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fever, day, eruption, period, suppuration, skin, days and attack

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SMALL-PDX. (Plate XXV1II.) is a contagious and infectious disease. Its chief feature is the appearance of a rash on the skin, consisting first of pimples, -which enlarge and become little sacs filled with clear fluid, afterwards changing into matter. Scabs form when the matter dries up, and on their fall they leave marks or not according to the severity of the attack. There are different degrees of severity of an attack of small-pox, indicated by the eruption. In the less serious form the different pocks are separate from one another, and the small-pox is said to be distinct or discrete; in a more violent form the pocks run together, and the disease is said to be con fluent. The former kind is often fatal, the latter nearly always so. The disease, like other contagious fevers, has a period of incubation, there is, that is to say, an interval between the time when the disease is caught and the time when it begins toshow itself. That period is from twelve to fourteen days. In all cases several stages can be recognized in the progress of the fever. These stages are—that of invasion, the period of the beginning of the attack; that of eruption, the period when the rash appears; that of suppuration, the period during which the contents of the pocks become matter; and that of drying-up or desiccation, when crusts form. The time of these stages may be given. As a rule the fever begins twelve to fourteen days after the disease is " caught ;" on the third day of the fever the eruption appears; about the eighth day suppuration begins, and lasts till the eleventh, after which the drying-up process goes on; the scabs tend to separate about the fifteenth, eighteenth, or twentieth day. These are the times for the appearance, suppuration, and drying-up of the eruption on the face. On other parts of the body the various stages are a little later in occurrence.

Distinct chief symptoms at the beginning of this form are fever and head ache, vomiting and costiveness of the bowels, and severe pain in the small of the back.

The attack is usually sudden. The patient is seized with shivering-fits (rigors) followed by great heat of the skin. The sweating is marked for several days in grown-up persons, not in children. In children also diarrhoea (looseness of the bowels) is usual and not costiveness, but in adults diarrhoea is rather the indication of a very severe attack. Convulsions are also

common in children. The pain in the back is usually severe, and may be attended by numb ness or paralysis of the legs and difficulty in making water. Instead of the severe pain in the small of the back, there may be dull pains throughout the body like those of rheumatism. During this time the fever runs high.

With the beginning of the second stage —the appearance of the erigotion—the fever falls and the other symptoms disappear, so that the patient may seem to be almost well. This con , tinues till about the eighth day, when the fever returns with the suppuration of the pocks. The eruption, as it appears on the third day, consists of small red hard points, slightly raised above the skin. They grow larger, and in the course of a day form hard prominent pimples. In the course of two more days they have become converted into resides, that is, small sacs oi blebs containing a milk-like fluid. They go on increasing in size. On the eighth clay the fluid they contain has become yellowish, and consists of matter or pus. Hence the eruption consists now of pustules, or small abscesses. On this day, also, the skin around each pock or pustule is distinctly red. There is, indeed, a ring of inflammation round each. Accompanying the inflammation there is swelling in the skin and parts beneath it. The pustules are painful and the fever returns.

The return of the fever marks the arrival of the third stage, that of suppuration. The pus• tides still increase in size, and the yellowness of their contents becomes more visible. This stage is marked also by swelling, already noted; of the parts on which the eruption is seated, which increases up to the ninth day of the dis ease, and then diminishes, disappearing about the eleventh day. It is greatest where the skin is loose, and thus is often very great on the eyelids, causing complete closure of the eyes. It is marked on the hands and feet. The fever of the period of suppuration may not be so high as the early fever. It is accompanied by shiverings, quick pulse, loss of appetite, furred tongue, and delirium. It lasts for three days, and then, if the case progresses favour ably, rapidly disappears, not to return, and the other symptoms with it. The pustules there after pass through the process of drying-up, to be noticed immediately.

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