Part 28

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

3. Tuberculous Pleurisy.

4. Tuberculous Pericarditis.

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

6. Tuberculosis of the Larynx.

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

8. Chronic Ulcerative Pulmonary Tuberculosis.

9. Chronic Miliary Tuberculosis.

10. Tuberculosis of the Alimentary Canal.

11. Tuberculosis of the Brain.

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

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

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

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

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

2. Consumption, Physicians' Remedy for.--

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

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

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

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

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

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