182 UEVIEW — TKOriOAL JIKDICINE, ETC. 



Small-pox In this same paper the author notes that we have learnt of late years the prepon- 



—conUiiii-al clorating importance of direct personal infection in the spread of most of the common, 

 comuumicable disorders, and that in small-pox this becomes the simple factor which has to 

 be controlled in order to suppress an epidemic outbreak. He states that in Bristol no 

 quarantine beds arc kept for contacts. They are not necessary, as contacts are not infectious 

 till they sicken, and a careful system of visiting on the calculated day for sickening has always 

 permitted all such cases to be headed off into hospital before further infection results. Work 

 is not usually interfered with in the case of contacts who consent to immediate vaccination. 

 Disinfection is attended to in the usual way, but the prime sources of infection in general 

 are men not fomites. The control of small-pox, tlien, from introduced centres resolves itself 

 into a careful personal search for contacts and the use of experience and judgment in looking 

 for them in the right place. 



This leads one to the vexed question of the iErial convection of small-pox, a subject 

 which, so far as one knows, has not yet been definitely settled, despite the lengthy discussion 

 of which it formed the subject, and which will be found fully detailed in the Proceedings 

 of the Epidemiological Society for 1904-5 {pages 174-258). 



Of interest in this connection is a paper by Vaughan,' on the Incidence of Small-pox 

 in Calcutta, wherein it is stated that the small-pox hospital appeared to be a very small 

 factor as compared with other influences favouring the spread of the disease, and certainly, 

 as far as the native population is concerned, its influence was that of a drop in a bucket. 

 One saw something of a small epidemic of variola in Omdurman some years ago. The cases 

 were treated in tents situated at no great distance from a fairly populous neighbourhood, 

 at least in one direction, and certainly there was nothing to show that the disease was spread 

 by aerial convection. 



A very valuable paper containing much tliat is not found in text-books is that by 

 Thomas,- which one is tempted to reproduce in full. Lack of space forbids such wholesale 

 pilfering, but certain points must be noted in detail. The incubation period is given as being 

 generally from ten to twelve days, oftenest twelve, but it may be as short as six days and as 

 long as twenty. After giving the signs and symptoms of the invasion period, he says : — 



During the iuvasioa stage, and before the appearance of the prodromal rashes, the diagnosis has to be made 

 from : — 



1. Other infectious diseases having an acute -onset, e.g. measles, scarlatina, typhus, influenza, and depends 

 primarily upon (a) Presence of an epidemic ; (b) History of exposure with the appropriate incubation period, 

 (a) and (h) in all cases. 



In the case of the diseases indicated below, the following points should be considered : — 



Scarlatina. — With rash absent or missed. — -Condition of tongue, cervical lymph glands, tonsils, nose discharge, 

 injection of soft palate (enanthem), circum-oral pallor, history of vomiting and sore throat. Backache absent 

 or slight. 



Measles. — Coryza, photophobia, lachrymation, Koplik's spots. Backache absent or slight. 



Small-pox. — Headache and backache intense and unremitting. Vomiting may be present. 



Typhus. — Backache not very pronounced. Headache intense, and very often associated with painful and 

 tender eyeballs. Faeces characteristic, face rather dark red, conjuuctivje injected, eyes look heavy, expression 

 dull and apathetic. Great and early muscular weakness. Vomiting uncommon. 



Enteric Fever. Although this has not an acute onset, many cases are, when small-pox is rife, notified as 

 small-pox. Attention should be paid to (a) Gradual rise of temperature at onset-step ascent on chart ; (h) Early 

 epistaxis or deafness not uncommon ; (c) Widal reaction, this may be absent ; (cl) Tympanites ; (e) Condition of 

 tongue, spleen, stools. 



Chickcn-Pox. Complete absence of prodromal illness, save in adults, when this stage may be moderately 

 severe. Rise of temperature, if present, and the appearance of the rash almost simultaneous. 



Inftiienza. Here the diagnosis may be impossible until the time interval for the appearance of the rash has 

 passed. The muscular soreness and prostration are both generally much more exalted in influenza than in 

 small-pox. The history of exposure and the presence of an epidemic are of special importance here. The 

 bacillus may sometimes be isolated from the sputum. 



Meninyitis. The history, with the presence of a possible cause, e.g. suppuration of the middle ear, or 

 tuberculous focus in a lung, is important. The subsequent course, with the attending palsies, generally soon clears 

 up the issue. Backache is uncommon. 



Cerebrospinal Meningitis. Retraction of the head. Rigidity of the neck muscles. Kernig's sign. 

 Possible presence of the bacillus in the nasal discharge or in the fluid obtained by lumbar puncture. 



' V:iuglmn, J. C. {.July, 1907), " On the Incidence of Sraall-pox in Calcutta." Indian Medical Gazette, 

 Vol. XLII. 



■' Thomas, A. E. (.Tanuary, 1908), "The Diagnosis of Small-pox." Public nealth, Vol. XX. 



