Several varieties of smallpox are described. To the ordinary or discrete the above description applies. In this the pustules remain distinct and scattered. Confluent smallpox is a severe form in which the rash is very abundant and the pustules exhibit a tendency to coalesce and form irregular purulent blebs. The mortality in this variety is very high. Malignant or hemorrhagic variola is characterized by small hemorrhages beneath the skin, and is also very fatal. Modified smallpox, often called rario/oid, occurs in per sons who have been vaccinated, but in whom protection is incomplete either on account of the lapse of time or because vaccination was inef ficient. This variety is of short duration, and recovery is the rule. In the form of smallpox produced by artificial inoculation, a pimple arises at the seat of the operation on the second day. This develops into a vesicle or pustule, and is followed by modified symptoms of the disease. About the eleventh day the typieal eruption of variola makes its appearance and passes through its various stages. The attack is generally mild, and confers immunity, but it is, on the other hand, occasionally fatal and always contagious. Inoculation is no longer practiced. Variola may be complicated or followed by destruction of the eyes, chronic discharge from the ears, bronchitis, pneumonia, and pleurisy.
The preventive treatment of smallpox at the present time consists almost solely in vacei nation and isolation. That vaccination confers complete immunity not only to individuals. but to communities, has been abundantly proved. A patient with the disease should be placed in bed in a well-ventilated room and should have an abundance of milk and other easily digested liquid foods, with cooling drinks to quench the thirst. Fever is kept within the limits of safety by cold sponging. Many attempts have been made to prevent the occurrence of disfiguring sears or pits. Painting the face with iodine or nitrate of silver, or washing it with various antiseptic lotions, or anointing it with carholized oil, have all been tried with indifferent success. The best plan is to protect the face from the light and keep it covered with a mask of lint satu rated with antiseptic solution. But if the in flammatory process goes below the true skin, a pit will result. Particular attention must be paid to the eyes. They must be sponged fre quently and kept free of secretion. Beyond these measures the treatment is purely symptomatic, no specific having been discovered for the disease.