ALA ST RIM 



1491 



From HcBmorvhagic Diseases. — -Any case of high fever of an acute nature 

 associated with purpura may be smallpox. It is extremely difficult to separate 

 haemorrhagic measles and scarlet fever from haemorrhagic smallpox, but in 

 the former diseases there is not so much bleeding from the mucous membranes. 

 The isolation for sixteen days and vaccination of all contacts, and the isolation 

 of the sick are the most important. 



Prophylaxis. — As smallpox is endemic in nearly all tropical countries, it is 

 important that the natives should be taught concerning it, and the fact that 

 vaccination is an excellent prophylactic measure, and this should be done by 

 verbal instruction and by vernacular pamphlets, if possible illustrated; in 

 this way the native prejudices, which are usually not strong, must be overcome. 

 Secondly, vaccination should be made compulsory by law; and, thirdly, a 

 vaccine service should be established. This vaccine service should consist 

 of an institute for the preparation of lymph, with a reliable man to make the 

 lymph, an inspector of vaccination, or more, according to the needs of the 

 country, and a series of native vaccinators. 



ALASTRIM. 



Synonyms. — -Afncan, Varioloid varicella, Amaas, Kaffir milk-pox ; A merican , 

 West Indian modified smallpox. Epidemic varioloid varicella ; perhaps Pseudo- 

 smallpox (Kersten), Sanaga smallpox (Plehn), 



Definition. — An acute specific fever resembling in all its symptoms and 

 pathological appearances a mild form of variola. 



History. — -As already stated in the history of smallpox, there is a possibility 

 that there were originally two distinct endemic foci of variola — viz., Asia and 

 Africa — and therefore, bearing in mind the different varieties of relapsing 

 fever, it is hardly surprising that there should be at least two varieties of 

 smallpox, even though the clinical symptoms are similar, and Guarnieri's 

 bodies are found in both. Moreover, the disease is known in Africa and 

 America, and there is no reason why it should not occur also in Asia when the 

 considerable intercommunication between India, Ceylon, and China, with 

 Africa, is considered. One of the earliest descriptions is by Anderson, in 

 1866, of an epidemic in 1865 in Jamaica, and there was another epidemic 

 described by Dickson and Lasselle in 1903, while Korte gave an account of 

 amaas, or Kaffir milk-pox, in 1904. In 1905 Welch and Schamberg gave an 

 account of it in their work on 'Acute Contagious Diseases' in 1908; Scheult 

 described it as seen in Trinidad from 1902 to 1904; while Grant, in 1910, 

 described ' amaas ' as seen in South Africa; and in the same year Ribas 

 describes it as seen in Brazil in 1909, and Carini as seen in the States of St. 

 Paul, Minas, and Parana. 



etiology. — The causation would appear to be the same as that of ordinary 

 smallpox, as it is generally agreed that Jenner's vaccination is protective, and 

 Guarnieri bodies have been found, and the classical reaction in the inoculated 

 cornea of the rabbit has been produced ; after sixty hours the Guarnieri bodies 

 have been recovered from the cornea, but it would appear to be due to an 

 attenuated virus. 



The question which has been much debated is whether it is smallpox, 

 chicken-pox, or a new disease halfway between the two. In the first place, 

 there are still some persons who disbelieve in the difference between variola 

 and varicella, but their objection is usually disregarded. In the second place, 

 alastrim differs from varicella because of — 



1 . Conflaence of the vesicles in certain cases. 



2. Its frequency among adults. 



3. The partial protection by Jenner's vaccine. 



It differs from variola vera by — • 



1. Its low mortality (i to 2 per cent.). 



2. Because it is less severe in children than in a,dults, and is often found 

 among babies, in whom the vesicles are often slnall. 



