Variola

(from varius, changing colour, because it disfigures the skin.) ‘The small- pox. A génus of disease in the cla pyrexia and order exanthemata of Cullen; distinguished by synocha; eruption of red pimples on the third day, which on the eighth day contain pu , and drying, fall off in crusts. It is a disease of a very contagious nature, supposed to have been introduced into Europe from Arabia, and in whicn there arises a fever, that is succeeded by a number of little inflammations in the skin, which proceed to suppuration, the matter formed thereby being capable of producing the disorder in another person. It makes its attack on people of all ages, but the young of both sexes are more liable to it than those who are much advanced’ in life; and it may prevail at all the seasons of the year, but in general is most prevalent in the spring and summer. The small-pox is distinguished into the distinct and confluent, implying that in the former the eruptions are perfectly separate from each other, and that in the latter they run much into one another. Both species are produced either by breathing air impregnated with the eflluvia arising from the body of those who labour under the disease, or by the introduction of a small quantity the variolous matter into the habit by inoculation; and it is probable that the difference of the small-pox is not owing to any difference in the contagion, but depends on the state of the person to whom it is applied, or on certain circumstances concurring with the application of A variety of opinions have been entertained respecting the effect of the variolous infection on the fetus in utero; a sufficient number of instances, however, has been recorded, to ascertain that the disease may be communicated from the mother to the child. In’some cases, the body of the child at its birth has been covered with pustules, and the nature of the disease has been most satisfactorily ascertained by inoculating with matter taken from the pustules. In other cases, there has been no appearance of the disease at the time of the birth, but an eruption and other symptoms of the disease have appeared so early, as to ascertain that the infection must have been received previously to the removal of the child from the uterus. Four different states or stages are to be observed in the small-pox: first, the febrile; second, the eruptive; third, the maturative; and fourth, that of declination or seabbing, which is usually known by the name of secondary fever. When the disease has arisen naturally, and is of the distinct kind, the eruption is commonly preceded by a jredné in the eyes, sorene in the throat, pains in the head, back, and loins, wearine and faintne , alternate fits of chillne and heat, thirst, nausea, inclinafron to yom it, and a quick pulse, In some instances, these symptoms prevail in a high degree, and in others they are very moderate and trifling. In very young chil. dren, startings and convulsion are apt to take place a short time previous to the appearance of the eruption, always giving great alarm ta those not conversant with the frequency of the occurrence. About the third or fourth day from the first seizure, the eruption shews itself in little red spots (similar to flea-bites) on the face, neck, and breast, and these continue to increase in number aud size for three or forr longer, at the end of which time, they are to be observed dispersed over several parts of the hody, f the pustules are not very numerous, the febrile symptoms will generally go off on the appearance of the eruption, or they will be-— come very moderate, It sometimes happens, that a number of little spois of an erysipelatous nature are interspersed amongst,.the pustules; but these generally go in again as soon as the suppuration commences, which is usually about the fifth or sixth day, at which period, a small vesicle containing an almost colourle fluid may be observed upon the top of each pimple. Should the pustules be perfectly distinct and separate from each other, the suppuration will probably be completed about the eighth or ninth day, and they will the a be filled with a thick yellow matter; but should they run much into each other, it will not be completed till some days later. When the pustules are very thick and nu« merous on the face, it is apt about this time to become much swelled, and the eyelids to be closed up, previous to which, there usually arises a hoarsene , and difficulty of swallowing, accompanied with a considerable discharge of ‘viscid saliva. About the eleventh day, the swelling of the face usually subsides, together with the affection of the fauces, and is succeeded by the same in the hands and feet, after which the pustules break, and discharge their contents, and then becoming dry, they fall in crusts, leaving the skin which they covered of a brown red colour, which appearance continues for many days. In those cases where the pustules are large, and are late in becoming dry and falling off, they are very apt to leave pits behind them; but where they are small, suppurate quickly, and are few in number, they neither leave any marks behind them, nor do they occasion much affection of the system. In the confluent small-pox, the fever which precedes the eruption is much more violent than in the distinct, being attended usually. with great anxiety, heat, thirst, nausea, vomiting, and a frequent and contracted pulse, and often with coma or delirium. In infants, convulsive fits are apt to occur, which either prove fatal before any eruption appears, or they usher in a malignant species of the disease. The eruption usually makes its appearance about the third day, being frequently preceded or attended with a rosy efflorescence, similar to what takes place in the measles; but the fever, although it suffers some slight remi ion on the coming out of the eruption, does not go off as in the distinct kind; on the contrary, it becomes increased after the fifth or sixth day, and continues considerabie throughout the remainder of the disease. As the eruption advances, the face being thickly beset with pustules, becomes very much swelled, the eyelids are closed up, so as to deprive the patient of sight, and a gentle salivation ensues, which towards the eleventh day is so viscid as to be spit up with great difficulty. In children, a diarrhoea usually attends this stage of the disease instead of a salivation, which is to be met with only in adults. The vesicles on the top of the pimples are to be perceived sooner in the confluent small-pox than in the distinct; but they never rise to an eminence, being usually flatted in; neither do they arrive to proper suppuration, as the fluid contained in them, instead of becoming yellow, turns to a brown colour. About the tenth or eleventh day, the swelling of the face usually subsides, and then the hands and feet becin to puff up and swell, and about the same time the vesicles break, and pour out a liquor that forms into brown or black crusts, which, upon falling off, leave deep pits behind them that continue for life, and where the pustules have run much into each other, they then dishgure and scar the face very considerably. Sometimes it happens that a putrescency of the fluids takes place at an early period of the disease, and shews itself in livid spots in-. terspersed amongst the pustules, and by a discharge of blood by urine, stool, and from various parts of the body. In the confluent small-pox, the fever, which, perhaps, had suffered some. slight remi ion from the time the eruption made its appearance to that of maturation, is often renewed with considerable violence at this last mentioned period, which is what is called the secondary fever, and this is the most dangerous stage of the disease. It has been observed, even amongst the vulgar, that the small-pox is apt to appear immediately before or after the prevalence of the measles. Another curious observation has been made relating to the symptoms of these complaints, namely, that if, while a patient labours under the small-pox, he is seized with the measles, the course of the’ former is retarded till the eruption of the measles is finished. ‘The measles appear, for instance, on the second day of the eruption of small-pox, the progre of this ceases till the measles terminate by desquamation, and then it goes on in the usual way. Several eases are however recorded in the Medical and Physical Journal, as likewise in the third volume of the Medical Commentaries, in which a concurrence of the smatl-pox and measles took place without the progre of the former being retarded. The distinct small-pox is not attended with danger, except when it attacks pregnant women, or approaches nearly in its nature to _ that of the confluent; but this last is always accompanied with considerable risk, the degree of which is ever in proportion to the viojence and permanence of the fever, the number of pustules on the face, and the disposition to putrescency which prevails. When there is a great tendency this way, the disease usually proves fatal between the eighth and eleventh day, but in some cases, death is protracted till the fourteenth or sixteenth. ‘The confluent small-pox, although it may not prove immediately mortal, is very apt to indace various morbid affections, Both kinds of small-pox leave behind them a predisposition to inflammatory complaints, — particularly to ophthalmia and visceral inflammations, but more especially of the thorax; and they not unfrequently excite scrophula into action which might otherwise have laid dormant in the system. The regular swelling of the hands and feet upon that of the face subsiding, and its continuance for the due time, may be regarded in a favourable light. The di ections which have been made of confluent small-pox have never discovered any pustules internally on the viscera. From them it also appears that variolous pustules ‘never attack the cavities of the body, except those to which the air has free acce , as the nose, mouth, trachea, the larger branches of the bronchi, and the outermost part of the meatus auditor i us. In cases of prolapsus ant, they likewise frequently attack that part of the gut which is exposed to the air.. They have usually shewn the same morbid appearances inwardly, as are met with in putrid fever, where the disease has been of the malignant kind. Where the febrile symptoms have run high, and the head has been much affected with coma or delirium, the ve els of the brain appear, on removing the cranium and dura mater, more turgid, and filled with a darker coloured blood than usual, and a greater quantity of serious fluid is found, particularly towards the base of the brain. Under similar circumstances, ihe lungs have often a darker appearance, and their moisture is more copious than usual.» When no inflammatory affection has supervened, they are most usually found. 40