INFECTIOUS DISEASES.
INFECTION AND CONTAGION.—These words are often used in such a way that a wrong impression is made. A disease may be infectious but not contagious. Malaria is an instance. Infection means an ability to enter the body from any source, wind, water, food or other persons and produce a characteristic disease. The agency doing this is known as a germ. Contagion is properly a poisoning of one individual from contact with a diseased individual in some way known or unknown. It may be conveyed indirectly through clothes, etc., or other person; but always comes from some person sick with the same disease. Diseases may be both infectious and contagious. Nearly all the epidemic diseases of infancy are both infectious and contagious and accompanied by fever. In nursing children, suffering from infectious diseases the mother or nurse should avoid their breath and handle them as little as possible. All secretion from bowels and kidneys should fall in a vessel containing a disinfecting solution of Copperas, bichloride of mercury, etc., and should be emptied into the sewer or buried. Following are the solutions as made. Copperas:—Put a lump as big as a walnut in the chamber with one-half pint of water, to receive feces, urine, sputum and vomited matter from infectious and contagious patients.
2. Solution of chlorinated soda, four fluid ounces; water ten ounces, useful for hands and dishes, not silverware. Dissolve eight corrosive sublimate tablets, also called bichloride, in a gallon of water. This is used to disinfect floors, woodwork, rubber, and leather, but not metal parts. Great care must be taken to have the hands washed after handling such a patient, so as not to infect the food, eyes, mouth, or any small skin sores.
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Diet in Infectious Diseases.—Foods that can be used: Milk, milk-water, milk and lime-water, Mellin's food, malted milk, imperial granum, albumin water, rice water, oatmeal water, barley water, egg (white part), and barley water, arrowroot water, whey, whey and cream mixture, cream and rice mixture, beef tea, beef extract, mutton broth, beef juice. Chewing broiled steak and only swallowing the juice, dry toast and soft boiled eggs, milk toast, dried beef broth, soups, rice, cornstarch, tapioca, etc. The diet must not consist of solid food in any severe case of fever. Small quantities of cold drinks can be given, frequently repeated if there is no vomiting. Frequent washing with tepid water or cool water lessens the fever and produces sleep. The bowels should be kept open at least once a day, and castor oil or salts usually can be given. (See Nursing and Dietetics department.)
Table of Infectious Diseases. Date of characteristic Whole Incubation lasts symptom. duration. Mumps 7 to 20 days 1st day 7 days or less Whooping Cough 2 to 7 days 7 to 14 days 2 months Diphtheria 1 to 12 days 1 to 2 days 1 week to 1 month Erysipelas 2 to 8 days 1 to 2 days 1 week to 3 weeks Varioloid 10 to 13 days 1 day 1 week to 3 weeks Chicken Pox 12 to 17 days 1 day 4 to 7 days German Measles 1 to 3 weeks 1 day 3 to 4 days Measles 12 to 14 days 4 days 7 to 9 days Scarlet Fever 1 to 7 days 1 to 2 days 7 to 12 days Typhoid Fever 1 to 14 days 7 to 8 days 3 to 5 weeks Smallpox 10 to 14 days 3 to 4 days 2 to 4 weeks
SCARLET FEVER. Definition.—Scarlet fever is an acute infectious disease, with a characteristic eruption.
Modes of Conveying.—The nearer a person is to a patient the more likely one is to take or convey the disease. Clothing, bedding, etc., may retain the poison for months. Scales from the skin of a patient, dried secretions, the urine if inflammation of the kidneys (nephritis) exists, the discharges (feces) from the bowels, are all means of infection. The longer a person remains near the patient the more likely he is to convey the disease. Foods handled by those sick of the disease, or by those who may have been near patients may convey the disease. This is especially true of milk. Epidemics of scarlet fever have been started by dairy-men who had scarlet fever in their family. I once attended a family where the only known cause for it in that family was a long-haired dog of a neighbor who had scarlet fever in the family. The dog was in the room with the sick ones, and visited the neighbor's family and played with the children who afterwards came down with the fever. Discharges from the ear, caused by scarlet fever, are said to be capable of giving it.
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Remains in the Room, how long?—It may remain for months in a room, and extend over two years as recorded by Murchison. We do not yet know how the poison obtains entrance to the body. Hence, the need for thorough disinfection.
Age, Occurrence, Susceptibility.—All children exposed to the disease do not contract the disease. It is less contagious than measles. A person who is exposed once, and does not take it, may take it at a future exposure. It occurs at any age and in all countries. It occurs oftener in autumn (September) and winter (February). Isolated cases occur, and then it is called sporadic. This disease attacks nursing children less frequently than older children. It is not often seen during the first year of life.
How Often?—As a rule, it attacks a person only once; yet there are recorded cases of well observed second and third attacks, but fortunately these are very rare. I once attended a family where they had it and claimed to have had it before, but very lightly.
Incubation.—The vast majority of cases develop within three to five days after exposure. If eleven days elapse without the appearance of symptoms we may reasonably expect that the danger is past, at least in the great majority of cases exposed.
Contagiousness.—There is danger of catching the disease during the stages of incubation, eruption and scaling. It is most contagious in the last two stages.
Onset.—Sometimes the onset is sudden; there may be a convulsion, preceded by a sharp rise in the temperature. An examination in such cases may reveal a marked sore throat or a membranous deposit on the tonsils preceding the eruption, and nothing more. A chill followed by fever and vomiting ushers in a large number of cases. These may be mild or severe. The severity of these symptoms usually indicates the gravity of the attack.
Rash.—The rash or eruption appears from twelve to thirty-six hours after the onset, usually on the second day, and looks like a very severe heat rash, but is finer and thicker. It consists of a very finely pointed rose-colored rash. In mild cases it is hardly noticeable. Usually it first appears on the upper part of the chest around the collar bones, spreads over the chest and around upon the back. Also it is now seen on the neck, beneath the jaw, behind the ears and on the temples, thence spreads over the body. There is a paleness about the mouth and wings of the nose, while the cheeks are flushed with a flame-like redness. There is much itching if the rash is severe. It attains the full development at the end of two or three days, and then gradually declines. In some cases the rash is seen only twenty-four hours.
Fever.—The fever rises rapidly in the first few hours to 104 or 105-8/10 degrees. It remains high except in the morning, until the eruption reaches its full development and falls with the fading eruption, and in uncomplicated and typical cases, within six days becomes normal.
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Sore Throat.—This we find on the pillars of the fauces, uvula, tonsils, and pharynx, reddened and inflamed. Sometimes it is very severe, and a membrane comes on one or both tonsils and pillars of the fauces. There is, generally a severe sore throat, and this makes swallowing difficult.
Tongue.—The tongue is covered with a coating at the onset, and may present a slightly reddened appearance at the borders and tip. The papillae are prominent and covered and look like a strawberry sometimes, or like the tongue of a cat. In fatal poisonous cases it becomes dry and cracked.
Scaling.—As the disease subsides the outer layer of the skin dries and peels off. The extent of this depends upon the severity of the attack. In some cases the scaling is hardly perceptible, and sometimes it appears only on certain parts, such as on the toes and inner parts of the thighs. There is always some scaling. This is called "desquamation." Generally speaking, scaling begins where the eruption first appeared on the upper part of the chest and neck. The scales may be fine and branny or as is most common, the skin peels in large particles. Some scaling is always present. The length of the scaling time is variable. It usually lasts from three to four weeks, but often longer. This stage is considered by many as the most contagious, as the fine scales fly in the air.
Complications. Nose.—The nose is affected at the same time if the "sore throat" is very severe. A membrane may also form in the nose.
Ear.—This may be affected in as high as one-fifth of the cases and needs careful watching and attention. Both ears may be diseased and deafness frequently results from it. Ten per cent of those who suffer from "deaf-mutism" can trace their affliction to scarlet fever. The ears usually become afflicted in the third week. The fever rises and there is pain in the ears or ear. The onset may not appear alarming and not be suspected until the discharge makes its appearance This is unfortunate; these complications are serious, as meningitis and abscess of the brain may result. The ear trouble (otitis) usually occurs during the scaling. The patient may be up and around. There is a rise of the temperature to 103 or 104 degrees, the patient begins to vomit food and has a headache. At night the child starts from its crib and cries as if in pain. They do not always locate the pain in the ear. The face and hands may twitch. The fever may fall to normal and rise sharply again. Such symptoms should call for a thorough examination.
Eye.—Inflammation of the (conjunctiva) red membrane of the eyes, often occurs.
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Kidneys.—There may be a mild form of inflammation in the earlier stages. The severe form comes, if at all, usually in the third week. It occurs in five to seven per cent of the cases. It may occur in the mildest case, as such cases are not so closely watched. The first symptom is a slight bloating of the eyes and face and spreads over the whole body. Sometimes the swelling is very slight; at other times it is extreme. The urine diminishes early and sometimes is wholly suppressed. It may be light colored, smoky or straw colored. This trouble usually runs for weeks. The patient may get uremia and result fatally.
Heart.—This also may be affected as the valves may become diseased.
Joints.—Rheumatism also may occur, and other complications.
Chorea.—Follows scarlet fever also, especially in girls from twelve to fifteen years.
Diagnosis.—In most cases it is easy to distinguish from other diseases.
Dermatitis, inflammation of the skin ("Itis" always means inflammation).
In dermatitis the throat symptoms and strawberry tongue are absent.
From Measles.—By the rapid onset, absence of cold symptoms of the nose, eyes, and bronchial tubes, blotchy eruptions that occur in measles. There is no strawberry tongue in measles and no coughing at beginning.
Recovery.—The prognosis is favorable in uncomplicated cases. It also depends upon the character of the epidemic type of the disease. In England it varies from thirteen to fourteen per cent. In this country it is sometimes as low as two to four per cent. The kidney trouble is always feared for it may result in uremia and death, or the acute may be followed by chronic nephritis or Bright's disease, which will ultimately prove fatal.
Sanitary Care of Room and Patient.—If you are exposed to this disease what can you do? If a child, it must be put in a room by itself. If several children have been exposed they should be put in separate rooms. These rooms should have no carpet, curtains, rugs, etc., or any unnecessary furniture, for everything must be disinfected afterward, and sometimes destroyed. The clothes worn just before the sickness should be sterilized in steam or boiled and then aired in the sun. Anyone suffering from sore throat who has been about the patient should not be allowed to be near the healthy. All the children must be kept from school. It is well for them to spray their throats with a simple cleansing solution morning and night, with a full teaspoonful of boric acid to a glass full of warm water; or you can use common salt, but not strong enough to irritate the throat, about one teaspoonful to a glass of water. If you have listerine or glyco-thymoline or any such disinfectant use them, one teaspoonful to sixteen spoonfuls of water. Hot water itself is a very good gargle, very healing and cleansing. Anyone who enters the sick room and comes out again should wear a sheet all over him. On coming out, he or she should leave this sheet outside the window of another room. If the person has a beard he should wash his face with a 1 to 2000 solution of corrosive sublimate, and the hands also, before leaving the sick room. The one who waits upon the sick one should remain there, but everyone can not do so. They must stay away from the healthy if possible.
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City and State Supervision.—If you live in the city your physician should notify the health board who will probably send someone to instruct you regarding cautions and some cities have private rules, laws, etc., for them to follow while under quarantine. A copy is usually furnished also to your close neighbors. Also some of the state departments of health have made up pamphlets which are circulated free on request dealing with the sanitary science of infectious and contagious diseases. Some colleges use these same pamphlets in their study of sanitary science. Much valuable information is contained in them. Comparatively few people learn of these pamphlets. For the benefit of those who have not read or seen them we quote from their scarlet fever subjects as follows:
HOW TO AVOID AND PREVENT SCARLET FEVER.
Do not let a child go near a case of scarlet fever. This is especially important to be observed.
Children are in much greater danger of death from scarlet fever than are adults; but adult persons often get and spread the disease, and sometimes die from it. Mild cases in adults may cause fatal cases among children. Unless your services are needed keep away from the disease yourself. If you do visit a case, bathe yourself and change and disinfect your clothing and hair, beard, if any, and hands before you go where there is a child. Do not permit any person or thing or a dog or cat, or other animal to come from a case of scarlet fever to a child. No cat or dog should be permitted to enter the sick room.
Do not permit a child to wear or handle clothing worn by a person during sickness or convalescence from scarlet fever.
Beware of any person who has sore throat. Do not kiss or come near to such a person. Do not drink from the same cup, blow the same whistle, or put his pen or pencil in your mouth. Whenever a child has sore throat and fever, and especially when this is accompanied by a rash on the body, the child and attendant should immediately be isolated until the physician has seen it and determined whether it has scarlet fever. Strict quarantine should be established and maintained throughout the course of the disease. Exposed persons should be isolated until such time has elapsed as may prove that they are not infected. The period of incubation, that is the interval of time between exposure to the contagion of scarlet fever and the first sign of the disease in the person so exposed, varies. In many cases it appears in seven days, in some cases in fourteen days, and in some cases twenty-one days; the average period is about nine days. Quarantine of persons exposed should not be raised under four weeks.
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Children believed to be uninfected may be sent away from the house in which there is scarlet fever to families in which there are no persons liable to the disease, or to previously disinfected convalescent wards in hospitals; but in either case they should be isolated from the public until the expiration of the period of incubation. This time may vary, but for full protection to the public isolation should be observed for four weeks.
Persons who are attending upon children or other persons suffering from scarlet fever, and also the members of the patient's family, should not mingle with other people nor permit the entrance of children into their house.