ms: first, red, feeling
like hard pimples or like shot; then, on the second or third day of
the eruption, these pimples become tipped with little blisters with
depressed centers, and surrounded by a red blush. Two or three days
later the blisters are filled with "matter" or pus and present a
yellowish appearance and are rounded on top. Finally, on about the
tenth day of the eruption, the pustules dry up and the matter exudes,
forming large, yellowish or brownish crusts, which, after a while,
drop off and leave red marks and, in severe cases, pitting. The fever
preceding the eruption often disappears upon the appearance of the
latter and in mild cases does not reappear, but in severe forms the
temperature remains about 100 deg. F., and when the eruption is at its
height again mounts to 103 deg. to 105 deg. F., and gradually falls with
convalescence. The eruption is most marked on the face, hands, and
forearms, and occurs less thickly on the body. It appears also in the
mouth and throat and when fully developed on the face gives rise to
pain and considerable swelling and distortion of the features, so that
the eyes are closed and the patient becomes frightfully disfigured and
well-nigh unrecognizable. Delirium is common at this time, and
patients need constant watching to prevent their escape from bed. In
the severe forms the separate eruptive points run together so that the
face and hands present one distorted mass of soreness, swelling, and
crusting. In these, pitting invariably follows, while in those cases
where the eruption remains distinct, pitting is not certain to occur.
A still worse form is that styled "black smallpox," in which the skin
becomes of a dark-purplish hue, from the fact that each pustule is a
small blood blister, and bleeding occurs from the nose, mouth, etc.
These cases are almost, without exception, fatal in five to six days.

The patient may say that the eruption was the first symptom he
observed. This was particularly noticed in negroes, many of whom had
never been vaccinated. The eruption may exhibit but a dozen or so
points, especially about the forehead, wrists, palms, and soles. After
the first four days the fever and all the disagreeable symptoms may
subside, and the patient may feel absolutely well. The eruption,
however, passes through the stages mentioned, although but half the
time may be occupied by the changes; five or six days instead of ten
to twelve for crusts to form. In such case