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
Catalogue details

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.

    123/730 (page 113)
    Si) surprising, that in former times these two diseases were very frequently regariled as one (compare History). The reason for this error is that at the time of eruption tlie exanthem of smallpox is papular in its nature, and this to a certain extent resembles the papular exanthem of measles. The main difference between the two exanthems consists in the tact that the exanthem of measles remains papular, while that of small- ])OX soon becomes vesicular, and later pustular. But, in addition to this, the papules of measles have, even from the beginning, the tendency to occur together and to arrange themselves in groups (or corymbose*); that is, with alternating paler interspaces. This is not the case in small- pox, and it is this which gives to the skin the measly appearance peculiar to measles. On the other hand, the general differences between the two diseases are almost more important than the cutaneous differ- ences, and they should therefore be taken into especial account in the dif- ferential diagnosis of the two in the critical stage (without regard to the ej)idemiologic factoi’s). Usually several [four] days of severe catarrhal svmptoms on the part of the conjunctiva, the nasal mucous membrane, and the whole respiratory tract precede the outbreak of the exanthem in measle.s, while such a catarrh is present to a very slight degree in variola at this time. But the behavior of the fever is the most different of all; in measles, before the outbreak of the exanthem, the fever is slight, but usually rises considerably with the eruption, while in variola, on the other hand, the fever is usually high in the initial stage, but regularly falls more or less with the eruption, even in the severe cases. This peculiar defervescence is in general most sharply characteristic of variola as com- pared with all the other exanthematous diseases (scarlet fever and exan- thematic typhus), and especially when compared with varicella, which, on account of the vesicular form of its exanthem, quite vividly reminds one of the real smallpox during the period of fidl development. As the nosologic unity of smallpox and varicella has been asserted and pro- claimed with all possible positiveness by many, and even by very prom- inent investigators (F. von Hebra), this seems the proper time to enter .somewhat into detail for a moment on this much-discussed question of the identity or non-identity of the two pathologic processes. Regarded in the right light, this hypothetic identity of variola and varicella de])ends on a very external and a very transient similarity, which con- sists in the fact that in both these acute infectious diseases, vesicles develop at a certain time in the skin ; that is, fluid is exuded in certain fwi between the cutis and the epidermis. Yet there are important differences, also purely morphologic, between the two kinds of efHores- * From Kopu/i/Jof, a cluster of fruit or a bouquet of flowers. II—8