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SMALLPOX or Variola
Category: Infectious Diseases
Smallpox is an acute infectious disease. It has a
sudden onset with a severe period of invasion which is followed by a
falling of the fever, and then the eruption comes out. This eruption
begins as a pimple, then a watery pimple (vesicle) which runs into the pus
pimple (pustule) and then the crust or scab forms. The mucous membrane in
contact with the air may also be affected. Almost all persons exposed, if
not vaccinated, are almost invariably attacked. It is very contagious. It
attacks all ages, but it is particularly fatal to young children.
Cause. An unknown poison in the contents of the pustules or crusts in
secretion and excretion, apparently, and in the exhalations of the lungs
and skin; one attack does not always confer immunity for life. It is
contagious from an early period. Direct contact does not seem to be
necessary, for it can be carried by one who does not have it.
Symptoms. Incubation lasts from ten to fourteen days, and is usually
without symptoms. Invasion comes suddenly with one or more chills in
adults, or convulsions in children, with terrible headache, very severe
pain in the back and extremities, vomiting, the temperature rising rapidly
to 103 or 104 degrees.
Eruptions. This usually appears on the fourth day as small red papules on
the forehead, along the line of the hair and on the wrists, spreading
within twenty-four hours over the face, extremities, trunk and mucous
Symptoms of fever diminish with the appearance of the rash, which is most
marked on the face and ripens first there. The papules become hollowed
vesicles and a clear fluid fills them on the fifth or sixth day. They fill
with pus about the eighth day, and their summits become globular, while
the surrounding skin is red, swollen and painful. The general bodily
symptoms again return and the temperature rises for about twenty-four
hours. Drying of the eruption begins the tenth or eleventh day. The
pustules dry, forming crusts, while the swelling of the skin disappears
and the temperature gradually falls. The crusts fall off, leaving scars
only where the true skin has been destroyed.
Confluent form. All the symptoms are more severe. The eruption runs
together and all the skin is covered.
Varioloid. This is smallpox modified by vaccination. The invasion may be
sudden and severe. It is usually mild and gradual, but with severe pain in
the back and head. A scanty eruption of papules, often only on the face
and hands, appears on the third or fourth day, with disappearance of
Treatment. Vaccinate the children the second or third month, and all
persons about every six years, and always after exposure to the disease or
during epidemics. Put the patient in a room cleared of all furniture,
carpets, curtains, rugs, etc.; keep the patient thoroughly clean, and the
linen should be frequently changed. The bed clothing should be light.
Disinfect and sterilize everything thoroughly that has been in contact
with the patient. Get a good experienced nurse, and one who has been
around the disease.
Diet. Give the supporting diet early. During the first stage give milk,
broths of different kinds, albumin water. Relieve the intense thirst by
water and lemonade. When the first (initial) fever subsides and the
patient feels improved, give milk, eggs, chops, steak, or rare roast meat,
bread or toast; vegetables, such as potato, spinach, celery, asparagus
tips, cauliflower tops. When the second fever returns go back to the
liquid diet again, and give regularly and as much as possible every two or
three hours during the day, and every three or four hours during the
night. Milk, plain or peptonized; milk punch, raw eggs, broths, beef
juice. If swallowing is difficult, give food cold and oftener, and in less
quantity. Increase the diet rapidly during convalescence.
Cold drinks should be freely given. Barley water and oatmeal water are
nutritious and palatable. Milk broths, and articles that give no trouble
Nursing. Nursing is the main thing. The bowels should be kept open with
salts. There is no special medicine we can claim will do good. Aconite may
be used for the fever at first, in drop doses every hour for twenty-four
hours. But the least medicine that is given the better it will generally
There is, I believe, something in protecting the ripening papules from the
light. The constant application on the face and hands of lint soaked in
cold water, to which antiseptics such as carbolic acid or bichloride may
be added, is perhaps the most suitable treatment. It is very pleasant for
the patient at least, and for the face it is well to make a mask of lint
which can be covered with oiled silk. When the crusts begin to form, the
chief point is to keep them thoroughly moist, which may be done with oil
or glycerin; vaselin is particularly useful, and at this stage can be
freely used upon the face. It frequently relieves the itching also. For
the odor, which is sometimes so characteristic and disagreeable, the
diluted carbolic acid solutions are probably the best. If the eruption is
abundant on the scalp the hair should be cut short. During, convalescence
frequent bathing is advisable. It should be done daily, using carbolic
soap freely in order to get rid of the crusts and scabs. There is danger
to others as long as the skin is not smooth and clean, and not free from
any trace of scabs. As you must have a physician, I give but little
medical treatment. Nursing is the main thing in this disease.
General Rules for Disinfection. The walls, woodwork, and ceiling may be
cleaned by washing with one to one thousand solution of corrosive
sublimate solution, or a five per cent carbolic acid solution, Or by
rubbing with bread if solutions would injure. All dust must be removed.
Plastered walls and ceilings may be white-washed. Woodwork must then be
scrubbed with soap and thoroughly wiped. Then fumigate, at least three
pounds of sulphur should be burned in the room for each 1,000 cubic feet
of space. Placing it in a pan supported in another containing water to
guard against fire. After scrubbing or fumigating, the room and its
contents should be freely aired for several days, admitting sunlight if
possible. All useless articles and badly soiled bedding should be burned.
Such pieces of clothing as will not be injured may be boiled or soaked in
a one to one thousand formaldehyde solution (one ounce of twelve per cent
solution in one gallon of water), or two per cent carbolic acid solution.
Clothing, bedding, etc., may be disinfected in the steam sterilizer.
Hands, Body, etc. Special outer garments may be worn while in the sick
room and removed, and clothing aired before leaving. Hands of the
attendant should be washed in one to one thousand corrosive sublimate
Vaccination and Re-vaccination and its Prevention of Smallpox. We quote in
part from an article prepared by the State of Michigan. It is well known
that smallpox can be prevented or modified by vaccination; and a
widespread epidemic of the disease can be attributed only to an equally
widespread ignorance or willfulness concerning smallpox and its prevention
by vaccination and re-vaccination.
A Good Time to be Vaccinated. Smallpox is usually most prevalent in the
winter and spring months, reaching the highest point in May. The rarity of
smallpox in Michigan for several years led to a feeling of security and to
neglect vaccination, resulting in an increased proportion of inhabitants
not protected by recent vaccination. This made possible a widespread
epidemic. The proper preventive of such an epidemic is general vaccination
and re-vaccination of all persons not recently thus protected. There is no
better settled fact than that vaccination does protect against smallpox.
But after a time the protection is weakened, therefore after a lapse of
five years there should be re-vaccination.
Next: Why Vaccinate
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