Period of Convalescence.—When the crusts have dried and fallen from the face and body and no unpleasant complications still exist, the patient may be considered as a convalescent. No treatment is now required except a liberal diet, the daily bath, and a continued application of carbolized vaseline or some antiseptic oil. When the discolored cicatrices left after the falling of the crusts appear elevated and hard, as is frequently the case upon the face and hands (variola verrucosa), it is customary with some to paint them with tincture of iodine. A pleasanter and more effective application is a twenty per cent. solution of resorcin in rose-water.
When the skin has assumed its normal smoothness, and no indication of the disease remains except the dull purplish-red spots where the crusts have fallen, the patient may be regarded as well, and, after a careful disinfection of his body, he may be furnished with fresh or thoroughly disinfected clothing and discharged from the hospital or sick-room.
In disinfecting a patient prior to his discharge, not only should a prolonged bath be taken, but the head should be thoroughly shampooed with carbolic soap, the nails cut and scrubbed with the same, and the mucous orifices of the body cleansed with peroxide of hydrogen.
Prophylactic Treatment.—The prophylactic treatment of smallpox is of vastly more importance than any therapeutic measure, since it concerns a community and not merely an individual. In dealing with smallpox cases many physicians discover only too late that an ounce of prevention is worth many pounds of cure. When a case of smallpox is first recognized, or even suspected, the patient should be isolated in a room from which all unnecessary articles of furniture, especially of soft texture, have been removed. A sheet moistened with some volatile disinfectant should be hung before the door, and no one allowed to enter the room save the nurse and doctor. A change of clothing should be made outside by the former whenever leaving the room, and a gown should be ready for the latter to wear at each visit. Upon leaving the sick-room the physician should carefully disinfect his hands and remain for some time in the fresh air before making another call. When the diagnosis is positively made, all who have come in contact with the patient, unless manifestly immune, should be found and vaccinated without delay.
During the course of the disease all discharges, such as fæces, urine, sputa, or vomited matter, should be received in glass or earthen vessels containing a five per cent. solution of carbolic acid. Handkerchiefs and soiled rags should be burned or with towels and soiled sheets placed in a carbolic solution and allowed to remain for twelve hours. The plates, knives, forks, and spoons used by the patient should be kept in the sick-room and washed in a disinfectant solution by the nurse, while any uneaten food should be treated in the same manner as the patient’s discharges. When the patient has fully recovered, and, after personal disinfection, has left the sick-room, this should be thoroughly fumigated. The mattress and bed-coverings should be burned or, in large cities, sent to the Board of Health for disinfection. In case of death the corpse should be washed with a strong bichloride solution or painted with carbolized oil (twenty per cent.), and buried or cremated as quickly as possible. The clothing worn by the patient at the beginning of the disease should be destroyed or disinfected by baking for an hour in an oven at a temperature of 220° F., or steamed for five minutes at a temperature of 212° F.
In disinfecting the sick-room, the furniture, woodwork, and floor should first be scrubbed with carbolic soap and hot water or a solution of bichloride of mercury (1–500). The windows, ventilators, and fireplace should then be tightly closed and the fumes of burning sulphur or formaldehyde gas used to complete the disinfection. Sublimed sulphur burned in a moist atmosphere (one pound to every thousand cubic feet of space) is effective, but is at the same time objectionable on account of its tendency to bleach or discolor all textile fabrics. In well-furnished rooms, containing articles liable to be injured by sulphur or steam, such as wall-paper, paintings, books, etc., it is advisable to use, whenever possible, a formaldehyde gas-generator, which can usually be obtained from the local Board of Health.