THE MYSTERIOUS DISEASE.

Auckland Star, Volume XLIV, Issue 178, 28 July 1913, Page 2

THE MYSTERIOUS DISEASE.

VARIOLA OS VARICELLA ? A LEADING DOCTOE'S OPINION. SMALLPOX THEORY DISCOUNTED. Auckland medical men are not at all unanimous concerning the nature of the epidemic which is at present provoking so much public concern. The Public Health Department has definitely pronounced the trouble to be smallpox, but this view is not generally accepted by the qualified medical men of the city. One of the leading local members of the profession this morning stated to a ";"tar" representative his emphatic belief that the di.-ease is not smallpox. Authorities the world over, he states, are agreed that there is the greatest difficulty in differentiating between mild smallpox and severe chicken-pox, and that, ho believes, is the problem which confronts us in Auckland to-day. it has been stated, since the outbreak of the present epidemic in Auckland, that one of the characteristics which mark it as variola (smallpox) is that the vesicles are confluent, whereas in varicella (chicken-pox) tliey are usually discrete. In a recent review, however, published for the Soudan De.partment of Education, cases of varicella are recorded in which the eruption became confluent. Before variola becomes confluent it is preceded by severe prodromes, such as high fever, intense headache and backache, and vomiting. "Wo have had no case of that kind in Auckland," declared the medical man. in dealing with the question from a local view-point. DISEASES EASILY CONFOUNDED. Equally interesting is the statement recorded by an aeeppted authority, Dt. A. E. Thomas, who notes that ""there is no one characteristic sign on which absolute reliance can be placed, and it is often yon,- difficult to distinguish moderately severe chicken-pox from mikl smallpox." Another authority, Professor H. W. Stelwagon, states that "varicella differs from variola in many particulars, although the differences ere much ]e-=t3 recognisable when it concerns mild cases of smallpox, or varioloid, and severe cases of chicken-pox.'' Dr. Morrow, in a treatise on the diagnosis nf smallpox, says: "-The disease with which chicken-pox is most likely to be confounded is smallpox, more especially in the earlier stage. In an analysis of 33 cases of error reported to the New York Health Board, at a certain period for smallpox. 17 were cases of chicken-pox." Dr. Kicketts. accepted as the greatest authority on ,-arrola. state.* that there is uo affection so frequently confused with smallpox as chicken-pox.

With most diseases nowadays is is possible to arrive at a complete understanding with the aid of the pathologist, but the bacteriology of smallpox is still snb judice. Pew will deny that the exciting cause of smallpox is the introduction into the system of a specific, microorganism, 'but so far what the parasite is science has not been able to discover. It has been stated chat smallpox is a disease most prevalent in the winter time, but statistics clearly show that the | spring and early summer are the periods j during which the epidemic attains its most widespread form. LNTERESTIN-G COMPARISONS. Tlie grades of variola cover a wide field of variation, but those opposing the , announcement that the prevailing epi-, demic is smallpox claim that there are I certain distinctive symtoms which have i not been evidenced in the case of the ; Point Chevalier patiente. Smallpox is acutely infectious, characterised by an initial fever of about three days' dura- j tion. succeeded by an eruption, ending in . incrustation, and leaving pits ox scars. | The period of incubation is seldom less j than eight days, or more than 14. and j the invasion comes with sudden violence, j As against this, the case is quoted of an Onehunga patieut who was qnaran- j lined after her husband was sent to the isolation liospit.il, and 22 days later was | stricken with the same complaint. The period of incubation for chicken-pox is 21 days. Among the earlier symptoms of variola, is a distinct chill, immediately ; followed by a high rice, in temperature. | 104 and 105 degrees being commonly re- j corded. Amongst the Point Chevalier j patients the temperature averages be- j tween 99 and 100 degrees. Prostration j i= often extreme in real smallpox, and | dizziness a frequent symptom. An ex- j cruciating headache begins at the onset of the disease. Violent backache is another frequent symptom, and vomiting and epigastric tenderness are commonly observed. These, however, aTe not the symptoms displayed in the cases now quarantined at Point Chevalier. In true I smallpox the eruption makes its appearance on the third day, manifesting itself first about the head and hands. With chicken-pox. the rash appears first on the br>dy, visually on the back. Likewise, at this stage, with smallpox the temperature goes down; with chicken-pox it jroes up. Within 24 hours the body and loyver extremities of the smallpox patient, become involved. The lesions consist at first of small red points, -which, in the course of twenty-four hours develop into elevated papules with shot-like induration. When the pustules are thickly set. great swelling of the face occurs, so distorting the patient's face as to make him unrecognisable. Desquamation commences about the eleventh day, and the normal contour of the features is Testorcl. gradually. The contents of the pustules dry into crusts, which process is accompanied by intense itching, and the entire duration of the disease extends over about live or six weeks. Some of the patients at Point Chevalier only remained in isolation for three weeks, and were then discharged. NO ONE CHARACTERISTIC SUFPICIBNT. While some of these characteristics have, to a certain extent, been noticed amongst the patients a. Point Chevalier, it is held that no one characteristic is sufficient to warrant the pronunciation j of smallpox. It has -been argued as presumptive proof of smallpox that when | patients at Point Ohavalier were vaccin- j ated. the vaccination did not take. Tliis. however, is iSot necessarily a sound d-e-1 duction. In fact, the doctor in question i remarked, it'would be really interesting ', if one could find out just how many ■people have been vaccinated in Auckland during the last few weeks, aud have had to report that the operation was not successful. In some families three out of four members vaccinated have reported that the vaccine has not taken. Another interesting suggestion put forward was that if the present epidemic, which has spread sn widely through the north, were smullpox. why. in the dairying districts, had not the cows contracted cow=pox? It was when the cattle became affected during a smallpox outbreak that the famous .Tenner hit -en his vaccination discovery, and it is. after all, not such a strange thing to expect that, as a natural sequence, the cowpox v would, even in a very mild form, have

1 made its appearance at Mangere, or in some of the other dairying districts where the epidemic is rife. HOW TO SOLVE THE MYSTERY. "A medical committee to inquire into the nature of the epidemic, as suggested to the Minister for Public Health by the Deputy-Mayor of Auckland, would hardly arrive at a satisfactory conclusion," said the doctor submitting to the interview, : 'for I think you would find that the medical men are equally and emphatically divided in opinion as to the real nature of the disease.'* With a view to settling the question more definitely, the doctor in question suggests that the patients at Point Chevalier should be closely watched in relation to the following characteristics: Prodromal, feeling ot sickness, facial appearance, temperature on appearance of rash, position of rash on first appearance, distribution of rash, regularity, rate of change from papule to vesicle, 6hape of veeiclc. firmness of vesicle, depth of vesicle, temperature on pustulation, character of scabs, character of scars. If a chart such as tWa were available for comparison with other charts showing the corresponding recognised symptoms of smallpox and chickenpox, an analysis could be made, which would make it possible to state whether variola is existent in Auckland to-day. "Personally," he added, "I am convinced that it is not. **

"There is just one satisfactory feature, about it all," added the doctor, "and that is the fact that the scare has driven the public in for wholesale vaccination. In my opinion, we have not got smallpox now, but a* we open up trade more extensively with China and the East we may get the real disease at any time. When we do get it we will know it, and the present scare, which lias resulted in such extensive vaccination, may lor that reason be regarded as a blessing in disguise."