§ 95. Variola.

An eruption consisting of acuminated pustules, which first appear on the third, fourth or fifth day of a contagious fever, in the shape of red spots; these spots gradually elevate themselves into pustules during three days, suppurate for three other days, after which they dry up and form scabs, which, on falling off, leave small, irregular cicatrices. This is the course of a single pock. As the breaking out of fresh pocks continues for three days, the period of desiccation terminates about a fortnight after the appearance of the first pock.

The first description of small-pox is found in the works of two Arabian physicians. At the end of the ninth century, it was described by Rhazes, another Arabian physician, in his book on the plague. Smallpox seems to have first existed in Africa. In Europe, the disease first invaded Spain, and thence . spread through the southern countries.

The essential features of the disease have remained the same. It runs a regular course, marked by distinct periods, which are liable to greater or lesser irregularities, in consequence of the disease being complicated with inflammatory, typhoid, gastric and other symptoms.

Such irregularities are, for instance, unusually rapid, or else irregular, delaying, interrupted breaking out of the pocks; imperfect or arrested formation of the pustules; depressed pustules without areolae; watery pustules (crystallinae, lymphaticae); empty pustules (siliquosae); discoloured pustules filled with blood (sanguineae); sudden falling in of the pustules, or sudden disappearance of the swelling of the face; too rapid and too general a desiccation of the pocks.

Small-pox is one of the most dangerous, painful and disgusting diseases. The more numerous the pocks, particularly in the face, the more complicated the disease; the older the patient, and the feebler the constitution, the more dangerous is the disease. Epidemic small-pox is more dangerous than sporadic, and more so about the middle of the epidemic than either at the commencement or end. Convulsive phenomena previous to the eruption are of no importance; but they indicate great danger when occurring during the period of desiccation. There is great danger when the eruption appears very suddenly, and in clusters, or when the pocks are depressed, pale, discolored or sanguineous; a discharge of blood by the urine or stool during the period of desiccation is particularly dangerous. The course of small-pox is distinguished into four stages.

(1.) The febrile stage, which sets in with a slight vascular excitement, and ceases upon the appearance of the first stigmata. The fever is very slight at first, but increases from day to day, and is a continuous remittent fever. The fever is accompanied with various secondary ailments, such as headache, ill-humour, low-ness of spirits, weariness, drowsiness, congestion of the head with bleeding of the nose, delirium, nausea, vomiting, a characteristic putrid smell of the breath and urine, epileptic convulsions when the patients are quite young, colic, drawing in the limbs, stretching, pains in the back, etc.

If the fever be violent and accompanied with pains in the limbs, congestion of the head, bleeding of the nose, headache, Aconite is indicated. If there be great sensitiveness to the light, if the headache be aggravated by light, and if the nervous system should be greatly irritated, Aconite may not always prove sufficient, and it may then be necessary to give a dose of Belladonna, or, in some cases, a dose of Rhus t. Opium is useful when there is a good deal of sopor. Some physicians assert that they have found Arsenic very useful, particularly after the stigmata had commenced to make their appearance. No particular remedy can be recommended for the first stage, on account of the great variety of the symptoms characterizing that stage. Pulsatilla, Ipecacuanha, Antimonium crudum, Arnica, Bryonia, etc., should be thought of when gastric symptoms are present; Rhus t., Bryonia, Dulcamara, when the patient experiences rheumatic, drawing-tearing pains in the limbs. Sulphur has been recommended by me and my late colleague, Doctor Franz, as a prophylactic for small-pox; however, I have not yet had an opportunity of ascertaining by experience whether Sulphur does really possess the power of arresting the disease at the termination of the first stage, and whether it has any prophylactic virtues whatsoever.

§ 96. The second stage is the eruptive stage, which lasts from three to four days. Towards the termination of the third paroxysm of fever the stigmata make their appearance, at first in the shape of small red points which increase in extent and elevation from hour to hour, and are distinguished from measles, petechiae and other cutaneous eruptions, by the fact, that upon close examination, a pimple of the size of a millet-seed is discovered in each stigma. The stigmata first appear on the face, next day on the hands, and on the third day the feet and the rest of the body are covered with them. In many cases the pustules form in the face before the stigmata make their appearance on the feet. Thus it is that every patient exhibits pocks in the different stages of development. When the last pocks have broken out, the vascular excitement ceases. Its continuance, under those circumstances, would denote an anomalous condition of the disease. Generally the patients complain of nothing but an itching and burning of the skin, sometimes of pains in the eyes and throat.

In the eruptive stage, Stramonium has frequently been useful in accelerating the appearance and shortening the course of the pocks. The remedies mentioned for the first stage, may likewise be employed if indicated. If gastric symptoms be present, Chamo-milla, Nux v., Antim. cr., Bryo., should be thought of. Aconite is to be continued if the fever be high. If the disease should set in during the period of dentition, it is generally accompanied with the fever incidental to that period, and characterized by various symptoms, and particularly by congestion of blood to the head, or, if there should be great vascular excitement, by congestion of blood to the chest. The congestion of the head is frequently accompanied with delirium, which, when continuing during the waking state, indicates an inflammatory condition of the brain, particularly when a good deal of thirst, sleeplessness, retention of stool, and a burning heat of the skin, with natural warmth or even coolness of the feet and hands are present. The congestion of the chest frequently assumes the character of angina pectoris or pneumonia, and is characterized by excessive shortness of breathing, constant short and sleep-disturbing cough, burning heat, great thirst, quick and strong beating of the heart, extreme restlessness, etc. Neither of these two kinds of congestion in small-pox is apt to yield to Aconite; Belladonna is much more suitable, and, if there should be great orthopnoe, and the thorax should expand like a cuirass during an inspiration, Phosphorus is the appropriate remedy. If catarrhal symptoms, an affection of the mucous membrane of the lungs, with cough, coryza, hoarseness, etc., should be present, the remedies indicated for catarrhal fevers are to employed; if the throat should be affected, we have to resort to the remedies indicated for angina.