Infectious or Contagious Diseases in Schools Information for Teachers

Four columns are omitted: (1) Interval between Exposure to Infection and the First Signs of the Disease; (2) Day from Onset of Illness on which Rash appears; (3) Period of Exclusion from School after Exposure to Infection; (4) Period of Exclusion from School of Person suffering from the Disease

DISEASE PRINCIPAL SIGNS AND SYMPTOMS Method of Infection REMARKS

Measles Begins like cold in the head, with feverishness, running nose, inflamed and watery eyes, and sneezing; small crescentic groups of mulberry-tinted spots appear about the third day; rash first seen on forehead and face. The rash varies with heat; may almost disappear if the air is cold, and come out again with warmth. Breath and discharges from nose and mouth. After effects often severe. Period of greatest risk of infection first three or four days, before the rash appears. May have repeated attacks. Great variation in type of disease.

German Measles Illness usually slight. Onset sudden. Rash often first thing noticed; no cold in head. Usually have feverishness and sore throat, and the eyes may be inflamed. Rash something between Measles and Scarlet Fever, variable. Breath and discharges from nose and mouth After effects slight.

Chicken Pox Sometimes begins with feverishness, but is usually very mild and without sign of fever. Rash appears on second day as small pimples, which in about a day become filled with clear fluid. This fluid then becomes matter, and then the spot dries upand the crust falls off.

May have successive crops of of rash until tenth day. Breath and crust of spots. When children return, examine head for overlooked spots. All spots should have disappeared before child returns. A mild disease and seldom any after effects.

Whooping Cough Begins like cold in the head, with bronchitis and sore throat, and a cough which is worse at night. Symptoms may at first be very mild. Characteristic "whooping" cough develops in about a fortnight, and the spasm of coughing often ends with vomiting. Breath and discharges from nose and mouth. After effects often very severe and the disease causes great debility. Relapses are apt to occur. Second attack rare. Specially infectious for first week or two. If a child is sick after a bout of coughing, it is most probably suffering from whooping cough.

Great variation in type of disease.

Mumps Onset may be sudden, beginning with sickness and fever, and pain about the angle of the jaw. The glands become swollen and tender, and the jaws stiff, and the saliva sticky. Breath and discharges from nose and mouth. Seldom leaves after effects. Very infectious.

Scarlet Fever or Scarlatina The onset is usually sudden, with headache, languor, feverishness, sore throat, and often the child is sick. Usually within twenty-four hours the rash appears, and is finely spotted, evenly diffused, and bright red. The rash is seen first on the neck and upper part of chest, and lasts three to ten days, when it fades and the skin peels in scales, flakes, or even large pieces. The tongue becomes whitish, with bright red spots. The eyes are not watery or congested. Breath, discharges from nose and mouth, particles of skin, and discharges from suppuratory glands or ears. Milk specially apt to convey infection. Dangerous both during attack and from after effects. Great variation in type of disease. Slight attacks as infectious as severe ones. Many mild cases not diagnosed and many concealed. The peeling may last six to eight weeks. A second attack is rare. When scarlet fever is occurring in a school, all cases of sore throat should be sent home.

Diphtheria Onset insidious, may be rapid or gradual. Typically sore throat, great weakness, and swelling of glands in the neck, about the angle of the jaw. The back of the throat, tonsils, or palate may show patches like pieces of yellowish-white kid. The most pronounced symptom is great debility and lassitude, and there may be little else noticeable. There may be hardly any symptoms at all. Breath and discharges from nose, mouth, and ears. Very dangerous both during attack and from after effects. When diphtheria is occurring in a school all children suffering from sore throat should be excluded. There is great variation of type, and mild cases are often not recognized but are as infectious as severe cases. There is no immunity from further attacks. Fact of existence of disease sometimes concealed.

Influenza Begins with feverishness, pain in head, back, and limbs, and usually cold in the head. Breath and discharges from nose and mouth. Excessively infectious. After effects often very serious and accompanied with great prostration and nervous debility.

Smallpox The illness is usually well marked and the onset rather sudden, with feverishness, severe backache, and sickness. About third day a red rash of shotlike pimples, felt below the skin, and seen first about the face and wrists. Spots develop in two days, then form little blisters, and in other two days become yellowish and filled with matter. Scabs then form, and these fall off about the fourteenth day. Breath, all discharges, and particles of skin or scabs. Peculiarly infectious. When smallpox occurs in connection with a school or with any of the children's homes, an endeavor should be made to have all persons over seven years of age revaccinated.

Cases of modified smallpox—in vaccinated persons—may be, and often are, so slight as to escape detection. Fact of existence of disease may be concealed. Mild or modified infectious as severe type.

In the following diseases only the affected child is excluded

Erysipelas. Child should not return till all swelling and peeling of skin has disappeared. Ringworm on Scalp. Child should be excluded till cured. Very difficult to cure and often takes a very long time.

Ophthalmia. Child should not return till all traces have disappeared. Phthisis (Consumption). If in advanced stage and coughing much or spitting, child should be excluded. (Infection from breath and dried spit floating in the air as dust.)

Scabies or Itch. Child should be excluded until cured.

Ringworm on Skin. Child should be excluded till cured. This takes only a few days if properly treated. Impetigo (Contagious Sore). Child should be excluded until cured. A week or ten days should suffice.

A. BROWN RITCHIE, Medical Officer to Education Committee.

Most people still think that colds are due to cold air or draughts rather than to a cold germ, which finds a body unequipped with resisting power, with its germ police off guard, exhausted from overwork, or disaffected and ready to turn traitor if the enemy seems stronger than our vitality. Sometimes it seems as if we contracted it from a sneezing fellow-passenger, sometimes from a draught from an open car window. An uninformed opponent of the theory that colds are a germ disease wrote the following letter last winter to a New York newspaper:

In addition to the Society for the Suppression of Noises there should be in this town a Society for the Suppression of "Fresh-Air" Fiends. The newspapers report an epidemic of pneumonia, grippe, and colds. It is almost entirely due to the fact that the average New Yorker is compelled to live, move, and have his being from daylight to midnight in a succession of draughts of cold air caused by the insanity of overfed male and female hogs, who, with blood almost bursting through their skins, demand "fresh air" in order to keep from suffocating. Everywhere a man goes, day or night, he is in a draught caused by the crazy ideas about fresh air.

Our wise ancestors, who as a rule lived much longer than we do, and had much better health, said:

"If the wind should blow through a hole,
God have mercy on your soul."

After the correspondent has learned that our ancestors had more colds than we, had poorer health, and died twenty years younger, perhaps he will listen to proof that his unclean warm air weakens the body and makes it an easy prey to cold germs.

Many physicians preach and practice this fallacy as to fresh air and colds, but few physicians now deny that influenza is a germ disease or that a nose so irritated and so neglected as to secrete large quantities of mucus is a better place for breeding disease germs than a nose whose membranes are clean and not thus irritated.

Until medical specialists are agreed, and until they have definitely located the cold germ, we laymen must choose for ourselves a working theory. The weight of opinion at the present time declares that colds are due to germs. Strong membranes with good circulation and drainage provide poor food for germs. Congested membranes furnish proper conditions for propagation. The germ theory explains the spread of germs from the nose to the passages of the head, and from head to arteries and lungs.

A cold can always be charged to some one else. How many can be laid to our account? There is one right that is universally not recognized, and that is the right of protection from the germs showered in the air we breathe, over the food we eat, by the sneezes of our unfortunate neighbor at school, in the street car, at the restaurant. The chief danger of a cold is to our neighbor, not to ourselves. A cold which a strong person may throw off in a day or two may mean death to his tuberculous neighbor. Though for our own health "lying up for a mere cold" is an unnecessary bore, the failure to do so may deprive our neighbor of a right greater than the right to protection against scarlet fever or smallpox. Though formerly this statement would not have been true, rights change with conditions, and the fact that to-day the three most deadly diseases are pneumonia, tuberculosis, and diphtheria,—all diseases of the respiratory organs,—justifies the assertion that we have a right to protection against colds. The prevalence of colds, sore throats, irritated vocal cords, bad voices, catarrh, bronchitis, laryngitis, and asthma in America to-day demands summary measures. One can learn to sneeze into a handkerchief, not into a companion's face or into a room. School children can be taught to avoid handkerchiefs on which mucus has dried. In the far distant future we may be willing to use cheesecloth, and boil it or throw it away, or, like the Japanese, use soft paper handkerchiefs and burn them after using.

Table IX

Death Rate per 10,000 Population, Pneumonia and Bronchitis
Five-Year Period, 1896-1900

England and Wales 22.70

Scotland 27.40

Stockholm 26.70

London 31.20

Berlin 16.10

Vienna 39.70

Christiania 21.30

Boston 30.60

Chicago 24.20

Philadelphia 25.10

New York City 36.60

One child with a cold can infect a whole class or family, thus depriving the class and family of the top of their vitality and efficiency without their consent. Because a person is thought a weakling who lies up for a "mere cold," one is inclined to wish that colds were as prostrating as typhoid, in which case there would be some hope of their extermination.

The exclusion of children with colds from school deserves trial as a check to children's diseases. Many of these "catching" diseases start with a cold in the head, as, for instance, measles, influenza, and whooping cough. The first symptom of mumps, diphtheria, and scarlet fever is a sore throat or swollen glands, which, because they commonly accompany a cold, are not at first distinguished from it.

The first step for the teacher or mother in reading the index for colds is to look into the coat closet for evidence of warm clothing and overshoes, then to note whether the children put them on when they go out for lunch or recess. Whether "cold" settles in the nasal passages, ear, or stomach depends upon which is the weak spot. Draughts, thin soles, wet soles, exposure when perspiring, may be the immediate cause of the nutritional or respiratory disturbances that give cold germs a foothold. Adenoids, diseased teeth, inflamed ears, may furnish the food supply. "There is no use treating children and sending them on fresh-air trips as long as they have nutritional and digestive disturbances due to bad teeth, or colds due to adenoids," said a physician when examining a party of children for a summer outing. The great preventive measure to be taken for catching diseases, colds, diseased glands,—in fact all germ diseases,—is the repeated cleansing of those portions of the human body in which germs may find lodgment,—the mouth, the nose, the eyes, and the ears.

In caring for young infants great pains is taken to cleanse all the orifices daily, but as soon as the child washes himself this practice is usually abandoned. Washing these gateways is far more important than washing the surface of the body through which germs could not possibly gain entrance into the system except through wounds. Oftentimes the douching of the nostrils with salt water will stop a cold at once. The mouth is the most important place of all, and the teacher should take care of her pupils' mouths first and foremost. As bad teeth, enlarged tonsils, and adenoids harbor germs and putrescent matter that vitiate every incoming and outgoing breath, these defects should be immediately corrected. Are we coming to a time when a thorough house-cleaning in the mouth of every child will take place before he enters the schoolroom, preferably in the presence of the teacher?

Two other "catching" diseases cause city schools a great deal of trouble,—trachoma and pediculosis (head lice). There are probably no two diseases more quickly transmitted from one person to another. Almost before their presence is known, all children of a school or all persons of a group have contracted them. When at college twenty men of my fraternity discovered almost at the same time that they had an infectious eye trouble; yet we thought we were using different towels and otherwise taking sanitary precautions. Last summer a Vassar graduate took a party of tenement children for a country picnic. She returned with head lice that required constant attention for weeks. What then may we expect of children who live in homes where there is neither water, time, nor privacy for bathing, where one towel must serve a family of six, where mothers work for wages away from home and see their children only before seven and after six?

Unfortunately for thousands of children, many parents still believe these troubles will be outgrown. Last summer a fresh-air agency in New York City arranged for several hundred school girls to go to a certain camp for ten days each. The only condition was that the heads should be free from lice and nits (eggs). From the list furnished by school-teachers—girls supposed to have been cured by school nurses—not one in five was accepted. A baby two weeks old, brought to Caroline Rest, had already begun to suffer from this easily preventable scourge. Of 1219 children examined in Edinburgh, Scotland, 909, or 69 per cent, had some skin disease, and 60 per cent had sores due to head lice. Even when neglect has caused the loss of hair and ugly sores on the head, mothers deceive themselves into believing that some other cause is responsible.

Trachoma, if neglected, not only impairs the health of the eye, but may cause blindness. Tears carry the germs from the eye to the face, where they are taken up on handkerchiefs, towels, and fingers and infect other eyes. Of late, thanks to school nurses and physicians and hygiene instruction, American cities have found relatively little trachoma except among recent immigrants. So dangerous is the germ and so insidious its methods of propagation, that a physician should be summoned at once at the first sign of inflammation. Conjunctivitis is due to a germ, and will spread unless checked. Since the board of health of New York City has instituted the systematic examination of the eyes of the children in the public schools, it has found fully one third affected with some form of conjunctivitis. Many of these cases are out-and-out trachoma, others acute conjunctivitis, and a larger proportion are "mild trachoma." This last form of the disease is found to a great extent among children who have adenoids. The adenoids should be regarded as a predisposing factor rather than a direct cause. Therefore sore eyes are given as one of the indexes of adenoids. When we consider that adenoids are made up of lymphoid material, and that trachoma follicles are made up of the same sort of tissue, it is not surprising that the two conditions are found in the same child. The catarrhal inflammation produced by adenoids in the nasal mucous membrane travels up the lachrymal duct and thus infects the conjunctiva by contiguity.

In preventing pediculosis and infection of the eye vigilance and cleanliness are indispensable. After the diseases are advanced, after the germ colonies have taken title, some antiseptic or germ killer more violent than water is needed,—kerosene for the hair or strong green oil soap; for the eye, only what a physician prescribes.