Popular Science Monthly/Volume 17/June 1880/The Infectious and Contagious Diseases of Children
THE teacher or director of the school is urged to give immediate personal attention to any child in the school who may appear ill, or who complains of feeling unwell. In such a case the teacher should specially note the presence of one or more of the following signs:
1. Increased temperature of the child's body, discovered by the teacher placing his hand upon the sick child's skin, particularly on the chest, armpit, face, or forehead.
2. Quickening of the pulse, as measured by the aid of a watch, together with hardness of beat.
3. Shivering. Increased or exaggerated sweating, not being the after-result of exercise, etc.
4. Great thirst, with loss of appetite.
5. Tongue more or less white; dry, or red. G. A flushed or pallid face.
7. Increased or diminished brilliancy of the eye.
8. General weariness and indisposition; sense of fatigue, with aching in the loins; headache; drowsiness or excitement; delirium.
The majority of the above-named symptoms will almost invariably indicate the presence of a febrile state.
Any child kept at home away from school for a week or more by its parents should, before returning to its school, bring a certificate of health, signed by a duly qualified medical practitioner.
Infectious Febrile Diseases.—Small-pox is rarely found in those schools where vaccination is enforced, as the majority of vaccinated children have not yet lost the protective influence of primary vaccination. Whenever possible, the teacher should have all the children over ten years revaccinated, especially in times of epidemic small-pox. The popular assertion, that, during epidemics of small-pox, revaccination tends further to develop small-pox, is absolutely false.
Small-pox sets in with fever, vomiting, and pains in the loins. After not less than two days, but most frequently on the third day of the illness, there appears—commencing on the face—an eruption of raised spots, more or less numerous, which pass later into pimples or pustules, having a depressed or navel-like center. These spots terminate in scabs, which should have completely disappeared before the child is allowed to return to school. Before readmission to the school the child should have had two or three baths.
Chicken-pox is a mild disease, occasionally preceded by fever. It is characterized by successive crops of blebs, preceded by red-colored spots, each new crop being apt to appear toward evening, and is generally accompanied with some accession of slight fever. Chicken-pox is characterized by pea-sized blebs, or blisters, filled with a transparent watery liquid, which soon becomes thick, muddy, or bloody, and terminates with scabs. Where the spots on the body are neither numerous nor well marked, the eruption is invariably observed among the hair of the head.
Measles is ushered in with general indisposition, fever, sneezing, weeping, and red eyes, loud noisy cough; occasionally there may be bleeding from the nose and passing diarrhœa. After three or four days' illness, sometimes sooner, an eruption shows itself, first on the chin and face in small, irregular rose-red spots, slightly elevated, which soon spread over the surface of the body, leaving more or less pale, irregular patches of skin unattacked. The complaint is highly contagious. Children with measles, when kept at home, and not exposed to the chance of catching cold, generally do well.
Scarlet fever commences with extreme general indisposition, high fever, a dry, burning skin, pains about the throat, and vomiting. Generally toward the end of the first day's illness, sometimes even at the very outset, a child, but a few minutes before in apparent good health, presents itself with a raspberry-red blush or rash, which may either cover the body completely or else appear here and there in patches. The face, the interior of the thighs, the groins, and the neighborhood of the joints are favored situations for the rash. At first glance the eruption looks uniform, but a closer examination discloses innumerable round points, some of which are more pointed and higher than their neighbors, and often run into minute bladders about the size of a pin's head.
Sometimes the disease is singularly mild; sometimes exceedingly virulent. Sometimes it is so fugacious that its presence is not suspected until the skin begins to peel, a process notably observed on the hands and feet. Frequently the joints, particularly the wrists, suffer pains analogous to those of rheumatism. Scarlet fever is an extremely contagious disease; and while, after ten days' isolation and the use of a bath at the close, a child convalescent from measles may be allowed to associate with others, not less than six weeks' isolation is required to exhaust the communicability of a case of scarlet fever.
Mumps may come on suddenly, or else be preceded by a few days of general indisposition, which now and then amounts to high fever. A feeling of stiffness about the jaws is soon followed by swelling, often very bulky, and more or less tense. The swelling is apt to extend either at the back of the lower jaw or underneath it. The swelling contains no fluid: dental pain is absent. Generally first one side of the jaw is attacked and then the other; it is rare for both sides to suffer simultaneously. Not uncommonlyswellings burst out in other localities of the body, the genital organs being most liable to seizure.
Ulcerative stomatitis is a contagious disease. Its invasion may be preceded by general indisposition, usually unattended with fever. Grayish bleeding ulcers, tending to spread in extent and depth, attack the edge of the gums, the inner side of the cheeks and lips, and the roof of the hard and soft palates, accompanied with an extremely fetid breath.
Diphtheritic sore-throat or croup is eminently contagious. Its approach is insidious, often commencing with some difficulty in swallowing and slight hoarseness. Possibly the glands at the back of the angle of the jaw swell, which in serious cases extends to the neighboring structures of the neck. At other times these symptoms occur subsequent to a swelling about the nostrils, with more or less copious discharge, indicating that the nasal membranes have been seized prior to those in the throat. Cough, if any, is faint and muffled; the voice is hoarse and smothered.
With a spoon press down the child's tongue, and note if there be any appearance about the tonsils and the soft palate of a skin or leatherlike membrane, which may be grayish or whitish, or even blackened by vitiated blood. This false membrane, which characterizes the disease, is prone to spread over the neighboring parts, notably reaching downward into the windpipe. This diphtheritic croup must not be confounded with false or spasmodic croup.
In false croup the child has generally been perfectly well during the day preceding the night on which it suddenly wakes up all at once ill with alarming signs of threatening suffocation, attended with loud, clamorous coughing and a clear voice. Here no false membrane is present in the throat, nor are the glands about the jaw swollen. False croup is generally mild, and it is not contagious.
Dysentery may be contagious. It is distinguished by a frequent, sometimes a continual, desire to seek relief in the closet, where in spite even of severe straining the child succeeds in passing only a little slime or mucus, often colored by small quantities of blood. General indisposition and colicky pains in the belly soon compel the child with dysentery to leave the school. To stop infection, no child suffering with dysentery should be allowed to use the general school water or other closet. Dysentery is not to be confounded with diarrhoea, where there are more or less frequent liquid motions.
Typhoid fever is infectious, and is apt to set in or to sneak in with ill-defined signs. For some days the child may have lost its appetite and its general energy, it is fatigued and "done up." Then the fever is next ushered in with great pain, noises and confusion in the head; the hearing becomes obtuse; giddiness occurs, with great difficulty to keep any upright position. There is often bleeding from the nose generally followed up by colicky pains in and swelling of the belly associated with some diarrhœa. The skin is dry, parched and hot; the tongue fouled, with red tip and sides. However, the child before this has been compelled by its state of indisposition to cease attending the school.
Whooping-cough, is eminently contagious. The child may be noticed to have had during one or more weeks occasional but violent fits of coughing, which are most frequent during the night. If no complication be present, there is practically no cough between these spasmodic attacks. Usually a short feeling of general indisposition precedes the attack, during which the child in vain struggles to suppress the cough about to burst, when all at once the trunk and frame are subjected to a violent series of successive throbs almost threatening suffocation. At this epoch a few deep drawings-in of the breath are followed by a whistling and almost convulsive inspiration, which may again be succeeded by boisterous coughing. Then in most cases, after a brief moment's repose, a second but a less severe and a shorter onslaught than the first is noticed. Lastly, the fit is terminated by the child's partly spitting and partly swallowing some thick mucus, often at the same time vomiting up any matter present in the stomach.
The time occupied by these seizures to their termination by expectoration varies from sixteen seconds to a couple of minutes.
Owing to the grave and fatal complications often associated even with apparently mild cases of whooping-cough, most especially in very young children, immediate isolation of the sufferer from its schoolfellows is necessary.
Ophthalmia.—Both catarrhal and purulent ophthalmia are highly contagious at all ages, but especially in very young children, and the last-named disease may cause the loss of one or both eyes.
The eyes and their lids become red, swollen, and bathed with a discharge often more or less offensive.
Contagious Parasitic Diseases.—Itch is characterized by the appearance of minute transparent vesicles, which occasion the most lively itching, particularly at night-time. The spaces between the toes and fingers, and the wrists, are most liable to invasion. The child's frequent scratching soon converts the rash into scabs, in which condition the disease will frequently first be noticed by the teacher.
The itch is caused by an insect (Acarus scabei or Sarcoptes) which is nocturnal in its habits and movements. Though highly contagious, the itch can be cured in a few hours.
Crusted ringworm, or Tinea favosa, is caused by a vegetable parasite frequenting the scalp, although it may visit other parts of the body which are covered with hair or down. The hair becomes thin and fragile, with loss of its original color; then follow irregular, unequal, puckered, crust-like yellowish scabs, which may be single or may cover the entire scalp. The scabby flakes in drying and dying crumble to minute fragments, and as dust propagate and disseminate the disease. Itching being frequent in scalp ring-worm, the child's scratching increases the destruction and pulverization of the scab, and thus increases the chances of contagion to others.
The heads of such children as suffer from the disease have a peculiar fetid odor resembling that of a cat's urine. Till quite cured, every child suffering from favus should be separated from its schoolfellows, and only be readmitted on presenting a proper medical certificate.
Common ringworm, or Tinea tonsurans, is very contagious, making itself manifest by the hair of the head becoming thinner, more fragile, less colored than the surrounding hairs. The affected hairs are apt to turn reddish or ashy-gray; they seem as if evenly and artificially clipped off at a distance of say 4 to 8 of an inch above the level of the outer layer of the skin. The surface of the patches is rough, irregular, shaggy, covered with a grayish, scurfy powder of a slightly bluish tinge. The diseased places maybe one or more in number; the form is circular, varying in size from that of a silver florin to a crown piece. By the fusing together of several of such parasitically affected localities the greater portion of the scalp may become affected.
Ringworm with Baldness of Scalp (Tinea decalvans).—This contagious complaint declares itself by the presence of defined patches naked of all traces of hair having a glistening ivory whiteness not unlike a scar without depression. Their size varies from that of a silver threepenny-piece upward.
Previous to the loss of hair there may have been considerable itching. The eyelids and other parts of the body covered with hair or down may also suffer from the vegetable parasite causing the disease (Microsporon Audouin). In children and adults with thick hair this disease may remain long undetected.—Practitioner.
- Instructions regarding the early symptoms of the infectious and contagious diseases of children, prepared by Dr. Delpech for the use of teachers of infant and elementary schools in the Department of the Seine. Abridged and translated by J. Lawrence Hamilton, M.R.C.S.