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.

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    the face and head, and latef on the rest of the body (trunk and extrem- ities), in obedience to the general law which governs the development of the exanthem in all its phases in variola vera. As the pocks in variola vera are very close together on the face and head, it is clear that here a diffuse and severe inflammatory edema may very easily and almost as a rule result from the mingling of the areolse, causing such a change in the patient’s features that he is almost unrecognizable. The coalescence of the areolae just mentioned in the variola vera dis- creta, which is quite usual in this form of the disease, may not be at all re- lated to the coalescence of the purulent masses which forms the clinical and anatomopathologic criterium of variola confluens (see later). The inflammatory edema often reaches a very severe and even exces- sive degree in those regions of the face and head on which the skin is loosely adherent or where a denser texture is wanting, especially on the eyelids, but also on the cheeks, the lips, the wings of the nose, and the lobes of the ear. The ])atient is, as can well be understood, much hin- dered and troubled by this ; thus, the impossibility of raising the lids or of using the eyes, the difficulty of nasal respiration, which compels the patient to breathe only by the mouth, the impediment to lip-articulation, and also the inability to close the mouth in the act of drinking, all add to his general discomfort. The inflammatory swelling of the skin in the more tightly fitting and more closely adherent skin of the head is not so marked, although even here the individual pocks are generally close together, just as in the cartilaginous portion of the concha auris and in the adjoining region of the external ear. But the sensitiv'eness and pain on pressure are here especially great, and are often so severe that mere pressure of the head on the pillow is sufficient to cause the patient the greatest torture. On the trunk and extremities the pocks are generally sparsely distrib- uted. Therefore confluence of the inflammatory areas is far less fre- quent here, and usually occurs only in certain regions. Nevertheless the local inconveniences are veiy severe, especially on the back and other parts on which the patient must lie. They reach their full develop- ment in these regions, as already indicated, somewhat later than in the head region, but latest of all, and also most severely, in the hands and feet, where suppuration sets in at last with all its accompaniments. The number of pocks is usually quite large in these parts; they are also influenced by the marked innervation of these parts, so that, espe- cially in the fingers and toes, but also in the palms of the hands and soles of the feet, considerable disturbance of function and almost unen- durable pain arise for the unfortunate patient.