SMALL-POX. 



605 



smaller, and less swollen, consequently the tension of the skin, the 

 pain, and deformity, are always less than in variola. As the dermatitis 

 is not so severe, the secondary fever is less, and, when the eruption is 

 very scanty, the stage of maturation may run its course almost with- 

 out fever. During the suppurative stage variola and varioloid differ 

 less in regard to the affections of the mucous membranes ; for the pho- 

 tophobia, dysphagia, cough, and hoarseness in varioloid often trouble the 

 patient as much as they do in variola ; on the other hand, croupous and 

 diphtheritic inflammations of the mucous membranes, and malignant af- 

 fections of the internal organs, are very rare. The suppurative stage 

 usually passes into the stage of desiccation by the fifth or sixth day of 

 the eruption. But few pustules rupture ; most of them dry up with 

 their contents ; a brown, dry spot forms in the centre, gradually be- 

 comes larger, and as it reaches the periphery, the pock changes into a 

 brown scab ; most of the scabs fall off in three or four days, and leave 

 red, somewhat prominent spots. The contents of some of the pocks 

 are not thickened, but are reabsorbed, and, instead of a slough, the 

 wrinkled, dry envelope is thrown off; this course is seen quite often, 

 especially in the pocks on the extremities. But, as, in the severest 

 cases of variola, some pocks always spare the tissue of the cutis, and 

 do not leave a scar, so, in the mildest cases of varioloid, single pocks, 

 which exactly resemble those of variola, often cause a loss of substance, 

 and leave cicatrices. If we group the peculiarities that distinguish 

 varioloid from variola, we should mention especially: 1. The short 

 duration of the different stages, and of the entire disease. 2. The 

 mildness or total absence of the secondary fever. 3. The escape of 

 the cutaneous tissue, and the recovery without cicatrices. 4. The 

 slighter mortality. In the times when, during small-pox epidemics, 

 variola prevailed, or occurred exclusively, a third, or in some epidemics 

 even a half, of the patients died. Of late, as the disease almost exclu- 

 sively affects persons who have been vaccinated, and consequently 

 varioloid is in excess, the mortality is very low ; scarcely four or five 

 per cent, of the patients die. 



TKEATMEITT. Prophylaxis demands vaccination or revaccination. 

 All objections to vaccination, even if well founded, would have to give 

 way to the facts, proved by statistics, that in the last century one- 

 tenth of the population died of small-pox (about 400,000 people dying 

 of the disease every year in Europe), another tenth were disfigured by 

 the disease ; and that, since the introduction of vaccination, the general 

 mortality is less, and that of small-pox is reduced to a minimum. Dur- 

 ing an epidemic, persons who have been vaccinated, but in whom the 

 vaccination has not yet taken, are attacked by small-pox, and the two 

 diseases run their course at the same time without modifying eacb 



