It is often weeks instead of days before the disease can be recognized. Then, if it develops in its usual form, begins the coughing so characteristic of the malady and the hard straining whoop so painful to listen to. Occasionally this coughing may be severe enough to cause a rupture of a blood vessel; but ordinarily, unless the stomach is affected by sympathy, no great danger need be feared. Fresh air, moderate exercise, good food, and some mild nerve depressant is all that can be done. The disease is very contagious and is usually transmitted directly from the sick person to the well person. It may, however, be carried in clothing, particularly in handkerchiefs and towels. Like measles, if it gains a foothold in an uncivilized community, it attains the size of an epidemic or plague with very fatal results. It seems to have a great power over girls and children, particularly those whose vitality is below the normal. Like measles, one does not generally have two attacks of this disease. In the winter, and this is the time when the whooping cough is most common, it is often followed by lung troubles, such as bronchitis and pneumonia. The death-rate from whooping cough is as large as from scarlet fever and measles combined, but chiefly because the disease is common among the smallest children. It is not unusual for babies under a year old to have whooping cough, and when their vitality is low, they scarcely ever recover.
Precautions against spread of whooping cough.
Probably the disease does not become contagious until the cough starts, and there is no reason why the disease should not be arrested in the first victim, provided proper isolation is practiced. The idea of a child with whooping cough, even when he whoops only once or twice a day, being allowed to attend school and mingle with the other scholars and to distribute the disease among them seems in these days of sanitary knowledge almost criminal. As soon as the first whoop occurs the child should be put in a room by himself and kept there until the last whoop has been whooped, and no other child should be allowed to go into the room, and the nurse or mother who is in charge should be careful about contact with other children after coming from the sick room until she has changed her outer garment. A big apron with long sleeves, fitted closely around the neck, which may be slipped on and off easily, is an admirable protection. The same precautions about disinfecting dishes, napkins, towels, handkerchiefs, and bedding should be observed here as already referred to.
Chicken pox.
Chicken pox is the mildest of eruptive diseases. It has no relation to smallpox, so that the theory sometimes held, that an attack of chicken pox prevents any attack of smallpox later, is a mistake. Instances are on record where a person has had both diseases almost at the same time. The appearance of the eruption is the characteristic feature of this disease, and it is so well distinguished that there is no danger of failing to recognize it. It is not common in grown people, and while it should not arouse suspicion in children, it is so uncommon in adults that a suspected case is probably a mild case of smallpox, and should always be quarantined as such.
With children, the accompanying cold and fever is often very mild, so that the appearance of the rash is the first and only symptom of the disease. The eruption is a progressive thing, each day's crop coming to full bloom and dying out as the next day's crop develops. This is, by the way, a distinguishing characteristic of this disease, differentiating it from smallpox where the pustules are more persistent and where the breaking out is more general. The pustules are sometimes extremely irritating, and it is very hard to keep children from scratching, the results of which may leave deep scars and so should be avoided. An antiseptic ointment should be used as with scarlet fever and measles, carbolized vaseline being suitable, although sometimes a strong solution of soda is substituted. It is not common to disinfect in chicken pox to the same extent as in the other diseases, the contagion being apparently in the air rather than in clothing and short lived. In New York State, in 1908, no deaths are recorded from chicken pox, and it is because of this lack of fatal results that the disease is regarded so indifferently and no particular pains taken to prevent its spread.
CHAPTER XIX
PARASITICAL DISEASES (MALARIA, YELLOW FEVER, HOOKWORM, BUBONIC PLAGUE, AND PELLAGRA)
Malaria.