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maintained that the two affections are identical, but most modern 
authorities are agreed that variola and varicella are two distinct diseases, 
produced by different infecting agents. The chief data bearing on this 
question, which the following cases present, are the occurrence of vaccina- 
tion or smallpox previous to the varicella attack. In a study of thirty- 
eight cases of varicella, three had the face deeply pitted by a previous 
attack of smallpox, and of this trio two also bore scars from recent 
vaccinations. Of the remaining thirty-five cases, thirty-two bore either 
recent, or both old and recent vaccine scars. There is no record of vaccine 
scars in the other three cases, but it is not improbable that they had 
recently been vaccinated, for a general vaccination had been accomplished 
some time before these observations, on account of the occurrence of 
smallpox in the prison. If the two diseases are identical, as is asserted 
by Hebra, it is difficult to explain why the severe form as seen in vartola 
vera, as well as the oft-repeated vaccinations, should not protect against 
so slight a form as varicella. 
Varicella is recognized as an easily communicable disease, yet less is 
known concerning the mode of infection than is the case with smallpox. 
While some authorities believe that the disease is communicable from a 
day or so previous to the eruption up to the time of complete healing 
of the skin lesions, the presence of the infectious agent in the skin lesions 
has not conclusively been proved by experimental inoculation. 
Inoculation of children with the vesicle contents of varicella has been 
tried in many instances but there is great discrepancy in the results 
obtained. Heim (7), Vetter (20) (21), Thomas (15) (16), Czarkert 
(2), Fleischmann (3) (4), Buchmiiller (1), Smith (12), and others were 
unable to produce the disease by inoculation. Fleischmann from his 
first series of inoculations concludes that it is not possible to produce 
either variola or varicella by the inoculation of varicella lymph. In seven 
inoculations done at a later date, he obtained a general eruption in one 
case and a local reaction in two. Buchmiiller gives a series of thirty 
inoculations with varicella. There was some local inflammation in 
children so inoculated and in one case a general varicella eruption. He 
regarded this as being a chance infection rather than the result of the 
inoculation. 
Opposed to these results are those of Hesse (8), Steiner (13), d’Heilly 
(9), and others. Hesse made inoculations with varicella in one hundred 
and fifteen cases, which resulted in a local reaction in seventeen, in a 
general eruption in nine, and was without result in eighty-seven cases. 
Hesse inoculated with purulent material and dried crusts as well as with 
clear lymph. Both Vetter and Thomas consider Hesse’s results of 
doubtful value: (a) On account of the possibility that his positive results 
_were due to the use of smallpox lymph instead of varicella lymph; (0) 
some cases may have been due to spontaneous infection. Vetter asserts 
that the inoculations should be done with the perfectly clear lymph of 
typical varicella vesicles and should not be performed during an epidemic, 
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