Chapter I: Front Matter

Transcriber’s notes:

In this plain text transcription, paired underscores denote _italicised text_ and paired asterisks denote *bold text*.

A short table of contents has been inserted to assist readers.

The following spelling errors have been corrected silently:

pathognomic —> pathognomonic
accidently —> accidentally
coalesence —> coalescence
hematomesis —> hematemesis
hemorraghic —> hemorrhagic
uniformily —> uniformly

A

PRACTICAL TREATISE

ON

SMALLPOX

_ILLUSTRATED BY COLORED PHOTOGRAPHS
FROM LIFE_

BY

GEORGE HENRY FOX, A.M., M.D.

CONSULTING DERMATOLOGIST TO THE HEALTH DEPARTMENT OF NEW YORK CITY

WITH THE COLLABORATION OF

S. D. HUBBARD, M.D., S. POLLITZER, M.D., AND J. H. HUDDLESTON, M.D.

Technical Book Co.

Domestic and Foreign Directories,
Telegraphic Codes, Maps, Foreign
and Domestic Periodicals,
Technical Books

MILLS BUILDING SAN FRANCISCO

Telephone Garfield 19

Copyright, 1902
By GEORGE HENRY FOX

PRINTED BY J. B. LIPPINCOTT COMPANY, PHILADELPHIA, U. S. A.

CONTENTS

Chapter Page
I Symptoms and course 1
II Diagnosis 9
III Treatment 15
IV Vaccination 26

LIST OF ILLUSTRATIONS.

NOTE.--The names of the colored plates are in capitals. The
letters H., P., and F. in brackets indicate that the cases were
photographed by Hubbard, Pollitzer, or Fox.

PLATE

I. VARIOLA ERYTHEMATOSA. (First Day.)

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.]