INFECTIOUS OR CONTAGIOUS DISEASES
Rules to be Observed in the Treatment of Contagious Diseases--What
Isolation Means--The Contagious Sick Room--Conduct and Dress of the
Nurse--Feeding the Patient and Nurse--How to Disinfect the Clothing and
Linen--How to Disinfect the Urine and Feces--How to Disinfect the
Hands--Disinfection of the Room Necessary--How to Disinfect the Mouth
and Nose--How to Disinfect the Throat--Receptacle for the Sputum--Care
of the Skin in Contagious Diseases--Convalescence After a Contagious
Disease--Disinfecting the Sick Chamber--The After Treatment of a
Disinfected Room--How to Disinfect the Bed Clothing and
Clothes--Mumps--Epidemic Parotitis--Chicken Pox--Varicella--La
Grippe--Influenza--Diphtheria--Whooping
Cough--Pertussis--Measles--Koplik's Spots--Department of Health Rules in
Measles--Scarlet Fever--Scarlatina--Typhoid Fever--Various
Solutions--Boracic Acid Solution--Normal Salt Solution--Carron
Oil--Thiersch's Solution--Solution of Bichloride of Mercury--How to Make
Various Solutions.
RULES TO BE OBSERVED IN THE TREATMENT OF CONTAGIOUS DISEASES
Every mother should know the elementary principles involved in the
treatment of contagious diseases. They are contagious because they may
be conveyed from one individual to another or because a person nursing a
victim of a contagious disease may carry that disease to another person
without having the disease herself. For this reason, certain rules have
been established by the medical profession, which experience has taught
are necessary in order to preserve the health of the community when such
diseases are prevalent.
The very first rule to which the physician will direct the mother's
attention, when there is a contagious disease, will be that the child
must be "isolated."
What Isolation Means.--Isolation means the complete seclusion of the
patient in a room by himself, so that no one will see him or come in
contact with him except the physician and the nurse or mother who will
tend him during the entire course of the disease. Isolation implies more
than it would seem to mean. It implies that every article used during
the sickness will be thoroughly disinfected before it leaves the room in
which the patient himself is isolated. Mothers must always remember that
every article used by the patient may carry the germs of the disease to
some other member of the family or to some other individual. These
articles are the clothing of the child, the bedclothes, napkins,
handkerchiefs, towels, dishes, knives and spoons, rags, the various
discharges--sputum, urine, and bowel passages--and, we may add to this
list, flies, insects, and domestic animals. Every precaution must,
therefore, be taken to safeguard any dissemination of the disease by
means of these articles.
Thorough isolation also implies that the nurse shall frequently bathe
and disinfect her person and her clothing, and that the sick-room itself
shall be carefully dusted with a moist cloth and disinfected from time
to time.
The Contagious Sick-Room.--The contagious sick-room will be prepared
in exactly the same way as the ordinary sick-room which has been
previously described. In addition, however, it will be safeguarded in
the following manner. A wet sheet will be hung up outside the door. This
sheet will be kept constantly moistened with a solution of chloride of
lime. One-half pound to an ordinary house-pail of water is the strength
of the solution to use. Every window must be effectively screened to
prevent the ingress and egress of flies and other insects.
Conduct and Dress of the Nurse.--She will remain in the sick-room all
the time unless when she takes outdoor exercise. Her dress will consist
of a long gown which will entirely cover her person from the neck to the
shoes and will be of plain, white, easily washed material, without tucks
or ruffles or adornment of any kind. She should wear an ordinary pair of
house slippers made of light leather. Her cap will be large enough to
cover and include her hair and head. When she leaves the room, she will
remove her cap, gown, and slippers, disinfect her hands in a
disinfecting solution and wash her face, neck, and hands in soap and
water. She should go directly out and in, without coming in contact with
any occupant of the home.
Feeding the Patient and Nurse.--The meals for the patient and nurse
should be left on a table outside the door of the sick-room, from which
place the nurse will then take them into the room. The utensils used for
these meals should not be used by other members of the family during the
entire sickness. After the patient and nurse have eaten, the utensils
should be placed in a chloride of lime solution for disinfection. If any
of the food is left over it should be put into a jar in which it may be
disinfected and rendered harmless before being disposed of.
How to Disinfect the Clothing and Linen.--All bed and body linen,
towels, handkerchiefs, napkins, etc., should be immediately put into a
large receptacle--a wash boiler, or tub, will answer the purpose
admirably--containing a five per cent. solution of carbolic acid in
which an adequate quantity of soft soap has been dissolved. They should
remain in this mixture for two hours, after which they may be wrung out
and taken to the laundry.
How to Disinfect the Urine and Feces.--The urine and the stools should
be passed into vessels containing a solution of four ounces of carbolic
acid to the gallon of water. This vessel should be covered and the
mixture allowed to stand for one hour, after which time it may be thrown
out.
How to Disinfect the Hands.--Any of the following solutions may be
used for disinfection of the nurse's hands: Creolin, one teaspoonful to
the quart of water; chloride of lime, one-half pound to a pail of water;
formalin, thirty-two drops to a quart of water. A basin containing one
of the above solutions should be constantly kept standing for the
frequent disinfection of the nurse's hands. After disinfection, the
hands should be washed in plain water and soap.
Disinfection of Room Necessary.--The room in which a contagious
patient is confined requires systematic attention on the part of the
nurse. Every other day all flat or projecting surfaces should be
disinfected. Mantels, window-sills, door knobs, picture moldings,
furniture, chairs, and bed-railings, should be wiped with cloths
moistened in a disinfecting solution. A suitable solution for this
purpose is one containing one ounce of carbolic acid to the quart of
water.
How to Disinfect the Mouth and Nose.--In the course of all contagious
diseases the mouth and throat of the patient and nurse should be
thoroughly disinfected as a matter of routine. It should be done at
least twice daily unless more frequent disinfection is called for
because of the nature of the disease. In measles and diphtheria, for
example, the nasal and throat conditions will undoubtedly call for more
frequent and more thorough disinfection than twice daily. This may also
apply to scarlet fever if the throat is involved as is often the case.
Pocket handkerchiefs should never be used by a patient suffering from a
contagious disease. The nose and mouth should be wiped with pieces of
gauze or cheesecloth, cut into small squares for this purpose. These
should be immediately burned after being used.
To disinfect the throat, a solution of formalin, six drops to six ounces
of water, is effective. To disinfect the nose, a solution of
Glyco-Thymoline is suitable. These applications should be made by means
of an atomizer, a different atomizer being used for the patient and
nurse.
Receptacle for the Sputum.--A cuspidor, or basin, should be constantly
kept at the side of the bed in which the patient may conveniently
expectorate. This utensil should contain the chloride of lime solution
previously mentioned.
Care of the Skin in Contagious Diseases.--As in all other sick
conditions, the skin of the patient should be bathed frequently with an
alcoholic solution. In the later stages of measles and scarlet fever it
is essential to anoint the skin while the patient is scaling. This may
be done with carbolated vaseline. Mothers should understand why this is
necessary. These diseases have a distinct rash or eruption. This
eruption practically kills the skin cells and at a certain period these
cells are cast off by the new growth of skin underneath. This process is
called scaling. In measles the scales are small, and are cast off in the
form of bran like dust. In scarlet fever, the cells adhere together and
are cast off in large scales. These scales are contagious. They are very
light and will float in the air if dry. The movement of the patient,
changing the bed clothing, etc., will waft a multitude of these
contagious scales into the air of the room and infect every article they
may land on. This would make the disinfection of the room difficult and
tedious. In order to obviate this tendency experience has taught us that
much of the difficulty and nearly all of the risk of contagion may be
overcome by rubbing some oily or sticky substance on the skin. By this
method the dust and scales are rendered heavier than the air, stick
together and will not float. During the scaling period there is a
constant itch present which irritates the little patient. By using
carbolated vaseline to anoint the skin we accomplish two purposes. The
carbolic acid in the vaseline relieves the itch, and the vaseline itself
greases the skin so that the scales remain in the bed. Each day the
nurse changes the bed-sheet, gathers the scales in the sheet and puts
all in the disinfecting solution.
Convalescence After a Contagious Disease.--Complete isolation must be
kept up until all danger from contagion is passed. In diphtheria this
period is not reached until the examination of the throat contents under
the microscope is returned negative. In diseases Which have a rash this
period is not reached until all scaling is completed. Even then, and for
a number of days or weeks, the patient may be taken out for exercise
daily, but must not be allowed to play with other children until his
strength justifies active exercise. It takes a much longer period to rid
the system of the poison of a contagious disease than most mothers
appreciate. Many children have died from heart failure after they were
considered well simply because the active exercise overtaxed the heart
before the system was wholly free from the poison of the disease.
Before the child is removed from the sick-room for the first time he
should have a disinfecting bath. This bath should be in a solution of
bichloride of mercury, the strength of which should be one part to five
thousand parts of water. The towels used to dry the patient after the
bath should be fresh and should not have been in the sick-room. He
should then be dressed in clothing which has never been in the
sick-room.
DISINFECTING THE SICK-CHAMBER
How to Disinfect a Room.--The most efficient way to disinfect a room
is by means of formaldehyde gas. This, however, requires a special
apparatus which can only be used by one familiar with the process. In
all large cities the Department of Health usually undertakes the
disinfection of rooms after any contagious disease. The next best method
is by sulphur.
When sulphur is employed it should be used in the form of powder or in
small pieces. This is placed in a shallow iron pan set on a couple of
boards in a tub partly filled with water. The sulphur is moistened with
alcohol before it is set on fire.
It is always necessary, of course, before disinfecting by any process to
make the room as nearly air tight as is possible. To accomplish this the
windows must be tightly closed, the doors locked, and the cracks and
keyhole sealed with pieces of paper or adhesive paper. The room should
remain closed for six or eight hours, after which it should be
thoroughly aired for several days.
The After Treatment of a Disinfected Room.--The walls, ceiling, and
all flat surfaces, such as mantels, window-sills, etc., should be washed
with a fresh chloride of lime solution. The floor should be scrubbed
with a four per cent. soda solution. All carpets and curtains, if any,
should be removed, taken to a vacant lot and thoroughly beaten and then
exposed to direct sunlight for a number of hours. The room should then
be well aired again for a couple of days before it is again occupied.
How to Disinfect the Bed Clothing and Clothes.--The surest way is to
boil them for half an hour; otherwise they may be left in the room while
it is being disinfected. Spraying the clothes with a spray of
formaldehyde is an effective way of disinfecting them.
MUMPS: EPIDEMIC PAROTITIS
Mumps is a contagious disease. It is most common between the fourth and
sixth years. Infants are rarely affected. The disease is not very
contagious, direct contact being necessary to communicate it. Every case
should be isolated for a period of three weeks from the beginning of the
disease.
The seat of the affection is the parotid gland which is located in front
of and on a level with the ear. One or both glands may be affected at
the same time or one may follow the other in succumbing. The duration of
the disease from the time the swelling becomes noticeable is about ten
days. It is contagious for a week after the swelling subsides. The
period of incubation is from one to three weeks.
Symptoms.--In the majority of cases the first symptom is the swelling
and the discomfort which it causes. In more severe cases the child feels
sick and is listless for from twenty-four to forty-eight hours. There
may be a headache, vomiting, pains in the back and limbs, and fever.
There is pain in the swelling which is increased by movement of the jaws
and by pressure. The degree of the swelling varies with the severity of
the attack. It may be very little or it may be so great as to completely
distort, and render unrecognizable, the face. It must be remembered
that, though mumps is not regarded as an important or dangerous disease,
it may assume dangerous characteristics.
We sometimes see distressing complications with mumps. In boys,
orchitis, or inflammation of the testicles, occasionally occur. In
girls, ovaritis, or inflammation of the ovaries may be present. These
complications may be avoided by keeping the patients in bed.
Treatment.--Keep the child in bed until the fever is gone. Keep him
in the house for one week after the swelling has entirely subsided. He
should be put on a liquid diet while the fever lasts. The bowels should
move each day.
The mouth should be kept clean by an antiseptic mouth wash. If there is
much pain in the swollen gland, warm, wet dressings give the best
results. Sometimes it is advisable to paint the gland with belladonna
ointment. If it is not very painful, the most comfortable way to dress
the gland is simply to place over it a large pad of absorbent cotton
held in place by a broad strip of flannel cloth.
CHICKEN POX. VARICELLA
Chicken pox is an affection almost entirely special to children, in whom
it may be observed from their first year, although it is especially
frequent from the ages of two to six. It appears often in the epidemical
form and spreads by contagion.
Some doctors are inclined to regard varicella as a very attenuated form
of smallpox, hence the name "chicken pox," by which it is popularly
known. This opinion is based merely on the analogy between the two types
of skin eruptions and the coincidence sometimes observed between two
epidemics of smallpox and chicken pox. But the theory falls on
considering that, on the one hand, chicken pox offers no safeguard
against infection by smallpox and does not prevent the effects of
vaccination, and, on the other hand the disease may occur in children
who have been vaccinated or who have had smallpox. Chicken pox, too,
differs essentially from smallpox in the course of its development.
After a period of incubation, extending over a fortnight, chicken pox
becomes apparent by such symptoms as slight shivering, extreme fatigue
and a general but not very intense condition of fever. In less than
twenty-four hours small pink spots will appear on the skin, and these
after a few hours are topped by a vesicle, and the next day the whole
rash shows a vesiculous appearance.
The vesicles are sometimes small and pointed, sometimes more voluminous
and globular in form. They are filled with a limpid or a slightly
yellowish liquid. Their base is sometimes surrounded by an inflammatory
ring. By the third day the contents of the vesicle has become thicker
and tends to become purulent. On the fourth day desiccation commences,
and the vesicles shrivel and shrink in and form small brownish scabs,
which fall about the eighth day. Frequently the child will scratch them
off with the finger nails before they are entirely desiccated. The
vesicles leave small reddish spots, which generally disappear gradually,
almost always without a scar.
An eruption of chicken pox does not burst out all over the body at once,
but appears in successive rashes. It is not confined to any special
parts of the body. It may begin and spread at the same time from the
face, the trunk of the body or the limbs. A dozen pimples may be seen
the first day, while three or even ten times as many may be visible the
next day, and so on for several days in succession.
Sometimes the vesicles appear on mucous membrane at different parts--the
mouth, tongue, soft palate and tonsils--and may also invade the
conjunctiva and cornea, or the larynx, where they will set up
laryngitis.
Owing to the very contagious nature of chicken pox, the first thing to
be done is to provide for the complete isolation during a period of
twelve to fifteen days of all patients attacked by the disease.
The treatment of the disease is solely a matter of hygiene. The more
severe the fever the stricter the diet should be, and in the case of
great fever, the diet should be restricted to broth and milk. If there
is no fever the child need not be placed on any special diet.
If the intestines are sluggish, they may be stimulated by administering
a dose of castor oil. It is advisable to make the patient rinse his
mouth two or three times a day with a mouth wash. It is also well to
apply a lotion around the eyes and face, consisting of two per cent.
boracic acid solution with the chill taken off. Finally, in order to
prevent the child scratching the sores and the consequent danger of
inoculation by the finger nails, it is a good practice to rub a small
amount of carbolated vaseline over the itching parts. It is frequently
found necessary to have the little patient wear white woolen gloves to
prevent scratching and infecting the sores. If a child scratches the
sores on the face it will leave an unsightly mark which will stay for
the rest of its life.
The child, of course, should not be allowed to rejoin his playmates
without having had a good bath, and having had his clothes completely
disinfected.
INFLUENZA: LA GRIPPE
The most important feature with reference to influenza in children is
its very active tendency to develop complications. These complications
generally affect the respiratory tract. So we find in children suffering
from grippe an easy disposition to get bronchitis or broncho-pneumonia.
The younger the child the greater the danger.
The disease itself, so long as it remains an uncomplicated influenza, is
not of much importance or severity. The lesson to be learned, therefore,
is to treat the disease with respect and take every precaution to avoid
the possibility of developing a complication.
La Grippe is a highly contagious disease. It prevails epidemically, and
after an active epidemic it may remain in the vicinity for a number of
years. It is more frequently seen in the late winter months and early
spring. The poison of the disease clings to clothing and apartments as
well as to railroad and street cars. The germ is found in the sputum and
in the nasal secretions.
Sneezing is one of its symptoms and it is one of the ways by which the
disease is spread around. Children should never be brought near an adult
suffering from influenza. One attack does not render the patient immune
to a subsequent attack as is the case with most of the contagious
diseases. The reverse is the rule with La Grippe because one attack
favors the development of another attack. It is a common experience for
many people to have influenza every winter or spring.
Symptoms.--If a child "catches" grippe, it becomes quite sick
abruptly. There is usually chilliness, pains in the muscles all over the
body, more or less fever, sometimes nausea and vomiting. If the attack
is a more severe one, the prostration is more marked, the temperature
higher and the signs of shock and poisoning of the system are more in
evidence. A child a few months old can get influenza so severely as to
cause collapse and death in thirty-six hours. As a rule the type of
grippe most common in infancy is of a very mild character. It lasts
about a week. Children may be a little slow in convalescing and it may
be three or four weeks before they regain their health.
Complications.--As has been intimated, the most frequent complication
is bronchitis and the most fatal one is broncho-pneumonia.
A congestion of the entire mucous membrane of the respiratory tract,
producing a nasal discharge, a sore and inflamed throat, pains and a
feeling of compression, with a cough in the chest, may accompany the
disease.
Gastric symptoms, with vomiting, intestinal disturbance, diarrhea, with
or without mucus and blood, are quite common in some epidemics.
Not infrequently we have numerous cases in which the ear seems to be the
vulnerable part. As a consequence running ears have to receive most of
our attention. When the ears are affected, the glands of the neck become
inflamed. They swell up and add considerable to the discomfort of the
little patient.
Treatment.--Cases of influenza should be isolated. Children should be
put in a room by themselves and the other children of the family should
not be permitted to see them. The rooms should be disinfected after the
case is over. As complications are the dangerous element in grippe, we
should try to prevent them. This can be best done by promptly putting
the child in bed, making him comfortable, opening his bowels by castor
oil or calomel. He should be made to drink hot lemonade. He should be
kept on a light diet from which meat and vegetables are excluded.
The above treatment will usually suffice in the ordinary uncomplicated
grippe. If complications arise they must be treated according to the
conditions.
It is well to remember that the degree of prostration following a rather
severe attack of grippe is out of all proportion to the extent of the
disease. These little patients sometimes suffer considerably and do not
regain their strength promptly. Experience has taught us that the best
thing to do is to send them away. A change of climate will do wonders
for them, more quickly and more thoroughly than all the medicine we can
give them at home. The seashore is particularly good for them.
DIPHTHERIA
Diphtheria is an acute, specific, infectious, communicable disease. It
affects the tonsils, throat, nose, or larynx. It is most frequently seen
in children between the ages of two and five years, though it may appear
at any time during life. The two sexes are equally liable to it. The
same person may have the disease twice or more times at different ages.
Children suffering from disease of the nose or throat are more likely to
get it than are others. Such diseases are cold in the head with running
nose, catarrh of the nose and throat, inflammation of the mucous
membranes of the nose or throat.
Diphtheria may occur at any time of the year, though it is more frequent
during the cold months. The incubation, or the length of time between
exposure to the disease and the development of the symptoms, is between
two and five days. In its mild form the disease may be present without
giving any constitutional symptoms. In its severe form, however, it is
one of the most dangerous diseases of childhood. In large cities it is
present all the year round with more or less frequent outbreaks in the
form of local epidemics. In the country it is only seen in its epidemic
form. It does not arise without a cause, that is, there is always a
preceding case from which an epidemic springs, though it is not always
easy to trace the connection. The child inhales the bacilli which cause
the disease with the air it breathes. The bacilli may lodge on toys or
other articles from which the child gets them. Direct infection is
usually the mode of communication through which a child obtains the
disease. The saliva and mucus from the nose contain the bacilli in large
quantities and if a patient coughs or sneezes they are expelled in this
way and infect others. Frequently a child suffering from a mild form of
diphtheria may attend school and infect others without it being known
that the child has the disease.
Symptoms.--The symptoms vary with the severity of the attack. There
are mild cases, as has been stated, that give no constitutional
symptoms. There may be a small amount of local disturbance in the throat
or nose and there may be some membrane present, but, for some reason,
there does not seem to be any absorption of the poison into the system
and the child escapes the systemic disturbance. Even as a local
condition these cases vary. There is always a fever at the beginning,
but the child never seems sick enough to go to bed. If the throat is
examined it will be found to be red and slightly inflamed, there may be
spots on the tonsils, or there may be a gray film over them. There is no
discharge from the nose and the child does not complain of an excess of
mucus from the throat. The spots may last for a week and then disappear.
These cases are difficult to diagnose without making a culture, and if
the physician insists upon keeping the child confined to bed while
apparently well the family as a rule object, though it is absolutely
necessary. These are the cases that do great harm in school, and no
mother should object if the physician insists in taking preventative
measures to stop an epidemic if the bacilli have been found in the
child's throat. She should rather feel thankful that the child escaped
so easily.
Since the introduction of antitoxin we do not see the severe cases now,
so that a description of them would not be of any use in a book of this
character. Mothers should, however, know that it is absolutely criminal
to take any chances with a "sore throat." Antitoxin is a prompt and an
absolute remedy if used soon after the onset of the disease. It is more
sure if used the first or second day, still reliable the third day, but
its efficacy diminishes the longer we postpone its use from the date of
the onset of the disease. When, therefore, a child complains of being
sick and states that its throat hurts, medical aid should be at once
sought.
The disease may develop in one of two ways. It may begin as a slight
indisposition for a day or two, and perhaps some soreness of the throat.
The fever may be slight. The child will continue to be sick despite any
treatment given and will get slowly worse until the fourth or fifth day,
when it will be impossible to mistake the condition.
At other times the disease begins abruptly. The child complains of being
sick. It may vomit, or suffer from headache, chilly feelings, and a
fever. The glands in the neck may swell and cause considerable
disturbance. There is, as a rule, an abundant discharge from the nose
and there is an excess of mucus in the throat. Membrane is seen in the
throat. It may cover the tonsils and spread over the entire throat
cavity, or it may extend up into the nose and over the roof of the
mouth. All the parts are much swollen and breathing is interfered with,
sometimes seriously. If the attack is very severe there is an active
absorption of poison going on from the throat which soon renders the
little patient intensely sick. There is marked weakness and prostration,
the circulation becomes poor, the pulse rapid and the child falls into a
stupor.
The physician will, of course, have taken complete charge of the case
before the patient has gone thus far. The nursing of the case, which may
fall to the mother if no trained nurse is present, is most important.
She should preserve absolute cleanliness of herself and of the sick
room. She should never eat or sleep in the same room with the patient,
and should use a gargle, which the physician should prescribe,
frequently during the day. She should dress simply, so that whatever is
worn can be changed often and washed easily. Every article of furniture
must be taken out of the sick room that is not absolutely essential in
the care of the case. If toys are allowed they should be burned as soon
as the child is tired of them, never left around the house after the
case is over. The room should be a large one and it should be thoroughly
aired each day. The floor should be washed each day with a solution of
bichloride of mercury, and all dusting should be done with a wet cloth.
The bed linen and any rags or handkerchiefs used should be treated as in
scarlet fever. All vessels in which the patient expectorates should have
an antiseptic in them. The room must be disinfected after the case is
over.
The patient must be kept in bed during the entire attack. He must not be
allowed to even sit up in bed until the physician gives him permission.
This is a very important essential in the treatment of this disease, and
the nurse must be held responsible for the conduct of the patient in
this respect. Because of the character of the poison, there is a
tendency to paralysis of the heart, and frequently children have been
allowed to sit up too soon only to fall back dead in bed. The same thing
has occurred later in the disease when children have been allowed to
play too heartily before the poison had an opportunity to completely
eliminate itself. Nursing children should be fed on breast milk pumped
from the mother, but they must not nurse it themselves. Older children
can take milk and should depend upon it mostly. The physician will give
any other special directions that he may think necessary, the duty of
the mother being to see that they are faithfully carried out.
WHOOPING-COUGH
Whooping-cough is usually seen in young children. It may, however,
affect a person at any age. It is contagious. During infancy it is one
of the most fatal diseases. During adult life it is a dangerous
condition, while in childhood it is simply regarded as a mildly
contagious disease.
It is most contagious during the catarrhal stage,--the first ten days.
Children suffering from whooping-cough should not be allowed to mix or
play with other children for two months. After an exposure to the
disease it takes about fourteen days for a case to develop. The danger
of whooping-cough is the tendency to develop pneumonia or bronchitis.
Symptoms.--During the first ten days the child acts as if suffering
from an ordinary catarrhal cold with cough. This is called the catarrhal
stage. There is no way of telling that whooping-cough is present until
the child whoops. Most children do not whoop until the expiration of the
catarrhal stage, though a very few do from the beginning of the disease.
If a child is treated for an ordinary cold with cough and does not
respond to treatment, and whooping-cough is epidemic, it is fair to
assume that whooping-cough has been contracted. When the cough shows a
distinct tendency to be worse at night it is further proof of this
assumption.
When they begin to cough in paroxysms, and whoop, the second, or
spasmodic stage begins. These fits of paroxysmal coughing are much more
severe than spells of ordinary coughing. These may only be three or four
attacks daily, or the child may have from forty to fifty such attacks.
When children feel these attacks coming on they seek support, holding on
to chairs or they stand by the mother's knee. The coughing is explosive,
rapid, and forceful, the child fails to catch its breath and is
compelled to take a deep inspiration, which is the whoop; it then goes
on coughing more. The face may become purple, the eyes protrude, and the
veins of the face swell up. Near the end of the attack the child raises,
or vomits a mass of stringy, glutinous mucus. After it is over the child
is exhausted, there is a more or less profuse perspiration, and he may
be quite dazed. These attacks are, as a rule, more frequent and more
severe during the night. This stage lasts about one month and is then
followed by the stage of decline, during which the disease subsides into
what appears as an ordinary bronchial cold.
It is quite common for these children to get relapses, especially during
inclement winter weather, and go on whooping for two or three months
longer. Their vitality suffers because their sleep and nourishment is
interfered with, and they become nervous and difficult to manage.
Treatment.--Inasmuch as there is no remedy known that will cure
whooping-cough, the best we can do is to render the patient physically
efficient to stand the severe strain of coughing, which is the worst
feature of the disease. Experience has taught us that those children do
best who spend their entire time out of doors. We, therefore, advise
parents to encourage their children to play in the open air. There is no
exception to this rule, even in winter weather, unless it is
particularly inclement. If the weather is wet or raw, or if the child
has bronchitis, or is running a fever, it would be more safe to keep the
child indoors, in a well-aired room, until the temporary conditions pass
over, when they could again resume the open-air treatment.
Naturally delicate children if under two years of age should not risk
staying out of doors too much in very cold or raw weather, even if not
suffering from any of the above complications.
The bedrooms of children suffering from whooping-cough should be large
and thoroughly aired day and night.
The nourishment in these cases is of great importance. They should be
carefully fed, and if they vomit with the paroxysms of coughing, they
should be fed small quantities frequently. Any form of digestive
disturbance is very apt to accentuate the frequency of coughing. A fluid
diet of milk is the best. Milk punches aid in keeping up the strength;
malted milk and eggs beaten in milk are nutritious and easily digested.
So far as internal medication is concerned, I have found pertussin to be
the most efficacious remedy. If it is begun early and in sufficient
dosage, it not only favors an early termination of the disease, but it
lessens the frequency and the severity of the paroxysms. If it is
suspected that the child has been exposed to whooping-cough, pertussin
may be given during the catarrhal stage with the advantage that it will
render the whole course of the disease milder. If it is given during the
course of an ordinary catarrhal cold, it will in most cases be as
effectual as any ordinary cough remedy. The dosage should be large
enough to produce results. I have found a teaspoonful every two hours
to a child of three years to be the average dose. In older children I
give two teaspoonfuls every three hours. It is necessary to continue its
use throughout the disease. The taste of pertussin is pleasant and young
children take it willingly.
When the disease is inclined to a protracted course, or when the cough
does not subside, especially during unfavorable weather, it is of great
importance to send the child away. A change of climate, preferably to
the seashore, even for a short time, will act like a charm, and will
cure the cough of whooping-cough quicker than any other possible
measure.
MEASLES
Measles is the most widely prevalent, eruptive, contagious disease. With
few exceptions, every human being "gets" measles. As an uncomplicated
disease it is never fatal, and is not even regarded as dangerous.
Because of this characteristic, however, parents are neglectful and
complications occur, and these frequently prove fatal. One attack
renders the patient immune. It is very highly contagious and spreads
with great rapidity among those who have never had it. It is not
possible to carry the disease any great distance by a third person or by
means of living objects. It does not, however, cling to clothing or
other objects as long as scarlet fever. Its period of incubation is from
eleven to fourteen days.
Symptoms.--The symptoms develop gradually. A severe cold in the head
is the first and most characteristic symptom of the disease. There is a
discharge from the nose, swollen and watery eyes, sneezing and a hoarse,
harsh cough. The patient may complain of the throat being painful and
examination will reveal a general congestion of the parts. There are
also headache, lassitude, pains in the back, and there may be vomiting
and diarrhea. Children in the early stages of measles are tired and
sleepy.
Koplik's Spots.--Three or four days, in rare cases somewhat longer,
before the appearance of the rash there appears on the mucous membrane
of the cheeks small, bluish white, or yellowish white points, the size
of a small pin head. These points are surrounded with reddened areas
which give the appearance of a general rash with fine white points upon
it. These points resemble milk particles. They adhere firmly to the
mucous membrane and when an effort is made to remove them it is found
that the underlying surface is ulcerated and excoriated.
The Koplik spots are not of much value to the mother other than that
they may be relied upon to indicate the coming disease with which they
child is affected. Physicians look for them as an aid in diagnosis
before the rash would of itself indicate the disease.
The rash appears on the third, fourth, or fifth day of the disease. From
the day of the infection to the outbreak of the rash about thirteen days
intervene. It is seen first at the roots of the hair on the forehead,
behind the ears or on the neck. It may be seen first on the cheeks. The
beginning rash appears as small, dark red, dull spots. At first there
are only a few, but they soon become more numerous, they join together,
and soon the surface looks inflamed as if entirely covered with the
rash. The rash covers the entire body, including the soles and palms. In
twenty-four hours it is at its height on the face. It spreads downward
like a wave, first the face, then the neck and chest, then the abdomen
and later the legs. By the time it invades the legs it has begun to fade
on the face. It fades slowly in the order of its appearance. Its
duration is about four days.
The skin is swollen; it burns and itches. The eyes are swollen and red
and intensely sensitive to light. There is usually a muco-pus discharge
from them. The cough is invariably an annoying feature. The fever is
high and reaches its highest point when the rash is at its height. As
the rash fades the fever subsides.
When the rash fades, the patient begins to "scale." The scales of
measles are fine, like bran, never in large patches like the scales of
scarlet fever. The amount of the scaling varies. It may be quite
considerable or it may be so small as to be overlooked.
Complications.--The most important and by far the most frequent
complication of measles is broncho-pneumonia. There may be various
conditions affecting the stomach, bowels, throat, ears, bronchi, and the
nervous system, which may accompany the disease but are seldom of a
serious or important character.
Treatment.--Measles runs a certain course and will run that course, no
matter what we may or may not do. We cannot stop it, or shorten it, or
lessen its severity. We can only hope to make the patient comfortable
and to prevent the development of complications.
The child should be put in bed and kept comfortably warm but not too
warm. The room should be kept at the ordinary temperature of the sick
room, 68° to 70° F. It should be darkened but not dark. The food should
be fluid and given regularly. The child may be given all the cool,--not
cold,--water it wants to drink. The bowels should be kept open daily. If
constipation occurs an enema may be given. The eyes must be carefully
watched and washed every hour or two during the day with a boracic acid
solution. If the cough is distressing, it may be rendered less
distressing, though we cannot hope to stop it until the disease has run
its course. The restlessness, headache and general discomfort can be
much modified by suitable remedies. If the itching is acute, the body
can be rubbed with carbolated vaseline. When the rash subsides and the
patient is free from fever a daily warm bath should be given in order to
facilitate scaling.
Should complications arise they should be promptly cared for by the
attending physician.
SUMMARY:--
1. Measles is the most prevalent infectious disease of childhood.
2. The danger of measles has been and is underestimated. Because of
its prevalency many mothers treat it with less respect than they
should, with the result that fatal complications occur, or the
future health of the child is permanently injured.
3. Children with measles should be put in bed and kept in bed and
treated as directed above.
The following rules have been formulated by the Department of Health of
New York City, with reference to measles, and embody precautions that
should find general observance:
1. All children in the family must be promptly excluded from school
attendance.
2. Careful and continued isolation of the patient must be enforced
until the case is terminated and fumigation has been ordered by the
medical inspector of the Department.
3. All secondary cases must be reported even if the first case is
still under surveillance of the Department of Health.
4. Suspected cases must be treated as contagious cases until a
sufficiently long observation has shown that the patient has a
non-contagious disease. All cases will be considered as measles, if
so reported. Any change in the original diagnosis must be made in
writing to the Department of Health and must be confirmed by a
diagnostician.
5. Physicians must not order the removal of patients to the
contagious disease hospital, or elsewhere, in cabs or other
vehicles, but must notify the Department of Health and the removal
will be effected by a coupé or ambulance of the Department.
6. Whenever there is a case of measles in rooms in the rear of, or
communicating with, a store, the inspector is required to have the
store closed at once, or to report the case for immediate removal
to the hospital.
7. A case of measles must not be removed from one house to another,
or even to a different apartment in the same house, without the
permission of the Department. Such removal is in direct violation
of the provisions of the Sanitary Code.
8. No case of measles shall be discharged from observation until
the Department has been notified, the case examined by an inspector
to see if desquamation is entirely completed, and the premises
ordered fumigated. This examination by the inspector is necessary
because the Department of Health must have official information as
to the completion of desquamation before a child is dismissed from
observation. Other people with children demand this protection. At
no other time is the inspector allowed to examine the patient. In
any case, however, where isolation has not been maintained and it
becomes necessary to remove the patient to the hospital, a
diagnostician will make an examination.
It is recommended that physicians provide a special washable gown
for each case of measles. This gown should be put on before
entering the sick-room and taken off outside the sick-room as soon
as the visit is completed. The gown should be kept in a closet or
suitable place, separate from all other clothing, and the gown, and
the closet should be fumigated after the termination of the case.
10. In private houses only fumigation may be performed under the
supervision of the attending physician; provided he follow
accurately the directions given in the following rules and
regulations. Upon request a blank will be provided upon which he
must state the manner and extent of the work performed under his
orders and supervision. If satisfactory to the Department, this
will be accepted in place of fumigation by the Department. It is
essential, however, that he should know that the disinfection has
been efficiently carried out.
In every case of fumigation the following regulations must be complied
with:
All cracks or crevices in rooms to be fumigated must be sealed or
calked, to prevent the escape of the disinfectant, and one of the
following disinfectants used in the quantities named:
a. Sulphur, 4 lbs., for every 1,000 cubic feet of air space, 8
hours' exposure.
b. Formaline, 6 oz. for every 1,000 cubic feet of air space, 4
hours' exposure.
c. Paraform, 1,000 grains for every 1,000 cubic feet of air space,
6 hours' exposure.
The following disinfecting solutions may be used for goods, which
are afterwards to be washed:
a. Carbolic acid, 2 to 5 per cent.
b. Bichloride of mercury, 1-1,000.
SCARLET FEVER. SCARLATINA.
Scarlet fever is an acute, contagious disease. It begins abruptly. The
child may have a severe attack and be quite sick from the beginning, or
he may have a mild attack and not be very sick. Usually the fever rises
rapidly, the child vomits and complains of a sore throat. If the attack
is very mild the throat symptoms may not cause any distress. Frequently,
about the third day, there are patches on the tonsils. Prostration may
be profound if the fever is very high. Convulsions and diarrhea are
sometimes present in very young patients. It takes from two to six days
to develop scarlet fever from the time the child is exposed to it. The
disease may be caught at any time, but it is most contagious during the
time the patient is scaling. It is not as contagious as measles. Some
children seem to escape even though directly exposed to it. It is more
frequent in the fall and during the winter, and it is more severe during
the latter months.
Eruption.--The eruption appears at any time after twelve hours. It may
not, however, appear before the third or fourth day. It lasts from three
to seven days, and only takes a few hours to cover the whole body after
it is first seen. The rash is first seen on the neck or chest; it
appears as a red, uniform blush, but, when examined closely, small
reddish spots may be seen all over it. If the rash is very faint and of
a doubtful character a hot bath may bring it out. A bright red,
well-developed rash is a sign of good heart action. In the event of
heart failure, the rash fades quickly. Itching is a constant symptom
after the rash is fully out.
About the eighth day the rash begins to scale or desquamate. It begins
on the neck and chest. It takes from one to three weeks to scale
completely, from the time it begins to peel. The hands and feet are the
last spots to scale.
It must always be kept in mind that mild cases are just as contagious as
severe cases, and that a mild case may cause in another person a very
severe attack.
The throat may be mildly affected or it may be the most troublesome
feature of the case. It is red and swollen and the child complains of
pain during the act of swallowing. Patches may be seen on the tonsils on
the third day. There is usually a discharge from the nose and this
discharge may be contagious. While the fever is high, the child is
restless, complains of thirst, and may be slightly delirious.
One attack is usually all a child has during life, though there are
exceptions to this rule. Complications are quite frequent with scarlet
fever. Inflammation of the ears and kidneys is most often met.
Measures to be Taken to Prevent Spread of Disease.--Every case, no
matter how mild, should be isolated for four weeks. Many cases must be
isolated longer,--until scaling is complete. Children should not play
or sleep with other children for three or four weeks after all symptoms
have been absent. Other children in the family, who have not been
exposed, should be sent away. All clothing should be changed and washed
in soap and water and then boiled in a carbolic solution. The nurse
should not mix freely with other members of the family. The sick room
should be kept clean, and well aired. It should be dusted with a wet
cloth, and this should afterwards be burned. There should be no
furniture, or hangings, or pictures in the room other than are
absolutely necessary. The room should not be used after the case is over
until it is thoroughly and completely disinfected.
During the period of scaling the patient should be rubbed all over with
carbolated vaseline. This allays itching and prevents the scales flying
around. The bed sheet can be taken off daily with the scales in it, and
immediately put in carbolic water and boiled.
Treatment.--Inasmuch as scarlet fever is one of the most dangerous and
one of the most treacherous diseases of childhood, we cannot afford to
take any chances with it. Every child with scarlet fever should be put
in bed, and kept there during the entire illness,--that is, from four to
six weeks. Light, and the free circulation of fresh air are absolutely
necessary for the proper care of a scarlet fever case. The child should
be clothed only with the usual night gown and a light undershirt. No
extra wraps or blankets are required.
The diet should be reduced in quantity and strength. The bowels should
move daily. If anything is necessary to accomplish this, citrate of
magnesia is quite satisfactory. There is no special medicine for the
treatment of this disease. Often it is not necessary to give any. Good
nursing is more essential, and with proper attention to the bowels,
diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result
favorably. Quiet is essential. Consequently, two persons at a time
should never be allowed in the room with the little patient.
The family physician will prescribe whatever medicine is necessary in
his judgment, and will meet any complication as it arises.
TYPHOID FEVER
Typhoid fever is an acute infectious disease. It is rare in infancy.
After the fifth year it is more common. It is caused by drinking
infected water or milk. It is not a serious disease in childhood, rarely
being fatal.
Symptoms.--It may begin suddenly or it may come on slowly. If
suddenly, the child develops what appears to be an attack of
indigestion, has fever, vomiting, and is prostrated. In cases developing
slowly the child complains of being tired, has a headache, nausea, and
fever. Vomiting is the suggestive and important symptom.
Diarrhea is usually present. Constipation, however, may accompany the
entire illness. Children may not complain of an excess of gas as do
adults. The abdomen is tender. The typhoid eruption is rarely seen in
children. They lose flesh steadily and then strength diminishes rapidly.
Headache and delirium at night are quite common, and the child is dull
and indifferent, and often in a state of semi-stupor.
In order to tell definitely whether the child has typhoid, it is
necessary to make a blood examination. There are so many intestinal
conditions in children that simulate typhoid, that a blood examination
is imperative.
Treatment.--The patient should remain in bed during the time fever is
present and for a few days after. A fluid diet, preferably milk, is the
most suitable means of nourishing the child. It may be diluted or given
plain according to the age of the patient. Water is essential and should
be given freely.
The discharges of the patient should be thoroughly disinfected in a
solution of carbolic acid, 1-20. All clothing and bed linen should be
boiled for two hours. If the fever remains high cold sponging is
advisable. The attending physician should instruct regarding this
feature, as some children do not stand cold applications well.
The average duration of the disease is about six weeks.
How to Keep From Getting and Spreading Typhoid Fever.--Typhoid fever
is a communicable disease, but, if certain precautions are taken, its
contraction and spread can almost certainly be prevented.
The disease is caused by a specific germ known as the typhoid bacillus.
These germs are found in the excreta (stools and urine) of persons ill
with typhoid fever.
Failure to properly disinfect these excreta and carelessness in the care
of persons ill with typhoid fever lead to the transmission of the
disease from the sick to the well by the infection of water, milk or
food with the typhoid bacillus or by direct contact.
The disease is contracted by taking into the mouth in some form the
discharges from some previous case. There is no other way. It is,
therefore, a disease of filth and someone is at fault somewhere for
every case of typhoid fever that occurs.
Bad sanitary conditions, such as lack of drainage, open cess-pools,
sewer gas, decaying vegetable matter, etc., may favor the contraction of
the disease, but cannot cause it unless the specific germ, the typhoid
bacillus, is present.
The water supply of a community becomes infected by the entrance into it
of the excreta (stools and urine) of persons suffering from typhoid
fever.
Milk (in which typhoid bacilli grow and multiply very rapidly) usually
becomes infected by washing out milk cans with water in which these
bacilli are present, or from the presence of the bacilli on the hands or
persons of those handling milk. Oysters spread the disease when they
have been "freshed" in water rich in sewage and containing the typhoid
bacillus. Flies, whose bodies have become foul with typhoid excreta, may
infect food, milk, etc. Those who take care of typhoid patients may
contract the disease if they do not at once disinfect their hands after
handling the patient, or clothing or bedding which has become soiled
with the discharges.
How to Keep From Getting Typhoid Fever.--If the chance of infection is
to be reduced to a minimum, all drinking water, concerning the character
of which there may be the slightest doubt, should be boiled, and all
milk, the handling and care of which is not absolutely beyond suspicion,
should be pasteurized or boiled. All food supplies (meat, milk,
vegetables, etc.), should be carefully protected against flies, and
flies should not be permitted access to the sick-room, the kitchen nor
to the room in which the meals are eaten. Bathing at all beaches which
have sewers emptying in their immediate vicinity should be strictly
avoided. In the majority of cases it is probable that the system must be
slightly below par in order that the disease may be contracted;
therefore, all indigestible food, green fruit, etc., which may set up
indigestion or diarrhea, and so render the system more susceptible to
infection, should be avoided. In addition, the elementary rules of
cleanliness and hygiene, both as to the house and person, should be most
strictly observed. No member of a household in which a case of typhoid
fever occurs should take food in any form without previously washing the
hands.
Typhoid bacilli enter the body only through the mouth. If sufficient
care be taken to prevent their entrance, the contraction of the disease
can be absolutely prevented.
How to Keep From Spreading the Disease.--In order to protect
themselves and others in the household, persons caring for or in any way
coming into contact with a case of typhoid fever must constantly bear in
mind that the secretions and excretions (urine, stools, etc.), of the
patient contain typhoid bacilli and are capable of transmitting the
disease to others. The person who nurses the patient should not do the
cooking for the family. The bedding used by the patient should be washed
separately from that used by others. Special dishes, plates, knives,
forks, etc., should be kept for the use of the patient alone, and should
be washed separately and thoroughly. Particular attention should be paid
to immediate disinfection of the stools and urine of the patients until
the restoration of health is complete.
The urine is especially dangerous. It may look entirely normal and yet
contain typhoid bacilli for some time after recovery is apparently
complete. In a few instances the typhoid bacilli may persist in the
stools for weeks or months after recovery. Such persons are called
"typhoid carriers," and constitute a grave menace to the health of the
community. The best disinfectants are carbolic acid and freshly slacked
lime; both are effectual, cheap and easily obtained. Urine or stools to
which has been added one-third of their volume of a solution of one part
of carbolic acid to twenty parts of water are, as a rule, sufficiently
disinfected in half an hour, provided the mass of the stool is broken up
and thoroughly mixed with the solutions. The best method is to keep the
urinal of bed-pan partly filled with the disinfecting solution at all
times. In this way any germs present in the urine or stools are almost
instantly destroyed. Stools and urine should never be thrown out on the
ground. If no system of drainage is at hand, they should be very
thoroughly disinfected and emptied into a hole in the ground and covered
with earth. All persons nursing or handling the patient in any way
should be careful to wash their hands very thoroughly with soap and
water before leaving the sick-room. They should never, while in the
sick-room, touch any article of food or put their hands to their mouths.
Careful observation of the above suggestions and precautions will almost
certainly prevent contraction of typhoid fever or the spread of the
disease.
VARIOUS SOLUTIONS
Boracic Acid Solution.--In the previous pages mothers are frequently
told to use "a saturated solution of boracic acid." A saturated solution
means that the water in the solution has dissolved all of the product
that is put into it that it is capable of dissolving. When boracic acid
is put into water, the water will dissolve it up to a certain point; if
you add more the boracic acid will not dissolve; it will float if it is
in the form of powder, or it will remain at the bottom of the glass if
it is crystal--in other words the water is saturated to its limit and
the solution is known as a saturated solution.
The strength of a saturated solution of boracic acid is as follows:--
Boracic Acid Ounces 1-1/2
Hot Sterile Water Pints 2
which means that 2 pints of hot water will completely dissolve 1-1/2
ounces of boracic acid. If any more boracic acid is added the water
will not dissolve it because it is already "saturated." Inasmuch,
however, as boracic acid is harmless, it is perfectly safe to use the
liquid part of a solution which contains some undissolved acid.
A saturated solution is used in the eyes after it is strained.
Normal Salt Solution.--A normal salt solution is made in the following
proportions:--
Sodium Chloride (ordinary table salt) Grains 128
Sterile Water Pints 2
Normal salt solution is much used in irrigating the bowel. A mother may
safely use it in the proportion of one heaping teaspoonful to two quarts
of water--two quarts being the size of the ordinary fountain syringe.
Carron Oil.--Lime water and raw linseed oil, equal parts. This mixture
is much used in burns. It should be made fresh.
Thiersch's Solution:--
Salicylic Acid Drams 1/2
Boracic Acid Drams 3
Sterile Water Pints 2
Thiersch's solution is a good, mild antiseptic solution, or wash.
Solution of Bichloride of Mercury (1 to 1000):--
Bichloride of Mercury Grains 15
Common Salt Grains 15
Sterile Water Pints 2
Bichloride of mercury is one of the most powerful and poisonous drugs.
Solutions made from it should never be used without special directions
from a physician. In much weaker solutions than the above it is one of
the best antiseptic washes known. It is used to disinfect wounds, for
douches, and for various other purposes, but always by special direction
of a physician.
Other solutions.--Frequently mothers are directed to use solutions in
the proportion of 1 to 500, or 1 to 1000.
This means that there will be one part of the drug, or of the liquid
medicine, to 500, or 1000 parts of water. For example if you were asked
to make up a solution of bichloride of mercury in the strength of 1 to
4000, you would use one ounce of bichloride of mercury to four thousand
ounces of water, or one grain of the mercury to four thousand drops of
water,--one grain being equivalent to one drop.
Sometimes solutions are made up on the percentage basis. For example, a
five per cent. solution of carbolic acid. In this case it would be
necessary to take five ounces of carbolic to one hundred ounces of
water, or five drops of carbolic to one hundred drops of water.
* * * * *