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.
79/730 (page 69)
![“ zii.<aninieii fliessende Pockon,” we understand cases of variola with special development of the typical skin exanthem, so that, during the suppurative process, the purulent masses, which are at first discrete and r(‘j)resented by single pocks, in certain regions, and sometimes for a con- siderable distance, fuse with each other (flow together). The condition necessary to the local fusion of the suppurative pocks is, naturally, that the individual pocks, during the period of eruption and maturation, shall stand so close together in loco that their boundaries shall touch and crowd each other. But this circumstance alone does not necessarily imj)ly the subsequent true confiuence, for even the pocks which stand closest together still retain, during this earlier period of the disease, their character as single individuals. Just as little is it required that, under such conditions, a confluence of the purulent masses should later (that is, during the suppurative period) necessarily take place; for these masses often remain discrete until- they dry, as is taught by experience and is d priori obvious. What is really essential for local confluence of the pocks during suppuration, and for the occurrence of variola con- fluens in the anatomoclinical sense, is, with the sufficiently close group- ing of the exanthem, such a vehemence of the suppurative pi’ocess that the tissue boundaries between the individual pocks may in many places become liquefied aud be mechanically broken through. By this the malignancy of the local process is characterized, as also, on the other hand, the malignancy of the corresponding clinical form of smallpox. Even in the severest cases of this kind the confluence never involves the whole body, for the condition of the exanthem is never so crowded all over the body as to even approximately fulfil the above-mentioned essential condition. The confluence during suppuration is ol)served most frecpiently and most extensively on the head and face, and also on the hands and feet; in other words, in those regions where the local variolous process is most severe. In especially severe cases small parts of the back and other parts of the extremities may also be involved, but this is by no means the rule. It is surprising that in those regions where previous mechanical or chemical irritation had occurred, and on which in consequence (compare the earlier note on this ])oint) a specially thick early development of the exanthem, limited in extent, took place, true confluence during sup])uration is rarely observed. Hence it is that these conditions do not involve that bad prognosis which is justly attrib- uted to confluent smallpox. Variola confluens was, in prevaccination times, not only absolutely, but also relatively, far more frequent than now under the regime of pro- tective vaccination, for it regularly formed a more or less considerable](https://iiif.wellcomecollection.org/image/b29012090_0079.jp2/full/800%2C/0/default.jpg)
