Essays In Pastoral Medicine

by Austin O'Malley; James J. Walsh

Ringworm is a kind of tinea, and it is caused by various mould fungi. Tinea Tonsurans is ringworm of the scalp; Tinea Circinata is ringworm of the body; Barber's Itch is another form; there is also a ringworm of the finger-nails; and Pityriasis Versicolor is still another form. All are contagious, and some are difficult to cure because the parasite gets down between the skin and the hair-follicles and an antiseptic can not reach it. Children affected with these diseases should be kept away from school until they have been cured.

The presence of lice and of the Acarus Scabiei can bring about acute and severe skin eruptions. The Acarus Scabiei causes itch, but fortunately it is rare in America. These parasites go from person to person, hence a child having either should be kept from school until he is clean. A thorough washing will remove lice if they have not yet inflamed the skin, but itch requires a more vigorous [{199}] treatment. The desks of such patients should be disinfected and their clothing should be baked. They will probably be reinfected at home if the treatment is not applied to other members of the family.

Contagious Impetigo, or porrigo, as it was formerly called, is a skin disease common among children, and it may affect adults. It appears to be of parasitic origin, but the specific organism that causes it has not been isolated. The lesions in this disease are commonly discrete—separate one from another—but they may be crowded together. They are vesico-pustular and they are sunken at the top in the typical form. If they are not broken by scratching, they dry into a yellowish crust. The disease affects only the skin, but as it is contagious a child affected with it should be kept from school until cured. The desk and articles used by the child should be disinfected, and his books are to be burned.

Whooping-cough is very infectious, and, contrary to the popular opinion, it is frequently a fatal disease. There is a period of incubation for from seven to ten days, then a catarrhal stage follows in which the child has the symptoms of an ordinary "cold." In about another week the dry cough becomes paroxysmal with the characteristic "whoop" when the air is drawn in after the fit of coughing. When there is an epidemic of whooping-cough, children with "colds" should be sent home from school. The objects used by a child that has whooping-cough should be disinfected, and its books and papers are to be burnt.

Mumps can be a serious and a very painful disease and it is infectious to a marked degree. The specific organism is not known. Boys are more liable to this disease than girls are, and recurrence is rare. After a period of incubation, which lasts from two to three weeks, there is fever, pain under one ear, and the parotid gland swells. The disease is commonly mild, but it may affect a child seriously. The patient is to be quarantined, what it has touched should be disinfected, and its books are to be burnt.

There are a number of infectious eye diseases that occur among school-children. Acute Contagious Conjunctivitis, [{200}] or "pink eye," is one of the most important. One form of acute Contagious Conjunctivitis is caused by the Koch-Weeks Bacillus; it is "pink eye," properly so called, and it is very infectious. Objects handled by the patient can infect others and spread the disease. The attack is severe, but the prognosis for full recovery is good. The child should be strictly quarantined until all secretion from the eyes has ceased, and whatever he has touched is to be carefully disinfected.

Another form of Acute Infectious Conjunctivitis, less contagious than that caused by the Koch-Weeks bacillus, is brought about by the introduction into the eye of the bacteria that give rise to pneumonia. Commonly the pneumonia bacteria do not cause conjunctivitis unless the patient is susceptible in a special manner. As it is difficult to differentiate this second form from the first, the same precaution should be used.

Trachoma, called also granular conjunctivitis, Egyptian ophthalmia, and military ophthalmia, is a very serious inflammatory disease of the external eye which has of late years become prevalent in American cities, whither it has been brought by immigrants from eastern and southeastern Europe. Persons that have this disease on landing in the United States are deported, but despite this precaution it has crept in and is now endemic. It is contagious, and when well established it is extremely difficult to cure. If untreated it lasts for years and it may destroy the cornea and consequently the sight. A trachomatous child should be kept from school until it has been cured, and that cure will take a very long time.

The Gonococcus can be carried into the eye by handling objects like soap, towels, wash-basins, which have been used by persons afflicted with gonorrhoea. The infection of the eye is very severe and dangerous, and the usual quarantine is to be observed. The ophthalmia of the new-born is gonorrhoeal.

The Diphtheria Bacillus also may get into the eye, and set up a primary infection there. A membranous conjunctivitis, too, is at times induced by pus organisms. [{201}] Xerosis Epithelialis, tuberculosis, leprosy, and syphilis may affect the eye primarily, and additional forms of eye-diseases are found that are infectious. The general rule, then, is that children with any inflammation of the eyes are to be kept out of school until a physician pronounces them harmless.