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- “Steamies can't get chickenpox!"
"I know that now, Paxton."
"But...maybe diesels can get measles!”
- ―Paxton and Henry
Henry Spots Trouble is the fourth episode of the nineteenth series.
One day, Henry arrives at Knapford where he meets the Fat Controller and his grandchildren. The Fat Controller explains that he is taking the children out in Winston for the day as they have both been stuck at home recently with chickenpox. Henry is worried by the spots on the children's faces; what if engines can catch chickenpox?
Meanwhile, at the farm, Thomas is dropping off some chickens while Butch is trying to pull a tractor out of the mud when he gets stuck. Butch revs his engine and his wheels kick a lot mud up which flies all over Thomas. Luckily, Thomas sees the funny side and knows he can have it washed off after delivering the rest of the chickens.
Henry arrives at Wellsworth station, but he cannot stop thinking about chickenpox. Emily arrives and is concerned that Henry seems very nervous. Henry explains that he saw Bridget and Stephen with spots all over their faces and he is worried he will catch chickenpox, too. Emily tries to reassure Henry by telling him that engines cannot get chickenpox. Henry is relieved momentarily, until he sees Thomas coming towards him with mud splattered all over his face, along with his trucks full of chickens. Henry thinks the mud is chickenpox and races away, scared.
At the Sodor Dieselworks, devious Diesel plays a trick on poor old Paxton and blows dirty, black smoke in the gullible diesel's face. Diesel swiftly exits, leaving Paxton coughing in a mist of thick, black smoke.
Shortly, Henry is taking his passenger train along the Main Line when Paxton, still coughing and spluttering, approaches him in the opposite direction. Henry thinks the black marks all over Paxton's face are the dreaded chickenpox. Henry is so scared that he races away as fast as his wheels can carry him, causing his passengers to bounce around like peas in a frying pan.
Kellsthorpe Road Station is being repainted when the painter knocks over a tin of red paint. The paint falls onto the rails and Connor runs through it, sending the paint flying into Gordon's face. Henry approaches with his passenger train and spots the red specks of paint on Gordon's face. Now, he is sure Gordon has chickenpox and reverses away at high speed. Henry reverses past a confused Paxton and has a very near-miss with James. Henry carries on backwards up Gordon's Hill when he sees Gordon approaching him in front. Henry orders Gordon to keep away, but the confused express engine cannot figure out what is wrong with Henry.
The Fat Controller is still enjoying his day out with Winston and his grandchildren when he gets a big surprise. He spots Henry reversing down the main line and gives chase. Henry is finally stopped at Wellsworth. Just then, Thomas puffs in and Henry wonders why the tank engine's spots have disappeared. Thomas explains it was just mud and he has had it washed off. Then, Gordon arrives and explains that he has red paint on his face. Henry confesses that he thought they both had chickenpox and Thomas tells him that engines cannot get chickenpox as the Fat Controller and his grandchildren arrive in Winston. The Fat Controller clarifies the situation by saying that it is usually only children who get chickenpox and even then, they recover very quickly and it is nothing to be afraid of; he even had it when he was young. The Fat Controller then gives a demonstration of his good health and rips his trousers in the process, revealing a red-spotted pair of underwear, something that Thomas, Stephen and Bridget find amusing, though Gordon could only point out the indignent factor.
After that, Henry did not worry about chickenpox again and he even stops to say hello to some chickens near the Sodor Dairy. He meets Paxton there and apologises for running away from him the other day. Paxton finds the situation quite amusing and says that steamies cannot get chickenpox and jokes that maybe diesels can get measles. Paxton makes sure he tells Henry that he is only joking, but poor old Henry still seems concerned.
- Sir Topham Hatt
- Stephen Hatt
- Bridget Hatt
- Edward (cameo)
- Connor (cameo)
- Farmer McColl (cameo)
- The Dairy Manager (cameo)
- The Teacher (cameo)
- The Bird Watcher (cameo)
- Dowager Hatt's Friends (cameo)
- The Ginger-haired Boy (cameo)
- The Blond-haired Boy (cameo)
- A Schoolboy (cameo)
- The Welsh Bird Watcher (cameo)
- The Lady with the Big Hat (cameo)
- Albert's Wife (cameo)
- The Female Puppet Show Entertainer (cameo)
- Knapford Station Yard
- McColl Farm
- Kellsthorpe Road
- Kirk Ronan Junction
- Gordon's Hill
- Vicarstown Dieselworks
- Sodor Dairy
- The Washdown (mentioned)
- John Hasler as Thomas
- Keith Wickham as Henry, Gordon, James and the Fat Controller
- Teresa Gallagher as Emily, Stephen Hatt and Bridget Hatt
- Kerry Shale as Diesel
- Steven Kynman as Paxton
- Matt Wilkinson as Winston and Butch
- Rob Rackstraw as Some Passengers
- Joseph May as Thomas
- Kerry Shale as Henry, Gordon and Diesel
- Rob Rackstraw as James and Some Passengers
- Jules de Jongh as Emily
- Steven Kynman as Paxton and Butch
- Matt Wilkinson as Winston
- Keith Wickham as Sir Topham Hatt
- Teresa Gallagher as Stephen Hatt and Bridget Hatt
- Reused animation from the previous episode is used depending on the fact that Gordon and the people at Kellsthorpe Road station are in the same positions as they were in that episode.
- The working title for this episode may have been "A Spot of Bother," as this name was originally listed on the Whale of a Tale and Other Sodor Adventures DVD.
- This episode marks the first of a few things:
- Stephen and Bridget's first speaking role since the fourteenth series episode, Diesel's Special Delivery:
- The first episode to feature Kerry Shale as Diesel in the US dub.
- The first episode known to become banned from airing on television, in this case, in Australia.
- This episode marks Winston's last speaking role to date.
- As Henry leaves Knapford, a variation of his sad theme from the originally composed by Mike O'Donnell and Junior Campbell is heard.
- While Henry is going backwards on the main line with his passenger train, he states that chicken pox are even scarier than rain. This is a reference to the first series episode, The Sad Story of Henry and the special, The Adventure Begins.
- In the US version, Henry's line "CHICKEN POX!!" when he sees Paxton with dirt on his face is used again when he sees Gordon with paint on his face.
- The Australian Broadcasting Corporation no longer airs this episode after receiving complaints from viewers believing the Fat Controller referring to chicken pox "as a mild disease that is nothing to worry about" was inappropriate and conveyed an anti-vaccination message, however it is still available to watch on the Whale of a Tale DVD.  
- In the UK version, when Henry is talking to Emily at Wellsworth, he says "The Fat Controller" but his mouth moves to say "Sir Topham Hatt."
- Thomas' face gets covered in mud, but immediately after that, there is nothing on his face but a small amount of dirt.
- When Henry first arrives at Wellsworth station, two children are near the brick bridge, in the foreground overlooking the station with one of Dowager Hatt's friends, but in the next shot they can be seen on the platforms.
- When Gordon arrives at Wellsworth another coach appears behind his brake coach.
- When Henry returns to Wellsworth in reverse, technically he should have arrived on the same line and platform that he was at earlier. However, he is on the opposite line and platform meaning he came from the wrong direction.
- In Paxton's final scene, his coupling rod has move backwards, disconnecting his leading wheels.
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