Communicable Diseases, Table of Contents
CHAPTER X
CHICKEN-POX
Chicken-pox is an acute, highly contagious, though benign, disease affectingadults less frequently than children. It is characterized clinically by a mildprodromal stage and a definite skin eruption. Pathologically there are nofindings peculiar to this disease.
STATISTICAL CONSIDERATIONS
There were 1,757 primary admissions for chicken-pox for the total Army duringthe World War (Table 59). Of this number 1,642 were among officers and enlistedmen of the American Army and 115 among the native enlisted troops. The highestadmission ratio for any troops was for the native enlisted men serving in theirown countries. This was 3.19 per 1,000 per annum. Of the various components ofthe total Army the colored enlisted men ranked second.
Table 59 shows that there were 31,534 days lost from duty on account ofchicken-pox, giving a noneffective ratio of 0.02 per 1,000 strength.
As with other epidemic diseases, chicken-pox was far more common in theUnited States than in Europe. There were 1,208 primary admissions for troopsserving in the United States, giving an admission ratio of 0.54 per 1,000 perannum.
The month of January, 1918, marked the peak for many of the epidemic diseasesin the Army during the war. This was true for chicken-pox occurring in theUnited States. The largest number of primary admissions reported for any onemonth, and the highest admission ratio, was for January, 1918, when there were146 primary admissions for the total Army, giving an admission ratio of 0.11 per1,000 strength.
| Total mean annual strengths |
| Days lost | Noneffective ratio per 1,000 strength | |
| 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: |
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| 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: |
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| 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: |
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| 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: |
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| 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: |
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| 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: |
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| White enlisted | 19,688 | --- | --- | --- | --- |
United States Army in other countries not stated: |
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| White enlisted | (a) | 7 | .49 | 140 | .03 |
| Colored enlisted | (a) | --- | --- | --- | --- |
| Total | 14,232 | 7 | .49 | 140 | .03 |
Transports: |
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| 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: |
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| 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 notavailable.
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Chicken-pox was reported from practically all camps, but itsoccurrence was not of great importance. Camp Gordon, Ga.; Camp Pike, Ark.; CampWheeler, Ga.; and Camp Bowie, Tex., contributed the largest number of cases. Theadmission 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 troopsthan among white. The highest admission ratio in any camp was for the coloredtroops serving at Camp Custer, Mich. This was 5.90 per 1,000 strength. Theaverage admission ratio for colored troops serving in the camps of the UnitedStates was 1.19, while the average for white troops was 0.45. The average forall 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 definitelydetermined; 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 thisstage not
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to be observed, that which attracts the attention first beingthe appearance of a skin eruption. This eruption commonly commences on the backand chest, spreading to other portions of the body, and occasionally involvesthe palms of the hands and soles of the feet. It is commonly seen on the scalpand on the mucous membrane of the mouth and throat. Theoretically, the eruptionpasses through the stages of macule, papule, vesicle, pustule, and scab.Practically, the papule is the stage first noticed, and in a few hours itbecomes a vesicle. The vesicle is usually not umbilicated, and collapses ifpunctured, and though its contents usually become somewhat turbid, a definitepustular stage is not common, as seen in smallpox. The vesicle dries, becomingindurated, and usually has a black center, the scab then forming. These lesionsare superficial, not generally involving the true skin. There is some itching,which usually leads to scratching, with resultant secondary infection, leadingto scarring and permanent defects. The temperature is usually not high, andpatients, as a rule, are not toxic. The eruption occurs in crops, which developrapidly. It is possible, therefore, to have several crops on the patient at thesame time, ranging from macule to scab. It is generally accepted that thepatient remains a source of infection as long as scabs are present.
During the war, much was written on the probable relationshipof herpes zoster and varicella. Lowe1 expressed the belief that epidemic herpeszoster is followed by chicken-pox. With respect to the question of immunity, heheld 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. Ifherpes zoster and chicken-pox are the results of the same infection, it shouldbe expected that an attack of one would produce immunity to the other. Lowebelieved that immunity to chicken-pox does not necessarily produce immunity toherpes zoster, but could find no record of a case of herpes zoster subsequentlydeveloping chicken-pox. Goldberg and Francis2 observed that herpes zoster mayoccur in the course of chicken-pox. According to these authors, inflammatoryconditions of the ganglia may throw some light on the etiology.
COMPLICATIONS AND SEQUEL?
The cases of chicken-pox reported in the Army during the warwere not followed by serious complications. There were no cases of nephritis andbut 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 thediagnosis of this disease one of especially great importance. This isparticularly true in the Army. The typical smallpox and chicken-pox cases arenot ordinarily confused but there are different types of each disease. Severeforms of chicken-pox have been reported and mild forms of smallpox areencountered. It is in this realm that the greatest confusion exists. Inchicken-pox the onset is more sudden, the lesions more superficial, and thegeneral symptoms less marked than in smallpox. Progress of the vesicle is moremarked in chicken-pox and there is little or no induration around the lesionwhich is ordinarily present in smallpox, giving the
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lesion the characteristic shotty feel. The prodromal stage ismore prolonged in smallpox, and, in the presence of an epidemic in theneighborhood, the absence of a well-marked vaccination scar on a patient, with askin eruption as above outlined, the diagnosis of smallpox would be stronglysuggested.
Experience during the war did not contribute any new andimportant factors in differential diagnosis between chicken-pox and smallpox.Occurrence of both was comparatively slight and no confusion in diagnosis wasreported.
PROGNOSIS
Uncomplicated chicken-pox terminates in recovery. Thestatistical records of the Surgeon General's Office show one death. This wasa white enlisted man who died in August, 1918, in the United States. It is mostprobable that his death was due to an intercurrent disease. The records alsoshow one case discharged from the service on account of disability followingchicken-pox. This case, too, was a white enlisted man, and the permanentdisability was due to conditions other than chicken-pox.
TREATMENT
There is no specific treatment for chicken-pox. The casesreported 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 ofthe 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.
