s the death rate has been
exceedingly low, although it is perfectly possible for a person to
contract the most severe smallpox from one of these mild (and often
unrecognized) cases, as has unfortunately happened. Smallpox occurring
after successful vaccination resembles, in its characteristics, the
cases just described, and unless vaccination had been done many years
previously, the results are almost always favorable as regards life
and absence of pitting.

=Detection.=--Smallpox is often mistaken for chickenpox, or some of
the skin diseases, in its mild forms. The reader is referred to the
article on chickenpox for a consideration of this matter. The mild
type should be treated just as rigidly as severe cases with regard to
isolation and quarantine, being more dangerous to the community
because lightly judged and not stimulating to the adoption of
necessary precautions. The preliminary fever and other symptoms
peculiar to smallpox will generally serve to determine the true nature
of the disease, since these do not occur in simple eruptions on the
skin. The general symptoms and course of smallpox must guide the
layman rather than the appearance of the eruption, which requires
educated skill and experience to recognize. Chickenpox in an adult is
less common than in children. Smallpox is very rare in one who has
suffered from a previous attack of the disease or in one who has been
successfully vaccinated within a few years.

=Outlook.=--The death rate of smallpox in those who have been
previously vaccinated at a comparatively recent date, or in
varioloid, as it is called when thus modified by vaccination, is only
1.2 per cent. There are, however, severe cases following vaccinations
done many years previous to the attack of smallpox. While these cannot
be called varioloid, yet the death rate is much lower than in smallpox
occurring in the unvaccinated. Thus, before the mild epidemic of 1894
the death rate in the vaccinated was sixteen per cent; since 1894 it
has been only seven per cent; while in the unvaccinated before 1894 it
was fifty-eight per cent; and since that date it has been but
seventeen per cent, as reported by Welch from the statistics of 5,000
cases in the Philadelphia Municipal Hospital.

=Complications.=--While a variety of disorders may follow in the
course of smallpox, complications are not very frequent in even severe
cases. Inflammation of the eyelids is very common, however, and also
boils in the