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Chapter X

Communicable Diseases, Table of Contents

CHAPTER X

CHICKEN-POX

Chicken-pox is an acute, highly contagious, though benign, disease affecting adults less frequently than children. It is characterized clinically by a mild prodromal stage and a definite skin eruption. Pathologically there are no findings peculiar to this disease.

STATISTICAL CONSIDERATIONS

There were 1,757 primary admissions for chicken-pox for the total Army during the World War (Table 59). Of this number 1,642 were among officers and enlisted men of the American Army and 115 among the native enlisted troops. The highest admission ratio for any troops was for the native enlisted men serving in their own countries. This was 3.19 per 1,000 per annum. Of the various components of the total Army the colored enlisted men ranked second.

Table 59 shows that there were 31,534 days lost from duty on account of chicken-pox, giving a noneffective ratio of 0.02 per 1,000 strength.

As with other epidemic diseases, chicken-pox was far more common in the United States than in Europe. There were 1,208 primary admissions for troops serving in the United States, giving an admission ratio of 0.54 per 1,000 per annum.

The month of January, 1918, marked the peak for many of the epidemic diseases in the Army during the war. This was true for chicken-pox occurring in the United States. The largest number of primary admissions reported for any one month, and the highest admission ratio, was for January, 1918, when there were 146 primary admissions for the total Army, giving an admission ratio of 0.11 per 1,000 strength.

TABLE 59.- Chicken-pox. Admissions and days lost, officers and enlisted men, United States Army, April 1, 1917, to December 31, 1919

 

Total mean annual strengths


Admissions

Days lost

Noneffective ratio per 1,000 strength


Absolute numbers

Ratios per 1,000 strength

Total officers and enlisted men, including native troops

4,128,479

1,757

0.43

31,534

0.02

Total officers and enlisted men, American troops

4,092,457

1,642

.40

29,780

.02

Total officers

206,382

66

.32

949

.01

Total American troops:

 

 

 

 

 

    

White

3,599,527

1,181

.33

21,755

.02

    

Colored

286,548

359

1.25

6,420

.06

    

Color not stated

---

36

---

656

---

         

Total

3,886,075

1,576

.41

28,831

.02

Total native troops (enlisted)

36,022

115

3.19

1,754

.13

Total Army in the United States, including Alaska:

 

 

 

 

 

    

Officers

124,266

52

.42

708

.02

    

White enlisted

1,965,297

942

.48

17,012

.02

    

Colored enlisted

145,826

214

1.47

3,723

.07

         

Total enlisted

2,111,123

1,156

.55

20,735

.03

         

Total officers and men

2,235,389

1,208

.54

21,443

.03

United States Army in Europe, excluding Russia:

 

 

 

 

 

    

Officers

73,728

13

0.18

221

0.01

    

White enlisted

1,469,656

209

.14

4,256

.01

    

Colored enlisted

122,412

130

1.06

2,452

.05

    

Color not stated

---

36

---

653

---

         

Total enlisted

1,592,068

375

.24

7,361

.01

         

Total officers and men

1,665,796

388

.23

7,582

.01

Officers, other countries

8,388

1

.12

20

.01

United States Army in Philippine Islands:

 

 

 

 

 

    

White enlisted

16,995

8

.47

121

.02

    

Colored enlisted

4,456

2

.45

25

.02

        

Total enlisted

21,451

10

.47

146

.02

United States Army in Hawaii:

 

 

 

 

 

    

White enlisted

16,161

2

.12

60

.01

    

Colored enlisted

3,319

7

2.11

159

.13

         

Total enlisted

19,480

9

.46

219

.03

United States Army in Panama:

 

 

 

 

 

    

White enlisted

19,688

---

---

---

---

United States Army in other countries not stated:

 

 

 

 

 

    

White enlisted

(a)

7

.49

140

.03

    

Colored enlisted

(a)

---

---

---

---

         

Total

14,232

7

.49

140

.03

Transports:

 

 

 

 

 

    

White enlisted

97,498

13

.13

166

.00

    

Colored enlisted

10,535

6

.57

61

.02

    

Color not stated

---

---

---

3

---

         

Total

108,033

19

.18

230

.01

Native troops enlisted:

 

 

 

 

 

    

Philippine Scouts

18,576

88

4.74

1,420

.21

    

Hawaiians

5,615

8

1.42

123

.06

    

Porto Ricans

11,831

19

1.61

211

.05

aSeparate strength of white and colored not available.


388

Chicken-pox was reported from practically all camps, but its occurrence was not of great importance. Camp Gordon, Ga.; Camp Pike, Ark.; Camp Wheeler, Ga.; and Camp Bowie, Tex., contributed the largest number of cases. The admission ratios per 1,000 strength in these camps were, respectively, 0.98, 0.93, 1.55, and 1.45.

Like smallpox, this disease was more common among colored troops than among white. The highest admission ratio in any camp was for the colored troops serving at Camp Custer, Mich. This was 5.90 per 1,000 strength. The average admission ratio for colored troops serving in the camps of the United States was 1.19, while the average for white troops was 0.45. The average for all troops serving in camps in the United States was 0.52 per 1,000 per annum.

SYMPTOMS

The period of incubation of chicken-pox has not been definitely determined; 10 to 15 days seem probable. The disease is not infrequently marked, particularly in adults, by a mild prodromal stage, but it is common for this stage not


389

to be observed, that which attracts the attention first being the appearance of a skin eruption. This eruption commonly commences on the back and chest, spreading to other portions of the body, and occasionally involves the palms of the hands and soles of the feet. It is commonly seen on the scalp and on the mucous membrane of the mouth and throat. Theoretically, the eruption passes through the stages of macule, papule, vesicle, pustule, and scab. Practically, the papule is the stage first noticed, and in a few hours it becomes a vesicle. The vesicle is usually not umbilicated, and collapses if punctured, and though its contents usually become somewhat turbid, a definite pustular stage is not common, as seen in smallpox. The vesicle dries, becoming indurated, and usually has a black center, the scab then forming. These lesions are superficial, not generally involving the true skin. There is some itching, which usually leads to scratching, with resultant secondary infection, leading to scarring and permanent defects. The temperature is usually not high, and patients, as a rule, are not toxic. The eruption occurs in crops, which develop rapidly. It is possible, therefore, to have several crops on the patient at the same time, ranging from macule to scab. It is generally accepted that the patient remains a source of infection as long as scabs are present.

During the war, much was written on the probable relationship of herpes zoster and varicella. Lowe1 expressed the belief that epidemic herpes zoster is followed by chicken-pox. With respect to the question of immunity, he held that an attack of chicken-pox usually confers immunity to chicken-pox, and, in like manner, one attack of herpes zoster is rarely followed by another. If herpes zoster and chicken-pox are the results of the same infection, it should be expected that an attack of one would produce immunity to the other. Lowe believed that immunity to chicken-pox does not necessarily produce immunity to herpes zoster, but could find no record of a case of herpes zoster subsequently developing chicken-pox. Goldberg and Francis2 observed that herpes zoster may occur in the course of chicken-pox. According to these authors, inflammatory conditions of the ganglia may throw some light on the etiology.

COMPLICATIONS AND SEQUELĘ

The cases of chicken-pox reported in the Army during the war were not followed by serious complications. There were no cases of nephritis and but two cases of pneumonia reported among the primary admissions for varicella.

DIAGNOSIS

To the experienced physician, the diagnosis of chicken-pox, as a rule, is not difficult. It is the confusion with smallpox that makes the diagnosis of this disease one of especially great importance. This is particularly true in the Army. The typical smallpox and chicken-pox cases are not ordinarily confused but there are different types of each disease. Severe forms of chicken-pox have been reported and mild forms of smallpox are encountered. It is in this realm that the greatest confusion exists. In chicken-pox the onset is more sudden, the lesions more superficial, and the general symptoms less marked than in smallpox. Progress of the vesicle is more marked in chicken-pox and there is little or no induration around the lesion which is ordinarily present in smallpox, giving the


390

lesion the characteristic shotty feel. The prodromal stage is more prolonged in smallpox, and, in the presence of an epidemic in the neighborhood, the absence of a well-marked vaccination scar on a patient, with a skin eruption as above outlined, the diagnosis of smallpox would be strongly suggested.

Experience during the war did not contribute any new and important factors in differential diagnosis between chicken-pox and smallpox. Occurrence of both was comparatively slight and no confusion in diagnosis was reported.

PROGNOSIS

Uncomplicated chicken-pox terminates in recovery. The statistical records of the Surgeon General's Office show one death. This was a white enlisted man who died in August, 1918, in the United States. It is most probable that his death was due to an intercurrent disease. The records also show one case discharged from the service on account of disability following chicken-pox. This case, too, was a white enlisted man, and the permanent disability was due to conditions other than chicken-pox.

TREATMENT

There is no specific treatment for chicken-pox. The cases reported during the war were not toxic and were treated symtomatically, attention being paid to local treatment of the skin lesions. In some instances, carbolized vaseline was applied to prevent itching. Patients were informed of the danger of scarring, resulting from secondary infection due to scratching.

REFERENCES

(1) Lowe, R. C.: Herpes Zoster; Its Cause and Association with Varicella. The British Medical Journal, London, 1919, i, January 25, 91.

(2) Goldberg, B. and Francis, F. D.: Herpes Zoster and Chicken-pox. The Journal of the American Medical Association, Chicago, 1918, lxx, No. 15, 1061.