Smallpox

Smallpox. Variola. An infectious disease, the chief symptoms of which are fever and a characteristic eruption, at first papular, then vesicular, and ultimately pustular. The malady appears to have prevailed in Europe in the early centuries of the Christian era, and it was recognised and described by the Arabian physicians. It is known to have caused considerable ravages in various parts of the world during succeeding ages, and until the end of the last century was regarded as one of the most serious of epidemic diseases. The introduction of inoculation into this country in the 18th century seems to have, in spme degree, diminished the amount of injury wrought by smallpox, and with the growth of the practice of vaccination (q.v.) introduced by Jenner at the end of the last century, the prevalence of the disease has markedly declined. Cases of smallpox are now rarely met with and it is difficult to realise how widespread and potent for mischief the disease formerly was.

Symptoms. The period of incubation of smallpox is usually about 12 days. On or about the 13th day after the exposure of a susceptible person to infection, a rise of temperature occurs, with shivering, aching of the limbs, vomiting, headache and intense pain in the back; on the thtrd day counting from the commencement of the initial symptoms, the rash develops in the form of minute reddened papules, which appear first on the face, neck, and wrists, and later become generally distributed over the body. The spots have at the outset a hard "shotty" feeling when touched; they increase in size, and in the course of about three days they have developed into vesicles, and in three days more into pustules. Sometimes the pustules are quite distinct from one another (discrete smallpox); sometimes they run into one another (confluent smallpox). The pustules when fully developed usually present a central depression, what is called the umbilicated appearance. The temperature, which at the outset may attain a considerable degree of elevation, usually falls when the eruption first appears, and again rises (secondary fever) when the pustules become formed. After a few days in cases which do well the fever again subsides, the pustules dry up, and convalescence supervenes. In the severer forms of the malady extensive scarring of the skin occurs, in the milder forms there is only slight pitting, and in the mildest no traces of the disease are left behind. The chief sequelae of smallpox are ophthalmia, otitis, laryngitis, and lung troubles. The severity of the disease bears a distinct relation to the extent of development of the eruption. Discrete smallpox is rarely fatal, while in confluent smallpox nearly half of those attacked die. Malignant smallpox is the variety of the disease in which the early symptoms are especially severe, in which haemorrhages beneath the skin and conjunctivae occur, and in which a fatal issue supervenes usually before the eruption has had time to become developed. The desirability of isolating smallpox patients in hospital, as soon as the nature of the malady becomes apparent, cannot be too strongly insisted upon, and any persons who have been brought into contact with the infected individual should at once seek advice as to the desirability of being revaccinated.