form of the disease, and is rarely attended with danger to human life. Confluent small-pox is much more serious, and often proves fatal. In the discrete or distinct form the primary fever is less intense than in the confluent form; in the latter there is often delirium, and more especially in intemperate persons. The malignant variety is terribly fatal; the blood seems profoundly poisoned from the first, and is more fluid than usual; bleeding from the mouth, nose and bowels is not uncommon; in women there are also genital bleeding and other disastrous results. In modified small-pox the patient is often able to keep about the whole time, and the rash may suddenly decline on the fourth or fifth day, and recovery follow.
Symptoms.—The disease begins with shivering or rigors, pain in the back, vomiting, thirst, headache, and a general feeling of indisposition; in children, convulsions may come on. In many cases the rash of small-pox in vaccinated cases is preceded by a more or less scarlet or roseolous rash, which is mottled over the body. If the finger be pressed on the forehead, a sensation is experienced as if pressing small shots, for the rash of small-pox generally commences there; at first a pimple forms, but afterwards a pustule, and then dries or scabs over, and leaves a pit or depression behind. When the rash comes out the temperature falls, but rises again about the eighth or ninth day; in mild cases, however, the secondary fever is hardly perceptible. The eruption usually appears first on the forehead, face and wrists, then on the rest of the body, coming out on the legs and feet 2 days later. The eruption takes about 8 days to arrive at its full development; during this time there is much swelling of the face and eyelids, so that the patient cannot see for a few days; in bad confluent cases the face seems covered with a mask, and a disagreeable odour proceeds from the body. Boils are apt to form in cases of confluent small-pox; the victims are also very subject to pleurisy, pneumonia and bronchitis; sometimes the tongue is much swollen and dry, and the patient may be unable to close the mouth or to speak; this is a very bad symptom. Inflammation of the ear, followed by an abscess, is not uncommon in this disorder. Erysipelas, gangrene, and pyæmia are occasionally met with. Inflammation of the eye and ulceration of the cornea may add to the general mischief. A medical man should always be called in when small-pox appears.
Treatment.—In the early stage, poultices and hot bottles will relieve the pain in the back and the chilly feeling. If the fever is high and delirium is present, sponging the body with tepid water is beneficial. When the eruption appears, warm baths are to be given night and morning. The pocks should be treated with some antiseptic application, such as carbolized oil or zinc ointment, or dusted with finely powdered boracic acid, as soon as the scabs come away. Painting with flexible collodion will both allay the irritation and in many cases prevent pitting. Dilute acetic acid, 1 part to 4 of water, often relieves
