NATURE OF EPIDEMIC

New Zealand Herald, Volume L, Issue 15411, 20 September 1913, Page 5

NATURE OF EPIDEMIC

THE OFFICIAL DIAGNOSIS. DOCTORS STILL IN DOUBT. Doubt still persists in the public mind regarding the true nature of the disease which has spread throughout the northern districts and filtered into the city during the past few months. Officially the sickness has been pronounced to be smallpox in a mild form, and, although agreeing that wisdom was shown in treating it as this disease, several doctors have maintained their opinions that some disorder of a much less serious character has been epidemic. True smallpox presents several features, which are essentially characteristic, and, to the layman, it seems that the expert in diseases should have no difficulty in diagnosing it. The hesitation which preceded an official statement in the Auckland province and in Sydney iWs been shown, in other parts of the world upon the appearance of a rapidly-spreading disease suggestive in its peculiarities of smallpox. An epidemic in Trinidad some 10 years ago was first described as chickenpox, afterwards as the graver disease. Throughout its course it was strikingly lacking in the traditional features of smallpox, and the attention of the whole medical faculty was attracted to it. The official diagnosis in that instance is still ia controversy. Last year, a zymotic disease of mild form became epidemic in one of the minor districts of South America, and to it the name "alastrim" was given by Jacobs, a wellknown authority. An epitome of his paper, published in the British Medical Journal, was reprinted in the Hek*ld on July 25, and received with general interest. In reviewing the whole period of the epidemic in the Auckland province its peculiarities are seen to be strikingly similar to those described by Jacobs. Ho wrote of a mild form of epidemic very similar to smallpox, but differing from it in the following particulars : — (1) In an epidemic at Sao Paulo the mortality was about half per cent.; (2) the disease is less dangerous in children than in adults; (3) there is no secondary fever, pustulation is quicker,- and the fetid smell of smallpox is absent; (4) cicatricial formartion is wanting, after the pustule dries a smooth irregular scar remains, with borders as if nibbled by insects; (5) although vaccination is * prophylactic against alastrim, cases have been observed in which persons vaccinated shortly before (one to two years) Buffered from alastrim, and of 16 persons who had passed through an attack of alastrim six months previously seven (46.6 per cent.) reacted positively to vaccination. Most patients complain at the beginning of pains in the neck, the tonsils become red but not much swollen. In the following days pains are complained of throughout the body, vomiting, loss of appetite, headache, and fever are noticed. The incubation stage lasts from 10 to 14 days. The eruption begins olmo.st always on the face and spreads to the arms, chest, abdomen, thighs, back, and, lastly, the palms of the hands and the soleß of the feet. Purulent changes take place in the papules and vesicles in from three to five days, and uie incrustation falls off in about 10 days. Pustules may form on the conjunctiva, and in almost all cases are found on the mucous membrane of the lips, gums, and pharynx. The severity of the disease and "** prognosis depend on the numbers and confluence of the pustules, and the cases may accordingly be divided into mild, where the pustules are irregularly distributed throughout the body; moderately severe, in which cases the pustules are confluent en the face and fairly thickly set over the whole body; and severe, m which they become confluent ever the whole body, and cause death nearly always in old and feeble individu™s'«™ Ihe onen of thft|disease is Africa, where it is called Am 3!» Aragaci considers that varicella, alastrim/ and variola are all derived from a common ancestor, and should be placed IP one group, - ,-4, - s ■-• •/? ; . : i In' -two important respects;* the disease experienced in the Auckland province -and in bydney closely resembles alastrim, and is strikingly different from smallpox/ It was these two particulars which were especially observed by doctors with whom' the subject was discussed yesterday.' there have been no deaths among European patients, while the mortality among Mao™ has been very low, and very few children have been attacked. Smallpox epidemics have been notorious by their high death-rate, and the entirely disproportionate attack-rate among young children. This striking departure from past experience was mentioned by one doctor as most unusual, and he added that he had expected that children would be particularly susceptible, as the community'is virtually unvaccinated. A cable - message from Sydney reported a statement by the, Minister for Health that "the "epidemic can no longer be regarded as typical smallpox, and there is a strong body of opinion in Auckland, now the danger is apparently past, that the official diagnosis should ' be reviewed, and much public anxiety allayed. There is a popular presumption in other parts of the Dominion and in Australia that smallpox has been epidemic in Auckland. Residents in the city have not been seriously alarmed, because they have known that the only actual epidemic has been almost entirely restricted to ' a comparatively large area, many miles north of the city. A number of cases have certainly developed in the suburbs of Auckland, a few in the city itself, and others in the southern districts, but the Health Department has never hesitated to declare that these have been caused by infection, introduced by travellers immediately from the infected district in the north. "The disease is rapidly dying out," said one doctor yesterday, who has been associated throughout with the treatment of patients "I am confident that there will be no recrudescence. Certainly no one who, has planned a visit to the city need have any fears about coming here. Since the disease appeared in May, the thousands of people who dwell in the city have never shown any serious anxiety, and in fact, very many more of them have been ill, and have recovered from more serious sicknesses that are always with us, than have suffered from this alleged smallpox"