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diff --git a/78158-h/78158-h.htm b/78158-h/78158-h.htm new file mode 100644 index 0000000..ec42c56 --- /dev/null +++ b/78158-h/78158-h.htm @@ -0,0 +1,2511 @@ +<!DOCTYPE html> +<html lang="en"> +<head> + <meta charset="UTF-8"> + <meta name="viewport" content="width=device-width, initial-scale=1"> + <title> + Measles, Diphtheria, Scarlet Fever, Chicken Pox and Whooping Cough | Project Gutenberg + </title> + <link rel="icon" href="images/cover.jpg" type="image/x-cover"> + <style> + +body { + margin-left: 10%; + margin-right: 10%; +} + +h1,h2,h3,h4,h5,h6 { + text-align: center; /* all headings centered */ + clear: both; +} + +p { + margin-top: .51em; + text-align: justify; + margin-bottom: .49em; +} + +hr { + width: 33%; + margin-top: 2em; + margin-bottom: 2em; + margin-left: 33.5%; + margin-right: 33.5%; + clear: both; +} + +hr.chap {width: 65%; margin-left: 17.5%; margin-right: 17.5%;} +@media print { hr.chap {display: none; visibility: hidden;} } + +div.chapter {page-break-before: always;} +h2.nobreak {page-break-before: avoid;} + +table { + margin-left: auto; + margin-right: auto; +} +table.autotable { border-collapse: collapse; } +table.autotable td, +table.autotable th { padding: 0.25em; } + +.tdl {text-align: left;} +.tdr {text-align: right;} + +.toc2row { + text-indent: 2em; + padding-left: 2em; +} + +.pagenum { /* uncomment the next line for invisible page numbers */ + /* visibility: hidden; */ + position: absolute; + left: 92%; + font-size: small; + text-align: right; + font-style: normal; + font-weight: normal; + font-variant: normal; + text-indent: 0; +} /* page numbers */ + +blockquote { + margin-top: 0; + margin-bottom: 0; + margin-left: 5%; + margin-right: 10%; +} + +.center {text-align: center;} + +figcaption {font-weight: bold;} +figcaption p {margin-top: 0; margin-bottom: .2em; text-align: inherit;} + +/* Images */ + +img { + max-width: 100%; + height: auto; +} + +.big-number { + font-size: 3.2em; + font-weight: bold; + padding: 0; +} + +.title-editor { + font-size: 0.9em; +} + +.title-table { + line-height: 0.8; +} + +/* Transcriber's notes */ +.transnote {background-color: #E6E6FA; + color: black; + font-size:small; + padding:0.5em; + margin-bottom:5em; + font-family:sans-serif, serif; +} + +.title-margin { + margin-bottom: 8em; +} + +.title-small-margin { + margin-bottom: 2em; +} + +.title-author { + font-size: 1.25em; +} + + </style> +</head> +<body> +<div style='text-align:center'>*** START OF THE PROJECT GUTENBERG EBOOK 78158 ***</div> + + +<p><span class="pagenum" id="Page_1">[Pg 1]</span></p> + + +<table class="title-table title-small-margin"> +<tr> +<td class="tdl">LITTLE BLUE BOOK NO.</td> +<td rowspan="2" class="big-number">136</td> +</tr> +<tr> +<td class="tdl title-editor">Edited by E. Haldeman-Julius</td> +</tr> +</table> + + +<h1> +Measles, Diphtheria, Scarlet<br> +Fever, Chicken Pox and<br> +Whooping Cough +</h1> + + +<p class="center title-author"><b>George H. Weaver, M. D.</b></p> + +<p class="center title-margin">Professor of Pathology, Rush Medical College, +Chicago; Physician in Charge of Durand +Hospital of the John McCormick Institute +for Infectious Diseases, Chicago, Ill.</p> + + +<p class="center"><b>HALDEMAN-JULIUS COMPANY</b></p> +<p class="center"><b>GIRARD, KANSAS</b></p> + +<hr class="chap x-ebookmaker-drop"> + + +<p><span class="pagenum" id="Page_2">[Pg 2]</span></p> + + +<div class=chapter> +<p class="center">LITTLE BLUE BOOK HEALTH SERIES.</p> + +<p class="center">EDITED BY MORRIS FISHBEIN, M. D.</p> + +<p class="center title-small-margin">Acting Editor, Journal of the American Medical +Association, and Associate Editor, Hygeia; a +Journal of Individual and Community Health.</p> + + +<p class="center">Copyright, 1924</p> +<p class="center title-small-margin">Haldeman Julius Company</p> + + +<p class="center">PRINTED IN THE UNITED STATES OF AMERICA</p> +</div> + + +<hr class="chap x-ebookmaker-drop"> + +<p><span class="pagenum" id="Page_3">[Pg 3]</span></p> + +<div class=chapter> +<p class="center"><b>MEASLES, DIPHTHERIA, SCARLET +FEVER, CHICKEN POX and +WHOOPING COUGH</b></p> +</div> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_4">[Pg 4]</span></p> + + + <h2 class="nobreak"> + PREFACE + </h2> +</div> + + +<p>It is generally recognized that the prevalence +of contagious diseases, and their associated +injury to life and health, especially of children, +can only be satisfactorily limited if the full +co-operation of those who have the care of +children is secured. This is dependent almost +entirely on general information. Scarcely any +parent will willfully endanger the health of the +children of others. It is hoped that this brief +statement of facts, on which authorities agree, +may be of some use to those who are responsible +for the health of children. It is not +intended to encourage the treatment of sick +children without trained advice, but rather to +aid in securing intelligent aid to the doctor +and public health officer.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_5">[Pg 5]</span></p> + + + <h2 class="nobreak"> + CONTENTS + </h2> +</div> + +<table class="autotable"> +<tr> +<td class="tdl"></td> +<td class="tdr">Page</td> +</tr> +<tr> +<td class="tdl">General Consideration</td> +<td class="tdr"><a href="#GENERAL_CONSIDERATION">7</a></td> +</tr> +<tr> +<td class="tdl">Measles</td> +<td class="tdr"><a href="#MEASLES">17</a></td> +</tr> +<tr> +<td class="tdl toc2row">Causes and Mode of Spread</td> +<td class="tdr"><a href="#CAUSE_AND_MODE_OF_SPREAD">19</a></td> +</tr> +<tr> +<td class="tdl toc2row">Symptoms</td> +<td class="tdr"><a href="#SYMPTOMS">20</a></td> +</tr> +<tr> +<td class="tdl toc2row">Complications</td> +<td class="tdr"><a href="#COMPLICATIONS">21</a></td> +</tr> +<tr> +<td class="tdl toc2row">Prevention</td> +<td class="tdr"><a href="#PREVENTION">23</a></td> +</tr> +<tr> +<td class="tdl toc2row">Treatment</td> +<td class="tdr"><a href="#TREATMENT">24</a></td> +</tr> +<tr> +<td class="tdl">Diphtheria</td> +<td class="tdr"><a href="#DIPHTHERIA">26</a></td> +</tr> +<tr> +<td class="tdl toc2row">Cause and How It Acts</td> +<td class="tdr"><a href="#CAUSE_AND_HOW_IT_ACTS">27</a></td> +</tr> +<tr> +<td class="tdl toc2row">Recognition of Diphtheria</td> +<td class="tdr"><a href="#RECOGNITION_OF_DIPHTHERIA">29</a></td> +</tr> +<tr> +<td class="tdl toc2row">How Diphtheria Is Spread</td> +<td class="tdr"><a href="#HOW_DIPHTHERIA_IS_SPREAD">30</a></td> +</tr> +<tr> +<td class="tdl toc2row">Treatment</td> +<td class="tdr"><a href="#TREATMENT_1">30</a></td> +</tr> +<tr> +<td class="tdl toc2row">Prevention of Diphtheria</td> +<td class="tdr"><a href="#PREVENTION_OF_DIPHTHERIA">33</a></td> +</tr> +<tr> +<td class="tdl toc2row">Bad Effects of Serum</td> +<td class="tdr"><a href="#BAD_EFFECTS_OF_SERUM">35</a></td> +</tr> +<tr> +<td class="tdl toc2row">Suggestions of Measures Calculated to Eliminate Diphtheria and Its Dangers</td> +<td class="tdr"><a href="#SUGGESTIONS_OF_MEASURES_CALCULATED_TO">36</a></td> +</tr> +<tr> +<td class="tdl">Scarlet Fever</td> +<td class="tdr"><a href="#SCARLET_FEVER">38</a></td> +</tr> +<tr> +<td class="tdl toc2row">Cause</td> +<td class="tdr"><a href="#CAUSE">39</a></td> +</tr> +<tr> +<td class="tdl toc2row">Mode of Spreading</td> +<td class="tdr"><a href="#MODE_OF_SPREADING">39</a></td> +</tr> +<tr> +<td class="tdl toc2row">Effects of the Infection</td> +<td class="tdr"><a href="#EFFECTS_OF_THE_INFECTION">40</a></td> +</tr> +<tr> +<td class="tdl toc2row">Symptoms</td> +<td class="tdr"><a href="#SYMPTOMS_1">40</a></td> +</tr> +<tr> +<td class="tdl toc2row">Complications</td> +<td class="tdr"><a href="#COMPLICATIONS_1">42</a></td> +</tr> +<tr> +<td class="tdl toc2row">Prevention of Scarlet Fever</td> +<td class="tdr"><a href="#PREVENTION_OF_SCARLET_FEVER">44</a></td> +</tr> +<tr> +<td class="tdl toc2row">Treatment</td> +<td class="tdr"><a href="#TREATMENT_2">45</a></td> +</tr> +<tr> +<td class="tdl">Chicken Pox</td> +<td class="tdr"><a href="#CHICKEN_POX">49</a></td> +</tr> +<tr> +<td class="tdl toc2row">Symptoms</td> +<td class="tdr"><a href="#SYMPTOMS_2">49</a></td> +</tr> +<tr> +<td class="tdl toc2row">Complications</td> +<td class="tdr"><a href="#COMPLICATIONS_2">51</a></td> +</tr> +<tr> +<td class="tdl toc2row">Different from Small Pox</td> +<td class="tdr"><a href="#DIFFERENT_FROM_SMALL_POX">52</a></td> +</tr> +<tr> +<td class="tdl toc2row">Prevention</td> +<td class="tdr"><a href="#PREVENTION_1">52</a></td> +</tr> +<tr> +<td class="tdl toc2row">Treatment</td> +<td class="tdr"><a href="#TREATMENT_3">53</a></td> +</tr> +<tr> +<td class="tdl">Whooping Cough</td> +<td class="tdr"><a href="#WHOOPING_COUGH">54</a></td> +</tr> +<tr> +<td class="tdl toc2row">Symptoms</td> +<td class="tdr"><a href="#SYMPTOMS_3">55</a></td> +</tr> +<tr> +<td class="tdl toc2row">Complications</td> +<td class="tdr"><a href="#COMPLICATIONS_3">56</a></td> +</tr> +<tr> +<td class="tdl toc2row">Prevention</td> +<td class="tdr"><a href="#PREVENTION_2">57</a></td> +</tr> +<tr> +<td class="tdl toc2row">Treatment</td> +<td class="tdr"><a href="#TREATMENT_4">58</a></td> +</tr> +</table> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum"><a id="Page_6"></a><a id="Page_7"></a>[Pg 7]</span></p> + + + <h2 class="nobreak"> + MEASLES, DIPHTHERIA, SCARLET + FEVER, CHICKEN POX and + WHOOPING COUGH + </h2> +</div> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="GENERAL_CONSIDERATION"> + GENERAL CONSIDERATION + </h2> +</div> + + +<p>Before beginning the consideration of the +individual diseases enumerated in the title, a +review of some of the things which relate to +them in common may prevent subsequent repetition. +The importance of this group of diseases +is realized when one remembers that +during the ten years ending in 1922, in a large +city such as Chicago, more than one person out +of every seven of the population suffered from +one of these diseases and one out of every 150 +died from one of them. Combined these diseases +cause about one-fourth of the deaths +among children from one to ten years of age. +Not only are they responsible for abundant +deaths, but they also leave in those that recover +a legacy of permanent damage in the +heart, lungs, ears, eyes and other parts of the +body. Statistics show that more than one-fifth +of the cases of deaf-mutism follow scarlet +fever, measles and diphtheria. Chronic diseases +of the heart and of the kidneys may be +due to earlier attacks of scarlet fever.</p> + +<p>The diseases here considered constitute an +important part of those which are known as +contagious. Contagious diseases are those +which are transmitted from one person to +others by direct or indirect contact. They are +<span class="pagenum" id="Page_8">[Pg 8]</span>sometimes also designated “communicable +diseases.”</p> + + +<p>CAUSES</p> + +<p>Each of these diseases is caused by its own +peculiar germ. We may compare the germs +causing contagious diseases to seeds of plants. +Each variety of seed will produce only the sort +of plant from which it came. Each of these +diseases is due to the implantation of its own +peculiar germ in the body, and except in this +way the disease never occurs. Each case thus +originates from a previous case of the same +sort. The old idea that contagious diseases +are caused by sewer gas, bad air, disturbances +in the weather or similar things, is now known +to be untrue. The germs causing diphtheria, +scarlet fever and whooping cough and perhaps +measles have been isolated and studied. They +are all bacteria, which are very small vegetable +organisms. In order to be seen by the +human eye, they must be magnified about one +thousand times by a microscope.</p> + +<p>As seeds must be placed in suitable soil if +they are to grow and produce plants, so disease +germs must find a suitable soil in the +body in order to cause disease.</p> + + +<p>IMMUNITY AND SUSCEPTIBILITY</p> + +<p>If disease germs are received by a person +whose body acts as barren soil no disease results, +while if they reach a person whose body +furnishes suitable soil for growth, disease follows. +The former person is said to be immune +to the disease. The latter is spoken of as +susceptible. It is well known that few persons +<span class="pagenum" id="Page_9">[Pg 9]</span>ever have the same contagious disease twice. +One attack renders immune a person who was +susceptible. This explains why we have epidemics +of contagious diseases. During the +epidemic most of the persons in a community +who are susceptible contract the disease. At +the end of the epidemic most of the suitable +soil for the growth of the special germ has +been exhausted and the population of the community +has become immune to the disease. +This causes the epidemic to cease. Another +outbreak in the same community of the same +disease can only occur when susceptible individuals +have again accumulated, i. e., when +children have been born and reached a suitable +age. Epidemics of contagious diseases are +naturally confined largely to children who have +grown up after the last epidemic occurred, the +older members of the community having been +rendered immune by attack of the disease +earlier in life. In isolated situations where the +germs of contagious diseases are not often +introduced persons may reach adult age without +ever having been exposed to them. Such +adults may then become infected the same as +children. In the late world war large numbers +of young men from rural communities who had +never had the usual contagious diseases were +brought together in training camps, and thus +furnished fertile soil for many epidemic diseases. +In a study of over 30,000 native white +children in 14 localities in the United States +it was found that at 5 years of age 65% have +had measles, 48% whooping cough, 22% chicken +pox, 5% scarlet fever, and 3.5% diphtheria. +<span class="pagenum" id="Page_10">[Pg 10]</span>As age advanced the proportions increased +until at 15 years of age, 88% have had measles, +77.6% whooping cough, 51% chicken pox, 11.6% +scarlet fever, and 8.7% diphtheria. By young +adult age most persons have had these diseases +which are often spoken of as children’s +diseases, but some persons are affected later, +some adults at quite advanced age.</p> + + +<p>HOW NEW CASES ORIGINATE</p> + +<p>The germs which cause these diseases are +given off and escape from the sick person in +various secretions and discharges. This includes +discharges from the throat, nose, ears +and eyes; pus from abscesses in the neck; +sputum or other excretions. The crusts from +the skin lesions of chicken pox contain the +germs of the disease, but the scales from the +skin in measles and scarlet fever do not usually +do so. The amount of secretion or discharge +required to carry enough germs to cause infection +is very minute. When the germs are +once located on suitable soil they multiply +rapidly and enormous numbers are soon produced +from an original few. In originating +new cases of disease the secretion from the +sick with its germs is deposited on some part +of the mucous membrane, or lining of the +respiratory tract, as the lining of the nose, +throat or larynx; or enters through the mouth, +and, being swallowed, lodges in the stomach or +intestine. At times the infecting material enters +through wounds and injuries of the skin, +the intact healthy skin usually forming a perfect +protection against infection.</p> + +<p>The passage of secretions from the sick person +<span class="pagenum" id="Page_11">[Pg 11]</span>to others is accomplished in numerous +ways. Sometimes this is through direct contact +between two persons, as in kissing. More +often the contact is indirect, the secretion being +carried on some object. Anything that is +contaminated by secretions may carry them to +a second person. A few of the most common +carriers, such as hands, clothing, bedding, eating +utensils, cups, forks and spoons, toys and +pet animals may be mentioned. During forced +expiratory efforts, such as coughing, sneezing, +hawking, stuttering, loud talking or crying, +small particles of secretions from the throat +and mouth are thrown into the air in the form +of what is known as mouth spray. This may +be inhaled by persons who are near and be +deposited in the throat or nose. This manner +of transferring contagious diseases is not so +frequent as the others mentioned, and only +occurs at distances of a few feet. Secretions +which become dry and pulverized into dust +outside the body soon lose their power of infecting. +Dust is not of much danger as a +means of transferring contagious diseases. +Sometimes various foods which are contaminated +by disease discharges serve to carry +them to well persons, in which case they may +be deposited in the throat or pass into the +stomach or intestines. This is specially true +of milk, which has been responsible for many +outbreaks of scarlet fever and diphtheria. The +disease germs in the milk do not come from +cows, but get into the milk during or after +milking from the hands, sputum and other +means of contact of the persons who handle +the milk.</p> + +<p><span class="pagenum" id="Page_12">[Pg 12]</span></p> + + +<p>CARRIERS</p> + +<p>In recent years persons who are known as +disease carriers have been looked on as important +factors in the spread of many contagious +diseases. The part they play in diphtheria +has been abundantly demonstrated and +is important. Carriers in this sense are persons +who are well, but who carry about disease +germs in their throats or noses. They +may have recently passed through mild attacks +of the disease whose germs remain for a long +time after recovery, or they may have received +the germs from sick persons, never having +been sick. This condition of carriage may persist +a long time, and carriers are especially +dangerous because not usually suspected.</p> + + +<p>COMMON PECULIARITIES</p> + +<p>Some common peculiarities of contagious +diseases may be mentioned. After exposure +a definite period of incubation passes before +any symptoms develop; many of these diseases +have characteristic skin eruptions; they occur +in epidemics, especially in children, and one +attack usually protects the individual during +life.</p> + + +<p>PREVENTION</p> + +<p>Because of the wide distribution of contagious +disease and the large number of deaths +caused by them, attempts to prevent their +spread have been made from remote times. +This has been largely concerned with isolation +or quarantine of sick persons. Doubtless +these measures have been useful, but that they +have largely failed to accomplish what is expected +<span class="pagenum" id="Page_13">[Pg 13]</span>of them is not surprising if we bear in +mind that many of these diseases are most +contagious early in their course before they +are recognized and before quarantine is begun, +and if we consider the important part which +is played by healthy carriers who are not suspected +and go about freely.</p> + +<p>An ideal condition would obtain if it were +possible to render all children, early in life, +immune to these diseases. In vaccination +against smallpox we have a measure which has +banished smallpox to a large extent and which, +if universally employed, would eradicate the +disease. Similar vaccination measures are now +available for diphtheria and scarlet fever. They +are easily carried out, devoid of danger, and +rarely cause even slight discomfort. These will +be again referred to in discussing the individual +diseases.</p> + + +<p>QUARANTINE AND DISINFECTION</p> + +<p>The term quarantine was originally applied +to the forty days during which a ship suspected +of being infected with a contagious disease was +held before those on board were allowed to +come into contact with those on shore. In +present conditions a better term to use is isolation +which varies in length and severity in +different diseases. The period of isolation in +diphtheria is until the person is free of the +germs which cause the disease. As it is possible +to cultivate and recognize the diphtheria +germs the period of isolation can be accurately +determined. At times it is only a few days; +at other times it must be extended to weeks +or even months. In the case of scarlet fever +<span class="pagenum" id="Page_14">[Pg 14]</span>and diphtheria the attendant who is liable +to carry infectious materials is isolated with +the patient.</p> + +<p>In scarlet fever the isolation is four or five +weeks and until all discharges have ceased. +Discharges from the nose and ear after scarlet +fever are apt to contain the cause of the disease, +and so are dangerous. Epidemics of +scarlet fever have been started in communities +by the coming of a child who still had a running +ear following scarlet fever many weeks +previously.</p> + +<p>The danger of transferring measles is quickly +over, and patients may be released after the +fever has been absent two or three days.</p> + +<p>In chicken pox the separation of all scabs is +the measure of the isolation period.</p> + +<p>Whooping cough is released when the characteristic +paroxyms cease.</p> + +<p>If measles or whooping cough appears in a +child in a family, other children may be sent +from home in hope that they have not been infected. +They must not be sent where there are +children who may be infected if the disease +develops.</p> + +<p>In diphtheria and scarlet fever the separation +of the sick must be absolute. No communication +must be allowed between the sick +and well. The patient and attendant should +be in a separate building, or in a room which +can be shut off from the rest of the house. +Nothing should pass from the sick room that +is not sterilized at once. All discharges should +be collected on pieces of gauze, and these with +surgical dressings, portions of food, fruit or +<span class="pagenum" id="Page_15">[Pg 15]</span>other material which the patient may have handled +may be placed in paper bags and burned +without opening. All sheets, towels, pillow +covers and bed clothes should be boiled in water +before being washed. The same disinfection +should be used for eating utensils. After recovery +the patient and attendant should be +given a thorough bath in warm water with +soap. The hair also is washed. In a clean +room fresh clothing is to be put on. After the +isolation room is emptied of its occupants all +its contents are disinfected as thoroughly as +possible. This can be accomplished by boiling +everything which can be treated in this way, +by burning things which have little value and +which cannot be boiled such as books, toys, +mattresses and pillows contaminated by secretions, +by thoroughly washing with warm water +and soap all wood work, floors and furniture, +and by thoroughly airing and sunning the bedding. +The fumigation which was formerly generally +used has been largely discontinued. +Much more can be accomplished by washing, +painting, and removal of paper and replacing +by new. A safe rule is to burn everything +which cannot be boiled in water or thoroughly +cleansed with warm water and soap. Fresh +air and sunshine are most efficient destroyers +of germs. Children recently relieved from isolation +after diphtheria and especially after +scarlet fever should not sleep with well children +for a week or two, and should not be +kissed.</p> + +<p>The disinfection required after measles, +whooping cough and chicken pox is limited +and consists of thorough airing and sunning.</p> + +<p><span class="pagenum" id="Page_16">[Pg 16]</span></p> + +<p>It is not desirable to confine children with +whooping cough. They may be taken out of +doors, but must not be allowed to play with +well children. Diphtheria carriers may also be +allowed to be out of doors provided provision +is made for keeping them from well persons. +Their eating utensils, toys, etc., must always +be treated as are those of persons with active +diphtheria.</p> + +<p>The closing of schools at the times of outbreaks +of the contagious diseases is of doubtful +value. It does not prevent contact between +the children when at play. Most favorable +conditions for dissemination of contagious diseases +exist in Sunday schools since children +too young to attend school as well as older +children are here brought together. If closing +of schools is to accomplish any good in controlling +contagious diseases it must be combined +with separation of the families of children +at home, and the prevention of children +coming together in picture shows and other +places.</p> + +<p>It is hardly necessary to state that no child +who is acutely sick should be sent to school. +So many contagious diseases are impossible +of recognition at the beginning that each case +of sickness must be considered suspicious until +it is shown to be harmless.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_17">[Pg 17]</span></p> + + + <h2 class="nobreak" id="MEASLES"> + MEASLES + </h2> +</div> + + +<p>Measles is one of the most contagious diseases, +ranking in this respect with small pox. +It was apparently observed by the earliest +medical writers and has been known throughout +the world for several hundred years as a +common epidemic disease. It is characteristic +of measles that it usually occurs in epidemics +which vary much in severity, and which appear +especially in the spring months. At such +times almost every one in a community who +has not had measles is affected. After a longer +or shorter interval when susceptible persons +have again accumulated, a new introduction +results in another epidemic. In cities a few +cases occur every year and about every two +or three years epidemic outbreaks appear. Almost +every person is susceptible to measles until +he contracts the disease after which there +is almost perfect immunity for life. Second +attacks are very rare. As high as 98 or 99 +per cent of people are originally susceptible. +The disease is usually contracted at the first +exposure. If persons have escaped in earlier +life they may be affected in adult years, even +at advanced age. Among people who have +never had measles, epidemics may take on +alarming proportions. When this disease was +introduced into the Faroe Islands in 1846, over +6,000 of the 7,782 inhabitants were attacked. +In 1775 measles was introduced into the Sandwich +Islands and in four months 40,000 of the +<span class="pagenum" id="Page_18">[Pg 18]</span>population of 150,000 died. In 1875, measles +was carried to the Fiji Islands with the resulting +death of one-fifth of the population (20,000). +In the late war many young men from +rural districts, who had never had measles, +were brought together in military camps. +When measles gained entrance extensive epidemics +resulted. Because of the great contagiousness +of measles, and its almost universal +susceptibility most persons are attacked +early in life. While it is especially a disease +of childhood, it rarely occurs in infants below +six months of age. By the time 15 years has +been reached about 90 per cent of children +have had the disease.</p> + +<p>Healthy children living in good hygienic surroundings +usually pass through measles without +much trouble. Delicate, poorly nourished +children who live in institutions and in parts +of cities where there is overcrowding in unhygienic +conditions often do badly and many +of them die. This is especially true of young +children. As a cause of death among children +measles ranks third among the acute contagious +diseases. In the registration area of the +United States in 1920, there were 7,712 deaths +from measles of which 78 per cent were in +children under 5 years of age. In Chicago from +1917 to 1921, 718 deaths from measles occurred, +over 90 per cent of which were children under +5 years of age. In this country 2 to 3 per cent +of children in private families who have +measles die, but in institutions and hospitals +the deaths may reach 6 to 10 per cent.</p> + +<p>Emphasis has been placed on the fact that +measles causes many deaths, especially among +<span class="pagenum" id="Page_19">[Pg 19]</span>young children, in order to draw attention to +the fact that young children, especially those +not very strong, should be kept away from +this disease as long as possible. To willfully +expose young children to measles, as is sometimes +done, is dangerous and open to the +severest criticism.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="CAUSE_AND_MODE_OF_SPREAD"> + CAUSE AND MODE OF SPREAD + </h2> +</div> + + +<p>The germ which causes measles has not been +certainly isolated but it is known to be in +the secretions from the respiratory mucous +membrane. It is there in the earliest stages +of the disease, two or three days before the +skin eruption appears, and it disappears when +the eruption fades. The danger of spreading +the disease is therefore present very early, +before the eruption develops, and it is soon +over, having passed when fever has been absent +a couple of days. The germs pass from +the sick to others in the secretions from the +respiratory tract. In coughing and sneezing +small particles of infected mucus are thrown +out into the air as mouth spray and the inhalation +of these causes infection. Outside the +body the germs quickly die. They do not survive +drying and exposure to the sunlight. +Transfer of the disease by a third person or +by any mechanical carrier can only occur if +it is done quickly. The particles of moist secretion +which convey the infection may be +very small and may be carried several feet in +the air. Thus a susceptible individual may be +infected by coming into a room with a case of +measles although never approaching very close. +Similarly a child coming down with measles +<span class="pagenum" id="Page_20">[Pg 20]</span>while in school may sow the germs widely +among other pupils.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="SYMPTOMS"> + SYMPTOMS + </h2> +</div> + + +<p>The symptoms may be considered as they +occur in three stages; catarrhal, eruptive and +convalescent. After infection no signs of illness +appear for several days. This is the +period of incubation. About eight to ten days +after exposure, very fine, pin-point size spots +appear on the lining of the cheek opposite the +molar teeth. These are known as Koplik spots. +They are bluish-white in color and seen only +by bright daylight. About the same time catarrhal +symptoms appear, such as a little fever, +coryza, sneezing, hoarse cough, watery eyes. +The symptoms as they occur in this catarrhal +stage of measles are usually supposed to be +due to a cold. After a further three, four or +five days, i. e.—12 to 13 days after exposure—the +typical eruption appears. It is first seen +over the forehead at the border of the hair, +behind the ears and on the neck. This gradually +spreads during two or three days over +the face, body and finally the arms and legs. +The eruption occurs as small red spots or +blotches, round or oval in form. They tend to +become larger and finally run together, so that +at the height of the eruption the skin of the +face and body is completely covered, only small +islands of pale skin appearing. The color of +the eruption is deeper red than that of scarlet +fever, and is much coarser. During the time +the eruption is coming out the fever is often +high and the catarrhal symptoms are marked. +Light hurts the eyes, and they become bleary +red, the secretions causing the lids to stick +<span class="pagenum" id="Page_21">[Pg 21]</span>together during sleep. The cough is often very +troublesome. At first it is dry and later looser. +There is often hoarseness and sometimes the +patient can talk only in a whisper. When the +eruption has reached its height it soon begins +to fade, but traces often remain for a week or +more. As the eruption begins to fade the fever +falls, often very rapidly. A fine branny scaling +of the skin follows the fading of the eruption.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="COMPLICATIONS"> + COMPLICATIONS + </h2> +</div> + + +<p>The danger from measles depends almost entirely +on its complications. In any case if fever +persists after the rash fades and the patient +does not rapidly improve complications must +be suspected. Sometimes a looseness of the +bowels occurs with the onset of measles, but +it usually stops as the eruption comes out. In +babies the intestinal disturbance may continue +and grow worse as the disease progresses. +This may become a grave complication in +young children. Most often dangerous complications +have to do with the respiratory tract. +In small children there is a special tendency +for the inflammation to extend from the bronchial +tubes to the lungs with resulting pneumonia, +which is the most common cause of +death. Sometimes the inflammation extends +to the covering of the lungs producing pleurisy. +This may become purulent, and then is known +as empyema. In this condition pus collects in +the chest between the lung and the chest wall, +causing compression of the lung. When the +pleurisy begins there is pain in the side, but +as the pus accumulates this stops. With the +collection of pus in the side breathing is interfered +with and in children especially the +<span class="pagenum" id="Page_22">[Pg 22]</span>side affected may be seen to be enlarged and +to move less than the other side when the +patient breathes. This condition is associated +with fever and sweats, and not infrequently has +aroused suspicion of consumption.</p> + +<p>Inflammation inside the ear is a frequent +complication of measles. The involvement of the +ear follows the passage of infectious material +from the throat through the Eustachian tube. +There is first fever and pain in the ear, which +may subside, or after a day or two, a discharge +from the ear appears. The discharge at first +is watery and may be tinged with blood, but +it soon becomes thick and purulent. With the +appearance of discharge the pain subsides and +the fever disappears. As healing takes place +the discharge again becomes thinner and finally +stops. Sometimes the inflammation extends +from the ear to the bone back of the ear and +mastoid disease results. This is recognized by +tenderness on pressing on the bone. When this +develops fever returns and the child appears +sicker. With mastoid disease there is always +danger of extension of the inflammation +through the bone and the production of meningitis. +Children with measles often have small +whitish ulcers in the mouth, on the lining of +the cheek, along the gums and on the edges and +tip of the tongue. These are apt to be sensitive, +causing pain when eating, and associated with +profuse flow of saliva. Very rarely these ulcers +become black and there results an extensive +ulceration of the entire face. This occurs only +in poorly nourished children, especially in institutions.</p> + +<p><span class="pagenum" id="Page_23">[Pg 23]</span></p> + +<p>Measles has the property of rendering the +patient susceptible to other contagious diseases. +Tuberculosis often progresses rapidly after +measles. This should always be suspected if +fever and cough continue after the rash fades. +If diphtheria is contracted during or soon after +measles it runs a particularly virulent course. +On the other hand when measles follows other +contagious diseases, especially whooping cough, +it is more fatal. Children with whooping cough +should be kept away from measles with special +care.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="PREVENTION"> + PREVENTION + </h2> +</div> + + +<p>Prevention of measles is difficult because the +most contagious period is that which precedes +the eruption. At this time the child is usually +supposed to have a cold and mixes freely with +other children. To prevent the further spread, +each patient must be isolated until fever has +been absent two or three days. Children who +have not had measles may be allowed to go +about freely for a week after exposure, and +then should be isolated until 15 days after exposure. +Fortunately we are now able to prevent +measles in young children even after exposure. +This is accomplished by drawing a little +blood from one who has recently recovered +from the disease and injecting it into the exposed +one. This usually prevents the disease +entirely or at any rate renders it mild if it +occurs. Blood drawn from a parent and injected +into the child soon after exposure renders +the disease mild. The drawing of the required +amount of blood is devoid of any danger.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_24">[Pg 24]</span></p> + + + <h2 class="nobreak" id="TREATMENT"> + TREATMENT + </h2> +</div> + + +<p>Each person with measles should be put to +bed and kept there until free of fever. Care +must be taken to avoid exposure to drafts. +Fluids are to be given freely, including cold +water. Tepid baths should be given and add +much to the comfort of the patient. If the fever +is high it may often be lowered by frequent +sponging with tepid water. Even quite warm +water is grateful and the temperature of the +bath may be determined by the feelings of the +patient. When pain in the ear occurs it may +often be relieved by applying heat, either wet or +dry as most grateful. The pain is often relieved +and the congestion reduced by putting in the +ear a few drops of warm glycerine to which 5 to +10 per cent of carbolic acid has been added. +When there is a discharge from the ear, the +secretion must not be allowed to accumulate. +The canal may be gently washed with warm +boric acid solution, using no force, and then +dried with little swabs of absorbent cotton. The +canal must not be plugged with cotton, but the +discharge allowed to drain freely. If the discharge +is profuse a pad of gauze over the ear +may be used to absorb it. Persistent discharge +or tenderness about the ear demands attention +by someone specially qualified.</p> + +<p>The room should be moderately darkened to +relieve the eyes. The eyes should be bathed +with warm boric acid solution and sticking of +the eye lids may be prevented by the application +to the edges, especially before sleep, of a +little vaseline. The diet at first may be largely +milk, but general diet may be given as the appetite +<span class="pagenum" id="Page_25">[Pg 25]</span>returns. In young children any intestinal +disturbance should receive the attention of a +doctor. The mouth should be kept clean by +washing with boric acid solution or other mild +washes. If there has been hoarseness in a +child with measles and it tends to increase, +especially if there are any croupy symptoms, +a doctor should be consulted at once. Such +cases are sometimes diphtheria of the larynx, +engrafted upon measles.</p> + +<p>At the termination of measles the measures +for disinfection consist especially of thorough +airing and sunning of room and contents.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_26">[Pg 26]</span></p> + + + <h2 class="nobreak" id="DIPHTHERIA"> + DIPHTHERIA + </h2> +</div> + + +<p>Of all the contagious diseases diphtheria is +most thoroughly understood. The cause is +known, its method of spread understood, and +the way in which it acts to bring about the disease +has been clearly demonstrated. For its +prevention and cure we have certain measures. +In spite of this it continues to be one of the +most dreaded and fatal diseases of children. +Diphtheria is an ancient disease and has appeared +in destructive epidemics in Europe and +America for two hundred years. It caused the +death of George Washington, and the empress +Josephine and her grand-child, heir apparent +to the French throne, died from it. As early +as 1771 it was epidemic in New York and in 1856 +an epidemic in San Francisco occurred in which +few children attacked by it recovered. Before +antitoxin came into use in 1894, of those attacked, +one-third to one-quarter died, and in +hospitals often 60 to 80 per cent of the cases +terminated in death. After antitoxin came into +use many more recovered, but for some years +now little improvement in the prevalence and +fatality from diphtheria has occurred. In Chicago +from 1911 to 1920, there was an annual +average of 7,358 cases and 813 deaths from +diphtheria. Of those dying, 63 per cent were +children below school age, and 90 per cent were +children less than 10 years of age.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_27">[Pg 27]</span></p> + + + <h2 class="nobreak" id="CAUSE_AND_HOW_IT_ACTS"> + CAUSE AND HOW IT ACTS + </h2> +</div> + + +<p>The cause of diphtheria, discovered in 1883-84 +by Klebs and Loeffler, two German scientists, +is the diphtheria bacillus. It is a minute rod +shaped vegetable organism sometimes spoken +of as a germ. If it is taken into the throat and +lodges and grows upon the tonsils two results +may follow. If the person is susceptible diphtheria +occurs. If the person is immune no local +changes occur and the individual becomes a +carrier. Both may transfer the germs to other +persons. We may compare what occurs here +to what happens when persons come in contact +with certain higher plants. The poison ivy vine +has in its leaves a specific poison which causes +an inflammation of the skin of some persons +who are susceptible to it, but has no effect upon +others who are immune. So the diphtheria +plant as it grows in the throat produces soluble +poisons or toxins which cause the changes +we call diphtheria in a susceptible person, but +is without effect on the immune person. The +immune person is protected by an antidote or +antitoxin which is in the blood, while the +susceptible person has none. After the diphtheria +bacilli have localized on the tonsil the +events which follow may be briefly stated. In +their growth the bacilli produce poisons and +as a result the tonsils become red and swollen. +On the surface of the tonsil, where the injury +is greatest, white spots appear, and, as they +enlarge, they run together to form the membrane +which is characteristic of the disease. +The name diphtheria means in its derivation a +<span class="pagenum" id="Page_28">[Pg 28]</span>pellicle or skin. This membrane often extends +beyond the tonsils, spreading over the throat, +up to the roof of the mouth, over the palate. +Sometimes it goes from the throat upward into +the back of the nose or downward into the +larynx. Wherever the membrane spreads the +tissues below are swollen. In the nose the nostrils +become occluded and the patient cannot +breathe through the nose; in the throat the tonsils +become very large interfering with swallowing +and breathing. In the larynx the swelling +causes hoarseness, croupy cough, and +finally difficulty in breathing which may +terminate in death from strangulation unless +relieved. This is what was formerly called +membranous croup. The membrane in the +throat is first white, but as it thickens it becomes +grayish-yellow, like buck skin, and finally +may be black. It is closely adherent and +not readily wiped off. When the disease extends +to the larynx it tends to go further along +the windpipe until it reaches the lungs with +resulting pneumonia. When the changes in the +throat are severe, there is external swelling +of the neck. This may be extreme and is sometimes +mistaken for mumps.</p> + +<p>While the things we have spoken of are going +on poisons are being taken by the blood +to all parts of the body. In this way they +reach and injure the muscle of the heart, and +this injury is of such a degree in severe cases +that it causes death. The poisons in the blood +also profoundly injure the nervous system with +resulting paralysis, so that the eyes are turned +to the side, swallowing becomes difficult or +<span class="pagenum" id="Page_29">[Pg 29]</span>impossible, and the muscles of the body and +limbs become weak. These paralyses appear +as late as six to eight weeks after the beginning +of the disease. The symptoms as described +are as they occur at the present time in cases +untreated by antitoxin. Some cases are mild +and never reach an extreme degree. In some +the laryngeal symptoms develop early and +death from obstruction to breathing may occur +before much is seen in the throat. Sometimes +a child who has what appears as a tonsilitis +for several days shows a sudden extension +to the larynx. The onset of diphtheria +is insidious. The child acts “dopey”, has a little +fever, and does not usually complain of pain in +the throat. A child with acute tonsilitis is at +first apparently much sicker, has more fever +and complains more of soreness in the throat.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="RECOGNITION_OF_DIPHTHERIA"> + RECOGNITION OF DIPHTHERIA + </h2> +</div> + + +<p>Many cases of diphtheria may be recognized +with considerable certainty by the appearance +of the membrane in the throat, but there is only +one way by which diphtheria of all degrees can +be certainly recognized especially at the onset; +that is by the detection of the germ. The making +of cultures for diphtheria bacilli by a doctor +is easily performed, and the materials for such +cultures and their examination are provided for +by local and state health laboratories. It would +be desirable to have cultures made from every +sore throat at the beginning. In this way much +valuable time would be gained and many lives +saved by the early use of antitoxin.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_30">[Pg 30]</span></p> + + + <h2 class="nobreak" id="HOW_DIPHTHERIA_IS_SPREAD"> + HOW DIPHTHERIA IS SPREAD + </h2> +</div> + + +<p>The general discussion of the ways in which +contagious diseases are spread at the beginning +of this article covers also diphtheria. The +germs are in the secretions from the throat and +nose. About one person out of every ten who +is about a case of diphtheria becomes a carrier. +Carriers play a large part in the spread +of this disease. When an outbreak occurs in a +school, it can usually be traced to one or more +healthy carriers among the pupils or even the +teachers. This is determined by making cultures +from all the throats and noses. Diphtheria +may be introduced into a community by +a carrier who comes from outside.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="TREATMENT_1"> + TREATMENT + </h2> +</div> + + +<p>The sovereign remedy for diphtheria is antitoxin. +If given early and in sufficient amount +practically every case could be cured. Diphtheria +antitoxin was first used in Berlin in +1891. It came into general use about 1894. +Like most new remedies it met much opposition +at first but is now recognized throughout the +civilized world as the one essential means of +cure. Cases given antitoxin on the first day +practically always recover, only a little over +1 per cent die. Each day of delay is shown in +the results. When given the second day, a +little over 3 per cent die; the third day, over +6 per cent die; the fourth day, nearly 11 per +cent, the fifth day, 15 per cent. In hospitals +where many cases come late under treatment, +<span class="pagenum" id="Page_31">[Pg 31]</span>about 10 per cent of the cases of diphtheria +now die. This is in marked contrast to the +50 to 80 per cent of deaths in preantitoxin days. +The patients who receive antitoxin early not +only have greater chance of recovery but they +get well promptly after a very brief illness, +while those that come late under treatment, +even if they recover, do so after a tedious illness +and protracted period of convalescence.</p> + +<p>The important things in treating diphtheria +with antitoxin are early administration and +sufficient amounts. The earlier given the +smaller the dose required. The doctor from +experience is able to estimate the dose needed +in each case. A moderate dose is 5 to 10 thousand +units, a full dose is from 20 to 30 thousand +units. A small fire may be extinguished by a +little water, but when it has spread much more +is needed. The damage done by the diphtheria +poisons before antitoxin is given cannot be undone +by any amount of antitoxin. Antitoxin +only prevents further injury. If sufficient injury +to the heart and kidneys has occurred +death will follow. Lost time cannot be regained. +The antitoxin must be injected with a +hypodermic needle. It cannot be given by mouth +as it is destroyed and rendered useless in the +stomach.</p> + +<p>A few hours after enough antitoxin to control +the disease has been given marked improvement +occurs. The restlessness subsides, +the swelling begins to grow less and the membrane +separates at the edges and begins to peel +off, the color reappears in the pasty cheeks, +the pale lips become red again, and the child +<span class="pagenum" id="Page_32">[Pg 32]</span>which has been blue and struggling for breath +falls into quiet sleep. The change in a short +time is one of the most remarkable observed +in sick persons.</p> + +<p>Local treatment is of little value. We no +longer gargle, spray and swab the throat. We +only try to keep the mouth and throat as clean +as we can with cleansing washes but this is +not done with the idea of influencing the disease.</p> + +<p>If the obstruction to breathing from diphtheria +in the larynx becomes extreme this must +be relieved by making an opening in the windpipe +or by passing a small rigid tube into the +larynx through the mouth.</p> + +<p>If antitoxin has been given late the complications +which have developed must receive appropriate +treatment. The duration of confinement +to bed will depend on the time antitoxin +was given. If given early the patient may be +up in a few days. Serious damage to the heart +and kidneys may require confinement to bed for +several weeks. When there are heart disturbances +perfect quiet in a horizontal position is +imperative. Even rising to a sitting position or +moderate exertion may be quickly fatal. Such +accidents are most apt to occur about the 5th +to the 14th day. Recovery from the paralysis +is usually complete, but may require several +weeks or months. These paralyses may continue +to extend for two months, and during this +time the weakened muscles must not be used. If +unable to swallow the patient must be fed with +a rubber tube through the nose or mouth.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_33">[Pg 33]</span></p> + + + <h2 class="nobreak" id="PREVENTION_OF_DIPHTHERIA"> + PREVENTION OF DIPHTHERIA + </h2> +</div> + + +<p>Efforts to prevent diphtheria take two main +directions. In one the object is to prevent the +infection of new persons; in the other the measures +employed are used to render well persons +immune to the disease so that they will not become +sick even if the germs reach them. Prevention +of the infection of other persons is accomplished +by isolation or quarantine of the +sick individual and his attendant. To be effective +quarantine must be carried out with conscientious +attention to the smallest details. +When a member of a family develops diphtheria, +other members of the household may +permanently leave the house if they are free +of diphtheria germs as shown by cultures. The +way in which quarantine is carried on has been +described as it relates to all the diseases under +discussion. In the case of diphtheria quarantine +can only be terminated when repeated +cultures from the throat and nose have shown +that the diphtheria bacilli have disappeared. +This may require several weeks and in exceptional +cases even months. Carriers must +be placed in quarantine as well as active cases. +As recovery from diphtheria progresses the +germs tend to die out and often are no longer +present after a few days. Sometimes the germs +persist and the patient becomes a persistent +carrier. In the persistent carrier usually some +abnormal condition in the nose and throat interferes +with the efforts of nature to destroy +the germs. When such are corrected the germs +often quickly disappear. Most often diseased +<span class="pagenum" id="Page_34">[Pg 34]</span>adenoids and tonsils are the offending conditions. +In this case the removal of abnormal +adenoids and tonsils is usually followed by +prompt disappearance of the germs. Persistence +of bacilli in the nose of children has sometimes +been dependent on the presence of foreign +bodies such as shoe buttons.</p> + +<p>Aside from the measures outlined which have +for their purpose the prevention of extension of +the germs to other persons, important steps +may be taken to render persons immune to +diphtheria so that they will not be affected by +the germs. This is accomplished in two ways. +In the presence of immediate danger, small +doses of antitoxin at intervals of three to four +weeks procure protection. This is to be selected +when children in a family cannot be protected +from infection by quarantine. When immediate +danger is absent an immunity which +lasts for years may be secured by a sort of +vaccination. This consists of three hypodermic +injections at intervals of a week of a mixture +of diphtheria toxin and antitoxin. The amount +injected is very small and produces little or +no inconvenience, but it is followed in a few +weeks by a lasting protection against future +infections. Almost all persons become immune +after such injections. Such vaccinations have +been used in a large scale among school children +in New York City. Among 90,000 school +children thus treated only one-fourth as many +cases of diphtheria occurred last year as among +the same number who refused the treatment. +Injections are advised in children as early as +possible after six months of age is reached. If +<span class="pagenum" id="Page_35">[Pg 35]</span>this were uniformly employed children would +be protected against diphtheria during the +most susceptible years, and the disease would +largely disappear. It is not too much to hope +that this vaccination measure against this most +fatal disease of children will accomplish corresponding +favorable results to those which +have followed vaccination against small pox.</p> + +<p>It is not desirable or necessary to use such +injections in children who are already immune. +By a simple harmless test it is possible to determine +if susceptibility exists in the individual. +This is known as the Schick test. It is +easily given and is devoid of all danger and +discomfort. Such tests have shown that the +proportion of persons susceptible to diphtheria +varies with age. Few infants under six months +are susceptible. From one to three years about +60 per cent are susceptible. As age advances +the proportion gradually decreases so that by +20 years only about 20 per cent are liable to +be infected if opportunity occurs. The children +in the families of the well-to-do are susceptible +in larger proportions than are those living in +crowded parts of cities, and in country districts +the proportion of susceptible children is very +high.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="BAD_EFFECTS_OF_SERUM"> + BAD EFFECTS OF SERUM + </h2> +</div> + + +<p>Antitoxin is contained in the blood serum of +horses, which have been injected with diphtheria +toxins, and cannot be entirely separated +from other parts of the serum. The antitoxin +itself probably produces no disturbances, but +the serum sometimes causes hives and other +<span class="pagenum" id="Page_36">[Pg 36]</span>inconveniences which quickly pass away. Probably +no person with diphtheria has been permanently +harmed by antitoxin. A few instances +of death have followed the use of small immunizing +doses in persons who were not sick +and were subject to “horse asthma”. Such cases +can be counted on the fingers of the hands and +appear insignificant when contrasted with the +hundreds of thousands of injections given during +the same time. Diphtheria in one week +causes five to ten times as many deaths as +antitoxin serum in thirty years. In our large +cities as many children are killed daily by +motor vehicles as have died from antitoxin +serum in thirty years. In the presence of the +enormous danger from diphtheria, we can ignore +the infinitesimal danger from the serum.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="SUGGESTIONS_OF_MEASURES_CALCULATED_TO"> + SUGGESTIONS OF MEASURES CALCULATED TO + ELIMINATE DIPHTHERIA AND ITS DANGERS + </h2> +</div> + + +<ol> +<li>Teaching children to have their throats +examined when they are well, and the examination +of the throat whenever a child is not well.</li> + +<li>Call a doctor immediately when a child +has a sore throat, swelling of the neck, or any +croupy condition with hoarseness.</li> + +<li>Taking cultures at the first visit of the +doctor.</li> + +<li>Giving antitoxin at once whenever there +is any exudate in the throat or any condition +resembling diphtheria. +</li> + +<li>Protection of children with antitoxin +when they are intimately associated with others +who have diphtheria. +<span class="pagenum" id="Page_37">[Pg 37]</span> +</li> + +<li>Immunization of all children over six +months of age with toxin-antitoxin.</li> + +<li>Pasteurization or heating of all milk used +by children.</li> +</ol> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_38">[Pg 38]</span></p> + + + <h2 class="nobreak" id="SCARLET_FEVER"> + SCARLET FEVER + </h2> +</div> + + +<p>Quite accurate descriptions of scarlet fever +have existed for over three hundred years. +One of the best of the early descriptions was +written by William Douglass, a doctor in Boston, +at the time when the first epidemic of this +disease on this continent occurred in 1735-1736. +From the Atlantic Coast the disease gradually +extended westward and ever since has appeared +at intervals in all parts of this country, +following the settlers into the new regions and +often causing many deaths among their children. +A very striking peculiarity of scarlet +fever is the great variation in virulence at different +times. Sometimes it is so mild that +scarcely any deaths are associated with it; at +other times it takes on such a high degree of +virulence that it wipes out whole families of +children. In cities isolated cases are always +present, and at intervals of a few years epidemic +outbreaks occur. For many years in +this country scarlet fever has gradually become +less severe and while the total cases of the +disease have not been much reduced, deaths +have become much fewer. In recent years the +proportion of deaths in scarlet fever has varied +from 1.5 to 10 per cent. The death rate is +highest in infancy and decreases with advancing +age. Few cases of scarlet fever occur in +children under one year of age, the largest +number is observed in children up to 10 years. +The disease is not so infrequent in young +<span class="pagenum" id="Page_39">[Pg 39]</span>adults, and occasional instances appear in persons +of quite advanced age. In these respects +it resembles diphtheria. The disease is most +prevalent in late autumn and winter.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="CAUSE"> + CAUSE + </h2> +</div> + + +<p>The cause of scarlet fever is a small round +bacterium known as the streptococcus of scarlet +fever. This germ is in the secretion from +the throat, and nose, in discharges from the +ears, in pus from abscesses in the neck and in +the discharges from infected wounds. The +germ is very tenacious of life. In dried secretions +it may remain alive for a long time. +Instances are known where clothing, worn by +children when sick with the disease, has been +put away in a dark place. When this clothing +was brought out many years later and given +healthy children to wear they contracted scarlet +fever.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="MODE_OF_SPREADING"> + MODE OF SPREADING + </h2> +</div> + + +<p>The germs of the disease pass from the sick +person to others in particles of the secretions +already mentioned. This transfer is usually +accomplished by direct contact or by the +agency of some carrier such as infected hands, +eating utensils, toys, etc. In the manner of +its dissemination scarlet fever resembles diphtheria +very closely. This disease does not +often pass from one person to another through +the air as occurs in measles. Like diphtheria +it is sometimes spread through milk which has +been handled by someone who has recently had +the disease or has been in close contact with +<span class="pagenum" id="Page_40">[Pg 40]</span>it. Many epidemics of scarlet fever have been +traced to contaminated milk. Usually the +germs first lodge in the throat, often on the +tonsils. Sometimes they enter through wounds.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="EFFECTS_OF_THE_INFECTION"> + EFFECTS OF THE INFECTION + </h2> +</div> + + +<p>The results of the location of the germs in +the throat or in wounds depend on whether the +individual is susceptible or immune. One attack +of scarlet fever is followed by immunity +which usually lasts through life. A second attack +is very rare. Many persons probably are +immune because they have sometime passed +through very mild forms of the disease which +were not recognized as scarlet fever at all. If +the germs have secured a footing in a susceptible +person they grow and produce their poisons +or toxines. These cause inflammation of +the tonsils, and other parts of the throat and +as the toxines enter the blood and are carried +to all parts of the body they cause fever, an +eruption of the skin, and injury to various organs, +especially the heart and kidneys.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="SYMPTOMS_1"> + SYMPTOMS + </h2> +</div> + + +<p>The period of incubation, i.e., the time between +exposure or infection and the appearance +of signs of illness—is very short in scarlet +fever. It may be only a day or two and is almost +always less than a week. The onset is +very sudden. A child goes to school as usual +in the morning and during the day becomes +acutely sick, or he goes to bed at night in apparent +health and by morning is virulently ill. +<span class="pagenum" id="Page_41">[Pg 41]</span>At the beginning there is fever, which may +quickly rise very high, sore throat and often +vomiting. The throat is so sore that the patient +usually complains very much of it, and +acute pain is caused by swallowing. Vomiting +once or several times in the early part of the +disease is very common. Whenever a child is +suddenly taken with fever, a sore throat and +vomiting, scarlet fever should be suspected. +Soon the eruption appears. This usually is +present within 24 hours, but may be delayed 2 +or 3 days in rare instances. It is first seen +upon the neck and chest, rapidly extends to the +body, then to the arms and legs. It is absent +on the face. The skin about the mouth is +paler than natural. The rash consists of very +small red points closely set upon the skin +which shows a uniform bright red flush. The +skin looks much like that seen after severe +sunburn. The color is bright scarlet. If one +looks at the throat it is bright red, and often +small white spots are seen upon the swollen +tonsils. The tongue is coated white through +which bright red points may project giving the +appearance spoken of as “strawberry tongue.” +At the sides of the neck the glands are swollen +and tender. In size they may correspond to a +marble, or may attain the size of a hen’s egg +or larger. While the eruption is coming out, +the throat remains very sore, and the fever is +high. Especially at night, children in this +acute stage of scarlet fever are apt to show +delirium and may try to get out of bed. After +two to four days the fever begins to fall, the +throat becomes less sore, and the rash fades. +<span class="pagenum" id="Page_42">[Pg 42]</span>As the rash fades the skin is roughened and +peels in small flakes. About three weeks from +the onset the thick skin of the palms of the +hands and soles of the feet peels off. The detached +pieces may be large, or only small delicate +pieces may come from the fingers and +toes. This late peeling is very characteristic. +The case to which the preceding description +applies is one of average severity. Many mild +cases have little fever and slight rashes which +last but a few hours. The sore throat is constant +even in mild cases.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="COMPLICATIONS_1"> + COMPLICATIONS + </h2> +</div> + + +<p>Complications of scarlet fever are common +and it is in these that most of the danger lies. +In the throat ulcers may form on the tonsils +and elsewhere resulting in extensive destruction +of tissues. Secondary to such conditions +the glands in the neck may become swollen +and may break down with resulting abscesses. +The inflammation in the throat may extend to +the nose and nasal sinuses with associated +purulent discharge from the nostrils. Extension +of the inflammation from the throat along +the Eustachian tubes to the middle ear is frequent, +and occurs most often when the illness +has lasted a week or so. Many times this +causes only transient pain, but often there develops +a discharge of purulent material from +the external ear. Sometimes the destruction +within the ear is so severe and extensive that +deafness results. Scarlet fever is responsible +for a considerable number of instances of acquired +deaf-mutism. Inflammation in the ear +<span class="pagenum" id="Page_43">[Pg 43]</span>is indicated by pain which may be severe. +After a few hours or sometimes only after days +perforation of the drumhead is followed by a +discharge from the ear. At first this is watery, +sometimes tinged with blood, and soon becomes +thick and purulent. With healing it again becomes +thinner and finally stops. Most of such +ears, after recovery have the hearing but little +dulled. Fever is apt to recur or become higher +when the trouble in the ear starts, and when +perforation occurs the pain stops and the fever +falls. Mastoid disease may be caused by extension +of the inflammation from the ear to the +bone behind the ear. This is recognized by +pain, tenderness and swelling back of the ear. +This is always dangerous.</p> + +<p>It is quite common for patients with scarlet +fever to have joint pains about 4 to 10 days +after being taken sick. A few or many joints +are involved, and as the pain disappears from +one joint it appears in another. After a few +days this disturbance comes to an end without +leaving any permanent damage. The poisons +of scarlet fever circulating in the blood, sometimes +cause severe and even fatal damage to +the heart. Injury to the kidneys is common +with resulting acute Bright’s disease. This develops +early or late in scarlet fever. The late +cases, which come after the child has been sick +for about three weeks, are most characteristic. +Attention is often directed to this condition by +a high colored, smoky urine, and by a puffy +swelling of the eyelids. Later the swelling, +due to the accumulation of water, becomes +more extensive and general dropsy may result. +<span class="pagenum" id="Page_44">[Pg 44]</span>With the dropsy and scanty, highly-colored +urine, there may be associated disturbances of +sight, headaches, vomiting and convulsions. +Under appropriate treatment recovery from +nephritis usually occurs, but in a few instances +death results. While usually the heart and +kidneys apparently return to normal after recovery +from scarlet fever, there is much evidence +which indicates that heart and kidney +diseases later in life may be dependent upon +damage done during this disease.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="PREVENTION_OF_SCARLET_FEVER"> + PREVENTION OF SCARLET FEVER + </h2> +</div> + + +<p>Effort to prevent scarlet fever may take +two directions; the first is directed toward +limiting the spread from the sick individual +and consist of isolation and disinfection; the +second concerns itself with the production of +immunity in susceptible children. Similar to +the Schick test in diphtheria, we have the Dick +test in scarlet fever. If a very small quantity +of the toxins of scarlet fever is injected +into the skin of a person the result will vary +according to whether the person is susceptible +or immune to the disease. In the susceptible +person a redness of the skin appears where the +injection was made, while in the immune person +this does not occur. In this way it is possible +to pick out the children who will not contract +scarlet fever if exposed. Those who give +a positive reaction with the Dick test, i.e.—show +a redness of the skin at the point of injection +of the toxin—may be rendered immune +by a process of vaccination. This consists of +three injections at intervals of a week of small +<span class="pagenum" id="Page_45">[Pg 45]</span>quantities of scarlet fever toxins or poisons. Little +or no disturbance follows the administration +of suitable amounts of the toxins, but usually +an immunity results. There is every reason to +believe that the immunity produced in this manner +will be permanent as is that which follows +an attack of the disease.</p> + +<p>Children who have been exposed to scarlet +fever should be kept away from other children +for 10 days after the last exposure. To prevent +spread of the disease the sick child must be +isolated and this must be continued for four +or five weeks, and in every case until all discharges +from the nose and ears have stopped. +The throat must also have become normal before +the child is released. Removal of the tonsils +does not appear to render children less +susceptible to scarlet fever, but diseased tonsils +when scarlet fever occurs add to the gravity +of the case by favoring severe throat and +nasal complications and especially extension to +the ear. The details of isolation and terminal +disinfection are discussed in detail in connection +with their use in these diseases as a group.</p> + +<p>Proper pasteurization of milk will prevent +the spread of scarlet fever through this common +food of children.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="TREATMENT_2"> + TREATMENT + </h2> +</div> + + +<p>The patient should be kept in bed for three +weeks and chilling of the skin prevented. This +is important in even the mildest cases in order +to avoid kidney complications.</p> + +<p>Skillful management and careful nursing +<span class="pagenum" id="Page_46">[Pg 46]</span>does much good in scarlet fever. In the acute +stage when fever is high much relief is afforded +by baths. Small children may be placed +in a bath of warm water and left there for 15 +to 20 minutes. The temperature of the water +must not be below that which is comfortable +to the child, but it may be gradually lowered +by adding cold water. While in the bath the +head should be kept cool with wet cloths. The +bath lowers the fever, quiets the nervous symptoms +and favors sleep. In older children and +adults the same results may be secured by +sponging the body and by packing in wet +sheets. In any case the temperature of the +water used should be adapted to the sensibility +of the patient. He should not be chilled, and +quite warm water is often most grateful and +followed by the most beneficial results.</p> + +<p>Throughout the disease liberal amounts of +water should be taken. This is given cold. In +young children this can be accomplished by +giving small quantities at frequent intervals. +Water increases the elimination of the poisons, +and its administration is one of the most important +measures in the management of the +disease. If the stomach is disturbed with a +tendency to vomit cold water, small amounts of +weak tea, taken as hot as possible, will sometimes +help settle the stomach.</p> + +<p>The diet during the early period will be principally +milk. As the fever falls and the appetite +returns cereals, toast, fruits and vegetables +may be added. Eggs and meats are best withheld +until three weeks from the onset. In +septic cases with prolonged course, liberal feeding +<span class="pagenum" id="Page_47">[Pg 47]</span>with easily digested foods is of the greatest +importance. The mouth and throat should +be kept as clean as possible. In persons who +are large enough frequent use of bland gargles +are desirable. For this purpose a tablespoonful +of table salt or baking soda to a pint of water +is suitable. Rubber bags filled loosely with +finely cracked ice and applied to the neck, relieve +the soreness of the throat. They are +specially useful when the neck is swollen, and +tend to prevent the formation of abscesses in +the glands of the neck.</p> + +<p>Pain in the ear is treated by the application +of heat. A few drops of warm glycerine, to +which carbolic acid in the proportion of five +to ten per cent is added when dropped into the +ear is very useful in relieving pain and reducing +inflammation. When a discharge from the +ear occurs, it must be collected on gauze which +is burned. The canal must be kept as clean as +possible and secretion not allowed to accumulate. +If it is thick and does not run out freely +the ear may be gently washed out with a saturated +solution of boric acid in water. The +ear must not be plugged with cotton but drainage +must be facilitated. As the discharge becomes +less the ear should be cleansed with +boric acid dissolved in alcohol and then dried +carefully with small pledgets of absorbent +cotton.</p> + +<p>Pain and tenderness back of the ear always +calls for expert advice. Such cases often come +to operation which must not be too long deferred +if results are to be satisfactory. Also +when signs of kidney disease appear, such as +<span class="pagenum" id="Page_48">[Pg 48]</span>swelling of the eyelids, vomiting, etc., medical +advice should be sought as quickly as possible.</p> + +<p>The painful joints which occur in some cases +are usually relieved by hot applications.</p> + +<p>Until recently the treatment of scarlet fever +has been entirely symptomatic, and directed +toward conserving the strength of the child +and toward preventing complications until nature +cured the disease. Natural recovery occurs +when the individual who is sick makes his +own antidote for the poisons of the disease. +We may assist nature by injecting into the +acutely sick person, some blood drawn from an +individual recently recovered from the disease. +The convalescent blood, containing the antidote +or antitoxin, serves to destroy the poison in +the blood of the acutely sick child, and so aids +recovery. Marked improvement often follows +the use of convalescent serum. Such serum is +not always at hand, but if an older child or +adult who has had scarlet fever is available, +his blood may be drawn and injected into the +sick child. There is reason to believe that we +may soon have a scarlet fever antitoxin, produced +from horses in a manner similar to that +in use in making antitoxin for diphtheria.</p> + +<p>The successful treatment of scarlet fever +with its many complications demands great +skill. There is no disease in which the outcome +depends more on judicious medical management +and careful persistent nursing than in +scarlet fever.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_49">[Pg 49]</span></p> + + + <h2 class="nobreak" id="CHICKEN_POX"> + CHICKEN POX + </h2> +</div> + + +<p>Corresponding to measles in its degree of +contagiousness, chicken pox occurs in extensive +epidemics. In cities occasional cases appear +at any time, but at intervals epidemic outbreaks +occur. Most children have the disease +during early years, but adults may also have +it if they have not come in contact with it in +childhood. This disease is entirely different +from small pox and has no relationship to +chickens. The cause is unknown, but doubtless +is a living germ. The crusts from the skin +have usually been blamed for the transferring +of the disease from one person to others. The +disease however is contagious before the crusts +from the body have separated, and it is likely +that the infectious agent may be in the respiratory +secretions early in the disease. One +attack protects for life. Second attacks are +practically unknown.</p> + +<p>The period of incubation which passes between +the time of exposure and the appearance +of signs of the disease is quite long, being +about three weeks, varying in individuals between +twelve and twenty-two days.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="SYMPTOMS_2"> + SYMPTOMS + </h2> +</div> + + +<p>As in all of these contagious diseases there +is much variation in the severity of the individual +case. Most cases of chicken pox are +mild affairs. There is no fever or general disturbance, +<span class="pagenum" id="Page_50">[Pg 50]</span>only the eruption of a mild or +moderate sort. In a few individuals the disease +assumes a severe form, in which case, +fever, headache, backache and chilliness +precede the eruption for a day. This is especially +apt to occur in adults, but children may +have some fever, and be generally unwell for a +day or so before the eruption appears. Preceding +the characteristic eruption there sometimes +appears a day or so earlier a redness of the +skin which has often been looked upon as scarlet +fever until the typical eruption has developed.</p> + +<p>The individual lesions of the chicken pox +eruption pass through an evolution which is +often very rapid. There is first a pink blotch +or spot which soon is a little elevated above +the skin, and disappears when pressed upon. +Soon this is replaced by a vesicle or water +blister. The vesicles are very near the surface +of the skin and have a very thin covering, +so that they often look like drops of water +lying on the skin. The covering is soon broken, +the fluid escapes, and as drying occurs a little +crust or scab is left. This separates after several +days. There is great variation in the number +of these lesions. Sometimes only two or +three develop. In severe cases the lesions are +very closely placed on the body so that the +finger can hardly be placed at any point between +them. In the average case the lesions +lie two or three inches apart. The distribution +upon the body is quite characteristic. Most +lesions are located on the parts of the body +covered by clothing. In mild and moderate +<span class="pagenum" id="Page_51">[Pg 51]</span>cases the eruption is almost confined to the +trunk, but some lesions are also seen upon the +arms, legs and forehead. In severe cases rather +abundant eruption appears on the face, arms +and legs. The lesions develop in the scalp, +palms of the hands and soles of the feet in +limited numbers especially in more severe +cases. In such instances also, vesicles appear +in the mucous membrane of the mouth, especially +on the palate, and as they rupture they +leave very sensitive points which are painful +when food is taken.</p> + +<p>One of the most characteristic things of the +chicken pox eruption is that the lesions appear +in crops. By the time the first lesions have +reached the crusting stage others are present +which are still vesicles, and still younger ones +appear as pink spots. New lesions continue to +appear for 3 or 4 days. In parts of the body +where the skin is thick as on the palms of the +hands, soles of the feet and forehead, the vesicles +may remain unruptured for some time in +which case the contents becomes yellowish +and the surrounding skin reddened. If the skin +has been rendered specially susceptible by any +cause, the eruption is apt to be more severe. +When chicken pox follows upon scarlet fever +the eruption is apt to be profuse. Upon parts +of the body which have been recently burned +by the sun or subject to irritation under a +surgical dressing, cast, or diaper, the eruption +is more abundant than on other portions of +the body.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="COMPLICATIONS_2"> + COMPLICATIONS + </h2> +</div> + + +<p>There are few deaths following chicken pox +<span class="pagenum" id="Page_52">[Pg 52]</span>and many of these cannot be properly blamed +on the disease. There occur occasionally in +poorly nourished children, gangrenous processes +in the skin which may cause death. Blood +poisoning may rarely follow the introduction +of ordinary wound infections into the open +lesions. The itching associated with the drying +stage is very troublesome, and children sometimes +in scratching, break the deeper layers of +the skin, and small ulcers are produced which +heal with scars or pits. One most often sees +these scars on the forehead of children. Usually +no permanent pits follow recovery.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="DIFFERENT_FROM_SMALL_POX"> + DIFFERENT FROM SMALL POX + </h2> +</div> + + +<p>In the presence of small pox in a community +its differentiation from some cases of chicken +pox is important but sometimes difficult. One +of the most striking differences between the +two diseases is that in chicken pox the lesions +occur in crops, all the stages of the eruption +being present at the same time, while in small +pox the lesions are all the same sort at any +time. Another difference consists in the distribution +of the eruption, in chicken pox most +is on the covered parts of the body while in +small pox the eruption is most abundant on the +exposed parts of the skin, the face, wrists and +hands. The presence of a fairly recent vaccination +scar is always strong evidence against +small pox.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="PREVENTION_1"> + PREVENTION + </h2> +</div> + + +<p>The only means of prevention is the isolation +<span class="pagenum" id="Page_53">[Pg 53]</span>of the sick person until all the scabs have +separated.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="TREATMENT_3"> + TREATMENT + </h2> +</div> + + +<p>Little treatment is required. Scratching of +the skin is to be avoided. During the acute +stage it is best to keep the skin dry. When the +crusts have become dry baths may be given, +and they probably hasten the separation of the +scabs.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + +<p><span class="pagenum" id="Page_54">[Pg 54]</span></p> + + + <h2 class="nobreak" id="WHOOPING_COUGH"> + WHOOPING COUGH + </h2> +</div> + + +<p>Whooping cough is a very contagious disease +which is contracted by most children during +early years. Occasional persons who have +escaped it in childhood are affected in adult +life. Second attacks are rare. Sometimes a +mother or nurse, who has had whooping cough +in childhood, will again contract the disease +when caring for children who are suffering +from it. In distinction to most of the contagious +diseases, whooping cough frequently +occurs in infants less than a year of age, and +the mortality associated with it is due largely +to this fact. In Chicago from 1911 to 1922, out +of 39,233 cases of whooping cough 1,630 were +fatal. This represents one death out of every +24 patients, and corresponds very closely to +the death rate in scarlet fever during the same +period and is about three times as high as that +in measles. Of 97 deaths from whooping cough +in Chicago during 1922, 58 were in children +under 1 year of age, and all but one were in +children under 5 years. This serves to emphasize +the importance of protecting young children +from the disease as long as possible.</p> + +<p>The cause of whooping cough appears to be +a very minute bacillus which is found in the +secretions from the upper respiratory tract. +The action of this germ seems to be through +poisons which it produces. The disease is transferred +from one person to others through small +<span class="pagenum" id="Page_55">[Pg 55]</span>particles of the secretions which are thrown +out into the air during coughing. These moist +particles being inhaled, gain a lodgement in +the throat and thus cause another case. The +time after exposure before symptoms appear is +indefinite. Exact dates are hard to fix, but the +incubation period is often very short. It may +vary from five to fifteen days.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="SYMPTOMS_3"> + SYMPTOMS + </h2> +</div> + + +<p>The onset of whooping cough is gradual and +for some time the child is usually supposed to +be suffering from a cold or bronchitis. This +first or catarrhal stage has nothing which is +characteristic. There is a cough which gradually +increases in severity. As the cough becomes +more severe it assumes also more of a paroxysmal +character with a tendency to recur at certain +intervals. After about two weeks with the +appearance of typical paroxysms the second or +paroxysmal stage is entered upon. This lasts +about six weeks on an average. The number of +paroxysms varies greatly. There may be but +one or two in 24 hours, or one may occur every +hour. On an average about 10 to 15 are observed +during 24 hours. They are apt to be most +severe at night. When a paroxysm of coughing +begins the child sits up and if old enough +tries to get hold of something for support. The +paroxysms consists of a series of expiratory +coughs following in such rapid succession that +the child is unable to get its breath. These +have been compared to the explosions of a motor +cycle, or those of a machine gun. At the +height of a severe paroxysm the face is red or +<span class="pagenum" id="Page_56">[Pg 56]</span>blue as in choking, saliva flows from the +mouth, the tongue protrudes and is blue, the +child struggles for breath, when finally, maybe +only after several seconds, the spasm relaxes +somewhat and air is drawn through the narrowed +opening in the larynx with a peculiar +crowing sound which is known as the whoop +and has given the name of the disease. Such +a series of events often is repeated several +times in quick succession. Finally the end +comes with vomiting which not only gets rid +of the mucus in the throat but also empties the +mucus from the air tubes. The child now falls +down on the bed exhausted, the skin wet with +sweat and it often falls to sleep. The struggle +of the little patient in its efforts to get its +breath cannot fail to awaken the sympathy of +anyone who witnesses it. In older children the +paroxysms are better borne and the general +strength is not much affected. In young children +with frequent paroxysms and loss of food +from vomiting much depression and weakness +develops. When there are frequent severe seizures +the face in the intervals has a woe-begone +expression, the skin is dusky and the +eyes dull.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="COMPLICATIONS_3"> + COMPLICATIONS + </h2> +</div> + + +<p>Occasionally a child dies in a severe paroxysm +from strangulation. Most deaths are, +however, dependent upon complications. Of +these the most frequent is pneumonia, which +is not uncommon in infants. Convulsions also +cause many deaths. They may occur during +the paroxysms of coughing and if repeated are +<span class="pagenum" id="Page_57">[Pg 57]</span>very dangerous. The great congestion of the +blood vessels of the head during the paroxysms +sometimes leads to rupture of blood vessels, so, +that nose-bleed is not infrequent. Hemorrhage +into the brain may occur. Bleeding beneath the +conjunctiva of the eye-ball results in red +blotches over the white of the eye. These may +be small or the blood may spread over the entire +white portion of the eye-ball causing a +most striking appearance. Bleeding into the +loose tissues of the eye-lid may occur, producing +a “black eye”. This has been mistaken as +due to injury and should be remembered as +something which may occur spontaneously during +whooping cough.</p> + +<p>In infants disturbances of digestion are frequent, +and intestinal disorders in them are +grave and add materially to the danger of the +disease.</p> + +<p>After recovery permanent damage to the +heart may remain. The condition brought +about by the disease also favors the rapid +progress of any tubercular disease which otherwise +might be of little moment.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="PREVENTION_2"> + PREVENTION + </h2> +</div> + + +<p>It is important that small children be kept +away from this disease as long as possible. It +is particularly difficult to limit the spread of +the disease by isolation because the period of +greatest contagiousness is that in the beginning +when the child is supposed to have a cold. +An older child in a family contracts the disease +at school or in play with other children, +<span class="pagenum" id="Page_58">[Pg 58]</span>and before he is suspected of having the disease, +the younger members of the family have +been infected. A vaccine has been prepared +from the bacillus of whooping cough which appears +to have some value in preventing and +rendering milder the disease. As this is harmless +it ought to be given to young children as +soon after exposure as possible in the hope that +it may prevent the disease or make it milder if +it develops. After the paroxysms have been +established the vaccine seems to be less useful.</p> + + +<hr class="chap x-ebookmaker-drop"> +<div class="chapter"> + <h2 class="nobreak" id="TREATMENT_4"> + TREATMENT + </h2> +</div> + + +<p>Many cases, especially in older healthy children, +require little treatment. When paroxysms +are frequent and severe, remedies to reduce +them are desirable, and of these paregoric seems +to do as well as any. If vomiting occurs frequently +the loss of food is of importance. In +such cases easily digested food should be given +as soon after a paroxysm as possible so as to +allow time for digestion and absorption before +another paroxysm occurs. The feeding is of +great importance in infants. A simple mechanical +appliance is of considerable use to these +children. It consists of a firm binder fastened +snugly about the entire abdomen. It should +come up over the lower ribs, and be held in +place by straps over the shoulders. This gives +support to the abdomen during coughing, enables +the child to endure the paroxysms easier, +and also supports the weaker points of the abdominal +wall and so prevents the development +of hernias or ruptures. Of all measures used +<span class="pagenum" id="Page_59">[Pg 59]</span>in the treatment of whooping cough the most +important is the furnishing of fresh air. In +suitable weather the children should be kept +out of doors all day, and at night should have +plenty of fresh air. This is equally the case +when pneumonia complicates whooping cough.</p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="transnote"> + <p class="center"><b>Transcriber’s Notes</b></p> + <p class="center">Obvious errors and omissions in punctuation have been fixed.</p> +</div> + +<div style='text-align:center'>*** END OF THE PROJECT GUTENBERG EBOOK 78158 ***</div> +</body> +</html> diff --git a/78158-h/images/cover.jpg b/78158-h/images/cover.jpg Binary files differnew file mode 100644 index 0000000..5beb9e1 --- /dev/null +++ b/78158-h/images/cover.jpg |
