VARIOLA. 41 



crusts begin to form, the whole face is covered, as it were, with a 

 mask. This incrustation falls off from about the fifteenth to the 

 twentieth day. Towards the termination of the suppuration, and the 

 commencement of desiccation, some patients fall into a state of coma, 

 and die within twenty-four or thirty-six hours. When the incrusta- 

 tion first falls off, no cicatrices are remarked on the skin ; furfura- 

 ceous scales are, however, soon thrown off, which leave such cica- 

 trices and ulcerations as completely disfigure and alter the expres- 

 sion of the countenance. 



During the progress of the disease, pustules are seen in the mouth 

 and pharynx, on the edges of the eyelids, and on the transparent 

 cornea. This structure ulcerates, but is rarely perforated. The 

 cornea frequently remains opaque in its whole extent after this 

 disease. 



It is during the secondary fever, which is very violent in the con- 

 fluent small-pox, that most danger is to be apprehended. Out of 168 

 deaths, recorded by Dr. Gregory, 27 occurred on the eighth day of 

 the eruption (eleventh day of the disease). Thirty-two died in the 

 first week, 97 in the second, and 21 in the third. In the first week 

 death seems to be caused by an overwhelming malignancy of the 

 poison, oppressing the brain, and causing coma ; in the second week, 

 from affections of the respiratory passages ; and in the third from 

 debility. 



Treatment. — When the disease is distinct and slio-ht, it will be 

 sufficient to keep the patient in pure air, in a large room, and at a 

 mild temperature, and to open the bowels. The skin may be sponged 

 with tepid water, if its temperature is very high. In the confluent 

 small-pox, the treatment is often not so simple ; but requires to be 

 varied to meet the symptoms that arise, just as in fever. Great 

 restlessness, wakefulness, and delirium about the eighth or ninth day 

 are generally benefited by opiates. If the pulse is feeble, broths 

 and wine are required; especially if the pustules do not fill out. 



During the secondary fever^ which generally sets in about the 

 eleventh day of the disease, aperients, opiates, and nourishing diet 

 should be given. 



Great dyspnoea requires a blister to the chest. 



The intolerable itching is best allayed by smearing the eruption 

 with cold cream. 



Various measures have been proposed, in order to prevent the 

 pitting and disfigurement occasioned by this horrid disease. Pen- 

 cilling the pustules with lunar caustic ; opening each of them ; co- 

 vering the face and hands with an ointment composed of litharge 

 and mercurial ointment ; keeping the patient in perfect darkness, 

 have each been recommended ; but with very doub^l success. 

 They should all be tried before the eruption becomes vesicular, 



4* 



