bon) + ie 
PP 
368 
The following methods are given, since they may be found of value 
in the diagnosis of cases in which there is a question of smallpox or 
varicella : 
1. The contents of early, clear vesicles of such a case may be examined 
fresh under the microscope. The presence of large multinucleated cells 
is consistent with varicella and against smallpox. This test seems quite 
reliable and may be applied at the bedside. 
2. The excision of a typical lesion for histological examination may 
be resorted to. In the smallpox lesion the presence of C. variole will 
furnish the diagnosis. In varicella the type of the vesicle, the ballooning 
degeneration and the constant presence of the described intranuclear 
and cytoplasmic inclusions will render certain the diagnosis. As will 
readily be inferred, the simple presence of definite cytoplasmic or nuclear 
inclusions within the epithelial cells is not sufficient to establish the 
diagnosis of smallpox, for both nuclear and cytoplasmic inclusions are 
also found in varicella. If the presence of these bodies is to be taken 
into account in the diagnosis one must possess a certain degree of famil- 
iarity with them, in one or both of the diseases in question, in order to 
determine their specificity. 
3. A slower but very reliable means of diagnosis is the inoculation 
of a rabbit’s cornea with fluid from the lesions. With smallpox lymph 
a variolous keratitis is produced which is evident in the roughening of 
the corneal surface in from twenty-four to forty-eight hours after inocula- 
tion. The inoculation of varicella lymph gives no process. : 
SUMMARY. 
The study of lesions excised from eleven cases of varicella in adult Fili- 
_pinos shows that the initial change consists in the appearance of peculiar 
eosin-staining inclusions within the nuclei and cytoplasm of epithelial 
and various other cells. Direct division of nuclei without subsequent 
division of the cytoplasm is associated with these inclusions. Cells 
undergoing these changes often attain relatively enormous dimensions 
(the ballooning degeneration of Unna). This type of degeneration is 
most prominent in the affected areas of the epidermis but occurs also in 
almost every type of cell in the corium. The epidermis presents also the 
reticulating type of degeneration, but only in a minor degree. 
Following these cell changes the typical varicella process consists of 
a rapid destruction of small areas.of the epidermis, associated with exuda- 
tion and vesicle formation. The exudate penetrates the injured area 
of the epidermis, forcing the degenerating cells apart and forming spaces 
which tend to coalesce to form a single chambered vesicle. HExudative 
cells probably of endothelial origin are occasionally met with in the 
epidermis very early in the process. Collections of similar cells are 
found about the blood vessels of the underlying corium. Later in the 
process they are present in the corium in large numbers and exhibit 
"he See 
