Printed Article titled “THE SMALLPOX” in Section “The Physician By the Fireside” by Frederick M. Rossiter, MD. (From February, 1902, Good Health, by permission of the author.)
SMALLPOX means small sacs which first contain serum, and later, pus.
Smallpox has prevailed in India and Africa for thousands of years. It is said to have invaded China in 200 A. D., and Galen tells of a marked epidemic in Rome in 16o A. D. Its progress from east to west has been slow. It entered England in 1241, Iceland in 1306, the West Indies in 1507, Mexico in 1520, and Boston in 1649, from Europe. The Indians were decimated ‘by the disease. It traveled westward with the slow onward march of emigration, reaching Kansas in 1837, and California in 1850s.
From 1700 to 1800, the century preceding vaccination, it is estimated that fifty millions of people in Europe died from smallpox. In a very short time after the Spaniards invaded Mexico in 1520, more than three and a half millions of the native Mexicans were swept off by the disease.
Macaulay, in speaking of the smallpox, called it the most terrible of all the ministers of death.
But since the introduction of vaccination in 1798, by William Jenner, and also in consequence of improved sanitary regulations, the disease has lost much of its former horror.
To-day there are many other diseases that are to be feared much more than smallpox. The number of deaths from smallpox reported in the United States last year was 2,385; from tuberculosis, 150,000; diphtheria and croup, 44,411; from typhoid fever, 13,284; scarlet fever, 9,211; measles, 6,424.
Smallpox is feared because of the rigid quarantine regulations, while tuberculosis and diphtheria go stalking through the land with but little thought
from any one except those who are directly afflicted.
The, real cause of smallpox is not known. It spares no age, and is most common between one and forty years of age. Children are more susceptible to it than adults. Smallpox is the most contagious of all diseases. More individuals, if exposed, and unprotected by vaccination take the smallpox, than take any other disease as the result of like exposure. Filth and unhygienic living favor the spread of the disease. It is more common during the colder months of the year.
As to the element of contagion, Dr. Osler says: “The contagion develops in the system of the smallpox patient, and is reproduced in the pustules. It exists in the secretions and excretions, and in the exhalations from the lungs and the skin. The dried scales constitute by far the most important element, and, as a dust-like powder, are distributed everywhere in the room during convalescence.”
As a rule, one attack protects against subsequent attacks of the disease.
During the last four years there have been frequent epidemics of smallpox in the United States, the disease having been brought from Cuba by the soldiers. It has been exceedingly mild in most cases, and with a very low death rate. In many epidemics it was at first diagnosed as chicken pox by the physicians because of its mild nature, and this partly accounts for its rapid spread.
Smallpox appears in several forms. In one type the pox are scattered all over the body, with healthy areas of skin between them. This is called the discrete type. In a more severe form the pox run together, especially on the face. This is the confluent type. Hemorrhagic or black smallpox is almost always fatal, and may appear in both the types mentioned.
There is also a mild form of the disease, called varioloid, that may appear after one has been vaccinated. Varioloid and smallpox are one and the same
disease. A mild case in one individual may give rise to a very severe attack in another.
The time intervening between exposure and the first symptoms is called the incubation period, and is usually from twelve to fourteen days.
The first symptoms of smallpox are very much like those of la grippe. The onset is sudden, with chills, rapid elevation of the temperature to 103° or 104°, often vomiting, aching all over, with a very severe headache, and intense pains in the small of the back. These last two symptoms are prominent in smallpox, even in mild forms, and disappear when the eruption appears. The respirations are rapid, and the pulse is from one hundred to one hundred and twenty a minute. If the fever is high, the face is flushed, the patient is very nervous and restless, and delirium may be present.
This usually appears at the end of the third day or on the fourth. It appears first on the forehead. Little red spots, looking like flea bites, are noticed near the border of the hair. A few hours later they may be noticed on the wrists, and later on the body. Within twenty-four hours these little spots are raised, and feel like shot under the skin, and are called papules. By the sixth day of the disease these little papules are filled with a clear fluid forming blisters, or vesicles, or sacs. They are distended, and, if noticed carefully, a little depression will be seen on the summit of each. This is called umbilication. By the eighth day the vesicle is filled with pus, and forms the pustule. It is tense, surrounded by a red ring, smarts, burns itches, and is tender and sore. If these run together, the patient suffers
intensely. These pustules form under the thick skin of the palms of the hands and the soles of the feet, and ache like boils. About the tenth day the pustules break, discharge, and dry up. Scaling begins about the fourteenth or fifteenth day.
The temperature drops when the eruption appears, and if the eruption is severe, it rises again on the eighth day, when the pustules form. If the disease is mild, the secondary fever will not appear.
In the confluent form the face is very much swollen, the eyes are closed, and the patient suffers intensely. The pox may appear in the mouth, throat, and breathing tubes.
In mild forms of the disease, the scaling is complete by the twenty-first day; in severe forms it may take several weeks.
If the pox extend down into the true skin, there will be pitting. Pitting is increased by scratching the pox, and opening them, and by intense light.
Mild forms of smallpox are often mistaken for chicken pox. ‘ In chicken pox the onset is mild. The eruption appears on the first or second day, is more pronounced on the body than on the face or limbs, is not shot-like, passes quickly through the vesicle form, and dries. The vesicles are not umbilicated. It is only in severe cases that pus forms in chicken pox, and then the pox is not surrounded by the red ring. There is no secondary fever. Chicken pox almost always occurs in children.
When an epidemic of smallpox appears in any neighborhood, those who have not been vaccinated within two or three years should be vaccinated at once. To sanitary reform as well as to vaccination is due the credit for stamping out the terrible epidemics of this. disease. Infants three months old may safely be vaccinated. According to the best authority, vaccination is useless three or four days after exposure to the disease.
There are probably some objections to vaccination, and it certainly does not represent the true principle of preventing disease; but until we know of a better means of preventing the disease, it should be resorted to. Many valuable lives have been lost because of the prejudice against vaccination. If repeated vaccinations from a pure source do not work, you probably will not take smallpox if exposed.
The room where the patient is confined should be stripped of all needless furniture, carpets, rugs, chairs, pictures,— in fact, it is better for the community if all smallpox cases are confined in one house, or in tents, if the weather is warm enough.
Before the eruption appears, the patient should be given a hot-blanket pack two or three times daily for ten or fifteen minutes, immediately followed by a cold wet-sheet pack, continued for twenty or thirty minutes. The sheet should be wrung out of water at 65°. During this treatment, towels wrung out of ice water should be kept on the neck and head. The first day the patient should have a hot enema, and during the next three days, if it is difficult to control the fever, an enema at 75°may be given every four or five hours. The fever may also be controlled by placing cold compresses over the heart, with frequent changes, for twenty minutes at a time, three or four times a day, afterward sponging the patient with cold water, and following this by light, rapid friction.
The great pain in the head and back may be relieved by placing an ice bag to the back of the head, by cold compresses to the neck, and a hot leg bath or pack continued for ten or fifteen minutes. Hot treatment will bring out any eruption quicker than cold treatment.
When the eruption appears, the fever goes down, much of the pain disappears, and the patient needs but little treatment aside from attention to the eruption. After the eruption appears, no friction of any kind should be given. For a mild fever, simple cold sponging is all that is necessary.
Compresses made of several layers of cheese cloth, and wrung out of cold water, should be kept on the face, and changed frequently. In one or two hours apply a hot compress for three minutes. This will relieve the pain and reduce the swelling. The eyes should be watched carefully, and washed several times a day with a saturated solution of boracic acid. The face may be oiled with simple vaseline, carbolated vaseline, or with an ichthvol ointment,—one part of ichthyol to three parts of vaseline,— and the cold compresses may be applied over this. The windows, or the exposed parts of the patient’s body, should be shaded with red cloth if the light is bright. If the mouth or nose is sore, use a wash of listerine,— one part in four parts of water.
If the eruption is severe, and the secondary fever appears, the prolonged bath at 95° will be of great benefit. If this treatment is impossible, give cool sponging, or the cold wet-sheet pack. The patient should have a light diet. Fruits may be eaten freely. For thirst, give water, fruit juice, barley water, or oatmeal water. Gruels and toasted breads, and milk and soft-poached eggs may be eaten.
During convalescence the patient should be careful to avoid exposure to cold or drafts, for pneumonia or inflammation of the kidneys might result.
When scaling begins, the patient should have a soap bath daily. The bath should be followed by the application of a carbolated ointment.
This should be rigid. For disinfection of the house, formaldhyde gas is the best disinfectant. This is used under the direction of the health officer. Sulphur is also good. Three pounds should be burned to every thousand cubic feet of room space. After sealing up the windows and cracks, place a tub or large pan partly filled with water in the room. Place in this an iron kettle, in which are live coals; place the sulphur on the coals, and leave the room, which should be kept closed for at least twenty-four hours. The woodwork should be washed with bichloride of mercury, one part to one thousand parts of water, and the walls should be repapered.
Linen and towels may be soaked in a bichloride solution (I to 5,000), and then boiled. Quilts and blankets are better burned, but after being subjected to the sulphur fumes, they may be hung out in the sun for several days. Bedticks should always be burned.
When a case of smallpox is in a private home, all other members of the family, excepting the attendant, should be excluded from the room. A sheet kept constantly moist with a weak carbolic-acid solution should be hung at the door. All the dishes used by the patient should be scalded and washed alone.
All other members of the family should bathe frequently, eat lightly, take plenty of sleep, and avoid exposing others.
Smallpox is rapidly spreading through Michigan, Wisconsin, Iowa, and many other States. It doubtless will continue to increase through the remaining portion of the winter and throughout the spring. Mild forms of the disease are often not reported, or detection is avoided, and so the disease spreads.
For this reason it doubtless would be a wise plan to see that all the camp-meetings this coming season are under careful sanitary inspection. One or more cases of smallpox in a camp-meeting will mean much inconvenience and delay. If each individual is conscientious in this matter, all large assemblies of our people may be free from this disease.