VIII, B, 1 Ashburn, Vedder, Gentry: Variola and Vaccinia 23 



the patient's low resistance, a consequence of the extreme state 

 of debility resulting from the sprue. 



The evidential value of recollections of thirteen years ago 

 is recognized as slight, but the facts are essentially as stated, 

 and the case is reported as being of interest, at least. 



There are three irregular forms of smallpox that are char- 

 acterized by a total lack of pock formation or by a very brief 

 and atypical pock stage. They are (1) purpura variolosa, 

 always fatal, (2) varioloid or modified smallpox, and (3) 

 variola sine eruptione. 



Variolous purpura is described by practically all writers on 

 smallpox, and there is general agreement that it proves fatal 

 before any eruption appears. It is not to be confounded with 

 that form of hsemorrhagic smallpox in which the hsemorrhages 

 occur into the pocks (hsemorrhagic pustular smallpox). The 

 investigation of a large number of writings does not show 

 unanimity of opinion as to the protective value of vaccination 

 against this form of the disease, but, as the form itself is 

 rare and as a few positive observations outweigh many nega- 

 tive ones, we think it safe to say that vaccination does not 

 protect against it. 



Bancroft (23) had 12 cases among 1,200 of smallpox. Of 

 these, 3 were unvaccinated ; 7 had been vaccinated in childhood, 

 of whom 3 had good f oveated scars ; and in 2 vaccination had been 

 attempted, without success, two weeks prior to the onset of 

 the disease. 



Armstrong (24) says: 



A history of previous vaccination, unless recent, does not play apparently 

 a very important role in this variety of the disease, as the infection is of 

 such severity that all resistance to immunity is overcome. 



He reports one case in the person of a discharged soldier, 

 who, because a soldier, had presumably been successfully vac- 

 cinated, though the fact is not mentioned. 



MacCombie(25) says: 



I have not met with a case in any one who had one-third of a square 

 inch of well foveated vaccination cicatrix, and who had been successfully 

 revaccinated. 



Osier (26) reports 27 cases, of whom 13 had been vaccinated, 

 but none revaccinated. 

 Kaposi (27) says: 



Vaccination does not appear to offer the slightest protection against 

 this form of the disease. 



