Study of 29 case: showed that there was marked hyperleucocytosis in small pos. ° - It is noticed from the outset and increases till the moment Nrhen the pust ules form, after which it decreases progressively only to rise again if the patient suffers from some form of sup puration. The cells affected are the mononuclear leucoeytes, but, if abscesses or other forms of suppuration appear. it is the polynuclear cells which increase in number. Courmont and Moutagnard (Semaine Med., June 20, 1900).
Prognosis.—Unmodified variola is al ways a serious disease. The ratio of deaths resulting from it is much greater, in both childhood and old age, than through the middle period of life. Cases properly designated as distinct, or dis crete, variola quite uniformly recover.
Cases presenting only a limited degree of confluence of the pustules on the face and backs of the hands also tend toward recovery, unless pulmonary or renal com plications occur. But eases presenting a very general confluence of the eruption or strongly hremorrhagic and other symp toms of malignancy, result in a high ratio of mortality. The existence of pregnancy in females increases the dan ger of a fatal result to the mother, often preceded by abortion or premature de livery. Considering all grades of the disease as they occur in different epi demics and in various countries. the ratio of deaths may be said to vary from 10 to 50 per cent. of the whole number of attacks. The chief complications that influence the ratio of mortality are pneumonia, urremia from renal conges tion, endocarditis, intestinal hwmor rhage, and oedema of the glottis.
Treatment.—As variola is well known to he caused by a specific poison or con tagium which requires a period of incu bation or evolution of from one to two weeks before any symptoms of disease become manifest, this is evidently the time when by a prompt resort to vacci nation and active administration of such antidotes or antiseptics as the hyposul phites of sodium or calcium we might expect to prevent, or, at least, greatly lessen the amount of contagium evolved, and thereby either wholly prevent the attack or render it so mild as not to jeopard the life of the patient. Unfort unately but few patients seek medical advice during the period of incubation or even know that they have imbibed the contagium until its evolution is com plete and active febrile symptoms have commenced. And, in the relatively few
cases in which the time of exposure to the contagium is known and medical ad vice is sought early, immediate vaccina tion with cow-pox virus is generally the only remedial agency resorted to. This, though of the utmost importance if prac ticed efficiently during the first five or six days of the incubative period, is gen erally of no use when resorted to later in that period. But there is much evidence in favor of doing more than this. Through the whole period of incubation the patient should abstain entirely from the use of alcoholic drinks; eat mod erately of plain, digestible food; sleep in clean, well-ventilated rooms; take a fair amount of exercise in the open air daily; and see that the functions of the skin, kidneys, and liver are maintained at their natural degree of activity. But all vio lent evacuating measures should be avoided, and also all excessive fatigue of body or mind.
That such attention to strictly hy ,c_rienic measures during the whole period of incubation is capable of rendering the active stage of the disease much milder is shown by the marked diminution of mortality from the disease in Europe after the introduction of the practice of inoculation by Lady Mary 'Wortley Mon tagu in MS. This practice consisted in inoculating persons when in good health with the virus of variola and keeping them under good sanitary and hygienic regulations through all subse quent stages of their progress, and re sulted in rendering the disease so much milder that the practice was applied ex tensively to new recruits of armies, be fore permitting them to enter upon im portant campaigns. During our own war for independence many of the new regiments were held in well-regulated camps and subjected to inoculation and rigid care until convalescence was com pleted, and the statistics show but a very small ratio of mortality, while the im munity acquired was as durable and com plete as when the disease had been taken in the natural way. The discovery and demonstration of the protective power of cow-pox virus by Edward Jenner in 1798 very soon rendered all further inocula tions with variolous virus unnecessary and unjustifiable, but it did not warrant the neglect of careful attention to the proper management of all patients dur ing the incubative stage of variola.