HINTS AS TO INFECTIOUS DISEASES.
As infection is sometimes spread by means of children attending school while suffering from undetected infectious diseases, the following hints may be useful to the teacher:—
1. Any scholar having a sore throat should be sent home and regarded as infectious until the throat has been examined by a doctor.
If a scholar has enlarged glands in the neck, and especially if he or she is very pallid, the suspicion of possible diphtheria should be entertained. Many slight cases of diphtheria escape detection.
2. Any scholar suffering from a severe cold, with sneezing, redness of the eyes and running at the nose, should be sent home. It may mean an influenza cold or the commencement of measles, and both are infectious. This recommendation is particularly important when measles is known to be prevalent.
3. A child with a violent cough, especially if it is severe enough to cause vomiting or nose-bleeding, should be suspected of whooping-cough, and sent home, even if the characteristic “whoop” is not heard.
4. Slight cases of scarlet fever sometimes escape notice, and the patients are sent to school with the skin on the hands, etc., freely “peeling.”
5. In any of the above instances, or any other case of suspicion, the Medical Officer of Health, on receiving a confidential intimation, will be glad to make an investigation.
SYMPTOMS OF ONSET OF SCARLET FEVER.
Sudden onset.
Usually vomiting.
Always headache.
Feverish, with dry, hot skin.
Sore throat.
Red rash on chest in a few hours.
MEASLES.
Severe “cold in the head” for 72 hours before the blotchy rash appears.
Measles is extremely infectious in this preliminary stage.
Consider every severe influenza cold as possibly measles.
DIPHTHERIA
may be very indistinct.
Languor and sore throat.
Glands under and behind jaw are enlarged.
Patient very pallid.
White or yellow patches seen on examining inside throat.
Whenever doubtful, send the scholar home.
WHOOPING COUGH.
In a child under seven, a severe cough should always be regarded as possibly whooping-cough, although no “whoop” has yet been heard.
2. The notification of all cases of infectious diseases to the medical officer of health, is clearly a means to an end, that of securing that the preventive measures to be next named are effectively carried out.
3. Means for the production of an artificial immunity. This is only practicable at present for two diseases of this country, small-pox by means of vaccination (page [293]), and a temporary immunity against diphtheria by a dose of antitoxic serum (page [299]). Apart from these means, any measures for improving the health of a child tend in the same direction. Enlarged tonsils, “adenoids” at the back of the nose (causing the child to snore at night and to breathe through his mouth), discharges from nostrils or ear, and similar conditions should receive early medical attention.
4. Isolation: preventing the conveyance of the contagium from the sick to the healthy.
5. Disinfection, i.e. destruction of the contagium of the disease.
The Infectious Disease (Notification) Act, 1889, and the corresponding London Act of 1891, impose a dual duty of notification (a) on every medical practitioner attending on or called in to visit an infectious patient, as soon as he becomes aware of its nature; and (b) on the head of the family to which the patient belongs or the nearest relative. The intimation must be sent by each of these to the local medical officer of health, the practitioner being paid a small fee for his trouble. Usually notification by the householder is only enforced when no doctor is in attendance. The diseases to which this Act applies are small-pox, cholera, diphtheria, membranous croup[11], scarlet fever, erysipelas, and the fevers known by any of the following names: typhus, typhoid, enteric, relapsing, continued or puerperal. The list of notifiable diseases may be extended by resolution of the Local Authority.
The enforcement of notification is most important for the public health. (a) It enables the medical officer of health to take immediate steps to prevent the spread of infection, by enforcing proper isolation of the patient, efficient disinfection, and by preventing the attendance of children from infected houses, at school, etc. (b) It enables the links of evidence connecting a series of cases to be identified, e.g. cases due to a common milk supply, or attendance at a particular school. (c) It has a valuable educational effect on all concerned in the cases.