SMALLPDX, or VARIOLA. A specific con tagious fever having a characteristic eruption fol lowed by permanent scarring. The first accurate description of variola was given by Rhazes, an Arabian physician, who lived in the ninth cen tury. After the Crusades it prevailed in most of the southern countries of Europe, whence it spread into England and the more northern countries by the thirteenth century. The Span iards introduced the disease into America in the early years of the sixteenth century. It appeared first in Santo Domingo, three years later in Mex ico, when it destroyed three and one-half millions of people. and thence spread with frightful severity over the New World. In 1707 it reached Iceland, when more than a quarter of the inhab itants fell victims, and in 1733 it almost depopu lated Greenland. In the seventeenth century a careful study was made of the disease by Syden ham, who introduced many improvements in its treatment, but no means of preventing its spread were devised until Jenner discovered vaccina tion (q.v.) in 1796. All attempt to mitigate the severity of smallpox was made by reviving the practice of inoculation (q.v.), and this was in troduced into England by Lady Mary Wortley Montagu in 1718.
Smallpox is one of the most contagious of dis eases, and few who are exposed, unless protected by vaccination, escape infection. Even the un born child may be attacked through the medium of the mother, and may be born with the charac teristic rash or pitted. The malady is particu larly fatal in young children and among aborigi nal races; negroes are especially susceptible. One attack usually, but not invariably, protects against another. No specific micro-organism has been identified with the disease, although eagerly sought. The co»tagium exists in the pustules, in the fluids of the body, and apparently in the ex halations from the lungs and skin. The dried scales thrown off during desquamation are the most important element in disseminating the malady. which travels long distances and with
great rapidity, through the medium of clothes, furniture. or other articles which have been in contact. with a patient.
The first symptoms of smallpox make their ap pearance after an incubation period of about 12 days. The onset is abrupt, with a severe chill, pains in the back and limbs, intense headache, and vomiting. The temperature rises rapidly to 103° or 104° F., with loss of appetite, furre6 tongue and the other accompaniments of high fever. On the third day the typical rash appears. This, however, is in some cases preceded by a preliminary eruption assuming various charac ters in different cas-el. These initial rashes com monly appear on the second day, if at all, and fade away before the full development of the typical eruption. The latter begins as a collection of small red papules on the face and forehead, spreading rapidly downward over the whole body. It sometimes occurs upon the mucous membranes. On the third day after their appearance they develop into vesicles filled at first with a clear transparent fluid. which becomes purulent in the course of the three days following, this change being preceded by a process known as umbilica lion. Each vesicle becomes depressed in the centre, the circumference forming a prominent ring around it. This change is often panied by great swelling of the face so that the features are unrecognizable. The suppurative stage lasts two or three clays, after which the pustules gradually dry up, leaving in their place depressed white sears, popularly known as 'pits.' After the initial rise of temperature, coincident with the primary rash, the fever falls nearly or quite to the normal, remaining, low until the vesicles begin to mature, when the secondary or suppurative fever begins. This lasts for six or eight days, and is accompanied by sleeplessness, headache, and perhaps delirium. The fever subsides with the drying up of the eruption, and convalescence begins.