CONCERNING VARIOLOID IN MANILA 



By p. M. Ashburn, E. B. Vedder, and E. R. Gentry ' 



(The United States Army Board for the Study of Tropical Diseases as they 

 Exist in the Philippine Islands) 



Both the Director of Health and the physician in charge of 

 San Lazaro Hospital have several times spoken of the disease 

 resembling varioloid that appears in Manila vv^ith a certain 

 amount of regularity during each hot season and have expressed 

 their uncertainty as to its nature. As a precautionary public 

 health measure the cases have been classified as modified small- 

 pox and isolated and treated as such. Having been particularly 

 anxious to obtain access to cases of smallpox for the purpose of 

 making experimental inoculations in monkeys, it has been our 

 fortune to see a number of cases, all of which have shown great 

 similarity and which are characterized in general by very slight, 

 or no, fever and constitutional disturbance and by the appearance 

 on the face, scalp, trunk, and limbs of a vesicular eruption, the 

 lesions of which vary from 1 to 5 millimeters in diameter, are at 

 times unilocular, at tim^s multilocular, that very rarely umbili- 

 cate or pustulate, and usually dry to form brown scabs by the 

 third or fourth day. The scabs fall off, leaving a small, pale 

 mark without pitting. The lesions when first seen appear as 

 mere papules roughening the skin, without redness. On the 

 second day they are apt to be clear vesicles surrounded by a 

 small area of redness. The lesions are most common on the 

 face; next on the shoulders and front and back of the trunk, 

 where they are distributed about equally; they occur less com- 

 monly on the arms and legs, and least so on the palms, soles, and 

 scalp. In the cases seen the lesions were always discrete. A 

 few red spots not to be positively identified with the skin lesions 

 have been seen on the palatal surfaces; a few patients have 

 spoken of mild sore throat. No complications or sequelae have 

 been observed. Some of the vesicles are elliptical in outline 

 rather than round. The ages of the patients seen by us have 

 varied from 12 months to middle life. The records show that 

 there have been lately about 500 cases of "varioloid" in Manila 

 per year, and Dr. A. P. Goff", physician in charge of San Lazaro 

 Hospital, who has seen and treated the cases, states that most 



'P. M. Ashburn, major; E. B. Vedder, captain; and E. R. Gentry, 

 lieutenant; Medical Corps, United States Army, members of the United 

 States Army Board for the Study of Tropical Diseases as they Exist in the 

 Philippine Islands. 



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