SMALL-POX 603 



The fourth stage, the stadium exsiccationis, usually begins on the 

 eleventh or twelfth day. Part of the pustules, which have remained 

 unruptured up to that time, burst, and their contents, which are thrown 

 out, dry to soft, yellow crusts, which subsequently become hard and 

 brownish. The other pocks lose their tension, become brown in the 

 middle, dry, and sink in ; gradually the contents and wall of the pock 

 dry into a round scab. In proportion as the formation of the crusts 

 progresses, the parts around lose their redness and swelling ; the pa- 

 tients again become recognizable ; the tense, pulsating pain subsides, 

 and gives place to a very annoying itching, so that the patient finds it 

 very difficult to avoid scratching. In the stadium exsiccationis it is 

 usually most evident that the pocks on the extremities are of more 

 recent origin than those on the face ; for just at the time the painful 

 tension and the disfigurement of the face are disappearing or are al- 

 ready gone, the patients complain of unbearable pain in the swollen 

 fingers and toes. The scabs are detached very irregularly; at the 

 points where there has been no ulceration of the skin (and these are 

 more or less frequent, even in the most malignant cases) the crusts do 

 not generally remain attached more than three or four days ; on the 

 other hand, at points where the ulceration has entered deeply into the 

 cutis, the crusts remain attached longer; as the suppuration contin- 

 ues, they become thicker and horny. The crusts that fall off early 

 leave red spots, which are somewhat elevated as long as the skin re- 

 mains swollen, and which, after a time, disappear without leaving a 

 trace, or else change to slight depressions. On the other hand, when 

 the crusts that have remained adherent for a long time at last fall off, 

 round deep cicatrices are left, these have inverted edges and a punc- 

 tate, seamed base. They are at first red, then become very white, and 

 last during life. The symptoms induced by the eruption on the mu- 

 cous membrane disappear when the redness and swelling of the skin 

 subside. The salivation, dysphagia, hoarseness, cough, photophobia, 

 and ischuria, all cease gradually. At the commencement of the stadi- 

 um exsiccationis the fever continues, but is moderated (exsiccation 

 fever) ; but the more the formation of the crusts progresses the more 

 the fever decreases ; the pulse becomes quiet, the skin is covered with 

 perspiration, the urine deposits a sediment, the general health becomes 

 normal. In confluent small-pox, which usually extends more in depth, 

 as well as superficially, than other varieties, during the drying stage 

 thick, dark crusts form, which cover the face like a mask. The irreg- 

 ular crusts constantly increase on account of the continued suppuration, 

 and cracks form in them, from which the pus trickles out. Finally, the 

 trusts fall off in large pieces, and extensive irregular losses of sub- 

 stance are left, instead of small round cicatrices, as after variola dis* 



