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Preventable Diseases of Children: Infection

Modes of Infection. -The germs gain entrance into the system through the mucous surfaces of the nose and throat. Infection may be direct by inhaling germs from the breath laden with infection from the mucous surfaces of the patient's nose and throat; or indirect, from the clothing of the nurse, physician, or other bedside visitor, or from objects contaminated in the sick room. There is PREVENTABLE DISEASES OF CHILDREN 189 danger also from the healthy carriers of the disease. Epidemics are probably due to mild cases and to "carriers" attending day or Sunday schools, fairs, or other public gatherings.

Symptoms. The period of incubation is from one to fourteen days. The average is from five to ten days.

This is one of the most difficult of all diseases to recognize, unless the physician is put on guard by the presence of other cases in the locality. It is especially difficult to recognize in the case of children. The onset of the disease is usually sudden. The fever rises from 101° to 103° in the first twenty-four hours. There is usually malaise, profuse sweating, vomiting and general severe pains in the arms and back, sometimes referred to the joints. Convulsions frequently occur in children. Tenderness, generally in the lower extremities, less frequently in the spine and trunk, but sometimes in the upper limbs and neck, is a frequent and highly important symptom.

Paralysis of one or both legs generally occurs within from twelve hours to three or four days, but the paralysis may extend to any part of the body. The fever lasts from five to nine days, accompanied by delirium, but rarely rises above 104° even in fatal cases. Diarrhœa often sets in on the second day.

This disease often occurs in a milder form without paralysis, and these cases may give the form that kills. A physician should be promptly summoned in suspicious cases, especially if this disease has been reported in the locality. The patient should be isolated until a positive diagnosis can be made.

Prevention. - The work of Flexner gives strong hope of the discovery of an antitoxin for poliomyelitis, but at present there is no certain means of cure. Hence the only safety lies in preventive measures. Children should be kept absolutely away from homes in which this disease has appeared and from association with members of the afflicted families, even though they are apparently well.

The patient should be isolated and the sick room should be prepared in all respects as for typhoid, and every sanitary precaution suggested for that disease should be observed. As the infection is present chiefly in the discharges from the nose and throat, special care should be taken to receive them on soft cloths which should be promptly burned. The nurse and physician should take the precaution to suspend a cloth moistened in a disinfectant solution over their mouth and nostrils when approaching the patient closely enough to take his infected breath.

The use of a 10 per cent solution of peroxide of hydrogen as a gargle or spray for the throat is advised both for the patient and also for the nurse, physician and members of the family, or others who may have been exposed to the infection. Contact with this substance kills all germs of this disease.

Special care should be taken to disinfect all excreta from the patient. The germs have great vitality, and being extremely small, it is probable they may be scattered through the air on particles of dust. Hence special care should be observed to wash floors, rather than sweep them, and to dust only with cloths wet with a disinfectant. After the death or recovery of the patient, the should be disinfected with about double the ordinary quantity of sulphur or formaldehyde, and on account of the extreme vitality of the germ, the entire exposed floor and all surfaces, woodwork and furnishings should also be washed with full strength standard solution, No. 3, bichloride of mercury. room Quarantine. Most boards of health now require all cases to be reported, the premises to be placarded, and strict quarantine maintained.

No one except the nurse and physician should be admitted to the sick room during the sickness, or for some months after recovery. There is danger that the patient may continue to carry the germs of the disease. Several epidemics have been stamped out by strict quarantine.

The period of infection is not precisely known, but is supposed to be chiefly while the fever lasts usually about three weeks. The quarantine of the other members of the family than the patient need not extend beyond this period. The bread winners should board and room elsewhere, especially during the quarantine period and for three weeks after their last exposure. They should avoid all public gatherings and mingle as little as possible with other persons. Or, preferably, the patient should be removed to a hospital at the outset of the disease.

CEREBROSPINAL MENINGITIS This malady, also called spotted fever, or simply meningitis, was formerly one of the most terrible and fatal of all diseases, the mortality in some local epidemics running up to as high as 100 per cent. It is an inflammation of the membrane coverd Germs of cerebrospinal meningitis: a, pus-cell; b, pus-cell containing germs of meningitis shown at c; d, the same germ lying outside of pus-cells. ing the brain and spinal cord and is caused by a specific germ.

Flexner has discovered a serum which cures this disease and leads to the hope that a similar antitoxin may be discovered for the control of infantile paralysis. The germ of this disease has been identified, and is always present in the brain and spinal cord of the patient, and in the spinal fluid. It may also occur in the nasal passages of the patient and of healthy carriers who have been infected from him. It attacks most frequently children between one and ten years of age. It is most prevalent in the late winter and spring months, especially in March, April and May. It is always present in certain neighborhoods and may occur at any season of the year.

Modes of Infection. - The germ of meningitis occurs in the discharges from the mouth, nose and ears of the patient, and the infection may be spread by direct contact with the patient or healthy carriers, or by objects infected by them. The germ is not thought to live long outside the human body. Hence the spread of the disease is easily controlled by the isolation of the patient and by proper sanitary precautions. - Symptoms. The first symptoms of infection are those of an ordinary cold. But when the brain is attacked, the onset of the disease becomes very sudden. There is usually a chill with intense headache, vomiting, restlessness, and a great dread of noises and bright light. In many cases the reddish spots appear beneath the skin, which suggests the name, spotted fever. These spots are usually quite tender on pressure. The muscles of the neck become very stiff and contract, drawing the head backward.

This is characteristic symptom.

The chill is followed by irregular temperatures, sometimes very high.

After a few hours or days, unless the antitoxin serum is injected, the patient becomes unconscious and shortly dies. Or, in mild cases, the symptoms quickly subside and recovery is rapid. a Prevention. The symptoms of an ordinary cold in the head should be regarded with suspicion during an epidemic of meningitis. A physician should be summoned in all suspicious cases, and the patient isolated in the sick room as for typhoid fever, until PREVENTABLE DISEASES OF CHILDREN a positive diagnosis can be made.