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INFECTIOUS AND CONTAGIOUS DISEASES
Direct and Indirect Transference of Germs
Air, water and insects are all agents in the dissemination of the parasitic germs of diseases, and direct contact of healthy people with sufferers from disease or with otherwise healthy carriers also spreads epidemics. The various processes are here described, and further information is given under the headings.
Diseases which may spread from one person to another are classified under two headings, contagious and infectious, but the terms are very loosely employed, and are often used interchangeably. The contagious diseases are few in number and are spread only by direct contact with the affected person or by means of the infective agent immediately it has left the body. Gonorrhoea is an example of this group. The infectious diseases are very much more numerous, and include those which are commonly termed the fevers. The chief infectious diseases met with in Europe during the early 1900’s were measles, scarlet fever, rubella or German measles, diphtheria, chicken-pox, smallpox, typhoid fever, whooping cough (diphtheria), mumps and erysipelas. The infectious diseases seen today are HIV-AIDS, tuberculosis, malaria, influenza, chicken pox, gonorrhea, and the common cold.
 
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Sources of infectious diseases
It may safely be said that all communicable diseases are due to infective parasites or carriers, though in the case of some diseases the actual parasite has not yet been discovered. Bacteria find a suitable medium for growth in the tissues of men, plants and animals, and cause disease by the poisons they generate in the course of their life activities. It is important to remember that when these parasitic germs become detached or cast off from the host upon whom they live, they are still capable of living, though in a modified way. Some infective agents have received the name of viruses. These are living entities of a much more minute size than bacteria. They are unable to propagate themselves outside of the living infected tissues they habitate.
The yeasts and moulds are larger vegetable organisms capable of causing disease including cancer. They are placed slightly higher in the scale of life than the bacteria and being somewhat larger in size. Instead of being single cells like the latter, they are formed of groups of cells linked together in various forms. Ringworm is an example of a well-known skin disease caused by a fungus, as is thrush.

In the animal kingdom there are also many parasites capable of causing disease. Of these the protozoa are the most important. They, like the bacteria, are single-celled microscopic individuals: examples of diseases caused by them are malaria, sleeping sickness, etc. Higher up the scale of animal life there are other infective parasitic forms; for example, the scabies parasite and the tapeworm.
How Disoase is Spread
Disease is disseminated in the community in a variety of ways. Since many germs are capable of living for long periods outside the body of the human host, it will readily be understood how the wind may carry dried but living germs in the form of dust. The germs given oft from the respiratory tract of patients suffering from the common cold, consumption (tuberculosis of the lungs), diphtheria, inftuenza, etc., give rise to other cases of these diseases. Germs thus floating in the air will in most cases cause disease by being breathed in or swallowed directly, but food esposed to such germ-laden dust may also spread the infection, as noted below.
In addition to the methods of inhalation and ingestion, germs may enter the body by inoculation. For this to take place there must be some injury or abrasion of the skin or of the lining membrane of the nose or mouth - Anthrax, glanders and hydrophobia (rabies) are examples of diseases spread in this way.
It is probable that migrating birds carry infection. It. has been suggested and is probable that £oot-and-mouth disease is frequently brought into this country on the feet of birds migrating from abroad. It is also known that aeroplanes may be responsible for the dissemination of disease. The danger of the spread of the yellow fever and dengue mosquito by air travel has been urged, and regulations to combat this type of menace have been drafted and in South America.
Many germs that cause disease are capable of living in the soil for long periods. From the soil they are washed by the rain into the rivers thus causing pollution of drinking water, with resulting epidemics of cholera and typhoid fever. This danger is, however, slight in comnmunities where adeduate means are undertaken to filter and aerate the water supply. Certain diseases may be carried by food, particularly by milk, which may give rise to epidemics of scarlet fever, diphtheria or infantile diarrhoea.
It is through personal contact, in all probability, that most of the cases of communicable disease are spread about. So close is human intercourse, so innumerable are the germs, that it is impossible to conceive of a patient sick of an infectinus diseaso being so completely isolated that some of the infective germs are not carried ahont by a person who may have been attending on him, or by fomites, which include articles used by the sick person, such as handkerchiefs, cups, spoons, towels, clothes, toys, etc.
Again, many cases of infections are so slight that the patient does not feel ill enongh to lie up. He goes about spreading the means of disease. A child may have such a mild degree of scarlet fever or diphtheria that it passes unnoticed. Yet the slight fever of scarlet fever can lead to permanent damage of the heart valves.
It frequently happens that after a patient has quite recovered from an attack of, say, typhoid fever or diphtheria he still continues tq carry about in his body the germs which caused his disease, and such disase has been traced to these carriers (q.v.).
Insects as Carriers
Insects play a very important part in the spread of disease. The house fly, passing from the sick room, where it has perhaps slighted on the hands or face of the sick person, to the food tray, carries the germs of disease on its legs to the food to be consumed by others. Typhoid fever, cholera, summer diarrhoea, rota virus, etc., are thus undoubtelly spread. Experiments have proved that a fly's legs and body when contaminated with disease germs remain so infected for many days.
The share of the insects so far mentioned in spreading disease is that of mere "porters." Other insects, e.g. mosquitoes, play a more active part. Malaria, sleeping sickness, yellow fever and some other tropical dieases are spread through the bites of mosquitoes or other insects. Here the insects play the part of host for the germs during part of the life cycle of the latter. A patient sufiering from malaria is bitten by a mosquito of a certain species. The germs of malaria, sucked up by the inseet with the patient's blood enter the mosquito's body and there pass through a definite life cycle. When this life cycle is completed the insect is capable of causing malaria by biting a fresh victim. The illness thus caused malaria is due to the second life cyole of the germ in its host, the human being.
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INFECTIOUS DISEASE: CHANNELS AND AGENTS THROUGH WHICH DISEASES ARE SPREAD
This diagram illustrates the three important considerations in the study of communicable diseases namely, the way in which the active agent leaves an infected person the intermediary conveying this agent to a healthy person, and the channel through which the latter receives the infection. It must be understood that other diseases besides those mentioned are conveyed by one or other of the routes delineated.
Varying Virulence of Germs
Seeing that the germs of dangerous disease are so universally distributed in nature, and that man is hourly brought in contact with them in the ordinary course of life, it may well be asked how does mankind escape annihilation by these ever present enemies. It is well that the poisonousness-technically called the virulence--of a germ diminishes the longer it is compelled to live away from the body of its host-man. Germs in the dust, in the water and the soil tend to become weaker the longer they remain there. Such weakened germs taken up again by man, may be incapable of causing disease, or any but the mildest of attacks. On the other hand, germs that have passed through and caused disease in one individual are likely to be very poisonous or virulent, and cause serious illness if passed directly to another.
Germs, so called, are mother nature’s means of keeping her balance. Germs in habit the body since the day of birth and live freely in the intestines and about the skin. When the secretions of the body are not poisonous, the germs remain relatively harmless. When the body violates the laws of nature, e.g. the rules of hygiene laid down by Moses, the bacteria once living in balance become mutated into germs of a harmful nature. The body isout of harmony of mother nature and will thus come to a crisis of purgation, called disease, in which case fever will cleanse the morbidity, or it will come to a premature end. Mother nature will thus reclaim that which is hers. This is a simple but valid notion of nature cure.
Again, the powers of resistance against disease that human beings possess vary from time to time. A man may be in such good health that, no matter how poionous are the germs he may pick up, he is able to heep them from harming him. When his resistance is lowered, however. and his natural defences weakened from any cause, such a man will fall a ready victim to the ubiquitous disease germs. Recent work tends to show that resistance to infection is definitely lowered by the absence of vitamins (especially the fat soluble A) from the dietary. Animals fed on a diet deprived of this substance rapidly develop severe septic infections. It is therefore highly probable that man's best protection from the agents of infection lies in a well-balanced dietary containing ample fresh raw, plant foodstuffs of high vitamin value. Worry, overstrain, insufficient food and rest, lackof exercise and over-indulgence of the body in any way are additional common agents by which the body is sapped of its natural resistance.
General Treatment of infectious diseases
Details of the signs, symptoms and treatment of the special fevers are given under their respective headings, but the general treatment of infectious diseases may be considered here.
In the management of these cases attention must be directed to the patient himself, and also to the protection of the community. Certain infectious diseases are notifiable to the medical officer of health in whose district they occur, but they vary in different towns and at certain times.
All patients suffering from infectious disease should be isolated so long as they are infections. This time varies with the disease, and is also dependent on the severity and complications of the individual case. Average isolation periods for uncomplicated cases of infectious diseases are given below.
Isolation may be carried out in the patient's home if there are facilities for so doing, otherwise he should be removed to a hospital. In the case of severe infections this should always be done. In hospital, segregation rather than isolation is the rule.
After suffering from an infectious disease the patient must be thoroughly disinfected by means of hot baths and careful shampooing of the hair. The room and and articles used during the illness must also be disinfected by appropriate means. It must be remembered, however, that infection is much more likely to spread from incomplete quarantine of the patient than from the room and fomites, and great care must be taken to avoid this.
ISOLATION
Patients who are suffering from infectious diseases must be isolated in order to prevent the disease from spreading to others and causing an epidemic; children and susceptible persons who have been in contact with the patient during the early stages of the disease must also undergo a modified form of isolation, known as quarantine (q.v.), until there is no risk that they may develop the disease.
The patient may be nursed at home if ciroumstances permit, or he may be removed to a special isolation or fever hospital. Removal to hospital is not compulsory unless in the opinion of the medical officer of health adequate isolation cannot be obtained at home. In the majority of cases of infectious fevers occurring in middle and upper class households home isolation is perfectly satisfactory. The patient must be kept in a separate room, preferably at the top of the house and away from other bedrooms. One or two persons at the most should be allowed into the room to look after him. These should be trained nurses or members of the household, who must not then mix with others until they have taken adeduate precautions to prevent the spread of infection.
Not only must the patient himself be isolated, but also everything which comes in contact with him and which might spread infection. Thus, his feeding and washing utensils must he kept separate and not allow,ed to be taken downstairs and washed with the other household vessels. His night clothes, pillow slips, sheets, etc. must all be washed separately, and should be boiled before being sent to a public laundry. In certain diseases it is essential that the urine and faeces should be disinfected before being poured down the drain; this particularly applies to tvphoid fever.
The length of time during which a patient must be thus strictly isolated varies with the disease from which he is suffering, but the average isolation periods of the moee common infectious diseases are as follows: Measles, 2 weeks; German measles, 1 week; scarlet fever, 6 weeks; diphtheria, 6 weeks; chickenpox, 2 to 3 weeks; mumps, 3 weeks; whooping-cough, 6 weeks; typhoid fever, 5 weeks smallpox, 5 to 10 weeks; typhus fever, 5 weeks.
Precautions Following Isolation
The actual length of the time during which an individual patient is isolated depends' also upon the severity of the disease and upon the occurrence of complications. In a mild attack of many of the infectious fevers the patient feels quite, fit and able to be up and about before he is passed as free from infection by the doctor. The latter may, however, allow him to go out for a walk provided that he meets no one in the house on his way out and in, that he speaks to no one while he is out, and that he docs not ride in any vehicle. At the end of the period of isolation he should enter a hot bath and wash all over, including his hair. He should then be given clean clothes and, before dressing, go into another room which is free from all infection. The sick-room will then have to be disinfected. This can be done most easily by means of formalin spray, and on applying to the local public health authority the disinfection of the room and its contents will he adequately effected. The nurse in attendance should wear an overall and cap, which should be discarded on leaving the room.
Those who have, been associated with the patient during the early stages of the disease, before he was isolated, are known as contacts. Children or susceptible contacts should be kept in quarantinc until there is no risk that they themselves may be incubating the disease. They should not be allowed to continue at school or to mix with other children, and they must also be kept isolated from the patient himself. No visitors should be allowed at the house until all the contacts have completed the preserihed term of quarantinc.
ISOLATION: In Veterinary Practice
The reasons for isolation are threefold: spread of contagious disease is limited, sick animals rest and do better when alone and undisturbed by others, and the attendant can look after the sick better when they are isolated. Horses, cattle, sheep and pigs are usually isolated in a loose-box or special sickbox if such exists, which, though warm and free from draughts, should be well ventilated and efficiently lighted. A door which is made in two halves, so that the upper part may be left open, is best, for then the larger animals can stand with their heads out of the box and take advantage of the fresh air outside.
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