SMALL-POX. 601 



earlier, and from the confluence of the pustules the face often looks as 

 if it were covered with one large bladder of matter. The affections of 

 the mucous membrane also, which in variola discreta do not usually cause 

 much trouble at this time, are also accompanied by very painful symp- 

 toms, severe salivation, dysphagia, croupy cough, great photophobia, 

 and by ischuria and burning pains in the external genitals. The high 

 fever and severe constitutional disturbance of the prodromal stage re- 

 mit during the eruptive stage of confluent small-pox also, but only to 

 a moderate extent ; the fever never disappears entirely, as it does in 

 discrete variola, nor does the patient feel well toward the end of the 

 eruptive stage, as he does in the latter form. 



The third stage, stadium suppurationis seu maturationis, begins 

 about the sixth day after the first appearance of the eruption, and about 

 the ninth day after the first symptoms of fever. The pocks become 

 larger ; the bluntness of their summit gives place to a hemispherical 

 shape. If they be punctured, their thick purulent contents escape all 

 at once, because of the atrophy of the partitions, which previously let 

 only part of the contents escape on puncture. The skin around the 

 pocks swells decidedly, and becomes dark red ; even in discrete variola 

 the red areola surrounding one pock unites with that around the next. 

 The redness and swelling thus become diffuse. The patients are 

 greatly disfigured, and complain of severe, tense, pulsating pain in the 

 reddened skin, which is covered with large pustules. More or less of 

 these pustules rupture, and their contents flow over the surface, where 

 they dry into crusts, which are at first yellow, subsequently brown. 

 In these changes, also, the pocks on the body and extremities are one 

 or two days behind those on the face. The pain and distress induced 

 by the intense dermatitis are increased, during the suppurative stage? 

 by the annoying symptoms due to the eruption on the mucous mem- 

 brane. The saliva trickles constantly from the mouth of the patient, 

 swallowing becomes almost impossible, the nose is stopped, the voice 

 inaudible, the cough distressing and hoarse, the eyes, dark red and 

 filled with muco-pus, burn and are very sensitive to the weakest light. 

 The eruption in the vulva, vagina, and urethra, comes later than that in 

 the mouth, pharynx, and larynx ; hence the tense, burning pain in the 

 external sexual organs and the ischuria are most severe after the sali- 

 vation, dysphagia, and laryngeal symptoms have subsided. The fever, 

 which had moderated or even disappeared during the eruptive stage, 

 exacerbates during the suppurative stage, or begins anew with re- 

 peated chills. This fever is generally called the secondary or suppu- 

 rative fever, and it really seems as if the secondary fever did not 

 directly depend on the variolous infection, but were chiefly or solely 

 due to the dermatitis. The more severe and malignant the inflamma 



