There is a symptom, not mentioned in the books, which will often determine the disease before the occurrence of any eruption. It is the appearance of hard shot-like pimples, to be felt under the skin in the palms of the hands, while there is, as yet, no trace of eruption to be seen upon the surface.
On the eighth or ninth day, the eruptions become vessicular, have flattened tops, and contain a limpid fluid. The parts continue to swell, the eruptions to enlarge, and become filled with purulent matter, having a dark color at the top, up to about the fourteenth or fifteenth day, when they begin to flat down, to dry up, and some of the scabs become loose. At this time, some fever arises, often quite severe, with headache and other inflammatory symptoms. If the eruption is very severe, fever will be of corresponding violence, and lighter or wanting when the eruption is mild. This fever rarely lasts more than twenty-four hours, from which time the patient rapidly recovers.
In the Confluent variety, all the symptoms are more violent, the fever continuing after the eruption begins. The pustules burst early, and run into each other, covering nearly or quite the whole skin; the surface swells and turns black or dark brown, the lungs are more or less irritated, producing cough, and not unfrequently the stomach is nauseated, and vomiting ensues.
If the patient survives the irritation up to the fifteenth or sixteenth day, when the secondary fever sets in, he is liable to be taken off by an affection of the brain or lungs, during this fever. If he recovers, his whole surface, especially that part exposed to air, is deeply pitted.
TREATMENT.
As it is not often known for a certainty, in the early febrile stage, that it is the small pox, the treatment will be first adopted that would be proper for a like fever arising from other causes. But in all my observations in this disease, and they extend to several hundred cases, I have not found in a single instance, any of the ordinary fever remedies, such as Aconite and Bell., which would be applicable for such symptoms in an ordinary case, to do any good in small pox. They are directed, however, for these symptoms by the authorities, in the febrile stage of the small pox; but I am quite sure they are not the proper remedies.
From the great similarity, the almost absolute identity of small pox headache and backache, with the same symptoms developed by the Macrotys racem. as well as the nausea and restlessness produced by the drug, I was led several years ago to the conclusion that this, or the Macrotin was valuable in small pox. Not only so, but during the prevalence of small pox in Cincinnati, to an extraordinary degree in the winter of 1849-50, I treated about one hundred cases, including both sexes, and all ages, from infants a few weeks old, to very old persons, giving the Macrotin to all, and had the good fortune to see all my patients recover. Since that time I have prescribed it for every case successfully.
Having then, been entirely successful in so many cases, with this medicine, I am not inclined at this time to give any other the preference. I must admit, however, that though my patients all recovered, I was not able to greatly abridge the duration of the disease, nor to prevent the development of all the stages in their proper order, as is claimed by M. Teste, for his use of Mercurius cor. and Causticum. I was satisfied with so far modifying the symptoms, as to enable my patients to live through, and come out well in the end. I would then direct, if small pox is suspected, the patient having been exposed to contract it, or from the peculiarity of the symptoms, in the early stage, or when the disease is discovered after the eruption, to give Macrotin at the first trituration, in one grain doses, once in two hours, while the fever, headache and backache continue, after which, during the whole course of the disease, give it three times a day. This will prevent the development of a dangerous secondary fever, as well as irritation of the lungs, stomach or bowels. In addition to this medicine I give the patients daily, from half an ounce to two ounces of pure (unrancid) Olive oil. This serves to prevent the development of pustules in the throat, lungs and stomach; is more or less nutritious, and keeps the bowels in a healthy condition. Wash the surface once a day in weak soap suds, following it with a bath of milk and water, and keep cloths moistened with warm milk and water, constantly upon all parts that are exposed to the air, lubricating the surface with Olive oil after the bath of milk and water. This keeps the surface quite comfortable.
The best diet is corn or oat meal mush and molasses, to be taken in small quantities. Cold water is the proper drink, though it should not be very cold.
The room should, at all times, be well ventillated, but in cold or cool weather, sufficient fire must be kept up, to keep the room warm and dry. A temperature of about 65° is the best. Hardly any thing can be worse for a small pox patient than to be in a cold or damp room, and to breathe cold air. Uniform temperature is important.