Scarlet fever is an acute, contagious disease. It begins abruptly. The child may have a severe attack and be quite sick from the beginning, or he may have a mild attack and not be very sick. Usually the fever rises rapidly, the child vomits and complains of a sore throat. If the attack is very mild the throat symptoms may not cause any distress. Frequently, about the third day, there are patches on the tonsils. Prostration may be profound if the fever is very high. Convulsions and diarrhea are sometimes present in very young patients. It takes from two to six days to develop scarlet fever from the time the child is exposed to it. The disease may be caught at any time, but it is most contagious during the time the patient is scaling. It is not as contagious as measles. Some children seem to escape even though directly exposed to it. It is more frequent in the fall and during the winter, and it is more severe during the latter months.

Eruption.--The eruption appears at any time after twelve hours. It may not, however, appear before the third or fourth day. It lasts from three to seven days, and only takes a few hours to cover the whole body after it is first seen. The rash is first seen on the neck or chest; it appears as a red, uniform blush, but, when examined closely, small reddish spots may be seen all over it. If the rash is very faint and of a doubtful character a hot bath may bring it out. A bright red, well-developed rash is a sign of good heart action. In the event of heart failure, the rash fades quickly. Itching is a constant symptom after the rash is fully out.

About the eighth day the rash begins to scale or desquamate. It begins on the neck and chest. It takes from one to three weeks to scale completely, from the time it begins to peel. The hands and feet are the last spots to scale.

It must always be kept in mind that mild cases are just as contagious as severe cases, and that a mild case may cause in another person a very severe attack.

The throat may be mildly affected or it may be the most troublesome feature of the case. It is red and swollen and the child complains of pain during the act of swallowing. Patches may be seen on the tonsils on the third day. There is usually a discharge from the nose and this discharge may be contagious. While the fever is high, the child is restless, complains of thirst, and may be slightly delirious.

One attack is usually all a child has during life, though there are exceptions to this rule. Complications are quite frequent with scarlet fever. Inflammation of the ears and kidneys is most often met.

Measures to be Taken to Prevent Spread of Disease.--Every case, no matter how mild, should be isolated for four weeks. Many cases must be isolated longer,--until scaling is complete. Children should not play or sleep with other children for three or four weeks after all symptoms have been absent. Other children in the family, who have not been exposed, should be sent away. All clothing should be changed and washed in soap and water and then boiled in a carbolic solution. The nurse should not mix freely with other members of the family. The sick room should be kept clean, and well aired. It should be dusted with a wet cloth, and this should afterwards be burned. There should be no furniture, or hangings, or pictures in the room other than are absolutely necessary. The room should not be used after the case is over until it is thoroughly and completely disinfected.

During the period of scaling the patient should be rubbed all over with carbolated vaseline. This allays itching and prevents the scales flying around. The bed sheet can be taken off daily with the scales in it, and immediately put in carbolic water and boiled.

Treatment.--Inasmuch as scarlet fever is one of the most dangerous and one of the most treacherous diseases of childhood, we cannot afford to take any chances with it. Every child with scarlet fever should be put in bed, and kept there during the entire illness,--that is, from four to six weeks. Light, and the free circulation of fresh air are absolutely necessary for the proper care of a scarlet fever case. The child should be clothed only with the usual night gown and a light undershirt. No extra wraps or blankets are required.

The diet should be reduced in quant.i.ty and strength. The bowels should move daily. If anything is necessary to accomplish this, citrate of magnesia is quite satisfactory. There is no special medicine for the treatment of this disease. Often it is not necessary to give any. Good nursing is more essential, and with proper attention to the bowels, diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result favorably. Quiet is essential. Consequently, two persons at a time should never be allowed in the room with the little patient.

The family physician will prescribe whatever medicine is necessary in his judgment, and will meet any complication as it arises.

TYPHOID FEVER

Typhoid fever is an acute infectious disease. It is rare in infancy.

After the fifth year it is more common. It is caused by drinking infected water or milk. It is not a serious disease in childhood, rarely being fatal.

Symptoms.--It may begin suddenly or it may come on slowly. If suddenly, the child develops what appears to be an attack of indigestion, has fever, vomiting, and is prostrated. In cases developing slowly the child complains of being tired, has a headache, nausea, and fever. Vomiting is the suggestive and important symptom.

Diarrhea is usually present. Constipation, however, may accompany the entire illness. Children may not complain of an excess of gas as do adults. The abdomen is tender. The typhoid eruption is rarely seen in children. They lose flesh steadily and then strength diminishes rapidly.

Headache and delirium at night are quite common, and the child is dull and indifferent, and often in a state of semi-stupor.

In order to tell definitely whether the child has typhoid, it is necessary to make a blood examination. There are so many intestinal conditions in children that simulate typhoid, that a blood examination is imperative.

Treatment.--The patient should remain in bed during the time fever is present and for a few days after. A fluid diet, preferably milk, is the most suitable means of nourishing the child. It may be diluted or given plain according to the age of the patient. Water is essential and should be given freely.

The discharges of the patient should be thoroughly disinfected in a solution of carbolic acid, 1-20. All clothing and bed linen should be boiled for two hours. If the fever remains high cold sponging is advisable. The attending physician should instruct regarding this feature, as some children do not stand cold applications well.

The average duration of the disease is about six weeks.

How to Keep From Getting and Spreading Typhoid Fever.--Typhoid fever is a communicable disease, but, if certain precautions are taken, its contraction and spread can almost certainly be prevented.

The disease is caused by a specific germ known as the typhoid bacillus.

These germs are found in the excreta (stools and urine) of persons ill with typhoid fever.

Failure to properly disinfect these excreta and carelessness in the care of persons ill with typhoid fever lead to the transmission of the disease from the sick to the well by the infection of water, milk or food with the typhoid bacillus or by direct contact.

The disease is contracted by taking into the mouth in some form the discharges from some previous case. There is no other way. It is, therefore, a disease of filth and someone is at fault somewhere for every case of typhoid fever that occurs.

Bad sanitary conditions, such as lack of drainage, open cess-pools, sewer gas, decaying vegetable matter, etc., may favor the contraction of the disease, but cannot cause it unless the specific germ, the typhoid bacillus, is present.

The water supply of a community becomes infected by the entrance into it of the excreta (stools and urine) of persons suffering from typhoid fever.

Milk (in which typhoid bacilli grow and multiply very rapidly) usually becomes infected by washing out milk cans with water in which these bacilli are present, or from the presence of the bacilli on the hands or persons of those handling milk. Oysters spread the disease when they have been "freshed" in water rich in sewage and containing the typhoid bacillus. Flies, whose bodies have become foul with typhoid excreta, may infect food, milk, etc. Those who take care of typhoid patients may contract the disease if they do not at once disinfect their hands after handling the patient, or clothing or bedding which has become soiled with the discharges.

How to Keep From Getting Typhoid Fever.--If the chance of infection is to be reduced to a minimum, all drinking water, concerning the character of which there may be the slightest doubt, should be boiled, and all milk, the handling and care of which is not absolutely beyond suspicion, should be pasteurized or boiled. All food supplies (meat, milk, vegetables, etc.), should be carefully protected against flies, and flies should not be permitted access to the sick-room, the kitchen nor to the room in which the meals are eaten. Bathing at all beaches which have sewers emptying in their immediate vicinity should be strictly avoided. In the majority of cases it is probable that the system must be slightly below par in order that the disease may be contracted; therefore, all indigestible food, green fruit, etc., which may set up indigestion or diarrhea, and so render the system more susceptible to infection, should be avoided. In addition, the elementary rules of cleanliness and hygiene, both as to the house and person, should be most strictly observed. No member of a household in which a case of typhoid fever occurs should take food in any form without previously washing the hands.

Typhoid bacilli enter the body only through the mouth. If sufficient care be taken to prevent their entrance, the contraction of the disease can be absolutely prevented.

How to Keep From Spreading the Disease.--In order to protect themselves and others in the household, persons caring for or in any way coming into contact with a case of typhoid fever must constantly bear in mind that the secretions and excretions (urine, stools, etc.), of the patient contain typhoid bacilli and are capable of transmitting the disease to others. The person who nurses the patient should not do the cooking for the family. The bedding used by the patient should be washed separately from that used by others. Special dishes, plates, knives, forks, etc., should be kept for the use of the patient alone, and should be washed separately and thoroughly. Particular attention should be paid to immediate disinfection of the stools and urine of the patients until the restoration of health is complete.

The urine is especially dangerous. It may look entirely normal and yet contain typhoid bacilli for some time after recovery is apparently complete. In a few instances the typhoid bacilli may persist in the stools for weeks or months after recovery. Such persons are called "typhoid carriers," and const.i.tute a grave menace to the health of the community. The best disinfectants are carbolic acid and freshly slacked lime; both are effectual, cheap and easily obtained. Urine or stools to which has been added one-third of their volume of a solution of one part of carbolic acid to twenty parts of water are, as a rule, sufficiently disinfected in half an hour, provided the ma.s.s of the stool is broken up and thoroughly mixed with the solutions. The best method is to keep the urinal of bed-pan partly filled with the disinfecting solution at all times. In this way any germs present in the urine or stools are almost instantly destroyed. Stools and urine should never be thrown out on the ground. If no system of drainage is at hand, they should be very thoroughly disinfected and emptied into a hole in the ground and covered with earth. All persons nursing or handling the patient in any way should be careful to wash their hands very thoroughly with soap and water before leaving the sick-room. They should never, while in the sick-room, touch any article of food or put their hands to their mouths.

Careful observation of the above suggestions and precautions will almost certainly prevent contraction of typhoid fever or the spread of the disease.

VARIOUS SOLUTIONS

Boracic Acid Solution.--In the previous pages mothers are frequently told to use "a saturated solution of boracic acid." A saturated solution means that the water in the solution has dissolved all of the product that is put into it that it is capable of dissolving. When boracic acid is put into water, the water will dissolve it up to a certain point; if you add more the boracic acid will not dissolve; it will float if it is in the form of powder, or it will remain at the bottom of the gla.s.s if it is crystal--in other words the water is saturated to its limit and the solution is known as a saturated solution.

The strength of a saturated solution of boracic acid is as follows:--

Boracic Acid Ounces 1-1/2 Hot Sterile Water Pints 2

which means that 2 pints of hot water will completely dissolve 1-1/2 ounces of boracic acid. If any more boracic acid is added the water will not dissolve it because it is already "saturated." Inasmuch, however, as boracic acid is harmless, it is perfectly safe to use the liquid part of a solution which contains some undissolved acid.

A saturated solution is used in the eyes after it is strained.

Normal Salt Solution.--A normal salt solution is made in the following proportions:--

Sodium Chloride (ordinary table salt) Grains 128 Sterile Water Pints 2

Normal salt solution is much used in irrigating the bowel. A mother may safely use it in the proportion of one heaping teaspoonful to two quarts of water--two quarts being the size of the ordinary fountain syringe.

Carron Oil.--Lime water and raw linseed oil, equal parts. This mixture is much used in burns. It should be made fresh.

Thiersch's Solution:--

Salicylic Acid Drams 1/2 Boracic Acid Drams 3 Sterile Water Pints 2

Thiersch's solution is a good, mild antiseptic solution, or wash.

Solution of Bichloride of Mercury (1 to 1000):--

Bichloride of Mercury Grains 15 Common Salt Grains 15 Sterile Water Pints 2

Bichloride of mercury is one of the most powerful and poisonous drugs.

Solutions made from it should never be used without special directions from a physician. In much weaker solutions than the above it is one of the best antiseptic washes known. It is used to disinfect wounds, for douches, and for various other purposes, but always by special direction of a physician.

Other solutions.--Frequently mothers are directed to use solutions in the proportion of 1 to 500, or 1 to 1000.