During an unusual prevalence of vari ola in Chicago between 1850 and 1860, an opportunity was afforded in several cases to control the management of the greater part of the incubative period, and in addition to immediate vaccination and proper attention to hygienic rules each adult was required to take from 10 to 15 grains of hyposulphite of sodium dissolved in mint-water, less, in propor tion, to children, three or four times a day, for the purpose of preventing or, at least, lessening the evolution of con tagium in the system. in some of the cases the vaccination took sufficiently early to prevent the development of vari ola. In other cases it was practiced too late and did not take effect. But, in every instance thus treated, if variola followed it presented only a mild aspect and terminated in recovery. In two in stances coming under my observation in which two women, each with a nursing child, lived continuously in the same rooms with two cases of well-marked variola throughout the whole course of the disease. Both mothers had been rendered immune from having had varioloid in their youth. The infants, however, had not been vaccinated, but had been fully exposed to the active stage of variola three days before their condition had been discovered. They were immediately vaccinated, given each 3 grains of hyposulphite of sodium three times a day; their only diet was their mothers' milk; the rooms were kept as clean and as well ventilated as possible, while the mothers continued to care for those sick with variola in the same rooms. The vaccination did not produce any effect, and both infants con tinued in good health, neither presenting any symptom of fever or eruption.
When the stage of incubation has passed and the evolution of variolous virus has been completed, producing a fever of greater or less intensity, the leading objects to be accomplished in the management are: 1. To secure as com plete isolation of the patient as possible, either in his own room or by direct re moval to a hospital for such cases. Q. To exclude from the room all unneces sary furniture and clothing, and to main tain strict cleanliness, ample ventilation, and disinfection. 3. To lessen the in tensity of the fever and mitigate the severity of pains and restlessness, and at the same time to promote natural ex creting activity of the skin, kidneys, and other secretory organs. 4. To sustain the patient by simple nourishment suit able for the several stages of the disease. The best means for accomplishing the third object just named during the pre-eruptive fever are frequent spong ing of the surface with cool water and the giving of a gelatin capsule containing 1 grain of calomel and V, grain of morphine sulphate, every four hours, and 2 minims of tincture of aco nite-root half-way between the capsules. At the end of twenty-four hours, if the bowels have not moved, instead of con tinuing the capsules give the patient sufficient liquid citrate of magnesia to move the bowels moderately, or accom plish the same purpose by rectal enemas of warm water containing a little chlo ride of sodium. If, when the eruption
of variolous papules appears on the surface, the active febrile symptoms and the pains in the back and head disappear, all active internal medication should be discontinued and strict at tention given to the administration of simple nourishment, consisting chiefly of good milk and plain meat-broths salted to suit the taste of the patient, and the maintenance of rigid sanitation. When, on the third or fourth day of eruption, inflammation supervenes, with only a very moderate rise of temperature and there is but little or no confluence of the pustules, the same hygienic and sanitary measures, without medicine, may be continued until convalescence is established. If, however, the eruption is more copious and the suppurative stage accompanied by more fever and restless ness, from 6 to 10 grains of pulverized Dover's and 2 grains of pulverized gum camphor may be given each evening, and 10 grains of hyposulphite of sodium with 5 minims of tincture of belladonna dis solved in mint-water may be given three times a day until the stage of desiccation has fairly commenced. If necessary, the bowels can be moved at suitable intervals by warm salt-water enemas, and as the process of drying up and cicatrization of the pustules goes on a greater variety of food may be taken.
Pock-marks are thickest on parts of the body, such as the face, most exposed to light: hence the custom has been in troduced into practice of leaving the patient in total darkness. Finsen some years ago suggested the exclusion of the chemical rays of light by using red glass over window-panes, or at least red cur tains.
The exclusion of the chemical rays must be absolute; even a brief exposure to daylight may produce suppuration and its sequehe. The skin mist be treated, therefore, as one would a photographic plate. If red window glass is employed, it is necessary for it to be of a deep-red color, and if cur tains are used they must be very thick or in several layers. When the patient takes his meals, or during the physi cian's rounds, artificial light—fo• in stance, faint candle-light—may be used without any danger. As even a brief exposure to daylight can produce sup puration, in order that the treatment may be carried out correctly it may be necessary to nail the curtains to pre vent meddlesome interference by at tendants. This method does not pre vent, but allows, the employment of any other treatment which may be con sidered necessary. The treatment should be commenced as early as pos sible; the nearer the commencement of the suppuration, the less the chance of success. The patient must remain in the red light until the vesicles have dried up. E. P. Joslin (Boston Med. and Surg. Jour., Nov. 10, '99).