[From the Proceedings of the Connecticut Medical Society, May, 1874. | 
SMALL-POX AT SOUTH WINDHAM, CONN. 
By ASH BEL WOODWARD, M.D., 
OF FRANKLIN, CONN. SMALL-POX AT SOUTH WINDHAM, CONN. 
The small-pox which, with almost unexampled severity, 
scourged the village of South Windham, Conn., during the 
winter of 1873-4, was marked with features which commend 
themselves to the attention of the profession. In a community 
of barely three hundred inhabitants there were about one hun- 
dred and thirty cases. The disease was introduced from abroad 
early in December and became generally prevalent towards the 
close of January, the contagion having been diffused by the free 
commingling of the people before its existence was suspected. 
The writer was first called in, Sunday, February 1st, and dur- 
ing the next six or seven weeks visited the village daily. A 
majority of the cases presented the ordinary symptoms only. 
The premonitory fever, accompanied by intense pain in the lumbar 
region and obstinate vomiting, ushered in the attack, and was fol- 
lowed in due order by the appearance of pimple, vesicle and pus- 
tule, and by the other symptoms which usually attend the malady 
in its progress. Some were predisposed to stupor, while others 
were restless and wakeful. Active delirium was not infrequent. 
Instead, however, of advancing in the ordinary way, we noticed 
many variations. One of the most common of the irregular forms 
was the " crystalline," in which the eruption continued vesicular. 
Deviating at first but slightly from the usual appearance, this 
variety afterwards became more distinctly defined by the unsym- 
metric shape of the pock and by the absence of color in the con- 
tained fluid, which did not pass on to purulency but left behind 
an immature and imperfect crust. The assumption that the pus- 
tule is an invariable accompaniment of the disease might lead to 
an error in diagnosis. In several instances the eruptive inflamma- 
tion extended to the larnyx, trachea, and to the larger divisions 
of the bronchia, producing hoarseness and sometimes complete 
loss of voice. This was a dangerous form, threatening death by 3 
suffocation. Other modifications were observed, which indicated 
the great malignancy of the poison, furthered, perhaps, by subtle 
endemic influences which weakened the power of resistance in the 
system. The effect was seen in the quick and complete prostra- 
tion of nervous energy, followed by an imperfect development of 
the eruption or even its subsequent retrocession. A still more 
striking proof of the potency of the poison is afforded by the 
fact that not less than eleven of the sufferers had previously had 
the disease. 
It is well known that the small-pox is more malignant in cold 
than in warm weather. It may be, too, that the frequent and 
heavy fogs of last winter, coupled with rapid changes of tempera- 
ture, favored the spread of the pestilence either by affording a 
surer medium for the diffusion of the germs, or by depressing the 
vital forces. The poison accumulates and becomes more search- 
ing and uncontrollable as the numbers stricken down in a neigh- 
borhood increase ; conditions capable of resisting successfully the 
less energetic contagion of sporadic cases succumb helplessly as 
the epidemic spreads. Prophylactic measures, proved by abun- 
dant experience to be effective ordinarily, now disappoint with 
painful frequency the hopes of the physician. This shows the 
supreme importance of isolating every case at the outset and 
crushing the pestilence in its incipiency. The fire which, if taken 
in time, a single foot could stamp out, may, if given brief head- 
way, sweep resistlessly through the forest or across the prairie. 
As a preventive, vaccination is of paramount importance. 
Where the system is once thoroughly pervaded by the vaccine 
virus, the writer believes the protection to be complete. As the 
small-pox itself does not afford absolute indemnity against the 
subsequent recurrence of the malady, neither can vaccination 
claim to be an infallible safeguard. Zymotic diseases generally 
occur but once in the same person, yet certain constitutions pre- 
sent exceptional susceptibilities to the influence of specific con- 
tagions, which may thus affect them several times in the course of 
life. Ordinarily, if vaccination is performed within four or five 
days after the exposure of the unprotected to the variolous con- 
tagion, it gains precedence of the small-pox and affords complete 
security. But such, as might be anticipated from what we have 
said, was not the case at South Windham, at least after the pesti- 
lence had gained such headway that the air had become loaded 
with the poison. 4 
The treatment of the small-pox at every stage of its progress 
demands from the physician the exercise of ceaseless vigilance 
and sound discretion. Erroneous and dangerous inferences were 
formerly drawn from the circumstance that the appearance of the 
eruption usually brings relief. It was thought desirable to pro- 
duce copious pustulation, and for that purpose heat and stimulants 
were freely used. The exact opposite is the truth. The less the 
eruption, the better. The fewer the pocks, the less the peril. 
The patient should lie in a cool and darkened room, under few 
bed clothes, with the access of an abundance of fresh air so grad- 
uated in temperature as to produce a sensation of agreeable cool- 
ness. Ice water and other refrigerant drinks are as salutary as 
they are refreshing. Persons of robust constitution should be 
kept on a light diet, while the feeble and aged require judicious 
support. The bowels and secretions are to be regulated by gentle 
medication so far as deviations from the normal standard call for 
interference. Inflammation, stupor, wakefulness, neuralgic pain, 
cerebral congestion, vomiting, and other symptoms, are to be con- 
trolled by the appropriate remedies. It is fortunate that meas- 
ures which minister to the comfort of the sick are generally 
salutary. 
In the advanced stages another class of perils menace the suf- 
ferer. The strength exhausted by extensive suppuration and by 
pain, now needs to be reinforced by the judicious use of tonics 
and stimulants. The cooling treatment indispensable during the 
progress of the fever should give place to a regimen of moderate 
and agreeable warmth. 
The small-pox has a definite course to run and no remedy can 
cut it short. As its severity is, as a rule, measured by the amount 
of the eruption, the main indication in the earlier stage is to re- 
duce the eruption to a minimum. Throughout, the treatment 
should be conducted on general principles, the materia medica 
offering no remedies which exert a specific control over the dis- 
ease, and yet in few maladies does the treatment determine more 
frequently the issue of life or death.