24 The Philippine Journal of Science i»i» 



Meirelles(6) reports 2 cases in persons successfully vaccinated 

 within five years. Without desiring to discuss at present this 

 writer's hypothesis that smallpox is flea-borne, we quote the 

 following statements as valuable because based on very exten- 

 sive clinical observation: 



The evolution of the blood phase of variola is similar in vaccinated 

 and unvaccinated. 



The eruptive phase is benign, almost absent, or rapid and slightly 

 pustulous in the vaccinated, even when confluence of macules and papules 

 promises confluent pustulation; it is grave, on the contrary, in the greater 

 part of the nonvaccinated. 



He then reports a case that we may include here as one of 

 severe varioloid, or possibly haemorrhagic smallpox modified by 

 vaccination. 



A German, aged 45 years, vaccinated in his own country on his entrance 

 to school and revaccinated later on entering military service, was admitted 

 during my service. 



He had fever of 40 °C. with intense headache and backache, pains in 

 all the body, vomiting, delirium, etc., like other variola cases. The third 

 or fourth day all his body was covered with macules and papules of small- 

 pox, so confluent that there was not a patch of sound skin the size of a 

 pinhead. The diagnosis of confluent smallpox was necessary. * * * 

 Notwithstanding the enormous confluence of macules and papules that 

 enabled one to foresee confluent and abundant pustulation, a half dozen 

 only, on the face and chest, became pustules of the size of a pinhead, at 

 the center of the papule; all the others disappeared; their red color 

 darkened progressively to black, while the macules diminished in size, 

 so that toward the end of the disease the German had his body covered 

 with black points. 



One sees that the hematic phase of smallpox in this patient, vacci- 

 nated and revaccinated, was developed vsrith the same intensity, with the 

 same symptoms as in the nonvaccinated; the eruptive phase, above all the 

 pustular, which in the nonvaccinated is usually grave and abundantly 

 purulent, was nothing, or insignificant in him. * * * j could cite still 

 other cases of variola similar to this, all vaccinated, where the hematic 

 phase was intense and where the confluence of macules and papules in- 

 dicated a grave infection, that nevertheless terminated with no or insig- 

 nificant pustulation. I do not recollect seeing a single similar case in a 

 nonvaccinated individual. 



Vaughan(28) asks: 



Why is it that in a protected case suffering from an affection that is 

 practically nearly universal, and almost confluent everywhere on the trunk, 

 one not infrequently finds practically no secondary fever, whereas a case 

 with a similar rash in an unprotected subject would give an abundant 

 secondary fever and would prove not by any means a matter for congratu- 

 lation, nor would it offer grounds for a prognosis such as may amply be 

 justified in a case protected by vaccination? 



