SANITARY CARE OF INFECTED AND SICK PERSONS AND ROOMS.

All persons known to be sick with this disease (even those but mildly sick) should be promptly and thoroughly isolated from the public and family. In ordering the isolation of infected persons, the health officer means that their communication with well persons and the movement of any article from the infected room or premises shall be absolutely cut off.

Except it be disinfected, no letter or paper should be sent through the mail from an infected place. That this is of more importance than in the case of smallpox is indicated by the fact of the much greater number of cases of sickness and of deaths from scarlet fever,—a disease for which no such preventive as vaccination is yet known.

The room in which one sick with this disease is to be placed should previously be cleared of all needless clothing, drapery and other materials likely to harbor the germs of the disease; and except after thorough disinfection nothing already exposed to the contagion of the disease should be moved from the room. The sick room should have only such articles as are indispensable to the well-being of the patient, and should have no carpet, or only pieces which can afterwards be destroyed. Provision should be made for the introduction of a liberal supply of fresh air and the continual change of the air in the room without sensible currents or drafts.

Soiled clothing, towels, bed linen, etc., on removal from the patient should not be carried about while dry; but should be placed in a pail or tub covered with a five per cent solution of carbolic acid, six and three-fourths ounces of carbolic acid to one gallon water. Soiled clothing should in all cases be disinfected before sending away to the laundry, either by boiling for at least half an hour or by soaking in the five per cent solution of carbolic acid.

[INFECTIOUS DISEASES 173]

The discharges from the throat, nose, mouth, and from the kidneys and bowels of the patient should be received into vessels containing an equal volume of a five per cent solution of carbolic acid, and in cities where sewers are used, thrown into the water closet; elsewhere the same should be buried at least one hundred feet distant from any well, and should not by any means be thrown into a running stream, nor into a cesspool or privy, except after having been thoroughly disinfected. Discharges from the bladder and bowels may be received on old cloths, which should be immediately burned. All vessels should be kept scrupulously clean and disinfected. Discharges from the nose, ears, etc., may be received on soft rags or pieces of cloth and which should be immediately burned.

All cups, glasses, spoons, etc., used in the sick room, should at once on removal from the room, be washed in the five per cent solution of carbolic acid and afterwards in hot water, before being used by any other person.

Food and drink that have been in the sick room should be disinfected and buried. It should not be put in the swill barrel.

Perfect cleanliness of nurses and attendants should be enjoined and secured. As the hands of the nurses of necessity become frequently contaminated by the contagion of the disease, a good supply of towels and basins, one containing a two per cent solution of carbolic acid (two and three-fifths ounces of carbolic acid to a gallon of water) and another for plain soap and water should always be at hand and freely used.

Persons recovering from scarlet fever, so long as any scaling or peeling of the skin, soreness of the eyes or air passages or symptoms of dropsy remain, should be considered dangerous, and, therefore, should not attend school, church or any public assembly or use any public conveyance. In a house infected with scarlet fever, a temporary disinfection after apparent recovery may be made, so as to release from isolation the members of the household who have not had the disease.

Diet and Nursing.—Food should be given every two to four hours. Only water can be given as long as there is nausea and vomiting, and sometimes not even that. After they have stopped you can give milk and water and then milk. You should give it to a child every two to three hours, about one-fourth of a glass full and warm if possible. A child can take at least one quart in twenty-four hours. Watch the stomach and bowels for bad symptoms; if necessary you can put in one teaspoonful of lime water after the milk has been heated. If the child will not take milk, use one of the prepared foods. Mellins' malted milk, Borden's malted milk, peptonized milk, Imperial Granum, and follow the directions on the bottle. The different food waters mentioned above are to use when milk and other food preparations cannot be given. Albumen (white of an egg and water, not whipped) can be given and always cold. Cold milk also tastes better.

[174 MOTHERS' REMEDIES]

During the Sickness, etc.—The linen, bedding, etc., of the patient should be put into a one to five-thousand solution of corrosive sublimate (you can buy that strength tablet) before being boiled, dried and aired in the sun. The sick room must be kept well ventilated, but no drafts should be allowed to go over the patient. The temperature is better at 68 degrees F. The patient should be kept in bed during all the feverish stage and during the scaling stage also.

Care must be taken lest the patient take cold. During this time there is a great danger of ear and kidney trouble. It would be safer to keep the patient in bed until the peeling is done. Children are naturally lively, risky, and a little careless. To keep the scales from flying you can grease the patient with cold cream, vaselin, lard, etc. This will also help to ease the itching. The peeling is aided by bathing the patient every day with warm, soapy water.

Special Treatment.—In ordinary cases little treatment is needed except to keep the throat and nose free from excessive secretions. The urine should be examined daily, and the bowels should move once or twice a day. Cold water should be given frequently after the nausea has passed away. Milk is the usual food, but must not be given during the vomiting stage. Equal parts of milk and water can be given after the vomiting stage, if the patient will not take pure milk.

During the vomiting stage very little water even can be given. The greatest danger in scarlet fever comes from the throat complications and the high fever.

When the fever is high the patient suffers from delirium. A temperature of 105 is dangerous and such patients must be bathed well in water, commencing at 90 degrees and rubbed well all over while in the water, allowing the temperature of the bath to fall to 85 or 80 degrees while so doing; bath to last five to fifteen minutes. Bathe the head with water, at the temperature of 50 degrees, all the time the temperature is at 103 degrees or higher. Always use the thermometer to determine the temperature of the water. Weakly children often do not stand the bath well, so you must exercise discretion in giving it often. The temperature must be kept down to 102 to 103-1/2, and baths must be used often to do so. Where baths cannot be used, frequent washing with water at 60 to 70 degrees must be adopted without drying the child afterwards. A mother should always remember that a feverish, restless child needs a bath or a good washing with cool soap and water. If the bowels and kidneys do not act freely enough give the following:

Epsom Salts 2 ounces Cream of Tartar 2 ounces

Mix and give one-half teaspoonful in water every three hours until the bowels move freely.

This is the dose for a child one year old.

[INFECTIOUS DISEASES 175]

Dropsy in Scarlet Fever.—In this case you must have a doctor. A simple way to make a dropsy patient sweat is to place the patient upon a cane seated chair, pin a blanket around the neck, covering the whole body. Under the chair place a wooden pail half full of cool water and into this put a brick baked as hot as possible; or you can introduce steam under the blanket while the patient is sitting on a chair, or lying in bed, taking care not to scald the patient. This will cause sweating, and relieve the dropsy and also congested kidneys.

How Soon May a Scarlet Fever Patient Associate with the Healthy?—It is best to wait a few weeks after scaling ends. Give the patient a bath in a one to 10,000 corrosive sublimate solution first.

Caution.—An ordinary case of scarlet fever does not need much medicine. Nursing and care are essential. Even the slightest case should be watched. There is always danger of the eyes, ears and kidneys becoming affected. If the child complains of pain in the head the ear must be examined. If the urine passed is small in quantity, or if there are any signs of dropsy, treatment must be given at once. You have heard very much lately about the sting of the honey bee for rheumatism. I often use a preparation of this for the kidney troubles in scarlet fever. The name is Apis Mel. I use the second or third homeopathic attenuation in tablet form and give one to two about every two hours. I have found this effective in such cases where the urine is small in quantity, and there is some dropsy. The lightest cases can have dropsy, especially if special care is not taken when scaling goes on.

I was once attending three children for scarlet fever. The one that had it in a mild form became affected with dropsy. For this I steamed her. In her case I placed her in a cane-seated chair, pinned a blanket tightly around her so as to thoroughly cover her, put a pail of cool water under her chair and dropped into the pail a hot baked brick. The hot brick caused steam to rise from the water and enveloped the child, producing sweating. This was done frequently, and the child considered it a joke, but it relieved her of the bloat. It was in the country and these crude means produced the desired result. By attaching a rubber tube to a steaming kettle and introducing the steam under the covering the same result can be produced. Sometimes you may not have all things you wish, then you must make use of what is handy. You would be surprised perhaps to know how much can be done to relieve sickness by what can be found in every house. (For disinfectants see chapter on nursing.)

[176 MOTHERS' REMEDIES]

MEASLES.—Measles is an acute infectious disease, distinguished by a characteristic eruption on the mucous membranes and skin. It is very contagious and spreads through the atmosphere. Almost everyone is susceptible to measles and suffers at least one attack. The disease is not frequent during the first year of life. It prevails in all countries.

Incubation.—This varies from thirteen to fifteen days. In calculating this period we include the time from exposure to the appearance of the eruption. One attack generally protects the person from another attack. The period of the greatest danger of taking it extends through the period of the eruption. It diminishes as the eruption fades. From this we learn that the infection in measles takes place generally in the incubation stage.

Symptoms and Description of Ordinary Type.—The first symptoms may be only a headache or a slight disturbance of the stomach. There may be some fever in the evening. There is now a redness and watery condition of the eyes, and general feeling of weariness. The cold symptoms (coryza) are not yet marked, but if we look in the mouth we may see a few spots on the mucous membrane of the cheek. Then follow the sneezing, running at the nose, sore and red eyes; running water, sensitiveness to the light, cough and fever. The eruption now appears, and is first noticed on the side of the head and the wings of the nose, as a red spotted eruption, which soon looks like a pimple, and then "blotchy." Older people feel quite sick. The aching all over, and headache are sometimes almost unbearable, especially when there is much coughing. The face, eyes and scalp are soon covered by the red rose irregularly shaped pimples, which next appear rapidly on the back of the hands, fore-arms, front of the trunk, on the back and lower extremities. This order is not always maintained. Sometimes it first appears on the back.

The eruptive stage generally lasts three or four days, during which time the symptoms are all aggravated, especially by any strong light, on account of the sore eyes for the measles are also in them. We have active cold symptoms like sneezing, running at the nose, snorting, snuffling, hawking. The cough is terribly severe, annoying, making the lungs and stomach very sore. The head feels as if it would split. The patient holds his chest and "stomach" while coughing. Symptoms of acute bronchitis develop. Sometimes there is much diarrhea. Pneumonia often develops through carelessness. The fever reaches its height when the eruption is fully developed. The eruption fades after it has been out for three or four days, and then all the symptoms decrease, the fever lessens and becomes normal by gradual morning remissions. Scaling begins when the pinkish hue of the rash has disappeared and continues until the last vestige of reddish spots has disappeared. As a rule it is completed in two to four weeks after the first eruption has appeared. Sometimes the scaling is difficult to see, but it is never absent in measles: It is best seen on the front part of the chest, shoulders, and the inner surface of the thighs. The temperature may reach 104 to 105-8/10 without complications. This description gives a picture of a typical case. The eruption that appears in the mucous membrane of the mouth appears three to four days before the skin rash. It is accompanied by redness of the pharynx and of the front and back pillars of the fauces. The soft palate is studded with irregular shaped, rose colored spots or streaks and the hard palate presents small whitish vesicles. They are also found on the colored mucous membrane of the cheeks and on that opposite the gums of the upper and lower teeth. The rash of measles is a characteristic eruption of rose colored or purple colored papules (pimples). As a rule the whole face is covered with the eruption and is swollen. Diphtheria may complicate measles. Bronchitis and brancho-pneumonia also may occur, especially if the patient is careless and takes cold. Diarrhea is frequently present.

[INFECTIOUS DISEASES 177]

Eyes.—Following severe cases fear of light, spasm of the orbicularis muscle, inflammation of the lachrymal duct, conjunctivitis, ulceration of the cornea and amaurosis (general blindness) may result. Hence the necessity of careful attention to the eyes. Never read anything during the attack of the measles. The ear may also become afflicted. There are other complications, but these mentioned are the important ones.

Mortality in Measles.—The mortality in childhood and infancy is about eight per cent. Mortality is greatest for number of cases during the first year. Six per cent between fifth and eighth years.

Diagnosis.—Presents few difficulties in a typical case. The mode of onset is cold symptoms of the nose and eye, cough; appearance of the mouth, throat and the blotchy eruptions are very characteristic.

Treatment. Prevention.—As soon as you know it to be the measles, separate the case and put the patient in a well-aired room where you can have air without a draft and where the room can be made and kept dark. Those persons who must go in the room should put over them a linen robe, and hang it outside of the sick room. It should thoroughly cover them. When not in use hang it in the open air. An attendant who wears a beard should disinfect his beard, face, head and hands before mingling with the well.

MOTHERS' REMEDIES.—1. Measles, Lemon Remedy from a Canadian Mother.—"Give child all cold lemonade it can drink and keep in warm room. This acts just as well as if the drinks are hot. We tried both on our children and cured both ways." Don't give so much of the cold as to chill. The cold drink makes child sweat, just as hot does. Also helps to carry off impurities by flushing bowels, just as clear water would.

2. Measles, Elder Blossom Tea to Drive Out.—"Elder blossom tea is good for a cold or fever. Gather the blossoms, and make a tea. Pleasant to take. Sweeten if desired. This is also good to drive out the measles." This remedy should be taken warm and is especially good to bring out the rash in children. Take a teaspoonful every hour.

[178 MOTHERS' REMEDIES]

General Treatment.—An ordinary case of measles does not need much treatment. If the patient has a high fever and is very hot and restless, bathe with tepid or cool water every two or three hours, till the patient becomes quite restful. Sometimes they have too much covering and that makes them hot and restless. Remove a little at a time. Bathing will not hurt the rash, for it can be done under the clothes and without any danger to the patient.

Cold Drinks.—These are refreshing and beneficial, if not given too freely. One-third of a glass of water is enough at one time, but it can be given often, if it does not chill the patient. After the feverish days have passed, diluted milk or plain milk can be given in greater amount.

Cough in Measles.—It is likely to be severe, straining and barking and hard to relieve. If it is too severe you can give, for a child one year old:

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

Mix and make into thirty powders.

Give one-half powder every two hours when awake or restless.

2. For a child two years old:

Paregoric 2 to 5 drops Syrup Ipecac 3 drops

Mix.

Give every three hours, according to age, one to three hours for a child two years old.

3. For Irritation of the Skin.—Sponge once a day with water at 100 degrees F. containing a little alcohol or a pinch of sodium bicarbonate or soda.

4. For Scaling.—Use ointment of benzoinated lard, combined with five per cent of boric acid.

Diet.—The food should be light; milk, broths, and when the fever is gone chicken and soft boiled eggs, jelly, toasted bread, crackers, cereals, with cocoa for drink. Orange juice or lemon juice may be given in moderation. Milk, one pint per day for every fifty pounds in weight of the patient, during a fever sickness, is a safe and liberal allowance. Smaller children in proportion. Mothers will be apt to give too much and it may then prevent rest and steep. When the fever subsides you can give more milk and some of the above foods. Water, as before stated, can be given for the thirst quite frequently.

[INFECTIOUS DISEASES 179]

Teas.—The laity gives lots of these to bring out the rash. It seems to me before the rash is out the patient is feverish and chilly and the skin is dry, and a small amount of tea given every hour or two might do good unless the patient is made warmer. There are many varieties given. Elder blossom seems to have the call. For some time after the patient is well he may be bothered with a cough; it better be looked after if it continues, for there might be bronchitis or some lung trouble left and unknown.

Caution.—A person who has had the measles or German measles, should be very careful about taking cold, for if they do they are liable to have serious trouble, especially in the chest. It is very easy to take bronchitis or pneumonia during and after an attack of measles. The mucous membrane of these parts is left somewhat swollen and it remains susceptible to disease for some time. "An ounce of prevention is worth a pound of cure." Remain in the house three or four days longer than may seem necessary and you will be paid for so doing by having good bronchial tubes and lungs,—as good as before if you were careful during the attack.

GERMAN MEASLES.—This is an acute self-limited disease and contagious. It has a mild fever, watery eyes, cough, sore throat and enlargement of the glands of the neck, not seen in the common measles. It has an eruption that may come the first day to the fourth.

Incubation Period Runs.—From fifteen to twenty days.

Rash.—Just before the rash appears there is a headache, nausea and irritation of the bronchial tubes. The eruption is so similar to that of measles at the outset that it is hard to differentiate between them. The eruption in the mouth, however, is not so characteristic. Before the appearance of the eruption, the glands on the back of the neck and angles of the jaw may be enlarged. At the time of its appearance the glands in the armpits and groin become enlarged to the size of a bean and bigger, and they remain enlarged for weeks after the eruption has disappeared.

Treatment.—Similar to the measles if any is needed.

CHICKEN POX (Varicella).—This is an acute infectious disease, characterized by a peculiar eruption. Children are the ones usually attacked. It generally occurs before the tenth year. It is transmitted through the atmosphere. The period of coming on is usually fourteen days, but it may extend to nineteen days. It is perhaps the simplest and mildest disease of childhood. It occurs but once, is contagious, is very common, and resembles varioloid. It has a mild light fever and large vesicles almost the size of a split pea, scattered over the body. There may be few and there may be hundreds. They are reddish gray and appear first on the head and face, then on the body, one crop following another on the body. They are filled at first with a clear liquid, which soon turns yellowish, then breaks and dries up. They leave no scar unless they are scratched or are very large. The patient is usually well in a week, but the scars last longer.

MOTHER'S REMEDY.—1. Chicken Pox, Catnip Tea and Soda Water for.—"Put the patient to bed and give catnip tea. A daily bath of saleratus water is good and the bowels should be kept open." One of the most essential things is to keep the patient warm.

[180 MOTHERS' REMEDIES]

PHYSICIANS' TREATMENT FOR CHICKEN POX.—Exclude other children. The child should be lightly fed and on ordinary food. Large vesicles on the face, when yellow, should be pricked with a needle that has been boiled, then wash them with a disinfecting lotion twice daily.

The following is a good lotion:

Boric Acid 1/2 ounce (4 teaspoonfuls) Boiled Water 1 pint

Mix thoroughly and use twice a day on the eruption.

The child should not pick the sores on his face, as this may cause delay in healing and leave a mark.

MUMPS (Parotitis).—This is an acute infectious disease of one or both of the parotid glands, located at the angle of the jaw, and extending up to the ear, and, also, to other salivary glands. It appears only once. One attack gives immunity. It may come at any age; but appears mostly before the age of fifteen. It comes on one side first and may pass over to the other side in a few days, as it usually does, and gives the face a broad appearance, under the ears, or ear, and makes chewing and swallowing almost impossible. There is no soreness of the throat in mumps. In well-marked cases there is considerable fever and pain. It may last from a few days to a week. The usual length of time the disease lasts is one week. There is no tendency to form pus, even when the face is very hard and swollen and tender. It will occasionally leave the face and appear in the breasts and ovaries in the females or in the testicles of the males, and in both places it causes much pain.

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]

[Illustration: Diphtheria (view of infected throat)]

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.

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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.