SMALLPOX or Variola

Categories: 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, ar 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

membrane.



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

constitutional symptoms.







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

to digest.



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

be.



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

solution.



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.