VI. CONTROL OF INFECTIOUS DISEASES.

A. Reduction of the incidence of disease.

1. By measures calculated to prevent the exposure of persons to infectious material.

(a) Isolation of persons ill with infectious disease

during their period of infectivity and of nonimmunes who have been exposed during the incubation period of the disease.

(1) Isolation of the ill person serves the following purposes:

(a) Destruction of infectious material at its source.

(b) Prevention of exposure of

patient to other infection. (2) Isolation of exposed persons during the period of incubation is most effective in the prevention of the spread of diseases, such as measles and whooping cough, which are infectious during the early and often unrecognized stages.

(3) Isolation, unfortunately, does not eliminate the carriers and mild unrecog

nized cases which act as sources for a number of diseases.

(b) Social measures.

(1) Elimination of overcrowding and promiscuous contact which favors" droplet" infection and gives the carriers opportunity to spread disease.

(2) The development in the person of a "social conscience," so that he voluntarily attempts to prevent the spread of even so common an infection as the cold.

(c) Use of pure water and food, milk in particular. 2. By measures calculated to increase the resistance of the individual.

(a) Building up general well-being.

(1) Prevention of anæmia, overfatigue,

and exposure to wet and cold. (2) Preservation of normal healthy condition of the nose, throat, and mouth.

A. Reduction of the incidence of disease-Continued.

2. By measures calculated to increase the resistance of the individual-Continued.

(a) Building up general well-being-Continued.

(3) Establishment of a healthy environ

ment.

(a) Plenty of fresh air and sun

shine.

(b) Freedom from dust.

(c) Avoidance of overheated dwellings.

(b) Production of immunity by inoculation when

possible.

B. Reduction of the mortality.

1. By careful nursing and general care.

2. By prompt and vigorous specific treatment when applicable.

C. Such preventive and therapeutic control is made effective by1. An efficient community, State, and Federal health administration, supported by legislation.

(a) To require the immediate reporting of all cases of contagious diseases. (See The Notifiable

Diseases.)

(b) To require satisfactory isolation at home, or in a hospital.

(c) To investigate the sources of contagion and take all necessary measures to prevent its spread.

(1) Isolation for a suitable period of nonimmune persons who have been ex

posed.

(2) Prevention of the spread of contagion through food and milk handlers.

(3) Provision for medical inspection of schools and playgrounds.

(d) To provide for the inspection and sanitary regulation of the water and food supplies.

(e) To provide experts in the diagnosis and treat-
ment of contagious disease and suitable public
isolation hospitals.

2. An intelligent and cooperative public which is—
(a) Aware of the danger of infectious disease.
(b) Eager to cooperate in all community and pri-
vate activities to prevent its spread.

50850°-21-17

READING REFERENCES VI.

The Control of Communicable Diseases, U. S. Public Health Service, Reprint No. 436, 1918.

HUBBARD, S. DANA: Infectious Diseases, Their Administrative Control in Different Cities of the United States, Department of Health of the City of New York, Reprint Series No. 35, October, 1915.

KERR, J. W. and MOLL, A. A.: Communicable Diseases, An Analysis of the Laws and Regulations for the Control Thereof in Force in the United States, U. S. Public Health Service, Public Health Bulletin No. 62, 1914. The Notifiable Diseases: Diseases and Conditions Required to be Reported in the Several States, U. S. Public Health Service, Reprint No. 501, 1919. PREBLE, PAUL: Public Health Administration, U. S. Public Health Service, Reprint No. 390, 1917.

OUTLINE 4. COMMON COMMUNICABLE DISEASES OF

CHILDHOOD.

The early recognition of infectious disease is important both for the treatment and future well-being of the patient and the protection of the community. A general idea of the common infectious diseases their manifestations, course, and control-will enable the mother, nurse, or teacher to know when to take the first steps for the benefit of the sick child and the protection of his associates.

I. THE SO-CALLED " CHILDREN'S DISEASES."

A. The eruptive fevers, or exanthemata-measles, German measles, scarlet fever, smallpox, chicken pox. They have in common the following characteristics:

1. The occurrence of an eruption, or exanthema on the skin. 2. No known causative organism.

3. Definite communicability.

B. Acute infections of the nervous system:

1. Acute cerebrospinal meningitis.

2. Acute anterior poliomyelitis.

C. Unclassified:

1. Diphtheria.

2. Whooping cough.

3. Mumps.

A tabulation of the most important facts concerning these diseases is given in Table XXI.

TABLE XXI.--Important facts concerning so-called "children's diseases."

Onset sudden with fever,
vomiting, severe head-
ache, chill, or convul-
sion; intense sensitive-
ness to motion, early de-
lirium or coma, tiny
hemorrhages into the
skin, rigidity of neck
and extremities, rapid
pulse, irregular, high,
persistent fever, com-
non symptoms. Dis-
ease may be fulminating
and death may take
place within 24 to 48
hours. Symptoms usu-
ally last from 3 to 6
weeks, occasionally
much longer. Recov-
ery depends largely on
early diagnosis by lum-
bar puncture and in-
jection of antimeningo-
coccus serum into the
subdural space; with the
serum treatment mor-
tality has decreased from
70 to from 15 to 25 per
cent.
Onset usually indefinite.
There may be fever,
vomiting, slight diar-
rhea, or constipation,
fretfulness or drowsi-
ness, prostration, head-
ache, muscular tremor,
spinal pain, and general
hyperesthesia. Muscu-
lar weakness and paraly-
sis of one or more ex-
tremities may appear at
onset, but usually not
until third or fourth day
of disease. There may

Strict isolation of cases
for 6 to 8 weeks, with
disinfection of nose,
throat, and fecal dis-
charges. Quarantine
of exposed children
and adults who deal
with children for 14
days from date of ex-
posure. Quarantine
of children in same
family until 2 weeks
after termination of
case by death, re-
moval, or recovery.

TABLE XXI.-Important facts concerning so-called "children's diseases"-Continued.

Disease.

Cause.

Prevalence.

Susceptibility.

Mode of infection.

Period of infectivity
of patient.

Incubation
period.

Salient features.

Measures of control.

be weakness without
any real paralysis or the
paralysis may be transi-
tory or unobserved.
Usually after 3 or 4 weeks,
which should be spent in
absolute rest in bed, ten-
derness disappears and
spontaneous improve-
ment begins. After sub-
sidence of acute stage-
usually 6 weeks-"re-
constructive" treatment
for paralyzed muscles
should be begun under
direction of a trained
orthopedist and should
be persisted in for at
least 2 years. It is im-
portant to realize that a
large percentage of cases
are atypical and would
not be recognized as poli-
omyelitis except during
epidemics. Mortality
during acute stage varies
between 5 and 20 per
cent in different epi-
demics. Permanent
paralysis of some degree
persists in approxi-
mately 50 per cent of re-
coveries.
Onset with 3 or 4 days of
premonitary symptoms,
with drowsiness and
signs of cold in head,
running nose and eyes
predominating. During
this period eruption
appears first on inside of
cheeks and lips as small
bluish-white spots,
"Koplik spots." Rash

Carrier problem at
present a very diffi-
cult one. To culti-
vate the organism as
a means of detection
of carriers is highly
impracticable.

Isolate patient during
period of communi-
cability. Children
exposed to infection
should be kept from
school and public
gatherings 14 days.
Isolate exposed chil-
dren showing rise in
temperature. Disin-
feet articles soiled

Measles (rube- Unknown. ola).

Winter and
spring.