The incubation period between contraction and the first obvious symptoms of the disease was around 12 days. Ordinary
Ninety percent or more of smallpox cases among unvaccinated persons were of the ordinary type. In this form of the disease, by the second day of the rash the macules had become raised papules. By the third or fourth day, the papules had filled with an opalescent fluid to become vesicles. This fluid became opaque and turbid within 24–48 hours, resulting in pustules. By the sixth or seventh day, all the skin lesions had become pustules. Between seven and ten days the pustules had matured and reached their maximum size. The pustules were sharply raised, typically round, tense, and firm to the touch. The pustules were deeply embedded in the dermis, giving them the feel of a small bead in the skin. Fluid slowly leaked from the pustules, and by the end of the second week, the pustules had deflated and began to dry up, forming crusts or scabs. By day 16–20 scabs had formed over all of the lesions, which had started to flake off, leaving depigmented scars.Ordinary smallpox generally produced a discrete rash, in which the pustules stood out on the skin separately. The distribution of the rash was most dense on the face, denser on the extremities than on the trunk, and denser on the distal parts of the extremities than on the proximal. The palms of the hands and soles of the feet were involved in most cases.
Methods
Medication
Dopamine agonists are currently the preferred medication for suppressing lactation, which work by suppressing prolactin production. Cabergoline (Dostinex™) is currently most effective option currently available, as it is available as a single dose (as opposed to bromocriptine which must be taken twice daily for 2 weeks.) It may be prescribed in the case of breast abscess. Although the preferred method of treatment for breast abscess and mastitis is actually to continue breastfeeding, if the decision is made to stop breastfeeding, then chemical lactation suppression is indicated, particularly for severe cases. Carbergoline is not indicated for treatment of discomfort caused by engorgement. In the UK dopamine agonists are routinely prescribed following a stillbirth. Pre-eclampsia is a contraindication for prescribing dopamine agonists.In the past, hormonal therapies such as diethylstilbestrol were routinely used in the postpartum period, but these are no longer recommended due to side effects such as nausea and vomiting, and severe potential side effects such as thromboembolism, cerebral accident, and myocardial infarction. Estrogen containing birth control pills may have the same side effect, but like diethylstilbestrol is inappropriate for use in the postpartum period due to the risk of side effects. Pseudoephedrine may also suppress lactation, as it is known to cause low supply.In the US. Spitz et al. in a 100-year review of all available information concluded that there was nothing new or helpful to assist with the mammary involution or milk suppression process or to treat the pain or discomfort of severely engorged breasts.