the rigors to the first appearance of eruption. The period is nev- er less, but it may be protracted by weakness of constitution to seventy-two hours, and the full development of the eruption over the whole sur- face may even occupy three days. Generally, however, the eruption appears on the third or fourth day of the fever. During this fever, be- sides the more prominent symptoms above men- tioned, stridor of the teeth in children, with sopor, is very common; and in adults, a peculiar and fetid odour, with sleeplessness, dryness of the fauces, and turbid state of the urine. The pulse is much increased in frequency, and is either soft, or broad and compressible. The febrile symp- toms more or less abate in the morning, and in- crease towards evening. 18. Minute papulse, sensibly elevated above the general surface or plane of the skin, show themselves, at first on the face, forehead and](https://iiif.wellcomecollection.org/image/b21111066_0034.jp2/full/800%2C/0/default.jpg)
