been calculated, that every seventh child died annually of the Small Pox.

It was formerly mentioned that in various parts of Italy the practice of buying the Small Pox, and a rude species of inoculation, had been long obscurely practised. But notwithstanding the publication of the Byzantine practice, by Dr. Pylarini in 1715, and the love of letters so prevalent in Italy, inoculation does not appear to have been ventured upon by the medical profession until 1754. When most of the Italian physicians of note recommended it, and it was extended to all parts of Italy, except Naples. The practice was however in a great measure confined to persons of condition.

Spain, which is so much behind the rest of Europe in all mental acquirements, benefited on this occasion by their sluggishness. One surgeon * introduced the practice into the town of Jadrigue in Andalusia, where it was continued during forty-two years, without extending beyond that district. In the year 1772, Dr. Don Miguel Gorman måde the exertion of coming to London, to collect some information upon the subject; when he returned to Madrid he was encouraged by the court, and practised

* Practica Moderna de la Inoculation. O Scanlan. History of Inoculation, Woodville.

upon a few of the nobility. Some inoculations also were effected in a few trading cities, which held communication with England. But these efforts were of short duration, and from the distinguished inaction of the Spaniards, inocula tion was soon relinquished; and no other country in Europe has suffered so little from the Small Pox.

CHAP. XI.

CULLEN.

W

THE FINAL TREATMENT OF SMALL
POX, AND THE RESULT.

'HEN the striking advantages of the cool regimen in the inoculated Small Pox had been ascertained, it naturally occurred to Baron Dimsdale to employ it also in the casual disease? but he took little notice of the remedies which were suited to controul the malady, when it assumed the confluent and dangerous aspect. It is chiefly to the celebrated CULLEN, * that we are indebted for fixing the general principles of the treatment of Small Pox, and of reducing the entire management of both the inoculated and casual disease to one plan.

This Professor improved the treatment of most diseases; and though every system of physic, and every page of every system is defective, yet that of Cullen is always perspicuous, and still

*First Lines of the Practice of Physic, by Wm. Cullen, M.D. Edinburgh, vol. ii.

U

unrivalled. He taught that this malady, however acquired, was to be treated according to the symptoms that arose, and the type it assumed.

In the distinct species, he asserted, that the fever was of the inflammatory kind, or a synocha, which abated on the third day, and usually vanished on the fifth. When the pustules on the face were numerous, some degree of fever re-appeared on the tenth and eleventh days, but generally disappeared after the pustules were fully ripened; or perhaps remained till the pustules on the feet had finished their course. It was seldom that in the distinct Small Pox the fever continued longer. With regard to the pustular eruption, it passed through the stages of inflammation, suppuration, and desiccation.

He stated, that in the confluent Small Pox, in which the pulse was more frequent and more contracted, the fever was far more violent, and approached to that form which was found in typhus. This species was often ushered in by epileptic fits, and accompanied with delirium and coma.

Some remission commonly occurred about the third or fifth days; but about the tenth or twelfth days the fever was renewed with violence, and termed secondary: this became of the same

3

nature, and was accompanied with every symptom of that fever which has been termed putrid, and its duration and event were various.

He discriminated the eruption of the confluent from that of the distinct Small Pox, as accurately as the fever. Remarking that the inflam mation, particularly on the face, assumed the erysipelatous disposition: that the pimples were less eminent, more numerous, conjoined, and irregular in figure. The liquor secreted was first clear, then brown or black, and of a thin consistence; and the skin in some places disposed to gangrene; while this was the state of the eruption on the face, frequently the pustules on the body, and especially on the extremities, were distinct, and proceeded nearly as in the milder malady.

The above are the characteristics of the two species of Small Pox, but the line of separation is too obscure to be clearly traced: yet the danger of the disease is proportioned to its declination from the distinct species, and to its apl proximation to the confluent.

At the beginning it is uncertain which form the malady will assume. But the measures to

and to mitigate the

remedy the milder species, worst, are the same. When inoculation is adopted, it has this great advantage, that an opportunity is acquired of employing a preparatory course previous to the attack of the fever.