SMALLPOX.

Manawatu Herald, Volume XXXV, Issue 1124, 19 July 1913, Page 2

SMALLPOX.

HEALTH OFFICER’S BULLETIN.

Wellington, July 17

Dr Valiutiue (Chief Health Officer), in a bulletin issued at ten o’clock this evening, stated that there are now 28 cases of the epidemic in the Pt Chevalier Hospital, of whom three are Euro peans. There are two suspected cases at Tawhera, near Morrins ville, and a suspicious case at Okuia. There is a case at Herekino, evidently a contact from Maugere, whilst Dr Lapraik also reports a case from Miranda, near Thames. The Bay of Islands .Hospital Board had reported that there were two suspected cases in a hotel at Kawa Kawa, but a later telegram from the secretary of the Board reports that the epidemic is spreading over that district, and that five Europeans have developed the disease. “Altogether,” says Dr Valintine, “the outlook this evening is not so good. - ’ O v LY HAKI HAKE

Nelson, July 17

The Rev T. G. Hammond, who has been working amongst the Maoris for thirty-five years, speaking here, stated that the so-called smallpox was only a scare. Ihe disease he described as “hakihaki.” The speaker had known an outbreak six months previously run its course, and not attack Europeans to any extent. The disease had appeared among the Maoris at different periods. There was no need for alarm.

SUSPECTED CASE AT WELLINGTON.

The Mayor of Wellington was officially informed yesterday that there was a suspected case in Wellington. The patient and a contact were isolated. The contact came from Kawakawa, Bay of Islands, Auckland, where several cases have already been reported. The Health Department, at a later hour last night, would give no details of the case. It is reported that the case of suspicious sickness which has been uotiGed in Wellington, occurred in the household of a northern member of Parliament. The member in question was not in his place in the House yesterday, and his absence is attributed to his being under observation as a contact.

BAST NIGHT’S BULLETIN

At 11 o’clock last night, Dr Valintine issued the following bulletin : “There are now thirty cases under treatment at the Auckland Hospital, three being Europeans. It has been found necessary to increase the hospital accommodation by eight beds, and a marquee has been obtained from the Defence authorities for this purpose.’’

Dr Mandl vaccinated about sixty natives at Motuiti yesterday morning, and his surgery presented a very animated appearance yesterday and this morning. Both old and young are submitting themselves to the needle point.

HOW SMALLPOA COMES ON

LIKE INLUENZA

DIFFERENCE FROM CHICKENPOX.

The people who scoff at the medical men controlling the smallpox outbreak, and refuse to believe that it is smallbox at all, are laughed at in turn by the doctors. They have not the least doubt at all about the disease, and say that the tests that have been carried out are conclusive proof that the invasion is smallpox and not chickenpox. There is one well-defined symptom in smallpox which is absent in chickenpox, and that is initial illness. The illness extends over three or four days, and it very much resembles Influenza. The onset is, as a rule, sudden, and the most constant symptom is headache, in most cases Iroutal. Backache, the most constant symptom, is, of all the initial symptoms, the most characteristic. It is usually severe, often excruciatingly so, and with the headache, usually lasts until the eruption comes out, or for some little time after. Rigors (shivering fits) severe or slight, and giddiness, are often present, while epigastric pains accompanied by nausea, retching, and vomiting (especially in children), is a very usual symptom. . Loss of appetite and thirst are also present. The breath is often foetid and the tongue coated with a white, or dirty white fur.

The skiu is usually hot, dry at first, but afterwards moist and even sweating. Most patients are sleepless and restless. In other cases there is great mental disturbance, with loss of co-ordina-tion of movement and aphasia; in some cases the patient has been thought by the relatives to be drunk. The average duration of the initial stage is two days. The charcteristic eruption of smallpox appears as a rule 48 hours after the onset of the initial symptoms. In some cases a solitary puuple (pimple) appears ou the face, hand, or elsewhere ou the first day of illness, and is not follo wed by others until the usual time. In other cases : umetous papules appear ou the second day, followed by an abundant eruption on the third day, and occasionally the eruption does not appear until the fourth day of illness. The earliest papules are usually found ou the face, < arms, and back of wrists aud

bauds, and are succeeded by others on the trunk and lower extremities. As a rule the eruption is most abudaut on the tace, scalp, extremities, and the back, whilst the skin on the front ot the chest is less afflicted, and the skin of the abdomen least. Strangley enough, winter is the season of greater prevalency than is summer. Chickenpox Is the disease most commonly mistaken for smallpox, and cases of smallpox in unvaccinated children are frequently mistaken for chickenpox. The diagnostic points of chickenpox are: —(i) The usually complete absence of initial symptoms : (2) the eruption is most abundant on the trunk, and sometimes on the scalp, less on the face, less still on the arms and thighs, forearms, and legs, and least of all on the hands and feet. It is almost invariably discrete, although it may be so abundant as to be nearly confluent, and may appear all in one crop or in successive crop extending over one, two, three, four, five, ■or more days alter the first; (4) in all cases of chickenpox the eruption is at first either macular (a spot) or paopular (a pimple), but on account ot the absence of symptoms the eruption is not usually observed until it has reached the vesicular (blister) stage. The vesicle of chickenpox is more superficial than that of smallpox, and its floor is very slightly indurated as long as the vesicle remains intact. On the forearms, hands, legs and feet the vesicles mature often within 12, always within 24, hours of their appearance. No such rapidity of evolution characterises the smallpox vesicles. When mature they are shiny, translucent, and filled with clean serum; if transfixed and pressed the contents escape and the vesicular wall collapses.

In smallpox the initial symptoms are marked, and the temperature is high when the eruption is fully out. The lesion (or rash) lies deeper in the epidermis than that of chickenpox, and it is not fully vesicular within 24 hours of its appearance, either in natural or modißed smallpox. When mature the vesicle often shows a central depression and a narrow, white ring at its periphery (the outside), and can only be emptied by cutting it open. Apart from such help as may be obtained from a consideration of the initial symptoms and temperature the differential diagnosis ol chickenpox and smallpox rests, in the early stages, on the distribution, character and evolution of the individual eruptions, but above all on the evolution, rapid in chickenpox, slow and gradual in smallpox.

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