Bianchi carries out the antiseptic treatment to the fullest extent. with apparently excellent results (no deaths in 96 cases). He renders the surface of the patient, his bedding, room, and all his surroundings, as aseptic as possible. The writer strongly recommends inunction of the patient's skin with the Oil of Eucalyptus mixed with Olive Oil (t in ;) from the very commencement of the disease, but this is not to be applied to the face when free suppuration is taking place.
Reports of the successful treatment of smallpox by injections of Salvarsan have raised the hope that in this new steriliser may he found a method of dealing with the disease on rational and scientific lines, hut it is still too early to judge of its action on the causal parasite, and the same remark applies to the intravenous injections of 5o c.c. Electrargol employed by Denman in the late outbreak in the Mauritius.
The Mineral Acids internally, as in the other eruptive fevers, give very good results, and in mild cases or modified smallpox should constitute the only drugs administered.
Alcohol in some form is often needed, the indications being those already discussed under Typhoid Fever. The presence of free suppuration, moreover, constitutes a further indication for alcoholic stimulation and free feeding by strong soups and extra nourishment in liquid form.
As in the other infectious fevers, cold sponging, cold baths and cold packs will be indicated by the height of the temperature, and these are always demanded in the confluent type of the disease. During the period 60 at tree Fustulation the tepid bath is obviously indicated for its antiseptic action, when weak Permanganate or other steriliser may be added to it.
llmmorrhagic smallpox will demand the free administration of Calcium Chloride with Quinine and Iron Perchloride; Alcohol will probably also he clearly indicated.
Ergotin by deep parenchymatous injection and Turpentine by both mouth and bowel are generally used. Moore's routine combination is: R. Extracti Ergotce Liq. 3iij.
Olei Terebinthbue iiij. Spiritus .Etheris Nit. 74 Spiritus Rectificati 31. O'i Aqua' Alenthrc Pip. ad F;viij. Misce.
Fiat inistura. Signa.—" One-eighth part every third, fourth or sixth hour, as required." Delirium may be very fierce, in which case the cold pack and ice-bag to the bead are the best measures; drugs are not to be relied on, hut occasionally the excitement may demand a full hypodermic dose of Morphia. The treatment of such complications as headache, insomnia and diarrhoea is already detailed under Typhoid Fever.
The treatment rJ the eruption, especially that on the face, constitutes a large part of the management of the disease. Stokes insisted that the air should he excluded from the rash, that the skin should be kept permanently moist so as to prevent the crusts hardening, and that the local irritation should he reduced to a minimum. These three indications he carried out by the application of warm poultices; these have passed out of fashion since the introduction of aseptic surgery, but MacCombie still advocates a mask of lint lined with a thin layer of linseed poultice, which latter should he smeared over with Todoform Vaseline; this should he changed every 2 hours, and apertures left for the eyes, nose and mouth.
After the removal of all crusts or scabs the application of warm Boric Acid Compresses under oiled silk is perhaps the safest and most effective routine which the young physician can employ.
Pcrchloride of Mercury solution (3 grs. in io oz.) has been used by Skoda and Ilebra. Carbolic Lotion (1 in 8o), Carbolic Oil (t in 12), and Carbolic l'astes made with Chalk and Oil are all recommended highly.
Thick oily preparations are more valuable than watery solutions. The writer recommends the following: It, Liniincnli Calcis 3171ISS.
Oki Eucalypti 5iv.
Preeparatee 3j. Misce.
Fiat applicatio. Signa.—" To he applied with a large camel's-hair brush to the shin of the face every two or three hours." Weak Tincture of Iodine has been extensively used for brushing over the papules till the free suppuration stage has occurred. This is a good routine, the only difficulty being in the smarting of the eyes which the iodine vapour produces after the spirit has been allowed to evaporate. After the superficial layer of the skin has been shed by the iodine a lint mask well lined with the firm Boric Acid Ointment of the B.P. may be applied.
Mercurial Ointment, diluted with $ to 15 parts of Lard, has been tried and reported upon favourably, but it is not without serious danger. A very innocent plan is to smear over the face with Olive Oil, and then to apply a powder consisting of equal parts of Subnitrate of Bismuth and prepared Chalk. hut most authorities condemn all powdery applications during the stage when crusts are present.
Ultra-violet rays have some influence upon the skin, and it has been recommended to only admit red light through red g lass window-panes or red curtains. Turkey-red window-blinds would answer every purpose and keep the sick-room cheerful. The plan of rigidly excluding daylight from the sick-room has some advocates, but it is manifestly objectionable, and by no means certain in its effects.
Cauterisation of the vesicles by solid Nitrate of Silver, or their evacua tion by means of a fine needle, and many other plans formerly in as the painting on of Collodion, applying Gold Leaf, &c., are not to be recommended.
Sir John Moore covers the face by a light mask of lint soaked in a mixture of Iced Water and Glycerin (S to r), and covers over the mask with oiled silk. Richardiere covers the head and face with a helmet made of bandages soaked in solution of Sublimate gr. in 5 oz. water), which is kept on all through the disease, the muslin being wetted several times a day with the solution.
Inspection of the eyes, which should he continually cleansed by weak Boric solution and Vaseline applied to the margins of the lids, is a necessary precaution, and when corneal ulcers appear they should be dressed with Hyd. Ox. Flay. Ointment (r gr. to each drachm), to which Atropine may be added with advantage (i per cent.).
For the general eruption, some authorities treat the entire cutaneous surface of the body by immersion in various medicated baths for long periods. A plan is immersion in a tepid or warm bath containing r ;o Sublimate for r5 minutes twice a day. Permanganate of Potassium is safer and equally efficacious.
Glycerin of Borax is the best application for the mouth and throat; and for laryngeal troubles the spray of Carbolic Acid, mentioned upon p. ;or, answers all purposes. Cocaine may he added with advantage when there is much pain present.