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64
FACTITIOUS INTENSIFICATION OF RASH.
R. H., ship's carpenter, aged 38, presented as severe a case of confluent Small-pox
as I have seen recover. He was seen at the earliest onset of his rash after two days of
" Influenza " when only thick-sown pin-point flecks were apparent, and these on the
scalp only. Sixteen hours later these had progressed but little. At the end of twentyfour
hours, however, the scalp was entirely covered by confluent papules, the face was
uniformly red, and flecks and papules were apparent on the body and hands. This
curious early distribution and a new growth of fine hairs on the otherwise bald head
suggested a question at a venture. In answer, it transpired that the lotion he had been
rubbing into his head—and incidentally into his hands, face, and possibly other parts of
his body, for one towel does much duty in a " fo'c'sle "—had been guaranteed to " bring
hair on a billiard ball."
Over and above the usual peripheral distribution of Small-pox, which is in itselt
" factitious " in that the incidence of the rash depends to a large extent on rubefaction
of the exposed peripheries during the invasion stage, nearly every case presents some
area of the body in which special " factitious intensification " of the rash and the causal
act producing this can be traced. It is impossible to doubt that in this case the strong
rubefacient used during the stage of invasion was responsible for the complete wrecking
of the whole epidermis of the face, head, neck and hands, and for a condition from
which, on maturation, recovery was both protracted and precarious.
To those who have the care of "contacts," and thus of cases in the earliest stage of
invasion, the above case would suggest that a regimen involving the prevention of any
rubefaction of the skin during this stage, will prevent in some measure the severity of
the rash incidence, and is an essential part of the treatment.