–This is one of the infectious, eruptive fevers, depending on a specific microbic poison. It generally attacks a person only once in a lifetime, and after vaccination the susceptibility is generally lessened for a time. When smallpox is caught by inhaling the poison the disease is generally more intense than water it is transferred by introducing smallpox matter under the skin. The discovery of this fact led to the practice of “inoculation.” But the disease when taken in this way was not always mild, and was sometimes fatal, and the person inoculated was just as likely to spread the infection in the intense form as any other smallpox patient, and this led to the abandonment of the practice before vaccination came in. The incubation period (that is, the time between the infection and the first appearance of the symptoms) is ten days. The first symptoms are severe backache and intense headache and fever.
There is also a dirty tongue, and symptoms of a deranged stomach. At the end of the third day small red spots appear, first on the face, communicating a “shotty” feel to the touch, and then appear on the body and limbs. On the second day the pock has a little blister at the top, which soon becomes filled with milky fluid.
The centre of the pock is depressed. It takes nine days for the eruption to come to dull maturity, and there is a marked subsidence of the symptoms. In a day or two the second stage– that of suppuration– begins, and then there is a rise of fever again. This lasts only a short time, and after this the pocks begin to dry up, a scab forms and becomes black. When this separates, if it is in a part that has been exposed to the air, it leaves a depressed scar or pit. When the eruption is very profuse the pocks run into one another, and the disease is called confluent smallpox. This is always dangerous. The critical days are the eighth and the eleventh. It is on these that the greatest number of deaths occur.
Diagnosis.–When smallpox is fully developed there is very little chance of making a mistake, but in the early stage, when the eruption is just beginning to appear, it is sometimes taken for measles. If, however, the finger is passed over the skin the eruption will be found to communicate a “shotty feeling,” as if there were fine shots under the skin. In measles the eruption is raised, but much more slightly and it does not give this feeling.
General Treatment.–The proper ventilation, lighting and warming of the sick-room are of the greatest importance. It should contain nothing that is not absolutely required, and should be isolated from the rest of the house. The nurse or nurses must also be quarantined.
During the first part of the illness the patient must be kept on low diet–milk, gruel, beef-tea, and no solids. When the fever is gone he must be fed well, and may take any plain food he can relish.
The face must be carefully protected from the light by a mask made of linen, and smeared with vaseline, or else with carron oil (equal parts of linseed oil and lime-water). Twice or three times a day the patient must be sponged (or brushed with a long- haired brush, such as used for white-washing) all over with a solution of carbolic acid (one part of the acid to sixty parts of warm water); this will be found most grateful to the patient. This may be continued throughout the fever and as long as the patient likes it.
Medicines.–(Every half hour to every two or three hours according to urgency.)
–May be given as a routine practice every four hours. It will sometimes cut short an attack. Other remedies may be given concurrently according to indications below.
–Before the eruption comes out; congestion to the head, injected eyes, fulness of the chest, palpitation, great restlessness.
–Before the eruption, delirium with headache; red face; inflammation of the eyes; with anxious look; intolerance of noises.
–Headache and backache; cough, with soreness of the chest; constipation.
–Great backache, restlessness, vesicles beginning to form.
Ant. tart. 6.
–Drowsiness, with gaping; coolness, with clamminess of the skin; vomiting when the eruption ought to appear.
–Sore throat, ulceration about the eyes and nose; fetid breath, and pains in the bowels, with perspiration and diarrhoea; matter forming in the pocks.
–Patients very restless, anxious, delirious; twitch, and throw themselves about; abdomen bloats, is very sensitive to touch; diarrhoea sets in.
-For the itching during the drying stage.