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pulse. Sweating stage lasts two to four hours, and entire body may be covered; fever and other symptoms abate and sleep usually follows. The patient feels nearly well between attacks.

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

[INFECTIOUS DISEASES 229]

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

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

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

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

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

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

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

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

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

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

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

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

Mix.

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

[230 MOTHERS' REMEDIES]

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

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

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

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

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

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

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

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

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

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

[INFECTIOUS DISEASES 231]

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

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

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

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

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

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

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

[232 MOTHERS' REMEDIES]

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

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