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Small-Pdx

disease, mucous, fluid, child, membrane, symptoms, sometimes, small-pox and times

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SMALL-PDX, to the beneficent discovery of Edward Jenner the full terrors of small-pox as it used to prevail can now hardly be realized. In unvacci nated persons, and those upon whom the operation has been performed im perfectly, the disease may still rage with all its natural violence, but in or-. dinary cases the form of the disease met with is the milder variety which is called varioloid. It is the same disease as variola, although modified more or less by occurring in a subject partially protected by vaccination.

Small-pox is one of the most infectious of the acute specific fevers, and in this respect the modified form is as dangerous as true variola. The patient seems to be capable of communicating the disease even before the eruption appears, probably, therefore, from the very beginning of the early fever. He also continues to be a source of danger to others as long as any par ticle of scale or scab remains attached to his body after the subsidence of the disease. One attack usually protects against a second, but it is far from uncommon for a person to take the fever two or even three times.

Morbid Anatomy.—As in most of the infectious fevers, the blood in fatal cases is dark and coagulates imperfectly ; fibrinous clots are often found in the right ventricle of the heart ; and in very severe cases hmmor rhagic extravasations are scattered about in the loose tissue beneath the serous and mucous membranes. Internal organs, such as the heart, liver, and spleen, are either pale, flabby, and soft, or deeply congested. The mucous membranes, especially of the air-passages, are intensely hypermmic, and are thickened, softened, and sometimes ulcerated. Their epithelium is partially separated, and their surface is covered with a brown tenacious mucus. The same condition may be found in the mucous membrane of the nasal fossa, the mouth, fauces, and gullet. In all of these parts small excoriations may be noticed. They are small round spots on the mucous surface, either covered by a whitish false membrane or presenting a round point of superficial ulceration. These are probably due to an eruption OIL the mucous membrane of a like nature to that which takes place upon the skin. No such appearances are seen upon the gastrointestinal mucous membrane, but the intestinal follicles and the glands of Pet'er's patches are large and projecting. The lungs are often intensely congested, and are sometimes the seat of pneumonia. Moreover, the pleura of one side may be filled with sero-purulent fluid.

In the skin the morbid changes are as follows : A punctiform hyper mmia takes place at various spots which extends through the cutis to the rete nrucosum. The cells of this part swell and proliferate, so that a solid sharply defined nodule is formed at the inflamed spot. Next, the epider

mis is raised up by fluid exudation into a vesicle. If this be formec1 round a hair-follicle or sweat-gland, it is umbilicated in consequence of the sum mit being held down by the duct. The vesicle is multilocular, for its in terror is divided into several chambers by delicate partitions. These are not fibrinous, as used to be thought, but are formed by compression of the altered cells by the effused fluid. They disappear, as well as the mu bilication, when the process of maturation is complete. The vesicular fluid contains many leucocytes and some red blood corpuscles. As the prolif eration of the cells of the rete mucosum continues, the fluid becomes purulent and the vesicle is changed into a pustule. The true skin is some times destroyed by this suppurative process to some depth, and there is a depressed permanent scar then left after the fall of the scab.

period of incubation of small-pox when contracted by infection is, according to Mr. Marson, thirteen times twenty-four hours, i.e., twelve whole days and parts of two others. If the disease is produced by inoculation, the period is shortened to seven or eight days. During this stage there are no symptoms in ordinary cases, although a certain amount of irritability and peevishness is sometimes noticed, not usual with the child and indicative of uneasiness ; but no definite symptoms can be observed. On the fourteenth day the first decided indication of the illness appears and the stage of invasion begins. Chilliness with a rise of tem perature, siclotess often distressing, and severe pains in the back and loins, sometimes in the limbs as well, are the characteristic features of this period. The pain in the back may be associated with temporary para plegia, and is often combined in children with incontinence of urine and forces. Other symptoms are : thirst, loss of appetite, a coated tongue, grinding of teeth, frontal headache, and constipation or diarrhea. A severe amount of nervous disturbance is often seen, and the child may be thrown into violent and repeated convulsions with intermediate delirium and stupor. The violence and frequency of these attacks are not to be re lied upon as an index of the severity of the illness which is to follow, as they are probably dependent less upon the intensity of the variolous poison than upon the natural nervous sensibility of the child. A little girl, aged six years, began to have fits on November 27th ; they continued until the 29th. Between the convulsive seiztu-es the child was drowsy and stupid, and often vomited. On the 29th the eruption appeared. The nervous symptoms then ceased, and the disease ran a particularly favourable course.

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