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.)
![nation was performed, age, general health, hab- its, idiosyncracies of the patient, and unknown causes. 2. The eruptiomnay have all the specific charac- ters of variola verrucosa (horn-pock), water-pock, swine-pock, varicella, varioloid, pemphigus, purpu- ra, and probably other forms of cutaneous disease. 3. In general, those persons who have been vaccinated will have the lighter forms, as vari- olodes of Gregory, and varicella, though in some cases it may be severe and even confluent. 4. As a general rule, the disease will assume a milder form in proportion to the recency of the vaccination. 5. The eruption produced by small-pox virus may recur in a vesicular form, or in a papular, speedily becoming vesicular, or it may be pustu- lar, the pustules sometimes with and sometimes without a central depression, or it may assume the form of purpura, &c. 6. The eruption may be irregular in size and form, as well as in the place of its first appear- ance, and may occupy merely the surface of the skin, or may occupy the true skin, leaving pits. It may come out in successive crops on the body, after it has reached its height on the face, as in true varicella. 7. The fluid thrown out by the eruption may be water or lymph, sero-purulent or purulent, sanguinolent or sanguineous (purpura); and the pock may dry into horny scabs covering tuber- cular elevations of the skin, or scale off and leave the skin perfectly smooth, though of a clar- et, dusky, or livid hue, or scarred and pitted. 8. At the decline of the eruption, vesications on an inflamed basis, to a greater or less extent, may appear, filled with air or lymph, and small abscesses may form in the sub-cutaneous cellular texture. 9. The eruption has generally none of the smell peculiar to small-pox, this being confined, for the most part, to the confluent cases. 10. The disease may be so severe as to prove fatal, or so slight as not to be attended with eruptions, and but slight if any constitutional dis- turbance, and this both in the vaccinated and un- vaccinated, though rarely in the latter. 11. The varioloid form often cannot be dis- tinguished from pure varicella by the character of the eruption ; frequently crops of vesicles may appear in succession for several days, the first beginning to shrivel while new ones are forming; the vesicles that remain after the third day becom- ing slightly opaque, and like pearls ; taking on in- flammation by the irritation of friction or scratch- ing, so as to be collected into pustules ; the scabs small and gummy, drying quickly and falling off, leaving small cicatrices or marks, and attended with little if any constitutional disturbance. 12. These conclusions do not militate against the doctrine that there is a separate disease, chicken-pox {varicella lymphatica), which springs from a specific contagion, producing a vesicular eruption, running a definite course; having no tendency, when undisturbed, to suppuration, oc- curring ordinarily but once, affording no protec- tion against small-pox, as small-pox affords no protection against it. 13. Chicken-pox often occurs epidemically in various parts of our country, unmixed with vari- oloid cases, and not traceable to variolous infec- tion, showing it to be a distinct disease. 14. Lastly, when practitioners meet with any eruption which is at all equivocal, they should use the same precautionary measures for pre- venting the extension of the disease as if they were certain it was modified small-pox. There are, then, cases of small-pox in which the eruption cannot be distinguished from that of gen- uine varicella, and it may assume the form of purpura, pemphigus, and other well-known cuta- neous diseases. The attempt to draw the line in all cases from physical characters, between small- pox and varicella, must necessarily fail, as such do not always exist {see the New York Journ. of Med. for September, 1853). I have seen, e. g.t in a family of seven children, all vaccinated when young with what I believe to have been genuine kine-pock matter, every form of the disease (taken from the same variolous infection), from conflu- ent small-pox down to a mild vesicular eruption, with all the characteristic marks of true varicella. The pathognomonic characters, therefore, if such exist, must be found in other marks or phenom- ena than the eruption.] 74. V. The Prognosis of Small-pox is toler- ably manifest from what has been already stated. The circumstances enumerated above as modify- ing and aggravating the fever of small-pox (§ 63, ct seq.), increase also the danger of the distemper^ but the following more especially tend to this: 1st. The quantity and confluence of the eruption. 2d. The state of the circulating fluids. 3d. The presence and nature of the complications, espe- cially those of the respiratory organs and nervous centres. 4th. The age, habit of body, and tem- perament of the patient. 5th. The circumstances and influences under which the patient is placed; and, 6th. The season, temperature, and epidemic constitution in which the disease occurs. 75. a. A confluent form of the malady should, even when proceeding favourably, be viewed with distrust; for, in children, a fit of convulsion may occur, and carry off the patient; and in adults the blood may become contaminated to an extent in- compatible with the continuance of life; or the secondary fever may farther implicate vital parts. If the vesicles on the trunk and extremities be flat, with a claret-coloured or livid areola, while the eruption on the face is white and pasty, no reasonable hope of recovery can be entertained. An excessive quantity of eruption always tends to depress vitality, to vitiate the blood, and to fa- vour the occurrence of internal complications, which concur with these to destroy life. On the other hand, if the pustules on the extremities acuminate, and exhibit a crimson areola, a good ground of hope is furnished. 76. b. The contamination ofthe fluids, as show'n by the hue of the surface, the colour of the lips, tongue, and gums, so far as they can show it; by the appearance of the vesicles; by the state of the evacuations ; and by whatever indicates a tendency to putrescency, or a partially dissolved state of the blood and depressed organic nervous influence, is extremely dangerous. Petechia?, ec- chymosis, gangrenous, or sloughing sores ; hs- morrhages from mucous canals, the blood being dark, dissolved, or ichorous ; monorrhagia or he- maturia ; the vesicles being filled with a dark, bloody, or ichorous matter ; purulent depositions in the joints, &c, are generally fatal indications. 77. c. The occurrence of any of the pulmonary complications mentioned above ; cough or hoarse- ness at an early period of the disease; hcemor tysis at a more advanced stage; bronchitis, or](https://iiif.wellcomecollection.org/image/b21111066_0047.jp2/full/800%2C/0/default.jpg)
