A Practical Treatise on Smallpox

by George Henry Fox

When delirium occurs in this stage the patient must be closely watched, and, if necessary, the limbs may be kept quiet by linen sheets folded and carried across the bed and fastened at either end. Since chloral given by the mouth is liable to cause œdema of the glottis, it may be advantageously administered by the rectum, or in its place the bromides or a hypodermic injection of sulphate of morphine may be substituted, although when the patient is suffering at the same time from severe bronchitis the use of opium is objectionable.

The treatment of the eruption in the suppurative stage is of the greatest importance so far as the comfort of the patient is concerned. A host of applications and peculiar methods of treatment have been recommended and tested in successive epidemics. Many of these have been found to have no effect save to intensify the patient’s horrible appearance and to aggravate his discomfort. From time immemorial attempts have been made to prevent the pitting of the face after the disease by treatment of the individual lesions. The cauterization of the pustules with nitrate of silver after evacuation of the pus—the so-called ectrotic method—has been practised by many in the past, but the consensus of opinion at the present day seems to be that the procedure is as useless as it is painful. The ointments, plasters, pastes, and varnishes which have also been advocated are usually unpleasant or troublesome to use, and in the pustular stage are not likely to accomplish any desirable end. At this period it is too late to consider the possibility of preventing pitting, although the resulting injury to the skin may be reduced to a minimum by the use of all local measures which tend to reduce the grade of inflammation.

For the highly inflamed condition of the skin which characterizes the suppurative stage of smallpox, especially in its confluent form, cold water is, beyond all doubt, the best antiphlogistic. The cold compresses advocated years ago by Hebra constitute the simplest method of local treatment and one which is most grateful and beneficial to the patient. They exclude the air, macerate and soften the lesions, and lessen the local inflammation. Although it cannot be claimed that they modify in any degree the development and course of the eruption, it is doubtful whether anything better in the way of local treatment has ever been suggested. Pieces of lint should be dipped in cold water and applied smoothly to the face and other portions of the body where the eruption is abundant and the skin inflamed. To prevent their drying too rapidly a little glycerine may be added to the water and the lint covered with gutta-percha tissue or oiled silk. Moore recommends covering the face with a light mask of lint and oiled silk, having holes for the eyes, nose, and mouth. The lint is wet with a mixture of glycerin and iced water (fʒi-f℥i). If preferred, a cold solution of boric acid may be used in place of plain water, and when there is an excessive and unpleasant odor present, thymol may be added to the solution. Immermann states that he used for a time sublimate dressings to the face (1–1000), but found that plain water did quite as much good and was safer to use.

Next to the face, the hands and feet suffer most from the eruption of smallpox, and, owing to the fact that the skin is not as lax in the latter region, particularly upon the fingers and toes, the inflammatory swelling of these parts is always attended with extreme pain when pustules are numerous. Under such conditions it may be found advisable, in place of merely wrapping the hands and feet in lint and oiled silk, to immerse them in pans or pails of water, or to supply the patient with mittens and stockings made of vulcanized rubber cloth. Indeed, if the patient is not in too critical a condition, he may be immersed for hours in a bath, as recommended by Hebra for the treatment of extensive burns, pemphigus, and various ulcerating affections involving a large portion of the body.

Period of Dessication.—When the distended, semi-globular pustules begin to dry, they tend to flatten, and often undergo a secondary umbilication from the shriveling of the central portion of the pock. In favorable cases the general condition of the patient improves as the fever subsides, and a more substantial diet may now be allowed.

The symptom which usually causes most local discomfort at this stage is the itching which invariably accompanies the drying of the pustules. This is often intolerable, and much of the pitting left after an attack of smallpox may be due to the tearing of the crusts from the face and other parts.

The best application which can now be made to the skin for the double purpose of softening the crusts and allaying the pruritus is a solution of carbolic acid in olive oil (five or ten per cent.). When the itching sensation of the face and hands is intense, it can be greatly relieved if the nurse will frequently spray these parts with pure chloroform, or, if the crusts have an unpleasant odor, with a mixture of chloroform and some antiseptic solution.

In the case of restless or unmanageable children the elbows may be put in splints so that the finger-nails cannot come in contact with the face.