A Series of Articles on What the Amateur Nurse Should Know

Mild and Severe Cases are Equally Infectious-scarlet Fever, or Scarlatina-after Results and Convalescence-measles-special Points to be Noticed-after Care of Patients-chicken-poxmumps-rules for the Nurse

The danger of carelessness in dealing with infectious disease cannot be too strongly impressed upon the general public.

The severity of an illness does not in any sense influence its infective power. A " mild " case of measles or scarlet fever, for example, may be the starting-point of an epidemic of serious cases. We have already spoken of the need of immediate isolation in the home of a case which is not to be taken to the fever hospital. We have emphasised the importance of the nurse in charge of the case taking every precaution to prevent the spread of infection to the rest of the household. The foundation for this is, of course, cleanliness-rigid cleanliness. Whatever the disease may be, the nurse must be extremely careful to work on the lines suggested in the last article (page 1819, Part 15) with regard to hygienic care of dishes, utensils, sheets and clothing. Each particular fever requires certain definite precautions, according to its mode of spreading. Scarlet Fever

Scarlet fever, or scarlatina, for example, is exceedingly infectious, because the germs lurk in vast numbers in the skin of the patient, especially during the peeling stage in convalescence, when particles of skin are shed as dry scales. It is most important for the amateur nurse to know something of this ailment, which is so common in childhood that the average mother regards it as inevitable. The period of " incubation," or the interval between taking the infection and the appearance of the first symptoms, is short in scarlet fever. Three or four days after the child has been exposed to infection a shivering attack is followed by sickness, headache, and sore throat. Sore throat, associated with a rapid pulse and rise of temperature, is very suggestive of scarlet fever, and the earlier a child is isolated from the others the better. Particularly is this true if a rash appears. The scarlet fever rash is bright red in colour; it comes out about the second day of the illness, and spreads over the body. In a few days it fades, and the patient begins to peel, or desquamate.

The nursing of scarlet fever is exceedingly important. The patient must be put to bed at once, kept in a well-ventilated room, protected from draughts. Nothing but milk should be given for the first week, and the bowels are to be regulated so as to act every day. A doctor, of course, must be in charge of the case, as scarlet fever is a disease with many serious complications, which include ear complications, kidney disease, and acute rheumatism. The throat will require spraying and inhaling, under the orders of the doctor, whilst any ear symptoms will call for syringing and hot fomentations to the ear. The nurse must watch for any symptoms of ear mischief, such as pain or discharge. A child who is too young to complain of pain will be fretful and irritable, constantly putting the hand up to the ear. A sudden rise of temperature, also, is suggestive of middle-ear disease, and these points have to be watched for, so that the doctor may be summoned at once.

During convalescence, when peeling has begun, the first duty of the nurse is to attend to the skin, in order to prevent spread of infection. All shreds of skin must be burnt at once, and the doctor will wish a little oil or carbolised vaseline to be applied to the skin once or twice daily, to prevent the dry particles, laden with infectious germs, from getting about the room.

In the second place, the nurse must carefully protect the patient from chill, which is extremely dangerous after any of the infectious fevers, as it may be the starting-point of complications.

When convalescence is complete, the patient must be disinfected with carbolic baths, dressed entirely in clean clothes, and removed into a new room. Disinfection of clothing and room will be considered in a later article. Measles

Measles has of late years been considered a much more serious disease than formerly. While in itself it may readily be considered a mild disorder, its complications are so serious, and its after effects so lasting, that every mother should know something about nursing a measles case until her children are at the age when they are not likely to contract it. If an epidemic of measles is about, it is wiser to isolate a child who shows signs of violent cold in the head and depression of health. This will go far to prevent the spread of measles, as it is most infectious in the early stage, when the chief signs are sneezing, coughing, and running of the nose and eyes. The child probably complains of headache and general seediness. The rash does not come out for four days, and by that time, if the child has not been isolated, every juvenile member of the household will probably develop the disease in ten or fourteen days.

A measles case, however mild it may be, should always be put to bed. The mortality from measles is more than twice as high as that of scarlet fever, simply because less care is given to the nursing of a measles case, the general idea being that it is not a very serious complaint. The disease may be followed by grave complications even in mild cases. About four days after the first symptoms, the rash appears as red, flat pimples, which tend to run into patches. The spots appear first on the upper part of the face, and afterward spread downwards over the neck and body.

In ordinary, uncomplicated cases, the temperature comes down as the rash fades after the beginning of the illness. In six or seven days the child is convalescent. No solid food should be given whilst the temperature is high. Milk-and-water are the best foods; or, if preferred, barley-water or albumen-water are excellent for allaying thirst, and at the same time they have nourishing properties. The making of barley-water was described in the last article. Albumen-water is made by stirring the whites of two eggs into a breakfastcupful of cold water, adding two lumps of sugar, and when dissolved passing the whole through muslin to remove the coagulated part. The fluid which passes the muslin, and which contains soluble albumen, is given to the child.

Points To Notice

Special points to be noticed in the care of measles patients are:

1. The care of the eyes. If there is any discomfort or swelling of the eyes, they should be bathed several times daily with boracic lotion (a teaspoonful of boracic acid powder dissolved in half a pint of warm water). The child will not be able to bear a strong light, and the room may even have to be kept partially darkened for a time.

2. As middle-ear disease is a fairly common symptom of measles, any ear symptom must warn the nurse to call in the doctor. If there is earache, she can apply hot fomentations to the ear, and a small mustard-leaf to the bony prominence behind the ear. The doctor may advise syringing, but the nurse should always inquire if this is to be done, as some doctors do not approve of putting anything into the ear itself.

3. The most dangerous complications of measles are chest ailments. There is always some degree of bronchitis. In some cases this is marked, and it may even go on to bronchopneumonia, which is, of course, a very serious disease. Because of the risk of these chest affections, the child ought to wear a little woollen jacket underneath his nightdress, reaching from the neck to below the waist right round the body. Thus the lungs, back and front, and the throat are protected. The nightdress should be made of light wool, and the pyjama shape is better for both boys and girls, as thus there is not the same risk of the child getting uncovered in tossing about during sleep. The temperature of the room for measles, as for all other fever cases, should be about 60° Fahr.

The thermometer should be hung on the wall, level with the patient and not too near the fire or window. The window should be left open at the top, and a screen round the bed will protect the child from draught.

The after care of measles is also important to the nurse, as many complications arise during convalescence from carelessness. The safest plan is to keep the child in the sick-room for at least a fortnight, if there are no complications. If these should occur, the whole course of the illness is lengthened. During convalescence the child's health must be built up by a nourishing diet of eggs, milk and cream, etc. A course of cod-liver oil is especially useful after measles. Remember also that any signs of flagging health afterwards should never be neglected, as consumption often follows upon measles. The child's clothing and foot-gear should receive special attention, and any slight cough requires medical advice. These facts apply also to mild cases of measles.

The nursing of German measles can be followed on the same lines. It is not a severe affection, however, although the child must be guarded from chill when there is any fever.

Chicken-Pox

Chicken-pox is a very mild complaint. In many cases the child does not seem to be ill at all, but crops of spots come out, and if the child is allowed to scratch them, and they get dirty and suppurate, slight scars may be left. It has been said that some cases of severe chicken-pox are in reality mild cases of smallpox, so that it is important to have a doctor to see the case, and advise as to treatment, even if the mother may not think it necessary.

Smallpox is always nursed in hospital, so that we need not consider it here. It is, of course, an exceedingly infectious disease, but its ravages have been modified since the great discovery of vaccination, and now it is rarely seen in the ordinary population.

Mumps

With regard to the nursing of mumps, the same rules should be followed as for other infectious ailments. It is a fever associated with inflammation and swelling of the large salivary gland in front of the ear. Swallowing is difficult, owing to the swelling, and there may be very high fever. The patient, of course, must be kept on fluid diet, and protected from chill.

The nursing of typhoid fever and diphtheria will be considered in another article.

Rules

1. Always wash the hands in a disinfecting solution immediately after attending to the patient, and before serving meals or taking food yourself.

2. Wipe away the discharges from the mouth, nose, or ears with pieces of cotton-wool, which must be immediately burnt.

3. Never allow a patient suffering from scarlet fever to be kissed during illness or convalescence.

4. Any appearance of sore throat in yourself must be reported immediately to the doctor.

5. All books, toys, etc., should be kept in the sick-room, and destroyed after an infectious ailment.

6. See that you have a good rest and a meal before going on duty in the sick-room, and regular exercise out of doors. Attend to your general health.