Excerpt from Second Biennial Report of the North Carolina Board of Health, to the General Assembly of North Carolina: Session of 1889

Vaccine matter was promptly forwarded and the patient isolated. Doubts and. Apprehension still hung around the case and a member of the State Board was sent to investi gate it.

The patient, a citizen of Wilson, had been discovered to have an eruption, which was pustular and covered the whole body. For some weeks he had not been away from Wilson, and then had been residing or visiting localities where there was no small-pox. There could hardly be a more difficult matter than to determine the exact nature of this disease. The pustules were distinct, round, pustular, in some places umbilicated. Inspection and inquiry revealed these facts: The patient had no initial fever, backache, frontal headache, the eruption did not begin on the forehead and pursue a regular course on the neck, arms, chest, etc, but was as much, in the beginning, on the legs and body as elsewhere, crust ing, which was just begun, was not in the usual order on the face, but scattered about, the patient had been vaccina ted within a few years, but the eruption dimmed the cicatrix, if there was any of a well marked character, the odor of the body was not characteristic, the sore throat was not that of small-pox. Altogether, there was hardly ever to be imagined a case so nearly like small pox not to be one, and a person with a like eruption during the prevalence of small-pox, would almost without question, be hustled off to a lazaretto. The deciding point lay in the fact that the patient had a hard-chancre still uncured, settling the diag nosis as one of pustular syphilide.

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