THE EXANTHEMATA 403 



(6) Some assert that small-pox does not render immunity from 

 alastrim. 

 The onset is sudden, with severe pains, high fever, vomiting, 

 sometimes delirium. The rash appears on the third day, the tempera- 

 ture is reduced and the symptoms disappear, and the patient feels well 

 again. 



Secondary fever is very rare, about the eighth day when present. 

 Papules become pustules and scales. These fall off with some 

 pigmentation, but very little permanent scarring. 



Yesicuiar Fever begins like chicken-pox and ends like small-pox. 



The symptoms are in accordance with these two diseases. 



The diagnosis is not easy, but the important points to note are : — 



There is no true pustulation with scarring as in small-pox. 



And Jenner's vaccination is successful during convalescence. 



In chicken-pox the vesicles are larger and leave crusts. 



In alastrim the eruption is often confluent and pustular. 

 The prognosis is good. 



Papular Fever — This resembles measles, but it has no catarrhal 

 symptoms. 



The onset is insidious. 



The prodromata are malaise, depression, rheumatoid pains in back. 



Course. — The rash appears on the third or fourth day suddenly all 

 over the bodv, morbiliform, bright red, pin-head papules and red 

 macuUe. 



The face is not much affected. 



There are papules in the mouth. 



A slight fever lasts one to two days. 



There is no enlargement of glands. 



The eruption lasts two to five days. There is no desquamation, 

 and there are no marks left. The rash itches. 



Aspirin relieves the pains and calamine lotion the itching. 



HsBmorrhagic Febrile Gastro-enteritis of Children. 



It is seen in Guadeloupe. 

 It somewhat resembles yellow fever. 



The onset is sudden with vomiting, followed by febrile biliousness. 

 There is a remittent fever, slight icterus, obstinate constipation, and 

 later, black vomit. 



After two to five davs, improvement sets in or the child may die. 



Convalescence is prolonged. 



The prognosis is grave. 



The treatment is svmptomatic. 



