CHAPTER XXIVTHE CURE OF DIPHTHERIA

(2) From diphtheria germs in throats that are not sore

There is another peculiar thing about the germ of diphtheria. It will often get into a throat and grow a little, just enough to keep alive, but without making the throat sore at all. The person in whose throat the germs are will have no idea that they are there, but when he comes in contact with some one who has a delicate throat, he may give diphtheria to that person. The disease does not develop in some throats because the body cells are all healthy and doing their work so well that, when the diphtheria germs try to take hold, they are driven off and not allowed to grow. This is the reason that, before he raises the quarantine, the careful health officer takes a "culture" from the throat of everyone in a house where there has been diphtheria.

How mild cases may be detected

The health officer takes a culture by wiping the throat with a little cotton on a long stick, which he then puts down into a long glass tube containing some substance that diphtheria germs like to grow on. If there are any diphtheria germs in the throat, they will soon show on this culture material. Then the health officer will say, "No, we cannot let you out yet, for the germs are still in your throat." No person who has been staying in a house where there is diphtheria should be allowed to go out until a culture proves that his throat is free from the germs of diphtheria.

You see how hard it is to quarantine all cases of diphtheria, when children are sometimes allowed even to go to school with sore throats that are really diphtheritic. Only two things are necessary for getting rid of diphtheria: one is to quarantine every case, and the other, to have the people do just what they are told when under quarantine. This latter is just as important as the quarantine itself,for people often do not obey the health officer's directions. Now let us see what are some of these directions.

Fig. 55.How pets may become carriers of disease.

Rules of quarantine

If you are the patient, the health officer will say that you must be put in a room where there is just enough furniture to make you comfortable, and that no one except the nurse and the doctor is to go into that room. He will say that the nurse must stay in your room all the time, or that she must at least not go into any other room in the house; that your meals must be left outside your door, and that the person who brings them must go away before the door is opened by the nurse. Furthermore, as everything in the room that cannot be boiled, or otherwise disinfected, will have to be burned when you are well, your pet books and toys had better not be taken in.

Finally, nothing is to be carried from the room until it has been put into a solution that will kill the germs, and this means not only dishes, bedding, and clothing, but even books and letters. The nurse must see that all discharges from the throat and nose are received on little cloths, which are to be burned immediately.

How quarantine rules are broken

These are the things that the health officer will tell your parents must be done. Now let us see what sometimeshappens. Your mother will want to see her little child so much that she cannot wait until you are well, so she will slip into your room, kiss your forehead, and hold you tight against her. When a little later she kisses your baby brother, and is so thankful that he is not sick too, she does not realize that she is kissing the very same disease into his little throat. Or, perhaps your mother is the nurse, and in the night she hears your little brother crying; she thinks, "Surely I can slip out and just cover him up; it will not hurt him just for once," and she does so. What happens? In a few days your doctor tells you that your little brother will have to come in and stay with you.

Perhaps your father grows anxious to see you, and one morning he says he cannot stand it another minute, so he slips in for a few moments before going to business. In a few days one of his clerks fails to come to work. Your father sends a messenger to see what the trouble is, and the word comes back, "He has diphtheria." Then your father says, "What are these health officers doing that they do not stop this thing?" He is very indignant, but it never occurs to him that he himself has spread the disease by doing just what he promised the health officer he would not do.

How dogs and cats carry disease germs

The doctor told your mother not to take anything from the room until it had been disinfected. But you do not consider Towser, your dog, and Tabby, your cat, "anything," so you persuade your mother to let them come in, and you have a good play with them. You let them rub against your face and romp on your bed, and do everything that pet dogs and cats like to do, and in the meantime their fur is getting full of diphtheria germs. Then Towser and Tabby run out-of-doors and play with the boys and girlsof the neighborhood. Soon the parents are wondering why the health officers do not stop the spread of the disease. No dog or cat should ever be permitted to come into a house where there is a contagious disease.

These are not all the ways in which people disobey the orders of the health officer and of the doctor, but these are enough to show you that it is a very important thing to do just what they tell you. It is not always easy to follow all these rules, but it is far better to follow these, and many more, than to have to think that you have caused the death of either a friend or a stranger.

Questions.1. How does the poison of diphtheria get into the system? 2. Where does the diphtheria germ come from? 3. What is quarantine? 4. What is the danger in breaking quarantine? 5. Why is quarantine continued after you feel well? 6. How does it happen that some cases of diphtheria are not quarantined? 7. What is a diphtheria culture? 8. What rules should you observe while in quarantine? 9. Tell some of the ways by which quarantine is broken. 10. How do pet dogs and cats sometimes get disease germs?Remember.1. The germs that cause diphtheria always come from some person or animal that carries diphtheria germs. 2. Diphtheria is always caused by the diphtheria germ, and the diphtheria germ cannot cause any other disease. 3. People are quarantined to prevent other people from getting the disease. 4. If there is diphtheria in your neighborhood, and your throat becomes sore, have the doctor examine it. 5. Every person who has been staying in a house where there is a case of diphtheria should have his throat examined to make sure he is not carrying germs. 6. Never play with dogs or cats when you have a contagious disease. 7. People who do not obey quarantine regulations cause a great deal of suffering and many deaths.

Remember.1. The germs that cause diphtheria always come from some person or animal that carries diphtheria germs. 2. Diphtheria is always caused by the diphtheria germ, and the diphtheria germ cannot cause any other disease. 3. People are quarantined to prevent other people from getting the disease. 4. If there is diphtheria in your neighborhood, and your throat becomes sore, have the doctor examine it. 5. Every person who has been staying in a house where there is a case of diphtheria should have his throat examined to make sure he is not carrying germs. 6. Never play with dogs or cats when you have a contagious disease. 7. People who do not obey quarantine regulations cause a great deal of suffering and many deaths.

Nature of diphtheria poison

The germs of diphtheria do not get into the blood through the skin, but grow on the surface of the mucous membrane (skin of the throat), and there produce a poison that gets into the blood through this membrane. It is this poison that makes you sick, and it is called atoxin. You already know that when people have diphtheria, they are sometimes very sick and sometimes only slightly sick, and that the germ can live in some throats without causing any ill effects whatever.

How diphtheria toxin is fought

As soon as the diphtheria germ begins to grow in a throat, the little cells of the body begin to make a certain substance and to pour it into the blood. This substance we callantitoxin, which means opposed to the toxin in the blood. If the little cells make the substance fast enough, the germs will stop growing, or in some cases they never really get started growing, because they cannot exist where there is much antitoxin. Antitoxin looks like clear water. The following experiment will show you something that acts in very much the same way that antitoxin does.

If you take a solution of litmus that is made alkaline, it will be very blue, like indigo; but if you drop a few drops of lemon juice into this solution it will turn red.[3]Lemon juice is acid, and is just the opposite of alkali. Now, if you put a few drops of ammonia, which is alkali, into the red solution, it will turn blue again. If you put a little more lemon juice, very carefully, drop by drop, into the blue solution, it will gradually turn lighter, until it is entirely clear.

How antitoxin acts

We will suppose that the blue is due to the toxin produced by the diphtheria germ, and that the lemon juice is the antitoxin produced by the cells in the body. If the antitoxin is made fast enough, the blue disappears; but if the toxin is made faster than the antitoxin, the blue remains. It is the same way in the body, only it is not litmus and acids and alkalies that we have to deal with. If the toxin is made faster than the antitoxin, the germs grow, and we get sicker and sicker; but if the antitoxin is made faster than the toxin, then the germs cannot grow, and we soon get well, or perhaps do not get sick at all.

How antitoxin was discovered

Doctors knew that this was what happened, but for a great many years they could not discover the composition of the antitoxin that is made in the body. One day a doctor suggested, "If we cannot find out the chemical nature of this thing that is made in the body, why can we not make it in the body of some animal and then use the blood of the animal?" And that is just what they did. They put diphtheria germs into beef tea, and let them grow very fast and make all the toxin they could. Then the doctors strained the germs out by passing the beef tea through a fine filter, in this way getting the poison, and not the germs. Then they gave a strong, healthy horse a small quantity of this poison; they did not feed it to him, but injected it into his blood. Of course the horse was sick for a while, but soon he began to get well again, for the cells in his body immediately went to work making antitoxin.

When the horse was well, the doctors gave him more of the poison; this time he was not so sick and got well even more quickly. This treatment with toxin was repeated in gradually increasing doses until the poison did not affectthe horse at all. Then the doctors said, "His blood is full of antitoxin, and we will see what it will do when injected into some other animal." So they drew off some of the horse's blood and took out all the little red cells, leaving nothing but the clear fluid of the blood. They planted diphtheria germs in a rabbit's throat, and when the rabbit became very sick, they gave him some of the antitoxin from the horse. The rabbit immediately got well. Afterward they gave some of this antitoxin to a little boy who was very sick with diphtheria, and he, too, got well. Ever since then the doctors have been saving many lives by the use of antitoxin.

Fig. 56.Showing the number of deaths in 100 cases of diphtheria when antitoxin is used on the first, second, third, fourth, and fifth days.

Evidences that antitoxin saves lives

Someone may ask, "How do we know that it is the antitoxin that saves lives?" In just this way: before we knew anything about antitoxin, about half of all the people with diphtheria died; but since we have had antitoxin, only about twelve die out of every hundred who have this disease. More than this, we know that when the antitoxin is given within the first twenty-four hours after the patient is taken sick, there is only about one death for every one thousand cases of diphtheria. Do you not think that this is strong proof that antitoxin saves lives?

How antitoxin saves lives

Antitoxin saves lives not only by curing those who have diphtheria, but by preventing others from having it. Ifa person who has been where there is a case of diphtheria is given a dose of antitoxin, he will not have the disease, because his blood will contain enough antitoxin to destroy the diphtheria toxin present. If you will watch a careful doctor when he makes his first visit to a case of diphtheria, you will notice that, as soon as he gets through treating the patient, he gives all members of the family who have been near the patient a dose of antitoxin to keep them from getting sick.

Antitoxin not a poison

Some people may tell you that antitoxin is a poison and should not be used. The statement that it is in itself a poison is true. But it is also true that in your body there are many things that would poison you if you got too much of them. For instance, there is a gland in your throat (the thyroid) which secretes a substance that is necessary for your health, but if you were to take the secretion of ten such glands it would kill you at once. Now, if the cells in your body make antitoxin when you have diphtheria, it is probable that antitoxin is the very thing needed. And if you can help these cells by giving them antitoxin, ready-made, does it not seem a reasonable thing to do? People who give the name of poison to a substance which is known to have saved many lives are not worthy of attention. Anything may prove a poison if taken in excess; too much play will prove a poison, and too much work also.

Questions.1. What is the poison of diphtheria called? 2. What is antitoxin? 3. Compare the action of antitoxin on the blood with the action of an acid on the litmus solution. 4. Tell about the discovery of antitoxin. 5. How do we know that antitoxin saves lives? 6. How does antitoxin prevent diphtheria? 7. Why should antitoxin not be regarded as a poison?Remember.1. Antitoxin is what the cells in your body make when you have diphtheria. 2. By using the antitoxin taken from a horse, you save your own cells the struggle necessary to make it fast enough to kill the diphtheria germs. 3. If you have diphtheria, and antitoxin is given promptly, you will get well. 4. If you have been exposed to diphtheria, antitoxin will prevent your having the disease. 5. Antitoxin is no more a poison than are many other medicines.

Remember.1. Antitoxin is what the cells in your body make when you have diphtheria. 2. By using the antitoxin taken from a horse, you save your own cells the struggle necessary to make it fast enough to kill the diphtheria germs. 3. If you have diphtheria, and antitoxin is given promptly, you will get well. 4. If you have been exposed to diphtheria, antitoxin will prevent your having the disease. 5. Antitoxin is no more a poison than are many other medicines.

How typhoid fever germs get into the system

There are certain diseases, the germs of which get into bodies through our mouths. That is, we eat or drink them. Some of these diseases are typhoid fever, cholera, the summer complaints of children, tuberculosis, and diphtheria. At present we shall learn about the germ that causes typhoid fever, how it gets into our food and drink, and how we may prevent the disease by getting rid of this germ.

Typhoid fever, like all other diseases caused by germs, is caused by one kind of germ, and one kind only. You cannot get typhoid fever by eating cholera germs any more than you can get diphtheria from typhoid germs.

Animals free from typhoid

So far as we know, there is no animal except man that has typhoid fever. Since the germs of any disease must come from an animal suffering from that disease, and as man is the only animal that has typhoid fever, it naturally follows that the only way to get typhoid fever is from some person who has the fever or has had it.

How typhoid germs leave the body

We know that typhoid fever germs get into the body with food, but how do they get out? Once in a great while germs are found in the matter that the patient vomits, or spits up, but this is a rare occurrence, so rare that we need hardly consider it. The germs are present in the blood of the sufferer, but other people do not get his blood on their hands or in their food. There are two things that come from the patient that are loaded with these germs, and these are the urine and bowel discharges. In these two excretions of the body are found practically all the typhoid germs that come from the patient, and these are the causes of otherinfections. In other words, it is from these two excretions that the germs get into food and drink.

How typhoid germs get into water

How do the typhoid germs get into our food? What is done with the excretions after they come from the body? You will probably say that the nurse throws them into the sewer. Very true; but where do they go when they are thrown into the sewer? The sewer must empty somewhere, and in most instances it empties into a stream, the water of which is used for drinking purposes.

Fig. 57.Pollution of a stream with sewage.

The widespread evil due to the sickness of one person

You may think that the germs from one person would not make much difference, but that is where you are mistaken. There is a town in Pennsylvania of about eight thousand inhabitants, which gets its water from a stream that flows down from the mountains. One cold winter, while the stream was frozen, a man living on the bank of the stream was taken sick with typhoid fever. His nurse threw the urine and the discharges from his bowels on the ice on the bank of the creek. When the ice melted, the typhoid germs in the discharges found their way to the stream that furnished drinking water to people farther down, and in a very short time there were over one thousand cases oftyphoid fever in that town. Before the ice melted there had not been a single case of typhoid, and every one of the thousand cases came from the water into which had been allowed to flow the discharges from one man with typhoid fever. You see what germs from one person may do.

How long typhoid fever germs live in a stream

Sometimes people say that a stream purifies itself every few miles. It does purify itself of some things, but disease germs live from twenty-five to thirty-five days in water, and a stream flows a long way in thirty days.

The pollution of streams with sewage

Sometimes we hear people say that it is safe to put sewage into a certain stream, because no town uses that stream for drinking water. But of this they can never be sure. Not long ago certain people said that the water from the river which flowed through their town was used only by two dairymen and a vegetable gardener, and therefore there was no danger in running sewage into the stream. Yet the dairymen and the gardener sold all their produce in that very town. The townspeople never considered that the water into which they ran their sewage was used by the dairymen for washing their milk vessels (and perhaps for diluting the milk), and by the gardener for washing his lettuce and other vegetables. Thus the germs of disease were brought directly back to the town.

Do not think that you are safe in polluting a stream with sewage because no town uses the water from that stream. The individual on the farm is entitled to protection just as much as the individual in the town. Always remember that when you pollute with disease the water used by the farmer, he may bring that disease back into the town with the produce of his farm.

No sewage, no matter how small the amount, should everbe permitted to go into a stream until all the disease germs it contains have been killed. This can be done, though it will cost something; but we cannot get rid of disease germs without work, and work cannot be done without being paid for.

There are other ways of scattering typhoid germs besides running sewage into streams. Sometimes the nurse does not throw the discharges from a typhoid fever patient into a sewer at all, but into a closet vault. Remember how the material from a closet vault goes through open ground into a well, and you will understand what happens. The germs get into the well, and the whole family may then have typhoid fever.

Let us suppose that the nurse did not throw the discharges either into the closet or into the sewer, but carelessly threw them out on the ground behind the house, where, as it was winter time, they froze as hard as rocks. It does not seem to hurt typhoid germs in the least to be frozen; when they get warm again they are as lively as ever. Let us suppose these particular germs lay there all winter, but in the spring when everything melted the germs were still alive and ready to spread disease. It happened that they did not get into the well or into the milk, but they did get on your food, and made you ill with typhoid fever.

How flies carry typhoid germs

How did the germs get to your food? About the time that the germs were thawed out, and were beginning to double in number every hour or two, along came a fly and thought that spot an attractive one for a lunch. Accordingly he walked over this mass of filth, collecting a supply of germs on his feet, and then came in and tracked them over your bread and butter or other food.

Fig. 58.Flies crawling on the edge of the glass or falling into the milk leave germs that cause disease.

How typhoid germs get into milk

That is how you got the fever; but the trouble did not stop with you. When you fell sick, your father thought it was time to clean the yard, but he was not very careful what he did with the dirt, including the typhoid fever discharges which the nurse threw out on the snow during the winter. There was a low place in the barnyard and there he dumped the dirt. One of the cows thought this fresh pile of dirt would make a comfortable place to lie down in. The next morning the milkman milked her without first washing her sides and udder, and hundreds of little particles of dirt, each one loaded with germs, fell into the milk. The milk from all the cows was mixed together, and by the time it got to town these germs had grown into many thousands. Some of the people who drank the milk became ill with typhoid fever and wondered afterward where they had taken this disease.

Why the recovered patient is dangerous

The discharges from a typhoid fever patient contain typhoid germs not only while the disease lasts, but for many months after the patient is well. In some cases they are present for years after the illness is over.

The story of the careless nurses

Here is a story about typhoid fever that illustrates the importance of washing and boiling everything that comes from a sickroom. A few years ago there was an epidemic of typhoid fever in a certain town. One of the hospitals was very much crowded, and it became necessary to employseveral extra nurses. All the nurses knew the importance of washing their hands after handling the patients, and the old nurses had seen so many bad results from failure to observe this rule that they were very careful. Three of the new nurses, however, thought it a great deal of trouble to be washing their hands all the time, so more and more they neglected this important duty. The result was that all three of these girls got typhoid fever and died. They paid the penalty for neglecting the duty that they well knew they should have performed.

Typhoid fever can be wiped out by attention to neglected details—that is, by disinfecting discharges before throwing them away; by disposing of excretions only in places that are made for them; by adding lime to the closet vault every day to kill any germs present; by making the closet in such a way that flies cannot get into it; and by not permitting sewage to enter any stream until all the disease germs have been killed. All these things can be done. It will require a little work; but had you not rather take a little extra care than run the risk of catching or spreading typhoid fever?

Questions.1. How do typhoid fever germs get into the body? 2. What is one source of these germs? 3. How do these germs leave the body? 4. Name several ways by which typhoid germs in a stream may get into foods. 5. How do flies carry typhoid fever germs? 6. How do these germs get into milk?Remember.1. Typhoid germs come from people who have typhoid fever; they are found in the urine and bowel discharges. 2. No one should ever answer Nature's calls except in a place provided for that purpose. 3. No sewage should be allowed to go into any stream until all the germs in it have been killed.4. Disease germs will live in running water fully as long as they will in still water. 5. The discharges from a single person may infect a whole city. 6. When typhoid fever germs get into milk, they grow very rapidly; hundreds of people have been given typhoid fever by drinking the milk from a dairy where there was a single person sick with this disease. 7. People who have had typhoid often carry the germs for several months after they are well.

Remember.1. Typhoid germs come from people who have typhoid fever; they are found in the urine and bowel discharges. 2. No one should ever answer Nature's calls except in a place provided for that purpose. 3. No sewage should be allowed to go into any stream until all the germs in it have been killed.4. Disease germs will live in running water fully as long as they will in still water. 5. The discharges from a single person may infect a whole city. 6. When typhoid fever germs get into milk, they grow very rapidly; hundreds of people have been given typhoid fever by drinking the milk from a dairy where there was a single person sick with this disease. 7. People who have had typhoid often carry the germs for several months after they are well.

Hookworm disease and amoebic dysentery resemble typhoid fever in one respect, in that they, too are spread by the improper disposal of human excreta.

Where hookworm disease prevails

Hookworm disease is found almost exclusively in tropical or subtropical climates. In the United States it is rarely seen north of the Potomac and Ohio rivers.

Fig. 59.A full-grown hookworm, magnified; the short line shows the average length of the hookworm.

What the hookworm is

This disease is not caused by a germ, as is typhoid fever, but by a worm from a quarter to half an inch long, and about as thick as a small hairpin. These worms get into a person's intestinal canal, and there lay their eggs, which are later given off in the bowel discharges. When these discharges are thrown on the ground, or are put into an open water-closet, they may be carried about by chickens, flies, and pigs. Then the eggs hatch in the soil and tiny hookworms result. When human excreta are not properly disposed of, in climates where hookworm disease prevails, the soil becomes practically full of these little worms, and from the soil they find their way into the bodies of the people.

How it enters the body

There are two principal ways by which the hookworm may enter the body. One is through the mouth, which these worms reach in practically the same way as do typhoid fever germs. The hookworm may enter the body through the skin also. Some authorities state that the worm bores its way in; but it is probable that it does not actually bore through sound skin, but enters at some point where there is a small break.

Where it lives in the body

After the worm gets through the skin, it is taken into the blood and carried to the lungs, and from there it finds its way to the throat and is swallowed. It makes no difference whether the hookworm is swallowed or enters the body through the skin; it finally reaches the intestinal canal, where it then makes its home. Sometimes thousands of these worms are found in a single person, and each one of them entered the body through the mouth or through the skin. The worms do not multiply in the body, and the eggs they lay never hatch until after they have left the body.

How it affects the patient

When the hookworm gets into the intestinal canal, it fastens itself to the wall and sucks the blood from it, at the same time giving off a poison that enters the blood of the victim. The loss of blood and the effects of the poison soon cause the person in whose body these worms are living to become weak, pale, and thin. He is not able to do much work, if any, and the result is that people suffering from this disease are often called lazy. They are not lazy; they are sick, and many of them die.

How hookworm disease can be prevented

All this sickness and all these deaths might be prevented simply by the proper disposal of human excreta. No human excreta should ever be put anywhere except intoa properly constructed sewer or properly constructed privy. If this rule were always observed, both hookworm disease and typhoid fever would be abolished.

Where amoebic dysentery prevails

Amoebic dysentery is another disease that is confined almost entirely to tropical and subtropical climates, though cases sometimes occur in colder regions.

How it is spread and how it may be prevented

This disease, like typhoid fever, is caused by a germ that leaves the body with the bowel discharges. The germ makes its way into the body in the same way that the typhoid germ enters; that is, it is taken in with food or drink. The various means by which this germ gets into our food are the same as those by which the typhoid germ gets in; and the precautions that will prevent the spread of typhoid fever will also prevent dysentery. Amoebic dysentery kills a great many people in warm climates, though it does not kill as many as does typhoid fever. If it does not cause immediate death, it often leaves the patient very weak and sickly for months or years.

Questions.1. In what climates are hookworm disease and amoebic dysentery commonly found? 2. In what respects do they resemble typhoid fever? 3. How does the hookworm enter the body? 4. Where do the hookworm eggs hatch? 5. How can hookworm disease be prevented? 6. What other diseases can be prevented by the same precautions?Remember.1. Typhoid fever, hookworm disease, and amoebic dysentery are all caused by the improper disposal of human excreta. 2. Most of the sickness that can be prevented is the result of dirty habits; if all people would keep clean and see that everything about them was kept clean, a great deal of sickness would be prevented and a great many lives would be saved.

Remember.1. Typhoid fever, hookworm disease, and amoebic dysentery are all caused by the improper disposal of human excreta. 2. Most of the sickness that can be prevented is the result of dirty habits; if all people would keep clean and see that everything about them was kept clean, a great deal of sickness would be prevented and a great many lives would be saved.

There are certain diseases that we know to be communicable (that is, "catching"), but as yet we do not know the germ that causes them, and therefore we cannot tell just how they are carried about. We do know that they are transferred from one person to another; but not being able to locate the cause, as we can in the diseases of which we do know the germ, we cannot explain how it is done.

How scarlet fever is like diphtheria

Among the diseases of this class we find scarlet fever. In one respect scarlet fever acts much the same as diphtheria. A person may have it and not be very sick, sometimes hardly sick at all. At night a child may have a high fever, with a slightly sore throat, and the next morning he may feel perfectly well. The mother supposes that the fever was due to an "upset stomach," thinks no more about it, and sends the child to school. The next time the child takes a bath, he perhaps notices that the skin peels off over some parts of the body. This means that the high fever was due to scarlet fever, but the breaking-out (rash) was so fine that it was not noticed. It also means that all the children in the school have been exposed to the disease. These very mild cases are the most dangerous because so often they are not recognized.

Why mild cases are dangerous:(1) For the severe cases they cause

There are two things to be remembered in connection with these mild forms of scarlet fever, as well as of every other communicable disease. The first is that the same cause which produces a mild form of the disease in one child may produce its most severe form in another child. You can contract a mild form of the disease from exposure to a severe case; and you can contract a severe form fromexposure to a mild case. The character of the case to which you are exposed will give no indication of the form the disease will assume in your body.

(2) For the bad after effects

The next thing to be remembered about the mild form of scarlet fever is that, though the child may not be made very sick at the time, there may later be very bad results. A child who has had scarlet fever in such a mild form that he hardly knew he was sick, may, for a while, appear to be quite well; then suddenly he has an earache, and an abscess forms. This abscess is due to the scarlet fever germs which have gone from the throat to the ear, and as a result the child may lose his hearing entirely.

The child may not, perhaps, have an abscess, but after a time he may begin to lose flesh, and to grow pale. He does not care for his meals, does not care to play, says he is tired, and wants to lie still all the time. Finally his mother thinks it might be a good idea to have a doctor see him. The doctor examines his body carefully, and then asks for a sample of his urine. When he has examined this, he looks very serious and asks the mother when the child was sick last, and what the disease was. Perhaps she has forgotten all about the slight attack of fever, and the doctor must question her very carefully before she recalls it. At length it occurs to her, and then the doctor asks, "After this attack of fever, did you notice that the skin came off his hands and body?" She replies that she did, and then the doctor tells her that the child really had scarlet fever, and, owing to lack of care, he now has kidney disease. This is a very serious trouble, from which he may never recover, or, in case of recovery, he may always be weak and sickly. Even a mild attack of scarlet fever is not to be neglected;it is a severe and dangerous disease in its very mildest form. It not only kills a great many boys and girls, but it makes delicate in health for all their lives many of those who apparently recover.

Fig. 60.One of the ways by which quarantine is broken.

How confusion of names causes mild cases to go undetected

We often hear people speak of two diseases which they think are not scarlet fever. These two diseases are scarlatina and scarlet rash. Now scarlatina is simply the scientific name for scarlet fever. Some doctors will tell you that you have scarlatina and that it is not exactly scarlet fever. A doctor who says this either is deceiving you or does not know any better. In either case, he ought not to be a doctor, for he lets children be exposed to a disease that is likely to kill many of them. It is the same with scarlet rash. This, too, is simply another name for scarlet fever. Changing the name does not change the disease, and you may call it scarlet fever, scarlatina, or scarlet rash—it makes no difference which; the disease is one and the same.

Why quarantine is necessary for scarlet fever

Quarantine is the only way known for preventing the spread of scarlet fever, as well as of diphtheria. If every case of scarlet fever were quarantined, we could soon stop this disease; but every case is not quarantined,because some of them are so mild that they are not recognized.

How breaking quarantine shows selfishness

Even when a case is quarantined, the people sometimes neglect the instructions given, just as they do when there is a case of diphtheria. Then there are cases that are known to be scarlet fever but are not reported to the health officers, because the people do not want to be quarantined. They simply do not want to be put to any inconvenience themselves, and although this seems a very strange way for people to act, it happens very often. There are many selfish people in the world; there are even people who will not report a case of scarlet fever because to do so might prevent their going to a party. Selfishness is at the bottom of it.

It is extremely important that a child should be absolutely free from all the little scales of skin which are thrown off after scarlet fever, before he returns to school or mingles again with others. If there is a discharge from the nose or ears after the scales have disappeared from the skin, there is still danger of spreading the disease, for these discharges often retain the infection for many months.

Questions.1. Give two reasons why mild cases of scarlet fever should be carefully treated. 2. Why is quarantine necessary? 3. How does selfishness lead people to spread scarlet fever? 4. When is it safe to let a scarlet fever patient mingle with well people?Remember.1. If you have scarlet fever and are not very sick, do not think that you will not be dangerous to others; severe cases sometimes come from exposure to the mildest cases. 2. Mild cases of scarlet fever often leave very bad results, if the patient is not cared for. 3. Be very carefuluntil you are entirely well. 4. Scarlatina and scarlet rash are nothing but scarlet fever; keep away from people who have them. 5. Quarantine is the only way by which we can prevent the spread of scarlet fever; there is no medicine that will prevent it. 6. People who violate quarantine regulations are both selfish and stupid.

Remember.1. If you have scarlet fever and are not very sick, do not think that you will not be dangerous to others; severe cases sometimes come from exposure to the mildest cases. 2. Mild cases of scarlet fever often leave very bad results, if the patient is not cared for. 3. Be very carefuluntil you are entirely well. 4. Scarlatina and scarlet rash are nothing but scarlet fever; keep away from people who have them. 5. Quarantine is the only way by which we can prevent the spread of scarlet fever; there is no medicine that will prevent it. 6. People who violate quarantine regulations are both selfish and stupid.

Measles is a disease in the same class as scarlet fever. We do not know the cause, but we do know that it is communicable.

Why measles should be avoided

Measles is usually not a severe disease; that is, it does not kill as many persons in proportion to the number of cases as does scarlet fever. It does, however, kill more people than most of us think; a great many little babies die of it. How often we hear mothers say, "I wish my children would have measles and be done with it." It would be very convenient if they could have measles in a mild way and "be done with it." The trouble is, that we cannot tell whether it will take a mild form, and, worse than this, we do not know when they will be done with it.

If you should go into the children's wards of a large hospital, you would know why measles should be avoided. There you would hear the doctors questioning the mothers about the previous diseases of the little ones. You would be surprised at the number who replied, "He has not had anything but measles." Then you would hear the question, "How long since he had the measles?" "He was just over it when he was taken sick with this trouble." What is "this trouble"? Follow the doctor along from bed to bed and see the cases of pneumonia that started when the child "was just over measles"; see how many cases of empyema (abscess in the chest) began just after the measles ended; how many cases of abscess in the bone, how many cases of disease of the kidneys appeared after the child recovered from the measles. Then go down intothe eye and ear wards and see how many diseased eyes and ears have followed an attack of the measles. The children would not have had these troubles had they not first had measles.

Necessity of care in measles

If you have measles, do not let others come near you, and do not think that, because you do not feel very sick, you can run about as usual. If you do not take good care of yourself, you may have some of the diseases that so often begin when children are getting over measles. Measles causes more deaths than is commonly supposed, especially among young children and very old people; and a great many children die of diseases which they never would have had if they had not first had the measles. Avoid people who have measles, and if you should get the disease, do not treat it as a slight thing, but consult your doctor at once.

Whooping CoughScarlet FeverMeaslesSmallpox4,8564,3094,30274Fig. 61.Deaths in 1907 from four common communicable diseases reported to the United States Census Bureau.

Whooping CoughScarlet FeverMeaslesSmallpox4,8564,3094,30274

Fig. 61.Deaths in 1907 from four common communicable diseases reported to the United States Census Bureau.

Evil effects of whooping cough

Whooping cough is much the same as measles in this respect. It kills many children, and, in cases where it does not kill them, their bodies become so weakened that they are liable to contract some other disease that may prove fatal. Avoid people who have whooping cough.

Questions.1. Why should people avoid measles? 2. Why should one take care of himself when he has measles? 3. Why is whooping cough to be avoided?Remember.1. Measles is more fatal, especially among babies, than people realize. 2. Measles causes more diseases of the bones, ears, and eyes than any other communicable disease. 3. Measles is not dangerous if properly cared for, but when neglected, it causes much suffering and many deaths. 4. Whooping cough causes almost as many deaths as does measles.

Questions.1. Why should people avoid measles? 2. Why should one take care of himself when he has measles? 3. Why is whooping cough to be avoided?

Remember.1. Measles is more fatal, especially among babies, than people realize. 2. Measles causes more diseases of the bones, ears, and eyes than any other communicable disease. 3. Measles is not dangerous if properly cared for, but when neglected, it causes much suffering and many deaths. 4. Whooping cough causes almost as many deaths as does measles.

We now come to the study of a disease, the cause of which has not been positively recognized. We know that it is very communicable; but we know also that there is absolutely no reason for anyone's ever contracting it, since there is a way by which it may easily be prevented.

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