Diagnosis of a well-developed case of variola is not difficult. In the early stage when prodromic rashes may be present, the symptoms to recollect in differentiating variola from the other exanthemata will be found in the table given on page 216. It is possible that impetigo contagiosa might be mistaken for variola but it is non-febrile, never generalized, usually affecting only the face and hands, with few lesions and without umbilication. Syphilis and acne are always distinguished by their comparatively chronic course, previous history and lack of fever.
Prognosis will depend upon the prevailing epidemic, age of the patient, his general condition, the extent and character of the lesions and, most important of all, upon the question of previous vaccination. One attack usually affords immunity from a second attack.
Treatment. Vaccination and revaccination are essential in the prevention of smallpox and are the most important consideration in the preventive therapeutics of this disease.
Local treatment of the active attack is for the purpose of relieving subjective sensations such as pain, burning and itching, to lessen the offensive odor, to prevent septicemia and to lessen or possibly prevent scarring. Various antiseptics have been advised but have been used without particularly good results. Among these may be mentioned the various salts of mercury, boric acid, potassium permanganate, iodoform, carbolic acid, eucalyptus, thymol and the salicylates. To relieve the itching and burning, the body may be sponged or bathed in cool or tepid water as often as is necessary. In severe cases a continuous warm bath is often beneficial. Throat gargles of potassium chlorate, myrrh, thymol or carbolic acid may be used. the edges of the eyelids should be covered with cold cream or vaseline twice daily. A 2 per cent. solution of creolin in glycerin, equal parts of olive oil and lime water, equal parts of ice water and glycerin, or 10 per cet. alcohol in glycerin, will relieve the itching and burning. Occasionally, to prevent septicemia, antiseptic baths of mercuric chlorid (1:10000 to 1:20000) or creolin (1:500 to 1:1000) may be used, or the pustules may be opened, evacuated and sponged with these same solutions is greater strength. After these baths or applications, dusting powder of 5 per cent. iodofrom or 15 per cent. aristol may be applied to relieve the offensive odor. The prevention or lessening of pitting is most important from the patient’s standpoint, but none of the remedies offered are sure. Many patients, especially those with superficial lesions or those who have been vaccinated, recover without any or slight pitting. The local application of tincture of iodin, applied once or twice daily, has given good results in the lessening of- pitting, and also in the prevention, to a certain degree, of secondary pyogenic infection. The red light treatment of smallpox, based upon the exclusion of the chemical rays of light, was advised by Finsen of Copenhagen, but it has not demonstrated its clinical value, and is not feasible in the great majority of cases.
The following measures are simple and sensible. An efficient nurse is all important to carry them out and to see that the sick room is darkened, and kept plentifully supplied with fresh air. the skin of the face may be sponged with a weak formalin or creolin solution and frequently anointed with some bland oily or fatty substance, over which may be laid compresses of weak solutions of carbonic acid, boric acid or thymol. Occasionally the simple ointments may contain the last-mentioned ingredients, or resorcin, bismuth or sulphur. The smallpox patient is a bed case and preferably a hosptial subject. The general treatment is the same as applied to any other acute infectious disease in that it embraces a simple nutritious diet, with stimulant, tonics and sedative as needed plus good nursing.
For symptomatic remedies, see Aconite, Ant. tart., Apis, Arsenicum, Baptisia, Carb.acid, Crot., Hepar sul., Hyd., Kali., Lachesis, Mercuriussol., Rhus tox., Sarrac., Sulphur, Thuja and Variolinum.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war