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.)
![of the other exanthemata, or even from the com- mencement of continued fever. In children, how- ever, there is a more frequent occurrence of con- vulsions, more sudden and severe vomiting, and pain at the epigastrium, than in these ; and in adults the muscular and other pains are more severe.—(a) The fever of measles is more gen- erally attended by cough and watering of the eyes than that of variola; and the eruption is about twenty-four hours later in the former than in the latter. The papula of small-pox are firm- er and deeper seated than those of measles, which are superficial, and do not give so knobby or so granular a sensation to the touch as those of the former, which implicate the cutis vera. 71. (i) Febrile lichen may be confounded with small-pox; but the interval between the occur- rence of rigour and the appearance of eruption is much shorter in the former, generally only twenty-fours, or half the time of that of the lat- ter. The eruption of variola generally appears first on the face, while that of lichen takes place uniformly over the head and trunk, is superficial, and devoid of the granular feel to the touch which belongs to variola. {See art. Lichen.) 72. (c) A form of secondary syphilis sometimes occurs, in which the eruption over the face and trunk is very similar to distinct small-pox, and passes through the grades of papulse, vesicles, and pustules. It is, however, generally preceded by little, or by a slighter fever, and the eruption is much more tedious in its development than that of variola ; the pustules do not maturate, or pro- ceed simultaneously, but irregularly, or in suc- cessive crops. The general aspect of the patient, and the history of the case, will farther assist the diagnosis. 73. (d) The diagnosis between variola and vari- cella has been fully discussed, and the distinct na- tures of these have been shown at another place; but independently of various other points of dif- ference, the impossibility of inoculating the lat- ter, the occurrence of it after cow-pox, and even after small-pox, and the absence from varicella of the deep-seated granular sensation to the touch, and of the umbilicated vesicle, characteristic of the variolous eruption, sufficiently distinguish the one from the other.* (See art. Chicken-pox, § 2, 3, 10, 11.) * The following remarks respecting the distinct nature of Chicken-pox and Small-pox, contained in Dr. Grego- ry's excellent work, already referred to, deserve perusal, and quite agree with my own observation. The first thing I observe in varicella is the eruption of vesicles of the size of a split pea, being simple elevations of the cuti- cle, or minute blisters. The parts chiefly occupied by the eruption are the back and scalp. The face is not so uni- versally the seat of eruption as in variola ; nevertheless, at times the face is extensively occupied. The vesicles vary in shape. Dr. Willan, who Lived minuteness, wishes to distinguish three kinds—the lenticular, the co- noidal, and globate. I cannot see these distinctions my- self. The vesicles are surrounded by a superficial and narrow areola. They appear in successive crops for two or three days. While the new vesicles are forming, the old ones shrivel and dry up. On penetrating the vesicles, a clear lymph, scarcely at all mucilaginous, escapes, and the cuticle falls to the level of the surrounding skin. There is no tumour, no varus. If the vesicles remain unbroken for twenty-four hours, the contained fluid becomes slight- ly opaque. They are very itchy, and, when rubbed, a de- gree of superficial inflammation may succeed, sufficient to convert the lymph into an imperfect pus. The scabs of varicella are very small, and, as the lymph is wanting in mucilaginous quality, they are granular. The desic- cation is very rapid, and in six days the complaint com- pletes the whole cycle of its phases. No constitutional symptoms of much importance are present. The com- plaint often shows itself in schools, and runs through all [No single fact in pathology is better estab- lished than that the eruptions of small-pox are extremely various. I have described an epidemic varioloid disease which prevailed in the town of Gorham, Ontario county, New York, in the sum- mer of 1853,* and from the appearances present- ed have drawn the following conclusions : 1. That the small-pox virus will give rise to eruptions of a very diversified character; the modifications being produced by previous vacci- nation, the period which has elapsed since vacci- the young members of a family. It is manifestly infec- tious and epidemic. Varicella almost exclusively attacks children ; it is very rarely seen in adults. It is taken indiscriminately by those who have and those who have not been vaccinated. It is now nearly always taken after vaccination. Wheth- er it was taken equally after inoculation of small-pox I cannot tell from my own experience, but I have the au- thority of the late Sir Henry Halford for saying that it was. These general considerations are of themselves suf- ficient to decide the question of non-identity. But if we examine the subject still more closely, we find that the or- ganization of the varicelloid vesicle differs from that of the variolous ; there is no umbilication, no central depression, no slough. There is simply elevation of the cuticle, of ir- regular and undetermined arrangement. Here we sec no groupings into threes or fives—no crescentic or circular figures formed. Every thing in varicella is hurried for- ward—the incubation, the eruption, the desiccation. There is a form of small-pox which, in 6ome of its fea- tures, and from its mildness, may be mistaken for vari- cella ; and physicians in former times, looking only to the general, and neglecting the minute anatomical charac- ters of the eruption, have thought proper to confound the two diseases. By way of distinction, we will call the one varicella vera; the other, variola varicelloides. In the true varicella there is little or no premonitory fever. In the variola varicelloides there are at least forty-eight hours of preceding febrile disturbance. In the varicella vera there are no hard vari or tubercles. In the varicelloid form of variola, tuberculous elevations of the skin are dis- tinctly perceptible. In the vesicles of the one there are no central depressions, in the other central depressions exist. In true varicella the crusts quickly fall off, and rarely leave any pits. Can varicella be communicated by inoculation ? Dr. Will an entertained the belief that it can ; but his experiments are few (two or three only), and these few, to my mind, very unsatisfactory. Since his time, Mr. Brvce, by more extended and more careful in- vestigation, has set the question at rest. He states that he has inoculated with the fluid of varicella vera at all pe- riods of the disease, and at all seasons of the year, chil- dren who had never undergone either small-pox or cow- pox, and yet that he had never been successful in pro- ducing from it either variola or varicella. Since the date ofBRYCE's experiments (1816), I know ofnonetin the in- oculation of varicella. What, then, are the arguments which can be brought forward in support of the doctrine of the identity of small- pox and chicken-pox! I have adduced the arguments which have been urged by Dr. Thomson and others in favour of this doctrine, and I have answered them seria- tim in another place (see art. Chicken-pox, t> 2, 3, 10, 11) ; but, nevertheless, it is interesting to know what far- ther Dr. Gregory has stated as to this topic. Dr. Thom- son's great argument is, that varicella presents itself when variola prevails, and never without. Hence, says he, '• we may deduce the probability that one contagion is operating, not two. The answer to this is, that the facts are incorrectly stated. Varicella frequently prevails with out variola. Dr. Mohl has shown this most satisfacto- rily from the experience of the Copenhagen epidemics. From 1809 to 1823. chicken-pox was annually observed at Copenhagen without accompanying variola' since 1*23 both diseases have prevailed epidemically, but the physi- cians could always trace their sources, arid this convinced them that the generating miasms were distinct. Besides, the doctrine goes for nothing if it can be shown, as has been shown over and over again, that some children take varicella aaer cow-pox, and others cow-pox alter varicel- la, while sometimes both diseases may be seen going through their phases at the same lime. It cannot be doubted for one moment, after reading the details of this controversy in the works of Dr. Thomson and elsewhere, that a very large proportion of the cases of alleged sec- ondary or recurrent small-pox are really cases of genuine lymphatic varicella mistaken for emall-pox ; or, I may add, that the supposed first attack of variola' was' merely that of varicella. * [American Journ. Med. Sciences, vol. li., p. 120.]](https://iiif.wellcomecollection.org/image/b21111066_0046.jp2/full/800%2C/0/default.jpg)
