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.)
![variolous infection. The destructive epidemics which have occurred in warm climates and in the Western World illustrate this fact. Although in many of these much may be attributed to the high range of temperature, humidity, and other concurring causes, nevertheless much more should be assigned to peculiarity of constitution, as evinced by the remarkable prevalence and fatal- ity of the distemper when introduced into Amer- ica among the natives of all climates and locali- ties in that quarter of the globe. [The Annual Reports of the City Inspector of the city of New York, for 1824, 1830, 1834, 1839, 1841, 1842, and 1844, show that 19.6 per cent, of all who died of small-pox were coloured, while only 7.8 per cent, of the total mortality was in this class.] 94. C. There are certain circumstances, apart from vaccination, which influence not merely the susceptibility, but also the character of the mal- ady. Those just mentioned ($ 91, ct scq.), while they increase the former, have generally a very remarkable influence in augmenting the quantity of the eruption and the severity and malignancy of the distemper.—a. The character of the case generating the infection has no influence upon that produced by it, whether the infection has taken place through the medium of the lungs or by inoculation ; a discrete case may occasion a confluent or malignant one, or this latter the for- mer. This may arise from the susceptibility, or constitution, or diathesis of the infected, or from the quantity or concentration of the poison in- haled in a tainted atmosphere. The general mild- ness of the distemper, when inoculated, may be the result of the small quantity of the poison which may be administered inthisway.—b. The best state of health, or vigour of constitution, may favour the occurrence of infection, but it will also favour the appearance of a mild form of the disease ; while unhealthy or cachectic states of the frame, or some pre-existing disorder, may diminish the disposi- tion to be attacked, and yet may render the dis- temper more severe or malignant when the infec- tion is once produced.—c. Certain physical and other influences or circumstances may concur with the first manifestation of disorder to render variola mild, or discrete, or confluent, or malig- nant. Some of these, especially high tempera- ture and impurity of the air, have been already noticed (§ 93), as tending to aggravate the mal- ady. Whatever determines the circulation to the surface, as warm baths, cordials, a heating regi- men, too many bed-clothes, stimulating diapho- retics, a plethoric habit of body, and external irri- tants, increase the quantity, or favour the con- fluence of the eruption; while a cool, dry air, large and well-ventilated apartments, a cooling regimen, and active purgatives, taken during the latent period, or at the commencement of the pri- mary fever, diminish the quantity of eruption, de- termine the circulation from the external surface and lower febrile action. Vascular plethora, espe- cially if accompanied with more or less excremen- titial accumulations, favour not merely a confluent or malignant form of the distemper, but many of the complications described above (^ 44, ct seq.). Extreme debility, weakness of constitution, and anaemia, delay the eruption, and impress the mal- ady with a nervous or asthenic character. 95. F. Epidemic visitations of small-pox ob- serve several of the same laws as govern the re- currence of other epidemic pestilences: 1st. They return to a locality after a varying number of years, the intervening years presenting merely a iew cases. This may, in some measure, be owing to the numbers of susceptible or unprotected cases having become, after many years, so numerous as to furnish a sufficient supply to an epidemic out- break ; the straggling or few cases usually met with readily extending the infection to the accu- mulated mass of susceptible persons, as soon as states of air and other influences concur to predis- pose their constitutions to this result. 96. 2d. These visitations are characterized by greater severity, and are attended by a greater mortality, than when the disease occurs in soli- tary instances, or when it does not assume an epidemic prevalence : this may be owing to aerial or other causes having predisposed the constitu- tion of susceptible or unprotected persons to se- verer attacks, and partly also to more concentra- ted states of the poisonous miasm conveyed by the air from the sick to the healthy. It is thus not uncommon to find persons who have been ex- posed to the infection of small-pox on ordinary occasions without being attacked, who neverthe- less are seized by the disease in the severest form when it is epidemic. 97. 3d. Small-pox epidemics, like others, have a more or less gradual increase, and, when they reach their height, a gradual decrease. The ra- pidity of progress towards their height and their disappearance necessarily depend upon the popu- lation of districts where they break out, upon the numbers of susceptible persons, upon the com- munications, direct or indirect, between the sick and healthy, upon the observance of segregation, upon the rapidity with which the susceptible are infected, and upon the prevalence of the atmos- pheric and other concurring influences to the for- mation of an epidemic constitution, either in a limited locality, or in a more extended sphere. 98. 4th. Small-pox differs from other pestilen- ces, inasmuch as that it may be propagated at all seasons of the year, and in very different atmos- pheric conditions, although with varying grades of rapidity and prevalence ; whereas other infec- tious pestilences, as I have shown when treating of these, require certain ranges of temperature for their epidemic prevalence, or even for their con- tingent or possible communication. But small- pox, like scarlet fever and measles, although fa- voured more or less by temperature and season as these are, may prevail at any season in temper- ate countries, and more especially in the British Isles, yet the more gerferal and most severe epi- demics appear during warm seasons, or when a high temperature and much moisture in the air favour predisposition of constitution and the con- centration of the poison. This compatibility of infection with any season and range of tempera- ture incidental to temperate countries, accounts for the circumstance of small-pox, as well as scar- let fever and measles, being a domiciliated mal- ady in these countries, although occurring after longer or shorter intervals in epidemic forms of prevalence and severity, as the numbers of un- protected persons become increased, or as the protection of vaccination wears out. 99. 5th. Epidemic small-pox may be local, ow- ing to local circumstances and influences, as oc- curred in Norwich in 1819, when, between tho months of May and October, about 530 persons died of the distemper within the limits of the bills of mortality, which do not include several parish-](https://iiif.wellcomecollection.org/image/b21111066_0052.jp2/full/800%2C/0/default.jpg)
