A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8).
- James Copland
- Date:
- 1834-59
Licence: Public Domain Mark
Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 8). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
![27. The inflammation of the phlyctidium is at- tended by a specific or erythematous inflamma- tion, called the areola, extending to some distance beyond the margin of the vesicle. The exact tint of this areola should always be carefully noted as indicative of important local and constitutional states. On the subsidence of this inflammatory areola, the ripened pustules, having burst and dis- charged their contents, are succeeded by scabs, which dry up and fall off, in a healthy constitu- tion, in four or five days. In very mild cases, when the process of pustulation is not fully gone through, many of the vesicles shrivel, and form only imperfect, scaly crusts. On the lower ex- tremities this premature desiccation of the vesi- cles is often very general. 28. In severe cases, the inflammation of the corion does not cease with the completion of the pustulating process. Portions of the cutis vera are then actually destroyed and slough away, the skin presenting the appearance of pits or fossae, with a clarety hue, when cicatrization is at length completed. The dark tint wears off in the course of three or four months, but the depressions are permanent. From the great vascularity of the face, and from the exposure of it to light and air during the progress of the eruption, there is al- ways a more severe effect and disfigurement pro- duced by the disease in this situation than in any other part of the surface of the body. 29. ii. Modifications of Discrete or Benign Small-pox.—A. Vcrrucose Small-pox—Variola verrucosa. — V. cornea — Horn-pock, cf-c. This mild, mitigated, or modified form was well de- scribed by Van Swieten. Its symptoms are similar to those of the preceding form, but are much milder. The primary fever is often little more than a febricula, and the pustules seldom exceed one or two hundred. These, indeed, sel- dom reach a pustular state, but, having passed through that of tubercle or papula into that of vesicle, on the sixth day, or even sooner, de- siccate, shrivel up, and crust. This form is so mild, that the secondary fever is not manifested and consequently is wanting, convalescence com- mencing on the eighth day of the eruption. 30. B. Variola discreta siliquosa.—When there are empty vesicles between the pustular pim- ples, or when the pus of the pustular pimples has been absorbed, so that they are left empty, the disease has been named discrete siliquose small- pox. When the eruption continues vesicular, instead of being pustular, the disease has been called discrete crystalline small-pox. When vesic- ular pimples appear in the interstices between the pustules, this modification has been named discrete vesicular small-pox. In these varieties the symptoms are generally mild, the eruptive fever generally slight or moderate, and the sec- mueosum, which forms a raised lip or cup around ; and, in most instances, the pustule may be stripped off with the cuticle and rete, still leaving the cutis entire. But the cutis vera has frequently a slight depression left from ul- ceration at the base of the cup, and occasionally a papule of the cutis projects into its centre, to which the band of attachment from the cuticle still adheres. After the incrustation has separated, and the eruption is gone, a stain, with a depression, is commonly left in the centre 'of the rete mucosum, occasioned by a zone of red vessels remaining long distended, both in the Ethiopian and in the European. In the former it is black and per- manent, except when the cutis vera has been penetrated; while in the latter the marks are red and transitory, un- less, indeed, when ulceration has penetrated the cutis, in which case, in them, also, the pits are white and perma- nent in the European. ondary fever is either wanting or mild; the du- ration of the disease being rarely prolonged, but often somewhat shortened.* 31. C. Small-pox without the Eruption.—Vario- la sine Eruptione.—Variola presents, in the more severe cases, the fever, the cutaneous eruption, the affection of the mucous membranes, and the internal complications, hereafter to be described. In the more mild or benign cases, it consists only of the fever and the eruption ; but in both classes of cases there is a primary and secondary fever. In small-pox the fever is remarkable, and distin- guished from all other fevers by its remission at the end of four days, or when the eruption has come out, and by its return after a remission of four days, or about the end of the eighth day in the discrete, and about the eleventh day in the confluent small-pox. But cases sometimes occur, especially where the pustules are few, or their maturation is rapid or abridged, in which the sec- ondary fever is either very slight or altogether wanting; and other cases are met with, much more rarely, where neither the eruption nor the secondary fever is detected; and yet there can be no doubt of infection having taken place, and of the system being protected from another at- tack. In those, however, the primary fever has taken place, but without inducing the usual erup- tion. Sydenham, Lentin, Pelargus, Dubousis, Du Bourg, Frank, and others have observed, during the epidemic prevalence of small-pox, that some few persons who have not previously had the disease, nor been vaccinated, have been seized with all the symptoms of the primary variolous fever, and which having subsided without any eruption having appeared, they have afterward been found unsusceptible of the disease. 32. Sydenham, De Violante, Crosse, and some other writers above referred to, have re- marked that cases have occurred, during the pe- riods when small-pox was raging, which have been attended by petechia?, bloody urine, or by purple spots and low fever, and have terminated fatally. These cases were viewed by them as small-pox without the eruption, the severity of the internal complication, or the state of the hab- it of body and of constitutional powers, prevent- ing the due and regular evolution of the disease on the surface. It is by no means unreasonable to suppose that analogous phenomena to those which I have described in respect of scarlet fever (see that disease, y 26, et seq.) may also occur during the prevalence of epidemic small-pox, and that, owing to a predominant affection of the kid- neys, or to depressed vital power, the eruption is either not developed on the surface, or very im- perfectly, or in such manner as remarked by these and other writers. In cases where the kidneys are thus severely and early implicated, especially so as to arrest their excreting functions, not only are the usual phenomena and progress of the dis- temper interrupted, but a fatal issue soon takes place. 33. iii. Symptoms of Confluent Small-pox. —This state of the distemper commences gener- ally with symptoms similar to those of the dis- * [This form of small-pox occasionally occurs in an epi- demic form, mixed with the ordinary form of the disease, and even confluent cases, and is not unfrequently mis- taken for chicken-pox. The character of the eruption, however, is very various, assuming in different cases al- most every form of cutaneous disease. As they may be all traced to variolous infection, there can be no doubt of their being cases of modified small-pox.]](https://iiif.wellcomecollection.org/image/b21111066_0037.jp2/full/800%2C/0/default.jpg)
