CLIMA TOLOGY— SYMPTOM A TOLOGY 



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were written. It would appear that the disease was introduced into China 

 perhaps from India, in the course of the third century B.C. 



Equally ancient is the evidence of the existence of smallpox in Africa, for 

 Riiffer and Ferguson have found an eruption on the skin of a mummy belong- 

 ing to the period of the twenty-eighth dynasty (1200-1100 B.C.), which they 

 believe to be suggestive of smallpox, and it is quite possible that there has 

 existed from time immemorable an endemic focus in Africa, perhaps in Central 

 Africa. 



From these two foci in Asia and Africa it would appear probable that the 

 disease has spread all over the woild. With its introduction and spread in 

 Europe we are not concerned, but with that into America a few remarks must 

 be made, as it is very interesting. It would appear not to have been known in 

 America until after the advent of the Spaniards ; it is first recorded as occurring 

 in the West Indies in the year 1507, when it was introduced from Europe, 

 as has happened on many occasions since — e.g., into Chili in 1554 — also by 

 the agency of the Spaniards. 



More interesting than this is the fact that it is recorded that importations 

 of slaves from Africa were often followed by the appearance of the disease — 

 as, for example, in Brazil, where, according to Piso,it appeared in 156c, being 

 introduced in this manner. 



With regard to Oceania, it has been introduced from Asia or America at 

 various times — as, for example, Australia in 1838, from China to Sydney; the 

 Hawaiian Islands in 1853, from San Francisco to Honolulu; while New Cala- 

 donia became infected in 1859, and Marquesas in 1863. 



To-day the disease is widespread all over the world, but is especially common 

 in the tropics, where institutes for the preparation of calf-lymph are urgently 

 required in order that efficient vaccination, the only method of keeping the 

 disease in check, may be successfully carried out. 



Climatology. — It is believed that smallpox is perhaps most active at the 

 present time in Central Africa, but if this is true certainly some portions of 

 tropical Asia must come very nearly equal in endemicity, and briefly the disease, 

 though world-wide in its distribution, is of the utmost importance in the 

 tropics. When first introduced among peoples previously unaffected with 

 the disease, it was most virulent — as, for example, its incidence on the Mexi- 

 cans and the North American Indians. 



iEtiology. — The causation is unknown, but various protozoal bodies have 

 been described, of which the most important is Cytoryctes variolce Guarnieri, 

 1892, minute spherical homogeneous bodies 3 to 4 in diameter, and staining 

 well with Romanowsky, when it takes on a chromatin coloration, while 

 Councilman and his colleagues have described a complicated life-history 

 (P-535). 



Whatever the virus may be, it is usually spread by the air, and enters the 

 body by means of the respiratory passages . Cases are on record of the infection 

 being probably carried by cotton from Egypt to England, and there starting 

 sporadic outbreaks, and this is possible if the cotton was handled by an in- 

 fected person. Hence the request for the vaccination and revaccination of 

 cotton-workers. 



Symptomatology. — This is described in all books on general medicine, and 

 need be only very briefly repeated here. 



Briefly, a typical attack of discrete smallpox, after an incubation of nine 

 to fifteen days, begins with a chill in an adult and a convulsion in a child, 

 and continues with high fever, severe headache, lumbar pains, and vomiting, 

 with or without a scarlatiniform or morbilliform rash on the second day, which 

 may be general or local; or haemorrhagic rashes, which are either petechial or 

 petechio-erythematous, which appear from the first to the third day. If these 

 latter rashes are associated with haemorrhages from the internal organs, they 

 indicate the onset of haemorrhagic smallpox. Generally the initial stage of 

 the disease lasts two days, but it may be shorter and milder than that recorded 

 above, or more severe. The peculiar odour of a smallpox case may be noted 

 in these early stages. 



The typical rash appears on the second, third, or fourth day as papules on 



