It is most contagious during the catarrhal stage,--the first ten days.

Children suffering from whooping-cough should not be allowed to mix or play with other children for two months. After an exposure to the disease it takes about fourteen days for a case to develop. The danger of whooping-cough is the tendency to develop pneumonia or bronchitis.

Symptoms.--During the first ten days the child acts as if suffering from an ordinary catarrhal cold with cough. This is called the catarrhal stage. There is no way of telling that whooping-cough is present until the child whoops. Most children do not whoop until the expiration of the catarrhal stage, though a very few do from the beginning of the disease.

If a child is treated for an ordinary cold with cough and does not respond to treatment, and whooping-cough is epidemic, it is fair to a.s.sume that whooping-cough has been contracted. When the cough shows a distinct tendency to be worse at night it is further proof of this a.s.sumption.

When they begin to cough in paroxysms, and whoop, the second, or spasmodic stage begins. These fits of paroxysmal coughing are much more severe than spells of ordinary coughing. These may only be three or four attacks daily, or the child may have from forty to fifty such attacks.

When children feel these attacks coming on they seek support, holding on to chairs or they stand by the mother's knee. The coughing is explosive, rapid, and forceful, the child fails to catch its breath and is compelled to take a deep inspiration, which is the whoop; it then goes on coughing more. The face may become purple, the eyes protrude, and the veins of the face swell up. Near the end of the attack the child raises, or vomits a ma.s.s of stringy, glutinous mucus. After it is over the child is exhausted, there is a more or less profuse perspiration, and he may be quite dazed. These attacks are, as a rule, more frequent and more severe during the night. This stage lasts about one month and is then followed by the stage of decline, during which the disease subsides into what appears as an ordinary bronchial cold.

It is quite common for these children to get relapses, especially during inclement winter weather, and go on whooping for two or three months longer. Their vitality suffers because their sleep and nourishment is interfered with, and they become nervous and difficult to manage.

Treatment.--Inasmuch as there is no remedy known that will cure whooping-cough, the best we can do is to render the patient physically efficient to stand the severe strain of coughing, which is the worst feature of the disease. Experience has taught us that those children do best who spend their entire time out of doors. We, therefore, advise parents to encourage their children to play in the open air. There is no exception to this rule, even in winter weather, unless it is particularly inclement. If the weather is wet or raw, or if the child has bronchitis, or is running a fever, it would be more safe to keep the child indoors, in a well-aired room, until the temporary conditions pa.s.s over, when they could again resume the open-air treatment.

Naturally delicate children if under two years of age should not risk staying out of doors too much in very cold or raw weather, even if not suffering from any of the above complications.

The bedrooms of children suffering from whooping-cough should be large and thoroughly aired day and night.

The nourishment in these cases is of great importance. They should be carefully fed, and if they vomit with the paroxysms of coughing, they should be fed small quant.i.ties frequently. Any form of digestive disturbance is very apt to accentuate the frequency of coughing. A fluid diet of milk is the best. Milk punches aid in keeping up the strength; malted milk and eggs beaten in milk are nutritious and easily digested.

So far as internal medication is concerned, I have found pertussin to be the most efficacious remedy. If it is begun early and in sufficient dosage, it not only favors an early termination of the disease, but it lessens the frequency and the severity of the paroxysms. If it is suspected that the child has been exposed to whooping-cough, pertussin may be given during the catarrhal stage with the advantage that it will render the whole course of the disease milder. If it is given during the course of an ordinary catarrhal cold, it will in most cases be as effectual as any ordinary cough remedy. The dosage should be large enough to produce results. I have found a teaspoonful every two hours to a child of three years to be the average dose. In older children I give two teaspoonfuls every three hours. It is necessary to continue its use throughout the disease. The taste of pertussin is pleasant and young children take it willingly.

When the disease is inclined to a protracted course, or when the cough does not subside, especially during unfavorable weather, it is of great importance to send the child away. A change of climate, preferably to the seash.o.r.e, even for a short time, will act like a charm, and will cure the cough of whooping-cough quicker than any other possible measure.

MEASLES

Measles is the most widely prevalent, eruptive, contagious disease. With few exceptions, every human being "gets" measles. As an uncomplicated disease it is never fatal, and is not even regarded as dangerous.

Because of this characteristic, however, parents are neglectful and complications occur, and these frequently prove fatal. One attack renders the patient immune. It is very highly contagious and spreads with great rapidity among those who have never had it. It is not possible to carry the disease any great distance by a third person or by means of living objects. It does not, however, cling to clothing or other objects as long as scarlet fever. Its period of incubation is from eleven to fourteen days.

Symptoms.--The symptoms develop gradually. A severe cold in the head is the first and most characteristic symptom of the disease. There is a discharge from the nose, swollen and watery eyes, sneezing and a hoa.r.s.e, harsh cough. The patient may complain of the throat being painful and examination will reveal a general congestion of the parts. There are also headache, la.s.situde, pains in the back, and there may be vomiting and diarrhea. Children in the early stages of measles are tired and sleepy.

Koplik's Spots.--Three or four days, in rare cases somewhat longer, before the appearance of the rash there appears on the mucous membrane of the cheeks small, bluish white, or yellowish white points, the size of a small pin head. These points are surrounded with reddened areas which give the appearance of a general rash with fine white points upon it. These points resemble milk particles. They adhere firmly to the mucous membrane and when an effort is made to remove them it is found that the underlying surface is ulcerated and excoriated.

The Koplik spots are not of much value to the mother other than that they may be relied upon to indicate the coming disease with which they child is affected. Physicians look for them as an aid in diagnosis before the rash would of itself indicate the disease.

The rash appears on the third, fourth, or fifth day of the disease. From the day of the infection to the outbreak of the rash about thirteen days intervene. It is seen first at the roots of the hair on the forehead, behind the ears or on the neck. It may be seen first on the cheeks. The beginning rash appears as small, dark red, dull spots. At first there are only a few, but they soon become more numerous, they join together, and soon the surface looks inflamed as if entirely covered with the rash. The rash covers the entire body, including the soles and palms. In twenty-four hours it is at its height on the face. It spreads downward like a wave, first the face, then the neck and chest, then the abdomen and later the legs. By the time it invades the legs it has begun to fade on the face. It fades slowly in the order of its appearance. Its duration is about four days.

The skin is swollen; it burns and itches. The eyes are swollen and red and intensely sensitive to light. There is usually a muco-pus discharge from them. The cough is invariably an annoying feature. The fever is high and reaches its highest point when the rash is at its height. As the rash fades the fever subsides.

When the rash fades, the patient begins to "scale." The scales of measles are fine, like bran, never in large patches like the scales of scarlet fever. The amount of the scaling varies. It may be quite considerable or it may be so small as to be overlooked.

Complications.--The most important and by far the most frequent complication of measles is broncho-pneumonia. There may be various conditions affecting the stomach, bowels, throat, ears, bronchi, and the nervous system, which may accompany the disease but are seldom of a serious or important character.

Treatment.--Measles runs a certain course and will run that course, no matter what we may or may not do. We cannot stop it, or shorten it, or lessen its severity. We can only hope to make the patient comfortable and to prevent the development of complications.

The child should be put in bed and kept comfortably warm but not too warm. The room should be kept at the ordinary temperature of the sick room, 68 to 70 F. It should be darkened but not dark. The food should be fluid and given regularly. The child may be given all the cool,--not cold,--water it wants to drink. The bowels should be kept open daily. If constipation occurs an enema may be given. The eyes must be carefully watched and washed every hour or two during the day with a boracic acid solution. If the cough is distressing, it may be rendered less distressing, though we cannot hope to stop it until the disease has run its course. The restlessness, headache and general discomfort can be much modified by suitable remedies. If the itching is acute, the body can be rubbed with carbolated vaseline. When the rash subsides and the patient is free from fever a daily warm bath should be given in order to facilitate scaling.

Should complications arise they should be promptly cared for by the attending physician.

SUMMARY:--

1. Measles is the most prevalent infectious disease of childhood.

2. The danger of measles has been and is underestimated. Because of its prevalency many mothers treat it with less respect than they should, with the result that fatal complications occur, or the future health of the child is permanently injured.

3. Children with measles should be put in bed and kept in bed and treated as directed above.

The following rules have been formulated by the Department of Health of New York City, with reference to measles, and embody precautions that should find general observance:

1. All children in the family must be promptly excluded from school attendance.

2. Careful and continued isolation of the patient must be enforced until the case is terminated and fumigation has been ordered by the medical inspector of the Department.

3. All secondary cases must be reported even if the first case is still under surveillance of the Department of Health.

4. Suspected cases must be treated as contagious cases until a sufficiently long observation has shown that the patient has a non-contagious disease. All cases will be considered as measles, if so reported. Any change in the original diagnosis must be made in writing to the Department of Health and must be confirmed by a diagnostician.

5. Physicians must not order the removal of patients to the contagious disease hospital, or elsewhere, in cabs or other vehicles, but must notify the Department of Health and the removal will be effected by a coupe or ambulance of the Department.

6. Whenever there is a case of measles in rooms in the rear of, or communicating with, a store, the inspector is required to have the store closed at once, or to report the case for immediate removal to the hospital.

7. A case of measles must not be removed from one house to another, or even to a different apartment in the same house, without the permission of the Department. Such removal is in direct violation of the provisions of the Sanitary Code.

8. No case of measles shall be discharged from observation until the Department has been notified, the case examined by an inspector to see if desquamation is entirely completed, and the premises ordered fumigated. This examination by the inspector is necessary because the Department of Health must have official information as to the completion of desquamation before a child is dismissed from observation. Other people with children demand this protection. At no other time is the inspector allowed to examine the patient. In any case, however, where isolation has not been maintained and it becomes necessary to remove the patient to the hospital, a diagnostician will make an examination.

It is recommended that physicians provide a special washable gown for each case of measles. This gown should be put on before entering the sick-room and taken off outside the sick-room as soon as the visit is completed. The gown should be kept in a closet or suitable place, separate from all other clothing, and the gown, and the closet should be fumigated after the termination of the case.

10. In private houses only fumigation may be performed under the supervision of the attending physician; provided he follow accurately the directions given in the following rules and regulations. Upon request a blank will be provided upon which he must state the manner and extent of the work performed under his orders and supervision. If satisfactory to the Department, this will be accepted in place of fumigation by the Department. It is essential, however, that he should know that the disinfection has been efficiently carried out.

In every case of fumigation the following regulations must be complied with:

All cracks or crevices in rooms to be fumigated must be sealed or calked, to prevent the escape of the disinfectant, and one of the following disinfectants used in the quant.i.ties named:

a. Sulphur, 4 lbs., for every 1,000 cubic feet of air s.p.a.ce, 8 hours' exposure.

b. Formaline, 6 oz. for every 1,000 cubic feet of air s.p.a.ce, 4 hours' exposure.

c. Paraform, 1,000 grains for every 1,000 cubic feet of air s.p.a.ce, 6 hours' exposure.

The following disinfecting solutions may be used for goods, which are afterwards to be washed:

a. Carbolic acid, 2 to 5 per cent.

b. Bichloride of mercury, 1-1,000.

SCARLET FEVER. SCARLATINA.