ACUTE INFECTIOUS DISEASES. 



jrcta. In such cases, just as after deep burns, the retractions of the 

 cicatricial tissue readily induce tense cicatrices, or bridge-like strings, 

 ectropion, distortion of the mouth, etc., which cause the most hideous 

 deformities. Not unfrequently, a previously beautiful countenance is 

 rendered disgustingly ugly by confluent small-pox. Salivation, hoarse- 

 ness, cough, and the other symptoms of variolous affections of the mu- 

 cous membranes, disappear far more slowly after confluent small-pox 

 than after the discrete form. And the affections of important organs 

 that have been caused by the infection during the eruptive stage have 

 not usually terminated in the suppurative stage. At this time the 

 patient often has subcutaneous and intermuscular abscesses, boils, and 

 other localizations of the variolous process, but especially pyasmia. 

 Hence, too, the secondary fever is usually more severe and continued 

 in confluent small-pox than in the discrete, and even in the most favor- 

 able cases a long convalescence follows the severe disease. 



We may describe varioloid very briefly, because its symptoms dif- 

 fer from those of variola only in degree. The prodromal stage is the 

 same as that of small-pox, except that it is shorter and less intense. 

 But there are numerous exceptions to this, a severe and protracted 

 prodromal stage being sometimes followed by varioloid instead of by. 

 variola. The appearance of an erythematous rash, forming large red 

 spots, or of a diffuse scarlatinous redness over a large part of the body, 

 particularly the lower part, is somewhat characteristic of varioloid, be- 

 cause it occurs more rarely in variola. This exanthema precedes the 

 varioloid eruption from twelve to twenty-four hours. In the eruptive 

 stage, which usually begins with the third exacerbation of the fever, 

 the eruption does not spread from the face to the body and extremities 

 quite so regularly as it does in variola. The eruption usually ends in 

 twenty-four or thirty-six hours. The pocks are generally less numer- 

 ous than in variola ; they rarely become confluent, and then only at 

 certain spots. The papules become vesicles, and the vesicles pustules, 

 much sooner than in variola ; the form of the efflorescence offers no 

 peculiarities. In varioloid also, the mucous membranes are affected, 

 and we have salivation, difficulty of swallowing, hoarseness, cough, etc. 

 As the eruption terminates, the fever usually disappears entirely, and 

 the patient almost always feels quite well, except suffering some incon- 

 venience from the affection of the mucous membrane. The most im- 

 portant differences between varioloid and variola occur in the stage of 

 maturation ; for it is then most evident that in the milder form the 

 dermatitis is more superficial, while in variola it affects the parenchyma 

 of the cutis deeply. During the suppurative stage the pocks are filled 

 with thick fluid pus, they become larger, and hemispherical ; some of 

 them burst, and let out their contents ; but the areola around them is 



