Home › Preventable Diseases of Children › Preventable Diseases of Children: Quarantine

Preventable Diseases of Children: Quarantine

Quarantine. Quarantine the entire household as recommended under scarlet fever. Keep children from day and Sunday school. Keep the members of the family indoors and arrange for the bread-winners to board and room elsewhere. Quarantine must be continued until the diphtheria bacilli disappear from the throat of the patient. This will ordinarily require about four weeks after recovery. "Cultures" should then be taken by the physician and quarantine should not be lifted until the bacilli are found to be absent from two successive "cultures." Remember that the mild cases and well persons who are carrying the germs of the disease are the most dangerous sources of infection. The only sure precaution is the bacteriological test made by a competent physician and the isolation of all infected persons until the bacillus disappears. SCARLET FEVER Scarlet fever has all the characteristics of a germ disease, though the specific germ which causes it has not yet been identified. Hence there is no antitoxin against scarlet fever and no efficient method for its control.

Scarlatina, scarlet rash, canker rash, fever rash and Duke's disease are merely other names for scarlet fever.

They are often applied to the mild cases under the mistaken belief that these are a different and less dangerous malady, but this is not the case. The mild cases will give the form that kills. Scarlet fever is highly contagious, but, like other germ diseases, is wholly preventable. It is, or should be, among the most dreaded of all the acute diseases of childhood. It attacks chiefly children between the ages of one and 10 years, although about 5 per cent of all cases occur in adult life. The death rate is about one out of every fifteen or twenty cases.

Occasionally parents expose a child to a mild case from the mistaken notion that all children must have the disease and that it is best to have it light. Parents frequently permit children suffering from mild cases or convalescing to play about the house or even run about the neighborhood at will. Such contacts of infected with healthy children are of great assistance in spreading the disease.

Persons who knowingly permit them often cause cases of death, and with the increase of sanitary knowledge the law will undoubtedly recognize such crimes and visit them with appropriate penalties. After childhood the liability to take the disease is very much lessened. Many persons who escape the disease in childhood have been immune to it although many times exposed in later life.

Two-thirds of all deaths occur in children under five. When the disease does not kill it frequently leaves its victim crippled for life.

The commonest after-effects are inflammation of the kidneys, heart, ears, glands and joints. Deafness sometimes results. Hence, although one attack usually renders a patient immune, the utmost care should be taken to protect all children from exposure.

Symptoms. The period of incubation after exposure varies from one to fourteen days. Hence, a child exposed to scarlet fever should be carefully watched during the following two weeks. Upon the first symptoms of shivering, lassitude, headache, frequent pulse, hot, dry skin, flushed face, furred tongue with much thirst and loss of appetite, the sick room should be prepared as for typhoid fever and the patient isolated until a positive diagnosis can be made by a physician.

Vomiting is usually among the first positive symptoms. Other symptoms are sore throat, intense fever with headache or backache, and the characteristic scarlet rash. This usually appears in from twelve to twentyfour hours, first upon the lower part of the neck and adjacent parts of the chest and afterwards gradually spreading over the entire body. This disease, like typhoid or diphtheria, appears in varying degrees of severity. It may cause death within twenty-four hours or may be so mild that the patient does not feel sick enough to stay in bed. There are many true cases of this malady with a very low fever and without vomiting or other acute symptoms, or even without the characteristic rash. A child with a sore throat is under suspicion of scarlet fever or diphtheria and should be kept away from school and from other children until a positive diagnosis can be made. Running Ear.-During the third or fourth week of the disease, it is possible that the ears may become diseased and lead to what is known as a "running ear." The child by this time has had no fever for a number of days. He suddenly becomes more or less feverish and restless, and complains at the same time of pain in the ear. This is a danger signal and calls for immediate action by the doctor. If this condition goes untreated, it may result in a running ear which sometimes lasts for years.

With proper treatment, however, most of these cases are soon cured.

Acute Nephritis, or inflammation of the kidneys, develops, at times, in the third to the fifth week of the disease. The child, who has seemed to be almost well, suddenly develops a fever. He complains of headache, usually vomits and may have convulsions. The amount of urine passed is small. The patient may complain of trouble with the eyes, and of not being able to see distinctly. Should any of these symptoms develop, the doctor should be called immediately.

Modes of Infection. - This disease is spread through carelessness. Every case comes directly, or indirectly, from some previous case, either by direct infection from inhaling the breath of a scarlet fever patient, or by secondary contact infection. Most cases of direct infection are due to neglect of mild cases and carelessness of those recovering from the disease. If every case could be thoroughly isolated-quarantined - the disease would disappear from the face of the earth. The only safe course to pursue is to isolate the patient and to quarantine and disinfect the sick room in all respects as for typhoid fever.

The nurse and attending physician should wear a hooded gown of washable material to avoid carrying infection from the sick room upon the hair or clothing. On leaving the sick room this gown may be disinfected by sprinkling it with one or two tablespoonfuls of 40 per cent solution of formaldehyde and packing it in a small valise or other tightly closed receptacle. Both the nurse and physician should avoid direct infection from the patient's breath. No one else should be permitted to enter the sick room.

The chief danger from contact infection is from scales from the skin, the spittle from the throat and mouth and the nose and ear discharges. But all the discharges of the patient should be disinfected as for typhoid fever. By confining the patient absolutely to the sick room until the danger of infection is passed and by proper and efficient disinfection, as elsewhere recommended, the spread of the disease can be absolutely prevented.

The germs of scarlet fever are very long-lived. They may communicate the infection after many months and at long distances by means of clothing, playthings, books, maga- 4 PREVENTABLE DISEASES OF CHILDREN zines, bedding, towels or any articles of household furniture or other objects on which the contagion from the patient may have lodged. Hence nothing should be removed from the sick room without having first been thoroughly disinfected.

Quarantine.-Most cities require strict quarantine in cases of scarlet fever. Keep the children from both day and Sunday school. Take care that the nurse and all members of the family remain indoors. Arrange for the bread-winners to room and board elsewhere during the course of the disease. Have milk and groceries left at the door and disinfect all articles even including letters and postal cards. This may be done by baking them in a suitable receptacle at a temperature of about 250 degrees.

Or, place the articles in an airtight receptacle with a closely-fitting cover, sprinkle them freely with a 40 per cent solution of formaldehyde, cover tightly and leave the receptacle in a warm room for at least four hours. No milk or groceries should be sold in, or accepted from, premises quarantined for scarlet fever. Milk from infected dairies is a frequent source of contagion.

Desquamation or "Peeling" is a highly characteristic phase of scarlet fever. After the rash begins to fade the fever disappears and the patient usually feels good and is anxious to get out and play. The skin affected by the rash now begins to scale or peel from all parts of the body, sometimes in large or small flakes, but often in the form of a dry mealy powder. This is charged with the virus of the disease in its most infectious form. The process of peeling occupies a variable time from ten days to six weeks and this is the most contagious period of the dis- The infectious dry skin is easily spread about the room and may be carried elsewhere upon the clothing of members of the family, or other objects. Or it may remain attached to articles of furniture, or ease. as dust in out-of-the-way places, to infect others with whom it may come in contact. To prevent all this, the patient must be confined to the sick room and bathed daily, under the advice of the attending physician, with soap and warm water. Bathing with disinfectants is not advisable. But the water used for the bath must afterwards be thoroughly disinfected.

After the bath the patient should be anointed with sweet or olive oil containing a little oil of Eucalyptus, or 3 per cent of carbolic acid, or with 2 per cent carbolized vaseline, or a boracic acid ointment at the discretion of the attending physician.

This will not only allay the itching from the rash, but will confine the dry scales to the body and bed linen and facilitate the work of disinfection. This should be continued until the skin is entirely smooth. The soles of the feet and palms of the hand are usually the last to peel.

Duration of Quarantine. - The length of time during which a scarlet fever patient is dangerous to others differs widely. Isolation must be enforced until all peeling or scaling off of the skin is completed, and until there is no further discharge from the ears, nose, throat, suppurating glands or inflammation of the kidneys. The time required for scaling varies from four to eight weeks. The soles of the feet and palms of the hands are the last to peel. Mild cases with very little scaling and without ear, nose, throat, kidney and glandular complications, should be isolated not less than four weeks, and severe cases not less than six weeks. This period must be prolonged if the ears, nose, throat, glands or kidneys continue to be diseased. The advice of a reliable physician should be followed in all cases. a Disinfection. -After death or recovery disinfect the sick room and its contents thoroughly as elsewhere described.