About the ninth or tenth day of the rash another change appears in
the pustule. In mild cases this change sometimes takes place several
days earlier. In the centre of the pustule is observed a small, darker
spot, which gradually grows larger. The membrane of the pustule becomes
shriveled, and the little, dark spot continues to get larger and darker
until it involves the entire area of the pustule. This is the drying
stage, during which the fluid part of the pustule is absorbed, leaving
the solid part behind to be exfoliated in the form of a crust. It
is during this stage that, owing to the softening of its membranous
covering, the pustule is broken by the movements of the patient or the
contact of rough bed-linen. The pustules of the face are usually the
first ones broken, and an ulceration frequently occurs which destroys
the true skin and results in a pit or scar. Pustules do not rupture
spontaneously and discharge their contents. Dessication lasts usually
from five to twenty days, the exposed parts being the first to dry and
shed their crusts. On the palms and soles the dessicated débris is left
deeply buried in the skin, and often has to be removed by the aid of
a lancet or other instrument. Sometimes there is a pustule under the
nail, and the removal of the kernel or seed is quite painful, though
necessary.
The crust is usually thin, of a light yellowish-brown tint, but
slightly adherent, and is shed or picked off without discomfort. The
spot where the crust has been is of a deep purplish hue, and the many
little stains here and there give the patient a peculiar spotted
appearance, which in time disappears, except where the ulceration has
left a pit or cicatrix. The pit soon loses its color and becomes of a
whitish hue.
As dessication proceeds the constitutional symptoms decline, the
appetite returns, and the patient gains strength.
*Complications.*--Sepsis is the one generally to be expected, and this
may assume any form from a local affection, such as a furuncle, to a
general septicæmia. Furunculosis is frequent and is often annoying,
and no sooner is one boil healed than others follow. Bed-sores are
also frequent if proper care is not used to prevent them. Bronchitis
from the affection of the mucous membranes may occur. When simple,
this can be handled easily; but when general pneumonia results, death
is inevitable in the weakened condition of the patient. Ulcers and
opacities of the cornea, laryngitis and croup (the latter generally
fatal), zoster, sciatica, nephritis and gastritis, are all frequent
complications, especially in severe cases.
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