I486 COSMOPOLITAN FEVERS 



knowledge, nor have we seen an indigenous case. The tropical practitioner 

 should be careful not to mistake for true scarlet fever, cases of scarlet fever- 

 like eruptions such as erythema scarlatmiforme. 



Measles is endemic in most tropical countries, but differs in no important 

 details as a rule from the same disease in the Temperate Zone, except that 

 when first introduced into Fiji it gave rise to a severe epidemic, and is still 

 severe in Oceania. 



Fig. 678. — Chicken-Pox: Fifth Day of the Eruption. 



Chicken-pox in the tropics is very often a disease of the adult, being most 

 common in India in February to March. The majority of the cases are mild, 

 but some are severe, and there may be great difficulty in diagnosing chicken- 

 pox from smallpox. Varicella cannot be transmitted to man very readily by 

 inoculation. Rabbits' cornea can be inoculated, and fine granulations have 

 been described by several observers in the epithelial cells, which may be early 

 stages of a cytoryctes arrested in its development, which would support the 

 people who believe the two diseases to be closely allied. 



VARIOLA. 



Synonyms. — Smallpox. French. La petite verole; Italian, Vajuolo; German, 

 Blattern; Spanish, Viruelas; Arabic, Jadari. 



Definition. — Variola is an acute specific fever of unknown causation spread 

 by various agencies, but especially by air, and characterized by a more or 

 less general eruption passing through the stages of papule, vesicle, pustule, 

 crust, and often scar. 



History. — There can be no doubt of the great antiquity of the occurrence 

 of smallpox in India and Africa, but whether it arose de novo in these two 

 centres we cannot say, but there is a suspicion that there are two varieties of 

 the disease — viz., the ordinary smallpox, which may have had its origin in 

 India and spread to Europe, and so to America, and later to the islands of 

 Oceania; and an African variety variously known as South African Amaas, 

 or milk-pox, which may have been imported by the negro slaves into the West 

 Indies, where it is called West Indian modified smallpox. Apart, however, 

 from conjectures of this nature, there are the facts that in India there was a 

 special worship defined in the Atharvaveda, and there were special prayers 

 to be said by the Brahmins when performing the operation of inoculation 

 of smallpox virus. References in the Charaka-Saihhita and the Susruta- 

 Sadihit:i make it almost certain that the disease was well known when they 



