Varicella, or Chicken-pox, is a complaint which ex hibits the characters of a true Exanthema, but is so mild in its symptoms as scarcely ever to become the subject of medical treatment ; and is only worthy of our notice, as being sometimes confounded with slight cases of Small-pox, and thus given rise to the idea of a second attack of Variola, or of its occurrence after Vaccinia. Varicella may, however, be distinguished from Small pox by the period of its successive stages, which are al together much shorter, not exceeding, in the whole, five or six days, and in the nature of the fluid contained in the vesicles, which is watery and nearly transparent, never assuming the purulent appearance.
Considerable difference of opinion has arisen on the subject of this disease, whether all the forms of it be long to one affection, of which they are merely varie ties ; whether the fever be symptomatic of the inflam mation of the throat, or whether it more properly belongs to the Exanthemata, where the fever and the eruption are both essential parts of the disease. This latter we believe to be the correct view of the subject ; and we farther conceive, that all the various forms which Scarlet fever assumes are simply varieties, like those which we noticed in Small-pox, principally de pending upon its degree of virulence.
The disease consists of a fever, which usually inclines to the inflammatory type. About the fourth day the face becomes swelled, and large patches of a red efflo rescence appear, which gradually spread over a consi derable portion of the surface. These, in two or three days, terminate in an exfoliation of small branny scales; a degree of anasarca frequently supervenes, on the de cline of the other symptoms. This may be considered as the simple form of the complaint, when it exists in a mild degree ; but, in its more violent state, all the symptoms are aggravated. The fever, from the com mencement, has more of the typhoid type ; the redness is more considerable ; and, at the same time, the deglu tition and the respiration are affected, and an inflam mation is observed in the internal fauces. These parts, when first affected, exhibit a deep red colour ; they are quickly covered with a brownish fur ; and vesicles appear, which assume a purulent aspect, and finally de generate into gangrenous sloughs. Great general de bility then comes on ; and the patient is carried off in a few days, with all the symptoms of complete exhaus tion, and an apparent tendency in the constituents of the body to fall into a state of decomposition.
The disease, when most acute, comes to its acme in five or six days, and requires an equal period to pass through the remaining stages. When it terminates fatally, the event usually occurs from the sixth to the tenth day; but it not unfrcquently happens that the patient survives long after this period, and is finally de stroyed, as it appears, from the effects of mere weak ness. It might appear highly improbable that so severe an affection as that of the throat should be only, as it were, an incidental part of the disease ; yet this seems to be the case ; for, in the same epidemic, we have some persons in whom the throat is severely affected, and others where it is not so, although, as was observed with respect to the two varieties of Small-pox, every epidemic has its characteristic form, or prevailing ten dency, in which one variety is met with more frequently than the other.
We are quite unacquainted with the nature of the connexion which the different parts of the complaint bear to each other, but we have learned the important fact, that they all have an exact relation to the nature or degree of the fever ; and hence we deduce the prac tical consequence, that whatever means tend to subdue the fever will mitigate all the subsequent symptoms. There is no complaint in which the cold allusion proves so valuable a remedy as in Scarlatina. The tempera ture of the body seems to be more increased in this complaint than in any other febrile affection ; and we find that this method of applying cold not only effec tually reduces the heat, but materially diminishes the virulence of the disease, so as, in a great measure, to ward off the danger which arises from its putt-id ten dency. If, however, these remedies fail in their de sired effect, or if we have not had an opportunity of seeing the patient in the early period of the disease, we have unfortunately to struggle with a succession of symptoms, which it is commonly beyond our power to remove. Bark and wine were, at one time, regarded as essential to the cure ; but, we apprehend, rather from theoretical opinions, than from any experience of their good effects. Emetics have been strongly recommend ed, as well as acids and acrid stimulants, together with topical remedies, such as have been supposed were adapted to subdue the tendency to putrefaction, or to counteract the effect of the putrid matter that was dis charged from the ulcers. Some benefit appears to have been gained by the use of stimulating gargles ; but, in general, we shall find the severe form of the scarlatina, when it arrives at its later stages, to be one of the most untractable and formidable of all complaints. Stimu lants and excitants may be given, as affording the only prospect of relief; and all circumstances are to be care fully obviated, that may, in any way, exhaust the languid powers of the patient, or produce a degree of morbid excitement. As the disease is extremely contagious, the same means of prevention are to be resorted to, as we recommended above in other analogous cases ; and we have reason to think that the acid fumigations possess the same power of extinguishing or decomposing the contagion of Scarlatina as of typhus. Some difference of opinion has arisen respecting the question, whether Scarlatina can occur twice in the same person ? We believe that it cannot do so in any considerable degree; yet it would appear, that the same individual is subject to repeated attacks of a slight local affection of the throat, and even to a degree of fever, provided he is much about the person of the sick, or immediately ex posed to the sources of infection.