Treatments

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Smallpox Treatment*

‘For if we have a mind to cure the Patient, let it be on what Day it will, we must bleed boldly the very first opportunity.’

Johannis Freind ad celeberrimum virum Ricardum Mead, M.D. de Quibusdam Variolarum generibus epistola (London, 1723), p. 129.

Michael Bernhard Valentini,

Praxeos medicinae infallibilis pars altera chirurgica (Frankfurt am Main, 1715), title plate.

Bleeding, in particular, was lauded as a cure all: for Helvetius nothing was more effectual and he concluded that ‘It is more or less necessary, according to the different Circumstances of the Disease, and the Patient’s Habit of Body.’ It was important to commence this form of treatment as early as possible, especially so in the cure of the ‘simple-distinct’ sort of smallpox. Initially the the patient was to be bled from the arm but if the physician was called in too late, bleeding via the foot might be attempted.

Bleeding was also the initial treatment open to doctors treating cases of ‘malignant-distinct’ smallpox and Helvetius suggested that while the patient was being bled s/he should be encouraged to ‘drink plentifully of a Ptisan made of the Root of Wild-Succory, of Gramen Caninum, and Liquourice. He must take a Diluting Apozem every Three Hours, and must have his Intestines cleansed of their Impurities, by such Clysters as we have prescribed for the Simple-Distinct Sort’. Bleeding was particularly important to initiate during the early stages of the disease, when the patient was strong enough to bear the treatment. Yet other writers were not so sanguine about blood-letting. John Woodward, writing in 1718, specifically argued against it as it did not affect the true seat of the disease in his view, the ‘vitious principles in the stomach’ and therefore preferred vomiting as the principal method in dealing with smallpox.

But if most doctors advocated bleeding a patient suffering from smallpox, there raged a debate concerning the use of cold and hot regimens. As Blackmore tells us, on one side stood Thomas Sydenham, one of the most pre-eminent physicians of seventeenth-century England. Sydenham, as Blackmore tells us, opposed the treatments put forward by his colleagues such as the use of ‘Venice Treacle, Virginian Snakeroot, Contrayerva, Zedoary, Saffron, Volatile Salt of Hartshown, Powder of Viper’s Flesh, and the like’ and instead argued for the use of a cold regimen and ‘discharged all the Train of warm Alexipharmack Remedies, such as above enumerated, and instituted a Method of Practice Reverse to this; for he opened not only the Curtains round the Bed, but often the Windows likewise to let in fresh Air to the Room, took the sick Persons out of Bed, and plied them constantly with diluting and attempering or with acid and cooling Remedies: In the mean Time he often thro’ the several Stages of the Distemper, prescribed six Drams, or an Ounce of Syrup of white Poppies to be taken in the Evening, or at the Beginning of the Night, and to be repeated, and the Dose to be increased as great Wakefulness and Inquietude should demand; and this Method has much obtained since his Time.’ Blackmore pointed out that both methods, hot and cold, had their proper places and times but that it should not be a choice of either/or but rather both at different times and stages of the disease.

Treating the symptoms of fever in smallpox was likewise an area of debate – one which was highlighted by Worth’s small collection of works on smallpox. John Friend argued for the efficacy of purging patients but Woodward disagreed, pointing out that purging patients and forced evacuations might heighten the pulse and exacerbate the heat of the fever. He clinched the argument by citing Hippocrates, the best known ancient author on fevers, as being opposed to the use of purging when the patient had a high fever.

Other physicians argued for the use of blisters but John Woodward, the author of Worth’s copy of The state of physick: and of diseases (London, 1718) suggested, these were of little value since they did not affect the true source of the disease in the stomach:‘the Fountain and Source of these Disorders: and so long as the Principles, and Causes of the Disorders, remain, disturbed, in the Stomach, any Attempt to operate upon the Blood may be incommodious: and must be fruitless.’

Inoculation

Thomas Nettleton, in his An Account of the Success of Inoculating the Small-Pox in a Letter to Dr William Whitaker, dated 3 April 1722 from Halifax, which is attached to Grierson’s 1722 Dublin publication on the policy of inoculation, outlines his method of treatment and the likely complications that might result, thereafter giving individual case studies:

‘The Method which I always took in the Operation, was to make two Incisions, one in the Arm, and another in the opposite Leg; I believe it is not very material whether the Incisions be large or small, but I commonly found that when they were made pretty large (in grown Persons three quarters of an Inch in length, proportionably less in Children, and so deep as to cut thro’ the Skin in the middle of the Incision) the Quantity of Matter discharged afterwards at those places was greater; and the more plentiful that Discharge, the more easy the rest of the Symptoms generally are; and they are also by this means the best secured from any ill Consequence afterwards.
At first I collected some of the Matter from the Pustules of one who had the Small-Pox of the natural sort, into a Shell or a Viol, and infus’d two or three Drops of it into the Wound; but finding it sometimes to be very troublesom and difficult to get any Quantity of the Matter; and observing also that the least imaginable will be sufficient for the purpose, I generally take small Pledgets of Cotton, and ripping the Pustules when they are ripe with the point of a Lancet, roll the Pledget over them till they have imbib’d some of the Moisture; I put one of these upon each Wound, covering them with any common Plaister ‘till the next Day, when I commonly take away both the Cotton and the Plaister, leaving the Wound to itself, only covering it with a slight Linnen Roller to defend it from the Air. I have sometimes rub’d the Pledget only once over the Wound, without binding it on, which I found to answer the End as well; and from some other Observations I have made, I have been surpriz’d to see the Small-Pox produced this way, when I was very well assured, the Quantity of Matter receiv’d into the Vessels could not amount to the Hundredth Part of a Grain…’

The first thing that occurr’d after the Incision, was the Inflammation of the Wounds, which commonly happen’d about the fourth Day, when they began to appear very red round about, and to grow a little sore and painful; in about two Days more they began to digest and run; in some they begin to run sooner, and the Quantity discharged is much greater than in others. I generally found, that in those who discharged most this way, the Fever was more slight, and the Small-Pox fewer; tho’ I have known some do very well, when these Places have only appear’d very red, but have not run at all, as it usually happens when the Incision is made so superficial as not to cut thro’ the Skin.
About the seventh Day, the Symptoms of the Fever began to come on, which are the very same that we always observe in the Small-Pox of the distinct Kind in the natural Way; a quick Pulse, great heat and Thirst, Pain in the Head and Back, and about the Region of the Stomach, Vomiting, Dosedness, Startings, and sometimes Convulsions. All were no seized with these Symptoms, nor in the same Degree or Continuance; some began on the seventh Day, and continued Ill without any Remission ‘till after the eleventh; many not ‘till the eighth or ninth Day; and the Fever in these was moderate, with great Intermissions; but some have scarce had any Illness at all: During all this time the Places of Incision continued to be very sore, and swell very much, so as to appear large and deep, and to discharge a great deal of Matter.
On the tenth Day the Small-Pox most commonly did appear, sometimes on the ninth, and sometimes not ‘till the eleventh; but I never found that any difference of Age, Constitution, or any other cause, ever made them vary above one Day from the tenth. The Number was very different, in some not above ten or twenty, most frequently from fifteen to two hundred, and some had more that cou’d well be numbred, but never of the Confluent sort: Their appearance was the same with those of the distinct Kind; they commonly come out very round and florid, and many times rise as large as any I have observed of the natural sort, going off with a yellow Crust or Scab, as usual; tho’ it sometimes happens, especially when the Sores discharge a very great Quantity of Matter, that they are both few in Number, and do not rise to any Bulk; but having made their appearance for four or five Days, they waste insensibly away.
After the Small-pox comes out, the feverish Symptoms gradually abate; and when the Eruption is completed they usually cease, without any second Fever, or any farther Trouble in any respect.
While the Pustules were rising, and for some time after they were gone, the Sores continued to swell, and to run very much; the longer they did so, the better; but they never fail’d to heal up, without any Trouble, after a certain Time.’

Nettleton’s letter is included in the pamphlet published by Grierson outlining the dedbate about inoculation in Boston, pp. 4-7.

Not all physicians welcomed this innovative treatment with open arms. Blackmore, writing late in his professional medical life, reflects the arguments of many contemporary practitioners in his ‘Dissertation upon the Modern Practice of Inoculation, appended to his A treatise upon the small-pox (London, 1723). First he focused on the social implications of the treatment – the voluntary inoculation with a disease known to be fatal – an act not only potentially endangering the person undertaking it but also those around him/her:

‘if a Man from a free and deliberate Choice, sets his own Veins on Fire, and inflames his Blood with the Small Pox, which by its contagious Quality may endanger the Lives of many others? Either the Disease must be declared not infectious, or the Consequence is unavoidable; and though he has made Provision for himself, and by that Means has undergone a mild and safe Distemper, yet, as I said before, when then Infection spreads in the Neighbourhood, many may be seized with a dangerous and fatal Kind: And one would think that this Reflection should stagger a Man of Prudence and Virtue, and make him hesitate and consider well with himself, before he ventures upon a Practice, that seems a great Breach of Christian Charity, and a Violation of Justice.’ For Blackmore too little was known about the procedure – it might, for example, be responsible for communicating other diseases in its wake. It was, in short, too risky a procedure to undertake.

*The above treatments are late seventeenth and early eighteenth-century treatments and should not be attempted. For smallpox treatments today see the following websites:

http://www.mayoclinic.com/health/smallpox/DS00424/DSECTION=causes
http://www.who.int/mediacentre/factsheets/smallpox/en/

Selected Reading

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