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

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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$equally persistent, and why it usually takes so long to reestablish even tolerably good health. In this way it happens that the patients, even when no other loealizations and complications exist which should have anv pyretogenic iuHucnce, yet have fever until late in the third week or even longer; that the sensoriiun, enthralled by delirium, very slowly clears up; and that all other signs of the general jjci’turbation pass very tardily into the background. As regards the disfiguring marks which remain in the skin of the face and elsewhere after variola confluens, we have, thanks to the pre- ventive influence of vaccination, rarely and exceptionally the oppor- tunity of seeing them. As such smallpox patients are almost always those who have not been vacinnatcd or who have not been pro])erly revaccinated, such specimens, from an esthetic standpoint, afford very impressive living warnings against the baneful phrases of the modern opponents of vaccination. Indeed, the permanent disfigurements which the destructive processes of confluent smallpox leave behind in the human countenance are often truly fearful. Where the confluence existed, we see not, as after variola discreta, small, round, isolated scar depressions, but, instead of these, extensive, irregular scar-formations, ^\•hich are frequently crossed by firmer strands and, by the traction of these, are unequally distorted in different directions. These scars are most disfiguring when, occurring in the regions of the eyes or mouth, they are complieated with ectropion of the lids or lips. ' They have also, as can readily be understood, a lasting influence on the function of these parts. But elsewhere also in the face, these scars may, by their dense structure as well as by the formation of adhesions, hinder the free action of the corresponding muscles and exert a disturbing influence not only in the play of expression, but also in chewing and talking. Hemorrhagic Forms of Variola.—Hemorrhagic smallpox (bloody smallpox or black smallpox) is generally characterized as a combination of variola with a hemorrhagic diathesis. This event may occur at dif- ferent times, so that the hemorrhagic character of a case of smallpox may be manifest during the initial period, while in other cases it is shown first after the appearance of the exanthem. Accordingly we distinguish two forms : primarily hemorrhagic and secondarily hemorrhagic small- pox. The former is known as purpura variolosa ; the latter, as variola ])ustulosa hiemorrhagica. Both forms surpass in malignancy all other forms of smallpox. ' A closer insight into the genesis of hemorrhagic smallpox of both kinds is for the present impossible. This is partly due to our ignorance of the nature of the hemorrhagic diathesis, but partly also to the seemingly quite$