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.
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![or earlier), and has usually entirely disappeared from the skin in little more than twenty-four hours; in no case does it last until the appearance of the true variola eruption. It consists of rose-red macules, just at the level of the skin, whose redness disappears on pressure, but quickly reappears; some of them are small, of the size of a lentil, and round, while others are larger and of irregular contour. These macules usually appear first on the face, but then extend to the rest of the body and are especially numerous on the extremities. In most cases they reach their maximal intensity in a very short time (a few hours), and then, as already remarked, disappear somewhat more slowly than they appeared, and leave no trace. From all that is known, it appears that this rash is due not so much to an exudative inflammation as to a pure hyperemia of the skin of vasomotor origin, as otherwise the extremely fleeting nature of the exanthem could hardly be explained. The roseolar initial eru])tion is found far more frequently in vario- loid than in severe cases of variola. A favorable prognostic indication for the further course of the disease is therefore, not without reason, assigned to it. My own quite numerous observations on this point confirm this decision, as I have seen this form of initial exanthem almost exclusively in cases of varioloid. The second and much rarer form of initial exanthem of variola is quite different from the first; it begins earlier, generally on the first day of the disease, and even sometimes precedes the fever and other initial symptoms (W. Bernouilli, Curschmann). In contrast to the initial erythema of the first kind (the roseola variolosa), it is called by many variolous initial exanthem,” or initial erythema of the second kind (Hebra); it is also called ‘‘scarlatinous initial exanthem” because of its dominant color, and also “hemorrhagic erythema,” on account of the capillary hemorrhages which regularly occur in the area of its distribu- tion. This area of distribution presents the following special peculiari- ties : It occurs mostly (Hebra) in the lower half of the abdomen in a region which is rather sharply limited above by a transverse line at about the level of the umbilicus ; further, also (excluding the genitalia) on the inner surface of both thighs to the knee ; the surface of the skin in these regions is of a dusky burning red color, as in scarlatina Icevi- gata, and presents numerous smaller and larger purple-red macules with irregular borders (arising from hemorrhages). If the patient lies with adducted thighs, then the whole presents a triangular figure of the red color mentioned above, the base of the triangle being directed toward the trunk, the somewhat rounded lower angle lying a little above the level of the knee. Following Th. Simon, the region mentioned is usu-](https://iiif.wellcomecollection.org/image/b29012090_0056.jp2/full/800%2C/0/default.jpg)
