A Practical Treatise on Smallpox

by George Henry Fox

The effect of light upon the development of the smallpox eruption is a subject of considerable interest, and in recent years it has become one of therapeutic importance. As long ago as the fourteenth century John of Gaddesden and other physicians of his time were in the habit of excluding both light and fresh air from smallpox patients. The walls and furniture of the sick-room were painted red, on account of a peculiar virtue supposed to reside in this color, and the unfortunate occupant was nearly smothered by red curtains hung around his bed. Ever since that time it has been a common custom to darken the room of a smallpox patient, partly on account of the photophobia present during the course of the disease and partly on account of the idea that sunlight would aggravate the eruption. The fact that the face and hands are most intensely affected would seem to substantiate this idea, but the argument fails when we consider that the feet are usually the seat of an eruption scarcely less profuse.

It was claimed by Black, in 1867, that the complete exclusion of light from the eruption of smallpox, even when occurring in unvaccinated persons, effectually prevented pitting of the face. Barlow, Gallivardin, and others, have expressed a similar belief. Experimentation by Finsen, Unna, and others having demonstrated that it was not the heat of the sun but the ultra-violet or chemical rays which cause solar eczema and pigmentation of the skin, it was suggested by Finsen that in place of the complete exclusion of light in the treatment of variola, it was only necessary to eliminate the chemical rays of sunlight by means of red glass windows or red curtains.

Acting upon this suggestion Lindholm, Svensen, Day, and others, treated smallpox by this new method, and made most favorable reports of their results. The red light proved agreeable and soothing to the eyes of the patients, frequently caused the vesicles to dry without becoming purulent, and lessened the suppurative fever. The patients, it is claimed, passed directly from the vesicular stage into convalescence, and neither pitting nor pigmentation of the skin was observed.

Some less enthusiastic experimenters with the red-light treatment of variola have been more moderate in their praises, and in some smallpox hospitals it has been tried and given up.

My own experience with this method is limited to the observation of a few cases treated at the Riverside Hospital in 1893. Under the direction of Dr. Cyrus Edson, health commissioner, one ward was fitted with red glass windows. The cases treated were of a mild type, and although no deaths occurred, the disease appeared to run its usual course and the experiment was negative as to results. In reply to a letter of inquiry, Dr. Edson writes me that “if the results had not been negative a very careful report would have been made.” For the advancement of therapeutic knowledge it is indeed unfortunate that while the enthusiast is always so ready to write, the sceptic or unsuccessful experimenter is usually inclined to remain silent.

Period of Suppuration.—With the transformation of the smallpox vesicles into pustules a rise of temperature occurs which is commonly known as the “secondary fever,” and in severe cases the swelling of the face, hands, and feet usually occasions the most intense suffering. The chief dangers of this stage arise from the possibility of septic poisoning and the probability of a greater or less degree of exhaustion.

A nutritious diet is now of the utmost importance, and in severe cases bouillon, malted milk, or other prepared foods which can be readily swallowed should be given every two or three hours. If the patient is in a stupor, he may be awakened in order to receive the necessary nourishment, but the calm, refreshing sleep which sometimes follows a period of wakefulness and complete exhaustion should not be disturbed. Alcoholic stimulants are usually of great service in this stage and may be given freely, especially at night and in the early morning hours when the patient’s vitality is at its lowest ebb. In case of delirium, rectal alimentation will often be found necessary as a substitute for or a supplement to oral feeding. The rectum should first be thoroughly cleansed by an enema of soap and water and then from four to six ounces of milk and brandy or eggnog may be injected.

As the eruption of smallpox attacks the mucous membrane of the mouth, nose, and throat, as well as the skin, difficulty in swallowing and considerable discomfort in breathing is often present, especially during the suppurative stage. If the patient is able to sit up and gargle, peroxide of hydrogen or some other antiseptic solution should be used at regular and frequent intervals. In case of extreme prostration, when any effort by the patient or the mere raising of the head might lead to syncope or symptoms of collapse, it is advisable to wash out the patient’s throat and nostrils with a large swab of absorbent cotton, dipped in a saturated solution of boric acid. Pyrozone, borolyptol, listerine, and other liquids may be conveniently used for this purpose diluted with one or two parts of water. Small pieces of ice or ice-cream given at frequent intervals with a small coffeespoon will usually be found extremely grateful to the suffering patient.

For a purulent conjunctivitis which may sometimes result from the presence of pustules on the lids, the saturated solution of boric acid should be frequently used in the form of a spray.