Chapter 32
CONTAGIOUS DISEASES
Never under any circumstances knowingly expose a child to any of the so-called "childhood diseases." The old method of "have the child get them as quickly as possible and get over them," has laid the foundation for many chronic disorders later in life. For instance, eye troubles and running ears are often the sequelae of measles; chronic coughs, tuberculosis and bronchitis frequently follow in the wake of whooping cough; heart disorders follow diphtheria, while kidney disease often follows in the course of scarlet fever.
CATCHING DISEASE
Under all circumstances keep the children away from these dangerous childhood diseases. When a contagious disease breaks out in a school and the little fellow has, along with the other pupils, been exposed to it, begin at once systematically to keep the nose and throat very clean with such well-known sprays as the champhor-menthol-albolene spray, which should be used in the nose morning, noon, and night. Throat gargles, such as listerine, or equal parts of alcohol and water, help to keep the throat in condition to resist the microbic invasion.
During this anxious time of patient waiting the bowels should move every day and the food should be cut down at least a third. In other words, moderate eating and a clean bowel tract go a long way toward keeping a child well and preparing him for an attack of disease. The skin at this time should be kept well bathed and free from the accumulated skin secretions which clog up the sweat glands and otherwise lower the vitality.
Stuffy, close rooms, where the ventilation is poor, not only harbor disease germs, but also lower the vitality of the child. Never take your child into a household where there is any form of sickness, for it may turn out to be a contagious disease--no matter how it began, it must be remembered that many contagious diseases, in their earlier stages, much resemble a simple cold.
Measles come on rather gradually, and one might suspect that the child was simply suffering from a severe cold in the head.
Scarlet fever usually begins with a sore throat, while chickenpox has very few initial symptoms; usually the first thing noted is the rash itself. Diphtheria begins with a sore throat, while whooping cough begins very insidiously.
The most important thing is to keep children away from people who are sick, and if a contagious or infectious disease is prevalent in the neighborhood discourage the mingling of the children in hot, illy ventilated rooms. Put a stop to "parties" and all similar gatherings. Let the little folks have good books, plenty of toys, in a well-ventilated room, and the more they keep to themselves at this particular time the better they are off.
THE SPREAD OF CONTAGION
It is possible to "stamp out" any known disease if only proper cooperation takes place and certain sanitary regulations are maintained. It is within the memory of most of our readers when yellow fever was put to flight and the cause of malaria discovered. We learned to screen our camps and no longer did our soldiers contract the fever; while the simple covering of stagnant pools with oil, together with proper screenage, stopped the ravages of malaria.
Likewise, many of the woeful tragedies of infant summer diarrhea and dysenteries have been tracked to the so-called "innocent house fly." We have all learned--only recently--that if we move the manure pile once in seven days the hatching of the maggots may be prevented, and so millions, yes trillions, of these carriers of disease may never be born.
If there is one sweet morsel above another for this fly pest it is tubercular sputum or feces, and from these feasts they go directly to walk over baby's hands, crawl over his cheek, and wash their feet in his milk. Proper screenage will prevent such contamination of food, such opportunities for carrying disease.
Sunshine, hot water, soap, and fresh air, are the best ordinary every-day disinfectants. It is possible so to conduct the treatment of a contagious or infectious disease that no other member of the family may contract it. A few simple but very important hints are:
1. Door knobs are one of the very greatest avenues of contagion--disinfect them.
2. Cleanse the hands both before and after attending to the sick; first, scrub with stiff brush, soap and water, then dip in alcohol.
3. An epidemic of sore eyes may be stopped by absolute "hand disinfection" and using separate towels.
4. Do not go visiting when you have a "common cold."
5. Kissing is one of the best ways of spreading many diseases.
6. In cases of contagious and infectious diseases completely cover all excretions from the body with lime.
7. Country homes would be as healthy as city homes if the privies and stables were screened.
8. In the country, the well water should be boiled; one infected well may be the cause of the death of a score of beautiful children.
INCUBATION PERIODS
The incubation period of scarlet fever is from one to seven days.
Measles, ten to twenty days. Whooping cough, from one to two weeks. Chicken-pox, fourteen to sixteen days. German measles, seven to twenty-one days. Diphtheria, any time from one to twelve days. Mumps, from one week to three weeks.
Of all the diseases, measles and chicken-pox are probably the most contagious. In scarlet fever and diphtheria, close contact is necessary for exposure, while whooping cough can actually be contracted in the open air, young babies being particularly susceptible.
TYPHOID FEVER
Typhoid fever is a disease of the small intestine. Typhoid germs accumulate in the little lymph nodes of the small intestines and that is the reason why we often have so many hemorrhages from the bowel--actual ulcerations take place--and if an ulcer is situated in the neighborhood of a blood vessel hemorrhage may result.
Typhoid fever begins rather insidiously with a slight debility and loss of appetite, but if a temperature record is kept the fever will be found to rise from one-half to a degree higher each day. A steady climb in the temperature curve is noted until the end of the first week, when it remains for a week, possibly 103 or 104 F. After one week it begins slowly to decrease and, if all goes well, the early part of the fourth week usually finds the temperature about normal. It is exceedingly important that the child be kept in bed during the entire course of the disease. The bed pan must be used at each bowel movement or urination.
_First Week Treatment._ During this week the child may feel quite well, but he should be kept in bed and sustaining treatments begun--such as wet-sheet packs and cold frictions to the skin (during which time there should always be external heat to the feet). The diet must be full and nourishing, but all pastries and "knicknacks" should be avoided. Abundance of fresh fruit that has been well washed before paring, eggs, pasteurized milk, baked potatoes, and toasted bread may be taken at regular periods--with an interval of not less than five hours between meals.
The bowels should be opened in the beginning of the disease with a liberal dose of castor oil, after which daily colonic irrigations should be employed. These enemas should be given at least once a day, the temperature being about that of the body, with a smaller terminal enema about five degrees cooler at the close of each bowel cleansing.
_Second Week Treatment._ The normal temperature at this time is no longer 98.6, it is 101.5 F. This fever is essential to the curative and defensive processes of the body; and while we do not care to have the fever fall below 101.5, at the same time nothing is to be gained by allowing the fever to go up much above 102.5 or 103 degrees F. And so, during the second week, while the disease is at its height, we make frequent use of the wet-sheet pack, always remembering that the extremities must be kept warm and never permitting the skin to become blue or mottled while the cold treatment is being administered. Since the real disease is localized in the small intestine, we will now describe a very important treatment for the diseased bowel--and one which is also very useful in combating high temperature.
_The Cooling Enema._ The temperature of this enema begins one degree higher than that of the body (supposing the body temperature to be 103, the temperature of the enema would start at 104 F.). This is allowed to flow into the colon and out again, under low pressure, without disturbing the patient, by means of a glass tube connection (See Fig. 15). The temperature is quickly brought down to 100, then to 98, then to 90, usually finishing up at 80 or 85 F. The water is allowed to enter the rectum slowly through a soft rubber catheter (not a hard rectal point), and as it comes out it will be noted that the water is very warm, sometimes registering 105, and it is needless to add that if the water goes in at 80 and comes out at 105 F., much heat has been taken from the body; and so, of all the treatments we have to suggest for typhoid fever, the one just mentioned is possibly the most important. When it is necessary to keep up this enema for an hour or two, the cool water may cramp the bowels, but this may be entirely obviated by applying hot compresses to the abdomen.
Another treatment of great importance in this second week is the cold abdominal compress. Much fever is occasioned in the abdomen because it is the seat of disease, and the much dreaded hemorrhages which often cause the death of the patient are usually avoided by the use of abdominal compresses--wrung out of water at 55 F.--the temperature of ordinary well water--and changed every twenty minutes.
I recall one mother in my dispensary practice who was so poor she could not afford a nurse, her only helper being a son twelve years old. A nurse went to the house twice each day and taught this lad of twelve years to give his mother the cooling colonic irrigation; he was also taught to warm up the abdomen by a hot application and afterwards to apply the cold compresses. The mother made a good recovery.
During this second week the diet should be sustaining. It should consist of boiled milk, eggs, fresh fruit and fresh fruit juices, dextrinized grains (hard toast, toasted corn flakes, shredded wheat biscuits, etc.). The mouth should be kept scrupulously clean, for in all the infectious and contagious diseases there is always the possibility of gangrene in the mouth if it is neglected.
_Third Week Treatment._ This is the week we look for hemorrhage from the bowel unless the abdomen has been well treated during the second week; and even so, the cool compresses to the abdomen will be continued well into the third week--also the daily or semi-daily enema. The skin is kept in good condition with soap washing and friction baths, and a fairly liberal diet is maintained. During the whole course of the disease the skin is never allowed to get blue or mottled, being quickly restored to the normal red color by the mustard sheet bath, the short hot-blanket pack, or the dry-blanket pack with hot-water bottles. Under no circumstances let the child leave the room or his bed for at least another week.
MUMPS
Infants are rarely affected with mumps. It is a disease of the salivary glands and (as a rule) is usually preceded by pain between the ear and the angle of the jaw, accompanied in a short time by swelling and temperature. It is distinctly contagious even during the incubation period. There is much tenderness on pressure, and chewing is difficult and may be impossible. It usually occurs on the face and only one side may be affected. The bowels should be kept open, the mouth should be kept clean, and the side of the face should be protected by a layer of cotton held in place by bandages.
Hot fomentations may be applied if the pain is severe. The electric light bulb on an extension cord, that was mentioned in connection with earache, is very comforting in this condition.
Isolation should be maintained for ten days or two weeks after all symptoms have disappeared.
SCARLET FEVER
Scarlet fever is one of childhood's most dreaded diseases because of, first, its long quarantine; second, its terrible possibilities of contagion; and, third, its sequelae.
Absolute quarantine is necessary until ten days after the last signs of desquamation have disappeared.
This disease is always alarming because of the possibilities of its sequelae--the danger of pneumonia, inflammation of the ears, abscesses of the glands of the neck, and nephritis (inflammation of the kidneys).
Scarlet fever is highly contagious at any time during its onset and course. Among the first symptoms of the disease are sore throat, swollen glands, fever, etc. Vomiting on a street car or at the movie may spread the disease to more than one child who might otherwise have escaped. One child who may have only a very light form of the disease may give it to another child in the most severe form. Any such group of classic symptoms--vomiting, fever, rapid pulse, and sore throat--should cause any parent immediately to isolate the little sufferer for several days--awaiting the "rash"--which usually puts in its appearance after three or four days of increasing temperature.
This rash has an appearance "all of its own," unlike any other. Because the fine "meal-like" red points are in such close proximity, the skin assumes a smooth "lobster red" color that is never to be forgotten. After three days of increasing redness, the color begins slowly to fade, and after four or five days of this fading a peculiar peeling takes place, whose scales vary in size from a small fleck to casts of the whole of the soles of the feet and the palms of the hands.
During the height of the disease, the throat is very red, the tonsils are not only inflamed, but covered over with white patches, the head aches and the tongue possesses a peculiar coating through which peep the red points of the swollen papillae, presenting the classic "strawberry tongue" of scarlet fever.
After ten days the fever disappears and the "real sick" stage of the disease is in the past.
Each morning of the ten previous days a small dose of Epsom salts is usually administered and the itching, which so often accompanies the rash, is relieved by carbolized-water sponge baths.
The nose, throat, and ears receive daily care--sprays to the nose and gargles to the throat, as well as special swabbing to the tonsils.
The physician in charge of the case will note the urinary findings, guard the heart and kidneys, prevent the spreading of the scales of desquamation by frequent rubbing of the skin with oil, and otherwise work for the future well-being of the patient.
MEASLES
Measles, one of the most common diseases of childhood, is not to be regarded lightly, for very often its sequelae--running ears, weak eyes, and bronchial coughs--may prove very serious and troublesome. Tuberculosis of the lungs not infrequently follows in the wake of measles. The early symptoms of measles are so mild that often the child is out of doors, at school, or about his usual play, until the second or third day of the fever. He was supposed merely to be suffering from a simple "cold in the head."
On the third or fourth day the patient begins heavy sneezing and wears a stupid expression; and it is then that the mother ascertains that his temperature is perhaps 101 to 102 F. He is put to bed and the next day the rash usually appears. The rash is peculiar to itself, not usually mistaken for anything else, being a purplish red, slightly elevated, flattened papule, about the size of a split pea. The coughing, which is very annoying, usually remains until about the seventh or eighth day--at which time the fever also disappears.
The bowels must be kept open; a daily bath be given--in which has been dissolved a small amount of bicarbonate of soda (simple baking soda)--after which an oil rub should be administered. The nose should be frequently sprayed with three per cent camphor-menthol-alboline spray, while the throat is gargled with equal parts of alcohol and water. The feet should be kept warm by external heat, while the physician in charge may order additional attention to the chest, such as a pneumonia jacket, etc.
Care should be taken to guard against "catching cold," for bronchitis or pneumonia is quite likely to develop in many cases of measles. The eyes should be protected by goggles and the room should be darkened; under no circumstances should the little patient be allowed to read. Carelessness in this respect may mean weakened eyesight all the rest of his life. Until two weeks after the rash has disappeared, the little fellow should be kept by himself, for the desquamation keeps up almost continuously during this time.
The food during the course of the disease is a liquid and soft diet. Children should never be allowed to go to a party or gathering with a cold in the head; the mothers of a group of small children will never forget the time that one certain mother allowed her little fellow to attend a party with "simply a cold in the head." He laughed, talked, and sneezed during the afternoon and when he went home the rash appeared that night, while eight of the ten exposed children came down with measles during the next two weeks.
CHICKENPOX
The incubation period of chickenpox is from ten to seventeen days. It is a mild disease, with a troublesome rash consisting of widely scattered pimples appearing over the scalp, face, and body. These pimples soon became vesicles (small blisters), which in turn quickly become pustular, afterwards drying up with heavy crust formation. Severe itching which attends these pustules may be greatly allayed by either the daily carbolic-acid-water bath or a baking-soda bath. The itching must be relieved by proper measures, for if the crust is removed from the top of the blebs by scratching, a scar usually results. The bowels should be kept open, the diet should be soft. Rigidly isolate, for chickenpox is highly contagious.
SMALLPOX
This disease occurs oftenest during the cold season. It spares no one unless vaccinated, attacking children and adults alike. The early symptoms are: headache, pain in the back, high fever, vomiting, and general lassitude. In many respects these resemble the symptoms of the grippe, while on the third day the eruption appears. The pimples are hard and feel like shot under the skin. Within a day or two these shotlike pimples have grown and pushed themselves beyond the skin into little conical vesicles which soon turn to pus. By the eighth or ninth day crusts are formed over the vesicle, beginning to fall off about the fifteenth day.
Patients are quarantined usually eight weeks and when a case of smallpox in the home breaks out everyone in the family should be revaccinated. The strictest isolation is important from the first of the disease.
We will not enter into the treatment of smallpox, for medical aid is sought at once and usually the patient is removed to a special isolation hospital.
VACCINATION
The history of the change brought about in the Philippines since vaccination has been introduced is an argument of itself which ought to convince the most skeptical of the value of vaccination. By all means, every child in a fair degree of health should be vaccinated. It is wise to vaccinate babies before the teething period--from the third to the sixth month. Babies with any skin trouble or suffering from malnutrition, but not living in a smallpox district, should be vaccinated during the second year. In young babies, under six months, the leg is the proper place to receive the vaccination.
If proper surgical cleanliness is practiced and ample protection is afforded in after dressing, vaccination need not be a taxing process. The child suffers from general lassitude--a little drowsiness with loss of appetite and a small amount of fever--but this passes off in a reasonable length of time, especially if he is not overfed and his bowels are looked after. On the second or third day after vaccination a red papule appears which soon grows larger, and, after five or six days, it becomes filled with a watery fluid. By the tenth day it has the appearance of a pustule about the size of a ten-cent piece, surrounded by a red areola about three inches in diameter. At the end of two weeks the pustule has dried down to a good crust or scab, in another week it falls off, leaving a pitted white scar.
If the vaccination does not take, it should be repeated after an interval of two months.
DIPHTHERIA
Diphtheria is a disease much dreaded during childhood and adolescence. It may attack any age--even little babies are susceptible. It begins with a general feeling of heavy, drowsy lassitude with a sore throat. White spots appear on the tonsils which may resemble a simple follicular tonsillitis, while in a short time white patches spread over the throat and tonsils.
It is not at all uncommon for this membrane to attack the nose, producing a bloody, pustular discharge; and when it does attack the nose, it is none the less contagious and must be regarded just as seriously. A physician is called at once, and, not only to the child, but to the other members of the family, antitoxin is immediately administered. The disease runs a regular course and its most dangerous complication is the membrane which forms in the larynx and threatens to suffocate the child unless prompt intubation is performed--the slipping of a silver tube in the larynx to prevent suffocation and death. The early use of antitoxin greatly lessens all these serious complications.
Care must be exercised to prevent sudden heart failure; and this is done by raising the child to an upright position with the utmost care; while you insist upon him lying quietly upon his back or his side, long after the disease has left his throat. While the throat or nose is the seat of disease, the toxins from these most dreaded diphtheritic microbes spread through the lymph channels and the blood vessels to the heart itself--so weakening that organ that it sometimes suddenly fails, or becomes more or less crippled for life. These serious results are to be prevented by the science of good nursing and the prompt use of antitoxin. In these days the "Schick test" may be administered for the purpose of ascertaining whether one is susceptible to contracting diphtheria.
A physician is always in charge of diphtheria, and he will supply directions for the bowels, the diet, and the sprays for the nose and throat, and the general well-being of the suffering child. Isolation and quarantine should continue for two weeks, and in bad cases three weeks, after the membrane has disappeared from the throat.
WHOOPING COUGH
A child suffering from a continuous cough, particularly if it is accompanied by a whoop or a condition which is so often seen in children who cough--not able to stop--should not be taken to church, nor to the movies, nor allowed to go to school; neither should he be allowed to leave his own yard. The average duration of the disease is usually six weeks. The child should have an abundance of fresh air, should spend much of his time out of doors, and while in the house should avoid dust of every kind; at night he should not be exposed to drafts. Call the physician early in the case and he may attempt to thwart the progress of the disease by certain administrations of vaccine medication.
In very bad cases, where a young child cannot catch his breath and gets blue in the face--which, fortunately, is uncommon--he should be slapped in the face with a towel wet in cold water; or, he may be lifted into a tub of warm water, then quickly in cold water, then back into the warm, etc. Hygienic measures should prevail, such as keeping the bowels open, the skin clean, and the use of the usual throat gargles and nasal sprays. Do not be misguided by the old-time thought that whooping cough must run its course; for, if medical aid is promptly secured, the disease may often be cut short and the severe paroxysms greatly lessened.
EYE INFECTIONS
Not long ago while in North Dakota near Canada, we took a trip one day just over the border to visit several villages of Russian peasants. We found the boys and girls of nearly the entire village suffering from trachoma--a dangerous, infectious disease of the eyes which spreads alarmingly from one child to another.
We saw the disease in all of its varying degrees among the children. Some of them had swollen, reddened lids. A discharge of pus was coming from the eyes of others, and they could not look toward a light or the sun. This disease is spread in a hundred different ways--through the common use of wash basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., and that is the reason why these isolated villages of foreign people who could neither read nor write the English language were nearly all so sorely afflicted.
The ordinary condition of "catching cold in the eye" ("pink eye") is just as infectious as the trachoma which we have mentioned, although it is more of an acute disorder and nothing like so serious.
In all such cases a physician is to be called immediately, isolate the patient, and give strict attention to carrying out the doctor's orders.
Another form of inflammation of the eye which was mentioned in a previous chapter, is the inflammation of the eye of the newborn.
In most civilized districts at the present, especially where the cases are attended by a physician, the eyes of all newborn babies are treated with either argyrol or silver nitrate. Just as soon as defective sight is discovered in the child the eyes should be examined at once and proper glasses fitted. While the glimmer and shimmer of moving pictures may seriously interfere with the child's vision, on the other hand, this very thing often discovers the defect in the eyesight earlier than it would otherwise be found out.
RUNNING EARS
Inflammation of the ears was fully covered in our discussion of adenoids and tonsils, but we would like to add at this time that under no circumstances should a running ear be regarded lightly. A chronic mastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. The attention of a specialist should be called to it and his instructions most carefully carried out; for, when we have a sudden stopping of the discharge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost.