Circular of Information PUBLISHED BY The Illinois State Board of Health. CHICKEN-POX (VARICELLA) IN THE ADULT. TO THE PHYSICIANS OF ILLINOIS: Notwithstanding the well demonstrated incontestible fact that chicken-pox is preeminently a disease of childhood, it is known that during the present wide-spread epidemic of modified small- pox in the State of Illinois and elsewhere, many cases of this dis- ease, occurring in both early and late adult life, have been pro- nounced chicken-pox. This diagnosis in the majority of instances, seemed to have been occasioned by the mild nature of the present outbreak, which tended to confuse physicians who were conversant only—in many cases, through the medium of their text books alone —with the typical form of small-pox, which has usually prevailed heretofore. The occurrence of chicken-pox in adults is so rare as to have escaped the observation of many of those who have devoted years to the study of exanthematous diseases. That it does occasionally exist during adult life is not denied, but its appearance at this period is so uncommon as to excite comment. All cases of so-called chick- en-pox in adults, seen by this Board during the present epidemic presented a well-defined variolous eruption. In support of the assertion that chicken-pox rarely attacks other than children, and that an epidemic eruptive disease affecting adults and children alike is not chicken-pox, the following quotations on the subject, from well recognized text books of unquestioned author- ity, are hereby submitted: “Varicella is essentially a disease of early life, occurring almost exclusively in infants and young children.”—Pepper’s System of Medicine. “Chicken-pox is a disease of childhood and rarely attacks any above ten years of age.”—Practice of Medicine, Bartholow. “Varicella is a disease of childhood and attacks by preference young children and even sucklings. In children over ten years of age, attacks are infrequent, and I never saw an adult suffering from varicella. Eruptions resembling varicella in adults always indicate variola.”—Ziemssen’s Cyclopaedia of Medicine. “An acute contagious disease of children. It is rarely seen in adults.”—Practice of Medicine, Osier. “Varicella affects children of all ages, and occurs almost al- ways in childhood.”—Practice of Medicine, Anders. “Varicella is confined exclusively to childhood up to the age of ten, and is rare after twelve.”—American Text Book of Theory and Practice of Medicine. “A disease affecting children.”—Diseases of Children, Eustace Smith. “The variolous disease whether small-pox or varioloid often occurs in the adult; varicella on the other hand is a disease of in- fancy and childhood. I have seen one case in adults, but its ap- pearance at this period of life is rare.”—Disease of Children, J. Lewis Smith. “Varicella is an acute epidemic contagious disease, occurring generally in children.”—Practice of Medicine, Hale. “A disease which chiefly affects children.”—Practice of Med- icine, Loomis. “A disease of childhood.”—Reynolds’ System of Medicine.- “An acute specific infectious disease peculiar to infancy and childhood. In children over ten years of age the disease is rare, while in adult life it is so infrequent that many observers of large experience have never met with it. Varicella is particularly a dis- ease of infancy and early childhood. Any varicella-like eruption in an adult should be looked upon with the greatest suspicion and the patients strictly isolated, until by the history of the case, its source and the course of the disease, all doubt as to the diagnosis is dispelled.”—Keating’s Cyclopaedia of the Diseases of Children. “A disease of childhood.”—American Text Book of Medicine. “Varicella affects children.”—Diseases of Infancy and Chil- dren, Holt. “In chicken-pox the eruption appears on the first or second •day, ***** the child remaining but little indisposed * * * * Heither do the vesicles become pustules unless * * * or the child is in a condition of debility or suffers from struma. Varicella is separated from variola by * * * * * and finally by the fact that it attacks children, who have been well vaccinated, whereas small-pox does not.”—Practical Diagnosis, Hare. “After nineteen years of age the disease may be said to dis- appear as it is only occasionally seen in adults.”—Dictionary of Medicine, Quaim “Chicken-pox is a disease of children mostly, the age of max- imum incidence is from three to four years.”—Allbutt’s System of Medicine. “Chicken-pox is a disease of early childhood * * * * If, however, small-pox is prevalent in the neighborhood, any case presenting symptoms assumed to be those of chicken-pox should be regarded as suspicious, especially if the patient be an adult.”— Handbook of Hygiene, Wilson. “As a rule very young children are attacked by chicken-pox.” —Twentieth Century Practice of Medicine. “Chicken-pox is almost purely a disease of childhood, occurring between the second and sixth year.”—Practice of Medicine, Tyson. “Varicella continues to be a common disease all through the early and middle years of childhood. The susceptibility to the contagion of varicella lessens after ten years of age and almost dis- appears at puberty.”—Pediatrics: The Hygiene and Medical Treatment of Children, Botch. In conclusion, the State Board of Health desires to emphasize the necessity for the observation of the most stringent precautions in every case of eruptive disease, particularly one resembling chicken-pox or small-pox. The failure of a physician to readily recognize small-pox, or a neglect to recommend the adoption of extraordinary care in all cases of a suspicious nature,may at any time cause the beginning of an outbreak in a community, entailing much sickness and loss of life, panic, interruption to travel and de- pression of business, and a financial loss impossible to estimate. The most rigid quarantine and isolation is recommended in every case concerning which there is the slightest uncertainty, and the maintenance of such until all doubts are set aside.* Especially should a varicella-like eruption in an adult be regarded with great suspicion. It may not be small-pox; it is extremely unlikely to be chicken-pox. Of “Puerto Rican chicken-pox,” so many cases of which have been reported in Illinois and other States recently, little need be said. fiSTo sanitary authority has knowledge of any type of varicella which is peculiar to the island of Puerto Rico. Every case of “Puerto Rican chicken-pox,” “Cuban itch,”** “elephant itch”*** and “elephant chicken-pox” seen by the officials of this Board dur- ing the past three months was found to be small-pox. Published by order of the Board, J. A. EGA hi, M. D., Secretary. February 1, 1900. * “The observation of the Marine Hospital Bureau has been that in the majority of mistaken diagnoses with regard to small-pox the disease has been called chicken-pox. This is more strictly a disease of children affecting especially those under six years of age. Chicken-pox is a con- tagious disease, and many local health authorities require its isolation. Particularly when small-pox is prevalent, any case of supposed chicken- pox should be isolated and guarded as if it were small-pox, at least until the diagnosis is proved beyond doubt.”—Precis upon the Diagnosis and Pre- vention of Small-pox, U. S. Marine Hospital Service, 1899. ** “I am aware of no disease called Cuban itch which could be mistaken for small-pox. There are several erythematous eruptions in Cuba called Cuban itch, but they are prickly heat or ringworm.”—Surgeon General U. S. Marine Hospital Service to Illinois State Board of Health, De- cember 7,'1899. *** “If an eruptive disease appears in a district, it is the duty of the authorities to learn the nature of that disease, and if it seems con- tagious, it should be isolated. If a doubt exists, an expert should be called to settle the diagnosis. All cases of so-called “chicken-pox,” “Cuban itch,” “elephant itch,” “nigger itch,” and the like, should be at once isolated; in nine out of ten cases these prove to be small-pox.”—• Public Health Reports, U. S. Marine Hospital Service.