CHAPTER I GENERAL DISEASES.
A: BLOOD DISEASES
6. Small Pox (Variola).
VARIETIES. This highly-contagious disease is termed discrete when the pustules are separate, and confluent, when they run into each other, and form continuous suppurating surfaces.
SYMPTOMS. The attack commences like most other fevers, and about twelve or fourteen days after the reception of the poison. There is 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. When the pain in the back and vomiting are violent, they may be regarded as the precursors of a severe form of the disease. On the third day the eruption appears in the form of red spots, or small hard pimples, feeling as though they were shot in the skin. It first comes out on the forehead and front of the wrists, is gradually extended over the body, and may also be seen upon the palate. The eruption being completed, the fever subsides, the pustules begin to fill like boils, are depressed in the centre, and surrounded by a circular inflamed ring. The eyelids, face, and hands are swollen and often the features obliterated. A peculiar disagreeable odour now begins to emanate from the patient, which, once smelt, cannot easily be forgotten. In about eight days from the first appearance of the eruption, the pustules break and discharge their contents; scales then form, which dry up, and, in a healthy state of the constitution, fall off in the course of four or five days, leaving purplish spots, which do not fade away before the sixth or eighth week.
DIAGNOSIS. In the early stage, Small-pox is chiefly distinguishable form the other eruptive fevers by severe pain in the back, and vomiting; also by the sensation which is given by the dots to the finger, as if small shots were embedded in the skin: this latter is a most useful sign by which to determine Small-pox from Scarlatina and measles.
DANGERS. The greatest danger arises from the secondary fever, about the ninth to the twelfth day, when the pustules are ripening; for then the fever is likely to return, after the vital strength has already been much exhausted. In a confluent case, fatal chest symptoms, or Laryngitis, may arise; or the pox may be followed by Abscesses in various parts of the body; or there may be ulceration and opacity of the cornea and loss of sight.
TREATMENT. Antimonium Tart. This is a prominent remedy in the disease, and often strikingly relieves the spasmodic retching, nausea, and hoarse cough, which are often very distressing. Anti- Tart. should therefore be given directly if Small-pox is suspected, either alone or in alternation with one of the following remedies.
Aconitum, every third hour, for fever, headache, and restlessness if the pulse be not lowered or the skin moistened. Veratrum Viride (1x), in hourly drop doses, should be resorted to if there be much sickness with the fever, and very rapid pulse. See also Belladonna
Belladonna. Stupor or delirium, severe headache, or Ophthalmia, Belladonna has a direct action upon the brain: it also tends to retain the eruption upon the surface.
Apis. Considerable swelling of the face and eyelids. If the swelling be attended with hoarseness and pain in swallowing, Apis and Bell, should be alternated.
Mercurius. Ulcerated throat, enlarged glands, salivation, and diarrhoea, the stools being bloody.
Rhus Tox. Valuable during the eruptive stage, when there are severe pains in the loins and back, and marked prostration.
Coffea. Much restlessness and inability to sleep. A few doses only will be required.
Carbo Veg. Low typhoid symptoms, with a tendency to putrescence. Tincture of Sulphur is also very valuable. The latter should be administered during convalescence to prevent sequelae.
ACCESSORY MEANS.
1 See also Nursing, Diet, etc., for the sick, pp. 73-87. As soon as the eruption appears, the patient should be placed in a moderately dark room, in which there is ample provision made for the uninterrupted admission of fresh air, and the free escape of tainted air; if possible in a room with opposite windows, and these should be kept open day and night in all seasons. If the weather is very cold, a good fire should be kept in the room, and the windows left open, the patient having an extra blanket to avert cold; if the weather is mild, the patient should be absolutely treated in the open air. “Nothing is of so much importance as pure air, and that in unlimited quantities.
In this hospital we have kept our windows open constantly by night and by day throughout the months of February, March, April, etc.; and this has been attended with the very best results, for our Mortality is the lowest of all the Small-pox hospitals in London, and we were receiving our patients from the same sources, and some time before this epidemic reached its height.” 1 Dr. A. Collie, formerly resident Medical Officer of the Homerton Fever Hospital. The patient should be kept cool, and the sheets and linen be frequently changed.
The posture of the patient in bed should be frequently changed, so as to avoid constantly lying on his back, or on particular parts, otherwise troublesome bed sores will be formed. The diet should be liberal, as the disease is an exhausting one, but it must be given in such a form as to be readily digested and absorbed; it should include a liberal allowance of milk diluted with about one-third soda- water, raw eggs beaten up with milk (cold), beef-tea, arrow-root, sago, etc. Tea or coffee, in moderation, is often graceful and useful; but to quench thirst, nothing is more pleasant and refreshing than pure cold water.
Any objection to cold water on the part of nurses or friends is to be firmly combated. Lemonade, soda-water, and other effervescing drinks may also be allowed. As soon as the eruption is well out, the whole surface should be smeared over with bacon-fat. the anointing being repeated twice or thrice daily. A piece of boiled bacon cut horizontally, leaving about a quarter of an inch of fat adhering to the skin, may be used to anoint the eruption. It completely prevents pitting, and allays irritation. As the pimples begin to ripen into pustules, and before they break, the skin should be sponged with glycerine and rosewater, in equal parts, and directly after- wards, by the aid of a soft puff, the skin covered with a powder prepared by mixing one part of the 1st trituration of Tart. Emetic with eight of violet powder.
The glycerine-water causes the powder to adhere, and pitting is effectually prevented. The process should be repeated as often as necessary. If the patient is a child, his hands should be muffed to keep him from scratching, which might lead to ulceration. Two or three times a day, whenever the skin becomes hot or irritable, great relief will be afforded by sponging it with tepid water, in which carbolic acid has been mixed in the proportion of one to sixty. Tepid sponging adds much to a patient’s comfort; it also hastens convalescence. When the pustules have burst, powdered starch should be freely applied, to absorb the matter.
FOR GENERAL TREATMENT See pp. 73-87.
7. Vaccination
This is the process by which the disease Vaccinia is artificially introduced into the body for the purpose of protecting it against Small-pox.
The performance of this great preventive is now rendered compulsory during the first three months of infancy. In performing vaccination there are four precautions to be observed: (1) The vaccine lymph should be taken direct from the calf, or, if this is not possible, from a child free from Scrofula or any constitutional taint. (2) The lancet employed should be absolutely clean. (3) The matter should be inserted in three places in the left arm, or whichever arm comes least frequently in contact with the nurse’s body. Much care should be taken to avoid rubbing or irritating the vesicles. If the operation is successful well-marked scars will be left. (4) It should be repeated at the age of puberty, the great changes which take place at this period of life rendering its repetition necessary.
8. Chicken-pox (Varicella)
On the second day of a slight fever an eruption appears similar to that of Small-pox, for which it may be at first mistaken. But it differs from Small-pox (1) in the mildness of the fever which attends it; (2) in the appearance of the eruption on the trunk first, on the face afterwards; (3) in the rapid appearance of the spots twenty-four hours: (4) in the spots having no inflammatory ring around them in the first stage; (5) in the vesicular character of the eruption, the spots of which become filled with a watery fluid about the second or third day, which is rarely converted into yellow matter; (6) in the absence of hardness to the touch; (7) in the absence of odour; and (8) in the rapid course of the complaint. Generally in the third day the pustules dry up, forming crusts or scabs, but no pits.
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."