It is an undoubted fact that not enough attention is paid to isolation
in times of sickness. There is too much visiting in the sick room, too
many people share the care of the patient, the nurse mingles too freely
with other members of the family, and there is not enough care to keep
the soiled bedding, garments and refuse of the sick room absolutely
separated from that of the rest of the house. Scarlet fever is a
noteworthy instance of a disease which constantly spreads by
carelessness. Just as long as the scaling or shedding of the outer skin
continues contagion may be carried, for it is these scales which bear
it. It is nothing less than criminal, therefore, to permit the patient
who is recovering to mix with other persons, except those who have been
caring for him already. In the early stages of the disease the infection
is chiefly in the breath, and in the secretion of the nostrils. During
the disease pocket handkerchiefs should never be used, soft linen or
cotton rags being substituted and immediately burned.
Most of the same things are true as to measles, whooping-cough, mumps
and German measles, which are constantly spread by sheer carelessness
because people do not realize the obligation resting upon them to guard
others from contact with disease. These ailments are highly infectious
before they are certainly recognized, and for that reason it is not
possible always to isolate cases in time, but at least after the fact is
clearly understood there should be no further carelessness.
Another prevalent disease in which carelessness is responsible for much
of its spreading is tuberculosis, phthisis, or consumption, as it is
more familiarly known. It is not possible yet to isolate every person
suffering with this insidious disease, nor is that suggested. But at
least it may be urged that every such sufferer shall thoughtfully guard
in every way in his power against communicating it to his own neighbors
and family. The bacilli, or bacteria, of consumption swarm in the
spittle of the patient, and are diffused by the wind as dust as soon as
they are dried. To guard against infection from this cause, spittoons
should be used, which can be absolutely disinfected, or cloths which can
be promptly burned.
Smallpox is perhaps the most infectious of diseases. Yet in vaccination
we have a means of protection which we have not in any other. As long as
a large unvaccinated population exists, however, we shall have epidemics
from time to time. Before the introduction of vaccination nearly
everyone had smallpox, just as now almost all persons have measles at
some time or other. The heaviest mortality occurred within the first
five or ten years of life, the deaths in later periods being very few,
since the population had mostly been rendered immune by having had it
already.
Measles is a well-defined disease, intensely infectious, occurring but
once in a lifetime. It is very rarely fatal, nearly all the deaths
credited to it being really due to bronchitis and inflammation of the
lungs, the results of neglect and exposure to cold. No age is exempt.
The only reason why it is looked on as a disease of childhood is that
being in the highest degree infectious from the beginning, when its
nature is not suspected, few children in the schools can hope to escape
it, but if by chance they do, they are just as susceptible to it in
afterlife.
Whooping-cough is a highly infectious disease, occurring but once in a
lifetime, but at any age, though most frequently in childhood. The
frequent belief that children suffering from whooping-cough should be as
much as possible in the open air is an entirely mistaken one, as it
leads not only to continuing the disease longer, but to danger of
bronchitis and pneumonia. As in diphtheria and scarlet fever the mucus
is the chief vehicle of contagion, and pocket handkerchiefs should be
forbidden, pieces of soft rag being substituted and burned as soon as
used.
Typhoid or enteric fever is slow and uncertain in its onset, a full
month in duration, and the return of health is usually tedious. It is
like diphtheria, directly a result of unsanitary conditions. Danger of
direct infection from the patient is slight, but the poison remains in
the evacuations from the bowels and is propagated by them. By this means
a reservoir or river has been known to infect a whole town. Broken or
defective drains, the entrance of sewer gas into houses, wells polluted
by cesspool drainage, and milk diluted with infected water, are among
the principal means of spreading the disease. It is an absolute rule
that all bedding which becomes soiled should be destroyed, and the
refuse of the sick room should be instantly disinfected and removed from
the dwelling.