In the successive stages of a typical case of variola a marked
change in the character of the treatment is demanded both by the
peculiarities of the eruption and the accompanying general symptoms.
Instead of considering the various types of variola from a therapeutic
stand-point, therefore, it would seem more practical to discuss in
their natural order those measures which are adapted to the successive
stages of the disease, beginning with the
*Period of Incubation.*--During this period, which extends from the
date of infection to the appearance of the earliest symptoms of the
disease, treatment is rarely demanded, since in the great majority of
cases the outbreak of the disease is a surprise, and in no case can
it be positively known that a patient has smallpox until the initial
symptoms appear, and often not until the characteristic eruption has
developed. In many instances, however, it is quite certain that an
individual has been exposed to the contagion of variola; and when
such a one happens to be unvaccinated, or has not been vaccinated in
recent years, the assumption is strong that the disease may have been
contracted and will manifest itself in due time.
The question as to whether vaccination can have any notable effect
in modifying the course of variola when performed after a person has
been exposed to and has contracted the disease is one concerning which
a considerable difference of opinion is expressed by modern writers.
While some contend that even if vaccination fails to prevent the
development of variola it is quite certain to modify its severity,
others claim that it can be of no more advantage than locking the barn
after a horse has been stolen.
The precise effect which vaccination during the stage of incubation
may exert upon the subsequent course of the disease is very difficult
to determine in one or even a small number of cases, since it is
almost impossible to predict in any given case what the severity of
the disease will be. In the opinion of Curschmann it is very doubtful
whether vaccination can even render the course of smallpox milder. He
states that in many instances where vaccination has been performed
after exposure to smallpox infection the pustules of vaccinia and
variola have been seen developing side by side, the former having
apparently no effect upon the latter. In the opinion of Welsh, on the
other hand, vaccination after infection often modifies the disease,
and not infrequently prevents it altogether. He believes that when
vaccinia has advanced to the stage of the formation of an areola around
the vesicle, about the eighth day, it begins to exert its prophylactic
power against smallpox; and as the period of incubation in variola
is usually twelve days or more, an early vaccination may exert its
protective influence in advance of the time when the variolous eruption
should appear.
Public-domain text, read in full here on John Shaqi.
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