VARIOLA, OR SMALLPDX.
Prophylaxis is of vital importance in a disease of such a highly contagious nature, and as vaccination affords a high degree of immunity, especially when repeated at intervals of 15 to 20 years, every individual in the community above 15 years should he revaccinated as soon as the presence of a case is reported. If periodical revaccination were compulsory it is highly probable that the disease would never be seen in such protected communities. Even as it is, with revaccination never resorted to except in the face of an epidemic, the mortality, as pointed out by Moore, is only the one-seventieth part of the death-rate in prevaccination times.
The most rigid isolation in a properly equipped hospital of every patient affected is essential, and a period of 15 clear days is the shortest quarantine for those who have been in contact with the disease: All linen, bedding, clothes, etc., which have been about the patient before his removal to hospital should be burned when possible, and the room or entire house in which he has been lying should be efficiently fumigated, and every individual within the zone of his infection should be vaccinated. Schools should be closed up in epidemics. Rigid pre cautions should be taken to prevent any convalescent child's return to school till long after every trace of eruption has disappeared and he has been thoroughly disinfected. All children in the immediate vicinity of an infected house should be prohibited from attendance at school.
Every hotly in ease of death should he carried from the hospital direct to the place of burial, and not permitted to be brought to the home, as the emanations from the cadaver are highly contagious, and the striking power of the infection has been demonstrated to extend for great distances.
Mild cases of the disease require very little treatment of any kind, and in those of average severity the various routine measures already described under Typhoid Fever, Measles, Scarlatina and Typhus will he indicated.
The environment of the patient demands the most careful attention, not only on account of the highly infectious nature of the disease, but also because of the extensive suppuration. Hence the most rigid isolation and the necessity for thorough ventilation. The details referring to the choice and arrangement of the sick-room and the patient's bed should receive special care. It is advisable to keep the temperature of the sick room between 53° and 6o° F. (see under Typhus, p. but in every possible case the patient should he removed to hospital, and not treated in his own dwelling.
In the confluent type and in all severe cases the pain in the back may be so intense as to call for relief. 3 grs. Antipyrine, ro grs. Aspirin or a r-gr. dose of Opium may be given. Moore advocates the application of the india-rubber hot bottle and dry cupping.
No drug is known which exercises a specific action over the parasite causing the disease, hence the treatment must he expectant and sympto matic. Antiseptic drugs have been extensively employed with the view of destroying the organism causing the fever, hut it does not vet appear that any marked results have been obtained. Sansom's plan of adminis tering the Sulphite of Sodium in 20 or 30 gr. doses or the Sulphocarbolates in similar quantities can do no harm; and though they have generally failed in making any very decided impression upon the constitutional symptoms, they may possibly sometimes turn the scale in the struggle against the microbe. leo has forcibly shown that slight modifications in the environment of the parasite may materially modify its activity. Thymol, Eucalyptus, Carbolic Acid, Corrosive Sublimate and Salicylic Acid have been extensively employed.
As the result of his extensive experience. Sir J. W. Moore states that in Quinine in 5-gr. doses and in Tincture of Perchloride of Iron in 20 to 30 min. doses we possess the two most valuable antiseptics known so far as smallpox is concerned.