Much of the care exercised at school to prevent children's diseases is counteracted because children are exposed at home and in public places to contagion, where ignorance more often than carelessness is the cause of uncleanliness. By hygiene lessons, illustrating practically the proper methods of cleaning a room, much may be done to enlist school children in the battle against germs. Through the enthusiasm of the children as well as through visits to the homes parents may be instructed as to the danger of letting well children sleep with sick children; the wisdom of vaccination to prevent smallpox, of antitoxin to prevent serious diphtheria, of tuberculin tests to settle the question whether tuberculosis is present; why anything that gathers dust is dangerous unless cleansed and aired properly; and why bedding, furniture, floor coverings, and curtains that can be cleansed and aired are more beautiful and more safe than carpets, feather beds, upholstery, and curtains that are spoiled by water and sunshine; how to care for the tuberculous member of the family, etc. Anti-social acts may be prevented, such as carrying an infected child to the doctor in a public conveyance, thereby infecting numberless other people; sending infected linen to a common laundry; mailing a letter written by an infected person without first disinfecting it; sending a child with diphtheria to the store; returning to the dairy unscalded milk bottles from a sick room.
The daily inspection of school children for contagious diseases by the school physician has, where tried, been found to reduce considerably the amount of sickness in a town. Such inspection should be universally adopted. Moreover, the teacher should be conversant with the early symptoms of these diseases so that on the slightest suspicion the child may be sent home without waiting for the physician's call. Like the little girl who never stuttered except when she talked, school children and school-teachers are rarely frightened until too late to prevent trouble. The "easy" diseases such as measles, whooping cough, etc., cost our communities more than the more terrible diseases like typhoid and smallpox. During one typical week ending May 18, 630 new cases of measles were reported to one department of health. Obviously the nineteen deaths reported give no conception of the suffering, the cost, the anxiety caused by this preventable disease. The same may be said of diphtheria and croup, of which only thirty-two deaths are reported, but 306 cases of sickness. Yet no one to-day will send a child to sleep with a playmate so as to catch diphtheria and "be done with it."
The most strategic point of attack is almost universally unrecognized. That is the child's mouth. Here the germs find lodgment, here they find a culture medium—at the gateway of the human system. The mouth is never out of service and is almost never in a state of true cleanliness. Solid particles from the breath, saliva, food between the teeth, and other débris form a deposit on the teeth and decompose in a constant temperature of ninety-eight degrees Fahrenheit. In the normal mouth from eight to twenty years of age the teeth present from twenty to thirty square inches of dentate surface, constantly exposed to ever-changing, often inimical, conditions. This bacterially infected surface makes a fairly large garden plot. Every cavity adds to the germ-nourishing soil. Dental caries—tooth decay—is a disease hitherto almost universal from birth to death. Thus the air taken in through the mouth becomes a purveyor of its poisonous emanations and affects the lung tissues and the blood. Food and water carry hostile germs down into the stomach. Thence they may be carried into any organ or tissue, just as nourishment or poison is carried.
Moreover, the child with an unclean mouth not only infects and reinfects himself but scatters germs in the air whenever he sneezes or coughs. In a cold apartment where there is no appreciable current of air a person can scatter germs for a distance of more than twenty-two feet. Germs are also scattered through the air by means of salivary or mucous droplets. It is this fact that makes colds so dangerous.
Four columns are omitted: (1) Interval between Exposure to Infection and the First Signs of the Disease; (2) Day from Onset of Illness on which Rash appears; (3) Period of Exclusion from School after Exposure to Infection; (4) Period of Exclusion from School of Person suffering from the Disease
| DISEASE | PRINCIPAL SIGNS AND SYMPTOMS | Method of Infection | REMARKS |
| Measles | Begins like cold in the head, with
feverishness, running nose, inflamed and watery eyes, and sneezing; small crescentic groups of
mulberry-tinted spots appear about the third day; rash first seen on forehead and face.
The rash varies with heat; may almost disappear if the air is cold, and come out again with warmth. | Breath and discharges from nose and mouth. | After effects often severe. Period of greatest
risk of infection first three or four days, before the rash appears. May have repeated attacks. Great
variation in type of disease. |
| German Measles | Illness usually slight. Onset
sudden. Rash often first thing noticed; no cold in head. Usually have feverishness and
sore throat, and the eyes may be inflamed. Rash something between Measles and Scarlet
Fever, variable. | Breath and discharges from nose
and mouth | After effects slight. |
| Chicken Pox | Sometimes begins with feverishness,
but is usually very mild and without sign of fever. Rash appears on second day as small pimples,
which in about a day become filled with clear fluid. This fluid then becomes matter, and then the spot
dries upand the crust falls off.
May have successive crops of of rash until tenth day. | Breath and crust of spots. | When children return, examine head for
overlooked spots. All spots should have disappeared before child returns. A mild disease and seldom any after
effects. |
| Whooping Cough | Begins like cold in the
head, with bronchitis and sore throat, and a cough which is worse at night.
Symptoms may at first be very mild. Characteristic "whooping" cough develops in about a fortnight,
and the spasm of coughing often ends with vomiting. | Breath and discharges
from nose and mouth. | After effects often very severe
and the disease causes great debility. Relapses are apt to occur. Second attack rare. Specially infectious for
first week or two. If a child is sick after a bout of coughing, it is most probably suffering from whooping cough.
Great variation in type of disease. |
| Mumps | Onset may be sudden, beginning
with sickness and fever, and pain about the angle of the jaw. The glands become swollen and
tender, and the jaws stiff, and the saliva sticky. | Breath and discharges from nose
and mouth. | Seldom leaves after effects.
Very infectious. |
| Scarlet
Fever or Scarlatina | The onset is usually
sudden, with headache, languor, feverishness, sore throat, and often the child is sick.
Usually within twenty-four hours the rash appears, and is finely spotted, evenly diffused,
and bright red. The rash is seen first on the neck and upper part of chest, and
lasts three to ten days, when it fades and the skin peels in scales, flakes, or even large
pieces. The tongue becomes whitish, with bright red spots. The eyes are not watery or congested. | Breath, discharges from nose
and mouth, particles of skin, and discharges from suppuratory glands or ears. Milk specially apt to
convey infection. | Dangerous both during attack
and from after effects. Great variation in type of disease. Slight attacks as infectious as severe ones.
Many mild cases not diagnosed and many concealed. The peeling may last six to eight weeks. A second attack
is rare. When scarlet fever is occurring in a school, all cases of sore throat should be sent home. |
| Diphtheria | Onset insidious, may be rapid
or gradual. Typically sore throat, great weakness, and swelling of glands in the neck, about the
angle of the jaw. The back of the throat, tonsils, or palate may show patches like pieces of
yellowish-white kid. The most pronounced symptom is great debility and lassitude, and there may be little
else noticeable. There may be hardly any symptoms at all. | Breath and discharges
from nose, mouth, and ears. | Very dangerous both during
attack and from after effects. When diphtheria is occurring in a school all children suffering from sore
throat should be excluded. There is great variation of type, and mild cases are often not recognized
but are as infectious as severe cases. There is no immunity from further attacks. Fact of existence
of disease sometimes concealed. |
| Influenza | Begins with feverishness,
pain in head, back, and limbs, and usually cold in the head. | Breath and discharges
from nose and mouth. | Excessively infectious. After
effects often very serious and accompanied with great prostration and nervous debility. |
| Smallpox | The illness is usually well
marked and the onset rather sudden, with feverishness, severe backache, and sickness. About third
day a red rash of shotlike pimples, felt below the skin, and seen first about the face
and wrists. Spots develop in two days, then form little blisters, and in other two
days become yellowish and filled with matter. Scabs then form, and these fall off about
the fourteenth day. | Breath, all discharges,
and particles of skin or scabs. | Peculiarly infectious. When
smallpox occurs in connection with a school or with any of the children's homes, an endeavor
should be made to have all persons over seven years of age revaccinated.
Cases of modified
smallpox—in vaccinated persons—may be, and often are, so slight as to escape detection.
Fact of existence of disease may be concealed. Mild or modified infectious as severe type. |