MODE OF PROPAGATION.- By contagion. No contagion is so strong, so sure, or operates at so great a distance of time and place. It is probably most infectious when the characteristic odour is perceived, and when the pustules suppurate. Recurrence of the disease is rare.
SYMPTOMS.- At first these are similar to those of most other fevers. There is lassitude, chilliness, heat, headache, a thickly-furred white tongue, a deep flush upon the face, a feeling of bruised pain all over the body, but especially in the back and loins, more or less pain or tenderness at the pit of the stomach, and sometimes vomiting. On the second and third day there may be transitory rashes of scarlatinal or measly type. these sometimes lead to errors of diagnosis, but their usual distribution, confined to lower abdomen, sides of thorax, axillae, and inner sides of thighs, should prevent mistakes. On about the third day the eruption appears in the form of red spots, or small hard pimples, feeling like shot in the skin. It first comes out on the forehead and front of the wrists;then on the neck and breast; then gradually extends over the body.
The eruption being completed, the fever subsides; the pimples begin to fill with fluid matter; this is first watery and transparent (vesicles), then yellowish (pustules); then become depressed in the centre (“umbilicated”), and are surrounded by a circular inflamed ring. The eyelids, face, and hands are swollen, and the features sometimes obliterated. A peculiarly disagreeable odour smell, cannot be forgotten. In about eight or nine days from the first appearance of the eruption, the pustules discharge their contents; secondary fever sets in; scabs then form, which dry up, and, in a strong constitution, fall off in the course of four or five days. There remain purplish spots, which do not fade away before the sixth or eight week, or indelible depressed scars, which are called pits or pocks. Discrete variola rarely leaves pocks; confluent variola always does.
DIAGNOSIS.- Unlike Measles and Scarlet fever, the pimples give the sensation to the finger of small shots embedded in the skin; the catarrhal symptoms of Measles, and the sore throat of Scarlet fever, are absent. Unlike Chicken-pox, the eruption suppurates and the fever is high. Unlike Enteric fever, the onset is abrupt.
DANGERS.- The more numerous and confluent the pustules, the greater the danger; the more perfect their maturity on the fourth day, the less the danger. The greatest danger arises from the secondary fever, about the ninth to the twelfth day, while the pustules are ripening; for then the fever is likely to return, when the vital strength is already much exhausted. In a confluent case, fatal chest symptoms may arise, or abscesses may form in various parts of the body, or there may be ulceration and opacity of the cornea or and loss of sight. Suppressed perspiration, scanty urine, Haematuria, great hoarseness, Convulsions, Delirium, or other complications increase the danger of fatality. Half the deaths occur between the seventh and eleventh days of the eruption. Smallpox is very fatal to young children. Small, dark, and badly ventilated dwellings, poor or scanty food, and want of cleanliness, constitute unfavourable conditions.
TREATMENT.- Ant.Tart. is considered to be the most suitable medicine, and a dose should be given every two or three hours. It may be preceded by a few doses of Aconite at similar intervals, and the two medicines may be administered alternately, if the violence of the fever demand the continuance of the Aconite Uncomplicated cases will in all probability yield to this treatment.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Aconitum.- Fever, headache, rapid pulse, etc.
Antimonium Tart.- This remedy should be given as soon as Smallpox is suspected. Spasmodic retching, nausea, and hoarse cough, often very distressing, may be relieved, Convulsions averted, and the severity of the disease greatly modified by it.
Apis.- Considerable swelling of the face and eyelids. If the swelling be attended with hoarseness, and pain in swallowing, Apis. and Belladonna should be alternated.
Belladonna.- Stupor or delirium, severe headache, dislike of light, Ophthalmia. Belladonna also tends to retain the eruption upon the surface.
Coffea.- Restlessness and sleeplessness.
Camphor.- If the eruption suddenly disappear, or suddenly assume a malignant type, with coldness of the skin, difficult breathing, disorder of the brain, etc., one or two drops in a little tepid water, or on a small piece of sugar, every ten or fifteen minutes, till the skin becomes warm, and the eruption reappears. The blanket-bath may be had recourse to with much benefit at the same time.
Mercurius Sol. 6 – Ulcerated throat, Salivation, and Diarrhoea, with bloody stools, especially during suppuration.
Sulphur.- When the disease pursues an irregular course; when the eruption shows a tendency to recede; when the pustules are green, purple or black; during the formation of the pustules; when there is excessive itching; and especially on the decline of the disease, to prevent the usual sequelae, the tincture of Sulph. is especially valuable.
ADDITIONAL REMEDIES.- Aconite (inflammation generally); Apis. (dropsical swelling); Arsenicum (prostration); Belladonna (delirium, inflamed throat ); Bryonia (Bronchitis); Card. Veg. (gastric disorder with putrescence); Hyoscyamus (delirium and restlessness); Kali bichromicum (bronchitis); Mercurius (glandular swellings); Phosph. (pneumonia); Rhus.Tox. (pain in back); Stram (delirium).
ACCESSORIES.- The patient should be placed in a moderately lighted room, in which there is ample provision made for the uninterrupted admission of fresh air, and the free escape of tainted air. A lighted fire and an open window are almost essential in all seasons. The patient’s eyes should be screened from the direct rays of light. He should be kept cool and scrupulously clean, and his sheets and linen frequently changed.
His posture in bed should be frequently changed, so as to avoid constant lying on his back or on particular parts; otherwise troublesome bed-sores are apt to be formed. As soon as the eruption is well out, the uncovered parts (face, hands, wrists) may be covered with lint soaked in dilute carbolic acid (1 to 80). This is grateful to the patient and helps considerably to allay the irritation. It is desirable in any case to protect the ripening pimples from the light. As the pimples begin to ripen into pustules, they should be kept most with olive oil, glycerine and water, or vaseline. The process should be repeated as often as necessary. The hands of the children should always be muffled to prevent them scratching.
Special attention must be paid to the eyes, which should be washed out, and the eyelids carefully cleaned, with weak boracic lotion several times a day. The mouth, throat and nose should also be swabbed out.
DISINFECTION.- All infected clothing and bedding should be burned; or, in default of this, baked or boiled for half an hour at a temperature of 212o. Rooms should be fumigated with burning Sulphur, the walls cleansed and divested of their paper, the floors scrubbed and washed with a solution of Chloride of Zinc, and walls and ceiling lime-washed; afterwards the doors and windows kept open for several days. (Seen Preventive Measures, Section 2.)
DIET.- During the presence of the primary and the secondary fever, the diet should be chiefly milk and soda-water, gruel, plain, or simple yolks of eggs beaten up with cold milk, grapes, oranges, cooked fruits, etc. For drink cold water, with or without the addition of raspberry-vinegar or current-jelly;toast-water, barley-water, lemonade, etc. Ordinary simple and nutritious diet may be taken in the absence of fever. But as the mucous membrane as well as the skin is affected, care must be taken not to irritate it.
PREVENTIVES DURING AN EPIDEMIC.- Vaccination (see next section); tincture of Sulphur, administered once or twice daily for several days, and fresh air. Too much importance cannot be attached to the dilution and dispersion of the Smallpox poison by free ventilation and disinfectants, which operate as preventives for the unaffected, and improve the condition of patients suffering from the disease. The spread of an epidemic of Smallpox is just in proportion to the overcrowded and insanitary condition of the places in which it occurs.
20. Vaccination – Cow-pox.
This disease is not natural to man, but to the cow. It is similar to Smallpox; and when artificially introduced into the human system is as nearly as possible, without being absolutely, protective against Smallpox.
During the last fifty years, since its general use, it has probably saved more human lives (to say nothing of disfigurement, loss of sight, etc.) than all other remedies put together. It has fallen into disrepute in some quarters on account of the troublesome affections that have occasionally followed it. These, however, bear but a very small proportion to the number of cases in which no secondary effects appeared, and are not to be mentioned in comparison with the loathsomeness and fatality of Smallpox.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."