suddenly. The eruption comes out about the third day of the attack,
sometimes not discoverable until the end of the third or beginning of
the fourth day. The eruption is at first very slight, beginning with
small red pimples on the forehead, upper part of the cheeks, neck and
upper part of the breast, extending by degrees to the arms, and other
parts of the body and limbs. About the end of the fourth or forepart of
the fifth day, the eruption is complete.

There is a symptom, not mentioned in the books, which will often
determine the disease before the occurrence of any eruption. It is the
appearance of hard shot-like pimples, to be _felt under the skin_ in the
palms of the hands, while there is, as yet, no trace of eruption to be
seen upon the surface.

On the eighth or ninth day, the eruptions become vessicular, have
flattened tops, and contain a limpid fluid. The parts continue to
swell, the eruptions to enlarge, and become filled with purulent matter,
having a dark color at the top, up to about the fourteenth or fifteenth
day, when they begin to flat down, to dry up, and some of the scabs
become loose. At this time, some fever arises, often quite severe, with
headache and other inflammatory symptoms. If the eruption is very
severe, fever will be of corresponding violence, and lighter or wanting
when the eruption is mild. This fever rarely lasts more than twenty-four
hours, from which time the patient rapidly recovers.

In the _Confluent_ variety, all the symptoms are more violent, the fever
continuing after the eruption begins. The pustules burst early, and run
into each other, covering nearly or quite the whole skin; the surface
swells and turns black or dark brown, the lungs are more or less
irritated, producing cough, and not unfrequently the stomach is
nauseated, and vomiting ensues.

If the patient survives the irritation up to the fifteenth or sixteenth
day, when the _secondary fever_ sets in, he is liable to be taken off
by an affection of the brain or lungs, during this fever. If he
recovers, his whole surface, especially that part exposed to air, is
deeply pitted.

TREATMENT.

As it is not often known for a certainty, in the early febrile stage,
that it is the small pox, the treatment will be first adopted that would
be proper for a like fever arising from other causes. But in all my
observations in this disease, and they extend to several hundred cases,
I have not found in a single instance, any