Treatment.—The patient should be kept in the house and isolated in bed as long as the symptoms last. When there is much pain, laudanum diluted one-third with water may be applied continually with a soft warm cloth. Oil of hyoscyamus applied twice daily to the sore parts is good if laudanum is not used. When the swelling goes down I know of nothing as good as a hot bean poultice, which must be changed often so as to keep hot. Bean poultice.—Simply boil the beans in water until they are soft and thick enough to use as a poultice. The bowels should be kept open with salts. The food must be liquid, such as milk, soups and gruels. If there is not much fever, soft boiled eggs and milk toast from the beginning. Do not use vinegar, acids or astringents.

[INFECTIOUS DISEASES 181]

WHOOPING-COUGH (Pertussis).—Whooping cough is an acute specific infectious, disease caused by a micro-organism. It is characterized in a majority of cases by a spasmodic cough, accompanied by a so-called whoop. It is not only infectious, but very contagious. It is propagated through the atmosphere in schools and public places; the air of which is contaminated with the specific agent of the disease. This agent is thought to reside in the sputum and the secretions of the nose and air passages of the patient. It is very contagious at the height of the attack. The sputum of the first or catarrhal stage is thought to be highly contagious. The sputum in the stage of decline is also thought to be capable of carrying the disease. It prevails in all countries and climates. During the winter and spring months it is most frequent. At times it prevails as an epidemic. It occurs most frequently in infancy and childhood, but a person can take it at any age. Second attacks are rare. It is most frequent between the first and second year; next most frequent between the sixth and twelfth month. After the fifth year the frequency diminishes up to the tenth year, after which the disease is very infrequent. Not everyone who is exposed contracts the disease. It seems that whooping-cough, measles, and influenza frequently follow one another in epidemic form. This is one of the diseases much dreaded by parents. It is very tedious and endangers the life of weak and young children by exhaustion. It is a terrible thing to watch one with this disease, day in and day out. It can be known by the impetuous, continuous and frequent coughing spells, following each other rapidly until the patient is out of breath, with a tendency to end in vomiting. When it comes in the fall or winter months there will likely be spasmodic coughing until summer through the usual colds contracted. Summer is the best time to have it.

Symptoms.—There is an incubation stage, but it is hard to determine its length. After the appearance of the symptoms there are three stages; the catarrhal, the spasmodic, and the stage of decline.

The First Stage.—This is characterized by a cough which is more troublesome at night. One can be suspicious, when instead of getting better in a few days, it gets worse and more frequent, without any seeming cause. After four or five days the cough may be accompanied by vomiting, especially if the cough occurs after eating. There may be some bronchitis, and if so there will be one or more degrees of fever. Fever is present as a rule, only during the first few days, unless there is bronchitis. As the case passes into the spasmodic or second stage, the paroxysms of coughing last longer, the child becomes red in the face and spits up a larger amount of mucus than in ordinary bronchitis. This period of the cough without a whoop, may last from five to twelve days. In some cases there is never a whoop. The child has a severe spasmodic cough, followed by vomiting. Usually at the close of this stage the incessant cough causes slight puffiness of the eyelids and slight bloating of the face.

[182 MOTHERS' REMEDIES]

Spasmodic or Second Stage.—The peculiar whoop is now present. The cough is spasmodic. The child has distinct paroxysms of coughing which begin with an inspiration (in-breathing) followed by several expulsive, explosive coughs, after which there is a deep, long-drawn inspiration which is characterized by a loud crowing called the "whoop." This paroxysm may be followed by a number of similar ones. When the paroxysm is coming on the face assumes an anxious expression, and the child runs to the nearest person or to some article of furniture and grasps him or it with both hands. It is so severe sometimes that the child will fall or claw the air, convulsively. In the severest and most dangerous types, a convulsion may come on in a moderate degree, the face is red or livid, the eyes bulge and when the paroxysm ends a quantity of sticky tenacious mucus is spit up. In other cases there is vomiting at the end of the paroxysm. There is frequently nose-bleed. In the intervals the face is pale or bluish, eyelids are puffy and face swollen. There is little bronchitis at this period in the majority of cases. In some cases the number of paroxysms may be few. There are generally quite a number during the twenty-four hours.

Stage of the Decline.—In this stage the number and severity or the paroxysms lessen. They may subside suddenly or gradually after four to twelve weeks. The whoop may reappear at times. The cough may persist, more or less, for weeks after the whoop is entirely gone.

Complications.—Bronchitis is common, it may be mild or severe. It may run into capillary bronchitis and this is dangerous.

Diagnosis.—Continued cough, getting worse and spasmodic, worse at night, livid face when coughing, causes great suspicion as to its being whooping-cough. The whoop will confirm it.

Mortality is quoted as twenty-five per cent during the first year. Between first and fifth year about five per cent, from fifth to tenth year about one per cent. Rickets, or wasting disease (marasmus) and poor hygienic surroundings makes the outlook less favorable.

MOTHERS' REMEDIES. 1. Whooping-Cough, Chestnut Leaves for.—"Steep chestnut leaves, strain, add sugar according to amount of juice and boil down to a syrup; give plenty of this. A friend of mine gave this to her children. She said they recovered rapidly and the cough was not severe." They are not the horse-chestnut leaves.

2. Whooping-Cough, Chestnut Leaves and Cream for.—"Make an infusion of dry chestnut leaves, not too strong, season with cream and sugar, if desired. The leaves can be purchased at a drug store in five cent packages."

3. Whooping-Cough, Mrs. Warren's Remedy for.—

"Powdered Alum 1/2 dram Mucilage Acacia 1 ounce Syrup Squills 1/2 ounce Syrup Simple, q. s 4 ounces

Mix this.

This is one of the best remedies known to use for whooping cough. It has been used for many years, and some of our best doctors use it in their practice. I do not hesitate to recommend it as a splendid remedy."

4. Whooping-Cough, Raspberry Tincture for.—"Take one-half pound honey, one cup water; let these boil, take off scum; pour boiling hot upon one-half ounce lobelia herb and one-half ounce cloves; mix well, then strain and add one gill raspberry vinegar. Take from one teaspoonful to a dessertspoonful four times a day. Pleasant to take."

[INFECTIOUS DISEASES 183]

PHYSICIANS' TREATMENT for Whooping-Cough.—The patient should be isolated and sleep in a large, well ventilated room. In spring and summer weather, the child is better in the open air all day. In the winter the child should be warmly clothed. Pine wood and a fairly high altitude are probably the best. The greatest care should be taken in all seasons to keep from taking cold, or bad bronchitis or pneumonia may result. All complications are serious, especially in nursing children. There should be no appreciable fever, and when the paroxysm of cough is over the child should sleep or play quite well, until the next one returns. So if there is much fever the case needs watching.

Medical Treatment.—Medicines have little effect in controlling the disease. The severity can be lessened. If the child is much disturbed at night, the following is good:

1. Acetanelid 1/2 dram Dover's Powder 1/2 dram

Mix thoroughly and make up into thirty powders; for one year old one-half a powder every two hours while awake or restless.

2. Syrup of Dover's Powder 1 fluid dram Tincture of Aconite 10 drops Simple Syrup enough to make two ounces.

Mix and give one-half teaspoonful every two hours for a child one year old. Shake bottle.

3. But the best treatment I know is the following: Go to any good drug store and get a fifty-cent bottle of vapo-cresolene. Burn this, according to the directions given on the bottle in the evening. Use a small granite cup, put about one-third of an inch of the medicine in this, set cup on a wire frame above a lamp, (can buy a regular lamp with the medicine) close windows and let the child inhale the fumes. This will give the patient a good night's sleep. I have used this for years, and know it is good and effective. A tea made of chestnut leaves is said to be good, and is often used as a home remedy. The leaves of the chestnut that we eat, not the horse-chestnut.

Diet.—This is an extremely important part of the treatment. As the child vomits frequently, especially after eating, the food is generally vomited, so there should be frequent feeding in small quantities. The food should be digestible and nourishing. Milk is a good food for older children. In nursing infants they should be nursed oftener, especially if they vomit soon after nursing. In older children, you must not feed too heavy and hearty foods; meat and potatoes should not be given to young children having the disease. When vomiting is severe the food should be fluid and given often. The child must be nourished. If this disease occurs in the winter the person attacked, after he is seemingly well, must be careful not to take cold. The condition of the mucous membrane of the air tube after an attack of this disease, makes it very easy for the person to contract inflammation of that part and have in consequence laryngitis, bronchitis, or pneumonia. Thc cough in very many cases will last all winter without any additional cold being added.

[184 MOTHERS' REMEDIES]

DIPHTHERIA.—Diphtheria is an acute disease and always infectious. There is a peculiar membrane which forms on the tonsils, uvula, soft palate and throat and sometimes in the larynx and nose. It may form in other places such as in the vagina, bowels, on wounds or sores of the skin. I once cut off the fingers for a child under the care of another doctor. The child came down with diphtheria, and the membrane formed on the fingers. Also it is often epidemic in the cold autumn months. Its severity varies with different epidemics. Children from two to fifteen years old are most frequently attacked with it. Catarrhal inflammations of the respiratory mucous membrane predisposes to it.

Cause.—The exciting cause is a bacillus called after the discoverers—Klebs-Loeffler—and this may be communicated directly to another person from the membrane or discharges from the nose and mouth, secretions of convalescents, or from the throat of normal persons. The local condition (lesion) may be a simple catarrhal inflammation, or a greenish or gray exudate, involving chiefly the tonsils, pharynx, soft palate, nose, larynx and trachea, less often the conjunctiva and alimentary tract. It is firmly adherent at first and leaves a bleeding surface when detached; later it is soft and can be removed.

Symptoms.—Incubation period usually lasts from two to seven days after exposure, usually two, generally there is chilliness, sometimes convulsions in young children, pain in the back and extremities and a fever of 102-1/2 to 104 degrees.

PHARYNGEAL DIPHTHERIA.—In typical cases this begins with slight difficulty in swallowing, and reddened throat (pharynx), then there is a general congestion of these parts, and membrane is seen on the tonsils. It is grayish white, then dull or yellowish; adherent and when removed it leaves a bleeding surface upon which a fresh membrane quickly forms. If the disease runs on, in a few days the membrane covers the tonsils and pillars of the fauces, often the uvula. The glands around the neck often enlarge. Temperature 102 to 103 degrees. Pulse 100 to 120. The constitutional symptoms are usually in proportion to the local condition, but not always. The membrane frequently extends into the nostrils and frequently there is a burning discharge. In malignant cases all the symptoms are severe and rapidly progressive ending in stupor and death in three to five days. Death may occur from sudden heart failure or complications.

[INFECTIOUS DISEASES 185]



LARYNGEAL DIPHTHERIA, Formerly Called Membranous Croup.—Diphtheria in the larynx may occur alone or with the pharyngeal kind, and was formerly called "Membranous Croup." After several days of hoarseness and coughing the breathing suddenly becomes hard, generally at night, and it is at first in paroxysms, but later it is constant. The space above the breast bone (sternum) is depressed and there is a drawing in of the spaces between the ribs during inspiration accompanied with a husky voice and blue look. The fever is slight. If the obstruction in the larynx is severe the cyanosis,—blueness,—and difficulty of breathing increase, and gradual suffocation leads to (coma) deep sleep and death.

Diagnosis.—Diagnosis can only be made certain by proper chemical tests. The presence of membrane on a tonsil and a small patch streak, or speck of membrane, on the adjacent surface of the uvula or tip of the uvula; a patch of membrane on the tonsil and an accompanying patch on the posterior wall of the pharynx; the presence of a croupy cough and harsh breathing with small patches of membrane on the tonsil or epiglottis. These symptoms are very suspicious and warrant separation of the patient. If such conditions are seen in any one, it will be the part of prudence to send for your doctor immediately. You give the patient a better chance by sending early, protect yourselves and also your neighbors.

Recovery.—Chances in mild cases are good. Antitoxin has brought the death rate down from forty to twelve per cent. Death may occur from sudden heart failure, obstruction in the pharynx, severe infection, complications or paralysis.

MOTHERS' REMEDIES.—Diphtheria is such a dangerous disease and so rapidly fatal that the family physician should be promptly called. Until he arrives the following may be used to give some relief:

2. Diphtheria, Kerosene Good for.—"Kerosene oil applied to the throat of child or adult is very good."

3. Diphtheria, Hops and Hot Water Relieves.—"Make two flannel bags and fill with hops which have been moistened with hot water; place bags in a steamer and heat. Keep one bag hot and the other around the throat. Change often, relief in short time." Mrs. Shaw has tried this in a case of diphtheria and other throat trouble and recommends it as an excellent remedy.

[186 MOTHERS' REMEDIES]

PHYSICIANS' TREATMENT for Diphtheria. Prevention.—The patient should be isolated as soon as the spots or membrane are seen. Other children who have been with the sick one should at once be given "immunizing" doses of antitoxin, and the furniture of the sick room such as hangings, carpets. rugs, etc., should be removed and disinfected, only the necessary articles being kept in the room. The room should be kept well ventilated, but no draught should get to the patient. The one nursing the patient should not come near the other members of the family. All articles of clothing worn by the patient should be dipped in a 1 to 2000 solution of corrosive sublimate before they are removed from the sick room. (Other solutions may be used; see Nursing Department). Dishes, etc., should be treated in the same way and foods left over should be put in a vessel containing an antiseptic solution, and then burned. Everyone going into the sick room should cover their head with a cap and wear a robe-covering over their clothes, and on leaving the room should gargle or rinse their mouth with a solution of boric acid, about one or two teaspoonfuls to a glass of water, The infant should not be nursed at the breast lest the breast become infected; the milk should be pumped out and fed to the infant with a bottle. If the infant has diarrhea milk must be stopped, the bowels irrigated, and no milk given until all danger from this source is past. The nurse must be careful of the discharges from the nose, mouth and bowels. Discharges from the bowels and the urine must be received in a vessel with an antiseptic solution in it like copperas, lime, etc. Cloths used to receive the discharge from the nose and mouth should be thrown in a vessel containing a solution of 1 to 2000 of corrosive sublimate and then burned. The nurse should wear a gauze protection over her nose and mouth when she is near the patient, and glasses, so that no sputum or discharge from the patient can enter these organs. When the nurse leaves the sick room for a rest or walk, she should change her clothes in an unused room and put them where they can air, wash her hands, face and hair in an antiseptic solution. Great care must be taken by the nurse, or she will carry the disease. The doctor also must take the same care.

PHYSICIANS' MEDICAL TREATMENT.—Antitoxin is the best. 1/100 grain of corrosive sublimate or more according to age is frequently given in the severe cases and is beneficial.

Local Treatment.—In older persons, inhaling steam may benefit. Gargling the throat or spraying the nose and throat is cleansing and helpful; but in children it is sometimes hard to do this, for they may struggle and thus injure and weaken themselves more than they can be benefited by the spraying or gargling. Swab the throat if you can with solution of corrosive sublimate, 1 to 1000. Peroxide of hydrogen, one-sixth to one- half to full strength, is good in many cases, used as a gargle and a swab. Wash out the nose with a normal salt solution. One dram to a pint of water. The persons doing this must take great care or the patient will cough and the discharge will go over them.

When in the Larynx.—Steam inhalations without or with medicine in them and the application of cold or hot to the neck are good. Compound tincture of benzoin is good to use in the water for steaming; one-half to one tablespoonful to a quart of water. A tent can be made by putting a sheet over the four posts of the bed and steam vapor introduced under this covering.

Diet.—The main food is milk, albumin water, broths, eggs given every two hours. Some doctors give stimulants with the food.

[INFECTIOUS DISEASES 187]

Cautions.—Members of the family have no idea how much they can aid the physician in this terrible disease. Pay particular attention to the directions the doctor gives you, if you are doing the nursing, watch so that you may detect any bad symptom, and immediately inform the physician. A harsh cough with increased difficulty in breathing may mean that the disease has extended to the larynx. If such symptoms are first noticed in the physician's absence, he should be sent for at once so he can treat it properly at the start. If the kidneys do not act properly he should be informed. One may take nephritis in diphtheria also. I was called one morning at 3 a. m., to see a case I was attending; she seemed to the parents to be worse; she was, but today she is living, and I believe her life was really saved by her parents. I would rather a loving mother and father nurse a case any time than a selfish, lazy professional nurse. Good nurses are a blessing; selfish ones are a curse; I have met both kinds. After an attack of this disease the patient is left "weak" in many organs. He should be careful, not only of taking cold, but of over-doing. The heart and nervous system in some cases have been terribly wrecked. Take life easy for some time, for you may be thankful that you are alive.

ACUTE TONSILITIS. (Follicular Inflammation of the Tonsils). Causes.— Authors regard this as an infectious disease. It is met with more frequently in the young; infants may take it. Some authors state it can be communicated either through the secretions or by direct contact, as in the act of kissing (Koplik). It is frequent in children from the second to the fourth year, but it is more common after than before the fourth year. Sex has no influence. In this country it is more common in the spring. The predisposing causes are exposure to wet and cold and bad hygienic surroundings. One attack renders a person more susceptible. It spreads through a family in such a way that it must be regarded as contagious. The small openings (Lacunae) of the tonsils become filled with products which form cheesy-looking masses, projecting from the openings of the (Crypts) hidden sacs. These frequently join together, the intervening tissue is usually swollen, deep red in color and sometimes a membrane forms on it in which case it may look like diphtheria.

[188 MOTHERS' REMEDIES]

Symptoms.—Chilly feelings or even a chill and aching pains in the back and limbs may precede the onset. The fever rises rapidly and in the young child may reach 105 degrees in the evening of the first day. The infant is restless, peevish and wakeful at night; it breathes rapidly, and there is high fever and great weakness. Nursing is difficult, not only on account of the pain in swallowing, but because in the majority of cases there is more or less inflammation of the nose. The bowels are disturbed as a result of swallowing infectious secretions from the mouth with the food. The tonsils are enlarged and studded with whitish or yellowish white points. The glands at the angle of the jaws may be enlarged. In older children the tonsils are enlarged and the crypts plugged with a creamy deposit. The surface is covered with a deposit and the pillars of the fauces, uvula and pharynx may all be inflamed. The tongue is coated, the breath is bad, the urine high colored, swallowing is painful; the pain frequently runs to the ear and the voice sounds nasal, as if one had mush in his mouth when talking. In severe cases the symptoms all increase, and the parts become very much swollen. Then the inflammation gradually subsides, and in a week, as a rule, the fever is gone and the local conditions have greatly improved. The tonsils, though, remain somewhat swollen. The weakness and general symptoms are often greater than one would suppose. The trouble may also extend to the middle ear through the eustachian tubes.

Diagnosis Between Acute Tonsilitis and Diphtheria.—Follicular form. "In this form the individual, yellowish, gray masses, separated by the reddish tonsilar tissue are very characteristic, whereas in diphtheria the membrane is of ashy gray and uniform, not patch."—Osler. A point of the greatest importance in diphtheria is that the membrane is not limited to the tonsils, but creeps up the pillars of the fauces or appears on the uvula. The diphtheric membrane when removed leaves a raw, bleeding, eroded surface; whereas, the membrane of follicular tonsilitis is easily separated as there is no raw surface beneath it.

MOTHERS' REMEDIES. 1. Tonsilitis, Raw Onion and Pork for.—"Take a raw onion and some salt pork, chop together, make a poultice on which put a little turpentine and wrap around the throat." This is a very good remedy and should be used for some time. Change as often as necessary.

2. Tonsilitis, Peppermint Oil Good for.—"Apply peppermint oil thoroughly on the outside of the throat from well up behind the ear nearly to the chin, also just in front of the ear. This will soon penetrate through to the tonsils; apply freely if the case is severe and later apply hot cloths if relief does not follow without."

3. Tonsilitis, Borax Water for.—"One-fourth teaspoonful borax in one cup of hot water, gargle frequently." This may be used for ordinary sore throat not quite so strong.

4. Tonsilitis, Salt and Pepper Will Relieve.—"Apply salt pork well covered with pepper to the swollen parts; will often give relief."

5. Tonsilitis, Peroxide of Hydrogen Will Cure.—"Tonsilitis and contagious sore throats are just now extremely popular. Persons having a tendency to them will seldom be sick if they gargle daily with a solution of peroxide of hydrogen and water in equal parts for adults. Peroxide diluted with five parts of water and used as a head spray will prevent catarrhal colds." Children, are often sent to school immediately after an attack of tonsilitis, when they should be at home taking a tonic and building up by a week of outdoor play.

6. Tonsilitis, a Remedy Effective for.—"Rub the outside of the throat well with oil of anise and turpentine, and keep the bowels open." Care should be taken not to take cold. The anise is very soothing and the turpentine will help to draw out the soreness. This would be a good remedy for children.

[INFECTIOUS DISEASES 189]

PHYSICIANS' TREATMENT for Tonsilitis. 1. First Home Treatment.—Put the patient to bed alone in a pleasant room, comfortably warm; for this disease is recorded as contagious in this form. Cold applied externally around the sore spot is good. Use an ice bag if you have it; or wring cloths out of cold water and put just under the jaw and a flannel over that, bound around the neck. It must be changed often to keep cold.

2. Smartweed.—Cloths wrung out of smartweed tea are very good when applied under the jaw.

3. Salt Pork.—Salt pork, well salted and peppered, sewn to a cloth and applied on both sides, if both are diseased, directly to the lumps is very good. These can be kept on indefinitely. I have used them.

4. Liniment.—A strong blistering liniment applied externally where the lumps are is also good. These applications tend to withdraw some of the blood from the sore tonsils, and of course, that relieves them. There are many such that can be used. Poultices should not be applied for this form as they tend to hasten formation of pus.

5. Internally.—Dip your clean moistened finger tip into dry bicarbonate of soda (baking soda), rub this gently on the sore tonsil and repeat it every hour. You can also put one teaspoonful of it in one-half glass of very hot water and gargle if you do not use it locally.

6. Hot Water.—Gargling frequently with very hot water is splendid. If you wish you can use one teaspoonful of some antiseptic, like listerine, in it.

7. Thyme.—You can make a tea of the common garden thyme and gargle or rinse your mouth and throat with it every half to one hour. This is not only healing and soothing, but it is also antiseptic. This is a constituent of many of the antiseptic preparations.

8. Steaming With Compound Tincture of Benzoin.—Tincture of benzoin is splendid. Put one tablespoonful in a quart of hot water and inhale the steam. Put a sheet over your head and pitcher; or put it in a kettle, and roll white writing paper into a funnel, tie one part over the spout and put the other end in your mouth if possible; or you can inhale simple steam in the same way. I know this is excellent and often recommended; everyone has it, and it costs literally nothing, except to heat the water.

9. For the Pain.—Dissolve two drams of chloral hydrate in an ounce of water, use a camel's hair pencil if you have it, or a soft piece of cloth tied on a smooth stick, and apply directly to the diseased parts. This is for older persons, relieves the pain very much. There are many other simple remedies that can be used in this way.

[190 MOTHERS' REMEDIES]

10. MEDICINES. Parke, Davis & Co., Anti-Tonsilitis Tablet No. 645 is very good. This can be bought at any drug store. For a child give one-half a tablet every two hours for four doses, then every three hours. An adult can take one to two every one to three hours according to the severity of the case.

11. Aspirin.—Aspirin is another good remedy; five grains every four hours for an adult; but used only under doctor's directions.

12. Dr. Hare of Philadelphia, uses 1/200 grain mercurius biniodide (pink powder) every four to six hours to abort tonsilitis. I would recommend the following:—Give one-tenth drop dose of a good tincture of aconite and 1/200 grain of the mercury biniodide (one to two tablets a dose) every hour, alternately, one of them one hour and the next, etc. If there is much deposit I would put ten tablets of mercury protoiodide (one-tenth of a grain in a tablet) in one-half glass of water and give two teaspoonfuls every hour until the bowels move freely, then every three to four hours. The aconite can be used if there is much fever, with hot, dry skin, alternately everyone-half hour. I prefer the pink powder when there is no deposit or membrane. These I have used for years, and know them to be excellent. For children the dose is about one-half. After twelve hours the remedies should be given only every three to four hours.

QUINSY. (Suppurative Tonsilitis).—In from two to four days the enlarged gland becomes softer and finally may break, sometimes in the pharynx; the breaking gives the patient great relief. Suffocation has sometimes followed the rupture of a large abscess and the entrance of the pus into the larynx. This form of tonsilitis was formerly called quinsy. By this term now is meant an abscess around the tonsils, (Peri-tonsilar abscess). The structures are very much swollen.

Causes are somewhat similar to what has produced the regular tonsilitis. It may follow exposure to cold and wet, and is very liable to recur. It is most common between fourteen and twenty-five years. The inflammation here is more deeply seated. It involves the main tissue of the tonsil and tends to go on to suppuration.

Symptoms.—The general disturbance is very great. The fever goes to 104 or 105 degrees; the pulse 110 to 120. Delirium at night is not uncommon. The weakness may be extreme. The throat is dry and sore, hurts terribly to swallow, this being the first thing of which the patient complains. Both tonsils may be involved. They become large, firm to the touch, dusky red and swollen, and the surrounding parts are also much swollen. The swelling may be so great that the tonsils may touch each other or one tonsil may push the uvula aside and almost touch the other tonsil. There is much saliva. The glands of the neck enlarge, the lower jaw is almost immovable and sometimes it is almost impossible to open the mouth at all.

QUINSY. Mothers' Remedies. 1. Willow Gargle for.—"Steep pussy willow and gargle throat with it. This remedy if taken in time, will cure quinsy and it will not return."

[INFECTIOUS DISEASES 191]

2. Quinsy, Liveforever Root Good Poultice for.—"Get the root of liveforever, pound it up and bind on throat as you would a poultice." We have tried this, and it has always given relief, if done in time.

3. Quinsy, Plaster of Lard and Salt for.—"Take one tablespoonful lard and stir into as much table salt as possible making it about like mortar. Spread on a cloth and apply." Splendid for sore throat and quinsy.

4. Quinsy, Oil of Anise Effective for.—"Rub inside of throat with oil of anise."

5. Quinsy, Quick Remedy for.—"In severe cases of quinsy where the tonsils are inflamed and almost meet, a third of a grain of mercury and chalk, or "gray powder," acts very quickly. Cold compresses used nightly to harden the throat is very good. At night use a gargle made of a teaspoonful tincture of cayenne pepper to half pint of water." This remedy is very good and is sure to give relief.

6. Quinsy, Pleasant Peppermint Application for.—"There is nothing better for this disease than oil of peppermint applied externally to the neck and throat." This is an excellent remedy.

7. Quinsy, Kerosene Good for.—"A cloth wet with kerosene oil applied to the throat is very good; also gargling with kerosene oil." Repeat the application of the wet cloths every two or three hours.

8. Quinsy, Raw Beef Has Cured.—"Bind raw beefsteak over the tonsils on one or both sides of the throat as required." The beefsteak acts as a poultice and counter-irritant, drawing the inflammation out in a short time. This is very good, and is easily prepared.

9. Quinsy, Easy and Simple Remedy for.—"Strong sulphur water. Broke up two cases I know."

PHYSICIANS' TREATMENT for Quinsy.—The external applications used should now be hot. Hot water; hot poultices, cloths wrung out of smartweed hot, and thyme tea or golden seal teas. The same steaming process and hot water gargles can be used as given under follicular tonsilitis. But if it continues the tonsils or tonsil must be opened to save pain and life. Just as soon as there is suppuration they should be opened. It will feel softer to the finger touch when ready for opening.

Prevention of Attacks.—By taking care a good many attacks of tonsilitis can be avoided. A person subject to this trouble must be careful about taking cold. He should not sit down with wet clothes, or feet, or shoes that are wet. Girls should wear rubbers and keep dry feet and skirts. Sleeping in damp unused beds is bad. Putting on underwear that has not been dried thoroughly and aired, and the use of bedding, pillows, etc., in the same condition should not be tolerated. Sleeping on the first floor is generally unhealthy for such persons, for it is generally damp.

[192 MOTHERS' REMEDIES]

Do not get chilled; wear sufficient clothing. Drying clothes in a kitchen is an abomination and terrible to one subject to this disease or rheumatism. You can keep from having it so often by proper care. It is likely to return, and repeated attacks will cause permanently enlarged tonsils and they will become so diseased that they, will not only be annoying, but dangerous to health and life. You will go around with your mouth open, "talk through your nose." The tonsil must then be removed, also the adenoids in the throat, to enjoy proper mental and physical health. Enlarged tonsils with pus in them are a menace to anyone. A person who has had these troubles should be careful not to expose himself to the danger of taking cold after an attack.

The parts are still tender and in danger of a return upon the least error in your daily life. I once had a friend who had a return of tonsilitis brought on through going out too soon, and the second attack was worse than the first, a genuine "hummer."

What to do with enlarged tonsils.—Moderate enlargement of the tonsils giving rise to no symptoms or inconvenience need not be interfered with. When, however, the enlargement is great, or when with moderate sized tonsils there are resulting troubles, such as liability to inflammatory rheumatism attacks, active local treatment will be called for; especially is this true when the tonsils contain pus and interfere with the breathing. They should be removed. An anaesthetic is not usually necessary, as the pain is not severe.



INFLUENZA (La Grippe).—La Grippe is an acute infectious disease caused by a germ. It may be epidemic, attacking a large number of persons at one time, or it may continue in the same region for some time and is then called endemic. It is caused by a germ, discovered by a man named Pfeiffer.

The Onset.—The onset may be from one to four days and is usually sudden with a chill and all the symptoms of an active fever due to a general infection, varying according to the location. If in the organs of respiration it begins like a severe cold; active fever, severe pains in the eyes, back, arms, legs, and in the bones; "aches all over" and great prostration. After the fever subsides there is usually a general sore feeling. Symptoms of bronchitis, pleurisy or pneumonia may develop. Then there is the nervous type, generally with a bad headache, neuralgia, pains in the head, backache, legs and arms ache and prostration. May also have inflammation of nerves. Then again the stomach and bowels may be the main seat, for La Grippe has no respect for any organ. We have then symptoms of acute indigestion with fever, nausea, vomiting, stomach pains or acute bowel trouble with fever, colicky pain in the abdomen; diarrhea; or we may have the febrile (fever) type. This may be the only symptom. The fever may be continuous or remittent, and last several days or several weeks and often with pains accompanying it.

In all forms convalescence is often gradual on account of the bodily and mental prostration with general soreness for several days. Many persons never fully regain their health, especially if they are careless during the attack, and almost any disease like bronchitis, kidney disease, pleurisy, pneumonia, etc., may follow.

[INFECTIOUS DISEASES 193]

LA GRIPPE, Mothers' Remedies.—1. Pepper, Red or Cayenne for.—"Make a tea of red pepper or cayenne, and take a tablespoonful in a cup of hot water, drink slowly, before each meal and on retiring. Larger doses in proportion to the intensity of the disease." Sponging the face, temples and neck with water as hot as can be borne relieves the headache of la grippe, which is often very painful and annoying.

2. La Grippe, Easy Remedy for.—"Plenty of good physic with hot teas of any kind has helped my own family."

3. La Grippe, Pleasant and Effective Remedy for.—"Use the oil of peppermint freely; rubbing it on the forehead, in front and back of the ears and each side of the nose. Inhale through each nostril separately. If the throat is affected pour two or three drops in small dish of hot water. Invert a funnel over the dish with the small end in the mouth and draw long breaths. Soak the feet in hot water at bedtime and take a good sweat, if possible."

4. La Grippe, To Allay Fever in.—"To produce sweating and to act on the kidneys and to allay restlessness in fever use the following: Lemon juice and water equal parts, enough to make four ounces; bicarbonate of potassium, one dram; water, three ounces. Make and keep in separate solutions to be used in tablespoonful doses several times daily and taken while effervescing, that is, foaming and bubbling up."

5. La Grippe. Poor Man's Herb Vapor Bath for.—"Give a Turkish or vapor bath every other day. A pail of hot water, with a hot brick thrown into it and placed under a cane-seated chair is the poor man's vapor bath. The patient should be covered. Then take the following herb tea:

Yarrow 2 ounces Vervain 2 ounces Mullein 2 ounces Boneset 1 ounce Red Sage 2 ounces

Add two quarts of water and boil down to three pints; strain, and then add one ounce fluid extract of ginger; sweeten with honey or syrup; take a wine glassful three times a day, hot. Keep the bowels open and let the diet be light."

6. La Grippe, Red Pepper Treatment From Canada for.—"Take a bottle of alcohol and put enough red peppers in it so that when four drops of this liquid are put in a half cup of water it tastes strong. This is what I always break up my grippe with." Peppers thus prepared stimulates and warms up the stomach and bowels, and increases the circulation.

[194 MOTHERS' REMEDIES]

PHYSICIANS' TREATMENT for La Grippe.—All discharges from the nose, throat and lungs should be disinfected, for the disease is contagious. Go to bed and stay there. You have no business to be around if you value your health. I am not writing of common cold. A great many people say they have had this disease when they have not had it. One who has had this disease is sick enough to go to bed, and there is where he should be. For the chill a sweat should be produced by putting hot water in fruit jars, wrapping them and placing them around the patient's feet, legs and body. Hot tea drinks can be given; hot lemonade, teas made from hoarhound, ginger, hops and catnip are good.

Corn Sweat.—The corn sweat can be used. Put from ten to twenty-five ears of corn in a boiler, boil thoroughly until the boiled corn smell appears, then put the corn ears into five packs, putting from two to five ears in a pack, according to the age of the patient. Use cloths or towels, but do not put the ears in contact, wrap the cloth between them. Put one pack to the feet and one at each side of the hips, and in each armpit. This will soon cause sweating and restore the external (capillary) circulation. It will generally produce a grateful sweat. Keep the clothes on the patient. After the patient has perspired enough you can remove one pack at a time. Have fresh aired sheets and night dress ready, and after bathing the patient slowly and carefully under the clothes with tepid water and drying all of the body put on the new night-dress and sheets. This remedy is also good for colds and inflammatory diseases of all kinds and when used carefully and thoroughly is always good. Of course, if there is great weakness it cannot be used, for it weakens a patient somewhat. I have saved lives with this sweat, and I know I have cut short many colds and inflammatory diseases. After the sweat the patient should have enough covering to keep comfortably warm and care must be taken to keep from the cold.

Fever.—If the disease goes on and there is high fever, so that the patient suffers from it, it is better to reduce it by cool sponging than by the coal tar products like antipyrin, acetanilid, etc. They are weakening and this is a weakening, prostrating disease. Good, careful cool sponging generally relieves the excessive fever and restlessness. The fever does not continue so long in this disease and it is not, therefore, so harmful. Delirium is present in some cases when the fever is not high.

Irritating Cough.—This can frequently he controlled by steam inhalations as directed under tonsilitis. You can also put in the steaming water one teaspoonful to one tablespoonful of compound tincture of benzoin for this disease. Hoarhound tea can be put in the water and the steam inhaled. If such measures do not stop the cough, medicine will be needed.

[INFECTIOUS DISEASES 195]

Sore Throat.—Spraying the throat with a solution of boric acid, one dram to one pint of hot water, is good. Listerine is good in the same way and dose.

Bowels.—They should be kept open from the first. Salts are usually handy and good.

Medicines.—Ten grains Dover's powder at night is good; unless there is much weakness. Some give quinine, some salol. Quinine, one to two grains, is given one to three hours. Salol, five grains, every three hours, especially for the backache.

Aspirin in five-grain doses for an adult every four hours is given very much now. The bowels should be kept open with salts.

Diet.—Children should take milk if there is no vomiting or diarrhea. If there is vomiting and diarrhea, give only water or diluted milk, or nothing if they continue. Water can generally be given.

For adults a good, nourishing diet when convalescence commences is necessary. During the sickness, milk, eggs,—raw and soft boiled, broths, soups, milk toast, can be given. A person must be very careful after an attack of the grip. He should remain in the house for some time, a week after he is well and thinks he can go out.

TYPHOID FEVER.—Typhoid fever is an acute infectious disease caused by a (Bacillus) germ, named after the discoverer (Eberth). This germ enters into the system, as stated below, locates itself in different organs, especially in the small intestine. It does its worst work in Peyer's glands, situated in the small intestines. They enlarge, ulcerate, break down and their structure is cast off into the bowel. This eating goes so far, in some cases, that it eats through the tissue to the blood vessels and other bleeding follows. Sometimes it goes through all the coats, the peritoneal being the last one. If this occurs we have what is called perforation of the bowel and the peritoneum around this perforation inflames and there is the dread complication of peritonitis. This is very fatal, as the patient is weakened from the inroads of weeks of fever and from the effects of the poison germ. Typhoid fever is also characterized by its slow (insidious), slyly, creeping onset, peculiar temperature, bloating of the abdomen, diarrhea, swelling of the spleen, rose-colored spots and a liability to complications, such as bleeding from the bowels, peritonitis, bronchitis and pneumonia. Its average duration is three to four weeks, often longer. In order to take this disease there must first be the poison germ and then this enters into the system, generally through water that contains the germ, milk, oysters and other foods, etc.

Cause.—The typhoid bacillus (typhoid). This enters into the alimentary canal usually through contaminated water or with milk directly infected by the milk or by water used in washing cans. Also through food to which the germs are carried from the excreta (discharges) by flies, occasionally through oysters by freshening.

Filth, improper drainage and poor ventilation favor the preservation of the bacillus germ and lower the power of resistance in those exposed.

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Time.—It occurs most frequently between August and November and in those of from fifteen to twenty years of age. The Peyer's patches and solitary glands of the bowel enlarge, become reddish and are somewhat raised. These go on and ulcerate until the blood vessels may be eaten into and bleeding sometimes results, it eats through the bowel, then there is perforation and peritonitis. The spleen is enlarged, the liver shows changes, the kidney functions are also deranged.

Symptoms.—The symptoms are variable. The following gives the symptoms in a typical case:

Incubation.—The period of incubation lasts from eight to fourteen and sometimes to twenty-three days. During the period the patient feels weak, is almost unable to work, has chilly feelings, headache and tiring dreams, does not know what is the matter with him, constipation or diarrhea, has no appetite, may have some pain in the abdomen which is occasionally localized in the right lower side. Soreness on deep pressure is often found there. In some cases there is nosebleed.

First Week.—After the patient is obliged to take to his bed: During the first week there is in some cases a steady rise in the fever each evening showing a degree or degree and one-half higher than the preceding evening, reaching 103 to 104, and each morning showing higher fever than the preceding morning. The pulse is characteristically low in proportion to the temperature, being about 100 to 110, full of low tension, often having double beat. The tongue is coated; there is constipation or diarrhea; the abdomen is somewhat distended and a little tender to the touch in the lower right portion. There may be some mental confusion at night. Bronchitis is often present. The spleen becomes enlarged between the seventh and tenth day and the eruption usually appears during this period on the stomach and abdomen.

Second week.—All the symptoms are intensified in the second week, the fever is always high and the weakening type; the pulse is more frequent; the headache is replaced by dullness; the bowel symptoms increase and we have the "pea soup" discharge if there is diarrhea; there is a listless, dull expression on the face; the tongue is coated in the center, red along the edges and the tip, becomes dry and sometimes cracked and almost useless. It is hard to put it out of the mouth, it sticks to the teeth or lips and curls there, and sometimes the patient allows it to remain partly out of the mouth. There may be bleeding from the bowels and perforation of the bowel, producing peritonitis.

[INFECTIOUS DISEASES 197]

Third week.—The temperature is lower in the morning with a gradual fall; the emaciation and weakness are marked. Perforation of the bowel or bleeding may occur. Unfavorable symptoms now include low muttering, delirium, shakings of the muscles, twitching of the tendons, grasping at imaginary things, lung complications and heart weakness.

Fourth week.—In a favorable case: The fever gradually falls to normal, the other symptoms disappear. Death may occur at any time after the second week from the disease or complications. The convalescence is very gradual and the appetite is very great.

Special symptoms and variations.—It may come on with a chill sometimes it is observed by nervous symptoms only.

Walking type.—In this type the patient is able to be around and can walk. The temperature is as high, but some of the other symptoms are not so violent. This is a dangerous kind because the patient is able to walk and thinks it foolish to remain quiet in bed. Walking and being around are likely to injure the bowels, and there is then more danger of bleeding from the bowels. A typhoid fever patient should always go to bed and remain there until he has fully recovered.

Digestive Symptoms.—The tongue is coated, white and moist at first, and in the second week it becomes red at the tip, and at the edges. Later it is dry, brown and cracked. The teeth and lips are covered with a brown material, called sordes.

Diarrhea.—In some cases constipation is prominent, in others diarrhea is a prominent symptom. Bloating is frequent, and an unfavorable symptom, when it is excessive. Bleeding from the bowel occurs usually between the end of the second and the beginning of the fourth week. A sudden feeling of collapse, and rapid fall of the temperature mark it. It is not always fatal.

Perforation of the bowel is usually shown by a sudden sharp pain coming in paroxysms generally localized in the right lower side. The death rate varies very much; in hospitals it is seven to eight per cent. Unfavorable symptoms are continued high fever, delirium and hemorrhage. Persons who are hard drinkers do badly and very many of them die.

TREATMENT. Prevention. Sanitary Care.—Do away with the causes. Keep your cellars clean; do not have them damp, filthy, and filled with decaying matter, as these all tend to weaken the system and make you more susceptible to the poison. In the country, no drainings should come near the wells or springs. Not all water that looks clear and nice is pure. The "out-houses" must be kept clean, and emptied at least twice each year. In the small cities, especially, the water should be boiled during the months when the supply is limited and the wells are low. If more attention was paid to our water supply to make certain that it was not contaminated, and to our foods, especially milk, and to keeping our cellars and drains in a good clean and dry condition, we would have little typhoid fever. Carelessness is the real cause of this terrible disease. The milk should be boiled as well as the water when there is an epidemic of typhoid.

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Sanitary Care of the Household Articles.—Dishes must be isolated, washed, dried separately and boiled daily. Thermometers must be isolated, kept in a corrosive sublimate solution one to one thousand, which must be removed daily. Linen when soiled must be soaked in carbolic acid, one cup of carbolic acid to twenty of water, for two hours before being sent to the laundry. Stools must be thoroughly mixed with an equal amount of milk of lime and allowed to stand for one hour. Urine must be mixed with an equal amount of carbolic acid, one to twenty, and allowed to stand one hour. Bed pans, urinals, must be isolated and scalded after each time of using. Syringes and rectal tubes must be isolated, and the latter boiled after using. (See Nursing Department). Tubs should be scrubbed daily, canvasses changed daily and soaked in carbolic acid as the linen is. Hands must be scrubbed and disinfected after giving tubs or rubbing over typhoid fever patients. Blankets, mattresses, and pillows must be sterilized after use in steam sterilizer. I know some people have not all the necessary conveniences, especially in the country, but the greatest care must be taken. A professional nurse was once taking care of a very severe case of typhoid for me. I was continually cautioning her to be more careful of herself. She did not heed it, and finally took the disease and battled eight long weeks with it, before there was much improvement. Careful nursing and a well regulated diet are the essentials in a majority of cases. Put the patient in a well ventilated room, and confine him to the bed from the beginning, and have him remain there until well. The woven wire bed with soft hair mattress, upon which there are two folds of blanket, combines the two great qualities of a sick bed, smoothness and elasticity. A rubber cloth should be placed under the sheet. An intelligent nurse should be in charge; when this is impossible, the attending physician should write out special instructions, regarding diet, treatment of the discharges and of the bed linen.

Much of the above on typhoid is from the world-wide authority, Dr. Osler, and should be-followed in all cases if possible.

Diet and Nursing in Typhoid Fever.—Milk is the most suitable food. Three pints every twenty-four hours may be given when used alone, diluted with water or lime-water.

The stools will show if the milk is digested. Peptonized milk, if not distasteful, may be used. Curds are seen in the stools if too much milk is given and is undigested. Mutton or chicken broth or beef juice can be used; fresh vegetable juices can be added to these, instead of milk. The animal broths are not so good when diarrhea is present. Some patients will take whey, buttermilk, kumiss, when ordinary milk is distasteful. Thin barley gruel well strained is an excellent food for this disease. Eggs may be given, either beaten up in milk or better still, in the form of albumin water, This is prepared by straining the whites of eggs through a cloth and mixing them with an equal quantity of water, which may be flavored with lemon. Water can be given freely; iced tea, barley water, or lemonade may be used, and there is no objection to weak coffee or cocoa in moderate quantities. Feed the patient at stated intervals. In mild cases it is well not to arouse the patient at night. When there is stupor, the patient should be aroused for food at the regular intervals night and day. Do not give too much food. I once had a case in which I did not give more than one quart of liquid food in four weeks, as it distressed her. She made a good recovery on plenty of water.

[INFECTIOUS DISEASES 199]

Cold Sponging.—The water may be warm, cool, or ice cold, according to the height of the fever. A thorough sponge bath should take from fifteen to twenty minutes. The ice cold sponging is quite as formidable as the full cold bath, for which there is an unsuperable objection in private practice.

The Bath.—This should be given under the doctor's directions, and I will not describe it.

Medical Treatment.—Little medicine is used in hospital practice. Nursing is the important essential in typhoid fever.

Management of the Convalescent.—An authority writes, My custom has been not to allow solid food until the temperature has been normal for ten days. This is, I think, a safe rule, leaning perhaps to the side of extreme caution; but after all with eggs, milk toast, milk puddings, and jellies, the patient can take a fairly varied diet. You cannot wait too long before you give solid foods, particularly meats, They are especially dangerous. The patient may be allowed to sit up for a short time about the end of the first week of convalescence, and the period may be prolonged with a gradual return of strength. He should move about slowly, and when the weather is favorable should be in the open air as much as possible. Keep from all excitement. Constipation now should be treated with an enema. A noticeable diarrhea should restrict the diet to milk and the patient be confined to the bed. There are many who cannot have a professional nurse. Good nursing is necessary in typhoid fever. Any sensible person who is willing to follow directions can do well. But she must do as the doctor directs.

These are some things you need to do: Look out for bad symptoms; twitching of the tendons, grasping at imaginary things are bad symptoms. Inform the doctor and soon. Never allow the patient to sit up in bed. The stool must be passed lying flat and you must place the bed pan without the patient's aid. Bleeding may be started by the least exertion. I knew of one woman who lost her life through necessity of getting up and passing the stool sitting on a chamber. Bleeding came on suddenly, and before the doctor could get there she was nearly gone. Cough and sudden pain in the lungs need prompt attention. I dismissed a boy on one Wednesday as convalescent. That night it became suddenly cold and he became chilled. The mother sent for me the next day, and we pulled him through pneumonia. Suppose she had waited another day? She was not that kind of a mother. Your greatest trial will come in convalescence, when the patient is so hungry. Be careful or you will kill the patient by kindness. A minister I knew killed himself by going against the doctor's orders and eating a hearty dinner. The doctor was rather profane, and when he went to see the preacher, after the relapse caused by the dinner, he relieved his mind in no gentle manner. Again allow no visitors in the sick room or one adjacent. They are an abomination. Many people are killed by well-intentioned ignoramuses. Do not whisper; the Lord save the patient who has a whisperer for a nurse. I cannot urge too strongly proper nursing in this disease. It is an absolute necessity. A nurse to be successful must have good sense and also must obey all directions. A diet is a necessity in this disease. The patient must not move any more than is absolutely necessary for his comfort. He must never try to help move himself. The muscles of the abdomen must remain lax and quiet. The danger, I think, is in the bowels. The mucous covering in the interior is inflamed and ulcerated, and there is always some danger of the ulceration eating through the coating into the blood vessels, causing more or less bleeding and even eating the bowel enough to cause an opening (perforation) and the escape of the bowel contents into the abdominal cavity causing inflammation of the peritoneum (peritonitis) and almost certain death. Walking typhoid is dangerous for that reason. The food must be of such nature that it is all digested. It must not leave lumps to press upon the sore places in the bowels causing more trouble there and more diarrhea.

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TYPHUS FEVER, (Filth Disease).—Typhus fever is an acute, infectious disease, characterized by a sudden onset, marked nervous symptoms, and spotted rash and fever ending quickly after two weeks. Also called jail, camp, hospital, or ship fever. Filth has a great deal to do with its production. There is no real characteristic symptom except the eruption.

Symptoms.—It generally lasts two weeks. Incubation period of twelve days or less, marked at times by slight weary feeling. The onset is usually sudden, by one chill or several, with high fever, headache, pain in back and legs, prostration, vomiting, and mild and active delirium. Pulse does not have the double beat, often there is bronchitis.

Eruption.—"This appears on the third to fifth day; the fever remaining high. During the second week all the symptoms increase and are weakening with marked delirium and coma vigil" (unconscious, delirious, but with the eyes open). When death occurs it usually comes at the end of the second week from exhaustion. Favorable cases terminate at this time by crisis; the prostration is extreme; but convalescence is rapid.

[INFECTIOUS DISEASES 201]

Fever.—Sudden onset to even 104 to 105 degrees; steady rise for four or five days with slight morning remissions; terminating by crisis on the twelfth to fourteenth day, falling in some cases below normal; in fatal cases there is a rapid rise to 108 or 109 degrees. The eruption appears on the abdomen on the third to fifth day.

Treatment like Typhoid.—Mortality, twelve to twenty per cent.

SMALLPOX or Variola.—Smallpox is an acute infectious disease. It has a sudden onset with a severe period of invasion which is followed by a falling of the fever, and then the eruption comes out. This eruption begins as a pimple, then a watery pimple (vesicle) which runs into the pus pimple (pustule) and then the crust or scab forms. The mucous membrane in contact with the air may also be affected. Almost all persons exposed, if not vaccinated, are almost invariably attacked. It is very contagious. It attacks all ages, but it is particularly fatal to young children.

Cause.—An unknown poison in the contents of the pustules or crusts in secretion and excretion, apparently, and in the exhalations of the lungs and skin; one attack does not always confer immunity for life. It is contagious from an early period. Direct contact does not seem to be necessary, for it can be carried by one who does not have it.

Symptoms.—Incubation lasts from ten to fourteen days, and is usually without symptoms. Invasion comes suddenly with one or more chills in adults, or convulsions in children, with terrible headache, very severe pain in the back and extremities, vomiting, the temperature rising rapidly to 103 or 104 degrees.

Eruptions.—This usually appears on the fourth day as small red papules on the forehead, along the line of the hair and on the wrists, spreading within twenty-four hours over the face, extremities, trunk and mucous membrane.

Symptoms of fever diminish with the appearance of the rash, which is most marked on the face and ripens first there. The papules become hollowed vesicles and a clear fluid fills them on the fifth or sixth day. They fill with pus about the eighth day, and their summits become globular, while the surrounding skin is red, swollen and painful. The general bodily symptoms again return and the temperature rises for about twenty-four hours. Drying of the eruption begins the tenth or eleventh day. The pustules dry, forming crusts, while the swelling of the skin disappears and the temperature gradually falls. The crusts fall off, leaving scars only where the true skin has been destroyed.

Confluent form.—All the symptoms are more severe. The eruption runs together and all the skin is covered.

Varioloid.—This is smallpox modified by vaccination. The invasion may be sudden and severe. It is usually mild and gradual, but with severe pain in the back and head. A scanty eruption of papules, often only on the face and hands, appears on the third or fourth day, with disappearance of constitutional symptoms.

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Treatment.—Vaccinate the children the second or third month, and all persons about every six years, and always after exposure to the disease or during epidemics. Put the patient in a room cleared of all furniture, carpets, curtains, rugs, etc.; keep the patient thoroughly clean, and the linen should be frequently changed. The bed clothing should be light. Disinfect and sterilize everything thoroughly that has been in contact with the patient. Get a good experienced nurse, and one who has been around the disease.

Diet.—Give the supporting diet early. During the first stage give milk, broths of different kinds, albumin water. Relieve the intense thirst by water and lemonade. When the first (initial) fever subsides and the patient feels improved, give milk, eggs, chops, steak, or rare roast meat, bread or toast; vegetables, such as potato, spinach, celery, asparagus tips, cauliflower tops. When the second fever returns go back to the liquid diet again, and give regularly and as much as possible every two or three hours during the day, and every three or four hours during the night. Milk, plain or peptonized; milk punch, raw eggs, broths, beef juice. If swallowing is difficult, give food cold and oftener, and in less quantity. Increase the diet rapidly during convalescence.

Cold drinks should be freely given. Barley water and oatmeal water are nutritious and palatable. Milk broths, and articles that give no trouble to digest.

Nursing.—Nursing is the main thing. The bowels should be kept open with salts. There is no special medicine we can claim will do good. Aconite may be used for the fever at first, in drop doses every hour for twenty-four hours. But the least medicine that is given the better it will generally be.

There is, I believe, something in protecting the ripening papules from the light. The constant application on the face and hands of lint soaked in cold water, to which antiseptics such as carbolic acid or bichloride may be added, is perhaps the most suitable treatment. It is very pleasant for the patient at least, and for the face it is well to make a mask of lint which can be covered with oiled silk. When the crusts begin to form, the chief point is to keep them thoroughly moist, which may be done with oil or glycerin; vaselin is particularly useful, and at this stage can be freely used upon the face. It frequently relieves the itching also. For the odor, which is sometimes so characteristic and disagreeable, the diluted carbolic acid solutions are probably the best. If the eruption is abundant on the scalp the hair should be cut short. During, convalescence frequent bathing is advisable. It should be done daily, using carbolic soap freely in order to get rid of the crusts and scabs. There is danger to others as long as the skin is not smooth and clean, and not free from any trace of scabs. As you must have a physician, I give but little medical treatment. Nursing is the main thing in this disease.

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General Rules for Disinfection.—The walls, woodwork, and ceiling may be cleaned by washing with one to one thousand solution of corrosive sublimate solution, or a five per cent carbolic acid solution, Or by rubbing with bread if solutions would injure. All dust must be removed. Plastered walls and ceilings may be white-washed. Woodwork must then be scrubbed with soap and thoroughly wiped. Then fumigate, at least three pounds of sulphur should be burned in the room for each 1,000 cubic feet of space. Placing it in a pan supported in another containing water to guard against fire. After scrubbing or fumigating, the room and its contents should be freely aired for several days, admitting sunlight if possible. All useless articles and badly soiled bedding should be burned. Such pieces of clothing as will not be injured may be boiled or soaked in a one to one thousand formaldehyde solution (one ounce of twelve per cent solution in one gallon of water), or two per cent carbolic acid solution. Clothing, bedding, etc., may be disinfected in the steam sterilizer.

Hands, Body, etc.—Special outer garments may be worn while in the sick room and removed, and clothing aired before leaving. Hands of the attendant should be washed in one to one thousand corrosive sublimate solution.

Vaccination and Re-vaccination and its Prevention of Smallpox. We quote in part from an article prepared by the State of Michigan. It is well known that smallpox can be prevented or modified by vaccination; and a widespread epidemic of the disease can be attributed only to an equally widespread ignorance or willfulness concerning smallpox and its prevention by vaccination and re-vaccination.

A Good Time to be Vaccinated.—Smallpox is usually most prevalent in the winter and spring months, reaching the highest point in May. The rarity of smallpox in Michigan for several years led to a feeling of security and to neglect vaccination, resulting in an increased proportion of inhabitants not protected by recent vaccination. This made possible a widespread epidemic. The proper preventive of such an epidemic is general vaccination and re-vaccination of all persons not recently thus protected. There is no better settled fact than that vaccination does protect against smallpox. But after a time the protection is weakened, therefore after a lapse of five years there should be re-vaccination.

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Why Vaccinate.—Because vaccination is a preventive of all forms of smallpox, and because by traveling, or by travelers, by articles received in the mail or from the stores or shops, or other various ways anyone at any time, may, without knowing it, be exposed to smallpox, it becomes important so far as possible without injury to health to render every person incapable of taking the disease. This may be done so perfectly by vaccination and re-vaccination with genuine bovine vaccine virus that no question of ordinary expense or trouble should be allowed for a day to prevent the careful vaccination of every man, woman and child in Michigan, and the re-vaccination of every one who has not been vaccinated within five years. It is well established that those who have been properly vaccinated are far less likely to take smallpox if exposed to it, and that the very few who have been properly vaccinated and have smallpox have it in a much milder form and are much less disfigured by it than those who have not been thus vaccinated. The value of vaccination is illustrated by the following facts: On March the 13th, 1859, Dr. E. M. Snow, of Providence, R. 1., found in a cluster of seven houses twenty-five families, and in these families ten cases of smallpox, all apparently at about the same stage of the disease. In the same families there were twenty-one children, who had never been vaccinated. The ten cases and the remaining members of the families, including the twenty-one children, were quarantined at home, and the children were all vaccinated and compelled to remain with the sick. Several other cases of smallpox occurred in the persons previously exposed, but not one of the twenty-one children referred to had the slightest touch of the disease.

In Sweden, the average number of deaths in each year from smallpox per million inhabitants was:

Before the introduction of vaccination (1774-1801), 1,973; During the period of optional vaccination (1802-1816), 479; And during the period of obligatory vaccination (1817-1877), 189.

Vaccination was introduced in England near the beginning of the nineteenth century, and since 1853 compulsory vaccination has been attempted. In England the number of deaths in each year from smallpox per one million inhabitants was:

At the close of the eighteenth century, 3,000. From 1841 to 1853 (average), 304. From 1854 to 1863 (average), 171.

Smallpox entirely prevented by re-vaccination.—In the Bavarian army re- vaccination has been compulsory since 1843. From that date till 1857, not even a single case of unmodified smallpox occurred, nor a single death from smallpox. During the year of duty, Dr. Marson, physician of the London Smallpox Hospital, has never observed a single case of smallpox in the officers and employees of the hospital, who are re-vaccinated when they enter the service, and who are constantly exposed to the infection.

"Out of more than 10,000 children vaccinated at Brussels with animal lymph, from 1865 to 1870, and who went through the terrible epidemic of smallpox, which in 1870 and 1871 frightened the world, not a single one was to my knowledge reported as being attacked by the disease. The same immunity was shared by those, a much larger number, whom I had re-vaccinated and who at the same time were living in epidemic centers."—Dr. Warlemont, of Brussels.

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Who should be Vaccinated.—Everybody, old and young, for his own interest, and that he may not become a breeding place for the distribution of smallpox to others, should seek that protection from smallpox which is afforded by vaccination alone. It is believed that all persons except those mentioned in the following paragraph may, if the operation is properly performed, at the proper time, and with pure bovine virus, be vaccinated with perfect safety to themselves. Even those who have had smallpox should be vaccinated, for otherwise they may take the disease; and it seems to be proved that a larger proportion, of those who have smallpox a second time, die than of those who have the disease after vaccination.

Who should not be Vaccinated.—Unless exposure to smallpox is believed to have taken place or likely to take place, teething children, pregnant women, persons suffering from measles, scarlet fever, erysipelas, or susceptible to and recently exposed to one of these diseases, persons suffering with skin diseases or eruption, and in general feeble persons not in good health, should not be vaccinated. In all cases in which there is any doubt as to the propriety of vaccinating or postponing vaccination the judgment of a good physician should be taken. The restriction, as to vaccinating teething children makes it important that children should be vaccinated before the teething process has begun, because smallpox is very much more dangerous than vaccination. Smallpox is exceedingly dangerous to pregnant women.

When should a person be Vaccinated.—The sooner the better as a rule, and especially whenever there is much liability of exposure to smallpox. Children should be vaccinated before they are four months old; those who have never been vaccinated, should, except teething children, be vaccinated at once. Because the vaccination often loses its protective power after a time, those who have been vaccinated but once or twice should, in order to test and to increase the protective power of the former vaccination, be vaccinated again, and as often as the vaccination can be made to work. In general, to insure full protection from smallpox, one should be vaccinated as often as every five years. It has been found that of those who have smallpox the proportion of deaths is very much less among those who have three or four good vaccination scars than among those who have but one scar.

Vaccination after exposure to Smallpox.—Vaccination as late as the second day after known exposure to smallpox is believed to have prevented the smallpox; vaccination the third day after exposure has rendered the disease much milder than usual, and in a case in Iowa, vaccination on the seventh or eighth day after exposure to smallpox ran a partial course and was believed to have modified the attack of smallpox, which, however, it did not wholly prevent. A recent case in Michigan was vaccinated three days after exposure, as were also the wife, mother, and two children, both under five years of age; all vaccinated again six days after the exposure. The health officer reported as follows: "The results were gratifying. During the first week of the eruption it was evidently aborting and without doubt as the result of vaccination eight days before the eruption. A complete and fine recovery. Certainly an aborted course, with scarcely a mark left, and not another case in the above family, whom necessity compelled to occupy the same house, the same rooms, continual contact with the contagion, scores one more big credit mark for vaccination."

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With what should one be Vaccinated.—Because the potency of virus depends largely upon its being fresh, and it is so easy to obtain pure and fresh bovine virus, and because such bovine virus is efficient it is better in all cases to use only the pure and fresh bovine virus.

Where should Vaccination be Performed.—In a room or place free from persons suffering from disease, and from dust which may convey to the scratched surface germs of any communicable disease; certainly not in or near a room where there is erysipelas or consumption, nor in the presence of one who has just come from a person sick with erysipelas, diphtheria, or scarlet fever.

By whom should one be Vaccinated.—The operation of vaccination should be performed always by a competent and responsible physician. To try to vaccinate one's self or one's family is poor economy, for it often results not only in a waste of money and of time, but in a false and dangerous feeling of security. To trust to vaccination by nurses and midwives is equally foolish. A well-educated and experienced physician has the skill, and the special knowledge necessary to the best judgment on all of the questions involved, without which the operation may be a failure or worse than a failure. In work of this kind the best is the cheapest, whatever it costs.

After Vaccination.—Let the vaccinated place alone. Do not scratch it or otherwise transfer the virus where it is not wanted. Protect it by a bandage, or cloth which has been boiled and ironed with a hot iron. Try to keep the pustule unbroken, as a protection against germs of diseases and against unnecessary discomfort. A bad sore arm may not be and probably is not true vaccination, but may be due to lack of care during and after vaccination to keep out septic germs.

Common appearances after Vaccination.—For a day or two nothing unusual should appear. A few days after that, if it succeeds regularly, the skin will become red, then a pimple will form, and on the pimple a little vesicle or blister which may be plainly seen on the fifth or sixth day. On the eighth day the blister (vesicle) is, or should be, plump, round, translucent, pearly white, with a clearly marked edge and a depression in the center; the skin around it for about half an inch is red and swollen. This vesicle and the red, inflamed circle about it (called the areola) are the two points which prove the vaccination to be successful. A rash, and even a vesicular eruption, sometimes comes on the child's body about the eighth day, and lasts about a week; he may be feverish, or may remain quite well. The arm may be red and swollen down as far as the elbow, and in the adult there will usually be a tender or swollen gland in the arm-pit, and some disturbance of sleep for several nights. The vesicle dries up in a few days more, and a crust forms which becomes of a brownish mahogany color, and falls off from the twentieth to the twenty-fifth day. In some cases the several appearances described above may be delayed a day or two. The crust or scab will leave a well-marked, permanent scar.

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What to do during and after Vaccination.—Do nothing to irritate the eruption, do not pull the scab off, when it drops off throw it in the fire. When the eruption is at its height show it to the doctor who performed the vaccination. If it is satisfactory, ask him for a certificate stating when and by whom you were vaccinated, whether with bovine or humanized lymph, in how many places and with what result at each place. When the arm is healed, if the vaccination did not work well, be vaccinated again as soon as possible, and in the best manner possible. This will be a test to the protection secured by the former vaccination, and will itself afford increased protection. Do not be satisfied with less than four genuine vaccine scars, or with four if it is possible to secure more than four. This vaccination a second or third time in close succession is believed to be hardly less important than vaccination the first time, and hardly less valuable as a protection against smallpox. Without doubt many persons are living in a false sense of security from smallpox because at some time in their lives they have had a little sore on their arm caused by a supposed or real vaccination, or because an imperfect vaccination failed to work, or because they were successfully vaccinated, or had the varioloid, or the unmodified smallpox many years ago. Until smallpox is stamped out throughout the world so that exposure of the disease shall be practically impossible, the only personal safety is in such perfect vaccination that one need not fear an exposure to smallpox through the recklessness of the foolish.

Make a record of your Vaccination.—Do not fail to procure and preserve the certificate mentioned in the preceding paragraph, and also to make a personal record of the facts with regard to any vaccination of yourself or in your family. From it you may sometime learn that it is ten years since you or some member of your family was vaccinated, when you thought it only five.

Lives saved from smallpox in Michigan.—Since the State Board of Health was established, many thousands of people in Michigan have been vaccinated because of its recommendations; and the statistics of deaths, published by the Secretary of State, show that at the close of the year 1906, the death rate from smallpox in Michigan had been so much less than before the board was established as to indicate that over three thousand lives had been saved from that loathsome disease. The average death rate per year, for the five years, 1869-1873, before the board was established, was 8.5 per 100,000 inhabitants, and since the board was established, for the thirty-three years, 1874-1907, it was only 1.5. Since 1896 an uncommon mild type of the disease has prevailed very extensively, but the death rate has been exceedingly low, being for the eleven years, 1897-1907, slightly less than one death for each 100,000 inhabitants. The great saving of life from smallpox in civilized countries has been mainly because of vaccination and revaccination.

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VACCINATION, Symptoms.—At first a slight irritation at the place of vaccination. The eruption appears on the third or fourth day as a reddish pimple surrounded by a reddened surface. On the fifth or sixth day this pimple becomes a vesicle with a depressed center and filled with clear contents. It reaches its greatest size on the eighth day. By the tenth day the contents are pus-like and the surrounding skin is more inflamed and often quite painful. These symptoms diminish, and by the end of the second week the pustule has dried to a brownish scab, which falls off between the twenty-first and twenty-fifth days, and leaves a depressed scar. Fever and mild constitutional symptoms usually go with the eruption and may last until about the eighth day.

Reliable lymph points should always be used. Clean the skin near the insertion of the deltoid muscle on the arm, and with a clean (sterile) knife or ivory point, a few scratches are made, deep enough to allow a slight flow of liquid, but no bleeding. The vaccine virus moistened, if dried on a point, is rubbed into the wound and allowed to dry. A piece of sterile gauze, or a "shield," is used as a dressing. This shield can be bought at any drug store. One vaccination may give immunity for ten to twelve years, but it is better to be vaccinated every six years at least.

DENGUE. Break-bone Fever, Dandy Fever.—This is an acute infectious disease characterized by pains in the joints and muscles, fever, an initial reddish swollen eruption and a terminal eruption of variable type. It occurs in the tropical regions and the warmer portions of the temperate zone. The disease appears in epidemics, rapidly attacking many persons.

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Symptoms.—Incubation lasts from three to five days without any special symptoms. The onset is marked with chilly feelings, an active fever with temperature gradually rising. There is severe pain in the muscles and in the joints which become red and swollen. There is intense pain in the eyeballs, head, back and extremities. Face looks flushed, eyes are sunken, the skin looks flushed and mucous membrane looks red. This is the beginning rash. The high fever falls quickly after three or four days, sometimes with sweating, diarrhea or nose bleed. The patient feels stiff and sore then, but comparatively well. A slight fever returns after two to four days, although this sometimes remains absent. Pains and eruptions, like scarlet fever or hives, appear. An attack usually lasts seven to eight days. Convalescence is often long and slow, with stiffness and pain in the joints and muscles and great weakness. A relapse may return within two weeks.

PHYSICIANS' TREATMENT for Dengue.—An anti-plague serum is sometimes used, though with doubtful results. The pain is controlled by doses of morphine of one-eighth to one-fourth of a grain every four or five hours. Hyoscin, one hundredth of a grain, is also given for the pain. The high temperature can be relieved by cold and tepid sponging. Tonics are given during the convalescence and continued for some time.

CEREBRO-SPINAL MENINGITIS.—This is an acute infectious disease. It comes in epidemics, when there are many cases, or appears here and there as a separate case (sporadic). It is caused by a specific organism (germ) and the disease attacks the membranes of the brain and spinal cord.

Of late years great progress has been made by patient investigation, and a serum is now prepared for the treatment of this disease. The results of this treatment are better than the treatments formerly used, and there is good reason to believe that in a few years this treatment will be as effective in this disease as antitoxin is in diphtheria.

Cause.—Young adults and children are affected most often. Bad surroundings and over-exertion are predisposing factors.

Conditions.—There is congestion of the membranes of the brain and spinal cord which are covered with an exudate confined on the brain, chiefly to the base.

Symptoms. Ordinary Form.—Incubation is of unknown length and occasionally marked by want of appetite, headache, and pain in the back. The invasion is usually sudden, chill, projectile vomiting, throwing forward, severe headache, pain and rigidity of the back of the neck, pain in various parts of the body, skin over-sensitive, irritable, and temperature about 102 degrees, with all symptoms of an active fever. Later, pains are very severe, especially in the head, neck and back; the head is drawn back; often the back is rigid; the muscles of the neck and back are tender and attempts to stretch them cause intense pain. The vomiting now is less prominent. Temperature is extremely irregular, 99 to 105 degrees or more. Pulse is slow, often 50 to 60, and full and strong at first. The delirium is of a severe and variable type in common, alternating with partial or complete coma, the latter predominating toward the close of fatal attacks. Stimulation of nerve centers causes cross-eyed look, drooping of upper eyelid, movement of eyeballs unequal, contracted, dilated, or sluggish pupils; acute and painful hearing, spasmodic contractions of the muscles followed by paralysis of the face muscles, etc. The disease may last several hours or several months. Many die within five days. In fatal cases the patient passes into seemingly deep sleep with symptoms of a very prostrating and weakening fever, and often retention of urine. Mild cases occur with only a little fever, headache, stiff muscles of the neck, discomfort in back and extremities. The malignant type occurs epidemically or sporadically.

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Malignant type.—Sudden invasion with severe chills, slight rise in temperature, pain in the back of the neck, headaches, stupor, muscular spasms, a slow pulse, often purple bleeding, eruption, coma and death within hours, rather than days. This is a terrible disease, and a physician is needed from the first. The death rate varies from twenty to seventy-live per cent. Treatment must be given by a physician. Spinal meningitis is inflammation of the membrane of the spinal cord along with the accompanying back and extremity symptoms, while the head remains clear and free from complications.

MENINGITIS.—This is an inflammation of the membranes covering the brain alone, and generally commences with fever and severe headaches, with avoidance of light and noise as these are painful. In some cases we have delirium, stupor and coma.

Treatment.—Treatment must be given by a physician, but cold applications to the head and back are generally good. The bowels also must be kept open.

MENINGITIS. Tubercular, (Basilar Meningitis).—This affection which is also known as acute hydrocephalus (meaning water on the brain), is essentially an acute tuberculosis in which the membranes of the brain, sometimes of the cord bear the brunt of the attack. It is more common in children than in adults. It is more frequent between the second and fifth years, than in the first year. It is caused by the tubercular infection, and follows the usual course of this disease. Ordinary meningitis is rapid and well defined in its course, with "high fever," severe pains in the head, intense nervousness, avoidance of light and sound, loss of appetite and constipation. These symptoms are easily understood and are generally clearly read by those around the patient. Unfortunately in tubercular meningitis the clearly defined symptoms are absent in the beginning, and when the physician is called the condition is dangerous. Usually the patient complains but little. There is a slight headache, low fever, no heat in the head, patient is pale most of the time, has little appetite, vomits occasionally and desires to sleep. He is nervous, stupid and lies on his side curled up with eyes away from the light. This disease appears mostly in delicate children, who are poor eaters and fond of books; usually in those inheriting poor constitutions. The mortality is very high. Parents who have thin, pale sallow children with dainty appetites, who frequently complain of headaches and are fond of books, should be afraid of infection from tuberculosis and make the little ones live in the open air and keep away from school. But earlier in the lives of these children care must be taken. A child with that pale, thin, sallow, delicate face and poor body should be fed with the best of food and live in the open air. I once had a family who lost their only two babies through this disease. After the first one died I instructed them carefully how to treat the second child. However, they loved their child foolishly and not wisely and fed it everything it wanted, and you know the children take an advantage of their parents. Give plenty of good, wholesome digestible food. Dress them comfortably and warm and keep them out in the open air. No cakes, candy, peanuts or any food that is not nourishing and easy to digest.