VIII, B, 1 Ashburn, Vedder, Gentry: Variola and Vaccinia 25 



Concerning mild smallpox (varioloid) Councilman says: 



The initial period may be typical and severe or mild. The symptoms 

 suddenly abate and are followed by an eruption that may consist of only 

 a few pocks. Welch and Schamberg report a case in which but a single 

 pock appeared. The pocks are usually small and superficial and may be 

 readily overlooked or their nature unsuspected. * * * Cases of con- 

 fluent and purpuric smallpox are just as apt to follow infection by these 

 mild cases as from any other form. * * * Such cases are now rarely 

 found except in vaccinated individuals. 



Immermann says: 



Fever, delirium, and other combinations of initial symptoms are often 

 as violent as could be wished. * * * The differences between mild and 

 grave variola (varioloid and variola) become more decided with the erup- 

 tion of the smallpox exanthem, that is, in general from the end of the 

 third day of the disease — and from that on the differences are found at 

 least as much in the general as in the local symptoms. 



The condition of the body temperature and the general condition are 

 pathognomonic for decided cases of varioloid. Immediately with the first 

 appearance of the smallpox exanthem on the skin the fever begins to 

 abate, and the fall of the temperature is generally so rapid and so complete 

 that on the fourth day of the disease complete apyrexia has already made 

 its appearance. 



Bancroft(23) says: 



In some instances an initial fever of the most severe type was present, 

 accompanied by delirium and unconsciousness, and continuing for four or 

 five days. 



Variola sine eruptione is recognized by practically all writers. 

 Councilman (29) says: 



It appears as an illness of an indefinite character, occurring chiefly 

 in hospital attendants on the twelfth day after exposure to smallpox. The 

 symptoms consist in headache, pain in the back, fever and nausea. They 

 may be so slight that the individual pursues his ordinary vocations, or 

 they may approach in severity an ordinary initial stage. The symptoms 

 last two or three days and then suddenly abate. The condition was well 

 marked in one of the physicians investigating the Boston epidemic in 1901. 

 Characteristic initial rashes may appear during the attack. One patient, 

 a pregnant woman, remembered having a headache about two weeks after 

 exposure to the disease, but was not otherwise affected. Her child showed 

 a typical eruption when two days old. A group of three cases which 

 appeared in one of the large hospitals in Boston, the onset in whom was 

 nearly simultaneous, was traced to a ward tender who had an attack of 

 what was supposed to be grip. 



There were 12 of these cases among Bancroft's 1,200. 

 Osier (26) says: 



They seem to have been not uncommon in recent epidemics. 



