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APHORISMS.

292. Small pox attacks those liable to it, enters into the blood, and breaks out by the skin.

293. The liability to receive small pox varies with age; rather great in the foetus living in the womb of its mother, rare in infants, very great in childhood, it becomes lessened in the adult, and disappears entirely in the aged.

294. Small pox is often congenital.

295. Intra-uterine small pox is an almost inevitably fatal disease.

296. Small pox is epidemic and contagious.

297- Small pox is regular or irregular, discrete or confluent, benign or malignant.

298. The small pox of young children is almost invariably discrete, but often irregular, which renders it very unfavourable.

299. A sudden convulsion, followed by fever and vomiting, in an unvaccinated child, would lead to the supposition of small pox.

300. The liability to receive small pox is neutralized by the inoculation of vaccine matter.

301. Decided small pox invariably follows the progress indicated by nature, and the eruption of the pustules on the skin can only be prevented to a very slight extent.

302. Broncho-pneumonia is a very frequent and a very fatal complication of the small pox of children.

303. The proper treatment of a simple, discrete, and regular small pox is to abstain from all energetic medication, and to content ourselves with prescribing rest and emollient drinks in the midst of a pure, mild, and temperate atmosphere.

304. The pustules of the face should be always made to become abortive by mercurial ointment or softened Vigo plaster.

305. The complications of small pox alone require the immediate and energetic interference of the practitioner.

CHAPTER III.

ON VARIOLOID.

The term varioloid is applied to a pustular and contagious cutaneous eruption,, of the variolic nature, without secondary fever, originating i from small pox, and able to produce it, and the duration of which is \Jj &(•■(, from one to two weeks.

Three sorts of varioloid must be admitted; pustular centrally fh Ji , depressed, globular, and conoid varioloid. All the three are developed ^l

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lytl- &~, •" vaccinated individuals at the time of epidemics of small pox, and

sometimes, also, when these epidemics are not observed. The centrally

/11 O^Jy/'j, depressed varioloid is the moat important to recognize, for it presents

great analogies with the eruption of small pox, and it is often difficult

Ljj L/v2juj r to distinguish the one from the other.

. , ' Varioloid does not appear until two or three days after the precursory

iHMrp*. symptoms, which arc characterized in young children by fever,

uneasiness, an unaccustomed restlessness, and sometimes by gastric y./jjjfyAjj disturbances, as vomitings, for example. Some children first present / an eruption of roseola, and it is only at the end of twenty-four hours ~//)/ia.* ■> that the pustules peculiar to the disease we are now considering manifest

/themselves. \( ,f/Jl Lt-c Red spots are at first perceived on the forehead, on the limbs, ml lastly, on the body. They often make a considerable projection, and then put on the pustular character which is proper to them. Their number is never very considerable. In some patients they remain '/.iii AJ he acuminated, or more or less rounded off; in others they present a

. central depression similar to that of the pustules of small pox. \, ii/U\jjs~)j.ul w These pustules enlarge and acquire the maximum of their development towards the fifth or seventh day. They are then surrounded by a small areola of inflammation, without swelling of the skin as'" ^ JT. j small pox. Suppuration is imperfectly established in their interior, or , is not established at all, and desiccation commences towards the eighth <J f' l-OAt {jjl hfay* a* *ne sajne time that the inflammatory areola disappears. In 'some patients the desiccation is not effected until at a more advanced

■ , , r -t . period of the disease. The crusts have nearly all fallen at the twentyfirst day, that is to say, at the end of the third week. ',j. . ,, y The general symptoms of the eruptions of varioloid do not sensibly * increase in children even by the fact of the eruption. The symptoms ', £± k' are verv much the same in the course of the disease as at the period of its invasion. The fever persists at the same degree for some day?* // f / li. r and diminishes at the time of the desiccation of the pustules. There _- is not, as in small pox, a primary fever, which momentarily ceases during the development of the pustules, and which reappears with such intensity at the period of their suppuration. In a word, there '.','■!/' t < k no secondary fever. The state of uneasiness, wakefulness, and agitation of the children is the same. There is loss of appetite, and \'-/ A ?'■ It vomitings arc sometimes observed. Convulsions are uncommon; however, they may be explained by the intensity of the fever in young ■'•'*< children. It fact, it is known that in them it is by convulsions, and ,, ■ / /, / not by delirium, that the cerebral disturbance is betrayed. How can they have delirium, since their intelligence is not yet developed? 'ltxJJ-1*/' t'-K The pustules of the centrally depressed varioloid last a little longcr than the pustules of globular and conoid varioloid. Their progress

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is often similar to that of variolic pustules, and they sometimes A x)j lytj/jJ

completely suppurate before they become cicatrized. However, at the *—C^

period of suppuration, there is no secondary fever as in small pox. /t^y

The symptoms of this kind of varioloid are also more severe. It is

in this variety that vomitings and convulsions are especially observed.

The only case of convulsions which I have remarked in varioloid, , /~. Jjj/j

occurred in a child who had been previously vaccinated, and in whorrf^

all the pustules were depressed in the centre. ftuTTiiJjJ

Varioloid is not a serious disease; the children are readily cured; however, varioloid with the centrally depressed pustule is sometimes more serious than a discrete small pox. It is related than in an X fy t epidemic of small pox at Marseilles, twenty of the vaccinated died, and in them the disease presented all the characters of pustular Mm Jj/j_ fii/ varioloid.* This disease is never followed by the eruption of boils and by the haemorrhages which are sometimes observed in small pox. J/i^-^i{MjU'( From the period of the commencement of desiccation fresh symptoms u hardly ever supervene, and unless complications which are quite special V&4JL4/ «. and unforeseen occur, the children may be regarded as cured.'

The course to be followed in the treatment of varioloid is very . "T evident. The eruption should be watched and allowed to accomplish JUCirhAAJ-y its necessary phases. The children should be dieted and placed in a J

properly warmed apartment, sheltered from the action of cold and damp UL&-LL-*- »air. They should not be covered too much, so as not to increase the fever, or to bring on abundant perspirations and the erythema which accompanies the sudorific secretion. Lastly, emollient and warm drinks should be administered until they may be again suckled.

In the case of complications referable to the alimentary canal or to the head, the appropriate means should be employed to vanquish these symptoms. Ipecacuanha powder may then be useful to empty the stomach completely, and magnesia to neutralize the acids which it contains. As to convulsions, as they are not dependent upon a change in the brain, there is nothing to be done for them; they cease naturally, and antispasmodics can only be given, of which we have spoken in the chapter devoted to the history of these symptoms.

CHAPTER IV.

ON CHICKEN POX.

Chicken pox is an epidemic and contagious disease, characterized by the presence on the skin of vesicles, more or less numerous, filled with

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a colourless and limpid serosity. This disease must not be confounded / (Lid. IAJL ; with varioloid, the nature of which is very nearly identical, but the character of which is essentially different. In fact chicken pox is a vesicular affection, and the varioloid, on the contrary, a well characterized pustular disease. •A: A \LAXdX4 Chicken pox is preceded by a slight fever which lasts from twelve to forty-eight hours at most. The febrile state is often scarcely to be (»<■/ *- Q (?* appreciated, and as M. Rayer has pointed out, it does not prevent the I . children following their usual games. In some rare instances, the

-i^UU>l mvasjon 0f t],e chicken pox is preceded by abdominal pains, vomitings. QlJj/i <*sc'' ^ut *'nese instances must be very exceptional, for I have collected twentv-three cases of this disease, and in not one of them were any of //tV, f/i^.^thcse symptoms observed.

"Chicken pox is either discrete or confluent. It is characterized by

~),< , ■. small red slightly prominent spots, circular when they are isolated,

irregular on the contrary when many are observed on the same spot.

On the next day a prominent vesicle filled with a colourless or pale

''' 1J t/j yellow perfectly limpid humour, which readily escapes when the

vesicle is pricked, is formed in the centre of most of these elevations.

'/<■ li l-tiCt&u the second day this vesicle is about one line and a half in diameter;

it either projects to a point or assumes a rounded form. On the third

, (L^ day the colour of the lymph is yellowish, but this is the only chaDgs

which the vesicles have undergone. On the fourth day, those which

.'. '. .•->' •' have not been accidentally broken, diminish in size, and become shrivelled

_ / at the circumference. The fifth day, a small crust adherent to the skin

1. l/i f is formed in their centre, and a small quantity of opaque lymph is

enclosed in their circumference which sometimes gives them an

'appearance of central depression. On the sixth day, small yellowish

or brown crusts occupy the place of the vesicles. On the seventh and

the eighth, the crusts become detached and leave small red spots without

depression on the skin, which remain for several days.

"During the course of this eruption, many of the elevations appear

to become abortive; some remain in the state of simple spots or of

popular elevations, and become gradually effaced; the others are only

surmounted by a very small vesicle which is easily broken, or vanishes

1 .. 1 very quickly."*

The vesicles of chicken pox are not always preceded by a red spot on the skin; they are then true bulla? which become developed without a precursory local symptom. If I can form an opinion of this from the .1 *s cases which I have collected and which are rather numerous, the vesicle becomes primarily formed in the majority of these cases without any <•'/".' K''". previous alteration of the dermis. Thus, I have many times observed, in the midst of the ordinary eruption of chicken pox, vesicles, or rather

.•.*,'" 11 1 * R»J«- <*»■*■ Paricclle. Dictionnaire tie mMtcint et tie chirmyie pratiqoet. t. »v, p. 5jM.

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bullae, of rather larger size, rounded, filled with transparent serosity and without an areola of inflammation. This areola does not become established until two or three days after, at the period of desiccation and cure of the bullae.

I am aware the difference is not of much importance; but it may be interesting to those who pay much attention to diseases of the skin, and who would be perfectly cognizant of their anatomical characters t to recognize it. /jtLJUl-4-t'h^'

Discrete chicken pox, is always a slight disease which scarcely 'x

affects the health of the children. When it is confluent it is accom- ty-ttJIULUf panied by more or less intense fever which does not fail to diminish - ttfjuj in proportion as the eruption disappears. The duration of chicken i

pox is from eight to fifteen days at most, and it only leaves behind LuuX-"" slight traces on the surface of the skin. /

Chicken pox presents itself under the epidemic form, as much in the course of epidemics of small pox as in the opposite circumstances, iv. "7~ Thus, I have observed, at the Necker Hospital, an epidemic of chick en -^nJUlALb pox, at a time when there was no epidemic of small pox. The ^ _disease, confined in the wards for children, seized each of them succes- 6 "- ^ sively and remained several months, for fresh children were admitted , every day into the focus Of infection, and did not fail to catch it. It ^-"^f^ commenced at the period when the slight epidemic of measles, the history of which will be given further on, ceased.

Chicken pox, like small pox, is contagious—it is-no protection against \*,AJ. / the latter disease.

It may be transmitted by the inoculation of the serous humour Li 'I, of the vesicles, and although the experiments which I have performed / do not confirm this opinion, they are not sufficiently numerous to invalidate the assertion of Willan, who declares that he has succeeded in its inoculation.

Chicken pox may produce small pox, and the latter may give birth to chicken pox (Rayer).

The diagnosis of chicken pox is not difficult. In fact, there is no cutaneous disease which presents the characteristic of chicken pox, scattered and isolated vesicles. It resembles pemphigus, when it appears in a primary manner as a small bulla not surrounded by an '.' inflammatory circle; but the bullae of pemphigus are always larger A, and more numerous than the bullae of chicken pox. Besides, it does^/ (< ' fi l not prevent in a general manner the character of the bullous eruption d Z i' just alluded to; on the same patient well-characterized vesicles are '''',• met with, which is not the case in pemphigus. ^lx<) A/ ."'

The treatment of chicken pox is very simple; the children should" be protected from the cold and emollient diaphoretic drinks administered, w"-y<J <-•'• without consideration as to the termination of the disease, which cannot be uncertain. j .

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