Varicella may be readily mistaken for modified small-pox. The differ ences between the two diseases are described elsewhere.
Prognosis.—The mortality from small-pox in childhood is very high up to the age of ten years. Infants usually succumb to the disease even in the discrete form. The previous health of the child is an important item in estimating his chances of recovery, for weakly children have small pros pect of passing safely through so formidable a trial. Little information can be gained from the severity of the initial stage, for violent convulsions may usher in a benign form of the disease. Remission of the fever and constitutional symptoms at the beginning of the eruptive stage, scantiness of the rash, normal development of the spots, and absence of subcutaneous hemorrhages, are favourable symptoms ; but even in these cases a serious complication may arise during the third stage and carry off the patient.
Of special symptoms, profuseness of salivation is not au unfavourable sign, although it occasions much discomfort. Mr. Marson even regards it as of auspicious omen, especially if combined with much swelling of the face and marked tenderness of the skin. Bleeding from a mucous surface, if limited to one tract of that membrane, is not, according to Dr. Collie, to be viewed with apprehension ; but if more than one tract is a source of hemorrhage, the prognosis is very unfavourable. Heinaturia is not neces sarily dangerous ; but hemorrhage into the skin, if anything more than a few scattered petechie can be seen, is of very serious import.
Destructive ulceration of the eyes may be expected in cases of the con fluent form of the disease when the secondary fever is high and the skin is very hot and dry. If, in such a case, the eyes do not suffer, some other serious complication is certain to occur, according to Mr. Marson. The same authority asserts that if an ulcer be found at the same time on each side of the cornea, that eye will be entirely destroyed.
Treatment.—In varioloid and the milder cases of discrete small-pox the child merely requires to be kept in bed in a large well-ventilated room, and to be fed with such articles of diet as are suitable to his age and de gree of pyrexia. While the fever is high, he should take nothing but milk and broth ; but when the pyrexia subsides, he may take fish or once cooked meat, light puddings, etc. His whole body should be sponged daily with tepid water, and if there is much heat of skin, this process may be repeated several times in the twenty-four hours. He may be allowed to drink freely of pure cold water, and his bed and body linen should be changed every day. No medicine will be required unless constipation be present, when
a moderate dose of castor-oil is indicated. As in scarlatina, the room should be cleared of all carpets, rugs, curtains, and other woollen fabrics not absolutely indispensable. Open windows, whatever be the season of the year, are insisted on by Dr. Collie.
The severer forms of the disease, and especially the confluent variety, require very careful treatment. The diet should be liberal, given in such form as the child can digest, and in quantity suitable to his power of as similation. Milk, strong beef-tea, essence of meat, yolks of eggs, light puddings, and jelly can be given frequently and in small quantities at a time. Stimulants, such as brandy and the brandy-and-egg mixture, will also be needed whenever signs of failure of strength are observed. It is best, however, to withhold stimulants during the earlier period of the ill ness, unless they are imperatively required, for they will certainly be wanted at the end of the second or beginning of the third week, when com plications generally appear.
If the patient be restless at night and wakeful, a little chlorodine may be given cautiously ; but we must be careful in giving narcotics, partly on account of the easily depressed condition of the patient, partly because the air-passages become readily choked by the abundant mucous and sali vary secretion.
The treatment of the skin eruption is an important matter ; for in small-pox, unlike the other eruptive fevers, the dermatitis which accompa nies the maturation of the pustules may produce severe local injury as well as marked constitutional disturbance. Very many different methods have been recommended and adopted for checking the ulcerative process and preventing pitting of the skin ; but none of these can be said to be success ful. The application of salves of various kinds appear to be useful, but rather through the oil or fat they contain than through the chemical ingre dient which was supposed to give them their value. Dr. Collie pronounces against distressing the patient by efforts in this direction, which are cer tain to prove ineffectual, and merely recommends the use of olive-oil to the skin. A thirtieth part of carbolic acid increases the value of this appli cation. German writers speak highly of cold compresses to the face and hands, and to any other part where the eruption is copious. They state that the application diminishes pain, heat, and redness, and contributes greatly to the comfort of the patient.