278 INFECTIVE DISEASES. 



with the stage of scabbing in vaccinia. The scabs fell ofE in about three 

 ■weeks to a month, and left permanent, depressed scars. 



Case VIII.— W. P., milker. This case was pointed out on the occasion 

 of another visit, and is the only one in which the eruption was seen in 

 its earlier stages. 



The history of this boy is as follows. He had taken the place of one 

 of the other milkers who had vesicles on his fingers, and had been obliged 

 to give up milking. After the seventh time of milking he noticed a 

 small pimple on his right cheek. This became larger and vesicular. 

 On examination it presented a depressed vesicle with a small central 

 yellowish crust and a tumid margin, the whole being surrounded by a 

 well-marked areola and considerable surrounding induration. On raising 

 the central incrustation a crater-like excavation was seen, in which 

 lymph welled up and trickled down the boy's cheek. On the following 

 day the crust had re-formed, and was studded with coagulated lymph. 

 The areola became more marked, and on pricking the margin of the 

 vesicle, the exuding contents were slightly turbid. 



From this day the surrounding infiltration increased enormously, 

 the whole cheek was inflamed, and the eyelids so oedematous that the 

 eye was almost closed. There was enlargement of the neighbouring 

 lymphatic glands. The crust which had re-formed thickened day by day. 

 It retained the character of central depression, and was situated on a 

 reddened, raised, and indurated base (Plate VII.). 



From this date the surrounding induration gradually diminished. 

 The crust changed in colour from dark brown to black, and finally 

 fell off, leaving an irregular, depressed scar. This scar, when seen several 

 months afterwards, was found to be a permanent disfigurement. The 

 eruption appeared on the fourth day after exposure to infection, and 

 allowing two days for incubation, the vesicle was at 'its height on the 

 seventh or eighth day, and a typical tamarind-stone crust fell ofE on 

 the twenty-first day after infection, leaving a depressed, irregular 

 cicatrix. 



A vesicle also formed on the thumb of the left hand. Two days 

 after the pimple appeared on his cheek, the lad said that he first noticed 

 a pimple on his thumb, and this, on examination, presented a greyish 

 flattened vesicle, about the size of a sixpence. Later, its vesicular 

 character was much more marked, and a little central crust had com- 

 menced to form. The margins became very tumid, giving it a marked 

 appearance of central depression. The vesicle was punctured at its 

 margin with a clean needle, and from the beads of lymph which exuded 

 a number of capillary tubes were filled. 



Two days afterwards suppuration had commenced, the vesicle con- 

 tained a turbid fluid, and the areola was well marked. Later, the crust 

 had assumed a peculiar slate-coloured hue, and, on pressing it, pus 

 welled up through a central fissure. The areola had increased, and 

 there was considerable inflammatory thickening. The lymphatic glands 

 in the armpit were enlarged and painful. Though there was deep 

 ulceration, which left a permanent scar, the ulceration did not assume 



