Chapter 25

Spasmodic or Second Stage.--The peculiar whoop is now present. The cough is spasmodic. The child has distinct paroxysms of coughing which begin with an inspiration (in-breathing) followed by several expulsive, explosive coughs, after which there is a deep, long-drawn inspiration which is characterized by a loud crowing called the "whoop." This paroxysm may be followed by a number of similar ones. When the paroxysm is coming on the face assumes an anxious expression, and the child runs to the nearest person or to some article of furniture and grasps him or it with both hands. It is so severe sometimes that the child will fall or claw the air, convulsively. In the severest and most dangerous types, a convulsion may come on in a moderate degree, the face is red or livid, the eyes bulge and when the paroxysm ends a quantity of sticky tenacious mucus is spit up. In other cases there is vomiting at the end of the paroxysm. There is frequently nose-bleed. In the intervals the face is pale or bluish, eyelids are puffy and face swollen. There is little bronchitis at this period in the majority of cases. In some cases the number of paroxysms may be few. There are generally quite a number during the twenty-four hours.

Stage of the Decline.--In this stage the number and severity or the paroxysms lessen. They may subside suddenly or gradually after four to twelve weeks. The whoop may reappear at times. The cough may persist, more or less, for weeks after the whoop is entirely gone.

Complications.--Bronchitis is common, it may be mild or severe. It may run into capillary bronchitis and this is dangerous.

Diagnosis.--Continued cough, getting worse and spasmodic, worse at night, livid face when coughing, causes great suspicion as to its being whooping-cough. The whoop will confirm it.

Mortality is quoted as twenty-five per cent during the first year. Between first and fifth year about five per cent, from fifth to tenth year about one per cent. Rickets, or wasting disease (marasmus) and poor hygienic surroundings makes the outlook less favorable.

MOTHERS' REMEDIES. 1. Whooping-Cough, Chestnut Leaves for.--"Steep chestnut leaves, strain, add sugar according to amount of juice and boil down to a syrup; give plenty of this. A friend of mine gave this to her children. She said they recovered rapidly and the cough was not severe." They are not the horse-chestnut leaves.

2. Whooping-Cough, Chestnut Leaves and Cream for.--"Make an infusion of dry chestnut leaves, not too strong, season with cream and sugar, if desired. The leaves can be purchased at a drug store in five cent packages."

3. Whooping-Cough, Mrs. Warren's Remedy for.--

"Powdered Alum 1/2 dram Mucilage Acacia 1 ounce Syrup Squills 1/2 ounce Syrup Simple, q. s 4 ounces

Mix this.

This is one of the best remedies known to use for whooping cough. It has been used for many years, and some of our best doctors use it in their practice. I do not hesitate to recommend it as a splendid remedy."

4. Whooping-Cough, Raspberry Tincture for.--"Take one-half pound honey, one cup water; let these boil, take off scum; pour boiling hot upon one-half ounce lobelia herb and one-half ounce cloves; mix well, then strain and add one gill raspberry vinegar. Take from one teaspoonful to a dessertspoonful four times a day. Pleasant to take."

[INFECTIOUS DISEASES 183]

PHYSICIANS' TREATMENT for Whooping-Cough.--The patient should be isolated and sleep in a large, well ventilated room. In spring and summer weather, the child is better in the open air all day. In the winter the child should be warmly clothed. Pine wood and a fairly high altitude are probably the best. The greatest care should be taken in all seasons to keep from taking cold, or bad bronchitis or pneumonia may result. All complications are serious, especially in nursing children. There should be no appreciable fever, and when the paroxysm of cough is over the child should sleep or play quite well, until the next one returns. So if there is much fever the case needs watching.

Medical Treatment.--Medicines have little effect in controlling the disease. The severity can be lessened. If the child is much disturbed at night, the following is good:

1. Acetanelid 1/2 dram Dover's Powder 1/2 dram

Mix thoroughly and make up into thirty powders; for one year old one-half a powder every two hours while awake or restless.

2. Syrup of Dover's Powder 1 fluid dram Tincture of Aconite 10 drops Simple Syrup enough to make two ounces.

Mix and give one-half teaspoonful every two hours for a child one year old. Shake bottle.

3. But the best treatment I know is the following: Go to any good drug store and get a fifty-cent bottle of vapo-cresolene. Burn this, according to the directions given on the bottle in the evening. Use a small granite cup, put about one-third of an inch of the medicine in this, set cup on a wire frame above a lamp, (can buy a regular lamp with the medicine) close windows and let the child inhale the fumes. This will give the patient a good night's sleep. I have used this for years, and know it is good and effective. A tea made of chestnut leaves is said to be good, and is often used as a home remedy. The leaves of the chestnut that we eat, not the horse-chestnut.

Diet.--This is an extremely important part of the treatment. As the child vomits frequently, especially after eating, the food is generally vomited, so there should be frequent feeding in small quantities. The food should be digestible and nourishing. Milk is a good food for older children. In nursing infants they should be nursed oftener, especially if they vomit soon after nursing. In older children, you must not feed too heavy and hearty foods; meat and potatoes should not be given to young children having the disease. When vomiting is severe the food should be fluid and given often. The child must be nourished. If this disease occurs in the winter the person attacked, after he is seemingly well, must be careful not to take cold. The condition of the mucous membrane of the air tube after an attack of this disease, makes it very easy for the person to contract inflammation of that part and have in consequence laryngitis, bronchitis, or pneumonia. Thc cough in very many cases will last all winter without any additional cold being added.

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DIPHTHERIA.--Diphtheria is an acute disease and always infectious. There is a peculiar membrane which forms on the tonsils, uvula, soft palate and throat and sometimes in the larynx and nose. It may form in other places such as in the vagina, bowels, on wounds or sores of the skin. I once cut off the fingers for a child under the care of another doctor. The child came down with diphtheria, and the membrane formed on the fingers. Also it is often epidemic in the cold autumn months. Its severity varies with different epidemics. Children from two to fifteen years old are most frequently attacked with it. Catarrhal inflammations of the respiratory mucous membrane predisposes to it.

Cause.--The exciting cause is a bacillus called after the discoverers--Klebs-Loeffler--and this may be communicated directly to another person from the membrane or discharges from the nose and mouth, secretions of convalescents, or from the throat of normal persons. The local condition (lesion) may be a simple catarrhal inflammation, or a greenish or gray exudate, involving chiefly the tonsils, pharynx, soft palate, nose, larynx and trachea, less often the conjunctiva and alimentary tract. It is firmly adherent at first and leaves a bleeding surface when detached; later it is soft and can be removed.

Symptoms.--Incubation period usually lasts from two to seven days after exposure, usually two, generally there is chilliness, sometimes convulsions in young children, pain in the back and extremities and a fever of 102-1/2 to 104 degrees.

PHARYNGEAL DIPHTHERIA.--In typical cases this begins with slight difficulty in swallowing, and reddened throat (pharynx), then there is a general congestion of these parts, and membrane is seen on the tonsils. It is grayish white, then dull or yellowish; adherent and when removed it leaves a bleeding surface upon which a fresh membrane quickly forms. If the disease runs on, in a few days the membrane covers the tonsils and pillars of the fauces, often the uvula. The glands around the neck often enlarge. Temperature 102 to 103 degrees. Pulse 100 to 120. The constitutional symptoms are usually in proportion to the local condition, but not always. The membrane frequently extends into the nostrils and frequently there is a burning discharge. In malignant cases all the symptoms are severe and rapidly progressive ending in stupor and death in three to five days. Death may occur from sudden heart failure or complications.

[INFECTIOUS DISEASES 185]

LARYNGEAL DIPHTHERIA, Formerly Called Membranous Croup.--Diphtheria in the larynx may occur alone or with the pharyngeal kind, and was formerly called "Membranous Croup." After several days of hoarseness and coughing the breathing suddenly becomes hard, generally at night, and it is at first in paroxysms, but later it is constant. The space above the breast bone (sternum) is depressed and there is a drawing in of the spaces between the ribs during inspiration accompanied with a husky voice and blue look. The fever is slight. If the obstruction in the larynx is severe the cyanosis,--blueness,--and difficulty of breathing increase, and gradual suffocation leads to (coma) deep sleep and death.

Diagnosis.--Diagnosis can only be made certain by proper chemical tests. The presence of membrane on a tonsil and a small patch streak, or speck of membrane, on the adjacent surface of the uvula or tip of the uvula; a patch of membrane on the tonsil and an accompanying patch on the posterior wall of the pharynx; the presence of a croupy cough and harsh breathing with small patches of membrane on the tonsil or epiglottis. These symptoms are very suspicious and warrant separation of the patient. If such conditions are seen in any one, it will be the part of prudence to send for your doctor immediately. You give the patient a better chance by sending early, protect yourselves and also your neighbors.

Recovery.--Chances in mild cases are good. Antitoxin has brought the death rate down from forty to twelve per cent. Death may occur from sudden heart failure, obstruction in the pharynx, severe infection, complications or paralysis.

MOTHERS' REMEDIES.--Diphtheria is such a dangerous disease and so rapidly fatal that the family physician should be promptly called. Until he arrives the following may be used to give some relief:

2. Diphtheria, Kerosene Good for.--"Kerosene oil applied to the throat of child or adult is very good."

3. Diphtheria, Hops and Hot Water Relieves.--"Make two flannel bags and fill with hops which have been moistened with hot water; place bags in a steamer and heat. Keep one bag hot and the other around the throat. Change often, relief in short time." Mrs. Shaw has tried this in a case of diphtheria and other throat trouble and recommends it as an excellent remedy.

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PHYSICIANS' TREATMENT for Diphtheria. Prevention.--The patient should be isolated as soon as the spots or membrane are seen. Other children who have been with the sick one should at once be given "immunizing" doses of antitoxin, and the furniture of the sick room such as hangings, carpets. rugs, etc., should be removed and disinfected, only the necessary articles being kept in the room. The room should be kept well ventilated, but no draught should get to the patient. The one nursing the patient should not come near the other members of the family. All articles of clothing worn by the patient should be dipped in a 1 to 2000 solution of corrosive sublimate before they are removed from the sick room. (Other solutions may be used; see Nursing Department). Dishes, etc., should be treated in the same way and foods left over should be put in a vessel containing an antiseptic solution, and then burned. Everyone going into the sick room should cover their head with a cap and wear a robe-covering over their clothes, and on leaving the room should gargle or rinse their mouth with a solution of boric acid, about one or two teaspoonfuls to a glass of water, The infant should not be nursed at the breast lest the breast become infected; the milk should be pumped out and fed to the infant with a bottle. If the infant has diarrhea milk must be stopped, the bowels irrigated, and no milk given until all danger from this source is past. The nurse must be careful of the discharges from the nose, mouth and bowels. Discharges from the bowels and the urine must be received in a vessel with an antiseptic solution in it like copperas, lime, etc. Cloths used to receive the discharge from the nose and mouth should be thrown in a vessel containing a solution of 1 to 2000 of corrosive sublimate and then burned. The nurse should wear a gauze protection over her nose and mouth when she is near the patient, and glasses, so that no sputum or discharge from the patient can enter these organs. When the nurse leaves the sick room for a rest or walk, she should change her clothes in an unused room and put them where they can air, wash her hands, face and hair in an antiseptic solution. Great care must be taken by the nurse, or she will carry the disease. The doctor also must take the same care.

PHYSICIANS' MEDICAL TREATMENT.--Antitoxin is the best. 1/100 grain of corrosive sublimate or more according to age is frequently given in the severe cases and is beneficial.

Local Treatment.--In older persons, inhaling steam may benefit. Gargling the throat or spraying the nose and throat is cleansing and helpful; but in children it is sometimes hard to do this, for they may struggle and thus injure and weaken themselves more than they can be benefited by the spraying or gargling. Swab the throat if you can with solution of corrosive sublimate, 1 to 1000. Peroxide of hydrogen, one-sixth to one- half to full strength, is good in many cases, used as a gargle and a swab. Wash out the nose with a normal salt solution. One dram to a pint of water. The persons doing this must take great care or the patient will cough and the discharge will go over them.

When in the Larynx.--Steam inhalations without or with medicine in them and the application of cold or hot to the neck are good. Compound tincture of benzoin is good to use in the water for steaming; one-half to one tablespoonful to a quart of water. A tent can be made by putting a sheet over the four posts of the bed and steam vapor introduced under this covering.

Diet.--The main food is milk, albumin water, broths, eggs given every two hours. Some doctors give stimulants with the food.

[INFECTIOUS DISEASES 187]

Cautions.--Members of the family have no idea how much they can aid the physician in this terrible disease. Pay particular attention to the directions the doctor gives you, if you are doing the nursing, watch so that you may detect any bad symptom, and immediately inform the physician. A harsh cough with increased difficulty in breathing may mean that the disease has extended to the larynx. If such symptoms are first noticed in the physician's absence, he should be sent for at once so he can treat it properly at the start. If the kidneys do not act properly he should be informed. One may take nephritis in diphtheria also. I was called one morning at 3 a. m., to see a case I was attending; she seemed to the parents to be worse; she was, but today she is living, and I believe her life was really saved by her parents. I would rather a loving mother and father nurse a case any time than a selfish, lazy professional nurse. Good nurses are a blessing; selfish ones are a curse; I have met both kinds. After an attack of this disease the patient is left "weak" in many organs. He should be careful, not only of taking cold, but of over-doing. The heart and nervous system in some cases have been terribly wrecked. Take life easy for some time, for you may be thankful that you are alive.

ACUTE TONSILITIS. (Follicular Inflammation of the Tonsils). Causes.-- Authors regard this as an infectious disease. It is met with more frequently in the young; infants may take it. Some authors state it can be communicated either through the secretions or by direct contact, as in the act of kissing (Koplik). It is frequent in children from the second to the fourth year, but it is more common after than before the fourth year. Sex has no influence. In this country it is more common in the spring. The predisposing causes are exposure to wet and cold and bad hygienic surroundings. One attack renders a person more susceptible. It spreads through a family in such a way that it must be regarded as contagious. The small openings (Lacunae) of the tonsils become filled with products which form cheesy-looking masses, projecting from the openings of the (Crypts) hidden sacs. These frequently join together, the intervening tissue is usually swollen, deep red in color and sometimes a membrane forms on it in which case it may look like diphtheria.

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Symptoms.--Chilly feelings or even a chill and aching pains in the back and limbs may precede the onset. The fever rises rapidly and in the young child may reach 105 degrees in the evening of the first day. The infant is restless, peevish and wakeful at night; it breathes rapidly, and there is high fever and great weakness. Nursing is difficult, not only on account of the pain in swallowing, but because in the majority of cases there is more or less inflammation of the nose. The bowels are disturbed as a result of swallowing infectious secretions from the mouth with the food. The tonsils are enlarged and studded with whitish or yellowish white points. The glands at the angle of the jaws may be enlarged. In older children the tonsils are enlarged and the crypts plugged with a creamy deposit. The surface is covered with a deposit and the pillars of the fauces, uvula and pharynx may all be inflamed. The tongue is coated, the breath is bad, the urine high colored, swallowing is painful; the pain frequently runs to the ear and the voice sounds nasal, as if one had mush in his mouth when talking. In severe cases the symptoms all increase, and the parts become very much swollen. Then the inflammation gradually subsides, and in a week, as a rule, the fever is gone and the local conditions have greatly improved. The tonsils, though, remain somewhat swollen. The weakness and general symptoms are often greater than one would suppose. The trouble may also extend to the middle ear through the eustachian tubes.

Diagnosis Between Acute Tonsilitis and Diphtheria.--Follicular form. "In this form the individual, yellowish, gray masses, separated by the reddish tonsilar tissue are very characteristic, whereas in diphtheria the membrane is of ashy gray and uniform, not patch."--Osler. A point of the greatest importance in diphtheria is that the membrane is not limited to the tonsils, but creeps up the pillars of the fauces or appears on the uvula. The diphtheric membrane when removed leaves a raw, bleeding, eroded surface; whereas, the membrane of follicular tonsilitis is easily separated as there is no raw surface beneath it.

MOTHERS' REMEDIES. 1. Tonsilitis, Raw Onion and Pork for.--"Take a raw onion and some salt pork, chop together, make a poultice on which put a little turpentine and wrap around the throat." This is a very good remedy and should be used for some time. Change as often as necessary.

2. Tonsilitis, Peppermint Oil Good for.--"Apply peppermint oil thoroughly on the outside of the throat from well up behind the ear nearly to the chin, also just in front of the ear. This will soon penetrate through to the tonsils; apply freely if the case is severe and later apply hot cloths if relief does not follow without."

3. Tonsilitis, Borax Water for.--"One-fourth teaspoonful borax in one cup of hot water, gargle frequently." This may be used for ordinary sore throat not quite so strong.

4. Tonsilitis, Salt and Pepper Will Relieve.--"Apply salt pork well covered with pepper to the swollen parts; will often give relief."

5. Tonsilitis, Peroxide of Hydrogen Will Cure.--"Tonsilitis and contagious sore throats are just now extremely popular. Persons having a tendency to them will seldom be sick if they gargle daily with a solution of peroxide of hydrogen and water in equal parts for adults. Peroxide diluted with five parts of water and used as a head spray will prevent catarrhal colds." Children, are often sent to school immediately after an attack of tonsilitis, when they should be at home taking a tonic and building up by a week of outdoor play.

6. Tonsilitis, a Remedy Effective for.--"Rub the outside of the throat well with oil of anise and turpentine, and keep the bowels open." Care should be taken not to take cold. The anise is very soothing and the turpentine will help to draw out the soreness. This would be a good remedy for children.

[INFECTIOUS DISEASES 189]

PHYSICIANS' TREATMENT for Tonsilitis. 1. First Home Treatment.--Put the patient to bed alone in a pleasant room, comfortably warm; for this disease is recorded as contagious in this form. Cold applied externally around the sore spot is good. Use an ice bag if you have it; or wring cloths out of cold water and put just under the jaw and a flannel over that, bound around the neck. It must be changed often to keep cold.

2. Smartweed.--Cloths wrung out of smartweed tea are very good when applied under the jaw.

3. Salt Pork.--Salt pork, well salted and peppered, sewn to a cloth and applied on both sides, if both are diseased, directly to the lumps is very good. These can be kept on indefinitely. I have used them.

4. Liniment.--A strong blistering liniment applied externally where the lumps are is also good. These applications tend to withdraw some of the blood from the sore tonsils, and of course, that relieves them. There are many such that can be used. Poultices should not be applied for this form as they tend to hasten formation of pus.

5. Internally.--Dip your clean moistened finger tip into dry bicarbonate of soda (baking soda), rub this gently on the sore tonsil and repeat it every hour. You can also put one teaspoonful of it in one-half glass of very hot water and gargle if you do not use it locally.

6. Hot Water.--Gargling frequently with very hot water is splendid. If you wish you can use one teaspoonful of some antiseptic, like listerine, in it.

7. Thyme.--You can make a tea of the common garden thyme and gargle or rinse your mouth and throat with it every half to one hour. This is not only healing and soothing, but it is also antiseptic. This is a constituent of many of the antiseptic preparations.

8. Steaming With Compound Tincture of Benzoin.--Tincture of benzoin is splendid. Put one tablespoonful in a quart of hot water and inhale the steam. Put a sheet over your head and pitcher; or put it in a kettle, and roll white writing paper into a funnel, tie one part over the spout and put the other end in your mouth if possible; or you can inhale simple steam in the same way. I know this is excellent and often recommended; everyone has it, and it costs literally nothing, except to heat the water.

9. For the Pain.--Dissolve two drams of chloral hydrate in an ounce of water, use a camel's hair pencil if you have it, or a soft piece of cloth tied on a smooth stick, and apply directly to the diseased parts. This is for older persons, relieves the pain very much. There are many other simple remedies that can be used in this way.

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