Owing to the beneficent discovery of Edward Jenner the full terrors of small-pox as it used to prevail can now hardly be realized. In unvaccinated persons, and those upon whom the operation has been performed imperfectly, the disease may still rage with all its natural violence, but in ordinary cases the form of the disease met with is the milder variety which is called varioloid. It is the same disease as variola, although modified more or less by occurring in a subject partially protected by vaccination.
As in most of the infectious fevers, the blood in fatal cases is dark and coagulates imperfectly; in very severe cases hemorrhagic extravasations are scattered about in the loose tissue beneath the serous and mucous membranes. Internal organs, such as the heart, liver, and spleen, are pale, flabby, and soft, or deeply congested. The mucous membranes, especially of the air-passages, are intensely hyperemic, and are thickened, softened, and sometimes ulcerated. Their epithelium is partially separated, and their surface is covered with brown tenacious mucus. The same condition may be found in the mucous membrane of the nasal fosse, the mouth and gullet. In all of these parts small excoriations may be noticed. They are small round spots on the mucous surface, either covered by a whitish false membrane or presenting a round point of superficial ulceration. These are probably due to an eruption on the mucous membrane of a like nature to that which takes place upon the skin. No such appearances are seen upon the gastro-intestinal mucous membrane, but the intestinal follicles and the glands of Peyer's patches are large and projecting. The lungs are often intensely congested, and are sometimes the seat of pneumonia.
[...] Marson, thirteen times twenty-four hours, i.e., twelve whole days and parts of two others. If the disease is produced by inoculation, the period is shortened to seven or eight days. During this stage there are no symptoms in ordinary cases, although a certain amount of irritability and peevishness is sometimes noticed, not usual with the child and indicative of uneasiness; but no definite symptoms can be observed. On the fourteenth day the first decided indication of the illness appears and the stage of invasion begins. [...]
[...] The spots are set more thickly on the face than on the body, and as they appear earliest in this situation, they run through all their stages, and scab earlier here than on the trunk and limbs. The papule is hard, and gives to the finger the sensation, of a small shot embedded in the skin. All are not, however, of equal firmness. Some have much more of a shot character than others. Between the papules the skin is of normal color and appearance; but if the spots are set very closely together, there may be a general redness and granular look of the face without any intervening normal tint of the skin being visible. [...]
[...] The disease then enters into its latest period, that of desiccation and decline. In the course of two or three days the pustules discharge their contents; the redness and swelling of the skin subside; the odor from the child's body becomes extremely offensive ; and yellowish-brown, thick scabs form from caking of the purulent secretion. Nearly at the same time - unless some febrile complication arise—the pyrexia begins to subside and the tongue to clean; the painful symptoms connected with the mucous membranes disappear in the order in which they occurred; the pulse slackens and the appetite improves. [...]
[...] Owen Rees directs that the corner of a towel should be soaked in water as this boils on the fire, so as to acquire the full temperature, and that it should be then applied rapidly to the region of the throat. Before doing so, the surrounding parts which it is not wished to blister must be covered with thick cloths. Diarrhoea, if it be troublesome, must be treated with a small dose of castor-oil, followed up, if necessary, by a draught containing dilute sulphuric acid and a drop or two of tincture of opium. [...]
[...] Pneumonia may begin insidiously, and is also a very serious complication. Bronchitis is sometimes a cause of death. The laryngeal symptoms during the period of secondary fever may be complicated by edema of the larynx. This, however, is seldom seen except in cases of confluent small-pox. Laryngitis may be one of the earliest complications, and is sometimes seen on the tenth or eleventh day. In the case of any of these complications the fever is high and the child, who is barely entering upon convalescence after an exhausting disease, is in a state of great weakness, which is instantly aggravated by the presence of the inter-current lesion. [...]
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