(Chicken-pox)
Definition. An acute, contagious disease of benign type, occurring chiefly in children and characterized by crops of discrete vesicles, accompanied by mild fever beginning with the appearance of the eruption.
Symptoms. the incubative period is from ten to twenty-one days. Prodromata are usually absent, or so slight as to be unimportant although there may be some rise of temperature, anorexia, indefinite pains, and chilliness. Rarely a prodromal erythema is the first evidence of the disease, and is generalized, somewhat like scarlet fever, but less punctate. Occasionally one or several umbilicated vesicles may be found and although the temperature may be up to 104* F., the patient does not seem sick. Both this preliminary erythema and the temperature disappear in from one to two days and the patient develops the typical varicella eruption. In adults the prodromal stage may be marked, and similar in the mildest sense to that observed in variola.
Commonly the eruption is the first symptom and a varying, moderate degree of fever, 99* to 100* F., accompanies it, but only lasts one to three days. The eruption appears first upon the back, face or scalp, although not distinctively so, and its extension is irregular. Ordinarily the lesions are more profuse on the back than on the distal portions. The palms and soles are rarely involved but when they are, much less so than in smallpox. the dorsal surfaces of the hands and feet are only slightly affected. In fact, it may be said that the eruption prefers the covered portion of the body. The vesicles of chicken-pox, which develop rapidly frompea-to bean-sized rosy macules, are ordinarily pinhead to pea-sized, round or oval, elevated, superficial in character, scanty or abundant, usually scattered and almost never unbilicated, puckered or fluted as in smallpox. They appear in crops at intervals of hours, never longer than a day or two, and because of this appearance are seen in the varying stages of evolution and involution. Hence there may be present at one time small or large vesicles, vesicopustules or even dark crusts; in fact, multiformity is a characteristic feature of chicken-pox. True umbilication does not occur in chicken-pox, although partial evacuation of contents, with central collapse of the vesicle wall, or the presence of a hair-follicle may show a slight invagination of the surface. The duration of the individual lesions is short, their course being from one to three days while the whole process is ended in from seven to twelve days. It is quite common for some lesions to be followed seven to twelve days. It is quite common for some lesions to be followed by scars, but they are never as numerous as those seen in smallpox, usually being limited to ten or a few more. They are invariably secondary to an infection from scratching or some other form of irritation, caused not so much by real itching as by the mere knowledge of the presence of the lesions. The mucous membranes may be involved, especially the hard and soft palate but the eruption is usually scant.
complications and sequelae are comparatively few, although pemphigoid bullae, boils, abscesses, erysipelas and gangrene have been noted.
Etiology and Pathology. The majority of cases are seen among infants and children, although adults are occasionally attacked. Second attacks may occur but are infrequent. Susceptibility is not influenced by season, climate or race. The disease is distinctly infectious but the inoculability is questionable. The reader is referred to Unna’s detailed findings concerning the pathological course of the chicken-pox lesion. It will be sufficient to say that there is an extensive fibrionoid metamorphosis of the epithelium, as in variola.
Diagnosis. The main diagnostic points of varicella are, the appearance usually in children of successive crops of a maculovesicular eruption, most marked on the trunk. For further differential points of this and other exanthemata see the table on page 216. Impetigo contagiosa will show lesions usually on the face and hands which are more persistent, with bulkier crusts, but no temperature feature as in varicella.
Prognosis and Treatment. Chicken-pox is the mildest of the exanthemata. Patients seldom die of it, although complications may possibly cause such a result. Treatment aims to avoid any aggravation of the attack. Complications brought about by exposure or by the severity of the disease may need special treatment but usually it is not necessary to keep a child in bed. Local treatment is of considerable importance to prevent scarring and here again the use of tincture of iodin, or glycerin and alcohol in equal parts, may be recommended, or and ointment containing 3 per cent. carbolic acid and 5 per cet., ammoniated mercury may be used to relieve the itching, and incidentally secondary infection and scarring. Internal medication is seldom needed but if desirable, the following may prove useful: Acon, Ant. tart., Dulcamara, Kali mur., Mercurius sol., Rhus tox., and Sulphur.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war