Report on an outbreak of mild smallpox in New South Wales in 1913, and the measures taken for its control / by W.G. Armstrong, J. Burton Cleland and E.W. Ferguson.
- New South Wales. Department of Public Health
- Date:
- [1914]
Licence: In copyright
Credit: Report on an outbreak of mild smallpox in New South Wales in 1913, and the measures taken for its control / by W.G. Armstrong, J. Burton Cleland and E.W. Ferguson. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![10G in one patient, in which the pocks were counted, they numbered over 4,000 upon the whole surface of the body, of which 362 were upon the face. In another instance there were over 900 counted upon the face alone. In the latter case nearly all the pocks were small and badly developed. These cases were exceptional, however, and the average number of lesions upon the face in the majority of instances ranged from about twelve to, say, thirty or more. The Individual Lesion. —- The focal lesion in the Sydney epidemic manifested great variations both in its anatomical characteristics and in its development. In a small minority of the severer cases it approximated in both directions very closely to that of the classical type of smallpox. In such cases the rash appeared in a single crop, the lesion passed through the regular stages of papule, vesicle, and pustule, and the whole evolution, from the first appearance of the papule to the beginning of incrustation, occupied about eight days. The vesicles in these rare cases were circular, fiat-topped or umbilicated, greyish in colour, and when pricked or incised the contents were not wholly discharged, indicating loculation of the vesicle. In the overwhelming majority of our cases, however, the regular states of develop- ment of the lesion were obliterated, or nearly so, and the whole period of evolution was much shortened. Often the first sign of the rash was an outcrop of pimples on the nose or forehead, which acquired pustular heads within a few hours; and sometimes the changes were so rapid that the lesions seemed almost to make their first appearance as pustules. They exhibited a strong tendency to appear in crops, which continued to erupt from day to day throughout the whole period of efflorescence until the earlier lesions had dried up or become scabbed over. As a consequence, lesions were generally present at the same time on the same part of the body in various stages of development— a state of matters which is not generally distinctive of smallpox. Another direction in which the eruption in our epidemic was aberrant was in the large proportion of small and abortive lesions. In most cases of the classical variety of smallpox a minority of the lesions are small and abortive, but in the New South Wales epidemic such abortive lesions were often in the immense majority. Most of the variations from the classical type observed in our epidemic appeared to depend very largely upon the superficial character of the lesions. This characteristic showed itself best in the absence of pitting of the skin after recovery, which was seen in most of the cases, and ip the shallowness of the little ulcers which were seen when a pustule was accidentally ruptured (about 10 per cent, of the patients, however, did show marked pitting). When the lesions were fairly large their superficial character was also shown by the appearance of the margin of the pustule. In chicken-pox the pustule or vesicle often appears to bo lying upon the surface of the skin, in ordinary smallpox it juts through the skin, throwing the surrounding skin up in a slope round the base of the pustule. In this form of smallpox the appearance presented by a full-sized lesion is half- way between the two. It is less superficial than in chicken-pox, and more so than in ordinary smallpox. The same fact accounts for the sinuous, jagged outline and oval shape of the lesions which were often seen in the Sydney epidemic, especially those lesions situated on the trunk. The clear watery pock which collapses easily on pressure with the finger-nail, with escape of its watery contents, which is near])’ always present in some stage of an attack of chicken-pox, is never seen in mild smallpox. The presence of even one or two of these watery pocks in an eruption which might otherwise be regarded as suspicious, is always sufficient to clinch the diagnosis as against smallpox. Some other characteristics of the focal lesions, such as shape, irregularity of outline, and the appearance of the rash in successive crops, have no great value in the diagnosis of the disease. It was the relative or complete absence of the eruptive fever which accounted for the exceeding mildness of the epidemic. Even in cases which passed as severe the maturation of the pustules was accompanied with very little elevation of temperature. In the case of the girl E.B., who was admitted into the Sydney Hospital, and whose illness in many respects was more typical of the ordinary form of smallpox than almost any other case seen in the epidemic, she never had a temperature to speak of after the rash appeared. She was admitted into the hospital on 12th June, and the rash first appeared on the 15th. Previous to the appearance of the rash she had a toxiemic fever running very near 105 degrees F., but after the rash had once appeared her temperature only once touched 101 degrees F., and that was on 20th June, the day after her removal to the Coast Hospital. On the 21st it fell to 99 degrees F., and on the 22nd to normal, from which it never rose again. All through the stage of pustulation she stated that she felt perfectly well, and complained of not getting enough meat to eat. In most of the cases sent to quarantine the temperature continued normal throughout ths eruptive stage, and the patients did not exhibit any symptoms of that profound illness which usually accompanies pustulation in the unvaccinated. The Invasion Period.—The mode of onset of the illness—the third member of the diagnostic trinity enumerated—would be of greater value if human testimony were more reliable. Patients and their friends so often deliberately suppressed the truth, or, for some reason, made false state nents, that this class of evidence always had to be received with great caution. When reliable, such evidence was of great value in diagnosis, and formed a diagnostic barrier between this degraded type of smallpox and the other diseases which it most resembles—chicken pox. It is usually rather gradual in its onset, and is marked by frontal headache (which, according to the statement of patients, is always the most prominent symptom), general febrile symptoms, backache (in about 20 per cent, of the cases), vague general pains, vertigo, rarely distinct rigors, and sometimes vomiting. Patients a'most always liken %](https://iiif.wellcomecollection.org/image/b2136056x_0010.jp2/full/800%2C/0/default.jpg)
