Variola, vaccination, varicella, cholera, erysipelas, whooping cough, hay fever / by H. Immermann [and others] ; edited with additions by John W. Moore ; authorized translation from the German, under the editorial supervision of Alfred Stengel.
- Immermann, H.
- Date:
- 1902
Licence: In copyright
Credit: Variola, vaccination, varicella, cholera, erysipelas, whooping cough, hay fever / by H. Immermann [and others] ; edited with additions by John W. Moore ; authorized translation from the German, under the editorial supervision of Alfred Stengel. Source: Wellcome Collection.
121/730 (page 111)
![DIAGNOSIS. The diagnosis of smallpox may be extraoi’dinarily easy, or under certain circumstances very difficult, or even at times im])ossible. The former statement is true in well-formed and in well-developed cases in the jwriod of eruption, and still more in the period of suppuration ; the latter statement is true of the initial stage, sometimes also of the period of eruption as well as of iri’egular and undeveloped types of the disease. Tlie especially important points for diagnosis are the epidemic relations and also certain clinical peculiarities which occur especially in variola. During the prevalence of a smallpox epidemic one is in general compelled to regard as sus})ieious any case which sets in acutely with high fever, especially when it can be shown that the patient has had any communication, direct or indirect, with a smallpox patient, and when personal susceptibility can be presupposed. The latter may be assumed if the patient has not been inoculated or if too long a time has elapsed since vaccination or revaccination (see for particulars under “Vaccina- tion ”). In such cases also the initial fever, especially in cases of later varioloid, is often very light and the history is indefinite and misleading, so that it is not to be wondered at that erroneous conjectures as to the nature of a doubtful case are by no means seldom made, up to the time of the critical moment of the eruption (that is, in general up to the fourth day). Thus the first cases of a smallpox epidemic, in the absence of more particular diagnostic points, often pass without an early diagnosis, whether they set in with mild or severe symptoms. It is naturally very easily possible to confuse the early stages of smallpox with such other acute febrile diseases as begin with a sudden rise of temperature and with intense general symptoms. Among these we may place pneumonia and influenza; of the acute exanthematous diseases, scarlet fever and typhus exanthematicus, as well as relapsing fever and, less frequently, measles and typhoid fever. Of especial value for the early diagnosis of smallpox are certain local signs which frequently appear in variola especially in this period of the disease. In this connection we may mention first the lumbar and sacral pain, as it very decidedly plays a frequent and imjjortant part among the subjective symptoms of the initial stage of variola, Avhile in none of the other diseases named](https://iiif.wellcomecollection.org/image/b29012090_0121.jp2/full/800%2C/0/default.jpg)
