A Practical Treatise on Smallpox

by George Henry Fox

A high degree of fever in the initial stage of smallpox with intense headache and backache are symptoms which call loudly for relief, although they may not betoken a corresponding severity of the disease in its subsequent stages. Aconite, quinine, phenacetine, and other antipyretics are remedies which may now be advantageously given, and the daily cool bath, although it may not have the notable effect so often observed in typhoid fever, will assist in lowering the temperature.

If the fever is combined with extreme nervousness, the old and reliable Dover’s powder will be found of service. In some cases delirium is present during the initial stage, and occasionally a suicidal tendency is manifested, which makes it necessary to have a watchful nurse in constant attendance upon the patient. Potassium bromide in full doses, chloral, or sulphonal may be advantageously employed as a sedative, but the most effective remedy is probably the hypodermic injection of the sulphate of morphine (gr.  1/4).

If the headache, which is almost invariably present, is very severe, an ice-bag or cold cloth applied to the scalp will afford relief. The fear which has been entertained by some that such a procedure might tend to suppress the eruption is utterly groundless. For the lumbar pain, of which the patient often complains, a hot application will usually feel more grateful. The custom of applying mustard-plasters to the lower part of the back is not to be recommended, since the irritation of the skin which is caused thereby is liable to increase the eruption in that region and add to the subsequent discomfort of the patient. The theory that the eruption can be lessened upon the face by increasing the number of lesions upon some other part of the body has never proved successful in practice.

The sensation of thirst which is always present, and is often intolerable, can be alleviated by frequent sips of cold milk or by weak lemonade, either hot or cold. If there is extreme nausea and vomiting, as is usually the case with children, small pieces of ice dissolved in the mouth will relieve it together with the excessive thirst.

Period of Eruption.—With the outbreak of the papular eruption of smallpox, which usually appears upon the face on the third day of the disease, a notable decrease of the fever occurs with a decided improvement in the general condition of the patient. In a mild case, when a diagnosis of variola is not promptly made, the patient often returns to his business or pursues his or her customary duties with no thought of the danger to which others are exposed through contact or association. But the rapid development of the eruption soon leads to the discovery of its true nature and a realization of the importance of continued isolation.

During the papular and vesicular stage little or no internal medication is required, Gayton, an English writer on smallpox, who evidently shares the popular belief that the main duty of a physician is to give medicine, remarks that “we may also prescribe a little effervescing saline, for unless something is given in the form of medicine, the impression on the sick man’s mind is that you are doing nothing to assist him.” An intelligent public, in this country at least, is gradually awakening to the fact that skilful medical treatment cannot longer be measured by the number and size of the apothecaries’ bottles.

Although the appetite may now return, a restriction of the diet to simple and nutritious articles of food, such as milk-toast, eggs, oysters, and jellies, should be enforced.

The daily bath should be continued, and there is no objection to its being made antiseptic by the addition of carbolic acid or bichloride of mercury. It is simpler and safer, however, to employ a plain bath and to disinfect the skin later by sponging with some antiseptic lotion, such as peroxide of hydrogen or permanganate of potassium. It has been claimed by some enthusiast, though never demonstrated, that carbolic soap will abort the disease.

The local treatment of the eruption during the papular and vesicular stage has been a subject of experimentation for centuries, and the prevailing opinion at the present time is that little or nothing can be done to arrest its development. Most of the local applications, like the mercurial and other plasters of former days, though doubtless of some value, have proved generally to be more uncomfortable than beneficial to the patient. Tincture of iodine, pure or diluted, with an equal part of alcohol, nitrate of silver solution, collodion, picric acid, and more recently ichthyol, have been advocated by some and rejected by others after a careful test of their merits. Gayton recommends the use of the old itch lotion of sulphur and quicklime when cases present themselves before eruption or during the papular stage. He claims that if the lotion is rubbed over the whole body every four or six hours it will prevent the papules from reaching the pustular stage and thus avert the severe secondary fever. This surprising statement he bases on the observation of hundreds of cases.