Isolating Cases Of Disease
( Originally Published 1917 )
Importance of Isolating Infected People.—Since disease germs come originally from infected people, it is clear that one of the best ways of stopping the spread of disease is to find these people and see that they do not pass their germs on to others. In the case of carriers who are perfectly well, we cannot do this, because we usually do not know who they are until an epidemic occurs.
When we do know, however, that a person has some communicable disease, everything should be done to see that the infected person is separated from others, so that disease germs shall not spread farther. This practice is called isolation.
What Isolation Means.—Until recent years, before it was known just how disease germs spread, not only the sick person but the whole family were often shut off from the rest of the world. This is called quarantine. Sometimes quarantine was declared against a whole country where some terrible disease was known to exist; that is, a government would decree that no one from the country where disease was raging should enter its borders. Old-fashioned quarantine was very inconvenient, and it is seldom necessary to-day to take such harsh measures. The modern way, when ships come from countries where there is plague or cholera, is not to quarantine the whole ship's company but to detect the few infected individuals by bacteriological tests, isolate them, and let the rest depart.
Isolation means simply the taking of proper precautions to prevent disease from spreading, inside the family or out. In order that this may be done, the law requires that all cases of communicable disease shall be promptly reported to the health authorities, so that the health officer may arrange for the necessary care.
The person who is suffering from the communicable disease must be in a separate room, away from the rest of the family. The nurse, mother, or other person in charge must take the greatest care that nothing soiled by the discharges of the patient leaves the room without first being disinfected—treated in such a way that the disease germs will be destroyed. All discharges from the nose, mouth, and ears of the sick person should be received on clean cloths which can be burned or disinfected with chemicals. Handkerchiefs, bedding, forks, spoons, dishes, and anything else which may have been infected by the patient should be boiled or otherwise disinfected. No one, except the doctor and the person caring for the patient, should come into the room. The nurse or attendant must see to it that she does not carry germs out of the room on her fingers or clothing. She should always wash or disinfect her hands before leaving the room, and it is a good plan for her to have a special gown for the sick room, which she changes when she goes out.
Whenever there is a case of communicable disease in a house, a placard should be posted outside to warn people not to enter. If the patient is properly isolated, however, the members of the family who do not come in contact with him need not be a danger to others; if they are immune from the disease (by reason of an earlier attack), they may in many cases go freely about their business. People who have once had chicken pox, German measles, measles, mumps, or whooping cough are generally immune from these diseases.
If, on the other hand, the house is crowded or for any other reason isolation cannot be carried out there, the sick person should be taken to an Isolation Hospital, where he can be properly cared for.
The Communicable Diseases That must be Isolated.—The Board of Health in each city, and in many states, has special rules as to just what diseases are to be isolated and how the isolation is to be carried on. There are twelve diseases which are so common and so important that special precautions are taken in regard to them almost everywhere. These are chicken pox, diphtheria, German measles, infant paralysis, measles, mumps, scarlet fever, septic sore throat, smallpox, tuberculosis, typhoid fever, and whooping cough.
In almost all these diseases, the germs are spread in the fine spray thrown out from the mouth in coughing or sneezing, and in the other discharges from the nose, mouth, and sometimes the ears.
Every one knows that diphtheria, scarlet fever, smallpox, and typhoid fever are serious, but many people think that measles and whooping cough are merely "children's diseases" and are not of much consequence. This is a great mistake, for in many cities more people die of measles than of typhoid fever, and more die of whooping cough than of scarlet fever. These diseases are particularly deadly for young children, and the greatest care should be taken to protect them from infection.
How Long Isolation should Continue.—Each communicable disease has its own definite period of duration, and experience teaches that a certain number of days or weeks must pass before it is safe for the patient to mingle with other people. The periods of isolation for the more common communicable diseases of children are shown in the following table. In each case, of course, the patient should be isolated until he has entirely recovered from the disease, and running of the nose or ears has ceased. In diphtheria, the only safe rule is to wait until tests made by a bacteriologist show that the nose and throat are free from diphtheria germs.
Disinfection and Cleansing.—After a person has re-covered from an attack of a communicable disease, the health authorities sometimes order that the room in which he has been ill shall be disinfected or fumigated. Disinfection is the treating of anything with chemicals, or heat, or in other ways, for the purpose of destroying disease germs. Sterilization is the destruction of all germs, whether disease germs or not. In fumigating, a room is filled with a gas which has the power of disinfecting. This process will kill only the germs exposed on the surface of things and cannot take the place of a thorough cleansing of the room. It is important to destroy all small objects which may have been soiled or handled by the patient, and which cannot be purified by disinfection or washing. The room should be aired and flooded with sunlight, if possible. After the dust has settled, the woodwork and the plain furniture should be washed, and the floor scrubbed with hot water and soap.
It should be remembered that the time of real danger is during the disease, not afterwards. Most diseases are much more catching at the beginning than toward the end. Proper care while the disease is going on is of the greatest importance; nothing the health authorities can do afterward will help much if the patient and the nurse have been care-less.
Signs of the Beginning of a Communicable Disease.—The fact that many diseases are particularly catching just when they are beginning makes it very important to watch for the onset of disease and to start isolation as soon as possible.
Measles, for instance, begins like an ordinary cold in the head, with sneezing and running nose and eyes. Generally people think it is just a cold, and the child who has it runs about and plays with other children as if nothing were the matter. Yet it has been found that there is far more danger of spreading the germs of measles at this time than there is later, when a rash has appeared and the patient has been put to bed.
Children should never be sent to school, and should not play with other children, when they have any of the signs which may mean an attack of a communicable disease, particularly if there is reason to think they may have been exposed to infection.
The principal signs of the beginning of an attack of communicable disease are as follows:
Coughing Weak, tired feeling
Sneezing Watery eyes
Running nose Headache
Sore throat Vomiting
Rash or spots of any kind Swelling or pain back of or under the ears
Isolation of Exposed or Contact Cases.—In each particular disease, a certain time must elapse between the day when a person first gets the germ into his body, and the day when the actual symptoms of disease appear. This is called the period of incubation ; during this time the germs are growing in the body until there are enough of them to make the person feel sick. The incubation period varies with different diseases, from a few days to several weeks.
When children are known to have been exposed to cornmunicable disease, they should be kept out of school and away from other children until the period of incubation has passed without any signs of the disease appearing. In the case of chicken pox, German measles, measles, mumps, or whooping cough, this is not necessary if the child has had the disease before and is, therefore, immune. In diphtheria, the incubation period is short (from one to five days), but carrier cases are so common that all persons who have been exposed to diphtheria should be examined and have samples taken from their throats by the doctor or health officer. An examination of the samples by a bacteriological test will show whether any diphtheria germs are present.
The Sanitary Conscience.—We shall never stop the suffering that comes from needless communicable disease until people remember how dangerous it is to expose others to infection. It is not a sign of courage for a person to keep up and about when that involves danger to others. The next time you have a cough, or a running nose, or feel half sick, and yet still want to go to a party or to school, remember that you may be coming down with some communicable disease, and that if you mingle with other children you will be almost sure to infect them, and that some of them.may be very ill and may even die as a result.
If you have a light case of whooping cough and feel well enough to go out to play, remember that however light your case may be, some other child may catch the disease from you and be dangerously ill.
Above all, remember that it is to young babies that these diseases are most fatal. Measles and whooping cough are more than five times as deadly in infants under one year of age as in children over five. So, whatever else you do, keep away from babies and young children, if you have the least sign of illness of any kind.
QUESTIONS FOR DISCUSSION AND REVIEW
1. What do we mean by isolation? What do we mean by quarantine?
2. Why do we have quarantine stations in all our big ports? Is complete quarantine usually required nowadays? Explain.
3. What precautions must the doctor and the nurse take so that they will not carry germs to others?
4. Why is it a good plan for a patient suffering from a communicable disease to use old soft muslin or cheesecloth in place of handkerchiefs?
5. Suppose that a nurse was holding a spoon to the mouth of a child that had diphtheria, and the child coughed violently. Suppose that the nurse then laid the spoon on the table, went to the bathroom, and turned the faucet with the same hand that had held the spoon. Would this be good isolation?
6. In what diseases is isolation considered necessary?
7. Which diseases are transmitted by the fine spray from mouth and nose?
8. What determines the length of time a patient must be isolated on account of a communicable disease?
9. What is meant by disinfection? Sterilization? Fumigation?
10. What should be done to clean a room after the patient has left it?
11. At what stage in a disease is there usually greatest danger of passing on the disease?
12. In a school where there had been cases of measles, a child who sneezed and coughed and who had running eyes and nose was sent home by the school doctor. Explain.
13. What is the incubation period of a disease?
14. What are some of the common signs of the beginning of an attack of communicable disease?
15. Mary has measles. Her brother John had the disease four years ago, and her brother Walter has never had it. The Health Officer said that John could go to school, but that Walter must stay out for fifteen days after the day on which he last played with Mary. Why?
16. Which are more likely to catch any communicable disease, little children or grown people? What do you think of exposing children to measles or whooping cough in order that they may "get it over with"?
17. How can we be careful about passing on a disease to other people?
18. How can every one help in the campaign to stamp out disease?
19. What is the " sanitary conscience "?