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Member of the Colleges op Physicians and Surgeons of Ontario AND Quebec; Member of the American Institute of Homeo- pathy ; Courebponding Member of the Homeopathic Medi- cal Society of Pennsylvania; one of th^ Contributors to " Amdt's System of Medicine based upon the Law of Homoeopathy; " Author of a " Treatise on Diseases of the Lart nx and Trachea in Childhood." W. DRYSDALB & CO., 232 ST. JAMES STREET. 1885. PRICE, 15 CENTS. AX N5 My original intention was to Issnc a Tract on some form of Disease al.erna.oly with one on some point of tl,e Homeopathic Law of Cure, and accordingly Ko, 2 «s to have been a collcotion of cases cured b, the material dose. But the advent of smallpo. forces me to change th.s plan, and I now send forth " Smallpox a.d its Pa.VB^x.o. " m .he hope that n,y readers will oUain a clear conception of the disease and also just views on the gre^t subject of its prevention. THCMAS NiCHOL, M.B. 140 MansSeld Street, Oct. 30, 1885. SMALLPOX AND ITS PREVENTION. :o:- Smallpox is at ouct; the most loathsome and the most easily prevented of all the eru[)tive fevers. Before the great discovery of Jenner it was undoubtedly the most fatal scourge that deci- mated the human race, and, though at the present time it occupies a less conspicuous place, the fact remains that to the dwellers in Montreal it is more frequent and more fatal than even ihe much- dreaded diphtheria. During the month of September, 1885, wo lost out of a popu- lation of a hundred and sixty thousand no less than 830, being at the rate of 10,000 per annum, etal abstinence from animal food and alcoholic drink. The older writers, who saw only the unmc lifted disease, all assert that in the country and at a distance f'-oiii large towns tho disease is much milder than in a crowded city. Chronic diseases do not diminish the predisposition to small- pox. Patients with heart or lung aftections are attacked in the same ratio as the healthy ; the only difference is that it is more likely to prove fatal. Smallpox may co-exist with measles, when, according to Munro, of Edinburgh, the course of the smallpox is interrupted until the eruption of measles has disappeared. Children ill with scarlet fever may take smallpox, but they are not at all likely to do so, and the same may be said of typhoid fever patients. A man of eighty, who has neglected vaccination, is more likely to take smallpox than a man of fifty, simply because he is further from his infantile vaccination. The young are the chosen victims of smallpox, chiefly because the disease is commonly contracted on the first exposure to the contagion. Thus, during the years 1840 and 1841, there died in London of smallpox 2,286 persons, of whom 2,060 were under the age of fifteen, and only 226 above it. During the months of June, July and August, 1885, three hundred and tive7dy-four 'persons died of smallpox in Montreal, of whom two hundred and eighty-three were children under five years of age ; the adults numbering but forty-one, about eight per cent, of the whole. The adult deaths for September were one hundred and five against seven hundred and twenty-five children. As a rule, smallpox is highly (jontagious. Sir Tliomas Watson aflh'ins that " thoro is no contagion so strong and sure as that of smallpox, none that operates at so great a dist.ince." Mr. Marsdeu says that "a single breathing of the air whe.e it is, is enough to give the disease ; " and Dr. Haygarth tells us that, during his long attention to this subject, not a single instance had occurrfid to j)rove that persons liable to the smallpox could associate in the same chamber wi'h a j)atient in the distemper without receiving the infection. Notwithstanding these strong statements, which, as a rule, are correct, there are many peojde who are but little susceptible to smallpox, and even before Jenner's discovery many thousands passed through life without being attacked. Dr, Gregory tells a story of a lady in Salisbury, wl.o had brought up a large familyi many of v/hom she had attended in smallpox, but had never taken it herself. Finally, in the year 1804, she, being at the tim3 cighty-three years of age, took a fancy to be inoculated, v.'hich was successfully accomplished. A distinguished railway officer lately told me that, while man- ager of a railway centering in Chicago, he one day entered a car in that city for the purpose of inspecti ig it. Almost immediately a delirious smallpox patient, with his face and body covered with the confluent eruption, rushed into the car, closely followed by the conductor. The passengers scattered, as a matter of course, but the conductor grappled with the man, and, after a good deal of exertion, succeeded in mastering him. The conductor, whose hands and face were smeared with the variolous matter, wished to proceed with his run, but the manager told hira to go home and get vaccinated, as the operation had never been performed. He went home, but did not vaccinate, and did not take smallpox. Occasionally persons are met with who state that they have had smallpox twice, or even thrice. This happens, and not so very seldom either, but I am inclined to think that in the great majority of these cases, one of the attacks was chicken-pox. Colored people are peculiarly susceptible to the contagion of smallpox, and the mortality is much greater than among whites. Culloii's famous definition of the discrete varietij is still the best: "Distinct smallpox, with few pustules, and those distinct, with circular margins, turgid ; the fever ceasing upon the (eruption breaking out," After a period of incubation, averaging twelve days, the individual is attacked by rigors, soon followed by burn- ing heat. This stage lasts, as a rule, three days, though I have seen it shortened to two or prolonged to four days. The fever remits slightly in the morning and rises towards evening. The pulse is full and tense, the skin hot and dry, respiration short and labortni. The patient rapidly becomes languid and weak, and after exertion the face becomes pale and sunken with a dull and heavy expression, while tl . pulse is quick and thready. The tongue is dry and parched, the thirst is constant and severe, apj)etite entirely gone. Nausea and vomiting are often present, with pain in the stomach increased by pressure ; constipation is very common. But the most characteristic of all the early symptoms is the pain in the back. This is a dull, heavy pain in the small of the back, which is not increased by motion. When it is severe it usually ushers in a severe attack of the disease ; when it is absent then the attack is mild. This back-ache is usually accompanied by drawing, tearing pains in the limbs, often mistaken for rheumatism, and Heberden remarks that it is a good sign when the pain is high up, between the shoulders. Headache is another constant symptom, which comes on very early and con- tinues till the eruption appears. It seems to be of a congestive nature, for the face is hot and flush id, the eyes red and glistening* while the great vessels of the neck pulsate violently. The head throbs and beats with severe lancinating pains, often with a feel- ing as if a cord tightly encircled the head. At times the disease sets in with restlessness and delirium, which soon passes into stupor, and in children it is often usherep in by convulsions, which take the place of rigors in adults. Sore throat is often present, with sneezing and running at the nose ; a bronchial cough is less common. Towards the close of this initial stage a red rash often comes out, especially on tne lower part of the abdomen and the inner H surface of the thighs. It takes the form of small, irregular points or streaks, or it may cover a larger surfaco as a uniform blush of a pale red or brownish red tint. This vaah. fades and disappears as the true smallpox eruption approaches, and very much depends upon its early recognition. The intense febrile symptoms no .v decline, the heat of the skin diminishes, tlie drowsiness and delirium pass away, and even the harassing back-achv. subsides. The characteristic eruption first appears on the face ; then, in succession, on the neck, trunk and limbs. Very rarely do the spots first appear on the extremities. Small reddish pimples first appear, which gradually enlarge until? after forty-eight hours, they feel like small shot in tlia skin, and this is hi^jily characteristic. At this early stage the erupticu looks a r,ood deal like measles, and in the olden time the two diseases were not distinguished from each other. About the third day of the eruptive stage a very little clear fluid appears on the summit of each pustule, and this vesicle steadily enlarges till the sixth or seventh day, when it has the size and shape of a small pea. In mild cases these pocks may be as few as twenty in number ; in bad ones, as many as five or six hundred. Soon after the appearance of the clear fluid a depression is seen at the apex of the pustule, which gradually deepens into the character- istic umbilication, and Dr. Hartshorne compares the pustule at this stage to 'a hat whose crown has been pushed down at the middle. The entire skin is now swollen and oedematous, and the head, face and eyelids are particularly puffy ; in severe cases the patient is often blinded. About tiiis time there is a distinct ring of inflammation around each pock. The fever now returns, a secondary fever, called the fever of suppuration, often opening with a, rigor, followed by heat of the body and slight delirium. I have frequently met with bronchial cough about this time, often with blood-streaked expectoration. The matter in the pustules increases till the eleventh day, when they begin to : break and discharge a yellowish matter, which dries into scabs or crusts and faUs off. The subjacent skin is found to be full of depressed scars of a bluish-purple color which persist for a long 86 time. As the scabs form, the fever declines, the tongue cleans, the appetite returns, and the patient is himself again. Very characteristic is the greasy sickly odor which exhales from the body during the maturation of the pustules. An experienced practitioner can often name the disease from the odor alone, for there is nothing on earth like it. Often the eruption appears in the mouth and throat, with soreness and difliculty in swallowing, and, in rare cases, the air passages are involved, causing hoarseness, cough and difficulty in breathing. In the confiuent form of the disease the stage of incubation is very short and the fever very severe. CuUen's definition is concise and accurate : " Confluent smallpox, with numerous pustules, confluent, with irregular margins, flaccid, and but little elevated, fever remaining after the eruption." It is well to remember, however, that it is only an aggravated form of the disease, and that there is every possible grade between the mildest distinct form and the most severe confluent. But every confluent case is serious, and the danger is ten times as great as in the distinct variety. The preliminary rigors are longer and more severe, and diarrhoea is common, both in children and adult?. The red rashes, already spoken cf, often precede this form of smallpox, and delirium and stupor may appear almost as soon as the fever commences. In children convulsions fre- quently come on the evening before the pocks come out. At times the eruption is preceded by an erysipelatous blush, covering large portions of the body. About the close of the second day, a large number of deep red points appear, and on the following day they assume the pustular form, and almost at once they become con- fluent. All the symptoms are greatly worse than in the distinct form. The pains in the back and limbs are more severe, the fever is much higher, the sickness more distressing. The eruption advances rapidly, but the pustules rise but little above-the skin, especially on the face. They are flat and irregular in form, and soon run together, till at times scarcely a morsel of healthy skin can be seen. I have noted collections of pus as large as a hen's 36 egg, and an eruption of small boils is common. Soon the pus- tules burst, scabs form, and the face looks as if it had been thickly plastered over with honey-comb. The face, hands and feet swell enormously, and this tumefaction is greater about the sixth day. The swelKng is greatest about the ears and the angles of the jaw, and the eyelids also participate in the tumefaction, though, on the whole, they are less swollen than in the milder form of the dis- ease. Still, I have seen patients unable to open their eyes for four, five or even six days. Severe inflammation of the eyes is somewhat common, sometimes ending in perforation and total blindness. The eruption in the mouth and throat is far more copious than in the distinct form of the disease, and it is accompanied by an abundant and distressing salivation, which is at its heiglit about the ninth or tenth day. Not unfrequently the eruption and its attendant inflammation extend with the most astonishing rapidity to the air-passages, causing a hoarse and muffled cough, with futile attempts at expectoration, and sometimes complete extinc- tion of the voice. The fever declines but little on the appearance of the eruption but as soon as matter forms in the pustules it rises higher than before. It is often accompanied by violent delirium, followed by profound stupor. I have often seen obstinate diarrhoea to- wards the close of the attack, and, as a rule, convalescence is slow. Unfavorable signs are, a sudden subsidence of the swelling, or a complete absence of the swelling; or a cessation of the salivation, or its absence. These statements are apparently contradictory, but I had abundant opportunity of verifying them during the epidemic that raged in this city from 1872 to 1880. Another unfavorable sign is the appearance of a blackish spot in the centre of each pock, foi' this is very often accompanied by increased fever, with brown tongue, frequent pulse and violent delirium. At other times the patient is overwhelmed by the increased virulence of the poison. The pulse does not increase in frequency, and the temperature is unchanged, but he suffers from constant restlessness and anxiety, with uncontrollable I 87 retelling and vomiting, and frequent desire to pass urine. Such cases are jilmost inevitably fatal. Varioloid is smallpox modified by vaccination, or by a pre- vious attack of smallpox. It is often ushered in by a good deal of fever, and yet it runs a milder course and has a shorter dura- tion than the other forms. The danger, too, is very much less, as we shall see when we come to discuss the statistics of the dis- ease, and yet it is not altogether devoid of danger, for fatal cases occasionally occur. The fever is one day shorter than in the distinct form of the disease, but the headaciie is very often of the most severe nature, with great prostration and distressing vomit- ing. The pain in the back, too, is so severe that patients often say that they feel it must break. The invasion-rashes, already described, are quite common. The fever disappears when the eruption comes out, and the eruption may consist of but a few scattered pocks. Sometimes there is no eruption whatever, and I have seen numbers of cases in which it first appeared on the body, not on the face. Again, it may be more copious, but it does not run its regular course, drying up on the sixth or seventh day, instead of the eighth or ninth. The smallpox smell is rarely present, and secondary fever is uncommon. In general terms it may be stated that this form of smallpox is severe in exact proportion to the length of time that has elapsed since vaccination. If fifteen years have elapsed, the attack is very light, an interval of forty years is foUowed by an attack of average severity ; while a man of seventy-five or eighty, who has not been vaccinated since infancy, may have a severe or even fatal attack of confluent smallpox. As a rule, pitting is rare ; when present it is usually slight. In spite of all these differences there can be no doubt but that modified smallpox is identical in its essential nature with the other forms of the disease. Black smallpox, or malignant smallpox, as it is more cor- rectly termed, is not nearly so frequent now as it was before Jenner's time. From the first onset all the symptoms are of the most formidable nature. The headache is very acute, the anxiety very great, the sickness and vomiting most distressing. In one 38 class of cases the nervous system is coinitletely prostrated f^'om the very first ; continual restlessness and anxiety, with delirium, which soon passes into coma. In these cases the eruption is either imperfectly developed, or else it suddenly retrocedes after it is formed. In another and more numerous class, a low de- praved condition of the blood is the most proTninent character- istic. The thin and watery blood oozes from nearly all the mucous surfaces, from the nose, mouth, air-passages, kidneys, bowels and womb. The eruption is badly developed, Ijloody or purplish, with an unendurable smell and, at times, a disposition to gangrene. The skin is covered with dark red spots, varying in size from a pin head to a ten cent piece, and sometimes the entire eye is crimson with effused blood. About the tenth day the pustules burst and disclu.rge a bloody icho", which dries into brownish or blackish crusts of a most offensive appearance. The patient's countenance is at first expressive of anxiety, but as the disease marches on he sinks into stupor with oppressed breathing and great weakness of the < 'rculation. Death usually takes place about the fifth or sixth da) . Unlike scarlet fever and tj 'loid fever, this disease, running as it does a definite and rapid course, has but few complications and after-effects. You never see a lingering smallpox as you see, lingering scarlet or typhoid fever. I look upon laryngitis as being one of the most frequent and fatal of the complications. It results from an extension of the eruption and its accompanying inflammation to the larynx, but still more frequently it is the re- sult of exposure to cold. I remember attending (November, 1871) an un vaccinated child ill of confluent small-pox of a malignant type. It did weU for ten days, and really looked like getting well, till one cold night the mother, exhausted by watcliing, threw herself across the foot of the bed and fell into the sleep of the weary. The child slipped from the bed and passed several hours on the cold, carpetless floor, and when the mother awoke the child was stricken with hopeless laryngitis. Pleurisy is a somew nat common and very fatal complication, and the same may be said of bronchitis. Ery- '/* 89 sipelas is quite frequently seen, and abscesses and gangrene often retard recovery and endanger life. Inflammation of the eye and ear are nothing like so common now as they were before Jenner's time, and I have seen virulent nasal catarrh quite frequently. % Diemerbroeck, a Dutch physician who flourished in the begin- ning of the seventeenth century, tells a preposterous story of having seen individuals take smallpox three time? within three months, and one English practitioner claims to have attended between eighty and ninety cases of recurring smallpox. But (there can be no doubt that, after excluding such tales for the marines, true smallpox may recur in the same individual, and a third attack is occasionally, but very rarely, seen. Thus ]\Ir. J. r. Marson, medical attendant at the Smallpox Hospital, London, 3 tells us that the son of a medical officer in the army, who had been vaccinated in infancy by his fatlier, and had a large cicatrix remaining from the vaccination, and who W3 s attended by his father for smallpox in early life, and bore decided pits of the disease, in 1844, at twenty-three years of age, was admitted into the Smallpox Hospital with severe confluent smallpox, of which he died. The celebrated Trousseau had in his wards a medical student who, though he bore the marks of two attacks of small- pox, took it a third time, and that, too, in rather severe form. But one who has had very severe smallpox is not likely to have it a second time, at least not so likely as one who had the disease in a very mild form. The temperature of the patient is often as high as 101" on the first day, and it continues to advance, with very slight morning remissions, till on the evening of the third day it may be 103^, or even higher. The chief point about the thermometry of the confluent form of the disease is that if the high temjjerature con- tinues after the eruption is well out then there is certain to be a formation of matter in the pocks, or else some inflammatory complication is at hand. When suppuration does take place a temperature of more than lOS'^ indicates danger, and I have noted 110*^ in fatal cases. The anatomical character of the eruption is now well under- 4a stood. Deep down on the true skin, and partly within it, little patches of congestion appear, wliich steadily enlarge, rising at tlie same time towards the surface. At tb.is early stage each of these bodies has the feeling of a small shot, and this is a characteristic of the early stage. As a result of the inflammatory action, effu- sion takes place into the surrounding tissues, and thus firm, flat- tened papules are formed. These stages occupy about forty-eight hours. Then follows an effusion of pearly fluid, which jonverts the papules into vesicles full of this colorless lymph, each having a central depression and an inflamed circle around it. This stag^ lasts about four days, when the vesicles ripen into pustules. The matter increases in quantity, and is deposited in little cavities formed by the adhesion of the changed epidermis to the true skin at some points and its separation at others. The pustular stage lasts three days, and, towards the close of the third day, when they have attained their full size, they rupture, the fluid or serai- fluid contents exude and form scabs, ''^he stage of scabbing lasts about three days more, making the entire duration of the normal eruption about twelve days. One would say that it should be a very easy matter to distin- guish smallpox from other diseases, but, as my old teacher of clinical medicine remarks, when writing on this subject, "the most experienced physicians are sometimes deceived." And yet much, very much, depends upon the prompt recognition of the disease, for it is contagious from the very first. If the two first cases which came to Montreal last April had both been promptly recognized, and both had been carefully isolated, then we would have been spared that calamitous loss of life compared to which our pecuniary losses, heavy though they be, are but the merest trifle. The initial fever of smallpox does not differ from any other fever. But severe pains in the back would be suspicious, and, if accompanied by excessive irritabihty of the stomach, occurring during an epidemic of smallpox, the probability would be quite strong. If a pustular eruption appeared, and if, at the same time, the fever subsided, then the proof would be almost 41 conclusive. lastly, should the eruption l)ecome vesicular, with the chiiractoristic umbilication, the evidence would be com]»l "te. It is at times (juite ditiicult to distinguish between smallpox and chicken-iiox. True, well-nnirked cases of these diseases are easily diagnosed, but they insensibly shade into eacli other, and there are cases of chicken-pox hardly to be distinguished from smallpox. Thus, Dr. Munro (Tertius), of Edinburgh, who wrote in the year 1818, speaks of "the more severe form of chicken-pox, in which the fever is considerable, the vesicles pass on to suppuration, and pits are left by tliem, whicli, in a few instanc(!S, have disfigured the face fully as much as those of the confluent snuiUpox, and which pits bear a resemblance to tliose- of smallpox." The fever of chicken-pox is sliglit : that of small- pox usually severe. The eruption of cliicken-pox ap[)cars twenty- four hours after the patient sickens, wliile the characteristic pimples of smallpox appear seventy-two hours from the attack of the primary fever. The eruption of chicken-pox is almost always vesicular, and seldom proceeds to suppuration, and very rarely leaves pits. Lastly, the entire course of chicken-pox is five or six days, while that of smallpox is fourteen or fifteen. Previous to the year 1767 chicken-pox was looked upon as being a variety of smallpox, and even at the present day they are considered identical by not a few. But vacciuation does not prevent chicken-pox, indeed it usually occurs after that operation ; and, though one or two great authorities on the Continent of Europe are said to hold the old doctrine of identity, nothing is more cer- tain than that chicken-pox always gives rise to chicken-pox, and smallpox to smallpox. Measles has often been mistaken for smallpox, sometimes with ludicrous results, sometimes with results which are far from ludicrous. Thus during the height of the epidemic of 1872-80, a young lady, a member of a somewhat prominent family, was attacked with what a leading practitioner averred w"-' smaUpox. She was strictly isolated, every one in the house was vaccinated, and the place reeked w^ith the fumes of carbolic acid. fwo trained nurses were procured from the General Hospital, and 42 public prayers were offiTcd up in the patient's bolialf. Tlie family «{(»t thoroughly r.lannuil, and the consulting ])hysician, the Nestor of the Montreal pltysiciana, cool and sagacious, was called in. As soon as ho entered the room, he smelt the patient, and exclaimed in the sweet Doric of his native land, '• Mizzha ! Dr , Mizzha ! ! " And measles it was, sure enough ! Tiio serious aspect of this weighty matter, the diagnosis of measles from smallpox, is well illustrated by a case which haj)pened in this city j ust about the same time. A poor man, fortunalely unmarried, was taken with what his medical attendant called amalli>ox. Ho was at once removed to the Smallpox Hospital, which in those days was a good brick building immediately in rear of the General Hospital, and connected vAth it — I presume, with the benevolent intention of giving the patients of the General Hospital an oppor- tunity of catcliing smallpox in addition to their other ailments. Tlie patient was barely within the walls of the smallpox depa'-t- ment when the attendant physician detected that the disease was measles. The patient was promptly sent to his home, but during his brief sojourn in the smallpox department he had taken small- pox. He died in a few days. In measles, then, a catarrh of the eyes and air-passnges is the essential part of the disease, but nothing of the kind is present in smallpox. Pain in the back is absent in measles, but almost uni- formly present in smallpox. The eruption of measles is destitute of the shot-like feeling so characteristic of the early stage of small- pox, and it is, from the first, much darker in color. Moreover, the eruj)tion of measles does not suppurate, and it never umbilicates. The orognosis of smallpox depends very much upon vaccination. If the patient has been vaccinated he is likely to recover ; if he has not been vaccinated he is likely to die. Before Jenner's time one-half of all the children under ten died of smalljwx; snow, when vaccination is systematically practised, the mortaUty jis nil, and the German statisticians — the most accurate in the ,world — affirm that in the eighteenth century smallpox caused ifrom seven to twelve per cent, of all the deaths. From this ifrightful slaughter Jenner delivered us. , 48 Smallpox is more fiitnl in woiueu than in men, and pref?nmicy greatly increa.scis the ilaii^er. Jt is rare for an adult to die of modilied smallpox, and, wilh good treatment, the danger in the distinct variety is very small. It is widely dillerent in tlu! con- iliient variety, and the black smallpox is as bad as the plague. I'eople who have had smallpox once are not very likely to take it a second time, but if they do take it, they are very likely to die. A given individual who had a mild attjick in his youth runs a greater risk from his second attack than another man whose first attack was severe. Hebra's experience is that, while among those who are unvac- cinated the mortality amounts to 30.1 per cent., it is not more than 5.2 per cent, in persons protected by vaccination — that is, the mortality is six times as great. Marson, the best English author- ity, says that, taking patients at all ages, as they came to the Smallpox Hospital, 50 ])er cent, die from the confluent form, and 4 per cent, from the distinct form of the disease. Curschniaini, the best German writer on this subject, admits that, even inc'lud- ing children up to ten years of age, the mortality in the epidemics observed by him was as high as fifty-eight per cent. Intemper- ance greatly reduces the chances of recovery, and a man of sixty, other things being equal, is more likely to die than a man of twenty-five. Hard work and insufficient food darken the prog- nosis. The homeopathic statistics ar:. eminently encouraging. Dr. Eubulus Williams, of Bristol, England, treated a large number of cases in a public institution in that city with the following results : he lost no patients at all of the period of life when the infantile vaccination remained effective, that is, up to the age of eleven. After that age, when the course of the disease proved that the patients were no longer protected, the mortality was 19 out of 257, or about 7^ per cent. Timid people and unvaccinated people should never nurse smallpox patients, indeed the unvaccinated should never come within many, many yards of them. The nurse should be thoroughly trustworthy, and should keep separate from all others 44 nil throiij^h the illness ; even tli(»iigh she liiid smnllpox herself, she slioiikl be vaccinated before conunenciiig her iluties, and she must be carefully disinfected before minglinj^ with her folluvvs again. The i)atienl's bedroom should be kept fresh and cool, cental idy not to exceed ti?"^ ; and I prefer a degree or two lower. Half a century ago all doors and windows were kej)t jealously closed and not a breath of fresh air was adnutted, now all are agreed that the room must be freel'" ventilated at stated intervals. In cold weather a fire in an open grate helps much in the mp<^:er of venti- lation, and in mild weather the windows should be kept open, day and night. The sick room should have no carpets, and as little furniture as may be. All heavy curtains should be removed, and paper blhids used instead. Quiet must Ije sttcured at all costs, and the nature of the disease etl'ectuaJly excludes the inevitable visitor. In tlie good old times the patient was loaded down with blankets and coverlets, but now-a-days he has light bed-cover- ing, frequently changed, very much to his own comfort. In the same good old times the patient was not allowed to change his linen, and Diemerbroeck, the Dutch physician already (quoted, writes as follows : — " Never shift the patient's linen till after the fourteenth day, for fear of striking in the pock, to the irrecover- able ruin of the patient. Far better is it to let the patient bear with the stench than to let him change his linen, and thus be the cause of his own death. Nevertheless, if a change be absolutely necessary be sure that he puts on the foul linen that he put oft' before he fell sick, and, above all things, take care that this supply of semi-clean linen be well warmed " Except under exceptional circumstances, the linen should be changed at least each second day. During the earlier stages the patient rarely can take food; further ou he should take milk, boiled and diluted with filtered water ; weak chicken broth, roasted apples, ripe fruit of almost any kind, liuddock advises raw eggs beaten up with cold milk. Cold water is by far the best drink, and a small piece of ice 45 allowed to dissolve .slowly in tlio mouth is very graUiful to most ])ati(ints. Tho water may l»o lliivored with the juice of onmges uiul ra-sphurried, hut as lemomule antidotes most hoiud'ojHithic rem«ulies it should never bo allowed. The sick man may be allowed to drink freely, but nt)t much at a time. Stimulants should very rarely be used in smallpox, but 1 have followed Sir Thomas Watson's advice and j^iven strong brotlis, or even wine, if the maturation of the pustules should proceed tardily, if they should not lill up properly, nor their contents become purulent. Carbolic acid, chloride of lime, thyrao-cresol (tho very latest fad) and similar things are of very doubtful value as (Usinfect- ants, and it must not be forgotten that homa;opathic medicines are liable to injury by such powerful odors. On this jxiint, the value of these so-called disinfectants, I am glad to be al)le to (|Uote the high authority of Dr. Abraham Jacobi, of New York, wIkj thus writes : — "The popular idea, sometimes even shared by pliysicians, that tho faint odor of chloride of lime or of carbolic acid in a sick room or in a foul privy is evidence tliat the place is disin- fected, is entirely erroneous. Particularly in regard to the latter agent, it may be stated at once that its employment for disinfecting purposes on a large scale is impracticable, both on account of the expensiveness of the pure acid and the enormous quantities required to produce the desired efiect. For in regard to its eitici- ency it does not rank very high in comparison with a great many I other articles, as may be seen from a table of the disinfcjctant 1 properties of different chemicals published by Miquel in the m Semiaine MMicale." Fresh air and cleanliness are by far the ])e,st 'I disinfectants, and without them all others are but of doubtful utility. I never use disinfectants, other than fresh air and cleanliness, during the illness, when I can possibly avoid it. Specially to be condemned is the sheet saturated with a strong solution of chloride of lime, for that tends to make the patient's breathing difficult and to bring on the much-dreaded laryngeal I complication. Very high authorities, Hebra among them, recommended cold -# 46 (louche baths, but spouj^Mug with U)\)'u\ vviittd" is mucli safor and more f^Tatoful to thojitttiout. An inunction with olivn oil shouli' follow each .H[ionj^in^. Dr. Ilydo states tliat "in Vienna warm l)aths, adiniiii.sturcd either by tho process of continuous iuiinersion 80 generally practised there or by ininicrsion for fro'n two to three hours of each day, has been found to furnish the ji;reate8t amount of comfort to the patient," but, in this citj at hmst, this can rarely bo done in private practif^o. A frequent chanj,'(? of position in bed is very gratt^ful to the j/itient, and, at tho same time, it tends to prevent bed-sores. Many things have been recommended to prevent pitting, mercurial ointment, nitrate of silver, tincture of iodine, but with very doubtful success. Ih. E. H. liuddock, the wtdl-known writer on houKeopathie practice, ])oints out that the action of light on the pustules photographs them on the skin, and to ])rc- vent that action he advised a mixture of cream and Hour in such ])roportion as will make a thick paste. I have found simple olive oil exceedingly elfective, and it has the additional advan- tage of relieving the intolerable itching. Kuddock, whose mis- sionary life ended all too soon, gives the following excellent advice: — "The hands of children should be mufU(Hl and lightly secured, to prevent scratching, which might lead to ulceration. Adults may wear loose gloves. This precaution is especially necessary while the i)atient is asleep, and acts unconsciously." All infected bedding and linen should be boiled repeatedly, after fumigating them with sulphur, and if they are not of good ([uality it is better to burn them at once. The bedroom sho''ld be most thoroughly disinfected, and the first stop should be a thorough fumigation with sulphur, accoixling to the rules laid down on page 22 of the first of these tracts. Then should follow a most thorough domestic cleaning witli hot water, scrubbing brushes and soap, permitting the fresh air to enter freely by open doors and windows. Next fumigate a second time with burning sulphur, using at least ' vO pounds for a room of ordinary size, and three, or even four, pounds for a larger one, — only less ridiculous than thymo-cresol, I 47 chloride) of limo ftiid carbolic acid is the burning of a tcuiapoonfiil or two of sulpliur in a room whoso atmosphoro in literally huUni with smallpox or diphthoriagorms. Then conclude with a .second domentic cleaning, oven more thorough, if [)ossible, than the first, allowing all windows to remain open for u week. TIio entire housis not merely the patient's bedroom, should be disinfected in this thorough manner, for the deadly germs may cluster thick in the neighboring rooms. On reaehing convalescence the patient should take a tepid bath lach day, followed by a copious inunction with olive oil. Kach u. '.ernate day the bath should be preceded by a fumigation with burning sulphur, standing in the fumes for five or six minutes, covering the mouth and nostrils with a handkerchief. If this ia done, thoroughly and conscientiously, ho nuiy mingle in society say in ten or twelve days, but if it is not douo then ho is a bearer of contagion for fif.y or sixty days. There are two methods of prevention in smallpox, inoculation and vaccination. Inoculation consists in the insertion of small- pox matter under the surface of the skin, so that the inoculated individual actually has an attack of smallpox, usually mucii milder than when acquired in the "natural way," that is by actual contact with a smallpox patient or by breathing an atmos- phere contaminated with the specific germ of the disease. A similar practice has been known in China since the dynasty of Song, A.D. 59. The smallpox crusts, powdered and perfumed, were snuffed up the nostrils, and his was called sowing small- pox. According to Mungo Park, himself a medical man, inoculation has been known to the dwellers on the Tiger from a very early period, and the regimen followed consisted in abstinence from animal food and drinking copiously of water acidulated with lime- juice. Inoculation has been known to the Brahmins of Hindo- stan from time immemorial, and Drs. De la Condamine and Boscovitch state that it was the custom, from a very early period, among nurses at Naples and Pa via, to communicate smallpox to children by rubbing the palms of their hands with recent matter of smallpox. 48 About the year 1700 inoculation si^ems to have been first practised in Constantinople, and, in the j'-ear 1713, Dr. Emanuel Timoni, an Oxford graduate practising in that city, sent an accouni of the process to the authorities of the Royal Society. Two years later, Mr. Kennedy, an English surgeon who had travelled in the East, described inosulation in his work " On External Remedies," and in the volume of " Philosophical Trans- actions " for 171G is an account of the same process by M. Pylariui, at the time Venetian Consul at Smyrna. The curious part of the matter is that the medical profession in Great Britain paid no attention whatever to these distinct and well-attested statements. - At last, in the year 1717, Lady Mary Wortley Montague, wife of the British Ambassador, had her son inoculated at Constanti- nople, and four years later her daughter was operated on in England. Next, a certain Dr. Keith ventured to inoculate his daughter, and then Dr. Munro (Tertius) tells us that, " six crim- inals, who had forfeited their lives to the laws of their country, were, by the royal prerogative, to receive full pardon on condition of submitting to be inoculated. The inoculation was accordingly performed, all of them had the disease in a mild form, excepting one, on whom it entirely failed, he having previously had the disease." Lastly, in April, 1722, after consultation with Sir Hans Sloane, Mr. Amyand, sergeant-surgeon, inoculated the Prin- cesst^s Amelia and Caroline of Wales. This seems to have established the practice in England, but it passed into the hands of ignorant non-professionals, and the mortality was so great that it fell into disrepute. But some medical men, notably the brothers Sutton, by applying Syden- ham's cool regimen to inoculated persons, secured wonderful results, and in the year 1746 the smallpox hospital was founded, to extend its benefits. In the year 1754, a generation after its introduction into England, it received the sanction of the Royal College of Physicians. In France, Trousseau tells us, it was absolutely prohibited when first proposed, in 1723; and it was not until 1756, thirty-three years later, that anyone ventured to try it. 49 Inoculation was not without its dangers, for, notwithstanding the statements rf Baron Dimsdale, a noted inoculator, that not one in fifteen hundred died, there can be no doubt but that the mortality was vastly higher. The National Vaccine Board, a much higher authority, places it at one in three hundred, that is when performed with all proper precautions, but in spite of the once-popular operation, half a million of people died annually in Europe of smallpox. Notwithstanding this frightful slaughter* and notwithstanding Jenner's glorious induction, it required the authority of an Act of Parliament to displace inoculation in Great Britain. The Act was passed in the year 1840, but the practice still lingers in obscure nooks of the British Islands, and in Septem- ber, 1885, 1 vaccinated a young woman who had been inoculated in infancy. Inoculation was an excellent thing in its day, but it had one obvious drawback in that each inoculated person became a centre of infection to all around. Then, as time pfiSsed on, people be- came careless, and so it came that the century preceding Jenner's discovery no less than four millions and a half of people died of smallpox in the British Islands. But Jenner was not the first who inoculated with cowpox for the purpose of protecting against smallpox, for in 1765 two English surgeons, named Sutton and Eewster, described cowpox and directed attention to its protec- tive power. Next, a certain Gloucestershire farmer, named Ben- jamin Jesty, inoculated his wii"" and tvo sons, for the purpose of protecting them against smallpox. The experiment succeeded, but the operator was hooted at and pelted with stones whenever he attended market. Lastly, a i-ench Protestant pastor, Eabaut- Pommier, of Montpellier, pointed ou'j th ^ame remarkable property in the year 1781. But to Jenner belongs the credit, of having systemized the hitherto scattered facts, and of having made almost innumerable expenments, so that, in the no jle language of August Hirsch, of Berlin : " That the achievement of Jenner was at once a turning- point in the history of smallpox, and a new era in the physical welfare of mankind ; that the powar of the pestilence became more and more restricted, both in range and in severity, in pro- portion as the practice taught by him obtained acceptance and careful attention at the hands of various nationalities ; that the disease at the present day, as is abundantly shown in the account of its geographical distribution, still bears, in +hose regions where ignorance and prejudice have opposed the adoption of vaccination, ' or where the carelessness of the authorities have neutralized its good effects, the same character for destructiveness that meets us in the medical and chronological accounts and in the mortality statistics of European countries of the pre-vaccination period; that even to-day we find in the devastation of popular districts, and in the uprooting of whole tribes, the indications of what this raging pestilence would do. All this is so thoroughly brought out in the writings T have named, that it can only be folly or stupidity that would seek now-a-days to minimise or to question the immortal merits of Jenner. The foolish attempts made to discredit vaccination may be met with the fimple but conclusive remark of Porter's : " it will require an immense accumulation of facts, more than the world ever saw, to abake our faith in the pro- tective influence of vaccination." Cowpox, then, is an eruptive disease, very similar to small- pox, passing through almost identical stages, but differing from smallpox in that it rarely has constitutional symptoms, that it can only be communicated by inoculation, and that, as a general rule, the pocks only appear at the point of inoculation or very close to it. I have, however, recently seen some cases of cow- pox, the result of vaccination, which bore such a close resem- blance to smallpox as to deceive very good observers. The entire body was covered with a reddish eruj)tion studded with pustules very like those of smallpox, and this eruption was accompanied by high fever, prostration and slight delirium. As the fever, eruption and scars of cowpox are so similar to those of smallpox, it follows that vaccination is an illustration of the homoeopathic law of cure — aimilia similibus curantur — likes are cured by likes. This similarity is admitted by some of the best writers of all schools of medicine. Thus Dr. Frank P. 51 Foster, of New York, w^-o writes on this subject in Prpper^ Sydem of Practical Medicine — the best work of the kind that has yet been written on this continent — affirms that cow])ox is '' characteHsed by a cutaneous lesion closely resembling tliat of smallpox" Cowpox, then, prevents smallpox in virtue of its homoeopathic relationship to that malady. It produces similar symptoms, and thus blunts the susceptibility of the organism to the assaults of its similar, but more temble, congener, small] )ox. It is true that Cohn, a German observer quoted by Lebert in Von Ziemssen's Cyclopcedia of the Practice of Medicine, asserts that the fungus of cowpox is identical with that of smallpox, but clinical experience proves that the poisons carried by these fungi are not ii ' ical but similar, differing of course greatly in energy. Edwai - enner, born in the year 1749, was the son of the Eev, Stephen Jenner, rectoi of Eocknampton, Gloucestershire, England. Wliile stiU an " apprentice " — as medical students were styled in those primitive times — his attention was directed to the antag- onism between smallpox and the eruptive vesicular disease of the udders of cows called cowpox. It was well known in his native country that a dairy-maid who caught cowpox from a cow could not take smallpox, and to test the matter Jenner inoculated with smallpox matter several girls who had had cowpox, but found, to his delight, that they were proof against the disease. These first experiments date from the year 1775, and as a result he conceived the idea of propagating cowpox from one human being to another, and thus quelling the dit.ease which slew over forty thousand every year in Great Britain alone. The difficulties in his path were great. In the first place he found that the teats of cows were subject to several eruptions, but that only one of these was protective against smallpox. Then he had the idea, still held by some excellent observers, that cowpox in the cow was caused by " the grease " of horses, but an exhaustive series of experiments satisfied him that horsepox did not possess the full protective power of cowpox, and that, moreover, it was open to ^^bjections which could not be brought against the latter. These experim i/J^ >u Deaths. Week ending August 1 56 Increase. << Sept. Oct. 8. 15. 22. 29. 5. 12. 19, 26. 3. 36 • ■ • 42 6 56 14 96 40 102 6 128 26 185 57 242 57 322 80 Here "Hovo does vaccination compare with non-vaccination ? is the reply. During the week ending September 18, six Protestants died of smallpox, four of them being under five years of age — the Protestants are just about a qu .rter of our population. During the same week nine Irish Catholics died, of whom six were under five years — the Irish Catholics are nearly as numer- ous as the Protestants — nearly a quarter of the people. Now the French- Canadians form rather more than one-half of our people in this city, and accordingly their mortality for the same week should have been about eighteen, or twenty at most. But it was one hundred and sixty-nine, of whom one hundred and fourteen were under five years of age ! What is the cause of this enormous difference ? It cannot lie in physical surroundings, for our French-Canadian fellow-citizens, in spite of the pitiful slanders of people who do not take the trouble to learn the truth, are the most cleanly of people. The floors of very humble homes remind one of the deck of a British man-of-war, the beds are clean and sweet in a superlative degree, while the master of the modest house, reading his paper and smoking the inevitable pipe at his door, is the ideal of a cleanly and comfortable citizen. The difference cannot lie in physical strength, for the average French-Canadian, stout and compact, is a stronger man than the average English-speaking citizen. w^ r 1%^ -f O-yvy^"-^ ^f ^s ^ M'^^^ 5» The difference lies in vaccinaHov, and in that alone. If our French Canadian people had boon vaccinated their lo83 during that fatal week would have been twenty instead of one hundred and sixty-nine — vaccination would have saved one hundred and fifty French Canadian lives. If the Irish Catholics had been unvaccinated to the same extent as their French-Canadian fellows they would have lost eighty-four; so that vaccination saved seventy-five Irish lives in a single week. If the Protestants had been unvaccinated to the same extent as the French-Cauadii ns, they too would have lost eighty-four; so that vaccination saved the lives of seventy-eight Protestants in one week. This train of thought and this chain of reasoning might be continued almost indefinitely, for all our reports tell of a hideous slaughter of the unprotected French-Canadians and of the com- parative immunity of the protected portions of our population. Thus during the same fatal September week, St. Ann's Ward, with a population of 12,360, largely composed of Irish Catholics and English-speaking Protestants, lost four by smallpox, while St. Mary's Ward, with a population of 13,4'28, chiefly French- Canadians lost seventy-five. Again, from August 29 to October 9, inclusive, there were no deaths from smallpox in St. Denis and St. Hubert streets, while in Wolfe street there were eighty-six, and in Montcalm stree*, sixty-two. Why the difference ? Simply bei. ^e the first-named streets are largely occupied by the higher class of French-Cana- dians, almost all of whom are vaccinated ; while the unfortunate dwellers in Wolfe and Montcalm streets are unprotected by vac- cination. The only help, the only hope, is in vaccination, and the anti- pathy shown to it by the mass of French-Canadians will fade away when they understand the differenca between humanized and animal vaccine. The vast majority of our fatal cases — ninety-two per cent. — are children under Ave years of age, and Dr. La Rocque, a most 59 competent authority, thinks he is justified in stating that, no matter how many thousands of dollars tho city miy spend, it will hardly reach the seat of the epidemic, namely, the infants, unless a compulsory vaccination law, or its equivalent, requesting tho vaccination of all infants, be carried out. Who should he vaccinated / The children should he, for they are the men and worarsn of the future, and, unvaccinated, they fall an easy prey to the foul destroyer. No infant should pass the third mouth of its life without this uiost beneficent of oper- ations, and in epidemic times even young children should be re- vaccinated, as in not a few it runs out in two or three years. Vaccinate the women, for in market and shop and street they too are exposed, and the harmless-looking stranger, met by the way, may wear garments laden with smallpox and death. Vaccinate the men, for they are constantly exposed to con- tagion in the performance of their duties. I heard the other day of the loss of a most valuable life from neglect of this simple precaution, and such cases occur with alarming frequency. Vaccinate the aged, for they are further from their infantile vaccination than the middle-aged, and during the present epidemic I have vaccinated many aged people with results which proved that they had been wholly unprotected. Vaccinde those who have had the smallpox, for though they are not very likely to contract the disease, they are likely to die if they do take smallpox. Vaccinate everyone, luhen smallpox is the epidemic. Vacci- nate again and again, and keep on vaccinating, for in vaccination lies the only hope of safety. Lastly, " pour light on the eyes of mental blindness " and vac- cinate the anli-vaccinationist doctor. / ntly PuhliHbcd and for sale by W. DIIYSDALE & CO., 202 St- James Street, Montreal, PRICE sa.so, DISEASES OP THK Nares. Laryox aod Tracliea io Cliiiood By Thomas N'ichol M.D., LL.D., B.C.L. "TliU nblo rikI «xliau*>tiv(< IrftkVxt^ ." — lloiixroiintliU' U'nrltl. 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Nlc^liol'H contribution to prncticul nifdlolniw Ib, tlu^rnrorc, one wo linvo inucli iilniiHiire in roi'oniinitndinir to our foll)>K^utiH; on« that wu bMlluvn will Ixdp tliom iniicli III niiiiiy Hiixioim oiim-h and Incntii-'a thi>ir contliloneo In tho menauroH tlit>y Hdopl to ineut tlicin." — Monthhi llnmiiimnthif Itfi'imr, " \Vi* fctd juHtitlt'd in cliiimlnK timt tli» profi'HHion In gtMierul, and youne practllionora in piirticuliir, aro unconiinonly irid:>bt«td to Hr. .Nicliol for K'vln(( lo the nutdicnl puhlif, In tho voluiDo b 'forn um ho valuiibh; a Hun\iniirv of liin cllntual expuriiMicu, and tho roHult* of IiIh lll<(rary ri-searchos."— A'cic h'liylitiid Aiitlinil (Inzitte. " It is aUvayH a pUmKuro to road a l)0(ik whero tlio author hafi not only wadod tlirnujih tho litt'raturo of nnrliiiit tlincH, "v', Jsichol i»an old hand in hualiiiK fhildron'a dlieafCB."— A'or/ft Amrru'n Joanuil nf llnmivo- pathii. " Wti nxpet'tf'd jUHt (tuch a full rondabli! book from Dr. Nkdiol. 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