A Practical Treatise on Smallpox

This shows the earliest eruption upon back and buttocks. The photograph was taken about seven hours after its first appearance. The patient was sent to Riverside Hospital, where she developed hemorrhagic smallpox, and died on the fourth day. [H.]

II. VARIOLA PAPULOSA. (Second Day.)

Showing numerous incipient papules upon the face. Those upon the forehead were the first to appear and are most prominent. The cheeks present a characteristic leathery appearance. [H.]

III. Variola Hemorrhagica.

Showing upon the face and cheeks a form of the disease commonly known as “black smallpox.” Figs. 1 and 2 were photographed on the second day and show a profuse and dark eruption. The swelling and disfigurement of the face present a most striking appearance. Figs. 3 and 4 were photographed on the fourth day, when the patient was in a moribund condition. [H.]

IV. VARIOLA VESICULOSA. (Fourth Day.)

A case of moderate severity, with well-developed vesicles and characteristic grouping of lesions upon the face. [P.]

V. Variola Vesiculosa.

Fig. 1 shows a mixed eruption of papules and vesicles upon the right thigh. (Third day.) This condition is exceptional in Variola, though quite common in Varicella. [F.] Fig. 2 shows well developed umbilicated vesicles upon the forearm. (Fifth day.) [H.] Fig. 3 shows a hemorrhagic effusion into the vesicles on the thigh and leg, a condition far less serious than the purpuric eruption of malignant variola. [P.]

VI. VARIOLA SEMI-CONFLUENS. (Fifth Day, Sixth Day.)

These illustrations show a partly confluent character which the eruption frequently presents, even in mild cases, and especially upon the legs. The influence of pressure in developing a more profuse eruption may be noted above the ankles, where shoes were laced, and below the knees, where garters were worn. [F.]

VII. VARIOLA CONFLUENS. (Seventh Day, Eighth Day.)

Fig. 1 shows umbilicated pustules with an intense œdema of the foot, considerably increasing its size and causing much pain. Fig. 2 shows the epidermis raised in a large, irregular patch by the confluence of pustules. [F.]

VIII. Variola Pustulosa. (Ninth Day.)

Fig. 1 shows an eruption discrete upon the trunk and even upon the hand, while confluent upon the forearm. [H.] Fig. 2 shows a vaccine pustule coexisting with variolous pustules. The vaccination took place before the disease began, but too late to exert a decided prophylactic effect. [P.] Fig. 3 shows an eruption of large, flaccid pustules with swelling of the foot. [P.] Fig. 4 shows an eruption of discrete, tense, hemispherical pustules. [F.]

IX. VARIOLA DISCRETA. (Ninth Day.)

A typical case of mild smallpox occurring after vaccination and sometimes called Variola modificata or Varioloid. [P.]

X. VARIOLA PUSTULOSA. (Tenth Day.)

A severe case, showing the characteristic aggregation of lesions on the face and extremities. [P.]

XI. VARIOLA PUSTULOSA. (Ninth Day, Tenth Day, Eleventh Day.)

These illustrations show the pustular lesions in the stages of complete distention, when they present a rounded appearance, and of incipient desiccation, when they appear flattened and with a central depression or “secondary umbilication.” [P., F., F.]

XII. Variola Pustulosa et Crustosa. (Tenth Day, Twelfth Day.)

In Fig. 1 an occlusion of the nasal passages is indicated by the lips parted in respiration. [P.] Fig. 2. shows a palmar condition which, in the adult, is found only in smallpox. [P.] Fig. 3 shows the desiccation of the facial eruption in advance of other regions. [P.] Fig. 4 shows a mild discrete case in which a diagnosis of acne had been made. [F.] Fig. 5 shows the eruption in the stage of desiccation. [F.]

XIII. VARIOLA CRUSTOSA. (Eighteenth Day.)

Showing a few thick crusts remaining upon the face with numerous dull red spots from which the crusts have fallen. [F.]

XIV. VARIOLA DESICCATA ET SQUAMOSA. (Twentieth Day.)

Figs. 1 and 3 show the dried pustules remaining in the thickened skin of palm and sole after the crusts have fallen elsewhere. [F., P.] Fig. 2 shows the superficial desquamation which follows the falling of the crusts, producing rings of partly detached epidermis. [F.]

XV.

Fig. 1 shows a peculiar pigmentation sometimes left after the eruption. The central portion, being darker, produces a “bull’s-eye” appearance. [F.] Fig. 2 shows the hypertrophic condition of the scars which occurs in certain cases in place of the usual pitting, and which tends to disappear in time. [H.] Fig. 3 shows severe pitting, a partial loss of hair and eyebrows, and destruction of one eye. [H.]

XVI.

Fig. 1 shows the typical appearance of a successful revaccination. (Fourth day.) [F.] Fig. 4 shows a small, well-formed vaccination pustule at its height. (Eighth day.) [F.] Fig. 2 shows a large, irregular pustule resulting from scarification of an area of unnecessary extent. (Eighth day.) [F.] Fig. 5 shows an ulcer resulting from infection of the vaccination lesion. [F.] Fig. 3 shows a primary vaccination at its height (eighth day) with a characteristic areola. [F.] Fig. 6, a case of Varicella on the third day. [F.]

PREFACE.

Whenever a physician is called to a case of suspected smallpox, he confronts a grave responsibility. If young or without special experience, he is apt to feel a sore need of assistance, and, although a book can never take the place of an experienced consultant, it is the object of the present work to render him as much aid as possible. The text aims to be practical rather than elaborate. The plates are reproductions of photographs from life, some of which have been obtained under great difficulty.

While many articles on variola have been illustrated by a few photographs of cases, mostly of the pustular type, this work is believed to be the first which has presented illustrations of the smallpox eruption in each of its successive stages. It is sincerely hoped that the reader will find it of service in familiarizing him with the peculiar features of the disease.

GEORGE HENRY FOX.

SMALLPOX.