Infectious Diseases in Public Schools. EARLY SYMPTOMS OF CONTAGIOUS DISEASES. SMALL-POX. This disease, though highly contagious, is comparatively rare, owing to the fact that vaccination is a safe preventive. Its early symptoms are so nearly similar to that of some other diseases, that only an experienced physician can properly diagnose it. Vaccination and re-vaccination are better in this disease than rules for diagnosis. SCARLET FEVER. This disease is also called Scarlatina and Scarlet Rash-both of which names are misleading, inasmuch as they are often used to express some harmless form of eruption. They are as equally dangerous and contagious as, and are identical with, Scarlet Fever. They are all Scarlet Fever. The disease is often sudden in its attack. There is nausea, vomiting; hot, dry skin; full, rapid pulse; high temperature, headache, flushed face; whitish-coated tongue, with little reddish projections through the coating; very fine rash in the roof of the mouth, sore throat and pain in swallowing. Rash usually appears within the first twenty-four hours; first, about the neck and face, and thence extends over the entire body. It is light red, uniform smooth patches (so-called Scarlatina), or a multitude of fine, red points, close together (so-called Scarlet Rash). All these symptoms may not be present, nor in the order named. The characteristic symptoms are: Vomiting, high fever setting in early, sore throat, whitish furred tongue, and appearance of fine rash within twenty-four hours. MEASLES. This disease comes on like what is commonly called a "cold in the head." Eyes watery and red, watery discharge from the nose, fever, hoarse, dry, husky and painful cough; an eruption in the roof of the mouth, with or without sore throat. The eruption does not appear before the second or third day-first in the forehead and face-is in patches, and of a dull red color; and the skin has a roughened feel to the touch. The earliest initial symptoms are: Watery eyes, sensitive to the light; discharge from the nostrils, sneezing; rough, dry cough, with pain under the breast bone; the late appearance of the eruption, its occurring in patches, with interspersed spaces, of healthy skin at intervals and the roughened feel, and swollen appearance of the skin. ROTHELN, OR GERMAN MEASLES. This disease in early symptoms occupies an intermediate place between Scarlet Fever and Measles, without possessing the dangers of either. Hence, it is better to mistake it for Scarlet Fever or Measles and treat it as such, Infectious Diseases in Public Schools. than to mistake either Measles or Scarlet Fever for Rotheln and treat them as such. It is highly contagious, and should be treated by isolation, quarantine and disinfection. The common symptoms are sore throat, watery eyes and nostrils, slight fever, an eruption appearing early on the neck and upper part of the chest, rapidly spreading over the body, and soon subsiding. There is very little constitutional disturbance. Its characteristic symptoms are: Moderate amount of fever, early appearance of a fine rash resembling the so-called "Scarlet Rash," with early disappearance of the same, and more or less swelling of the glands of the neck. DIPHTHERIA. This disease is specially characterized by precursory symptoms. There is more or less languor, impaired appetite, slight fever and restlessness for some days before the throat symptoms manifest themselves, and if Diphtheria is prevalent in a community, a child manifesting such symptoms should receive prompt attention, and should excite serious apprehension. In addition to these premonitory symptoms, the pulse is rapid and rather feeble, the throat and soft palate are red and moderately swollen; there is pain on swallowing fluids rather more than solids; putrid breath and the appearance upon the tonsils of whitish or ash-colored spots, which rapidly coalesce and form a thick, leathery, ash-colored membrane. If the air passages become involved, there is a croupous cough and breathing. The characteristic symptoms of Diphtheria are: Langour and debility; redness, soreness and swelling of the throat; fetid breath, ash-colored spots running together; rapid, feeble pulse, and croupous symptoms of the extension of the membrane into the air passages. MEMBRANOUS CROUP. This so closely resembles Diphtheria when the latter invades the air passages, that the terms "Membranous Diphtheria” and “Diphtheritic Croup" are often used to designate either or both "Croup" and "Diphtheria.” Hence, many regard the disease as identical in origin and pathological effects. It is apparent that under the name of "Croup" widespread epidemics of Diphtheria have occurred; hence, Membranous Croup is included in the rules and regulations of this Board for restriction and prevention of Diphtheria, and for sanitary purposes, is to be deemed and considered dangerous to the public health. TYPHOID FEVER. This disease closely resembles Diphtheria in its initials symptoms. There is languor, a tired feeling lasting many days, headache, wakefulness, frequently diarrhea, tongue red, especially at tip and edges, and tendency to bleeding at the nose, with fever, which gradually increases toward evening. There are no throat symptoms. Quarantining Mild Cases of Scarlet Fever. The above named diseases are all contagious, or infections, and depend upon a specific poison for their origin and spread, unless it be Membranous Croup, and ALL, under the rules of the Board, must be isolated, quarantined, and the persons and things exposed disinfected. In Typhoid Fever all the matter from the bowels, kidneys, or vomited from the stomach, must be disinfected, as positively dangerous. Upon the outbreak of either, especially of Diphtheria and Typhoid Fever, the teacher, especially in country districts where the local health board is too often ignorant or neglectful of their duty, should suggest, and so far as possible, insist upon a careful inquiry into the source and healthfulness of the water supply. In nearly all such cases the drinking water is found contaminated, and its early discovery may prevent many other cases occurring. The greatest prevalence of Scarlet Fever and Diphtheria in any community, has come from mild cases, scarcely recognizable, where there was little or no restraint of children, who were permitted to go to church or school, mingle with each other; the premises not quarantined, and children permitted to enter, so that before danger was apprehended the disease spread over a large area; or possibly not until some malignant and fatal case had developed. Hence, the great importance of quarantine in all suspicious cases, at least until the question is settled. A very dangerous habit, is that of female school teachers kissing their pupils at each closure of school. Infectious diseases are often conveyed from mouth to mouth by a kiss, and especially is this true of Diphtheria. It is a practice that should be abolished, at least in the school-room, per force if necessary. QUARANTINING MILD CASES OF SCARLET FEVER. The following correspondence fully explains itself: IOWA, March 14, 1889. J. F. KENNEDY, Secretary State Board of Health: DEAR SIR-We are having quite a number of cases of Scarlet Fever in our town and surrounding country. The disease thus far has been mild-so mild in fact that the most of the people seem to have little or no fear of it, and even go so far as to say that it is not Scarlet Fever, or some of them would have died out of as many cases as we have had. I think some of the cases are not reported, and others overlooked, especially cases of sore throat —thus furnishing us continually with unlooked for, and often times unknown Quarantining Mild Cases of Scarlet Fever. sources, of contagion. These cases of sore throat are what annoy me most, and how to manage them with equal justice to all concerned. The diagnosis, in many cases, is very doubtful. I do not want to treat a case of Tonsillitis for Scarlet Fever, and in the course of a few weeks, or months, be called to treat the same person with a well marked type of Scarlet Fever. How can these cases of sore throat be most satisfactorily managed? What is the usual custom? Can you give some pointers in the differential diagnosis of common sore throat and a Scarlet Fever sore throat, without eruption. REPLY: Yours, etc., ....." M. D. OFFICE OF THE IOWA STATE BOARD OF HEALTH, } M. D.: My Dear Doctor-I have read your letter with interest and fully appreciate the difficulties to which you refer. The best possible, because the only safe way, is to isolate and quarantine, at least for a few days, all suspicious cases. There are often cases of simple Tonsillitis that for a day or two resemble Scarlet Fever. Allow me, however, to say that I do not believe there can be a case of Scarlet Fever without desquamation. That (desquamation) is the special diagnostic sign of Scarlet Fever. As that does not begin for several days, and as in the meantime many exposures might take place, I recommend, and the Board orders, that all such suspicious cases be treated as dangerous-that the community, rather than the affected, be given the benefit of the doubt. In no other way can efficient preventive measures be carried out. After two or three days' quarantine and careful observation, if it be found that the disease is not an infectious one, then the quarantine can be raised by the action of the local board, not upon the motion of the attending physician. It is the duty of the attending physician to report the facts to the local board, whose duty alone it is to raise a quarantine once established. Very respectfully, J. F. KENNEDY, Secretary. J. F. KENNEDY, SECRETARY, ETC., Des Moines, Iowa: IOWA, March 18, 1889. DEAR SIR-Yours of the 16th inst. at hand. I do not wish to trouble you too much, nor ask questions for any other purpose than to get practical facts. You say we cannot have a case of Scarlet Fever without desquamation. Can we have, or are we likely to have, desquamation without an eruption on the skin? I have never observed it. Yet, I have seen cases of sore throat, without eruption, followed in the same family by well marked cases of Scarlet Fever with no other known source of contagion. And again, I have noticed in many families, the smaller children, say from two to ten years of Quarantining Mild Cases of Scarlet Fever. age, would have the fever with eruption followed by desquamation, whilst the other children, and adults would be, some of them, at least, sick with fever and sore throat, without eruption, or desquamation. Now it has appeared to me that many of these cases of sore throat in larger children and adults, without eruption or desquamation, are capable of furnishing the contagion of Scarlet Fever, and smaller children become infected from them, and have a well marked type of the disease, eruption and all the attending sequel. Should all cases of Scarlet Fever be isolated for thirty-five days, or do you think that in a mild case of Scarlet Fever, time may be cut down to twentyone or thirty days? Our local board seems to think that in mild cases it is unnecessary to quarantine for thirty-five days, and consequently in their rules and regulations they say, "they shall be isolated until they are well," and, the result is, many of the families who are sick, think in ten days or two weeks they are well, and want the doctor sent around to let them disinfect and get out. In mild cases of Scarlet Fever, it does seem to me that many of them would be perfectly safe to turn loose on the public in thirty days, but it seems to me also, that the local board should have a minimum time stated for isolation, and not have a doctor called short of that time to examine them with a view to raising the quarantine. DR......DEAR DOCTOR-Your letter of March 18th is at hand, and I have carefully noted what you say in regard to the symptoms, and the difficulties in the diagnosis of Scarlet Fever at times, and especially of desquamation as a characteristic sign of the disease. It is possible that there have been many cases of Scarlet Fever where there has been no eruption and no discoverable desquamation, and yet that desquamation may occur without eruption has been attested by very good authority. Let me cite you, perhaps the best authority we have upon Scarlet Fever, that of Prof. Thomas, of Leipzic, Germany, in his very exhaustive treaties upon Scarlet Fever as found in Ziemssen's Cyclopedia, Vol. II. After speaking of desquamation as always present in the usual form of Scarlet Fever, he says, on page 237: "The cases of Scarlatina without eruption: These attacks, it should be noted, are sometimes followed by more or less well marked and extensive desquamation" showing that at times even without the eruption desquamation may occur. On page 252, after speaking of the very slight case where there is little constitutional disturbance, but slight if any throat symptoms, and no eruption; and of the difficulty of diagnosis in such cases, he says: "In the |