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.

    57/730 (page 47)
    ally called the “ fenioi’al triangle ” (Sclienkeldreieck), and the exanthem thus localized is called the “ erythema in the femoral triangle.” At other times, but more rarely, this triangle shows on both sides lateral extensions upward, and the erythemato-hemorrhagic region covers to the right and left the sides of the trunk, the axillary regions, a part of the inner surface of both arms, and the portions adjacent to the axillary space of the anterior region of the chest wall on both sides (“ shoulder triangle ”). Sometimes the shoulder triangles exist alone or the erythema appears chiefly on one side in these upper regions of the body (“ unilat- eral shoulder triangle ”). The scarlatinous “ erythema variolosum ” lasts, as a rule, until after the beginning of the true variola eruption and recedes slowly. The numerous hemorrhagic spots (petechi® and ecchymoses) pass through the usual changes in color, and, of course, therefore last especially long. A subsequent desquamation of the skin in the affected parts does not, however, take place. (It is thus distinguished from true scarlatina.) It is remarkable that a certain relation of exclusion exists be- tween the areas of distribution of the hemorrhagic initial erythema and the subsequent true variola exanthem ; however abundant the smallpox eruption may be in the cases in question, the parts of the body affected by the initial erythema are either entirely spared by the real pocks or are very sparingly covered by them (Trousseau, Hebra). The reason for this peculiar relation is as little understood as is the nature of the hemorrhagic eiythema. [It is probable that the devitalized state of the blood in the area of the initial erythema interferes with the develop- ment of the true variolous eruption. There is doubtless a condition of bacterial thrombosis.] The striking and noticeable peculiarities in the distribution and limita- tions of the hemorrhagic erythema must naturally suggest a trophoneu- rotic influence; but it would be decidedly premature to say anything more definite at this time. The hemorrhagic erythema is said by some (Hebra) to occur in women more frequently than in men, and, in contrast to the roseolar er^’thema, to indicate an unfavorable prognosis concerning the further progress of the disease; but both these assertions are energetically dis- puted by others (Th. Simon). My own observations, which happen to have been very limited in this special region of the pathology of smallpox, do not indicate any controlling influence of sex, but, on the other hand, they do suggest a warning con- cerning the prognosis. The few cases of this kind observed by me died, with one exception, in the suppurative stage of the disease.