4. Room should be well ventilated, with windows screened and slightly
darkened with red curtains to exclude the ultra-violet rays of light.
Temperature should be maintained at 65 degrees. Door-way may be
protected by a sheet dampened with a 1:60 carbolic solution.
5. Nurse must be robust, perfectly immune and not afraid. If male
nurse, hair must be very short and must have no beard; if female, hair
must be short and must wear close fitting cap.
6. Absolute cleanliness is secured by plenty of baths, clean bed and
personal linen, and careful nursing. Physician must put on special
suit with cap and gloves which are kept in the house, but not in the
sickroom.
The first symptoms being the headache, nausea and vomiting and the
lumbar pains, the first points of attack in the treatment would be the
relief of these pains in the head and back by thorough relaxation of
the spinal muscles, paying particular attention to the suboccipital,
mid-dorsal and lumbar areas. The headache may be partially relieved
by steady pressure between the frontal and occipital regions. No
interosseous adjustments requiring painful or difficult technique
should be given after the more severe symptoms have appeared. Patient
should be visited from one to three times per day, and the reflex
contractures of the muscles must be relieved as often as they occur.
Dysentery and diarrhea are controlled by strong inhibitory pressure in
the sacral and lumbar regions. Give vasomotor treatment to the superior
cervical ganglion. Stimulate the anterior aspect of the solar plexus to
stir up its acid function, the blood being alkaline in smallpox.
During all the stages up to the stage of pustulation, the patient
responds very readily and successfully to osteopathic treatment. The
headache, the backache and the aching joints respond to treatment as
readily as, if not more readily than, the headache and backache of
influenza do to osteopathic care. The constipation is usually quite
readily relieved. It has been the experience of those who have handled
smallpox cases, that the tendency to the confluent type is greatly
reduced by this treatment and that the response of the patient to
osteopathic treatment is very gratifying. Indeed, those of experience
have less fear of the outcome of their smallpox cases than do they have
of scarlet fever or pneumonia.
After the pustules have formed, each pustule is treated with iodine
painted on the pustule with a camel’s hair brush. During the pustular
stage it is not necessary to give manipulative treatment, and indeed
it is sometimes impractical because of the tenderness of the skin.
However, about all that is needed during this period is good hygienic
treatment and good nursing. During convalescence constitutional
treatment should be given.
=Diet.=—During period of vomiting, pellets of ice in the mouth are
comforting. During periods of fever give plenty of water with,
preferably, lemon juice. As the fever declines begin with barley and
oatmeal water with lemon juice; then follow with easily digested and
nutritious diet of milk, eggs, broths, beef juice and gruels. Feed
every three hours during that period but not large quantities. During
convalescence a full, well-regulated, nutritious diet should be ordered.
=Hygienic Care.=—Keep nose cleansed with glycerine, cold cream or
olive oil, which keeps the crusts soft. The mouth and nasopharynx may
be cleansed with any mild antiseptic. The eyes are washed with warm
boric acid solution. Cold compresses applied over the eyelids assist in
reducing the edema. A daily tepid sponge bath is necessary. Bath may be
given with bichloride of mercury solution (1:20,000) or creolin (1:500).
=Headache.=—Deep, steady digital pressure in the suboccipital fossa and
at eighth thoracic spine; ice bag to the head; or a mustard plaster at
the back of the neck may relieve.
=Vomiting.=—Thorough relaxation and adjustment of the great splanchnic
and cervical areas, with deep, steady digital pressure in the occipital
triangles, and at the fourth and fifth dorsal vertebræ on the right
side will usually control the condition.
=Fever.=—Relaxation of the upper dorsal area, relaxation of the
cervical area, and deep, steady pressure in the suboccipital region
often reduce temperature. Warm sponging in lower grades of fever, bath
at 70° F., and cold pack may be needed. If temperature goes very high
give a continuous cool colonic irrigation.
=Pitting.=—Cold wet dressings of lint soaked in any comfortable mildly
antiseptic solution, or of ice water and glycerine, are to be used on
the hands and face to prevent pitting. Hot water dressings are more
comfortable to some patients. It is well to protect the skin from the
light, especially from the ultra-violet rays. This, however, must not
lead to any lack of ventilation. When crusts are forming keep them
moist with vaseline, oil, glycerine, or carbolic acid in lanolin or
vaseline.
=Odor.=—Baths, the daily toilet and the use of dusting powder or 5%
iodoform powder, an open bottle of smelling salts or of weak ammonia
are good. Plenty of fresh air is best of all.
=Cardiac Weakness.=—If pulse is feeble and frequent, a general quieting
treatment should be given, including relaxation of the cervical area
and of the fourth and fifth dorsal segments. An ice bag in flannel
directly over the heart is often very useful. Gentle, careful spinal
extension is very restful and eases the spinal circulation.
=Delirium= is usually relieved, or prevented, by spinal extension,
the prolonged warm bath or the cold pack, if given when signs of
nervousness appear. Morphia or chloroform may be necessary in violent
and suicidal cases.
=Laryngeal Obstruction.=—Usually caused by edema and may require
tracheotomy.
=Bed-sores.=—These and abscesses may occur even under the best of care.
Place patient upon a water-bed or in a continued warm bath.
Convalescence is not complete until the skin is entirely free from
crusts and is perfectly smooth.
=Prognosis.=—Prognosis depends upon age of patient; complications; and
environment from which patient comes, as well as upon the nursing. In
varioloid the prognosis is recovery; in the discrete variety, good;
in the confluent type over 50% are fatal; in the malignant types
practically all die. In patients under five years old and over forty
years old the prognosis is very grave. A filthy environment predisposes
to complications. Recurrences seldom occur; second attacks are usually
varioloid.
=Prophylaxis.=—Usual rules of health authorities are: rigid quarantine
or isolation, vaccination, disinfection of the skin and all fomites,
and final fumigation. Quarantine of a suspected individual is sixteen
days after exposure. Isolation continued until every trace of eruption
has disappeared. The dead body is very dangerous and a public funeral
is not permitted. The clothes used by the patient must be steamed and
other articles must be washed with bichloride of mercury and fumigated
with formaldehyde vapor. Disinfection of the hands, face, beard and
hair of attendants with bichloride solution is imperative.