Part 7 (1/2)
For the irritation of the brain, and furious delirium that sometimes sets in after the cessation of cholera symptoms, _Secale_ and _Belladonna_ in alternation will prove specific.
Let the patient have warm or cold drink as he prefers, and let his covering be light or plentiful as is most agreeable. As soon as he gets easy, and the vomiting and purging cease, and his pulse begins to return, keep him quiet as possible, let the room be darkened and everything still, so that he may go to sleep, which he is inclined to do, this being the surest restorer. I am quite sure I have known several patients carried off by a return of the disease, after it had been effectually arrested, in consequence of sleep being prevented by the rejoicing officiousness and congratulations of friends, disturbing and preventing that early and quiet slumber which nature so much needs, and must have, or hopelessly sink. The diet for two or three days after recovery, should be a little oat meal gruel or rice.
Small Pox--Variola.
This disease begins with pain in the head and back, chilly sensations, followed by a high fever, so similar in all respects to a severe attack of Bilious or ”winter” fever, that it is difficult or impossible to distinguish it with certainty, as Small Pox. The fact of the prevalence of the disease at the time, and the exposure of the patient, may lead the Physician and friends to suspect Small Pox. There is one very striking symptom of Small Pox, however, that exists from the beginning, which, though it may be present in fever simply, is not uniformly so.
This is a severe and constant aching _pain in the small of the back_.
The headache is also constant.
The Small Pox is of two varieties or degrees, _distinct_ and _confluent_. The _distinct_ is when the pustules are separated from each other, each one a distinct elevation, with more or less s.p.a.ce between them not affected by the eruption.
The _confluent_ is where the pustules spread out from their sides and run together, covering the whole surface as one sore.
It may be distinct on some parts, as on the body, and confluent on others, as the arms, face, and parts most exposed to the air.
In the _Distinct_ variety the fever continues without abatement until the eruption appears, when it entirely subsides, and that quite suddenly. The eruption comes out about the third day of the attack, sometimes not discoverable until the end of the third or beginning of the fourth day. The eruption is at first very slight, beginning with small red pimples on the forehead, upper part of the cheeks, neck and upper part of the breast, extending by degrees to the arms, and other parts of the body and limbs. About the end of the fourth or forepart of the fifth day, the eruption is complete.
There is a symptom, not mentioned in the books, which will often determine the disease before the occurrence of any eruption. It is the appearance of hard shot-like pimples, to be _felt under the skin_ in the palms of the hands, while there is, as yet, no trace of eruption to be seen upon the surface.
On the eighth or ninth day, the eruptions become vessicular, have flattened tops, and contain a limpid fluid. The parts continue to swell, the eruptions to enlarge, and become filled with purulent matter, having a dark color at the top, up to about the fourteenth or fifteenth day, when they begin to flat down, to dry up, and some of the scabs become loose. At this time, some fever arises, often quite severe, with headache and other inflammatory symptoms. If the eruption is very severe, fever will be of corresponding violence, and lighter or wanting when the eruption is mild. This fever rarely lasts more than twenty-four hours, from which time the patient rapidly recovers.
In the _Confluent_ variety, all the symptoms are more violent, the fever continuing after the eruption begins. The pustules burst early, and run into each other, covering nearly or quite the whole skin; the surface swells and turns black or dark brown, the lungs are more or less irritated, producing cough, and not unfrequently the stomach is nauseated, and vomiting ensues.
If the patient survives the irritation up to the fifteenth or sixteenth day, when the _secondary fever_ sets in, he is liable to be taken off by an affection of the brain or lungs, during this fever. If he recovers, his whole surface, especially that part exposed to air, is deeply pitted.
TREATMENT.
As it is not often known for a certainty, in the early febrile stage, that it is the small pox, the treatment will be first adopted that would be proper for a like fever arising from other causes. But in all my observations in this disease, and they extend to several hundred cases, I have not found in a single instance, any of the ordinary fever remedies, such as _Aconite_ and _Bell._, which would be applicable for such symptoms in an ordinary case, to do any good in small pox. They are directed, however, for these symptoms by the authorities, in the febrile stage of the small pox; but I am quite sure they are not the proper remedies.
From the great similarity, the almost absolute ident.i.ty of small pox _headache_ and _backache_, with the same symptoms developed by the _Macrotys racem._ as well as the nausea and restlessness produced by the drug, I was led several years ago to the conclusion that this, or the _Macrotin_ was valuable in small pox. Not only so, but during the prevalence of small pox in Cincinnati, to an extraordinary degree in the winter of 1849-50, I treated about one hundred cases, including both s.e.xes, and all ages, from infants a few weeks old, to very old persons, giving the _Macrotin_ to all, and had the good fortune to see _all_ my patients recover. Since that time I have prescribed it for every case successfully.
Having then, been entirely successful in so many cases, with this medicine, I am not inclined at this time to give any other the preference. I must admit, however, that though my patients all recovered, I was not able to greatly abridge the duration of the disease, nor to prevent the development of all the stages in their proper order, as is _claimed_ by M. TESTE, for his use of _Mercurius cor._ and _Caustic.u.m_. I was satisfied with so far modifying the symptoms, as to enable my patients to live through, and come _out well in the end_. I would then direct, if small pox is suspected, the patient having been exposed to contract it, or from the peculiarity of the symptoms, in the early stage, or when the disease is discovered after the eruption, to give _Macrotin_ at the first trituration, in one grain doses, once in two hours, while the fever, headache and backache continue, after which, during the whole course of the disease, give it three times a day. This will prevent the development of a dangerous secondary fever, as well as irritation of the lungs, stomach or bowels.
In addition to this medicine I give the patients daily, from half an ounce to two ounces of _pure_ (_unrancid_) _Olive oil_. This serves to prevent the development of pustules in the throat, lungs and stomach; is more or less nutritious, and keeps the bowels in a healthy condition.
Wash the surface once a day in weak soap suds, following it with a bath of milk and water, and keep cloths moistened with warm milk and water, constantly upon all parts that are exposed to the air, lubricating the surface with _Olive oil_ after the bath of milk and water. This keeps the surface quite comfortable.
The best diet is corn or oat meal mush and mola.s.ses, to be taken in small quant.i.ties. Cold water is the proper drink, though it should not be very cold.
The room should, at all times, be well ventillated, but in cold or cool weather, sufficient fire must be kept up, to keep the room warm and dry.
A temperature of about 65 is the best. Hardly any thing can be worse for a small pox patient than to be in a cold or damp room, and to breathe _cold_ air. Uniform temperature is important.
If the eruption is tardy about appearing, or after it is out, a recession takes place, the Alcoholic Vapor bath will soon bring it out.
(See Rheumatism **p. 30).
Occasionally the feet and limbs below the knees, will swell prodigiously, and become extremely painful, causing the princ.i.p.al suffering. For this, wrap the feet and legs in cloths wet in a strong solution of Epsom salts, quite warm, and cover with flannels so as to keep them warm. This will afford immediate relief, and reduce the swelling in a day or two. The finely pulverized Epsom salts, dry, sprinkled on the pustules, will very often prevent pitting. It is the safest and surest remedy of which I have any knowledge.