VARICELLA. 



their appearance, acuminated, and contain a bright traufpareot 

 lymph. On the fecond day they appear fomewhat more 

 turgid, and are furrounded by more extenfive inflammation 

 than on the preceding day ; the lymph contained in many of 

 tthem is of a light ft raw-colour. On the third day, the ve- 

 ficles are (hrivelled ; thofe which have been broken exhibit 

 at the top flight gummy fcabs, formed by a concre- 

 tion of the exuding lymph. Some of the fhrivelled veficles, 

 |which remain entire, but have much inflammation round 

 them, evidently contain on this day purulent fluid. Every 

 lyeficle of this kind leaves, after fcabbing, a durable cica- 

 itrix or pit. On the fourth day, thin dark-brown fcabs 

 appear intermixed with others, which are rounded, yellowifh, 

 and femi-tranfparent. Thefe fcabs gradually dry and fepa- 

 rate, and fall off in four or five days. 



I " A frelh eruption of veficles ufually takes place on the 

 (fecond and third day, and as each fet has a fimilar courfe, the 

 whole duration of the eruptive ftage in this fpecies of vari- 

 xella is fix days ; the laft-formed fcabs, therefore, are not fe- 

 iparated till the eleventh or twelfth day. 

 ; 3. " In the fwine-pox, or hives, the veficles are large and 

 •gtobated, but their bale is not exaftly circular. There is an 

 ;inflammation round them, and they contain a tranfparent 

 ilymph, which, on the fecond day of eruption, refembles 

 milk-whey. On the third day, the veficles fubfide, and, as 

 'in the two former fpecies, become puckered or flirivelled. 

 [They likewife appear yellowifh, a fmall quantity of pus 

 Ibeing mixed with the lymph. Some of them remain in 

 Ithe fame ftate till the following morning, but, before the 

 Iconclufion of the fourth day, the cuticle feparates, and thin 

 iblackifh fcabs cover the bafes of the veficles. The fcabs 

 'dry and fall off in four or five days. 



' " The eruption is ufually completed in three days, but I 

 (have fometimes obferved a few frefh veficles on the fourth 

 day ; in which cafe, therefore, the eruptive ftage occupied 

 'eight days. 



! "The fever in varicella commences two or three days before 

 the eruption appears, and it fometimes continues to the third 

 !day of the eruption, but is generally very flight. Its fymp- 

 'toms are, languor, with difpofition to fleep, lofs of appetite, 

 thirft, heat of the flcin, occafional flufhing of the cheeks, a 

 fevere cough, forenefs of the throat, a white fur on the 

 'tongue, a quick but unequal pulfe, pains in the head, back, 

 'and limbs, fometimes pain in the ftomach and bowels, with 

 naufea, or vomiting of bile. 



; " The eruption ufually commences on thebreafl and back, 

 i appearing next on the face and fcalp, and lafl;ly on the ex- 

 'tremities. It is attended, efpecially in children, with an in- 

 'ceflant tingling or itching, which leads them to fcratch off 

 ;the veficles, fo that the charafteriftics of the difeafe are 

 'often deftroyed at an early period. Many of the veficles, 

 ' thus broken and irritated, but not removed, are prefently 

 ! furrounded by inflammation, and afterwards become puf- 

 I tules, containing thick yellow matter. Thefe continue three 

 I or four days, and finally leave pits in the fliin. The erup- 

 ; tion is ufually fuUeft in the conoidal form of varicella : I 

 ' have feen the veficles clofe together, or coherent, but feldom 

 j confluent. When they are numerous on the fcalp, fome of 

 I the glands below the bafe of the cranium are enlarged. 

 ' " The incidental appearance of puftules among the veficles 

 j fometimes occafions a doubt refpefting the nature of the 

 I eruption." See Dr. Willan's " Treatife on Vaccination," 

 ! page 86. ) Dr. Heberden fays, " the principal marks by 

 which the chicken-pox is diflinguifhed are : 

 I I. " The appearance, on the fecond or third day from the 

 I eruption, of the veficle full of ferum upon the top of the 

 j pock. The puftules which are fulleft of the yellow liquor 



refemble what the genuine fmall-pox are on the fifth or 

 iixth day, efpecially when there happens to be a larger fpace 

 than ordinary occupied by the extravafated ferum. It hap- 

 pens to moll of them, either on the firfl day that the little 

 veficle arifes, or on the day after, that its tender cuticle is 

 burft ; a thin fcab is then foiined at the top of the pock, and 

 the fwelling of tlie other part abates, without its ever being 

 turned into pus, as it is in the fmall-pox. 



2- " Slight fcabs cover the chicken-pox on the fifth day ; 

 at which time the fmall-pox are not at the height of their 

 fuppuration. 



3. " The inflammation round the chicken-pox is very 

 fmall, and the contents of them do not feem to be owing to 

 fuppuration, as in the fmall-pox, but rather to what is ex- 

 travafated immediately under the cuticle by the ferous veffels 

 of the flcin, as in a common blifter. No wonder, therefore, 

 that this liquor appears fo foon as on the fecond day, and 

 that upon the cuticle being broken, it is prefently fucceeded 

 by a flight fcab. Hence too, as the true flcin is fo little 

 affefted, no mark or fear is likely to be left." See Med. 

 Tranf. of the Coll. of Phyficians, vol. i. art. 16. 



To thefe remarks Dr. Willan adds, that " variolous puf- 

 tules, on the firfl and fecon 1 day of their eruption, are 

 fmall, hard, globular, red, and painful. The fenfation 

 of them to the touch, on paffing the finger over them, ia 

 fimilar to tliat which one might conceive would be excited 

 by the prefFure of fmall round feeds under the cuticle. In 

 the varicella almofl every veficle has, on the firfl day, a hard, 

 inflamed margin, but the fenfation communicated to the 

 finger in this cafe, is like that from a round feed, flattened 

 by preffurc." He alfo obferves that, " on the third and 

 fourth days, the fhrivelled or wrinkled ftate of the veficles 

 which remain entire, and the radiating furrows of others, 

 whofe ruptured apices have been clofed by a flight incrutta- 

 tion, fully charadterife the varicella, and diftinguilh its erup- 

 tion from the firm and durable puftules of fmall-pox. As 

 the veficles of the chicken-pox appear in fuccefhon during 

 three or four days, a partial examination will not always dif- 

 cover the charafteriftic here fpecified. In order to form a 

 proper judgment, praftitioners fhould infpect the eruption 

 on the face, breaft, and limbs, attending more efpecially to 

 the places in which it was firft obferved. If the whole 

 eruption be viewed on the fifth or fixth day, every grada- 

 tion of the progrcfs of the veficles will appear at the fame 

 time. This circumftance may be added to the diagnoftics 

 of varicella, as it cannot take place in the flow and regu- 

 lated progrefs of the fmall-pox. 



" The globated veficles not having any refemblance to 

 variolous puftules, diftinguifh the varicella from the fmall- 

 pox, whenever they appear ; for it is to be remembered, that 

 thefe large veficles are occafionally intermixed, both with the 

 lenticular and conoidal voficles of the chicken-pox. It may 

 be faid, that an acknowledged co-exiftence of different fets 

 of veficles in the fame perfon tends to abrogate the diftinc- 

 tions I have made. Tlie veficles, however, are, in many 

 cafes, all of the fame kind ; or, where they arc intemiixed, 

 one fort greatly predominates. I do not contend for the 

 pcrfeft accuracy of nofological arrangement, but I adopt it 

 becaufe it is in many refpefts convenient. Syftems of bo- 

 tany and zoology are ufeful, tliongh they have not been yet 

 brought to perfection, for we find fome fpecies which break 

 the order of every claffification propofcd." Loc. cit. p. 9J. 



With refpcct to the treatment of varicella, under any of 

 its forms, ver" little need be faid : fince it is feldom attend- 

 ed by any fcv re indifpofition, and often by fcarcely any 

 perceptible diforder of any of the fun£lions, except a little 

 lafTitude and inability for the ufual exertions, a whitifli 



tongue', 



