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50
CHICKEN-POX.
At the commencement of the epidemic, in June, July, and August, 1901,
if reference be made to the memoranda of the Metropolitan Asylums Board,
it will be found that the principal local outbreaks at that time were due to the
mistaking of modified small-pox for chicken-pox. Before and since, also,
there have been numerous instances. If the memoranda published by the
Metropolitan Asylums Board be referred to for a number of years past it
will be quite frequently found that the small outbreaks in London have been
either due to, or aggravated by, the mistaking of small-pox for chicken-pox.
At the beginning of the outbreak of small-pox in St. Pancras the very first
case was a female laundry hand (a sorter of dirty linen), who was regarded
ar.d treated as suffering from chicken-pox. This girl gave the disease to her
two sisters, to a child next door, and to others. The child next door was also
regarded as suffering from chicken-pox, was so treated, and died after giving
the disease to six other members of the family living in other parts of London,
to seven other persons in the same house, and to some twenty others in the
same street. Many other examples can be cited of small-pox mistaken for
chicken-pox with the most disastrous results; in fact, modified small-pox will
always be liable to be so mistaken, and it is a strong argument in favour of
re-vaccination, became, after primary vaccination in infancy young adults
tend to have a very mild and modified form of small-pox often mistaken for
chicken-pox.
In "Public Health" for September, 1902, there is an interesting paper on
"An examination of the blood as an aid in the diagnosis of Small-pox," by
Dr. H. Roger, of Paris, and he says, "One disease alone gives similar results,
that is chicken-pox. This is not surprising, for chicken-pox seems to depend
upon a similar germ to that of small-pox." It has been proved over and
over again that the two diseases are not the same and are not convertible, but
there is a remarkable parallelism between the two complaints. They appear
to prefer to attack unprotected persons at the same age, at the same season of
the year, and under the same meteorological conditions.
My opinion is that it is not necessary that chicken-pox should be a notifiable
disease when small-pox is absent, but that immediately upon the appearance
of small-pox, chicken-pox should be made notifiable as one of the protective
measures against the more fatal disease.
The procedure in dealing with chicken-pox in St. Pancras has been as
follows:—When a case of chicken-pox is notified or becomes known, if it is
not medically certified, it is referred to a medical referee, who certifies or not
accordingly; when it has been medically certified, inquiry is made by letter as
to vaccination or revaccination. If the certificate relates to a person under
ten years of age, a copy is sent to the Vaccination Officer, inquiring as to the
vaccination; and if over ten years of age, to the medical practitioner, as to
revaccination. The number over ten years of age is very few (7 or 8 per
cent. only) compared with those under, and as it is extremely rare for a person
efficiently vaccinated in infancy to be attacked by small-pox under ten years
of age, it follows that a statement that the patient has been efficiently
vaccinated confirms the dagnosis of chicken-pox almost to a certainty. In
the case of adults successfully revaccinated within ten years, it also confirms
the diagnosis.