Part 30

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.

[INFECTIOUS DISEASES 225]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

INFECTIOUS DISEASES 227

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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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.