A Practical Treatise on Smallpox 1

A Practical Treatise on Smallpox 1

A Practical Treatise on Smallpox

: George Henry Fox

 

CONTENTS

 

 

Chapter Page

I Symptoms and course 1

II Diagnosis 9

III Treatment 15

IV Vaccination 26

PLATE

 

I. VARIOLA ERYTHEMATOSA. (First Day.)

 

This shows the earliest eruption upon back and buttocks. The

photograph was taken about seven hours after its first appearance.

The patient was sent to Riverside Hospital, where she developed

hemorrhagic smallpox, and died on the fourth day. [H.]

 

II. VARIOLA PAPULOSA. (Second Day.)

 

Showing numerous incipient papules upon the face. Those upon the

forehead were the first to appear and are most prominent. The

cheeks present a characteristic leathery appearance. [H.]

 

III. Variola Hemorrhagica.

 

Showing upon the face and cheeks a form of the disease commonly

known as “black smallpox.” Figs. 1 and 2 were photographed on the

second day and show a profuse and dark eruption. The swelling and

disfigurement of the face present a most striking appearance. Figs.

3 and 4 were photographed on the fourth day, when the patient was

in a moribund condition. [H.]

 

IV. VARIOLA VESICULOSA. (Fourth Day.)

 

A case of moderate severity, with well-developed vesicles and

characteristic grouping of lesions upon the face. [P.]

 

V. Variola Vesiculosa.

 

Fig. 1 shows a mixed eruption of papules and vesicles upon the

right thigh. (Third day.) This condition is exceptional in Variola,

though quite common in Varicella. [F.] Fig. 2 shows well developed

umbilicated vesicles upon the forearm. (Fifth day.) [H.] Fig. 3

shows a hemorrhagic effusion into the vesicles on the thigh and

leg, a condition far less serious than the purpuric eruption of

malignant variola. [P.]

 

VI. VARIOLA SEMI-CONFLUENS. (Fifth Day, Sixth Day.)

 

These illustrations show a partly confluent character which the

eruption frequently presents, even in mild cases, and especially

upon the legs. The influence of pressure in developing a more

profuse eruption may be noted above the ankles, where shoes were

laced, and below the knees, where garters were worn. [F.]

 

VII. VARIOLA CONFLUENS. (Seventh Day, Eighth Day.)

 

Fig. 1 shows umbilicated pustules with an intense œdema of the

foot, considerably increasing its size and causing much pain.

Fig. 2 shows the epidermis raised in a large, irregular patch by

the confluence of pustules. [F.]

 

VIII. Variola Pustulosa. (Ninth Day.)

 

Fig. 1 shows an eruption discrete upon the trunk and even upon the

hand, while confluent upon the forearm. [H.] Fig. 2 shows a vaccine

pustule coexisting with variolous pustules. The vaccination took

place before the disease began, but too late to exert a decided

prophylactic effect. [P.] Fig. 3 shows an eruption of large,

flaccid pustules with swelling of the foot. [P.] Fig. 4 shows an

eruption of discrete, tense, hemispherical pustules. [F.]

 

IX. VARIOLA DISCRETA. (Ninth Day.)

 

A typical case of mild smallpox occurring after vaccination and

sometimes called Variola modificata or Varioloid. [P.]

 

X. VARIOLA PUSTULOSA. (Tenth Day.)

 

A severe case, showing the characteristic aggregation of lesions on

the face and extremities. [P.]

 

XI. VARIOLA PUSTULOSA. (Ninth Day, Tenth Day, Eleventh Day.)

 

These illustrations show the pustular lesions in the stages of

complete distention, when they present a rounded appearance, and

of incipient desiccation, when they appear flattened and with a

central depression or “secondary umbilication.” [P., F., F.]

 

XII. Variola Pustulosa et Crustosa. (Tenth Day, Twelfth Day.)

 

In Fig. 1 an occlusion of the nasal passages is indicated by the

lips parted in respiration. [P.] Fig. 2. shows a palmar condition

which, in the adult, is found only in smallpox. [P.] Fig. 3 shows

the desiccation of the facial eruption in advance of other regions.

[P.] Fig. 4 shows a mild discrete case in which a diagnosis of

acne had been made. [F.] Fig. 5 shows the eruption in the stage of

desiccation. [F.]

 

XIII. VARIOLA CRUSTOSA. (Eighteenth Day.)

 

Showing a few thick crusts remaining upon the face with numerous

dull red spots from which the crusts have fallen. [F.]

 

XIV. VARIOLA DESICCATA ET SQUAMOSA. (Twentieth Day.)

 

Figs. 1 and 3 show the dried pustules remaining in the thickened

skin of palm and sole after the crusts have fallen elsewhere.

[F., P.] Fig. 2 shows the superficial desquamation which follows

the falling of the crusts, producing rings of partly detached

epidermis. [F.]

 

XV.

 

Fig. 1 shows a peculiar pigmentation sometimes left after

the eruption. The central portion, being darker, produces a

“bull’s-eye” appearance. [F.] Fig. 2 shows the hypertrophic

condition of the scars which occurs in certain cases in place of

the usual pitting, and which tends to disappear in time. [H.]

Fig. 3 shows severe pitting, a partial loss of hair and eyebrows,

and destruction of one eye. [H.]

 

XVI.

 

Fig. 1 shows the typical appearance of a successful revaccination.

(Fourth day.) [F.] Fig. 4 shows a small, well-formed vaccination

pustule at its height. (Eighth day.) [F.] Fig. 2 shows a large,

irregular pustule resulting from scarification of an area of

unnecessary extent. (Eighth day.) [F.] Fig. 5 shows an ulcer

resulting from infection of the vaccination lesion. [F.] Fig. 3

shows a primary vaccination at its height (eighth day) with a

characteristic areola. [F.] Fig. 6, a case of Varicella on the

third day. [F.]

 

 

 

 

PREFACE.

 

 

Whenever a physician is called to a case of suspected smallpox,

he confronts a grave responsibility. If young or without special

experience, he is apt to feel a sore need of assistance, and, although

a book can never take the place of an experienced consultant, it is

the object of the present work to render him as much aid as possible.

The text aims to be practical rather than elaborate. The plates are

reproductions of photographs from life, some of which have been

obtained under great difficulty.

 

While many articles on variola have been illustrated by a few

photographs of cases, mostly of the pustular type, this work is

believed to be the first which has presented illustrations of the

smallpox eruption in each of its successive stages. It is sincerely

hoped that the reader will find it of service in familiarizing him with

the peculiar features of the disease.

 

GEORGE HENRY FOX.

 

 

 

 

SMALLPOX.

 

 

 

 

CHAPTER I.

 

SYMPTOMS AND COURSE.

 

 

Variola, or smallpox, is an acute, contagious disease, characterized by

an eruption upon both the skin and mucous membrane, with constitutional

symptoms of greater or less severity. The eruption presents

successively a macular, papular, vesicular, and pustular stage, the

pustules finally drying into crusts, which fall and leave the skin

temporarily discolored. Where ulceration has occurred it is permanently

scarred or pitted. The lesions of the mucous membrane appear upon

those parts more or less exposed to the air,--the mouth and eyes, for

example,--but in exceptional cases they may be found throughout the

entire intestinal tract, and in the uterus and bladder. These lesions

do not run a course similar to those observed upon the skin, but

appear as red macules, which rapidly change into ulcerations, covered

with a whitish pellicle. The ulcers are imbedded in the substance of

the mucous membrane and are not as superficial as in cancrum oris.

The constitutional symptoms are most prominent during the periods of invasion and pustulation.