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Prevention of Communicable Disease: Inoculation

When to Vaccinate. Every child should be vaccinated during the first year and again at the age of puberty, i. e., twelve or fourteen years of age. If a case of smallpox occurs in the family or neighborhood, or even if it is known to exist in the community, every member of the family should be promptly revaccinated. Inoculation within three days after exposure has been found to give immunity, and if performed as late as the fifth day the attack will be averted or much modified. This is especially the case when revaccination is performed. In one recorded case a mother and three small children were vaccinated after the father was taken down with the smallpox.

The wife nursed her husband during the disease and took care of her children, but no other member of the family became infected.

Symptoms. The period of incubation varies from 7 to 20 days, the average being 12 days. Inoculation shortens the time to 7 or 8 days.

During this period the symptoms are very slight. The invasion of the disease is sudden. It begins with a chill which may be followed by others. There is severe aching in the small of the back, sometimes in the limbs, intense headache, vomiting and fever. The pulse is rapid and strong.

Convulsions often occur in children.

An initial rash in the form of a diffused redness somewhat similar to the rash of scarlet fever occurs in a few cases on the second day. The distinctive eruption appears on the third day on the forehead, around the mouth, and on the wrists. Now the temperature, which has been continuously high, begins to fall. Within twenty-four hours the eruption spreads all over the body, and at this stage the disease strongly resembles measles. On the fourth and fifth days the eruption is papular and a characteristic "shotty" sensation is obtained by passing the fingers over the skin.

In the milder cases commonly called varioloid or variola, the fever falls at once after the appearance of the eruption on the third or fourth day, and the patient feels comfortable. The eruption is slight, scat- PREVENTION OF COMMUNICABLE DISEASE 169 tered, and often limited to the face and hands.

There is danger that this disease may be mistaken for measles, scarlet fever, chickenpox or some other infection. The characteristic symptoms are the severity of the attack together with chills, backache, headache and vomiting. The presence of these symptoms associated with a high fever from 102% to 105 F. continuing for three or four days and falling on the appearance of an eruption should excite suspicion of smallpox, especially when the disease is prevalent.

The symptoms of measles have been described elsewhere. The eruption occurs about the fourth or fifth day without the fall of temperature which is characteristic of smallpox.