CHAPTER I
Contagious Diseases
Scarlet Fever—Symptoms and Treatment—Precautions Necessary—Measles—Communicating the Disease—Smallpox—Vaccination—How to Diagnose Chickenpox.
ERUPTIVE CONTAGIOUS FEVERS (including Scarlet Fever, Measles, German Measles, Smallpox, and Chickenpox).—These, with the exception of smallpox, attack children more commonly than adults. As they all begin with fever, and the characteristic rash does not appear for from one to four days after the beginning of the sickness, the diagnosis of these diseases must always be at the onset a matter of doubt. For this reason it is wise to keep any child with a fever isolated, even if the trouble seems to be due to "a cold" or to digestive disturbance, to avoid possible communication of the disorder to other children. While colds and indigestion are among the most frequent ailments of children, they must not be neglected, for measles begins as a bad cold, smallpox like the grippe, and scarlet fever with a sore throat or tonsilitis, and vomiting.
By isolation is meant that the sick child should stay in a room by himself, and the doors should be kept closed and no children should enter, nor should any objects in the room be removed to other parts of the house after the beginning of its occupation by the patient.
The services of a physician are particularly desirable in all these diseases, in order that an early diagnosis be made and measures be taken to protect the family, neighbors, and community from contagion. The failure of parents or guardians to secure medical aid for children is regarded by the law as criminal neglect, and is subject to punishment. Boards of health require the reporting of all contagious diseases as soon as their presence is known, and failure to comply with their rules also renders the offender liable to fine or imprisonment in most places.
SCARLET FEVER (Scarlatina).—There is no difference between scarlet fever and scarlatina. It is a popular mistake that the latter is a mild type of scarlet fever. Fever, sore throat, and a bright-red rash are the characteristics of this disease. It occurs most frequently in children between the ages of two and six years. It is practically unknown under one year of age. Prof. H. M. Biggs, of the New York Department of Health, has seen but two undoubted cases in infants under twelve months. It is rare in adults, and one attack usually protects the patient from another. Second attacks have occurred, but many such are more apparent than real, since an error in diagnosis is not uncommon. The disease is communicated chiefly by means of the scales of skin which escape during the peeling process, but may also be acquired at any time from the onset of the attack from the breath, urine, and discharges from the body; or from substances which have come in contact with these emanations. Scarlet fever is probably a germ disease, and the germs may live for weeks in toys, books, letters, clothing, wall paper, etc. Close contact with the patient, or with objects which have come in close touch with the patient, is apparently necessary for contagion.
Period of Development.—After exposure to the germs of scarlet fever, usually from two to five days elapse before the disease shows itself. Occasionally the outbreak of the disease occurs within twenty-four hours of exposure, and rarely is delayed for a week or ten days.
Symptoms.—The onset is usually sudden. It begins with vomiting (in very young children sometimes convulsions), sore throat, fever, chilliness, and headache. The tongue is furred. The patient is often stupid; or may be restless and delirious. Within twenty-four hours or so the rash appears—first on the neck, chest, or lower part of back—and rapidly spreads over the trunk, and by the end of forty-eight hours covers the legs and entire body excepting the face, which may be simply flushed. The rash appears as fine, scarlet pin points scattered over a background of flushed skin. At its fullest development, at the end of the second or third day, the whole body may present the color of a boiled lobster. After this time the rash generally fades away and disappears within five to seven days. It is likely to vary much in intensity while it lasts. As the rash fades, scaling of the skin begins in large flakes and continues from ten days to as many weeks, usually terminating by the end of the sixth to eighth week. One of the notable features is the appearance of the tongue, at first showing red points through a white coating, and after this has cleared away, in presenting a raspberry-like aspect. The throat is generally deep red, and the tonsils may be dotted over with white spots (see Tonsilitis) or covered with a whitish or gray membrane suggesting diphtheria, which occasionally complicates scarlet fever. The fever usually is high (103° to 107° F), and the pulse ranges from 120 to 150; both declining after the rash is fully developed, generally by the fourth day. The urine is scanty and dark. There is, however, great variation in the symptoms as to their presence or absence, intensity, and time of occurrence and disappearance.
Complications and Sequels.—These are frequent and make scarlet fever the most dreaded of the eruptive diseases, except smallpox. Enlarged glands under the jaw and at the sides of the neck are common, and appear as lumps in these sites. Usually not serious, they may enlarge and threaten life. Pain and swelling in the joints, especially of the elbows and knees, are not rare, and may be the precursors of serious inflammation of these parts. One of the most frequent and serious complications of scarlet fever is inflammation of the kidneys, occurring more often toward the end of the second week of the disease. Examination of the urine by the attending physician at frequent intervals throughout the course of the disorder is essential, although puffiness of the eyelids and face, and of the feet, ankles, and hands, together with lessened secretion of urine—which often becomes of a dark and smoky hue—may denote the onset of this complication. The disease of the kidneys usually results in recovery, but occasionally in death or in chronic Bright's disease of these organs. Inflammation of the middle ear with abscess, discharge of matter from the ear externally, and—as the final outcome—deafness, is not uncommon. This complication may be prevented to a considerable extent by spraying the nose and throat frequently and by the patient's use of a nightcap with earlaps, if the room is not sufficiently warm. Inflammation of the eyelids is an occasional complication. The heart is sometimes attacked by the toxins of the disease, and permanent damage to the organ, in the form of valvular trouble, may result. Blindness and nervous disorders are among the rarer sequels including paralyses and St. Vitus's dance.