=Burns, Scalds, Frostbites, Etc.=
_Classes of Burns--Treatment--Burns Caused by Acids and
Alkalies--First Aid Rules for Frostbites--Real Freezing--Ingrowing Toe
Nail--Fainting--Suffocation--Fits._
=BURNS AND SCALDS.=--If slight, skin very red, unbroken.
_First Aid Rule.--Cover with cloths wet in strong solution of baking
soda in cold water. Dry gently, and spread with white of egg, thick._
If deeper, blisters, skin broken, thick swelling; there may be some
bleeding.
_First Aid Rule 1.--Stop pain quickly. Cut away clothing very gently.
Break no blisters. Cover with Carron oil (equal parts of limewater and
linseed or olive oil) and light bandage. Give fifteen drops of
laudanum[9] every half hour in tablespoonful of water, till relieved
in part or three doses are taken._
_Rule 2.--Combat shock. If patient is cold, pulse weak, head confused,
give tablespoonful of whisky in a quarter of a glass of hot water. Put
hot-water bottles at feet._
_Rule 3.--Quench thirst with pieces of ice held in mouth or a swallow
of cold milk._
See page 174 for subsequent treatment.
A burn is produced by dry heat, a scald by moist heat; the effect and
treatment of both are practically identical. Burns are commonly
divided into three classes, according to the amount of damage
inflicted upon the body.
_First Class._--There is redness, pain, and some swelling of the skin,
followed, in a few days, by peeling of the surface layer (epidermis)
and recovery. Sunburn and burns caused by slight exposures to gases
and vapors fall into this category.
=Treatment.=--The immediate immersion of the part in cold water is
followed by relief, or the application of cloths wet with a saturated
solution of saleratus or baking powder is useful. Anything which
protects the burned skin from the irritating effect of the air is
efficacious, and in emergencies any one of the following may be
applied: starch, flour, molasses, white paint, or a mixture of white
of egg and sweet oil, equal parts. Usually after the first pain has
been relieved by bathing with soda and water, or its application on
cloths, the employment of a simple ointment suffices, as cold cream or
vaseline.
_Second Class._--In this class of cases the inflammation is more
severe and the deeper layers of the skin are involved. In addition to
the redness and swelling of the skin there are present blisters which
appear at once or within a few hours. The general condition is
affected according to the size of the burn. If half of the body is
only reddened, death usually results, and a burn of a third of the
body is often fatal. The shock is so great at times that pain may not
be at once intense. Shock is evidenced by general depression, with
weakness, apathy, cold feet and hands, and failure of the pulse. If
the patient rallies from this condition, then fever and pain become
prominent. If steam has been inhaled, there may be sudden death from
swelling of the interior of the throat, or inflammation of the lungs
may follow inhalation of smoke and hot air.
_Third Class._--In this class are included burns of so severe a nature
that destruction and death of the tissues follows; not only of the
skin but of the flesh and bones in the worst cases. It is impossible
to tell by the appearance of the skin what the extent of the
destruction may be until the dead parts slough away after a week or
ten days. The skin is of a uniform white color in some cases, or may
be of a yellow, brown, gray, or black hue, and is comparatively
insensitive at first. Pus ("matter") begins to form around the dead
part in a few days, and the dead tissue comes away later, to be
followed by a long course of suppuration, pain, excessive granulations
("proud flesh"), and, unless skillfully treated, by contraction of the
surrounding area, leaving ugly scars and interfering with the
appearance and usefulness of the parts. The treatment of such cases
after the first care becomes that to be pursued in wounds generally
(p. 50), and belongs within the domain of the surgeon.
=Treatment of the More Severe Burns.=--If the patient is suffering
from shock he should receive some hot alcoholic drink, as hot water
and whisky, and be put to bed under warm coverings with hot-water bags
or bottles at his feet.
The clothing must be cut away from the burned parts with the greatest
care, and only a portion of the body should be uncovered at a time and
in a warm room. Pain may be subdued by laudanum[10]; fifteen drops may
be given to an adult, and the drug may be repeated at hour intervals
in doses of ten drops until the suffering has been allayed. Lumps of
ice held in the mouth will quench thirst, and the diet should be
liquid, as milk, soups, gruels, white of egg, and water. The bowels
should be moved daily by rectal injections of soap and warm water. As
a matter of local treatment, the surface layer of the skin should be
kept intact if possible. Blisters are not to be disturbed unless they
are large and tense; if so, their bases may be pricked with a needle
sufficiently to let out the fluid contents.
Carron oil (equal parts of olive oil and limewater) has been the
common remedy for burns, and it is an efficient, though very dirty,
dressing, useful if the skin is generally unbroken. It should be
applied on clean, soft linen or cotton cloth, which is soaked in the
oil, laid over the burned area, and covered with a thick layer of
cotton batting and a bandage. When the skin is denuded, leaving a raw
surface exposed, the burn must be treated on the same plan as wounds,
and should be kept as clean and free from germs as possible. An
ointment made of equal parts of boric acid and vaseline, spread
thickly on clean cloth, is a good antiseptic preparation in cases
where the skin is broken. It is best not to change the dressing
oftener than once in two or three days, unless the discharge or odor
are considerable. Fresh dressing is very painful and often harmful.
When the dressing is removed, warm saline solution (one teaspoonful of
common salt in a quart of water) is allowed to flow over the burn
until all discharge is washed off. Then the raw surface is dusted over
with pure boric acid or aristol, and the boric-acid ointment applied
as before. The cloth upon which the ointment is spread should be made
free from germs by boiling in water, and then drying it in an oven and
keeping it well wrapped in a clean towel except when wanted.
The same care is requisite as that described under wounds (p. 50) in
regard to cleanliness.
Very extensive burns are most satisfactorily treated by complete
immersion of the burned limbs or entire body in salt solution (same
strength as above), which is kept at a temperature of from 94 deg. to
104 deg. F., according to the feelings of the patient. The patient lies in
a bath tub on horsehair, or better, rubber mattress and rubber
pillows; completely covered with water except the head. The urine and
bowel discharges must be passed in the water, which is then changed,
and the temperature is kept at an even mark by allowing warm water to
continually run into the tub to displace that which runs out. The
latter can be arranged by siphonage with a rubber tube. While this
method requires more care, and running hot and cold water, it is the
most comfortable treatment for these cases, usually attended by awful
suffering, and at the same time it is most favorable to healing.
It is beyond the scope of this work to describe the various
complications and the details of the after treatment in severe burns,
including skin grafting, which may tax all the ingenuity of the
skilled surgeon. It is hoped that the foregoing may give a clear idea
of the treatment to be pursued in emergencies and may prove of some
use to those who may unfortunately be compelled to care for burns
during a considerable time without the aid of a physician.
=BURN BY STRONG ACID.=
_First Aid Rule 1.--Neutralize the acid. Scatter baking soda thickly
over burn, or pour limewater over it._
_Rule 2.--Control pain. Wash off soda with stream of water. Apply
Carron oil (equal parts of limewater and linseed oil or olive oil).
Bandage lightly._
=BURN BY STRONG ALKALI.=--As ammonia, quicklime, lye.
_First Aid Rule 1.--Neutralize the alkali. Pour vinegar over the
burn._
_Rule 2.--Control pain. Wash off vinegar with stream of water. Dry
gently. Apply vaseline or cold cream._
=BURNS CAUSED BY STRONG MINERAL ACIDS OR BY ALKALIES.=--If acids are
the cause, the skin should not be washed at first, but either chalk,
whiting, or some mild alkali, as baking soda, should be strewn over
the burn, and then after the effect of the acid is neutralized, wash
off the soda with stream of warm water. Dry gently with gauze. Apply
Carron oil or paste of boric acid and vaseline, equal parts. If strong
alkalies have been spilled on the skin, as ammonia, potash, or
quicklime, then vinegar is the proper substance to employ, followed by
washing. Then dry gently. Vaseline or cold cream is usually sufficient
as after treatment. Limewater is useful in counteracting the effect of
acids spattered in the eye. In the case of alkalies in the eye, the
vinegar used should be diluted with three parts of water. Albolene or
liquid vaseline is the best agent to drop in the eye after either
accident, in order to relieve the irritation and pain, and the
patient should stay in a dark room.
=FROSTBITE, REAL FREEZING.=--Nose, ears, fingers, toes; insensible to
touch, stiff, pale or blue. Person may be unconscious.
_First Aid Rule 1.--Restore circulation. Rub gently, then vigorously,
with snow._
_Rule 2.--Restore heat very gradually. Sudden heat is fatal. Keep in
cold room, and rub with cloth wet with very cold water till
circulation is established. Then rub with equal parts of alcohol and
water and expose gradually to heat of living room._
_Rule 3.--If person ceases to breathe, resuscitate as if drowned. Open
his mouth, grasp his tongue, and pull it forward and keep it there.
Let another assistant grasp the arms just below the elbows and draw
them steadily upward by the sides of the patient's head to the ground,
the hands nearly meeting (which enlarges the capacity of the chest and
induces inspiration.) (See pp. 30 and 31.) While this is being done,
let a third assistant take position astride the patient's hips with
his elbows resting on his own knees, his hands extended ready for
action. Next, let the assistant standing at the head turn down the
patient's arms to the sides of the body, the assistant holding the
tongue changing hands if necessary to let the arms pass. Just before
the patient's hands reach the ground the man astride the body will
grasp the body with his hands, the ball of the thumb resting on
either side of the pit of the stomach, the fingers falling into the
grooves between the short ribs. Now, using his knees as a pivot, he
will at the moment the patient's hands touch the ground throw (not too
suddenly) his whole weight forward on his hands, and at the same time
squeeze the waist between them, as if he wished to force something in
the chest upward out of the mouth; he will deepen the pressure while
he slowly counts one, two, three, four (about five seconds), then
suddenly lets go with a final push, which will send him back to his
first position. This completes expiration. (A child or a delicate
person must be more gently handled.)_
_At the instant of letting go, the man at the head of the patient will
again draw the arms steadily upward to the sides of the patient's head
as before (the assistant holding the tongue again changing hands to
let the arms pass, if necessary), holding them there while he slowly
counts one, two, three, four (about five seconds)._
_Repeat these movements deliberately and perseveringly twelve or
fifteen times in every minute--thus imitating the natural motions of
breathing. Continue the artificial respiration from one to four hours,
or until the patient breathes; and for a while after the appearance of
returning life carefully aid the first short gasps until deepened into
full breaths._
_Keep body warm after this with warm-water bottles._
=FROSTBITE.=--The nose, chin, ears, fingers, and toes are the parts
usually frozen, although severe results ending in death of the frozen
part occur more often owing to low vitality of the patient than to the
cold itself. In the milder degree of frostbite there is stiffness,
numbness, and tingling of the frozen member; the skin is of a pale,
bluish hue and somewhat shrunken. Recovery ensues with burning pain,
tingling, redness, swelling and peeling of the epidermis, as after
slight burns. The skin is icy cold, white, and insensitive in severe
forms of frostbite, and, if not skillfully treated, becomes, later,
either swollen and discolored, or shriveled, dry, and black. In either
case the frozen part dies and is separated from the living tissue
after the establishment of a sharp line of inflammation which results
in ulceration and formation of pus, and thus the dead part sloughs
off. It is, however, possible for a part thoroughly frozen to regain
its vitality.
=Treatment.=--The essential element in the treatment is to secure a
very gradual return of blood to the frozen tissues, and so avoid
violent inflammation. To obtain this result the patient should be
cared for in a cold room, the frozen parts are rubbed gently with
snow, or cloth wet with ice water, until they resume their usual
warmth. Then it is well to rub them with a mixture of alcohol and
water, equal parts, for a time and expose them to the usual
temperature of a dwelling room. Warm drinks are now administered to
the patient. The frozen member, if hand or foot, is raised high in
the air on pillows and covered well with absorbent cotton and bandage.
If much redness, swelling, and pain result this dressing is removed
and the part is wrapped in a single thickness of cotton cloth kept
continually wet with alcohol and water.
Subsequent treatment consists in keeping the damaged parts covered
with vaseline or cold cream, absorbent cotton, and bandage. If
blisters and sores result, the care is similar to that described for
like conditions under burns. If death of the frozen part becomes
inevitable, the hand or foot should be suspended in a nearly vertical
position to keep the blood out, and the part bathed twice daily with a
solution of corrosive sublimate (one 7.7 gr. tablet to pint of water),
dusted well with aristol, and dressed with absorbent cotton and
bandage until the dead tissue separates and comes away. If the frozen
part is large it may be necessary to remove it with a knife, but this
is not essential when the tips of the fingers or toes are frozen.
=General Effect of Cold.=--Sudden exposure to severe cold causes
sleep, stupor, and death. Persons found apparently frozen to death
should be brought into a cold room, which should be gradually heated,
and the body rubbed with snow or ice water, and artificial respiration
employed, as just directed. Attempts at resuscitation ought to be
persistent, as recoveries have been reported after several hours of
unconsciousness and apparent death from freezing.
=CHILBLAINS AND MILD FROSTBITES.=--The effects of severe cold on the
body are very similar to those of intense heat, though they are very
much slower in making their appearance. After a person has frozen a
finger or toe he may not notice much inconvenience for days, when
suddenly violent inflammation may set in. The fingers, ears, nose, and
toes are the members which suffer most frequently from the effects of
cold. Similar symptoms of inflammation, described under burns, also
result from cold, that is, redness and swelling of the skin, blisters
with more severe and deeper inflammatory involvement, or, in case the
parts are thoroughly frozen, local death and destruction of the
tissues. But it is not essential that the body be exposed to the
freezing temperature or be frozen at all, in order that some harm may
result, for chilblains often follow when the temperature has not been
lower than 40 deg. F., or thereabouts.
The effect of cold is to contract the blood vessels, with the
production of numbness, pallor, and tingling of the skin. When the
cold no longer acts then the blood vessels dilate to more than their
usual and normal state, and more or less inflammation results. The
more sudden the return to warmth the greater the inflammatory sequel.
Chilblains represent the mildest morbid effect of cold on the body.
They exist as bluish-red swellings of the skin, usually on the feet or
hands, but may attack the nose or ears, and are attended by burning,
itching, and smarting. This condition is caused by dilatation of the
vessels following exposure to cold. It is more apt to happen in young,
anaemic women. Chilblains usually disappear during warm weather.
Scratching, friction, or the severity of the attack may lead to the
appearance of blisters and sores. In severe cases the fingers and toes
present a sausage-like appearance, owing to swelling.
=Treatment.=--Susceptible persons should wear thick, warm (not rough)
stockings and warm gloves. The chilled members must never be suddenly
warmed. Regular exercise and cold shower baths are good to strengthen
the circulation, but the feet and hands must be washed in warm water
only, and thoroughly dried. If sweating of these parts is a common
occurrence, starch or zinc oxide should be dusted on freely night and
morning. Cod-liver oil is an efficacious remedy in these cases; one
teaspoonful of Peter Moeller's pure oil three times daily after meals.
The affected parts are bathed twice daily in a solution of zinc
acetate (one dram to one pint of water), and followed by the
application, on soft linen or cotton, of zinc-oxide ointment
containing two per cent of carbolic acid. If this is not curative,
iodine ointment mixed with an equal quantity of lard may be tried.
Exposure to cold will immediately bring on a recurrence of the
trouble. If the affection of the feet is severe the patient must rest
in bed. If the parts become blistered and open sores appear, then the
same treatment as for burns is indicated. Wash with a weak solution
of corrosive sublimate (one tablet for surgical purposes in two quarts
of warm water) and apply an ointment of boric acid and vaseline, equal
parts, spread on soft, clean cotton or linen. Rest of the part and
existence in a warm atmosphere will complete the cure.
=INGROWING TOE NAIL.=--This is a condition in which the flesh along
the edges of the great toe nail becomes inflamed, owing either to
overgrowth of the nail or to pressure of the soft parts against it.
Improper footgear is the most common cause, as shoes which are too
narrow across the toes, or not long enough, or those with high heels
which throw the toes forward so that they are compressed by the toe of
the boot, especially in walking downhill.
A faulty mode of cutting the toe nails in a healthy foot may favor
ingrowing toe nails. Toe nails should be cut straight across, and not
trimmed away at the corners to follow the outline of the toes--as then
the flesh crowds in at the corners of the nails, and when the nail
pushes forward in its growth it presses into the flesh. Nails which
have a very rounded surface are more apt to produce trouble, because
then the edges are likely to grow down into the flesh. Inflammation in
ingrowing toe nail usually arises along the outer edge of the nail.
The flesh here becomes red, tender, painful, and swollen so that it
overlaps the nail. After a time "matter" or pus forms and finds its
way under the nail, and the parts about it ulcerate, and "proud
flesh" or excessive granulation tissue springs up and imbeds the edge
of the nail. Wearing a shoe, or walking, becomes impossible. The
condition may last for months, or even years, if not rightly treated.
=Treatment.=--Properly fitting footgear must be worn--broad at the
toes with low heels and of sufficient length. If pus ("matter") forms,
the cut edge should be raised up by pushing in a little absorbent
cotton under the nail every day. Hot poultices of flaxseed meal, or
other material will relieve any special pain and inflammation. Soaking
the foot frequently in hot water, and observing especial cleanliness,
will aid recovery. Tannic acid, or some antiseptic powder like
nosophen, should be dusted along the edge of the nail, and the flesh
crowded away from the nail by pushing in a little cotton with some
tannic acid upon it.
If there is a raw surface about the border of the nail, powdered lead
nitrate may be dusted upon it each morning for four or five days, till
the ulcerated tissue shrinks away and the edge of the nail becomes
visible. The toe should be covered with absorbent cotton and a
bandage. As soon as the toe is really inflamed the case becomes
surgical, and as such demands the care of a surgeon when one can be
obtained.
=FAINTING.=
_First Aid Rule 1.--Remove impediments to respiration. Remove collar,
loosen all waist bands and cords, unhook corset or cut the laces at
person's back._
_Rule 2.--Assist heart and brain with blood pressure. Put cushion
under buttocks, wind skirt close about legs, and raise feet in air.
Wait ten seconds._
_Rule 3.--Aid respiration. Put mild smelling salts under nose. Spatter
cold water in face._
=SUFFOCATION FROM GAS IN WELLS, CISTERNS, OR MINES, OR FROM
ILLUMINATING GAS.=
_First Aid Rule 1.--Remove quickly into pure air._
_Rule 2.--Resuscitate as if drowned. Open his mouth, grasp his tongue,
pull it forward and keep it there. Let another assistant grasp the
arms just below the elbows, and draw them steadily upward by the sides
of the patient's head to the ground, the hands nearly meeting, which
enlarges the capacity of the chest and induces inspiration. (See pp.
30 and 31.) While this is being done, let a third assistant take
position astride the patient's hips with his elbows resting on his own
knees, his hands extended ready for action. Next, let the assistant
standing at the head turn down the patient's arms to the sides of his
body, the assistant holding the tongue, changing hands if necessary to
let the arms pass._
_Just before the patient's hands reach the ground, the man astride the
body will grasp the body with his hands, the ball of the thumb resting
on either side of the pit of the stomach, the fingers falling into
the grooves between the short ribs. Now, using his knees as a pivot,
he will, at the moment the patient's hands touch the ground, throw
(not too suddenly) his whole weight forward on his hands, and at the
same time squeeze the waist between them, as if he wished to force
something in the chest upward out of the mouth; he will deepen the
pressure while he slowly counts one, two, three, four (about five
seconds), then suddenly lets go with a final push, which will send him
back to his first position. This completes expiration. A child or a
delicate person must be more gently handled._
_At the instant of letting go, the man at the head of the patient will
again draw the arms steadily upward, to the sides of the patient's
head, as before (the assistant holding the tongue again, changing
hands if necessary to let the arms pass, holding them there while he
slowly counts one, two, three, four (about five seconds))._
_Repeat these movements deliberately and perseveringly twelve or
fifteen times in every minute, thus imitating the natural motions of
breathing. Continue the artificial respiration from one to four hours,
or until the patient breathes; and for a while after the appearance of
returning life, carefully aid the first short gasps until deepened
into full breaths._
_Keep the body warm with hot-water bottles and blanket._
_Rule 3.--Give oxygen to breathe from a cylinder, for two days, at
short intervals, in the case of illuminating gas._
=FIT; CONVULSION.=
_First Aid Rule 1.--Aid breathing. Loosen collar, waist bands, and
unhook corset, or cut the laces behind._
_Rule 2.--Protect from injury. Gently restrain from falling or rolling
against furniture; lay flat on bed._
_Rule 3.--Protect tongue from being bitten. Open jaws and put between
teeth rubber eraser tied to stout string, or rubber stopper tied to
stout string._
_Rule 4.--Crush pearl of amyl nitrite in handkerchief, and hold close
to patient's nose and mouth, till face is red and patient relaxes._
_Rule 5.--Let patient sleep after fit without rousing._
FOOTNOTES:
[9] Caution. Dangerous. Use only on physician's order.
[10] Caution. Dangerous. Use only on physician's order.
Part II
GERM DISEASES
BY
KENELM WINSLOW
CHAPTER I
=Contagious Diseases=
_Scarlet Fever--Symptoms and Treatment--Precautions
Necessary--Measles--Communicating the
Disease--Smallpox--Vaccination--How to Diagnose Chickenpox._
=ERUPTIVE CONTAGIOUS FEVERS= (_including Scarlet Fever, Measles,
German Measles, Smallpox, and Chickenpox_).--These, with the exception
of smallpox, attack children more commonly than adults. As they all
begin with fever, and the characteristic rash does not appear for from
one to four days after the beginning of the sickness, the diagnosis of
these diseases must always be at the onset a matter of doubt. For this
reason it is wise to keep any child with a fever isolated, even if the
trouble seems to be due to "a cold" or to digestive disturbance, to
avoid possible communication of the disorder to other children. While
colds and indigestion are among the most frequent ailments of
children, they must not be neglected, for measles begins as a bad
cold, smallpox like the _grippe_, and scarlet fever with a sore throat
or tonsilitis, and vomiting.
By isolation is meant that the sick child should stay in a room by
himself, and the doors should be kept closed and no children should
enter, nor should any objects in the room be removed to other parts of
the house after the beginning of its occupation by the patient.
The services of a physician are particularly desirable in all these
diseases, in order that an early diagnosis be made and measures be
taken to protect the family, neighbors, and community from contagion.
The failure of parents or guardians to secure medical aid for children
is regarded by the law as criminal neglect, and is subject to
punishment. Boards of health require the reporting of all contagious
diseases as soon as their presence is known, and failure to comply
with their rules also renders the offender liable to fine or
imprisonment in most places.
=SCARLET FEVER= (_Scarlatina_).--There is no difference between
scarlet fever and scarlatina. It is a popular mistake that the latter
is a mild type of scarlet fever. Fever, sore throat, and a bright-red
rash are the characteristics of this disease. It occurs most
frequently in children between the ages of two and six years. It is
practically unknown under one year of age. Prof. H. M. Biggs, of the
New York Department of Health, has seen but two undoubted cases in
infants under twelve months. It is rare in adults, and one attack
usually protects the patient from another. Second attacks have
occurred, but many such are more apparent than real, since an error in
diagnosis is not uncommon. The disease is communicated chiefly by
means of the scales of skin which escape during the peeling process,
but may also be acquired at any time from the onset of the attack from
the breath, urine, and discharges from the body; or from substances
which have come in contact with these emanations. Scarlet fever is
probably a germ disease, and the germs may live for weeks in toys,
books, letters, clothing, wall paper, etc. Close contact with the
patient, or with objects which have come in close touch with the
patient, is apparently necessary for contagion.
=Period of Development.=--After exposure to the germs of scarlet
fever, usually from two to five days elapse before the disease shows
itself. Occasionally the outbreak of the disease occurs within
twenty-four hours of exposure, and rarely is delayed for a week or ten
days.
=Symptoms.=--The onset is usually sudden. It begins with vomiting (in
very young children sometimes convulsions), sore throat, fever,
chilliness, and headache. The tongue is furred. The patient is often
stupid; or may be restless and delirious. Within twenty-four hours or
so the rash appears--first on the neck, chest, or lower part of
back--and rapidly spreads over the trunk, and by the end of
forty-eight hours covers the legs and entire body excepting the face,
which may be simply flushed. The rash appears as fine, scarlet pin
points scattered over a background of flushed skin. At its fullest
development, at the end of the second or third day, the whole body may
present the color of a boiled lobster. After this time the rash
generally fades away and disappears within five to seven days. It is
likely to vary much in intensity while it lasts. As the rash fades,
scaling of the skin begins in large flakes and continues from ten days
to as many weeks, usually terminating by the end of the sixth to
eighth week. One of the notable features is the appearance of the
tongue, at first showing red points through a white coating, and after
this has cleared away, in presenting a raspberry-like aspect. The
throat is generally deep red, and the tonsils may be dotted over with
white spots (see Tonsilitis) or covered with a whitish or gray
membrane suggesting diphtheria, which occasionally complicates scarlet
fever. The fever usually is high (103 deg. to 107 deg. F), and the pulse
ranges from 120 to 150; both declining after the rash is fully
developed, generally by the fourth day. The urine is scanty and dark.
There is, however, great variation in the symptoms as to their
presence or absence, intensity, and time of occurrence and
disappearance.
=Complications and Sequels.=--These are frequent and make scarlet
fever the most dreaded of the eruptive diseases, except smallpox.
Enlarged glands under the jaw and at the sides of the neck are common,
and appear as lumps in these sites. Usually not serious, they may
enlarge and threaten life. Pain and swelling in the joints, especially
of the elbows and knees, are not rare, and may be the precursors of
serious inflammation of these parts. One of the most frequent and
serious complications of scarlet fever is inflammation of the kidneys,
occurring more often toward the end of the second week of the disease.
Examination of the urine by the attending physician at frequent
intervals throughout the course of the disorder is essential, although
puffiness of the eyelids and face, and of the feet, ankles, and hands,
together with lessened secretion of urine--which often becomes of a
dark and smoky hue--may denote the onset of this complication. The
disease of the kidneys usually results in recovery, but occasionally
in death or in chronic Bright's disease of these organs. Inflammation
of the middle ear with abscess, discharge of matter from the ear
externally, and--as the final outcome--deafness, is not uncommon. This
complication may be prevented to a considerable extent by spraying the
nose and throat frequently and by the patient's use of a nightcap with
earlaps, if the room is not sufficiently warm. Inflammation of the
eyelids is an occasional complication. The heart is sometimes attacked
by the toxins of the disease, and permanent damage to the organ, in
the form of valvular trouble, may result. Blindness and nervous
disorders are among the rarer sequels including paralyses and St.
Vitus's dance.
=Determination of Scarlet Fever.=--When beginning with vomiting,
headache, high fever, and sore throat, and followed in twenty-four
hours with a general scarlet rash, this is not difficult; but
occasionally other diseases present rashes, as indigestion, _grippe_,
and German measles, which puzzle the most acute physicians. Measles
may be distinguished from scarlet fever in that measles appears first
on the face, the rash is patchy or blotchy, and does not show for
three to four days after the beginning of the sickness. The patient
seems to have a bad cold, with cough, running at the nose, and sore
eyes. German measles is mild, and while the rash may look something
like that of scarlet fever, the patient does not seem generally ill,
is hardly affected at all, though rarely troubled with slight catarrh
of the nose. In no sickness are the services of a physician more
necessary than in scarlet fever; first, to determine the existence of
the disease, and then to prevent or combat the complications which
often approach insidiously.
=Outlook.=--The average death rate of scarlet fever is about ten per
cent. It is very fatal in children about a year old, and most of the
deaths occur in those under the age of six. But the mortality varies
greatly at different times and in different epidemics. In 1904-5, in
many parts of the United States, the disease was very prevalent and
correspondingly mild, and deaths were rare.
=Duration of Contagion.=--The disease is commonly considered
contagious only so long as peeling of the skin lasts. But it seems
probable that any catarrhal secretion from the nose, throat, or ear is
capable of communicating the germs from a patient to another person
for many days after other evidences of the disease are past. Scarlet
fever patients should always be isolated for as long a period as six
weeks--and better eight weeks--without regard to any shorter duration
of peeling, and if peeling continues longer, so should the isolation.
=Treatment.=--In case a physician is unobtainable the patient must be
put to bed in the most airy, sunshiny room, which should be heated to
70 deg. F., and from which all the unnecessary movables should be taken
out before the entrance of the patient. A flannel nightgown and light
bed clothing are desirable. The fever is best overcome by cold
sponging, which at the same time diminishes the nervous symptoms, such
as restlessness and delirium. The body is sponged--part at a
time--with water at the temperature of about 70 deg. F., after placing a
single thickness of old cotton or linen wet with ice or cold water
(better an ice cap) over the forehead. The part is thoroughly dried as
soon as sponged, and the process is repeated whenever the temperature
is over 103 deg. F. There need be no fear that the patient may catch cold
if only a portion of the body is exposed at any one time. If there is
any chilliness following sponging, a bag or bottle containing hot
water may be placed at the feet. It is well that a rubber bag
containing ice, or failing this a cold cloth, be kept continually on
the head while fever lasts. The throat should be sprayed hourly with a
solution of hydrogen peroxide (full strength) and the nose with the
same, diluted with an equal amount of water, three times a day. The
outside of the throat it is wise to surround with an ice bag, or
lacking this, a cold cloth frequently wet and covered with a piece of
oil silk (or rubber) and flannel.
The diet should consist of milk, broths, or thin gruels, and plenty of
water should be allowed. Sweet oil or carbolized vaseline should be
rubbed over the whole body night and morning during the entire
sickness and convalescence. The bowels must be kept regular by
injections or mild cathartics, and, after the fever subsides,
vegetables, fruit, cereals, and milk may be permitted, together with
meat or eggs once daily. It is imperative for the nurse and also the
mother to wear a gown and cap over the outside clothes, to be slipped
off in the hall at the door of the sick room when leaving the latter.
=MEASLES.=--Measles is a contagious disease, characterized by a
preliminary stage of fever and catarrh of the eyes, nose, and throat,
and followed by a general eruption on the skin. One attack practically
protects a person from another, yet, on the other hand, second attacks
occur with extreme rarity. It is more contagious than scarlet fever,
and isolation of a patient in a house is of less service in preventing
communication to other inmates, whereas in scarlet fever half the
number of susceptible children may escape the disease through this
precaution. The germs which cause measles perish rapidly, so that
infected clothes or other objects merely require a thorough airing to
be rendered safe, whereas in scarlet fever the danger of transmission
of the contagion may lurk in infected clothing and other substances
for weeks, unless they are subjected to proper disinfection. A patient
with measles is capable of communicating the disorder from its onset,
before the appearance of the rash, through the breath, discharges from
the nose and eyes, tears and saliva and all the secretions. At the end
of the third week of the disease the patient is usually incapable of
giving the disease to others. Close contact with a patient is commonly
necessary for one to acquire the disease, but it is frequently claimed
that it is carried by a third person in the clothes, as by a nurse. It
is infrequent in infants under six months, and most frequent between
the second and sixth year. Adults are attacked by measles more often
than by scarlet fever.
=Development.=--A period of from seven to sixteen days after exposure
to measles elapses before the disease becomes apparent.
=Symptoms.=--The disease begins like a severe nasal catarrh with
fever. The eyes are red and watery, the nose runs, and the throat is
irritable, red, and sore, and there is some cough, with chilliness and
muscular soreness. The fever, higher at night, varies from 102 deg. to
104 deg. F., and the pulse ranges from 100 to 120. There is often marked
drowsiness for a day or two before the rash appears. Coated tongue,
loss of appetite, occasional vomiting, and thirst are present during
this period. The appearance of minute, whitish spots, surrounded by a
red zone, may often be seen in the inside of the mouth opposite the
back teeth for some days before the eruption occurs.
The preliminary period, when the patient seems to be suffering with a
bad cold, lasts for four days usually, and on the evening of the
fourth day the rash breaks out. It first appears on the face and then
spreads to the chest, trunk, and limbs. Two days are generally
required for the complete development of the rash; it remains thus in
full bloom for about two days more, then begins to subside, fading
completely in another two days--six days in all.
The rash appears as bright-red, slightly raised blotches on the face,
which is generally somewhat swollen. The same rash extends to the
abdomen, back, and limbs. Between the mottled, red rash may be seen
the natural color of the skin. At this time the cough may be hoarse
and incessant, and the eyes extremely sensitive to light. The fever
and other symptoms abate when the rash subsides, and well-marked
scaling of the skin occurs.
=Complications and Sequels.=--Severe bronchitis, pneumonia, croup,
laryngitis, sore eyes, ear abscess and deafness, violent diarrhea,
convulsions, and, as a late result, consumption sometimes accompany or
follow measles. For the consideration of these disorders, see special
articles in other parts of this work.
=Outlook.=--The vast majority of healthy patients over two years old
recover from measles completely. Younger children, or those suffering
from other diseases, may die through some of the complications
affecting the lungs. The disease is peculiarly fatal in some epidemics
occurring among those living in unhygienic surroundings, and in
communities unaccustomed to the ravages of measles. Thus, in an
epidemic attacking the Fiji Islanders, over one-quarter of the whole
population (150,000) died of measles in 1875. Measles is more severe
in adults than in children.
=Diagnosis.=--For one not familiar with the characteristic rash a
written description of it will not suffice for the certain recognition
of the disease, but if the long preliminary period of catarrh and
fever, and the appearance of the eruption on the fourth day, be taken
into account--together with the existence of sore eyes and hoarse,
hard cough--the determination of the presence of measles will not be
difficult in most cases.
=Treatment.=--The patient should be put to bed in a darkened,
well-ventilated room at a temperature of 68 deg. to 70 deg. F. While by
isolation of the patient we may often fail to prevent the occurrence
of measles in other susceptible persons in the same house, because of
the very infectious character of the disease, and because it is
probable that they have already been exposed during the early stages
when measles was not suspected, yet all possible precautions should be
adopted promptly. For this reason other children in the house should
be kept from school and away from their companions, and they ought
not to be sent away from home to spread the disease elsewhere. The
bowels should be kept regular by soapsuds injections or by mild
cathartics, as a Seidlitz powder. If the fever is over 103 deg. F. and is
accompanied by much distress and restlessness, children may be sponged
with tepid water, and adults with water at 80 deg. F., every two hours or
so as directed under scarlet fever. When cough is incessant or the
rash does not come out well, there is nothing better than the hot
pack.
The patient is stripped and wrapped from feet to neck in a blanket
wrung out of hot water containing two teaspoonfuls of mustard stirred
into a gallon of water. This is then covered with two dry blankets and
the patient allowed to remain in the blankets for two or three hours,
when the application may be repeated. It is well to keep a cold cloth
on the head during the process. Cough is also relieved by a mixture
containing syrup of ipecac, twenty drops; paregoric, one teaspoonful,
for an adult (or one-third the dose for a child of six), which should
be given in one-quarter glass of water and may be repeated every two
hours. If there is hoarseness, the neck should be rubbed with a
mixture of sweet oil, two parts; and oil of turpentine, one part, and
covered with a flannel bandage. The cough mixture will tend to relieve
this condition also. A solution of boric acid (ten grains of boric
acid to the ounce of water) is to be dropped in both eyes every two
hours with a medicine dropper. Although usually mild, the eye symptoms
may be very severe and require special treatment, and considerably
impaired vision may be the ultimate result. Severe diarrhea is
combated with bismuth subnitrate, one-quarter teaspoonful, every three
hours. For adults, the diet consists of milk, broths, gruels, and raw
eggs. Young children living on milk mixtures should receive the
mixture to which they are accustomed, diluted one-half with barley
water. Nourishment must be given every two hours except during sleep.
The patient should be ten days in bed, and should remain three days in
his room after getting up (or three weeks in all, if there are others
who may contract measles in the house), and after leaving his room
should stay in the house a week longer. The principal danger after an
attack of measles is of lung trouble--pneumonia or tuberculosis
(consumption)--and the greatest care should be exercised to avoid
exposure to the wet or to cold draughts.
=GERMAN MEASLES= (_Roetheln_).--German measles is related neither to
measles nor scarlet fever, but resembles them both to a certain
extent--more closely the former in most cases. It is a distinct
disease, and persons who have had both measles and scarlet fever are
still susceptible to German measles. One attack of German measles
usually protects the patient from another. Adults, who have not been
previously attacked, are almost as liable to German measles as
children, but it is rare that infants acquire the disease. It is a
very contagious disorder--but not so much so as true measles--and
often occurs in widespread epidemics. The breath and emanations from
the skin transmit the _contagium_ from the appearance of the first
symptom to the disappearance of the eruption.
=Development.=--The period elapsing after exposure to German measles
and before the appearance of the symptoms varies greatly--usually
about two weeks; it may vary from five to eighteen days.
=Symptoms.=--The rash may be the first sign of the disease and more
frequently is so in children. In others, for a day or two preceding
the eruption, there may be headache, soreness, and redness of the
throat, the appearance of red spots on the upper surface of the back
of the mouth, chilliness, soreness in the muscles, loss of appetite,
watering of the eyes. Catarrhal symptoms are most generally absent, an
important point in diagnosis. When present, they are always mild.
These preliminary symptoms, if present, are much milder and of shorter
duration than in measles, where they last for four days before the
rash appears; and the hard, persistent cough of measles is absent in
German measles. Also, while there is sore throat in the latter, there
is not the severe form with swollen tonsils covered with white spots
so often seen in scarlet fever. Fever is sometimes absent in German
measles; usually it ranges about 100 deg. F., rarely over 102 deg. F. Thus,
German measles differs markedly from both scarlet fever and measles
proper. The rash usually appears first on the face, then on the chest,
and finally covers the whole body, in the space of a few
hours--twenty-four hours at most. The eruption takes the form of
rose-red, round or oval, slightly raised spots--from the size of a pin
head to that of a pea--sometimes running together into uniform
redness, as in scarlet fever. The rash remains fully developed for
about two days, and often changes into a coppery hue as it gradually
fades away. There are often lumps--enlarged glands--to be felt under
the jaw, on the sides and back of the neck, which occur more commonly
in German than in true measles. The glands at the back of the neck are
the most characteristic. They are enlarged in about two-thirds of the
cases.
=Determination.=--The diagnosis or determination of the existence of
measles must be made, in the absence of a physician, on the general
symptoms rather than on the rash, which requires experience for its
recognition and is subject to great variations in appearance, at one
time simulating measles, at another scarlet fever.
German measles differs from true measles in the following points: the
preliminary period--before the rash--is mild, short, or absent; fever
is mild or absent; the cold in the nose and eyes and cough are slight
or may be absent, as contrasted with these symptoms in measles, while
the enlarged glands in the neck are more pronounced than in measles.
The onset of German measles is not so sudden as in scarlet fever and
not accompanied with vomiting as in the latter, while the sore throat
and fever are much milder in German measles. The peeling, which is so
prominent in scarlet fever with the disappearance of the rash, is not
infrequently present. It may be absent. Its presence or absence seems
to depend upon the severity of the eruption. The desquamation when
present is finer than in either measles or scarlet fever.
=Outlook.=--Recovery from German measles is the invariable rule, and
without complications or delay.
=Treatment.=--Little or no treatment is required. The patient should
remain in bed in a darkened room on a liquid diet while fever lasts,
and be isolated from others indoors until all signs of the eruption
are passed. The eyes should be treated with boric acid as in measles;
the diet, during the fever, consisting of milk, broths, thin cereals,
beef juice, raw eggs or eggnog, for adults and older children; while
infants should have their milk mixture diluted one-half with barley
water. A bath and fresh clothing for the patient, and thorough
cleansing and airing of the sick room and clothing are usually
sufficient after the passing of the disease without chemical
disinfection.
=SMALLPOX.=--Smallpox is one of the most contagious diseases known. It
is extremely rare for anyone exposed to the disease to escape its
onslaught unless previously protected by vaccination or by a former
attack of the disease. One is absolutely safe from acquiring smallpox
if recently and successfully vaccinated, and thus has one of the most
frightful and fatal scourges to which mankind has ever been subject
been robbed of its dangers. The _contagium_ is probably derived
entirely from the scales and particles of skin escaping from smallpox
patients, and in the year 1905-6 the true germ of the disease was
discovered by Councilman, of Boston. It is not necessary to come in
direct contact with a patient to contract the disease, as the
_contagium_ may be transmitted some little distance through the air,
possibly even outside of the sick room. One attack almost invariably
protects against another. All ages are liable to smallpox; it is
particularly fatal in young children, and during certain epidemics has
proved more so in colored than in white people.
=Development.=--A period of ten or twelve days usually elapses after
exposure to smallpox before the appearance of the first symptoms of
the disease. This period may vary, however, from nine to fifteen days.
=Symptoms.=--There is a preliminary period of from twenty-four to
forty-eight hours after the beginning of the disease before an
eruption occurs. The onset is ushered in by a set of symptoms
simulating those seen in severe _grippe_, for which smallpox is often
mistaken at this time. The patient is suddenly seized with a chill,
severe pains in the head, back, and limbs, loss of appetite and
vomiting, dizziness on sitting up, and fever--103 deg. to 105 deg. F. In young
children convulsions often take the place of the chill seen in
adults. On the second day a rash often appears on the lower part of
the belly, thighs, and armpits, which may resemble that characteristic
of measles or scarlet fever, but does not last for over a day or two.
It is very evanescent and, consequently, rarely seen. Diarrhea often
occurs, as well as vomiting, particularly in children. On the evening
of the fourth day the true eruption usually appears; first on the
forehead or face, and then on the arms, hands, and legs, palms, and
soles. The eruption takes successively four forms: first, red, feeling
like hard pimples or like shot; then, on the second or third day of
the eruption, these pimples become tipped with little blisters with
depressed centers, and surrounded by a red blush. Two or three days
later the blisters are filled with "matter" or pus and present a
yellowish appearance and are rounded on top. Finally, on about the
tenth day of the eruption, the pustules dry up and the matter exudes,
forming large, yellowish or brownish crusts, which, after a while,
drop off and leave red marks and, in severe cases, pitting. The fever
preceding the eruption often disappears upon the appearance of the
latter and in mild cases does not reappear, but in severe forms the
temperature remains about 100 deg. F., and when the eruption is at its
height again mounts to 103 deg. to 105 deg. F., and gradually falls with
convalescence. The eruption is most marked on the face, hands, and
forearms, and occurs less thickly on the body. It appears also in the
mouth and throat and when fully developed on the face gives rise to
pain and considerable swelling and distortion of the features, so that
the eyes are closed and the patient becomes frightfully disfigured and
well-nigh unrecognizable. Delirium is common at this time, and
patients need constant watching to prevent their escape from bed. In
the severe forms the separate eruptive points run together so that the
face and hands present one distorted mass of soreness, swelling, and
crusting. In these, pitting invariably follows, while in those cases
where the eruption remains distinct, pitting is not certain to occur.
A still worse form is that styled "black smallpox," in which the skin
becomes of a dark-purplish hue, from the fact that each pustule is a
small blood blister, and bleeding occurs from the nose, mouth, etc.
These cases are almost, without exception, fatal in five to six days.
The patient may say that the eruption was the first symptom he
observed. This was particularly noticed in negroes, many of whom had
never been vaccinated. The eruption may exhibit but a dozen or so
points, especially about the forehead, wrists, palms, and soles. After
the first four days the fever and all the disagreeable symptoms may
subside, and the patient may feel absolutely well. The eruption,
however, passes through the stages mentioned, although but half the
time may be occupied by the changes; five or six days instead of ten
to twelve for crusts to form. In such cases the death rate has been
exceedingly low, although it is perfectly possible for a person to
contract the most severe smallpox from one of these mild (and often
unrecognized) cases, as has unfortunately happened. Smallpox occurring
after successful vaccination resembles, in its characteristics, the
cases just described, and unless vaccination had been done many years
previously, the results are almost always favorable as regards life
and absence of pitting.
=Detection.=--Smallpox is often mistaken for chickenpox, or some of
the skin diseases, in its mild forms. The reader is referred to the
article on chickenpox for a consideration of this matter. The mild
type should be treated just as rigidly as severe cases with regard to
isolation and quarantine, being more dangerous to the community
because lightly judged and not stimulating to the adoption of
necessary precautions. The preliminary fever and other symptoms
peculiar to smallpox will generally serve to determine the true nature
of the disease, since these do not occur in simple eruptions on the
skin. The general symptoms and course of smallpox must guide the
layman rather than the appearance of the eruption, which requires
educated skill and experience to recognize. Chickenpox in an adult is
less common than in children. Smallpox is very rare in one who has
suffered from a previous attack of the disease or in one who has been
successfully vaccinated within a few years.
=Outlook.=--The death rate of smallpox in those who have been
previously vaccinated at a comparatively recent date, or in
varioloid, as it is called when thus modified by vaccination, is only
1.2 per cent. There are, however, severe cases following vaccinations
done many years previous to the attack of smallpox. While these cannot
be called varioloid, yet the death rate is much lower than in smallpox
occurring in the unvaccinated. Thus, before the mild epidemic of 1894
the death rate in the vaccinated was sixteen per cent; since 1894 it
has been only seven per cent; while in the unvaccinated before 1894 it
was fifty-eight per cent; and since that date it has been but
seventeen per cent, as reported by Welch from the statistics of 5,000
cases in the Philadelphia Municipal Hospital.
=Complications.=--While a variety of disorders may follow in the
course of smallpox, complications are not very frequent in even severe
cases. Inflammation of the eyelids is very common, however, and also
boils in the later stages. Delirium and convulsions in children are
also frequent, as well as diarrhea; but these may almost be regarded
as natural accompaniments of the disease. Among the less common
complications are: laryngitis, pneumonia, diseases of the heart,
insanity, paralysis, various skin eruptions, inflammation of the
joints and of the eyes and ears, and baldness.
=Treatment.=--Prevention is of greatest importance. Vaccination stands
alone as the most effective preventive measure in smallpox, and as
such has no rival in the whole domain of medicine. The modern method
includes the inoculation of a human being with matter taken from one
of the eruptive points on the body of a calf suffering with cowpox.
Whether cowpox is a modified form of smallpox or a distinct disease is
unknown.
The period of protection afforded by a successful vaccination is
uncertain, because it varies with different individuals. In a general
way immunity for about four or five years is thus secured; ten or
twelve years after vaccination the protection is certainly lost and
smallpox may be then acquired. Every individual should be vaccinated
between the second and third month after birth, and between the ages
of ten and twelve, and at other times whenever an epidemic threatens.
An unvaccinated person should be vaccinated and revaccinated, until
the result is successful, as immunity to vaccination in an
unvaccinated person is practically unknown. When unsuccessful, the
vaccine matter or the technique is faulty. A person continuously
exposed to smallpox should be vaccinated every few weeks--if
unsuccessful, no harm or suffering follow; if successful, it proves
liability to smallpox. A person previously vaccinated successfully may
"take" again at any time after four or five years, and, in event of
possible exposure to smallpox, should be revaccinated several times
within a few weeks--if the vaccination does not "take"--before the
attempt is given up. An unvaccinated person, who has been exposed to
smallpox, can often escape the disease if successfully vaccinated
within three days from the date of the exposure, but is not sure to
do so.
Diseases are not introduced with vaccination now that the vaccine
matter is taken from calves and not from the human being, as formerly.
Most of the trouble and inflammation of the vaccinated part following
vaccination may be avoided by cleanliness and proper care in
vaccinating.
In the absence of a physician, vaccination may be properly done by any
intelligent person when the circumstances demand it. Vaccination is
usually performed upon the outside of the arm, a few inches below the
shoulder, in the depression situated in that region. If done on the
leg, the vaccination is apt to be much more troublesome and may
confine the patient to bed. The arm should be thoroughly washed in
soap and warm water, from shoulder to elbow, and then in alcohol
diluted one-third with water. When this has evaporated (without
rubbing), the dry arm is scratched lightly with a cold needle which
has previously been held in a flame and its point heated red hot. The
point must thereafter not be touched with anything until the skin is
scratched with it. The object is not to draw blood, but to remove the
outer layer of skin, over an area about one-fourth of an inch square,
so that it appears red and moist but not bleeding. This is
accomplished by very light scratching in various directions. Another
spot, about an inch or two below, may be similarly treated. Then
vaccine matter, if liquid, is squirted on the raw spots, or, if dried
on points, the ivory point is dipped in water which has been boiled
and cooled, and rubbed thoroughly over the raw places. The arm must
remain bare and the vaccination mark untouched until the surface of
the raw spot is perfectly dry, which may take half an hour. A piece of
sterilized surgical gauze, reaching halfway about the arm and kept in
place with strips of adhesive plaster (or an absolutely clean
handkerchief bound about the arm, and held by sewing or safety pins),
ought to cover the vaccination for three days. After this time the
sore must only come in contact with soft and clean old cotton or
linen, which may be daily pinned in the sleeve of the under garment.
If the scab is knocked off and an open sore results it should be
treated like any wound.
If the vaccination "takes," it passes through several stages. On the
third day following vaccination a red pimple forms at the point of
introduction of the matter, which is surrounded by a circle of
redness. Some little fever may occur. On the fifth day a blister or
pimple containing clear fluid with a depressed center is seen, and a
certain amount of hard swelling, itchiness, and pain is present about
the vaccination. A sore lump (gland) is often felt under the arm. The
full development is reached by the eighth day, when the pimple is full
and rounded and contains "matter," and is surrounded by a large area
of redness. From the eleventh day the vaccination sore dries, and a
brown scab forms over it about the end of the fourteenth day, and the
redness and swelling gradually depart. At the end of about three weeks
the scab drops off, leaving a pitted scar or mark. Not infrequently
the vaccination results in a very slight pimple and redness, which
passes through the various stages described, in a week or ten days, in
which case the vaccination should be repeated. Unless the vaccination
follows very closely the course described, it cannot be regarded as
successful, although after the first one or two vaccinations the
result is often not so severe, and the time of completion of the
various stages somewhat shortened.
Rarely an eruption, resembling that at the vaccination site, appears
on the vaccinated limb and even becomes general upon the body, due to
urticaria or to inoculation, through scratching.
The special treatment of an attack of smallpox is largely a matter of
careful nursing. A physician or nurse can scarcely lay claim to any
great degree of heroism in caring for smallpox patients, as there is
no danger of contracting the disease providing a successful
vaccination has been recently performed upon them. The patient should
be quarantined in an isolated building, and all unnecessary articles
should be removed from the sick room, in the way of carpets and other
furnishings. It is well that the room be darkened to save irritation
of the eyes. The diet should be liquid: milk, broths, and gruels.
Laudanum, fifteen drops, or paregoric, one tablespoonful in water,
may be given to adults, once in three hours, to relieve pain during
the first few days. Sponging throughout the course of the disease is
essential; first, with cool water, as directed for scarlet fever, with
the use of cold on the head to relieve the itching, fever, and
delirium. The cold pack is still more efficient. To give this, the
patient is wrapped in a sheet wrung out in water at a temperature
between 68 deg. and 75 deg. F. The sheet surrounds the naked body from feet to
neck, and is tucked between the legs and between the body and arms;
the whole is then covered with a dry blanket, and a cold, wet cloth or
ice cap is placed upon the head. The patient may be permitted to
remain in the pack for an hour, when it may be renewed, if necessary,
to allay fever and restlessness; otherwise it may be discontinued. The
cold sponging or cold pack are indicated when the temperature is over
102.5 deg. F., and when with fever there are restlessness and delirium.
Great cleanliness is important throughout the disease; the bedclothes
should be changed daily and the patient sponged two or three times
daily with warm water, unless fever is high. Cloths wet with cold
carbolic-acid solution (one-half teaspoonful to the pint of hot water)
should be kept continuously on the face and hands. Holes are cut in
the face mask for the eyes, nose, and mouth, and the whole covered
with a similar piece of oil silk to keep in the moisture. Such
applications give much relief, and to some extent prevent pitting.
The hair must be cut short, and crusts on the scalp treated with
frequent sponging and applications of carbolized vaseline, to soften
them and hasten their falling. The boric-acid solution should be
dropped into the eyes as recommended for measles, and the throat
sprayed every few hours with Dobell's solution. Diarrhea in adults may
be checked with teaspoonful doses of paregoric given hourly in water.
Vaseline and cloths used on a patient must not be employed on another,
as boils are thus readily propagated. All clothing, dishes, etc.,
coming in contact with a patient must be boiled, or soaked in a
two-per cent carbolic-acid solution for twenty-four hours, or burned.
When the patient is entirely free from scabs, after bathing and
putting on disinfected or new clothes outside of the sick room, he is
fit to reenter the world.
=CHICKENPOX.=--Chickenpox is a contagious disease, chiefly attacking
children. While it resembles smallpox in some respects, at times
simulating the latter so closely as to puzzle physicians, it is a
distinct disease and is in no way related to smallpox. This is shown
by the fact that chickenpox sometimes attacks a patient suffering
with, or recovering from, smallpox. Neither do vaccination nor a
previous attack of smallpox protect an individual from chickenpox.
Chickenpox is not common in adults, and its apparent presence in a
grown person should awaken the liveliest suspicion lest the case be
one of smallpox, since this mistake has been frequently made, and
with disastrous results, during an epidemic of mild smallpox. One
attack of chickenpox usually protects against another, but two or
three attacks in the same individual are not unknown. The disease may
be transmitted from the patient to another person from the time of the
first symptom until the disappearance of the eruption. The disease
ordinarily occurs in epidemics, but occasionally in isolated cases.
=Development.=--A period of two weeks commonly elapses after exposure
to the disease before the appearance of the first symptom of
chickenpox, but this period may vary from thirteen to twenty-one days.
=Symptoms.=--The characteristic eruption is often the first warning of
chickenpox, but in some cases there may be a preliminary period of
discomfort, lasting for a few hours, before the appearance of the
rash; particularly in adults, in whom the premonitory symptoms may be
quite severe. Thus, there may be chilliness, nausea, and even
vomiting, rarely convulsions in infants, pain in the head and limbs,
and slight fever (99 deg. to 102 deg. F.) at this time. The eruption shows
first on the body, in most cases, especially the back. It consists of
small red pimples, which rapidly develop into pearly looking blisters
about as large as a pea to that of the finger nail, and are sometimes
surrounded by a red blush on the skin. These blisters vary in number,
from a dozen or so to two hundred. They do not run together, and in
three to four days dry up, become shriveled and puckered, and covered
with a dark-brown or blackish crust, and drop off, leaving only
temporary red spots in most cases. The fever usually continues during
the eruption. During the first few days successive fresh crops of
fresh pimples and blisters appear, so that while the first crop is
drying the next may be in full development. This forms one of its
distinguishing features when chickenpox is compared with smallpox. In
chickenpox the eruption is seen on the unexposed skin chiefly, but may
occur on the scalp and forehead, and even on the palms, soles,
forearms, and face. In many cases the eruption is found in the mouth,
on its roof, and the inside of the cheeks. The blisters rarely contain
"matter" or pus, as in smallpox, unless they are scratched. Scratching
may lead to the formation of ugly scars and should be prevented,
especially when the eruption is on the face. Pitting rarely occurs.