AMERICAN HEALTH PRIMERS. 
 
 Edited by W. W. KEEN, M.D., 
 
 Fellow of the College of Physicians of Philadelphia ; Surgeon to 
 St. Mary's Hospital, etc. 
 
 LIBRARY OF CONGRESS. 
 
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 It is one of the chief merits of the Medical Profession in modern times that its mem- 
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 Not only in large cities, but in every town and hamlet, the Doctor leads in every effort 
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 the efforts to imprc 
 
 But the great ma 
 if they do, are ignc 
 practical applicatic 
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 the bearings and a] 
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 proper sanitary laws, especially in our large cities. 
 
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 Dr. W. W. Keen has undertaken the supervision of the series as Editor, but it will be 
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 authors. 
 
 UNITED STATES OF AMERICA. 
 
 h efforts, or, 
 and of their 
 n of disease, 
 direct result 
 :he object of 
 ■ as possible, 
 edicine, and 
 ich of Medi- 
 .ist in curing 
 their pupils, 
 
The first FOUR volumes are now ready, others will follow at intervals 
 of about once a month. 
 
 I. Hearing, and How to Keep It, 
 
 By CHAS. H. BURNETT, M.D., of Philadelphia, 
 
 Consulting Aurist to the Pennsylvania Institution for the Deaf and Dumb, 
 Aurist to the Presbyterian Hospital, etc. 
 
 II. Long Life, and How to Reach It, 
 
 By J. G. RICHARDSON, M.D., of Philadelphia, 
 
 Professor of Hygiene in the University of Pennsylvania, etc. 
 
 III. The Summer and its Diseases, 
 
 By JAMES C. WILSON, M.D.,of Philadelphia, 
 
 Lecturer on Physical Diagnosis in Jefferson Medical College, etc. 
 
 IV. Eyesight, and How to Care for It, 
 
 By GEORGE C. HARLAN, M.D., of Philadelphia, 
 
 Surgeon to the Wills {Eyej Hospital. 
 
 V. The Throat and the Voice, 
 
 By J. SOLIS COHEN, M.D., of Philadelphia, 
 
 Lecturer on Diseases of the Throat in Jefferson Medical College. 
 
 VI. The Winter and its Dangers, 
 
 By HAMILTON OSGOOD, M.D.,of Boston, 
 
 Editorial Staff Boston Medical and Surgical Journal. 
 
 VII. The Mouth and the Teeth, 
 
 By J. W. WHITE, M.D., D.D.S., of Philadelphia, 
 
 Editor of the Dental Cosmos. 
 
 VIII. Our Homes, 
 
 By HENRY HARTSHORNE, M.D.,of Philadelphia, 
 
 Formerly Professor of Hygiene in the University of Pennsylvania. 
 
 IX. The Skin in Health and Disease, 
 
 By L. D. BULKLEY, M.D.,of New York, 
 
 Physician to the Skin Department of the Demilt Dispensary and of the 
 New York Hospital. 
 
 X. Brain Work and Overwork, 
 
 By H. C. WOOD, Jr., M.D., of Philadelphia, 
 
 Clinical Professor of Nervous Diseases in the University of Pennsylvania, etc. 
 
 XI. Sea-Air and Sea-Bathing, 
 
 By JOHN H. PACKARD, M.D., of Philadelphia, 
 
 Surgeon to the Episcopal Hospital. 
 
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 LINDSAY & BLAKISTOIM, Publishers, Phlla. 
 
AMERICAN HEALTH PRIMERS. 
 
 EDITED BY 
 
 W. W. KEEN, M.D., 
 
 Fellow of the College of Physicians of Philadelphia 
 and Surgeon to St. Mary's Hospital. 
 
ffl- 
 
 -*■ 
 
 AMERICAN HEALTH PRIMERS. 
 
 The Summer 
 
 AND ITS DISEASES. 
 
 BY 
 
 JAMES C. WILSON, M.D., 
 
 Physician to the Philadelphia Hospital and to the Hospital of the 
 
 Jefferson Medical College, and Lecturer on Physical 
 
 Diagnosis in the Jefferson Medical 
 
 College, in Philadelphia. 
 
 OF 
 
 >K 1679. 
 
 PHILADELPHIA: 
 
 LINDSAY & BLAKISTON, 
 
 1879. 
 
 ,1 
 
 ■f* 
 
Copyright. 
 
 LINDSAY & BLAKISTON. 
 
 1879. 
 
CONTENTS. 
 
 CHAPTER I. , AGB 
 
 The Summer ........ 7 
 
 CHAPTER II. 
 Sunstroke and Heat Fever . . . .35 
 
 CHAPTER III. 
 
 Summer Diarrhoea and Dysentery . . .57 
 
 CHAPTER IV. 
 Cholera-Infantum 79 
 
 CHAPTER V. 
 
 Summer and Autumnal Fevers . . . .99' 
 
 CHAPTER VI. 
 Summer Colds and Hay Asthma . . .114 
 
 CHAPTER VII. 
 The Skin in Summer, and its Diseases . .134 
 
 I* V 
 
The merry Earth, flying through, space, swinging as she goes, 
 turns first one side of her fair face and then the other to the 
 kisses of her lord, the Sun. Where the caresses of his life-giving 
 rays fall lightly, she shudders and grows pale. Nature sleeps, 
 and Man, in the discontent of winter, awaits with longing the 
 return of spring. Where they fall full and ardently, blushes of 
 love and smiles of plenty brighten her beauty. Nature awakes 
 to loveliness and abundance, and the children of Earth are 
 blessed in the open-handed fruitfulness of the glorious Summer. 
 
 But man, born to sorrow as the sparks fly upwards, finds 
 some pain in every pleasure, some sadness in all joy, some fear 
 in every hope. The changing seasons remind him that the seed 
 is not quickened except it die, and each one brings to him, as it 
 comes with its many blessings, some new suffering and sickness. 
 
THE SUMMER 
 
 AND 
 
 ITS DISEASES. 
 
 CHAPTER I. 
 
 THE SUMMER. 
 
 THE object of the following pages is to point out 
 some of the peculiarities of our summer climate; 
 to show what season-influences at that time act un- 
 favorably upon the public health, and to suggest such 
 means as will best enable each individual to escape the 
 sicknesses peculiar to summer by avoiding the causes 
 which give rise to them. 
 
 Preventive medicine is the latest and highest de- 
 velopment of the Healing Art ; to discover and study 
 the causes of sickness, and to point them out to the 
 people, that they may destroy some of them and 
 avoid others, is a more reasonable and more effectual 
 mode of warfare upon disease than the mere endeavor, 
 however energetic and skilful, to combat maladies 
 
 7 
 
8 THE SUMMER AND ITS DISEASES. 
 
 already established, whilst their neglected causes are 
 left to do evil work upon the health of the multitudes 
 who expose themselves blindly to unknown and un- 
 suspected dangers. To be warned is to be prepared, 
 and a little prevention is better than much cure. 
 
 Our summer is remarkable not alone for the notable 
 contrast to the winter which it presents, by which we 
 experience in the course of a few short months the 
 rigors of cis-arctic climates and the broiling heats 
 of sub-tropical skies, but it is also remarkable for its 
 long-continued, unbroken high temperature. The 
 marvellous adaptability of human beings to varying 
 climatic conditions enables us to bear the great and 
 rapid, but orderly, changes of the seasons with com- 
 fort, and even to find in them an almost perennial 
 source of physical and intellectual pleasure ; but the 
 protracted heats of summer exhaust us and depress 
 us ; they wear us out by their very sameness : they 
 call into being around us innumerable noxious in- 
 fluences that they make us the less able to withstand ; 
 and they tempt us to many direct violations of the 
 laws of health which in more comfortable days would 
 be un thought of. 
 
 The following table of the mean temperature of the 
 different months of the year is compiled from the 
 statistics of the signal office at Philadelphia, one of 
 the most healthful of the large cities of the world. 
 Although a commercial port, it is an inland city, and 
 
THE SUMMER. g 
 
 possesses a climate unmodified by nearness to the sea 
 on the one hand, or by mountain ranges on the other. 
 Such references to exact official observations as may 
 be necessary to illustrate or confirm the statements of 
 this little volume will be founded, unless otherwise 
 stated, upon the Health Office Reports, and other 
 similar publications of the same city — the climate 
 of which is taken as a type. 
 
 TABLE 
 
 SHOWING THE MEAN TEMPERATURE OF EACH MONTH, AND THE 
 AVERAGE MEAN TEMPERATURE OF THE SEASONS DURING TEN 
 YEARS ENDING 1 876. 
 
 Dec, 33.92° F. 
 Jan., 32.72 " 
 Feb., 33.12 " 
 
 Mar., 39.16° F. 
 April, 53.36 " 
 May, 63.24 " 
 
 June, 73.54° F. 
 July, 78.74 " 
 Aug., 75.92 " 
 
 Sept., 67.72° F. 
 Oct., 56.03 " 
 Nov., 43.34 " 
 
 Winter, 33.25° F. 
 
 Spring, 5i.92°F. 
 
 Sum'r, 76.07° F. 
 
 Autu'n, 55.69° F. 
 
 It is thus seen that the arbitrary division of the 
 year into seasons is sustained by the recorded monthly 
 temperature during a long period, each season-group 
 of three months showing a marked difference from 
 that which precedes and that which follows it, whilst 
 the mean temperature of the months constituting the 
 group is, with few exceptions, nearly the same. 
 
 July is by far the month of highest temperature; 
 but the latter part of June is often very hot, and the 
 mean temperature of August is brought down by the 
 
10 THE SUMMER AND ITS DISEASES. 
 
 increasing length of the nights. The days are quite 
 as hot, and there is a dampness in the sultry air that 
 makes the heat still more oppressive. It is the 
 month of summer mists and fogs. Organic matters 
 undergo rapid decomposition, and neglected drains 
 and foul places about the dwellings of men pour forth 
 emanations which sap the health and the life of the 
 inmates. Some give warning by the stenches which 
 attend them; but others — and it is thought that 
 they are the most potent in their effects — are odor- 
 less, and strike, assassin-like, without warning. In 
 this month, also, food -substances change most rapidly, 
 and errors in diet are easily, often unwittingly, com- 
 mitted, with swift retribution. 
 
 The thunder-storms which are so frequent during 
 the summer do excellent work in flushing water-ways 
 and drains, and in altering the electrical tension 
 and the physical condition of the atmosphere; but 
 they are not infrequently the cause of sickness and 
 death by lightning-stroke, by the sudden chilling of 
 those caught without shelter, and especially among 
 infants and children, by rapid chemical changes pro- 
 duced in the milk, which constitutes their chief food. 
 
 The heats of summer favor the disengagement of 
 that obscure but potent entity called "malaria" in 
 regions favorable to its production ; and much of the 
 sickness of the late summer and of the autumn is due 
 to exposure to its influence. 
 
THE SUMMER. II 
 
 Finally, one of the most prolific sources of sick- 
 ness in summer lies in the power of confirmed habit 
 in many people, and their inability to adapt them- 
 selves temporarily to the circumstances of the season. 
 In tropical countries, the daily life of the people is 
 arranged in accordance with the climate. The bustle 
 and activity of cooler lands are replaced by repose and 
 tranquillity; the struggle for wealth is scarcely known, 
 and the means of a bare livelihood are so easily pro- 
 cured, that the keen stimulus of competition, which 
 makes life so hard elsewhere, is but slightly felt; 
 food is taken in smaller quantities, and it is of a lower 
 heat-producing kind ; clothing is light in color and 
 in texture ; the business of life is transacted in the 
 cool hours of the morning, and its social pleasures 
 enjoyed in the long, starlit evenings ; whilst the 
 hours of the strong, hot mid-day are calmly passed 
 in a shaded hammock in undisturbed siesta. But 
 with us the case is different. In the most exhausting 
 "hot spell," the hours of business are but little 
 abridged — the restless, eager life of the year is car- 
 ried into the summer. Instead of arranging the day 
 so as to spare himself, the American nerves himself 
 up to endure the hardships of the hottest weather, 
 and too often eats and drinks that which it is his 
 custom to live upon the year round. Even in his 
 recreation his old habits cling to him, and he vainly 
 seeks relaxation in the stifling theatre, the crowded 
 
12 THE SUMMER AND ITS DISEASES. 
 
 and fatiguing excursion, the glaring hop, or in the 
 exhausting restlessness of rapid travel. 
 
 The diseases peculiar to summer arrange themselves 
 in two groups. 
 
 I. Diseases due to the direct action of intense heat 
 and prolonged high temperature upon the tissues of 
 the body : 
 
 Sunstroke. 
 Heat fever. 
 
 Exhaustion from heat. 
 Simple continued fever. 
 Diarrhoea (a group of cases). 
 Cholera infantum (a group of cases). 
 Some affections of the skin. 
 
 II. Diseases due to morbific influences generated 
 by the action of the high temperature of summer 
 upon the surroundings : 
 
 Diarrhoea and dysentery. 
 
 Cholera infantum. 
 
 A group of fevers (non-malaria). 
 
 Malarial fevers. 
 
 Hay asthma. 
 
 Colds (from sudden changes of temperature). 
 
 f caused by certain articles of food. 
 Affections of ^ frQm insect bites and the lik ^ 
 
 the skin 
 
 I from poisonous plants, 
 
THE SUMMER. 1 3 
 
 Several affections are set down in both of these 
 groups for the reason that they frequently arise from 
 each of the general causes. As an example may 
 be especially mentioned cholera morbus, which must 
 often be attributed to exposure to exhausting heat, 
 without the concurrence of traceable errors in diet or 
 living, on the one hand, and which more frequently 
 is directly due to the eating of unwholesome food and 
 like acts of imprudence, on the other. My observation 
 has satisfied me as to the evidence that the formidable 
 group of infantile disorders, which will be best recog- 
 nized by its old name of cholera infantum, is also 
 largely due to the depressing influence of heat alone; 
 whilst, as all the world knows, it is frequently pro- 
 duced by alterations in the food. 
 
 To escape the diseases of summer, there are two 
 courses — one is to conform our lives to the require- 
 ments of the season, the other to take refuge in places 
 where the heats are less intense. 
 
 Spring fever is more than a carelessly given syno- 
 nym for laziness. No thoughtful person can observe 
 the wide-spread sense of weariness, the effort which 
 attends continued bodily or mental work in the spring, 
 without recognizing that there is a real meaning in 
 the term. At this season the bodily forces are below 
 par, something of power has been lost by the hard 
 work of the winter that must be regained before the 
 strain of another winter begins. The observation that 
 
14 THE SUMMER AND ITS DISEASES. 
 
 many persons habitually lose weight in the spring, to 
 regain it in the autumn, confirms the view that there 
 is a spring-period of health and strength depression. 
 The custom of taking a summer holiday, and the 
 eagerness with which it is looked forward to, are alike 
 founded upon the real requirements of hard-working 
 men and women. The clerk's "two weeks off" is 
 not merely a season of pleasure and amusement ; it is 
 a necessity for his body, if it is to be kept healthy. 
 It is not alone that he escapes for a brief time the 
 stifling air of the city and the shop, and his hours of 
 daily toil; but it is that he has the repose which comes 
 from complete change of scene, from long restful 
 reaches for the eyes, weary with months of keen, 
 close looking ; from the many-tinted green of sloping 
 fields, from the quiet beauty of shady woods and deep 
 clear waters, and fresh skies, and the ever-changing 
 sea, and the peaks of mountains that change not — it 
 is this that does him good. The man is to be pitied 
 that cannot have his summer holiday; a thousand 
 times he who cannot enjoy it. To conform one's life 
 to the demands of hot weather calls for the observance 
 of a few simple rules : The daily bath on rising, to be 
 repeated with warm water on going to bed, if the heat 
 of the nights be so great as to prevent sleep — many 
 a time, after hours of restlessness, has sleep followed 
 quickly upon a warm bath ; to wear the lightest of 
 gauze-merino underwear for the body, and linen or 
 
THE SUMMER. I 5 
 
 cotton for the legs, and outside stuffs light in weight 
 and color, and loose-woven; to live upon a simple 
 diet, bread and butter, milk, sound ripe fruit, vege- 
 tables, meat sparingly, and non-stimulating drinks 
 taken slowly. I find no harm, for those who like 
 them, in the light beers, or claret and water at din- 
 ner. Above all, it is important to take life easily, to 
 make haste slowly, to keep the body tranquil, and 
 the mind serene. We ought to rise with the dawn, 
 and to have done all that is possible of the day's work 
 before the sun is high. An hour's light half-slumber 
 in a darkened room at mid-day tends to keep the in- 
 ternal temperature down. In a word, the life in the 
 tropics is to be imitated. Excitement, hurry, the 
 direct rays of the high sun, strong drinks, much meat 
 and tiffin are to be eschewed. It is only for a season; 
 frosty mornings and sharp east winds will soon make 
 these things bearable again. 
 
 As I write these lines, to-night, hundreds of house- 
 holds are discussing the question of where to go for 
 the summer. Many voices mingle in praise of different 
 modes of spending the summer, and of various places 
 in which to spend it ; but all agree in this, that their 
 owners must go away. From that opinion there is 
 no dissent, except, perhaps, in the unspoken thoughts 
 of the head of the house, who ponders weighty ques- 
 tions of expense, the long duration of hard times. 
 
 Ah ! curly pates, you are for the country and a 
 
1 6 THE SUMMER AND ITS DISEASES. 
 
 farm-house, are you? Such fun, is it? You are 
 right — it is just the place for you. It gives you 
 plain, wholesome food — such milk and eggs, and 
 such bread and butter, and luscious fruit, that you 
 wait and long for as it ripens ! But you must have a 
 care that it is ripe. It gives you change of scene and 
 fresh air, and early hours and such delightful tired- 
 ness, that you fall asleep while they are undressing you, 
 as you ought, for you have had a glorious day. For 
 you, my boys, the farm is an unending, summer-long 
 delight. Never once, till it is time to go back to 
 town and to school, will you utter that saddest of 
 child-laments, "I wish I had something to do." 
 The farm is a practical menagerie, which is open all 
 day long, and don't smell badly. To be sure, there 
 are no tigers ; but there is much natural history to be 
 learned in the stable and milk-shed and the pens, 
 and there used to be bears in the woods beyond the 
 mill ! It is better than any circus you ever saw, for 
 you can ride yourself, sometimes, — to the black- 
 smith's shop or to the mill. There is work for you 
 to do. You can help in the hay-field, if you like. 
 Certainly, you can roll in the fresh hay, and lie upon 
 it and toss it about. How sweetly it smells ! Perhaps 
 the men will take you home on the last load. Was 
 there ever anything so exciting, as when they shout 
 and the horses rush, and you sweep up into the 
 shadowy barn between the teeming, fragrant mows, 
 
THE SUMMER. \J 
 
 and all grows suddenly silent, for the crop is in? 
 Then there are nine hundred* and ninety-nine other 
 things to do, — dams to build; and wading and fish- 
 ing. It is not likely you will catch more than a min- 
 now or two and a little sun-perch ; but it 's great fun 
 to dig the worms. 
 
 We might go on for hours talking about this sum- 
 mer life on a farm, for I know it well, and loved it 
 years ago, just as you love it now. And I am sure of 
 one thing, and that is this, — it is the very best of all 
 places for the youngsters. It is not a bad place for 
 the baby, either, if there be plenty of shade around 
 the house, and not too much on it. But it must be a 
 reai farm — not merely a fashionable boarding-house 
 in the country. Aye, to be sure. What ? You 
 don't like the nap after dinner ? But, my little man, 
 it is necessary; it was the doctor's strictest order. 
 You would never in the world stand the work you do 
 without it. 
 
 For children of an older growth, the monotony of 
 simple country life is wearisome. Its gentle pleasures 
 pall upon senses used to the more highly-seasoned, 
 piquant viands of city life. One must have society, 
 perhaps, and new faces about him. To meet the 
 wants of such, who desire neither the mountains nor 
 the sea, or who may be compelled to abide near the 
 city, hotels and huge boarding-houses have sprung up 
 on the lines of many railroads. They have their ad- 
 2* B 
 
1 8 THE SUMMER AND ITS DISEASES. 
 
 vantages and their disadvantages. You have change 
 of air, and fields instead of bricks to look upon ; if 
 not a new society, at least a gossippy rearrangement 
 of old acquaintanceships, and plenty of good roads 
 for riding or walking, over a fair, rolling country, 
 with anon a vista through noble trees, or a fertile val- 
 ley with its silver stream, spreading out from a far- 
 off point till it widens at your feet into a rich cornu- 
 copia of earth's blessings. But for children these 
 places are ill-suited ; the life is too artificial and too 
 far from nature. Besides, there are too many of 
 them crowded together. And they must, God pity 
 them, be dressed and dance. The very selfsame 
 things that make life in these huge hotels of the 
 railroad lines unfit for children, make it unbearable 
 to some older folk. 
 
 The effect of constant evaporation, of the sluggish- 
 ness of the ocean in absorbing and in giving up its 
 heat, and the resulting alternations of land-breeze by 
 night and sea-breeze by day, make insular and mari- 
 time climates much more equable than those of con- 
 tinental inlands. Hence the apparent paradox of 
 sending invalids to the sea-shore in winter to be warm, 
 and in summer to be cool. 
 
THE SUMMER. 1 9 
 
 TABLE 
 
 SHOWING THE HIGHEST AND LOWEST TEMPERATURE AND THE 
 RANGE ANNUALLY, FOR FOUR YEARS, AT PHILADELPHIA 
 AND AT CAPE MAY. 
 
 1874 
 1875 
 1876 
 1877 
 
 PHILADELPHIA. 
 
 CAPE MAY. 
 
 Temperature. 
 
 Temperature. 
 
 Highest. 
 
 Lowest. 
 
 Range. 
 
 Highest. 
 
 Lowest. 
 
 Range. 
 
 97-° F. 
 95- " 
 100. " 
 
 95- " 
 
 io.° F. 
 
 —5- " 
 
 4- " 
 
 8. " 
 
 87.0 F. 
 100. " 
 96.0 " 
 87.0 " 
 
 87. F. 
 90. " 
 
 89. » 
 88. " 
 
 i 3 .°F. 
 2. " 
 8. " 
 
 12. " 
 
 74.o° F. 
 88.0 « 
 81.0 " 
 76.0 " 
 
 4 Yrs. 
 
 100. " 
 
 —5- " 
 
 105.0 " 
 
 90. " 
 
 2. " 
 
 88.0 « 
 
 What wonder, then, that thousands of people seek 
 the sea-side to escape the heat and the ills of the hot 
 season at home ; that the silent stretches of sand 
 become, under July skies, thronged cities and the 
 gay sojourning-places of vast caravans of pilgrims, 
 who come down to worship at — not the tomb — but 
 the shrine of the ever-living Hygeia, goddess of 
 Health ! Air, skies, and sea are laden with blessings 
 for those who know how they are to be obtained. 
 
 But here, as elsewhere, the gifts of health are to be 
 sought in moderation and prudence. How often, 
 with the best intentions, is the pursuit of health de- 
 feated by some imprudence unwittingly committed, — 
 prolonged exposure to the sun, too frequent or too 
 long bathing in the surf, hours that should be given 
 
20 THE SUMMER AND ITS DISEASES. 
 
 to sleep thoughtlessly spent in the heated and crowded 
 ball-room ! How much oftener is the season made a 
 prolongation of the dissipation and revelry of winter, 
 and looked upon not so much as an escape from un- 
 favorable surroundings, as an opportunity for social 
 gaieties that would be impracticable without the cool 
 sea-breeze and the invigorating sea-air and surf- 
 bath ! 
 
 For those who love the borders of ocean, our At- 
 lantic coast offers a long list of places, varying in 
 their attractions, none without some special charm 
 of its own. Far away to the north lies Mount 
 Desert, in the loveliness of its scenery no mean rival 
 of Monaco and Sorrento. Above the beetling cliffs 
 of the southern shore of the island, whose faces are 
 worn into weird, arched, sea-anemone bearing caves, 
 rise the steep, wooded slopes of a bold cluster of 
 mountains, to the far-off bouldered peaks which form 
 their barren summits. Here and there the eye rests 
 upon a patch of green pasture-land, wrested with 
 much toil from the wilderness around it ; on one 
 hand stretches away the illimitable sea, on the other 
 lie the placid waters of Frenchman's Bay, studded 
 with many islands ; between them, ever on guard, 
 stands the light-house, built upon an up-jutting mass 
 of rock. Fair roads wind around the mountain 
 bases, and clamber deviously to their summits, whence 
 such views may be had as are not excelled in any 
 
THE SUMMER. 21 
 
 land. In the deep, chasm-like valleys, hundreds of 
 feet above the level of the sea, which spreads out 
 below you, and is, in truth, but a mile or two away, 
 lie blue, gleaming lakes, whose cragged and fir-clad 
 shores recall Swiss landscapes. There is no surf, and 
 at this point on the coast the Arctic current creeps 
 down, making the water too cool for any but the 
 most robust bathers, who, indeed, rarely prolong the 
 dip beyond a few minutes, and find great comfort 
 in brisk towelling afterwards. There is no lack of 
 amusements, however, which, in years gone by, were 
 of a simple, healthful kind, — moderate mountain- 
 climbing, excursions afoot or in wagon, riding, pic- 
 nics, and boating upon the bay, the waters of which, 
 in August nights, show a phosphorescence like that 
 of the tropics. Alas ! Mount Desert grows civilized 
 as it grows older and the life there more complex. 
 They dance the "cotillon" nowadays, and "even- 
 ing-dress ' ' is often de riguer. 
 
 Westward, on the coast of Maine, is Castine, a 
 quiet place of great natural beauty, and a climate not 
 very different from that of Mount Desert, to which 
 the dense August fogs are certainly an objection. 
 
 Further around to the south you come to Old 
 Orchard, with its long glistening beach, and clear, 
 cool water, usually innocent of breakers ; and further 
 on, Rye, delightful for the fair country back of it ; its 
 noble groves, and the little rocky, half-moon beach, 
 
22 THE SUMMER AND ITS DISEASES. 
 
 where you can enjoy surf-bathing of the most gentle 
 kind. From Rye you look across ten miles or more 
 of sea to the low-lying Isle of Shoals, attractive for 
 being out at sea, almost beyond the land-breeze and 
 its mosquitoes. Here, those fond of sea-fishing can 
 find abundance of amusement ; and the life is tran- 
 quil, healthful, and without undue excitement. The 
 number of sea-side places of resort increases as we 
 approach the neighborhood of the great cities. It is 
 but necessary to speak of Narragansett Pier, of stately 
 Newport, with its mild English climate, and luxurious, 
 ostentatious, but refined social life, of the multitu- 
 dinous localities upon the Sound, and near New York, 
 that find favor in the eyes of their annually returning 
 frequenters. But let me not forget Nantucket, for, as 
 a whaling-port, with ninety ships, and that but little 
 more than a quarter of a century ago, she has seen 
 better days. There is something weird about this 
 island city, twenty miles from the main, once so 
 prosperous, now fallen so low among her rivals, with- 
 out a ship, her harbor closed up by a rapidly formed 
 bar, her people for the most part departed. But it is 
 no bad place to pass a brief summer holiday. There 
 is room to walk, abundance of room for the most 
 ambitious sailor, and good boats, with sea-fishing, 
 and fine still- and surf-bathing. Moreover, no land- 
 breeze can reach her shores, a consideration, in certain 
 seasons, of no mean importance. From Sandy Hook 
 
THE SUMMER. 2$ 
 
 to its most southern point, the shore of New Jersey 
 offers excellent accommodations for the summer so- 
 journer. Its hotels are more numerous than the coast- 
 guard stations, and they grow up in new spots from 
 year to year. In the course of time, miles of con- 
 tinuous park, with hotels, cottages, and every accom- 
 modation for summer and winter visitors, will skirt 
 the coast at various points. More easy of access than 
 some more famed shores, untrammelled by natural or 
 artificial boundaries to its available space, blessed with 
 a delightful climate as compared with inland regions 
 but little remote, this sandy coast, useless for other 
 purposes, is destined to be the summer park for mil- 
 lions of people. Already from point to point it is 
 thronged from June till September with, thousands of 
 happy men, women, and children, who find change, 
 rest, cool salt air, bathing, and such society as suits 
 them, within a few hours of their homes. This coast 
 is too well known to those into whose hands this 
 volume is likely to fall, to make any description of 
 the separate places of resort upon it necessary. They 
 differ in many respects, but the most notable natural 
 changes are those in the beach, and in the back coun- 
 try — from Long Branch, with its superb bluff, its lovely 
 rolling farm-land, and fine bathing, to Cape May, 
 which has no back country to speak of, but makes 
 up for it by the finest beach in the world, and surf- 
 bathing unsurpassed for excellence and safety. I 
 
24 THE SUMMER AND ITS DISEASES. 
 
 cannot leave this subject without a passing allusion 
 to some of the spots in which it has been my lot to 
 pass pleasant summer days — Elberon, with its smooth 
 turf and pleasant cottage-life ; Spring Lake, famous 
 for its pretty body of clear spring-water, only a few 
 hundred feet from the surf, its forests, and its corn- 
 fields reaching to the beach, and its excellent drives 
 back into Monmouth, the most fertile country in New 
 Jersey. A little to the southward is Sea Girt, its 
 porches so close to the water that you seem to be upon 
 a yacht, and wonder why there is so little motion. 
 Then come Squan, Point Pleasant, Tuckerton, Long 
 Beach, Beach Haven, and Brigantine. From Brigan- 
 tine, across shoals that have been the grave of many 
 a noble ship and many a brave sailor, to Atlantic 
 City, dear to the hearts of my townsmen whom she 
 has blessed so long ; doubly dear to many an invalid 
 who has left the wearisome four walls rendered too 
 hatefully familiar by the long days of sickness, and a 
 bleak winter climate at home, to find a new place, 
 and warmth and sunshine, and a quick return to 
 health in some one of her many comfortable cot- 
 tages. Sixty miles of as yet unoccupied beach bring 
 us to Cape May, most southern and most excellent of 
 bathing-places. 
 
 It must not be thought that the chief advantage of 
 a summer stay at the sea-shore is to be derived from 
 the bathing. I am so far from holding that opinion, 
 
THE SUMMER. 2$ 
 
 that I believe those who derive most benefit from it 
 are those who do not bathe in the surf at all. Many 
 people cannot stand surf-bathing ; many enjoy it, but 
 are so depressed by it that they are warned against 
 the indulgence; a larger number still enjoy it greatly, 
 and feel so little unfavorable after-effect, that they con- 
 tinue it day after day, until the health suffers in one 
 way or another in consequence. The majority of 
 bathers who are cautious as to the length of time they 
 spend in the bath, and the way they pass the hours 
 after it. are doubtless benefited by it. But how few 
 are so ! My lady, who rarely rises till nine or ten, 
 and never in her life has walked five miles at a stretch, 
 who spends much of her time on soft cushions at ease 
 without muscular effort, must not forget that fifteen 
 minutes fighting the surf uses up a great deal of force, 
 and that a longer time spent in the bath is a great 
 risk which she would by no means run, a great exer- 
 tion which she could by no means endure, were she 
 not kept up by the excitement of the whirling water, 
 the gay throng and the consciousness that she looks 
 marvellously well in her pretty bath-costume. The 
 best plan is to make the pleasure a short one, to excite 
 a speedy reaction by brisk towelling, and to stretch 
 out in delightful quietude till it is time to dress for 
 dinner. It is impossible for me to leave this topic 
 without entering a most earnest protest against the 
 common error of taking young children who are 
 3 
 
26 THE SUMMER AND ITS DISEASES. 
 
 frightened into the surf. The little faces that I have 
 seen convulsed with a terror which was agonizing, at 
 being forced or dragged into the water, haunt me 
 still. The unknown is always terrible, and the tum- 
 bling, roaring waters so familiar and so delightful to 
 many a thoughtless man, are monstrous to his timid 
 child. Set the youngster down upon the sand and 
 watch him. He will quickly make experiences for 
 himself, and that not only without suffering, but even 
 with manifold expressions of infantile delight. 
 
 The sea has its drawbacks, too, and not among the 
 least of them is this, that many persons cannot pro- 
 long their stay at the shore without suffering from ful- 
 ness of the head, a sense of dulness and vague mental 
 as well as physical discomfort, with coated tongue, 
 loss of appetite, constipation, in a word, that inde- 
 scribable collection of bodily discomforts to which is 
 given the name of biliousness. There are often per- 
 sons of sedentary habits, indisposed to exercise, who 
 find in the sea air an appetizing tonic, and in a varied 
 table daily temptation, and who in consequence un- 
 consciously commit excesses in diet. It is possible, 
 also, that there is something in the maritime climate 
 itself unfavorable to certain individuals. The brisk 
 air and plainer tables of high altitudes usually work 
 a speedy and enduring cure. A change to the moun- 
 tains is the best course for those who, after some 
 weeks, find themselves suffering in this fashion. 
 
THE SUMMER. 2J 
 
 Among the mountains one lives nearer to Nature. 
 The hotel, with its long porches and waving flags, its 
 tiresome bustle, its futile emulation of urbane magnif- 
 icence, is not so difficult to escape as its rival on the 
 long, level stretches of low coast lands ; a turn in the 
 road cuts it off from your view, and you may be alone 
 among the rocks and hemlocks. 
 
 " Jocund day 
 Stands tip-toe on the misty mountain-top. " 
 
 There is nothing dull or heavy in this high atmos- 
 phere laden with balsamic principles. You breathe 
 it with the keen relish with which you enjoy the faint 
 ethereal bouquet of rare wine — for it is likewise rich 
 with subtile transmutations of the sunshine. It makes 
 the blood dance in your arteries, and your muscles 
 tense with a vigor the consciousness of which is a 
 delight. Whether you ride or walk, it is with ease, 
 and fatigue itself is grateful, for it courts refreshing 
 sleep. As you stretch yourself at length upon some 
 overhanging ledge cushioned with deep layers of the 
 soft, dry sheddings of the murmuring trees which 
 shade you, what ibrgetfulness of the daily worries of 
 life comes up to you from the long, soft, serene land- 
 scape far below, from the unchanging peaks, scarred 
 but not moved by the storms of cycles, and drops 
 down upon you from the cloudless, tranquil sky. 
 
 Goethe has said, — 
 
 " On every height there lies repose." 
 
28 THE SUMMER AND ITS DISEASES. 
 
 Here you have that best of all repose, — repose 
 with the sense of unusual power, unusual capacity for 
 successful effort. 
 
 I have often thought that the mountains are more 
 attractive to those who are no longer young, because 
 of the fixedness of their scenery, which tells of strug- 
 gles that are past, of tumult and throes that have 
 ended in a sublime repose ; and which, in the gran- 
 deur of its sweeping lines and their vertical tendency, 
 and its heavenward-pointing peaks, suggests aspira- 
 tions that are not of earth. While the sea, restless, 
 changing, ever the scene of a present tumult and 
 commotion, appeals, as it stretches away from his feet 
 to far countries, to the restless, yearning, ambitious 
 heart of youth, to whom the world is a rich and 
 fabled terra incognito, which he is impatient to dis- 
 cover and explore. 
 
 ** I remember the black wharves and the slips, 
 And the sea-tides tossing free; 
 And Spanish sailors with bearded lips, 
 And the beauty and mystery of the ships, 
 And the magic of the sea. 
 
 And the voice of that wayward song 
 Is singing and saying still : 
 'A boy's will is the wind's will, 
 And the thoughts of youth are long, long thoughts.' " 
 
 To the valetudinarian, stiffened with chronic rheu- 
 matism or racked with the pangs of gout, the various 
 
THE SUMMER. 29 
 
 mineral springs offer the threefold attraction of a 
 cooler climate for the hot seasons, a new place in 
 which he can meet society, agreeable by reason of 
 sympathy and many common experiences, and the 
 opportunity of spending the summer in a "course" 
 of the baths and waters. 
 
 And the time is by no means always misspent. I 
 have repeatedly known such persons to derive very 
 great, even permanent, benefit from a summer at 
 Sharon or Richfield, the White Sulphur, or a roving 
 season among the famous thermal springs of Virginia; 
 and certain maladies of a chronic nature become less 
 troublesome after some weeks at Berkley, or lovely 
 Capon, with its Beauty Spring, even if they be too 
 obdurate to yield entirely. How many men and 
 women past middle life would shudder at the pros- 
 pect of a summer spent without some weeks at Sara- 
 toga. 
 
 To drink the waters and to see the world. This is 
 life at the Springs, A pleasant life of leisure it is, 
 too, with often a most charming society, made up of 
 such an admixture of experienced, worldly men and 
 women who have come to drink the waters, and their 
 younger people whom they have brought along, who 
 do not feel the need of alterative draughts, but are 
 ripe for a good time, that the shaded grounds and 
 neighboring hills are changed into a merry picnic 
 place, and the weeks pass quickly away in a life that 
 3* 
 
30 THE SUMMER AND ITS DISEASES. 
 
 has a charm for its devotees so great that they know 
 no rival to the "Springs." 
 
 Another class of persons buy a long excursion 
 ticket, and spend their holiday in travel. So much 
 beautiful scenery, so many spots of interest, are to be 
 seen in this way, that it has great attractions. But 
 in our climate it is a poor way to spend the summer. 
 The greatest care in dividing up long journeys or in 
 arranging the stoppages will not prevent this mode 
 of spending the season from being a veritable hard- 
 ship to most persons in the long, hot, dusty days of 
 July and August. In the spring, if you like, in the 
 autumn, if you can, make up a party and see some 
 of the fair places in your own land ; but in summer, 
 if you are in search of health, spend as little of your 
 time as you can in railroad-cars. 
 
 If all this has grown to be an old story, and you 
 are comfortable at sea and can afford it, pack up a 
 small quantity of luggage and take an out and back 
 berth on an ocean steamer to Liverpool. Six or 
 eight weeks will be enough to enable you to catch a 
 glimpse of Mont Blanc, or, if you prefer not to cross 
 the Channel, a trip to Scotland or the coast of Wales 
 will repay you for all it costs in time or trouble. On 
 the score of health this is an excellent holiday jour- 
 ney, particularly for men whose lives are devoted to 
 hard, unsparing, responsible head-work. 
 
 The best holiday for the hard-worked citizen is that 
 
THE SUMMER. 3 I 
 
 spent in the wilderness. Maine, Canada, the shores 
 of Lake Superior, or the more accessible Adirondacks 
 are wild enough and lonely enough, and abound in 
 excellent camping grounds on which to pitch your 
 tent. Dr. Mitchell has sketched the picture of camp- 
 life in the woods so cleverly, that I venture to trans- 
 cribe a page of his little book.* " One wants more 
 than eight by ten to sleep in, and society of a kind 
 one does not crave, and the delights of unlimited 
 boarding-house gossip. Civilization has hurt, bar- 
 barism shall heal. In a word, my tired man who 
 cannot sleep, or who dreams stocks and dividends, 
 and awakens leg-heavy, aud who has fifty other name- 
 less symptoms, shall try awhile the hospital of the 
 stone-carver. He shall reverse the conditions of his 
 life. Wont to live in a house, he shall sleep in a tent, 
 or, despite his guide's advice, shall lie beneath ' the 
 moon's white benediction.' So shall he be in the 
 open air all day and all night, for the tent is but a 
 mere cover and wind-guard, or scarce that. He shall 
 rise when he likes, unstirred by imperious gongs, but 
 I think he will be apt to see the sun rise, and, honestly 
 tired from travel or food-getting, will want to turn in 
 at eight or nine. If too warm, he will take his coat 
 off; if cold, to replace the demon furnace in the 
 cellar with its breath of baked air, he shall find 
 warmth in the ' ruby wealth of roaring logs ' he has 
 
 *Camp Cure, by S. W. Mitchell, M. D. 1877. 
 
32 THE SUMMER AND ITS DISEASES. 
 
 helped to chop and carry. The best part of his meals 
 he shall earn by sweet labor with his rod or his gun. 
 His shall be the daily plunge in lake or river, and the 
 intense, eager hungriness which has no quarrel with 
 the menu of wood or stream. The sleep that is 
 dreamless, the keen senses, the Arab rigor that makes 
 exercise a jest and the mindless work of the camp a 
 simple pleasure — all these are the rewards which 
 comes to a man who is living the out-door life of the 
 camp by the silent lake or merry river, or far in the 
 noiseless deeps of northern forests, rich with the scent 
 of pine, and the fragrant wood-odors of the moulder- 
 ing logs of the windfall." 
 
 Much benefit is to be derived from the change of 
 climate and surroundings, in addition to the escape 
 from the heated air of cities and the routine of our 
 daily life. In choosing a summering place, it is 
 therefore desirable that one should be selected which 
 contrasts the most strongly with the home scenes and 
 home life. A good part of the gain lies in change, 
 and it is this that makes a stay in the mountains or by 
 the sea, or a voyage, or camp-life, at once so delight- 
 ful and so profitable to the jaded citizen, who needs 
 more in summer than a cooler atmosphere to breathe. 
 
 There are those all around us to whom these pleas- 
 ures are but idle tales; they have no part in them. 
 Whether it be hot or cold, they must bide at home 
 and toil for the bare means to keep the ever-snarling 
 wolf from the door. For them the summer, with all 
 
THE SUMMER. 33 
 
 the miseries of its hottest days and nights, is easier 
 than the winter, for coals cost money that is hard to 
 earn. How shall they be taught that temperance and 
 cleanliness make the body better able to withstand 
 disease ; that an evening spent in the park, upon the 
 river's bank, or on the water, gives change and rest- 
 fulness and health to mind and body alike ? 
 
 Too much praise cannot be given to the large- 
 hearted men and women who, in the past few years, 
 have organized and carried out, in spite of many diffi- 
 culties, plans for children's excursions upon the rivers 
 and to the parks, where, for a day, at least, the for- 
 lorn little ones of the people may look upon the sky 
 and the green fields, and breathe the pure air of 
 heaven. To the same generous thoughtfulness is due 
 the existence by the sea-side of the " Homes " for con- 
 valescent children, for mothers who are destitute to 
 go to with their young babes, and for working-girls, that 
 are now to be found in the best localities. Here, for 
 a trifling outlay, or oftener without money, a holiday 
 and a health-giving change of two or three weeks' 
 duration is brought within the reach of those who 
 require it as much as any in the land. These institu- 
 tions, as a rule, supply good, wholesome food, extra 
 diet for the sick, nursing, medical advice, and medi- 
 cines without charge ; in fact, they provide for all the 
 necessary wants of their temporary inmates. 
 
 In going away for the season, the medicine-chest 
 C 
 
34 THE SUMMER AND ITS DISEASES. 
 
 is not to be forgotten. Let us hope that it will prove 
 to be a useless precaution. It may, however, be a 
 friend in need. It should be small. There is but little 
 room for it in the trunk, and but few drugs that are 
 likely to be required. In the first place, it should 
 contain a roll or two of bandages, some lint, adhe- 
 sive and court plaster, and a yard of oiled silk, in 
 case of accidents ; then some of the best preparations 
 of opium, paregoric, the deodorized tincture of 
 opium, and Collis-Brown chlorodyne. If there are 
 children, magnesia, aromatic syrup of rhubarb, and 
 castor-oil are useful. Camphor water, aromatic spirits 
 of ammonia, an ounce of chloroform, essence of gin- 
 ger, some simple rhubarb pills, some compound cathar- 
 tic pills, a box of Seidlitz powders, quinine, and a 
 package of carbonate of soda for burns and bites, 
 complete the list of things likely to be useful or to be 
 used in the absence of a doctor, w T ho must be sent for 
 as soon as the domestic skill is baffled or at fault. 
 Each bottle must have a printed label, with the dose 
 for an infant, a child, and the adult distinctly stated. 
 Narcotic drugs should have an extra, conspicuous la- 
 bel, "Use with care," or " Poison," and the stronger 
 preparations, such as laudanum, should not be given 
 to children without the advice of a medical man. 
 
 No one should go away from home without a flask 
 of sound spirits, brandy, or, because you can obtain 
 that of good quality more easily, whiskey. It may 
 save great suffering in emergencies. 
 
CHAPTER II. 
 
 SUNSTROKE AND HEAT FEVER. 
 
 THE most obvious and direct effect of the intense 
 heat of summer in producing disease is seen in 
 sunstroke. In truth, though several agents have been 
 regarded by various writers as predisposing causes of 
 this formidable malady, and though there can be no 
 doubt that the habitual abuse of alcoholic drinks and 
 great fatigue increase the liability to it, prolonged 
 high temperature, whether solar or artificial, is always 
 the exciting cause, and, in most instances, the sole 
 cause. For this reason sunstroke is a disease un- 
 known in this climate except during the summer 
 months ; the cases become numerous as the tempera- 
 ture rises to its highest point, and much suffering and 
 many deaths take place from this cause in those trying 
 days when the sheltered thermometer indicates for 
 many hours continuously a heat greater than ninety- 
 five degrees of the scale of Fahrenheit. Sunstroke is 
 frequent in tropical climates, and whilst it attacks 
 European residents in greater numbers, native races 
 are by no means exempt. 
 
 35 
 
36 THE SUMMER AND ITS DISEASES. 
 
 It has been known from the earliest historical 
 times. Several instances are related in the Bible. 
 The reader will recall the graphic story of the child 
 of the woman of Shunem : "And when the child was 
 grown, it fell on a day that he went out to his father 
 to the reapers. And he said unto his father, My 
 head, my head. And he said to a lad, Carry him to 
 his mother. And when he had taken him and 
 brought him to his mother, he sat on her knees till 
 noon, and then died." 
 
 Jonah, the son of Amittai, seated under the booth 
 which he had made, found the sun very hot, as he 
 watched to see what would become of mighty Nin- 
 eveh, so that he was exceeding glad of the gourd 
 which grew up to be a shadow over his head, to de- 
 liver him from his grief. But the gourd withered. 
 "And it came to pass, when the sun did arise, that 
 God prepared a vehement east wind. And the sun 
 beat upon the head of Jonah that he fainted, and 
 wished in himself to die." 
 
 To the people of a "dry and thirsty land," the 
 promise that " the sun shall not light upon them, nor 
 any heat," is rich in meaning, and the metaphor of 
 " the shadow of a great rock " has a significance that 
 we can scarcely comprehend. 
 
 Until very recent times, sunstroke has been con- 
 founded, even by physicians, with a number of other 
 diseases, among which may be mentioned continued 
 
SUNSTROKE AND HEAT FEVER. 37 
 
 and remittent fevers, to which, as we shall see later, 
 many cases certainly bear a resemblance, and apoplexy 
 of the brain, with which the more rapidly fatal cases 
 have many symptoms in common. 
 
 Sunstroke is a very fatal affection. 
 
 In May, 1834, the 68th Regiment, quartered in 
 Fort St. George, Madras, attended the funeral of a 
 general officer. The regiment paraded in full dress, 
 at an early hour in the afternoon, in one of the hot- 
 test months of the year, their tight-fitting, red cloth 
 coats buttoned, wearing their stiff, unyielding leather 
 stocks, their heavy cross-belts, and their black felt 
 shakoes, with flat, circular tops and brass ornaments; 
 in fact, the complete uniform of the British soldier 
 of that date. The route of march extended over 
 several miles. Before the funeral parade was over 
 the men began to fall to the ground insensible — one 
 died on the spot, two others in a short time. Men 
 suffering from sunstroke were carried to the hospital 
 all that night and part of the next day. There lin- 
 gers a tradition of that parade in Madras to this 
 day. 
 
 Dr. Maclean was an eye-witness of the following 
 outbreak. On the 21st of July, 1842, the 98th Reg- 
 iment took part in the attack on Chin-Kiang-Foo. 
 This regiment had just arrived from England in an 
 overcrowded ship. The men were dressed as has 
 been described in the instance of the 68th. Thus 
 4 
 
38 THE SUMMER AND ITS DISEASES. 
 
 laden down, the poor fellows were ordered to take 
 possession of a steep hill, exposed to the fierce rays 
 of an unclouded sun. A great many were struck 
 down by the heat ; about fifteen died on the spot, 
 falling on their faces ; they gave a few gasps and 
 perished before anything could be done for their 
 relief. 
 
 The following account is by Dr. Barclay. The 
 43d Light Infantry marched, in 1857-58, at the time 
 of the India mutiny, from Bangalore to Calpee, in 
 Central India, a distance of more than eleven hun- 
 dred miles by the route taken. The march was 
 almost continuous, and the greatest part of it accom- 
 plished during the hottest season of the year. The 
 men were exposed to a very high temperature by 
 night as well as by day. Dr. Barclay observed the 
 thermometer on one occasion at 118 F. in the 
 largest tents, and 127 in the smallest, during the day, 
 and once at io5°at midnight. No case of sunstroke 
 occurred until the regiment had marched nine hun- 
 dred and sixty-nine miles, and the signs of exhaus- 
 tion were very evident in the emaciation and altered 
 looks of the men. From ttjat time they increased in 
 frequency. When at the foot of the Bisram gunge 
 Ghat, a narrow pass with precipitous walls of great 
 height, cases were brought to the hospital tent at 
 every hour of the day and night, and though a large 
 proportion recovered, two officers and eleven men 
 
SUNSTROKE AND HEAT FEVER. 39 
 
 were buried under one tree in the neighborhood of 
 the camp. Several natives were struck down and 
 perished within an hour. 
 
 That the direct rays of the sun are not necessary to 
 the causation of sunstroke, is shown by the following 
 facts. Soldiers are not infrequently seized after they 
 have retired to their tents, and one writer states that 
 out of sixteen cases, thirteen occurred in barracks or 
 in hospital. On board the French man-of-war Du- 
 quesne, while lying at Rio Janeiro, one hundred cases 
 of sunstroke occurred in a crew of six hundred men. 
 Most of the men were attacked, not when exposed to 
 the direct heat of the sun, but at night, when in the 
 recumbent position ; that is, when breathing a hot 
 and also an impure air. It is thus seen that the 
 attack not only may occur at night, but that the affec- 
 tion is also encountered on shipboard. 
 
 I have known of instances upon the smaller boats 
 of rivers. A young gentleman, clerk in an office, 
 was directed to take a tug-boat and overhaul a ves- 
 sel that had proceeded down the Delaware River, 
 in order to serve some papers of legal importance 
 upon her master. The day was intensely hot, and 
 the small steamer afforded poor protection from 
 the sun. At the close of the day he returned to 
 his home complaining of headache, and lay down. 
 During the night he became unconscious, with all the 
 symptoms of sunstroke. He recovered, but for sev- 
 
40 THE SUMMER AND ITS DISEASES. 
 
 eral years suffered from distressing headache upon 
 exposure to heat. 
 
 Cases often occur in laundries, sugar-refineries, rail- 
 road depots and workshops. Dr. Swift states that 
 eleven persons were attacked on the same morning in 
 the laundry of a large hotel in New York. 
 
 Dr. Flint relates that eight cases of insensibility 
 from sunstroke were admitted to the Bellevue Hos- 
 pital on the 9th of August, 1862, and that of these 
 seven died. According to this author, 40 to 50 per 
 cent, of those attacked die, mild and grave cases taken 
 together. 
 
 Dr. H. C. Wood, to whom it will be necessary to 
 again refer, gives* the notes of eight cases seen in the 
 Pennsylvania Hospital, with but a single recovery. 
 In this climate the seizure generally occurs during the 
 hottest part of the day. One author states that of 
 sixty cases observed, forty occurred between 1 1 a. m. 
 and 4 p. m., seventeen between 4 and 9 p. m., and 
 three between 8 and 11 a. m. 
 
 Intemperance is universally acknowledged to be a 
 predisposing cause; so, also, are debilitating influences 
 of every kind, particularly those of such a character as 
 lower the tone of the nervous system and increase its 
 irritability. Among the latter group of influences 
 may be mentioned previous prolonged exposure to a 
 
 * Sunstroke. Boylston Prize Essay, by H. C. Wood, M. D> 
 1872. 
 
SUNSTROKE AND HEAT FEVER. 4 1 
 
 high temperature, not in itself sufficiently intense to 
 cause the disease, but having an unfavorable influence 
 upon the nervous system, and in this way impairing its 
 powers of resistance ; excessive fatigue, bad ventila- 
 tion, at night especially ; the febrile state, and the 
 debility following other diseases. 
 
 Owing to the different nature of the avocations of 
 the sexes, the affection is very much more common 
 among men than among women ; and in consequence, 
 in part, of their more delicate organization, and in 
 part of their ignorance of danger, numerous cases 
 occur among children. 
 
 Numerous writers concur in the opinion that the 
 plethoric, or " full habited," are more liable to sun- 
 stroke than others. 
 
 Whilst the foregoing conditions are predisposing 
 causes, that is to say, whilst they increase the liability 
 to the disease, the sole exciting cause, that is, the 
 cause which actually produces it, is heat, intense and 
 prolonged. Hence, no class of persons exposed to 
 its influence are exempt from danger, though the 
 avoidance of the unfavorable conditions enumerated 
 as predisposing causes diminish the danger pro tanio. 
 
 It is in recognition of its cause, that the malady has 
 been designated by such names as, heat apoplexy, 
 heat asphyxia, sun fever, coup de soleil, insolatio, 
 ictus solis, sunstroke. 
 
 The exact point on the scale at which the danger 
 4* 
 
42 THE SUMMER AND ITS DISEASES, 
 
 begins cannot be pointed out with certainty. It must 
 vary with the powers of resistance of the individual, 
 his condition at the time as regards acclimatization, 
 temperance, health and so forth, and with the condi- 
 tion of the atmosphere with reference to dryness and 
 moisture, electrical tension and the like. The views 
 of observers are conflicting upon this point ; but it is 
 probable that a moist atmosphere, as interfering with 
 free evaporation from the surface of the body, increases 
 the danger. And that electrical state of the atmos- 
 phere which precedes thunder-storms is generally 
 thought to be favorable to the occurrence of sun- 
 stroke. Various classifications have been made by 
 different authors with a view to simplify their descrip- 
 tions of the disease and render their accounts of it 
 more exact. It appears to me that most, if not all, 
 of the cases may be referred to one or the other of 
 two groups. 
 
 I. Cases of a severe form, coming on suddenly, with 
 but little warning, after exposure to the sun's rays, or 
 in an atmosphere of intense heat, either under cover 
 or out of doors. The attack is preceded by giddi- 
 ness, nausea, a confused blending of colors, and sharp 
 pain in the head. The symptoms last a short time. 
 In some instances the patient may scarcely have time 
 to speak of them before he falls to the ground un- 
 conscious, with noisy breathing, restlessness and con- 
 vulsions, or he may lie absolutely motionless. The 
 
SUNSTROKE AND HEAT FEVER. 43 
 
 pulse may be so rapid that it cannot be counted ; the 
 surface of the body is intensely hot, the temperature 
 reaching from 104° F. to no° F. Death may occur 
 in a few minutes, or the symptoms may last from six 
 to forty-eight hours. 
 
 In some cases instant death occurs, like that from 
 lightning-stroke, the patient falling forwards, gasp- 
 ing and dying before anything can be done to aid 
 him. These cases occur during active exertion. 
 When the attack occurs at night in bed, the first indi- 
 cation to those around is often the noisy breathing of 
 the unconscious patient. 
 
 To this form of the disease the name of sunstroke 
 is especially applicable. 
 
 II. The attack is generally sudden, often without 
 much chilliness. The face becomes flushed \ there is 
 giddiness and much headache, intolerance of light 
 and sound. The heat of skin is great ; pulse frequent, 
 full and firm. There is pain in the limbs and loins. 
 The respiration is anxious. There is a sense of op- 
 pression at the pit of the stomach, with nausea and 
 frequent vomiting of bilious matters. The bowels 
 are sometimes confined ; at others vitiated discharges 
 take place. The tongue is white, often with florid 
 edges. The urine is scanty and high-colored. If 
 the excitement continues unabated, the headache in- 
 creases, and is often accompanied with delirium. If 
 symptoms such as these persist for from forty-eight 
 
44 THE SUMMER AND ITS DISEASES. 
 
 to sixty hours, then the fever may subside, the skin 
 may become cold, and there will be risk of death 
 from exhaustion and sudden collapse. (Morehead.) 
 
 Or there is simple loss of nerve- force caused by 
 over-exertion during exposure to high heat. Such 
 cases may happen in the open air under the vertical 
 rays of the sun, or in the close and heated atmosphere 
 of furnace-rooms, laundries, or of crowded barracks 
 in India. The symptoms of such cases are a feeble 
 and moderately frequent pulse, a moist skin, head 
 generally hotter than the trunk, little or no change in 
 the pupil, a tendency to fainting on the slightest 
 exertion. (Levick.) These cases usually terminate in 
 recovery ; or the symptoms may after some hours be- 
 come intensified, and the signs of fully developed sun- 
 stroke, with profound disturbance of the nervous sys- 
 tem, unconsciousness, convulsions, palsies, may show 
 themselves. 
 
 Thermic fever, or heat fever, is the name given to 
 this form. 
 
 The difference between the two forms is one of 
 degree, not of kind. 
 
 The affection may then be looked upon as a fever 
 caused by heat, and running a rapid course. In some 
 instances, as has been seen, the nervous system is 
 speedily overwhelmed by the intensity of the fever, 
 and death occurs at once or in a few hours ; in others 
 the fever is of a milder type, resembling the hot 
 
SUNSTROKE AND HEAT FEVER. 45 
 
 stage of remittent fever, or transient irritative fevers 
 produced by other causes, and running a similar 
 course. But it is not to be forgotten that in this 
 form also there may be a sudden, rapid augmentation 
 of the fever, followed by the speedy death of the 
 patient. 
 
 Heat of skin is never absent ; it is attended with 
 dryness, and is, in most instances, intensely pungent 
 and stinging to the touch. When not dry, the skin 
 is bathed in a profuse perspiration. The tempera- 
 ture, as has been pointed out, may range from 104 
 to 110 during life or at the moment of death. 
 
 Giddiness and various disturbances of vision, with 
 congestion of the eyes, are present in most cases. 
 
 The debility is extreme ; there is inaptitude and 
 disinclination for mental or physical exertion. 
 
 Nausea and the vomiting of bilious matters also 
 occur. The bowels are sometimes constipated, some- 
 times there are repeated watery discharges. 
 
 The cutaneous perspiration is almost invariably 
 suppressed at the outbreak of an attack. 
 
 The urine is at the onset sometimes copious and 
 limpid, and the desire to void it frequent ; later it is 
 suppressed. 
 
 The action of the heart is rapid and sharp, the 
 pulse frequent, sometimes uncountable, tense, or fee- 
 ble, sometimes irregular. 
 
 A shout of mad laughter, or the frantic attempt to 
 
46 THE SUMMER AND ITS DISEASES. 
 
 escape in terror from some imaginary enemy, may 
 mark the onset of the seizure. A soldier seized the 
 piece from the hands of a sentry to defend himself 
 from such a foe. Sailors have with difficulty been 
 restrained from throwing themselves into the sea. 
 
 Insensibility supervenes ; the heat of the skin aug- 
 ments; the pupils may be dilated, normal, or con- 
 tracted, and are insensible to light ; the patient lies 
 motionless upon his back, or his body is distorted 
 with rapidly recurring convulsions. 
 
 The breathing grows more rapid and noisy ; mucus 
 collects in large quantities in the mouth and throat ; 
 the pulse grows feeble and flickering, and death 
 closes the scene. 
 
 An examination of the body after death reveals 
 the changes found at the termination of fatal cases of 
 the continued or essential fevers, so that one author 
 has supposed that, in consequence of the action of 
 heat, a poison analogous to that of typhus fever was 
 generated in the blood. This fluid is dark, thin, un- 
 coagulated, feebly alkaline, or even acid ; the right 
 side of the heart, and the branches of the pulmonary 
 artery, are distended, engorged with this dark fluid 
 blood ; so, also, are the vessels of the membranes of 
 the brain, though the brain tissue itself is not as a 
 rule notably congested. The heart substance is re- 
 markably firm, rigid. That setting of the muscles 
 which is known by the name of rigor mortis, takes 
 
SUNSTROKE AND HEAT FEVER. 47 
 
 place with great rapidity. There is no other char- 
 acteristic and constant change encountered. 
 
 In the rigidity of the heart, the morbid anatomy of 
 sunstroke differs from that of the other fevers, in 
 which that organ is always softened and flabby. 
 
 Prof. Wood, who produced sunstroke artificially 
 in animals, and was thus enabled to study its phe- 
 nomena, both during life and after death, with great 
 accuracy, and under varying conditions, comes to the 
 conclusion that this rigidity of the heart, and the re- 
 markably rapid stiffening of the body after death, are 
 due to the same cause, namely, coagulation of the 
 albuminoid fluid of the muscles, which is called My- 
 osin. He found that this muscle-juice coagulates 
 almost instantaneously at a temperature of 115 F., 
 and at a considerably lower temperature, if the 
 muscles have been in great activity before death.* 
 
 * The results of experimental physiology receive some curious 
 confirmations from other sources. It is well known to hunters 
 that the carcasses of animals slain after a long chase become 
 rigid with great rapidity. And some remarkable instances of 
 the instantaneous occurrence of rigor mortis on the battle-field, 
 i. e., when death has occurred during prolonged intense muscular 
 activity, are related by military surgeons. 
 
 Dr. Brinton [American Journal of the Medical Sciences, Jan., 
 1870) has collected a number of examples, among them the fol- 
 lowing : 
 
 While a detail of United States soldiers were foraging in the 
 vicinity of Goldsboro', N. C, they came upon a party of Southern 
 cavalry dismounted. The latter immediately sprang to their 
 saddles ; a volley at about two hundred yards' range was fired 
 at them, apparently without effect, as they all rode away, with 
 
48 THE SUMMER AND ITS DISEASES. 
 
 He further established the facts that heating the brain 
 of a mammal to 108 F. produced sudden insensi- 
 bility, with or without convulsions, and death when 
 1 1 3° F. is reached; that this effect of the local ap- 
 plication of heat is not due to congestion, but is the 
 result of the direct action of the heat upon the brain, 
 and that the centres of the nervous system are as un- 
 favorably affected by high heat as the muscles are ; 
 that the life of the blood is not destroyed by any 
 temperature reached in sunstroke; that there is no 
 
 the exception of one trooper. He was left standing with one 
 foot in the stirrup; one hand, the left, grasping the bridle-rein 
 and mane of his horse : the right hand clinching the barrel of 
 his carbine near the muzzle ; the butt of the carbine resting on 
 the ground. The man's head was turned over his right shoulder, 
 apparently watching the approach of the attacking party. Some 
 of the latter were about to fire a second time, but were restrained 
 by the officer in charge, who directed them to advance and take 
 the Southern soldier alive. In the meantime he was called upon 
 to surrender, without response. Upon a near approach and ex- 
 amination he was found to be rigid in death, in the singular 
 attitude above described. Great difficulty was experienced in 
 releasing the mane of the horse from his left hand, and the car- 
 bine from his right. When the body was laid upon the ground, 
 the limbs still retained the same position and the same inflexi- 
 bility. This man was shot through the body and the head, and 
 had, of course, died instantly. The horse had remained quiet, 
 being fastened by a halter. 
 
 It is related that a party of German officers were dining in a 
 trench before Paris, and that by the explosion of a shell near at 
 hand one of their number was instantly killed, a portion of his 
 skull being torn off. His body remained in the sitting position, 
 and his arm extended, rigid, still holding the cup, in which was 
 some wine remaining, upraised. 
 
SUNSTROKE AND HEAT FEVER. 49 
 
 specific poison, like that of typhus, for example, de- 
 veloped in the blood by the action of heat, but that 
 the deterioration of this fluid is due to rapid tissue 
 changes induced by the fever-process, and the more 
 or less complete arrest of secretion ; that these changes 
 in the blood are secondary to changes in the nervous 
 system, not primary; and that if the heat be with- 
 drawn before it has produced permanent injury to the 
 nervous system, the blood or other tissues, the uncon- 
 sciousness, and other symptoms immediately disap- 
 pear, and recovery takes place. The conditions with 
 which sunstroke is most likely to be confounded are 
 apoplexy of the brain, and insensibility produced by 
 alcohol or other narcotics. 
 
 A person walking in the street is seen to totter ; he 
 sits down, and soon sinks to the earth, or he may 
 fall at once ; or a workman lets his tools drop from 
 his hands, and in a moment falls to the ground. On 
 examination, he is found to be in a state of uncon- 
 sciousness. He lies quiet, or there may be restless- 
 ness, and rarely talkative delirium ; still more rarely 
 he may be aroused for an instant by shaking or shout- 
 ing in his ear. Of the other symptoms, most of which 
 have been enumerated above, many would escape the 
 attention of an untrained observer ; others might not 
 at once appear. One is, however, constant, and most 
 readily recognized. It is the intense heat of skin. It 
 almost scorches the hand. This is of the utmost value as 
 pointing to coup de soliel. Or the patient may have 
 5 P 
 
50 
 
 THE SUMMER AND ITS DISEASES. 
 
 been found insensible, and his life may depend upon 
 the prompt action of the bystanders. The discrimi- 
 nation of these conditions is then of the greatest prac- 
 tical value. A comparison of the principal symptoms, 
 as arranged in columns, will be of service as fixing 
 them in the memory. 
 
 Apoplexy. 
 Attack sudden, 
 
 Insensibility usually 
 complete for a vary- 
 ing length of time. 
 
 Breathing snoring. It 
 is slow, irregular, 
 and explosive in ex- 
 piration. 
 
 No convulsions. 
 
 Paralysis of one side 
 
 or the other. 
 Flushing of face. 
 
 Pupils often uneven. 
 
 Sunstroke. 
 
 Attack sudden, but 
 usually preceded by 
 dizziness, disturbed 
 vision, headache. 
 
 Deep insensibility of 
 shorter duration. 
 Patient may often 
 be roused by shout- 
 ing or shaking. 
 
 Also snoring breath- 
 ing. Apt to be rapid 
 and labored; noisy 
 from presence of mu- 
 cus in the upper air- 
 passages ; not ex- 
 plosive. 
 
 Convulsions often re- 
 cur. Twitchings of 
 muscles. 
 
 No paralysis. 
 
 Face often deeply 
 flushed ; or, together 
 with the whole sur- 
 face, it may be of a 
 dusky hue. 
 
 Pupils alike; immova- 
 ble ; they may be 
 contracted, dilated, 
 or about normal. 
 
 Alcoholic Intoxica- 
 tion. 
 
 Insensibility comes on 
 gradually after the 
 stage of excitement. 
 
 Insensibility 
 complete. 
 
 rarely 
 
 Respiration slow and 
 snoring. 
 
 No convulsions. 
 
 No paralysis. 
 
 Face dusky and bloat- 
 ed. 
 
 Pupils alike. 
 
SUNSTROKE AND HEAT FEVER. 5 I 
 
 Apoplexy. Sunstroke. 
 
 Alcoholic Intoxica- 
 tion. 
 
 Pulse slow and full. Pulse very rapid and Pulse slow, 
 
 sharp ; often want- 
 ing in volume. 
 
 Skin cool and moist. Skin intensely hot. Skin cool and leaky. 
 
 Usually burning and 
 pungent to the touch, 
 and exceedingly 
 
 dry. More rarely 
 it is bathed in a pro- 
 fuse perspiration. 
 
 Heat fever in its milder forms can only be distin- 
 guished from other transient febrile states by a care- 
 ful inquiry into the cause ; in graver cases the inten- 
 sity of the fever-process, and the history of exposure 
 to a high temperature, serve to indicate the true 
 nature of the malady. The absence of the initial 
 chill of remittent and other malarial fevers, ought to 
 enable the observer to distinguish it readily from the 
 hot stage of these periodical diseases. 
 
 For months after the attack, the patient is liable to 
 suffer from irritability and exhaustion of his nervous 
 system. Headache of a persistent character, always 
 aggravated by exposure to the hot sun, and by pro- 
 longed mental effort, is apt to trouble him. This is 
 usually due to an irritable condition of the coverings 
 of the brain, and, after a time, passes off; it is, how- 
 ever, sometimes symptomatic of chronic inflammation 
 of the brain-coverings. Epileptic fits have followed 
 recovery from sunstroke in some instances, particu- 
 
52 THE SUMMER AND ITS DISEASES. 
 
 larly in those who have been subject to them in 
 childhood, or who have inherited a tendency to them. 
 Saint Vitus's dance is an occasional result. Insanity 
 sometimes follows. Maclean relates that an officer of 
 distinction lost his cap while pursuing a wild hog, 
 and, in the excitement of the chase, rode for miles 
 bareheaded. Sunstroke resulted ; his mind was af- 
 fected, and complete recovery never took place. 
 
 Those who have suffered from sunstroke are, for a 
 long time, unfitted to live in tropical climates. 
 
 The Treatment of Sunstroke. — If the theory of the 
 disease sketched in the foregoing pages be correct, 
 the indications for treatment are sufficiently evident. 
 
 i. The disease is of the nature of a fever of great 
 intensity, induced by the action of heat upon the 
 nervous system. 
 
 2. The insensibility, convulsions, rapid action of 
 the heart, hurried, labored respiration, all indicate 
 depression, not exaltation, of vital processes. 
 
 3. The dry skin, the suppression of urine, consti- 
 pation, or vitiated discharges if diarrhoea be present, 
 point to the action of heat upon that portion of the 
 nervous system which controls secretion, and tend 
 speedily to affect the quality of the blood by favor- 
 ing the retention of the products of tissue-waste, 
 which goes on with great rapidity in consequence of 
 the intensity of the fever-processes. 
 
 The object of treatment, then, is threefold : 
 
SUNSTROKE AND HEAT FEVER. 53 
 
 The abstraction of heat. 
 
 Stimulation. 
 
 The restoration of the functions of the excretory 
 glands. 
 
 The patient should immediately be removed to the 
 nearest shade. Valuable time — indeed, life itself — 
 may be lost, in transporting him a long distance to 
 his home or to a hospital. Besides, in addition to 
 the delay in instituting treatment, it almost always 
 involves further exposure to the sun's rays. 
 
 Medical aid must be at once summoned ; mean- 
 while, much may be done by those at hand. 
 
 His clothing being removed, he is to be placed 
 upon his back, with the head and shoulders slightly 
 raised, and cold water poured freely upon his head, 
 neck, and chest. The sole object of this procedure 
 is to reduce temperature ; it is not, therefore, neces- 
 sary to use the douche with force. Indeed, in some 
 cases, it is not admissible at all, because it excites 
 convulsions or causes pain. 
 
 Ice may be rubbed over the surface of the body, 
 and pieces of ice wrapped in towels are to be held in 
 the armpits. 
 
 Cold-water injections are to be administered. If 
 the circumstances admit of it, the patient may be 
 placed in a cold bath (50 F.). 
 
 As the temperature of the body falls, the pulse 
 becomes slower, the breathing more natural, con- 
 sciousness returns. 
 5* 
 
54 THE SUMMER AND ITS DISEASES. 
 
 These are powerful measures, and capable of doing 
 harm if persevered in for too long a time. 
 
 Signs of improvement are a measure of their suc- 
 cessful action in abstracting heat. An accurate guide 
 is the actual temperature as taken by the thermometer 
 in the bowel or in the armpit every ten or fifteen 
 minutes. 
 
 After the temperature has fallen, and even a de- 
 cided amelioration of the symptoms has taken place, 
 there is not infrequently a relapse ; the temperature 
 rises again, and insensibility may again come on. 
 This may be avoided by occasional cold sponging, 
 fanning, and the like. It must be treated by recourse 
 to the same energetic measures to abstract heat. 
 
 Stimulating injections are to be administered ; 
 they have the additional advantage of occasioning a 
 movement of the bowels. Diarrhoea, however, should 
 not prevent their employment. An ounce of turpen- 
 tine beaten up with an egg, and then stirred into a 
 sufficient quantity of soapsuds, will be found useful 
 and convenient. Ammonia may be held to the nos- 
 trils. Mustard-plasters are to be applied to the ankles 
 and wrists, and, if the circulation flag, over the region 
 of the heart and along the spine. As soon as the 
 patient can swallow, he may be allowed iced brandy- 
 and-water in moderation. If he vomit, so much the 
 better — the act relieves the chest of accumulated 
 mucus. 
 
SUNSTROKE AND HEAT FEVER. 55 
 
 If the bowels be stubbornly confined, an injection 
 of castor-oil should be administered, or a drop of 
 croton-oil may be given. If the secretion of the 
 kidneys be not reestablished, dry cups must be ap- 
 plied to the loins, or four or six ounces of blood may 
 be removed by cut cups. As improvement takes 
 place, frequent sponging of the whole body with 
 vinegar and water, and the free use of the alkaline 
 mineral waters, are beneficial. 
 
 The patient must be kept absolutely at rest. If 
 mucus accumulate in the throat and mouth, he must 
 be turned upon his side, or even upon his face. 
 
 Hypodermic injections of morphia (gr. ^ to |) are 
 useful. 
 
 On no account is general blood-letting to be prac- 
 tised. 
 
 The management of the milder forms of heat fever 
 is very simple. But in all cases medical advice is to 
 be sought. 
 
 To those exposed by their avocations to the action 
 of high heat, a few words of advice as to the pre- 
 cautions by which the dangers of sunstroke may be 
 lessened. 
 
 Temperance in living ; the greatest moderation in 
 the use of alcoholic beverages, or, better still, total 
 abstinence ; cleanliness ; frequent bathing and fric- 
 tion of the skin. Puddlers, furnace-men, persons who 
 fire china-ware, expose themselves with impunity to 
 
$6 THE SUMMER AND ITS DISEASES. 
 
 a temperature far above that of the body in sunstroke, 
 for the reason that the skin acts freely. It is bathed in 
 a proper perspiration, which evaporates with a rapidity 
 proportionate to the surrounding heat, and in this way 
 keeps the body at its normal temperature. With a 
 dry, non -acting skin, thin men would scorch. The 
 clothing should be light and loose ; thin flannel is the 
 best underwear for the body. The head covering must 
 be light and wide, so as to protect the face and neck. 
 The evaporation from a wet handkerchief, or the 
 countryman's cabbage-leaf in the hat, keeps down the 
 heat. Over-fatigue is to be shunned and long hours 
 of rest courted. The sleeping-place must be the cool- 
 est possible, and well ventilated. 
 
CHAPTER III. 
 
 SUMMER DIARRHCEA AND DYSENTERY. 
 
 DIARRHCEA and dysentery occur at all seasons 
 of the year and in all climates, but they are 
 most common within the tropics, and elsewhere 
 most frequent in hot seasons. 
 
 TABLE 
 
 SHOWING THE MORTALITY IN PHILADELPHIA FROM DIARRHOEA 
 AND DYSENTERY IN EACH MONTH OF THE YEAR 1 878. 
 
 1878. 
 
 
 
 V 
 
 Q 
 
 a 
 
 
 a 
 
 s 
 
 < 
 
 
 <u 
 
 
 3 
 <3 
 
 a. 
 
 CO 
 
 
 
 O 
 
 > 
 
 
 Diarrhoea 
 
 8 
 
 7 
 
 4 
 
 6 
 
 6 
 
 12 
 
 9 
 
 19 
 
 23 
 
 12 
 
 8 
 
 7 
 
 Dysentery.... 
 
 2 
 
 3 
 
 2 
 
 2 
 
 2 
 
 3 
 
 6 
 
 13 
 
 9 
 
 8 
 
 3 
 
 2 
 
 
 Winter, 
 
 26. 
 
 Spring, 
 
 3*- 
 
 Summer, 79. 
 
 Autumn, 40. 
 
 Deaths reported under the heading of Cholera-In- 
 fantum and Cholera-Morbus, are not included in this 
 table. Exclusive of these, it is seen that simple non- 
 epidemic affections of the bowels are much more fre- 
 
 57 
 
58 THE SUMMER AND ITS DISEASES. 
 
 quently fatal in summer than in the other seasons ; the 
 ratio being about 3 to i for the winter; 2.5 to 1 for 
 the spring, and 2 to 1 for the autumn. But it is not 
 to be forgotten that the acute form of the affections 
 arising in summer, from causes prevalent at that season, 
 may run on into the chronic form, and destroy the 
 life of the patient after many weeks, or even months, 
 of sickness. That this is the cause of the . excess of 
 the mortality for the autumn, as compared with the 
 spring, cannot be doubted. 
 
 A brief consideration of the morbid processes which 
 characterize these affections of the bowel, and the 
 causes that give rise to them, will serve to explain 
 their greater frequency in hot weather and in hot 
 climates. Our knowledge of the diseases will, how- 
 ever, be gained with less difficulty, if it is sought in 
 connection with some general knowledge of the ana- 
 tomical structure of the bowels, and their physiological 
 action in health. 
 
 The bowel (or intestine) consists of a membranous 
 tube about twenty-five feet in length, and of varying 
 diameter ; its upper or narrower portion, about twenty 
 feet in length, is called the small intestine : its lower 
 portion, which is of much greater diameter and about 
 five feet in length, the large intestine. It is capable 
 of contracting when empty, and of very great dis- 
 tention by its contents, particularly under some con- 
 ditions of disease. The large and small intestines 
 
SUMMER DIARRHCEA AND DYSENTERY. 59 
 
 are each divided into parts, which are rather of con- 
 venience for anatomical description than based upon 
 anatomical differences of structure. The whole lies 
 coiled up in the cavity of the belly, at various points 
 attached directly to the posterior wall of the cavity 
 and to other organs, but in the main supported by a 
 membranous fold of the peritoneum {mesentery) which 
 encircles the bowel forming its outer layer, and passes 
 back to be attached to the parts in the neighborhood 
 of the back-bone, thus allowing a certain amount of 
 freedom of motion to the bowels within the cavity in 
 which they lie. The upper end of the bowel is given 
 off directly from the stomach. This great tube is 
 very far from being a simple membranous canal. It 
 consists of three layers, one outside the other, held 
 together by delicate sheets of connective tissue. There 
 are, first, the outer layer {serous), spoken of above; 
 secondly, the muscular layer, consisting of fibres en- 
 circling the tube, and others running lengthwise; and, 
 third, the mucous layer, which is innermost, and con- 
 stitutes the lining of the tube. This inner layer is 
 richly supplied with glands of several kinds. It is 
 thrown up into innumerable folds, which vastly in- 
 crease its extent of surface; and it is penetrated al- 
 most to its surface by fine blood-vessels and absorb- 
 ent vessels, the walls of which reach so near the free 
 surface, as to be in many places only covered by a 
 thin layer of the cells (eptthelid) which cover the 
 
60 THE SUMMER AND ITS DISEASES. 
 
 mucous membrane. This surface presents, besides 
 the folds spoken of above, innumerable minute pro- 
 jections {villi), which give it a velvety appearance ; 
 they contain the finest twigs of the lacteal or absorb- 
 ent vessels. Between the muscular and mucous layers 
 are placed the nerves of the bowels, and the blood- 
 vessels which constitute an extremely rich and fine 
 net-work. At a distance of nearly four inches from 
 its upper end, the common tube which conveys the 
 fluids secreted by the liver (the bile) and by the 
 pancreas, or sweet-bread (the pancreatic juice), the 
 two great digestive glands of the body, enters the 
 bowel. 
 
 The function of the bowel is much more than a mere 
 mechanical one. The processes of digestion, begun 
 so actively in the stomach, are here continued. And 
 it is through the walls of the intestines, by means of 
 the lacteal vessels contained in the villi, and the walls 
 of the blood-vessels which so closely approach the 
 surface, that the absorption of the digested food-sub- 
 stances takes place. In order that absorption may 
 take place, the processes of digestion must prepare 
 the food. Putrefactive decomposition, with the pro- 
 duction of excess of gases, is prevented by the bile, 
 which aids also in converting part of the fat into a 
 soapy solution, and which by its presence otherwise 
 aids in the digestion of fats; the pancreatic juice 
 converts starchy substances into sugar with energy, 
 
SUMMER DIARRHCEA AND DYSENTERY. 6 1 
 
 and, like the bile, digests the fatty portions of the 
 food ; the juices secreted by the intestinal glands 
 possess a feeble digestive power, but are endowed with 
 the property of dissolving various principles of the* 
 food (fibrin, albumen), and of converting cane-sugar 
 into grape-sugar. No portion of the food can be ab- 
 sorbed except in complete solution, and the juices 
 of the bowel not only effect this solution by the 
 various chemical processes just spoken of, but they 
 also supply the amount of fluid necessary for the pur- 
 pose. During digestion, these juices are secreted and 
 reabsorbed with marvellous energy, and in enormous 
 amounts. But the food eaten is not all of it capable 
 of complete digestion; much is insoluble, inert, mere 
 bulk, and incapable of supplying the wants of the 
 body. This must be moved inwards to be ultimately 
 expelled. This is the function of the muscular coat 
 of the bowel. The encircling fibres contract from 
 above downwards in waves, which sweep the contents 
 of the bowel onwards before them, a process in which 
 the longitudinal fibres aid. This is called the ver- 
 micular or worm-like motion of the bowel. These 
 fibres belong to the muscular system of organic life, 
 as it is called, and their action is not under the control 
 of the will. They contract under the influence of lo- 
 cally acting causes, as for example the distention of the 
 intestinal tubes by partially digested food and the like, 
 and being independent of the brain, they have a supply 
 6 
 
62 THE SUMMER AND ITS DISEASES. 
 
 of minute nerve-centres {ganglia) of their own. The 
 processes above described take place most actively in 
 the small intestine, but absorption still goes on in 
 • the large intestine, as is shown by the facts that the 
 bowel contents, hitherto fluid, here lose moisture, and 
 begin to solidify, and that nutritious and medicinal 
 substances introduced into the bowel disappear, and 
 produce constitutional effects. 
 
 It is very important to bear in mind that the walls 
 of the blood-vessels lie so near the surface of the 
 mucous membrane, that the absorption of some of the 
 dissolved food-substances takes place by simple dif- 
 fusion through them ; for if fluid, under the ordinary 
 circumstances of health, can thus enter the blood, it 
 is not difficult to understand that it may, under cir- 
 cumstances of disease, pass in the opposite direction 
 out from the blood-vessel into the bowel. 
 
 The morbid processes which give rise to diarrhoea, 
 may consist of an intensification of the healthy physio- 
 logical processes, such as increased action of the mus- 
 cular coat, by which the fluid contents of the small 
 intestine are too rapidly hurried on, or an excess of 
 the secretions of the liver or pancreas, or of the in- 
 testinal glands themselves, giving rise to an amount 
 of fluid too great to be readily absorbed, or incapable 
 of absorption by reason of alterations in its character, 
 or the passage of the watery portions of the blood 
 into the cavity of the bowel, such as has been above 
 
SUMMER DIARRHOEA AND DYSENTERY. 63 
 
 spoken of; or, on the other hand, diarrhoea may be 
 due to an arrest of the function of absorption, or these, 
 conditions may be, as is probably most frequently the 
 case, variously combined. 
 
 The abundant blood-supply of the bowels, their 
 great functional activity, the elaborateness of their 
 organization, and the complexity of the processes 
 taking place in them, render them extremely liable 
 to functional and to inflammatory derangements, 
 both primary, that is, having their cause in the in- 
 testines themselves ; and secondary, that is, dependent 
 upon disorders of other organs, or diseases of distant 
 parts of the body. 
 
 Diarrhoea is a symptom of disease rather than a 
 disease itself. In the simplest forms of diarrhoea, the 
 symptom constitutes the chief, if not, indeed, the only, 
 manifestation of illness, both to the patient and the 
 doctor ; and with the relief of the diarrhoea a cure is 
 established. 
 
 Disturbances of the nervous system and intense 
 mental emotion occasionally give rise to transient 
 diarrhoea. Dr. Flint relates the case of a surgeon 
 who, whilst performing an important operation, was 
 so affected by anxiety and the sense of his responsi- 
 bility, that a violent attack of diarrhoea immediately 
 came on, and he was obliged to relinquish his instru- 
 ments, and retire from the room. 
 
 Exposure to cold not infrequently gives rise to this 
 
64 THE SUMMER AND ITS DISEASES. 
 
 affection by driving the blood from the surface of the 
 body to the internal organs, thus producing in the 
 bowel an excess of blood (congestion), which is re- 
 lieved by the escape of the watery parts into the 
 bowel, and an increased production of fluid by the 
 intestinal glands. 
 
 The affection known as "cold," or "catching 
 cold," (see Chapter VI.,) sometimes manifests itself 
 as a diarrhoea; and a "cold in the head" is not 
 infrequently attended by slight, transient diarrhoea, 
 particularly as it is passing off. 
 
 Exposure to intense heat may also occasion diar- 
 rhoea, which is then probably due to some disturb- 
 ance of the nervous system. The abrupt alternations 
 of hot day temperatures with cool night tempera- 
 tures, is particularly apt to produce it. Over-exertion 
 is likewise not an infrequent cause. Malarial influ- 
 ences are often concerned in the production of diar- 
 rhoea, which may then be of an intermittent type. 
 And in this connection are to be mentioned a numer- 
 ous group of diarrhoeas due to the inhalation of sewer- 
 gases, the emanations from cesspools, from decaying 
 animal and vegetable substances, the accumulations 
 of filth about ill-kept yards and dwellings, and the 
 like causes which abound in hot weather, which are 
 very destructive to health, and which are entirely 
 within the control of man. Such atmospheric influ- 
 ences, even when powerless in themselves to originate 
 
SUMMER DIARRHCEA AND DYSENTERY. 65 
 
 disease, are active in keeping it up. I once saw- 
 several cases of simple diarrhoea, of a most obstinate 
 character, in one wing of a hotel at the seaside, which 
 was evidently kept up by the emanations from priv- 
 ies, so situated that the prevailing winds blew over 
 them into this part of the house. Elsewhere in the 
 hotel similar cases recovered in a few days. And all 
 of the cases in question at last promptly got well, 
 some on being transferred to the main part of the 
 hotel, others on being sent elsewhere. 
 
 The drinking of water contaminated by similar 
 substances is a cause of diarrhoea not to be overlooked. 
 Diarrhoea is often attributed to change of water by 
 those travelling, when it is in fact due to other causes, 
 errors of diet, exhaustion, and the disarrangement of 
 the regular habits of life. 
 
 Children and young infants are especially prone to 
 affections of this kind, particularly when teething, 
 and in summer. The affection known as cholera-in- 
 fantum, or summer complaint, will be considered in 
 the next chapter. 
 
 But the most common cause of diarrhoea is defec- 
 tive or arrested digestion, especially that part of the 
 whole process which goes on in the intestines. The 
 diarrhoea which follows imprudence in eating, both in 
 the quality and the quantity of the food, is familiar 
 to every one. Particular articles of diet will always 
 cause the disorder in some individuals. Articles 
 6* E 
 
66 THE SUMMER AND ITS DISEASES. 
 
 capable of producing chemical or mechanical irrita- 
 tion of the delicately organized lining membrane of 
 the bowel, will give rise to diarrhoea. Coarse, indi- 
 gestible articles of food, unripe fruit, or fruits con- 
 taining indigestible seeds, or the acid or sub-acid 
 fruits in excess, and large amounts of coarse vege- 
 tables, containing much fibrous matter, may be enu- 
 merated among these. When the digestion is en- 
 feebled, as it is during the heats of summer, or when 
 the intestines are unduly sensitive, the ordinary food, 
 or even a restricted diet, may be the cause of the 
 trouble. In some cases the accumulation and reten- 
 tion of hardened masses in the bowel occasions diar- 
 rhoea by their acting as a mechanical irritant, just as 
 coins, rings, and the like, when accidentally swal- 
 lowed, may occasion similar trouble, which usually 
 forthwith subsides as soon as they are voided. This 
 is true of most of the simpler forms of diarrhoea. As 
 soon as the offending substance, the irritant, is voided, 
 the trouble to which it has given rise ceases, unless 
 inflammation has resulted, in which case the diarrhoea 
 may continue, but with a tendency to ultimate re- 
 covery. 
 
 Diarrhoea is a symptom of various constitutional 
 states and diseases; among these, general debility 
 from various causes, from deprivation of food, from too 
 long-continued nursing, may be mentioned ; so also 
 congestions of the liver and other organs, the last 
 
SUMMER DIARRHCEA AND DYSENTERY. 6? 
 
 stages of consumption, and of some forms of Bright's 
 disease of the kidneys. In the last of these it is not 
 to be incautiously checked, as by this means the 
 tissue-waste, which the diseased kidneys are no longer 
 able to discharge from the body, is gotten rid of. 
 
 Pain is usually present ; it is often of a colicky 
 nature, and relieved by an action of the bowels. It 
 is apt to be more or less constant, with tenderness 
 when there is actual inflammation {enteritis), in which 
 case fever is present. Diarrhoea is occasionally unat- 
 tended by pain of any kind. The movements of the 
 bowel may vary in number from three or four in the 
 twenty-four hours to twenty or more ; and their 
 character is not less variable than their number. If 
 the attack be due to acute indigestion from an over- 
 loaded stomach, or other cause, vomiting may be 
 present ; it does not, however, as a rule occur. 
 
 The inflammation of the mucous membrane of the 
 bowel may assume the chronic form, or ulceration 
 may occur, and chronic diarrhoea result. It is of the 
 utmost importance that the cause of every case of 
 diarrhoea should be at once ascertained and corrected, 
 and that the diarrhoea itself, if it do not shortly cease, 
 be promptly treated. The adage, " Resist the begin- 
 nings of evil," is especially applicable here. 
 
 The exhausting heats of summer, the direct action 
 of the sun, the suddenness of temperature changes, 
 and the diminished protection against them afforded 
 
68 THE SUMMER AND ITS DISEASES. 
 
 by lighter clothing, the vicissitudes of hotel life and 
 of travel, the disarrangement of confirmed habits of 
 living, all increase the liability to bowel disorders. 
 Then changes in the character of the food, the larger 
 proportion of vegetables and fruits consumed, the 
 more perishable nature of food-substances, and the 
 greater risk of their having undergone slight putre- 
 factive changes, the drinking of unaccustomed water, 
 and the greater danger of its not being pure in the 
 hot season, likewise exert their influence in favoring 
 the development of these diseases. 
 
 Fortunately, the greatest number of the cases of 
 summer diarrhoea in adults are of a simple character, 
 and cease upon the removal or avoidance of the cause, 
 which is, as a rule, not difficult to discover. 
 
 It is very important that those prone to affections 
 of the digestive organs should learn to recognize the 
 special exciting causes in their own cases, and so 
 avoid them. If it be cold, or the abruptness of tem- 
 perature changes, a light flannel bandage under the 
 merino underwear of summer should be used, and ex- 
 posure to draughts of air carefully shunned, especially 
 when fatigue exerts its depressing influences ; if the 
 change of water, a dash of essence of ginger may 
 avert trouble ; if the danger lurks in certain craved- 
 for dishes, fortitude may take a lesson from not un- 
 forgotten pangs ; if in foul air and stenches, refuge 
 must be taken in flight to purer haunts. 
 
SUMMER DIARRHCEA AND DYSENTERY. 69 
 
 Exhaustion and fatigue enter largely as factors in the 
 production of summer diarrhoea. Many things, at other 
 times harmless, act as exciting causes when we are 
 tired and used up. It is important, then, to husband 
 the forces of the body as far as possible, and, when 
 unavoidably worn out, to be unusually vigilant about 
 what we eat and drink, and put on or put off in the 
 way of raiment. 
 
 The management of a simple case of diarrhoea de- 
 mands the consideration of four points : (1,) the re- 
 moval of the cause ; (2,) repose of the body; (3,) bland 
 nourishment; (4,) medicine, if required. 
 
 (1.) After what, has been said concerning the causes, 
 it is only necessary to add that, if there be offending 
 material, such as undigested food, hardened masses of 
 substance that should have been expelled, etc., still 
 retained in the bowel and acting as an irritant, it 
 must be got rid of. To this end, mild laxatives are to 
 be employed, and we, most of us, still trust to the use 
 of the household remedy of a tablespoonful of castor- 
 oil with laudanum (from 1 or 2 to 15 or 20 drops, ac- 
 cording to the age of the patient and the urgency of 
 the distress). A solution of the citrate of magnesia 
 may be used, if it can be obtained. The necessity 
 for measures of this kind will be determined by in- 
 quiry into the urgency and the character of the attack. 
 
 (2.) Just as fatigue has a large influence in causing 
 diarrhoea, so over-exertion is baneful in keeping it up. 
 
yO THE SUMMER AND ITS DISEASES. 
 
 I do not mean that which would constitute over-exer- 
 tion to the individual in his usual health — far less 
 any amount of bodily exertion which is attended by 
 effort in his sickness. There is scarcely any remedy 
 so useful in acute intestinal disorders as repose, abso- 
 lute rest in the recumbent posture, or as nearly that 
 as is practicable. 
 
 (3.) The diet must be regulated. All articles dif- 
 ficult of digestion must be eschewed. Milk and the 
 milk-foods, the lighter starch-foods, farina, rice, and 
 the like, custards, meat-broths, small quantities of the 
 red meats, under-done, and dry bread a day old, or 
 toasted and in restricted quantities, make up the bill 
 of fare. Food should be taken often and in small 
 amounts. A little red wine and water, or sound spir- 
 its well diluted, or wine whey, will be advantageous 
 in counteracting debility. 
 
 (4.) In many cases no medicines will be needed. 
 The medicine-chest will afford a drop or two of chlo- 
 rodyne, a teaspoonful of paregoric, or five drops of 
 laudanum for the adult, and domestic medicines will 
 attend to the application of spice- or mustard-plasters, 
 or mush poultices with mustard and plenty of grease, 
 if the pain is continuous or severe. If these fail, send 
 for the nearest doctor of repute and experience. 
 
SUMMER DIARRHCEA AND DYSENTERY. ?I 
 
 Cholera- Morbus is the name given to an affection 
 of the stomach and bowels common enough in hot 
 weather, and rarely seen in this climate at other sea- 
 sons. In many respects it resembles true or Asiatic 
 cholera, and the more severe cases can only be dis- 
 tinguished from that pestilence by the fact that the 
 disease in question does not occur in an epidemic 
 form. At the outbreak of epidemics of cholera, these 
 two affections are not distinguishable, and in fact they 
 have much in common, the chief points of difference 
 being connected with difference of causation and the 
 far milder course of cholera-morbus. 
 
 This disease is therefore sometimes described under 
 the names European cholera, English cholera, and, 
 from its occurring in isolated or single cases, spo- 
 radic * cholera. 
 
 The attack is often sudden ; it may, however, be 
 preceded for a few hours by a sense of discomfort in 
 the bowels, with colicky pains, nausea, and slight 
 diarrhoea. It occurs most frequently at night, and 
 begins with vomiting, to which speedily succeeds 
 purging, only to be followed again by repeated vom- 
 iting and purging in rapid succession. With these 
 symptoms are associated pains of a crampy or colicky 
 nature in the pit of the stomach and over the whole 
 of the abdomen, anxiety, a sense of oppression and 
 
 * Sporadic, "scattered," from ansifxo, "I sow." 
 
72 THE SUMMER AND ITS DISEASES. 
 
 great general distress. The acts of vomiting are sud- 
 den and forcible, and the matters vomited consist at 
 first of the food that has been taken ; later, of fluid 
 of an acid or acrid character, and bitter to the taste 
 from the admixture of bile. The evacuations from 
 the bowels are large, and attended with pain in the 
 abdomen and pain of a bearing-down character. As 
 the attack progresses they become watery in consist- 
 ence, and in severe cases they are sometimes color- 
 less, and resemble the "rice-water" discharges of 
 epidemic cholera. There is sometimes severe pain 
 in the back. 
 
 Thirst is urgent ; it is only momentarily relieved 
 by drinking, which is apt to provoke vomiting. 
 There is not usually great tenderness over the ab- 
 domen. Cramps occur in various parts of the body. 
 The patient is pale, haggard, restless, and exhausted 
 in proportion to the length and intensity of his suf- 
 ferings. The pulse is feeble, the skin cool, or even 
 cold, and is often covered with sweat. 
 
 The attack is usually of only a few hours' duration. 
 The vomiting and purging become less frequent, the 
 pains subside, thirst is less urgent, the anxiety and 
 restlessness are calmed, and the patient falls asleep. 
 Irritability of the stomach and slight diarrhoea may 
 last a few days, but complete recovery takes place in 
 most cases with a rapidity that is remarkable when 
 considered in relation to the violence of the attack 
 
SUMMER DIARRHCEA AND DYSENTERY. 73 
 
 and the urgency of the symptoms. But this is not 
 always the case. Elderly persons, and those who are 
 debilitated by previous disease, not unfrequently make 
 tardy recoveries. A gentleman under my observa- 
 tion, who had suffered from long-continued dyspeptic 
 troubles, was many months in regaining his usual 
 health after a sharp attack of cholera-morbus, which 
 left him with great and persistent irritability of the 
 stomach, and a troublesome tendency to diarrhoea. 
 
 In rare cases the affection pursues an unfavorable 
 course to a fatal ending. The vomiting and purging 
 go on uncontrolled, the pulse grows feebler, the face 
 becomes pinched, the surface cold and shrivelled, 
 and death takes place in the course of a few hours. 
 
 This affection presents in most instances the symp- 
 toms of very great disturbances of the nervous system, 
 and frequently occurs in those who are exhausted from 
 over-exertion, worriment, or anxiety. It spares no age, 
 but attacks with diminishing frequency the old, and 
 less often women than men. It is extremely common 
 and frightfully fatal in infancy, and constitutes the 
 disease known as cholera-infantum, hereafter to be 
 considered. Indigestion must in many cases be re- 
 garded as the exciting cause, and the eating of certain 
 articles of food, such as fruit, ices, and animal food not 
 perfectly fresh, often appears to have caused the attack. 
 It is sometimes attributed to copious draughts of iced 
 water, taken by persons who are tired and overheated. 
 7 
 
74 THE SUMMER AND ITS DISEASES. 
 
 The pain is in part due to spasm of the muscular 
 walls of the stomach and intestines, in part to neu- 
 ralgia. The large quantity of fluids lost by vomiting 
 and purging is due to a direct transudation or leakage 
 of the watery portions of the blood through the walls 
 of the vessels into the stomach and bowels, to which 
 is also due in part the pinched expression of the face ; 
 while the anxiety, restlessness, and tendency to col- 
 lapse are to be referred to a profound disturbance of 
 the sympathetic (or vaso-motor) nervous system. 
 
 These are the chief points of treatment, set down 
 in the order of their importance: — (i,) To tran- 
 quillize the irritated nervous system; (2,) to check the 
 vomiting and purging; (3,) to relieve pain; (4,) to 
 assuage the torturing thirst; (5,) to induce sleep, and 
 (6,) to secure rest and a suitable diet during the rapid 
 convalescence. 
 
 The drug upon which reliance can be placed to 
 meet the greater number of these indications is 
 opium. It tranquillizes the nervous system, it checks 
 the movements of the bowels and quiets the stomach, 
 it is the foe of pain, it induces sleep. It may be 
 given in various ways, and various preparations of it 
 may be used. The hypodermic syringe in the doctor's 
 hands is a heaven-sent blessing in these cases. A 
 quarter of a grain of morphia thus given, and, if nec- 
 essary, once or twice repeated, will work wonders. 
 Twenty drops of laudanum (the deodorized) in a tea- 
 
.SUMMER DIARRHCEA AND DYSENTERY. ?$ 
 
 spoonful of water may be given to an adult while the 
 doctor is coming. It will be at once rejected in all 
 probability, and must then be repeated. The patient's 
 outer clothing must be removed, and as far as possible 
 rest in bed secured. Mustard-plasters must be applied 
 to the abdomen and to the extremities, if the circula- 
 tion flag, in which case rubbing with dry mustard is 
 also useful. Drink must be restricted to a table- 
 spoonful of iced water with a few drops of spirits, 
 every 15 or 20 minutes. Iced champagne in the same 
 small doses will often be retained when all other fluid 
 is instantly rejected. Lumps of ice may be swallowed 
 at will. During the attack, unless it be unusually pro- 
 tracted, the patient needs no nourishment ; as soon 
 as the vomiting is less urgent, hot beef-tea in table- 
 spoonful doses at intervals of an hour will be accept- 
 able, or in lieu of this the London Company's, or 
 Johnston's or Valentine's meat-juice iced. The next 
 day rest, a milk-and-broth diet, and small doses of 
 pepsine, or perhaps no medicine will be needed, and 
 that is just as well. But the person who has had such 
 an attack must look out for himself for the remainder 
 of the summer, and keep quiet, and eat selected, whole- 
 some food, and not too much at a time when he is 
 very tired. 
 
 Dysentery is a disease of hot climates ) within a 
 belt of 35 north and south of the equator, there 
 
j6 THE SUMMER AND ITS DISEASES. 
 
 are lands never free from it. Regions of India, Asia, 
 the explored coasts of Africa, South America, and 
 the West Indies, within this belt, are dysentery coun- 
 tries. With us it is rare in the epidemic form, except 
 in military life; but it is common enough, as a " scat- 
 tered " or sporadic disease in the hot season, to be 
 classed properly among the diseases of summer. 
 
 The epidemic form of dysentery is thought to be 
 due in whole or in part to miasmatic influences con- 
 nected with the nature of the soil in particular regions; 
 with this various other exciting causes concur in pro- 
 ducing the attack in individual cases. The precise 
 nature of the miasma is unknown, just as* the precise 
 nature of the malarial poison is as yet undiscovered. 
 These entities are known to us only by their constant 
 effects. Epidemic dysentery and malarial fevers are 
 frequently prevalent in the same districts. Non- 
 epidemic or sporadic dysentery is due to the action 
 of various causes similar to those which induce 
 cholera-morbus ; it may be regarded as bearing the 
 same relation to the epidemic form of the disease 
 that cholera-morbus bears to epidemic or Asiatic 
 cholera. 
 
 Unlike diarrhoea, dysentery is a disease, not merely 
 a symptom. 
 
 Fever is frequently absent ; when present, it is usually 
 moderate. The characteristic manifestations of the 
 disease are distressing, twisting, colicky pains in the 
 
SUMMER DIARRHCEA AND DYSENTERY. J J 
 
 abdomen, with a constant tormenting desire to have 
 the bowels moved, and violent straining and bearing- 
 down pains, these efforts resulting in the passage of 
 small amounts of mucus or blood, or these com- 
 mingled, often nothing more. The dysenteric symp- 
 toms are usually preceded for a few days by diar- 
 rhoea. The duration of the disease is from four to 
 twenty-one days. The acute form may run on into the 
 chronic under unfavorable circumstances. 
 
 The structural changes in dysentery consist in in- 
 flammation and ulceration of the mucous membrane 
 of the large intestine, especially and most commonly 
 in its lowe* portion, the glands being especially in- 
 volved. The restriction of the processes of the dis- 
 ease to this part of the bowel will explain the common 
 limitation of pain on pressure to those portions of the 
 surface of the abdomen overlying the large intestine, 
 whilst the inflammation of the mucous membrane of 
 the bowel explains the increased secretion of altered 
 mucus, and the presence of blood in the stools. The 
 bearing-down pains, and constantly returning desire 
 to have the bowels moved, are due to the swollen 
 condition of the lining membrane of the bowel, and 
 to spasm of its muscular coat, which is, doubtless, 
 also concerned in producing the violent twisting 
 pains in the abdomen which characterize the dis- 
 ease. There is no reason to believe that this form 
 of dysentery is contagious. It is not usually a highly 
 7* 
 
78 THE SUMMER AND ITS DISEASES. 
 
 dangerous malady, except in persons whose powers of 
 resistance are feeble, or who have been debilitated 
 by previous disease, extreme old age, or other causes. 
 Its course appears to be modified, both in duration 
 and intensity, by judicious treatment; but the con- 
 verse of this proposition is also true, and the respon- 
 sibility of the management of each case should be 
 promptly transferred to medical hands. 
 
CHAPTER IV. 
 
 CHOLERA-INFANTUM. 
 
 THIS term is very loosely applied, both popularly 
 and by many medical men, to several different 
 affections of the stomach and bowels occurring in 
 infancy. 
 
 Of these the principal are (i,) diarrhoea from indi- 
 gestion following improper food, exhaustion from heat 
 or other causes ; (2,) true inflammation of the mucous 
 membrane of the bowels, from the more intense action 
 of the causes which produce simple diarrhoea, or their 
 long-continued working; (3,) dysentery, and (4,) 
 sporadic cholera, or cholera-morbus, which may oc- 
 cur alone, or, under circumstances favorable to its de- 
 velopment, during the course of any of the others. 
 
 It is to the last of these that the term cholera-in- 
 fantum is properly applicable, and to which it would 
 be accurate, scientifically speaking, to restrict it. 
 
 As we have already seen, heat and hot weather are 
 largely concerned in the causation of acute affections 
 of the stomach and bowels at all periods of life. The 
 influences of climate in this respect are twofold; first, 
 
 79 
 
80 THE SUMMER AND ITS DISEASES. 
 
 by the direct action of the heat, and, second, by the 
 special modifications of diet which the hot season 
 brings about, which consist in an increase of the 
 variety of articles and their more complex nature, 
 and in the greater danger of the development of 
 noxious or irritating principles in the food in conse- 
 quence of the chemical changes attending decompo- 
 sition and the like, processes favored by heat. 
 
 The more delicate organization of the body of the 
 young child makes it far more liable to the influences 
 under consideration than that of the adult. It feels 
 the depressing effect of great heat more speedily 
 and more profoundly, for its nervous system is much 
 more sensitive and much more fragile ; and it suffers 
 from changes in its food that would not affect the 
 adult, for the reason that its digestive system is as 
 yet not completely developed, and therefore incapable 
 of more than the simplest processes of digestion. 
 Moreover, the food of infancy is of the most sensi- 
 tive and perishable kinds. It does not surprise us 
 to find that these affections are most prevalent and 
 most fatal in the earliest periods of life ; but we start 
 back aghast from the statistics which set forth the 
 enormous mortality from them, and we are filled with 
 dismay at the reflection that much of the sickness, 
 suffering, and life-waste caused by this class of dis- 
 eases is entirely preventable. 
 
 The folk-term "summer-complaint," which is ap- 
 
CHOLERA-INFANTUM. 
 
 81 
 
 plied to this group of affections, expresses the popular 
 
 recognition of the causative relation which climate 
 
 bears to them. 
 
 TABLE 
 
 SHOWING THE MEAN MONTHLY MORTALITY FROM ACUTE AF- 
 FECTIONS OF TUE STOMACH AND BOWELS, UNDER THE AGE 
 OF FIVE YEARS, COMPARED WITH THE MEAN TOTAL MOR- 
 TALITY FROM ALL CAUSES AND AT ALL AGES, AND WITH 
 THE MEAN MONTHLY TEMPERATURE, COMPILED FROM THE 
 RECORDS OF THE SEVEN YEARS FROM 1 862 TO 1 868, IN- 
 CLUSIVE, IN PHILADELPHIA. 
 
 
 Mean Mortality 
 
 from Causes 
 
 Named Under the 
 
 Age of Five. 
 
 Mean Total Mor- 
 
 Mean Monthly Tem- 
 
 Month. 
 
 tality for Seven 
 Years. 
 
 perature lor Seven 
 Years. 
 
 January... 
 
 I2f 
 
 I296f- 
 
 30.87 
 
 February. 
 
 4$ 
 
 I2C)6f 
 
 33-89° 
 
 March 
 
 H 
 
 1-344? 
 
 40.85° 
 
 April 
 
 105 
 
 I281I 
 
 52.27 
 
 May 
 
 I4f 
 
 I234f 
 
 62. 77 
 
 June 
 
 82f 
 
 "78* 
 
 71-97° 
 
 July 
 
 W\ 
 
 1837 
 
 777i° 
 
 August.... 
 
 36if 
 
 i82 5 f 
 
 76.62 
 
 Septem... 
 
 102 
 
 1215! 
 
 68.31° 
 
 October... 
 
 163! 
 
 12181 
 
 5630° 
 
 Novem.... 
 
 36 
 
 1052} 
 
 46.68 
 
 Decern.... 
 
 13} 
 
 1191 
 
 347o 
 
 The influence of hot weather is so great that the 
 mortality rises and falls with the mercury, and be- 
 comes enormous during the hottest months of the 
 year. It is during these months, namely, July and 
 August, that the greater number of cases of real 
 cholera-infantum occur ; and it is to be doubted if 
 
 F 
 
82 THE SUMMER AND ITS DISEASES. 
 
 cases outside the season from May to October are of 
 a true choleraic character. 
 
 It is scientifically of great importance that the va- 
 rious diseases included under this designation should 
 be carefully distinguished. Their symptoms vary, their 
 course is different, and the processes which character- 
 ize them are not the same ; but their causes are com- 
 mon, and, in considering them from this practical 
 stand-point, they may be regarded as a group of dis- 
 orders very closely allied. 
 
 Atmospheric heat is a sufficiently common cause of 
 all the forms of disease classed under the head of 
 cholera-infantum. Impure air, from inadequate venti- 
 lation, from the decomposition of animal and vegetable 
 substances, and from personal uncleanliness in over- 
 crowded dwellings, is also an important cause ; hence, 
 the vastly greater frequency of these diseases in cities, 
 and particularly in the crowded and dirty districts in- 
 habited by the poor. The exciting cause is usually 
 improper food, though it is occasionally associated 
 with abrupt changes of temperature, especially during 
 sleep or at night, when the baby has not been suffi- 
 ciently covered. It will aid us in our attempt to ac- 
 quire practical information upon the subject of these 
 disorders, if we direct our attention briefly to the 
 natural food of infancy, and to the nature of the di- 
 gestive processes in the early periods of life. 
 
 Under circumstances unmodified by the influences 
 
CHOLERA-INFANTUM. 83 
 
 of artificial living, the milk of the mother is the sole 
 food required by the young infant. It is secreted in 
 sufficient quantity, and contains the principles neces- 
 sary to growth and nutrition in a soluble and most 
 easily digestible form, so that digestion makes but 
 slight demands upon the organs. This is in accord- 
 ance with the undeveloped condition of the baby's 
 glandular system, which affords to a most limited ex- 
 tent, and in minute quantities, the necessary solvents 
 and ferments for the chemical changes which effect 
 digestion in their developed state. Blessed are the 
 babes whose mothers can supply them with all the 
 food they need, and who are proud and happy to do 
 it. If they are sweet-tempered and pure-minded, and 
 enjoy that best of Heaven's boons, good health, it will 
 be a joy rather than a hardship ; and their healthy 
 babies — rosy, well-nourished, plump, smiling asleep 
 and crowing awake — will have that best start in life 
 within a human being's reach, a well-laid foundation 
 for a life of healthfulness and good temper. But, alas ! 
 too few mothers are so happy, and too many madly 
 throw away this blessing of motherhood from selfish- 
 ness, and many must give it up for health, and some 
 die and leave the little one to a practical and not 
 very sentimental world. A large number of babies 
 must be otherwise supplied with food. The best sub- 
 stitute, but a long way after the mother's milk, is that 
 of a nurse. But, aside from the objection that another 
 
84 THE SUMMER AND ITS DISEASES. 
 
 child is too often deprived of its natural rights, there 
 are inconveniences of a very serious kind associated 
 with the employment of wet-nurses, in consequence 
 of the social classes from which they are recruited as 
 a rule, their undisciplined characters, their untidy 
 personal habits, and their ignorance and imprudence 
 in the matter of attending to their own health. For 
 the milk of a nursing-woman is speedily and pro- 
 foundly modified by her condition, and a fit of anger, 
 or fatigue, or an error in diet on her part, may occa- 
 sion serious illness in the babe she suckles. 
 
 Numbers of children, then, must be artificially fed, 
 brought up by hand, and at best they receive a diet 
 which is very different from what it should be, and 
 which is exposed in the course of its preservation and 
 preparation to many risks of contamination and 
 change, 
 
 Of all these probably the best is pure, fresh cow's 
 milk, slightly diluted for very young infants in ac- 
 cordance with its richness and the child's digestive 
 powers. The mixed milk from a small, well-kept dairy 
 is, in my opinion, as good as that from one cow, and 
 is more likely to be what it is represented to be. It 
 should be obtained, if possible, twice a day in small 
 cans, or, better, glass jars kept for the purpose, which 
 should be scalded, washed, and set to air as soon as 
 emptied, and again scalded and cooled before being 
 used again. Milk must be kept in an ice-box by itself, 
 
CHOLERA-INFANTUM. 85 
 
 not in a separate compartment, but independent of 
 and away from all supplies of fish, meat, vegetables, 
 fruits, and the like. 
 
 The milk of goats may be advantageous under some 
 circumstances, but so little attention is paid to keep- 
 ing these animals, as a rule, in this part of the world, 
 that it is better to depend upon cow's milk. Milk 
 should be warmed through when given, but boiled 
 milk is neither so digestible nor so nutritious as be- 
 fore cooking, and is not adapted to the wants of the 
 young baby. The milk should be alkaline when 
 taken, otherwise it tends to form in the stomach 
 large and firm curds. To prevent this, it may be ren- 
 dered alkaline, when necessary, by the addition of a 
 teaspoonful of lime-water or one or two grains of car- 
 bonate of soda to each feeding. 
 
 The care of the nursing-bottle requires vigilance, 
 common sense, and faithfulness, and very often lacks 
 all three. It must be kept clean. When the child 
 ceases nursing, the bottle, together with the rubber 
 tip, must be at once emptied and washed in warm 
 soapsuds, rinsed and placed in a basin of cold water 
 in which is dissolved carbonate of soda in the pro- 
 portion of a drachm to the pint. It must be again 
 washed in pure water before being next used. Bot- 
 tles with simple rubber nipples are far preferable 
 to those with rubber or glass tubes, on account of 
 8 
 
86 THE SUMMER AND ITS DISEASES. 
 
 the absolute certainty that the tubes cannot be kept 
 clean. 
 
 Young children must be fed as often as they are 
 hungry ; the habit of the child has much to do with 
 the frequency of required feeding ; an interval of two 
 hours is not too long under ordinary circumstances, 
 but it should not be prolonged much beyond this 
 period. 
 
 Prior to the age of five months no starchy sub- 
 stances should be given, and I think it a good rule to 
 avoid them still longer, in some cases even until six 
 or eight teeth are through, especially during hot 
 weather. 
 
 If good cow's milk cannot be had, condensed milk 
 is an excellent substitute. And foods consisting of 
 starchy matters converted into dextrine and glucose, 
 by a process of artificial digestion as first suggested by 
 Baron Liebig, or some analogous procedures and as 
 prepared by several manufacturers, are useful. I may 
 mention the preparations of Nestle, of Horlick, of 
 Keasby and Mattison, as well borne by infants. But 
 till the appearance of five or six teeth, milk is the 
 proper food. After this, a little arrow-root, sago, 
 wheat-flour or rice-flour may be cautiously employed ; 
 simple broth, custard and eggs added to the diet, and 
 the baby may have a chicken-bone to suck. Between 
 the age of one and two years light food may be mas- 
 ticated, and, finally, cut or minced meat, mashed or 
 
CHOLERA-INFANTUM. 87 
 
 roasted potatoes, bread and butter, and carefully se- 
 lected fruit may be given. 
 
 A tendency to constipation, which produces both 
 indigestion and diarrhoea, must be corrected. After 
 the second year, intestinal disorders are less fre- 
 quent, less easily provoked, and less fatal. It is thus 
 seen that their period of greatest frequency is during 
 dentition, a process which, without doubt, increases 
 the excitability of the nervous system, and thus favors 
 the development of the diseases under discussion, 
 which are largely of nervous origin. The common 
 dread, on the part of mothers, of the second summer 
 is well founded ; that passed, the voyage of life lies 
 thenceforth in much less perilous waters. 
 
 It is not difficult to understand the anxiety of those 
 having charge of young children, and to whom it 
 is possible, to escape from the city during summer. 
 After the first of June, the earlier they go the better ; 
 until the middle of September, the later they return 
 the better. All other considerations being set aside, 
 as regards only the welfare of the baby, it should go 
 out of town. If its mother suckle it, her health will 
 be the better in the country; if a nurse, she escapes a 
 multitude of summer dangers by being out of the city; 
 if the baby be bottle-fed, it is where the milk is fresh 
 and pure, the air uncontaminated and crowding im- 
 possible. If it can be avoided, the child should not 
 be weaned during the summer months. 
 
88 THE SUMMER AND ITS DISEASES. 
 
 We will now briefly consider in detail the diseases 
 forming the group called cholera-infantum. 
 
 i. Simple diarrhoea often comes on suddenly, 
 especially if due to cold or improper food, otherwise 
 it may be preceded for a few days by restlessness, 
 fretfulness, and such symptoms of indigestion as loss 
 of appetite and vomiting ; the stools are frequent, and 
 often green ; if they are very frequent and watery, 
 there is apt to be thirst. Fever is absent or slight. 
 The general appearance of the child is not rapidly 
 changed. If the malady run on, it is apt to pass into 
 the inflammatory form, and the features, in that case, 
 become pale, and there is manifest loss of flesh and 
 weight. 
 
 The avoidance of the cause, a change of diet, 
 simple evacuant remedies, such as castor-oil with 
 rhubarb, or, if there be acidity of the matters vomited 
 or the stools, rhubarb and magnesia, followed by 
 astringents, such as bismuth, chalk mixture and 
 brandy, and pepsine ; or the last class of medicines, 
 without evacuants from the beginning, if the bowels 
 have moved often and freely, will usually arrest the 
 disease. Should it show the slightest disposition to 
 become intensified, or to continue under treatment, 
 flight to the sea-shore may alone avert serious trouble. 
 Opium preparations in minute doses are also some- 
 times required; but I repeat, that it is extremely 
 hazardous to give them to infants, except under the 
 
CHOLERA-INFANTUM. 89 
 
 observation of a physician. And I may here add 
 that the use of the various cordials, drops, and sooth- 
 ing syrups sold in the shops to ignorant and cruel 
 women for the purpose of quieting their babies, is 
 attended with the most disastrous results. I have 
 seen babies thus lulled into a stupor which, in 
 several instances, has been the beginning of an eter- 
 nal slumber. 
 
 2. Inflammatory diarrhoea (entero- colitis) may be- 
 gin as above, or more abruptly. The baby grows 
 rapidly weak, feverish, and fretful. If diarrhoea have 
 not preceded these symptoms, it speedily appears. The 
 stools are frequent, and of a thin consistency; their 
 color is yellow, brown, or green; they are often acid, 
 and sometimes yeasty in appearance, and they contain 
 lumps of undigested casein, or curd. The tongue is 
 coated, and often exhibits patches of thrush ; the 
 whole mouth is often red and dry. Vomiting soon 
 ensues. It may occur promptly after food is taken, 
 from irritability of the stomach, or later, in which 
 case it is found to consist of firmly curdled milk, 
 acid, and sometimes in a fermenting state. The stools 
 are now more frequent ; they resemble putty-masses, 
 or chopped spinach, or they may be thin, as at first. 
 They now contain little collections of tough, altered 
 mucus. The skin is apt to become chafed from the 
 irritating character of the discharges. The urine 
 is but scantily secreted. The little patient grows 
 8* 
 
90 THE SUMMER AND ITS DISEASES. 
 
 rapidly worse, and in fatal cases acquires a pinched 
 and shrivelled appearance. He is thirsty, but refuses 
 food ; he turns peevishly away, moves his head from 
 side to side or burrows it in the pillow, and utters 
 a fretful, constant cry. Convulsions may or may not 
 occur. He sinks into collapse, and quietly passes 
 away. Head-symptoms are not due to inflammation 
 of the brain or its coverings, but to nervous depres- 
 sion, or lack of blood-supply to the head, in conse- 
 quence of diminution of its total quantity from the 
 diarrhoea. 
 
 Under judicious management, especially where it is 
 possible to secure change of diet and prompt and rad- 
 ical change of climate and air, as by going to the sea- 
 side, many cases may recover. In cities and among 
 the poor the death-rate is frightful. The wide-spread 
 opinion that in this malady the liver is chiefly or 
 largely at fault is erroneous. This view has had a 
 most pernicious influence upon the treatment. Many 
 doctors have in consequence of it used calomel freely 
 instead of using their brains. The changed color of 
 the stools has been found, in most instances, to be 
 due to other causes than altered bile. The disease 
 sometimes becomes chronic, and it may then destroy 
 life after weeks of wasting. Enough has been said 
 upon the subject of diet and change of food \ enough, 
 perhaps, on the necessity of change of air. I may add, 
 that if one locality do not benefit the child, it may be 
 
CHOLERA-INFANTUM. gi 
 
 necessary to try another, and that next to the sea-shore 
 upland regions are advantageous. And I must insist 
 upon the cruelty and absurdity of withholding cold 
 water in small quantities from a child burning up with 
 fever, and maddened by thirst from the draining away 
 by diarrhoea of the watery portions of his blood. A 
 little drink, frequently repeated, does no harm in these 
 cases. 
 
 3. Dysentery in childhood presents the symptoms 
 of the disease as they are modified by the physiolog- 
 ical processes of early life, and does not here demand 
 further consideration. 
 
 4. True cholera-infantum (cholera-morbus of in- 
 fancy) may occur in the course of any of the fore- 
 going diseases ; or it may begin without previous illness. 
 In either case the stools are very frequent and watery, 
 often soaking through the napkin like water, with 
 scarcely a discoloring stain ; their odor is musty, 
 sometimes they are without smell. Vomiting sets in 
 at once or shortly after the diarrhoea. The irritable 
 stomach promptly rejects all food. Appetite is lost ; 
 thirst is eager ; the little sick one turns its eyes and 
 reaches out its hands towards the glass of water. 
 There is fever, the head is hot, the extremities speedily 
 become cool. Urine is suppressed ; the belly is not 
 tender; there is no reason to believe that there is much 
 pain. The restlessness is caused partly by thirst, partly 
 by the general discomfort of sudden, grave illness and 
 
92 THE SUMMER AND ITS DISEASES. 
 
 profound disturbance of the circulation of the blood 
 and the action of the nervous system. Wasting and 
 loss of strength take place with alarming rapidity, the 
 eyes are sunken, the eyelids and lips are half-closed, 
 the pallid skin has a shrunk look, collapse comes on, 
 and death takes place after a course like that of Asiatic 
 cholera. In some instances the alarming symptoms 
 abate and recovery takes place ; in others the disease 
 passes into a chronic diarrhoea of the inflammatory 
 form. 
 
 The duration in fatal cases is from twenty-four 
 hours to three or four days. 
 
 This malady has been thought to be closely allied 
 to sunstroke. I have seen it more than once follow 
 the reckless exposure of infants to the fierce rays of a 
 summer sun ; but it must be regarded as a disease of 
 the stomach and bowels. 
 
 At the risk of some repetition, I subjoin the follow- 
 ing important directions, drawn up by the Obstetrical 
 Society of Philadelphia, and widely and gratuitously 
 distributed by the Board of Health every summer for 
 several years. 
 
 Rules for the Management of Infants During 
 the Hot Season. 
 
 Rule i. — Bathe the child once a day in tepid water. If it 
 is feeble, sponge it all over twice a day with tepid water, or with 
 
CHOLERA-INFANTUM. 93 
 
 tepid water and vinegar. The health of a child depends much 
 upon its cleanliness. 
 
 Rule 2. — Avoid all tight bandaging. Make the clothing light 
 and cool, and so loose that the child may have free play for its 
 limbs. At night undress it, sponge it, and put on a slip. In the 
 morning remove the slip, bathe the child, and dress it in clean 
 clothes. If this cannot be afforded, thoroughly air the day- 
 clothing by hanging it up during the night. Use clean diapers, 
 and change them often. Never dry a soiled one in the nursery 
 or in the sitting-room, and never use one for a second time with- 
 out first washing it. 
 
 Rule 3. — The child should sleep by itself in a cot or cradle. 
 It should be put to bed at regular hours, and be early taught to 
 go to sleep without being nursed in the arms. Without the 
 advice of a physician , never give it any Spirits, Cordials, Cai'- 
 minativeSy Soothing Syrups, or Sleeping Drops. Thousands 
 of children die every year from the use of these poisons. If the 
 child frets and does not sleep, it is either hungry or else ill. If 
 ill, it needs a physician. Never quiet it by candy or by cake ; 
 they are the common causes of diarrhoea and of other troubles. 
 
 Rule 4. — Give the child plenty of fresh air. In the cool of 
 the morning and evening, send it out to the shady sides of broad 
 streets, to the public squares, or to the Park. Make frequent 
 excursions on the rivers. Whenever it seems to suffer from the 
 heat, let it drink freely of ice-water. Keep it out of the room 
 in which washing or cooking is going on. It is excessive heat 
 that destroys the lives of young infants. 
 
 Rule 5. — Keep your house sweet and clean, cool and well 
 aired. In very hot weather let the windows be open day and 
 night. Do your cooking in the yard, in a shed, in the garret, or 
 in an upper room. Whitewash the walls every spring, and see 
 that the cellar is clear of all rubbish. Let no slops collect to 
 
94 THE SUMMER AND ITS DISEASES. 
 
 poison the air. Correct all foul smells by pouring into the sinks 
 and privies carbolic acid or quicklime, or the chloride of lime, or 
 a strong solution of copperas. These articles can be got from the 
 nearest druggist, who will give the needful directions for their 
 use. Make every effort yourself, and urge your neighbors to 
 keep clean the gutters of your street or of your court. 
 
 Rule 6. — Breast-milk is the only proper food for infants. If 
 the supply is ample and the child thrives on it, no other kind of 
 food should be given while the hot weather lasts. If the 
 mother has not enough, she must not wean the child, but give 
 it, besides the breast, goat's or cow's milk, as prepared under 
 Rule 8. Nurse the child once in two or three hours during the 
 day, and as seldom as possible during the night. Always remove 
 the child from the breast as soon as it has fallen asleep. Avoid 
 giving the breast when you are over-fatigued or over-heated. 
 
 Rule 7. — If, unfortunately, the child must be brought up by 
 hand, it should be fed on a milk-diet alone — that is, warm milk 
 out of a nursing-bottle, as directed under Rule 8. Goat's milk 
 is the best, and, next to it, cow's milk. If the child thrives on 
 this diet, no other kind of food whatever should be given while 
 the hot weather lasts. At all seasons of the year, but especially 
 in summer, there is no safe substitute for milk if the infant has 
 not cut its front teeth. Sago, arrow-root^ potatoes, corn-flour, 
 crackers, bread, every patented food, and every article of diet con- 
 taining starch, cannot and must not be depended on as food for 
 very young infants. Creeping or walking children must not be 
 allowed to pick up unwholesome food. 
 
 Rule 8. — If the milk is known to be pure, it should have one- 
 third part of hot water added to it, until the child is three months 
 old ; after this age the proportion of water should be gradually 
 lessened. Each half pint of this food should be sweetened, 
 either with a heaping dessert-spoonful of sugar of milk, or with 
 
CHOLERA-INFANTUM. 95 
 
 a teaspoonful of crushed sugar. When the heat of the weather 
 is great, the milk may be given quite cold. Be sure that the 
 milk is unskimmed ; have it as fresh as possible, and brought 
 very early in the morning. Before using the pans into which it 
 is to be poured, always scald them with boiling suds. In very 
 hot weather, boil the milk as soon as it comes, and at once put 
 away the vessels holding it in the coolest place in the house — 
 upon ice, if it can be afforded, or down a well. Milk carelessly 
 allowed to stand in a warm room soon spoils, and becomes unfit 
 for food. 
 
 Rule 9. — If the milk should disagree, a tablespoonful of 
 lime-water may be added to each bottleful. Whenever pure 
 milk cannot be got, try the Condensed Milk, which often answers 
 admirably. It is sold by all the leading druggists and grocers, 
 and may be prepared by adding to ten tablespoonfuls of boiling 
 water, without sugar, one tablespoonful or more of the milk, ac- 
 cording to the age of the child. Should this disagree, a teaspoon- 
 ful of arrow-root, of sago, or of corn-starch may be cautiously 
 added to a pint of the milk, as prepared under Rule 8. If 
 milk in any shape cannot be digested, try, for a few days, pure 
 cream diluted with three-fourths or four-fifths of water — return- 
 ing to the milk as soon as possible. 
 
 Rule 10. — The nursing-bottle must be kept perfectly clean; 
 otherwise the milk will turn sour, and the child will be made 
 ill. After each meal, it should be emptied, rinsed out, taken 
 apart, and the nipple and bottle placed in clean water, or in 
 water to which a little soda has been added. It is a good plan 
 to have two nursing-bottles, and to use them by turns. The 
 best kind is the plain bottle with a rubber nipple and no tube. 
 
 Rule ii. — Do not wean the child just before or during the 
 hot weather ; nor, as a rule, until after its second summer. If 
 suckling disagrees with the mother, she must not wean the child, 
 
g6 THE SUMMER AND ITS DISEASES. 
 
 but feed it, in part, out of a nursing-bottle, on such food as has 
 been directed. However small the supply of breast-milk, pro- 
 vided that it agrees with the child, the mother should carefully 
 keep it up against sickness ; it alone will often save the life of 
 a child when everything else fails. When the child is over six 
 months old, the mother may save her strength by giving it one 
 or two meals a day of stale bread and milk, which should be 
 pressed through a sieve and put into a nursing-bottle. When from 
 eight months to a year old, it may have also one meal a day of 
 the yolk of a fresh and rare-boiled egg, or one of beef or mutton- 
 broth into which stale bread has been crumbed. When older 
 than this, it can have a little meat finely minced ; but even then 
 milk should be its principal food, and not such food as grown- 
 up people eat. 
 
 Brief Rules for Cases of Emergency. 
 
 Rule i. — If the child is suddenly attacked with vomiting, 
 purging, and prostration, send for a doctor at once. In the mean 
 time, put the child for a few minutes in a hot bath, then carefully 
 wipe it dry with a warm towel, and wrap it in warm blankets. 
 If its hands and feet are cold, bottles filled with hot water and 
 wrapped in flannel should be laid against them. 
 
 Rule 2. — A mush-poultice, or one made of flaxseed meal, to 
 which one-quarter part of mustard flour has been added, or 
 flannels wrung out of hot vinegar and water, should be placed 
 over the belly. 
 
 Rule 3. — Five drops of brandy in a teaspoonful of water 
 may be given every ten or fifteen minutes ; but if the vomiting 
 persists, give this brandy in the same quantity of milk and lime- 
 water. 
 
CHOLERA-INFANTUM. g? 
 
 Rule 4. — If the diarrhoea has just begun, or if it is caused 
 by improper food, a teaspoonful of castor-oil, or of the spiced 
 syrup of rhubarb, should be given. 
 
 Rule 5. — If the child has been fed partly on the breast and 
 partly on other food, the mother's milk alone must now be used. 
 If the child has been weaned, it should have its milk-food di- 
 luted with lime-water, or should have weak beef-tea or chicken- 
 water. 
 
 Rule 6. — The child should be allowed to drink cold water 
 freely. 
 
 Rule 7. — The soiled diapers or the discharges should be at 
 once removed from the room, but saved for the physician to ex- 
 amine at his visit. 
 
 For the Convenience of Mothers, the following Re- 
 cipes for Special Forms of Diet are given : 
 
 Boiled Flour or Flour Ball. — Take one quart of good flour ; 
 tie it up in a pudding-bag so tightly as to make a firm, solid 
 mass ; put it into a pot of boiling water early in the morning, 
 and let it boil until bedtime. Then take it out and let it dry. 
 In the morning, peal off from the surface and throw away the 
 thin rind of dough, and with a nutmeg-grater grate down the 
 hard dry mass into a powder. Of this from one to three tea- 
 spoonfuls may be used, by first rubbing it into a paste with a 
 little milk, then adding to it about a pint of milk, and, finally, 
 by bringing the whole to just the boiling-point. It must be given 
 through a nursing-bottle. 
 
 An excellent food for children who are costive may be made 
 by using bran-meal or unbolted flour instead of the white flour, 
 preparing it as above directed. 
 
 9 G 
 
98 THE SUMMER AND ITS DISEASES. 
 
 Rice- Water. — Wash four tablespoonfuls of rice ; put it into 
 two quarts of water, which boil down to one quart, and then 
 add sugar and a little nutmeg. This makes a pleasant drink. 
 
 A pint or half a pint of milk added to the rice-water, before 
 it is taken from the fire, gives a nourishing food suitable for cases 
 of diarrhoea. 
 
 Sago, tapioca, barley, or cracked corn can be prepared in the 
 same manner. 
 
 Beef-Tea. — Take one pound of juicy lean beef — say a piece 
 from the shoulder or the round — and mince it. Put it with its 
 juice into an earthen vessel containing a pint of tepid water, 
 and let the whole stand for one hour. Then slowly heat it to 
 the boiling-point, and let it boil for three minutes. Strain the 
 liquid through a cullender, and stir in a little salt. If preferred, 
 a little pepper or allspice may be added. 
 
 Mutton-Tea may be prepared in the same way. It makes 
 an agreeable change when the patient has become tired of beef- 
 tea. 
 
 Raw Beef for Children. — Take half a pound of juicy beef, 
 free from any fat ; mince it very finely ; then rub it into a smooth 
 pulp, either in a mortar or with an ordinary potato masher, and 
 press it through a fine sieve. Spread a little out upon a plate, 
 and sprinkle over it some salt, or some sugar, if the child pre- 
 fers it. Give it alone, or spread upon a buttered slice of stale 
 bread. It makes an excellent food for children with dysentery. 
 
 Lime-Water. — Take a handful of quicklime, slake it, and 
 put it into a quart bottle full of soft water. Shake the bottle 
 well, and then allow the undissolved portion of the lime to 
 settle. Pour off the clear liquid when needed, replacing it with 
 more water, and afterwards shaking the bottle briskly. 
 
CHAPTER V. 
 
 SUMMER AND AUTUMNAL FEVERS. 
 
 FEVER is a morbid state characterized by increased 
 body-temperature, quickened circulation of the 
 blood, arrested secretion, and rapid wasting of the 
 tissues of the body. We are as yet ignorant of the 
 essential modifications of the functions of life that 
 cause fever, just as we are ignorant of the controlling 
 principle in that adjustment of physiological processes 
 which constitutes life itself. But with the phenomena 
 or manifestations of fever we are brought into almost 
 daily contact. In the flushed face and burning skin 
 we recognize the signs of increased temperature; in 
 the throbbing head and frequent pulse, those of an 
 excited and unduly rapid blood circulation; in the 
 dry surface and parched mouth and tongue, and the 
 scantiness of other secretions, we behold the evidences 
 of the arrested or perverted working of the glandular 
 system, and in the rapid emaciation of the body, the 
 fact that waste goes on more rapidly than repair. 
 
 Fever may constitute the whole sickness. It is 
 then called essential fever. A fever may be due to 
 
 99 
 
100 THE SUMMER AND ITS DISEASES. 
 
 some local disease or process of irritation in a par- 
 ticular portion of the body. It then receives the 
 name of irritative or symptomatic fever. As ex- 
 amples of essential fever, I may mention the transient 
 fevers known as ephemeral (because they last a day 
 or so), or febricula (because it is a slight fever), typhoid, 
 typhus, and the like. Here the fever is not a symptom 
 of some other malady, it is the malady itself; as ex- 
 amples of irritative fever, that which follows a wound 
 or a surgical operation, or which accompanies acute 
 inflammation of some organ, as the lungs or kidneys, 
 or the formation of an abscess ; in these instances the 
 fever does not constitute the primary disease, it is 
 merely a symptom of it. 
 
 Those fevers which run an unbroken course to their 
 termination are called continued ; those in which the 
 course of the fever is interrupted are called periodi- 
 cal. 
 
 Of periodical fevers, those having a regular period 
 of abatement without actually ceasing are called re- 
 mittent ; those in which the fever disappears to re- 
 turn at short intervals, as the next day, or the second 
 or third day, are called intermittent. Most of the 
 periodical fevers are due to the influence of miasmatic 
 poisons. 
 
 Until within a recent period, it was customary to 
 judge of the intensity of the fever by the sensation 
 of heat imparted to the hand of the observer as well 
 
SUMMER AND AUTUMNAL FEVERS. IOI 
 
 as by the frequency and character of the pulse, and 
 the symptoms in general. In addition to these 
 methods of observation, we are now enabled to ascer- 
 tain the actual temperature of the body by means of 
 a pocket thermometer, made for the purpose, the bulb 
 being placed in the patient's mouth or armpit. The 
 temperature thus taken in healthy persons is 98. 4 
 Fahrenheit. It is found to be the same in all persons 
 in health, and in all latitudes, with slight variations. 
 It is therefore called the norme, or normal tempera- 
 ture. Transient variations within a degree do not 
 indicate disease, especially in childhood, at which 
 period of life the temperature is more easily in- 
 fluenced than afterwards. In shock, collapse, and 
 immediately after the loss of blood, the temperature 
 falls ; very great activity causes it to rise, as does in- 
 flammation of an acute character. An increase of a 
 degree, or a degree and a half, that is continuous, 
 indicates fever. The thermometer in fever often rises 
 to 102 or 104 . If it reach 105 in continued fever, 
 the case is grave; a temperature of 106 , which does 
 not promptly fall, indicates great danger ; and above 
 this a fatal result is to be dreaded. In periodical 
 fevers, when the rise in temperature is of short du- 
 ration, it is frequently very high. In fatal cases of 
 acute rheumatism it may reach 109 or no°. And, 
 as we have seen, it may reach no°, or exceed that in 
 sunstroke, which is a fever of great intensity. In 
 9* 
 
102 THE SUMMER AND ITS DISEASES. 
 
 many instances, where death takes place in conse- 
 quence of the rapid, overwhelming increase of the 
 heat of the body, the temperature rises a degree, or 
 even more, during the first hour or so after life has 
 become extinct. 
 
 There is a daily slight variation in the normal tem- 
 perature, the highest point being attained in the latter 
 part of the day, the lowest being reached before dawn. 
 There is a corresponding diurnal temperature revolu- 
 tion in fever; the rule being that the evening temper- 
 ature exceeds by some part of a degree or more that 
 of the morning ; although in rare instances the range 
 is the reverse of this, the temperature being higher in 
 the morning than in the evening. 
 
 Many fevers, and many maladies accompanied by 
 fever, have a regular temperature course from begin- 
 ning to end, — the typical fever-range of the disease. 
 Hence, medical thermometry, as it is called, is of great 
 value in discriminating diseases ; and it often enables 
 the physician to predict with definiteness the duration 
 and the ultimate result of an attack of sickness. 
 
 Irritative or symptomatic fevers occur frequently in 
 summer as at all seasons of the year, and they are es- 
 pecially apt to show themselves in young children. 
 Thus an attack of simple indigestion which is speedily 
 over may be attended with high fever while it lasts ; 
 and this is true of any local irritation or inflammation, 
 such as the irritation of teething or the inflammation 
 
SUMMER AND AUTUMNAL FEVERS. IO3 
 
 of the mouth and gums, which in some infants attends 
 the cutting of the teeth, inflammatory diarrhoeas, or, 
 as we shall see hereafter (Chapter VII.), acute affections 
 of the skin and the like. Closely allied to these forms 
 of irritative fevers, but different in causation, are the 
 transient fevers which result from direct exposure to 
 heat, from over-exertion, exhaustion due to any cause, 
 from chilling or " catching cold," when it produces 
 simply a constitutional and not a local disturbance. 
 
 This last group of fevers includes those which are 
 most common in hot weather, and which are the most 
 easily avoided by care and prudence. 
 
 In the chapter on sunstroke and heat fever, we have 
 seen how direct and how potent is the action of heat 
 in causing fevers of varying gravity ; and, later, we 
 have seen that heat and improper exposure to the sun 
 is a powerful cause of intestinal disorders at all periods 
 of life. But it will not in this connection be amiss 
 again to point out the influence of this agent in the 
 production of fevers which are in truth nothing more 
 or less than simple continued fevers, and to call at- 
 tention to the fact that an influence, which in certain 
 individuals or under certain circumstances provokes 
 an attack of diarrhoea, or cholera-morbus, or of sum- 
 mer-complaint in children, will in other persons or 
 under different circumstances occasion simply an at- 
 tack of fever. If the exposure to heat be combined 
 with over-exertion ; sickness is the more likely to fol- 
 
104 THE SUMMER AND ITS DISEASES. 
 
 low. How often do we find that the intense, burning 
 fever, with throbbing head, restlessness and delirium, 
 that comes on in young lads at bedtime, follows three 
 or four hours' bathing in the mill-pond under a fierce 
 July or August sun ! This fever in youngsters, after 
 excessive bathing, often shows a distinctly remittent 
 type, which extends over two or three days. I have 
 met with many examples of it at the sea-shore in those 
 who have habitually or occasionally spent too long a 
 time in the bath. 
 
 The fever of " catching cold," will be described in 
 the following chapter. It is of short duration, and of 
 much less intensity than the fevers due to the causes 
 we have already mentioned, and it is common enough 
 in summer as in other seasons. 
 
 Another very important group of fevers is com- 
 posed of those due to the action of substances inhaled 
 in the air we breathe, or taken in the water or milk we 
 drink, or in our food, and which act as special poisons 
 in producing fevers characterized by certain definite 
 symptoms and running a more or less definite course. 
 
 To this group belong all the epidemic contagious 
 diseases, such as small-pox, scarlet- fever, measles and 
 the like, in which the special poison is redeveloped 
 in the sick person, and from him conveyed by the air 
 or by contact to those around him and in his vicinity, 
 to produce in them the same sickness, in the course 
 of which the poison is developed anew, and thus 
 
SUMMER AND AUTUMNAL FEVERS. 105 
 
 spreads from each new sufferer as a centre of conta- 
 gion to those about him. But with these it is not our 
 present duty to concern ourselves. They are not par- 
 ticularly diseases of hot seasons : on the contrary, 
 they are usually less prevalent in summer than in the 
 other seasons of the year. More germane to our sub- 
 ject, and yet scarcely falling within the scope of this 
 book, are the epidemic non-contagious diseases, such 
 as true cholera, epidemic dysentery, influenza and the 
 like, which are due to poisons disseminated by means 
 of the atmosphere or the drinking-water, and which 
 produce violent disturbances of the functions of the 
 body with most destructive sickness, but which do not 
 appear to be so undeveloped within the body during 
 the illness they give rise to, as to make each case a 
 new centre of contagion, except by means of the direct 
 action of the substances passed out of the body, as 
 the matters vomited and the stools in cholera, and the 
 stools in dysentery, which are capable of causing the 
 disease in others who, for example, happen to drink 
 water contaminated by them. 
 
 There are fevers produced by analogous causes, how- 
 ever, which are neither epidemic nor contagious, for 
 the reason that the poisons which give rise to them 
 are of feebler intensity, and consequently act upon a 
 relatively small percentage of the persons exposed to 
 them, and are not reproduced in the body of the suf- 
 ferer in such a way as to infect his neighbors. These 
 
Io6 THE SUMMER AND ITS DISEASES. 
 
 are the fevers that are common in summer and autumn, 
 though prevalent at all seasons. The poisons that oc- 
 casion them are, in general, of two kinds — marsh- 
 miasms and sewer-miasms, and the fevers which they 
 occasion are called respectively malarial fevers and 
 sewage fevers. 
 
 Marsh-miasm, or malaria, is known to us only by its 
 effects. The most elaborate investigations of science, 
 the most untiring research, have failed to isplate and 
 bring before our senses their cause. But the effects 
 are so constant, so regular, and so exact, that they es- 
 tablish the existence of the cause and the natural laws 
 which it obeys. 
 
 Malaria is generated in warm, moist regions ; it is 
 most abundant in the late summer and early autumn ; 
 hence it is most active in the tropics, and has been 
 attributed to the decay of vegetation. Cold destroys 
 it; it is therefore absent in winter and in high lati- 
 tudes. It does not ascend to great heights ; at 500 
 feet above the sea-level its effects are but little felt ; 
 above 1,500 feet they are unknown. It spreads in the 
 direction of prevailing winds ; large bodies of water 
 absorb it ; forests prevent its course ; certain plants 
 appear to possess the power of neutralizing its effects, 
 among these are the sunflower and the gum-tree, the 
 Eucalyptus of Australia. It is more active at night. 
 It is developed by the first cultivation of virgin soils, 
 by extensive digging, as for the laying of drains, water- 
 
SUMMER AND AUTUMNAL FEVERS. IO/ 
 
 pipes, and so forth, and by other disturbances of the 
 ground, as in grading and the digging of cellars. 
 
 The effects of malaria are shown in the production 
 of the periodical or malarial fevers. These may ap- 
 pear within a few days of the exposure to their cause, 
 or not for many months. I attended a lady of mid- 
 dle age in an attack of violent ague, under the follow- 
 ing circumstances. She had never had malarial fever 
 in her life, nor had she lived in a malarious district. 
 In August she visited some friends living on the 
 banks of a river malarious throughout its course. 
 She returned home well, and remained there and in 
 good health until the following May, a period of nine 
 months, when the attack came on. Malarial fevers 
 are intermittent, remittent, and congestive. A per- 
 son once having suffered from them, is liable to a re- 
 turn upon slight exposure to the cause, or other sub- 
 sequent diseases may be so modified as to show an 
 intermittent character. Malarial diseases often lack 
 the distinct febrile character, and manifest themselves 
 as neuralgias, bilious attacks, or vague impairments 
 of the general health. 
 
 From what has been said, it will be evident that it 
 is essential to avoid spending the summer in malarious 
 districts, especially after the middle of July ; that if 
 you are obliged to go into such regions, it is better to, 
 avoid the night air, to sleep in an upper room in the 
 house, and to make the sojourn as brief as possible. 
 
108 THE SUMMER AND ITS DISEASES. 
 
 It may be added, that quinine should be taken faith- 
 fully. Some of the most attractive places in our 
 country are highly malarious, so that, in selecting a 
 summer place, it is most important to inquire into 
 this subject, which is a fruitful cause of both speedy 
 and remote sickness. 
 
 Many fevers of low type are due to the contamina- 
 tion of the air, the drinking-water, milk, etc., by the 
 emanations from badly-made sewers, choked drains, 
 and the like. With the general subject of sewage- 
 miasm may be classed the poisons generated in ill- 
 constructed privies, in heaps of decaying offal, and 
 by surface drainage, for in fact these are but detrac- 
 tors and robbers of the good sewer, to which human 
 ignorance and sloth suffer an existence at once offen- 
 sive to decency and baleful to health. 
 
 Those fevers which are due to sewer-miasms are of 
 insidious onset, and at first of mild intensity. A 
 vague impairment of the health is felt, loss of appe- 
 tite and nausea occur ; they are followed by a ten- 
 dency to diarrhoea, not easily accounted for and not 
 easily controlled ; with these symptoms there is head- 
 ache, increased towards evening, and the patient 
 grows feeble and languid. Unless the cause be sus- 
 pected, the doctor and the patient are alike puzzled 
 by the vagueness of the symptoms of the sickness; 
 but a careful inquiry will often reveal the cause. 
 
 A drain is choked, and some wall in the house or 
 
SUMMER AND AUTUMNAL FEVERS. IO9 
 
 the cellar floor is soaked with the foul overflow ; or 
 there is a leak in a terra-cotta drain-pipe, or kitchen 
 garbage and household slops are thrown upon the 
 ground under the window of the patient's sleeping- 
 room, or the summer breeze blows over some un- 
 cleanly place into his chamber ; or the privy-well is 
 but a few paces from the well from which his drink- 
 ing-water is obtained, and he has been slowly poi- 
 soned by the rotting waste from his own and a score 
 of other bodies ; or else the milk he has been drink- 
 ing has been watered with some similarly polluted 
 water, or brought in cans washed with it. 
 
 In some one of these ways, or by like channels, 
 the poison has reached his blood, and through it 
 caused his sickness. Unknown in its physical attri- 
 butes, it is too familiar to us in its disease-producing 
 effects. It may be of the nature of some minute or- 
 ganism, or germ, which, finding within the body a 
 resting-place, grows and multiplies ; or it may be 
 some gaseous product of the imperfect oxidation of 
 organic matter, which, by its chemical action upon 
 the more delicate tissues of the body, perverts the 
 more subtile processes of life, as a speck of rust de- 
 ranges the working of the finest watch. There is 
 reason to believe that sewer-miasm is of a complex 
 nature, and that both disease-germs of special kinds 
 and deleterious gases of considerable chemical energy 
 enter into its composition. 
 10 
 
110 THE SUMMER AND ITS DISEASES. 
 
 If the cause be removed, or the patient removed 
 from the infected neighborhood, recovery takes place 
 slowly ; — for the slow-acting poison has too often 
 made serious havoc before it is discovered. But in 
 many instances the poison thus working is of a special 
 kind, and the fever produced is a special form of dis- 
 ease, which once developed must run its course to 
 the end. In typhoid fever we have a too familiar 
 example of such a malady. 
 
 Once firmly developed, its course is from three to 
 four weeks, and then follows a tedious convalescence, 
 which may count months before health is regained ; 
 whilst in a certain proportion of cases the malady 
 runs on to a fatal issue. 
 
 The rich man of old wrote at the threshold of 
 his sumptuous house in Pompeii " Cave Canem;" it 
 would be well if the rich men of to-day were to 
 write it in bright letters over their " modern conven- 
 iences." 
 
 The great diversity of fever- forms, the variety of 
 their causes, their great range of intensity, and the 
 complexity of the disease-processes which charac- 
 terize them, make it impossible to discuss at length 
 the treatment of fever or of fevers in a brief sketch 
 such as this. 
 
 Enough has been said of their causes to enable the 
 reader to avoid some of them, to put him on his 
 guard against many. If I have succeeded in this, 
 
SUMMER AND AUTUMNAL FEVERS. Ill 
 
 my aim is reached — it is the object of the volume 
 in his hand. Being on guard, he will observe for 
 himself and reflect for himself. Preventive treatment 
 consists in the avoidance of the cause. 
 
 In the general management of fever, the chief 
 points to which attention must be directed are these 
 — (i) to reduce temperature, (2) to control the 
 force of the circulation and the frequency of the 
 heart's action, (3) to re-establish the action of the 
 skin, the kidneys and the glandular system in gen- 
 eral, and (4) to keep up the nutrition of the body 
 by giving such food and in such quantities as can be 
 best taken up by the digestive organs in their de- 
 ranged condition. 
 
 (1.) Temperature is to be reduced by the abstrac- 
 tion of heat from the body. In mild cases, system- 
 atic sponging of the surface with cold vinegar and 
 water or spirits and water answers admirably. It is 
 usually grateful and refreshing to the patient; it 
 promotes cleanliness, and it tends to re-establish the 
 arrested secretion of the skin at the same time that 
 it removes heat. If cold sponging be uncomfortable 
 to the patient, the lotion may be warmed, for it is the 
 rapid evaporation of the thin film of fluid that lowers 
 temperature, so that a grateful tepidity by no means 
 defeats the object in view. Cool and slightly acid 
 drinks may also be given in moderation. In graver 
 cases, more active measures, such as the ice-cap, the 
 
112 THE SUMMER AND ITS DISEASES. 
 
 wet pack, the cold bath, will be suggested by the 
 physician in charge, who will at the same time pre- 
 scribe medicines that have an influence in lowering 
 the heat of the body. 
 
 (2.) The action of the heart and the force of the 
 circulation are favorably influenced by the greatest 
 quietude that can be attained both for the body and 
 the mind. All excitement, all hurry, all visits of 
 friends, and conversation on unnecessary topics are 
 hurtful to the person ill of a fever. He should be 
 placed on a firm, comfortable bed ; his room should be 
 large, airy, and well-ventilated, and not darkened un- 
 less the light disturbs him. The footsteps of the at- 
 tendants must be silent, their voices low, their manner 
 quiet but firm. Drugs potent to quiet the heart are 
 at hand, but with their choice and administration the 
 doctor alone has to do. 
 
 (3.) Cool sponging, the moderate allowance of cold 
 water and acidulated drinks, tend to promote secretion 
 whilst they lower temperature. The action of the 
 glandular system is aided by acting upon the bowels 
 by such remedies as magnesia, Rochelle salts, the 
 solution of the citrate of magnesia, Pullna, Friedeich- 
 alle or Honyadi waters, at the same time that remedies 
 directed to the kidneys and skin are used. It is often 
 pleasant to wash the mouth with water containing a 
 few drops of tincture of myrrh. 
 
 (4.) The fever patient must be systematically fed. 
 
SUMMER AND AUTUMNAL FEVERS. II3 
 
 If the fever is a brief one, whose duration may be 
 counted by hours, he will not suffer much from absti- 
 nence from food ; but the fevers which last days and 
 weeks make serious demands upon the resources of 
 the kitchen. Systematic feeding means regular feed- 
 ing, in small quantities and at short intervals. By 
 small quantities I mean 2 to 4 fluidounces (4 to 8 
 tablespoonfuls) of strong meat broth for an adult and 
 by short intervals, 2 to 3 hours, and in low fevers 
 this must be kept up during the night. 
 
 The food must be as far as possible palatable, highly 
 nutritious, and easy of digestion. We look upon meat 
 broths, milk, custards, the more delicate preparations 
 of corn-starch, farina and so on, as the best fever 
 foods. Wines, brandy, whiskey are only to be given 
 as ordered by the medical man in attendance ; and in 
 truth it is one of his most important duties to order 
 in detail every article of the patient's food and drink 
 as well as his physic, and to inspect his surroundings 
 as well as to investigate his condition at each visit. 
 10* H 
 
CHAPTER VI. 
 
 SUMMER COLDS AND HAY ASTHMA. 
 
 WE are familiar enough with the expression, " to 
 catch cold/' and scarcely one of us but is too 
 familiar with the disagreeable sensations attending 
 the process, and the usually, but not invariably, unim- 
 portant ailments which follow it. Yet it would be dif- 
 ficult for any of us, even in that profession which makes 
 the ills that flesh is heir to the subject of its constant, 
 untiring, and conscientious study, to define precisely 
 what is meant by catching cold. 
 
 A person engaged in the usual pursuits of his every- 
 day life, conscious of no change in his surroundings, 
 nor in his relation with them, in weather not even, 
 it may be, characterized by any unusual change of 
 temperature or atmospheric state, becomes suddenly 
 aware that he has caught cold. Or, as more frequently 
 happens, he has made some injudicious change of 
 raiment, or sudden atmospheric changes have taken 
 place, or his feet have been wet ; or, after active exer- 
 cise, he has thoughtlessly seated himself in a draught 
 of air, and the surface of his body, or some part of 
 
 114 
 
SUMMER COLDS AND HA Y ASTHMA. I I 5 
 
 it has been chilled. Presently, or after the lapse of 
 some hours, and, in point of fact, often without his 
 being aware that he has been chilled or taken cold at 
 all, he begins to experience the symptoms of a mild, 
 febrile state. There is a general feeling of malaise, 
 into which a sense of muscular weakness enters largely ; 
 a disposition to shiver, attended with chilly sensations 
 which come and go, provoked by the slightest puff 
 of air, or sometimes by changes of position ; the 
 hands and feet are cold, and it is only by toasting 
 before the fire, or being covered up in bed, that feel- 
 ings of comfortable warmth can be transiently se- 
 cured. There is a marked tendency to sweating, 
 which adds not a little to the unpleasantness of the 
 situation. If not actual slight fever, there is feverish - 
 ness, and the heat of the head is in notable contrast 
 with the coldness of the extremities. Muscular sore- 
 ness, with pain on motion {Myalgia) is often present. 
 
 Acute inflammatory conditions of internal organs 
 may follow " cold," and in that case the special fever 
 (irritative fever) of the graver malady will show itself. 
 If no complications arise, a cold, or a feverish cold, 
 runs a brief course. 
 
 The symptoms following taking cold are usually 
 wide-spread or constitutional ; and local symptoms 
 are more frequently manifested at other remote parts 
 of the body than at the part actually chilled. It is not 
 necessary that the entire surface of the body be cooled, 
 
Il6 THE SUMMER AND ITS DISEASES. 
 
 a small area is enough. Nor is it necessary that the 
 change of temperature be very decided, though it is 
 usually more or less prolonged. 
 
 Here, as elsewhere, in considering the causes of 
 disease, we must bear in mind that they are of two 
 kinds, predisposing and exciting. It is evident that 
 there must be a marked predisposition to take cold on 
 the part of certain persons, since it happens to them 
 under circumstances in which most people escape. 
 Such persons are usually wanting in physical power, 
 are feebly organized, with sensitive skins prone to 
 perspire on slight exertion, often neuralgic. They 
 take but little exercise, leading sedentary lives, and 
 spending too much of their time indoors. But others, 
 robust, hearty, with good blood and a healthy skin, 
 active and hardened, find at times that they take cold 
 with the greatest readiness and under circumstances 
 in which they usually escape. In these, the predis- 
 posing cause is fatigue, mental or physical exhaustion; 
 in a word, that condition of the nervous system which 
 we call " tired." At such times the powers of resist- 
 ance of the most robust and the wiriest are brought 
 down to the level of the feeble and puny. 
 
 The exciting causes will be found to be threefold — - 
 a lowered temperature, air in movement, and moisture, 
 or some combination of these three. They act with 
 much greater frequency when the body is at rest than 
 when exercising, and the danger of taking cold is 
 
SUMMER COLDS AND HAY ASTHMA. WJ 
 
 greatest when at rest after prolonged energetic and 
 fatiguing exertion. Colds are most common in cold 
 and damp weather, but they are by no means unfre- 
 quent in summer — without doubt by reason of the 
 greater physiological activity of the skin, and the 
 temptations to relax our customary watchfulness in 
 such matters. How often in summer, tired, over-heated, 
 oppressed, do we throw ourselves at length upon the 
 ground or by a window, and with throat and arms 
 bared, court the welcome breeze that at any other 
 season we would most sedulously shun. 
 
 Medical theories concerning the morbid processes 
 of taking cold are as yet mere theories. Ingenious 
 as they are, they depend upon problems in physiology 
 and pathology, which contain very many unknown 
 quantities, and the solution of which can only take 
 place step by step as medical science advances. 
 
 The old notion that the whole process was depend- 
 ent upon suppression of the cutaneous perspiration can 
 scarcely stand against the objections that cold is often 
 taken when the skin is not in active perspiration, or 
 when but a limited area of the surface is chilled ; and 
 that, on the other hand, the body is suddenly cooled, 
 and the freest perspiration checked abruptly, in the 
 procedures of the Turkish bath without "cold" re- 
 sulting; that no symptoms resembling "cold " occur 
 in animals in whom perspiration is wholly brought to 
 an end experimentally by a coat of varnish, and that 
 
Il8 THE SUMMER AND ITS DISEASES. 
 
 moderate fluctuations in the activity of the skin must 
 constantly take place in every-day life without occa- 
 sioning "cold," the function of the skin as an organ 
 of excretion being to a very considerable extent inter- 
 changeable with that of the kidneys and the lungs. 
 
 The following hypothesis of Professor Seitz * ac- 
 cords with the present views of the physiology of the 
 nervous system. "When the skin is exposed to cold 
 of sufficient intensity and for a sufficient time, the 
 sensory nerves are thrown into a peculiar state which 
 is propagated to the nerve-centres, and reflected by 
 them along certain other channels which are endowed 
 with special susceptibility to this form of stimulus. 
 Should the affected tract be sensory, we get rheumatic 
 pains or neuralgia; should the vaso-motor centre (the 
 nerve-centre which controls the size of the blood- 
 vessels) be implicated, alterations in the calibre of the 
 blood-vessels may result, especially vascular dilatation 
 (dilatation of the blood-vessels) in particular areas; 
 lastly, should the heat-regulating centre be involved 
 and its activity depressed, fever may result." 
 
 The action of cold upon the sensory nerves may be 
 direct, or it may be through the influence of the blood. 
 Individuals differ as to which of the three above-named 
 channels the irritation may follow; some persons 
 
 * Cyclopedia of the Practice of Medicine. — Ziemssen, Vol. 
 XVI., p. 235. 
 
SUMMER COLDS AND HA Y ASTHMA. 1 1 9 
 
 always suffer pains of a neuralgic character, others 
 from so-called muscular rheumatism, others from local 
 congestions, which may run into inflammation, and 
 in that event are attended with fever, or the trouble 
 in others again manifests itself in a transient, mild, 
 febrile disorder, without any indication of local 
 trouble. In each individual the effects of taking cold 
 manifest themselves in " the part of least resistance M 
 to the specially acting morbid influences. My expe- 
 rience would lead me to regard the mild systemic 
 febrile disorder as the most common form, but the 
 congestive is by no means infrequent, and particularly 
 that form of it which affects the mucous membrane 
 of the upper air-passages. The every-day expression, 
 "I have a cold," means in the vast majority of in- 
 stances that the speaker suffers from some mild, acute, 
 inflammatory trouble of the throat or nasal passages; 
 oftenest the latter. 
 
 A " cold in the head " isa minor hardship of life 
 at any season, but a summer cold is a hardship indeed. 
 It is as easy to catch, and a deal harder to get rid of, 
 being kept up by the action of the slightest puffs of 
 air upon an over-sensitive skin on the one hand, and 
 on the other by the local irritations of dust, the perfume 
 of flowers, the pollen of plants, and other substances 
 suspended in the air, which are either not present at 
 all, or to a very much less extent at other seasons of 
 the year. Many influences of this kind, not potent 
 
120 THE SUMMER AND ITS DISEASES. 
 
 enough to occasion the affection acting alone, are 
 active agents in prolonging it when fairly established. 
 The popular opinion that this kind of a cold is apt to 
 last longer in summer, is based upon correct observa- 
 tion. 
 
 The symptoms are so well known as to make more 
 than an enumeration of them unnecessary. In addi- 
 tion to the slight constitutional disturbance described, 
 there is a sensation of weight or fulness in the head 
 and forehead ; frequent sneezing ; dryness and red- 
 ness of the mucous membrane lining the nasal pas- 
 sages ; swelling soon succeeds, and there is an in- 
 creased flow of nasal mucus. At first watery, this 
 fluid soon becomes thicker, and more like matter in 
 character; it is often abundant. The feeling of 
 weight and discomfort in the head is frequently re- 
 lieved on the appearance of free secretion. The sense 
 of smell and that of taste are usually somewhat, or 
 even greatly, impaired. The inflammation sometimes 
 extends by the route of the tear-ducts to the mucous 
 membrane of the eyes and eyelids, which become 
 red, swollen, and irritable, secreting likewise an ex- 
 cessive amount of altered mucus. By reason of the 
 irritating nature of the discharge, and the violence 
 used in constantly blowing the nose, excoriations not 
 rarely form about the nostrils and upper lip, and 
 occasionally an attack of facial erysipelas follows. 
 
 Of the many names applied to the affection, most 
 
SUMMER COLDS AND HAY ASTHMA. 121 
 
 have reference to the abnormal discharge, which is 
 the chief symptom. Coryza, catarrh, nasal catarrh, 
 running at the nose, rhume de cerveau, by the French, 
 from the old idea that the flow came from the brain, 
 are the most common terms. The Germans call it 
 " schnupfen," a word almost equivalent to our " snuf- 
 fles," — not polite, but expressive. Gravedo is an 
 old name, derived from the sense of weight in the 
 forehead attending the earlier stages of a cold. 
 
 The physicians of antiquity held the erroneous view 
 that the secretions of catarrh came directly from the 
 brain, an opinion still vaguely entertained by the 
 people, but which was demonstrated to be false more 
 than two centuries ago (1660) by Schneider, a pro- 
 fessor in Wittenberg. This anatomist showed that 
 there were no channels by which such a flow could 
 take place from the interior of the skull, and that the 
 discharge was derived in reality from the surface of 
 that extensive mucous membrane, thickly abounding 
 in blood-vessels, richly furnished with glands, which 
 lines the cavities of the nose and extends as a lining 
 membrane into those extensive, hollow chambers oc- 
 cupying the forehead, the upper jaw-bone, and other 
 neighboring bones of the face, and to which his name 
 has since been applied the world over — the Schnei- 
 derian mucous membrane. This membrane constitutes 
 the "vascular area," or tract of tissues rich in blood- 
 vessels, most prone to become abnormally flushed with 
 
122 THE SUMMER AND ITS DISEASES. 
 
 blood (hypersemic) in consequence of taking cold. It 
 becomes, as has been said, swollen, dark-red, deeply 
 congested. This explains the pain and fulness over 
 the eyes, the position of the frontal sinuses (spaces in 
 the frontal bone), the sense of fulness or obstruction 
 in the nose itself, and the arrest of the natural secre- 
 tions, as manifested in a feeling of dryness; for the 
 first effect of deep congestion of every mucous mem- 
 brane is a more or less complete arrest of its natural 
 secretion. The blood-spaces in the Schneiderian 
 membrane are so relatively large, and their inter- 
 communication is so free, that the contained blood 
 is affected by the action of gravity ; and it is often 
 observed that if the sufferer lie upon his side during 
 the period of greatest swelling, when both nostrils 
 seem to be stopped up, the upper one will become 
 comparatively free. 
 
 The engorged vessels relieve themselves shortly by 
 a free discharge, which is composed in part of altered 
 secretions from the mucous glands, in part of blood 
 elements (white corpuscles, serum), which, as in every 
 inflammation, find their way through their walls. 
 
 Well may the sufferer exclaim in the words of Othello, 
 but with far greater sincerity : 
 
 " I have a salt and sullen rheum offends me." 
 
 A cold in the head, unless prolonged by fresh expo- 
 sure, by unfavorable surroundings, or by irritating sub- 
 
SUMMER COLDS AND HAY ASTHMA. 1 23 
 
 stances floating in the air, usually comes to an end in 
 from two to seven days. Chronic catarrh does not 
 result, as a rule, except in scrofulous persons, or those 
 the subjects of some other depraved constitutional 
 state. 
 
 Coryza, or cold in the head, is produced in some 
 persons by the emanations from certain animals, as 
 the horse, or from certain flowers, as the rose, or drugs, 
 as ipecacuanha. This form is usually of a very tran- 
 sient nature, although often quite severe. It is closely 
 allied to hay-fever. Some drugs internally adminis- 
 tered, as iodide of potassium, occasion similar symp- 
 toms. 
 
 Some authorities, and not without reason, look upon 
 simple coryza as contagious by direct contact. A 
 mere suspicion of this kind is enough to warrant 
 every precaution on the part of those living in com- 
 panionship with a person suffering from the disease. 
 
 Bronchitis, or inflammation of the lining membrane 
 of the bronchial tubes, sometimes follows a coryza, by 
 extension of inflammation along the air-passages to the 
 bronchial tubes. In such cases there is some special 
 liability to bronchial catarrh. 
 
 Whilst it is not to be advised that persons suffering 
 from a cold in the head should neglect it, and refuse 
 to look upon it as a disease, it is candid to say that 
 it is an affection which cannot always be cut short by 
 treatment. Under ordinary circumstances, the symp- 
 
124 THE SUMMER AND ITS DISEASES. 
 
 toms being moderate in intensity, no very active treat- 
 ment is called for, the most useful agents being those 
 of a tonic character, and particularly repose. Quinine, 
 from its known influence in dispelling local congestion, 
 is, when judiciously used, of great advantage ; so also 
 are minute amounts of opium, both locally and inter- 
 nally ; small, frequently-repeated doses of carbonate 
 of ammonia are highly recommended. If the secre- 
 tion be excessive and long continued, astringents are 
 advised ; but they are, in my opinion, of questionable 
 value. But these are not tools to be taken rashly into 
 untrained hands. Measures looking to the establish- 
 ment of free sweating are not always beneficial nor 
 without risk, and had better be avoided, except at the 
 very outset of the trouble. 
 
 In the earliest stages, such old-fashioned, time-hon- 
 ored, and honorable measures as a hot mustard foot- 
 bath, hot sleeping-draughts, like strong lemonade or 
 lemonade strengthened with a table-spoonful of whis- 
 key, or Hollands and the like, taken with a view to pro- 
 voke abundant sweating,are excellent ; but they must be 
 taken at the beginning to do the good they are capable 
 of; and it is not to be forgotten that harm may come 
 of imprudent exposure the next morning. 
 
 A plain, nutritious diet, the sparing consumption 
 of fluids, attention to ventilation and the temperature, 
 and to the weight and warmth of clothing, are required. 
 
 Preventive treatment consists in attention to the 
 
SUMMER COLDS AND HAY ASTHMA. 12$ 
 
 general health, and the greatest care in avoidance of 
 exposure when fatigued. An over-sensitive skin may 
 be hardened by systematic cold or lukewarm sponging, 
 by regular exercise in the open air, and by long hours 
 of sleep upon a hard bed with light coverings. 
 
 Schneider thought that the secretion of catarrh was 
 an effort on the part of Nature to purge the blood of 
 injurious accumulations, the result of high living ; and 
 that the abundance of riches bi ought to its possessor 
 an abundance of phlegm. This view led him to a 
 choice of remedies as unpalatable to those given up 
 to luxurious living as they are useful in building up 
 and maintaining health : "Inasmuch as catarrhs are 
 born of luxury and indolence, therefore their appro- 
 priate medicine consists in sobriety, in continence, in 
 bodily exercise, and in tranquillity of mind." * 
 
 One of the most remarkable, and not rarely one of 
 the most distressing, diseases of summer is hay asthma. 
 This affection, for which a number of different names 
 has been proposed, — such as hay-fever, rye-catarrh, 
 rose- cold, typical summer-catarrh, catarrhus sestivus, 
 pollen-catarrh, pollen-asthma,— was first fully described, 
 in 1 819, by an English physician named Bostock, who 
 
 *"Ut ex luxu ac otio nascentur catarrhi, ita horum medi- 
 cina est in sobrietate, in continentia, in exercitationibus corporis, 
 in mentis tranquillitate." — Quoted by Fraenkel, in Ziemssen's 
 Cyclopedia, Vol. IV. 
 
126 THE SUMMER AND ITS DISEASES. 
 
 wrote about it from personal experience, being him- 
 self a sufferer. Since his day, more and more atten- 
 tion has been given to this ailment, both by physicians 
 and others, and an extensive literature concerning it 
 has grown up, chiefly the work of men who, like Bos- 
 tock, were subject to its attacks. It now finds a recog- 
 nized place in the systematic books on medicine. It 
 is a disease remarkable by reason of the comparatively 
 small number of persons whom it attacks, the regu- 
 larity with which it makes its annual return, — often to 
 the very day or hour, — and the fact that our knowl- 
 edge of the nature of the cause is very much more 
 exact and definite than in most other diseases. It is 
 often distressing by reason of the extreme intensity 
 of the symptoms, which frequently prevent the suf- 
 ferer from the discharge of business duties and the 
 enjoyment of social pleasures alike, and in many cases 
 oblige him to remain for some days, or even weeks, 
 a close prisoner in his room. Recovery always takes 
 place. 
 
 Hay asthma may be described as a catarrhal affec- 
 tion of the mucous membrane lining the bronchial 
 tubes, the upper air-passages, and that which covers 
 the globe of the eye and lines the eyelids, (conjunc- 
 tiva,) attended with slight febrile action, and occur- 
 ring once a year, at the season of the blooming of 
 certain grasses and cereals. The attack lasts a variable 
 length of time, from a few days to six weeks, and is 
 
SUMMER COLDS AND HAY ASTHMA. \2*J 
 
 subject to a daily increase in the intensity of the 
 symptoms usually towards evening. It is at once re- 
 lieved, in the great majority of cases, by an escape 
 from the exciting cause — the pollen of the plants 
 named. 
 
 If the eyes and nasal passages be alone or chiefly 
 affected, the symptoms are those of a more or less 
 pronounced coryza, while if the bronchial tubes be 
 implicated, the symptoms are those of asthma. In 
 many cases these two groups are associated, and to 
 the swelling and redness of the eyelids, and excessive 
 secretion of tears, and the most distressing symptoms 
 of cold in the head, are added the difficult respira- 
 tion, oppression, and general distress of asthma, the 
 whole being reinforced by a slight febrile condition, 
 general malaise, and a leaky, chilly, and acutely sen- 
 sitive skin, as in "cold," — certainly no very endu- 
 rable array of ills. In some cases the patient has 
 urgent difficulty in breathing, is obliged to sit bolt- 
 upright, is anxious and extremely restless, with con- 
 vulsively clinched hands, and a disturbed, pale, or 
 even livid face. But the intensity of the trouble is 
 very variable, not amounting, in some cases, to more 
 than an annoying and persistent cold in the head. 
 
 The first attack may occur in early childhood ; the 
 period of adolescence and early adult life is most 
 prone to it, and those who escape till middle life are 
 not apt to become the victims of the disease. Men 
 are much more liable to it than women. 
 
128 THE SUMMER AND ITS DISEASES. 
 
 The educated classes of society alone suffer from 
 this malady. Doctors are especially liable to it. A 
 curious contrast is afforded by persons living side by 
 side, but a different life. The physician suffers; his 
 coachman, who breathes the same air, or, at all 
 events, a better one, escapes ; the clergyman, the 
 officer, the merchant are made wretched some weeks 
 every year, and always anxious by it ; whilst the sex- 
 ton, the private soldier, and the porter have never 
 even heard of hay asthma, and in this respect can 
 well forego the folly of being wise. 
 
 All observers agree that the class of persons who 
 suffer least from hay asthma, is that most exposed to 
 its exciting causes, namely, farmers. Whether this 
 be due to their simpler life, or to the fact that a con- 
 stant exposure renders them less sensitive, is as yet 
 undecided. 
 
 Those resident in rural districts are very much less 
 liable than dwellers in cities. 
 
 Persons of a strongly marked nervous temperament 
 are more apt to suffer from the affection under con- 
 sideration than others. 
 
 The liability is, in some families, hereditary. 
 
 It prevails to some extent in all civilized countries, 
 but is especially prevalent in England and the United 
 States, the Anglo-Saxon races appearing to possess a 
 peculiar susceptibility to the substances which call it 
 forth. 
 
SUMMER COLDS AND HAY ASTHMA. 1 29 
 
 Certain conditions of age, race, sex, dwelling-place, 
 social state, temperament, hereditation, are the pre- 
 disposing causes, which in combination render a 
 limited number of individuals in any community in- 
 capable of resisting influences which are inoperative 
 with the majority, but which in them produce the 
 disease with the greatest certainty and regularity. 
 These influences have been found to be inseparably 
 associated with the summer, from May to September, 
 that is to say, with the time of the blossoming of the 
 grasses and cereals. 
 
 Bostock thought that the disease was due to heat ; 
 others, that dry heat with intense light; or again, 
 others, that moist heat are the exciting causes of the 
 affection. Dust, also, and the odors of certain plants 
 and flowers, and ozone have been viewed as exciting 
 causes; but the general experience of both medical 
 observers and their patients tends to establish the 
 opinion, that the pollen of certain plants, and that 
 alone, is capable of producing hay asthma in those 
 individuals who are liable to it. The elaborate and 
 painstaking experiments of Dr. Blakley have gone 
 far towards confirming the popular view.* 
 
 It is familiar to all that dust, the emanations from 
 powdered ipecach, the scent of certain flowers, and 
 
 * Experimental Researches in the Causes and Nature ofCatar- 
 rhus ^Estivus. 1873. 
 
 I 
 
I3O THE SUMMER AND ITS DISEASES. 
 
 volatile principles emitted from the skins of certain 
 animals will produce marked irritation of the mucous 
 membrane of the nose and lungs of some persons; but 
 this is not the disease in question. This may and 
 does happen at all seasons of the year ; it is transient 
 in character, vanishing with the cause ; it lacks, finally, 
 the intensity, the complexity, the daily revolution and 
 variation of the symptoms produced by the true 
 malady. 
 
 Dr. Blakley found that pollen — he experimented 
 with that of seventy- four kinds of plants, among 
 which were many grasses — produced the symptoms 
 of the disease both in the fresh and dried states. He 
 conducted a series of experiments with a view to es- 
 tablish the relative quantity of pollen floating in the 
 air in different localities, at varying altitudes, and the 
 relation between the urgency of the symptoms and 
 the amount of pollen. These observations were ex- 
 tended over two years, 1866 and 1867. The differ- 
 ence in quantity was very great in the two years. In 
 cities, the proportion was less than in the country. The 
 greatest quantity was found to coincide with the high- 
 est temperature of the season ; the higher strata of air — 
 the experiments were carried in to a height of 1500 feet 
 above the sea level — were found to contain a rela- 
 tively greater amount, a fact contrary to what would 
 have been supposed. It was observed, also, that a 
 rain-fall and rainy weather diminished the quantity, 
 
SUMMER COLDS AND HAY ASTHMA. I3I 
 
 which was also influenced by the force and direction 
 of the winds. 
 
 The experimenter found that the intensity of the 
 symptoms, in his own case, varied in conformity with 
 the above observations, being greatest when the 
 amount of pollen floating in the air was greatest, ag- 
 gravated on going from the city to the country, miti- 
 gated upon the fall of rain, observations constantly 
 made by sufferers from this affection. It is also in 
 accordance with this observation that patients suffer 
 less while quiet than when in motion, and indoors 
 than in the open air. 
 
 The pollen grain, which is of microscopic size, con- 
 sists of a membranous sac with granular contents. 
 The bursting of the membrane allows the granules to 
 become free ; they then exhibit an active movement, 
 which continues for some time. The bursting of the 
 membrane is quickly brought about by the absorption 
 of water or other fluids. In addition to the mechan- 
 ical effects of these granules in motion upon the sur- 
 face of the mucous membrane, it has been suggested 
 that some not yet investigated chemical action may 
 take place. 
 
 The symptoms above described are due to an in- 
 flammation of the mucous membrane, with the accu- 
 mulation of inflammatory products in the tissues form- 
 ing it, giving rise to thickening and altered secretion. 
 
 The duration of the attack is variable, but may be 
 
I32 THE SUMMER AND ITS DISEASES. 
 
 set down as about six weeks. It may gradually sub- 
 side or may cease as abruptly as it began. 
 
 In the neighborhood of Philadelphia, and other dis- 
 tricts on the Atlantic seaboard familiar to the writer, 
 the pollen of the maize or Indian corn appears to 
 be active in producing hay asthma. Many persons, 
 experience the first symptoms of its annual visitation 
 about the middle of August (17th to 23d), about the 
 time the ordinary field-corn comes into tassel. 
 
 A gentleman, who suffered from the disease in a 
 very severe form, related to the writer that on one 
 occasion, while at Cresson, when his sufferings were 
 usually less intense, he undertook an excursion by 
 carriage to visit some place of interest distant about 
 ten miles. It was towards the end of August, and 
 the road lay, for the greater part of the distance, be- 
 tween corn-fields then in full bloom. His sufferings 
 became greater than he had ever before felt, and at 
 the end of his journey he was scarcely able to speak. 
 
 Persons who have once manifested the liability to 
 hay asthma, and have once had the disease, are apt 
 to suffer from it with each returning year, unless they 
 seek refuge in flight from cultivated regions. As yet 
 the most diligent search on all sides has failed to 
 bring to light any sure preventive treatment for those 
 who are exposed to the exciting causes. The pollen 
 is capable of being transported long distances and at 
 considerable heights^ as was shown by the experiments 
 
SUMMER COLDS AND HAY ASTHMA. 1 33 
 
 of Dr. Blakley; but it is evident that it fails to reach 
 great altitudes ; for those escape it who take refuge 
 in such high regions as Deer Park, Kane, several spots 
 in mountainous New England, notably Jefferson, and 
 at Paul Smith's in the Adirondacks. It is probable 
 that dense masses of foliage, as that of forests, arrest 
 the progress of the pollen wafted in the air, as they 
 arrest the course of that obscure entity to which the 
 name of malaria is given. Those who go to sea of 
 course escape, and some islands afford refuge, notably 
 Fire Island, off the coast of Long Island, and, on 
 the Jersey coast, Beach Haven. Many persons are 
 moderately comfortable at the sea-shore whilst the 
 sea-breeze blows, but their sufferings return in full 
 intensity upon the setting in of a breeze from the 
 land. 
 
CHAPTER VII. 
 
 THE SKIN IN SUMMER, AND ITS MALADIES. 
 
 THE skin is not only the covering of the body and 
 a protection to the parts beneath, but it also 
 serves several important physiological purposes. 
 
 Richly endowed with nerves, it serves as a great 
 organ of touch, by means of which the nature of 
 things in direct physical relation with our bodies is 
 brought to our knowledge. 
 
 The sweat-glands and the function of perspiration, 
 which is vicarious with that of the kidneys to a certain 
 extent, place the skin in the excretory system of the 
 organism, of which in truth it forms an important ele- 
 ment. 
 
 The skin is exceedingly rich in blood-vessels. 
 These, under the influence of external impressions, 
 and of the action of that portion of the nervous sys- 
 tem, the sympathetic, which presides over the circu- 
 lation of the blood in the various organs, are capable 
 of rapid and great changes of calibre. It thus has an 
 office of no little importance in relation to the circu- 
 lation of the blood, and, as it constitutes the "heat- 
 
 i34 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 35 
 
 losing" area of the body, in contradistinction to those 
 internal organs in which rapid oxidation takes place, 
 and which together make up the "heat-producing" 
 area, it has much to do with animal heat and the main- 
 tenance of a constant temperature. 
 
 The skin is endowed with the function of absorp- 
 tion. Substances applied to its surface produce local 
 and constitutional effects. Absorption takes place 
 with the greatest readiness in those parts where the 
 outer or horny layer of the epidermis is least devel- 
 oped. 
 
 It does not fall within the scope of this book to 
 describe in detail the anatomy of the skin, nor to 
 discuss skin diseases at length from any point of view ; 
 but there are a number of skin affections so common 
 in summer, and so directly due to influences acting 
 only in summer, that their brief consideration is not 
 out of place here. For more general information, 
 the book of Dr. Bulkley * may be referred to. 
 
 It will not be without use, however, to remind the 
 reader that the skin is, as has been seen, a complex 
 organization. It is made up of several parts, of which 
 some are essential, and present everywhere ; others 
 are of the nature of appendages, and are to be found 
 only in certain parts. 
 
 The essential layers are (1) the epidermis, or scarf - 
 
 * The Skin in Health and Disease. By L. D. Bulkley, 
 M. D. American Health Primers. 
 
I36 THE SUMMER AND ITS DISEASES. 
 
 skin, a cellular layer, which is divided into an outer 
 or horny part, and an inner or mucous layer. 
 
 The epidermis is of variable thickness, being thin- 
 nest on the lips and elsewhere in the face, and thick- 
 est on the palms of the hands and the soles of the 
 feet. 
 
 (2.) The corium, or cutis vera, or true skin, a firm, 
 membranous structure, composed chiefly of connective 
 tissue with elastic fibres, is the most important element 
 of the integument. It consists of an upper or papil- 
 lary and a lower or reticular layer. 
 
 The papillary layer consists of a dense tissue, be- 
 set with minute, teat-like projections called papillae. 
 These are of two kinds, those containing blood- 
 vessels and those containing nerves. 
 
 The reticular layer forms the bulk of the corium. 
 It consists of an interlacement of connective tissue, 
 looser in texture than the papillary layer, from which 
 it is not separated by any distinct line. 
 
 (3.) The subcutaneous connective tissue is com- 
 posed of bands of ordinary connective tissue crossing 
 one another so as to form a coarse network. It con- 
 tains, as a rule, an abundance of fat ; but in certain 
 regions, as the eyelids and the ears, it is without fat. 
 When fat is plentiful, it is called adipose tissue. The 
 contour of the body is to some extent determined by 
 the quantity of fat contained in the meshes of this 
 deepest layer of the skin. It merges into the corium 
 
THE SKIN IN SUMMER, AND ITS MALADIES. I 37 
 
 above, and is connected with the deep fascia, or the 
 proper coverings of the muscles below. Good-sized 
 blood-vessels ramify in it, giving off twigs to the over- 
 lying corium. 
 
 The appendages of the skin are sebaceous or oil- 
 glands, sweat-glands, hairs, and nails. 
 
 The glands, hairs, muscular fibres of the skin, 
 together with the lymphatic vessels, nerves, and 
 blood-vessels, are contained in the corium, along with 
 some fat. 
 
 The outer or horny layer of the epidermis is con- 
 stantly shed in the form of fine scales. This loss is 
 compensated by a constant renewal from beneath. 
 
 The secretion of the sebaceous glands is rich in 
 fat, and serves as a natural lubricant for the skin and 
 hair. Its amount and character vary in different in- 
 dividuals and different conditions of health. Excess 
 in production constitutes a troublesome disease. 
 
 The perspiration contains products of tissue-waste, 
 fine fat cells, and granular matter from the walls of 
 the gland-tubes. 
 
 Cold applied to the surface causes the blood-vessels 
 of the skin to contract, and thus diminishes the quan- 
 tity of blood near the surface by compelling it to go 
 to the internal organs ; on the other hand, warmth, 
 by causing the little arteries of the corium to dilate, 
 invites the blood to the surface, and causes a freer 
 blood-supply and more active circulation in the skin. 
 
I38 THE SUMMER AND ITS DISEASES. 
 
 A freer blood-supply and more active circulation, 
 within the limits of health, are followed by increased 
 activity of the physiological processes of the part ; 
 hence, in summer, the warmth of the atmosphere, 
 acting upon the circulation of the skin, intensifies its 
 natural processes ; a more rapid growth and falling 
 off of the outer surface takes place, a more abundant 
 secretion of sebum, the product of the sebaceous 
 glands, a vastly more abundant and continuous sweat- 
 ing. At the same time rapid evaporation removes 
 the watery portions of these secretions, thus lowering 
 the temperature of the surface and of the blood near 
 it, and maintaining the normal temperature of the 
 whole mass of the blood. But the solid, non-volatile 
 portions are left upon the surface. Epithelial scales, 
 tallowy sebum, the cellular and crystallizable elements 
 of the sweat, rapidly produced, tend to accumulate 
 upon the surface of the body, unless as rapidly and 
 carefully removed. 
 
 Systematic washing is at every season necessary 
 to high health and decent living. It is much more 
 necessary in summer than in other seasons, as the 
 activity of the skin is greater at that time. The daily 
 bath on rising, whether it be by sponging or the im- 
 mersion of the whole body, is not alone useful in 
 removing the accumulations of secretion and other 
 foreign substances from the surface, in a word, in 
 cleansing the skin, but also, along with the necessary 
 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 39 
 
 friction of towelling, it acts as a general tonic to the 
 circulation and the nervous system. u Wash and be 
 clean," may with truth be broadened to " wash and 
 be well." Those only are ignorant of the grateful, 
 refreshing, tonic influence of a quick, cool bath on 
 getting out of bed, who have not made it a daily habit. 
 
 I have used the expression "systematic bathing" 
 advisedly. Excessive bathing, either in frequency 
 or in undue length of time spent in the bath, is hurt- 
 ful. Especially is this true if strong alkaline soaps 
 be freely employed. The outer layer of the epidermis 
 is too rapidly removed, and the oily secretion of the 
 skin, its natural lubricant, reduced below the line of 
 health. The skin is thus rendered harsh and irritable, 
 and actual disease may result. 
 
 From five to fifteen minutes is ample time for the 
 daily bath. If bathing be too frequent, or the bath 
 too long, the constitutional effects cease to be tonic, 
 and become depressant. 
 
 It is needless to urge the bad taste, uselessness, and 
 danger of the so-called cosmetics, whether they be 
 red or white. 
 
 The maladies to which the skin is most liable in 
 summer are : 
 
 I. Those produced by the direct action of heat 
 and light — 
 Sunburn. 
 
I4O THE SUMMER AND ITS DISEASES. 
 
 Freckles. 
 Prickly heat. 
 Chafing. 
 
 II. Those due to other agencies chiefly acting in 
 summer, 
 
 a. Consequent upon derangements of the stomach 
 and bowels — 
 
 Simple erythema. 
 Roseola, or rose-rash. 
 • Eczema. 
 Urticaria, or nettle-rash. 
 
 b. Insect-bites and the like. 
 
 c. Those produced by poisonous plants. 
 
 The more active circulation of the skin in summer 
 renders it especially prone to inflammatory troubles 
 upon exposure to the action of irritants. Almost all 
 the diseases that we are about to consider are essen- 
 tially of the nature of inflammations, and they are, 
 for the most part, acute in character. The exciting 
 causes may be divided into two classes — external, or 
 those acting from without, as intense sunshine, in 
 producing inflammation of the skin exposed to it ; 
 or internal or constitutional, as is seen in the action 
 of certain articles of diet in producing nettle-rash. 
 
 With very few exceptions; they are attended with 
 
THE SKIN IN SUMMER, AND ITS MALADIES. I4I 
 
 redness of the surface, varying from the mere blush 
 of tissues suffused with an excessive flow of blood in 
 the vessels (hyperemia) to an intense, angry livid- 
 ity; with pain of an itching, smarting, or burning 
 character ; with greatly increased heat of the surface, 
 both to the sufferer and to the hand of the observer ; 
 and with swelling, which is due to the formation of 
 the products of inflammation, and their accumulation 
 in the tissues themselves or beneath the epidermis. 
 This swelling may be in minute points scattered over 
 the surface (papules), or it may be diffuse, and ex- 
 tend over considerable areas (inflammatory oedema), 
 or it may form collections of watery fluid (serum) 
 beneath the outer layers of the skin. These, when 
 small, are called vesicles ; when larger, blebs or blis- 
 ters ; or there may be matter (pus), forming pustules 
 or small abscesses. In extreme cases there may be 
 destructive inflammation, terminating in gangrene. 
 
 As the inflammatory process subsides, the epider- 
 mis dries up (dessicates), and is shed either in the 
 form of small scales or larger strips (desquamation). 
 The new surface is soft and smooth by reason of the 
 delicate nature of the cells which form it (epithelium), 
 and of a brighter hue than normal ; but it soon regains 
 the color and texture of the surrounding integument. 
 
 Sunburn {Dermatitis Caloric a). — Heat and cold 
 alike, when sufficiently intense, produce inflammation 
 of the skin. The direct rays of the sun, in which we 
 
142 THE SUMMER AND ITS DISEASES. 
 
 have the combined action of high heat and intense 
 light, speedily bring about that group of changes in 
 the skin of persons unaccustomed to such exposure 
 that we call sunburn. There is redness, varying 
 from a slight blush to an intense red or even purple. 
 If the exposure be not too great, the redness gradually 
 subsides, the smarting which attended it ceases, and 
 nothing is left but a moderate deepening of the color 
 of the surface. If the exposure be continued from 
 week to week, the skin becomes accustomed to the 
 sun's rays, inflammatory symptoms are no longer ex- 
 cited, but the color is deepened (pigmentation) until 
 the skin is bronzed, as is seen in sailors, and soldiers 
 after a summer campaign, or in pale-faced profes- 
 sional men after a season of camping out. 
 
 Very great exposure may, however, be followed by 
 troublesome and painful symptoms, in children and 
 others whose skin is delicate. The redness becomes 
 intense, the skin swells, blisters form, the surface 
 may be raw as if burned. The suffering attending 
 this condition is often very great. It is, however, of 
 short duration, and the malady tends to spontaneous 
 recovery upon the avoidance of the cause. 
 
 Preventive treatment consists in guarding against 
 undue direct exposure, as far as possible, by the use 
 of suitable articles to shield the face, neck, and other 
 parts of the body exposed, and especially by only a 
 brief exposure to the sun for the first few days. 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 43 
 
 When active inflammation has been excited, the 
 application of soothing lotions is useful. Dilute lead- 
 water is often employed. I have found very rapid re- 
 lief follow the employment of the carbonate of soda 
 in solution, of the strength of one to two drachms to 
 the pint of water. These preparations are best used 
 in the form of evaporating lotions, by means of masks 
 or compresses of one or two thicknesses of cotton-cloth, 
 which are to be wetted and reapplied as they become 
 warm, for several hours at a time. Zinc ointment 
 also often serves an excellent purpose. As the in- 
 flammatory process subsides and the skin begins to 
 dry, bland ointments, such as cosmoline or zinc 
 ointment, may be applied, or a dusting powder, such 
 as rice-flour, starch, or fine rye-meal. Sunburn may 
 occasion eczema in persons predisposed to that affec- 
 tion. 
 
 Freckles {Lentigines). — This affection usually makes 
 its appearance for the first time in summer, and is 
 always more marked at that season of the year; for 
 this reason, it is supposed to be due to the action of 
 the sun's rays, though the precise mode of its causa- 
 tion is not well understood. Freckles are occasion- 
 ally met with on portions of the body not exposed to 
 the direct action of sunlight. They are small, round, 
 irregularly shaped, or even angularly outlined, yel- 
 lowish or yellowish-brown flecks, varying in size from 
 the diameter of a small shot to that of a split pea, 
 
144 THE SUMMER AND ITS DISEASES. 
 
 symmetrically disposed, without regularity of distri- 
 bution on the face, neck, backs of the hands, and 
 the arms, when habitually exposed to the sun's rays. 
 They may appear before the third or fourth year of 
 life, and generally vanish in advanced age. Once 
 having appeared, they last a long time, fading in the 
 winter to reappear in the hot season. Persons of fair 
 complexion are most liable to them, and those hav- 
 ing red hair are rarely quite free from freckles. Dark- 
 complexioned people are not, however, always ex- 
 empt. The discoloration is due to an abnormal de- 
 posit of the natural pigment or coloring matter of the 
 skin. They are not attended by any symptoms, and 
 are annoying only by reason of the disfigurement 
 which they cause. 
 
 There is no convenient preventive treatment for 
 those in whom there exists a natural predisposition 
 to freckles. An avoidance of the sunshine, which is 
 most probably the exciting cause, would doubtless 
 keep their development within endurable bounds ; 
 but the sunshine does more good than the freckles 
 do harm. 
 
 Such external remedies are of service in diminish- 
 ing the intensity of the discoloration as act upon the 
 epidermis, and thus remove the excess of coloring 
 matter. Among these may be mentioned several 
 preparations of mercury, subnitrate of bismuth, and 
 mild alkaline applications, as solutions of carbonate 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 45 
 
 of soda, or of carbonate of potash. These, variously 
 combined with emulsion of almonds and tincture of 
 benzoin, form agreeable remedies, which should be 
 perseveringly used. Better results are obtained by 
 the prolonged use of mild remedies than by strong 
 applications. Freckles may be rapidly removed by 
 using applications of such strength that their contin- 
 uous action for some hours gives rise to the formation 
 of minute blisters. The pigment may be carefully 
 removed with the epidermis forming the roof of the 
 blister. The epidermis which reforms over the sur- 
 face thus treated, will be found to be free from excess 
 of pigment. This process is not to be advised, how- 
 ever, as the benefit is of short duration, and in un- 
 skilful hands permanent injury to the skin might 
 result. Various ointments are recommended ; they 
 contain stimulating substances, and act by exciting a 
 rapid formation of the superficial elements of the skin 
 and their correspondingly rapid shedding (exfolia- 
 tion), and should only be used under the observation 
 and advice of a competent medical man. 
 
 Prickly Heat {Miliaria) is an acute affection of the 
 sweat-glands of an inflammatory nature. It shows 
 itself in numerous minute red points, slightly raised 
 above the surface of the surrounding skin (papules), 
 and in equally minute water-blisters (vesicles) which 
 rise from a reddened inflammatory base. These two 
 forms may exist separately, or, as is more commonly the 
 13 K 
 
I46 THE SUMMER AND ITS DISEASES. 
 
 case, they coexist. The disorder is not attended with 
 marked constitutional symptoms other than the an- 
 noyance and distress resulting from the tingling, prick- 
 ing and burning which always accompany the eruption. 
 The points are separate, but they may be very close 
 set and usually recur in patches of greater or less ex- 
 tent. Its commonest seat is upon the trunk and neck, 
 but it not infrequently appears upon the face and 
 upper and lower extremities. In the natural creases 
 of the skin it often becomes aggravated, and gives rise 
 to distressing raw surfaces. Its duration may be brief, 
 or crop after crop may appear, and the trouble be thus 
 prolonged during the continuance of hot weather. 
 It occurs at all periods of life, but is most common 
 in infancy and old age. Professor Duhring has ob- 
 served that the papular form is more apt to show 
 itself in the healthy and well nourished, the vesicular 
 in those who are feeble or in poor health. The out- 
 break is sudden, without premonitory symptoms, and 
 it frequently disappears and breaks out again abruptly, 
 without discoverable cause. 
 
 It is a disease of hot weather, and is produced by 
 heat. Young infants, fleshy persons, and those who 
 take much exercise and perspire excessively, are most 
 liable to it. Flannels and other irritating underwear, 
 and superfluous clothing in general, produce it when 
 the external temperature is high. 
 
 The disorder varies greatly in intensity. In tropical 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 47 
 
 climates it is of greater importance than here, where 
 it is usually an insignificant malady, tending to speedy 
 spontaneous cure upon the removal of the exciting 
 cause — heat. The treatment is a very simple one. 
 Irritating and stimulating applications of every kind 
 are to be carefully avoided ; they tend to aggravate 
 the symptoms, and to prolong their duration. Meas- 
 ures to diminish and control perspiration are to be 
 taken ; with diminished activity of the sweat-glands, 
 the symptoms tend to disappear with more or less 
 promptness. In ordinary cases, light clothing, rest, 
 a cool apartment, the occasional partial or complete 
 exposure of the affected surface to the air, simple diet, 
 limited quantities of fluid, and a simple purgative, 
 as a rule, work a speedy relief. Cool sponging is to 
 be resorted to, and the surface should be dried with- 
 out friction with the towel. Lycopodium, or starch- 
 powder, or oxide of zinc mixed with these, may be 
 lightly dusted over the surface. Internal remedies 
 of a cooling or astringent character are sometimes 
 needed. Where debility is present, or the ill-health 
 of the patient has an influence in prolonging the dis- 
 order, measures designed to improve the constitutional 
 condition are called for. There need be no fear of 
 evil results from " driving in " the eruption. As long 
 as hot weather continues, relapses are liable to occur. 
 Chafing {Erythema intertrigo, Eczema intertrigo) 
 is one of the most annoying of the simpler skin af- 
 
I48 THE SUMMER AND ITS DISEASES. 
 
 fections of summer. It chiefly affects fleshy persons 
 and infants, whose skin is soft and tender, and it 
 occurs in those parts of the body where the natural 
 creases of the skin bring two opposing surfaces in 
 contact with each other. The skin becomes red, feels 
 hot and sore; the outer surface is softened and rubs 
 off, leaving abrasions that are often exquisitely tender. 
 An acrid fluid is now poured out, and acts as an irri- 
 tant in intensifying the inflammatory process, and in 
 extending the inflamed area. Its outbreak is sudden, 
 and under judicious management it frequently goes 
 away as promptly as it came, its whole duration not 
 exceeding a few hours. It may, however, continue 
 for weeks. The term Erythema intertrigo is applied 
 to the affection just described. If there be a predis- 
 position on the part of the individual to that special 
 form of inflammation of the skin known as eczema, 
 or in some cases where the chafing is very severe, ob- 
 stinate, or has been neglected, the simple inflamma- 
 tory processes may run on into more complex, and 
 Eczema intertrigo may supervene. 
 
 Chafing may ocrur at all seasons of the year, and 
 is constantly met with in young infants. It is much 
 more common during hot weather, and is then en- 
 countered in persons not liable to it at other times. 
 Heat, friction of opposed surfaces or of garments, an 
 unreasonable quantity of clothing, excessive exercise 
 on the one hand, and too little of it on the other, 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 49 
 
 are all efficient causes of this affection. The irritating 
 influence of the excretions, want of neatness and at- 
 tention on the part of the nurse, and derangements 
 of the stomach and bowels, such, for example, as 
 are incident to the period of teething, produce it in 
 young babies. It is thus seen to be dependent either' 
 upon causes that are purely local, or upon those of a 
 constitutional character. When the latter exist, any 
 treatment to be successful must be-addressed to their 
 removal. 
 
 Preventive treatment lies in a careful avoidance of 
 the causes. These are heat, friction, and the action 
 of moist secretions retained in contact with the sur- 
 face of the skin. It is of great importance that fre- 
 quent ablutions be performed, and that unscented 
 soap, such as castile, be sparingly used. The skin 
 must be dried with a soft towel, by repeated, light, 
 direct pressure, and without friction. A plethoric 
 gentleman, whose sufferings from this cause in summer 
 had been very great, informed me that he had for 
 several years been quite free from it, in consequence 
 of having formed the habit of washing himself with 
 cold water eight or ten times a day. 
 
 The affection once established, measures to dry the 
 surfaces, and keep them asunder, are called for. The 
 readiest of these consist of dusting powders ; the best 
 being composed of starch and oxide of zinc com- 
 bined in varying proportions. Lycopodium powder 
 13* 
 
I50 THE SUMMER AND ITS DISEASES. 
 
 or oxide of zinc ointment are also useful. The folds 
 of skin may be separated by strips of lint. The ten- 
 dency of the disorder thus managed is to a speedy 
 recovery. If it be obstinate, applications of dilute 
 alcoholic washes, or mild astringent lotions, or the 
 black wash — a preparation of calomel in lime-water 
 — may be advantageously resorted to. 
 
 It is a good plan to allow babies suffering from 
 chafing to play about upon the bed an hour or so at 
 a time, once or twice a day, without more clothing 
 than their little shirt and a slip, and particularly sans 
 citlotles. 
 
 We now pass on to the brief consideration of some 
 of the skin affections of summer produced by other 
 causes than heat. 
 
 Derangements of the digestion not unfrequently 
 give rise to eruptions of various kinds. Children are 
 much more liable to these disorders than adults. One 
 of the most common is 
 
 Simple Erythema. — This is a redness or congestion 
 of the skin. We have seen that it characterizes the 
 early stages of other affections produced by irritating 
 causes. It appears as a non-elevated rash, red in 
 color, either diffuse, that is, extending over con- 
 siderable areas, or even over the greater part of the 
 body uniformly, or else as small, circumscribed spots 
 or patches. It may be due to external causes, but is 
 frequently due to constitutional disturbances, partic- 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 5 I 
 
 ulariy to acute indigestion in children. It tends 
 rapidly to disappear upon the removal of the cause, 
 and is in itself devoid of importance. These sud- 
 denly appearing, diffuse, often scarlet, rashes assume 
 occasionally great importance, from the fact that 
 they sometimes simulate, and are occasionally mis- 
 taken for the eruptions of more serious diseases. A 
 child three years old, previously well, was seized 
 during the night with vomiting, and complained of 
 sore throat. Intense fever followed. At daybreak, 
 the whole surface of his body was covered with a 
 bright scarlet eruption. His parents were greatly 
 alarmed, and the fact that they were living in a 
 crowded watering-place hotel added to their conster- 
 nation, as they were convinced that their youngster 
 had scarlet-fever. The fever rapidly subsided, how- 
 ever, within a few hours, the rash vanished as ab- 
 ruptly as it had appeared, and the next day the boy 
 was as well as ever. It was a case of erythema asso- 
 ciated with indigestion from improper diet. 
 
 Roseola. — This term is applied to a hypersemia or 
 congestion of the skin, wide-spread, and of a peculiar 
 arrangement, consisting of small, round or oval spots, 
 the size of a pea or bean. It is nothing more than a 
 form of erythema, and is usually associated with some 
 form of constitutional disease. 
 
 Eczema is an inflammatory affection of the skin of 
 a special nature, and attended with the formation of 
 
152 THE SUMMER AND ITS DISEASES. 
 
 fluid, which oozes out, then dries, and forms unsightly 
 crusts. It is acute or chronic, sometimes difficult to 
 discriminate from other diseases of the skin, often 
 difficult to treat. It is mentioned here only because 
 it occasionally follows some of the foregoing maladies, 
 if neglected, or if they have occurred in persons con- 
 stitutionally liable to this form of skin disease. 
 
 Nettie-Rash {Urticaria). — This disorder is also 
 popularly known as " hives." It is an acute affection, 
 often appearing in the course of a few minutes. 
 Raised patches, called wheals, of various shapes, 
 round or oval, elongated, crescentic, appear abruptly 
 on different parts of the body, no part being exempt 
 from their invasion. They even appear on the scalp. 
 Their arrangement is extremely irregular ; their color 
 is usually whitish, or pale at the top and red at the 
 base, which is surrounded by a ring of reddened skin, 
 which shades off gradually into the natural color. To 
 the touch they are sometimes firm. They are often 
 quite evanescent, fading as quickly as they came, and 
 are often seen to disappear and reappear in other 
 regions during the same attack. No alteration of the 
 skin is seen after the wheals have disappeared. 
 
 Urticaria is. invariably attended with the most 
 annoying stinging and burning of the affected skin. 
 The distress is often almost intolerable. Scratching 
 and rubbing aggravate the symptoms. The duration 
 of the acute form is from a few hours to a day or two, 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 53 
 
 and is greatly influenced by the removal of the ex- 
 citing cause. 
 
 Certain individuals are much more prone to this 
 affection than others ; and external irritants or internal 
 derangements that produce in some persons a slight 
 local inflammation of the skin, or a simple erythema, 
 will in others give rise to nettle-rash. Among the 
 external irritants which not infrequently cause it may 
 be mentioned fleas, bedbugs, mosquitoes, and other 
 insects, the jelly-fish, so common in certain seasons 
 in the waters of our Atlantic coast, and the stinging- 
 nettle, which last gives to the eruption its name. 
 
 By far the greater number of cases arise from in- 
 ternal causes ; these are chiefly referrible to disturb- 
 ances of the digestive organs. Indigestion from 
 over-eating, highly-seasoned dishes, and excess in 
 drink, often causes the outbreak. Certain articles of 
 food, many of which are in season in summer, and 
 are esteemed as delicacies, are especially apt to pro- 
 duce this affection. Such are sea-food, crabs, lob- 
 sters, clams, oysters, fish ; some of the small fruits, 
 as strawberries and raspberries ; pork and sausages, 
 and some other articles. These things are eaten 
 with impunity by the vast majority of persons ; it is 
 therefore evident that they produce nettle-rash in the 
 minority by reason of some personal peculiarity. 
 
 Numerous other agents are efficient causes of the 
 disease, but it would be foreign to the purpose of 
 
154 THE SUMMER AND ITS DISEASES. 
 
 this book to enter into the discussion of them. A 
 sudden checking of the perspiration has been, in a 
 few cases that have come under my observation, the 
 only assignable cause. Intense emotion has been also 
 assigned as a cause. 
 
 It is obvious that successful treatment will depend 
 upon a prompt recognition of the cause. As a rule, this 
 will be readily discovered. Measures directed to its 
 removal or neutralization must be at once resorted to. 
 Inquiries into the nature of food recently taken should 
 be instituted. It may be necessary, if there is reason 
 to believe that the offending substance still remains 
 in the stomach, to administer an emetic, especially if 
 the attack be severe or the suffering very great. This 
 measure is apt in many cases to be followed by alle- 
 viation of the symptoms. A free movement of the 
 bowels should be as promptly as possible brought 
 about, and laxatives employed from time to time 
 during the attack, if it be protracted. For this pur- 
 pose there is nothing better than magnesia, or the 
 effervescing solution of the citrate of magnesia. The 
 alkaline and aperient, effervescing mineral waters are 
 useful and grateful. There is usually decided acidity 
 of the stomach, which should by no means be over- 
 looked in the management of the case. 
 
 Local remedies are very important, and must be 
 used with an energy proportionate to the severity of 
 the symptoms. They are most conveniently applied 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 5 5 . 
 
 in the form of lotions or baths ; among the former, 
 vinegar and water, alcohol and water. For this pur- 
 pose, bathing whiskey or bay rum may be used, soda, 
 a drachm to half a pint of water, and weak solutions 
 of carbolic acid. 
 
 The baths most useful are those containing car- 
 bonate of sodium or bicarbonate of potassium, of 
 the strength of three ounces to thirty gallons ; these 
 substances may be combined with advantage. Bran 
 and starch baths are also useful in allaying the sting- 
 ing and burning. Acid baths are often grateful, the 
 strength being half an ounce of nitric or sulphuric 
 acid to thirty gallons. The temperature of the bath 
 should be warm enough to be agreeable, and the 
 patient should remain in it not less than fifteen or 
 twenty minutes. The strength of the bath will vary 
 in accordance with the patient's skin. The above 
 directions may be regarded as meeting the require- 
 ments of the average case. 
 
 Acute nettle-rash is likely to recur from time to 
 time, unless the exciting cause be sedulously avoided. 
 
 Insects and other small fry of the woods and waters 
 occasion great inconvenience by the inflammation 
 which they set up in the skin. It has been seen that 
 they not infrequently produce nettle-rash. The sting 
 or bite of most of these creatures produces at the spot 
 a wheal, which in appearance and in the symptoms 
 which attend it closely resembles nettle-rash, differing 
 
I56 THE SUMMER AND ITS DISEASES. 
 
 in truth only in the fact of its being a local trouble. 
 At the summit of such swellings, the puncture made by 
 the insect may usually be observed. Trifling consti- 
 tutional disturbances, with a little transient fever, may 
 occasionally coexist, especially in children. This, as 
 a rule, speedily subsides along with the local difficulty. 
 Many persons once inconvenienced by such irritation* 
 are free from it for the season, the subsequent attacks 
 of mosquitoes and so on resulting in much less dis- 
 tressing consequences thenceforth. About the eyelids 
 and in persons of feeble health, these insect-wounds 
 occasionally give rise to abscesses, which must be 
 opened and treated in the usual way. 
 
 The wheals thus produced are to be treated by lo- 
 tions of vinegar, alcohol, ammonia and the like. I 
 have found soda solutions of the strength of one or 
 two drachms, as advised for sunburn, steadily mopped 
 on, to be fully as useful as any other remedy. 
 
 Ticks are to be removed by pouring upon them a 
 drop of oil. They must never be forcibly removed, 
 lest some part be left on the skin to keep up the trouble. 
 It is important to avoid scratching, and other irritation 
 of the wounds made by insects, as it intensifies the 
 suffering and retards their. healing. 
 
 Persons camping out in the wilderness are apt to 
 suffer from the attacks of black flies during the early 
 months of the summer. The effect of their bites is 
 similar to that of the mosquito. In the later months 
 
THE SKIN IN SUMMER, AND ITS MALADIES. 1 57 
 
 the harvest mite is troublesome in cultivated regions, 
 attacking the legs and feet. The last may to some 
 extent be escaped by using some aromatic oil. 
 
 It remains finally to speak of the skin affections 
 produced by contact with or the approach to certain 
 poisonous plants. 
 
 The stinging-nettle gives rise to a painful urticaria, 
 which is usually of a very transient character, and 
 requires no treatment other than the avoidance of 
 scratching and rubbing. A lotion of ammonia or of 
 soda, if required, will, as a rule, allay the suffering. 
 
 An active inflammation of the skin {Dermatitis 
 venenata) is produced in some individuals by contact 
 with certain plants, or even by coming into proximity 
 with them. The poison oak {Rhus toxicodendron) and 
 the poison vine {Rhus radicans), plants which belong 
 to the same family, and are thought by botanists to be 
 identical, their habit merely being modified by the 
 spot in which they grow, are the most frequent cause 
 of this form of cutaneous poisoning. 
 
 The poison vine is a climbing plant, which is found 
 upon the trunks of i:rees, rocks, and along fences and 
 walls, to which it clings by means of stout, short, 
 rooting fibres. Its leaves are arranged by threes, 
 hence it is often called the three-leaved creeper; they 
 are smooth and shining on both the upper and under 
 surfaces. It frequents such rocky spots and sloping 
 
I58 THE SUMMER AND ITS DISEASES. 
 
 banks as the dew -berry vine selects, and children are 
 often poisoned while gathering berries. 
 
 The characteristics of the poison oak are the same, 
 save that instead of climbing it assumes the form of a 
 shrub from one to three feet in height. It is thought 
 that the difference in form is due to the want of sup- 
 port. It is found in the woods, fields, and along 
 fence-borders, from Canada to Georgia. These plants 
 owe their poisonous qualities to the possession of a 
 highly volatile principle, to which the name of toxi- 
 codendric acid has been given. This exists in the 
 juice, and is emitted by the leaves of the growing 
 plant. Its effect upon the skin varies, with the sus- 
 ceptibility of the individual and the concentration of 
 the poison, from a slight erythematous inflammation 
 to an intense erysipelatous eruption, attended with 
 extensive swelling and irritation. If the plants be 
 wet with dew or after a rainfall, the poison is more 
 active. So great is the difference in the suscepti- 
 bility of different persons, that some may touch, even 
 handle, the plant with impunity, while others suffer 
 severely from remaining a short time merely near it. 
 
 The more common rule is that touching the plants 
 occasions a more or less severe inflammation of the 
 skin. The hands are most frequently affected, but 
 the poison is speedily conveyed to other parts of the 
 body, especially the face, and it may appear in a 
 brief time in scattered patches all over the body. 
 
THE SKIN IN SUMMER, AND ITS MALADIES. I 59 
 
 The period intervening between the contact with 
 the plant and the appearance of the trouble, varies 
 from a few hours, as the common rule, to several days, 
 as the exception. 
 
 The duration of the malady is from six or seven 
 days to several weeks. It is greatly influenced by the 
 treatment selected, and the way in which it is carried 
 out. 
 
 Many remedies are lauded as specifics for this 
 form of inflammation of the skin. At the outset, the 
 employment of alkalies has been thought to be of 
 great service in arresting the development and miti- 
 gating the intensity of the process. This treatment 
 is based upon the fact that the volatile poison is an 
 acid. Soothing lotions, mildly astringent in char- 
 acter, are called for. Lead-water, very dilute solu- 
 tions of carbolic acid, and decoctions of white-oak 
 bark are useful. In the later stages, when the skin 
 begins to dry, and crusts and scabs form, bland oint- 
 ments, such as axungia (washed lard), zinc ointment, 
 or cosmoline, should be used. During the acute stage, 
 the swelling is often excessive, so that the eyes are 
 closed, and the face unpleasantly disfigured. Com- 
 plete recovery without complications is the rule. 
 
 A more severe affection is sometimes produced by 
 the swamp sumac {Rhus venenata). This is a beau- 
 tiful shrub or small tree, reaching a height of from 
 fifteen to twenty-five feet. It grows in swamps and 
 
100 THE SUMMER AND ITS DISEASES. 
 
 low grounds as far south as Carolina. The bark is 
 dark gray, the branches lighter, and the fine twigs of 
 a beautiful red color. It bears a small, round, green- 
 ish-white berry. 
 
 The poisoning from this plant is more severe and 
 more extensive than that produced by those already 
 described. Sometimes the whole surface is enor- 
 mously swollen, and the patient quite unable to move. 
 Recovery takes place. 
 
 The treatment is that described above. Individual 
 susceptibility to the poison of this plant also varies 
 greatly. 
 
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