Eruptive Stage.—About the third day of the illness the fever abates, the pains subside and the patient begins to feel that his illness is at an end. But he is woefully mistaken, for it has hardly begun. At this time the eruption makes its first appearance; it is not formidable at first sight and looks not unlike a multitude of flea-bites on the face, hands and elsewhere. Soon it spreads over the greater part of the body. From day to day the eruption under goes a change; soon the face is covered with numerous- pustules, the features are swollen beyond their normal proportions and the patient disfigured beyond recognition. The fever again rises and acquires the characteristics of blood poison fever. The patient suffers greatly from the soreness occasioned by the multitude of pustules present, particularly those on the hands and feet. In severe cases the pustules may reach the enormous number of 30,000 to 40,000. The presence of smallpox sores in the nose and mouth causes great difficulty in breathing and great distress in swallowing.
The Plague of Boils.—At about the end of a fortnight, the patient, if he recovers, has passed through the height of the eruptive process and is led to believe that he is on the road to convalescence. Now a new plague at tacks the unfortunate victim, for he begins to be the subject of boils and abscesses which may number but a half dozen or may reach a hundred or more. In a proportion of small pox cases, which varies with the severity of the attack, one or both eyes may be damaged, with consequent impairment or loss of vision. An attack of unmodified smallpox runs its course in about five or six weeks. At its conclusion the patient exhibits on his countenance nu merous disfiguring pits and scars which re main throughout his life as a sad reminder of the cruel malady through which he has passed.
Smallpox in its usual form is a terrible disease and there is an almost universal sus ceptibility of the human family to its infection, but there is no malady against which science possesses a surer and more complete safeguard. For that great discovery, the world is indebted to Edward Jenner. Like all other infectious diseases, smallpox varies in severity and fatal ity in different epidemics. One of the most virulent outbreaks occurred after the Franco Prussian War in 1871; this became a veritable pandemic, spreading over the entire civilized world and destroying the lives of hundreds of thousands of persons. In other epidemics the type of the disease may be much less virulent and may be characterized by a lower mortality rate.
Since 1896 there has been widely prevalent in the United States a peculiarly mild type of smallpox which kills only a very small propor tion of those attacked. Hundreds of thousands of such cases have occurred throughout the country. This mild type is doubtless due to the weakness of the infecting germ. Two entirely different types of smallpox have prevailed in America — one the virulent imported variety which destroys the lives of one-quarter of those whom it attacks, and the other the mild type above referred to. An interesting feature of the latter type is that it is not only mild as to mortality but also as to its contagiousness; practically it attacks only the unvaccinated, while vaccinated persons even if the vaccination dates back 30 or more years are, as a rule, protected against it. The opponents of vaccination point
to this mild type of smallpox and say that the disease has lost its terrors. Those who are thoroughly familiar with the subject, however, know that neglect of vaccination may prepare a community for a death-dealing epidemic of the classic type of the disease.
Types of Smallpox.— The most malignant and fatal type of smallpox is that known as hemorrhagic or °black smallpox.° In this form, the patient is overwhelmed with the poison and succumbs to it before the characteristic erup tion is enabled to appear. Instead of the usual eruption, blood spots occur on the skin and the patient dies in one, two or three days. This malignant type is more prone to occur during virulent epidemics, and appears chiefly in pregnant women, men addicted to alcohol and in those debilitated from various causes.
(Confluent smallpox° is a severe form of the disease in which the vesicles and pustules run together and cover extensive areas of the skin surface. In °discrete smallpox° the pustules are separated by areas of skin free of eruption. The mortality in this type is lower.
When an individual who has been vaccinated some years before exposure to smallpox in fection contracts the disease, the course of the malady is apt to be favorably modified by the vaccination. If the vaccination be recent, he will in all human probability be immune against infection.
The Mortality of Smallpox in Vaccinated and Unvaccinated Persons.—As years pass, the protective power is prone to wane and after a number of years may become completely ex hausted. In most instances, some protection is still exerted after many years. The follow ing statistical tables of Welch (Wm. M.) and Schamberg (Jay F.), covering nearly 10,000 cases treated in the Municipal Hospital of Philadelphia between 1870 and 1904, are of interest: It will be seen from this table that only 12 per cent of vaccinated persons died, as against 42 per cent of unvaccinated. It is furthermore shown that the perfection of the vaccination as indicated by the type of vaccinal scar present influences the mortality. Those with good scars representing the results of excellent vac cination had the lowest fatality rate (a little over 6 per cent).
Treatment of The treatment of smallpox is eminently preventive: after the disease has once been contracted by an unvac cinated person relatively little of ari effective character can be done; this consists largely in supporting the strength of the patient until the disease has run its course. The usual prin ciples underlying the treatment of infectious fevers apply to smallpox. Special care is neces sary, however, to protect the eyes from infec tion by frequent cleansings with mild antiseptic solutions, in order to avoid the possibility of destruction of vision.
Thorough and adequate vaccination is a complete safeguard against smallpox. Isolation of the patient, quarantine of those who have been in contact with him and disinfection of the premises after recovery are important sani tary measures. See VACCINATION.