Mother's Remedies / Over One Thousand Tried and Tested Remedies from Mothers of the United States and Canada

by Thomas Jefferson Ritter

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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.

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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.

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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.

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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.

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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.

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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."

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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.

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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."

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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.

[INFECTIOUS DISEASES 235]

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.

[INFECTIOUS DISEASES 237]

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.

[INFECTIOUS DISEASES 239]

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.

[INFECTIOUS DISEASES 241]

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.