Chapter X: Preface: iii (9)

CHRONIC BRIGHT'S DISEASE. (Chronic Parenchymatous Nephritis. Chronic Diffuse Desquamative or Tubal Nephritis. Chronic Diffuse Nephritis with Exudation). Causes.--Young adult life and most common in males. It may come from acute inflammation of the kidneys that was due to exposure, pregnancy, or scarlet fever, or follow excessive use of alcohol, etc. In children it usually follows acute inflammation of the kidneys or scarlet fever.

Condition.--The kidneys may be enlarged, with thin capsule, white surface, cortex thickened and yellowish, or whitish (large white kidney). The epithelium of the tubules is granular, or fatty or the tubules are distended and contain casts. Cells of the "Glomeruli" and their capsules are swollen. There is moderate increase of interstitial tissue. In other cases, the "small white kidney," the kidney is small and pale either at first or as a later stage of the large white kidney. The surface is pale, rough and granular; the capsule is thickened and partially adherent; the surface is thin with white and yellowish areas of fatty degenerations. The interstitial tissue is much increased; epithelial degeneration in the tubules extensive. There is also the large red kidney, and with any of these types the left heart may be enlarged and the arteries thickened.

Symptoms.--If it occurs after acute nephritis the symptoms of acute nephritis subside, but anemia and the changes in the urine persist. Usually there is a gradual onset with paleness and puffiness of the eyelids, ankles or hands in the morning. Later there is difficult breathing, increased watery swelling of the face, extremities and dependent portions of the body; worse in the morning. There is a pasty yellowish pallor, afterwards dropsy of the abdominal and chest cavities. The urine is diminished, high colored, specific gravity usually 1020 to 1025 with much albumin. Many casts which are named hyaline, granular, epithelial and fatty. The action of the heart is bad. There may be trouble with the stomach and bowels, constipated, etc. The digestion is poor and the patient frequently suffers with much gas. Recovery is rare after it has lasted one year.

Treatment. Diet.--Milk or buttermilk should be the main article of food. You can give gruels made of arrowroot or oatmeal, barley water, beef tea, and chicken broth, but it is better to keep strictly to milk. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges and other fruits may be given. The return to the meat diet should be gradual. The patient should drink freely of mineral water, ordinary water, or lemonade. These keep the kidneys flushed and wash out the "debris" from the tubes. One dram (teaspoonful) of cream of tartar in a pint of boiling water, add the juice of a half a lemon and a little sugar. This when taken cold is a pleasant, satisfactory drink. Medical treatment is not satisfactory. The only thing to do is to give medicines to meet the indications; fifteen to twenty grain doses of lactate of strontium. Diuretin also is used. Basham's mixture for anemia is of help in some cases. It can be bought at any drug store.

[KIDNEY AND BLADDER 159]

CHRONIC INTERSTITIAL NEPHRITIS. (Sclerosis or Cirrhosis of the Kidneys. Granular, Contracted or Gouty Kidney).--This is met with, (a) as a sequence of the large white kidneys forming the so-called pale granular or secondary contracted kidney; (b) as an independent primary affection; as a sequence of arterio-sclerosis.

Causes.--The primary form is chronic from the onset, and is a slow creeping degeneration of the kidney substance, and in many respects an anticipation of the gradual changes which take place in the organ in extreme old age. Families in which the arteries tend to degenerate early are more prone to this disease. Doctor Osler says: "Among the better classes in this country Bright's disease is very common and is caused more frequently by over-eating than by excesses in alcohol."

Arterio-Sclerotic Form.--This is the most common form in this country, and is secondary to arterio-sclerosis. The kidneys are not much, if at all, contracted; very hard, red and show patches of surface atrophy. It is seen in men over forty who have worked hard, eaten freely, and taken alcohol to excess. They are conspicuous victims of the "strenuous life," the incessant tension of which is felt first in the arteries. After forty, in men of this class, nothing is more salutary than to experience the shock brought on by the knowledge of albumin and cast tubes in the urine.

Symptoms.--Perhaps a majority of the cases are latent (hidden) and are not recognized until the occurrence of one of the serious and fatal complications. There may have been no symptoms to suggest to the patient the existence of a dangerous malady. In other cases the general health is disturbed. The patient is tired, sleepless; he must get up two or three times at night to pass urine; the digestion is disordered, the tongue is coated; the patient complains of a headache, failing sight, and gets out of breath by exercising. There may be vomiting, headache, neuralgia, and increase of the quantity of urine is common. This is light in color, of low specific gravity, 1005 to 1012; frequently there is a trace of albumin and a few casts of the hyaline and granular kind. In the late stages the albumin may be increased with high specific gravity and a less quantity of urine. The disease often lasts for a year.

In the arterio-sclerotic variety the urine may be normal or diminished in quantity, specific gravity normal or increased, the casts are more numerous, and the albumin is usually more abundant. There is an enlargement of the heart; the pulse is increased in tension; the wall of the artery is thickened. The skin is usually dry, with eczema common, but dropsy is rare, except when it is due to heart failure. There may be bronchial and lung troubles; attacks of uraemia, or hard breathing caused by the heart, frequently occurs. There may be hemorrhage of the brain or hemorrhage of the membranes, and these are often fatal.

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Recovery.--Chances are unfavorable, but life may be prolonged for years, especially with care and especially if it is discovered early.

Treatment.--A quiet life without mental worry, with gentle but not excessive exercise, and residence in a climate that is not changeable should be recommended. A business man must give up his worry; his rush; his hurried eating, and rest. The bowels should be kept regular; there should be a tepid water bath daily, and the kidneys should be kept acting freely by drinking daily a definite amount of either distilled water or some pleasant mineral water. Alcohol, tobacco, excessive eating and improper food must not be allowed. Weak tea and coffee may be allowed. The diet should be light and nourishing. Meat should not be taken more than once a day. If it is possible, the patient should be urged to move to a warm equable climate during the winter months, from November to April, like that of southern California. Medicines must be given to meet the indications. No special directions can be given. The heart, stomach, and bowels must be watched.

DIET as Allowed by a Prominent Hospital.--

May Take:--

Soups.--Broths with rice or barley, vegetable or fish soup.

Fish.--Boiled or broiled fresh fish, raw oysters, raw clams.

Meats.--Chicken, game, fat bacon, fat ham (sparingly).

Farinaceous.--Hominy, oatmeal, wheaten grits, rice, stale bread, whole wheat bread, toast, milk toast, biscuits, maccaroni.

Vegetables.--Cabbage, spinach, celery, water-cresses, lettuce, mushrooms, mashed potatoes, cauliflower, onions.

Desserts.--Rice and milk puddings, stewed fruits, raw ripe fruits.

Must Not Take:--

Fried fish, pork, corned beef, veal, heavy bread, hashes, stews, battercakes, lamb, beef, mutton, gravies, peas, beans, pastry, ice cream, cakes, coffee, tobacco, malt or spirituous liquors.

[KIDNEY AND BLADDER 161]

PYELITIS.--This is an inflammation of the pelvis of the kidney and may be caused by bacteria from the blood, or by ascending pus, infection or tuberculous infection from the lower tracts like the ureter, bladder and urethra.

Symptoms.--There is pain in the back, with tenderness and pressure, cloudy-looking urine, either acid or alkaline, containing pus, mucus, and sometimes red blood cells; chills, high fever, and sweating occur. This may become chronic and then it becomes quite serious. Anemia and emaciation are then marked. Mild cases usually recover; pus cases may end in other diseases or death from exhaustion.

Treatment. Diet.--In mild cases fluids should be taken freely, particularly the alkaline mineral water to which citrate of potash can be added. Tonics should be given when called for, and milk diet and buttermilk may be taken freely. When a tumor has formed, and even before, it is perceptible, if the symptoms are serious and severe, an operation may be necessary.

KIDNEY STONE. (Renal Calculus. Nephro-Leithiasis).--Forming of a stone or gravel in the kidney or its pelvis may occur in intra uterine, (before the child is born), in the womb, or at any age. A family tendency, sedentary life, excesses in eating and drinking and very acid urine predispose. They vary in size from that of fine sand to that of a bean.

Symptoms.--Patients may pass gravel for years without having an attack of renal (kidney) colic, and a stone may never lodge in the ureter. A person may pass an enormous number of calculi. Dr. Osler speaks of having had a patient who had passed several hundred kidney stones (calculi) with repeated attacks of kidney colic. His collection filled an ounce bottle. A patient may pass a single stone and may never be troubled again. A stone remaining in the kidney may cause dull aching pain in the affected kidney, or the pain may be referred to the other side and sometimes there may be blood or pus in the urine, with chill and fever due to pyelitis. Kidney (renal) colic comes on when a stone enters the ureter, if it is at all large. At attack may set in abruptly, without any apparent reason, or it may follow a strain in lifting. The pain may be agonizing in character, which starts in the flank of the affected side, passes down along the course of the ureter and is felt in the testicle and along the inner side of the thighs. The testicle is drawn back. The pain may also go through the abdomen and chest, and be very severe in the back. In severe attacks nausea and vomiting are present and the patient is collapsed; sweating breaks out in his face and the pulse is feeble and weak. The pain lasts from an hour to several days, until the stone reaches the bladder, partial suppression of the urine during the attack occurs, but a large quantity of urine is usually passed after it and a feeling of soreness may, be present for several days. The stone may again cause pain in passing through the urethra, or it may remain in the bladder as a nucleus for a bladder calculus (stone). Dr. Osler gives Montaigne's description as follows; "Thou art seen to sweat with pain, to look pale and red, to tremble, to vomit well nigh to blood, to suffer strange contortions and convulsions, by starts to let tears drop from thine eyes, to urine thick, black and frightful water, or to have it suppressed by some sharp and craggy stone that cruelly pricks and tears thee."

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Treatment.--Great relief is experienced in the attacks by the hot baths or fomentations which sometimes are able to cause the spasm to relax. If the pain is very severe morphine should be given by the hypodermic method and inhalations of chloroform given until morphine has had time to act. Local applications are sometimes grateful,--hot poultices or cloths wrung out of hot water may be helpful. Cloths wrung out of steaming hop, wormwood, or smartweed teas, are of benefit sometimes. Change of position often gives relief; when the stone is large an operation may be needed. The patient should drink freely of hot lemonade, soda water, barley water. When the patient is free from the attack, he should live a quiet life and avoid sudden exertion of all kinds. There should be a free passage of urine always. The patient should drink daily a large but definite quantity of mineral, or distilled water which is just as satisfactory. You may take the citrate or bicarbonate of potash. Mineral springs are good to visit, such as Saratoga, Hot Springs, Arkansas, etc. Abstain from alcohol and eat moderately. Live an open-air life with plenty of exercise and regular hours. The skin should be kept active; a cold friction bath in the morning is good, if one is strong; but if he is weak and debilitated the evening warm bath should be substituted. The patient should dress warmly, avoid rapid alterations in temperature, and be careful not to allow the skin to become suddenly chilled.

Diet.--Most persons over forty eat too much. One should take plenty of time to eat, and not too much meat should be eaten.

"Queen of the Meadow."--The Indians used this medicine quite frequently in the treatment of kidney and bladder troubles. A lady, whom I know well, told me that she had a cousin who was affected with the kidney stone colic. At one time, when he was suffering from an attack, an Indian happened in their home and saw him suffering. He went into the meadow and dug some of this remedy and made a tea of it. It seemed to do the work, for while he gave it, the pain was eased and he never had any more attacks. I give this for what it is worth. The remedy will certainly do no harm for it is a good diuretic.

INFLAMMATION OF THE BLADDER. (Cystitis). Causes.--It may occur from injury from passing a catheter, etc., from the use of drugs like cantharides, from the presence of a stone, from stricture of the urethra and from gonorrhea or cold.

Symptoms.--The urine is passed more frequently, sometimes the desire to pass the urine is almost constant. The distress is relieved for only a few minutes by passing the urine; sometimes only a few drops are passed, and it gives no relief from the desire for passing urine. The straining is extremely severe. Sometimes the patient will lean over the vessel quivering with the muscular effort to pass urine. The bowels often move at the same time from the straining. The urine becomes thick with much mucus, then scanty, and then tinged with blood.

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BLADDER TROUBLE. Mothers' Remedies. 1. English Oil of Sandal Wood for.--"Get one ounce of the pure English oil of sandal wood, take four drops three times a day in a little water. As you urinate more freely reduce the dose. This is a splendid remedy."

2. Bladder Trouble, Effective Herb Teas for.--"Make a tea of half ounce of buchu leaves, half ounce of uva ursi leaves (barberry leaves), one pint of boiling water. Dose: Two or three tablespoonfuls three times a day, or may drink quite freely." A tea made of cornsilk is a common and standard remedy.

Treatment.--Remove cause if possible. Fomentations of hops, smartweed, wormwood are good, even hot water over the bladder. Hot hip bath is good, and also the warm foot bath. The bowels should be kept open with saline laxatives. Buchu tea is very good. Use about one-half ounce of the leaves to a pint of warm water and let it steep, not boil. Drink freely of this. Pumpkin seed tea or watermelon seed tea is good, also flaxseed tea. Dr. Hare recommends the following at the beginning if there is fever:

Tincture of Aconite 3 drams
Sweet Spirits of Nitre 1 ounce
Solution of Citrate of Potash enough to make 6 ounces

Mix.

Give a dessertspoonful every four hours until all fever ceases and the pulse is quiet. The patient should be kept quiet.

Diet.--Should be milk only.

CHRONIC INFLAMMATION OF THE BLADDER.--Causes.--It follows repeated attacks; partial retention of urine in the bladder, decomposing there; Bright's disease, inflammation of the urethra, injury, etc.

Treatment.--Wash out the bladder with pure warm water or water containing about one to two teaspoonfuls of boric acid to the pint of warm water. This should be given once or twice a day; or enough permanganate of potash can be put into the water to give the water a tinge of the color. An injection of golden seal, one teaspoonful to the pint of warm water, is good if there is much mucus. The best way to give the irrigation is to attach a small funnel to a soft rubber catheter and fill the bladder by raising the funnel when full of water above the patient's belly; or you can attach the rubber tube of a fountain syringe to a catheter at one end and to a funnel at the other and raise the funnel to the desired height; or you can attach a catheter to the rubber tube of a fountain syringe (clean one) and raise syringe high enough to allow the water to run into the bladder gently. The patient will stand just about so much water. The rubber can then be detached from the catheter and the water allowed to run out.

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DISEASE OF THE PROSTATE GLAND. The prostate, which both in structure and in function is rather a muscle than a gland, is situated at the neck of the bladder and around the first inch of the urethra. It is divided into two lateral (side) lobes (parts) by a deep notch behind and a furrow at the upper and lower surfaces. The so-called middle or third lobe is the portion which is between the two side lobes at the under and posterior part of the gland, just beneath the neck of the bladder. The urethra (the channel for the urine to pass through from the bladder out through the penis) usually passes through the gland at about the junction of its upper and middle third.

HYPERTROPHY OF THE PROSTATE.--This is a general enlargement of the gland in all directions. All the three lobes may enlarge and in about one-third of the men who have passed middle life some enlargement takes place, and in about one-tenth of all men over fifty-five this enlargement becomes of importance in regard to the size. The middle lobe may enlarge so much that it may extend up into the bladder and block the opening into the urethra; the side lobes may compress the urethra into a mere slit, or may lengthen it so that the prostatic portion measures three or four inches, or may twist and distort it so that the most flexible instrument can only be made to pass through it with difficulty.

Symptoms.--The earliest symptom may be increased frequency in passing urine, especially at night. Soon some urine is retained in the bladder, and this may increase so much that only an ounce or two can be passed spontaneously, although the bladder contains one pint or more. The stream of urine is feeble, and will drop perpendicularly towards the feet of the patient. In some cases an inflammation of the prostate and bladder is set up, and then the symptoms felt are very distressing. There is an almost constant desire to pass urine; there is much pain and straining with it; a slight bleeding may follow and night rest is broken; the general strength fails from the continual suffering; the urine becomes foul, smells like ammonia, and is reduced in quantity; inflammation of the kidneys develops also; general poisoning occurs; and the patient dies of uraemia and in a "coma" condition.

Treatment. Preventive.--The patient should avoid taking cold in this disease. Light and easily digested diet is necessary. The bowels must be kept regular. Alcohol of any kind should not be used. The bladder should be emptied at regular intervals. Some patients keep a catheter and "draw" their own urine. Unless the patient takes great care, the bladder and urethra will be irritated and perhaps infected through neglect of cleanliness. Medicines are not very useful in severe cases. Operation is the only reliable cure especially when some urine is always retained.

URINARY PASSAGE. Mother's Remedy.--1. Dandelion Root Will Clean.--"A decoction made of the sliced root of dandelion in white wine is very effectual for cleansing and healing inward ulcers in the urinary passage. If the fresh root cannot be obtained, buy extract of dandelion and give two teaspoonfuls in water once in two or three hours as the case requires. It also acts on the liver, gall and spleen."

[KIDNEY AND BLADDER 165]

DROPSY.--Dropsy should be regarded as a symptom, which may arise from many causes, such as heart disease, lung disease or kidney disease, or it may depend upon obstruction to the normal flow of blood and lymph through the vessels and tissues.

From Heart Disease.--In heart disease dropsy is due to a weak heart. The heart is unable to supply the arteries with enough blood to maintain the normal pressure, or to damming up of blood in the venous system as the result of imperfect emptying of the heart cavities. In kidney trouble the dropsy depends more on the lack of proper nourishing processes in the capillary walls and upon changes in the blood and blood pressure. If the kidneys are diseased, they may not be able to eliminate the proper amount of liquids which accumulate and finally escape into the tissues. Liver troubles cause dropsy by producing pressure upon the large blood-vessels going to the liver, and consequently the fluid is generally confined to the lower limbs and abdomen.

MOTHERS' REMEDIES. Dropsy, 1. Juniper Berries Fresh or Dry for.--"The berries of the juniper tree are regarded as excellent home remedies in dropsy. They may be eaten fresh or dry, or make a decoction and drink. Two teaspoonfuls of the berries two or three times a day is considered a dose. It is well to bruise them thoroughly by breaking the seeds with a hammer before taking." The decoction is more effective. This helps the dropsy by acting on the kidneys.

2. Dropsy, Wild Milkweed for.--"Steep the root of the wild milkweek and drink the tea in doses of a wineglass three times a day. This is a sure cure if taken in early stages."

3. Dropsy, White Bay Buds for.--"White bay buds steeped in water." The white bay buds can be secured at any drug store, and are easily prepared. Make a tea of these the same as you would make green tea for the table, only stronger. Take several times a day. This is an excellent remedy.

4. Dropsy, Canada Thistle for.--"Steep dwarf elder root, or Canada thistle root, and drink the tea." This is an old tried remedy that our grandmothers used to use, and can be depended upon. We all know that in olden times mothers had to use these herb remedies, as doctors could not be secured as easily as they can in these days.

5. Dropsy, Very Effective Remedy for.--"Make a decoction of fresh dandelion root slices, one ounce to one pint of water boiled down to one-half pint, strain, adding two drams of cream of tartar. Dose: A wine glassful two or three times a day."

6. Dropsy, Common Herb Remedy for.--"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 bakers' yeast and one cup of 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 in Kalkaska, Michigan."

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7. Dropsy, "Queen of the Meadow" for.--"Is a symptom of morbid conditions existing in the system, therefore nutritious diet, alkaline baths and a general hygienic regulation of the daily habits are of the greatest importance. Take one teaspoonful of powder of "Queen of the Meadow" in a cupful of water three or four times a day as the case may require. Either use tea or powder."

PHYSICIANS' TREATMENT for Dropsy.--Treat the disease that causes it. Remedies should be given that will cause an outpouring of the liquids. Salines, such as epsom salts in large doses. Cream of tartar and epsom salts (equal parts) taken freely is effective. If the kidneys are inactive owing to heart trouble, the following may be used: An infusion of digitalis in one to four teaspoonful doses every three to four hours. This pill is good.

Powdered Digitalis 20 grains
Powdered Squills 20 grains

Mix into twenty pills and take one every five hours.

INFECTIOUS DISEASES.

INFECTION AND CONTAGION.--These words are often used in such a way that a wrong impression is made. A disease may be infectious but not contagious. Malaria is an instance. Infection means an ability to enter the body from any source, wind, water, food or other persons and produce a characteristic disease. The agency doing this is known as a germ. Contagion is properly a poisoning of one individual from contact with a diseased individual in some way known or unknown. It may be conveyed indirectly through clothes, etc., or other person; but always comes from some person sick with the same disease. Diseases may be both infectious and contagious. Nearly all the epidemic diseases of infancy are both infectious and contagious and accompanied by fever. In nursing children, suffering from infectious diseases the mother or nurse should avoid their breath and handle them as little as possible. All secretion from bowels and kidneys should fall in a vessel containing a disinfecting solution of Copperas, bichloride of mercury, etc., and should be emptied into the sewer or buried. Following are the solutions as made. Copperas:--Put a lump as big as a walnut in the chamber with one-half pint of water, to receive feces, urine, sputum and vomited matter from infectious and contagious patients.

2. Solution of chlorinated soda, four fluid ounces; water ten ounces, useful for hands and dishes, not silverware. Dissolve eight corrosive sublimate tablets, also called bichloride, in a gallon of water. This is used to disinfect floors, woodwork, rubber, and leather, but not metal parts. Great care must be taken to have the hands washed after handling such a patient, so as not to infect the food, eyes, mouth, or any small skin sores.

[INFECTIOUS DISEASES 167]

Diet in Infectious Diseases.--Foods that can be used: Milk, milk-water, milk and lime-water, Mellin's food, malted milk, imperial granum, albumin water, rice water, oatmeal water, barley water, egg (white part), and barley water, arrowroot water, whey, whey and cream mixture, cream and rice mixture, beef tea, beef extract, mutton broth, beef juice. Chewing broiled steak and only swallowing the juice, dry toast and soft boiled eggs, milk toast, dried beef broth, soups, rice, cornstarch, tapioca, etc. The diet must not consist of solid food in any severe case of fever. Small quantities of cold drinks can be given, frequently repeated if there is no vomiting. Frequent washing with tepid water or cool water lessens the fever and produces sleep. The bowels should be kept open at least once a day, and castor oil or salts usually can be given. (See Nursing and Dietetics department.)

Table of Infectious Diseases. Date of characteristic Whole Incubation lasts symptom. duration. Mumps 7 to 20 days 1st day 7 days or less Whooping Cough 2 to 7 days 7 to 14 days 2 months Diphtheria 1 to 12 days 1 to 2 days 1 week to 1 month Erysipelas 2 to 8 days 1 to 2 days 1 week to 3 weeks Varioloid 10 to 13 days 1 day 1 week to 3 weeks Chicken Pox 12 to 17 days 1 day 4 to 7 days German Measles 1 to 3 weeks 1 day 3 to 4 days Measles 12 to 14 days 4 days 7 to 9 days Scarlet Fever 1 to 7 days 1 to 2 days 7 to 12 days Typhoid Fever 1 to 14 days 7 to 8 days 3 to 5 weeks Smallpox 10 to 14 days 3 to 4 days 2 to 4 weeks

SCARLET FEVER. Definition.--Scarlet fever is an acute infectious disease, with a characteristic eruption.

Modes of Conveying.--The nearer a person is to a patient the more likely one is to take or convey the disease. Clothing, bedding, etc., may retain the poison for months. Scales from the skin of a patient, dried secretions, the urine if inflammation of the kidneys (nephritis) exists, the discharges (feces) from the bowels, are all means of infection. The longer a person remains near the patient the more likely he is to convey the disease. Foods handled by those sick of the disease, or by those who may have been near patients may convey the disease. This is especially true of milk. Epidemics of scarlet fever have been started by dairy-men who had scarlet fever in their family. I once attended a family where the only known cause for it in that family was a long-haired dog of a neighbor who had scarlet fever in the family. The dog was in the room with the sick ones, and visited the neighbor's family and played with the children who afterwards came down with the fever. Discharges from the ear, caused by scarlet fever, are said to be capable of giving it.

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Remains in the Room, how long?--It may remain for months in a room, and extend over two years as recorded by Murchison. We do not yet know how the poison obtains entrance to the body. Hence, the need for thorough disinfection.

Age, Occurrence, Susceptibility.--All children exposed to the disease do not contract the disease. It is less contagious than measles. A person who is exposed once, and does not take it, may take it at a future exposure. It occurs at any age and in all countries. It occurs oftener in autumn (September) and winter (February). Isolated cases occur, and then it is called sporadic. This disease attacks nursing children less frequently than older children. It is not often seen during the first year of life.

How Often?--As a rule, it attacks a person only once; yet there are recorded cases of well observed second and third attacks, but fortunately these are very rare. I once attended a family where they had it and claimed to have had it before, but very lightly.

Incubation.--The vast majority of cases develop within three to five days after exposure. If eleven days elapse without the appearance of symptoms we may reasonably expect that the danger is past, at least in the great majority of cases exposed.

Contagiousness.--There is danger of catching the disease during the stages of incubation, eruption and scaling. It is most contagious in the last two stages.

Onset.--Sometimes the onset is sudden; there may be a convulsion, preceded by a sharp rise in the temperature. An examination in such cases may reveal a marked sore throat or a membranous deposit on the tonsils preceding the eruption, and nothing more. A chill followed by fever and vomiting ushers in a large number of cases. These may be mild or severe. The severity of these symptoms usually indicates the gravity of the attack.

Rash.--The rash or eruption appears from twelve to thirty-six hours after the onset, usually on the second day, and looks like a very severe heat rash, but is finer and thicker. It consists of a very finely pointed rose-colored rash. In mild cases it is hardly noticeable. Usually it first appears on the upper part of the chest around the collar bones, spreads over the chest and around upon the back. Also it is now seen on the neck, beneath the jaw, behind the ears and on the temples, thence spreads over the body. There is a paleness about the mouth and wings of the nose, while the cheeks are flushed with a flame-like redness. There is much itching if the rash is severe. It attains the full development at the end of two or three days, and then gradually declines. In some cases the rash is seen only twenty-four hours.

Fever.--The fever rises rapidly in the first few hours to 104 or 105-8/10 degrees. It remains high except in the morning, until the eruption reaches its full development and falls with the fading eruption, and in uncomplicated and typical cases, within six days becomes normal.

[INFECTIOUS DISEASES 169]

Sore Throat.--This we find on the pillars of the fauces, uvula, tonsils, and pharynx, reddened and inflamed. Sometimes it is very severe, and a membrane comes on one or both tonsils and pillars of the fauces. There is, generally a severe sore throat, and this makes swallowing difficult.

Tongue.--The tongue is covered with a coating at the onset, and may present a slightly reddened appearance at the borders and tip. The papillae are prominent and covered and look like a strawberry sometimes, or like the tongue of a cat. In fatal poisonous cases it becomes dry and cracked.

Scaling.--As the disease subsides the outer layer of the skin dries and peels off. The extent of this depends upon the severity of the attack. In some cases the scaling is hardly perceptible, and sometimes it appears only on certain parts, such as on the toes and inner parts of the thighs. There is always some scaling. This is called "desquamation." Generally speaking, scaling begins where the eruption first appeared on the upper part of the chest and neck. The scales may be fine and branny or as is most common, the skin peels in large particles. Some scaling is always present. The length of the scaling time is variable. It usually lasts from three to four weeks, but often longer. This stage is considered by many as the most contagious, as the fine scales fly in the air.

Complications. Nose.--The nose is affected at the same time if the "sore throat" is very severe. A membrane may also form in the nose.

Ear.--This may be affected in as high as one-fifth of the cases and needs careful watching and attention. Both ears may be diseased and deafness frequently results from it. Ten per cent of those who suffer from "deaf-mutism" can trace their affliction to scarlet fever. The ears usually become afflicted in the third week. The fever rises and there is pain in the ears or ear. The onset may not appear alarming and not be suspected until the discharge makes its appearance This is unfortunate; these complications are serious, as meningitis and abscess of the brain may result. The ear trouble (otitis) usually occurs during the scaling. The patient may be up and around. There is a rise of the temperature to 103 or 104 degrees, the patient begins to vomit food and has a headache. At night the child starts from its crib and cries as if in pain. They do not always locate the pain in the ear. The face and hands may twitch. The fever may fall to normal and rise sharply again. Such symptoms should call for a thorough examination.

Eye.--Inflammation of the (conjunctiva) red membrane of the eyes, often occurs.

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Kidneys.--There may be a mild form of inflammation in the earlier stages. The severe form comes, if at all, usually in the third week. It occurs in five to seven per cent of the cases. It may occur in the mildest case, as such cases are not so closely watched. The first symptom is a slight bloating of the eyes and face and spreads over the whole body. Sometimes the swelling is very slight; at other times it is extreme. The urine diminishes early and sometimes is wholly suppressed. It may be light colored, smoky or straw colored. This trouble usually runs for weeks. The patient may get uremia and result fatally.

Heart.--This also may be affected as the valves may become diseased.

Joints.--Rheumatism also may occur, and other complications.

Chorea.--Follows scarlet fever also, especially in girls from twelve to fifteen years.

Diagnosis.--In most cases it is easy to distinguish from other diseases. Dermatitis, inflammation of the skin ("Itis" always means inflammation). In dermatitis the throat symptoms and strawberry tongue are absent.

From Measles.--By the rapid onset, absence of cold symptoms of the nose, eyes, and bronchial tubes, blotchy eruptions that occur in measles. There is no strawberry tongue in measles and no coughing at beginning.

Recovery.--The prognosis is favorable in uncomplicated cases. It also depends upon the character of the epidemic type of the disease. In England it varies from thirteen to fourteen per cent. In this country it is sometimes as low as two to four per cent. The kidney trouble is always feared for it may result in uremia and death, or the acute may be followed by chronic nephritis or Bright's disease, which will ultimately prove fatal.

Sanitary Care of Room and Patient.--If you are exposed to this disease what can you do? If a child, it must be put in a room by itself. If several children have been exposed they should be put in separate rooms. These rooms should have no carpet, curtains, rugs, etc., or any unnecessary furniture, for everything must be disinfected afterward, and sometimes destroyed. The clothes worn just before the sickness should be sterilized in steam or boiled and then aired in the sun. Anyone suffering from sore throat who has been about the patient should not be allowed to be near the healthy. All the children must be kept from school. It is well for them to spray their throats with a simple cleansing solution morning and night, with a full teaspoonful of boric acid to a glass full of warm water; or you can use common salt, but not strong enough to irritate the throat, about one teaspoonful to a glass of water. If you have listerine or glyco-thymoline or any such disinfectant use them, one teaspoonful to sixteen spoonfuls of water. Hot water itself is a very good gargle, very healing and cleansing. Anyone who enters the sick room and comes out again should wear a sheet all over him. On coming out, he or she should leave this sheet outside the window of another room. If the person has a beard he should wash his face with a 1 to 2000 solution of corrosive sublimate, and the hands also, before leaving the sick room. The one who waits upon the sick one should remain there, but everyone can not do so. They must stay away from the healthy if possible.

[INFECTIOUS DISEASES 171]

City and State Supervision.--If you live in the city your physician should notify the health board who will probably send someone to instruct you regarding cautions and some cities have private rules, laws, etc., for them to follow while under quarantine. A copy is usually furnished also to your close neighbors. Also some of the state departments of health have made up pamphlets which are circulated free on request dealing with the sanitary science of infectious and contagious diseases. Some colleges use these same pamphlets in their study of sanitary science. Much valuable information is contained in them. Comparatively few people learn of these pamphlets. For the benefit of those who have not read or seen them we quote from their scarlet fever subjects as follows:

HOW TO AVOID AND PREVENT SCARLET FEVER.

Do not let a child go near a case of scarlet fever. This is especially important to be observed.

Children are in much greater danger of death from scarlet fever than are adults; but adult persons often get and spread the disease, and sometimes die from it. Mild cases in adults may cause fatal cases among children. Unless your services are needed keep away from the disease yourself. If you do visit a case, bathe yourself and change and disinfect your clothing and hair, beard, if any, and hands before you go where there is a child. Do not permit any person or thing or a dog or cat, or other animal to come from a case of scarlet fever to a child. No cat or dog should be permitted to enter the sick room.

Do not permit a child to wear or handle clothing worn by a person during sickness or convalescence from scarlet fever.

Beware of any person who has sore throat. Do not kiss or come near to such a person. Do not drink from the same cup, blow the same whistle, or put his pen or pencil in your mouth. Whenever a child has sore throat and fever, and especially when this is accompanied by a rash on the body, the child and attendant should immediately be isolated until the physician has seen it and determined whether it has scarlet fever. Strict quarantine should be established and maintained throughout the course of the disease. Exposed persons should be isolated until such time has elapsed as may prove that they are not infected. The period of incubation, that is the interval of time between exposure to the contagion of scarlet fever and the first sign of the disease in the person so exposed, varies. In many cases it appears in seven days, in some cases in fourteen days, and in some cases twenty-one days; the average period is about nine days. Quarantine of persons exposed should not be raised under four weeks.

[172 MOTHERS' REMEDIES]

Children believed to be uninfected may be sent away from the house in which there is scarlet fever to families in which there are no persons liable to the disease, or to previously disinfected convalescent wards in hospitals; but in either case they should be isolated from the public until the expiration of the period of incubation. This time may vary, but for full protection to the public isolation should be observed for four weeks.

Persons who are attending upon children or other persons suffering from scarlet fever, and also the members of the patient's family, should not mingle with other people nor permit the entrance of children into their house.

SANITARY CARE OF INFECTED AND SICK PERSONS AND ROOMS.

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

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

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

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

[INFECTIOUS DISEASES 173]

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

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

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

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

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

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

[174 MOTHERS' REMEDIES]

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

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

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

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

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

Epsom Salts 2 ounces
Cream of Tartar 2 ounces

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

This is the dose for a child one year old.

[INFECTIOUS DISEASES 175]

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

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

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

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

[176 MOTHERS' REMEDIES]

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