Measles, Diphtheria, Scarlet Fever, Chicken Pox, and Whooping Cough

Part 1

LITTLE BLUE BOOK NO. 136 Edited by E. Haldeman-Julius

Measles, Diphtheria, Scarlet Fever, Chicken Pox and Whooping Cough

George H. Weaver, M. D.

Professor of Pathology, Rush Medical College, Chicago; Physician in Charge of Durand Hospital of the John McCormick Institute for Infectious Diseases, Chicago, Ill.

HALDEMAN-JULIUS COMPANY GIRARD, KANSAS

LITTLE BLUE BOOK HEALTH SERIES.

EDITED BY MORRIS FISHBEIN, M. D.

Acting Editor, Journal of the American Medical Association, and Associate Editor, Hygeia; a Journal of Individual and Community Health.

Copyright, 1924 Haldeman Julius Company

PRINTED IN THE UNITED STATES OF AMERICA

MEASLES, DIPHTHERIA, SCARLET FEVER, CHICKEN POX and WHOOPING COUGH

PREFACE

It is generally recognized that the prevalence of contagious diseases, and their associated injury to life and health, especially of children, can only be satisfactorily limited if the full co-operation of those who have the care of children is secured. This is dependent almost entirely on general information. Scarcely any parent will willfully endanger the health of the children of others. It is hoped that this brief statement of facts, on which authorities agree, may be of some use to those who are responsible for the health of children. It is not intended to encourage the treatment of sick children without trained advice, but rather to aid in securing intelligent aid to the doctor and public health officer.

CONTENTS

Page General Consideration 7 Measles 17 Causes and Mode of Spread 19 Symptoms 20 Complications 21 Prevention 23 Treatment 24 Diphtheria 26 Cause and How It Acts 27 Recognition of Diphtheria 29 How Diphtheria Is Spread 30 Treatment 30 Prevention of Diphtheria 33 Bad Effects of Serum 35 Suggestions of Measures Calculated to Eliminate Diphtheria and Its Dangers 36 Scarlet Fever 38 Cause 39 Mode of Spreading 39 Effects of the Infection 40 Symptoms 40 Complications 42 Prevention of Scarlet Fever 44 Treatment 45 Chicken Pox 49 Symptoms 49 Complications 51 Different from Small Pox 52 Prevention 52 Treatment 53 Whooping Cough 54 Symptoms 55 Complications 56 Prevention 57 Treatment 58

MEASLES, DIPHTHERIA, SCARLET FEVER, CHICKEN POX and WHOOPING COUGH

GENERAL CONSIDERATION

Before beginning the consideration of the individual diseases enumerated in the title, a review of some of the things which relate to them in common may prevent subsequent repetition. The importance of this group of diseases is realized when one remembers that during the ten years ending in 1922, in a large city such as Chicago, more than one person out of every seven of the population suffered from one of these diseases and one out of every 150 died from one of them. Combined these diseases cause about one-fourth of the deaths among children from one to ten years of age. Not only are they responsible for abundant deaths, but they also leave in those that recover a legacy of permanent damage in the heart, lungs, ears, eyes and other parts of the body. Statistics show that more than one-fifth of the cases of deaf-mutism follow scarlet fever, measles and diphtheria. Chronic diseases of the heart and of the kidneys may be due to earlier attacks of scarlet fever.

The diseases here considered constitute an important part of those which are known as contagious. Contagious diseases are those which are transmitted from one person to others by direct or indirect contact. They are sometimes also designated “communicable diseases.”

CAUSES

Each of these diseases is caused by its own peculiar germ. We may compare the germs causing contagious diseases to seeds of plants. Each variety of seed will produce only the sort of plant from which it came. Each of these diseases is due to the implantation of its own peculiar germ in the body, and except in this way the disease never occurs. Each case thus originates from a previous case of the same sort. The old idea that contagious diseases are caused by sewer gas, bad air, disturbances in the weather or similar things, is now known to be untrue. The germs causing diphtheria, scarlet fever and whooping cough and perhaps measles have been isolated and studied. They are all bacteria, which are very small vegetable organisms. In order to be seen by the human eye, they must be magnified about one thousand times by a microscope.

As seeds must be placed in suitable soil if they are to grow and produce plants, so disease germs must find a suitable soil in the body in order to cause disease.

IMMUNITY AND SUSCEPTIBILITY

If disease germs are received by a person whose body acts as barren soil no disease results, while if they reach a person whose body furnishes suitable soil for growth, disease follows. The former person is said to be immune to the disease. The latter is spoken of as susceptible. It is well known that few persons ever have the same contagious disease twice. One attack renders immune a person who was susceptible. This explains why we have epidemics of contagious diseases. During the epidemic most of the persons in a community who are susceptible contract the disease. At the end of the epidemic most of the suitable soil for the growth of the special germ has been exhausted and the population of the community has become immune to the disease. This causes the epidemic to cease. Another outbreak in the same community of the same disease can only occur when susceptible individuals have again accumulated, i. e., when children have been born and reached a suitable age. Epidemics of contagious diseases are naturally confined largely to children who have grown up after the last epidemic occurred, the older members of the community having been rendered immune by attack of the disease earlier in life. In isolated situations where the germs of contagious diseases are not often introduced persons may reach adult age without ever having been exposed to them. Such adults may then become infected the same as children. In the late world war large numbers of young men from rural communities who had never had the usual contagious diseases were brought together in training camps, and thus furnished fertile soil for many epidemic diseases. In a study of over 30,000 native white children in 14 localities in the United States it was found that at 5 years of age 65% have had measles, 48% whooping cough, 22% chicken pox, 5% scarlet fever, and 3.5% diphtheria. As age advanced the proportions increased until at 15 years of age, 88% have had measles, 77.6% whooping cough, 51% chicken pox, 11.6% scarlet fever, and 8.7% diphtheria. By young adult age most persons have had these diseases which are often spoken of as children’s diseases, but some persons are affected later, some adults at quite advanced age.

HOW NEW CASES ORIGINATE

The germs which cause these diseases are given off and escape from the sick person in various secretions and discharges. This includes discharges from the throat, nose, ears and eyes; pus from abscesses in the neck; sputum or other excretions. The crusts from the skin lesions of chicken pox contain the germs of the disease, but the scales from the skin in measles and scarlet fever do not usually do so. The amount of secretion or discharge required to carry enough germs to cause infection is very minute. When the germs are once located on suitable soil they multiply rapidly and enormous numbers are soon produced from an original few. In originating new cases of disease the secretion from the sick with its germs is deposited on some part of the mucous membrane, or lining of the respiratory tract, as the lining of the nose, throat or larynx; or enters through the mouth, and, being swallowed, lodges in the stomach or intestine. At times the infecting material enters through wounds and injuries of the skin, the intact healthy skin usually forming a perfect protection against infection.

The passage of secretions from the sick person to others is accomplished in numerous ways. Sometimes this is through direct contact between two persons, as in kissing. More often the contact is indirect, the secretion being carried on some object. Anything that is contaminated by secretions may carry them to a second person. A few of the most common carriers, such as hands, clothing, bedding, eating utensils, cups, forks and spoons, toys and pet animals may be mentioned. During forced expiratory efforts, such as coughing, sneezing, hawking, stuttering, loud talking or crying, small particles of secretions from the throat and mouth are thrown into the air in the form of what is known as mouth spray. This may be inhaled by persons who are near and be deposited in the throat or nose. This manner of transferring contagious diseases is not so frequent as the others mentioned, and only occurs at distances of a few feet. Secretions which become dry and pulverized into dust outside the body soon lose their power of infecting. Dust is not of much danger as a means of transferring contagious diseases. Sometimes various foods which are contaminated by disease discharges serve to carry them to well persons, in which case they may be deposited in the throat or pass into the stomach or intestines. This is specially true of milk, which has been responsible for many outbreaks of scarlet fever and diphtheria. The disease germs in the milk do not come from cows, but get into the milk during or after milking from the hands, sputum and other means of contact of the persons who handle the milk.

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