For the highly inflamed condition of the skin which characterizes
the suppurative stage of smallpox, especially in its confluent form,
cold water is, beyond all doubt, the best antiphlogistic. The cold
compresses advocated years ago by Hebra constitute the simplest method
of local treatment and one which is most grateful and beneficial to
the patient. They exclude the air, macerate and soften the lesions,
and lessen the local inflammation. Although it cannot be claimed that
they modify in any degree the development and course of the eruption,
it is doubtful whether anything better in the way of local treatment
has ever been suggested. Pieces of lint should be dipped in cold water
and applied smoothly to the face and other portions of the body where
the eruption is abundant and the skin inflamed. To prevent their drying
too rapidly a little glycerine may be added to the water and the lint
covered with gutta-percha tissue or oiled silk. Moore recommends
covering the face with a light mask of lint and oiled silk, having
holes for the eyes, nose, and mouth. The lint is wet with a mixture
of glycerin and iced water (fʒi-f℥i). If preferred, a cold solution
of boric acid may be used in place of plain water, and when there is
an excessive and unpleasant odor present, thymol may be added to the
solution. Immermann states that he used for a time sublimate dressings
to the face (1-1000), but found that plain water did quite as much good
and was safer to use.
Next to the face, the hands and feet suffer most from the eruption of
smallpox, and, owing to the fact that the skin is not as lax in the
latter region, particularly upon the fingers and toes, the inflammatory
swelling of these parts is always attended with extreme pain when
pustules are numerous. Under such conditions it may be found advisable,
in place of merely wrapping the hands and feet in lint and oiled silk,
to immerse them in pans or pails of water, or to supply the patient
with mittens and stockings made of vulcanized rubber cloth. Indeed, if
the patient is not in too critical a condition, he may be immersed for
hours in a bath, as recommended by Hebra for the treatment of extensive
burns, pemphigus, and various ulcerating affections involving a large
portion of the body.
*Period of Dessication.*--When the distended, semi-globular pustules
begin to dry, they tend to flatten, and often undergo a secondary
umbilication from the shriveling of the central portion of the pock. In
favorable cases the general condition of the patient improves as the
fever subsides, and a more substantial diet may now be allowed.
The symptom which usually causes most local discomfort at this stage is
the itching which invariably accompanies the drying of the pustules.
This is often intolerable, and much of the pitting left after an attack
of smallpox may be due to the tearing of the crusts from the face and
other parts.
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