VESICULAR FEVER— PAPULAR FEVER 1471 



become umbilicated. The size is generally much less than those 

 of chicken-pox, and a few may become umbilicated. There is little 

 or no inflammation of the base. The contents are at first clear and 

 then purulent. Superficial scabbing may occur, and, as a rule, no 

 scars are left, though rarely some scars may be found. 



Diagnosis, — ^The diagnosis is based upon the characters of the 

 eruption, there being no true pustulation, with scabbing and scars, 

 as in smallpox, and by the fact that during convalescence Jenner's 

 vaccination is generally successful. 



In chicken-pox the vesicles are generally larger, and often leave 

 thick crusts. 



In alastrim the eruption is often confluent, pustular, and clinically 

 almost identical with smallpox. 

 Prognosis. — ^This is good. 



Treatment. — ^The treatment is purely symptomatic. 



PAPULAR FEVER. 



Definition. — slight febrile disorder, described by Castellani, of 

 unknown causation, characterized by a maculo-papular eruption 

 and rheumatoid pains. 



Remarks. — ^We have seen an epidemic of this peculiar fever in 

 Ceylon; it resembled measles in the appearance of the rash, but 

 was without any catarrhal symptoms. 



etiology. — ^This is quite unknown. 



Symptomatology. — ^The disease begins with a prodromal period, 

 during which the patient suffers from malaise, depression, and 

 rheumatoid pains, especially in the back, which are associated with 

 chilliness. After three or four days the rash comes out suddenly all 

 over the body, but most marked on the arms, trunk, and legs, the 

 face being least affected. The eruption is morbilliform, being com- 

 posed of bright red pin-head papules and red maculae. It is, as 

 already stated, visible on the arms, legs, and chest ; while there may 

 be a few maculae on the palms of the hands and soles of the feet. 

 The face is not much affected, and there the eruption is rather more 

 macular than papular. Filatow's papules in the mouth are absent. 

 There is generally slight fever lasting for a day or two. There are 

 no catarrhal symptoms of the eyes, nose, or throat, no enlargement 

 of the lymphatic glands. The eruption generally lasts between two 

 to five days, and then fades without any desquamation and without 

 leaving any marks. In most cases the eruption is associated with 

 itching, especially on the arms, and in a few cases there is no 

 fever. 



Diagnosis, — It is to be distinguished from measles by the absence 

 of the catarrhal symptoms, absence of Filatow's and Koplik's signs, 

 from German measles by its longer duration and the diffuse type 

 of the eruption, from toxic rashes of intestinal origin by the absence 

 of any intestinal symptoms, and from dengue by the rash being 

 frankly papular. 



