Mother's Remedies Over One Thousand Tried and Tested Remedies from Mothers of the United States and Canada (part 2 of 5)

Mother's Remedies Over One Thousand Tried and Tested Remedies from Mothers of the United States and Canada (part 2 of 5)

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.

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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]

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

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

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

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

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

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

[186 MOTHERS' REMEDIES]

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

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

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

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

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

[INFECTIOUS DISEASES 187]

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

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

[188 MOTHERS' REMEDIES]

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

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 189]

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

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

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

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

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

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

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

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

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

[190 MOTHERS' REMEDIES]

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 191]

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

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

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

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

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

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

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

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

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

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

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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.

[196 MOTHERS' REMEDIES]

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.

[INFECTIOUS DISEASES 203]

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

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

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

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

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 205]

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

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

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 207]

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

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

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

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

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

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

[INFECTIOUS DISEASES 209]

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

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

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

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

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 211]

TUBERCULOSIS. (CONSUMPTION).--Tuberculosis is an infectious disease caused by the bacillus, tuberculosis, and characterized by the formation of nodules or diffuse masses of new tissue. Man, fowls and cows are chiefly affected.

Indians, negroes and Irish are very susceptible. The disease is less common at great altitudes. Dark, poorly ventilated rooms, such as tenements and factories and the crowding of cities favors infection, as do in-door life and occupations in which dust must be inhaled. Certain infections such as measles, whooping-cough, chronic heart, kidney and liver diseases and inflammation of the air tract are predisposing factors. Inhalation is the chief mode of transmission. Hereditary transmission is rare.

Forms. The Lungs.--Consumption. This is caused by a germ. Some have the form called galloping consumption. This person is attacked suddenly, wastes away and dies, in a very short time. There is rapid loss of strength and weight, high fever, night sweats, fast breathing, pains in the chest, cough and profuse expectoration, and rapid loss of strength.

Ordinary Consumption.--Begins slowly and the patient is not aware of the danger. He may have loss of appetite, dyspepsia, diarrhea and distress after meals. He looks pale, is weak and loses flesh. Soon he has a hacking cough, worse in the morning, with a scanty, glairy sputum. His weight continues to decrease, his heart is weak and beats faster. He has pain in his chest below the shoulder blades. He may have a slight bleeding from the lungs. His cough becomes worse, the expectoration gets thicker and more profuse, with night sweats, high fever, and shortness of breath. The eyes are bright; the cheeks are pale or flushed. Chronic looseness of the bowels may be present. Bleeding from the lungs may occur at any time, but it is most frequent and profuse during the last stages. The patient becomes very weak, thin and pale, emaciated. The brain action remains good, and he remains hopeful almost until the last. Tuberculosis may exist in almost every part of the body and we have many forms. It is not necessary to discuss all. It would tend to confusion. I will name the most of them:

1. Acute Miliary Tuberculosis. (A.) Acute General Miliary Tuberculosis. (B.) Pulmonary (lung) type. (C.) Tubercular Meningitis.

2. Tuberculosis of the lymph nodes (glands). This was formerly called Scrofula. This is more curable and will be treated more fully elsewhere.

3. Tuberculous Pleurisy.

4. Tuberculous Pericarditis.

5. Tuberculous Peritonitis. (Of this there are a good many cases.)

6. Tuberculosis of the Larynx.

7. Acute Pneumonia (Pulmonary Tuberculosis) or "Galloping Consumption."

8. Chronic Ulcerative Pulmonary Tuberculosis.

9. Chronic Miliary Tuberculosis.

10. Tuberculosis of the Alimentary Canal.

11. Tuberculosis of the Brain.

12. Tuberculosis of the liver, kidneys, bladder, etc.

13. Tuberculosis of joints, this will be treated more fully elsewhere.

[212 MOTHERS' REMEDIES]

CERVICAL, TUBERCULOSIS (Scrofula).--This is common in children that are not well nourished, living in badly ventilated and crowded houses, and in the negroes. Chronic catarrh of the nose and throat and tonsilitis predispose to it. The glands under the lower jaw are usually the first involved. They are enlarged, smooth, firm and often become matted together. Later the skin may adhere to them and suppuration occurs, that is, pus forms. An abscess results that breaks through the skin and leaves a nasty looking sore or scar. The glands in the back of the neck may enlarge also; or in the arm pit or under the collar bone and also the bronchial glands. There is usually secondary anemia. A long course and spontaneous recovery are common. Lung or general miliary tuberculosis may occur.

Mesenteric Kind.--Symptoms are loss of flesh and strength, anemia, distended abdomen (pot-belly) and bloated, with offensive diarrhea.

MOTHERS' REMEDIES.--1. Consumption, Simple Home Method to Break up.--"A cloth saturated with kerosene oil, bound around the chest at night and frequently repeated, will remove lung soreness, and it may be taken inwardly with advantages, eight to ten drops three or four times a day in sarsaparilla. It has been tried efficaciously as a cure for consumption."

2. Consumption, Physicians' Remedy for.--

Arsenic Acid 1 part Carbonate of Potash 2 parts Cinnamyllic Acid 3 parts

Heat this until a perfect solution is obtained, then add twenty-five parts cognac and three parts of watery extract of opium which has been dissolved in twenty-five parts of water filtered. Dose:--At first take six drops after dinner and supper, gradually increasing to twenty-two drops. Mild cases are cured in two months, but the severe cases may require a year or two. This treatment should be given under the care of a physician, as it is poisonous and needs close watching.

[INFECTIOUS DISEASES 213]

PHYSICIANS' TREATMENT for Consumption.--Tuberculous peritonitis is often present. General better hygienic measures; fresh air, nourishing food; cod-liver oil. The glands are now often cut.

Sanitary Care. Prevention of Tuberculosis.--The sputum of consumptives should be carefully collected and destroyed. Patients should be urged not to spit about carelessly, but always use a spit cup and never swallow the sputum. The destruction of the sputum of consumptives should be a routine measure in both hospitals and private practice. Thorough boiling or putting in the fire is sufficient. It should be explained to the patient that the only risk, practically is from this source.

The chances of infection are greatest in young children. The nursing and care of consumptives involves very slight risks indeed, if proper precautions are taken.

Second.--A second important measure, relates to the inspection of dairies and slaughter houses. The possibility of the transmission of tuberculosis by infected milk has been fully demonstrated, and in the interest of health, the state should take measures to stamp out tuberculosis in cattle.

Individual Prevention.--A mother with pulmonary tuberculosis should not nurse her child. An infant born of tuberculosis parents or of a family in which consumption prevails, should be brought up with the greatest care and guarded most particularly against catarrhal affections of all kinds. Special attention should be given to the throat and nose, and on the first indication of mouth breathing or any affection of the nose, a careful examination should be made for adenoids. The child should be clothed in flannel, and live in the open air as much as possible, avoiding close rooms. It is a good practice to sponge the throat and chest night and morning with cold water. Special attention should be paid to the diet and to the mode of feeding. The meals should be given at regular hours, and the food plain and substantial. From the onset the child should be encouraged to drink freely of milk. Unfortunately in these cases there seems to be an uncontrollable aversion to fats of all kinds. As the child grows older, systematically regulated exercise or a course of pulmonary (lung) gymnastics may be taken. In the choice of an occupation, preference should be given to an out of door life. Families with a predisposition to tuberculosis should, if possible, reside in an equable climate. It would be best for a young person belonging to such a family to remove to Colorado or Southern California, or to some other suitable climate before trouble begins. The trifling ailments of children should be carefully watched. In convalescence from fevers, which so frequently prove dangerous, the greatest care should be exercised to prevent from catching cold. Cod-liver oil, the syrup of iodide of iron and arsenic may be given. Enlarged tonsils should be removed. "The spontaneous healing of local tuberculosis is an every-day affair. Many cases of adenitis (inflammation of the glands) and disease of the bone or joints terminate favorably. The healing of pulmonary (lung) tuberculosis is shown clinically by the recovery of patients in whose sputa elastic tissue and bacilli have been found."

[214 MOTHERS' REMEDIES]

General Measures.--The cure of tuberculosis is a question of nutrition; digestion and assimilation control the situation; make a patient grow fat, and the local disease may be left to take care of itself. There are three indications:

First, to place the patient in surroundings most favorable for the greatest degree of nutrition; second, to take such measures as in a local and general way influence the tuberculosis process; third, to alleviate the symptoms. This is effected by the open air treatment with the necessary feeding and nursing.

At Home.--In the majority of cases patients must be treated at home. In the city it has many disadvantages. The patient's bed should be in a room where he can have plenty of sunshine and air. Two things are essential--plenty of fresh air and sunshine. While there is fever he should be at rest in bed. For the greater part of each day, unless the weather is blustering and raining, the windows should be open. On the bright days he can sit out-doors on a balcony or porch, in a reclining chair. He must be in the open air all that is possible to be. A great many patients spend most of the time out in the open air now. In the country places this can be easily carried out. In the summer he should be out of doors from eleven to twelve hours; in the winter six to eight at least. At night the room should be cool and thoroughly ventilated. "In the early stages of the disease with much fever, it may require several months of this rest treatment to the open air before the temperature falls to normal." The sputum is dangerous when it becomes dry. As long as sputum is moist the germs are held in the sputum; but when it is dry they are released and roam at will in the atmosphere and are inhaled. They are then ready to lodge themselves in suitable soil. Always keep the sputum (expectoration) moist, and then there is no danger.

Diet. Treatment.--The outlook in this disease depends upon the digestion. Nausea and loss of appetite are serious obstacles. Many patients loathe foods of all kinds. A change of air or a sea voyage may promptly restore the appetite. When this is not possible, rest the patient, keep in the open air nearly all day and feed regularly with small quantities either of buttermilk, milk, or kumiss, alternating if necessary with meat juice and egg albumin. Some cases which are disturbed by eggs and milk do well on kumiss. Raw eggs are very suitable for feeding, and may be taken between meals, beginning with one three times a day, and can be increased to two and three at a time. It is hard to give a regular diet. The patient should be under the care of a physician who will regulate the kind of diet, amount and change. When the digestion is good there is less trouble in feeding. Then the patient can eat meat, poultry, game, oysters, fish, animal broths, eggs. Nothing should be fried. Avoid pork, veal, hot bread, cakes, pies, sweet meats, rich gravies, crabs, lobsters.

[INFECTIOUS DISEASES 215]

Diet in Tuberculosis furnished us by a Hospital.--

May Take.--Soups.--Turtle or oyster soup, mutton, clam, or chicken broth, puree of barley, rice, peas, beans, cream of celery or tomatoes, whole beef tea; peptonized milk, gruel.

Fish.--All kinds of fresh fish boiled or broiled, oysters or clams, raw, roasted or broiled.

Meats.--Rare roast beef or mutton, lamb chops, ham, fat bacon. sweetbreads, poultry, game, tender steaks, hamburger steak rare.

Eggs.--Every way except fried.

Farinaceous.--Oatmeal, wheaten grits, mush, hominy, rice, whole wheat bread, corn bread, milk toast, biscuits, muffins, gems.

Vegetables.--Potatoes baked, boiled, or creamed, string beans, spinach, onions, asparagus, tomatoes, green peas, all well cooked, cresses, lettuce, plain or with oil dressing, celery.

Desserts.--Farina, sago, tapioca, apple or milk pudding, floating island, custards, baked or stewed apples with fresh cream, cooked fruits, rice with fresh cream.

Drinks.--Fresh milk, cool, warm, or peptonized, cocoa, chocolate, buttermilk, pure water, tea, coffee, panopepton.

Must Not Take.--Fried foods, salt fish, hashes, gravies, veal, pork, carrots, parsnips, cabbage, beets, turnips, cucumbers, macaroni, spaghetti, sweets, pies, pastry, sweet wines.

WHAT EVERY PERSON SHOULD KNOW ABOUT TUBERCULOSIS, WHETHER HE HAS THE DISEASE OR NOT.

Tuberculosis is caused by a germ.

Tuberculosis is communicable and preventable.

Consumption of the lungs is the most common form of tuberculosis.

Consumption of the bowels is the next most common form.

The germ causing tuberculosis leaves the body of the person who has the disease by means of the discharges; by the sputum coughed up from the lungs, by nasal discharge, by bowel excrement, by urine, by abscesses.

If the sputum of the consumptive is allowed to dry, its infected dust floats in the air, and is breathed into the lungs.

[216 MOTHERS' REMEDIES]

Any person breathing such air is in danger of contracting tuberculosis. It is best not to stand near a person suffering with tuberculosis who is coughing, because in this act finely divided droplets of saliva are thrown from the mouth, and may be carried for a distance of three feet. These may contain large numbers of the bacilli. They are also sometimes thrown out in forcible speaking. The ordinary breath of a consumptive does not contain them.

If the bowels or other discharges from the tuberculous person are not disinfected, but are thrown into a sewer, privy, river or buried they are a source of danger, and may pollute a source of drinking water.

Impure milk, that is, milk from a tuberculous cow or milk exposed to infected dust is a common source of tuberculosis. Milk from suspected sources should be boiled. The all-important thing to do to prevent tuberculosis from spreading from one person to another, and from one part of the body to another, is immediately to destroy all discharges from the body of a person who has tuberculosis.

Destroy by fire or by disinfectant all sputum, all nasal discharges, all bowel excrement, all urine as soon as discharged. For such a purpose use a five per cent solution of carbolic acid (six and three-fourths ounces of carbolic acid to one gallon of water).

No person, well or sick, should spit in public places or where the sputum cannot be collected and destroyed.

Flies carry sputum and its infection to food, to your hands, your face, clothes, the baby's bottle, from which the germs are taken into the mouth, and thus gain access to the stomach or lungs.

Spitting on the sidewalk, on the floor, on the wall, on the grass, in the gutter, or even into a cuspidor containing no disinfectant is a very dangerous practice for a consumptive to indulge.

The person infected with tuberculosis should protect himself, his family, his associates and the public by not spitting in public places, and by promptly destroying all discharges.

The well person should defend himself by insisting that the tuberculous person shall destroy all discharges.

Well persons should set the example of restraint and themselves refrain from spitting promiscuously. A person may appear quite healthy and yet be developing tuberculosis without knowing it.

Such a person, if he spits where he pleases, may be depositing infected sputum where it can endanger the health and lives of other persons.

Do not sleep with a person who has tuberculosis, nor in the room occupied by a tuberculous person, until that room has been thoroughly disinfected.

[INFECTIOUS DISEASES 217]

Any person is liable to contract tuberculosis, whether he is well or not. Sickly persons, or those having bad colds, influenza bronchitis or pneumonia or any general weakness are much more liable to contract tuberculosis than a perfectly well or robust person. If you have a cough that hangs on consult at once a reliable physician who has ability to diagnose tuberculosis.

Prevention is possible; it is cheaper and easier than cure.

Any person having tuberculosis can recover from the disease if he takes the proper course in time.

Advanced cases of tuberculosis, that is, those cases where the disease is well developed, are the most dangerous to the public and the most difficult to cure.

Every advanced case of tuberculosis should be in a sanatorium.

Sanatoria offers the best chance, usually the only chance, of cure to an advanced case.

They also protect well citizens from danger of infection from advanced stages of tuberculosis. There are fewer deaths from tuberculosis in those localities where sanatoria are established for the care of tuberculous persons.

One person out of every seven who die, dies from tuberculosis.

One child out of every ten dies from tuberculosis.

Homes and school-houses greatly need more fresh air supplied to their occupants.

Day camps are city parks, vacant lots or abandoned farms where the tuberculous persons of a community may go and spend the entire day in rest, receiving instructions in proper hygiene and skillful treatment. Such camps are supplied with tents, hammocks, reclining chairs, one or more nurses, milk, eggs and other nourishment.

Dispensaries are centers of sanitary and medical instruction for local tuberculous persons.

Every locality should establish and maintain a dispensary for the benefit of tuberculous persons; for their instruction how to prevent the disease from spreading, and how to conduct themselves to insure relief and cure.

Householders are required by law to report a case within their households to the local health officers. The local health officer has certain duties to perform under the law, and co-operation with him by the householder and tuberculous person, works for the suppression of this disease.

Do not consider a tuberculous person an outcast, or one fit for the pesthouse. Your crusade is against tuberculosis, not against the person suffering from the disease.

Give the freedom of a well person to the tuberculous who is instructed and conscientious in the observance of necessary precautions. Be very much afraid of the tuberculous person who is ignorant or careless in the observance of necessary precautions.

[218 MOTHERS' REMEDIES]

PNEUMONIA (Lobar) Lung Fever.--Inflammation of the lungs. This is an acute infectious disease characterized by an exudative inflammation of one or more lobes of the lungs, with constitutional symptoms due to the absorption of toxins (poison), the fever terminating by crisis (suddenly). In speaking of pneumonia you frequently hear the expression "the lungs are filling up." This is the real condition. The structures surrounding the air cells are inflamed and from the inflamed tissues a secretion exudate is poured out into the cells. This is expectorated, thrown out, by coughing; but it is poured out into the cells faster than it can be spit up and consequently it remains in some of the cells and fills them up.

The air does not get into such cells and they fill, with many others, and make that section solid. When the patient is improving he keeps on spitting this up, until all is out and the air cells resume their normal work. Sometimes they remain so and we have chronic pneumonia.

Causes of Pneumonia.--Pneumonia occurs frequently as a complication of other diseases, such as typhoid fever and measles. Yet the majority of cases occur spontaneously. Many times the disease seems to be induced by exposure to the cold, and there can be no doubt that such exposure does at least promote the development of this affection. It seems, however, probable that there is some special cause behind it without which the exposure to cold is not sufficient to induce this disease. Pneumonia may occur at any period of life, and is more common among males than females. It occurs over the entire United States, oftener in the southern and middle, than in the Northern States; it is more frequently met with during the winter and spring months than at other times in the year.

Symptoms.--The onset is usually abrupt with a severe chill and chills lasting from fifteen minutes to an hour, with the temperature suddenly rising and an active fever. There is usually intense pain in a few hours, generally in the lower part of the front of the chest, made worse by breathing and coughing. The patient lies on the affected side so as to give all chance for the other lung to work, cheeks are flushed, with anxious expression; the wings of the nostrils move in and out with each breath. The cough is short, dry and painful. Rapid, shallow, jerky breathing, increasing to difficult breathing. On the first day the characteristic expectoration mixed with blood appears (called rusty). Pulse runs from 100 to 116, full bounding, but may be feeble and small in serious cases. After three or four days the pain disappears, the temperature keeps to 104 or 105, but falls quickly the seventh, fifth, eighth, sixth and ninth day in this order of frequency. In a few hours, usually twelve, the temperature falls to normal or below, usually with profuse sweating and with quick relief to all symptoms. This relief from distressing symptoms is, of course, a time of rejoicing to both patient and friends and the patient and nurse may feel inclined to relax a little from the strict observance of rules followed up to this time. Do not, under any circumstances, yield to such folly. Keep patient properly covered, as he is weak from the strain and the pores are open.

[INFECTIOUS DISEASES 219]

Convalescence is usually rapid. A prolonged rise of temperature after the crisis may be regarded as a relapse. Death may occur at any time after the third day from sudden heart failure, or from complications such as pleurisy, nephritis, meningitis, pericarditis, endocarditis, gangrene of the lungs.

MOTHERS' REMEDIES.--1. Lungs, Salt Pork for Inflammation of.--"Salt pork dipped in hot water, then covered thick with black pepper. Heat in the oven and lay or bind on the throat and lungs."

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

3. Lungs, Herb Ointment for Congestion of.--

"Oil of Turpentine 1/2 ounce Oil of Hemlock 1/2 ounce Oil of Peppermint 1/2 ounce Oil of Feverweed 1/2 ounce

Mix this with one cup warm lard."

Rub this ointment on throat or lungs and apply a flannel over it. Heat it through thoroughly with hot cloths. If used thoroughly and the cold is taken in time will prevent pneumonia.

4. Lungs, Mullein for Congestion.--"The mullein leaves may be purchased at any drug store or gathered in the fields. Make a tea of the leaves by steeping them. Add enough water to one tablespoon mullein to make a pint, which will be three doses, taken three times a day." This is a very good remedy.

5. Lungs, Salve for Weak.--

"Bees Wax 1 ounce Rosin 1 ounce Camphor Gum 1 ounce Lard about the size of an egg."

The beeswax forms sort of a coating and may remain on for several hours.

This is very good.

[220 MOTHERS' REMEDIES ]

PHYSICIANS' TREATMENT FOR LUNGS.--The home treatment should be to put the patient to bed and try to produce sweating. This will cause the blood to leave the congested lung and return to the full regular circulation. By doing this, you not only relieve the congested lung, but also the pain. If the patient is stout and strong, give him the "corn sweat" under La Grippe (see index); or you can put bottles of hot water about the patient. Use fruit jars, wrap cloths around them so that you will not burn the patient. Always put one to the feet. If you have a rubber water bag, fill that and put it to his affected side over the pain. After you get him into a sweat you can remove a little, of the sweating remedy at a time and when all are removed give him a tepid water sponging. By this time the physician will be at hand. If you give medicine you can put fifteen drops of the Tincture of Aconite in a glass one-half full of water and give two teaspoonfuls of this every fifteen minutes for four doses. Then give it every one-half hour. Water can be given often, but in small quantities; plain milk alone, or diluted, or beaten with eggs will make a good diet and keep up the strength.

Fomentations.--Cloths wrung out of hot hop tea are often applied to the affected part with good effect. Be careful about wetting the patient. Flaxseed poultices are used.

If used they must be moist and hot. Some doctors are opposed to them. An antiphlogistine poultice is good. Apply it hot. For children you can grease the whole side of the chest, back and front, with camphor and lard and put over that an absorbent cotton jacket. In the early life of the country, home treatment was necessary. Men and women were posted on herbs, etc. Teas made of them were freely and successfully used. A great mistake made was the indiscriminate use of lobelia in too large doses. We have learned that the hot herb drinks in proper doses are of help. Teas made of boneset, hoarhound, pennyroyal, ginger, catnip, hops, slippery elm, etc., were good and are now. They produced the desired result--sweating--and relieved the congestion of the internal organs and re-established the external or (peripheral) circulation. So in the home treatment of pneumonia, etc., if you are so situated that you cannot get a physician use teas internally for sweating, fomentations upon the painful part and if done properly and not too excessively, they will accomplish the desired result. With the corn sweat, I have saved many lives.

ERYSIPELAS.--Erysipelas is an infectious disease, and it is usually caused by a germ which we call "streptococcus pyogenes." The disease shows itself by its local symptoms, pain, swelling, etc., and also by general or constitutional symptoms such as fever, headache, etc., as hereafter given.

Causes.--It is a disease that occurs at any time, and is sometimes epidemic, that is, attacks many persons at a time, like La Grippe. It occurs more often in the spring; it is contagious, and can be carried by a third person or in bedding, etc.

Symptoms.--The type that appears upon the face is the most common. The incubation lasts from three to seven days and it usually comes suddenly with a chill, followed by an active fever and with the local inflammation. In some cases the local condition appears first. There is at first redness, usually of the bridge of the nose and it rapidly spreads to the cheeks, eyes, ears, etc. It is red, shiny hot, drawing, but with a distinct margin at its edges, showing how much skin is inflamed. It may take the form of vesicles. The eyelids may be so swollen as to close, the face and scalp greatly swollen with watery swelling of the eyelids, lips, eyes, ears, etc. The glands under the jaw may become enlarged. The general or constitutional symptoms may be severe. The fever may rise to 104 to 106 and terminates suddenly. The parts that were first affected become pale and more normal, as other parts are involved. It occurs also on other parts of the body. A sting of an insect sometimes looks like it at first; but it does not spread like erysipelas. It seems to me to be more dangerous around the head.

[INFECTIOUS DISEASES 221]

MOTHERS' REMEDIES. 1. Erysipelas, Slippery Elm Bark for.--"Slippery elm used as a wash and taken as a drink." Slippery elm is a very good remedy for this on account of its soothing effect to the affected parts. It is very good to take internally, as it cleanses the system by acting on the bowels and kidneys.

2. Erysipelas, Bean Poultices for.--"White navy beans boiled soft and applied as a poultice to the affected parts and renewed frequently is a sure cure for erysipelas if taken in time." This is a very good and effective poultice, but care should be taken not to use it too long, as the parts will become too soft and might slough.

3. Erysipelas, Soda Wash for.--"Put about a tablespoonful of baking soda in one pint of water and bathe parts several times a day," This is an extremely simple remedy for such a serious disease, but has been known to do good in many cases. The baking soda is soothing.

4. Erysipelas, Easy Remedy for.--"Keep parts well bathed with witch-hazel." A good preparation should be bought. By applying this freely to the affected parts it will be found to have a very soothing effect.

5. Erysipelas, Copperas Liniment for.--"A few cents' worth of common copperas. Make a solution and keep applying it. This kills the poison as it comes on and relieves the pain. I knew of a very bad case to be cured by this treatment."

6. Erysipelas, Cranberry Poultice for.--"Take cranberries and stew them and make a poultice of them." This is a remedy that cannot be beaten for this disease. It gives relief in a very short time and saves the patient a great deal of suffering. If the whisky is used to wet the poultice it is much better, as it keeps the poultice moist longer. All that is necessary is simply to put on more whiskey and it will not be necessary to change the poultice so often.

PHYSICIANS' TREATMENT for Erysipelas.--It is best to separate the patient from the others in the family. Some people very easily take this disease. I know one who cannot be in the room where such a patient is for even five minutes without contracting it.

Local Treatment.--1. Wash the parts with a solution of boric acid, one-half teaspoonful to eight teaspoonfuls of tepid water, put this on the inflamed parts. Then apply a poultice of bruised cranberries. Wash the face each time with the solution before applying the cranberry poultice afresh.

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2. Paint thoroughly with tincture of iodine outside of the margin of the disease where the skin shows no sign of the trouble. This is very effective. If done freely it produces a slight inflammation. The stain made by it remains for some time and that is the objection to it on the face, but do not hesitate on that account if the other remedies do not work well or are not at hand.

3. The following is a splendid local application.--Cleanse thoroughly the inflamed part with pure castile soap and water, and then wash this off with one to one thousand corrosive sublimate solution. Dry the skin with a soft towel and apply a thick coating of equal parts of Ichthyol and vaselin, and over this place antiseptic gauze or sterilized absorbent cotton. Keep this in place with adhesive straps. If the diseased surface is small it may not be necessary to use the gauze, etc.

4. Tincture Chloride of Iron in dose of ten to twenty drops and more if necessary four times a day, well diluted with water. This is very hard on the teeth and should be taken through a glass tube.

Diet.--Milk, broths, etc., liquid diet or foods. (See Nursing Dept. under liquid diet.)

Nursing.--When you nurse any infectious patient, you must be not only careful of your patient, but of yourself. It is not necessary in order to do good nursing to endanger yourself; and a nurse who does not know how to care for herself, cannot successfully nurse the sick. In erysipelas I always watch the eruption closely. Sometimes it recedes, and the patient, of course, is worse. Then there are some people who believe in "pow- wowing." They have that done and then do not take care of themselves. I have attended such cases. One case was especially striking. The "pow-wow" person did his work and then the patient thought himself well and proceeded to enjoy himself and caught cold. The result was the "going in" of the eruption and a beautiful cough. I succeeded in my efforts and the next day he had the erysipelas going along nicely, but no cough. I write this so you will take proper care of yourself and shun conjurers and their "pow-wow."

TOXEMIA, SEPTICEMIA; PYEJMIA.--Toxemia refers to the group of symptoms and lesions caused by the presence in the blood of toxins (poison) usually resulting from bacterial growths.

Septicemia refers to the condition caused by the presence in the blood of bacteria (microbes) as well as toxin.

Pyemia refers to the same condition as septicemia with the development of fresh places of suppuration.

Sapremia is a septic intoxication, the result of the absorption of toxins.

[INFECTIOUS DISEASES 223]

SEPTICEMIA.--The presence of bacteria in the blood, introduced from a local lesion (wound, injury, etc.) or with no obvious local infection.

Symptom.--If there is a local infection, symptoms of this precede the septicemia. The invasion may be sudden or gradual, with chill or chilly feelings, followed by symptoms of active fever and later of an asthenic (absence of strength and feeling) fever, with dry tongue and dullness or delirium. Death may occur in one to seven days.

PYEMIA.--This means the presence in the blood of bacteria with resultant foci (places) of suppuration.

Symptoms.--They are local at first where the lesion is. The invasion of the general infection is marked by a severe chill, then high fever and sweating, repeated daily or at irregular intervals.

Fever is variable with sudden falls. In some cases the fever assumes very weakening type and the patient looks like a case of typhoid fever in the third week, and death soon occurs.

In other cases the chills, fever and sweating are repeated at irregular intervals. The patients are emaciated and the skin has a sallow color. Death usually occurs eventually from exhaustion in a few days or months.

Local Treatment.--This should be attended to from the beginning. If you injure your finger or any part and it soon looks red, and feels sore, open it up thoroughly with a clean instrument and cover it with a clean gauze or cotton. It must not be covered too tightly so that the discharge, if any, can leave the wound. Enough dressing must be put on to absorb that. Then keep the wound clean, and so it can "run" if necessary. If you neglect this or do it carelessly and admit dirt you will make it worse.

See treatment of wounds, etc.

General Treatment.--Keep the strength up in every way. The strength should be kept up by giving nourishing diet that will suit that special case and medicine that will produce a tonic effect, such as quinine and strychnine.

ASIATIC CHOLERA.--This is an acute infectious disease caused by a specific organism and characterized by profuse watery discharges from the bowels and great prostration.

Causes.--Some inherit a weakness, making them more susceptible than others to this disease. Other causes are intemperance, general debility, unhygienic surroundings, exciting causes. The spirillum (cholera asiaticus) found in the stools, watery discharges and intestines of affected cases and its transmission by infected food and water.

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Symptoms.--After an incubation period of about one to five days, the invasion is marked either by simple diarrhea with some general ill-feeling and prostration, or by abdominal pains, vomiting and diarrhea. Mild cases may recover at this time. In the stage of collapse, there are frequent watery movements resembling rice water, with vomiting, great thirst, abdominal pains and eruptions on the legs. There is sudden collapse and temperature that is below normal; nearly all secretions are greatly diminished. In the so-called cases of cholera sicca (dry) death occurs before the diarrhea begins, although a rice water fluid is found in the intestines after death. After two to twenty-four hours those who have not died may recover or pass into the stage of reaction in which the signs of collapse and purging disappear. After improvement, with slight rise of temperature at times, there may be a relapse or the patient may have inflammation of some of the viscera (cavity organs) and suppression of the urine with delirium, coma and death.

The prognosis is worse in infancy, old age and debilitated persons, and in cases of rapid collapse, low temperature and great blueness. Death rate from thirty to eighty per cent.

Treatment.--Isolate the patient and disinfect all discharges and clothing.

Use boiled water during an epidemic.

For pain, morphine hypodermically, and apply hot applications to the abdomen.

For vomiting.--Wash out the stomach and give cocaine, ice, coffee, brandy or water by the mouth. Intestines may be irrigated with a two per cent solution of tannic acid.

During collapse.--Hypodermic of camphor, hot applications to the body. Good nursing and careful diet.

YELLOW FEVER.--Yellow fever is an acute infectious disease characterized by jaundice, hemorrhages, albuminuria (albumin in the urine).

Cause.--It is common in the West Indies and epidemic in nearby countries. It is most common in crowded, dirty, poorly drained portions of sea coast cities. It is probably caused by a specific organism which is conveyed from one person to another by mosquitoes and not in clothing, as formerly believed. One attack usually confers immunity.

Symptoms.--Incubation is about three to four days. There may be a fore-warning period, but the attack is usually sudden, with chills, headache, backache, rise in fever, and general feverish symptoms, vomiting, and constipation. Early in this disease the face is flushed, while the conjunctiva and the mucous membrane lining the eyelids is congested and slightly jaundiced. Fever is 102 or 103 degrees, and falls gradually after one to three days. Pulse is slow, and while the temperature rises, it again falls. The stage of calm follows the fall of the temperature with increased jaundice and vomiting of dark altered blood, the "black vomit." Hemorrhages may also occur into the skin or mucous membranes. Brain symptoms are sometimes severe. Convalescence is usually gradual. The disease varies from great mildness to extreme malignancy. Mortality from fifteen to eighty-five per cent.

[INFECTIOUS DISEASES 225]

Treatment.--Prevent spread of the infectious mosquitoes; use screens and netting in infected districts. Careful nursing, food by rectum while vomiting is frequent. For the hemorrhage opium is given; frequent bathing will keep down the fever; and for the vomiting cocaine is given and cracked ice.

PLAGUE (BUBONIC PLAGUE).--Plague is an infectious disease characterized by inflammation and suppuration of the lymph nodes and cutaneous (skin) hemorrhages. It has long been known as the Plague or "Black Death," on account of its "flea-bite looking eruptions." This disease is becoming a serious matter on our western coast, especially in and around San Francisco. The disease exists in India all the time, and there is now danger of it becoming epidemic (existing all the time) in San Francisco, according to today's, Jan. 10th, Detroit Free Press. Mr. Merriam, chief of the U. S. Bureau of Biological Survey, recently appeared before congress and asked for more money to investigate this and other conditions, and how to stamp out the carriers of this dreadful disease. European wharf rats, introduced about San Francisco, have spread the plague to the ground squirrels, and the gophers, rabbits, field mice, and other rodents are now being infected. In India, fleas on the native squirrel, perpetuate the plague. The way to stop the plague is to kill the carriers.

Causes.--The bacillus pestis (pests) is transmitted through insects, small animals, like rats, through the air, or in clothing, bedding, and is contained in the feces and urine. The poor in unhygienic districts are most often attacked.

Bubonic Type.--In this type the lymph nodes, particularly in the arm-pit, and groins show inflammatory lesions with marked overgrowth of new tissue. Sometimes there is suppuration, hemorrhage and local death of the part. The bacilli are formed in great numbers in the affected nodes and secondary lesions.

Septicemic Type.--In this type all lymph nodes and nodules show signs of toxemia and the bacilli are formed in the primary (first) lesions and in the blood.

Pneumonic Type.--In this type there are areas of broncho-pneumania, with lesions of the bronchial lymph nodes. The bacilli occur in these situations and in the sputa.

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Symptoms.--In the bubonic plague (the usual form) the invasion is marked by headache, depression, pain in the back, stiffness of the extremities and fever. This rises for three or four days, then falls several degrees and is followed by a more severe secondary fever of the prostrating type. At about the third to the fifth day the lymph nodes usually become enlarged most often in the inguinal (groin) region. This is followed by a resolution (getting better) suppuration forming pus or necrosis (local death of the part). "A flea bite looking eruption and hemorrhages from the mucous membrane often occur. The mild cases, which often occur at the beginning of an epidemic, and at its close, are marked only by slight fever and glandular swelling, which may terminate in the forming of pus in the part. In these cases the symptoms are slight and last only a few days."

Septicemic Plague.--This is characterized by symptoms of severe general infection, with hemorrhages, rapid course, and death in three or four days, without the development of swelling of the lymph nodes. Cultures from the blood show bacteria.

Pneumonic Plague.--The symptoms are those of a severe "lobular" pneumonia, with bloody sputum containing many bacilli. It is usually rapidly fatal. Death rate may reach ninety per cent.

Treatment. Prevention.--Prolonged isolation, disinfection of the discharges, cremation of plague victims, destruction of rats, and preventive inoculation of healthy persons with sterilized cultures of the bacillus pestis.

Immunity following this procedure is said to last from one to eighteen months.

For pain, morphine; for weakness, stimulation; for fever, bathing; for buboes, application of ice, injection of bichloride and excision have been advised.

DYSENTERY.--A group of inflammatory intestinal affections, either acute or chronic, and of infectious origin, characterized by frequent painful passages, (containing mucus and blood) or by loose movements.

Acute Catarrhal Dysentery.--This is the most common form in the temperate climate The colon is congested and swollen with a covering of blood-tinged mucus on its mucous membrane.

Symptoms.--The invasion: This is usually marked by diarrhea, then cramp-like general pain in the abdomen and frequent mucous, bloody stools, accompanied by hard straining at stool. The temperature may reach 102 to 103 degrees. After one or two days the stools consist entirely of bloody mucus and are very frequent. The thirst is great. In about one week the stools may become normal.

MOTHERS' REMEDIES. 1. Dysentery, Sweet Cream for.--"One or two teaspoonfuls of thick cream every hour. Three doses is usually sufficient. (This remedy proved successful with my baby when all others failed)."

2. Dysentery, One Ounce Dewberry Root for.--"Boil in one quart of water one ounce of dewberry root. This should be boiled down to one-half pint and a half wineglassful given to patient two or three times a day, or in severe cases, a half wineglassful every two or three hours until discharge diminishes."

INFECTIOUS DISEASES 227

3. Dysentery, "Colt Tail" Remedy for.--"The herb called "Colt Tail," steep and drink the tea. It's a tall weed and grows in damp places. It is one of the best herbs for this." This is especially good when the discharge from the bowels is bloody or contains mucus.

4. Dysentery, Sugar and Brandy for.--"Two tablespoonfuls brandy poured into a saucer. Set fire to the brandy and hold in flame lump of sugar on fork. This is a very good remedy, and has cured cases when doctors' remedies failed. This sugar will melt and form a syrup. Dose:--One-half teaspoonful every two hours or oftener if necessary."

5. Dysentery, Herb Remedy for.--"Take four ounces poplar bark, four ounces bayberry bark and three ounces tormentil root, simmer gently in four quarts of water, down to three, strain and add two pounds granulated sugar; let it come to boiling point, skim and add one-half pound blackberry or peach jelly and one-half pint best brandy. Keep in a cool place, take one-half wineglassful three or four times a day or more often if required."

6. Dysentery, New Method to Cure.--"A hot hip bath will often relieve distressing sensations of dysentery or itching piles." This is a very simple remedy and will have a very soothing effect upon the whole system, relieving any nervousness that may be present and usually is with this disease.

7. Dysentery, Starch Injection for.--"Use injection of one cup thin boiled starch, and one-half teaspoonful laudanum. Repeat every 3 to 4 hours."

8. Dysentery, To Cure Bloody.--"Put a teaspoonful of salt into a quart of warm water and inject into the bowels to wash them out thoroughly."

PHYSICIANS' TREATMENT for Dysentery.--Remain in bed on fluid diet, and give a free saline cathartic or castor on, one-half ounce, followed by salol five grains in capsules every three hours.

2. Bismuth subnitrate, one-half to one dram every two to three hours.

3. Irrigation of the colon with normal salt solution or weak solution of silver nitrate at about one hundred degrees with a long rectual tube. Dr. Hare, of Philadelphia, recommends one two-hundredth grain of bichloride of mercury every hour or two (in adults), if the stools are slimy and bloody and if much blood is present, and high rectal injections of witch-hazel water and water, half and half. I know this last is good, and also the following; Oil of fireweed, five drops on sugar every two to three hours.

4. Ipecac.--In acute dysentery ipecac is one of the best remedies, Dr. Hare says; "When the passages are large and bloody and the disease is malignant as it occurs in the tropics, ipecac should be given in the following manner: The powdered ipecac is to be administered on an empty stomach in the dose of thirty grains with thirty drops of the tincture of deodorized opium, which is used to decrease the tendency to vomit. Absolute rest is essential for its success. Finally a profuse gray, mushy stool is passed." This is a favorable sign.

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Nursing and Diet.--The patient should always remain in bed and use bed-pan. He must be given a bland, unirritating diet, composed of milk, with lime-water, beef peptonoids, broth, egg albumin, etc., in acute cases.

MALARIA FEVER.--Malarial fever is a group of diseases characterized by intermittent, quotidian (daily), tertian (every other day) or quartan (every fourth day) fever or remittent fever; there are also several pernicious types of this disease and chronic malarial condition of the system with enlargement of the spleen.

Causes.--It occurs most frequently in low lands, along sea coasts, and swamps, particularly in the tropics and warmer portion of the temperate zone. The exciting cause it what is called the plasmodous malarial, a parasite developing in the body of all species of anopheles, a common form of mosquito and transmitted to man, its intermediate host, by the bite of the infected mosquitoes.

INTERMITTENT MALARIAL FEVER. (a) Tertian. (b) Quartan. (c) Quotidian. Symptoms.--The symptoms of all these are the same, except that in tertian fever, the paroxysms occur every third day; in quartan they occur every fourth day. Quotidian occurs daily.

The incubation time is unknown. It consists usually of three stages, cold, hot, and sweating, and they usually occur in the morning. "The cold stage is ushered in by yawning, lassitude and headache, and rapid rise of temperature; sometimes nausea and vomiting followed by shivering and rather violent shaking with chattering of the teeth." It may last from ten minutes to two hours. The internal temperature may rise to 104 to 106 degrees, while the surface is blue and cold, with severe headache, often nausea and vomiting. Hot stage: this may last from one-half to five hours; the temperature may increase somewhat, the face is flushed, the skin is red and hot, great thirst, throbbing headache and full bounding pulse. Sweating stage lasts two to four hours, and entire body may be covered; fever and other symptoms abate and sleep usually follows. The patient feels nearly well between attacks.

REMITTENT OR CONTINUOUS MALARIAL FEVER (Aestivo-Autumnal Fever).--This form occurs in the temperate zone regions, especially in the summer and autumn. The symptoms vary greatly. The fever may be irregularly intermittent, but at longer intervals than the Tertian variety. The cold stage is often absent, and in the hot the temperature falls gradually. The appearance is often like typhoid for there may be then hardly any remission of fever.

[INFECTIOUS DISEASES 229]

PERNICIOUS MALARIAL FEVER.--This is a very dangerous disease. The chief forms are the comatose, algid and hemorrhagic.

(a) Comatose form is characterized by delirium or sudden coma (deep sleep) with light temperature.

(b) The algid or asthenic form begins with vomiting and great prostration. The temperature is normal or below normal. There may be diarrhea and suppression of the urine.

(c) The hemorrhagic form includes malarial hemoglobinuria, hemoglobin in the urine. Haemoglobin is the coloring matter of the red corpuscles.

Treatment. Prevention.--Destroy mosquitoes and protect from them by screens. Small preventive doses of quinine for persons in malarious regions, three grains three times a day. Five grains three times a day will nearly always cure tertian and quartan cases, especially if the patient is kept in bed until the time for one or two paroxysms has passed. Attacks often stop spontaneously for a time when the patient is kept in bed, even without the administration of quinine.

In Remittent Fever larger doses are necessary. For pernicious forms: Hydrochlorate of quinine and urea ten to twenty grains, given hypodermically, every three or four hours until improvement occurs, when the sulphate of quinine by the mouth may be substituted.

AGUE. (See Malarial Fever.)--By ague is meant the cold chills and fever; or dumb ague where there is little chill, mostly chilly and fever. These attacks may come on every day, every other day, or every third day.

MOTHERS' REMEDIES. 1. Ague and Fever, Dogwood Good for.--"Take one ounce of dogwood root and one quart of water. Make an infusion by boiling down to one-half pint. Strain and give one-half wineglassful every two or three hours."

2. Ague in Face, Menthol and Alcohol Effective Remedy for.--"After making a solution of teaspoonful of menthol crystals, dissolved in two ounces of alcohol, apply several times a day to the face. Care should be taken that this solution does not enter the eyes, as it would be injurious,"

3. Ague, Simple Remedy for.--"Give purgative and follow with quinine. Give large 4 grain capsule every four hours.

MOTHERS' REMEDIES. 1. Chills and Fever, Peruvian Bark and Rhubarb for.--

"Pure Rye Whisky 4 ounces Pulverized Peruvian Bark 1 dram Pulverized Rhubarb 1 ounce

Mix.

Put in bottles. Dose for adults:--One tablespoonful three times a day. This is an excellent remedy."

[230 MOTHERS' REMEDIES]

2. Chills and Fever, Horse-radish for.--"Take fresh green horseradish leaves, bruise and mash them to the consistency of a poultice and bind on the bottom of the feet. This will tend to reduce the fever and is a reliable remedy. I have often used this with great satisfaction."

3. Chills and Fever, Dogwood Known to be Good for.--"Make a decoction of one ounce of dogwood root, boiled in one quart of water down to one pint; strain, and give half wineglassful every two or three hours." This remedy has been used by our grandmothers for many years, and is one to be depended upon. The dogwood root can be purchased at any drug store.

Treatment.--For acute cases quinine in various doses. I usually prescribe two grains every two hours until the ears ring, and then take only enough to keep them in that condition.

It is well always to see that the bowels and liver are active before taking quinine. The medicine acts better when the patient remains quiet in bed. If the chill and fever comes on every day, the quinine should be taken every hour between the paroxysms.

MALTA FEVER.--This occurs in the Mediterranean countries, India, China, the Philippines and Porto Rico. The fever is irregular or marked by intervals of "no fever" for two or more days with febrile relapses lasting one to three weeks. Constipation, anemia (scarcity of blood), joint symptoms and debility exist. Ordinary cases may last three months to two years. Mortality two per cent.

Treatment.--Like that for typhoid. Change climate, if possible.

BERI-BERI.--Beri-beri is a disease rarely occurring in the United States. It is usually found in the warmer climates and peculiar to certain regions such as India, and Japan.

It is characterized by paralysis and fatal effusion, also neuritis, which is an inflammation of the nerves. It seems to be undecided among the medical profession as to whether the disease is infectious or not. Some claim it is brought on by the eating of bad rice or certain raw fish. Young men in those climates seem to be most susceptible to beri-beri.

Treatment.--There is very little known about this disease. Fortunately it does not often occur here. It is necessary to keep up the strength by food and tonics and relieve the pain.

ANTHRAX. (Charbon, Wool Sorters' Disease, Splenic Fever).--This is "an acute infectious disease of animals, transmitted to man by inoculation into the wounds, or by inhalation of, or swallowing the germs." Butchers, tanners and shepherds are most liable to it. The exciting cause is the bacillus anthracis (anthrax bacillus). The local skin condition is a pustule containing the bacilli, which may also invade the general circulation. If the germs are inhaled, there is broncho-pneumonia; if swallowed, areas of inflammation and local death occur in the intestines. The spleen and lymph nodes are enlarged.

[INFECTIOUS DISEASES 231]

Symptoms. 1. External anthrax, malignant pustule. This begins in a papule (pimple) at the point of inoculation turning into a vesicle and then a pustule, (blister-like pimple) surrounded by an inflammatory area (space) with marked watery swelling. The nearby glands are enlarged and tender. At first the temperature rapidly rises; later it may be below normal. The fever symptoms may be severe. Recovery takes place slowly. Death occurs in three to five days.

MALIGNANT ANTHRAX (swelling).--In this lesion is a pustule, with very marked swelling. It most frequently occurs on the eyelid and face and the swelling may terminate in fatal gangrene.

2. Internal anthrax.--(a) Internal anthrax is caused by the introduction of the bacteria into the alimentary canal in infected meat, milk, etc. The invasion is marked by a chill, followed by moderate fever, vomiting, diarrhea, pain in the back and legs and restlessness. Sometimes convulsions occur and hemorrhages into the skin from the mucous membranes. The spleen is swollen. Prostration is extreme and it often ends in death.

(b) Charbon or Wool Sorter's disease occurs among those employed in picking over wool or hair of infected animals--the germs being inhaled or swallowed. The onset is sudden with a chill, then fever, pain in the back and legs, and severe prostration. There may be difficulty of breathing and signs of bronchitis, or vomiting and diarrhea. Death is a common termination, sometimes within a day. Death rate is from five to twenty-six per cent. Greatest when the swelling is near the head.

Treatment.--The wound or swelling should be cauterized and a solution of carbolic acid or bichloride of mercury injected around it and applied to its surface. Stimulants and feeding are important.

LOCKJAW. (Tetanus).--Tetanus or lockjaw, as it is commonly called, is an infectious disease and is characterized by painful and violent contractions of the voluntary muscles; it may be of the jaw alone or of a considerable part of the body.

Causes.--The intelligence and mental faculties are not impaired. In most cases it follows a wound or injury, although in others there seems to be no exciting causes. Fourth of July celebrations furnish a great many of our lockjaw cases. Ten to fifteen days usually elapse after the wound before lockjaw really sets in.

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Symptoms.--It comes on occasionally with a chill or chilly feelings; usually by rigidity (stiffness) of the neck, jaw and face. On arising in the morning there is sometimes a stiffness of the muscles at the back of the head. It is not unusual on taking a slight cold to have a stiff neck and often the patient's attention is not attracted by this symptom. Sometimes this stiffness begins or soon extends to the muscles of the lower jaw; the throat becomes dry and is painful and gradually the stiffness increases to a continuous contraction, spasm, and extends to the muscles of the trunk and extremities. The body becomes rigid in a straight line or bent backward, forward or sidewise. This spasm occurs after any slight irritation and is extremely painful. Temperature is usually low. During the first spasms the patient may attempt to open his mouth as he may naturally be suspicious of the trouble that is coming; he succeeds with difficulty and even finds it hard to swallow; soon the jaws may be firmly closed, and it is from this feature of the disease that it gained the name of lockjaw. The contractions in some cases do not extend beyond the neck and face muscles. During the contractions the face may be drawn into frightful contortions. Food can be given only through such spaces as may exist between the teeth, as often the patient cannot open his mouth himself, nor can it be pried open by any force that would be allowable. When the muscles of the trunk are affected the abdomen may be drawn inward, become very hard and stiff, chest movements are affected, making it difficult to breathe, sometimes almost to suffocation. Sometimes the body becomes bent like a bow, as in some cases of spinal meningitis, so that only the head and heels support the weight of the body. The body may become so rigid that it can be lifted by a single limb as you would a statue. It is fortunate that there are few cases, comparatively, of lockjaw as the distorted face and general contractions of the body are painful to witness.

Recovery.--The mortality in lockjaw cases runs about eight per cent. Sometimes death is caused by exhaustion from the muscular exertions; the patient is seldom able to sleep and sometimes wears out in a few days. Sometimes suffocation brings a sudden end to his sufferings and usually one or two days to ten or twelve days is the limit. Among the lower classes where sanitary science is seldom observed, and even among the better classes, lockjaw has been known to occur in infants. It usually comes on, in ten to fifteen days after birth, and the child seldom lives more than a few days, It is hard to account for such cases which may come on suddenly from the slightest excitement such as sudden noises, etc.

MOTHERS' REMEDIES.--l. Lockjaw, Successful Remedy for.--"A very good and successful remedy for this disease, is to apply a warm poultice of flaxseed meal, saturated with laudanum and sugar of lead water, to the jaws and neck."

2. Lockjaw, Smoke as a Cure for.--"Smoke the wound for twenty minutes in the smoke of burnt woolen cloths. This is considered a never failing remedy."

[INFECTIOUS DISEASES 233]

PHYSICIANS' TREATMENT.--If from a wound cut open and use antiseptics. Isolate the patient and have absolute quiet. Antitoxin is used with success in some cases of lockjaw, but this and other remedies or measures must be handled by a physician, Opium is sometimes given and stimulants such as brandy, whisky, etc. As it is a case of life or death in a very short time, we cannot advise depending upon home treatment. A preventive caution that must always be observed is the use of antiseptics and the strictest care of all injuries and wounds that might result in lockjaw. This is a disease where an ounce of prevention is worth a thousand pounds of cure, because by the time the disease is recognized as lockjaw and has really made an appearance, it may be too late for medical skill. While you are waiting for the doctor you may apply cold cloths or even an ice bag to the spine. If the spasms are severe let the patient inhale chloroform to kill the pain and quiet him. In the meantime secure the best physician within your reach, and follow his directions carefully, be calm and self- possessed when in the presence of the patient, for you must remember that he has full possession of his mental faculties and will notice every evidence of fear or worry in the faces of those who are nursing him. This will only add to his sufferings, affect his nervous system and undermine his general vitality. Read carefully the nursing department in this book and you will gain some valuable hints and knowledge regarding the sick room.

GLANDERS.--This is an acute disease of the horse and occasionally of man. It is called "glanders" when the affection appears in the nostrils, and is called "farcy" when in the skin.

Causes.--The bacilli is usually introduced from infected horses through the nose, mouth and cheek, mucous membranes or skin abrasions (rubbing off of the skin). There are large or small lumps in the skin, mucous membrane of the nose and mouth.

Symptoms. Acute Glanders.--1. Incubation lasts from three to four days. There are signs of inflammation at the site of infection and general symptoms. In two or three days, small lumps appear on the mucous membrane of the nose, and ulcerate, with a discharge of mucus and pus. Sometimes these nodules die locally, and their discharge is then foul. The glands around the neck are enlarged. An eruption appears over the face and joints. Inflammation of the lungs may occur. Death may take place in eight to ten days.

2. Chronic Glanders.--This may last for months. It acts like chronic cold with ulcer in the nose. Some recover.

3. Acute Farcy.--The local and general signs are those of an infection, with necrosis (local death) at the site (in the skin) of inoculation; nodules, (lumps) known as "farcy buds" form along the lymphatics (glands) and form pus. There may be pus collections in the joints and muscles. Death often occurs in one to five days.

Chronic Farcy.--Tumors in the skin of the extremities, containing pus. The process is local, the inflammatory symptoms light, and the duration may be months or years.

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Treatment of Glanders.--This disease does not often occur in man; it is an awful affliction. All infected horses must be killed, it is dangerous for man to be around one. If seen early, the wound should be cut out or burned out with caustics, and afterwards dressed like any wound. The "farcy buds" should be opened early. There is very little hope in acute cases of glanders. In chronic cases recovery is possible, but it will be after a long tedious time. There must be proper nourishing food and tonic medicines. Each case should be treated according to the indications. It is safe to say the parts should be thoroughly cut or scraped out and then treated with antiseptics and the general system built up, by tonics and stimulating remedies, if needed. As stated before, acute glanders and acute farcy are almost always fatal.

BIG-JAW OR LUMP-JAW. (Actinomycosis).--This is an infectious disease of cattle, less frequently of man, and it is caused by what is called the "ray fungus." This grows in the tissues and develops a mass with a secondary chronic inflammation.

This disease is widespread among cattle, and also occurs in the pig. In the ox it is called the "big jaw." The infection may be taken in with the food, and it locates itself often in the mouth or surroundings. Oats, barley, and rye may carry the germ to the animals. The fungus may be found even in decayed teeth.

Alimentary Canal Type.--The jaw has been affected in man. One side of the face is swollen or there may be a chronic enlargement of the jaw, which may look like a sarcoma (tumor). The tongue also is sometimes affected and shows small growths. It may also occur in the intestines and liver. There is at first a tumor (lump), and this finally suppurates.

In the Lungs.--They also can be affected. It is chronic here and there is cough, fever, wasting and an expectoration of mucus and pus, sometimes of a very bad odor (fetid). It sometimes acts like miliary tuberculosis of the lungs, and this is quite frequent in oxen. Other diseases of the lungs and bronchial affections occur and abscesses and cavities are formed that may be diagnosed during life.

Symptoms.--If in the jaw there may be toothache, difficulty of swallowing and of opening the jaw. The adjacent muscles may be hardened (indurated). A swelling appears at the angle of the jaw and this quickly passes into suppuration; later it opens first outside, then inside--into the mouth and discharges pus containing little yellow masses. It will extend down even into the bowels unless it is properly treated. Then there will be stomach disturbances and diarrhea. It may ulcerate through the bowels and cause peritonitis. The liver, spleen and ovaries may also become affected.

The Skin.--There may be chronic suppurating ulcers of the skin and the "ray fungus" can be found in them.

Diagnosis.--The "ray fungus" can be found. There is a wooden hardness of the tissues beyond the borders of the ulcers; there are the little yellow granules in the pus. The course is chronic. Mild cases recover in six to nine months or earlier, the mouth form being the most favorable.

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Treatment.--Surgical. Remove the parts involved. Internally, iodide of potash in large doses is recommended. The food should be plenty and nourishing. In this case we must recommend you to a physician instead of the home treatments.

GONORRHEA (Urethritis).--This can be called an infectious inflammation of the urethra, caused by the gonococcus, a microbe or germ, causing a specific inflammation of the mucous membrane of the urethra or vagina.

Incubation.--The time that elapses between the exposure and development of the symptoms in the urethra is variable, extending from a few hours to twelve or fourteen days. In the great majority of cases, however, the disease appears during the first week. The patient notices a drop of milk-like fluid at the opening of the urethra, which is slight, red and puffed or turned out; a tickling sensation is often felt in this locality, and the next time urine is passed it is attended with a feeling of warmth at the end of the canal, or with actual scalding. After this the symptoms increase rapidly in number and severity, so that within forty-eight hours, or even sooner, the disease may be described as having passed its first or increasing stage, the characteristic phenomena of which are as follows:

Changes in the meatus (opening). There are redness, eversion (turning out), ulceration and eating away and often erosion of the lips of the opening of urethra. Sometimes, but rarely, so much swelling that the person can hardly pass the urine, which drops away. The other symptoms are too well-known by those who have had this disease to need a description.

Prognosis.--It is now considered more than a cold, and it is the cause of terrible sickness in both sexes, among the innocent as well as the guilty.

Treatment.--It may be cured perhaps in a short time, and yet no one can be certain of its absolute cure. This disease is better understood now, and the treatment is entirely different from formerly. The strong injections are now considered not only useless but dangerous to the future health of the patient. The best treatment is mild antiseptic injections, irrigation carefully done by an expert person; remaining quietly in bed, being careful to use food and drink that are not stimulating, keeping the bowels open by proper diet and mild laxatives and the urine mild by soothing diuretic remedies. Unfortunately those affected want quick work and they get it, frequently to their future sorrow. The following are good injections. Before each injection the urine should be passed and an injection of an antiseptic like listerine, etc., one dram to an ounce of boiled water, to cleanse the canal. You can use twice a day the following:

Fluid Extract Hydrastis (colored) 1 dram Water 1 ounce

Use one dram of this for each injection. It stains the clothes so you must be careful. This is good and healing.

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GONORRHEAL ARTHITIS. (Gonorrheal Rheumatism, Inflammation of the Joints).--This is more common in men than women. Occurring during, and at the end of or after inflammation of the urethra. It usually involves many joints, such as the temporal, maxillary and collar bone. The effusion in the joints is usually serious.

Symptoms.--Variable joint pains may be the only one. The attack may resemble an acute articular rheumatism of one joint, or a subacute rheumatism of one or more.

Sometimes there is a chronic one-jointed inflammation usually of the knee. The tendon sheaths and bursae may be involved alone, or with the joints. Gonorrheal septicemia may result from arthritis. This is protracted. Iritis is a most frequent complication. The urethra source of the infection must be cured.

Treatment.--Keep the joint quiet and you can use an ice cap for the pain. Tonic treatment with quinine, iron, and arsenic in chronic cases is needed. The joints should be kept at rest in acute cases. In chronic cases massage and slight motion. The tonics must be chosen for each individual case. One afflicted with this must be under treatment for a long time.

HIP JOINT DISEASE. (Morbus Coxarius).--This is more common in children than in adults.

Cause.--It is usually tubercular.

Symptoms. First stage.--It may be overlooked; slight lameness, a little stiffness is noticed at times. The muscles begin to dwindle.

Second stage.--Child limps very perceptibly, dwindling is more apparent. Pain appears.

Treatment.--Absolute rest. Lying down treatment if begun early arrests this disease often. Build up the system. Splints and brace are needed sometimes.

KNEE JOINT DISEASE. (White Swelling).--This is simply a tuberculous knee.

Treatment.--Rest. Stop motion of the joint by some form of splint or plaster of Paris cast. Get a good physician at the beginning in these cases and you will save lots of after worry and blame for yourself. It does not pay to wait. These joint diseases will progress, and often treatment is begun months after trouble is seated. It ought to be criminal negligence and dealt with accordingly to neglect such diseases. Parents should never forget that they have endowed their children with such a constitution, and they should be glad and willing to correct it as far as they can.

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LEPROSY. Definition.--Leprosy is a chronic infectious disease, caused by what is called the "Bacillus Leprae," and is characterized by the presence of tubercular nodules in the skin and mucous membranes (tubercular leprosy), or by changes in the nerves (anaesthetic leprosy). These forms are separate at first, but ultimately they are combined and there are disturbances of sensation in the characteristic tubercular form.

History.--Leprosy is supposed to have originated in the Orient, and to be as old as the records of history. It appears to have prevailed in Egypt even so far back as three or four thousand years before Christ. The Hebrew writers make many references to it, and it is no doubt described in Leviticus. The affection was also known both in India and China many centuries before the Christian era. The old Greek and Roman physicians were familiar with its manifestations, ancient Peruvian pottery represent on their pieces deformities suggestive of this disease. The disease prevailed extensively in Europe throughout the middle ages and the number of leper asylums has been estimated at, at least, 20,000. Its prevalence is now restricted in the lands where it still occurs while once it was prominent in the list of scourges of the old world.

It is now found in Norway and to a less extent in Sweden, in Bulgaria, Greece, Russia, Austro-Hungary and Italy, with much reduced percentage in middle Europe; it is the rarest of diseases in England where once it existed. In India, Java, and China, in Egypt, Algiers, and Southern Africa, in Australia and in both North and South America, including particularly Central America, Cuba, and the Antilles, it exists to a less extent. It has been recognized in the United States chiefly in New Orleans, San Francisco, (predominantly among the Chinese population of that city). The disease has steadily decreased among the latter colonists in Minnesota, Wisconsin and Iowa. Isolated cases have been recognized in almost every state, and leprous cases are presented at the public charities of New York, Philadelphia, Boston, etc. The estimated number of lepers a few years ago in the United States varied between two hundred and five hundred. It is represented as diminishing in frequency in the Hawaiian Islands, Porto Rico and the Philippines. In the Hawaiian Islands it spread rapidly after 1860, and strenuous attempts have been made to stamp it out by segregating all lepers on the island of Molokai. There were 1,152 lepers in that settlement in 1894. In British India, according to the leprosy commission, there were 100,000 lepers in 1900.

Cause.--The bacillus, discovered by Hansen, of Bergen, in 1874, is universally recognized as the cause of leprosy. It has many points of resemblance to the tubercle bacillus. These bacilli have been found in the dwellings and clothing of lepers as well as in the dust of apartments occupied by the victims.

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The usual vehicle by which the disease is transmitted is the secretions of a leprous patient containing bacilli or spores. The question of inheritance of leprosy is regarded now as standing in the same position as that relating to the inheritance of tuberculosis; no foetus, no new-born living child, has been known to exhibit the symptoms of either disease. Several cases have been cited where infants but a few weeks old exhibited symptoms of leprosy. It affects men more than women. Infection is more common after the second decade, though children are occasionally among its victims. When it occurs in countries where it had not previously existed, its appearance is invariably due to the infection of sound individuals by lepers first exhibiting symptoms where the disease is prevalent.

Neisser states this: "The number of lepers in any country bears an inverse ratio to the laws executed for the care and isolation of infected persons. The disease appears to spread more rapidly in damp and cold, or warm and moist, climates than in temperate countries. It is not now regarded as contagious. The leprosy of the book of Leviticus not only includes lepra, as that term is understood today, but also psoriasis, scabies and other skin affections," The leper, in the eye of the Mosaic law, was ceremoniously unclean, and capable of communicating a ceremonial uncleanness. Several of the narratives contained in the Bible bear witness to the fact that the Oriental leper was seen occasionally doing service in the courts of kings, and even in personal communication and contact with officers of high rank.

Symptoms.--Previous symptoms: Want of appetite, headache, chills, alternating with mild or severe feverish attacks, depression, nosebleed, stomach and bowel disturbances, sleeplessness. The durations of these symptoms is variable. Some patients will remember that these symptoms preceded for years the earliest outbreak of lepra (leprosy). In other cases only a few weeks elapsed. These earlier skin lesions are tubercular, macular (patches), or bullous elevations of the horny layer of the skin. It may then be divided into three varieties tuberculous, macular and anaesthetic.

LEPRA TUBEROSA. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy).-- This nodular type comprises from ten to fifty per cent of cases. After the occurring of the symptoms just mentioned spotted lesions appear, which are bean to tomato in size, reddish brown or bronze-hued patches, roundish, oval or irregular in contour, well defined, and they occur upon the face, trunk and extremities. The skin covering them is either smooth and shining, as if oiled, or is infiltrated, nodulated and elevated. The surface of the reddened spots is often oversensitive.

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After a period ranging from weeks to years, tubercles rise from the spots described, varying in size from a pea to that of a nut, and they may be as large as a tomato. They are in color, yellowish, reddish-brown, or bronzed, often shining as if varnished or oiled, are covered with a soft, natural, or slightly scaling outer skin, roundish or irregular in shape and are isolated or grouped numbers of very small and ill-determined nodules may often be seen by careful examination of the skin in the vicinity of those that are developed. They may run together and cause broad infiltrations and from this surface new nodules spring. They may be in the skin or under the skin and feel soft or firm. The eruption of these tubercles is usually preceded at the onset by fever, as well as by puffy swelling of the involved region, eyelids, ears, etc. These leprous tubercles choose the face as their favored site. They mass here in great numbers, and thus produce the characteristic deformity of the countenance that has given to the disease one of its names, Leontiasis (lion face).

In such faces the tubercles arrange themselves in parallel series above the brows down to the nose, over the cheeks, lips and chin, and as a result of the infiltration and development of the conditions the brows deeply over-hang; the globes of the eyes, and the ears, are so studded with tubercular masses as to stand out from the side of the head. The trunk and extremities, including the palms of the hands and soles of the feet, are then usually involved to a less degree. The arm-pit, genital and mammary regions, and more rarely the neck and the palms of the hands and soles of the feet, may be invaded. In occasional cases when the development of tubercles upon the face and ears is extensive, there may not be more than from five to fifty upon the rest of the body, and these either widely scattered and isolated or agglomerated in a single hard, flat, elevated plaque of infiltration upon the elbow or thigh. When the tubercles run together (become confluent) large plaques of infiltration may form, which are elevated and brownish or blackish in color.

The soft palate and larynx are often involved when the skin lesions are present. The voice may sound gruff and hoarse, and the tongue, the larynx and soft palate have been found studded with small sized, ashen-hued tubercles. These tumors or tubercles may degenerate and form into irregularly outlined, sharply cut, glazed ulcers, with a bloody or sloughing floor, or they may disappear and leave behind pigmented, shrunken depressions, or they lose their shapes from partial resorption. A large plaque may flatten in the center until an annular disk is left to show its former location. Coincident symptoms are disturbance in the functions of the sweat and sebaceous secretion, thinning and loss of hair in the regions involved, especially the eyebrows, and disorders of sensibility. Later results, are a nasal catarrh, atrophy of the sexual organs in both sexes, with impairment or loss of procreative power, hopeless blindness. However the course of the disease is very slow, and years may elapse before these several changes are accomplished. Often the disease appears quiescent for months at a time, after which fever occurs and with it acute or sub-acute manifestations appear, including gland disease, orchitis, ulcerative processes, slow or rapid, followed by gangrene and a relatively rapid progress is made toward a fatal conclusion.

Toward the last the mutilations effected by the disease may result. Parts of the fingers or toes, whole fingers or toes, and entire hand or foot may become wholly or partially detached by the ulcerative and other degenerations. This stage of this type of the disease may extend through ten or more years. After it has fully developed the dejected countenance of the leper, with his leonine expression and general appearance is highly characteristic.

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LEPRA MACULOSA.--This form is more common in tropical countries and is distinguished chiefly by its macular (spotty) lesions. In size they vary from a small coin to areas as large as a platter. They are diffused or circumscribed, roundish or shaped irregularly, yellowish, brownish or bronzed in color, often shiny or glazed. They may be infiltrated and may be elevated, or on a level with the adjacent tissues. The patches are usually at first very sensitive, but they finally become insensitive, so that a knife can be thrust deeply into them without being felt. The regions chiefly affected by this type are the back, exposed parts, the backs of the hands and wrists, the forehead, the cheeks, ears, back of the feet, and ankles. The eruptions may be scanty or general; conspicuous or insignificant. The eruptive symptoms are associated commonly, early or late, with the serious phenomena described below.

LEPRA ANAESTHETICA. (Nerve Leprosy. Atrophic Leprosy. Lepra Trophoneurotica).--Before the development of this form of leprosy there may be one or two years of ill-health. Usually the skin at this time becomes in localized patches over-sensitive, sometimes there is over-sensitiveness and special nerves, because of their enlargement, become accessible to the touch. Those named later become tender, and the seat of lancinating or shooting pains. This clinical variety may be commingled in its symptoms with each of the other types. With or without such commingling, however, there commonly is noted, after exposure to cold or after being subject to chills first an eruption, red (erythematous) patches, or of "bullae," size of a bean on cheeks, ears, back of the feet, and ankles. The eruption may be outer skin covering (epidermis) and filled with a clear tinted or blood-mixed serum, and usually occurring upon the extremities. The scars that follow are shrunken (atrophic) patches, each often greater in extent than the base of the original trouble, color whitish, shiny, glazed, or better described as a tint suggesting the hue of mica; their outline is circular and form also the dumb-bell figure by running (coalescing) together, or juxtaposition. These scars are always without sensitiveness (anaesthetic), and they may exist together with spotted and non-sensitive patches upon the trunk or other parts such as the face, hands, feet, ankles, thighs, but rarely on the palms and soles. Neither those of the one class nor of the other, however, are disposed over the surface of the body in lines, bands or curves, corresponding with the distribution of the skin (cutaneous) nerves. Sometimes the ulnar and other nerves (median, posterior tibial, peroneal, facial and radial) that are accessible to the touch are swollen, tender, insensitive or as rigid as hardened cords. Reddish-gray swellings may be recognized by the eye along the nerve tract. General shrinking skin symptoms follow. The skin becomes dry and harsh; there is little or no sebaceous product and the skin of the face seems tightly drawn over the bones. As a consequence of deforming shrinking (atrophy) of the eyelids, a persistent overflow of tears, consequent eye changes follow, and a constant flow of saliva escapes from the parted lips. The fingers are half drawn into the palm of the hands; the nails are distorted and ulceration occurs later. These ulcers are irregular, oval, roundish or linear in form covered with thin blackish, flattened, tenacious crusts with soft bases, and their floors covered with a soft debris mixed with blood, the whole insensitive to every foreign body, and external application. At last the symptoms of mutilating lepra (leprosy) may occur, digits or portions of the wrist, part of hand (meta carpus) or corresponding portions of the foot may be detached from the body. Death may occur at any time during the course of the disease. In this form it is said to last from eighteen to twenty years and is thus not so rapidly fatal as the tubercular variety.

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Treatment.--The main treatment is the isolation and segregation of all lepers from contact with the well; wholesome laws are enforced in some countries where leprosy prevails, and provision is made not only for the isolation and segregation, but also for their care. On account of its relative variety America has not yet awakened and legislation only forbids the entry of infected persons. At Molokai, in the Hawaiian Islands, provision is made for the care of lepers. Many of the public hospitals for the care of the sick poor refuse to receive lepers. The child of a leprous woman should be removed from the mother after birth and not nursed by another woman. No medicines are known to have any curative effect. An immediate change of residence and climate should be made if the patient happens to live in a district where the disease prevails. A highly nutritious diet should be taken.

The outlook.--The future is in general dark for the leper. It is often of a malignant character, and a fatal result is the rule. A change of climate and conditions may help. Scandinavian lepers who have removed to the United States have been greatly benefited by the change, but there is no known cure. The isolation should be as effective as that for tuberculosis. It is not contagious but infectious.

HYDROPHOBIA.--Rabies and hydrophobia are two different terms, meaning the same disease, the former meaning to rage or become mad. This term applies more especially to the disease as it exists in the maniacal form in the lower animals, while hydrophobia comes from the Greek, meaning "dread of water." As we occasionally find this dread of water only in the human subject, the term is properly used in such a case. The lower animals frequently attempt to drink water even though the act brings on a spasmodic contraction of the swallowing (deglutitory) muscles. Hydrophobia is an acute infectious disease communicated to man by the bite of an animal suffering from rabies. It is due to a definite specific virus which is transmitted through the saliva by the bite of a rabid animal. Its natural habitat (location) is the nervous system, and it does not retain its virulence when introduced into any other system of organs. It is essentially a nervous disease and transmitted by the saliva of rabid animals. When inoculated into a wound this virus must come in contact with a broken nerve trunk in order to survive and reproduce itself. If by accident it attacks the end of the broken nerve trunk, it slowly and gradually extends to the higher nerve centers and eventually produces the disease.

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The incubation, or the time it takes for the disease to develop, varies, but usually is from three to six months. There is a recorded case where the person began to show symptoms of the disease thirteen days after having received a severe wound on the head. The incubation period is seldom longer than six months. The symptoms of the disease in the human being vary within narrow limits. There are three classic symptoms usually encountered, and these are fear, apprehension or excitement, together with deglutitory (swallowing) spasms, terminating in general paralysis. The patient remains conscious of his agony to the end, but the period of illness is of short duration, lasting from one to three days.

The bites of rabid dogs cause ninety per cent of the cases in man and animals. The cat is the next important factor in spreading the disease and about six per cent of the cases are caused by this animal. For other cases four per cent come from bites of horses, wolves, foxes, etc. The wolf in Russia, or other animals like it, may be the chief cause there; but dogs cause ninety per cent, taking all the cases found. Man, dog, cat, horse, cattle, sheep, goat, hog, deer, etc., are subject to the disease either naturally or experimentally. The disease is confined commonly to dogs, because the dog naturally attacks animals of his own species and thus keeps the disease limited mainly to his own kind. Naturally the dog follows this rule, but on the other hand, in the latter stages of the disease he usually goes to the other extreme and even attacks his own master, etc. The dogs that are the most dangerous and do the greatest damage are of the vicious breeds.

The rabbit or guinea pig is used for demonstration in the laboratory. Guinea pigs respond to the virus more rapidly than do other animals and therefore they are especially useful in diagnostic work. Rabbits, however, on account of the convenient size and ease with which they are operated upon, are usually the choice in the production of material used in treating patients.

The director of one Pasteur Institute says, "We have two classes of patients to deal with in the Pasteur institute. The larger class, of course, are those inoculated by the bite of rabid animals, but we also have a few who are infected by the rabid saliva accidentally coming in contact with wounds already produced. In these accidental eases the disease is almost as likely to result as in those to whom the virus is directly communicated by the bite." The wounds considered most dangerous are the recent fresh wounds. The possibility of infection decreases with the formation of the new connective tissue which protects the ends of the broken nerve fibres. One must remember, however, that wounds over joints, especially on the hands, are likely to remain open for some time. A dog ill of this disease can give the disease to man through licking a wound. Such a case has been recorded. This dog licked the child's hands before it was known to be mad. The child died from the disease. As stated before ninety per cent of the cases are inoculated by the bites of rabid animals.

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The wounds are considered according to their severity and location. Lacerating, tearing wounds upon uncovered surfaces, especially the head, are the most dangerous. This is due to the fact of the closeness of the brain and the large amount of infection in such a wound, and for this reason treatment should be immediately given. But smaller wounds should also be treated for the smallness of the wound furnishes no sure criterion as to the future outcome of the disease. All possible infections should be regarded as dangerous when considering the advisability of taking the Pasteur Treatment. The small wound has usually a longer period of incubation, because of the small amount of infection, still it may cause a fatal termination. A dog never develops rabies from a lack of water or from being confined or overheated during the summer months. A spontaneous case of rabies has never been known. It must be transmitted from animal to animal and the history of the case will point to a previous infection by a diseased animal.

Where rigid quarantine rules exist the disease does not occur. In Australia they quarantine every dog, that comes to that country, for six months, and in consequence they have never had a case of rabies. In Russia they have had many cases. In Constantinople the disease frequently "runs riot." France has lost as many as 2,500 dogs in one year. Before the Pasteur Treatment was instituted (in 1885) there was an average of sixty deaths in human beings in the Paris hospitals.

Belgium and Austria average one thousand dogs annually. There was a yearly average in Germany of four hundred dogs, dying of rabies, until the law requiring the muzzling of dogs was strictly enforced and since that time the disease is practically unknown. We do not have strict quarantine laws against dogs, and the result is death from hydrophobia in many states annually. It was formerly believed that rabies was a hot weather disease. The number of cases during the winter months of late years has disproved that belief, for the records of the institute for treatment of hydrophobia at Ann Arbor have shown a decrease of cases during the summer months. This was before 1908. This shows that rabies is not a hot weather disease.

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Ordinarily cases of rabies occur here and there (sporadic), but if the conditions are favorable epidemics break out. One dog may bite several dogs and these dogs bite others and thus spread the disease to many. Not every animal bitten by a mad dog develops the disease. The disease does not always follow the bite. Only about forty per cent of all animals bitten by a mad dog contract the disease. This is given by a noted authority. Statistics also show that in man the disease develops in only about twenty per cent of the cases in those who have been bitten by rabid dogs. But in dealing with those who have been bitten such measures should be taken as would be if they were certain of developing the disease; one cannot tell how much poison enters the system in such cases and preventive procedures should be taken. There are reasons why everyone who is bitten does not contract the disease.

The location and character of the bite must be considered. Bites on the head, neck and hands have been recognized as more dangerous, from early times, and such bites produce fatal results quicker than do bites on other parts of the body, and the reason is largely due to the fact that the other parts of the body are more or less protected by the clothing, and this clothing prevents the entrance of so much poison into the system. Bites on the head give a high mortality rate and are rapidly fatal. The close proximity to the brain is one reason.

The part the clothing plays in protection is clearly shown by the following quotation from an eminent authority: "In India where the natives dress very scantily, the mortality was exceedingly high up to a few years ago, at which time the British introduced the Pasteur laboratories. The clothing protects the body and it holds back the saliva and can be looked upon as a means of filtering the saliva of the rabid animal, most of the saliva is held back as the teeth pierce the clothing, so that upon entering the flesh the teeth are practically dry, and only a portion of the virus is introduced. Upon entering the wound this small amount of virus is further diluted by the tissue juices to the non-infectious point. We know from actual experimental work in the laboratory that the higher dilution will not kill."

If a portion of the brain of an animal dead from street virus is taken and made up in a dilution of one to five hundred, and this is injected, we find that it does not produce death. But a dilution of one to three hundred will invariably kill. This is practically what very often happens when one is bitten through the clothing. The saliva may be filtered and held back so that a small amount is introduced; perhaps a dilution of one to five hundred of the virus may get into the wound, but this is usually not enough to cause the disease. There is no possible way of estimating the amount of the inoculation. In such cases one's chances of never contracting the disease are only decreased; that is all we can say.

The treating of individuals, bitten by rabid animals, in the Pasteur Institutes, is simply the practical application of results obtained by Pasteur from his original work on rabies virus. Pasteur was a French chemist living in Paris, and he began his search for the cause and cure of rabies in 1880. He hoped to find a sure method of preventing the development of the dread disease, even if he could not find a cure for it after it had developed. While he was pursuing this research Pasteur had access to the cases of rabies in the Paris hospitals, and these numbered sixty each year. He had practically an unlimited supply, for France could furnish him with twenty-five hundred more mad dogs, and a large number of other animals each year.

[INFECTIOUS DISEASES 245]

Pasteur devoted the remainder of his life to the study of this subject. He collected some saliva from the mouth of a child, on December 11, 1880, who had died at the Hospital Trousseau four hours before. This saliva he diluted with distilled water, and this mixture he injected into rabbits, and they all died, and the saliva taken from these rabbits when injected into other rabbits caused their death with rabies. He found also that saliva from rabid dogs almost always caused the disease. The incubation period varied within wide limits, and very often the animals lived. He then used the blood of rabid dogs for inoculation, but these blood inoculations always failed to produce the disease. Pasteur was convinced after careful study of rabid animals during the many months necessary to complete his experiments, that rabies was a disease of the nervous system, and that the poison (virus) was transmitted from the wound to the brain by the way of the nerve trunks. Then to prove his theory Pasteur removed a portion of the brain of a dog that had died of rabies. A part of this was rubbed up in sterile water and used to inoculate other animals; and subcutaneous inoculations with this material almost always produced death.

After this Pasteur tried a new method and injected directly into the nervous system, either into the nerve trunk or directly into the brain, after trephining, and all such injections produced rabies in the injected animal and death. He also found that rabbits inoculated in the brain always died in the same length of time. When he injected into the nerve trunk the inoculation period was longer, depending upon the distance from the brain. Two problems now remained for Pasteur to solve, and these were, how could he obtain the definite virulence and how could he reduce the virulence regularly and gradually, so that it could be used by inoculation safely as a vaccine to produce immunity to rabies in healthy animals, and also to prevent the development of rabies in animals bitten by rabid animals. He first tried successive inoculations. These inoculations were made, after trephining, directly to the brain, and he used a portion of the brain as a virus each time. He inoculated rabbit number one with a portion of brain taken from a rabid dog, and this rabbit died on the fifteenth day. He then inoculated rabbit number two with a portion of the brain of rabbit number one; from the brain of rabbit number two the virus was supplied for inoculating rabbit number three, and thus the brain of each inoculated rabbit was taken, after its death, for material to inoculate the next rabbit in the series. This experimentation showed him that each rabbit in the series died a little sooner, showing that the virus was becoming more virulent, till no increase in activity of the poison was shown after the fiftieth successive inoculation. "Rabbits inoculated with a brain suspension of rabbit number fifty all died in seven days." This caused Pasteur to name the virus of number fifty "virus fixe," a virus of definite length. He now had obtained a virus of definite strength and the next question was, how could the virulence be gradually and definitely reduced.

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This he accomplished after many experiments. He proved that pieces of the "medulla oblongata" suspended in sterile tubes which contained fragments of caustic potash, steadily and gradually reduced their virulence as they dried, till the fourteenth day, when they were practically inert. New specimens were prepared each day and cords which had dried in one day Pasteur called "one-day virus;" cords which had dried in two days, "two day's virus," and so on up to the fourteenth day. With this graduated virus he now experimented on dogs, and the injection he used on the first day consisted of an emulsion of fourteen-day virus; for the second day, the thirteen-day virus, thus using a stronger virus each day, until on the fourteenth day he used the full strength virus. This treatment produced what is called immunity in the dog, and even the direct inoculation into the brain of the strong virus would not produce death.

After Pasteur had thoroughly satisfied himself by repeated trials, he announced his wonderful discovery, and it was in 1886 that Pasteur considered the preventive inoculation in human beings as resting upon a satisfactory experimental basis. During these five years this eminent man proved that it was possible to protect or immunize the lower animals, rabbits and dogs, against inoculation with the virulent virus.

The efficiency of this immunity was given trials by different methods of inoculation. It was found that sixty per cent of dogs inoculated under the "dura" (a membrane of the brain) were saved if treatment was given the second day. This test is more severe than is required to meet the ordinary infection of rabies. Pasteur, after a series of these final tests were so convincing, prescribed the preventive inoculations in human beings and on July 6th, 1886, the first human patient received the first treatment of his series of inoculations.

The method of obtaining the attenuated virus used in the treatment is as follows: A rabbit is inoculated by the brain method before described, each day, with suspension of the fresh, fixed virus. These rabbits die in six days after the inoculation. In this way a rabbit dies each day; the spinal cord is removed, divided into sections, and suspended in a flask containing potassium hydrate. The action of potassium hydrate is drying (desiccating). A series of these cords, which have been hung on fourteen successive days, are always kept in stock for the treatment of patients. The virus becomes less active with each successive day of exposure to drying (desiccation) and finally the virulence is altogether lost.

When the patient comes for treatment the fourteenth and thirteenth-day cords are used for the first inoculation, and on each successive day the patient receives inoculation, the strength of which has been regulated by the number of days the cord has been hanging. During the first four days patients receive injections of six cubic centimeters of emulsions made from cords aging from fourteen to seven days, and from the fifth day until the completion of the course of treatment patients receive emulsions from cords of higher immunizing properties, but no cords desiccated for less than four days are used.

[INFECTIOUS DISEASES 247]

Death rate from 1878-1883 before Pasteur treatment was instituted taken from documents in the department of the Seine:

1878 143 bitten. 24 deaths. 1879 76 " 12 " 1880 68 " 5 " 1881 156 " 22 " 1882 67 " 11 " 1883 45 " 6 "

Average of one death to every six bitten, or seventeen per cent mortality.

Incubation period from eleven days to thirteen months, average one hundred and twenty days, depending upon location of bite. Pasteur Institute records during the years 1886-1887 and first half of 1888, show that Pasteur had under his supervision 5,374 persons bitten by animals either proven or thought to have been mad. Mortality for 1886 was 1-34 per cent, during 1887 it was 1-12 per cent, during 1888 it was 77/100 per cent. With the later treatment the mortality has decreased to 3-10 per cent in 1908. The Pasteur method of treatment is a process of immunization which must be completed before the development of the disease. It is of no value after the symptoms have appeared.

Those who have not been affected can be immunized the same as those who have been bitten. The individual who has been bitten by a mad dog realizes when and how severely he has been bitten, and were it not for the so-called period of latent development of the virus, it would not be possible to carry out the Pasteur treatment. The patient may, if he will, take advantage of this fact and be immunized by treatment before the disease has developed. Deep and severe bites are most dangerous, but the disease may develop simply from a rabid dog licking a scratch of the skin. As before stated bites on exposed or uncovered surfaces, are more dangerous than those through clothing. There is a very easy access of the saliva to the wound in the unprotected part, while in the protected parts the teeth in passing through the protection, clothing, are freed of their saliva at least partially. The virus is conveyed from the bitten part or inoculation to the central nervous system through the nerve trunk, and the rapidity of extension depends upon the resistant powers of the patient, the virulence and the amount of virus deposited in the bitten part at the time the person was bitten. This disease develops only in nerve tissues. Virus can be found in the nerves of the side bitten, while the corresponding nerves on the opposite side are free from it. It can be ascertained that the virus is present in the medulla oblongata before the lower portion of the cord.

[248 MOTHERS' REMEDIES]

Comparative danger.--A wound of the hand after a delay of three weeks is as dangerous as a bite on the head exposed only a few days. There is always a possibility of an accumulative action and extension of the virus along the nerve trunk to the central nervous system during the interval of exposure, and this should be always borne in mind. It is stated by authority that the virus is not transmitted by the bite of a rabid animal until two days previous to the appearance of the first symptoms. It is with some difficulty that a decision is reached in advising patients who are bitten to take treatment early in the course of the disease. The symptoms are often so very obscure and slight that they are not recognized. If a dog which is not naturally vicious suddenly bites without any cause it should be tied securely and watched for seven days; and should it develop symptoms of the disease during this period the bite should be considered dangerous.

Immediate treatment of the wound.--A temporary measure is the cauterization of the wound; do not neglect this because a few hours have passed since the person was bitten, for wounds may be cauterized with advantage even after two or three days have elapsed. Of course the earlier it is done the better. If they are thoroughly laid open and scrubbed it is more effective. Nitric acid used freely is the best method to use. Wash the wound freely with boiled water after the acid has been applied; ninety-five per cent carbolic acid may be used if nitric acid cannot be obtained.

If carbolic acid is used it is necessary that it be washed from the wound by the free use of absolute alcohol, followed by boiled water and a dressing of bichloride of 1-7000. This prevents the ulceration of the wound by the carbolic acid. Cauterization thoroughly done destroys a part of the inoculated virus. Thorough cauterization is especially necessary with large wounds in which large quantities of the virus is inoculated.

When to send patients to an Institute.--Send them immediately, if there is good reason to believe the animal had rabies. It is not wise to wait until the animal dies; it is very important that treatment is begun as soon as possible, especially in severe bites.

What to send for examination.--The entire head may be sent by express, or better, the health officer should bring it in person. This saves time and relieves anxiety; or a portion of the brain may be removed under thoroughly clean conditions and placed in a sterilized twenty per cent solution of glycerin and water. In this way the virus retains its virulence and putrefaction is diminished. The first method is the best, taking the head directly. The head after it reaches the laboratory is examined microscopically for "negri bodies," and if there is no contamination the microscopic findings are verified by animal inoculations. The presence of negri bodies in a specimen is of great value owing to the rapidity with which a diagnosis can be made. In one case a positive diagnosis was reported within twenty minutes after the specimen entered the laboratory and within the next hour and a half the patient bitten by the dog the same day had begun her course of protective injections and was saved.

[BLOOD AND DUCTLESS GLANDS 249]

Protection.--To stamp out this disease city authorities, etc., can enact laws. All ownerless dogs should be killed, and the keeping of useless dogs should be discouraged by taxation. All dogs should be thoroughly muzzled where the disease prevails. This article is made up from an article written by an acknowledged authority on this disease, a man in charge of a Pasteur Institute.

Cities where Pasteur Institutes are located: Ann Arbor, Michigan. Baltimore, Maryland. Chicago, Illinois. Austin, Texas. Minnesota. Toronto, Ont. New York City.

DISEASES OF THE BLOOD AND DUCTLESS GLANDS.

Anaemia, or Anemia.--This may be defined as a reduction of the amount of blood as a whole or of its corpuscles, or of certain of its more important constituents, such as albumin and haemoglobin. Primary or essential anemia includes chlorosis and pernicious anemia; secondary anemia results from hemorrhages, poor nourishment or intoxications, poisons. Chlorosis, a primary anemia chiefly of young girls, characterized by marked relative decrease of haemoglobin.

Causes.--It usually occurs in blondes of from twelve to twenty years of age and most often from fourteen to seventeen years of age, when the menstrual function is being established and during which time they are rushed with their school work. There may be a family history of chlorosis or tuberculosis. Poor food, hard, unhealthy work, confinement in close unventilated rooms are other causes.

Symptoms.--Rounded fleshy appearance may continue. There is some difficulty of breathing, palpitation of the heart on slight exertion, from a fright or from excitement, tendency to faint feeling or even fainting, headache, a tired feeling, hard to stir or do anything, irritable temper, poor or changeable appetite, the digestion is disturbed, there is constipation, coldness of the hands and feet, difficult menstruation, irregular menstruation, leucorrhea, amenorrhea, and sometimes there is a slight fever. The color is often of a yellowish-green tinge, and this is more noticeable in the brunette type, though the cheeks may be flushed; the whites of the eyes bluish white in color. The heart sounds are not right. The blood is pale in color. The red cells are diminished, but usually are not below eighty per cent of the normal; the haemoglobin is greatly reduced, sometimes to thirty-five or forty per cent. The age, greenish tint of pallor, bluish whites of the eyes, poor nutrition, etc., aid in making the diagnosis.

[250 MOTHERS' REMEDIES]

Treatment.--Fresh air, good food, care of the bowels and rest if the symptoms are severe. When it is not so severe, plenty of outdoor exercise is necessary and beneficial. That takes them away from their cramped sedentary life and gives the sunshine, good pure air, and change of the scene. Horseback riding is a very good form of exercise, but it should be slow riding. "Tending" the horse is also good, and sleeping in the open air is excellent. Automobile riding is too straining and should not be indulged in.

1. Blaud's pills are very much used. The formula follows:

Dried Sulphate of Iron 2 drams Carbonate of Potash 2 drams Syrup Sufficient

Mix thoroughly, and make forty-eight pills. Take one to three pills, three times a day after meals.

2. Fowler's solution of arsenic is also very good remedy; three to four drops three times a day. It must be watched for bad symptoms and should only be taken under a physician's supervision.

Diet.--This should be good and varied to suit the special taste, and as the stomach and bowels are usually disordered such food should be chosen as will best agree. Diet plays a very important part.

PERNICIOUS ANAEMIA.--This is characterized by great decrease of the red cells of the blood with a relatively high color index and the presence of large number of germs. The causes are unknown.

Condition.--The body is not emaciated. A lemon color of the skin is usually present. The muscles are a dark red, but all the other organs are pale and fatty. The heart is large and fatty. The liver and spleen are normal in size, or only slightly enlarged with an excess of iron in the pigment. The red cells may fall to one-fifth or less of the normal number. The rich properties of the blood are fearfully decreased.

Symptoms.--Stomach and bowels, dyspepsia, nausea and vomiting, or constipation, may precede other symptoms or they may last throughout the case. The onset is gradual and unknown, with gradually increasing weary feeling, paleness and some difficulty in breathing and palpitation of the heart on exertion. There is paleness of the skin and the mucous membranes, the lips look pale, no color. The paleness becomes extreme, the skin often having a lemon yellow tint. The muscles are flabby; the ankles are swollen, you can see the arteries beat. Hemorrhages may occur into the skin, mucous membrane and retina of the eye. Nervous symptoms are not common. The pallor and weakness become extreme, sometimes with intervals of improvement and death usually occurs. The following is Addison's description given by Dr. Osler:

[BLOOD AND DUCTLESS GLANDS 251]

It makes its approach in so slow and insidious a manner that the patient can hardly fix a date to the earliest feeling of that languor which is shortly to become extreme. The countenance gets pale, and white of the eyes become pearly, the general frame flabby rather than wasted. The pulse perhaps larger, but remarkably soft and compressible, and occasionally with a slight jerk, especially under the slightest excitement. There is an increasing indisposition to exertion, with an uncomfortable feeling of faintness or breathlessness in attempting it; the heart is readily made to palpitate; the whole surface of the body presents a blanched, smooth and waxy appearance; the lips, gums and tongue seem bloodless, the flabbiness of the solid increases, the appetite fails, extreme languor and faintness supervene, breathlessness and palpitation are produced by the most trifling exertion, or emotion; some slight oedema (swelling) is probably perceived about the ankles; the debility becomes extreme. The patient can no longer rise from the bed; the mind occasionally wanders; he falls into a prostrate and half torpid state and at length expires; nevertheless, to the very last, and after a sickness of several months' duration, the bulkiness of the general frame and the obesity (fat) often present a most striking contrast to the failure and exhaustion observable in every other respect. The disease is usually fatal.

Treatment.--The patient should remain in bed and should use a light nourishing diet, taking food in small amounts and at stated intervals. Rest in bed is essential. Dr. Osler treated a case in the following way: I usually begin with three minims (drops) of Fowler's solution of arsenic three times a day and increase the dose to five drops at the end of the first week; to ten at the end of the second week; to fifteen at the end of the third week, and if necessary go up to twenty or twenty-five. Symptoms of an overdose are rare; vomiting and diarrhea occur. Then the medicine must be discontinued for a few days.

SECONDARY ANEMIA. Causes.--Hemorrhage form (bleeding). (a) Rapid bleeding from the rupture of an aneurism, from a blow, or eating into the blood vessels by an ulcer. (b) Slow bleeding as from nose-bleed, flow from the womb, piles or in "bleeders" people who bleed readily.

2. Inanition form.--Not nourished because of interference in taking food or assimilating food, from cancer of the gullet, or disease of the stomach.

3. Toxic poison cases; from acute and chronic diseases, such as typhoid fever, tuberculosis, rheumatism, syphilis, malaria, nephritis; or chronic lead poisoning, mercury, arsenic, and copper poisoning.

Symptoms.--There is pallor, dizziness, headache, palpitation and dyspnoea, difficult breathing on exertion; there is weakness, tendency to fainting, poor appetite, dyspepsia and constipation. The red blood cells are diminished, also the haemoglobin. Death may occur from a single hemorrhage.

[252 MOTHERS' REMEDIES]

Treatment.--Remove the cause and rest. Good fresh air, good easily digested food. The bowels must be kept regular. Iron and arsenic are good remedies if necessary. It is not possible to give special directions. A person in this condition needs a good physician. There is no time to waste. Iron and arsenic are good remedies, but they must be used intelligently and in proper doses. Blaud's pill is good in some cases. It contains iron. Also Fowler's solution of arsenic.

LEUKAEMIA.--An affection characterized by persistent increase in the white blood corpuscles, associated with changes, either alone or together, in the spleen, lymphatic glands and bone-marrow.

1. Spleen and Bone-Marrow, (Spleen-Medullary) type.--The changes are especially localized in the spleen and in the bone-marrow while the blood shows a great increase in elements which are derived especially from the latter tissue.

2. Lymphatic Type.--The changes in this type are chiefly localized in the lymphatic apparatus, the blood showing an especial increase in those elements derived from the lymph glands.

Causes--Unknown. It is most common before middle age.

Symptoms.--Either type may be acute or chronic. The invasion may be gradual, sometimes with disturbance of the stomach and bowels, or nose-bleed. (a) The first type is the common one. The spleen generally becomes enlarged; it is sometimes tender and painful, it may occupy over half of the abdominal cavity and varies in size after a hemorrhage, diarrhea or after a meal. There may be paleness of the face, etc., early and late nausea, vomiting, diarrhea, and dysentery are common, as is also ascites (dropsy in the abdomen). The pulse is rapid, full and soft. Fever is usual. Hemorrhages occur in the skin, retina, pleura, peritoneum, etc. Headache, dizziness, short breathing, and fainting may occur from the anemia. The liver may be enlarged. The blood shows a great increase in the white cells. Sometimes they are more numerous than the red blood cells. (b) Lymphatic type is rare, various groups of the lymph glands are enlarged, usually separate, but sometimes matted together; others, such as the tonsils may become large. The blood shows an increase of the white cells, but less than in the other form. The spleen is usually somewhat enlarged. Recovery is rare; the lymphatic cases may last only six or eight weeks. The course is usually progressive for two or three years.

Treatment.--The same as for Pernicious Anaemia.

FALSE LEUKAEMIA. (Pseudo-Leukaemia).--Also called Hodgkin's disease, malignant lymphoma, and general lymphadenoma. This is a progressive anemia and enlargement of the lymph glands and the skin, with secondary lymphoid growth in the liver, spleen and other organs.

Causes.--Males are more affected than females, and usually young persons. Continual local irritation causes a local enlargement of the gland, but the actual cause is unknown.

[BLOOD AND DUCTLESS GLANDS 253]

Symptoms.--The lymph glands of the neck, arm-pit or groin are enlarged and without any pain, followed by anemia, loss of strength and slight fever. The glands enlarge slowly or rapidly, forming large masses, while the growth extends to other regions. The spleen may be felt; the skin may be bronzed. In cases with involvement of deep seated nodes the first symptoms may be those of pressure on blood vessels, nerves, trachea, bronchial tubes or other structures.

Treatment.--Cut them out if they are small and localized. Arsenic, quinine, cod-liver oil are good medicines.

PURPURA.--This is not strictly a disease, but a symptom. This includes a group of affections characterized by hemorrhages into the skin.

Symptoms.--There are hemorrhages into the skin, and this takes the form of small blood spots underneath the skin, (petechia) and spots like the bursting of a blood vessel shows vibices or ecchymoses. The first are in small minute points and appear, as a rule, in the hair follicles and unlike the erythemas (redness) do not disappear upon pressure. Another kind occurs as streaks, while the ecchymoses are larger, but similar in nature to the first kind. They may be larger than a split pea, and they range from a deep red to a livid bluish tint. They assume a yellowish brown, then a yellow color, as they fade away and finally disappear. This eruption appears in a series of crops and the legs are the usual seat.

1. Symptomatic Purpura. (a) Infectious. Occurs in typhus fever, endocarditis, cerebro-spinal meningitis, typhoid fever, etc. (b) Toxic; from snake bites, iodide of potash, quinine, copaiba, bella donna, ergot, etc., and with jaundice. (c) Cachectic; with cancer, tuberculosis, leukaemia, false leukaemia, scurvy, etc. (d) Neurotic; with hysteria, neuralgia, and some organic disease. (e) Mechanical; due to violent effort and poor venous circulation.

2. Type arthritic purpura. (a) Simple Purpura. A mild form usually occurring in children, sometimes with pains in the joints, rarely any fever. There is anemia, disturbance of the stomach and purpuric spots on the legs, often on the arms and trunks. (b) Rheumatic purpura; this usually occurs in men from twenty to forty years old. There is usually pain and swelling of several joints, temperature 101 to 103 degrees, purpuric eruption chiefly on the legs and about the affected joints, often with hives and digestive disturbances: (c) Henoch's purpura; usually in children and is sometimes fatal. There are recurrent joint pains and swelling, disturbances of the stomach and bowels, skin troubles resembling it, and hemorrhage from mucous membrane.

[254 MOTHERS' REMEDIES]

PURPURA HAEMORRHAGIC.--This is a severe form, usually seen in delicate girls. The cause is unknown.

Symptoms.--Weakness, extensive purpuric spots (small blood spots in the skin), eruption, hemorrhages from the mucous membranes which may cause secondary anemia, slight fever, slow clotting of the blood. The duration is from ten to fourteen days. Death may occur within a day in cases marked by profuse bleedings into the skin and prostration.

Treatment.--Remove the causes. Fresh air, food and tonics, etc. This disease is serious and needs careful treatment from a physician.

HAEMOPHILIA. "Bleeders."--This is a hereditary disorder characterized by a tendency to persistent bleeding, spontaneously or even after a slight injury.

Causes.--Usually hereditary through many generations. It is transmitted through daughters, themselves usually not "bleeders," to their male children. It is found most often in the Anglo-German races.

Condition.--The blood vessel walls are thin; the skin is delicate, clotting of the blood is usually retarded.

Symptoms.--It comes spontaneously or after only slight wounds; the person is extremely delicate. The bleedings occur from the skin, or mucous membrane, or from wounds, but rarely during menstruation or confinement. They vary from small spots to bleeding which may end fatally, or in recovery with marked anemia. There may be pain and swelling of the joints, etc., and this may leave deformities resembling deformed arthritis. The result is worse the earlier the disease shows itself. They may live to old age.

Treatment.--Avoid, as much as possible, wounds and operations in "bleeding" families. Marriage of the women should be discouraged. For bleeding: rest, ice, tannic or gallic acid or adrenalin locally if the bleeding points can be reached. Plug the nostrils for nose-bleed both behind and in front.

SCURVY. (Scorbutus).--A constitutional disease characterized by weakness, anemia, sponginess of the gums and tendencies to bleeding.

Causes.--This disease has been called "The calamity of sailors." It has been known from the earliest times, and has prevailed particularly in armies in the field and among sailors on long voyages. It has become a very rare disease in the United States.

Predisposing Causes.--Overcrowding; dark unhealthy rooms; prolonged fatigue; mental depression.

Exciting Cause.--The lack of fresh vegetables, poisoning from slightly tainted food, or an infection. The gums are swollen, sometimes ulcerated, skin is spotted, bluish, etc,

[BLOOD AND DUCTLESS GLANDS 255]

Symptoms.--It comes on gradually (insidiously). There is loss of weight, progressively developing weakness and pallor, very soon the gums are swollen and look spongy and bleed easily. The teeth may become loose and fall out. The breath is very foul. The tongue is swollen, but it may be red and not coated. The skin becomes dry and rough and (ecchymoses) dark spots soon appear, first on the legs, and then on the arm and trunk and particularly about the hair follicles. These are spontaneous or follow a slight injury. In severe cases hemorrhages under the periosteum (the covering of the bones) may cause irregular swelling, especially in the legs, and these may break down and form ulcers. The slightest bruise or injury causes hemorrhages into the injured part. Extravasion under the skin, especially in the lower extremities may be followed by permanent hardness (induration) and stiffness due to connective tissue infiltration (scurvy sclerosis). There may be pains in the joints and often watery swelling (oedema) of the ankles. Bleeding from internal mucous membranes is less common than from the skin. The appetite is poor, palpitation of the heart and feebleness and irregularity of the pulse are prominent symptoms. Owing to the sore gums the patient is unable to chew the food. The urine often contains albumin and is scanty and concentrated. There are weariness, depression, headache and finally delirium or coma, or symptoms due to hemorrhages within the brain; or day and night blindness may be present.

Recovery.--The patient will recover if the cause can be removed, unless it is far advanced. Death may result from complications.

Treatment. Preventive.--Fresh or canned vegetables or fruit must be eaten.

Treatment for the attack.--Dr. Osler, of England, says: "I think the juice of two or three lemons daily and a diet of plenty of meat and fresh vegetables will cure all cases unless they are far advanced. For the stomach small quantities of scraped meat and milk should be given at short intervals, and the lemon juice in gradually increasing quantities. As the patient gains in strength you can give a more liberal diet, and he may eat freely of potatoes, cabbage, water cresses, and lettuce. A bitter tonic may be given. Permanganate of potash or dilute carbolic acid forms the best mouth-wash. Penciling the swollen gums with a tolerably strong solution of nitrate of silver is very useful. Relieve the constipation by enemas."

ADDISON'S DISEASE. Diseases of the Suprarenal (above Kidneys) Bodies.--A constitutional disease characterized by great weakness, stomach and bowel symptoms, heart weakness, and dark coloring of the skin.

Causes.--It usually occurs in men from twenty to forty years old. The skin and mucous membrane and sometimes the serous, like the pleura, etc., membranes are pigmented (darkened).

Symptoms.--There is a gradual onset of weakness, changeable symptoms in the stomach and bowels and darkening of the skin. There is great feeling of fatigue and feeble irregular action of the heart; nausea and vomiting and often absence of appetite and some diarrhea. The abdomen may be painful and drawn back in the course of the disease. The pigmentation (coloring of the skin) varies from the light yellow to dark brown, olive or black. It usually begins on the skin or regions naturally pigmented; or where pressure is exerted by the clothing. The mucous membranes are also pigmented. Death may occur from fainting, extreme weakness, convulsions or delirium or through tuberculosis. Usually death occurs within one year, though this may occur in a few weeks to two years, sometimes after intervals of improvement.

[256 MOTHERS' REMEDIES]

Treatment.--This must be to meet the indications as they arise. It is a serious disease and should be under the supervision of a competent physician.

DISEASES OF THE SPLEEN. 1. Rupture of the spleen.--This may occur spontaneously from no apparent cause, or from hurts received in cases of typhoid or malaria.

Symptoms.--Severe pain, and signs of intestinal hemorrhages.

2. Acute inflammation of the spleen (splenitis).--This occurs in acute infections after injuries.

Symptoms.--They are pain, tenderness, and enlargement of the spleen.

Treatment.--Treat the cause and relieve the pain. As this is a serious and painful affection a physician should be called. The pain is often relieved by a mustard poultice or hot fomentations. The patient should remain in bed for acute inflammation of the spleen no matter what the cause.

3. Chronic Splenitis. Causes.--It comes from malaria, syphilis or leukaemia, etc.

Symptoms.--There is the feeling of weight and symptoms of pressure on the lungs or bowel.

Treatment.--Remove the cause. If it comes from malaria, attend to that, etc.

MOTHERS' REMEDIES. 1. Blood Purifier, Molasses and Sulphur as a.--"Take a pint of molasses to five cents' worth of sulphur, and mix well." A teaspoonful four times a day in the spring will do wonders towards purifying the blood.

2. Blood Purifier, Sassafras Tea, Known all over as.--"Sassafras tea made from the root and boiled to extract the strength." Drink freely of this for a few days in the spring. It thins the blood, and is a good tonic.

3. Blood Purifier, Herb Tea Used as.--

Burdock Root 2 ounces Yellow Dock 2 ounces Slippery Elm Bark 1 ounce Mezeron Root 1 ounce Licorice Juice 1 ounce

Simmer gently in three pints of water down to one quart; when cold, strain and add one-fourth ounce of iodine potassium." A wineglassful may be taken three times a day. This preparation is a fine blood purifier and can be relied upon.

[BLOOD AND DUCTLESS GLANDS 257]

4. Blood Purifier, Sweet Fern for.--"Make a tea of this and drink freely. This is very good to take in the spring of the year, as it thoroughly cleanses the system."

5. Blood Purifier, Doctor Recommends Senna and Salts for:--"Five cents' worth of senna leaves, one tablespoonful of epsom salts in one quart of cold water; cover and let stand over night, then strain and put in bottles. Take a wine-glass full every morning until you feel well." This is from Mrs. Jonathan Shaw, she has used it with good results in her family. A physician in England told her if people would use this the year round they would seldom need a doctor.

6. Blood Purifier, Remedy Easy to Make for.--"We always use one teaspoonful of cream of tartar, two spoonfuls of sulphur, and mix with syrup. Any size spoon will do. Take a teaspoonful at a dose." This is an excellent remedy, and should be taken before retiring; about three times a week would be sufficient.

7. Blood Purifier, Beech Bark and Blackberry Root a Good.--"One gallon white beech bark (after the rough bark is removed), good big handful of blackberry root (cut fine), and also of sassafras root. Cover with cold water and steep to get the strength, then strain. When cool (not cold) add one pint baker's yeast and one cup sugar. Let it stand twenty-four hours in a warm place. Then strain and set in a cool place. Take a wineglassful three times a day before meals. This has been highly recommended to me by a friend from Kalkaska, Michigan."

8. Blood Purifier, from a Madison, Connecticut, Mother.--"Take blackberry root, black cherry bark, spruce boughs, wintergreens: sarsaparilla roots; steep in a large vessel, till all the goodness is out; strain and when lukewarm put in a cup of yeast, let work and bottle up."

9. Blood Purifier, How to make, Celery Compound for a.--

"Celery Compound 2 ounces Chamomile Flower 1 ounce Sassafras Root 1 ounce Senna Leaves 1 ounce Mandrake 1 ounce Wintergreen Essence 1 ounce Whisky 1 gill White Sugar 1 pound Hops 2 handfuls

Steep three hours in four quarts of water, strain, add sugar, when cold add wintergreen and whisky. Dose:--One teaspoonful before meals and at bedtime."

10. Blood Purifier, Another Effective Herb Remedy.--"Pour boiling hot water on four ounces of gentian root with two ounces of dried orange peel, a sufficient amount of water should be used to exhaust the strength in the root and orange peel; then boil in a porcelain pot until there is left one-half pint of the concentrated infusion to every ounce of gentian root used. Then to every one-half pint add one half ounce alcohol. The effect of the alcohol is to coagulate it from a quantity of jelly looking substance which must be separated by straining. This is one of the best strengtheners of the human system. Dose:--One teaspoonful in an ounce of water."

[258 MOTHERS' REMEDIES]

11. Blood Purifier, Burdock for.--"The root is the part employed eliminating very rapidly the specific poison from the blood. Best administered in decoction by boiling two ounces of the root in three pints of water, to two pints. Dose:--One tablespoonful four times a day." Burdock is a splendid blood purifier and is not expensive. It can be purchased at any drug store for a reasonable amount.

DISEASES OF THE THYROID GLAND.--Inflammation of the thyroid gland, (Thyroiditis),--Acute inflammation of the gland, simple or suppurative. It may develop in a patient with goitre, or acute infectious diseases, or from other parts, or from wounds. The gland is enlarged and soft and may contain abscesses.

Symptoms.--Pain, tenderness, and enlargement of the part or of all the gland. Fever may be present even in cases without signs of pus forming (suppuration). If there is great enlargement, there may be symptoms of compression of vessel, nerves or the windpipe.

Treatment.--If there is pus it must be carefully opened. The patient must remain quiet in bed. Sometimes cold applications relieve. Do not use warm applications. This disease is not frequent and the patient needs care and watching more than medicine.

GOITRE (BRONCHIAL). Causes.--No satisfactory explanation can be given for this disease. It seems to be more prevalent where lime-stone water is used. Heredity plays a part. This is an enlargement of the thyroid gland. Chronic enlargement of the thyroid is sporadic. Cases are scattered and endemic in certain mountainous regions. It affects young women most often. A great excess in lime drinking water may be the cause. It is very prevalent about the eastern shore of Lake Ontario and in parts of Michigan. It is a common complaint in this country.

Symptoms.--There is a gradual painless enlargement of the whole gland or one lobe, etc. It may press on the windpipe, and cause difficult breathing, also on the blood vessels and nerves.

Recovery.--This is usually favorable as to life, but not so favorable as a cure. It becomes chronic. A sudden fatal ending may come.

GOITRE, MOTHERS' REMEDIES,--1. Three Ingredient Remedy for.--"The following treatment is excellent, but must be continued for several months:

Extract of Belladonna 1/2 dram Compound Ointment Iodine 1/2 dram Vaselin 1/2 ounce

Apply this to the affected parts several times a day."

If this treatment is kept up faithfully it is sure to help.

[BLOOD AND DUCTLESS GLANDS 259]

2. Goitre, Simple Remedy for.--"Wring a cloth from cold water and bind it around the neck every night when retiring. This is a sure cure if continued for some time."

3. Goitre, Inexpensive Remedy for--"Apply the following several times a day: Extract of belladonna one-half dram, compound ointment of iodine two drams; this treatment must be kept up several months." The above treatment will be found very beneficial and is not an expensive one.

PHYSICIANS' TREATMENT for Goitre.--1. Locally tincture of iodine; paint some on the gland once or twice a day until it gets a little sore and keep it so for weeks, or use cosmoline and put in it about one-quarter as much iodine and rub on. Lard will do instead of cosmoline. The parts should be kept red and a little sore. Use also iodide of potash, five grains, three times a day internally, while you are using external applications.

2. Use the compound of tincture of iodine the same way, externally. This is not so strong and can be used longer with, I think, better results. At the same time you may use this same medicine internally. Take one to two drops internally three times a day; or you may take five grains of iodide of potash three times a day instead. Externally: These applications must produce a little redness and be continued for some time.

3. An Ointment. The red iodide of mercury is also good to rub on the part. This may be used if the others fail.

4. Other medical remedies are used, but they must be closely watched and must be used under the supervision of a doctor. The thymus or thyroid extracts are thus used and with good results in many cases.

5. Colorless Iodine: This does not stain, but I have no faith in it. It is used very much now and can be used freely. It is simply, druggists tell me, iodide of potash made in solution, dissolved, and put on the part. A great many cases of large goitres are now being operated upon with quite good success. It is not done until other measures have failed, unless the goitre is interfering with breathing and the blood supply.

6. This is very good, both for internal and external use.

Iodide of Potash 20 drams Iodine 1 dram Water enough for 3 ounces

Mix thoroughly and shake bottle before using.

Put some in two bottles; one for internal and other for external use. Take internally five to ten drops in a little water before meals. Externally, put on the enlarged neck, night and morning, unless it feels too sore, when you can use it once a day or less.

[260 MOTHERS' REMEDIES]

EXOPHTHALMIC GOITRE. (Parry's, Graves or Basedows Disease).--It is characterized by exophthalmos (bulging of the eyes), Goitre, fast beating of the heart, trembling and nervousness.

Causes.--It is most common in women from twenty to thirty. Several cases may occur in the same family. The exact cause is unknown.

Symptoms.--Acute cases. Sudden onset, vomiting, diarrhea, the heart beats fast with throbbing arteries, bulging of the eyes, enlarged thyroid gland. Death may occur in a few days.

Chronic Cases.--There is usually a gradual onset of tachy cardia,--fast beating of the heart,--pulse being 100 to 180 or more, if excited. Later there are throbbing of the arteries and of the thyroid glands.

Bulging of the eyeball is sometimes extreme. There may be fever and usually is anemia, emaciation, weakness, nervousness, perspiration, difficult breathing, dark color of the skin. It usually lasts several years. Spontaneous recovery may occur in six months to a year and is not common. Recovery is rare in advanced cases.

Treatment.--Prolonged rest in bed, with an ice bag constantly over the heart, or better over the lower part of the neck and upper breast bone. Avoid all worry and excitement. Drugs are uncertain. Surgery is sometimes resorted to. The thyroid extract has been used.

MYXOEDEMA.--This is a constitutional disease due to atrophy (wasting away) of the thyroid gland and characterized by swollen condition of the tissue under the skin, wasting of the thyroid and mental failures. Three forms exist, myxoedema proper, cretinism and operative myxoedcma.

Causes of Cretinism.--This may exist at birth (congenital) or it may develop at puberty, and is due to the absence or loss of function of the thyroid gland. Sporadic (here and there) cretinism may follow an acute infectious disease or it may be congenital. Myxoedema may be hereditary and is most common in women.

Symptoms, (a) Cretinism.--Mental and bodily development is slow. There is extraordinary disproportion between the different parts of the body. The condition is sometimes not recognized until the child is six or seven years old, then the slow development is noticed. The tongue looks large and hangs out of the mouth. The hair may be thin, the skin very dry. Usually by the end of the first year and during the second year the signs of the cretinism become very marked and should be recognized. The face looks large, looks bloated, the eyelids are puffy and swollen, the nose is flat and depressed and thick. Teething is late, and the teeth that do appear decay. The fontanelles are open. The abdomen is swollen, the legs are short and thick, the hands and feet are not developed and look pudgy. The face is pale and has a waxy, sallow tint. The muscles are weak and the child cannot support itself. Above the collar bone there are pads of fat. The child does not develop mentally and there may be one of the grades of idiocy and imbecility (feeble-minded).

[BLOOD AND DUCTLESS GLANDS 261]

(b) Myxoedema, proper--The skin is infiltrated, causing loss of the lines of the facial expression, skin is dry and harsh, much thickened, especially in the region above the collar bone. The face is broad, with coarse features, the nose is broad and thick, the mouth is large, lips thick, hair scanty and coarse, slowness of motion and thought, weak memory, irritability, headache, suspiciousness, followed sometimes by hallucinations, delusion and dementia (insane). The disease may progress for ten or fifteen years. Death may occur early.

Operative type.--This rarely develops except the thyroid glands have been entirely removed and then only if no extra glands are present.

Symptoms.--Are the same as that of cretinism.

Treatment.--An even, warm climate. Thyroid extract, to be given by a physician, is the remedy. After the recovery occasional small doses still may be necessary for some, or in cretinism for life.

DISEASES OF THE NERVOUS SYSTEM.

NEURALGIA.--Pain occurring in the course of the nerves and in their area of distribution. The pain has remission and intermissions, and is due to some morbid affection of the nerves of sensation or their spinal or (brain) centers.

Causes.--The affection may depend upon some functional disturbance alone; or it may be due to some organic disease of the nerve or to some disease or diseased state outside of the nervous system. It occurs more frequently in women past the middle-age, in those of a nervous tendency. As stated, it affects women more than men. Debility is a frequent cause. Neuralgia is frequently associated with the various forms of anemia. It may occur at the onset of acute diseases like typhoid fever. Exposure to cold causes it in susceptible persons. Decayed teeth may cause neuralgia of the fifth nerve. It also occurs in rheumatism, gout, lead poisoning, and diabetes. Persistent neuralgia may be a feature of hidden Bright's disease.

Symptoms.--Pain is the chief and characteristic symptom. It may develop suddenly and without warning, or soreness or stiffness in the tissues surrounding may precede it. There is a burning or violent sensation in the course of the affected nerve, increased on exertion in acute cases. In other cases the pain comes intermittently or in paroxysms, and is of a darting, stabbing character, or accompanied by tingling sensations. There may be a want of sensation of the skin in the affected region or over-sensitiveness over the entire nerve-trunk with certain painful points. The attacks of pain may come only at long intervals of time, but usually they occur every few minutes and last for some hours. Pain may be continued for hours or days in severe cases. In rare cases it may persist for months or years, being worse at a certain time each day, especially in cases where malaria exists. There is paleness or congestion of the part affected, various eruptions, and changes in the color of the hair occur and, in advanced chronic cases, symptoms of interference with the general nutrition also occur. Spasms of the adjacent muscles may accompany the severe paroxysms.

[262 MOTHERS' REMEDIES]

[NERVOUS SYSTEM 263]

Varieties.--Neuralgia may be classified according to its causes, as neurotic, toxic, rheumatic, etc.; or according to its location as trifacial, intercostal, sciatic, and so on, Exposure to cold, mechanical irritations, tumors, pressure on the nerves, and wounds may lead to neuralgia. It is more frequent in cold and damp climates than in dry and warm locations; everyone should remember the causes.

MOTHERS' REMEDIES. Neuralgia.--1. Lemon Juice as Liniment for.--"Cut a lemon in two and squeeze juice on parts afflicted and rub in, then place hot cloths over it. I know this will cure the pain." This is very good.

2. Neuralgia, Salt and Vinegar Will Relieve.--"A small sack of hot salt applied to the pain, or steam with vinegar." The heat from the salt is very effective and the moisture of the vinegar is also very good. This simply produces a counter irritation.

3. Neuralgia, Quinine Will Cure.--"Use quinine three times a day." It is well in taking quinine to take two grains three times a day for two days, then take some good cathartic, so as not allow the quinine to remain in the system. This is very beneficial, especially when neuralgia is due to malarial conditions.

4. Neuralgia, Four Ingredient Remedy for.--

"Oil of Peppermint 1 ounce Oil of Mustard (strong) 1/4 ounce Vinegar 1 pint White of one egg.

Beat egg and stir all together."

5. Neuralgia, Good Liniment for.--

"Essential Oil of Mustard 1 dram Tincture Aconite 1 dram Glycerin 1 ounce Alcohol 4 ounces

Mix and shake well before using."

This remedy is a valuable external preparation for all nervous and neuralgia pains, rub twice a day until relieved.

6. Neuralgia, Menthol Liniment for.--"One dram of menthol liniment, two ounces of alcohol. This makes a very excellent liniment for many purposes. For rheumatism, neuralgia, headache, etc." This liniment will be found very beneficial as the menthol is soothing and quieting, and we all know that alcohol is very good to be applied for any of the above mentioned diseases.

7. Neuralgia, Belladonna Plaster for.--"Melt three ounces of rosin plaster and add one-half ounce of extract of belladonna. An excellent application in neuralgia and rheumatism."

[264 MOTHERS' REMEDIES]

PHYSICIANS' GENERAL TREATMENT for Neuralgia.--Remove the cause if possible. If from anemia, give tonics for that and try to cure that disease. Tonics with good nourishing food, and proper surroundings are needed for anemia. In malaria, syphilitic or gouty patients, constitutional treatment must be given for those diseases before the neuralgia will be better. The systematic use of galvanic electricity, properly used, is the most valuable means at the physician's disposal, especially in the descending current, beginning with the mild current and gradually increasing in strength. Internally: Arsenic, bromine, ergotinc, aconite, gelsemium, valerian, ether, cannabis indica and quinine are recommended. Opium may be used in the very severe forms, but it must be used with caution, or you will make your patient a drug fiend, and his latter state will be worse than the first condition. Wet compresses, vapor baths, cold affusions, wet cloths, are highly recommended.

1. For the Cure of an Attack--

Antipyrine 30 grains Citrate of Caffeine 20 grains

Make into ten powders. Take one everyone-half hour until 3 doses are taken. Three (3) doses at least should relieve the neuralgia.

2. Antipyrine 30 to 60 grams Bromide of Potash 3 drams

Mix: and make into ten powders; one every thirty minutes until relieved or until six doses have been taken; this is better than the first prescription when there is much nervousness with the neuralgia or neuralgic headaches.

3. If caffeine in first prescription causes nervousness, give this one:

Antipyrine 30 to 60 grains Citrate of Caffeine 10 grains Bromide of Potash 3 drams

Mix and make ten powders. Take one every half hour until relieved or until six doses have been used.

These are very effective prescriptions, but if a person has any heart trouble I would not advise their use except under a physician's care. (Sometimes a patient with neuralgia gets desperate, and he will even resort to morphine). Antipyrine is one of the simplest coal tar remedies, and most persons can safely take it. Persons who are subject to neuralgia or headaches need to take good care of themselves. Get plenty of rest and sleep. Neuralgia at first can be cured, but when it once becomes chronic, especially neuralgia of the face, it is hard to cure and frequently makes life a constant misery. Plenty of outdoor life is essential. In that way the system will be built up, and when the body is strong the disease can be thrown off much easier. A great many people depend too much upon strong medicines. Medicines are all right in their place, but all the medicine in the world cannot cure a person unless that person does his or her part.

[NERVOUS SYSTEM 265]

SPECIAL DISEASES. Facial Neuralgia. (Neuralgia of the fifth pair of Cranial Nerves. Also known as Trifacial Neuralgia. Neuralgia of the Trigeminus. Tic doloureux, etc.).--This form is more frequent than all other forms combined, this nerve being peculiarly susceptible to functional and organic disorders. All three branches are very rarely affected together, the ophthalmic (eye) branch being most often involved. The symptoms depend upon the branch involved.

1. Ophthalmic Neuralgia Pain, (eye neuralgia pain).--This pain is above the eye, or frontal kind, with a special painful point at the supraorbital (above the eye) notch. Sometimes the pain is very severe in the eye-ball.

2. Supramaxillary Neuralgia.--In this the pain is along the infraorbital (nerve beneath the eye) nerve, and there is a marked tender point at the opening in the bone (infraorbital foramen) beneath the eye. A toothache-like pain in the upper teeth is common in this variety.

3. Inframaxillary (lower maxillary) Neuralgia.--This is characterized by a scattered (diffused) pain along the inferior dental (teeth) branch, and extends from the temporal (side forehead) region over the side of the face to the chin, with pain in the lower teeth and side of the tongue. The pain in this nerve may come on without any special cause, or it may come after excitement of a physical or mental nature. Disorders of nutrition occur. The circulation is interfered with and the face, at first pale, becomes red. Eruptions may appear along the course of the nerve, while salivation and "running" (lachrymation) of the eyes are often prominent symptoms. Spasms of muscles of the face (tic doloureux) may accompany the paroxysms and this is the most terrible form of nerve pain. The attacks may be mild or very severe and sometimes sudden. This is a terrible disease, especially when it has existed for some time. A person with severe pain in the face should always attend to it immediately, before it becomes chronic.

Treatment.--It is directed towards removing the cause, if possible. Chronic cases are difficult to cure. The patient should be careful not to take cold, keep strong and healthy by regular hours for sleep, good sufficient clothing. The general health must be improved. These directions apply to all kinds of neuralgia.

INTERCOSTAL NEURALGIA.--A neuralgia of one or more of the intercostal nerves. These nerves run in a groove in the lower edge of the ribs. Causes.--It may develop without any special cause. It comes in anemia, after exposure to cold, from affection of the vertebrae, ribs, spinal cord, or from the pressure of tumors, or aneurism of the aorta. This is next in importance to neuralgia of the fifth nerve, and occurs more often in women and very common in those who have hysteria. It is more common on the left side and mostly in the nerves situated from the fifth to the ninth intercostal space. If it is located in the nerves distributed to the mammary glands it gives rise to neuralgia of the mammary gland. The flying darts of pain in the chest (pleurodynia) are to be regarded as neuralgic in character.

[266 MOTHERS' REMEDIES]

Symptoms.--The pain is usually very severe, especially on movement of the intercostal (between the ribs) muscles. With this pain, as a rule, an eruption (herpes) appears along the course of the affected nerve and this is supposed to be due to the extension of the inflammation from the nerve-ends to the skin. Pain, when pressed upon, is most marked near the spinal vertebral, the breastbone (sternal) end and the middle part of the nerve. The trouble may continue a long time after the eruption (herpes) has disappeared, for it is very obstinate.

PHYSICIANS' TREATMENT for Intercostal Neuralgia.--This consists in using remedies that will cause counter-irritation. Electricity and pain destroying (anodynes) remedies are indicated in chronic cases. Apply heat for pain in the "breasts." For the eruption an ointment like oxide of zinc can be used.

Local Treatment.--A mustard plaster is frequently good to use. It produces the counter-irritation desired. Application of dry heat from hot cloths; a hot sand bag may help in some cases. A rubber bag containing hot water can also be used. Fomentations of hops, etc., applied hot and frequently changed to keep them hot are beneficial in some cases. I have found in some cases that an adhesive plaster put over the sore parts relieves the severe pain. Porous plasters are also good. Tincture of ranunculus bulbosus (buttercup) is a good remedy. Put ten drops in a glass half full of water, and take two teaspoonfuls every hour.

SCIATICA.--This is as a rule a neuritis of the sciatic nerve or of its cords of origin. It is characterized by pain chiefly along the course of the sciatic nerve.

Causes.--It occurs most commonly in adult males. The person may have a history of rheumatism or gout in many cases. Exposure to cold after heavy muscular work or exertion, or a severe wetting are common causes. The nerves in the pelvis may be compressed by large tumors of the ovaries or womb, by other tumors, or by the child's head during confinement. Occasionally hip joint disease causes it. The nerve, as a rule, is swollen, reddened, and in a condition of "interstitial neuritis." The pain may be most severe where the nerves emerge from the hip bone, behind, or in the inner back, and middle part of the thigh.

NERVOUS SYSTEM 267

Symptoms.--Pain is the most constant and troublesome. It is sometimes very severe. The onset is usually gradual, and for a time there is only a slight pain in the back of the thigh; soon the pain becomes more intense, extends down the thighs, and leg and reaches to different parts of the foot. The very sensitive spots can often be pointed out by the patient, and on pressure these spots are very painful. It is gnawing and burning in character, usually constant, but sometimes it comes in paroxysms, and is often worse at night. Walking usually causes great pain. The knee is bent and the patient treads on his toes. As a rule it is an obstinate trouble, and it may last for months, or even with slight remissions for years. In the severer forms the patient must remain in bed and such cases are very trying for both patient and doctor.

(See Mothers' Remedies under Neuralgia above).

PHYSICIANS' TREATMENT. Cautions for Sciatica.--Remove all causes if you can. Rheumatism and gout, if the patient have them, should be treated. The patient should not overwork or expose himself to wet, damp weather. Keep every part dry. Rest in bed with the whole leg fixed is a valuable mode of treatment in many cases. Hot water bags from the hip to the knee placed along the painful nerve, sometimes gives great relief. Mud baths are beneficial. Hot Springs baths relieve many cases. Fly blisters placed along the track of the nerve relieve the pain in many cases. Fomentations of smartweed and hops are good, but they must be changed often so as to be hot. Wet or dry cupping is a help in many cases. It draws the blood from the inflamed nerve. Morphine given hypodermically will relieve the pain, but it is a dangerous medicine to use in a chronic case. The patient will be very likely to form the habit, and that is worse than the sciatica. By care and treatment most cases can be greatly helped and cured. Rhus tox (poison ivy) is very good in minute doses in cases where it is impossible to remain in one position for any length of time. Ten drops of the tincture in a glass two-thirds full of water and two teaspoonfuls given every hour. I have helped many cases with this remedy. The hot iron along the track of the nerve is helpful. Electricity is better in a chronic case where there is wasting of the legs, and it should be combined with massage. The galvanic current should be used.

MOTHERS' REMEDIES. Nervousness. 1. Catnip Tea for.--"A tea made of catnip will quiet the nerves. This is good for women when they are apt to be nervous."

2. Nervousness, Hops Will Stop.--"Purchase a small package of hops at any drug store, and make a tea of it, drinking frequently in tablespoonful doses." It is a harmless remedy, and should be used more freely by nervous people. The hops are very soothing. Nervous mothers should never be without this. It is surprising to see how few people know the value of some of these simple home remedies.

3. Nervousness, Effective Remedy for.--

"Spirits of Camphor 1/2 ounce Comp. Spirits of Lavender 1/2 ounce Tincture of Valerian 1 ounce Sulphuric Ether 1/2 ounce

Mix. Dose, one or two teaspoonfuls every three hours."

[268 MOTHERS' REMEDIES]

The foregoing remedy is very effective, as spirits of camphor and the tincture valerian quiet the nerves. The sulphuric ether also has a soothing effect. This combination makes a fine tonic, but should not be taken too long, as it is quite strong.

4. Nervousness, Five Ingredient Remedy That Relieves.--"In extreme nervous debility with tendency to fainting fits, use the following:

Spirits of Camphor 1/2 ounce Aromatic Spirits of Ammonia 1/2 ounce Spirits of Lavender Compound 1 ounce Tincture Valerian 1 ounce Tincture Castor 1 ounce

Mix. Dose.--From one to three teaspoonfuls at intervals of from fifteen minutes to three hours, according to urgency of symptoms. This mixture should be kept on hand by all persons subject to fainting fits."

Spirits of camphor and aromatic spirits of ammonia stimulates the heart, while the tincture of valerian quiets the nervous system.

5. Nervousness, "Lady's Slippers" Breaks up.--"A decoction is made with two ounces of the root, sliced, to two pints of water, boiled to one and one-half pints. Dose: One tablespoonful four times a day. Has been used with marked success in epilepsy and in other various nervous diseases." This is used very extensively for nervous people, and has proven very successful.

HEADACHE.--This term means a pain in the head, all over the head, or at one particular spot. It may be only a symptom of a general constitutional derangement, some disease of some other organ, a temporary inability of some organ like the stomach, liver, bowels, etc., to do work, or it may be due to some local affection depending upon some trouble with the skull and its contents. It is frequently but a symptom of some other trouble. It occurs in fevers, infectious diseases, brain disease, etc. There are different varieties depending upon the causes.

Sick Headache. Nervous Headache. Catarrhal Headache. Congestive Headache. Neuralgic or Gastric (stomach) Headache. Bilious Headache. "Bowel" Headache. "Womb" Headache. Rheumatic Headache.

[NERVOUS SYSTEM 269]

CATARRHAL HEADACHE and RHEUMATIC HEADACHE may be treated together. This is due to exposure to a draught of air, walking against the sharp and keen wind, by getting the feet or other parts of the body wet, sudden suppression of perspiration about the head, or by some other exposure such as might result from cold, influenza or attack of rheumatism. There may be aching pains and a feeling of heavy weight in the forehead; tearing, stitching pains above the eyes, in the cheek bones; sometimes the skull feels as if it would fall to pieces. In the rheumatic variety the scalp is sore and tender, tearing throbbing pains or hard aching pains. There is some fever, dry skin, the pulse is faster.

Treatment.--Get into a sweat by hot drinks of lemonade and hot foot baths. Apply cold or warmth to the head, lie down and keep quiet.

Medicine.--Aconite in doses of one-tenth of a drop to an adult every hour will frequently abort it: open the bowels with salts. Remain in bed.

NERVOUS HEADACHE.--This may occur as a sick headache or be simply a nervous headache: This occurs oftenest in a nervous person, or in persons who are run down by different causes, such as diseases, overwork, worry, trouble, etc. It is not periodic, and has no fixed type, but breaks out at indefinite intervals, and is excited by almost any special cause such as motions, mental exertions, menses, excitement, overdoing, over-visiting, want of sleep. It is often due to eye strain in persons who have poorly fitted, or who do not wear glasses. It appears in any part of the head, usually one-sided, or it may be all over the head, which feels enlarged and sometimes as if a band was around it. The least mental effort makes it worse. Sometimes there is a feeling as if a nail was being driven into the head; head is too big; eyes feel heavy and the lids droop; sees double; hard to keep eyes open. This kind of headache, or sick-headache, can be brought on suddenly by womb trouble, especially if the womb has fallen from a jar, fall, etc. The patient often moans and cries, laments and simply cannot stand thc pain. In some cases the menses cause it, and it appears at every menstrual period.

Treatment.--The patient should be quiet and remain in bed in a darkish room. Womb troubles and other diseases that cause it such as protruding piles, etc., should be attended to. Tincture gelsemium is a good remedy. Put ten drops in a glass half full of water, and take two teaspoonfuls every half hour until better. A tea made from lady's slipper is also effective in some cases, used freely. Bromide of potash in ten-grain doses one-half hour apart, for three doses, if necessary, is quieting in many attacks. Mustard plaster to back of the neck.

CONGESTIVE HEADACHE.--In this kind there is or seems to be too much blood in the head. The patient may be stupid, with a flushed face. If conscious, the brain feels as if it was rising or falling, especially upon the motion of the head. The top of the head sometimes feels as if it would fly off. The head throbs and beats violently. The hands and feet may be cold, the face flushed or pale, the eyes bright, the pulse is generally heavy, full and fast, or it may be feeble, slow and intermittent.

[270 MOTHERS' REMEDIES]

Treatment.--1. The patient should remain in bed in a dark room, with the head usually high. Cold should be applied to the head and heat to the hands and feet. Move the bowels with salts and, if necessary, give an enema also. It is well to give the foot-bath before going to bed. If these things do not relieve the headache a doctor should be called, for it may mean something serious. A hot mustard foot-bath and a mustard plaster applied to the nape of the neck are of great value. In severe cases an ice bag or very cold water, applied to the forehead and temples will very often give great relief.

2. Spirits of Camphor 1 ounce Spirits of Lavender 2 ounces Alcohol 2 ounces

Wet the top of the head with it.

3. Camphor 1 dram Oil of Peppermint 1 dram Chloroform 1-1/2 ounces Alcohol enough for 3 ounces

Shake the bottle and apply a little of the liquid to the place. Horseback riding and walking are good for nervous girls and women.

NEURALGIC HEADACHE.--This commonly comes periodically, usually, one- sided. It may occur at the same hour for several days in succession. The pains are of all kinds. It may start in the morning or at any time. It involves more especially the eyes, side of the head, face, and goes into the teeth and neck. It comes in persons subject to neuritis in other parts or neuralgia.

Treatment.--Build up the system with tonics in the interval. Lead a quiet restful life. Acetanilid in five-grain doses frequently relieves it. This is a dangerous medicine to use, except under a doctor's supervision. Spigelia in doses of one-twelfth of a drop of the tincture is good for left-sided attacks; two doses are enough, one-half hour apart.

STOMACH OR GASTRIC HEADACHE.--This, as the name indicates, is due to some acute or chronic trouble with the stomach. It is caused by over-loading the stomach, or eating food that does not agree, such as fat meat, gravies, starchy food, warm bread, pastry, etc., or it may be due to dyspepsia. The tongue is generally coated, the mouth tastes bitter. If it is acute and the stomach is full, take a common emetic like warm water, salt water or mustard water. If it is due to decomposed food, drink lots of warm water and take an enema and also a dose of salts. If there is much gas in the stomach, take some baking soda in a glass of warm water; one drop doses of tincture of nux vomica every half hour for three hours often relieves.

[NERVOUS SYSTEM 271]

HEADACHE FROM CONSTIPATION.--This is frequent. There is generally a dull, heavy feeling in the forehead, the head feels full and sometimes dizzy, the patient feels blue and morose, the tongue is coated on its back part, mouth tastes bitter, patient is drowsy and stupid and work goes hard. A free passage from the bowels relieves the headache.

Treatment.--Cure the constipation as directed in another part of the book. Take a good full enema of warm soap suds and water, and one drop of tincture of nux vomica every hour for six hours during the attack.

BILIOUS HEADACHE.--This is so-called because the bilious symptoms are the most prominent. It may be caused by violent anger, disputes, excessive eating causing congestion of the liver; abuse of spirits; some persons are of a bilious constitution and the least error in diet and habit produces such an attack. The pain may be violent or dull, the head may throb terribly; the whites of the eyes have a yellowish look, and the face may be of a dark brown hue, the patient may vomit bile. The vomiting causes more brain distress. The mouth is bitter, the tongue coated yellowish, the breath smells badly. Bowels may be irregular.

Treatment.--A free movement of the bowels often relieves. First take an enema and then one-half ounce of epsom salts. Do not eat anything but drink all the water you may wish. A tea made of blue flag is often of benefit. The diet should be regulated so as not to overload the stomach and liver and the bowels should move freely daily.

WOMB HEADACHE.--Women who suffer from womb troubles such as leucorrhea, torn cervix, falling womb displacements and diseases of the inner womb, ovaries and tubes, suffer from all kinds of headache. The pain may be in the nape of the neck, the back part of the head and on the top behind (occiput). It may come on suddenly when the womb is displaced by a sudden fall or over-lifting, etc. The woman should then go to bed and lie down with her arms crossed over her chest, with the knees drawn up and weight resting upon them and chest with the buttocks elevated, (knee-chest- position). This replaces the womb. The other troubles should be corrected or these headaches will keep on. The womb and its appendages are the cause of many kinds of headaches, neuralgias, dyspepsia, and constipation; correct the troubles and the headache will disappear.

MENSTRUAL HEADACHES.--These are very common. They may be regular every month, and they are then caused by some trouble with the womb or ovaries, or may be due to a run-down condition or heredity. It comes sometimes from suppression of the menses as a consequence of some violent emotion, fright, anger, grief, or by exposure to wet, draughts of air, privations, over-fatigue, etc. It may last for several days. The headache may be mild or severe.

Treatment.--A foot bath or sitz bath is very good, with free drinking of pennyroyal tea after the bath, and when in bed. Place warmth to the feet, moist heat over the abdomen, such as a hot water bag or fomentations. Remain quietly in bed. If constipated, take an enema. Frequently a free bowel movement gives much relief in this trouble. During the interval doctor the patient for the trouble causing the headache for which see another part of this book, "Diseases of Women."

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MOTHERS' REMEDIES, 1. Headache, Paregoric and Soda for.--"A teaspoonful of paregoric, with one-half teaspoonful of baking soda in a tumbler of water, May be taken all at once or sipped slowly."

2. Headache, Hops Good for.--"Make a strong decoction of hop tea, and take a wineglassful every half hour until relieved." This is an old tried remedy and a good one.

3. Headache, Mustard Excellent for.--"Place a mustard plaster on the back of the head, also bathe the feet in mustard water and stay in a darkened room, and avoid all excitement and noise." The one essential thing is to get the nerves quieted; take as little food as possible for twenty-four hours, giving the stomach an opportunity to rest, as most of the headaches come from a disordered stomach.

4. Headache, Peppermint Beneficial for,--"Bathe the head in strong peppermint. Then apply cloths wrung from water as hot as can be endured." Hot or cold applications are known to be very beneficial. After the cloths are taken off, the soothing effect can be further enhanced by gentle rubbing of the forehead.

5. Headache, Cold Application in Case of.--"Apply cold applications on the forehead and over the eyes." These cold applications have been known to give relief in a very few minutes to many people suffering with severe headaches. It is well to continue the treatment; even after relief has been obtained, for at least a half hour. Gentle rubbing of the head is very good, also.

6. Headache, Castor Oil Will Relieve.--"One tablespoonful of castor oil. Have used this and found relief." This remedy gives relief as the castor oil carries off the food that is distressing the stomach. It is well to take two tablespoonfuls of lime-water in a glass of milk three times a day for about a week after the castor oil has operated.

SICK HEADACHE. (Migraine. Hemicrania).--Migraine is a peculiar form of severe paroxysms of unilateral (one side) headache often associated with disorders of sight.

Causes.--It is frequently hereditary, and it has occurred through several generations. Women and members of nervous families are usually attacked. Many of the headaches from eye-strain are of this type, It is often inherited, and may last from puberty to the menopause. Some authors claim that decay of the teeth without toothache will cause it. Adenoid growths in the pharynx and particularly abnormal conditions of the nose will cause it. Many of the attacks of severe headaches in children are of this nature, and the eyes, nose and throat should be examined when children or older persons suffer from this complaint. Mental emotion, physical or mental fatigue, disorders of the female genital organs, eye-strain, etc., loud noises, toothache, act as predisposing causes. Some think it a poisonous condition due to the absorption of poisons from the stomach and intestines, and others regard it as a nervous condition due to anemia and all conditions which weaken the resistance of the nervous system.

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Symptoms.--The premonitory symptoms, which may last a few hours or a day or more, are sleepy feelings of discomfort, uneasiness, weariness, chills, vertigo (dizziness), disturbance of the sight or disturbances of the senses. The real attack may follow quickly, beginning with the characteristic headache, at first one sided, located in one spot in the temple, eye or back of the head, but spreading, as it increases in severity, until it involves all of one side of the head and occasionally both sides. The pain is usually constant and of great severity and it is increased by motion, noises, light, or mental strain. The skin over the painful part is very sensitive. There are loss of appetite, nausea and vomiting. If the stomach has a great deal of food in it, vomiting relieves the pain sometimes. In the spasmodic form the affected side is painful, the skin is cool, the pupil is dilated, and the flow of saliva is increased. In the paralytic form the affected side is flushed, hot, the vessels are dilated and the pupils are contracted. There is great weakness, prostration and depression. The urine may be abundant or suppressed, temporarily. The results of treatment in this disease are uncertain, as the attacks are likely to occur in spite of treatment. They usually cease in old age, and in women they may stop after the menopause. The attacks in women are likely to occur at or near the menstrual periods.

First Thing to do in Sick Headache.--It is well to remain in a darkened room away from noise, etc. If the head throbs and beats very hard, either a cold ice bag or hot applications often bring relief. A mustard plaster at the base of the brain with a hot foot-bath often helps. Some people by stroking the forehead and temples have the power to ease the pain, producing quiet and sleep. If the bowels are costive, salts should be taken to move them, or they can be moved by an enema, if salts are not at hand. If the stomach is full, or tastes sour, drink a lot of warm water and vomit, or produce vomiting by tickling your throat with your finger, after having taken a large quantity of warm water for sometimes warm water thus taken fails to cause vomiting. If there is no food in the stomach, but there is sour and bilious vomiting, the warm water will frequently help. For a sour stomach or when it is full of gas, a teaspoonful of baking soda in some hot water will often feel very pleasant and grateful. The patient should keep absolutely quiet after these are done, and often they fall into a refreshing sleep.

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EMERGENCY MEDICINES.--If anemia is the cause, give tonics such as iron and arsenic. If the patient feels faint and nauseated, a small cup of strong hot coffee gives relief, sometimes. Antipyrin, given early in doses of two and one-half grains often relieves. Take another dose in one-half hour if necessary. But such remedies are hard on the heart.

TREATMENT. Preventive in Sick Headache.--The patient is often aware of the causes that bring on an attack. Such causes should be avoided. A great many people who are afflicted with this trouble are not only careless in their eating, eating anything and everything and at all times--at meal time and between meals--but also careless in their habits of life. Patients should avoid excitement, like card parties, etc., staying up late, or reading exciting books. The meals should be regular, no food taken that is hard to digest. Pies, cakes, puddings, gravies, ham, pork, sausage, and fried foods must be avoided. Rich, greasy foods will not do for such persons to eat. Strong tea and coffee are bad. Plenty of water should be taken between meals. At meals it is better to take no water unless it is hot water. Every morning on arising it is well to drink a large quantity of either cold or hot water. This washes out the stomach, bowels and kidneys, and stimulates them to better perform their functions. The bowels must be kept regular, one or more passages a day and at a regular hour. Sometimes, especially in younger persons, the eyes are at fault and may need glasses. Frequently it is caused by overwork in school in young girls, especially during their menstrual periods. Social duties cause them in many women, and then strong tea or coffee, or headache powders, or tablets, are taken to keep up or to stop the pain, making the patient more liable to the attacks in the future; and then still more tea, coffee, and headache remedies are taken until the patient is a slave to the remedies taken to help her. A great many of these headaches can be helped by simple measures, and the time between the attacks, in about all cases, made longer if the patient will but work with the physician, not only at the time of the attack, but in the interval. The clothing should be comfortable. The feet should always be kept dry. This applies especially to neuralgia. In fact the above measures of prevention and care apply to all kinds of headaches and neuralgias. Prevention is worth more than the cure.

MOTHERS' REMEDIES. 1. Sick Headache, Hop Tea Will Relieve.--"Hop tea is very good if a good strong decoction is made. A wineglassful may be taken every half hour or hour until relieved." This is very easily prepared, as the hops may be purchased at any drug store.

2. Sick Headache, a Favorite Remedy for.--"Aconite liniment or aconite rubbed on the forehead will relieve the pain in the head almost instantly. One drop of the tincture of nux vomica in a teaspoonful of water every five or ten minutes will quickly relieve." Nux vomica is good only when the headache comes from constipation and stomach trouble and too high living.

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3. Sick Headache, Aromatic Spirits of Ammonia for.--"For a nervous headache there is nothing better for immediate relief than fifteen or twenty drops of the aromatic spirits of ammonia." This relieves the pain and quiets the nerves and stimulates the heart.

4. Sick Headache, Camphor Application for.--"A very simple but effective remedy is a cloth wet with spirits of camphor and sprinkled with black pepper applied to the head gives almost instant relief."

5. Headache, Soda and Peppermint for.--"One teaspoonful (level) of soda in two-thirds glass of hot water, add five or eight drops of oil of peppermint and a little sugar. Drink quite warm. This has been often tried and proven to be a success." The soda will relieve any gas in the stomach and the peppermint aids digestion and relieves sickness of the stomach.

6. Sick Headache, Lemon Good for.--"One lemon before breakfast will help to keep off sick headache. Have never found a remedy to cure sick headaches. A sack of hot salt will always help the pain." The lemon will help to tone up the stomach and the salt applied to the head will help the pain by relieving the congestion. It is always well to take a good cathartic after a spell of sick headache.

PHYSICIANS' TREATMENT for Sick Headache.--

1. Antipyrine 25 grains Citrate of Caffeine 10 grains Bromide of Potash 25 grains

Mix and make into five powders. One powder as needed. (You might take second one in three hours.) This is not good when it is bilious sick headache. In fact, it would make it worse. It is good for sick headache and neuralgia due to eye or nerve strain, but then the first remedy, antipyrine, can be left out. It is not needed. I would then put twice as much of the bromide of potash, fifty grains, and take a powder every two hours until better.

2. Citrate of Caffeine 1/2 dram (30 grains) Phenacetine 60 grains Bicarbonate of soda 60 grains Aromatic powder 12 grains

Mix and make twelve powders. Take one every three hours. This is good. Sometimes it is depressing on the heart for some people, due to the phenacetine. Acetanilid can be substituted in same dose.

(The homeopathic treatment is very successful in relieving spells of sick headache. See chapter on Homeopathy.)

3. Sodium Phosphate, taken every morning, about one-half to one teaspoonful in hot water. It is good for the bowels and liver.

4. Prescription for the Liver and Bowels in Sick Headache.--

Sulphate of soda 30 grains Salicylate of soda 10 grains Sulphate of Magnesia 1 grain Benzoate of Lithia 5 grains Tincture of Nux Vomica 3 minims Distilled water 4 ounces

This mixture should be made up in large quantity and placed in a siphon by one of the concerns which charge soda water, and from one-quarter to one-half a glass of this water, at ordinary temperature, is to be taken every morning at least one-half an hour before breakfast; enough being taken to insure an adequate bowel movement during the forenoon. This ought to be a good combination to use regularly.

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5. Dr. Hare gives the following recommendations. Probably no single source of pain compares in its frequency to headache, chiefly because it is essentially a symptom of diseases or functional disturbances.

It may come from constipation or eye strain, from brain disease, anemia, uremia, too much blood in the head, etc. In many cases a mild laxative to thoroughly empty the bowels is necessary. Sometimes the urine will be deficient in solids and liquids, so that the effete and poisonous material are retained in the blood, which produce headache. For such cases if the urine is acid, the frequent use of Vichy water, to which is added a little bicarbonate of potassium, about five grains to a drink, as a diuretic will prove of great service. If the urine is alkaline (and this you can tell by using a red litmus paper which will turn blue if it is alkaline) ten grain doses of benzoate of ammonium three (3) times a day are often useful.

NERVE TUMORS (Neuroma).--A morbid increase in the tissue-elements of the peripheral (the external surface) nerves.

Varieties. True and False Nerve Tumors.--True nerve tumors (neuromata) are composed of nerve-fibres provided with a medullary (marrow) sheath or of nerve tissue; false nerve tumors are composed of other structure than nerve tissue, are usually of secondary origin, extending to the nerve from nearby structures.

Symptoms.--The true nerve tumors may be hereditary or due to wounds or blows and amputation. They may give rise to no symptoms, or may cause intermittent pain. Pressure increases this pain, when the condition of the nerve fibre is interfered with. Loss of local sensation and power may develop. It is sometimes possible to feel the little nodular growths, and they can be seen when they are superficial. They may give no pain, or they may become very sensitive. They may become chronic and they are very liable to do so. Some of them may disappear.

PHYSICIANS' TREATMENT for Nerve Tumor.--The severe forms should be cut out; others can be let alone.

NEURITIS (Inflammation of the Nerves. Neura-Nerves; Itis-Inflammation. Inflammation of the Bundles of Nerve Fibres).--Nagel describes it as "an inflammation of the nerves of an acute or chronic nature, associated with more or less degeneration, change in the nerve fibrils of the affected nerves."

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Causes.--An injury to the nerves, frequent muscular strains, exposure to cold. Inflammation can extend to the nerve from adjacent inflamed structures. Pressure can cause it. Fractures of bones cause it by compression and it is also caused by infectious diseases, such as rheumatism, typhoid fever, syphilis, etc. In some cases it simply appears without apparent cause.

When the disease process involves the nerve sheaths and connective tissue structures in particular, an interstitial neuritis results; when the disease locates itself in the nerve fibrils it gives rise to "parenchymatous neuritis" (main part of the nerve is inflamed).

Simple Neuritis.--This means that a single nerve of a group of adjacent nerve trunks is affected. If a number of nerves are affected at the same time it is called Multiple Neuritis or Polyneuritis.

Causes.--(a) Exposure to cold. This is a very frequent cause, as for example, in the facial (face) nerve. (b) Traumatism,--that is, wounds, blows, injuries caused by fractures and dislocations; pressure from tumors, sleeping with the head resting on the arms. Pressure from crutches, "crutch paralysis." (c) Diseases involving the nerves due to extension of inflammation from nearby structures, as in neuritis of the facial nerve due to decay of the temporal bone.

Symptoms.--The constitutional or general symptoms are usually slight. The pain is the most important symptom, being of a boring in the parts to which it is distributed. This pain may be very distressing, or of a stabbing character, and is usually felt in the course of the nerve; or it may cause little inconvenience. Sometimes the skin is red and swollen over the affected parts. There is impaired nerve function and as a result of this the muscles supplied by these nerves become weak, and occasionally paralyzed. In severe cases they may become atrophied and an eruption often appears along the course of the nerve. Sometimes the hair and nails are not properly nourished, causing falling out or grayness of the hair and loss of the nails. This neuritis may extend from the peripheral (external) nerves and involve the larger nerve trunks or even reach the spinal cord. This rarely occurs in neuritis from cold, or in that which follows fevers; but it occurs most frequently in neuritis caused by blows, wounds, etc., (traumatic).

Duration.--This varies from a few days to weeks or months. If the primary cause can be remedied it usually ends in full recovery. Sometimes it is followed by the chronic form.

PHYSICIANS' TREATMENT for Neuritis.--The first thing to do is to try to remove the cause. Then absolute and continued rest of the affected part. If one has a sore hand it will be rested, if possible; so it must be with the sore and inflamed nerve.

For the Attack.--After having placed the part in absolute rest, moist heat applied to it frequently brings great relief. Sometimes a mustard plaster applied along the sore part does good. This produces a counter irritation and thus draws some of the congestion from the congested, inflamed nerve. Ice is more effective in some cases than heat. The bowels should be kept open daily with salts. Build up the general health with tonics; no alcohol can be used. If it shows a tendency to become chronic, use massage, electricity or change of climate. Atrophy (shrinking) of the muscles is likely to follow if the disease continues long and for this massage and electricity must be given.

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Treatment. Preventive.--A person who has once had neuritis must exercise all care to keep from taking cold or exposing themselves to severe cold winds and storms. Wet clothing will be apt to cause its return. Damp houses are bad. The climate should be dry and not changeable. There should be enough and proper kind of clothing to keep the body heat at the normal point. Plenty of rest and sleep are required. These cautions also apply to rheumatism and neuralgias.

Multiple Neuritis.--Other names: Polyneuritis, Disseminated Neuritis, Peripheral Neuritis. Meaning--Multiple neuritis is an inflammatory disease of the peripheral (toward the end of the nerves or external nerves) nervous system. It varies much in extent and intensity and affects symmetrical parts of the body.

Varieties.--These arise from differences in the nature, causes, severity and location of the disease process.

Causes.--They are many. (1.) The poison that comes from infectious diseases such as typhoid fever, diphtheria, smallpox, leprosy, la grippe, etc. (2) From poisons such as alcohol, lead, arsenic; phosphorus, mercury, coal gas, etc. (3) From anemia, cancer, tuberculosis, syphilis, septicemia, diabetes. (4) From cold, over-exertion, etc.

Symptoms.--Acute febrile multiple neuritis. A typical case: This comes on from exposure to cold, over-exertion, or in some cases spontaneously. There are chills, headaches, pains in the back, limbs and joints, and the case may be called rheumatism. Loss of appetite, coated tongue, constipation, and other symptoms of stomach and bowel trouble. The temperature rises rapidly, and may go to 103 to 104 degrees. The limbs and back ache, but intense pain in the nerves are not always constant. The pain is usually sharp, severe, and located in the limbs, and is worse from moving and pressure. There are tingling feelings in the hands, feet and body, and a feeling as if ants or insects were crawling over them, and there is also increased sensitiveness of the nerve trunks or entire limb. There is loss of muscular power, first marked, perhaps, in the legs, and it extends upwards and reaches the arms. Sometimes it first begins in the arms. In typical cases the extending muscles of the wrist and ankles drop. (Wristdrop and foot-drop). In severe cases there is a general loss of muscular power, producing a flabby paralysis. This may extend to the muscles that control speaking, swallowing and hearing resulting in impairment of these functions. The muscles soften and waste away rapidly. Disorders of nutrition are frequent, like watery swelling (oedema), glossy looking skin, sweating, hives, etc.

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Recovery.--The course of the disease varies considerably. In mild cases the symptoms disappear very soon. In the worst form the patient may die in a week or ten days. As a rule, in moderately severe cases after persisting for five or six weeks, the condition remains about the same for a few months, and then improvement slowly begins and recovery takes place in six to twelve months. In neuritis from alcohol drinking there is a rapid onset as a rule, with delirium and delusions. The result is usually favorable and after persisting for weeks or months improvement gradually begins, the muscles regain their power, and even in the most desperate cases recovery may follow. The mental symptoms are very severe in alcoholic cases. Delirium is common. It takes much longer for such cases to regain what they call their normal condition.

Neuritis following diphtheria and other infectious diseases. The outlook in cases from these diseases is usually favorable, and except in diphtheria, fatal cases are uncommon. It is most common from diphtheria. Recovery, in neuritis from diphtheria, takes place in about three months, but some cases are fatal.

Neuritis from lead.--The first symptoms are those of intestinal colic, lead line on the gums, "dropped-wrist." The recovery is quite gradual and the poison may be cast out in three to four months.

In Neuritis from Arsenic.--We have disturbance of the stomach and bowels first, then the legs and arms are about equally affected, weakened; may recover in two to six months.

Treatment for acute kind.--The first thing to do is to rest in bed and control the pain and acute symptoms. Hot applications help to relieve the suffering. Patient must be kept comfortably and constantly warm and quiet. Hot applications of lead water and laudanum.

Medicines.--It may be necessary to use morphine to control the pain. Remedies such as antipyrine or aspirin are often used. A physician must be called. When the disease is caused by arsenic and lead and alcohol, of course you must remove the cause before you can hope for any improvement.

Caution.--Any one can readily understand from reading this description that the thing to do is to be careful not to needlessly expose yourself to taking cold. One subject to rheumatism or neuritis, even in small degree, should take care not only not to take cold but not to overdo in laboring; cold, wet and over-exertion cause the majority of the acute attacks. But some are caused by diseases, such as diphtheria, typhoid fever, etc., and a great many cases of neuritis following these and other infectious diseases can be avoided if proper care is taken during and after these diseases. Such care can easily be taken. Keep your rooms warm and comfortable, and the patient in bed or in a comfortable room until all danger is past. How often I have heard a doctor blamed for such results when in most cases it is the patient's or nurse's fault. Certain results will follow certain diseases and only proper care can keep such results from following. Dropsy frequently follows even a light case of scarlet fever. Why? Simply because, on account of being a light case, the child is left to roam at will about the rooms and catches cold, takes la grippe. If people would only take care of themselves this disease would not leave so many lifelong victims. I have seen men and women who have just recovered from this disease stand on the street corners on a cold, damp day, and talk an hour, and the next day they wondered how they could possibly have taken cold. We cannot disobey the laws of nature safely. Persons who are subject to neuritis or rheumatism should be especially careful on cold, damp, wet days and of over-exertion.

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GENERAL AND FUNCTIONAL BRAIN DISEASES. NERVOUS PROSTRATION. NERVOUS EXHAUSTION. NEURASTHENIA.

NERVOUS PROSTRATION.--Is a condition of weakness or exhaustion of the nervous system, giving rise to various forms of mental and bodily inefficiency.

Causes. 1. Hereditary causes.--Some children are born of parents who are weak themselves, and who have led fast lives through business or pleasure and these parents have given their offspring a weakened body, and the children are handicapped with a nervous predisposition and furnish a considerable proportion of "nervous" patients.

2. Acquired.--It is acquired by continual worry and overwork, sexual indiscretion, excesses, irregular living and indiscretion in diet. A great many business men, teachers and journalists become "neurasthenics." It may follow infectious diseases, particularly influenza, typhoid fever and syphilis. It also follows operations sometimes. Alcohol, tobacco, morphine may produce a high grade of the disease, if their use is abused.

Symptoms.--These are varied. The most prominent symptom is fatigue. The patient feels so tired and complains of being unable to do any mental labor. It is almost impossible to put the mind on one subject for any length of time. There are headache, dizziness, want of sleep, and there is great depression of spirits; patient is gloomy, irritable in temper with manifestations of hysteria. Sometimes there are marked symptoms of spinal trouble. Pain along the spine with spots or areas of tenderness. Pains simulating rheumatism are present. There is frequently great muscular weakness, great prostration after the least exertion, and a feeling of numbness, tingling, and neuralgic pains. In spinal symptoms, there is an aching pain in the back, or in the back of the neck, which is a quite constant complaint. Then there are the anxiety symptoms in many cases. There may be only a fear of impending insanity or of approaching death, or of apoplexy, in simple cases. More frequently the anxious feeling is localized somewhere in the body, in the heart region, in the head, in the abdomen, in the thorax (chest, etc.). In some cases the anxiety becomes intense. They are so restless they do not know what to do with themselves. They throw themselves on the bed, complain, and cry, etc. Sometimes the patients become so desperate they commit suicide. Some patients do not wish to see anyone. Some patients cannot read, reading wearies them so much, or they get confused and dizzy and must stop. Some are very irritable. They complain of everything. Remember they cannot help it, usually. Some are easily insulted and claim they are misunderstood. The circulation may be disturbed in some cases. Then there is palpitation of the heart, irregular and very rapid pulse, pains, and feeling of oppression around the heart, cold hands, and feet. The heart's action may be increased by the least excitement and with the fast pulse and palpitation there are feelings of dizziness and anxiety and such patients are sure they have organic disease of the heart. No wonder. Flashes of heat, especially in the head, and transient congestion of the skin are distressing symptoms. Profuse sweating may occur. In women, especially, and sometimes in men, the hands and feet are cold, the nose is red or blue, and the face feels "pinched." Nervous dyspepsia is present in many cases. The digestion is poor and slow and constipation accompanies it. Sometimes there is neuralgia of the stomach. The sexual organs are seemingly affected, many men are "almost scared to death" and they use all sorts of quack remedies to restore their sexual vigor. Spermatorrhea is their bugbear. They usually get well if they stop worrying. In women there is the tender ovary and the menstruation may be painful or irregular. The condition of the urine in these patients is important. Many cases are complicated with lithaemia (sand-stone in the urine). It is sometimes also increased in quantity.

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PHYSICIANS' TREATMENT for Nervous Prostration.--The patient must be assured and made to believe that the disease is curable, but that it will take time and earnest help on the part of the patient. Much medicine is not needed, only enough to keep the system working well. Encouragement is what is needed from attendants. Remove the patient from the causes that produce the trouble, whether it be business, worry, over-study, too much social duties, or excesses of any kind. The patient must have confidence in the physician, and he must be attentive to the complaints of the patient. It is the height of foolishness and absurdity for a physician to tell such a patient before he has thoroughly examined him or her that the troubles are imaginary. I believe that is not prudent in the majority of cases. I have heard physicians talk that way to such patients. I thought, what fools! The patient needs proper sympathy and sensible encouragement. You must make them believe they are going to get well. If you do not wish to do this, refuse such cases, or you will fail with them. If there are any patients that need encouragement and kindly, sympathetic, judicious "cheering up," these patients are the ones, and they generally are "laughed at and made fun of" by people who should know better. Remember their troubles are real to them, and are due to exhaustion or prostration of the nervous system and this condition, as before described, produces horrid feelings and sensations of almost every part of the body. The patient must be made to believe that he may expect to get well; and he must be told that much depends upon himself, and that he must make a vigorous effort to overcome certain of his tendencies, and that all his power of will will be needed to further the progress of the cure.

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First, then, is rest.--Both mental and physical diversions, nutritious though easily digested food, and removal of baneful influences as far as possible. Physical exercise for the lazy. Rest for the anemic and weak. For business or professional men the treatment is to get away and far off, if possible, from business. It will often be found best to make out a daily programme for those that must remain at home, something to keep the mind busy without tiring, and then times of rest. The patient, if it is possible, should be away from home if home influences and surroundings are not agreeable. Dr. S. Weir Mitchell, of Philadelphia, has devised and elaborated a cure, called a rest cure, for the relief of this class of patients, and it is wonderfully successful especially in thin people. "Be the symptoms what they may, as long as they are dependent upon nerve strain, this 'cure' is to be resorted to, and if properly carried out is often attended with surprising results." "A bright, airy, easily cleaned, and comfortable room, is to be selected, and adjoining it, if possible, should be a smaller one for an attendant or nurse. The patient is put to bed and kept there from three to six weeks, or longer as may be necessary, and during this time is allowed to see no one except the nurse and doctor, since the presence of friends requires conversation and mental effort. The patient in severe cases must be fed by the nurse in order to avoid expenditure of the force required in the movement of the arms. No sitting up in bed is allowed and if any reading is done it must be done by the nurse who can read aloud for an hour a day (I have seen cases where even that could not be done). In the case of women, the hair should be dressed by the nurse to avoid any physical effort on the part of the patient. To take the place of ordinary exercise, two measures are employed, the first of which is massage or rubbing; the second, electricity. By the kneading and rubbing of the muscles and skin the liquids in the tissues are absorbed and poured into the lymph spaces, and a healthy blush is brought to the skin. This passive exercise is performed in the morning or afternoon, and should last from one-half to an hour, every part of the body being kneaded, even the face and scalp. In the afternoon or morning the various muscles should be passively exercised by electricity, each muscle being made to contact by the application of the poles of the battery to its motor points, the slowly interrupted current being used. Neither of these forms of exercise call for any expenditure of nerve force; they keep up the general nutrition. The following programme for a day's existence is an example of what the physician should order:

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7:30 a. m.--Glass of hot or cold milk, predigested, boiled or raw as the case requires.

8:00 a. m.--The nurse is to sponge the patient with tepid water or with cold and hot water alternately to stimulate the skin and circulation, the body being well wrapped in a blanket, except the portion which is being bathed. After this the nurse should dry the part last wetted, with a rough towel, using some friction to stimulate the skin.

8:30 a. m.--Breakfast. Boiled, poached or scrambled eggs, milk toast, water toast, or a finely cut piece of mutton chop or chicken.

10:00 a. m.--Massage.

11:00 a. m.--A glass of milk, or a milk punch, or egg-nog.

12:00 m.--Reading for an hour.

1:00 p. m.--Dinner. Small piece of steak, rare roast beef, consomme soup, mutton broth, and any one of the easily digested vegetables, well cooked.

3:00 p. m.--Electricity.

4:30 p. m.--A glass of milk, a milk punch or egg-nog.

6:30 p. m.--Supper. This should be very plain, no tea or coffee, but toast and butter, milk, curds and whey, or a plain custard.

9 :30 p. m.--A glass of milk or milk punch.

In this way the day is well filled, and the time does not drag so heavily as would be thought. If the stomach rebels at over feeding, the amount of food must be cut down, but when all the effort of the body is concentrated on respiration, circulation, and digestion a large amount of nourishment can be assimilated by the exhausted body, which before this treatment is undertaken may have had its resources so shattered as to be unable to carry out any physiological act perfectly. For the treatment to be successful the rules laid down should be rigidly followed, and the cure should last from three to six weeks or longer."

HYSTERIA.--A state in which ideas control the body and produce morbid changes in its functions.

Causes.--It occurs mostly in women, and usually appears first about the time of puberty, but the manifestations may continue until the menopause or even until old age. It occurs in all races. Children under twelve years are not very often affected. A physician writes: One of the saddest chapters in the history of human deception, that of the Salem witches, might be headed, "Hysteria in Children," since the tragedy resulted directly from the hysterical pranks of girls under twelve years of age. During late years it has been quite frequent among men and boys. It seems to occur oftener in the warm and mild climates than in the cold. There are two predisposing causes that are very important--heredity and education. Heredity acts by endowing the child with a movable (mobile) abnormally sensitive nervous organization. Cases are seen most frequently in families with marked nervous disease tendencies, whose members have suffered from various sorts of nervous diseases.

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Education.--The proper home education is neglected. Some parents allow their girls to grow up accustomed to have every whim gratified, abundant sympathy lavished on every woe, however trifling, and the girl reaches womanhood with a moral organization unfitted to withstand the cares and worries of every-day life. And between the ages of twelve and sixteen, the most important in her life, when the vital energies are absorbed in the rapid development of the body, the girl is often "cramming" for examinations and cooped in close schoolrooms for six or eight hours daily; not only that, but at home she is often practicing and taking lessons on the piano in connection with the full school work. The result too often is an active bright mind in an enfeebled body, ill-adapted to subserve the functions for which it was framed, easily disordered, and prone to act abnormally to the ordinary stimuli of life.

Direct Influences.--Those influences that directly bring on the attack are fright, anxiety, grief, love affairs, and domestic worries, especially in those of a nervous nature. Diseases of the generative organs and organic diseases in general, and of the nervous system especially, may be causes of hysteria.

Symptoms.--These may be divided into two classes: 1. Interparoxysmal or time between the paroxysms (spells). 2. Paroxysmal. During the time of the attack. First variety--The will power seems defective. In bad cases self-control is lost. The patient is irritable, and easily annoyed by the slightest trifle; is very excitable and easily moved to laughter or tears without any apparent cause for either. Easily discouraged and despondent. She wants lots of sympathy. Second--Loss of sensation is frequently present, and it is most commonly one-sided; it may involve certain parts, as one or two limbs, the trunk escaping, or part of one limb. Various spots of want of sensation (feeling) may exist. The skin of the affected side is frequently pale and cool and a pin prick may not cause bleeding. In some cases they feel the touch of the hand, but there is no feeling from heat. There may also be oversensitiveness to pain and of the skin. It may be one-sided or both, or only in spots. The left ovarian region is a common sensitive point; also over the breasts, lower positions of the ribs, on top of the head and over many portions of the backbone. Pain in the head is a very common and distressing symptom, and is usually on the top. Pain in the back is common. Abdominal pains may be very severe and the abdomen may be so tender as to be mistaken for peritonitis. Various parts of the body may have neuralgic pains. There may be intense pain around the heart. There may be complete blindness, the taste and smell may be disturbed or complete loss of hearing. Third--Paralysis is frequently present. It may be one-sided or only of the lower extremities, or only one limb. The face is usually not involved when it is on one side. The leg is more affected than the arm. Sensation is lessened or lost on the affected side. Paralysis of the lower extremities is more frequent than one-sided paralysis. The power in the limbs hardly ever is entirely lost; the legs may usually be moved, but the legs give way if the patient tries to stand. The affected muscles do not waste. The feet are usually extended and turn inward. Sudden loss of voice occurs in many cases. The paralysis is generally paroxysmal, and is frequently associated with contractures, shortening of the muscle. The contractures may come on suddenly or slowly, and may last minutes, hours, or months, and some cases even years. Movements of the hands, arms, etc., like the motions in chorea are often seen in the young. A trembling (tremor) is sometimes seen in these patients. It most commonly involves the hands and arms, more rarely the head and legs. These movements are small and quick. Fourth--Swallowing may be difficult on account of spasms of the muscles of the pharynx. The larynx may be involved and interfere with respiration. Indigestion in some form is often present. The stomach and bowels may be very much bloated with gas. There may be a "phantom tumor" in the intestine (bowel). Constipation may be very obstinate, vomiting may be present and persistent and hiccough present. The action of the heart may be irregular, and rapid heart action is common. The least motion may cause difficult breathing and false Angina Pectoris (heart pang); the urine is retained not infrequently in female patients.

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Symptoms of the Paroxysms.--Convulsive seizures are common manifestations of hysteria, and frequently present a great similarity to epilepsy. The prodromal (fore-running) symptoms are frequently present and may begin several days before the convulsion occurs. In milder forms, in which the cause may be due to a temporary physical exhaustion, or emotional shock, the fore-running symptoms are of short duration. The patient may become very nervous, irritable, impatient, have fits of laughing and crying, alternately, or have a feeling of a chill rising in the throat. The convulsion follows these symptoms. The patient generally falls in a comfortable place; consciousness is only apparently lost, for she frequently remembers what has taken place; the tongue is rarely bitten, In the milder forms the movements are apt to be disorderly. In the severe forms the movements are apt to be a lasting contraction of the muscles and the patient may have the head and feet drawn back and the abdomen drawn front. There then may follow a condition of ecstacy, sleepiness, catalepsy, trance, or the patient may show symptoms of a delirium with the most extraordinary sights of unreal things. These convulsions may last for several hours or days. Firm pressure over the ovaries may bring on a convulsion, or if made during a convulsion may arrest it. The disease is rarely dangerous to life, yet death has followed exhaustion induced by repeated convulsions or prolonged fasting. The duration of hysteria is very uncertain.

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DURING A CONVULSION. The first thing to do is not to be frightened. A patient in a convulsion from hysteria very seldom injures herself during the convulsions. If you are sure it is hysteria, give a nasty tasting medicine, asafoetida is a splendid remedy, but not in pill form, for there is no taste or smell to them. Sometimes a convulsion may be arrested by the sudden use of ice to the backbone or abdomen or by dashing cold water in the face and chest, or by pressing upon the ovaries. When the hysteria is of a mild form it is sometimes a good plan, when the convulsion comes on, to place the patient in a comfortable position and then leave her, and when the patient comes to and finds herself alone and without sympathy, the attacks are less likely to be repeated. Sometimes if you watch a patient closely when she is seemingly unconscious, you will see, if you look at her very guardedly, that one eyelid is not entirely closed, and that the patient really sees much that is occurring around her. I am writing of real genuine hysteria, in which the patient is not quite right, not only physically but mentally,--especially the latter,--during the attack at least. For that and other reasons such patients should not be treated cruelly.

Preventive Treatment of Hysteria.--In order to be successful in this line of treatment the cause must be found and treated. An English physician writes: "It is pitiable to think of the misery that has been inflicted on these unhappy victims of the harsh and unjust treatment which has resulted from false views of the nature of the trouble; on the other hand, worry and ill-health, often the wrecking of the mind, body and estate, are entailed upon the near relatives in the nursing of a protracted case of hysteria. The minor manifestations, attacks of the vapors, the crying and weeping spells are not of much moment, and rarely require treatment. The physical condition should be carefully looked into and the mode of life regulated, so as to insure system and order in everything. A congenial occupation offers the best remedy for many of these manifestations. Any functional disturbance should be attended to and a course of tonics prescribed. Special attention should be paid to the action of the bowels. The best preventive treatment is the one that is given early, when the girl is growing from childhood to girlhood. It should be begun even earlier. A weakly baby should be built up by proper food and outdoor life. Dainties should not be given to such a child. When the child is old enough, as some mothers think, to go to kindergarten school, keep the little one at home. It is plenty early enough to send such a child to school when she is seven years old. This early school work rushes the child, makes it nervous. If you should happen to listen to the heart of many young school children you would find it pounding away at a furious rate. Do not hurry a weakly child. Do not hurry or rush a young girl even though she is strong, from the ages of twelve to sixteen years. Our school system does just that. Instead of taking life easy when she is nearing the crisis (puberty) or is in that period, she is hurried and rushed and crammed with her school work; the girl frequently goes to school during this period, even when she is unwell and sits there for an hour or more with wet skirts and sometimes wet shoes and stockings. Every day I see girls of all ages go past my office here in this cultured city of Ann Arbor, without rubbers, treading through the slush and water. Is it any wonder they become sickly, become victims of hysteria and suffer from menstrual disorders? Dysmenorrhea must follow such carelessness, and the parents are to blame in many cases. Be careful of your children, especially girls at this age, care less for their intellectual growth, and pay more attention to their body development, even if it should happen to be at the expense of their intellectual development. A healthy body is better than all the knowledge that can be obtained, if it goes, as it too often does, with a body that is weak and sick. Outdoor life is necessary. Horseback riding is splendid; walking is also good exercise at a regular time each day."

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PHYSICIANS' TREATMENT for Hysteria.--If there is any womb trouble, it must be attended to. There is frequently trouble with the menses in cases of hysteria. It sometimes comes from anemia or simply comes without any special reason. Tonics like arsenic, iron, strychnine and cod-liver oil are needed for anemia. Iron valerate is good, in one grain doses, three times a day, in this disease, when the patient is not fleshy.

1. The following is recommended by Dr. Goodell:

Of each one scruple (20 grains). Quinine Valerate Iron Valerate Ammonia Valerate

Make into twenty pills. Take one or two pills three times a day.

(This is a good tonic in such cases.)

2. Fowler's Solution of Arsenic in three to five drops doses is frequently used (three times a day) and is a good lasting tonic in cases where the patient has a very pale white looking skin.

3. Asafoetida in three to five-grain pills is a splendid tonic in such cases, and in that form is pleasant to take. Take three during the day, before meals.

4. Sumbul or musk root is a good remedy. Tincture in one-half dram doses three times a day. This is good when the patient is very nervous.

5. The following is good when anemia is prominent:

Dried Sulphate of Iron 20 grains Alcoholic extract of Sumbul 20 grains Asafoetida 10 grains Arsenious acid 1/2 grain

Mix thoroughly and make twenty pills, one after each meal.

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6. Tincture of hops in doses of one-half to two teaspoonfuls is good for nervousness and sleeplessness, taken at bedtime. It can also be taken regularly four times a day in from one-half to one teaspoonful doses.

7. General Cautions.--Proper, easily digested foods must be taken. Keep the bowels open daily. Let trash and dainties alone. Pies, cakes, and rich foods are an abomination for such patients. Candy is not to be eaten. Let novels alone. Go to bed at nine and sleep until six or seven. Bathe five or ten minutes every morning or evening in tepid water or cool water. The patient should be warmly clothed. Sleep in a pleasant, sunshiny and airy room. In severe forms of the disease the "Rest Cure" and feeding described under Nervous Prostration should be used.

EPILEPSY. (Falling Sickness).--This is an affection of the nervous system, characterized by attacks of unconsciousness, with or without convulsion.

Causes.--In a large proportion of cases the disease begins before puberty. It rarely begins after twenty-five. It is more liable to attack females than males. Heredity is thought by some to play a big role. Dr. Osler says: "In our figures it appears to play a minor role." Another doctor says: "Heredity plays an important role in the production of the disease. Besides epilepsy, insanity, migraine, alcoholism, near relationship of parents (consanguinity) and hysteria are among the more common ancestral taints observed." All factors which impair the health and exhaust the nervous system are predisposing causes. Injury to the head often causes it. Teething, worms, adherent foreskin and clitoris, closing of the internal opening of the womb, delayed menstruation, are sometimes the cause.

Symptoms.--There are two distinct types. The major attacks--or "grand mal"--in which there are severe convulsions with complete loss of consciousness, etc.; and the minor attacks or "petit mal," in which the convulsive movements are slight and may be absent, and in which the loss of consciousness is often but momentary or practically absent. In some the attacks occur during the day; in others during the night, and they may not be noticed for a long time.

Characteristic paroxysm of the Major attacks.--This may be ushered in by a localized sensation, known as the Aura, in some part of the body; but it may come without any warning and suddenly. The convulsions begin suddenly and at first are tonic, that is, it does not change but holds on. Thc patient falls unconscious regardless of the surroundings, and the unconsciousness may be preceded by an involuntary piercing cry. The head is drawn back and often turned to the right. The jaws are fixed (tonic spasm). The fingers are clenched over the thumb and the extremities are stiff. The breathing is affected and the face looks blue. The urine and bowel contents may escape; but this occurs oftener in the next stage. This tonic spasm usually lasts from a few seconds to a half minute when it is succeeded by the clonic spasm stage.

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Clonic spasm stage.--In this the contraction of the muscles is intermittent. (Tonic spasm is the opposite condition.) At first there is trembling, but it gradually becomes more rapid and the limbs are jerked and patient tosses violently about. The muscles of the face are in intermittent motion, the eyes roll, the eyelids are opened and closed convulsively. The jaws move forcibly and strongly, and the tongue is apt to be caught between the teeth and bitten. The blue look now gradually decreases. A frothy saliva, which may be bloodstained from the bitten tongue, escapes from the mouth. The urine and bowel contents may escape involuntarily. The length of time of this stage is variable. It may last two minutes. The contraction becomes less violent and the patient gradually sinks into the condition of deep sleep, when the breathing is noisy and stertorous, the face looks red and swollen, but no longer bluish. The limbs loose their stiffness and unconsciousness is profound. The patient, if left alone, will sleep for some hours and then awakes and complains only of a dull headache. His mind is apt to be confused. He remembers nothing or little of what has occurred. Afterwards the patient may be irrational for some time and even dangerous.

The minor attack or "petit mal."--There is a convulsion; a short period of unconsciousness, and this may come at any time, and may be accompanied by a feeling of faintness or vertigo. Suddenly, for example, at dinner time the person stops talking and eating, the eyes are fixed and staring and the face is slightly pale. The patient usually drops anything he may be holding. The consciousness returns in a moment or two and the patient resumes conversation as if nothing had happened. In other instances there is a slight incoherency or the patient performs some almost automatic action. He may begin to undress himself, and on returning to consciousness find that he has partially disrobed. He may rub his beard or face, or may spit about in a careless way. An eminent physician states: "One of my patients, after an attack, was in the habit of tearing anything he could lay his hands on, particularly books; violent actions have been committed and assaults made, frequently giving rise to questions which come before court. In the majority of cases of "petit mal" (light attacks) convulsions finally occur, at first slight, but ultimately the grand mal (major attacks) becomes well developed, and the attacks may then alternate."

Recovery.--The authority above goes on to say: "This may be given today in the words of Hippocrates: 'The prognosis in epilepsy is unfavorable when the disease is congenital (that is, existing at birth), when it endures to manhood, and when it occurs in a grown person without any previous cause. The cure may be attempted in young persons but not in old.' '' Death rarely occurs during the fit, but it may happen if the patient is eating. If the attacks are frequent and the patient has marked mental disturbance the conditions are unfavorable. Males have a better outlook than females.

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PHYSICIANS' TREATMENT.--What to do during the Attack of Epilepsy.--Keep the patient from injuring himself, loosen the clothing, take off the collar or anything tight about the neck. Place a cork or spool or tooth-brush handle between the teeth to keep the patient from biting his tongue, but attach a stout cord to the object and hold it in that way.

Preventive and general treatment.--In the case of children the parents should be made to understand that in the great majority of cases epilepsy is incurable. The patients need firm but kind treatment. It does not render a person incapable of following some occupations. "Julius Caesar and Napoleon were subjects of epilepsy." The disease causes gradual impairment of the mind, and if such patients become extremely irritable or show signs of violence, they should be placed under supervision in an asylum. A person with this disease should not marry.

Diet.--Give the patient a light diet at regular hours, and the stomach should never be overloaded. There are cases in which meat is injurious, and it should not be eaten more than once a day and at noon time. A vegetable diet seems best. The patient should not go to sleep until the digestion is completed in the stomach.

Causes.--Should be removed if possible. Circumcision should be done, especially in the young. In case of a female child the "hood of the clitoris" should be kept free. Undue mental and physical excitement should be avoided. Systematic exercise should be taken. Baths in cold water in the morning, if possible, as the skin should be in good working condition.

Medicines.--The bromides are the best, and should always be given under proper supervision of a physician or nurse.

Caution.--I wish to add that parents should always attend to the seemingly harmless "fits" in their young children. It will not do to say they are due to teething or worms. If they are, the worms at least can be treated and that cause removed. They may be due to too tight opening in the penis. If that opening is small, or if the foreskin is tight it will make the child irritable and cause restless sleep. Attend to that immediately. The same advice applies to female children. The "cover" of the "clitoris" may be tight, making the little one nervous; loosen it. If your child keeps its fingers rubbing its private organs there is reason for you to have the parts examined and the cause removed as masturbation often starts in that way. The parts itch and the child tries to stop the itching. These little things often cause "big things" and I am sure "fits" can be stopped very often by looking after the private organs in both sexes.

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SHAKING PALSY. (Paralysis Agitans).--This is a chronic affection of the nervous system, characterized by muscular weakness, trembling and rigidity.

Causes.--It usually occurs after the fortieth year, and is more common in men than in women. The exciting causes are exposure to cold and wet, business worries, anxieties, violent emotional excitement and specific fevers.

Symptoms.--The four prominent symptoms are trembling, weakness, rigidity, and a peculiar attitude. It generally develops gradually, usually in one or the other hand. There is at first a fine trembling, beginning in the hands or feet, gradually extending to the arms, the legs and sometimes the whole body. The head is not involved so frequently. This trembling (tremor) consists of rapid, uniform "shakings." At first it may come in spells, but as the disease advances it is continuous. Any excitement makes it worse. It is very marked in the hands. The trembling generally ceases during sleep. The muscles become rigid and shortened; the head is bent and the body is bent forward; the arms are flexed (bent) and the thumbs are turned into the palms and grasped by the fingers; the legs are bent, movement soon becomes impaired and the extremities show some stiffness in motion. There is great weakness of the muscles and it is most marked, where the trembling is most developed. There is no expression on the face, and the person has a slow and measured speech. The walk is very peculiar, and in attempting to walk the steps are short and hurried. The steps gradually become faster and faster, while the body is bent forward and the patient must keep on going faster to keep from falling. It is difficult to go around in a short circle. The patient cannot change his position in bed easily. The mind is rarely affected.

Recovery.--It is an incurable disease. It may run on for twenty years or more. There may be times of improvement, but the tendency is to grow, gradually worse.

PHYSICIANS' TREATMENT for Shaking Palsy.--This is simply to make the patient as comfortable as possible. Regulate the diet. The patient should not worry or have much exercise. Frequent warm baths are sometimes beneficial with gentle massage of the muscles.

APHASIA.--A partial or total inability to express thoughts in words or to interpret perceptions.

Varieties.--Motor and sensory aphasia.

Causes.--Softening of the brain, tumors of the brain, lesions in syphilis especially, hemorrhage in the brain, blows on the head, and inflammation of the brain and its covering.

Symptoms of Motor Aphasia.--The patient cannot make the muscles of the larynx, tongue, palate and lips perform their functions and produce speech. The patient knows what he wishes to say, but cannot pronounce it. This may be complete or partial. Complete, when the patient can only utter separate sounds. Partial, when the words are only slightly mispronounced and when some certain words cannot be pronounced at all. In some cases, nouns only or verbs cannot be pronounced. Agraphia, means inability to write down the thoughts. Sensory aphasia: word deafness. This is an inability to interpret spoken language. The sound of the word is not recognized and cannot be recalled; but sounds such as that of an engine whistle, or an alarm clock, are heard and recognized. Word-blindness: the person cannot interpret written language. Pharaphrasia: cannot use the right word in continued speech; the patient uses words but misplaces them.

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Recovery depends a great deal upon the cause.

Treatment.--Treat the cause. If from syphilis, iodide of potash and mercury. If from an injury or tumors, operate if possible. Teach the patient how to speak, read and write. The result of this often gives you a pleasant surprise.

WRITERS' CRAMP. Causes.--This occurs much oftener in men than in women, and usually between the ages of twenty-five and forty. The predisposing causes are a nervous constitution, heredity, alcoholism, worry, etc. The chief exciting cause,--excessive writing, especially when it is done under a strain.

Symptoms.--It usually begins with fatigue, weight, or actual pain in the affected muscles. In the spasm form the fingers are seized with a constant or intermittent spasm whenever the person grasps the pen. The neuralgic form is similar in symptoms but severe pain and fatigue comes with writing. The tremulous form: In this the hand when used becomes the seat of the decided tremor. The paralytic form: The chief symptoms are excessive weakness and fatigue of the part and these disappear when the pen is laid aside.

Recovery.--If taken in time and if the hand is allowed perfect rest, the condition may improve rapidly. There is, however, a tendency to recur.

PHYSICIANS' TREATMENT for Writers' Cramps.--There must be absolute rest of the hand. General tonics, such as iron, strychnine, arsenic, and cod-liver oil may be needed to tone up the system.

APOPLEXY. (Cerebral Hemorrhage). (Brain Hemorrhage). Causes.--Bleeding (hemorrhage) into the brain substance is almost always due to an affection of the walls of the large or small arteries of the brain, producing rupture and subsequent bleeding. Persons of fifty or over are more subject to it, and it is more common in men than in women. Any disease that will cause degeneration of the arteries, helps to cause it, such as nephritis, rheumatism, syphilis, gout and alcoholism. Nephritis is one of the most certain causes, because arterio-sclerosis (hardening and decaying of the walls of the arteries) and hypertrophy of the heart are associated with nephritis, etc.

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Direct Causes.--Straining at stool, heavy lifting, anger, rage, fright, etc.; paroxysm of whooping-cough or convulsions may cause it in children.

Symptoms.--Sometimes the patient experiences headache, dizziness, paleness or flushing of the face, fullness in the head, ringing in the ears, etc., temporary attacks of numbness or peculiar tingling in one-half of the body. When the bleeding takes place there is usually loss of consciousness. In the attack:--If the bleeding is extensive the patient falls suddenly into coma, and this may soon prove fatal. If the bleeding is slight at first and gradually increases, the patient is delirious at first, then one arm, then one side, and finally the whole body may become paralyzed, and unconsciousness, and even death may come from the paralysis of the heart and breathing nerve centers. In many cases the patient falls unconscious without previous warning. The face is red, the eyes injected, the lips are blue, the pulse is full and slow, and the breathing is slow and deep. The head and eyes may be strongly turned to the injured side. The pupils may be unequal. The paralysis may not be noticed while the patient is unconscious and is quiet. The urine and the bowels contents may pass involuntarily or the urine may be retained. Sometimes when the case is very grave the patient does not awake from his deep sleep (coma); the pulse becomes very feeble, respiration becomes changed, mucus collects in the throat, and death may occur in a few hours or days. In other cases the clot in the brain is gradually absorbed, and the patient slowly returns to consciousness. Sometimes relapses occur. In mild cases instead of deep coma, there may be only headache, faintness, nausea and vomiting.

Subsequent Symptoms.--When the patient improves, consciousness returns, but there remains a half-side paralysis, hemiplegia, on the side and opposite to that of the seat of the injury in the brain. It may not take in the whole side, only a part. The gait is peculiar. In walking the patient supports the paralyzed arm. In many cases the paralyzed parts gradually regain their functions in a few weeks, but not always complete. The leg improves more than the arm. There is danger of other attacks. When the sleep (coma) is very deep, the breathing is embarrassed, with vomiting and prolonged half-consciousness and extension and complete paralysis, the danger to life is great.

What can I do at once? Loosen the clothing around the neck and waist. Raise the head and shoulders and put cold to the head (ice bag if you have it) and warmth to the feet, legs and hands. Watch the bladder closely. The urine must be drawn frequently in this disease, especially if there is much paralysis. It may dribble away, but that is not enough. Look out for bed sores, especially if the sickness is a long one.

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APOPLEXY. 1. Mothers' Remedies, Simple yet Effective Remedy for.--"Place the feet of the patient in hot water and mustard," This is a very simple treatment for such a serious disease, but very often will relieve as the hot bath will cause a reaction, take the pressure of blood from the brain and by this means has been known to save many lives.

2. Apoplexy, Simple Injection for.-"Place dry salt on the tongue and give an injection as follows:

Warm water 1 quart Common salt 2 teaspoonfuls Brandy 1/2 ounce

This injection is recommended for any kind of a shock which affects the circulation."

The injection of the bowels will relieve the congestion by drawing the blood away from the brain.

Medical treatment must be to regulate the diet, bowels, kidneys, and stomach. Restore the general health.

Caution.--A person who has had an attack of this kind may have another. The mode of life must be changed in most cases. The patient must take things easy. The bowels, kidneys, stomach, and liver must work naturally and the stomach must not be overloaded. Too much meat must not be eaten; alcohol must be let alone; rich foods are prohibited. Hurry, worry, anger, fright, excitement, etc., are bad. Be lazy, take life easy, do not get over-heated, and sleep, sleep, SLEEP,--in a room where there is plenty of good air. Do not lift or strain to have a passage of the bowels. Stooping is injurious. The blood must be kept from the head. Take proper care and you are likely to live years longer. And now you may wonder why I give such cautions. Apoplexy is directly due to a breaking of the wall of a blood vessel, large or small; due to a weakening, or decay, or degeneration of the wall. This lets the blood into the substance of the brain and presses upon the nerve centers, causing the trouble and paralysis. Any wrong action tends to fill the blood vessels very full and the weakened wall bursts.

PALSY. Paralysis.--A loss of movement, entire or partial, in the voluntary muscles of the body. When this loss of power is complete it is called paralysis; when it is not complete, paresis.

Causes.--Inflammation of the brain and spinal cord, tumors in these parts, accidents and injuries, poisons, apoplexy, etc.

Symptoms.--The patient cannot make all the usual motions of the part. The affected muscles may waste after a time.

Different Varieties.--

(a) Paralysis of the ocular (eye) muscles.--The vision becomes double, the eyelids do not act normally, may droop. The eye may not move in every direction as it should.

(b) Paralysis of the muscles of mastication (eating). Symptoms.--If paralysis is only on one side, it is difficult to chew; if on both sides, chewing is impossible. The jaw hangs down.

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(c) Paralysis of the facial (face) muscle.--This is a rather common occurrence, and is due to exposure to wet, and cold, diseases of the middle ear, tumors, etc. Symptoms:--The eyelids do not close tightly, and tears are continually trickling over the cheek; the corner of the mouth droops and the saliva runs out, etc. The mild cases last two or three weeks; the severe form from four to six weeks; the worst cases usually recover in a long time.

(d) Paralysis of the muscles of the upper extremity.--There are various and many symptoms, but with all there is the same loss of the usual motion. That particular muscle does not do its special work; for instance, if the paralysis is of the deltoid muscle of the arm and shoulder, it is not possible to raise the arm, usually pain in the shoulder. The muscle soon wastes and the head of the arm bone (humerus) falls away from the shoulder, etc.

(e) Paralysis of the muscles of the lower extremities.--Paralysis of the "Gluteus Maximus and Minimus." (Hip muscles). Lifting up of the thigh is difficult and so is walking up hill or rising from sitting position. The toes are turned out. The other muscles may be paralyzed and simply cannot do their usual duty.

(f) Toxic (poison) paralysis. Lead paralysis.--It is hard to extend the fingers. The lead line is shown on the gums.

PHYSICIANS' TREATMENT for Palsy.--Remove the cause. Give salts and iodide of potash. Paralysis from arsenic, mercury, zinc or copper:--The symptoms are those of neuritis and are greatly similar in each kind. The spongy gums show mercury; the puffy face and diarrhea show arsenic poison. Remove the cause.

CONGESTION OF THE BRAIN. (Diseases of the Cerebral (Brain) Circulation). (Hyperaemia).--The brain is too full of blood.

Causes. For Active Congestion.--Over-exertion in study, etc.; chronic pletbora (too much blood in the blood vessels); from constant use of alcohol, tobacco, amyl nitrite, and from the stomach.

For passive congestion.--Local obstruction to the return of blood from the brain. Prolonged mental and physical exertion with excesses and irregular living may cause it.

Symptoms of active kind.--Head feels warm, face is red, the arteries in the neck beat hard, violent headache, ears ringing, very restless and does not sleep well.

Symptoms of the passive form.--The headache is not so great; there may be stupor, drowsiness and dull intellect and very sleepy.

Recovery.--Favorable if the cause is removed.

Treatment for active congestion.--Keep the patient absolutely quiet in a dark, well aired room, with the head and shoulders raised, an ice bag or cold cloths to the head and warm applications to the hands and feet. A warm foot bath will aid in drawing the blood away from the head. Give salts (salines) to move the bowels. These take away a great deal of water from the blood and aid in relieving the congestion of the head.

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Treatment for passive congestion.--Remove the cause if possible. Give a light nutritious diet; prohibit alcohol in any form; keep the bowels regular.

CEREBRAL ANEMIA. (Too little blood in the brain). Causes.--Heart disease, general anemia, and mental excitement.

Symptoms.--"Fainting spells," dizziness, the ears ring and there are spots before the eyes; nausea and vomiting may go ahead of the fainting spells. The face is pale, the pupils are dilated, the pulse is small and feeble, and there may be cold sweating on the body. If you can remove the cause the result is favorable.

Treatment.--For the fainting fits:--Place the patient in the "lying down" position and this frequently restores consciousness; loosen any tight clothes, corset, waist, collar, etc. Give plenty of fresh air and do not crowd. Keep quiet yourself; do not get excited. In mild cases, mild stimulants may be necessary. Let the patient smell of camphor, put a cloth with camphor or ammonia near the nose. In other cases amylnitrite and strychnine may be necessary. Small doses of whisky or brandy frequently help. Remove the cause. Give tonics for general anemia.

TUMORS OF THE BRAIN AND INFLAMMATION, Abscess, etc. Abscess.

Causes.--This is always secondary and comes from some other part of the body. It comes often in young and middle life and is more common in males than in females. The most frequent cause is inflammation of the ear and the next is from fracture of the skull bones. It may be large or small.

Symptoms.--May come slowly or quickly. After an injury to the head the symptoms may come on suddenly such as intense headache, delirium, vomiting, chills, high fever, and sometimes convulsions, and a very deep seeming sleep (coma). In chronic cases the symptoms are not so severe.

Treatment.--An operation if the abscess can be reached. If not, an ice bag should be applied to the head; quiet the distress with narcotics.

TUMORS OF THE BRAIN.--Varieties in order of their frequency. Gumma, tuberculous tumors, glioma, sarcoma, cancer, etc.

Causes. Predisposing.--Men are about twice as often affected as women until fifty and then it is about equal. It is more frequent in early adult life. The exciting causes are blows and severe emotional shock.

Gumma (in third stage of Syphilis) appear as a round, yellow, cheesy mass, usually beginning in the membranes and are usually seen between thirty and fifty. They come from syphilis.

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Tuberculous tumors. These appear as hard masses and vary in size. They may be single or many, and are situated in any part of the brain. More than half of the tumors appearing in children are of this variety.

Glioma. "Glue-tumor." They come from tissue forming the basis of the supporting framework of the nervous tissue. This kind occurs often in the young.

Sarcoma and Cancer are rare.

Symptoms.--The most of the growths start in the membranes of the brain, and by compressing a certain part of the brain they produce their special symptoms such as headache, vomiting, inflammation of the nerves of the eye, double vision, blindness, the memory impaired, dullness and apathy, an irritable temper, and sometimes become demented. There is often vertigo or a sense of giddiness. There may be convulsions, and paralysis of some muscles. A general tuberculosis tendency or history of syphilis will help to make the diagnosis. In children it is more likely to be tuberculous. The result is more favorable in tuberculous growths in children and syphilitic tumors in adults. It may last from a few months to three years in a bad case.

Treatment.--For gumma, caused by syphilis, iodide of potash and mercury should be given. In both kinds, syphilitic and tuberculous, a nutritious diet and general tonic treatment, such as cod-liver oil, iron, arsenic, and quinine should be given. The bowels must be kept open and special attention given to the digestion.

For headache.--Ice bags, cold to the head, mustard to the nape of the neck.

For Vomiting.--Mustard over the stomach. Surgery is necessary for some tumors that can be reached. You will naturally depend upon your attending physician for advice and treatment.

SYPHILIS OF THE BRAIN. Causes.--The symptoms of syphilis of the brain, belong to the third stage of the disease, and are rarely ever observed until at least one year or longer from the time of the first lesion (chancre). It may be from ten to twenty years coming on. Both sexes are equally liable, and it may come at any age. Syphilis may produce a circumscribed tumor, a disease of the arteries or a general hardened infiltration of the brain. The tumors are small, yellowish, and cheesy in the center. They originate in the "Dura Mater" (covering) and spread to the brain structure proper. The disease of the arteries causes a thickening of these vessels, a narrowing of the blood channel in them, thus producing a clot.

Symptoms.--Of gumma (syphilis tumors) at the base of the brain, are persistent headache, worse at night; sleeplessness, depression of the mind, memory impaired, vertigo, sometimes vomiting and paralysis of some of the nerves (third and sixth pairs). Violent convulsions, like epilepsy, appear in some cases.

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Symptoms when arteries are diseased.--Temporary loss of speech, numbness or weakness in one limb, the sight is disturbed, or vertigo; and, when the clot (thrombus) appears, symptoms of apoplexy, This is a common variety of syphilis of the brain.

How to tell what the disease is.--The history of the patient will help. An apoplexy in a young person would suggest syphilis.

Recovery.--The chances are better when the disease forms gumma (tumors) than when the blood vessels are diseased.

Treatment.--Should be begun and properly carried on when the person has the primary sore (chancre), and then these after troubles may not follow. This is one of the diseases where the victim reaps a big harvest on account of the sexual sin, and in order to escape the bad results for himself, etc. he should go through a regular course of treatment when he first contracts the disease, perhaps for a year or more, This treatment should last as a rule for some years. It is late to begin when the brain symptoms show brain involvement. For this there must be radical and careful treatment with mercury and iodide of potash; with tonics and general building up treatment, and then even if the patient lives he may be a nuisance to himself and others.

GENERAL PARESIS. (Paretic dementia. General Paralysis of the Insane. Softening of the Brain).--This belongs under diseases of the mind, but there are so many cases that a description of this disease may be instructive and interesting. One author says: "General paresis is a chronic, progressive, diffuse, encephalitis (inflammation of the brain), resulting in structural changes in the cerebral (brain) tissue, with involvement of the cortical, and meningeal, (covering) blood and lymph vessels, presenting characteristic symptoms, with progressive course and fatal termination usually within three years." There are three stages:--1. The period of incubation (the prodromal stage). 2. A stage of pronounced mono-maniac activity with symptoms of paralysis. 3. Stage of extreme enfeeblement with diminution and final loss of power. These stages run into each other. First stage in a typical case:--There are tremblings and slight trouble in speech and expression of the face. The mind has exalted and excited spells, etc.

Symptoms.--The patient is irritable. The mental and moral character is unstable. His affairs are in confusion. He uses bad language, neglects his family, goes with drunkards and bad women, makes indecent proposals to respectable women of his acquaintance without realizing that it is improper. He cannot keep his mind on one thing. Speech is a little thick, indistinct and hesitating. Syllables are dropped or repeated, speech finally becomes undistinguishable. He is very excited; he thinks he is persecuted. He is a big fellow generally. He is a king, he is rich and mighty. This is the usual run. As the disease progresses he becomes feeble-minded more and more so continually. Persistent insomnia comes on early and frequently recurring, one-sided headache often goes with it. Sometimes there is an uncontrollable desire to sleep. Loss of consciousness is an early symptom. After severe attacks there may be one-sided paralysis (hemiplegia) which usually disappears in a few hours or days. Convulsions like epilepsy may appear early, but usually occur in the later stages. The pupils are mostly dilated, rarely contracted, and they are often unequal and react slowly to light. When the tongue is protruded it trembles and is put out in a jerky manner. The hands tremble, in the advanced stage. The speech is jerky and slow. Syllables are dropped and repeated. One early symptom is retention of the urine. There is another annoying symptom--a constant grinding of the teeth. The walk is very spasmodic, but in advanced stages it becomes slouching or dragging. The skin may be red or blue. When the feeble-mindedness is fully developed the mind does not perceive anything accurately. He sees imaginary things, and things that he does see do not appear to him as they are. Finally he has no mind.

Treatment.--The end is sure. You can relieve the distress partly. Personal attention by a physician is needed.

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INSOMNIA.--Insomnia is not a disease, but a symptom of disease. It may, however, become so active, prominent, and important a symptom as to constitute a condition which merits individual management and treatment.

Definition.--Insomnia is the term employed to denote actual or absolute sleeplessness, and also lack of fully restful sleep, which might be termed relative sleeplessness.

Causes.--Organic causes. Disease of the brain and spinal cord. Toxic causes due to poison circulating in the blood which by irritation of the brain and cord (axis) and especially of the brain, cause such diseases as nephritis (chronic), jaundice, typhoid fever and consumption.

Primary causes. Depend upon insanity.

Nervous or simplest causes.--These are present in nervous persons and comprise the two conditions of congestion and anemia of the brain. The brain congestion is typified by the nerve-tire of the student; over-study and anxiety bring too much blood to the brain and necessarily too much activity and then insomnia. Anemia of the brain acts in the opposite manner. The brain cells are not properly nourished and hence irritated, and sleeplessness follows.

SLEEPLESSNESS. Mothers' Remedies. 1. Hop Pillow Stops.--"People affected in this way will be very much benefited by the use of a pillow composed of hops, or cup of warm hop tea on retiring. The hops have a very soothing effect upon the nerves."

2. Sleeplessness, Easy and Simple Remedy for.--"On going to bed, take some sound, as a clock-tick or the breathing of some one within hearing, and breathe long breaths, keeping time to the sound. In a very short time you will fall asleep, without any of the painful anxieties attending insomnia."

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3. Sleeplessness, Ginger at Bedtime for.--"Ginger tea taken at bedtime soothes one to sleep," This is a very good remedy when the stomach is at fault. It stimulates this organ and produces a greater circulation, thereby drawing the blood from the head. This will make the patient feel easier and sleep will soon follow.

4. Sleeplessness, Milk Will Stop.--"Sip a glass of hot milk just before retiring. This is very soothing to the nerves, and a good stimulant for the stomach,"

PHYSICIANS' TREATMENT.--Remove the cause and be careful in using drugs. In the organic kind the treatment is not very successful. In the toxic kind drugs must be given to correct other diseases and also tonics given. For brain congestion and anemia kind other means must be used first, and the drugs as the last resort. Treatment of the congestive insomnia.--1. Hot or warm general body-baths are very advantageous to stimulate the circulation and restore its balance alike in congestion and anemic cases. After such baths the patient must go to bed at once and not get chilled in cold rooms or by drafts. They must be properly covered and kept warm.

2. Cold spongings, cold shower baths, or cold plunge baths are given when the hot or warm bath does not produce the correct result. If this does not depress it is better than the warm bath. The person should be rubbed with warm rough towels until the skin is aglow. If he feels rested and quieted, the reaction is proper; if depressed, the treatment is too vigorous and not suitable.

3. The patient should stand ankle deep in a tub of hot water and a "drip sheet," from water at 75 to 80 degrees temperature, thrown over him. Then rub the patient's back and abdomen hard and a general brisk rub-down immediately after leaving the tub. This treatment should quiet, not excite or depress.

4. The cold abdominal pack is valuable. Flannel is wrung out in water, 75 to 80 degrees temperature and laid in several thicknesses upon the abdomen; place a dry towel over this, cover all with oiled silk, overlapping widely in order to protect the bed. Tie or bandage all this firmly. The effect of this work is first that of a cold then of a warm poultice.

5. Exercise. This should be in the open air when possible. A fast walk, horseback ride or ride on bicycle for a half hour before bedtime, followed by a rub-down will frequently give a good sleep. Dumb-bell, Indian club exercise, chest weight, are good in some cases.

Diet.--A light easily digested supper is often better than a heavy meal. Sometimes a little eaten before bed-time will give sleep. A piece of toast, for instance. It draws the blood from the brain and more to the stomach.

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Medicines. If you must use them.--The bromides are the best. Sodium and strontium bromide are first choice. Twenty to thirty grains in water one-half hour before retiring. Chloral hydrate should not be used often. Sulphonal, trional, etc., should always be given with a little food-never alone. Sometimes bread pills do just as well.

ANEMIC CONGESTION. Diet.--A light supper before retiring, like hot milk, broths, milk punch, etc., will very frequently promote sleep by removing the cause and quickening the circulation. Give nutritious, easy food to digest. The baths are not so valuable for this kind of insomnia. A cold sponge bath or plunge may be of service.

Medicines.--Tonics are needed here as in regular anemia. The patient must be carefully treated, and very many of these cases can be cured. The patient must render all the aid he can give, and the physician should gain his confidence. If he does he will not need to give much medicine to put the patient to sleep, and if he does give it he can frequently use a Placebo with the same effect. Mind has an influence over mind. By "Placebo" is meant any harmless substance, as bread-pills, given to soothe the patient's anxiety rather than as a remedy.

SLEEP WALKING.--There is a tendency to sleep walking in some families, often more than one child will do this to a greater or less extent. It is very extreme in some cases, and the next morning they do not know anything about it. The person is very seldom hurt and he can do some dizzy things. Many persons walk about in their sleeping room or simply get out of bed. Fatigue, worry, poor sleep, restlessness, nervousness, a hearty late dinner are aggravating causes. As age advances and the person becomes stronger, the patient will do less of it.

Treatment.--Avoid over-eating, worry, over-study. The evening should be spent quietly. Such persons had better drop parties, late hours or anything that tends to cause worry, fatigue or nervousness.

STAMMERING.--This may be inherited to some extent; excitement, nervousness, bodily fatigue, want of rest, etc., make it worse.

MOTHER'S REMEDY. 1. Stammering, Easy Cure for.--"Read aloud in a room an hour each day. Repeat each word slowly and distinctly."

PHYSICIANS' TREATMENT.--The person should be taught early to talk slowly, and to do everything to control himself and not get nervous. There are schools for this trouble, and they seem to do good work. They teach the patients how to speak slowly, distinctly and to keep their minds off of themselves.

HICCOUGH.--This is caused by intermittent, sudden contraction of the diaphragm; obstinate hiccough is a very distressing symptom and sometimes it is hard to control.

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Causes.--Inflammatory causes. It is seen in gastritis, peritonitis, hernia, appendicitis, and in severe forms of typhoid fever. Irritative causes. Swallowing hot substances, local disease of the gullet near the diaphragm, and in many cases of stomach trouble and bowel disorder, especially when associated with gas (flatus). Specific causes: Gout, diabetes or chronic Bright's disease. Nervous (Neurotic) causes. Hysteria, epilepsy, shock, or brain tumors.

MOTHERS' REMEDIES. 1. Hiccough. Vinegar for.--"One teaspoonful vinegar sipped carefully (so it will not strangle the patient) will stop them almost instantly."

2. Hiccough, Sugar and Vinegar Stops.--"A few drops of strong vinegar dropped on a lump of sugar and held in the mouth until dissolved, will stop most cases of hiccoughs."

3. Hiccough, Sugar Will Relieve Patient of.--"Place a little dry sugar on the end of the tongue and hold the breath. I have tried this remedy after others have failed and obtained instant relief."

4. Hiccough, Simple Remedy for.--"Have patient hold both ears closed with the fingers, then give them three swallows cold water while they hold their breath."

5. Hiccough, Home Remedy to Stop.--"Take nine swallows of cold water while holding the breath."

6. Hiccough. Vinegar Stops.--"One teaspoonful of vinegar thickened with sugar and eaten slowly."

7. Hiccough, Cinchona Bark in Peppermint Stops.--"Put about one-fourth teaspoonful of cinchona bark, powdered in two ounces of peppermint water, and give one teaspoonful every five or ten minutes until relieved, or three drops of camphor and aqua ammonia in wineglassful of water," These remedies are very good when the stomach is at fault, as they have a stimulating effect.

PHYSICIANS' TREATMENT.--Sudden start may check it in the light forms. Ice, a teaspoonful of salt and lemon juice may be tried. Inhalations of chloroform often relieve. Strong retraction of the tongue may give immediate relief. Spirits of camphor, one teaspoonful. Tincture of cayenne pepper one to two drops in water. Ten grains of musk by the rectum. Hoffman's anodyne one teaspoonful in ice water is very good.

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INJURIES TO THE HEAD. Concussion or Laceration of the Brain.--The brain may be injured by a blow on the head, or indirectly by falling fully upon the feet or sitting down hard upon the buttocks.

Symptoms.--The person who is injured may lose his balance and fall, become pale, confused, and giddy, may have nausea and vomiting and recover. If the injury is more severe and there is a tear of the membranes of the brain or the brain itself, the patient will fall and lie quietly with a feeble and fluttering heart, cold, clammy skin, and apparent unconsciousness; he can be roused by shouting but will not reply intelligently. He will be able to move his limbs. The urine and contents of the bowels will be passed involuntarily. As he gets better he may vomit. He may soon return to entire consciousness, but still suffer from some headache, feel wearied, and tired, and not feel like exerting himself. This may continue for some time. Occasionally the results are more serious even after a long time has passed, and an abscess of the brain should be watched for, sometimes epilepsy or insanity follows. If the patient grows worse instead of recovering, either deep seeming sleep sets in or symptoms of inflammation of the covering (meninges) or the brain itself follows. Such injuries must be carefully watched, for you can not tell at first how severe they may prove to be.

TREATMENT. What to do First.--Put the patient to bed without any pillow, and put around his body hot water bottles or bags, suitably covered. He should be kept quiet and free from excitement, and sleep should be encouraged. Hot water or ice water, when awake, as is most agreeable to the patient, may be given. Aromatic spirit of ammonia, during the shock is better for the patient to take than alcohol, for alcohol excites the brain; dose, one-half to two drams; the former can be given every ten minutes in a little water for about three doses. Surgical treatment may be necessary at any time.

INJURIES OF THE SPINAL CORD. Concussion of the Spine.--A severe jarring of the body followed by a group of spinal symptoms supposed to be due to some minute changes in the cord, of an unknown nature.

Causes.--Severe concussion may result from railway accidents or violent bending of the body, fall from a house, blow on the back, jumping, etc.

Symptoms.--May come on suddenly, when it is due to a jar of the brain as well as the cord. Loss of consciousness, complete paralysis, small pulse, collapse, and within a few hours death may follow. In other cases improvement, though very slow, follows. Walking is difficult and the upper extremities are weak in these cases. There are pain and tenderness along the spine. Brain symptoms, such as headache, dizziness and fainting, may be present or absent.

Treatment.--Absolute rest from the beginning, stimulants if necessary, electricity is useful.

TRAUMATISM OF THE CORD. (Blows, etc.).--(Fractures and dislocations, gunshot and stab wounds, etc.).

Symptoms.--They differ according to the place where the cord is injured. The motion and feeling power may be disturbed. There may be sudden complete paralysis of the upper and lower extremities depending on how severely the cord is injured, and how high up the injury is. The bladder and rectum may not act properly. The contents may be retained or "run-away." Death follows sooner or later if the injury is extensive. In some cases the symptoms are slight in the beginning, but increase in a few days, or they may suddenly increase a few months afterwards. In other cases, bad symptoms at first may gradually abate which is due to the blood clot having been absorbed.

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Recovery depends upon the extent of the injury and the constitution of the patient. It is always well to be careful about expressing an opinion about this injury.

Treatment. Immediate.--Surgical treatment is necessary. Absolute rest is a necessity, and must be had for weeks according to the severity of the case. It may seem long and become tedious, but the case must have rest for a long time.

ORGANIC DISEASES OF THE SPINAL CORD. Caisson Disease; Divers' Paralysis. Causes.--This affection occurs in divers, bridge builders, and others who are subject to increased atmospheric pressure. The symptoms develop on coming suddenly to the surface when the atmospheric pressure is greatly lessened.

Symptoms.--They usually occur on the return to the surface of the water, or after a few hours have passed. There are pains in the ears and joints and nose-bleed. The pulse is slow and strong. Neuralgia of the stomach and vomiting often occur. Paralysis of one side, or of the lower extremities may occur. Brain symptoms may develop and death may follow in a few hours. In most cases recovery takes place in a few days or weeks.

Treatment.--Persons who are engaged in such work should change very gradually from a great depth to the surface, and should not go into the outer air suddenly.

MYELITIS.--Myelitis is an inflammation of the spinal cord.

Causes.--It may occur at any age, and is more common in male than in female. The exciting causes are prolonged exposure to severe colds, too great mental and physical exertion, sexual excess, blows, bleeding into the cord, alcoholic excess, acute infectious diseases, syphilis, etc.

Symptoms.--These depend upon the location of the inflammation and the severity. The onset may be sudden or gradual--when it is sudden, there may be a chill followed by a fever of 101 to 103 degrees--general feeling of illness, loss of appetite, with coated tongue and constipation. There may be over-sensitiveness to pain and touch. Pain may radiate from the back into the limbs, with numbing and tingling of the limbs. The urine may be retained or may dribble away. Usually there is obstinate constipation. There is frequently the feeling of a band around the body. Paralysis may follow in the lower extremities and higher up, sometimes, depending upon how high up in the cord the inflammation exists. This paralysis may cause no motion of the limbs or produce an exaggerated contracting of the affected muscles, the knees being drawn up on the abdomen and the heels touching the buttocks.

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Recovery.--Chances for recovery depend upon the cause. Most cases are chronic and may last for years.

Treatment.--Treatment depends also upon the cause. Rest in bed; counter-irritation, wet cupping, with care on account of bed sores. A water-bed from the first may prevent bed-sores. The urine must be drawn if it is retained. The medical treatment must be carefully given and a physician of experience should be obtained.

LOCOMOTOR ATAXIA. Tabes dorsalis. Posterior Spinal Sclerosis).--A hardening (sclerosis) affecting the posterior parts of the spinal cord and characterized by incoordination, which means a condition where a person is unable to produce voluntary muscular movements; for instance, of the legs, etc., loss of deep reflexes to bend them back; disturbances of nutrition and sensation, and various affections of sight.

Causes.--This is a disease of adult life, persons under twenty-five being rarely affected, and is more common in men than women (ten to one). Sometimes children suffering from hereditary syphilis have it. The chief predisposing cause is syphilis which precedes it in from seventy to eighty-five of the cases according to various authorities. Exposure to cold and wet, sexual and alcoholic excesses, mineral poisoning, and great physical exertion also exciting causes.

Symptoms.--These are numerous. They appear in succession and with the same regularity.

Stages.--Stages of pain; the stage of ataxia, peculiar gait; and the state of paralysis.

1. Prodromal or forerunning; the stage of pain.--This consists of lightning-like pains in the lower extremities, numbness, formication (feeling of ants, etc., crawling), sensation of dead extremities; pins and needles in the soles of the feet and fingers, coldness, itching of arms and scrotum or other parts, a sensation of constriction around the chest, headache, pain in the small of the back and loins of an aching character may occur. These symptoms may constitute the only evidence of locomotor ataxia and last for years; but sooner or later there are added absence of knee cap bone reflex (knee jerk), and immobility of the pupil. The loss of the knee jerk is always observed in time. The pupil fails to respond to light while it still accommodates for distance, called Argyll Roberston pupil. There may be imperfect control of the bladder with slow, dripping or hasty urination. Later the control is not imperfect, but it may be painful. Inflammation of the bladder may occur which is dangerous. There is usually obstinate constipation and loss of sexual power. These symptoms may last for several months and years, and then the second stage symptoms appear.

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2. Stage of Ataxia (Disturbance of motion).--The disturbance of motion (ataxia) is very marked, especially in the lower extremities; the walking becomes difficult and uncertain; there is difficulty in rising or rapid turning; the legs are wide apart; feet lifted too high and come down too forcibly; the length of the steps is irregular, and the body is imperfectly balanced. If the patient stands with his feet together and eyes closed he begins to sway, (Romberg's symptom), which is due to a defect in controlling the muscles from impairment of sensation. There may be imperfect use of the hands in dressing, writing, etc.; lancinating pains are marked in all cases and come on in paroxysms. The pains are mostly in the legs, but also occur in the arms, head, loins, back, and trunk. Then the sense of touch is partially lost. The prick of a pin may not be felt until a few seconds after being applied. This stage may last for years and remain at a "standstill;" but it is usually progressive, and advances to the third stage.

3. The stage of paralysis is marked by a gradual change to the worse, and the patient must remain in bed, because he cannot get out. The lower and sometimes the upper extremities have lost a great deal of their power of sensation: The joints, mostly the knee and hip joints show on both sides of the body a painless swelling, owing to the great quantities of watery liquid there. Dislocations and fractures occur simultaneously. Bed-sores and peculiar ulcers on the sole of the foot also occur. The urine dribbles away constantly, for all control of the bladder is lost. Death occurs from exhaustion; bedsores, inflammation of the bladder, or pneumonia coming on as a complication.

Treatment;--The only thing to do when the patient has this disease is to make him comfortable and arrest the progress of it, if possible. It is incurable, but treatment sometimes arrests the progress and at least lessens the suffering and prolongs life as long as it is worth living to them. I have given a longer description than was necessary, for I wanted men who live such fast lives to understand what it brings them for most cases are caused by syphilis. The description could have been made longer and other symptoms and complications put in. I think enough has been given and perhaps this description may deter some one from going the same road.

The Diagnosis is made at first by the fatigue, peculiar pains, loss of the knee jerk, the peculiar pupil and history of syphilis. Later it is made from the ataxia; the peculiar walk, etc., and the bladder disturbances.

HEREDITARY ATAXIA. Friedrich's Disease.--This peculiar disease is due to a degenerative disease of the posterior and lateral columns (parts) of the spinal cord, occurring in childhood, and often in several children of the same family.

Causes.--More in boys than in girls and oftener in the country districts. Heredity is frequently a cause and it is traced to syphilis, epilepsy, alcoholism, and insanity in the ancestors. Several children of the same family may have it.

Symptoms.--In very young children it is noticed that they are slow in learning to walk; the child staggers in trying to stand or to walk; it uses its hands clumsily, and has difficulty in speaking. The movements of the hands are peculiar, the hands move like in chorea, the speech is slow and drawling.

Recovery.--Very doubtful, but they may last for years.

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INFANTILE PARALYSIS. (Acute Anterior Polio Myelitis).--This is an acute disease occurring almost exclusively in young children with paralysis, followed by rapid dwindling of the muscles of the parts affected by the paralysis.

Causes.--Found in children under three years old. It is more common in summer than in winter. It often follows scarlet fever, measles, and diphtheria.

Symptoms.--The onset is usually sudden; often the child is put to bed at night seemingly well and in the morning is found paralyzed in one or more limbs. High fever or chills, general feeling of illness, pain all over the body, decided brain symptoms, like delirium or convulsions and intermittent contractions of the muscles may usher in the disease. These forerunning symptoms may last a short time or for several weeks, after which the paralysis is noticed, being extensive as a rule, and affecting one, two, or all of the extremities and sometimes the muscles of the trunk. This general paralysis soon disappears being left permanently in only one extremity, chiefly in one leg. The other symptoms disappear. The paralyzed part atrophies (wastes) rapidly. The disease is very rare in adults. If the paralysis does not show a decided change within the first few months, full recovery is doubtful.

Treatment.--During the acute stage there must be absolute quiet and rest with a diet that is not stimulating, one that is easily digested; ice to the head or cold cloths, counter-irritation to the spine; electricity should be used after a few weeks. There is quite a good deal of this paralysis, and the case should receive careful attention from the start.

TASTE.--Taste-Buds.--There are three kinds of papillae or eminences on the human tongue,--the circumvallate, the fungiform and the filiform. The circumvallate are from seven to twelve in number and lie near the root of the tongue, arranged in the form of a V, with its open angle turned forward. Each one is an elevation of the mucous membrane, covered by epithelium and surrounded by a trench. On the sides of the papillae, embedded in the epithelium, are small oval bodies called taste-buds. These taste-buds consist of a sheath of flattened, fusiform cells, enclosing a number of spindle-like cells whose tapering ends are prolonged into a hair-like process. As the filaments of the gustatory nerves terminate between these rod-like cells, it is probable that they are the true sensory cells of taste.

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In the human tongue taste-buds are also found in the fungiform papillae, often seem as red dots scattered over its surface; and to an area just in front of the anterior pillar of the fauces. It is also possible that single taste-cells are scattered over the tongue, as the sense of taste exists where no taste-buds can be found.

Many so-called tastes are really smells. This is easily proved by compressing the nostrils and attempting to distinguish by taste different articles of food.

The taste sensation is greatest when the exciting substance is at the temperature of the body. There is no perceptible sweetness to sugar when the tongue has been dipped for a half-minute in water either at the freezing temperature or warmed to 50 degrees C. Neither is there any sense of taste until the substance is dissolved by the natural fluids of the mouth, as will be seen by wiping the tongue dry and placing sugar upon it.

The four primary taste-sensations are bitter, sweet, sour and salt. These probably have separate centers and nerve fibers. Sweet and sour tastes are chiefly recognized at the front and bitter and alkaline tastes at the back of the tongue. The same substance will often excite a different sensation, according as it is placed at the front or back of the tongue.

There are also laws of contrast in taste sensations. Certain substances will enhance the flavor of another and others will destroy it. Again, certain tastes may disguise others without destroying them, as when an acid is covered with a sweet.

INSANITY. History.--The earliest reference to insanity is found in the book of Deuteronomy. Another reference is in Samuel where it speaks concerning David's cunning and successful feigning of insanity. "And he changed his behavior before them and feigned himself mad in their hands, and scrabbled on the door-posts of the gate, and let his spittle fall down upon his beard," Feigning insanity under distressing circumstances has been one of man's achievements throughout the centuries. It is spoken of in Ecclesiastes. Jeremiah says in regard to the wine cup: "And they shall drink and be moved and be mad." Nations also were poisoned by the wine cup, for Jeremiah says, "Babylon has been a golden cup in the Lord's hands, that made all the earth drunken. The nations have drunken of her wine, therefore the nations are mad." Greek writers speak of cases of mental unsoundness as occurring with some frequency in Greece. The inhabitants of the Roman Empire were afflicted with mental unsoundness and Nero was considered crazy. In ancient Egypt there were temples and priests for the care of the insane.

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Hippocrates, who lived four hundred years before Christ, was the first physician who seemed to have any true conception of the real nature of insanity. For many centuries later the masses believed that madness was simply a visitation of the devil. The insane, in the time of Christ, were permitted to wander at large among the woods and caves of Palestine. The monks built the first hospital or asylum for the insane six centuries after Christ.

A hospital for the insane was established at Valencia in Spain in 1409. In 1547 the hospital of St. Mary of Bethlehem was established near London and was known as "Bedlam" for a long time.

The first asylum to be run upon reform principles was St. Luke's of London, founded in 1751. About 1791 Samuel Hahnemann established an asylum for the insane at Georgenthal, near Gotha, and the law of kindness was the unvarying rule in the institution. Hahnemann says in his Lesser Writings: "I never allow any insane persons to be punished by blows or other corporeal inflictions." Pineli struck the chains from the incarcerated insane at the Bicetre, near Paris in 1792 or 1793.

There has been a gradual tendency during the last century toward better things in the behalf of the insane. A hundred years ago they were treated with prison surroundings and prison fare. Then asylum treatment began to prevail. This means close confinement, good food, sufficient clothing and comfortable beds. Asylum care means the humane custody of dangerous prisoners. "From the asylum we move on to the hospital system of caring for the insane and this system recognizes the fact that the lunatic is a sick man and needs nursing and medical treatment in order to be cured. Hospital treatment has been gradually introduced during the past thirty years or more," and in time it will eventually supercede asylum treatment and prison or workhouse methods in the management of the insane everywhere.

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Causes of Insanity.--There are many and various causes. One author states: "Mental abnormality is always due to either imperfect or eccentric physical development, or to the effects of inborn or acquired physical disease, or to injurious impressions, either ante-natal or post natal, upon the delicate and intricate physical structure known as the human brain." Some physical imperfections, more than others, give rise to mental derangements, and some persons, more than others, when affected by any bodily ailment, tend to aberrated conditions of the mind. Some impressions more than others, are peculiarly unfortunate by reason of their crowding effects upon the brain tablets of a sensitive mind. To these natural defects and unnatural tendencies, we apply, in the general way, the term "Insane Diathesis." This diathesis may be inherited or acquired. Those who are born to become insane do not necessarily spring from insane parents or from an ancestry having any apparent taint of lunacy in the blood. But they do receive from their progenitors oftentimes certain impressions upon their mental and moral, as well as upon their physical being, which impressions, like iron molds, fix and shape their subsequent destinies."

The insane diathesis in the child may come from hysteria in the mother. A drunken father may impel epilepsy, madness or idiocy in the child. Ungoverned passions, from love to hate, from hope to fear, when indulged in overmuch by the parents, may unloose the furies of unrestrained madness in the minds of the children. "The insane may often trace their sad humiliation and utter unfitness for life's duties back through a tedious line of unrestrained passion, of prejudice, bigotry, and superstition unbridled, of lust unchecked, of intemperance uncontrolled, of avarice unmastered, and of nerve resources wasted, exhausted, and made bankrupt before its time. Timely warnings by the physician and appeals to his clients of today, may save them for his own treatment, instead of consigning them to an asylum where his fees cease from doubling, and the crazed ones are at rest." The causes of the insane diathesis (constitution) are frequently traceable to the methods of life of those who produce children under such circumstances and conditions that the offspring bear the indelible birthmark of mental weakness. Early dissipations of the father produce an exhausted and enfeebled body; and a demoralized mind and an unholy and unhealthy existence in the mother, are causes. Fast living of parents in society is a fruitful cause of mental imperfections in their children. "The sons of royalty and the sons of the rich, are often weak in brain force because of the high living of their ancestry."

The fast high livers of today are developing rapidly and surely, strong tendencies to both mental and physical disorders. Elbert Hubbard says of those who live at a certain hotel and waste their substance there, that they are apt "to have gout at one end, general paresis at the other, and Bright's disease in the middle."

Drunkenness, lust, rage, fear, mental anxiety or incompatibility, "if admitted to participation in the act of impregnation will each, in turn or in combination, often set the seal of their presence in the shape of idiocy, imbecility, eccentricity, or absolute insanity."

Diogenes reproached a half-witted, cracked-brained unfortunate with this remark, "Surely, young man, thy father begat thee when he was drunk."

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Burton in his anatomy of melancholy states that: "If a drunken man begets a child it will never likely have a good brain," Michelet predicts: "Woe unto the children of darkness, the sons of drunkenness who were, nine months before their birth, an outrage on their mothers."

Children of drunkards are often "sad and hideous burlesques upon normal humanity." Business worry may cause unsoundness in the offspring generated under such conditions.

One father had two sons grow up strong and vigorous, mentally and physically, while a third son was weak, irresolute, fretful, suspicious and half demented. The father confessed to his physician that on account of business troubles he was half crazy and during this time the wife became pregnant and this half-crazy son was born and the father states that "he inherits just the state of mind I was then in." Many such cases could be mentioned. "A sound body and a cheerful mind can only be produced from healthy stock." Mental peculiarities are produced by unpleasant influences brought to bear upon the pregnant mother. The story is told of King James the Sixth of Scotland, that he was constitutionally timid and showed great terror at a drawn sword. His father was murdered in his mother's presence while she was pregnant. Children born under the influence of fear may be troubled with apprehensions of impending calamity, so intense that they may become insane at last. An instance is given of "an insane man who always manifested the greatest fear of being killed and constantly implored those around him not to hurt him." His mother lived with her drunken husband who often threatened to kill her with a knife.

Other Causes of Insanity. Imperfect Nutrition.--Whatever tends to weaken the brain or exhaust the central forces of life must favor the growth of insanity. The brain is not properly nourished.

Blows and Falls upon the Head.--Sometimes such injuries are forgotten, but they result infrequently in stealthily developed, but none the less dangerous, conditions, which may result in the derangement of all mental faculties. A child should not be struck on the head. Teachers or parents should not box a child's ears. One author says such a person "is guilty of slow murder of innocents."

Fright is Another Cause.--Punishing a child by locking it in a dark room or by "stories of greedy bears or grinning ghosts produces, oftentimes, a mental shock that makes a child wretched in early life, and drives him into insanity at a later date." Overtaxing the undeveloped physical powers is another cause.

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Insanity is most Prevalent among the Working Classes.--Our factories, shops and stores frequently employ the young of both sexes and they are overtaxed by day and night and they become feeders of our hospitals for the insane. Another cause is forced education in the young. Our present school system tends to break down the body. The work may not be too hard, but the amount of anxiety and worry, which this work causes in the minds of sensitive children, tends to enfeeble them. Many children are sensitive, with nervous temperaments, and they are easily affected by the strain of mental toil. Delicate children should be kept in the open air and their physical condition should be considered more than their mental. Girls, especially, at the age of puberty, should be built up instead of rushed through a heavy routine of study. Herbert Spencer says: "On old and young the pressure of modern life puts a still increasing strain. Go where you will, and before long there comes under your notice cases of children, or youths of either sex, more or less injured by undue study." Here, to recover from a state of debility thus produced, a year's vacation has been found necessary. There you will find a chronic congestion of the brain that has already lasted many months and threatens to last much longer. Now you hear of a fever that has resulted from the over excitement, in some way, brought on at school. And, again, the instance is that of a youth who has already had to desist from his studies, and who, since he has returned to them is frequently taken out of his class in a fainting fit.

Social pleasure also tends to weaken the system of parents who produce nervous and weakened children. Another great cause of insanity is the unnatural, improper and excessive use of the sexual organs, and diseases that often come from indiscriminate sexual relations. General paresis is very often caused by specific disease. I might go on and enlarge upon these causes, but enough has been written to give warning to those who are breaking nature's laws.

Classification.--There are many classifications. I will mention only the leading names, such as Melancholia, Mania. Dementia, General Paresis.

MELANCHOLIA (Sad Mania).--Melancholia is a disease characterized by great mental depression.

Causes--Predisposition, physical disease, dissipation, work and worry, shock, brooding. In simple melancholia the mildest attack may be called the "blues."

ACUTE MELANCHOLIA.--Is generally the result of some mental shock.

CHRONIC MELANCHOLIA is the end of all other forms of mental depression. All these have their own peculiar manifestations and need a special line of treatment.

MANIA.--This type of insanity means a raving and furious madness. There are many cases of this kind. The causes are many and may be the same as those which produce melancholia. In melancholia the shock, etc., causes depression, while in the mania the causes of mental injury tend to produce irritation and excitement. In dementia, the causes of insanity tend to exhaust the body and to mental failure, while in general Paresis "the shock of disease comes after long and unwise contact with worry, wine and women." Insufficient sleep often causes mania. It often follows after exhausting and irritating fevers. Long continued ill health, together with worry, etc., may cause it.

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To sum up, "mania" may result from any unusual shock or strain upon the nervous system; or it may come after any unusual mental excitement in business, politics or in religion. Such are the exciting or stimulating causes, but we must go back of the presence of worldly misfortune and trace the tendency to mental disorder through channels of hereditary influence. "Infants are born every day whose inevitable goal is that of insanity." What is said in the Bible about sins of the parents is true.

DEMENTIA.--This term literally means "from mind," out of mind, and such a person is in a state of the most deplorable mental poverty. We all have seen such cases and some cases are not only very sad but disgusting.

PRIMARY DEMENTIA comes on independently of any other form of insanity.

SECONDARY DEMENTIA follows after some other form of insanity,--chiefly melancholia or mania. Dementia may be acute or chronic.

SENILE (OLD AGE) DEMENTIA may be Primary.--Acute dementia attacks both sexes, but it occurs most often in females, though in a milder degree. It is a disease of youth, being rarely seen beyond thirty years of age. It seems to depend often upon exhausting influences operating at a period of rapid growth. Monotony of thought and feeling or want of mental food can also induce it. Children who are sent at an early age into factories often pass into the condition of acute dementia. Prison life also tends to produce such a condition. Acute diseases such as typhoid and other fevers are sometimes followed by acute dementia. Persons frequently go "out of their mind" suddenly in this age, and upon recovering from acute dementia, the patient finds a great "vacancy of memory."

Chronic Dementia.--Shakespeare says, "Last scene of all, that ends this strange, eventful history, is second childishness and mere oblivion; sans teeth, sans eyes, sans taste, sans everything."

"The Sans Everything."--Is the sad and hopeless obscuration by time or disease of the once bright, vigorous, scintillating mental powers of exhuperant and lusty youth. Everyone has seen such people who are partially or hopelessly demented. It may come from diseases, such as epilepsy and syphilis; alcohol produces it.

Senile dementia is the result of old age and of acquired brain disease. It is different from simple old age or dotage. In old age the mind is weakened, but the patient is conscious of it, such a person forgets a name or date and gropes about in his memory to find it.

The demented person is not conscious of loss of memory, but applies wrong names to persons, and serenely thinks he is right.

The senile demented person does not realize his condition, and if there is any mental power left he cherishes delusions or false beliefs.

The victim of old age is unconscious of his weakness.

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GENERAL PARESIS.--Wine, worry and women produce a great many cases of this disease. The doctors claim a notorious criminal now committed to one asylum and about whom we have read so much, is a victim of this disease.

First stage.--There is worry, anxiety, sleeplessness and melancholy.

Second stage.--Stage of mania, wealth, power, and grandeur, alternating in some cases with attacks of temporary depressions.

Third stage.--Patient passes into a condition of subacute or chronic mania, with a slow tendency to decadence of all the powers, idiotic.

Fourth stage.--Stage of physical and mental failure and of death. Syphilis causes most cases. It usually develops between twenty-five and fifty years. The outlook for such cases is very unfavorable, as the patient usually dies from one to eight or ten years after the beginning of the disease.

TREATMENT.--There have been great advances made in recent years in the treatment of persons mentally unsound. They should be placed under proper treatment at an early stage. The causes have been given so that preventive measures may be taken.

CONSTITUTIONAL DISEASES.

RHEUMATIC GOUT. (Rheumatic Arthritis. Arthritis Deformans).--Cause.--It occurs most often from thirty to fifty-five, usually in women, generally at or after the change of life, and most frequently in those who have not had children. The involvement of the joints is most common in adult males.

Exciting cause may be: Exposure to cold and wet, improper food, unhygienic surroundings, worry, blows and acute infections.

Conditions.--Several joints are usually involved symmetrically. At the edge of the joints there is formation of new bone covered with cartilage, causing the enlargement of the bone and often partial loss of motion in that joint.

Symptoms.--Several distinct types exist. 1. General progressive types which may be acute or chronic.

Acute.--This occurs usually in women from twenty to thirty and at the change of life. It comes on like acute joint rheumatism, many joints being affected, permanent enlargement appearing early, redness of the joints rarely existing, the pain being very severe, some fever, feel very tired, with anemia, loss of flesh and strength. The first and later attacks are often associated with pregnancy, confinement or nursing.

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Chronic Type.--There is a gradual onset of pain or stiffness in one or more joints, usually of the fingers, then of the corresponding joints of the other side and then other joints. The swelling at first may be in the soft parts of the joints with effusion in the joints and tenderness. The pain varies from slight to severe. Periods of improvement and getting worse alternate; the joints becoming enlarged and deformed, often nearly stiff in partial bending on account of the thickened bone and soft tissues. The muscles that move the joint dwindle and there may be changes in the skin and nails of the parts affected due to the want of proper nourishment. Disturbances of the stomach and anemia are common. The heart is not affected. There may be only a few joints affected, or many, with great deformity, before the disease reaches the period of inactivity.

2. Monarticular or one joint type.--This usually occurs in males over fifty; one joint or a few large joints may be affected, generally with shrinking of the corresponding muscles. If it occurs in the hip it is called Morbus Coxae Senilis,--Hip joint disease in the aged.

Recovery.--The disease usually goes on with intervals of improvement and often results in great crippling and disability. In some cases it becomes permanent.

General Treatment.--The climate should be warm and dry. The patient should avoid exposing himself; lead a general hygienic life, with as nourishing food as his digestion will permit. The chief line of treatment should be to improve the general health and relieve the pain. The stomach, bowels, and kidneys should be kept working well. Nourishing food should be taken, but its effect must be watched. Cod-liver oil to build up the system, iron and arsenic may be of value. Sometimes iodide of potash is good. Early and thorough treatment at Hot Springs offers the best hope of arresting its progress, the Hot Springs in Bath County, Va., and in Arkansas. Much can be done at home by hot air baths, hot baths, and compresses at night to the tender joints.

Local.--Massage carefully given is helpful. The hot air treatment is good. Baking the joints is now frequently done.

GOUT (PODAGRA).--A disorder of nutrition characterized by excess of uric acid in the blood, attacks of acute arthritis (inflammation of joints) with deposit of urate of sodium in and around the joints; with various general symptoms.

Causes.--Heredity; male sex, usually appears from thirty to fifty and rarely under twenty; from continued use of alcoholic liquors, especially fermented, with little or no exercise; too much meat. Unhygienic living with poor food, and excessive drinking of ale and beer may be followed by the "poor man's gout." It is common in lead workers.

Symptoms. Acute Type.--There is often a period of irritability, restlessness, indigestion, twinges of pain in the hands and feet; the urine is scanty, dark, very acid, with diminished uric acid and deposit when it is cooled. The attack sets in usually early in the morning with sudden intense pain in a joint of the big toe, generally the right; less often in an ankle, knee, wrist, hand or finger. The part swells rapidly, and is very tender, the overlying skin being red, glazed and hot. The patient is usually as cross as a wounded bear. The fever may be 103. The pain may subside during the day, and increase again at night. There is no suppuration (pus forming). The symptoms usually decrease, gradually, the entire attack may last from five to eight days. Scaling of the skin over the sore part may follow. After the attack, the general health may be improved, and the joint may become normal or but slightly stiff. It recurs at intervals of a few months commonly.

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Retrocedent Gout.--This is a term applied to serious symptoms which sometimes go with rapid improvement of the local joint conditions. There are severe pains in the stomach, nausea, vomiting, diarrhea, pain in the heart, difficult breathing, palpitation, irregular and feeble action of the heart with brain symptoms, probably from uraemia. These attacks often cause death.

Chronic Gout, Causes, etc.--Frequent acute attacks; many joints, beginning with the feet, become stiff and deformed, perhaps with no motion. The overlying skin may ulcerate, especially over the knuckles. Dyspepsia, arterio-sclerosis, enlargement of the left ventricle of the heart and a great quantity of urine with low specific gravity are common. The patient is morose and irritable. Eczema, chronic bronchitis, frequently complicate the case.

Death often occurs from uraemia, meningitis, pleurisy, pericarditis or peritonitis.

Treatment, Preventive.--Live temperately, abstain from alcohol, eat moderately, have plenty of fresh air and sunshine, plenty of exercise and regular hours. These do not counteract the inherited tendency. The skin should be kept active, if the patient is robust, by the morning cold bath with friction after it; but if he is weak and debilitated, the evening warm bath should be substituted. The patient should dress warmly, avoid rapid alternations in temperature, and be careful not to have thc skin suddenly chilled.

Diet in Gout.--Most persons over forty eat too much. Eat reasonably and at regular hours and take plenty of time to eat. Do not eat too freely of meats and avoid too much starchy and sugary foods. Fresh vegetables and fruits may be used freely, except cranberries and bananas.

Dr. Osler of England says.--While all stimulants are injurious to these patients some are more so than others, particularly malted liquors, champagne, port and a very large proportion of all the light wines. Take large quantities of water on an empty stomach, mineral waters are no better than others, but treatment of chronic and irregular gout at springs gives the advantage of regular hours, diet, etc.

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Diet from a prominent hospital for gout patient:--

May Take--

Soups.--Fresh fish soups, vegetable broths clear.

Fish.--Raw oysters, fresh fish, boiled.

Meats.--Fat bacon, boiled or broiled chicken, game (all sparingly).

Farinaceous.--Cracked wheat, oatmeal, rice, sago, hominy, whole wheat bread, or biscuits, rye bread, graham bread or rolls, crackers, dry toast, milk toast, macaroni.

Vegetables.--Mashed potatoes, green peas, string beans, spinach, cabbage, cucumbers, cresses, lettuce, celery.

Desserts.--Plain milk pudding, junket, rice and milk, sago and milk, stewed fruits, all without sugar.

Drinks.--Weak tea (no sugar), milk, buttermilk, toast water, pure water, cold or hot.

Must Not Take--

Veal, pork, goose, duck, turkey, salted, dried, potted or preserved fish or meat (except fat bacon), eels, mackerel, crabs, salmon, lobster, eggs, rich soups, gravies, patties, tomatoes, sweet potatoes, asparagus, mushrooms, rhubarb, lemons, pickles, vinegar, fried or made dishes, rich puddings, spices, pies, pastry, sweets, nuts, dried fruits, tobacco, coffee, cider, malt liquors, sweet wines, champagne.

Treatment.--In an acute attack raise the affected limb and wrap the "sick" joint in cotton wool; warm fomentations may be used. The wine or tincture of colchicum in doses of twenty to thirty drops may be given every four hours in combination with the citrate of potash, fifteen grains, or the citrate of lithium five to ten grains. Stop the tincture of colchicum as soon as the pain is relieved and then you can give wine of colchicum ten drops every four hours, watching for irritation of the stomach, bowels and kidneys.

Dr. Hare of Philadelphia says.--For hospital practice a very useful mixture is made by adding one part of bicarbonate of sodium to nine parts of linseed oil. The joint is then wrapped in a piece of lint soaked with this concoction. In some cases oil of peppermint has been recommended. In chronic gout Dr. Hare also gives for diet milk and eggs, the white meat of chicken; fruits, cooked without sugar being added, are allowed. Tea and coffee being used only in moderation. If any wine is taken it must be followed by copious draughts of pure water and the last article should be used ad libitum. On the other hand, pastries and, more than all, sweet wines, are the worst things that such a patient can take, and must be absolutely prohibited.

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RHEUMATIC FEVER (Articular Rheumatism).--Causes. This may be acute or chronic. It is an infectious disease characterized by inflammation of several joints. The joints are held in place by ligaments and are inclosed by a thin membrane. In this acute rheumatism these parts become congested and inflamed, there is redness and swelling, heat and pain. Fluid is passed into the joint sometimes and then the parts look watery (oeclematous). The inflammation and swelling cause great pain in the joint.

Predisposing.--A damp climate, winter and spring, young adults and persons who are exposed to damp, wet and cold.

Condition.--There is congestion of the soft parts of the joints and effusion into the joint cavities of a watery fluid. Endocarditis, pericarditis, myocarditis, pleurisy and pneumonia may complicate it. The first named, endocarditis, is very common and as the mitral valves become inflamed it is likely to leave valvular trouble unless carefully watched and treated at the time.

Symptoms.--The invasion may be gradual, with a very tired feeling and often tonsilitis; but it is usually sudden, with pains, soreness in one or more joints and fever. The knees, ankles, elbows and wrists are much affected, but it frequently goes through almost every joint in the body and sometimes repeats the terrible dose. I know, for I had it twice. The suffering, torture and pain sometimes are simply indescribable and almost too hard to bear. The joints become hot, red, painful, swollen and tender to touch and motion. It seems to hurt worse when anyone comes near, for the patient is afraid of careless handling.

Fever.--This runs from 102 to 104 and is modified by profuse perspiration with bad odor and, generally, it does not afford any relief. The urine is very acid, very thick and looks like thick, strong coffee. The symptoms frequently disappear partially from one joint or joints as they begin in other joints, attacking several in rapid succession, the fever varying and changing with the degrees of joint involvement.

We may see the shoulder and hip, the elbow and wrist, knee and ankle, etc., all affected at once: Heart complications are frequent and bear close watching, for they are dangerous to life and the future health of the patient. The patient becomes very anemic and this progresses rapidly. When improvement does begin it is gradual; or the disease may become chronic. Care must be taken not to be too active when improvement sets in or you will cause a return by using the joints before they have become thoroughly well. I did the same thing in my anxiety to get out, but would never be as reckless again. Pain and stiffness of the joints often last long after convalescence has set in. One who has had this disease once is liable to another attack if he is not careful.

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MOTHERS' REMEDIES. 1. Articular Rheumatism.--A gentleman sends us the following treatment for articular rheumatism and writes as follows: "I send you the following treatment for articular rheumatism because I used it myself and was cured in a very short time, in fact, about ten days. It was a number of years ago in the early spring when my knee joints, ankles and wrists began to pain me and continued to become worse for about a week, at the end of which time both my knees were perfectly stiff. I sent for my physician; he wrapped my knees with common baking soda; taking long wide bandages he was enabled to have the baking soda a fourth of an inch thick around the knee, raising the bandage as he laid the soda on; after this was completed I had heavy wet hot cloths laid around my knee and renewed every fifteen or twenty minutes for probably eight or ten hours. In the meantime I was taking the salicylate of soda and the cathartic, veronica water, as directed below. The following day I sat up with my legs resting on a chair, straightened out, and hot flat irons at my knees. I began this treatment on Saturday, and the following Thursday was able to walk about and go out of town, and never had rheumatism since, but at two or three different times I suspected it was coming on and used the salicylate of soda and veronica water as a successful preventive; at least the rheumatism did not materialize.

Veronica Water.--Dose:--Glassful every two and one-half hours till bowels are free, then one dose a day.

Also Salicylate of Soda 1 ounce Water 6 ounces

Large teaspoonful every two hours with a quinine pill every other dose."

2. Rheumatism, Cotton Excellent for Inflammatory.--"Take a roll of cotton batting and wrap the limb, or part of the body affected, as firmly and tightly as possible, without tearing the cotton, let it remain "twenty-four hours, then tighten it up by unwinding and rewrapping the cotton as tight as possible, as on the first application, and so continue every twenty-four hours until cured, which, in my case, was three days. I had been troubled with rheumatism for a long time, and was unable to walk. I tried everything, doctors and all, but nothing helped me. A lady from Cincinnati, who was visiting at a neighbor's, called at my house one day and learning what was the matter with me, advised me to put cotton on as stated above. I had no faith in it, but I had tried everything else and concluded I would try that, with the result that it cured me. Possibly if a case should require a longer time for a cure than mine it might be necessary, or be better, to replace the cotton with a fresh roll. The rewrapping every twenty-four hours is intended to keep the cotton batting firmly and tightly around the part affected as the swelling recedes."

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Prevention.--Wear flannel late and early. Keep from taking cold. Put off wet things of every kind immediately upon getting home and dry your body and put on dry well-aired clothes. Never sleep in a damp bed, under damp unaired clothes. When you go away from home do not sleep in a room or bed that has been unoccupied for any length of time, especially if there is no furnace in the house. Do not sit down in wet damp clothes, stockings, shoes, etc. Do not sit down anywhere to "cool off." It is inviting trouble and sickness. Do not lie on the damp ground, do not sleep on the first floor of an old damp house. Have plenty of sunlight and air in your sleeping room. These directions apply to the chronic cases also. It does not matter so much if one is wet or sweating as long as he keeps moving or working. On wash day do not dry your clothes in the kitchen or sitting room, or put them on your bed, unless they have been thoroughly dried, aired and warmed before using. These little things mean much in real life.

PHYSICIANS' CAUTION for Articular Rheumatism.--Go to bed and remain there and do not get up too soon, for remember the parts are still tender when they may not be painful.

Local Treatment.--1. There must be absolute rest. Remove the sheets from the bed and wrap woolen cloths or blankets about the patient and protect the inflamed joints from the weight of the coverings. Cover the joints with gauze or absorbent cotton, after putting on the parts a thick coating of ichthyol ointment.

2. Sometimes hot fomentations are helpful in relieving the suffering; sometimes cold cloths are best.

3. The following is good. Apply with cloths wrung out of it:

Carbonate of Soda 6 drams Tincture Arnica 10 ounces Glycerin 2 ounces Water 9 ounces

4. Oil of Wintergreen 1 ounce Compound Soap Liniment 8 ounces

Mix.

Rub the affected parts with oil of wintergreen and then wrap the parts in cotton wool and soak with the solution.

5. "A layer or two of gauze saturated with methyl-salicylate is wrapped around the painful joints and covered with paraffin paper, or other impervious dressing, held in place by a bandage. This is renewed once or twice daily until the pain in all the joints is relieved."

6. Internal.--Sodium salicylate or aspirin given until the pain and temperature are relieved; usually five to ten grains of sodium salicylate every three hours for an adult; or five grains of the aspirin every three hours.

7. Dr. Hare recommends for the beginning in a strong, healthy individual, ten drops of the tincture of aconite at once in a little water, and follow it by a teaspoonful of a mixture containing fifteen drops of tincture of aconite and two ounces of water everyone-half hour, until perspiration on the skin betokens the circulatory depression through the action of the drug. I use aconite in this disease very often, but not in such doses as the first one. It seems to me that it is uselessly large. I use about one-tenth of a drop at a dose everyone to two hours during the first twenty-four hours.

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Nursing.--The nurse must have the patience of Job to attend a patient sick with this disease; but you must remember the suffering is awful. The patient may be very restless and the pillows may need rearranging every few minutes. Also be careful how you handle the patient. It hurts terribly to be even touched. A rough, hearty person has no business to care for such a patient. I allow patients to say anything they wish, for this is a painful disease. They may swear at me if they wish. I know how it is, for I was there twice, the last time for six long weeks. Have patience and courage and cheer your patient. Do not look cross or scold.

Diet.--Milk mainly, broths, gruels, albumen water, oyster or clam broth, milk toast, buttermilk, kumiss. Do not give solid food. Water, lemonade, vichy or carbonated water.

CHRONIC RHEUMATISM.--Causes.--Heredity may predispose to it. It is most common in those who are exposed to hard labor in the cold and wet; especially in women about middle age. It occasionally follows sub-acute, but rarely acute rheumatism.

Symptoms.--Many large joints are usually affected; sometimes it may be only one joint; at times, the small joints only are affected. It may be only on the one side. It usually persists in the joints involved, but may attack others. The chief symptoms are stiffness of the joints, especially after a rest and this diminishes after some motion, also pain, which grows worse in damp weather. The joints may be tender to the touch, slightly swollen, rarely red. They may in time become entirely stiff and deformed. The general health may be good or there may be anemia, dyspepsia and valvular disease due to sclerosis,--hardening of the valves of the heart.

Prognosis.--This is good as to life, but the disease is often progressive.

Treatment. Preventive.--A warm, dry, unchangeable climate, good surroundings, good food; keep the stomach and bowels and kidneys in good condition, avoid taking cold. Do not sit down in a draft to "cool off." Do not go into a cool room in summer when you are warm or sweated. Do not sleep in a bed that has not been used for months and kept for "company." Do not dry your clothes in the kitchen and in that way make the whole house steamy and damp. Do not sleep under unaired damp covers or in a damp night dress. Always air and dry your bedding and night dress before using. Do not take a hot bath and go into a cool room to cool off, but wrap yourself up so as to be warm and cool off gradually. Any additional cold will cause more rheumatism.

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Sleeping rooms on the first floor are an abomination for rheumatic persons. Do not sit down in wet clothes, stockings or shoes. Take them off immediately on getting home, wipe yourself dry and put on dry garments. Care in such little seemingly foolish things will do wonderful things for a rheumatic person. I had two rheumatic attacks in my first year of practice. Since then I have learned caution and through a hard and busy life I have kept myself reasonably well by looking after such little aids and cautions as, the above. I never sit down for any length of time in damp or wet clothes, and if I can do that, persons that are not driven like doctors can do the same. These cautions apply to not only this kind of rheumatism, but to all kinds of rheumatism, neuralgias, and to inflammatory diseases, such as neuritis, tonsilitis, pneumonia, pleurisy, etc. Hot air baths, Hot Springs, massage will be more effectual in this disease than in the former. Iodide of potash also is very useful. Flannel underwear, heavy and light weight, is very beneficial in rheumatism. Great benefit can be derived at home by wrapping the affected joints in cold cloths, covering with a thin layer of flannel and protected by oiled silk. A great many cases are helped by using hot fomentations of hops, wormwood, smartweed, etc. Turpentine applied locally to the joints is effective, but it is very likely to injure the kidneys when used freely and in these days when there are so many diseases of the kidneys one must be careful or they will produce an incurable and serious disease in the place of one that is painful, but not necessarily dangerous. Many of the simple remedies have a good effect on the rheumatic troubles.

PHYSICIANS' TREATMENT for Rheumatism.--Dr. Hare gives the following to rub on large joints:

1. Ichthyol 1/2 to 1 ounce Lard 1 ounce

2. Tincture of Aconite 6 drams Tincture Arnica 1 ounce Oil of Turpentine l ounce (l or 2) Soap Liniment enough for 8 ounces

Use as a liniment three times a day. This can be used for some weeks.

3. Strong Water of Ammonia 6 drams Oil of Cajeput 1 dram Tincture of Belladonna 1 to 2 ounces Camphor Liniment enough for 8 ounces

Use as a liniment.

4. Tincture of Aconite 1 ounce Tincture Belladonna 2 drams Strong Ammonia Water 4 drams Chloroform Liniment 6 drams

Used as a liniment on chronic or inflamed muscles or joints.

5. Iodide of Potash 1/2 ounce Compound Syrup of Sarsaparilla 3 ounces Distilled Water 3 ounces

Mix and take a dessertspoonful in a glass of water two hours after meals for chronic rheumatism.

[CONSTITUTIONAL DISEASES 323]

6. This is prepared by Parke, Davis & Co., and made into a syrup:

Red Clover 32 grains Queen's Root 16 grains Barberry 10 grains Prickly Ash Bark 4 grains Burdock Root 16 grains Poke Root 16 grains Honduras Bark 16 grains Iodide of Potash 8 grains

This portion to each fluid ounce of the syrup.

7. The following is good:

Equal parts of each of the following: Blue Cohosh Root Black Cohosh Root Poke Root Yellow Dock Root Blue Flag Root Prickly Ash Root Burdock Root Dandelion Root

Bruise them thoroughly or grind them coarsely, steep and make a tea and drink freely of it. If you wish you can take three to five grains of Iodide of Potash to each dose. This may in time disorder the stomach and you may then stop it for a time. All these can be used in muscular rheumatism also. The food should not be rich or highly seasoned. Spices are bad for such patients. Pickles, mustard, etc., are best let alone.

MUSCULAR RHEUMATISM.--This is a very painful affection of the voluntary muscles, called also neuralgia, or according to its location, torticollis (stiff neck, wry neck), pleurodynia, lumbago (rheumatism in the back).

Causes.--Predisposed to it by previous attacks, having a rheumatic or gouty constitution (diathesis). It follows sudden exposure, hence it is most common in men.

Symptoms.--Local pain in the muscles, sharp or dull, aching constant, or caused by certain movements and is usually relieved by pressure. It lasts from a few days to several weeks and frequently recurs. The common forms are: Lumbago. This affects the muscles of the back, and usually comes on suddenly with a sharp stich-like pain, and is chiefly seen in those who labor hard, often completely disabling them for a time.

Torticollis (stiff or wry neck).--It is usually on the side or back of the neck. Comes from a draught of cold wind on the neck, etc.

Pleurodynia, pain in the chest muscles, etc.--With pain in all movements of the chest, resembling intercostal neuralgia or pleurisy.

[324 MOTHERS' REMEDIES]

Diet for Rheumatism from the Head Nurse of a Prominent Hospital:--

May Take--

Soups.--Mutton broth, chicken or beef tea, in small quantities.

Fish.--Raw clams or oysters, fresh fish (whiter kinds) boiled.

Meats.--Chicken, calf 's head, sweetbread, tripe, broiled fat bacon or broiled ham (all sparingly).

Farinaceous.--Whole wheat, corn or brown bread, arrowroot, rice, dry toast, milk toast.

Vegetables.--Spinach, green peas or cabbage (well boiled), celery, lettuce, cresses, radishes.

Desserts.--Milk, rice or arrowroot pudding, (all without sugar), junket.

Drinks--Tea (without sugar), buttermilk, pure water, plain with lemon or lime juice (no sugar).

Must Not Take--

Pork, veal, turkey, goose, duck, fried fish or salt meats, cooked oysters or clams, salted, dried, potted or preserved fish or meats (except fat bacon or ham), crabs, salmon, lobster, eggs, rich made dishes, gravies, potatoes, tomatoes, beans, asparagus, mushrooms, candies, rich puddings, pies, pastry, nuts, cheese, coffee, cider, malt liquors, wines.

Treatment for Stiff Neck.--Wry Neck, (torticollis).--Warmth applied either dry or moist as hot salt bag or fomentations of hops, etc. Parke, Davis & Co., Detroit, now make a preparation called capsicine. This is very good for this trouble, rubbed on thoroughly as directed. It can be bought at most drug stores. It is also good for headaches and neuralgias. The same line of treatment, hot and cold applications, can be given for pain in the chest muscles (pleurodynia) and lumbago.

A MOTHERS' REMEDY for Stiff Neck.--Hot Salt and Oil of Sassafras.--"If troubled with stiff neck, fill a bag with hot salt and sleep on it, or rub the neck with oil of sassafras which, by the way, is also excellent for lumbago and to scatter, not cure, rheumatism pains."

PHYSICIANS' TREATMENT for Rheumatism.--Preventive.--Avoid exposure as stated for other rheumatism. Rest the chest by strapping with adhesive plaster as in pleurisy. Porous plasters are good and liniments; sometimes help is obtained by rubbing freely with camphor. Hot dry or wet applications are frequently useful. Mustard plaster is very good when the space is not too great. Mix the mustard with the white of an egg and after it is taken off grease the part and keep on warm cloths. Hot foot baths and hot drinks of lemonade or teas, after which the person should go to bed and sweat and remain there for some hours.

[CONSTITUTIONAL DISEASES 325]

Liniment.--

Oil of Wintergreen 1/2 to 1 ounce Compound Soap Liniment 8 ounces

Mix and rub on thoroughly.

MOTHERS' REMEDIES.--Lumbago, Menthol Liniment for.--Apply the menthol liniment, cover with a thick cloth and put the hot water bottle next to it and go to bed. If up through the day have a cotton batting sewed to cloth and keep affected parts warm, using the liniment freely." The menthol liniment will be found an excellent remedy for lumbago, The menthol absorbs quickly and by applying the hot water bottle relief is sure to follow.

1. Weak Back, Vinegar and Salt for.--"One tablespoonful of salt and one tablespoonful of vinegar to a quart of hot water. Bathe the back, then rub well with sweet oil and relief will soon follow,"

2. Weak Back. Simple Remedy for.--"Aching may be relieved by taking a large pinch of buchu leaves, steep and drink. Sweeten if desired. Use a pint of water for steeping the leaves," This is a good remedy for a weak back, resulting from kidney trouble. The buchu leaves acts quickly on the kidneys and it is surprising to see how quickly the backache will disappear. You can purchase a two ounce package for five cents at any drug store.

3. Weak Back, Good Liniment for.--

"Tincture of Aconite 1 ounce Oil of Wintergreen 1/2 ounce Tincture of Belladonna 1 ounce Tincture of Arnica 1 ounce Aqua Ammonia 2 ounces

Mix and use as a liniment."

This is a very good liniment.

4. Lameness, Chloroform Liniment for.--"Chloroform liniment is the best for all lameness and sore limbs."

5. Lameness, Plantain Leaves and Cream for.--"Make ointment from plantain laves, simmered in sweet cream or fresh butter. This is very cooling."

MOTHERS' REMEDIES.--1. Rheumatism, Saltpetre Good in Cases of.--"One ounce of saltpetre to one pint of water. Take one teaspoonful of the above in a large glass of water, about six times daily." The saltpetre acts on the kidneys, carrying off the impurities in this way. Care should be taken not to continue this treatment too long at a time, as continued use would result in injury to the kidneys.

2. Rheumatism, Rochelle Salts for.--"One teaspoonful rochelle salts in one-half glass water every other morning." This acts on the bowels and cleanses the system.

3. Rheumatism, Flowers of Sulphur Will Relieve Pain of.--Sciatica is sometimes very much improved by wrapping the limb for one night with flowers of sulphur."

[326 MOTHERS' REMEDIES]

4. Rheumatism, Three Simple Ingredient Liniment for.--"One pint pure cider vinegar, one pint of turpentine, four fresh eggs, put the egg shells and all in the vinegar, let stand until the vinegar eats the eggs all up, then add the turpentine." This makes a fine liniment.

5. Rheumatism, Sulphur Good for.--"Cases of chronic rheumatism are often relieved by sulphur baths and sulphur tea. Dose:--Powder sulphur and mix with molasses. A teaspoonful three times a day," Sulphur is a good blood purifier and laxative.

6. Rheumatism, Horse-Radish for.--"An excellent and well-known remedy for rheumatism is to make a syrup of horse-radish by boiling the root and add sufficient sugar to make it palatable. Dose:--Two or three teaspoonfuls two or three times a day,"

7. Rheumatism, Simple Remedy to Relieve Pain of.--

"Peppermint 1 ounce Oil of Mustard 1/4 ounce Vinegar 1 pint White of one egg.

Beat egg; stir all together."

8. Rheumatism, Liniment for Chronic.--

"Olive Oil 1 pint Sassafras Oil 2 drams Camphor Gum 2 ounces Chloroform 1/2 ounce

Dissolve the camphor in the oil and when dissolved add the chloroform and four ounces of turpentine or rosemary. Rub the parts well night and morning. If the limbs are very sensitive to cold, add to the mixture two ounces of tincture of capsicum."

9. Rheumatism, Herb Remedy for.--

Tincture Colchicum Seed 4 ounces Gum Guaiacum 4 ounces Black Cohosh Root 4 ounces Prickly Ash Berries 4 ounces Iodide Potash 1 ounce

Dose for adult, one teaspoonful three times a day in wineglassful of water or milk."

10. Rheumatism, Three Things that Will Help.--

"Best Rye Whisky 2 pints Ground Burdock Seed 1/2 pound Poke Berry Juice 1/2 pint

Mix, shake well before using.

Dose for adults, one and one-half or two tablespoonfuls night and morning." In severe cases take three times a day. This is a thoroughly tried remedy and is a very successful one.

[ CONSTITUTIONAL DISEASES 327]

11. Rheumatism, Good Liniment for.--

"Alcohol 1 ounce Oil of Wintergreen 1 dram Chloroform 5 drams Gum Camphor 1/2 ounce Sulphuric Ether 3/4 ounce Oil of Cloves 1/2 dram Oil of Lavender 1 dram

Mix and apply externally for rheumatism and you will find it a very beneficial remedy."

12. Rheumatism, Camphor and Alcohol for.--"Soak cotton batting in alcohol and camphor and apply on part." Application to the affected parts will frequently give relief in some rheumatic patients, when in others no relief is obtained by this method, it being necessary to take something internally.

13. Rheumatism, Sweet Fern Tea Excellent for.--"Sweet fern tea taken three times a day. Dose, one cupful. Father has used this successfully himself."

14. Rheumatism, Well-known Celery Remedy for.--"Celery tea several times a day with plenty of celery cooked or raw as a regular table food. Cut the celery in pieces, boil until soft in water and let the patient drink the tea, then make a stew of the remaining bits. If fresh celery cannot be obtained, celery preparations can be found at the drug store.

15. Rheumatism, Flowers of Sulphur Relieves.--"Rheumatism is effectually removed by enveloping the limb one night with flowers of sulphur." The flowers of sulphur can be purchased at any drug store, and will give great relief, especially in severe cases.

16. Rheumatism, Poultice for.--"Apply belladonna ointment to seat of pain, poultices applied very hot. Sulphur applied to painful part is very effective, after which the parts should be enveloped in flannel." The belladonna ointment acts like a fly blister, but not quite so severe. The ointment can remain on for some time without blistering. This treatment relieves by removing the inflammation from the sore parts.

17. Rheumatism, Novel Relief for.--"The best remedy is electricity. It cured me; I used medical battery." Electricity has been known to help in a great many cases, but should be applied by a competent person.

18. Rheumatism, Snake Root and Lemons Good for.--"Make use of lemon juice freely. Use decoction of black snake root, one ounce to pint of boiling water; a tablespoonful four times a day. Wet compress renewed every two hours applied to painful joints."

The black snake root is a remedy that was used by the early settlers for this trouble. The wet compresses are very soothing, but care should be taken not to wet the bed clothing, as the patient would then take cold.

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19. Rheumatism, Another Good Liniment for.--

Alcohol 5 ounces Amber 30 drops Tincture of Pinoum 30 drops Hemlock Oil 30 drops Tincture of Iron 30 drops Aconite 30 drops

DIABETES MELLITUS.--A disorder of nutrition in which sugar accumulates in the blood and is excreted in the urine, the daily amount of which is greatly increased.

Causes.--Hereditary influences play an important role and cases are on record of its occurrence in many members of the same family. Men are more frequently affected than women, the ratio being about three to two. Persons of a nervous temperament are often affected. It is a disease of the higher classes. Hebrews seem especially prone to it. The disease is comparatively rare in the colored race; women more than men in the negro,- nine to six. In a considerable proportion of the cases of diabetes the patients have been very fat at the beginning of or prior to the onset of the disease. It is more common in cities than in country districts. The combination of intense application to business, over-indulgence in food and drink, with a sedentary life, seem particularly prone to induce the disease. Injury to or disease of the spinal cord or brain has been followed by diabetes. It is much more frequent in European countries than here. Acute and chronic forms are recognized in the former.

Symptoms.--The only difference is that the patients are younger in acute forms, the course is more rapid and the wasting away is more marked. The onset of the disease is gradual and either frequent passing of urine (six to forty pints in twenty-four hours) or inordinate thirst attracts attention. When it is fully established, there is great thirst, the passage of large quantities of sugar urine, a terrible appetite, and, as a rule, progressive emaciation. The thirst is one of the most distressing symptoms. Large quantities of water are required to keep the sugar in solution and for its excretion in the urine. Some cases do not have the excessive thirst; but in such case the amount of urine passed is never large. The thirst is most intense an hour or two after meals. The digestion is generally good, but the appetite is inordinate. Pain in the back is common. The tongue is usually dry, red and glazed, and the saliva is scanty. The gums may become swollen. Constipation is the rule. The skin is dry and harsh and sweating rarely occurs. The temperature is under normal. In spite of the enormous amount of food eaten a patient may become rapidly emaciated. Patients past middle life may have the disease for years without much disturbance of the health; on the other hand I have seen them die after that age. Progress is more rapid the younger the person. Death usually occurs from coma of diabetes. This is most common in young patients.

[CONSTITUTIONAL DISEASES 329]

1. There is a sudden onset after exertion of weakness, feeble pulse, stupor, coma, death in a few hours.

2. Sudden headache, coma, death in a few hours.

3. After nausea, vomiting or a lung complication, there are headache, delirium, abdominal pain, rapid labored breathing, sweetish odor of the breath, stupor, rapid feeble pulse, coma and death within a few days.

Recovery.--Instances of cure in true diabetes are rare.

Treatment. Preventive.--The use of starchy and sugary articles of diet should be restricted in families with a marked disposition to this disease. Sources of worry should be avoided and he should lead an even quiet life, if possible, in an equable climate. Flannel and silk should be worn next to the skin, and the greatest care should be taken to promote its action. A lukewarm and, if tolerably robust, a cold bath should be taken every day. An occasional Turkish bath is useful.

Diet.--Let the patients eat food of easy digestion, such as veal, mutton and the like, and abstain from all sorts of fruit and garden stuff. In Johns Hopkins' Hospital these patients are kept for three or four days on the ordinary ward diet, which contains a moderate amount of carbo-hydrates, in order to ascertain the amount of sugar excretions. For two days more the starches are gradually cut off. They are then placed on the following standard non-carbohydrate diet.

Breakfast: 7:30, six ounces of tea or coffee; four ounces of beefsteak, mutton chops without bone, or boiled ham; one or two eggs.

Lunch: 12:30, six ounces of cold roast beef; two ounces celery, fresh cucumbers or tomatoes with vinegar, olives, pepper and salt to taste, five drams of whisky with thirteen ounces of water, two ounces of coffee without milk or sugar.

Dinner: 6:00 P. M., six ounces of clear bouillon; seven and a half ounces of roast beef; one and one-half drams of butter; two ounces of green salad with two and a half drams of vinegar, five drams of olive oil, or three tablespoonfuls of some well-cooked green vegetable: three sardines; five drams of whisky with thirteen ounces of water.

Supper: 9:00 P. M., two eggs, raw or cooked, thirteen ounces of water .

The following is a list of articles which a diabetes patient may take as given by one of the best authorities in the world on diabetes:

Liquids: Soups.--Ox tail, turtle bouillon and other clear soups. Lemonade, coffee, tea, chocolate and cocoa; these to be taken without sugar, but they may be sweetened with saccharin. Potash or soda water and appollinaris, or the Saratoga-vichy and milk in moderation may be used.

[330 MOTHERS' REMEDIES]

Animal Food.--Fish of all sorts, including crabs, oysters, salt and fresh butcher's meat (with the exception of liver), poultry and game, eggs, buttermilk, curds and cream cheese.

Bread.--Gluten and bran bread, almond and cocoanut biscuits.

Vegetables.--Lettuce, tomatoes, spinach, chickory, sorrel, radishes, asparagus, water-cress, mustard and cress, cucumber, celery and endives; pickles of various sorts.

Fruits.--Lemons and oranges, currants, plums, cherries, pears, apples (tart), melons, raspberries and strawberries may be taken in moderation. Nuts, as a rule, allowable.

Must Not Take--

Thick Soups and Liver. Ordinary bread of all sorts (in quantity), rye, wheaten, brown or white. All farinaceous (starchy) preparations, such as hominy, rice, tapioca, arrowroot, sago and vermicelli.

Vegetables: Potatoes, turnips, parsnips, squashes, vegetable-marrows of all kinds, beets, common artichokes.

Liquids: Beer, sparkling wine of all sorts and the sweet aerated drinks.

Medicines. Codeine.--A patient may begin with one-half grain three times a day, which may be gradually increased to six or eight grains in the twenty-four hours (under the doctor's care); withdraw it gradually when sugar is absent or reduced as far as possible.

DIABETES INSIPIDUS.--A chronic affection characterized by the passage of large quantities of normal urine of low specific gravity.

Causes.--It is most often found in young males and is probably of nervous origin. It may follow excitement or brain injury.

Symptoms.--The onset is usually gradual. The urine is pale; ten to twenty quarts a day. Thirst, dryness of the mouth and skin. Appetite and general conditions are usually normal; sometimes there are feebleness and emaciation. Death usually occurs from some other disease.

Treatment.--There is no known cure. Keep the general health in good condition according to the advice of your family physician.

OBESITY.--An excessive development of fat; it may be hereditary. It occurs most frequently in women of middle age and in children. Its chief cause is excessive eating and drinking, especially of the starch and sugar foods and malt liquors, and lack of exercise. The increase of fat is in all the normal situations and the heart and liver are often large and fatty. The condition in general may be good or there may be inactivity of the mind and body. Disturbances of digestion and symptoms of a fatty heart. There is less power to resist disease. Death may occur from fatty infiltration of the heart, resulting in dilatation or rupture.

[CONSTITUTIONAL DISEASES 331]

Treatment.--Must be in regulating the diet. The person must avoid all excess in food and drink, and avoid especially foods that contain starch and sugar. There must be regular and systematic exercise, hot baths and massages are helps. Medicines made from the poke berry are much used and are successful in some cases.

Diet.--The food of a fleshy person should be cut down gradually. Its bulk can be great, but its nourishing properties should be small. The diet for reduction of obesity should consist chiefly of bulky vegetables, but not too much of any one article or set of articles. The following list is recommended by Dr. Hare of Philadelphia:

For Breakfast.--One or two cups of coffee or tea, without milk or sugar, but sweetened with a fraction of a grain of saccharin. Three ounces of toasted or ordinary white bread or six ounces of brown bread; enough butter may be used to make the bread palatable, not more than one ounce. Sliced raw tomatoes with vinegar, or cooked tomatoes without any sugar or fats. This diet may be varied by the use of salted or fresh fish, either at breakfast or dinner. This fish must not be rich like salmon or sword-fish, but rather like perch or other small fish.

Noon Meal--Dinner.--One soup plate of bouillon, consomme julienne, or other thin soup, or Mosqueras beef-jelly, followed by one piece of the white meat of any form of fowl or a small bird. Sometimes a small piece, the size of one's hand, of rare beef, or mutton but no fat, may be allowed, and this should be accompanied by string beans, celery (stewed or raw), spinach, kale, cabbage, beans, asparagus, beets and young onions. Following this, lettuce with vinegar and a little olive oil (to make a French dressing), a cup of black coffee or one of tea, and a little acid fruit, such as sour grapes, tamarinds and sour oranges, or lemons may be taken, and followed by a cigar, if the patient has such a habit.

Supper.--This should consist of one or two soft boiled eggs, which may be poached, but not fried, a few ounces of brown bread, some salad and fruit and perhaps a glass or two of light, dry (not sweet) wine, if the patient is accustomed to its use.

Before Going to Bed.--To avoid discomfort from a sensation of hunger during the night, the patient may take a meal of panada, or he may soak graham or bran crackers or biscuits in water and flavor the mess with salt and pepper. The reduction of the diet is generally best accomplished slowly and should be accompanied by measures devoted to the utilization of the fat present for the support of the body. Thus, the patient should not be too heavily clad, either day or night, should resort to exercise, daily becoming more severe, and should not drink freely of water, unless sweating is established sufficiently to prevent the accumulation of liquid in vessels and tissues. Baths of the proper kind, cold or Turkish, should be used, if the patient stands them well. The bowels should be kept active by laxative fruit or purges. Salts are useful if drinks are thrown off rapidly. If proper exercise is impossible the rest cure with massage, electricity, passive exertion and absolute skimmed milk diet may be resorted to, particularly in those persons known as "fat anemics," who have not enough red corpuscles in their blood to carry sufficient oxygen to the tissues to complete oxidation.

[332 MOTHERS' REMEDIES]

CANCER.--(In the following article on cancer we quote in part from material issued by the Public Health Department of the State of Michigan).

Cancer is curable if it be operated upon in its early stages.--If it be left to grow and develop, cancer is always fatal. It may be partially removed when in an advanced stage, and relief may be had for some time after operation; but beyond the early stage, cancer cannot at present be permanently removed, nor permanently cured. Permanent cure of a cancer is possible if the afflicted person obtains an early diagnosis and receives early attention from a skilled surgeon. The only permanent cure for cancer known at the present time is early surgical operation.

Have Operations Failed to Cure?--Very few persons die from operations performed by skilled surgeons for the removal of cancer. Where cancer operation is done by experienced surgeons the fatality in America for the past fourteen years is less than one case out of a hundred, or in other words ninety-nine persons out of a hundred survive operation for cancer. Many persons have died from the return of the cancerous growth even after operation by a skilled surgeon, and this fact has led many persons to believe that operation for cancer is, therefore, unsuccessful, that it does not cure. This is not the fact. It is true that cancer often returns after operation, and that this method does not always effect a permanent cure; but it is not true that operations are, therefore, useless. The reason that operations do not remove cancers permanently in a great number of cases is that such cases do not submit to operation soon enough. The majority of persons suffering from cancer seek surgical aid too late. If a house is on fire and one refuses to turn in an alarm until the fire has spread from cellar to garret, neither blame nor disparagement must be placed upon the fire department if it failed to save the burning house. So with cancer; if the public refuses or neglects to operate for cancer at the time when it can be eradicated, the public cannot censure or belittle surgery. A cancer is like a green and ripe thistle. Pull up the green thistle and you have gotten rid of it. But if you wait until the thistle is ripe, and the winds have blown away the seeds, there is no use of pulling up that thistle. Early operations are successful. Late ones are not.

No reliable surgeon claims to save his patient or cure him of cancer if the disease be in an advanced stage. But experienced surgeons do recognize the fact that cancer in its early stage can be permanently removed and a permanent cure can be effected by surgical operation. No other means of permanent cure are known.

[CONSTITUTIONAL DISEASES 333]

Caustic pastes applied to cancerous growths or sera, are sometimes successful in obliterating the cancer for a time; but they are not reliable for effecting enduring cures, and usually are merely palliative, The fact that a cancer does not return for three years after removal is not sure proof that it will not return; the return of a cancerous growth depends upon its state of development and other conditions at the time of removal from the cancer. In Johns Hopkins' Hospital forty-seven per cent of all patients with cancers of the breast operated upon remained well for three years or more, and seventy-five per cent of this forty-seven per cent were cured, being in the most favorable condition for cure at the time of the operation. But where conditions are not favorable at the time of the operation, many patients have a return of the cancer even after the three years of apparent cure have elapsed.

What is Cancer?--A cancer is a growth of cancerous cells in a network of connective tissue. The cause of cancer is not known. It has not been proved to be communicable and the majority of investigators of this subject believe that it is not caused by a germ. Nor is it thought to be inherited. Out of 8,000 cases of cancer at Middlesex Hospital, London, no evidence of heredity was found. Until the cause of cancer is known, it cannot be prevented. The only safeguard lies in an early diagnosis of the condition and an immediate operation. Eminent investigators are carrying on extensive research and thousands of dollars are being spent annually to ascertain, if possible, what is the cause of this dread disease, and it is confidently believed that final success will crown this labor.

When to Suspect Cancer and What to Do.--External or Exposed Cancer.--Cancer of the exposed or surface parts of the body, such as the skin of the lip, nose, cheek, forehead, temples, etc., is more readily recognized than internal cancer, and is therefore more liable to early operation and prompt cure. One rarely sees these forms of cancer in an advanced stage, because such cases are readily seen and recognized by physicians in the early stage of development, when operation can be sufficiently early to effect a lasting cure.

The least malignant of all cancers is that kind which first exhibits itself by a hardening of the skin, forming a nodule looking pimple or a mole and having a dark red color, due to tortuous blood vessels, upon the sides of the nose near the eyes, upon the cheek bones, forehead or temples. This form of epithelioma is called rodent ulcer, flat epithelioma or cancroid and sometimes does little harm for many years, but should receive the attention of a physician familiar with cancer and its eradication.

Deep or squamous cancer occurs on the lip, the tongue or the forehead or wherever the mucous membrane joins the skin, and is characterized by a hard, deep-seated sore formed upon any such part, growing down into the flesh and having a dark red or purplish-red color.

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If such a cancer is suspected of being present, the patient should at once seek diagnosis from a competent physician. Cancer of the lip is more frequent in men than in women, occurring usually in the under lip and called "Smoker's Cancer." Any hard persistent nodule in the under lip should cause suspicion and should be taken to a skilled surgeon, as cancer of the under lip is easily removed when in its early stage of development.

CANCER OF THE STOMACH.--The beginning of cancer of the stomach is very difficult to recognize and it is far safer and wiser, upon the appearance of the first suspicious symptom, to seek the aid of some physician skilled in cancer diagnosis than to ignore and neglect these early warnings of the disease. Although cancer of the stomach may occur in younger persons, it is usually met with in persons after forty years of age. Therefore, any person at this age who suffers from continuous indigestion or characterized by retention and prolonged fermentation of food in the stomach, should at once consult a competent physician. In the early stages of the cancer of the stomach the patient loses weight, but in the later stages there is more or less pain.

Whenever a physician finds that a patient has a pappy, insipid taste with a furred, pale, rarely dry and red tongue, and is suffering from continuous, dull sensations or pain in the region of the stomach, periodically increasing to paroxysms, often induced by pressure or increased by it, together with a sensation of weight, drawing pains of varying character, and frequent pain in the shoulder, loss of appetite, frequent belching of fetid gas from the stomach, severe and frequent vomiting, often periodical, often occurring before partaking of a meal but more often afterwards with slight indigestion, but vomitus being more or less watery and containing mucus and blood, usually decomposed and recurring frequently, together with constipation of the bowels, the skin being sallow, yellowish, dry and flaccid, and losing weight and strength, he should suspect cancer of the stomach and where possible advise an immediate surgical operation for the removal of the cancer.

CANCER OF THE UTERUS.--What women should know regarding it. The menopause or change of life comes on gradually, rarely suddenly. It is not preceded by excessive flowing or discharge or pain in a healthy woman.

By cancer period is understood those years after forty, although rarely it may occur earlier. The first symptoms of uterine cancer are:

1. Profuse flowing, even if only a day more than usual. Flowing or spotting during the interval or after the use of a syringe or the movement of the bowels.

2. Whites or Leucorrhea, if not existing previously. If existing but getting more profuse, watery, irritating, or producing itching is a very suspicious symptom.

[CONSTITUTIONAL DISEASES 335]

3. Loss of weight, if no other cause is apparent. Pain in the region of the womb, back or side.

If any of the above symptoms occur after the age of thirty-five or forty, a woman should seek relief and insist on thorough investigation of the cause and prompt treatment.

Cancer is always at first a local disease and can be removed if early recognized and an absolute, permanent cure brought about.

CANCER OF THE BREAST.--Eighty-one per cent of an tumors of the breast are cancer or become so. Whenever a woman feels a lump in her breast, particularly if she be at the cancerous age, she should consult a skilled physician at once and keep that breast under medical observation. If so advised by her physician or by a skilled surgeon, she should have an operation for the removal of the cancer, as it can be completely eradicated when operated upon in its early stages. If left to grow and develop it will get beyond the aid of even the most skillful surgeon. Early diagnosis plus surgery is the only hope for a cancerous person. Operation offers a most hopeful outlook for those afflicted with cancer. It is more important to make an early diagnosis in cancer of the breast than it is in appendicitis.

CANCER (CARCINOMA).--This is very malignant. This kind is divided into two classes, Scirrhus and Epithelial.

1. Scirrhus cancer. This is a hard, irregular growth of moderate size. Its special seat is the breast, the pyloric (smaller) end of the stomach and in few instances the glands of the skin.

Soft Medullary or Encephaloid cancer. This type resembles brain tissue both in appearance and consistence. It appears quite soft and may be mistaken for an abscess. In form, it differs according to the organ attacked. Special seats: The testicle, liver, bladder, kidney, ovary, the eye and more rarely the breast.

Colloid cancer; jelly-like substance.--The cancer cells have undergone a degeneration in one of the preceding varieties. The material it contains is a semi-translucent, glistening, jelly-like substance. Its special seats are the stomach, bowel, omentum, ovary and, occasionally, the breast.

Diagnosis.--This kind is very rare before thirty years of age and common after forty. They involve the gland early, contrary to what the sarcoma variety does. Innocent growths occur, as a rule, in younger patients, do not grow so rapidly, do not become adherent to neighboring parts and do not ulcerate.

2. The Epithelial Cancer (Carcinoma).--These always spring from free epithelium-clad surfaces, as the skin, and mucous membranes or from the glands of the same. These growths appear with great frequency at the points of junction of mucous membranes and skin surfaces, probably because these parts are subjected to more frequent and varied forms of mechanical and chemical irritation, Special seats: Skin surfaces, the nose, the lower lip, the penis and scrotum, the vulva, the anus (mucous surfaces), tongue, palate, gums, tonsils, larynx, pharynx, gullet, bladder, womb.

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MOTHERS' REMEDIES.--l. Cancer, Simple Remedy for.--"Give a teaspoonful of sarsaparilla tea four times daily, made with two ounces of sarsaparilla root and quart of water boiled to one pint and apply to cancer growth a poultice made of carrots scraped or mashed cranberries." These simple remedies will relieve and often cure growths taken for cancers, but if it is really a cancerous growth no medicine will help and a physician should be consulted at once.

2. Cancer, Nettles and Laudanum Will Help.--"Take the juice of common nettles inwardly and mix a little laudanum with the juice and rub the parts outwardly. Cancer has often yielded to this treatment." This remedy will no doubt help an ugly looking ulcer, repeatedly taken for cancer, by the patients themselves and frequently the doctor. It is always well to give this simple home remedy a trial, at least, for it is frequently admitted by the medical fraternity to-day that ugly ulcers are often treated in this way as cancers, sometimes to the lasting detriment of the sufferer. Then why not try some efficient home remedy like the above until you are certain that it is a cancer?

TUMORS.--A tumor is a new growth which produces a localized enlargement of a part, or an organ, has no tendency to a spontaneous cure, has no useful function, in most cases tends to grow during the whole of the individual's life. Clinically, tumors are divided into the benign and the malignant.

A benign tumor is usually composed of tissues, resembling those in which it originates.

A malignant tumor usually consists of tissues widely different from those in which it originates; its growth is rapid and therefore often painful; it infiltrates all the surrounding tissues, however resistant, even bone, because it is never encapsulated; it thus early becomes immovable; the overlying skin is apt to become adherent, especially when the breast is involved. Sooner or later it usually infects the group of lymphatic glands intervening between it and the venous circulation and from these new centres, or directly through the veins, gives rise to secondary deposits in the internal organs.

Some varieties. 1. Fibrous tumors; these consist of fibrous tissues. 2. Fatty tumors (or lipomata); these consist of normal fat tissue. 3. Cartilaginous tumors; consist of cartilage. 4. Osseous (bony) tumors. 5. Mucous tumors (myxomata). 6. Muscular tumors (myomata). 7. Vascular tumors (Angeiomata). 8. Nerve tumors (Neuromata).

Malignant Sarcoma (Sarcomata).--These are a variety of tumors. The result of these varies with the location of the tumor. If located in the jaw, an operation may cure it. If in the tonsil or lymphatic gland, it destroys life rapidly. If in the sub-cutaneous tissue, it may be repeatedly removed, the system remaining free, or the amputation of the limb involved will probably cure the disease.

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TUMORS.--Diagnosis. It is uncommon under thirty, quite common after. Epithelioma of the lower lip is limited almost entirely to men. If, then, a man of from forty to seventy develops a small tumor in the lower lip which ulcerates early, it is likely to be the cancer. The same applies to some extent to the tongue. These growths and sores need attention early.

Treatment.--The best treatment is early free removal of the entire growth before the glands are involved.

DISEASES OF THE CIRCULATORY SYSTEM

HEART DISEASE, Emergency Treatment.--For collapse or fainting, loosen clothing, lie down, rub camphor on forehead, and keep quiet.

To Revive When Fainting.--Smell of camphor or aromatic spirits of ammonia. Put one to two teaspoonfuls of whisky or brandy in eight teaspoonfuls of hot water, and give one or two teaspoonfuls at a time and repeat often. Some are not accustomed to stimulants and it may strangle them, so give it slowly. Pulse is weak in such cases, calling for stimulants.

2. Pearls of Amylnitrite. Break one in a handkerchief and put the handkerchief to the patient's nose so that he may inhale the fumes.

Stimulant.--A person with heart valvular trouble should always carry pearls of amylnitrite. Inhale slowly so as not to get too much of it at once.

HEART FAILURE.--The pulse may be slow and weak or fast and weak.

Digitalis.--Give five drops of the tincture in a little water. Another dose can be given in fifteen minutes. Then another in an hour, if necessary.

PALPITATION OF THE HEART.--Irregular or forcible heart beat action usually perceived by the person troubled.

Causes.--Hysteria, nervous exhaustion, violent emotions or sexual excesses; overdose of tea and coffee: alcohol or tobacco.

Symptoms.--There may be only a sensation of fluttering with that of distention or emptiness of the heart. There may be flushing of the skin, violent beating of the superficial arteries, with rapid pulse, difficult breathing and nervousness. Attack lasts from a few minutes to several hours.

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MOTHERS' REMEDIES.-l. Palpitation of the Heart, Tea of Geranium Root for.--"Make an infusion of geranium root, half an ounce in pint of boiling water, strain, cool, and give wine glass full three or four times a day." The geranium root will be found to be an excellent remedy where female weakness has caused the palpitation of the heart.

2. Palpitation of the Heart, Hot Foot Bath and Camphor for.--"Place the feet in hot mustard water and give two grains camphor every two or three hours, or two drops aconite every hour. This remedy is very good and is sure to give relief."

3. Palpitation of the Heart, Valuable Herb Tea for.--"All excitement must be avoided. Where there is organic disease, all that can be done is to mitigate the severity of the symptoms. For this take the following herb tea: One ounce each of marigold flowers, mugwort, motherworth, century dandelion root, put in, two quarts of water and boil down to three pints; pour boiling hot upon one-half ounce of valerian, and one-half ounce of skullcap. Take a wineglassful three times a day. Let the bowels be kept moderately open and live principally upon vegetable diet, with plenty of outdoor exercise."

MOTHERS' REMEDIES.--1. Heartburn, Home Remedy for.--"A few grains of table salt allowed to dissolve in the mouth and frequently repeated will sometimes give relief." People who have too little acid in the stomach will be much benefited by this remedy.

2. Heartburn, Soda a Popular Remedy for.--"One-half teaspoonful soda in glass of water. Everybody uses this in the neighborhood."

3. Heartburn, Excellent Remedy for.--

"Powdered Rhubarb 1/2 ounce Spirits of Peppermint. 2 drams Water 4 ounces Bicarbonate of Soda 1/2 ounce

Dose--One Tablespoonful after meals."

The bicarbonate of soda relieves the gas and swelling of the stomach, while the rhubarb has a tonic action and relieves the bowels. The spirits of peppermint stimulates the mucous membrane.

4. Poor Circulation, Remedy for Stout Person.--"Ten cents worth of salts, five cents worth of cream of tartar; mix and keep in a closed jar. Take one teaspoonful for three nights, then skip three nights." This is an old-time remedy known to be especially good, as the salts move the bowels and the cream of tartar acts on the kidneys, carrying off the impurities that should be thrown off from these organs.

PHYSICIAN'S TREATMENT FOR PALPITATION.--When caused by valvular trouble, digitalis can be given as above directed under heart failure.

When Caused by the Stomach.--From gas or too much food, take salts to move the bowels. Hot whisky is good when caused by gas; or soda, one teaspoonful in hot water is also good when gas causes palpitation.

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Difficult Breathing.--If caused by gas, soda, hot whisky or brandy will relieve. If caused by too fast beating of the heart, give digitalis as above directed. If caused by dropsy, the regular remedies for dropsy. If the dropsy is due to scanty urine you can use infusion of digitalis, dose one to four drams; or cream of tartar and epsom salts, equal parts, to keep the bowels open freely.

PHYSICIAN'S CAUTIONS:--Quiet the patient's mind and assure him there is no actual danger; moderate exercise should be taken as a rule with advantage. Regular hours should be kept and at least ten hours out of twenty-four should be spent in lying down. A tepid bath may be taken in the morning, or if the patient is weakly and nervous, in the evening, followed by a thorough rubbing. No hot baths or Turkish bath. Tea, coffee and alcohol are prohibited. Diet should be light, and the patient should avoid overeating at any meals. Foods that cause gas should not be used. If a smoker the patient must give up tobacco. Sexual excitement is very pernicious, and the patient should be warned especially on this point. Absolute rest for the distressing attacks of palpitation which occur with nervous exhaustion. In these cases we find the most distressing throbbing in the abdomen, which is apt to come after meals, and is very much aggravated by the accumulation of gas.

Diet.--A person with heart disease should not bring on palpitation from over-eating or eating the wrong kind of food. Such a person dare not be a glutton. The diet must be simple, nutritious, but food that is easily digested. Any food that causes trouble must be avoided; starchy foods, spiced foods, rich greasy foods, are not healthy for such a person. The stomach must be carefully treated by such a patient. The bowels should move daily. The kidneys should always do good work and pass enough urine and of the right color and consistency. Stimulants like alcohol, tea and coffee are not to be used. Weak cocoa is all right in most cases. Hot water, if any drink must be taken, at meals. Such a patient in order to live and live comfortably, must take life easy. He cannot afford to run, to over lift, or over exert, to walk fast upstairs, hurry or to "catch the car." He must not get angry or excited. Games of all kinds that have a tendency to make him nervous must be avoided. The same caution applies to exciting literature. In short, a patient with organic heart disease must be a drone in the hum of this busy, fast-rushing life, if he would hope to keep the spark of life for many years. Sleep, rest and quiet is a better motto for you than the strenuous life.

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The Heart.--The heart is the central organ of the entire system and consists of a hollow muscle; by its contraction the blood is pumped to all parts of the body through a complicated series of tubes, termed arteries. The arteries undergo enormous ramifications (branchings) in their course throughout the body and end in very minute vessels, called arterioles, which in their turn open into a close meshed network of microscopic (very minute) vessels, termed capillaries. After the blood has passed through the capillaries it is collected into a series of larger vessels called veins by which it is returned to the heart. The passage of the blood through the heart and blood vessels constitutes what is termed the circulation of the blood. The human heart is divided by a septum (partition) into two halves, right and left, each half being further constricted into, two cavities, the upper of the two being termed the auricle and the lower the ventricle. The heart consists of four chambers or cavities, two forming the right half, the right auricle and right ventricle, and two forming the left half, the left auricle and left ventricle. The right half of the heart contains the venous or impure blood; the left the arterial or pure blood. From the cavity of the left ventricle the pure blood is carried into a large artery, the aorta, through the numerous branches of which it is distributed to all parts of the body, with the exception of the lungs. In its passage through the capillaries of the body the blood gives up to the tissues the material necessary for their growth and nourishment and at the same time receives from the tissues the waste products resulting from their metabolism, that is, the building up and tearing down of the tissues, and in so doing becomes changed from arterial or pure blood into venous or impure blood, which is collected by the veins and through them returned to the right auricle of the heart.

From this cavity the impure blood passes into the right ventricle from which it is conveyed through the pulmonary (lung) arteries to the lungs. In the capillaries of the lungs it again becomes arterialized by the air that fills the lungs and is then carried to the left auricle by the pulmonary veins. From this cavity it passes into that of the left ventricle, from which the cycle once more begins. The heart, then, is a hollow muscular organ of a conical form, placed between the lungs and enclosed in the cavity of the pericardium. It is placed obliquely in the chest. The broad attached end or base is directed upwards, backwards and to the right and extends up to the right as high as the second rib and the center of the base lies near the surface underneath the breast bone. The apex (point) is directed downwards, forward and to the left and corresponds to the space between the cartilage of the fifth and sixth ribs, three-fourths of an inch to the inner side, and one and one-half inches below the nipple, or about three and one-half inches from the middle line of the breast bone. The heart is placed behind the lower two- thirds of the breast bone and extends from the median line three inches to the left half of the cavity of the chest and one and one-half inches to the right half of the cavity of the chest.

Size: In adults it is five inches long, three and one-half inches in breadth at its broadest part and two and one-half inches in thickness. Weight in the male ten to twelve ounces; in the female eight to ten. It increases up to an advanced period of life. The tricuspid valve (three segments) closes the opening between the right auricle and right ventricle. Pulmonary semilunar valves guard the orifice of the pulmonary artery, keeping the blood from flowing back into the right ventricle. The mitral valve guards the opening to the left ventricle from the left auricle. The semilunar valves surround the opening from the left ventricle into the aorta and keep the blood from flowing back. If any one of these valves becomes diseased it may not thoroughly close the opening it is placed to guard and then we have a train of important symptoms.

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PERICARDITIS.--This is an inflammation of the pericardium, the sac containing the heart.

Primary or First Causes.--They refer in this disease to a peculiar constitution. Children that have a tuberculous constitution are more liable to this disease. Acute rheumatism or tonsilitis are the causes and this trouble follows or goes with them. Infectious diseases also cause it.

Symptoms.--Slight pain in the heart region, fever moderate. These subside or effusion may set in and this usually occurs with acute rheumatism, tuberculosis and septicemia. Sometimes these symptoms are absent.

Treatment of Pericarditis.--The patient must rest quietly in bed and a doctor should be in attendance. An ice bag placed over the heart frequently gives relief and quiets the distress and pain. There is apt to be liquid in the sac (pericardium) and to lessen the tendency to this there should not be much drink or liquid food taken. There should be what is called a dry diet. (See Nursing Department for this.)

ENDOCARDITIS.--Inflammation of the lining of the heart chiefly confined to the valves; it may be acute or chronic.

Simple Kind, Cause.--Occurs at all ages, but most often in children and young adults. It most frequently comes with acute rheumatism, chorea, tonsilitis, scarlet fever, and pneumonia. The valves in the left heart are most often affected, the mitral simply swollen or bearing small growths.

Symptoms.--If it is caused by acute rheumatism, there may be higher temperature, without increase of joint symptoms. Heart beats faster and is irregular. It may run into chronic valvular disease.

Treatment of Endocarditis.--Preventive.--Much can be done to prevent this disease by closely watching the patient having the disease that causes it. The heart should be closely watched. Acute inflammatory rheumatism is a frequent cause and the heart must be watched continually in this disease. When the patient has this disease he must be quiet and in bed. This is essential. A doctor must be called, for the disease is serious and dangerous.

Diet.--Should be liquid. Milk or preparations made with it is the usual diet. Care must be taken that the stomach and bowels be not disordered. Gas collecting in the stomach causes much distress to one who has endocarditis or valvular disease.

Caution.--Avoid early exertion after getting well.

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CHRONIC ENDOCARDITIS.--Usually occurs in persons under middle age. Generally follows acute endocarditis. It may be caused by syphilis, alcoholism, gout, and prolonged over-exertion. The edges of the valve become thickened and then the thickened parts separate and cannot meet exactly and therefore fail to close the opening they are set to guard.

CHRONIC VALVULAR DISEASE.--Results of valve lesions. Narrowing of a valve causes increased difficulty in emptying the chamber of the heart behind it. Insufficiency of a valve allows the return of the blood through the valve during the dilation of a chamber, thus increasing the amount of blood entering the chamber beyond the normal. Either trouble causes dilation of the chamber and compensatory hypertrophy. Enlargement of its wall must take place in order to perform the extra work demanded constantly, for the normal reserve force of the heart muscles can accomplish the extra task only temporarily. This enlargement increases the working power of the heart to above normal, but the organ is relatively less efficient than the normal heart, as its reserve force is less and sudden or unusual exertion may cause disturbance or failure of the compensation acquired by the enlargement. If this loss of reserve force is temporary, compensation is restored by further enlargement and by diminution, by rest, of the work demanded of the heart. Any valvular lesion, whether a stenosis (narrowing) of the outlet or insufficiency from the moment of its origin, leads to certain alterations in the distribution of pressure upon each side of the affected valve. If the body of the heart itself did not possess a series of powerful compensatory aids, that is, the power of making good a defect or loss, or restoring a lost balance, to improve this relation of altered pressure, then every serious lesion at its very beginning would not only cause serious general disturbances of circulation, but very soon prove fatal. Without compensation of the power of making good the defect or loss, the blood in every valvular disease or lesion would be collected behind the diseased valve. The heart's reserve power prevents to a certain extent such a dangerous condition; the sections of the heart lying behind the diseased valve work harder, diminish the blood stoppage and furnish enough blood to the peripheral arteries. The reserve force is used in stenosis to overcome the obstacle, whereas in insufficiency it must force more blood forward during the succeeding phase through the diseased valve. To effect this increased work permanently, anatomic changes in the heart are bound to follow. The changes consist in hypertrophy (enlargement of the heart muscle) and dilatation of the different chambers. Under this head, compensation, is included the increased filling and increased work of certain heart chambers with their resulting dilatation and hypertrophy. But this compensation cannot last forever. It fails sometimes and certain symptoms follow as hereafter related. Therefore persons who have valvular disease and who have been informed that the heart has adapted itself to the condition by enlarging of its walls and chambers and thus forming the condition called compensation, should be very careful of their mode of living and not put any undue or sudden strain upon the heart that might destroy the conditions that make compensation continue. In the following pages symptoms are given showing what happens when compensation continues and when it fails.

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AORTIC INSUFFICIENCY OR INCOMPETENCY.--The valves are not doing their work thoroughly.

Symptoms.--They are often long absent; headache, dizziness, faintness, flashes of light, difficult breathing, and palpitation on exertion, and pain in the heart region may occur early. The pain may be dull and localized, or sharp and radiating to the neck or left arm. When compensation fails, we have difficult breathing, which is worse at night, swelling of the eyes and feet, cough, anemia. Sudden death is more common in this than with any other valvular disease. You can hear a soft blowing sound by listening with your ear.

NARROWING (Aortic Stenosis).--Caused by chronic endocarditis, etc. Their valve segments are usually adherent to each other by their margins and are thickened and distorted.

Symptoms.--When compensation is gone, diminished blood in the brain causes dizziness and faintness.

MITRAL INSUFFICIENCY OR INCOMPETENCY.--This is the most common valvular disease. The segments of the valve may be shortened and deformed. There is often stenosis (narrowing) caused by this deformity. The effects are regurgitation, flowing back of blood from the left ventricle into the left auricle, which is also receiving blood from the lungs, causing dilatation of the auricle and its enlargement to expel the extra blood; dilatation and other enlargement of the left ventricle occurs on account of the large quantity of blood forced in by the auricle; obstruction to flow of blood from pulmonary veins due to extra blood in left auricle, hence dilatation and enlargement of right ventricle which forces blood through the lungs; dilatation and enlargement of right auricle.

Symptoms.--If compensation is slightly disturbed we have blueness (cyanosis), clubbing of the fingers, hard breathing on exertion, and attacks of bronchitis and bleeding from the lungs. If compensation is seriously disturbed we are likely to have the blueness (cyanosis) more marked, heart beat feeble and irregular, constant hard breathing, with cough and water or bloody sputum, dropsy in the feet first and going up and involving the abdomen and chest cavities.

MITRAL STENOSIS.--This is the narrowing of the valve opening. It is most common in young persons, chiefly females. The narrowing of the valve opening may be due to thickening or hardening of the valve segments, adhesion of their edges, thickening and contraction of the tendinous cords of the valve ring.

Symptoms.--Similar to mitral insufficiency, but they develop slower and those symptoms of venous congestion of the lungs, liver, etc., are more marked; bleeding from the lungs is more common.

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TRICUSPID (VALVE) INSUFFICIENCY.--Cause.--Usually due to dilatation of the right ventricle in mitral disease or with lung emphysema or other obstruction to the lungs' circulation.

TRICUSPID STENOSIS (NARROWING).--Rare except in cases from the time of birth.

Recovery from the valvular disease, depends upon the degree of compensation maintained and is best when this is acquired spontaneously. This is to be judged by the heart action. The prognosis is poor in children. It is better in women than in men.

Treatment (a) While Compensated.--Medicine is not necessary at this period. The patient should lead a quiet, regulated, orderly life, free from excitement and worry; and the risk of certain death makes it necessary that those suffering from a disease of the aorta should be especially warned against over-exertion and hurry. An ordinary healthy diet in moderate quantities should be taken, tobacco and stimulants not allowed at all.

The feelings of the patient must control the amount of exercise; so long as no heart distress or palpitation follows, moderate exercise will be of great help. A daily bath is good. No hot baths should be taken and a Turkish bath absolutely prohibited. For the full-blooded, fleshy patient an occasional dose of salts should be taken. Patients with a valvular trouble should not go into any very high altitudes; over-exertion, mental worry and poor digestion are harmful.

(b) The stage of broken compensation. Rest. Disturbed compensation may be completely restored by rest of the body. In many cases with swelling of the ankles, moderate dilatation of the heart and irregularity of the pulse, the rest in bed, a few doses of the compound tincture of cardamon and a saline purge suffice within a week or ten days to restore the compensation. For medicine a doctor must be consulted as each individual case must be treated according to its peculiar symptoms.

FATTY HEART.--This occurs often in old age, prolonged, infectious, wasting disease, anemia, alcoholism, poisoning by phosphorus and arsenic.

ANGINA PECTORIS.--True angina, which is a rare disease, is characterized by paroxysms of agonizing pain in the region of the heart, extending into the arms and neck. In violent attacks there is the sensation of impending death. Usually during the exertion and excitement, sudden onset of agonizing pain in the region of the heart and a sense of constriction, as if the heart had been seized in a vise. The pains radiate up the neck and down the arm. The fingers may be numb. The patient remains motionless and silent, the face usually pale or ashy with profuse perspiration. Lasts for several seconds or a minute or two.

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Treatment.--Live an absolutely quiet life, avoid excitement and sudden muscular exertion. During the attack, break a pearl of amylnitrite in a handkerchief and inhale the fumes. These should always be carried. If no relief is had in a minute or two chloroform should be given at once. It is dangerous and you must look to your physician for advice and treatment.

ARTERIOSCLEROSIS.--A localized or diffused thickness of the inner coat and then of the other coats of the arteries. Arteries look lumpy and are crooked, dilated with stiff, thin or calcified walls. All coats, especially the middle, show degeneration. It usually comes in later life.

Treatment.--Regulate the mode of life, avoid alcohol, excess of eating, drinking, exertion, excitement and worry. Keep the bowels and kidneys acting regularly. There is no medicine for it.

ANEURISM.--This is a local dilatation of an artery. A local tumor.

Treatment.--Absolute rest, restrict fluids. There is always danger from rupture.

MYOCARDITIS.--This is an inflammation of the muscle substance of the heart. It may be acute or chronic.

Causes.--Endocarditis and pericarditis in the course of rheumatism; acute fevers like typhoid, etc.; clots lodging in the heart arteries, coming from diseases such as septicemia and pyemia.

Symptoms.--The heart is weak. The pulse is rapid, small and irregular, palpitation and fainty sensations come on suddenly during the course of diseases mentioned. The outlook is serious and life may end suddenly.

Treatment.--The same as that given for endocarditis. Absolute rest is necessary. A good nourishing diet must be given and a doctor is always needed.

PHLEBITIS, INFLAMMATION OF THE VEINS.--Causes.--Some irritation of the vein, as a puncture or any other injury accompanied by infection.

Symptoms.--Pain and tenderness along the course of the vein with discolored skin and acute swelling (watery) below the obstruction. Pulse rapid, high temperature, chills, dry and brown tongue and pain.

Treatment.--Absolute quiet is necessary, with the affected limb elevated. Lead and laudanum wash should be applied, or hot antiseptic fomentations if an abscess is forming. An abscess should be opened, keep up the patient's strength.

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VARICOSE VEINS (Varix).--This term means an enlarged, elongated, tortuous, knotty condition of the veins. The term "varicose veins" is restricted in general use to the veins of the extremities, and especially those belonging to the lower extremity. The disease begins with a slow dilation of the vein, which gradually becomes thickened and tortuous. The inner lining membrane or coat of the vein is altered, the valves are shortened and thus rendered insufficient to support the column of blood. The outer coat becomes thickened. The varicose conditions affect chiefly the superficial veins.

Predisposing Causes.--They are most frequent in the female sex. The tendency increases as the age advances. Obstruction. Anything that obstructs the full return of blood in the veins, as tight garters below the knee, etc. Standing work may bring it on.

Exciting Causes.--Tumors in the pelvis; diseases of the heart and lungs; pregnancy. These all obstruct the full return of blood in the veins.

PHYSICIANS' TREATMENT FOR VARICOSE VEINS.--Palliative.--Remove the cause if possible. Treat the heart and lung troubles. Remove the pelvic tumors. In pregnancy, the woman afflicted with this trouble should not be much on her feet, but should remain lying down in bed as much as possible. This position removes the weight of the pregnant womb from the veins and allows a free return of the venous blood. An elastic bandage, or a perfectly fitting elastic stocking, supports the veins, equalizes the circulation and turns the flow to the deeper veins, which do not, as a rule, become varicose. This silk stocking should be made to order. This treatment gives much comfort in chronic varicose veins.

DISEASES OF THE EYE AND EAR

The first thing we notice in looking at the eye may be the lids and at each edge are the eyelashes. When this edge becomes inflamed it is called Blenharitis Marginalis or inflammation of the margin of the eyelids. It is called thus from the name of the eyelid "Blepharon;" It is always means inflammation.

If we turn down the lower lid and turn up the upper, we see a red membrane called the conjunctiva (connecting). This is the mucous membrane of the eye. It lines the inner surface of both lids and is reflected over the fore part of the Sclerotic and Cornea--two other coats of the eye, The palpebral or eyelid portion of the conjunctiva is thick, opaque, highly vascular (filled with blood vessels) and covered with numerous papillae. It turns back (reflects) over the Cornea, but it consists only of a very thin structure (epithelium) forming the anterior layer of the cornea and is, in health, perfectly transparent. Upon the sclerotic it is loosely attached to the globe. When the conjunctiva becomes inflamed it is called (Conjunctiv(a)itis) conjunctivitis. The sclerotic-cornea forms the external tunic (coat) of the eyeball, the sclerotic being opaque and forming the posterior five-sixths of the globe; the cornea, which forms the remaining sixth (the front white part that is plainly seen) being transparent. The sclerotic (means dense and hard) serves to maintain the form of the globe, the eyeball.

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The cornea.--This is almost circular in shape. It is convex anteriorly and projects forward from the sclerotic in the same manner that a watch glass does from its case. This layer covers what we call the pupil.

The second tunic or coat (membrane) is formed from behind forward by the Choroid, the ciliary body and the Iris. The choroid is the vascular and dark coat covering the posterior five-sixths of the globe. The ciliary body connects the choroid to the circumference of the iris. The iris is the circular muscular septum (division) which hangs vertically behind the cornea, presenting in its center a large rounded opening, the pupil.

The choroid is a thin highly vascular membrane of a dark brown or chocolate color and is pierced behind by the optic nerve and in this situation is firmly adherent to the sclerotic.

The ciliary body comprises three muscles for its make-up and connects the choroid to the circumference of the iris.

The Iris (rainbow) has received its name from its various colors in different individuals. It is a thin, circular shaped, contractile curtain, suspended in the aqueous (watery) humor behind the cornea and in front of the lens, being perforated a little to the nasal (nose) side of its centre by a circular opening, the pupil, for the transmission of light. By its circumference it is continuous with the ciliary body, and its inner or free edge forms the margin of the pupil. The anterior surface of the iris is variously colored in different individuals and marked by lines which converge toward the pupil.

The Retina.--This is a delicate membrane, upon the surface of which the images of external objects are received. Its outer surface is in contact with the choroid; its inner, with the vitreous (glass) body. Behind it is continuous with the optic nerve; it gradually diminishes in thickness from behind forward. The retina is soft, semi-transparent and of a purple tint in the fresh state. Exactly in the centre of the posterior part of the retina corresponding to the axis of the eye, and at a point in which the sense of vision is most perfect, is an oval yellowish spot, called after its discoverer, the yellow spot or Macula lutea of Sommering.

Refracting Media.--The aqueous humor completely fills the anterior and posterior chambers of the eyeball. The anterior chamber is the space bounded in front by the cornea; behind by the front of the iris. The posterior chamber is a narrow chink between the peripheral part of the iris, the "suspensory ligament" of the lens and the "ciliary processes."

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The vitreous body forms about four-fifths of the entire globe, It fills the concavity of the retina and is hollowed in front, forming a deep cavity, for the reception of the lens. It is perfectly transparent and of the consistency of thin jelly. The fluid from the vitreous body resembles nearly pure water. The crystalline lens enclosed in its capsule is situated immediately behind the pupil, in front of the vitreous body. The lens is a transparent, double-convex body. It is more convex on the posterior than on the anterior surface. The rays of light go through this body and converge to a point at the back of the retina.

BLEPHARITIS MARGINALIS.--This means a chronic inflammation of the margin or edge of the eyelids accompanied by congestion, thickening and ulceration of the parts and the formation of scales and crusts.

Causes.--The underlying cause is often an inflammation of the conjunctiva where the proper care is not taken in cleansing the roots of the lashes when the discharge collects.

Other causes are keeping late hours, smoke and dust.

Symptoms.--The red swelling along the roots of the lashes is often the only symptom. This comes and goes at the least excuse, such as eye strain, late hours, dust and wind. Scales and dust form in the severe forms, of the disease. It is most common in children, extends over many years and may finally result in the loss of the lashes, with the edge of the lid, thickened, reddened and turned out.

Treatment.--This is tedious. Fit glasses if there is eye strain, reform the mode of life and attend to any constitutional disease that may tend to make it worse.

Local treatment.--Keep the parts thoroughly clean. The edges of the lids should be washed carefully with soap and warm water or mild solution of borax or soda until the crusts are all cleaned off and then use at night an ointment composed of the following ingredients:

Yellow oxide of Mercury 2-1/2 grains Petrolatum 2-1/2 drams

Mix and make an ointment and rub on the edge of the lids every night, first cleaning them. The conjunctivitis must be cured.

STYE (HORDEOLUM).--This is a swelling beginning in a gland or glands at the edge of the lid and pus forms finally.

Causes.--Inflammation of the edge of the lid, stomach trouble, run down condition, poorly fitted glasses, when glasses should be worn to relieve the eye strain.

Symptoms.--Itching and burning feeling followed by a red swollen area (lump) at the edge of the lid. Later it comes to a point and discharges.

Cause.--Styes usually run their course in a few days or a week; another frequently follows. When it does not reach the pus stage, it often leaves a hard swelling (blind stye).

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MOTHER'S REMEDY. 1. Stye.--Home Method to Kill.--"To hasten the pointing of a stye apply hot compresses for fifteen minutes every two hours. As ill health may be the cause, a tonic may be needed; glasses properly fitted should be worn and a boric acid eyewash used until long after the stye has disappeared." Applying hot compresses will relieve the congestion and gives much relief. Ill health produces a poor circulation of the blood and a good tonic will be found beneficial. Styes are frequently produced by need of glasses.

Treatment.--Treat the stomach and system if necessary. Ice or cold cloths against the stye may abort it. If it goes on, hot fomentations will hasten it. It should then be opened up and scraped out. It will soon heal then and will not leave a lump.

ACUTE CATARRHAL CONJUNCTIVITIS (Pink Eye).--Definition.--This is an acute inflammation of the mucous membranes under the eyelids, and there is congestion (too much blood), swelling and a discharge of mucus and pus.

Causes.--Exposure to wind, dust, smoke, or irritating foreign substance, cinder, sand, etc. It may occur in epidemic form and then is contagious and is called "pink eye."

Symptoms.--The lids appear stiff to the patient, the light causes discomfort and the patient fears it. Burning feeling as if there was some dirt, etc., under the lid, not much pain, but discomfort especially in the evening. The lids look swollen and red. The conjunctiva on the cornea is reddened and that on the lid is thickened, reddened and rough. The discharge collects at the roots of the lashes or lies on the conjunctiva. The lids are stuck together in the morning. The sight is slightly affected by the discharge on the cornea, which is otherwise clear. Sometimes little (minute) ulcerations are seen.

Course.--It may run into a chronic conjunctivitis. One eye is usually attacked a few days before the other. The first stage lasts a few hours or a day and then the discharge follows which may last a few days or a week or more.

Treatment.--First: Use gauze or cotton and dip in ice or cold water and apply to the eyelids. A wash of hot water can be used to cleanse the eye or ten to sixty grains (one teaspoonful) of boric acid to an ounce of water can be used as a wash also.

The following remedies are good in combination as follows:

Alum 3 grains Sulphate of Zinc 2 grains Distilled Water 1 ounce

Mix and drop one drop into the eye two or three times daily. A weak solution of tea can be used also as a wash. Anoint the lids at night with white (tube) vaselin.

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INFLAMMATION OF THE EYE OF NEWLY BORN (OPHTHALMIA NEONATORUM).--This is a severe inflammation of the conjunctiva in the new born infant, usually due to a discharge from the mother and it is characterized by a discharge of pus.

Causes.--Mild cases may come from a less violent form of infection from the mother's discharge from the vagina, or from outside causes. The majority of the severe cases is due to a poison (the gonococcus infection).

Symptoms.--The first symptoms are swelling and redness, usually of both eyes, usually occurring a few days after birth. Soon the discharge appears and shortly becomes creamy pus, which runs from the eyes when the swollen lids are partly opened. As the disease continues to advance, the membrane of the lid is thickened, red and velvety looking and the conjunctiva (membrane) in the eye is swollen, puffy and watery.

The disease may last from two to six weeks or longer.

If the pus is not cleaned from the eye, the cornea may look dim and ulcers may appear. If the ulcer eats through the cornea the iris is apt to be caught in the opening and in the scar resulting from the ulcer. The cornea may later bulge and protrude or the disease may involve the whole eye in an inflammation which may destroy it.

The result generally depends upon how soon treatment is begun. If attended to early the great majority of cases recover. It is serious to neglect early treatment for this disease. It causes a great many cases of blindness and generally the cases are neglected too long. Treatment must begin before the disease begins. Immediately at the birth of the child, when if there is any poison in the eye due to a discharge in the mother's vagina, it can be immediately cleansed.

TREATMENT PREVENTIVE. What to do first.--As soon as the child is born and before its eyes are opened the discharges should be carefully wiped away from the lids with small squares of cotton or gauze, pieces wrung out of a weak solution, three per cent (three parts to one hundred of warm, boiled, water) of boric acid. The eyes should not be exposed to the light. At the first both the eyes should be bathed and the same piece of linen should not be used for both eyes.

As soon as any redness appears the eye should be frequently bathed with this warm, weak solution of boric acid and sometimes cold compresses should be used by taking squares of folded gauze or masses of absorbent cotton. Take them cold from a block of ice and lay them over the eyes, and keep constantly changing to keep them cold. This relieves the congestion and prevents a great amount of blood from flowing and settling (congestion) there. When pus appears in the eye it should be cleansed every half hour at least. You can do this by letting the solution run over it from a medicine dropper. After being allowed to trickle from the outer to the inner angle (corner) of the eye, it will then run down beside the nose and can be caught in a piece of absorbent cotton or sponge. If there is a great amount of pus in the eye, the eye may have to be washed out in this manner, every fifteen minutes, day and night, so that the cornea will be kept clean. If this must be done a small fountain syringe with a glass tube (eye-dropper) attached will cause a steady flow of the solution. The boric acid can be increased to five or ten grains to the ounce of water. If only one eye is diseased the other eye may be covered.

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All cloths, etc., should be burned at once and the basin which has held them, filled with carbolic acid solution of the strength of one part acid to twenty parts water. The nurse's hands should be thoroughly scrubbed in hot water and soap and disinfected in the same strength of carbolic acid solution, as the disease is very contagious and dangerous to adults. An attendant should not touch her face or hair with her hands unless they have been washed quite clean. The conjunctiva should be brushed with a solution of nitrate of silver of two per cent strength (two parts to one hundred of distilled water) and then neutralized with a salt solution, not strong enough to burn.

When the cornea is diseased one per cent solution of atropine may be necessary once or twice a day.

Caution.--In the cities this disease is disastrous in its results to the sight of babies. This is due to the want of necessary care. Persons who must be with the patient should be very careful not to get any of the discharge upon their clothes or person, as it is very contagious.

ULCER OF THE CORNEA.--Causes.--Poor general health is an underlying cause or the cornea itself may be poorly nourished. Ulcers are common among the poor classes. They often begin through a rubbing of the cornea by a foreign body. They also come from diseases of the conjunctiva. Weakly babies are easily affected.

Symptoms.--The light hurts the patient; there is a feeling of something in the eye. When the ulcer is over the pupil the sight is impaired. The eyeball shows a ring of pink congestion about the cornea, with congestion of the conjunctiva. The form of the ulcer may be irregular, circular, etc.

Course.--The simple ulcers heal in a week or two. Infected ulcers may spread, or they may sink deeply into the substance of the cornea and eat through. The danger to the sight depends upon the kind and severity of the ulcer. There is apt to be more or less film over the eye for some time and if the ulcer eats through it may destroy the sight.

Treatment. Preventive.--When the cornea has been injured and there has been some rubbing off of its tissue (abrasion) mild antiseptic solution in the form of eye drops should be used. Boric acid, as much as will dissolve in warm, distilled water and some dropped in the eye three or four times a day. If there is a foreign body in the cornea, clean instruments should be used to remove it. The cocaine used to render the eye painless must be pure.

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General Treatment.--If the patient is "run down" the general system should be built up.

Local Treatment.--One to two per cent solution of Atropine should be put into the eye three to six times a day to keep the pupil dilated and prevent it from adhering to the cornea. Hot fomentations repeated according to the severity of the case and the amount of "easing" they give. A three per cent solution of boric acid should be used for cleansing purposes. The bowels should be regular. The patient should remain in one room.

FILM ON THE EYE PTERYGIUM.--This is a growth beginning near the inner or outer corner and extending with its point towards the center of the cornea.

Symptoms.--The patient only complains when it has advanced toward the center of the cornea and the vision is lessened or cut off. It occurs more often from the inner corner. It keeps growing for many years and may cease advancing at any time.

Treatment.--Surgical treatment is often necessary. Dr. Alling says: "Dissect off the growth from the cornea and sclera coats, leaving the base attached (toward the corner of the eye) and bury its point under the undermined conjunctiva below. If the growth is dissected off the cornea, which may readily be done, and then cut off (towards its base) it would recur."

IRITIS. (Inflammation of the Iris.)--This is an inflammation of the iris, characterized by congestion, small pupil and posterior synechia.

Causes.--It occurs in the second stage of syphilis, second to eighteenth month, from rheumatism, diabetes, gout, injury, and without any known cause (idiopathic).

Symptoms.--More or less severe pain in the eye, forehead and temple, worse in the night and early morning especially. There is fear of the light and the eyes water very much. The sight is affected and there may be some fever. On examination the lids are found swollen and red, the eyeball shows congestion in the cornea and ciliary body, with some congestion of the conjunctiva. The cornea looks hazy. The anterior surface of the iris looks muddy and does not look so fine and delicate. The pupil is small and the light does not make it contract readily. If atropine is put in the eye (one per cent solution) the pupil will not dilate regularly, because at different points the pupillary edge of the iris is held to the lens by an exudate that lightly holds it.

Course and Recovery.--The disease may occur at any age, but it is most common in children. It may last from one to six weeks.

Chances of recovery are good if treatment is begun early. There is a tendency to recurrence.

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MOTHER'S REMEDY.--1. Iritis.--Sensible Remedy for.--"Doctor the blood with sulphur and lard, a teaspoonful three times a day. Refrain from using the eyes. This disease is said to be brought on by rheumatic fever, and rheumatism is a disease of the blood." This is a very serious disease and a physician should be called.

Treatment. What to do first.--Confine the patient in a darkened room and if the attack is severe in bed.

Local Treatment.--Dry or moist heat should be applied, according to the ease they give. Leeches are good in severe cases placed near the outer corner of the eye. Atropine usually made of about the strength of two to four grains Atropine to an ounce of water; or one per cent (1 to 100) may be used, and it should be dropped into the eye from three to six times a day. The pupil must be dilated and kept so from the beginning to keep the adhesions from forming between the iris and lens. If too much is used the throat and tongue will feel dry, face will flush, and there will be dizziness and a rapid pulse. Stop it until that effect is gone and then cautiously use it again. The bowels should be kept open.

The diet should consist of milk to a great extent. Water of course can be taken freely. Soups, broths, gruels, etc., can be used if desired; but meats should be withheld for a time unless the patient runs down.

Caution.--If a person has any of the special symptoms above mentioned it would be prudent to begin treatment at once. The great danger is permanent adhesion of the iris to other parts, especially the lens, and the dilating and contracting power may be lost.

INJURIES OF THE IRIS.--Concussion of the eyeball may produce an irregular dilation of the pupil. This is due to paralysis of the sphincter muscle of the pupil, but it generally disappears. The edge of the pupil may be torn in the form of one or more rents, or the iris may be separated from its root at its circumference, leaving a clear space, or it may be entirely torn from its attachment.

Perforating wounds are accompanied by injury to the lens and other structures; when the cornea is wounded it is often complicated by falling of the lens. When a small foreign body passes through the cornea and iris a small opening may be seen. The greatest danger from wounds is due to infection and if it reaches the iris, it may produce violent iritis. If the lens is displaced or absent the iris being without support, will tremble with every movement of the eye. In some cataract operations, if there is a loss of the "Vitreous" body a part of the iris may be folded upon itself, thus enlarging the pupil in that point.

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CATARACT.--This is an opacity of the crystalline lens or its capsule. The lens is not clear and bright and keeps the light from going through it. Then it is called opaque.

SENILE CATARACT.--The vast majority of these cataracts are found after the age of fifty. They simply come without any known cause. Of course, injury can cause a cataract and it is then called traumatic cataract.

Symptoms of Senile (Old Age) Cataract.--Blurred vision, flashes and streaks of light, dark spots, double vision. There is no pain. Eye strain due to imperfect sight. Sometimes the first symptom is ability to read without glasses (second sight). This is due to the increased refractive power of the lens from swelling. The lens looks a little whitish through the pupil opening and looks more so as time goes on.

Course.--The progress is slow. It usually takes a number of years before it is "ripe" for operation. They may remain in the same condition sometimes. In this kind of cataract both eyes are affected sooner or later, although one eye may be fully matured before the other is much changed.

The result of an operation depends upon the condition of the eye. The eye should be free from evidence of disease. "The anterior chamber should be of normal depth. The pupil should react to light. There should be a homogeneous (all alike) white or gray opacity immediately back of the pupil, with no shadow from the edge of the pupil (except in cases of sclerosis, already mentioned). A candle carried on all sides of the patient while the eye is fixed, should be properly located by him. The tension of the eyeball should be normal."

The operation is very frequently done and it is very successful. The patient should be ready and willing to place himself in the charge of the operator and do as he says.

SYMPATHETIC INFLAMMATION OF THE EYE.--(Sympathetic Ophthalmia.)--A condition in which the healthy eye becomes the seat of a destructive inflammation transferred from the other eye which has been the subject of a similar inflammation usually following a perforating injury of the eyeball. The injured eye is called the exciting eye; the other, the sympathetic eye.

This is a rare disease, but it may occur when one eye is injured or diseased and on the first indication of trouble in the injured eye the other eye should be closely watched for symptoms of sympathetic trouble so that if can be removed.

Symptoms in the Exciting Eye.--This is more or less congested and painful; when pressure is made upon the upper lid, it shows tenderness. The tension is not as strong; the pupil may be blocked with an exudate.

In the Sympathizing Eye.--There is an inflammation involving the choroid, ciliary body and iris. There is pain, tenderness, small blocked pupil and sight is poor.

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Course.--It usually appears between the third week and the sixth month after the original injury. "The extreme limits are two weeks and twenty years." The sound eye is likely to be attacked when the exciting eye is in a state of active inflammation.

Treatment.--The "exciting eye" should be enucleated (taken out) before any signs of sympathetic inflammation appears in the healthy eye. If it has appeared, enucleation will be of no value; at all events if there is vision in the exciting eye, the operation should not be done then.

INFLAMMATION OF THE RETINA FROM BRIGHT'S DISEASE (Albuminuric Retinitis).--The retina is a very delicate structure and we are often able to diagnose Bright's disease from the peculiar effect it produces upon the retina.

Causes.--The cause is usually Bright's disease, (nephritis) and usually the chronic Interstitial variety. Pregnancy causes it sometimes. Interference of the vision, sight, is what the patient complains of. This may be very slight, when you consider the great changes occurring in the retina. Such patients are subject to attacks of temporary blindness of uremic origin. The vessels of the retina are swollen and tortuous. Bleeding and shining white patches are scattered through the back part of the eye and a peculiar arrangement of glistening white dots around the yellow spot. This disease shows itself late in Bright's disease and the patient is not likely to live more than two years after the appearance of this eye lesion.

Treatment.--It sometimes occurs during pregnancy. Then the question of inducing premature labor arises. There is no local treatment that can be of any use when it is caused by Bright's disease.

FITTING GLASSES.--This is done by lenses and prisms, etc.

Lens.--A lens is made of glass and prisms graded in strength, one surface curved, and has the power of refracting or changing the direction of the rays of light. A prism is wedge-shaped and bends rays of light towards its base. A great many people are troubled with their eyes, much more than years ago. We even see little children wearing glasses. It is unfortunate, but true, that even more children and grown people should wear them. Fitting glasses is an art in itself. It takes more ability to fit glasses well than it does to operate well. Poorly-fitted glasses are not only annoying to the wearer, but dangerous. Glasses rest the eyes, not tire them. When the eyes water and feel tired or strained, even after using them but little, glasses are needed. Headaches are frequently caused by the eye strain. When glasses are needed it does not pay to put off getting them and the person needing them should go to one competent to properly fit them. A great many eyes are hard to fit, and they need not only ability to fit them well, but time and attention must be given to fitting them properly.

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SQUINT OR STRABISMUS.--Both lines of sight are not directed towards the same object of fixation.

Internal or Convergent Squint.--Where one eye is turned inward toward the nose.

External or Divergent Squint.--One eye turns outward toward the temple. Squinting upward and downward are uncommon.

Causes of Convergent (Internal) Squint.--It generally appears between two and five years; at first periodically, later constantly. The patient is generally far-sighted.

Treatment.--Internal squint in very young children may be treated by covering the well eye and forcing the child to use the other. When the child is old enough, proper glasses should be worn. Operation can be done when needed and is generally successful.

External (Divergent) Squint.--This may appear at any age and is often associated with near-sightedness. An operation is necessary and the tendons on both sides must generally be cut and properly placed. Parents should always attend to a child who has this trouble. The operation is not difficult to perform and it will not only, as a rule, give the child good sight, but better looks. Parents who are able to have an operation or glasses fitted when needed, and who neglect their children, should be punished; they are guilty not only of neglect, but cruelty.

MOTHERS' REMEDIES. Inflammation of the Eye. 1. Chickweed a Relief for.-- "The juice of chickweed is good for inflammation of the eyes, when dropped into them."

2. Inflammation of Eyes, Sassafras, Excellent Remedy for.--"Take sassafras bark and make into a tea. Apply this externally to the eyes, and it will be found very beneficial for this trouble." This is a very good remedy, on account of its oily soothing nature.

3. Inflammation of Eyes, Tried Remedy for.--

Boric Acid 10 grams Camphor Water (not spirits) 1/2 ounce Water 1/2 ounce

Apply this with a soft cloth.

This trouble usually results from or is associated with constitutional disease and requires treatment for same, but the above wash is good for local applications. This prescription was given me by an oculist."

4. Inflammation of Eyes, Common Potato Will Cure.--"Scrape raw potato and apply to the temple until relieved." This helps to draw the blood away and relieves the inflammation.

5. Inflammation of Eyes, Milk Curd Relieves.--"Make a curd of sweet milk; that is, set it on the stove till it forms a curd; then add quite a little alum and wash eyes." The milk is very soothing and the alum acts as an astringent. Care should be taken in using this remedy that none of the mixture gets into the eyes.

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6. Inflammation of Eyes, Wild Hairs Cause.--"A few years ago, I had trouble with my eyes. They felt as though there was something in them scratching the eye-ball. I went to an eye specialist, and he gave me two little vials of medicine to drop into my eyes six times a day. I doctored with him several months, and while the medicine reduced the inflammation largely, it did not relieve the scratching sensation in the eyes. Then I was away from home for about ten days and did not use the medicine, and when I returned my eyes were very much inflamed, and very painful. I visited the doctor again, and he said I had a little ulcer on the eyeball, and he pulled out several hairs or winkers from the eyelid. I asked him if wild hairs were the cause of the ulcer and he admitted they were. After a few days' more treatment by the doctor I learned of a neighbor who understood a little about wild hairs in the eyelid and had him examine my eyes. He pulled out more wild hairs, and my eyes got well. Ever since then, when my eyes begin to hurt me as though there was some foreign substance in them, I go to my neighbor and he pulls out the wild hairs, and that was the trouble with my eyes. My experience in obtaining this knowledge cost me twenty dollars in fees to the eye specialist, which I could have saved by going to my neighbor at first,"

MOTHERS' REMEDIES.--Sore Eyes. 1. Rose Leaves Rest.--"Steep rose leaves and apply often." Apply the leaves as a fomentation and relief will soon follow. This is very soothing and very easily applied.

2. Sore Eyes, Soothing Remedy for.--"Use a wash of borax and water. One-half teaspoonful to a cupful of water." This is very good.

3. Sore Eyes. Slippery Elm Excellent for.--"This is a very soothing dressing far the eyes. You can buy a small package of the slippery elm at any drug store, and prepare it by making a tea and using externally.

4. Sore Eyes, Common Remedy for.--"Use a wash night and morning of common table salt and water." This is often sold by druggists for 10 or 15 cents an ounce under a medical name.

5. Sore Eyes, Elder Berry Flowers Relieve.--"In a severe case of inflammation of the eyes apply a poultice of elderberry flowers; bathe the eyes with warm water and witch-hazel." This remedy was given by a mother who tried it a great many times and always had success.

6. Sore Eyes. Borax and Camphor Good Wash for.--"Borax one teaspoonful, spirits of camphor fifteen drops, distilled water one-half cupful. This makes a fine wash for sore eyes, and is perfectly harmless."

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7. Sore Eyes, Tested Eye Wash for.--

"Hydrastis (Golden Seal Root) 1/2 ounce Best Green Tea 1/2 ounce Sulphate of Zinc, Pulverized 1 dram

Steep the root and tea for a few minutes in a pint of boiling water; while cooling add the sulphate of zinc; when cold strain well and bottle. Use as an eye wash three times a day. In severe cases a poultice is useful, made of pulverized slippery elm and warm milk and water. All eye washes should be used with caution and especially those containing belladonna or caustic solutions,"

8. Sore Eyes, Borate of Soda and Camphor Water Relieves.--

"Borate of Soda 2 grains Camphor Water (not spirits) 1 ounce

Mix, drop one or two drops in the eye four times a day.

Camphor water is made by allowing the gum to dissolve in water instead of alcohol, also saturate lint in this mixture and apply on the eyes."

EAR AND ITS DISEASES.

The external ear is called auricle or pinna. It is an oval funnel-shaped organ. The canal leading in to the membrane (drum) is called the external auditory meatus. It extends inward about one and one-quarter inches and terminates in a membrane.

Membrane Tympani (drum) which separates the external ear from the tympanic cavity. To examine the drum, you must pull the ear backward and outward to make the canal straight.

Membrane Tympani (the drum) Membrane.--This is situated at the inner end of the canal and separates it from the tympanum or middle ear. It is placed like the membrane in the telephone. It is pearly gray in color. This membrane not only serves as a protection to the delicate structures within the tympanum, but also receives the sound vibrations from without and transmits them to the ossicular (bony) chain of the middle ear.

The Tympanum or Middle Ear.--This cavity just beyond the drum, which forms the greater part of its outer wall, is an irregular cavity, compressed from without inward and situated in the petrous bone. The mastoid cells lie behind. It is filled with air and communicates with the nose-pharynx (naso-pharynx) by the eustachian tube. The upper portion of this cavity, the attic, lies immediately below the middle lobe of the brain, separated from it by a thin layer of bone, which forms the roof of the cavity. This cavity is separated from the internal ear.

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The Eustachian tube.--This is the channel through which the middle ear communicates with the pharynx. With an opening in the anterior of the middle ear, a bony canal passes from this point, inward, forward, and downward through the petrous bone, when it merges into a cartilaginous canal, which terminates in a funnel-shaped protuberance, with a slit-like orifice, located in the nose pharynx. This is the eustachian tube. It is lined with mucous membrane like the throat. The air goes up from the throat, through this canal to the middle ear. The mucous membrane of the middle ear is continuous with that of the nose-pharynx through the eustachian tube. So you can readily understand how easy it is for an inflammation of the throat to extend to the middle ear through the eustachian tube.

The posterior wall which has the greatest height, reveals in its upper portion a passage (antrum) through which the vault of the tympanum (attic) communicates with the cells of the mastoid process, situated posteriorly. From this description you see how near to each other these parts are placed and when one becomes diseased the disease can extend to the other part or parts. The brain is separated from some of these cavities by a very thin shell of bone, and the disease can soon affect the brain through infection or breaking through the thin structures that separates the parts.

Diseases of the middle ear and the mastoid are always to be considered serious, and should be very closely watched. A child with a running ear is in danger, for it may at any time become closed up and serious.

ECZEMA OF THE EXTERNAL EAR (Auricle).--This is an inflammatory disease of the skin, and in the poorer classes it is very frequent. It is quite a common disease in old age. It develops in other parts of the body at the same time in a certain percentage of cases.

Causes.--Soaps, alkalies, foreign bodies in the ear, removing ear wax and a chronic discharge from the middle ear. There is a tendency to it in some families; stomach trouble, improper food are also causes.

Symptoms.--Itching,--and this is very pronounced,--burning feeling. The part is somewhat reddened, fluid oozes out, crusts form, the skin thickens, and scales. Sometimes it swells very much.

Treatment.--Regulate the bowels, give a simple easily digested and proper food for children and adults. Cleanse the inflamed skin gently with castile soap and tepid water once a day. Cloths dipped in some cooling lotion, such as the lead and opium wash, or in plain water to which has been added a little alcohol or eau de cologne, should be wrapped around the inflamed ear during the acute stage and they should be kept wet. Clean vaselin, etc., is good to put on the scabs. The ear should be covered as before directed to keep dirt, dust, etc., out.

[360 MOTHERS' REMEDIES]

HARDENED WAX OR IMPACTED CERUMEN.--This mass may be mixed with foreign bodies or be made up of "wax" alone.

Symptoms.--A large mass of wax may remain in the ear for many years without causing any special loss of hearing so long as the plug does not rest against the drum and there remains a passage between the mass so that the sound-waves can strike the drum. Generally the hearing gradually grows less. Loss of hearing may take place suddenly, as after washing the head, or after a general bath, or after an attempt to clean the ear with the end of a towel. Patients will often say the dullness of hearing appeared suddenly. This no doubt was due to the fact that the mass of wax was displaced against the drum suddenly by an unusual movement of the head or the jaws, or the mass became swollen through fluids getting into the canal. If the canal is filled there will be more or less deafness, ringing in the ear, and there may be piercing pain produced by the hardened mass, especially if the jaws are moved from side to side. If the mass is thoroughly and carefully removed, the hearing may entirely return if it was caused by this wax.

Treatment.--The mass is best removed by syringing the hardened plug and softening it gradually. Removing it with a currette and forceps without softening it may do injury to the parts. The syringe and hot sterilized, boiled water should be used for some time, and the patient asked occasionally if there is any faintness or dizziness caused by it. It often comes, in a lump after the water has been used for some time. A strong solution of bicarbonate of sodium is also good to use.

FOREIGN BODIES IN THE EAR.--These are not of frequent occurrence. In the case of children these bodies may comprise such objects as pebbles, beads, beans, pieces of rolled paper, fly, bed-bug; insect of any kind may get into ear of adults. If they reach the drum a very unpleasant sensation is produced by the attempt to escape. Sometimes a layer of wax may gather around the dead object. These bodies should be removed, for their presence may produce a swelling or soreness in the canal. If the object is a dried pea or bean the syringe should not be used. The object must be carefully removed. Sometimes an operation is necessary to remove the object.

DISEASE OF THE MIDDLE EAR.--The ordinary cold in the head rarely runs its course without one of the eustachian tubes at least is involved to some extent.

SIMPLE INFLAMMATION OF THE EUSTACHIAN TUBE.--Causes.--Acute colds, inflammation of the nose and pharynx, tonsilitis.

Symptoms.--The ear may feel full and numb, roaring in the ear may occur. There may be pain on swallowing, shooting up through the tube.

[EYE AND EAR 361]

Treatment.--Remove the cause. Treat the nose and pharynx. Spray and gargle with solutions advised for throat trouble. If it continues the throat should be examined for adenoids, enlarged turbinate bones and so on.

ACUTE CATARRHAL INFLAMMATION OF THE MIDDLE EAR. Causes.--Acute coryza, acute pharyngitis, influenza, scarlet fever, inflammation of the eustachian tube, gargling, bathing, employing the nasal douche or violently blowing the nose.

Inflammation of the eustachian tube is, in many cases, simply the first stage or onset of this disease. The congestion extends beyond the tube and involves to a greater or less degree this cavity. If it continues for a few hours or an entire day, the watery elements of the blood will begin to escape from the distended vessels into the tissues of the mucous membrane and ooze out upon its free surface. If this is copious enough pressure may be developed within the cavity, middle-ear, to cause pain. These cases vary much in severity. In the mildest ones there may be a few twinges of pain in the affected ear, but nothing more; and even in the most severe cases the pain does not last longer than a few hours, although it may return on several successive days. Very many of the earaches of young children, from two to ten years of age, are due to this disease. The pain is very likely to come on late in the afternoon or during the night, while earlier in the day the child may be free from pain. In the milder forms the condition of the drum is similar to that existing in inflammation of the eustachian tube. It is not then much changed from normal. There may be more congestion than in this condition. In a fairly severe case the membrane (drum) a few hours after the onset presents a most striking change. It is a picture of obstructed venous (dark blood) circulation of a high degree. In some cases one or more of these distended veins may rupture and form a blood tumor in the external ear canal. The drum is red and more or less swollen.

Treatment.--Very little is needed for this kind, except care and watching. Use the simple hot water in the ear carefully or poulticing when there is pain with onions, bread and milk, and puncture of the drum if it bulges or is too tense. Hot water for gargle, steaming of the pharynx. Keep the patient in a room with an even temperature. The patient must not take cold as it might extend farther.

Recovery.--The outcome is usually good in this disease if proper care is taken; Generally in a few weeks the inflammation is gone and the hearing is restored.

[362 MOTHERS' REMEDIES]

SEROUS MUCOUS EXUDATION INTO THE MIDDLE EAR.--The disease just described is often associated with an (exudation) watery oozing of fluid into the middle ear, but the following condition is different. Sometimes a comparatively normal middle ear is found to contain a variable amount of either fluid or mucus, or a fluid which represents a combination of both. The failure of the fluid to absorb is due first to the fact that the drainage through the eustachian tube is still obstructed; second, that the absorbing process in the cavity is not acting normally.

Symptom.--Sudden change from somewhat poor to good hearing and the reverse. It is due to the changing in the position of the fluid. The hearing may be normal when the head is thrown far backward, for the fluid then escapes into the antrum, or when the chin is resting upon the chest.

Another symptom that is peculiar is a feeling of something moving in the ear. This is only felt when the head is moved suddenly. Sometimes the patient says: "I went in bathing and got some water into my ear, and I am unable to get it out." He thinks the water went into the ear by the way of the external ear canal. It was due to the chilling of the surface of the body, or the water accidentally entered into the ear through the mouth, or nose, throat, and eustachian tube, and this caused an exudation of fluid to take place in the middle ear. Hearing gurgling sounds in the ear during coughing, sneezing and swallowing is an important symptom. The drum on being examined varies greatly. The simplest case is seen when fluid contained in the cavity is small in quantity and consists of a thin serum. The upper level of this fluid can then be seen like a hair crossing the drum in a more or less horizontal direction. It retains its horizontal position when the patient moves his head backward and forward.

Treatment.--The fluid can be evacuated by an opening made into the drum, but it usually accumulates again. The proper treatment is to treat the diseased condition of the nose and throat, as described in other parts of this book.

CHRONIC CATARRHAL INFLAMMATION OF THE MIDDLE EAR.--The expression, acute inflammation of the middle ear, is rightly employed when it is applied to a case in which the underlying cause is of a temporary nature, as for example, a cold in the head, and mild attack of influenza, perhaps also in an attack of hay fever. But when the causes are of a more permanent character and the middle ear continues for an indefinite period to be the seat of all sorts of disturbances the combination of these different diseased phenomena receives the name of chronic catarrhal inflammation of the middle ear.

Causes.--Troubles (lesions) located in the upper pharynx, the naso-pharyngeal (nose-pharynx) vault and the nasal passages. Adenoids may cause it.

The course of this disease has of recent years been growing more favorable, because the causes are being removed more and more.

Symptoms.--Symptoms of the acute inflammation would be present, and impairment of hearing which sometimes comes so gradually as not to be noticed by the patient. It will be better and then worse. A harassing, hissing, blowing, ringing, usually accompanies it. Pains soon or later add to the discomfort. One side is usually affected first.

[EYE AND EAR 363]

Treatment.--It must be devoted to removing the causes just mentioned. Restore the general health. Abstain from alcohol, tobacco and excess of all kinds. Active outdoor exercise, horseback riding, mountain climbing, rowing, walking, etc., are great health producers.

ACUTE SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.--This inflammation of the middle ear is one in which, at an early stage of the disease, the free liquid poured out assumes a pus-like character. At the onset the mucous membrane of the eustachian tube and middle ear becomes first congested and afterward oedematous (watery swelling). Then a serous or a bloody-serous fluid is poured out into the middle ear; and finally this assumes all the outward characteristics of pus. In a few exceptional cases this pus fluid will find a sufficient passage through the eustachian tube; but in the great majority of cases this passageway becomes closed almost at the very beginning of the attack, and then the free exudation; under an ever increasing pressure and on account of the softening and breaking down of the tissues of the drum forces an opening for itself directly through the drum membrane.

Causes.--The same causes that produce the acute variety will produce this variety of the disease. It occurs more frequently during the spring and fall months as the result of changes in the climate. Acute and chronic catarrh of the nose and pharynx are causes. It frequently occurs in connection with scarlet fever and measles. It complicates nose and pharyngeal diphtheria.

Symptoms.--Pain in the ear is the most striking symptom noticed by the patient. In infants and young children of two or three years of age it may appear and not be recognized until a slight discharge appears at the opening of the external ear. The child is feverish, fretful and peevish, seemingly suffering great pain, and the parents think it is, not very sick or has only an earache. Sometimes physicians fail to recognize the trouble until the discharge appears in the external ear. The symptoms are more severe at night. Any physical or mental exertion increases the plain. The pain is sometimes very severe, and a spontaneous or artificial rupture of the drum eases the suffering very quickly in some cases, and a bloody, serous, pus-like discharge escapes into the external ear canal. Often a patient will say: "I felt something give away in the ear, a watery discharge appeared, and the pain soon subsided." In many cases the rupture of the drum gives little or no relief from suffering. This is due in some cases to the small and insufficient size of the opening in the drum. If the pain persists, after a free opening has been made, it may indicate that pressure exists in some cavity or cavities other than the middle ear proper. A sensation of fullness and sometimes of throbbing or pulsation in the affected ear; roaring, singing, whistling, etc.; impairment of hearing; increased pain, when the jaws are opened and shut, are symptoms of minor importance. If there are no complications after free discharge sets in the pain disappears, the fever gradually returns to the normal point, and the patient drops to sleep. In the course of a week or two the discharge subsides and if the rupture is not too extensive the wound will close and the patient will soon be well. Frequently, however, on account of disease of one or more of the bony parts, the wall of the middle ear or the mastoid cells, the discharge continues for weeks and may become chronic in its character.

[364 MOTHERS' REMEDIES ]

Treatment.--Apply heat or cold first. Open the bowels.

How to apply heat.--With the patient lying on his side with the affected ear turned upward, fill the external ear canal with hot water (about 105 degrees F.), then place immediately over the affected ear a hot flaxseed meal poultice, five or six inches square and one-half inch thick, and spread a folded blanket or shawl over the whole to keep it warm as long as possible. Bread and milk with catnip, or onions will do if flaxseed is not at hand. The flaxseed holds the heat longer. Water is a good conductor of heat, and that which fills the external auditory (ear) canal may rightly be considered as an arm of the poultice which extends down to the drum itself.

Leeches also can be applied in front and below the tragus (front of the opening). If the symptoms do not improve under this treatment and especially if the drum is bulging, an opening should be made at the bulging point of the drum. The canal is now syringed with a warm antiseptic solution--like one part listerine, etc., to twenty parts of warm boiled water, with a clean syringe, or warm boiled water can be used alone. If there is any odor carbolic acid one part, to fifty or sixty of water can be used. A strip of sterile gauze is put into the canal for drainage and protection. This syringing can be done from two to four to five times a day, and gradually decrease the number of times as the discharge lessens. It must be syringed and dressed often enough to allow a free discharge and produce cleanliness.

Recovery.--The result of this disease cannot be told at the outset. The majority of such attacks end favorably, with care and treatment; this in persons of good constitution and health. It may run ten days to three to six weeks. In tuberculous patients the result is not so favorable. Recovery follows as a rule in this disease following scarlet fever and measles, but not so quickly, and there may be a discharge for some time, due to chronic disease of the ears, etc.

Complications and results.--In the majority of cases, in ordinarily healthy persons, this disease runs its course without doing any great amount of damage to the organ of hearing, and without involving any structure lying outside of the middle ear proper. In scarlet fever, measles, la grippe, or nasal diphtheria, actual destruction of tissue often takes place in some part of the middle ear before it is recognized. Sometimes it results the same way even when it is discovered in time.

Caution.--A person who has had this disease should be very careful not to take cold. The patient should take plenty of time to get well and strong. The diet should be liquid mostly.

[EYE AND EAR 365]

CHRONIC SUPPURATIVE INFLAMMATION OF THE MIDDLE EAR.--An inflammation that forms pus; hence called suppurative. This is an inflammation that has become chronic (continued) and has one characteristic at least that is very noticeable, and that is the discharge. This may last for an indefinite period. The acute suppurative (pus-forming) inflammation just described in the foregoing pages, may have inflicted various kinds and degrees of damage upon the mucous membrane which lines the cavities, and as a result of the conditions thus established there will be a discharge which may last an indefinite time.

Causes.--Improper or lack of treatment for the acute suppurative inflammatory attack. This is the chief cause. The first attack may have been caused by scarlet fever, measles, etc. They are prone to become chronic, especially if not recognized early and treated properly.

Symptoms.--The main symptom is the discharge from the ear. This may be abundant or scanty. It may stop for a time and begin again. The hearing may be slightly or seriously impaired. Such patients are not accepted by life insurance companies.

Treatment.--Cleanliness of the parts and perfect drainage must be secured. Syringing with one to fifty carbolic acid solution (acid one part, warm water fifty parts) is good treatment. The opening in the drum should be made large enough to give free discharge to the pus in the middle ear.

The patient's strength must be built up if necessary.

INFLAMMATION OF THE MASTOID' CELLS. (Acute or Chronic Mastoiditis).--This disease represents one of the most serious terminations of an acute or a chronic suppurative inflammation of the middle ear. This is fortunately a comparatively rare event. There are, however, quite a good many cases of this terrible disease.

Causes.--It occurs as a primary or secondary disease. The first condition is rare and the result from injury, exposure to cold and dampness, or from syphilis or tuberculosis. Secondary disease is catarrhal or pus-like in form. This results from an extension of middle ear disease through the antrum, as a rule. The disease may develop at any time and endanger the life of the sufferer.

Symptoms.--Dull constant pain behind the ear and tenderness on pressure, more severe at night, the tenderness is very apt to be followed in a short time by redness and swelling of the skin in the same region. The pus may drain from the mastoid into the middle ear cavity. If this does not happen it may swell behind the ear and break through some other place. It may involve the structures within the brain. If meningitis develops, the patient has headache and later it becomes very severe. Lights hurts the eyes, The patient is restless, sleepless, may have nausea and vomiting and a constant high temperature. The neck is stiff and rigid. If there is more brain involvement (phlebitis) there will be sudden rise of temperature, followed by a rapid fall of temperature and attended by profuse sweating and chills,--a dangerous condition. There can be abscess of the brain also. In abscess of the brain symptoms are less severe and localized; the rigid neck and fear of light and vomiting are absent.

[366 MOTHERS' REMEDIES ]

Treatment.--If seen early it may be aborted. If an examination of the drum shows bulging, an incision of the drum head should be made. If an opening is there it should be enlarged, if necessary. Cold applications are valuable and should be applied directly over the mastoid behind the ear. Sometimes hot applications are better, hot poultices, cloths, etc., syringing the canal with hot water. These applications, etc., should be constantly used for a day or, so, unless unfavorable symptoms set in, when if a marked improvement, especially in the local tenderness and pain, has not occurred, an operation should be done and the mastoid opened.

The diet should be liquid (milk), nourishing and sustaining. Bowels should be kept open.

This disease must be carefully watched. It is not only dangerous to life, and very quickly, but it is full of disagreeable and dangerous possibilities, lifelong discharge from the ear, an external fistulous opening, a permanent paralysis of the facial nerve, abscess in the brain. Brain symptoms, paralysis and pus symptoms do not now preclude an operation on the mastoid for mastoid disease. The patient should be closely watched and an operation performed as soon as called for.

I have given a longer description of the diseases of the ear than I intended when I began this part of the work. Diseases of the ear are becoming quite frequent, and the subject is important. I did not give much general medical treatment because I consider the local treatment is of more importance in a work of this kind. In treating the baby, I shall give more medical treatment. I shall treat the disease also, especially in relation to the baby. There can be more local applications used than those given. If the hot treatment is thought best, not only hot water and poultices of many kinds can be used, but fomentations of hops, etc., and hot water cloths alone. The intent of such treatment is to keep hot moist applications to the part continually. The use of laudanum in poultices used for ear trouble is not recommended because its soothing power may obscure symptoms that might appear and be dangerous in themselves and need quick and thorough treatment. The syringing of hot water into the external canal is often of great help. Five to ten grains of boric acid can be used in an ounce of water. If there is much odor to the discharge, you can use one part of carbolic acid to fifty parts of boiled water. The water should not be used too hot. One teaspoonful of the acid to fifty teaspoonfuls of water, or that proportion. After using the hot water, the canal should be filled with gauze for protection and drainage. For the fever, the first twenty-four hours, one-tenth to one drop of aconite can be used every one to three hours. By putting one drop in ten teaspoonfuls of water you get one-tenth of a drop at a dose.

[EYE AND EAR 367]

DEAFNESS.--This is usually the result of a disease and is merely a symptom. Diseases of the middle ear, rupture of the drum membrane, and large ulceration of this membrane cause it. Ear wax causes temporary deafness. Diseases of the throat and nose cause it very often, and deafness frequently accompanies catarrh of the nose. Adenoids cause it sometimes, especially in children.

Treatment.--The only way to prevent this trouble is to treat the disease that causes it. Discharge from the ear, due to ear disease should be treated from the first or it may cause permanent deafness in that ear. Many cases of scarlet fever leave deafness behind in one ear at least. This trouble should be closely watched during an attack of scarlet fever, and in other infectious diseases and proper treatment given.

Chronic deafness is hard to cure; so often some of the deeper parts of the ear are diseased. When a person recognizes that his hearing is growing less acute he should have his ear examined. People often let the trouble go too long before beginning treatment.

MOTHERS' REMEDIES. Deafness. 1. Quick and Effective Remedy for.--"Five or ten drops of onion juice put in the ear several times a day is very good. If there is any pain in the ear, add a drop or two of laudanum, or you may just use two or three drops of glycerin with the other ingredients. In about an hour after treating the ear in this manner, syringe it well with warm castile soap suds or warm milk."

2. Deafness. Often Tried Remedy for.--"Take one dram each of tincture of lobelia, tincture of gum myrrh, oil of sassafras, tincture of opium and olive oil, mix and apply lint wet with the liniment in the ear, night, and morning, then syringe out with warm water and castile soap."

3. Deafness, My Mother, in Galt, Found Mullein Good for.--"Small blossoms of mullein, fill bottles and cork, hang in sun till oil forms, drop three drops every third day in the ear for three or four weeks. We tried this successfully in our family."

EARACHE.--The general belief exists that earache is something which is quite harmless and entirely different from a genuine inflammation of the ear. This belief is strengthened by the fact that the great majority of earaches subside without inflicting any harm upon the ear. As soon as a discharge appears, in many cases, there is relief. If a discharge appears, the earache was the result of an inflammation in the ear. So-called earache lasts but a short time, and can be relieved by either hot or cold applications; but when the earache continues for a day or more it is an indication of more than pain in the ear and if a thorough examination is made there will, no doubt, be found disease of the ear that is causing the earache. Then the disease proper should be treated.

[368 MOTHERS' REMEDIES]

Treatment.--Hot or cold applications are of benefit. With the patient lying upon the well ear, fill the canal with hot water (105 degrees F.). Then place over the ear a flaxseed poultice or a roasted onion poultice, four to five inches square and one-half inch thick and spread over all a folded shawl. Bread and milk makes a good poultice also. A hot bran bag or a hot salt bag is good. The heat must be continuous.

MOTHERS' REMEDIES. 1. Earache, Hot Raisin for.--"Hot raisins sometimes relieve earache. Soak them in hot milk and change frequently." This is an excellent remedy. The raisins should be placed in the ear canal, and they are sure to give relief.

2. Earache, Flax and Cornmeal for.--"Flaxseed and cornmeal in oil." Take equal parts of flaxseed and cornmeal and mix together, then add enough sweet oil to moisten this mixture. This should be applied hot and kept so by repeating as each poultice is cold. This will be found very beneficial.

3. Earache, Soothing Home Remedy for.--"Glycerin and laudanum heated and dropped in the ear. Hot poultice of hops inclosed in cotton bag and applied to the ear is very soothing." The glycerin and laudanum will give temporary relief and the hops poultice retains the heat, which is one of the essential things in earache.

4. Earache, Horse-radish Leaves for.--"Steaming the face and ear with crushed horseradish leaves will give relief and soothes one to sleep." When through steaming the face the horseradish leaves should be applied to the face and ear as a poultice. This is very soothing.

5. Earache, Onion Sure Cure for.--"The heart of an onion." Roast the heart of an onion and put in the canal of the ear. Then apply heat to the outside of the ear and relief will soon be obtained.

6. Earache; Temporary Relief for.--

"Gum Camphor 1/2 dram Olive Oil 1/2 ounce Glycerin 1/2 ounce

Mix and drop in ear."

This is good to relieve, but should not be continued, as this oily substance lodges in the ear and may cause trouble.

7. Earache, Sweet Oil and Pepper for.--"Take a piece of cotton batting, cover with sweet oil, then cover that with black pepper, inserting into ear." This is a good remedy.

8. Earache, Steaming With Hot Water for.--"Steam the ear and side of the head with cloths wrung out of hot water; put feet in hot mustard water; do not put anything in the ear but keep steaming it and you will find relief in a few hours, even if it is a gathering."

[Illustraion: SKELETON.]

[DEFORMITIES 369]

9. Earache, Castor Oil for.--"Put a drop of castor oil in the ear. Fill hot water bag and warm the ear that aches."

10. Earache, Fresh Warm Milk for.--"The warm milk from a cow will cure earache and has also been known to cure deafness." While still warm from the cow drop a little in the ear.

DEFORMITIES.

HARE-LIP.--This is due to the fact that the flesh or bony parts do not quite properly unite. It may form a single or double hare-lip, or complicated, or it may involve the soft parts, or the hard (bony) and soft parts at the same time. It is always to one or the other side of the middle line. It is double hair-lip in about one-tenth of the cases, and when double it is frequently complicated with cleft palate.

Symptoms.--Upon examination you notice that there is a split in the lip, either partly through the lip or entirely, so that the bone is exposed; or the slit goes not only through the lip, but also through the bone.

Operation.--This is necessary, and it is quite successful. The best time is between the third and sixth month, especially when it is a simple case. In some cases of double hair-lip, when the child cannot take the breast and has to be fed, early operation should be done if the child is strong. The operation for a simple hare-lip is very easily and quickly done. For complicated cases it takes longer, and of course is not without some danger. It should be done, for a child is a pitiable sight with this deformity. When grown up it is a source of great annoyance and shame.

CLEFT PALATE.--The bones that form the hard palate do not unite in the median line and a longitudinal opening is left in the roof of the mouth. This is called Cleft Palate.

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