Rural Hygiene

by Henry N. Ogden

There is such a striking difference in the severity of cases of scarlet fever that the name "scarletina" was for a long time applied to mild cases with the feeling that possibly it represented an altogether different disease. At the present time the disease is more intelligently diagnosed, and while there is vast difference in the severity of the sickness, it is all the same thing. Of the ordinary cases, about 5 per cent terminate fatally; that is, in a village or a community where a hundred cases occur, there would be five deaths. If the epidemic, however, is of the severe form, a larger percentage of deaths occur, often reaching 20 per cent of those affected. It has been noted that as an epidemic progresses, the disease becomes more serious, and a death-rate of only 5 per cent may, in the course of an epidemic lasting several months, gradually increase to one of 20 or 25 per cent. For this reason strong efforts ought to be made to stamp out an epidemic while it is in the first stages.

Besides the possibility of contagion from the skin as it comes off, to prevent which the antiseptic ointment is used, contagion also occurs through clothing used in the sick room. In fact, the contagiousness of scarlet fever is probably as malignant as any other infectious disease. It has been observed that a year after a case of scarlet fever in a house, the unpacking of a trunk or the unrolling of a bundle would set free the contagion and would result in new cases of the disease. The writer learned recently of a family in which a child had died of scarlet fever and some of its clothing had been packed away in the attic. A younger sister grew up, married, moved away, and some twenty years after the death of the child, came back to her former home on a visit with her own little girl. The grandmother, visiting the attic, found the clothing packed away so long before, gave it to her grand-daughter to wear, and in ten days the child was dead with the same disease.

There are a number of cases where scarlet fever seems to have been carried by infected milk, and great care must be taken on dairy farms to avoid any possibility of this kind of infection. To prevent the disease being transmitted after apparent recovery, thorough disinfection should be practiced. The patient's body should be very carefully and completely and continuously covered with antiseptic ointment which prevents the distribution of the contagion in small particles of skin. The sick room, after the patient's recovery, should be thoroughly disinfected, and all bedding steamed or boiled. All the surfaces in the room should be washed with a solution of carbolic acid, 1 in 50, or corrosive sublimate, 1 in 1000.

Measles.

If the disease is measles, one may expect a general epidemic, since its power of direct contagion is nearly equal to scarlet fever, although the fatality is much less. It is unfortunate that so little pains are taken to prevent the spread of this disease and fortunate that, except in the case of very young children, the effect of the illness is only a temporary inconvenience. Curiously, however, if measles attacks savage tribes where it has been before unknown, the severity of the disease is very great. Cases are on record where measles have broken out on the frontier and whole villages were wiped out; where the insignificant measles, so innocuous in civilized communities, became a plague similar to a scourge of the Middle Ages. It apparently has been modified by its passage through generations of individuals, just as any bacterial disease germ is modified by successive transmission through the bodies of different animals. When, however, the disease breaks out in a community which has not suffered from the disease for many years, it is, on that account, likely to appear in a far more virulent form.

Characteristic eruptions of measles.

Measles, like scarlet fever and chicken pox, is an eruptive disease; that is, is accompanied with a rash, differing slightly in the three diseases of which the presence of the rash and its progress over the body is one of the distinguishing features. In scarlet fever, for instance, the rash appears first on the neck and chest or back and spreads outward to the extremities. In measles, the rash appears on the extremities, beginning on the face usually, and spreads to the chest and trunk. In scarlet fever, this rash appears as fine scarlet pin points scattered around on the reddened skin, and on the second or third day the entire body may look like a boiled lobster. In measles, the rash appears as blotches, while the skin is not flushed but retains its natural color. In chicken pox, the rash appears generally on the body first and consists of small red pimples which develop into whitish blisters about as large as a pea and well separated. They are much more distinct and separated than the rash of scarlet fever and measles, and are much more likely to be mistaken for smallpox pustules than for an ordinary eruptive rash.

One of the old-time fancies connected with these eruptive diseases is the belief that an abundant eruption is a sort of guarantee against the severity of the disease. The old nurse was careful to keep the child in bed, well covered, steamed in fact, until the eruption appeared, and it was commonly thought that nothing should be done to check the rash or to prevent its coming out. This is not sustained by later science, and the appearance of the rash, whether it strikes in or strikes out, has nothing to do with either the disease or with its severity. No possible connection can be traced between the dissemination of the poison through the system by the action of the bacteria and the appearance of the skin, which is a minor factor in the disease. It may be worth while to repeat that the greatest danger from measles consists in the possibility of lung complications, and infinite care should be taken to keep the patient shielded from drafts and free from overexertion until recovery is complete. Like scarlet fever, the skin peels off, although not to the same extent, and the small particles are capable of transmitting the disease. Probably, also, the secretion from the nose and throat will transmit the disease, so that it is the height of folly to allow a sick person to use a handkerchief, for example, and then to use the same handkerchief to wipe the baby's nose when he comes into the sick room. All dishes and clothing of every sort should be boiled or steamed, and to be rendered harmless they should be soaked in a disinfecting solution before being taken from the sick room. The room itself, after being vacated, should be disinfected and the walls washed, as already prescribed.

Whooping cough.

Whooping cough is unlike the other three diseases in that it is a nervous trouble, and probably the germ or the poison formed by the germ attacks the nervous system, and particularly one great nerve connecting the lungs and stomach. This is why the spasm of coughing is frequently followed by vomiting, and the only remedy which is of value in whooping cough is a nerve depressant which will diminish the activity of the nervous system without at the same time interfering with the strength or vigor of the patient. On account of this connection between the lungs, whose spasmodic ejection of air seems to threaten the entire collapse of the little patient, and the stomach, so alarming do the repeated fits of vomiting appear that often this feature of the disease is even more serious than the coughing, pathetic as it is with younger children. In some cases the stomach cannot retain nourishment long enough to feed the body, and the child literally wastes away unless the period of the disease runs out before the child starves to death.