(CHICKEN POX)
=Definition.=—Chicken pox is an acute, specific, contagious, slightly
febrile, eruptive disease, usually of childhood, affecting the whole
organism through the blood. It is an epidemic disease that spreads
rapidly, is highly contagious but not inoculable, and confers immunity.
=History.=—Varicella was first recognized about 1553 and was
distinguished from smallpox by Trousseau.
=Etiology.=—The agent that causes the disease is not known; the
disease usually affects children under ten years of age, but does
occasionally attack adults. It bears no relation to variola, except the
very slightly similar eruption. It is transferred by direct personal
contact, by the air or by a third person. It is infective from the
first symptoms until all the crusts have disappeared. Although the
disease usually occurs in epidemics, frequently we see sporadic cases.
As in all other contagious or infectious diseases the predisposing
causative factors are those conditions which lower the resistive
powers of the body, such as fatigue, improper diet, exposure to sudden
temperature changes and imperfect elimination of the body wastes. The
structural lesions found as predisposing factors are contractured
muscles of the neck and behind the jaw, and muscular and interosseous
lesions of the upper cervical, mid-dorsal and dorso-lumbar areas, also
of the clavicle and upper ribs.
=Symptoms and Diagnosis.=—There are three stages to the disease: (1)
Incubation, (2) Prodromal, (3) Eruptive.
1. Incubation Period.—This period lasts about fourteen days though it
may vary from seven to seventeen days. During this period there is
practically no symptomatology except perhaps the last two or three
days, when the child shows evidence of a little excitability and
irritability. Often on the day before the first noticeable symptoms the
child appears even more active than usual.
2. Prodromal Stage.—Prodromal symptoms are not common and usually
last but about twenty-four hours. The first noticeable symptom is
the irritability of the patient, which is followed by a temperature,
usually 99° to 101°, which temperature persists during the course of
the disease. There are sometimes thirst, anorexia, constipation, seldom
vomiting, and a furred tongue. Some cases have been observed to have
the following as prodromal symptoms, but these we believe are usually
due to concurrent conditions that exist at the time of the infection:
delirium, convulsions, angina, conjunctivitis, dysphagia, bloody
vomiting and stools, and an initial erythema, usually scarlatiniform.
3. Eruptive Stage.—The eruption comes within twenty-four hours and is
often the first symptom that is noticed. It appears first as hyperemic
macules and then rose colored papular spots, somewhat comparable to
the typhoid roseola and not hard. These papules rapidly become raised,
flattened, ovoid, pin-head to pea-sized vesicles containing a fluid at
first watery and then pearly. They disappear on pressure. The vesicles
mature within twenty-four hours, are very superficial, and leave a
slight areola about them, which is not inflammatory as in smallpox.
The eruption appears first on the chest and then on the neck, face,
scalp, and then trunk and limbs in the order named. The eruption is
most abundant upon the back, and over the entire body they may number
anywhere from eight to many hundred and are usually scattered.
The vesicles are not umbilicated, but some may have slightly depressed
centers, are discrete, and appear in successive crops which require
from three to six days to complete. Pustulation and hemorrhage into
the vesicle rarely occur. On the third or fourth day yellowish-brown
crusts form and gradually disappear. Scars may result from scratching
or infection. By the fifth day we may find all stages of the eruption
because of the appearance of the successive crops. There may be an
efflorescence upon the mucous membrane of the oral cavity and of the
pharynx causing slight difficulty in deglutition.
The itching may be more or less intense. As scratching may cause
pitting it should be guarded against. The fever which is usually
slight may persist during the entire eruptive stage, but if it is high
and persists as high temperature it suggests complications. Muscular
tension of the cervical muscles, especially those in front, and around
the angle of the inferior maxilla are usually found, and often the
clavicles are bound down, and relation of ribs is disturbed. Ulceration
sometimes follows scratching, and even gangrene may appear around the
vesicles in debilitated children, especially those who are tubercular
or congenitally syphilitic. It is apt to be fatal in these cases.
Complications of tubular nephritis, which occurs within two weeks;
cardiac hypertrophy; uremia; otitis media; and bronchial affections,
are sometimes met with.
=Treatment.=—Isolate patient so as not to come in contact with other
children. The younger children should be put to bed until the crusts
have formed; older children may be allowed to be up around the room if
their cases are light. Pay particular attention to the muscular lesions
of the neck, lower maxilla, mid-dorsal and dorso-lumbar regions,
keeping them relaxed by gentle relaxing treatments. A general systemic
treatment is soothing and helps to prevent complications.
“Be very careful and very thorough in your neck adjustments. Loosen the
atlas and axis and draw forward the inferior maxilla from its pressure
upon the vessels and nerves back of its angle. Draw the hyoid bone
forward and secure good circulation of blood throughout the entire
cervical area.”—A. T. STILL.
Give treatment at the 4th and 5th dorsals to stimulate the superficial
circulation and thus increase elimination through the eruption as well
as the sweat glands. Remember the eruption is the expression of the
body’s attempt to eliminate the toxins within.
Keep the bowels active by splanchnic and abdominal manipulations and
by laxative diet. If bowels are persistently inactive use enemata.
Diet should be bland and easily digested. During fever, diet should be
liquid or better restricted, giving only water in abundance.
During the eruptive stage do not use tub baths. Daily tepid sponges
with either plain water or boric acid solution answers both as an
antiseptic wash and bathing. After the daily sponging, and as often as
necessary to control itching, anoint with a 10% boric acid ointment
or with carbolized vaseline. If scratching can not be controlled, the
hands should be tied in muslin bags. As in smallpox the ultra-violet
rays seem to irritate the eruptions and to increase the tendency to
scarring, therefore the windows and lights should be screened with a
dull red material.
=Prognosis.=—Invariably favorable unless complications set in, which is
seldom. Recurrences are very rare.
=Prophylaxis.=—The child should be kept in quarantine for three weeks
or until the skin is entirely clean.