Chapter XXIII: Transmission of Diphtheria

[Sidenote: How germs may cause sickness without entering the body]

Some germs that cause disease do not get into the body, but grow upon its surface, that is, they grow on the mucous membranes--the skin of the mouth, the throat, and the nose. As they grow, they develop poisons that are absorbed by the body, and that make us very sick. The germs that cause diphtheria belong to this class.

[Sidenote: Prevalence of diphtheria]

Diphtheria is one of the most common of all the preventable diseases. It causes more deaths than any of the other diseases that can be prevented, except tuberculosis. The great prevalence of diphtheria is due to lack of care on the part of those who have this disease and of those who come in contact with them.

[Sidenote: Where the diphtheria germ comes from]

The germ that causes diphtheria always comes from some person or animal that has diphtheria. It never "just happens." If you went into your yard in the morning and found some beets growing in your flower bed, you would know positively that beet seeds had got into your flower bed in some way. You would not say that the beets just happened to grow there. So diphtheria will not "just happen." Diphtheria is always caused by germs that come from some one who has diphtheria. They may have come in a letter that was written in the room with the sick person. They may have come from the library in a book that had been used by some one ill with diphtheria. They may have come on some toy that had been played with by a child that had the disease. There are a thousand ways by which the germs may be brought to you without your knowing where they come from.

[Sidenote: How to confine diphtheria germs]

The public health officers try hard to keep these germs from being brought to you. In order to do this, they have to shut away from other people those who have diphtheria germs; that is, they make the sick ones stay at home until they are free from the germs of the disease. We call this _quarantine_. Quarantine means that you must stay away from other people when you are sick with a communicable disease, and that other people must stay away from you. People are not put in quarantine because they are sick, but because they are dangerous, and because we are trying to prevent other people from getting the same disease. Do not think the health officers unreasonable when they tell you that you must stay at home and that no one can come in to see you. This is done to protect other people and to keep them from getting the same disease that you have. If you ever have diphtheria, or any other communicable disease, you must remember that if any of your playmates come in to see you, they may get the same disease.

[Sidenote: Seriousness of breaking quarantine]

Diphtheria kills a great many children, and to play with your friends after you have had diphtheria, and before the health officer tells you that you may, is almost like trying to kill them. They might be very sick and die, or they might be very sick and get well, or they might not be sick at all; but you never can tell what will happen if they are exposed to the disease. If you were to take a gun and shoot at a friend, you might kill him, or you might shoot his leg off, or you might not hit him at all; but you would be trying to hit him, and it would not be your fault if you did not. It is just the same if you play with a friend when you have a communicable disease; you shoot the disease germ at him, and if you do not hit him, it is not your fault.

[Sidenote: Why quarantine is not raised sooner]

Sometimes people who have been sick with a communicable disease feel perfectly well, but the health officer tells them he cannot let them out of quarantine. This is because he knows that such people still have in their bodies the germs that cause the disease, and that as long as these germs are there they can give the disease to other people. It is not pleasant to have to stay in quarantine when you feel that you are well, and children, as well as older people, are very likely to become restless under the circumstances. You see an illustration of such a patient in Figure 60, where the little girl, who is under quarantine for scarlet fever, but who is feeling quite well, is giving a book to two of her friends. The book contains the germs that cause scarlet fever, and the boys are very likely to contract the disease by handling the book.

[Sidenote: Why some cases of diphtheria escape quarantine:]

[Sidenote: (_1_) From failure to detect mild cases]

If every case of diphtheria were quarantined, and the people obeyed the health officer, there would soon be no more diphtheria. But how does it happen that every case of diphtheria is not quarantined? Diphtheria is a very peculiar disease. Sometimes it makes people so sick that they die in spite of everything that can be done for them; sometimes it makes the throat only a little sore, and the child seems so slightly ill that his mother says to herself, "He is fretful," and does not call the doctor. In the latter case the child often keeps on going to school, and exposes other children to the disease; some of them catch it, and become very sick or even die. In still other cases, the mother thinks that a child has only a case of tonsillitis and does not call a doctor; the child's brothers and sisters go to school and may carry the germs to other children. I have known a great many cases of diphtheria to be spread in this way.

Sometimes a dairyman thinks that his child has nothing more serious than tonsillitis, and goes on selling milk. A great many epidemics have resulted from such cases. Sore throats should not be treated lightly, for the most severe forms of diphtheria may develop from germs that come from a throat that is only slightly sore. If there is a case of diphtheria in the town where you live, and if your throat feels the least bit sore, have your doctor examine it at once. If you do not wish to have your family doctor look at your throat, go to the health officer. Had you not rather stay at home for a week or two than see your best friends ill or dead because of your carelessness?

[Sidenote: (_2_) From diphtheria germs in throats that are not sore]

There is another peculiar thing about the germ of diphtheria. It will often get into a throat and grow a little, just enough to keep alive, but without making the throat sore at all. The person in whose throat the germs are will have no idea that they are there, but when he comes in contact with some one who has a delicate throat, he may give diphtheria to that person. The disease does not develop in some throats because the body cells are all healthy and doing their work so well that, when the diphtheria germs try to take hold, they are driven off and not allowed to grow. This is the reason that, before he raises the quarantine, the careful health officer takes a "culture" from the throat of everyone in a house where there has been diphtheria.

[Sidenote: How mild cases may be detected]

The health officer takes a culture by wiping the throat with a little cotton on a long stick, which he then puts down into a long glass tube containing some substance that diphtheria germs like to grow on. If there are any diphtheria germs in the throat, they will soon show on this culture material. Then the health officer will say, "No, we cannot let you out yet, for the germs are still in your throat." No person who has been staying in a house where there is diphtheria should be allowed to go out until a culture proves that his throat is free from the germs of diphtheria.

You see how hard it is to quarantine all cases of diphtheria, when children are sometimes allowed even to go to school with sore throats that are really diphtheritic. Only two things are necessary for getting rid of diphtheria: one is to quarantine every case, and the other, to have the people do just what they are told when under quarantine. This latter is just as important as the quarantine itself, for people often do not obey the health officer's directions. Now let us see what are some of these directions.

[Sidenote: Rules of quarantine]

If you are the patient, the health officer will say that you must be put in a room where there is just enough furniture to make you comfortable, and that no one except the nurse and the doctor is to go into that room. He will say that the nurse must stay in your room all the time, or that she must at least not go into any other room in the house; that your meals must be left outside your door, and that the person who brings them must go away before the door is opened by the nurse. Furthermore, as everything in the room that cannot be boiled, or otherwise disinfected, will have to be burned when you are well, your pet books and toys had better not be taken in.

Finally, nothing is to be carried from the room until it has been put into a solution that will kill the germs, and this means not only dishes, bedding, and clothing, but even books and letters. The nurse must see that all discharges from the throat and nose are received on little cloths, which are to be burned immediately.

[Sidenote: How quarantine rules are broken]

These are the things that the health officer will tell your parents must be done. Now let us see what sometimes happens. Your mother will want to see her little child so much that she cannot wait until you are well, so she will slip into your room, kiss your forehead, and hold you tight against her. When a little later she kisses your baby brother, and is so thankful that he is not sick too, she does not realize that she is kissing the very same disease into his little throat. Or, perhaps your mother is the nurse, and in the night she hears your little brother crying; she thinks, "Surely I can slip out and just cover him up; it will not hurt him just for once," and she does so. What happens? In a few days your doctor tells you that your little brother will have to come in and stay with you.

Perhaps your father grows anxious to see you, and one morning he says he cannot stand it another minute, so he slips in for a few moments before going to business. In a few days one of his clerks fails to come to work. Your father sends a messenger to see what the trouble is, and the word comes back, "He has diphtheria." Then your father says, "What are these health officers doing that they do not stop this thing?" He is very indignant, but it never occurs to him that he himself has spread the disease by doing just what he promised the health officer he would not do.

[Sidenote: How dogs and cats carry disease germs]

The doctor told your mother not to take anything from the room until it had been disinfected. But you do not consider Towser, your dog, and Tabby, your cat, "anything," so you persuade your mother to let them come in, and you have a good play with them. You let them rub against your face and romp on your bed, and do everything that pet dogs and cats like to do, and in the meantime their fur is getting full of diphtheria germs. Then Towser and Tabby run out-of-doors and play with the boys and girls of the neighborhood. Soon the parents are wondering why the health officers do not stop the spread of the disease. No dog or cat should ever be permitted to come into a house where there is a contagious disease.

These are not all the ways in which people disobey the orders of the health officer and of the doctor, but these are enough to show you that it is a very important thing to do just what they tell you. It is not always easy to follow all these rules, but it is far better to follow these, and many more, than to have to think that you have caused the death of either a friend or a stranger.

=Questions.= 1. How does the poison of diphtheria get into the
system? 2. Where does the diphtheria germ come from? 3. What is
quarantine? 4. What is the danger in breaking quarantine? 5.
Why is quarantine continued after you feel well? 6. How does it
happen that some cases of diphtheria are not quarantined? 7. What
is a diphtheria culture? 8. What rules should you observe while
in quarantine? 9. Tell some of the ways by which quarantine is
broken. 10. How do pet dogs and cats sometimes get disease germs?

=Remember.= 1. The germs that cause diphtheria always come
from some person or animal that carries diphtheria germs. 2.
Diphtheria is always caused by the diphtheria germ, and the
diphtheria germ cannot cause any other disease. 3. People are
quarantined to prevent other people from getting the disease.
4. If there is diphtheria in your neighborhood, and your throat
becomes sore, have the doctor examine it. 5. Every person who
has been staying in a house where there is a case of diphtheria
should have his throat examined to make sure he is not carrying
germs. 6. Never play with dogs or cats when you have a contagious
disease. 7. People who do not obey quarantine regulations cause a
great deal of suffering and many deaths.