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pustule, on the eleventh day, or soon after, is spontaneously broken, and a portion of the matter oozes out; in consequence of which, the pus. tule is shrivelled, and subsides; while the matter oozing out dries, and forms a crust upon its surface. Sometimes a little only of the matter oozes out; and what remains in the pustule becomes thick, and even hard. After some days, both the crusts and the hardened pustules fall off, leaving the skin which they covered of a brown red colour; and it is only after many days that the skin. in these places resumes its natural colour. In some cases, where the matter of the pustules has been more liquid, the crusts formed by it are later in falling off, and the part they covered suffers some desquamation, which leaves in it a small pit or hollow.
This is the course of things on the face; and successively, the pustules on the rest of the body take the same. The matter of the pustules, on the arms and hands, is frequently absorbed ; so that, at the height of the disease, these pustules appear as empty vesicles. On the tenth and eleventh days, as the swelling of the face subsides, a swelling arises in the hands and feet; but which, again, subsides, as the pustules come to maturity.
When the pustules on the face are numerous, some degree of pyrexia appears on the tenth and eleventh days, but disappears again after the pusa tules are fully ripened; or perhaps remains in a
very slight degree till the pustules on the feet have finished their course. It is seldom that in the disa tínct small-pox the fever continues longer.
When the pustules on the face are numerous, some uneasiness in the throat, with a hoarseness of the voice, comes on upon the sixth or seventh đay, and a thin liquid is poured out from the mouth. These symptoms increase with the swelling of the face; and the liquids of the mouth and throat becoming thicker, are more difficultly thrown out. There is, at the same time, some difficulty of swallowing ; so that liquids taken in to be swallowed are frequently rejected, or thrown out by the nose. But all these affections of the fauces abate as the swelling of the face subsides.
590. In the other form of small-pox, or what is called the Confluent, the course of the disease is, in general, the same with what we have described; but the symptoms of every stage are more violent, and several of the circumstances are dif. férent. ... .
In particular, the eruptive fever is more violent. The pulse is more frequent and more contracted, approaching to that state of pulse which is found in typhus. The coma is more considerable, and there is frequently a delirium. Vomiting, also, is a common symptom, especially at the coming on of the disease. In very young infants, epileptic fits are sometimes frequent on the first
days of the disease, and sometimes prove fatal before any eruption appears; or they usher in a very confluent and putrid small-pox.
591. The eruption appears more early on the third day, and it is frequently preceded or accompanied with an erisipelatous efflorescence. Sometimes the eruption appears in clusters, like that of the measles. When the eruption is complet d, the pimples are always more numerous upon the face, and at the same time smaller and less eminent. After the eruption, the fever suffers some remission, but never goes o, entirely; and, after the fifth or sixth day, it again increases, and continues considerable through the remaining course of the disease.
The vesicles formed on the tops of the pimples appear sooner; and while they increase in breadth, do not retain a circular, but are every way of an irregular figure. Many of them run into one another, insomuch that very often the face is covered rather with one vesicle than with a number of pustules. The vesicles, so far as they are anywise separated, do not arise to a spheroidical form, but remain flat, and sometimes the whole of the face is of an even surface. When the pustules are in any measure separated, their circumference is not bounded by an inflamed margin, and the part of the skin that is free from pustules is com. monly pale and flaccid.
The liquor that is in the pustules changes from a clear to an opaque appearance, and becomes whitish or brownish, but never acquires the yellow colour and thick consistence that .appear in the distinct small-pox..
592. The swelling of the face which attends the distinct small-pox, when they are numerous, and almost then only, always attends the confluent, comes on more early and arises to a greater degree; but abates on the tenth day, and on the eleventh still more. At this time the püstules or vesicles break, and shrivelling pour out a liquor that is formed into brown or black crusts, which do not fall off for many days after. Those of the face, in falling off, leave the parts they cover subject to a desquamation, which pretty certainly pro: duces pittings.
On the other parts of the body, the pustules of the confluent small-pox are more distinct than upon the face, but never acquire the same maturity and consistence of pus as in the properly distinct kind.
The salivation which only sometimes attends the distinct small-pox, very constantly attends the con. fluent; and both the salivation and the affection of the fauces above mentioned, are, especially in adults, in a higher degree. In infants, a diarrhca comes frequently in place of the salivation.
In the confluent small.pox, there is often a con.
siderable putrescency of the fluids, as appears from petechiæ, from sérous vesicles, under which the skin shews a disposition to gangrene, and from bloody urine or other hæmorrhagy ; all which symptoms frequently accompany this disease.
In the confluent small-pox, the fever, which had only suffered a remission from the time of eruption to that of maturation, is often, at or immédiately after this period, renewed with consider. able violence. This is what has been called the secondary fever ; and is, in different cases, of yarious duration and event.
593. We have thus endeavoured to describe the various circumstances of the small-pox; and from the difference of these circumstances, the event of the disease may be determined. The whole of the prognosis may be nearly comprised in the following propositions.
The more exactly the disease retains the form of the distinct kind, it is the safer; and the more completely the disease takes the form of the confluent kind, it is the more dangerous.
It is only when the distinct kind shews a great number of pustules on the face, or otherwise, by fever or putrescency, approaches to the circumstances of the confluent, that it is attended with any danger.
In the confluent small-pox there is always danger; and this is always more considerable and cer.