Chapter XIII: Appendix: C

METHOD OF TREATMENT OF SMALL-POX BY MEANS OF CARBOLISED OIL.

My reason for giving this treatment of small-pox in detail is the frequent presence of the disease in India, in an epidemic form amongst the natives, with the hope that it may prove useful in ameliorating it, and thus save many useful lives which otherwise would probably succumb to its ravages from the terrible purulent discharge acted upon by a hot climate, creating a form of disease scarcely known in colder latitudes.

Before attending upon or assisting in the treatment of a case of small-pox, it is the duty of every one to see that they, their households, and those others who are likely to attend upon the case are sufficiently protected from the likelihood of infection by having been properly vaccinated, and that this operation had been successfully performed within at least four years. When there is a necessity for any one coming into immediate contact with the disease, as on the occurrence of an epidemic, it is advisable to be vaccinated whenever such epidemics occur.

There is a general belief that vaccination does not prove a success in the hot weather in India; do not credit this. If small-pox occurs as virulently as it does during the hot weather, on occasion, the success of the vaccination is also a certainty, if performed with care and a determination in its success.

Never mind how young an infant is, vaccinate it, even if it is only a day old, if you believe there is any probability whatsoever of its having come into, or likely to come into, contact with the infection of small-pox. Remember "the mortality of small-pox in childhood is very high up to the age of ten years. Infants usually succumb to the disease even in the discrete form."

Since the time that I first gave my opinion to Dr. Waring (in 1872) upon the treatment of small-pox with carbolised oil, I have seen a good deal more of the disease, and I still, with slight modifications, maintain my preference for this form of treatment. When I first used the application I employed a mixture of one part of Carbolic Acid and ten parts of Sweet Oil, applied twice daily over the whole body. I now advocate the employment of one part of Carbolic Acid to fifteen parts of any bland or Sweet Oil, moistening the body on such parts as may require it, frequently during the day and night.

Sesamum or Til Oil is ordinarily the most easily procurable throughout India, but any of the following will do: Poppy, Ground-nut, Apricot, Walnut, Cocoa-nut, Linseed, Almond, or Olive Oil, the two last being rather expensive. On no account be led into using any of the Mustard oils, which, owing to the natives using some of them in their diet, are occasionally spoken of as "sweet oils."

At whatever stage of the disease the patient comes under treatment, at once apply this liniment over all the parts being affected, or are affected by the eruption, by means of a mop of soft cotton-wool (_never on any account employ a sponge_); apply the liniment freely as if you were treating a severe burn, and then carefully cover the oiled surface with cotton-wool, so as to exclude all air, and keep the cotton-wool dressing in position. The carbolised oil to be freshly reapplied every four or six hours, so as to keep the parts moist, and the cotton-wool to be renewed every forty-eight hours. If flakes of wool stick into the broken skin, moisten these freely with oil, but do not tear them away. Any amount of cotton-wool can be obtained throughout India at the smallest hamlet, on a few hours' notice; and at all hours in any bazaar.

Let the patient lie between blankets, not cotton sheets; in commencing to dress the patient on the first occasion have a layer of cotton-wool placed upon the lower blanket, then place the patient on this cotton-wool naked, cover with a similar sheet of cotton-wool and over this again a blanket; having done this, set to and piecemeal dress the whole body, where the presence of the coming eruption requires it, with the carbolised oil, and cotton-wool, supporting the position of the cotton by means of very light bandages, or by a few stitches with a needle and thread, so as to keep the wool carefully together as well as firmly against the body. If suitable under the circumstances, a thin elastic gauze jersey and drawers keep the cotton protected from being rubbed off by restless patients.

So soothing and comforting is the application of the oil, that almost the youngest patients look forward to its re-application, will at once tell you when the body is getting hot and dry, and will in all probability ask to be allowed to apply the liniment themselves when they begin to feel uncomfortable, especially at the inflammatory stage of the vesicles when they are just changing to their pustular condition.

What is gained by the above treatment?

1. The carbolised oil soothes and cools down the inflamed surface of the skin, exactly as is done when oil is applied to a burn.

2. The cotton keeps all air from the skin, and aids in keeping the skin moist with the oil.

3. The oil saturates the surface of the eruption, penetrates into the skin desiccation, and as the oil becomes heated by the temperature of the body it gives off some of its carbolic acid in the form of gas.

4. The carbolic acid keeps the oil from becoming rancid.

5. If the liniment is applied to the eruption at a sufficiently _early_ stage, viz., when the eruption is becoming vesicular, the carbolised oil on the surface of the eruption, and the gaseous carbolic acid, between the skin and the cotton and in the interstices of the cotton, prevent the microbes of the atmosphere from coming into direct contact with the epidermis, and subsequently with the contents of the vesicle, the result of which is the contents of the vesicle do not become pustular and purulent; and the eruption dries up without ulceration.

6. If the liniment is applied _late_ in the vesicular stage, or not until the pustular stage has set in, the carbolised oil penetrates more or less into the epidermis which is being thrown off by the suppuration of the pustule; as the pus is discharged by rupture of the epidermis the oil mixes with the pus, disinfects it, and keeps it sweet, as is to be observed by the entire non-existence of, or extremely modified condition of, the horrid stench that accompanies small-pox, subsequent to the pustular stage of the disease.

7. The exuviæ becoming loaded with the carbolised oil, are (probably) disinfected and are incapable of spreading the disease.

8. If the eruption is prevented from reaching the pustular stage, the complications that would otherwise have resulted from pus absorption are no longer to be dreaded, such as the secondary fever, boils, abscesses, acute cellulitis, erysipelas, pyæmia, &c. &c.

No eroding ulcers with deep cavities, leaving the well-known cicatrices of small-pox, are produced.

9. The pustular stage having occurred before the carbolised oil treatment was applied, it still proves of immense value, as it prevents the pus becoming impure and poisonous, and this greatly ameliorates the results of the disease even at this stage.

So long as the disease lasts is this application to be applied, limited certainly to the extent of the eruption; as long as this treatment is being adopted, not a drop of water should be allowed to touch any part of the skin surface (no washing of any sort) until healthy action of the skin has set in, recognised by the falling off of the crops of scabs, without any raw, ulcerated surfaces.

Is there any danger to the patient from the absorption of the carbolic acid into the system? So long as the oily solution is used, and no water allowed to come into contact with the skin, I consider there is little or no danger, but it is necessary _always to be careful_. Should the patient be suffering from the absorption of the carbolic acid, you will find a cold, clammy skin, rapid fall of both temperature and pulse, and the urine of a smoky _greenish-brown_ colour, and having the odour of carbolic acid. In many cases of small-pox, but where no carbolic acid has been employed, the urine becomes smoky-brown, but it has not the peculiar greenish tinge of where carbolic acid is present. To judge the odour correctly, the urine should be put into a fresh dish and examined in some other room, or, what is better, the open air, so that there can be no mistake, as the air of any house gets so saturated with the odour of carbolic acid that it is not easy to judge whether the odour is that of the air or of the urine. If danger from excess of absorption of carbolic acid is feared, do not give up the treatment, but lower the strength of the carbolic acid in the oil to 1 in 20, and more or less limit the number of the applications. But what is far more important, see that there is abundance of ventilation in the room. I would fear more from a close chamber and excess of carbolic acid vapour in the air than the possibility of the excess of acid having been absorbed from the oil. Remember you are not dealing with a _watery_ solution where there, I believe, _is danger_, as water, besides quickly evaporating, rapidly yields up its carbolic acid to the tissues, which too readily absorb it. Oil but slowly evaporates, and with difficulty parts with the carbolic acid it holds in solution to the tissues.

All the swabs, mops, &c., of cotton-wool, and the wool itself that may have been employed in treating a case, should be burnt at once when they are no longer required.

The blankets and bedding, after a good washing and exposure to sun, will be found to be free of infection, and may be again with safety employed.

Upon the above principles I have treated the vesicle of vaccination, with much comfort to the patient, and in most of the cases entirely prevented the pustular stage.

AITCHISON.