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.)
![wrists, especially on the sides of the nose, upper lip, and chin ; then on the neck and breast, and afterward, on the limbs and trunk. When the papulae are numerous, their lirst appearance is at- tended by tension and slight pruritus; and, upon moving the fingers over the skin with some firm- ness, the papula? are felt to be not merely super- ficial, but based in the cutis vera. The eruption rarely commences in the lower extremities. Some- times two or three large papulae precede the gen- eral eruption, and advance to the state of vesicle before the surface is extensively occupied. The papulae are generally not thrown together con- fusedly and without order, but are arranged in groups of three or five. Crescents and circles may be traced very distinctly, when the eruption is not too copious. This constitutes an important diagnostic between variola and varicella. In most cases, the eruption affords great relief to the general constitutional disturbance. The fever abates, the sickness subsides, and the pains of the head, loins, and limbs moderate, or altogether cease. 19. The deve!opme?it of the papulae commences with the evolution of the eruption and the sub- sidence of the fever, which precedes and evolves the eruption. But during this period, although the fever abates more or less remarkably, espe- cially in the benign or distinct form of the dis- temper, yet it rarely ceases altogether, or dis- appears without returning more or less slightly in the evening. When the eruption is abundant, or the temperament of the patient is irritable or san- guineous, the mitigation of the fever is less re- markable ; and, if the eruption has been delayed, or is confluent, or if the disease be complicated by some internal congestion or prominent affec- tion, the febrile action may be continued during the development and maturation of the eruption with but little abatement, and generally in a ty- phoid, adynamic, or even putro-adynamic form or type. 20. The number of the pustules vary according to the severity of the case—from three or four to some thousands, appearing first on the face, neck, and upper extremities, then on the trunk, and lastly on the lower extremities, and changing from the state of papulae, or vari, to that of vesi- cle and of pustule in succession. When the erup- tion is fully out over the body, and the pustules on the face begin to maturate, or about the eighth day from the commencement of the eruptive fever, the whole face, head, and neck become somewhat swollen, particularly the eyelids, which are often so distended as to close the eyes ; and the swol- len parts are painful when touched, and even throb. This intumescence lasts about three days, the spaces between the pustules appearing in- flamed, or of a deep red, or damask rose colour: the closer this resemblance, the milder, generally, is the subsequent disease. Nearly one fifth of the number of pustules appear on the face ; and according to Svdenii \m, the danger is in propor- tion to the number of pustules on the face, those on the other parts of the body hardly influencing the event. This, however, is not altogether the case, for the danger chiefly arises from the ter- tian/ affects of the poison, or those produced upon vital or internal parts ; the secondary effects being the cutaneous eruption. 21. D. The suppurative or maturative Starrc— the Period of secondary Fever and Desiccation.— With the intumescence of the face, the fever,] which had remitted, returns, and the secondary fever commences. In cases of ordinary severity, the return of the fever is marked by a consider- able increase of heat of surface, by a frequent pulse, and by slight delirium, from which the pa- tient is easily roused. In favourable cases, the swelling of the face, the redness of the interven- ing spaces, and the secondary fever, having con- tinued from the eighth to the eleventh day, sub- side, and the pustules, now fully ripe, burst and discharge a thin yellow matter, which concretes into crusts that fall off on the fourteenth or fif- teenth day from the commencement of rigors, and the disease terminates, leaving the surface underneath the crusts depressed and of a pale lake colour. If the disease be of greater severity, haematuria, haemoptysis, oppression in the chest, or a hard dry cough, may be complained of, with severe headache or pains in the loins or limbs, and more marked delirium, or even sopor ; these more severe symptoms, however, generally sub- siding on the eleventh or twelfth day. 22. When the symptoms assume an unfavour- able aspect or threaten a fatal issue, then the face, which ought to have been intumescent on the eighth day, remains without any fulness or swelling; and the spaces between the pustules, instead of being red or inflamed, as seen in the favourable cases, are pale and white. Syden- ham says that the pustules look red, and continue elevated even after death ; and the sweat, which was free up to this day, suddenly ceases. At this critical period, the secondary fever, instead of presenting more or less of asthenic character, may assume either a typhoid or an asthenic or a sinking form. When the secondary fever pre- sents a typhoid type, the tongue becomes brown and dry, the pulse very frequent, and delirium soon appears, and often quickly passes into sopor or coma. In the rapidly sinking form, the patient may appear as suddenly overwhelmed by the de- pressing influence of the morbid poison, the pulse being hardly increased in frequency, the heat of the body natural, and the intellect unimpaired. Dr. R. Williams remarks, that the first case he saw of this kind, he could not help assuring the patient that his symptoms were favourable; but he shook his head, and, perhaps from an in- ward feeling that his fate was sealed, affirmed that to survive were impossible, and he died a few hours afterward.—{On Morbid Poisons, p. 228.) Such cases are, however, rare in the dis- crete small-pox, but they are much more fre- quent in the confluent (see § 33, et seq.), and result from the influence of the poisoned and con- taminated blood on the organic nervous system and heart. These cases very closely resemble, in all respects excepting the eruption, the character and termination of the putro-adynamic form of fever (which see, § 472, et seq.). 23. In the more severe cases of the discrete or distinct small-pox, the morbid poison acts not only on the skin, but also on the mucous mem- brane of the eyes, throat, and mouth, occasioning an eruption, often somewhat pustular, in these parts. This additional affection does not appear to aggravate the fever, at least not materially, but it occasions more or less inconvenience. The eruption in the mouth and throat causes hoarse- ness, soreness of throat, and difficulty of swal- lowing. When the eruption extends to the con- junctiva or cornea, it is often not attended by much pain ; but when the swelling of the eye-](https://iiif.wellcomecollection.org/image/b21111066_0035.jp2/full/800%2C/0/default.jpg)
