CHAPTER XV CONTAGIOUS DISEASES (Part 1)

CHAPTER XV CONTAGIOUS DISEASES A contagious disease is one that can be transmitted through contact with the patient. SCARLET FEVER OR SCARLATINA This is an acute contagious disease characterized by high fever, rapid pulse, a scarlet rash, and an unusual tendency to nephritis. The germ that causes scarlet fever has not been discovered. The contagion is carried by the clothes, bed-clothing, or other articles which have come in contact with a patient suffering from scarlet fever. Milk is suspected of sometimes being a means of dis- semination. The disease c°an be transmitted by direct inoculation and, therefore, is characterized as a contagious disease. The poison is extremely tenacious to life, infected clothes unused for years being known to lead to fresh outbreaks. The young are especially predisposed, but not equally so. One attack practically gives immunity, as second attacks are uncommon. Period of incubation is from a few hours to a week. Symptoms. — Mild Cases. — At times the symptoms of scarlet fever are so mild that the disease may escape notice. There is fever, a slight sore throat and a very faint rash, often escaping proper diagnosis; a hot bath will cause such a rash to show plainly. It may fade away very CONTAGIOUS DISEASES -7' quickly and the character of the rash not be suspected until slight desquamation appears. This form is con- tagious and is especially dangerous, as it is often not isolated. Ordinary Case. — The disease begins suddenly with vomiting or it may be ushered in with convulsions. Throat Symptoms. — There is pain and difficulty in swallowing, fulness and tenderness under the jaw, and enlargement of the lymphatic glands. The tongue is at 1 z 3 4- 5 6 7 8 9 10 // /? 13 p. T. in.e In. e me in. e in. e. m. e. l-n- e. in. e m. e. m. e m.e. m. e. m. e. 170 /as 160 107 r. ■\ '50 (OG ,- A '\ 10 /Ob v v w \ /\ 130 /09 / \ A , v A I2fi 703 A V /y n/ V V 'N V. 110 JOZ V \ \ ^ too 101 / <\ \ 90 166 W A do 99 N 70 fs €0 n Fig. 82.— Pulse (-- fever. The acme in thi: marked (Kerr). -) and temperature ( ) of a simple uncomplicated scarlet case was reached somewhat late; the defervescence is rather first heavily coated, red at the tip and edges. This white coat peels off, beginning at the edges, and in a few days it disappears and the papillae of the tongue become bright red and swollen. This appearance has given rise to the name strawberry tongue. The whole posterior portion of the mouth and pharynx arc deeply injected and may show a punctiform erythema before the rash appears on the skin. In severe cases the tonsils may be the seat of follicular inflammation or they may be covered with false membrane. 2J2 DISEASES OF CHILDREN FOR NURSES Eruption. — A scarlet punctiform rash appears, at the end of the first or the beginning of the second day, on the neck and chest and spreads over the entire body. Some- times the appearance of the rash is delayed. It disappears on pressure and if the finger-nail be drawn through it a white line will remain for a second or two. It may be a uniform rash or it may appear in patches with healthy skin surrounding it. In five or six days the rash gradually disappears and a scaly desquamation or peeling follows. A bright rash shows a strong heart; sudden fading of the rash may mean heart failure. In some cases the rash is slightly papular or vesicular {scarlatina miliar is). Febrile Symptoms. — The fever rises abruptly, reaching the maximum temperature of 1040 F. to 105 ° F. in twenty- four or forty-eight hours, and remaining at about this height for three or four days and then falling by lysis. The duration of the febrile period is from seven to nine days. The pulse is rapid, out of all proportion to the fever, and the respirations are accelerated. The appetite is lost, the bowels are constipated, and the urine is scanty and high colored and often contains albumin. Nervous Symptoms. — Restlessness, headache, insomnia, delirium, and convulsions may occur. Convulsions occur- ring late in the disease are very significant of uremia. More Severe Cases. — Anginoid Scarlet Fever. — This form is characterized by severe throat symptoms. The tonsils are much swollen and often covered with a false membrane. The fever is high and the prostration is profound. Ulceration, and, at times, gangrene of the throat occur; the carotid artery may be involved. In this form death may result from exhaustion, aspiration pneu- The eruption of scarlet fever on the third day (Hecker, Trumpp, and AM). CONTAGIOUS DISEASES 273 monia, or hemorrhage from an ulceration of the carotid artery. Malignant Scarlet Fever. — This is a very severe form of the disease. The onset is abrupt, with a chill, vomiting or a convulsion. The fever is very high (1060 F. to 1070 F.). The pulse is rapid and feeble. Delirium sets in and is followed by coma. Death may result before the appear- ance of the rash in twenty-four or forty-eight hours. The rash, if present, may become hemorrhagic. Complications. — Nephritis. — This usually develops during convalescence and, as it may be unattended by subjective symptoms, the urine in a case of scarlet fever should be examined daily in order to detect immediately the presence of albumin. In other cases the onset of nephritis is recognized by the suppression of urine, the development of uremia, and the appearance of dropsy. Nephritis may be the immediate cause of death, but more commonly the case ends in recovery or in chronic nephritis. Among other complications may be mentioned hyper- pyrexia, endocarditis, pericarditis, pneumonia, suppura- tion of the lymphatic glands, ophthalmia, inflammation of the middle ear, chorea, and a peculiar inflammation of the joints resembling rheumatism. Prognosis. — Always guarded. The mortality varies in different epidemics from five to forty per cent. Treatment and Nursing. — A case of scarlet fever should be immediately isolated. It is kept in isolation for at least six weeks, for it takes that length of time for the peeling to be completed. Children should not mingle with others for a month following their release from quaran- tine and should not sleep with others for three months. 2;4 DISEASES OF CHII.DREX FOR .YURSES Cases of scarlet fever should be kept absolutely at rest to avoid complications and should be given a liquid diet as long as the fever lasts. The rash and the peeling which follows render it necessary to anoint the surface of the body with cold cream or carbolized vaselin two or three times a day. This relieves the itching and irritation of the skin and controls the desquamation. To avoid the danger of nephritis the children should be encouraged to drink water or lemonade freely. The nose and throat should be sprayed with antiseptic solutions. Nervous symptoms are relieved with ice-caps and cool sponges. Cardiac weakness should be combated by heart stimulants. Prophylaxis should be complete, as the disease is highly contagious and is prone to leave many serious complica- tions. The room selected should be at the top of the house if practicable, and it should have plenty of ventila- tion and be bright and sunshiny. All upholstered furni- ture should be removed, curtains and hangings taken down, and the carpets taken up. Sheets wet with carbolic acid, i :4c, should be hung over the doorways. All desquamation should be immediately burned or immersed in carbolic acid. The thorough disinfection of all articles which come in contact with the child is absolutely necessary. The nurse should be protected by a gown and cap, and before going out should take an antiseptic bath (see page 400) and change all of her clothing. The physician should be protected by a gown and cap while in the room and before leaving should wash his face and hands in an antiseptic solution. The contagium is contained in the secretions such as Scarlatinal angina (third day) dicker, Trumpp, and Abt). Lacunar angina (Hecker, Trumpp, and Abt). CONTAGIOUS DISEASES 275 the urine, bowel movements, perspiration, and discharges from the nose and ear. All of these should be disinfected by covering with carbolic acid, 1 : 40. The mildest cases should receive the same treatment and care, and isolation should be for the same length of time. A discharging nose or ear may be capable of causing the disease after the desquamation has ceased. Cases of empyema following scarlatina have caused outbreaks in surgical wards. After recovery all books and articles handled by the child should be burned, the room and mattress thoroughly fumigated, and all linen boiled. MEASLES OR RUBEOLA This is an acute contagious disease characterized by catarrh of the respiratory tract, moderate fever, and a papular eruption appearing on the fourth day, lasting two or three days, and disappearing by fine desquamation. The rash also has the tendency to form crescents. Measles is a highly contagious disease. The poison is transmitted through the clothing and other articles which have come in contact with the person suffering from the disease; it can also be contracted by direct contact. The contagium is apparently associated with the nasal and bronchial secretions, but has not been isolated. Measles is most commonly observed in children, but unprotected adults are very liable to be attacked. It is essentially an epidemic disease, but now and then sporadic cases are seen. One attack is fairly protective, but does not give absolute immunity. The period of incubation is two weeks. Symptoms. — Prodromal. — There is chilliness, coryza, 2/6 DISEASES OE CHILDREN FOR NURSES watering of the eyes, photophobia (the inability to stand light), cough, and drowsiness. The Fever. — The temperature rises rapidly to 102 ° F. or 1030 F., but on the second day there is decided remission, the temperature remaining down until the appearance of the rash on the fourth day when it again rises to or beyond the first range of temperature. It remains at this height for two or three days and then falls by crisis. FAH R. 1 Z 3 4 5 6 7 8 M. ■ M. e M c M E M L M E M. E M. e 107 106 \oS A 1 04- /S / ;\ / 03 J V \ 102 7 \ 1 V /\ I 0 1 A r ^J 1 00 j V V \ 99 7 \ A <38 T^ V f V" 97 Catarrhal Stage ExanlhemaCous Stage. Corns. Fig. 83. — Temperature chart of rubeola of moderate severity in a child of four and one-half years ( Kerr). The Catarrh. — There is redness of the conjunctiva, lacrimation, sneezing, hoarseness, cough, and expectora- tion. There may be vomiting and diarrhea. A slight adenitis of the cervical glands is common. Rash. — This appears on the fourth day on the face and rapidly spreads over the entire body. It is composed of small, dark red, velvety papules which form groups having crescentic borders. There is an eruption on the mucous ■ -— a «;',-. x- X, The eruption of measles two days after its first appearance (Hecker, Trumpp, and Al>t I. CONTAGIOUS DISEASES 277 membrane of the throat one day before the rash appears on the skin. In two or three days the eruption begins to fade and a fine desquamation soon follows. Koplik's Sign. — This consists in minute bluish-white specks surrounded by a red areola, appearing on the mucous membrane lining the cheeks and lips one or two days before the rash appears. Malignant or hemorrhagic measles is a form of the disease which occurs under bad hygienic conditions and is characterized by a petechial rash, hemorrhages from the mucous membranes, and by profound prostration. Complications and Sequelae. — By far the most prevalent are capillary bronchitis or catarrhal pneumonia and otitis media. Gastro-intestinal disturbances, cancrum oris, tuberculosis, and paralysis are also seen. Prognosis. — Guardedly favorable. Complications are apt to occur and render the prognosis grave. The usual mortality is low. In epidemics and in hospitals at times it is as high as 30 or 40 per cent. The majority of the deaths are due to bronchopneumonia. Treatment and Nursing. — Measles must be isolated. The quarantine is not so rigid as in scarlet fever, for six- teen days only is the length required. A dark room must be chosen on account of the photophobia, or intolerence to light. The prophylactic measures to be employed are the same as described under Scarlet Fever on page 274. The treatment is symptomatic. Inunctions of carbolized vaselin arc used to allay the irritation and help the des- quamation. Warm baths arc given after the rash dis- appears to facilitate desquamation. 2/S DISEASES OF CHILDREN FOR NURSES The most important complications to guard against in measles are bronchopneumonia and otitis media. To avoid these children should remain in bed and a flannel or cotton jacket should be worn. The chest should be rubbed daily with some counterirritant, such as camphor- ated oil or amber oil. Earache should be treated by syr- inging the ear with hot water (see pages 376 and 377). ROTHELN OR RUBELLA This is an acute contagious disease resembling both scarlet fever and measles, but differing from both in its short course, slight fever, and freedom from sequelae. The disease is highly contagious; the poison may be carried in the clothes or may be directly transmitted. Symptoms. — Prodromal symptoms are slight or absent. The disease begins with drowsiness, slight fever, and sore throat. The eruption appears on the first or second day and varies greatly in character. In some cases the rash is composed of small, red, slightly elevated papules resem- bling measles; in others the rash is bright red and diffuse, resembling scarlet fever. It begins on the face and spreads rapidly over the entire body, but it fades so quickly that the face may be clear before the extremities become involved. Slight desquamation frequently follows, though it is often absent. Apart from the sore throat the catarrhal symptoms are slight. The superficial cervical and pos- terior auricular lymph-glands are more swollen than in measles. The duration is from three to five days. The prognosis is good. Isolation for five or six days is advisable, though not imperative. Nursing. — The disease does not require much attention. The room should be darkened, the nose and throat washed Koplik's spots in measles (Hecker, Trumpp, and Abt). Appearance of the throal in measles (Hecker, Trumpp, and Abt). CONTAGIOUS DISEASES 279 with antiseptic sprays, and the temperature, pulse, and respiration taken twice a day. DIPHTHERIA This is an acute contagious disease excited by the Klebs-Loffler bacillus and characterized by moderate fever, great prostration, glandular enlargement, and a fibrinous exudate which is usually located in the throat. Etiology. — Diphtheria is most common between the ages of three and six in children who suffer from catarrhal conditions of the nose and throat. The poison is contained in the secretions of the throat and may be transmitted through the atmosphere and through the clothing. One attack does not protect the child from a second. The Klebs-Loffler bacillus is found in the membranous exudate and the constitutional symptoms result from the poison generated by this bacillus. The membrane is not a true membrane, but a necrosis of the superficial cells of the mucous membrane caused by the Klebs-Loffler bacillus. It is grayish-white in appearance and more or less adherent, so that when it is stripped off it leaves a raw, bleeding surface. Sometimes the necrosis extends to the deeper tissues, causing wide- spread ulceration and gangrene. The membrane is usually found on the tonsils, pillars, and pharynx, but it may extend to the mouth, larnyx, and nose. It is then called laryngeal diphtheria or membranous croup, and nasal diphtheria, respectively. The lymphatic glands are considerably swollen; the spleen is engorged. The lungs frequently show bronchopneumonia. Types. — According to location, there may be jaucial, laryngeal, nasal, and cutaneous diphtheria. According to 280 DISEASES OE CHILDREN FOR NURSES the severity of the attack the disease may be mild, grave, and malignant. The period of incubation is from two to ten days. A condition, resembling faucial diphtheria, called Vincent's angina has already been described on page 106. Symptoms. — Catarrhal diphtheria, so-called because there is an absence of membrane, is only a catarrhal con- dition of the nose and throat; the secretions, however, contain the Klebs-Loffler bacillus. The symptoms are mild, but the risk of spreading the contagion is great. Faucial Diphtheria oj Ordinary Severity. — The disease commonly begins with a chill, moderate fever, malaise, and sore throat. The fever, as a rule, is not very high, io2° F. to 1040 F., and its course is quite irregular. The pulse soon becomes rapid and feeble, the bowels are con- stipated, the urine is scanty and frequently albuminous, and the prostration is out of proportion to the severity of the febrile symptoms. Local Phenomena 0} Faucial Diphtheria. — The child complains of difficulty in swallowing, the muscles of the neck feel stiff, and there is tenderness under the jaw. The lymphatic glands are considerably enlarged and the tonsils are covered with grayish-white membrane which, when stripped off, leaves a raw, bleeding surface. The membrane soon forms again and may extend to the larynx and into the nose. The average duration of the disease is from one to two weeks. Laryngeal Diphtheria. — This is usually secondary, by extension from the faucial diphtheria, but it may be primary. It is recognized by hoarseness, aphonia (loss of voice), croupy cough, progressive dyspnea, and stridu- lant breathing. The wings of the nose play, the sterno- Diphtheria of the lips (Hecker, Trumpp,