Class. lOnk Book ._^ GoipghtN^ r COPYRIGHT DEPOSIT. COLDS, COUGHS ^ SORE THROATS THEIR CAUSE PREVENTION AND CURE WITH DIRECTIONS FOR HOME TREATMENT ¥ BY WILLIAM CONYNGTON, M. D. New York The Ronald Press 1906 Hci ^(i, .\_ ClB Ck.;. t i90i. , ©LASS A t^t^:^ '^^i7- Copyright 1906 By The Ronald Press Company PREFACE. Reader, whoever you may be, this book is in- tended for you. That person does not exist, unless he be numbered among the very few who have never '' taken cold,'' and is likewise indifferent to suffering and inconvenience among his friends, who is not interested in its subject. There is not a school boy or girl who cannot understand how to apply the more obvious rules for the avoidance of those conditions which pre- dispose to colds; not a mother who cannot use the simpler methods of prevention and cure; not a business-man, farmer, lawyer, senator or horse- wrangler who will not do well to heed the cautions in regard to unnecessary exposure, improper cloth- ing, lack of ventilation, carelessness in eating and neglect of early symptoms. The primary object of the book is to tell in plain words why we catch cold, how to avoid the causes, how to check or break up the morbid process when acquired, and how to put the body in such a condi- tion of health that it will not readily take cold. In discussing medical treatment it deals only with remedies that can be safely, promptly and properly used at home, and these it explains fully and clearly so that there need not be the slightest difficulty in 11 PREFACE. their application. Colds and coughs, with a few well-marked exceptions, come on by rather slow degrees. There is no sudden outbreak, but mild symptoms make their appearance, gradually increas- ing in severity until the disease is fully developed. This mild commencing period is the golden oppor- tunity for home treatment. As a few drops of water will quench a fire when just starting, so a very small amount of treatment, promptly adminis- tered at this critical time, will frequently check the disease so that it never gets beyond the initial stage. When, however, such a disease does begin with much severity, or refuses to yield to simple reme- dies, or for any other reason seems unsuited for home treatment, a physician should be sent for without delay. The first part of the book contains a brief de- scription of the respiratory tract; a consideration of the anatomical and physiological changes in- volved in the process of " catching cold," and a discussion of bacteria, together with the general subject of infectious and contagious diseases. The medicinal remedies and their doses, and the simple apparatus used in the treatment of afifections of the respiratory tract are also considered. The second part is devoted to the consideration of the diseases to which the respiratory tract is sub- ject. The causes, symptoms and treatment of the simpler forms are discussed at length; the more COLDS^ COUGHS AND SORE THROATS. Ill dangerous affections are discussed with such ful- ness as to secure their early recognition, and, as a result, their prompt treatment at the hands of a competent physician. In all cases the work tries to make plain when professional advice is needed, and, when it is needed, the importance of calling in a doctor before harm, perhaps beyond the possi- bility of repair, has been done. And finally, a short section is devoted to the more general principles of hygiene; the methods of se- curing the necessary sunshine, fresh air, exercise and rest ; the importance of applying common sense to the affairs of daily life so as to make the most of its opportunities for health and exercise, and, generally, the necessity of taking an interest in life, thereby making life interesting, and as a conse- quence more healthful and better worth living. William Conyngton, M. D. Washington, D. C, September i, 1906. COLDS, COUGHS AND SORE THROATS. TABLE OF CONTENTS. PART I. PRELIMINARY CONSIDERATIONS. Chapter. Page. I. The Respiratory Tract and Its Diseases... 7 II. Causes of Colds, Coughs and Sore Throats.. 23 III. Bacteria and Their Relation to Disease... 45 IV. Infectious and Contagious Diseases and Their Causes 6s V. Apparatus Used in Treatment of Respira- tory Diseases 76 VI. Medicinal Remedies and Their Doses 88 PART II. RESPIRATORY DISEASES AND THEIR TREATMENT. VII. Cold in the Head 104 Coryza; Acute Nasal Catarrh; Acute Rhinitis. VIII. Sore Throat (Common Forms) 129 Naso-Pharjmgitis; Adenoids; Pharyngitis; Laryngitis. IX. Sore Throat (Severe Forms) _. . 142 Diphtheria; Membranous Croup. X. Sore Throat (Severe Forms) 159 Tonsillitis. V VI TABLE OF CONTENTS. Chapter. Page. XI. Cough (Cold on the Chest) i66 Bronchitis. XII. Cough (Cold on the Chest, Severer Forms) 179 Pneumonia; Broncho-Pneumonia; Pleurisy. XIII. La Grippe or Influenza 197 XIV. Hay Fever 207 XV. Whooping Cough. (Pertussis.) 211 XVI. General Treatment 218 Constipation; Diarrhoea. XVII. General Treatment 227 Fever. PART III. HYGIENE. XVIII. Fresh Air and Sunshine 235 XIX. The Food We Eat 248 XX. Exercise 256 XXI. Clothing, Bathing and Sleep 269 XXII. Conclusion and Conclusions 278 COLDS, COUGHS AND SORE THROATS. PART I. — Preliminary Considerations. CHAPTER I. The Respiratory Tract and Its Diseases. The very common and very annoying disease conditions popularly known as colds, coughs and sore throats, are met with in every family, and in the majority of families they occur many times in the course of a year. The conditions dealt with in this book are all of the acute type; that is, they come on with some degree of suddenness, and they are all affections of the respiratory tract; that is, of those inner portions of the head, neck and chest which take part in respiration or the act of breath- ing; hence if the book were principally or entirely intended for the reading and study of physicians and medical students it might very properly be termed ''Acute Diseases of the Respiratory Tract.'' 7 8 COLDS, COUGHS AND SORE THROATS. Its main object, however, is to furnish a convenient volume for home use, giving wherever possible plain, honest English words in preference to more technical terms, and for this reason the ordi- nary household words *'Colds, Coughs and Sore Throats" are chosen to form its title. As all of these conditions are more or less directly connected with the respiratory tract, a few words will be here devoted to the consideration of this part of the body. The respiratory or breathing tract, consists of the air channels of the nose and throat, the wind- pipe and all of its branches, and the microscopically small air cells of the lungs. All are lined or cover- ed with delicate velvety tissues, the mucous mem- branes, which serve the purpose of an internal skin, and are kept moist and to some extent protected by their own secretion of mucous. The air channels of the nose form an admirably effective apparatus for purifying and preparing the inspired air for further progress to, and final useful- ness in the air cells of the lungs. A number of short hairs at the entrance form a partial screen through which the air is drawn, after which it is whirled and twisted about, in and through the curi- ously-shaped nasal passages, in such wise that it is brought into most intimate and thorough contact with the warm, moist membranes, which in this location are peculiar in the great number and large THE RESPIRATORY TRACT AND ITS DISEASES. 9 size of blood vessels lying just beneath their sur- faces, while the somewhat labyrinthine arrange- ment of the internal nasal walls increases the amount of surface and prolongs the time of transit. The structure of these membranes favors a rapid trans- fer of warmth and moisture from the large and constantly changing blood current to the entering air, and so well are these offices performed that the entire quantity of inspired air is saturated with moisture and warmed to the normal bodily tem- perature before reaching the deeper and still more delicate tissues. It is also claimed that a large proportion of those injurious germs which are so commonly found in the atmosphere are retained and finally destroyed and thrown off by this same useful old nose. When the nose is stopped up, as by a cold in the head, or when from bad habit, mouth breathing is indulged in, the inspired air is only partially warmed, moistened and otherwise prepared for contact with the deeper tissues, and diseases of the throat, windpipe or lungs are very apt to develop as a consequence of such misfortune. The inspired air passes from the cavities of the nose into the throat, which comprises, according to the ordinary usage of the word, the pharynx and larynx. The pharynx is much the larger portion and extends from the nasal openings to the larynx and oesophagus. It is divided into the naso- pharynx, oro-pharynx and laryngo-pharynx, bult lO COLDS, COUGHS AND SORE THROATS. the divisions are much hke those of latitude and longitude on the earth's surface; that is to say, they are imaginary lines laid down on an unbroken surface. The naso-pharynx (nose part of the throat) is above and behind the mouth, reaching much higher than is usually realized, so that we have here quite a large concealed cavity. The nasal cavities open directly into it and a little behind these openings and at the sides the Eustachian tubes pass to the middle ear cavities, each tube supplying air to the middle ear of that side and regulating pressure on the tympanum or ear-drum. The Eustachian tubes are of considerable importance in considering dis- eases of the throat, as inflammation often reaches the ear through these channels and at other times they may be closed by swollen tissues or blocked by increased secretions, giving rise in either case to various disorders of hearing or diseases of the ear. Lymphatic glands are found in considerable num- bers in the deeper layers of the walls of the naso- pharynx and their overgrowth causes the very harmful condition of adenoid hypertrophy. (See Part II, Chapter VIII.) The oro-pharynx (mouth-pharynx) is that part lying behind the mouth and extending forward to the soft palate. It includes the part of the throat visible from the outside when the mouth is widely opened and afifords passage for food from the THE RESPIRATORY TRACT AND ITS DISEASES. II mouth to the oesophagus as well as for air from the upper throat to the larynx. The soft palate and tonsils are anatomically a part of the mouth, but as inflammation of these parts gives a severe sore throat they will be considered in connection with throat troubles. The laryngo-pharynx com- prises those portions of the throat adjacent to the larynx and oesophagus. The larynx lies between the pharynx and trachea or windpipe. It is a box-like structure composed of plates of cartilage, ligaments and muscles, and contains the parts by which the voice is produced. Its largest plates of cartilage form the most prom- inent part of the external throat in the midline, commonly known as the ''Adam's apple.'' The uppermost part is the epiglottis, a very effective and snug-fitting lid, composed of cartilage and membranes, opening freely and widely in speaking and breathing but closing tightly when food or liquids are swallowed, while at the same time the whole larynx is drawn forward and upward under the root of the tongue. The larynx opens into the trachea or windpipe, which is a cartilaginous tube about three-quarters of an inch in diameter, extending downward three and a half to four and a half inches as a single tube. At this point it divides into the right and left bronchi, and these bronchi rapidly divide and subdivide until the finest bronchioles (little bronchi) 12 COLDS, COUGHS AND SORE THROATS. terminate in the minute alveoli or air-cells of the lungs. A cold, as ordinarily understood, means a catar- rhal inflammation affecting one or more of those internal portions of the body which are concerned in the act of breathing, and is frequently although not always brought on by exposure to cold. All of these internal parts of the body over or through which the inspired air passes, are lined or covered with mucous membranes which in health continually secrete a sufficient quantity of mucous to keep themselves moist and protected from direct con- tact with the inspired air and whatever it may contain. Catarrhal signifies a condition in which these secretions are so increased in amount as to clog the air passages by their quantity, and so changed or perverted in character that they become injurious and improper substances for retention in the body, hence they are gotten rid of by blowing the nose, coughing and spitting. A sore throat is any condition in which there is pain and irritation in or about the internal throat, and as these conditions are almost always accompa- nied by some degree of inflammation and increased and perverted secretions, and are also frequently brought on by exposure to low temperatures, they too are called colds. More commonly such a con- dition is referred to as "a cold and sore throat," and as this covers all of the disease conditions found, it is perhaps preferable. THE RESPIRATORY TRACT AND ITS DISEASES. 1 3 A cough signifies the violent and noisy expulsion of air from the lungs, owing to some cause of irri- tation affecting the membranes of the lower air passages, or some nerve or nerves connected with them. The commonest cause is, of course, the in- creased and perverted secretions, for getting rid of which coughing is the natural and effective means. Another common factor is some swollen portion of the respiratory tract which partially closes an air channel, interferes with other parts, or presses on some nerve. At times, however, coughing is caused by dis- orders in parts of the body entirely distinct from the breathing apparatus, as by stomach disturbance, or by some improper and irritating object lodged in the external ear. The great vagus (vagabond or wandering) or pneumogastric (lung-stomach) nerve supplies a large part of the respiratory tract and is also the chief nerve of the stomach, hence irritation of the stomach terminals may be referred to some part of the throat or windpipe and result in coughing. Or, the trifacial nerve (three-branch- ed nerve of the face) may carry an impulse from an irritated ear over to the nose or throat, of suffi- cient strength to knock the wind out of the lungs by a good strong cough. The one term ''Colds'' is often used to include all of the conditions above referred to, and it is not at all uncommon to hear such a conversation 14 COLDS, COUGHS AND SORE THROATS. as the following, between distant but friendly neigh- bors: "Hello, John! How's all the folks?'' to which John replies, "Just tolable to middlin', Henry. Mandy's been havin' a cold in her head most all the winter ; the girls has been havin' theirn in their throats, and Peter, he's had the worst cold on his chest since the war." The phrase "cold on the chest" is commonly used to designate bronchitis, but it is also applied to the graver conditions of pleurisy and the pneumonias. Besides the colds already referred to, certain other conditions such as la grippe, whooping cough, hay fever and diphtheria, usually classed under other headings, are considered in the present volume, for the reason that in some of their forms, or at some stage of their development, it is itnpossible to dis- tinguish them from diseases which are unhesitating- ly classed as colds. A mild case of the respiratory type of la grippe, and a severe cold in the head with extension to throat and upper chest, call for a trained bacteriologist with a good microscope to tell the difference ; whooping cough is a cough both by name and by nature ; hay fever is almost a dupli- cate of other colds, and diphtheria was formerly, and for very sufficient cause, known as putrid sore throat; and for these reasons they all seem to fall very naturally and properly under the heading of "Colds, Coughs and Sore Throats." In all of the diseased conditions referred to, with THE RESPIRATORY TRACT AND ITS DISEASES. 1 5 the single exception of hay fever, two ideas are always popularly prominent. One is that some por- tion of the delicate membranes of the respiratory tract, together with more or less of the underlying structures, is congested or inflamed, the arteries, capillaries and veins engorged with blood, and the tissues swollen with serum and other constituents of the life fluid which have escaped from their proper channels, and that this congestion or swell- ing, together with the consequent tenderness and pain, causes more or less irritation and inconveni- ence in the act of breathing. And this first idea is strictly correct. The other idea is that this condition is caused, either wholly or in part, by low temperature, and from this idea the name "cold" is derived. This belief is only partially true, and so far as absolute cold is concerned, there is nothing to it at all, unless exposure is unduly prolonged. You may freeze a man's ears, his hands or his feet, or all of them, without his catching cold, and the same man may easily catch cold with the thermometer well above the freezing point. What will give him cold is to chill one part of the body more than other parts usually no better protected, hence the danger of cold drafts, getting the feet wet and so on. Absolute cold, to a robust person, is for a time much of a tonic and stimulates the heat producing centers to greater activity. But when such exposure l6 COLDS^ COUGHS AND SORE THROATS. is extreme and long continued, the bodily organism fails to react fully, the individual becomes "chilled through,'' and the superficial circulation is largely checked. Under these circumstances, cold becomes one of the very depressing forces, lowers vitality, puts the mucous membranes into the finest possible shape for bacterial proliferation and activity, and the end of the process may be a severe cold, that is to say a catarrhal inflammation of nose, throat or chest. Damp cold is far more depressing and much more likely to result in colds and kindred affections than a temperature low enough to freeze the moisture out of the air, giving what is called "dry cold." Hence we catch cold with the greatest ease and frequency when the temperature is barely above freezing and full of moisture, as in a cold, slow thaw, when melting snow and ice keep the dense, sodden atmosphere saturated with moisture to the fullest limit of its capacity. Hay fever is the only cold that is not associated with low temperature either by actual relationship or popular belief. It is caused by some form of pollen or other vegetable dust and necessarily comes at that time of the year when the plant (be it rose, rag-weed, golden-rod, or other weed or flower) that furnishes the poisonous substance arrives at the proper stage of development to scatter the causative dust. THE RESPIRATORY TRACT AND ITS DISEASES. 1 7 Home treatment is proper in many forms of respiratory diseases. Very frequently an ordinary cold in the head, a mild sore throat, or a cough of moderate severity, is not considered of enough im- portance to justify sending for the doctor, and yet these ailments cause much discomfort and annoy- ance, and if neglected may lay the foundations for more dangerous diseases in the future. These are the forms that are strictly suitable for home treat- ment. At home they can be noticed and taken in hand at the very beginning, and at this stage they usually yield readily and completely to comparative- ly simple and easy treatment. And if from tardi- ness in recognizing and treating such a condition, or from unusual severity of the attack, it fails to yield completely, the illness is so shortened, the discomfort so mitigated and the general health so much less disturbed, that all of the time and trouble so expended is vastly more than paid for. And again, there is no shadow of doubt but that prompt attention to what was deemed a simple cough or cold has frequently checked some disease process that would have developed into a dangerous or fatal illness if left to run its course. Other cases in which home treatment is most absolutely proper are those where no doctor can be obtained. Some of our readers will smile at this statement and remark, "Well, this doctor has his imagination with him for sure. Such things might l8 COLDS^ COUGHS AND SORE THROATS. have been a century ago, but not by a jugful in this day and generation." Nevertheless it is a fact that people, and not a few of them either, suffer and die without medical care in this very year of Grace, A. D. 1906, some of them because a medical prac- titioner cannot be found within a hundred miles or more, others because they prefer to take chances rather than to ride ten, fifteen, or fifty miles and pay anywhere from ten to three hundred dollars for medical attention that is frequently far from first- class. And in all of the cases falling under either of these classes it is very desirable that some knowl- edge of the commoner forms of disease should be at hand, with simple directions for treatment that can hardly do harm any way it is applied, while the chances of its doing much good are many and large. When, then, should a doctor be called? Where a good physician is within easy reach and the dis- ease condition is at all severe, call in your doctor without hesitation, and if in doubt as to whether the case is within your ability or a little too much for home medication, err on the side of safety and send for the physician. A good doctor is a bless- ing to any community, earns every cent he ever gets and a very great many that he never gets, and if any man deserves patronage and encouragement it is the physician. Hence if he earns a fee where it might have been saved by taking extra risk and THE RESPIRATORY TRACT AND ITS DISEASES. 1 9 unnecessary trouble, do not begrudge it or consider it so much to the bad ; neither for paying him what you justly owe look for a reward from heaven. That rather belongs to the big-hearted old doctor who loses his rest in this wicked world that others may enjoy theirs during health and prosperity, with the well-founded assurance that in time of need they can depend on the medical man's keenest watchfulness and most skillful care, freely given up to such limits that he has to prop his eyes open to keep awake, or drops in his tracks from sheer inability to stand up any longer. May blessings light on every good and honest doctor's head, and down to the deepest depths with all the bad ones, with a millstone tied to every evil neck. Another object of the present work is to give instructions as to the avoidance and prevention of colds. The story is often told of a recipe in an old time cookbook for preparing hare soup for an invalid, commencing with the proposition, "First catch your hare." If no hare is caught, of course the preparations cease right there, and it is the same way with a cold ; if no cold is caught no treat- ment is needed, and everybody will agree that this condition is preferable to the finest of treatment after the cold is caught. Something about the causes of colds and how to avoid them we all know, but we do not know enough, and what we do know we do not properly 20 COLDS, COUGHS AND SORE THROATS. apply. 'It is a little damp," says the young lady, '*but it will not hurt me to just run around the corner in my slippers," and round the corner she goes and presently her head is going round too, and the next laundry bill is larger by some dozen or two of dainty handkerchiefs. ''Oh, well," says the Congressman, "it used to give me indigestion and a cold to eat lobsters, but lobsters elected me and I reckon they'll treat me better this time," and so the lobsters have their revenge. And again, while it is generally recognized that getting the feet cold or damp, and indigestion, are very common exciting causes of colds, there are other less commonly understood causes that are just as efficient, such as sitting or kneeling in a cold, damp church through a long prayer or sermon, mouth breathing, wearing too much or too heavy clothing, and going from the hottest part of a hot room to colder outside air, or vice versa. And the fact that many of the commoner colds, as well as diphtheria, consumption and whooping cough, are readily transmitted from person to person, usually through breathing the air contaminated by the coughing or sneezing of the victims of such disorders, is not by any means properly appreciated. Neither is it at all realized what an efficient means of spreading infection our public conveyances are, especially when heavily upholstered, as even the street cars of the present day frequently are. How often does THE RESPIRATORY TRACT AND ITS DISEASES. 21 it happen that in a crowded street car the victims of consumption, or sufferers from milder respira- tory disease, keep up a constant coughing or sneez- ing, without even dreaming of screening the moutb with hand or handkerchief, although every cough or sneeze sends the disease germs flying for several yards. What chance then has the weakly individual right across the narrow aisle and in direct range of this volcanic eruption of dangerous germs. Or sup- pose a victim of tuberculosis has the car to himself ; what a fine ambush the cushioned seats form, and how freely the microbes will be spread throughout the car in its rattling, shaking travels, when they are brushed and rubbed from the cushions by every passenger who does not have to stand. And yet one step further: such a condition of physical health and vigor that ordinary causes of disease are harmless as so many drops of water on a duck's back is the ideal state of affairs. Un- fortunately this is a better condition than most of us can possibly attain to, notwithstanding which it is worth much effort to approximate it; hence a portion of the present book will be devoted to a consideration of the means by which we may so use whatever advantages are at our command as to increase our bodily health and vigor, which is the first and greatest thing to be desired. The next object is to avoid so far as possible all recognizable causes of ill health. If both of these precautions 22 COLDS, COUGHS AND SORE THROATS. fail us, as they sometimes will, and a cold, cough or sore throat is caught in spite of all our care, the next thing is to secure the simplest and most effect- ive treatment possible, whether it require the pres- ence of a physician or whether it fall within the scope of home treatment. And if home treatment is decided on, while always striving to do all the good you can, let the old doctor's parting words to his graduating class, ''Young gentlemen, if you do no good be sure you do no harm,'' remain with you and be a cardinal principle in all parts of your home treatment. CHAPTER II. Causes of Colds^ Coughs and Sore Throats. Everything in this wicked world has a cause and a result, and colds, coughs and sore throats are no exception to this general rule. Every disease has some cause although our ignorance thereof may be profound, and every disease has certain results of which our knowledge is usually pretty full and com- plete. And as these results are, as a rule, far from agreeable or desirable, our knowledge thereof should lead us to seek out and avoid the causes with an earnestness proportionate to our dislike for the results. It is customary to divide the causes of disease into predisposing, or those which merely lower vital resistance and put the body into such shape that it may readily fall a prey to sickness, and exciting causes, or those which actually start the disease processes and determine their character. But this division, in our present condition of knowledge or lack of knowledge, can never be mathematically exact and positive, and while some causes must al- ways be regarded as predisposing and others just as certainly exciting, there are a number that hover in a debatable land, sometimes being classed under the one heading, sometimes under the other. And 23 24 COLDS, COUGHS AND SORE THROATS. again, circumstances may easily be such that an exactly similar cause is at one time, or to one person, merely predisposing, while at another time, or to another person, it is actively exciting. For instance, a forced march through sleety rain and freezing mud, to some of the seasoned veterans, will ap- parently be no more than a temporary source of discomfort and grumbling, but in a large proportion of the soldiers it will markedly lower vitality and predispose to disease, while to many it will be the exciting cause of pneumonia, pleurisy, rheumatism, or other form of disease. The most reasonable and useful division, and that which will be adhered to in this book, is to con- sider those factors which have to do with methods and habits of life, are prolonged in action and slow to produce results, as predisposing causes, while those which are of brief duration and quickly fol- lowed by ill effects are accounted as the exciting ones. Lowered vitality is often given as the greatest of the predisposing causes of ill health or disease. It is really a condition of the body brought about by the action of one or many predisposing causes, as lack of exercise, neglect of fresh air and sun- shine, worry, overwork, indigestion, — in short any- thing that decreases the bodily vigor and health, and it may be regarded as a sort of common center, or a halfway station on the road from health to CAUSES OF COLDS^ COUGHS^ ETC. 25 disease, to which all other predisposing causes tend and from which the exciting causes find their most favorable starting point. Those early stages of life known as infancy and childhood are rightly placed in the front rank of predisposing causes. The tender little bodies have in themselves small power of resisting adverse in- fluences, experience is lacking and reasoning powers undeveloped. Nature's provision for this period of helplessness is the care and wisdom of the parents, but while the care is ungrudgingly bestowed, wis- dom and education along these lines are frequent- ly most woefully deficient, and the young human being has a poorer outlook as to health (although better as to mere existence) than the offspring of any other free animal. Old age and a fairly high degree of vitality are not inconsistent, but this combination is the rare exception and few who live the civilized life can hope to attain it. Lowered vitality and feebleness of the physical frame are the usual characteristics, and they are only partially compensated by the wisdom of experience and the less active and more protected life ; hence old age is a potent predisposing cause of various forms of disease. Neglect of fresh air and sunshine is a very common predisposing cause. "Something for noth- ing'^ has been the swindler's most alluring and ef- fective bait in all ages, and thousands hasten to 26 COLDS, COUGHS AND SORE THROATS. his toils in the vain expectation of securing some- thing, it matters not how tawdry, without rendering an equivalent. But while thousands strive after these transparent frauds, milHons hasten with even greater eagerness to shut themselves off from the most vital necessities of life, the golden luxuries of fresh air and sunshine, which are not only absolute- ly free, but are so forced on us that it is only by the most skillful devices of civilization that we are able to keep away from them at all. The coun- try boy spends most of his waking hours out of doors and he can wade through melting snow all day, with feet soaking wet and cold as ice, and not take cold. Many of us cannot be out of doors all day, but most of us could be out for hours in- stead of minutes if we chose. How many a neu- rasthenic clerk pays five cents for the privilege of riding in a stuffy street car so that he may spend an extra half-hour of his own private time in a dingy office reading sensational newspapers or trashy novels, when a brisk walk down town would not only give him sunshine and what of fresh air the city affords, but also add a third great requisite of health, a moderate amount of vigorous exercise to stir the sluggish heart and torpid liver. In the evening another nickel saves him from exercise, sunshine and fresh air, and he is able to get indoors again with the smallest possible exposure to these life-giving influences. But now at night, with base- CAUSES OF COLDS, COUGHS, ETC. 2/ burning stove and plenty of bedclothing if it be winter, surely this cringer from sunshine will throw the windows wide open and let the fresh air do him some modicum of good. Will he? If the night air were the deadliest miasma it could not be more carefully shut out than is often done by people who by all rights of education ought to be thoroughly posted as to the value of fresh air, and so they roll and toss in uneasy, restless slumber and awaken unrefreshed for the duties of another day. In winter time the Indians of the Northwest, those erstwhile hardy warriors of the Little Big- horn, retire into their houses, low log cabins, chink- ed with mud and roofed with sod, and there with stove red hot and door and windows closely shut, they are as tightly and as hotly boxed as any of their civilized brethren, and breathe an atmosphere even more confined and vitiated than our own. And they die with consumption as sheep with the rot. When warm weather comes they move out into their tents and in a few days the reservation doctor, who has scarcely had time to eat and sleep, wonders where all the sick Indians are. If it were not for this tenting business the Indian question would exist only in history. Lack of exercise is a potent predisposing factor of disease. Exercise, proper in kind and moderate in quantity, is a sine qua non for the maintenance of high vitality. How many of our city people pay any attention to it? It goes hand in hand 28 COLDS, COUGHS AND SORE THROATS. with fresh air and sunshine, like them it is to be had for the taking, and Hke them it is avoided by means of the ready street car. A brisk morning walk to the ofifice and a more leisurely return when the day's work is done would be worth tens of mil- lions of dollars annually to those of our office work- ers who live within a mile or two of their places of business. The clerk who rides a bicycle not only saves car fare, more than enough to pay for his wheel, but also secures somewhat of exercise, sun- shine and fresh air, and when, as often happens, he is tempted to use his wheel and part of the time at his own disposal in exploring the surrounding country or in other out-of-town rides, he is nearing a satisfactory solution of the problem of higher vitality. In country life these conditions are apt to be reversed and over-exertion and too much exposure also predispose to disease. Instead of too little out-of-doors air, sunshine and exercise, there is more than likely over-exposure, and exercise is fre- quently carried beyond the limits of healthful en- durance. These ills are not the result of ignorance, but are regarded as unavoidable evils, necessarily undergone and submitted to as a means of bread- winning. Here the remedy is better methods of farming, raising more of the home necessities, studying the markets and selling at favorable times — in short, more wisely converting mind and muscle into cash or the things that cash will buy, so that CAUSES OF COLDS, COUGHS, ETC. 29 bodily vigor is no longer bartered for the wages of a galley slave while the mind rusts for the want of healthful exercise or is worn to a frazzle by dis- contented repinings. In the matter of diet it is doubtful if we err as much as is generally claimed. A horse in pasture eats as much or more than one that is working, but his food is not so highly nutritious and he has plenty of fresh air, sunshine and exercise. Neglect- ing these three great essentials we cannot make up for them by cutting down rations. Certainly if we are going to lead a strictly sedentary life its evils may be lessened by some reduction of diet, but it is better to get hold of this problem by the other end ; eat plenty of suitable food and turn it into good rich blood by out-of-doors exercise. Suitable food is a far better key-note than any material reduction in quantity. The northern lumberman smiles broadly over a huge plate of pork and beans swim- ming in molasses, with plenty of potatoes, biscuits that are sometimes very heavy, and an abundance of strong black coffee. The ofifice man who at- tempted this meal might smile on the other side of his face before the day was done, but that is no rea- son why he should rise hungry and with an aching void just below his heart from a scanty bowl of breakfast food and a cup of imitation coffee. There is a golden mean in all these matters and each man should be his own best adviser as to what food 30 COLDS, COUGHS AND SORE THROATS. articles give him the best results in the way of health and a capacity to work and to enjoy life. Diet rules may be given you by the hundred, many of them not worth the paper they are written on, but the one safe and practicable rule is to regu- late your own diet, both as regards quantity and quality, by your own careful observation as to the effect of what you eat. If sliced cucumbers, toasted cheese and ice cream do not comfortably adjust themselves to each other and to your own internal economy, why, '*Take the one that you like best," if by itself it agrees with you, and let the others go; until next time, anyhow. If you know that pickles give you colic you deserve colic if you eat them. A dyspeptic friend (a clerk, not a lumber- man) walked complainingly down the street with me one day at noon to get ''a little light lunch" that would rest easy and not give him a pain. He first ate a plate of buckwheat cakes with a cup of coffee, then a dish of beans with another cup of coffee, and finished with a large slice of mince pie. As we walked back he, still complaining, asked, ''What do you suppose makes me feel so queer?" I told him it was because he had not topped off with a keg of ten-penny nails, whereon he got keenly angry, said I might think that was funny but there wasn't anything funny about it ; and maybe he was right, only it illustrates by way of contraries, the importance of using judgment in diet. Worry is yet another factor of lowered vitality. CAUSES OF COLDS, COUGHS, ETC. 3 1 mainly artificial it is true, but still of mighty power. Man's mental activity cannot be suppressed and unless it finds legitimate exercise in some field of keenest interest, hunting, fishing, boating, poultry- raising, music, business, or other chosen pursuit, it is usually expended on imaginary troubles. Avoiding sunshine, abjuring fresh air and shrink- ing from physical exercise, the man finds vent for his misdirected energies in fretting and worrying, magnifying trifles, cultivating discontent and gene- rally making himself a nuisance of the first water, and this reacts directly on his health, i. e., lowers his vitality. That real causes for worry exist is not denied, but the real are to the imaginary as a glow worm in the grass to a battleship's searchlight. Hosts of office workers who are given to useless worry only need some out-of-doors pursuit in which they can take an absorbing interest to make them- selves practically different individuals, and the change would be a most agreeable surprise to them- selves as well as to their friends and associates. Look about you, brother, and see what your en- vironment and tastes allow in this line. Get a dozen Plymouth Rock chickens and go in for fine fowls, set out a flower bed or a vegetable garden, buy a bicycle and explore every nook and corner for forty miles or more; do something and take an interest in it and drive out the blue devils. But suppose a man is taking too much interest in something already, working all day and until 32 COLDS^ COUGHS AND SORE THROATS. late at night at his business, with no more time for chickens, flowers or bicycling than the sun has for afternoon tea; or is bending every energy to the keen strife of politics, or in any other way is at- tempting to do more than any one man is capable of — what then? In that case he must simply take his choice between whatever he is so engrossed in on the one hand, and on the other some less exacting pursuit with more of health, comfort and all else that makes life worth living. If he persists in spending every available ounce of energy along one particular line he is in the same class as the con- firmed drunkard. Defective and poorly ventilated dwellings, of- fices and workrooms form another predisposing cause. The rooms and buildings in which we live and work for a large proportion of our lives are as yet very far from perfection or even a possible degree of excellence. In the horribly unsanitary sweat shops of the great cities, human health and life are simply disregarded, but in many costly and externally handsome buildings, ventilation is defi- cient, light often poorly supplied and the heat supply varies from depressing cold to debilitating warmth. The harsh, dry air of furnace-heated rooms plays havoc with the respiratory apparatus, defective light causes eye-strain with resulting headaches and nerv- ous disorders, and poor ventilation is one of the most effective means of lowering vitality and pre- disposing to all manner of disease. CAUSES OF COLDS^ COUGHS, ETC. 33 Self-indulgence is another potent predisposing cause of lowered vitality. Immoderate smoking or chewing of tobacco, drunkenness and improper in- dulgence of the sexual propensities, all lower vitali- ty, and this fact is too well known to require more than a passing reference. In these matters it is the will and not the judgment that is at fault, and warnings by the thousand are useless if he whose interests are at stake sets intelligence aside and makes a hog of himself because he feels like it. As to the moderate use of alcoholic liquors and tobacco there is little to say, only be sure that your definition of moderate be not too liberal for your financial capacity or physical welfare. To summarize, we catch cold easily because our vitality is low, and our vitality is low because we are slothful and self-indulgent, because we neglect fresh air, sunshine and out-of-doors exercise, be- cause we eat, not for the purposes of health and strength, but at the dictates of an appetite spoiled by being allowed to rule where it should be under strictest control, and because we wear ourselves out in petty worrying w^hen the whole world is full of objects of worthy interest. As to those who are obliged to work in badly ventilated, insufficiently warmed and poorly lighted offices and workrooms, shop-girls with killingly long hours and miserably insufficient pay, and all others whose health is sacrificed to greed, we can at present only extend our sympathy to these vie- 34 COLDS, COUGHS AND SORE THROATS. tims of avarice and express our detestation for the brutish employers. But when the time does come when we, the people, really have a voice in govern- ment ; when representatives really represent and sen- ators and judges are honest, whether from choice or necessity; — when this desirable condition of affairs does come to pass, let us see to it that taking ad- vantage of a man's (much more of a woman's) necessities to cut down wages to less than living rates, or to fit up workrooms without due regard to the health of the workers, shall be placed among the most keenly watched and most severely punish- ed crimes of our commonwealth. Exciting causes are those which actually start the disease processes and determine their character. The most generally recognized exciting causes of colds, coughs and sore throats are exposure to cold and dampness, bacteria or vegetable micro-organ- isms, mouth breathing (which in children is often associated with or brought about by the condition of adenoid hypertrophy), acute attacks of indiges- tion or other digestive disturbances, impure air or air containing irritant substances such as smoke, factory fumes, fine particles of steel, stone, wool or other substances used in the arts and industries, and the vegetable dusts causing hay fever and its kindred. At one time exposure to cold and dampness cover- ed the greater number of the recognized causes of colds, coughs and sore throats, but in the present CAUSES OF COLDS, COUGHS, ETC. 35 day bacteria enjoy the distinction of being con- cerned in the majority of cases, sometimes as the sole exciting cause, oftener perhaps as increasing and prolonging the effects of exposure, inhaled ir- ritants or disturbances of the digestive and circula- tory systems. Very frequently two or more of these exciting causes act together to produce one form of cough or cold, as in bronchitis, where exposure causes a congestion of the bronchial mucous mem- branes which might be temporary and hardly severe enough to be called a disease were it not that this mild congestion favors enormous increase, both in numbers and virulence (power for evil) of the ordinarily harmless bacteria found in this locality, so that these combined factors, neither of which alone would be of much importance, cause a well marked condition of disease. Exposure to cold and dampness is one of the commonest exciting causes of cold. Getting the feet wet is a typical method of catching cold by exposure. A limited and sensitive part of the body is chilled (dampness has little effect without the chilling) while the rest of the body remains at its usual temperature, the circulation is unduly checked at this particular point, heat production and distri- bution are seriously interfered with, and somehow it results in a cold. Getting the feet wet is probably the commonest and most familiar of all the exciting causes. Speak of a cold and your hearer immediately thinks of a 36 COLDS^ COUGHS AND SORE THROATS. cold in the head; speak of catching cold and he as quickly jumps to the conclusion that you have got your feet wet. Suppose you ask some street Arab, one of the newsboys for instance, *'Bud, what is the easiest way to catch cold?" and if the boy be in a friendly and communicative mood he will probably answer, ^'Go get your feet wet, you old guy, and you'll catch cold all right," and the boy has answer- ed well. Given the predisposing factor of lowered vitality and it is a most potent and efficient cause. Getting soaked to the skin, as by falling over- board from a boat, or encountering a sudden shower without sufficient protection is another mode, and it sometimes works very well even in summer time. Here the entire outer surface of the body is chilled, the blood is driven to the internal parts which have received no such shock, the circulation is grossly interfered with, and again we have a cold. But suppose the dampened party runs home, takes off his wet clothes, rubs himself into a glow with a coarse towel and puts on dry garments, perhaps even takes a nip of whiskey or similar excitant, what then? Why, if he has any amount of vitality at all he has knocked that particular cold most effectually out of commission. And in either of these cases, or similar ones, if the vitality is high enough to cause a vigorous re- action no cold occurs. The chilling, which is the real cause of the cold, contracts the blood vessels and drives the blood to the internal parts of the CAUSES OF COLDS, COUGHS, ETC. 37 body. If reaction occurs an abundant supply of warm blood is hurried into the contracted vessels so that they are again filled and expanded and the part brought back to the normal temperature or even a little above it, the chilly feeling gives way to a warm glow, and the subject of the dampening feels better and more vigorous than before. If vi- tality is high you can remove your clothing, wade a good sized stream amid cakes of floating ice, then rub the exposed parts dry and warm with a towel or some outer piece of clothing, and go on your way without harm. If, however, vitality is not high enough to bring about vigorous reaction the parts remain chilled and a cold of some variety is almost sure to follow. Drafts of cold air which take effect on a limited part of the body are another frequent cause of colds. The neck, wrists and ankles are the parts commonly chilled by these causes. All of these parts are partially protected by clothing, and the amount of protection varies greatly according to the clothes worn, posture of the body and contact with chairs or other furniture. Shrinkage of under- garments is a frequent cause of undue exposure of wrists and ankles. Perhaps new underclothing is purchased at the beginning of winter and the pur- chaser rejoices in well protected wrists and ankles, but with each succeeding washing the protection is less, and by the time really bad weather arrives, from one to two or three inches of these sensitive 38 COLDS^ COUGHS AND SORE THROATS. parts are inadequately protected and numerous un- accountable colds puzzle and exasperate the victim. Leaning from a window to carry on a conversa- tion with some one below is very apt to expose neck, chest and wrists unduly; somewhat similar methods of exposure are wearing a low-necked opera or ball dress and neglecting to add a shawl between dances or when sitting in some cooler part of the room; throwing off the coat or other outer garment for some short, sharp piece of work and not resuming it quickly enough when the work is ended; rolling up the sleeves and after getting the arms warm and wet as in washing clothes, going out in the cool wind to hang out the wash. All of these are likely to result in chilling beyond the power of reaction and are among the commoner modes of catching cold. The face and hands are habituated to exposure and trained to quick and complete reaction, hence a biting, frosty wind produces rosy cheeks and a feeling of exhilaration instead of a cold. To take a warm bath and then go out of doors on a cool day is a very effective mode of catching cold. The superficial blood vessels are expanded and a large amount of blood is drawn near to the surface and on exposure much blood is chilled, while the relaxation from the bath precludes vigorous re- action. If warm baths are taken in cool weather, and they certainly should be, the process should be undergone about bed-time or an hour or two should CAUSES OF COLDS, COUGHS, ETC. 39 be spent in a comfortable room before risking ex- posure. Then there are days when the thermometer hangs persistently about the freezing point, maybe a few degrees above, maybe a trifle below, but not enough lower to freeze the dampness out of the air; any- how it is very chilly, the atmosphere is moisture laden, and a mean, searching kind of a wind takes every opportunity to make itself felt; if melting snow is on the ground the conditions are intensified. This is the greatest time of all to take cold without any apparent reason, and unless vitality is high and the circulation active, the out-of-doors exercise had better be brisk and brief, care be taken to put on overshoes and overcoat before any long exposure, and generally to be on guard. A vastly colder day will be much less apt to result in coryza or bronchi- tis. After nightfall on just such days you may sometimes see two or three hundred people lined up on a damp, chilly sidewalk waiting for a theater door to open. They are not ignorant negroes, nor Indians willing to barter life and health for any tinsel show, but well educated people, used to in- doors life, not trained to even moderate exposure, and hollow graveyard coughs ring out along the line, proving that the cold demon is getting in his work. No show on earth can possibly be worth this amount of exposure and these people are "old enufif, big enuff, and oughter knowed better dan to gone and done dat way." 40 COLDS^ COUGHS AND SORE THROATS. Bacteria, those strange, omnipresent, vegetable micro-organisms to the action of which contagion and infection of so many kinds are due, are beheved to be an exciting cause of almost every kind of respiratory disease. La grippe, v^hooping cough, diphtheria and croupous pneumonia are each caused by its own particular variety of organism, and in these diseases it is fair to account these forms of bacteria as the exciting causes. In other respiratory diseases, as coryza, bronchitis and several forms of sore throat, the bacteria are there and take an active part in the disease process, but no particular form is necessarily present and they remain harmless and inactive until exposure or other cause starts the condition. Yet the disease would not fully develop . without them, so here it would perhaps be proper to account the bacteria a secondary exciting cause, while exposure or other factor that actually started the process may figure as the primary exciting cause. There are still other diseases, notably ton- sillitis, which are believed to depend on some kind of bacterial activity but in which no special causa- tive organism has as yet been detected, and these we must be content for the present to designate as doubtful. The ill effects of breathing through the mouth have been explained in Chapter I. There is no doubt that laryngitis, bronchitis and catarrhal pneu- monia are frequent results of this bad habit. Some- times it is merely a habit ; in children it often results CAUSES OF COLDS, COUGHS, ETC. 4I from adenoids, and in other cases it depends on other obstructions in the nasal passages, such as polypi, the presence of a foreign body, malforma- tion of the parts, or some unrecognized disease condition. When merely a habit it may be cured by persistent training and a bandage about the jaw and head at night, but before going to this length with a child it should be definitely ascertained that healthful and easy breathing through the nostrils is possible, otherwise harm may be done rather than good. Nasal polypi or adenoids are to be removed by surgical procedure, and any other disease con- dition should be properly treated before success in breaking up the habit need be expected. That indigestion and constipation are sometimes classed among the exciting causes of respiratory diseases will be news to some of our readers; the experience of others will lead them to accept this view very readily. That either condition disturbs the circulation is sure, whether they be exciting causes or merely a part of the symptoms of the dis- ease. Some physicians go so far as to claim that a cold never occurs unless these disorders are present. Impurities of inspired air may cause respiratory diseases. To external irritants in the inspired air some people are very susceptible, others almost in- different. Some unfortunates promptly take cold on their return from a country vacation to the less pure, dust-laden atmosphere of the town or city, others are affected by some particular drug odor, 42 COLDS, COUGHS AND SORE THROATS. or fumes from furnaces and factories, while still other people require much of any of these irritants to produce unpleasant symptoms. Among the more susceptible individuals may be classed the hay fever, or rose-cold sufferers. At the time that some par- ticular flower or weed scatters its pollen or other vegetable dust, they can confidently anticipate a period of the most intense wretchedness, and noth- ing but removal to some locality where the irritating substance is not found seems to avail, either in the way of prevention or of cure. To the question, "How would you treat a case of hay fever?'' a medical student once answered, "First remove the patient," this being a word-play on the time-honor- ed phrase, "First remove the cause," and the pro- fessor approved the answer as the best that could be given. The singular fact that these patients can often tell to a day just when their troubles will begin renders this mode of treatment both possible and practicable. Certain of the newer remedies do afford much relief, and vigorous claims are made for an antitoxin designed to give immunity and said to have been used with success in a large pro- portion of the cases experimented on. It is cer- tainly to be hoped that this stubborn and annoying complaint may finally be brought into subjection. Respiratory diseases are in some cases ascribed to unknown constituents of the air. At times some form of respiratory disease, which for a number of years has been almost unknown or of very mild CAUSES OF COLDS^ COUGHS^ ETC. 43 degree, will rage with so much violence and break out almost simultaneously at such widely distant points, that the theory of changed atmospheric con- ditions has been discussed by our ablest and most conservative investigators. That climatic changes and different factors of disease become more or less prominent as population increases, forests are de- stroyed, and smoke and factory fumes contaminate the air, we know. Other conditions are, however, believed to occur, such as substances projected into our atmosphere from distant worlds and vaporizing to such extent as to alter health conditions in large degree, giving rise to these otherwise unaccountable epidemics. That such occurrences do take place is probable, but in the limited state of knowledge along such lines there is as yet but little practical usefulness in these theories, and for the time being they are merely matters of interest, except to a few scientists who are willing to devote time, money and hard work to the task of increasing useful knowledge for the benefit of the world at large. In conclusion it may be said that exposure to cold and dampness has been recognized as a most potent exciting cause of respiratory diseases from time immemorial. Modern investigation has as- signed an equally important role to infection and contagion, the growth and multiplication of micro- scopical germs known as bacteria, and their trans- mission from one individual to another. Among 44 COLDS, COUGHS AND SORE THROATS. other exciting causes we find digestive disturbances, mouth breathing, the inhalation of impure air and various air-borne substances, and possibly atmos- pheric changes of a character as yet not fully under- stood. A high degree of vitality is the most effective safeguard against the exciting causes of disease. Exposure to cold and dampness that will surely render a weakly, thin-blooded person dangerously sick will merely increase a robust, hearty man's appetite and make him sleep sounder. Proper clothing will enable us to stand a degree of exposure that would otherwise be dangerous, and storm- proof garments are effective against rain and snow. Mouth breathing imperatively demands investiga- tion and removal of the cause. Digestive disorders should always be remedied, by diet, exercise and hygiene as far as possible, by medicines when abso- lutely necessary. Plenty of fresh air is every one's right and should be secured as far as possible. When exposure to exciting causes is unavoidable and vitality is not high enough to withstand them, measures may sometimes be taken to successfully counteract them, as the prompt removal of wet clothing, rubbing the skin into a vigorous glow, and perhaps taking a stimulant, when chilled and wet; washing the mouth and throat and spraying the nasal cavities with antiseptic solutions when ex- posed to bacterial diseases, and when obliged to breathe foul and dust laden air, increased time spent in the purest out-of-doors atmosphere available. CHAPTER HI. Bacteria and Their Relation to Disease. Bacteria is the plural form of the word bacte- rium, which is derived from a Greek word meaning a little stick or short rod. Bacteria are wonderfully small plants, differing in many ways from plants large enough to be seen by the naked eye and re- quiring a powerful microscope to render them visi- ble at all, and yet each individual bacterium is a distinct and complete organism, leading its own separate life and performing its own particular part in the economy of Nature just as thoroughly as any larger and visible form of plant life, be it tree, herb or flower. A very common misapprehension as to the true character of bacteria arises from the habit of jest- ingly referring to them as ''bugs,'' ''little varmints," or in other similar terms leading to the inference that they are animal organisms. The fact that in many varieties each cell leads an independent ex- istence, and the further facts that many of them have the power of locomotion in high degree, that they attack, destroy and consume other cells, and in other ways exhibit powers and properties usually associated with animal life, adds to this confusion 45 46 COLDS^ COUGHS AND SORE THROATS. of ideas, and there is no doubt that professional men sometimes refer to them as animal organisms from forgetfulness as to their true character. According to the dictum of modern science, bac- teria are vegetable organisms, and this fact should not be forgotten, although they are very strange and puzzling examples of plant life and differ in many ways from the larger flora with which we are familiar. Bacteria are frequently referred to as microbes, micro-organisms or germs. The word "microbe" is generally understood to mean a bacterium, but it may also be properly applied to a microscopical animal organism, as the malarial parasite. The word micro-organism simply means a very small organism, either animal or vegetable, while the word germ is likewise applied indiscriminately to bacteria or animal micro-organisms. Each bacterium consists of a single cell, so ex- ceedingly small that it takes about 5,000 individual organisms of the largest forms, and 25,000 or even more of the smaller bacteria placed end to end, to form a line a single inch in length, while there are excellent reasons for believing in the existence of forms so minute that the most powerful microscopes have as yet failed to reveal them. What they lack in size, however, is made up for by their marvelous powers of reproduction. Under favorable circum- stances a single bacterium within twenty-four hours BACTERIA RELATION TO DISEASE. 47 becomes tens of millions, and each one of these millions upon millions continues multiplying at the same almost incredible rate, so that in spite of the insignificance of the individual bacterium they quick- ly become a factor of mighty importance in the world's economy. Their mode of reproduction is peculiar and gives them the name of schizomycetes (splitting or fission fungi). Lines of cleavage appear in one, two or three planes of the parent bacterium, deepen and finally divide the organism into two, four or eight portions, each of which rapidly becomes an adult cell, when the same process of fission or division is repeated, and so on ad infinitum. To explain these lines of cleavage in different planes, just suppose an apple is cut in half. The path of the knife gives one plane of cleavage and the apple is divided into two parts. If it is quartered there are two planes and four parts; and if it now be cut through mid- way between stem and blossom end, there are three planes of cleavage and the apple is divided into eight parts. Cleavage or fission in bacteria, how- ever, gives no such irregular forms as the halves, quarters or eighths of the apple. If a string be tied around a toy balloon and drawn so tightly as to give the appearance of two smaller balloons it much more nearly represents bacterial division, but in the bacterium the dividing forces act from within and growth proceeds while division is going on. 48 COLDS^ COUGHS AND SORE THROATS. SO that the twins, quadruplets or octets may be nearly of adult size by the time fission is complete. Very probably dividing forces are already active in the rapidly growing bacterial offspring, even be- fore parental division is complete. Another peculiarity of bacterial life, by which these minute organisms retain their existence under unfavorable circumstances, is spore formation. When nutrition fails, or considerable variations of temperature are to be met, certain forms of bacteria undergo changes of structure resulting in bodies known as spores. The spore is believed to be re- lated to the bacterium, much as a seed is related to the plant that produces it. When this change is about to occur, a bright glistening spot appears in the substance of the bacterium. This portion be- comes constantly larger, while the remainder of the bacterium disintegrates and disappears, leaving a very resistant, hard and refractive body — the spore. This spore can undergo very considerable changes of temperature, and survives conditions that would infallibly destroy the parent organism. When cir- cumstances again become favorable for bacterial growth and multiplication, the spore becomes once more a bacterium, which immediately takes advan- tage of its appropriate environment to divide and multiply, exactly as it would have done had no such interruption occurred. The whole habitable world teems with these tiny BACTERIA RELATION TO DISEASE. 49 organisms. Their numbers are too vast for our minds to grasp, but a faint comprehension as to their size and numbers, when but a comparatively few are dealt with, may be gleaned from the follow- ing quotation from William's excellent Manual of Bacteriology : *'When one touches a growth of bac- teria with the sterilized platinum wire and spreads the tiny portion that adheres to the wire upon a slip of glass, it is found upon examination with the microscope that the bacteria left on the glass may be compared to the stars in the sky, the grains of sand on the shore, or any of the other standards for numbers that are nearly beyond computation/' Wherever visible plants and animals exist, bac- teria are found in countless millions, in the air, the earth and the water, on trees, plants, animals, stones, dust and dirt of every description, on the walls of our houses, on food, household utensils, clothing, window panes, pictures, books, — in short, on or in almost everything that you can see, touch or think of. They are found in the soil to the depth of three or four feet, but lower than this so far as present knowledge goes they are absent, and water drawn from wells does not usually contain any species that present methods reveal. The air on the summits of high mountains seems to be bacteria free, and the same is true of air examined far out at sea. Animals, human beings included, have bacteria in their mouths, nasal cavities, bronchial tubes, stomachs, intestines, and in all other cavities 50 COLDS, COUGHS AND SORE THROATS. that communicate with the external world, while in disease they are also found in the blood and the strictly internal organs. Fortunately for the human race a very large majority of these hosts of organ- isms are harmless, and many of them are actively beneficial, while to those varieties that are harmful sunlight and cleanliness are deadly enemies. Bacteria, properly prepared, stained and examin- ed under a powerful microscope, appear as small bodies of varying form, round, rod-shaped, comma- like, spiral or cork-screw shaped. According to these forms and the manner of grouping of the non- motile bacteria, they receive various names. The round forms are cocci (plural of coccus, a grain or berry), and, indicating their microscopical size, they are called micrococci. Cocci, occurring in pairs, are diplococci (double berries), in fours they are tetrads (tetrad, a group of four), and in groups of eight they are sarcinse (plural of sarcina, a pack or burden). When found in irregular masses they are called staphylococci (a bunch of grapes), and when in chains, the individual cocci joined end to end, they are streptococci (twisted berries or berry- wreaths). The rod-shaped organisms, or those which are longer in one diameter than another, are bacilli (plural of bacillus, a short stafif). Those forms that are twisted, each individual appearing like several turns of a cork-screw, are spirilla (plural of spirillum, a spiral), and the comma-shaped bac- teria are considered short forms of the spirilla. BACTERIA RELATION TO DISEASE. 5 1 The bacilli and spirilla are usually motile and rarely form characteristic groupings, hence there are no group names for these varieties corresponding to the diplococci, streptococci, etc., of the spherical bacteria. Bacteria also differ from visible plants in the fact that many, perhaps most, of the rod-shaped and spiral forms are actively motile, or possess the power of moving freely in liquids or semi-liquid sub- stances. Some of them are compared to minnows from their swift, darting movements, others resem- ble small power boats in their steady, business-like progress, and other peculiarities of motion charac- terize still other forms. These movements are caused by flagella (plural of flagellum, a whip) which are whip-like or hair-like processes, capable of twisting, turning or lashing movements in such manner as to propel the organisms in the fluids in which they live or which are prepared for their examination under the microscope. Sometimes there is a single flagellum at one end, sometimes several, or there may be many flagella projecting from all parts of the little organism, and frequently these processes are many times longer than the bac- terium itself. The micrococci, or spherical forms, are usually non-motile, hence rarely have flagella, and being incapable of any great amount of motion, they tend to grow or arrange themselves in some regular grouping, as streptococci, staphylococci, etc. There are many other facts concerning these as 52 COLDS, COUGHS AND SORE THROATS. yet but slightly understood organisms, and there is much that is of the greatest interest in even the little that is known of them. Many varieties are valuable and necessary in the arts and industries, others of vast importance to agriculture, while a comparatively small number are capable of produc- ing disease. These latter, the pathogenic or disease- producing bacteria, are the forms that have been most carefully studied, consequently most of our knowledge is of these harmful varieties, and this fact has given rise to a very false idea of bacteria in general. In the minds of very many people the idea of bacteria is inseparably connected with dis- ease, and largely with the more severe and danger- ous forms of disease at that; whereas in truth, but a very small proportion of bacteria are responsi- ble for disease at all, and a vastly greater number are closely connected with the most necessary and bene- ficial processes. To understand something of their widest field of activity we must devote some time to the consideration of the many varieties of bac- teria grouped under the heading of saprophytes. The word saprophytes literally means rotten plants, but a fuller and better rendering would be ''Microscopical plants, which by their growth cause putrefaction and decay.'' All life, including our own, is wholly dependent on bacterial life and ac- tivity, just as it is on visible plant and animal growth. If all visible plant life were destroyed all other forms of life would shortly cease, and the BACTERIA RELATION TO DISEASE. 53 same is largely true of animals. These facts are generally understood, and it is equally true, thougti far from being as well known, that if bacterial life were to cease the higher forms would also neces- sarily perish. Such forms of plant life as are characterized by green leaves make use of the waste products of animal life for nourishment, and in so doing these waste materials are again prepared for animal use. Animals breathe in ordinary air and retain the free oxygen until combined with other substances in the necessary processes of life. In exchange for this free oxygen they give off oxygen combined with carbon in the form of carbon dioxide, a waste and useless substance so far as animals are concerned, but the very breath of life to plants, which retain the carbon and throw off the oxygen, once more fit for animals. This process is independent of bacterial action and is a simple matter of exchange between plants and animals. But other forms of animal waste, including their dead bodies, are too complex or too highly organized for the use of visible plants and these substances must be worked over and reduced to simpler forms before further exchange can occur, and this is where the friendly bacteria known as saprophytes find their great field of usefulness. Dead animals, and likewise dead plants, putrefy and decay, and very unpleasant they often are until the process is carried so far that simpler and in- 54 COLDS, COUGHS AND SORE THROATS. ojffensive substances are formed. But if this un- pleasant process did not take place these dead ma- terials, plants as well as animal bodies, would simply lie unchanged and encumber the earth, and in a short time such a large proportion of the more necessary elements would be inert and useless that life would cease for want of proper material to sup- port it. But decay and putrefaction, which are the work of swarming myriads of saprophytes (fre- quently aided in the first stages by maggots and other low forms of animal life), do take place and the waste organic matter is reduced to simpler com- pounds suitable for the nutriment of visible vegeta- tion, which now takes up the process and again prepares these matters for animal use as food. Then herbivorous animals fulfill their part of Nature's scheme, preparing vegetable substances for the sus- tenance of flesh-eating animals, and all of these in turn fall and furnish more food for bacteria. And thus the life cycle rolls on ; plants, animals, bacteria, and then visible plants again; a never-ending chain with alternating links of animal, vegetable and bac- terial life and death, each link of equal importance with every other link, and all necessary for the continuance of the various forms of life on this terrestrial sphere. Bacteria which live on and draw their nutriment from living plants and animals are called parasites, and it is principally among these forms that we find the comparatively few pathogenic (disease- BACTERIA RELATION TO DISEASE. 55 producing) varieties. A few notable exceptions exist, and of these the deadly bacillus of tetanus or lockjaw is most familiar. These bacilli are found in garden soil and other earths, and in the excreta of certain domestic animals, and here they are of course harmless. But when carried deeply into living tissues in such manner that the wound closes and air is excluded they produce one of the most quickly fatal diseases known. A punctured wound, such as is often made by stepping on a nail or other loose piece of metal, affords an ideal location for these dangerous germs, and if the piece of metal has lain in contact with garden soil, manure, or even the dust of the streets, in parts of the country where this bacillus flourish- es, lockjaw is very likely to follow. For this reason the surgeon converts such a wound into an open one by cutting to the very bottom of the puncture and so enlarging it that air has access to every part. Oxygen is a sure preventive of activity for this organism, hence this procedure. As an additional precaution, however, the wound is generally steril- ized with pure carbolic acid or other powerful germ- icide, and in this way all danger is averted. Fourth of July wounds, made by prematurely exploding fireworks, or by other causes that pro- duce jagged, deep and irregular lacerations on sur- faces already dirt infected, and very hard to clean, are a frequent cause of this disease, and numerous cases generally follow any widespread celebration that includes fireworks in its list of attractions. 56 COLDS, COUGHS AND SORE THROATS. Where this bacillus is rarely found, as in the high, dry plain country of Dakota, vastly worse and deeper wounds than such as are ordinarily sufficient to produce lockjaw, heal quickly and completely with very slight care or none at all. The unbroken skin and healthful mucous mem- branes are sufficient protection against the milder pathogenic bacteria, and even such dangerous varie- ties as the bacillus of diphtheria have been found in healthy human throats where they may exist for months and yet cause no disorder. But that these bacilli are still deadly has been proven only too well and too often by the transmission of disease from these healthy human carriers of the contagion to a more susceptible person, with a malignant form, of the disease as the result. Numerous deaths from contagion thus harmlessly carried by persons, for the time being immune, have proven these facts beyond question. Moreover, abundant experimental proof has surely proven that dogs, cats, and even rats and mice can carry the contagion of the most deadly ailments, and infectious diseases undoubtedly often spread by these means. It is well known that the ordinary house fly is a carrier of infection, and other insects may at times be equally dangerous. A slight congestion of the mucous membranes, or the least scratch or break of the external skin, afifords even the milder pathogenic bacteria sufficient opportunity for harmful activity, and some form of disease, or the formation of pus, and sometimes BACTERIA RELATION TO DISEASE. 57 a rapidly spreading septic inflammation, are quite possible and by no means infrequent results. Some forms of bacteria are always present on the human skin and in accidental wounds they are almost cer- tain to gain access to the deeper and less resistant tissues. Sometimes the vitality of these tissues is so high that the bacteria are destroyed or rendered harmless and the wound heals healthfully and rapidly. In lower conditions of tissue vitality a slight inflammation with a small amount of pus formation occurs, and in still lower conditions a mere scratch may be the starting point of a severe and widespread infection with abundant pus forma- tion and destruction of tissues. Sometimes when the vitality is low these organisms may even gain entrance to the deeper tissues along the course of a hair follicle or a sweat gland and a boil or car- buncle results. The elaborately careful sterilization of hands, instruments, bandages and other appliances and of the parts to be incised in a surgical operation, are intended to destroy bacteria which would otherwise gain access to the exposed and wounded tissues, causing suppuration and all its attendant train of ills. It is probable that a small number of bacteria do gain access to the field of operation, but health- ful tissues can contend with a few germs and no harm results. Before the days of surgical asepsis and antisepsis, bacteria almost always found abun- dant lodgment on the wounded tissues during an 58 COLDS^ COUGHS AND SORE THROATS. Operation, and in those days surgery was often- times and with some degree of justice spoken of as scientific butchery. At the present time this term properly appHes to surgery only when, as sometimes happens, needless operations are performed because the surgeon ''likes to cut,'' loves to get a good fat fee, or craves increase of reputation more than the welfare of the patient. Those diseases of the respiratory tract of which enough is known to speak with any degree of posi- tiveness, are all, excepting hay fever, more or less dependent on the action of bacteria. Some of them are entirely due to these little one-celled plants, while in others comparatively mild conditions are increased and rendered severe enough to be classed as diseases by the same all-pervading germs. It is" to bacteria, allied vegetable organisms and certain minute forms of animal life, that all infectious or contagious diseases owe their power of spreading from person to person, and bacteria alone are con- sidered responsible for infectious diseases of the respiratory tract. Coryza, or the common cold in the head, is believed to be complicated and rendered more severe by bacteria, although any one or more of several varieties may be concerned, and the same is true of ordinary pharyngitis and laryngitis. Ton- sillitis is believed to be due to some germ, either animal or vegetable, diphtheria is known to be caused by the Klebs-Loffler bacillus, bronchitis is partially due to any one or more of several varieties. BACTERIA RELATION TO DISEASE. 59 lobar pneumonia is due to the pneumococcus, and catarrhal pneumonia is a bacterial disease, though no one form is necessarily present. The bacillus of Pfeiffer causes la grippe, while hay fever is due to a vegetable dust, but not a bacterium. Some forms of bacteria produce a condition of disease by their action on the tissues at their point of lodgment, and in addition throw off poisonous substances (toxins) which are taken into the cir- culation and injuriously affect the whole system. Other bacteria produce no symptoms at the point of lodgment, but their effects are entirely due to the liberated poisons, and of these forms the tetanus bacillus is a notable example. The toxins or poi- sonous substances are sometimes the result of the life processes of the bacteria and depend on the living organisms for their formation ; in other cases they are contained in the bodies of the germs and do not produce injurious results until after the death of enough of the organisms to set free suffi- cient poisonous matter to cause disease. Persons suffering from bacterial diseases throw off vast multitudes of the infective germs. In res- piratory diseases this is accomplished by sneezing, coughing and spitting, and to a much less degree in speaking or singing. In quiet breathing the ex- pired air is free from germs, and the authorities tell us that in a room full of consumptives keeping per- fectly quiet but breathing as usual, there would be no danger of receiving any of the germs or of 6o COLDS^ COUGHS AND SORE THROATS. contracting the disease. But if some of the lady consumptives should commence talking (as they surely would) there would be some danger; if they should sing there would be greater peril; and if they should cough or sneeze the atmosphere of the entire room would shortly swarm with the deadly tubercle bacillus. In other types of disease the intestinal discharges are the main sources of infection, and in eruptive diseases (those characterized by a rash or other breaking out) the infection is contained in the scaly particles which are thrown off from the skin and is usually contained in other excretory products as well. These pathogenic bacteria may also remain alive for months on non-living substances, such as clothes, bedclothing, handkerchiefs or toys with which they have come in contact during the course of some case of the disease and after a variable period, sometimes as much as, or even much greater than a half year, they are still capable of causing the disease in its full measure of severity. Some knowledge of the requirements and habits of bacteria is useful as well as interesting, and through such knowledge we obtain reasons for many valuable processes known and practiced before any of the micro-organisms had been discovered. The disease producing bacteria flourish best at or near the body temperature and may be destroyed by boiling or a high degree of dry heat. Moisture is another requirement of bacterial life, while sunshine BACTERIA RELATION TO DISEASE. 6l kills all of the dangerous forms. This is one of the great reasons why sunshine is such an absolute ne- cessity and by itself should decide every one to buy, rent or occupy only such houses or rooms as have an abundance of sun light every day that the sun shines and for as many hours of every day as may be practicable. Heavy draperies, upholstered fur- niture and darkened rooms are regular bacteria farms, sheltering and encouraging the deadliest forms. The ever-present bacillus of tuberculosis finds in such surroundings a congenial dwelling place wherein, after the death of one victim, it will patiently await another, and the records of what are called ''tuberculosis houses" show that it does not wait in vain. Houses built side by side so that only front and rear have light, air and sunshine are a direct viola- tion of one of Nature's plainest laws and ought to be forbidden by law in the interest of public health. Churches, theaters and other buildings which are at times crowded with human beings, should be solidly and plainly constructed, cushioning and draperies avoided, and should be ventilated thor- oughly and scientifically. Railroad cars, street cars and other closed conveyances are always a possible source of contagion, and this fact should be taken into consideration in their use. As a mere matter of fairness and justice, if you must sneeze or cough in a crowded hall, a closed conveyance or other public place, hold your hand- 62 COLDS, COUGHS AND SORE THROATS. kerchief before your face, and if some ill-bred or grossly ignorant person sneezes or coughs toward you without using such precaution, turn your own face away or intervene your own handkerchief so that at least you need not breathe in the expelled germs. The free use of warm water and good soap is another measure very destructive to pathogenic bac- teria and is at all times applicable to hands, cloth- ing, utensils and bedding. If there is known ex- posure of clothing, towels, handkerchiefs or bed- ding to the germs of disease, boiling the infected articles is a certain and speedy way of destroying the microbes. Free and prolonged use of warm water and good soap is the first step in sterilizing the hands in preparing for surgical operations, and in purifying them if infected, and many physicians believe it to be the most important part of the whole proceeding. Should any of the readers of this book desire further knowledge on this most interesting subject, it will pay to invest a dollar or two in some good book on bacteria, and in this particular instance one of the smaller technical works designed for the use of medical men and students will probably serve the purpose better than those books which spoil the subject by trying to make it so plain that a five-year- old child can understand what little is really told, and leaving out the most interesting and practical parts for fear of over-taxing the reader's comprehension. CHAPTER IV. Infectious and Contagious Diseases and Their Causes. This chapter might with almost perfect propriety appear under the heading of ''Alicro-organisms and Their Results/' for all infectious and contagious diseases are caused by living organisms of micro- scopical size. What difference whether we say, ''Diphtheria and its cause/' or ''The Klebs-Loffler bacillus and its results'' ? An infectious disease is one caused by some form of living micro-organism, either vegetable or ani- mal, which by its growth and multiplication in or on the body of the victim, causes the disease in question. If these disease-producing organisms can be transferred directly from one human being to another, the disease which they cause is directly contagious, while those in which the infection can not be transferred directly, but requires some inter- mediate agency (as the mosquito in malaria and yellow fever), are indirectly contagious. Ordinari- ly the two words, infectious and contagious, are used interchangeably. All of the respiratory diseases considered in this book, with the single exception of hay fever, are believed to be infectious and directly contagious, and all of them in which the inefective organism has 63 64 COLDS, COUGHS AND SORE THROATS. been certainly determined, are due to bacteria, or vegetable micro-organisms. After the bacteria effect a lodgment in the mouth, or some part of the respiratory passages, a certain amount of time, known as the incubation period, elapses before the germs manifest their activity. In some instances this interval is very short, perhaps a day or two, in other cases it may be several weeks. During the incubation period there may be no indi- cations that the victim has contracted disease, but more commonly there are mild symptoms of ill health which are known as prodromes, or prodro- mal symptoms. At the expiration of the incubation period the disease breaks out, frequently with vio- lence and great suddenness, and from this time on to recovery or death it follows a recognized course. Why the symptoms are so slight and indefinite for a certain period of time, and then break out, in many instances with almost explosive violence, has not, as yet, been satisfactorily explained. That it is so, however, is proven by a vast amount of ex- perience. The pathogenic organisms cause disease by vari- ous methods. Sometimes their growth gives rise to inflammation and tissue destruction at the point of lodgment. Frequently in their growth and mul- tiplication they manufacture deadly poisons (tox- ins), which are carried to all parts of the body in the blood and lymph currents, affecting the whole INFECTIOUS AND CONTAGIOUS DISEASES. 65 system, and causing general, or constitutional symp- toms. And quite commonly one and the same or- ganism will produce both the localized inflammation and injury, and the general poisoning by violent toxins. In diphtheria we have a fine illustration of this combination of ill results. The bacilli cause inflammation and coagulation of tissues at their point of lodgment, while at the same time the most violent poisons are thrown into the circulation and carried to all parts of the body. While knowledge concerning disease-producing germs is still in its infancy, an amount of informa- tion has already been obtained that is of the greatest practical value. It explains facts and methods known and practiced for ages, and renders their application more rational and satisfactory. That rooms exposed to the direct rays of the sun are vastly more conducive to health than those remain- ing in shadow and comparative darkness, has been recognized from the days of the cave-dwellers. That sunshine is one of the most fatal influences to which the tubercule bacillus and other deadly germs can be exposed, explains a part of the value of sunlight and renders its admission into dwelling rooms more imperative. Cleanliness is justified on more positive grounds than mere increase of com- fort and improved appearance. Cooking becomes of vast importance when the influence of heat on dis- ease germs is understood, and sanitation becomes a necessity, justified by exact knowledge. Isolation 66 COLDS, COUGHS AND SORE THROATS. of persons suffering with contagious diseases, prac- ticed in the dark ages, and by savage people, by abandoning the victims, is reduced to a rational procedure benefiting both patient and relatives. Infectious and contagious diseases are to be avoided, or combated, by maintaining high vitality, by sanitary surroundings and strict cleanliness, by isolation of the sick and their attendants, and by the use of various germicides and modes of disinfec- tion. Even in those respiratory diseases which are only mildly contagious, such as coryza and pneumonia, a moderate amount of precaution is profitable. Coughed-up matter or other discharges from mouth or nose should be disinfected or burnt, and the hands should at least be well washed in warm water and soapsuds after coming in contact with any such sub- stances. Ventilation and abundant sunlight should be secured, both for their healthful influence on the human beings concerned, and for their destructive action on contagion. Handkerchiefs, even in a mild case of coryza, should not be long used, nor allowed to become much soiled. In pneumonia, owing to its dangerous character, especial care should be ta- ken to destroy or disinfect any source of contagion, and as few people should be about the patient as possible. In the more actively contagious diseases, as diphtheria, whooping cough and la grippe, much greater precautions should be observed. In diph- theria especially, the patient and his nurse should INFECTIOUS AND CONTAGIOUS DISEASES. 67 have a room to themselves in which no other person save the physician in charge should be allowed. If two rooms can be given up to them, and one room disinfected while the other is in use, it is distinctly advantageous. Nothing should leave such a room without thorough disinfection, and in every way the contagion must be prevented from spreading. For the patient himself, of course, antitoxin is the great- est prophylactic measure attainable. The following rules of the New York Board of Health, taken from Jacobi's ''Therapeutics of In- fancy and Childhood,'' edition of 1893, will give most valuable instruction as to the management of contagious diseases : PREVENTION OF CONTAGIOUS DISEASES. Directions of the New York Health Department, Diphtheria, Scarlet Fever, Measles. "These diseases are very contagious. Diphtheria is usually transmitted from the sick to the well by the moist or dry discharges from the nose and throat of the sick person. Scarlet fever and measles are transmitted by the discharges from the nose and throat and also by the scales thrown off from the surface of the skin. These discharges and scales 68 COLDS, COUGHS AND SORE THROATS. contain the minute germs that cause these diseases. The importance, therefore, of their proper disin- fection can be at once understood. Directions to Prevent Other Cases of Diph- theria, Scarlet Fever, and Measles Occur- ring IN A Family Where One Case Exists. ''i. If possible, one attendant should take the entire care of the sick person, and no one else be- sides the physician should be allowed to enter the sick room. The attendant should have no com- munication with the rest of the family. The mem- bers of the family should not receive or make visits during the illness. "2. The discharges from the nose and mouth must be received on handkerchiefs or cloths, which should be at once immersed in a carbolic solution (made by dissolving six ounces of pure carbolic acid in one gallon of hot water, which may be diluted with an equal quantity of water). All handker- chiefs, cloths, towels, napkins, bed-linen, personal clothing, night clothes, etc., that have come in con- tact in any way with the sick person, after use should be immediately immersed without removal from the room in the above solution. These should be soaked for two or three hours and then boiled in water or soapsuds for one hour. "3. In diphtheria and scarlet fever great care should be taken, in making applications to the INFECTIOUS AND CONTAGIOUS DISEASES. 69 throat or nose, that the discharges from them in the act of coughing are not thrown into the face or on the clothing of the person making the appHca- tion, as in this way the disease is Hkely to be caught. ''4. The hands of the attendant should always be thoroughly disinfected by washing in the car- bolic solution, and then in soapsuds, after making applications to the throat or nose, and before eating. '^5. Surfaces of any kind soiled by the discharges should be immediately flooded with the carbolic solution. ''6. Plates, cups, glasses, knives, forks, spoons, etc., used by the sick person for eating and drinking must be kept for his especial use, and under no circumstances removed from the room or mixed with similar utensils used by others, but must be washed in the room in the carbolic solution and then in hot soapsuds. After use the soapsuds should be thrown in the water closet, and the vessel which contained it should be washed in the carbolic solu- tion. '^7. The room occupied by the sick person should be thoroughly aired several times daily, and swept frequently, after scattering wet newspapers, saw- dust, or tea leaves on the floor to prevent the dust from rising. After sweeping, the dust upon the woodwork and furniture should be removed with damp cloths. The sweepings should be burned and the cloths soaked in the carbolic solution. In cold weather, the sick person should be protected from 70 COLDS^ COUGHS AND SORE THROATS. draughts of air by a sheet or blanket thrown over his head while the room is being aired. ''8. When the contagious nature of the disease is recognized within a short time after the beginning of the illness, after the approval of the Health De- partment Inspector, it is advised that all articles of furniture not necessary for immediate use in the care of the sick person, especially upholstered furni- ture, carpets, and curtains, should be removed from the sick room. "9. In scarlet fever and measles, when the pa- tient is beginning to recover and the skin is peeling off, the body should be washed once daily in warm soapsuds, and afterwards annointed with oil or vas- eline. This should be continued until all roughness of the skin has disappeared. *^io. When the patient has recovered from any one of these diseases, the entire body should be bathed and the hair washed with hot soapsuds, and the patient should be dressed in clean clothes (which have not been in the room during the sickness) and removed from the room. Then the Health Department should be immediately notified, and disinfectors will be sent to disinfect the room, bed- ding, clothing, etc., and under no conditions should it be again entered or occupied until it has been thoroughly disinfected. Nothing used in the room during the sickness should be removed until this has been done. "11. The attendant and any one who has as- INFECTIOUS AND CONTAGIOUS DISEASES. 7 1 sisted in caring for the sick person should also take a bath, wash the hair, and put on clean clothes, be- fore mingling with the family or other people, after the recovery of the patient. The clothes worn in the sick room should be left there to be disin- fected with the room and its contents by the Health Department. Methods of Disinfection. "i. Hands and Person. Standard Solution No. I * should be diluted with an equal amount of water. Hands soiled in caring for persons suffering from contagious diseases, or soiled portions of the patient's person, should be immediately and thor- oughly washed in this solution, and then washed with soap and water. The nails should be kept perfectly clean and the hands should always be care- fully disinfected before eating. ''2. Soiled Clothing, Towels, Napkins, Beddings etc., should be immediately immersed in Standard Solution No. i, and soaked for twelve hours, being occasionally moved about in the fluid so as to bring the disinfectant in contact with all parts. They should then be wrung out and boiled in soapsuds for one hour. Articles, such as beds, etc., that can not be washed should be burned. "3. Food and Drink. Food thoroughly cooked and drinks that have been boiled are free from dis- *See " Carbolic Acid" in list of disinfectants, page 74. y2 COLDS^ COUGHS AND SORE THROATS. ease germs. In presence of an epidemic of cholera or typhoid fever, milk and the water used for drink- ing, cooking, washing dishes, etc., should be boiled just before using, and all persons should avoid eat- ing fruit, fresh vegetables, and ice. Ice may, how- ever, be used when ordered for the sick by a physi- cian. '*4. Discharges of all kinds from patients suffer- ing from contagious diseases should be received into earthen vessels containing Standard Solution No. I or 3. Special care should be observed to dis- infect at once the vomited matter and the intestinal discharges from cholera patients, as these alone contain the dangerous germs. The volume of the disinfecting solution used should be at least four times as great as that of the discharge. After standing for at least one hour in the disinfecting solution, these discharges may be thrown into the water closet. Bedding or clothing soiled by the discharges must be at once placed in Solution No. I, and the hands of the attendants disinfected, as described above. "5. Closets, Sinks, etc. Each time the closet is used for infected material, at least one quart of Solution No. i should be poured into the emptied pan and allowed to remain there. All discharges should be disinfected before being thrown into the closet. Sinks should be flushed at least once daily with the same solution. "6. Dishes, Spoons, etc., used by the patient INFECTIOUS AND CONTAGIOUS DISEASES. 73 should be kept for his exclusive use, should not be removed from the room, but should be washed there, first in Solution No. i, and then boiled in strong soapsuds. These washing fluids should afterwards be thrown into the water closet. The remains of meals should be thrown into a vessel containing milk of lime. The contents of the vessel, after standing half an hour or more, should be thrown into the water closet. ''7. Soiled Wood-work, Floors, Plain Furniture, etc., should be thoroughly washed with Solution No. 2. Upholstered furniture, curtains, or carpets which have been soiled by the discharges should be referred to the Health Department for disinfection or destruction. 'Tt is important to remember that an abundance of fresh air, sunlight, and absolute cleanliness not only help protect the attendant from infection, but also aid in the recovery of the sick. '*Note. — The cost of the carbolic solution is much greater than that of the other solutions, but gene- rally it is to be much preferred. When the cost is an important element, the bichloride solution may be substituted for all purposes for which the car- bolic is recommended, excepting for the disinfec- tion of discharges, eating utensils, or articles made of metal, and of clothing, bedding, etc., which is very much soiled. Its poisonous character, except for external use, must be kept constantly in mind. 74 colds, coughs and sore throats. Disinfection and Disinfectants. "The contagious diseases are caused by minute living germs. The object of disinfection is to de- stroy these. In order that as few articles as possi- ble shall be exposed to infection by the disease germs, at the very beginning of the illness all un- necessary furniture (especially upholstered furniture and curtains) and other unnecessary articles, should be removed from the sick room. ''The following are the best known disinfectants : ''i. Heat. Continued high temperatures destroy all forms of life. Boiling for at least one-half hour will destroy all disease germs. ''2. Carbolic Acid. Standard Solution No. i is composed of six ounces of carbolic acid, dissolved in one gallon of hot water. This makes approxi- mately a five-per-cent. solution of carbolic acid. The commercial colored impure carbolic acid will not answer for this purpose. Great care must be taken that the pure acid does not come in contact with the skin. When practicable, the carbolic solu- tion should be used as hot as possible. ''3. Corrosive Sublimate (bichloride of mer- cury). Standard Solution No. 2 is composed of sixty grains pulverized corrosive sublimate and sixty grains of chloride of ammonia, dissolved in one gallon of water. This solution must be kept in glass, earthen or wooden vessels (not in metal vessels). INFECTIOUS AND CONTAGIOUS DISEASES. 75 ''The above solutions are very poisonous when taken by mouth, but are harmless when used ex^ ternally. ''4. Milk of Lime. Standard Solution No. 3 is made by mixing one quart of dry, freshly slaked lime with five quarts of water. Lime is slaked by pouring a small quantity of water on a lump of quick-lime. The lime becomes hot, crumbles, and as the slaking is completed, a white, dry powder results. The powder is used to make Solution No. 3. Air-slaked lime has no value as a disinfectant. "The proprietary disinfectants, often widely ad- vertised, and whose composition is kept secret, are relatively expensive and often unreliable and in- efficient. It is important to remember that sub- stances which destroy bad odors are not necessarily disinfectants." While some of the above precautions may not be applicable to respiratory diseases, and others (as notice to the Board of Health) do not apply to country districts, enough is given that is applicable to town and city, home and hospital treatment, to furnish a good working basis and explain what ob- jects are aimed at and how contagion can be re- stricted. In any community or in any home where it is determined to prevent the spread of infection, it can be done, and as a rule it will be done. Its impor- tance is apparent to every one, and every one should assist in limiting the dangerous contagious diseases to the smallest number of victims possible. CHAPTER V. Apparatus Used in Treatment of Respiratory Diseases. Discomfort and restlessness consume large amounts of vital energy; therefore, whatever adds to the patient's physical comfort exerts a beneficial influence on the course of his disease. For this reason certain very simple articles of apparatus for the sick room are highly useful, and many such can be supplied, with little or no expense, in every home. A small outlay of money will provide other articles that will pay for themselves ten times over in comfort and in the increased chances of a quick and favorable recovery from disease. The articles described in this chapter are useful in the treatment of respiratory diseases, but their application is not by any means limited to diseases of that character. In fact, many of them are useful in almost any condition of disease, and should form a part of the household furnishing in every home. If any of our readers wonder at descriptions being given of articles as familiar to them as the letters of the alphabet, they must kindly remember that it is hoped that this book will be read in houses where an atomizer is as great a novelty as an air ship and a soft-rubber hot water bottle is only 76 APPARATUS USED IN TREATMENT. "JJ known of by hearsay. Also many other articles might have been herein included, and perhaps very properly. The aim has been to mention only some of the simplest and most readily obtainable. Among these simple aids to comfort, extra pil- lows may be mentioned, by means of which a rest- less or convalescing patient may change his attitude, and light cushions to go under the hollow of the back, or give grateful change to tired or painful limbs. Regular back rests are procurable, but they are less convenient than the pillows and do not permit of as many uses. One or more small tables or stands, that may be moved about as desired, set close to the bed for the invalid's use, or for the basin when giving him a bath ; that may be used for food and dishes at meal times, and at other times, for flowers, books, etc., are simple and very convenient appliances. They should be strong and light and, in contagious dis- eases, of such character as to permit of ready sterili- zation. In diseases marked by great loss of strength, so that the patient may not even leave the bed to at- tend to the calls of nature, bed pans and urinals must be supplied to meet the emergency. They are of small cost and may be found at most of the hardware and house furnishing stores. Drug stores also commonly carry them in stock. Light metal articles are probably the best as being most readily 78 COLDS, COUGHS AND SORE THROATS. cleansed and sterilized, but very good ones may be had in earthenware or glass. Chamber vessels must also be provided, of similar light and easily disin- fected material. In respiratory diseases a spit-cup is also often needed. Often some household utensil will answer this purpose, but ease of cleansing must always be borne in mind. Wash bowls, water pitchers, and slop pails are also needed, and all should be light and readily sterilizable. A portable bathtub is an inexpensive luxury, and will permit the convalescing patient to enjoy a full bath in a warm room. So simple a matter as an abundance of safety pins will also be found of great conveni- ence. An ordinary thermometer is useful, and will often show that the part of the room occupied by the patient is really chilly, while to the nurse, or other attendant, sitting nearer the fire, it seems properly warm. The clinical thermometer, used for taking the patient's temperature, is often of service. It is a closed glass tube, one end of which forms the mercury bulb. Figures at the side enable the temperature to be ascertained. The bulb, or end containing the mercury, is slipped as far under the patient's tongue as the size of his mouth will allow, the lips (but not the teeth) are tightly closed and the thermometer allowed to remain for from two to five minutes. Or it may be placed in the arm- pit with the arm held closely to the side, but re- APPARATUS USED IN TREATMENT. 79 quires longer in this position to secure an accurate reading. As the column of mercury is very small a magnifying index thermometer should always be used. It requires some practice to read the tem- perature correctly, the thermometer being turned slowly in the fingers until the mercury shows plain- ly. After using, the mercury must be shaken down, and many thermometers are broken in this process. The tube should be taken in the thumb and fingers of the right hand as a penholder is held. A quick, sharp fling of the hand is required to bring the mercury down, and the thermometer must be tight- ly held, or another one purchased. The tempera- ture should not be taken too often. Once in two or three hours is enough, even in severe illness, and twice a day is usually sufficient. More than this worries the patient needlessly and does no good. The soft-rubber hot water bottle is useful in many ways and should find a place in every household. A very efficient substitute is found in an ordinary glass bottle of large size, which can be securely corked after receiving the hot water. Other sub- stitutes are large, smooth stones, bricks and even blocks of hard wood. Care must be taken with all of these appliances, to avoid too great a degree of heat, and they should be wrapped in large towels, blankets, or other cloths, before being used. Prop- erly wrapped they retain their heat for a surprising length of time. A large stone, well heated and 8o COLDS^ COUGHS AND SORE THROATS. well wrapped, will retain heat for many hours in a zero temperature. Any of these appliances placed at the feet of a chilly patient will add greatly to his comfort and keep him snug and warm all night. In cases of collapse, or great weakness, where the patient grows cold and the circulation flags, a num- ber of these hot water bottles should be placed about him. They will impart the necessary heat and frequently, in conjunction with internal stimu- lants, save life. It is claimed that when bed cloth- ing is scanty, a good hot water bottle will equal two blankets as a means of keeping warm. Often an agonizing stitch in the side, or other localized pain, will yield as if by magic to a hot water bottle laid over the affected area. The rubber bag, form- ing the main part of a fountain syringe, can be readily transformed into a hot water bottle. Ice bags, also made of soft rubber, are of various shapes and sizes, adapted to different parts of the body. A broad, flat form is used for chest and abdomen. The bladder of a sheep or pig may be used as a substitute. These appliances are partly filled with small pieces of ice, tightly tied, wrapped in towels and applied to the proper part. They are often used over the painful area in pneumonia or pleurisy, and smaller forms are applied to the side of the neck or about the throat in tonsillitis and other forms of sore throat. These ice bags should always be wrapped in some kind of cloth, to prevent APPARATUS USED IN TREATMENT. 8 1 too great a degree of cold, and to keep moisture from gathering on the cold surface. If the patient feels at all uncomfortable under these cold appli- cations they should, as a rule, be promptly dis- continued. Compresses are a convenient and efficient method of applying either heat or cold. They are easily improvised from large towels, folded to suitable size and thickness and wrung out of very hot or very cold water, and frequently changed, so as to keep the temperature at about the right point. Hot compresses retain the heat much longer if covered with oiled silk, rubber cloth, or other protective that checks heat dissipation. A cold compress, frequently changed, often gives most marked relief in headache, and in various inflammations it will prove most useful. A coal oil heater is sometimes very handy in sick- ness, either for warming the room, furnishing heat, heating water, or preparing food. Its odor, and the impurities due to its combustion, are to be taken note of, and greater quantities of fresh air must be admitted to the room when it is employed. An alcohol lamp will boil sufficient water to keep the air of the room moist, or to prepare a good many articles of diet, and it contaminates the air very slightly as compared with the coal oil heater. Gas heaters, or cooking devices, are open to the same objections as the coal oil stove, and are to be used 82 COLDS, COUGHS AND SORE THROATS. with the same precautions. If a stove is used for warming the sick room a kettle should always be kept on its top to moisten the air properly. In furnace-heated rooms the air is almost always dry and harsh. This may be remedied by having a pan of water so placed that the incoming hot air must pass over the water. The croup kettle is used to keep the air of the sick room moist, and if desired, medicated. For description see Chapter XI, ^'Bronchitis." A tea- kettle may be used as a substitute for the croup kettle and the results are exactly similar. A piece of rubber tubing of proper size to fit the spout will serve the same purpose as the extra tubing used for lengthening the spout of the croup kettle. Coffee-pots and other household utensils have been employed for the same purpose with very satisfac- tory results. The bronchitis tent is simply a tent built over the bed of the invalid, with one side partially open to insure sufficient ventilation. Its object is to keep the steam-moistened air furnished by the croup kettle close about the patient, and it also serves to prevent drafts. A fuller description of this appli- ance is given in Chapter XI, ''Bronchitis.'' The benefits of both croup kettle and bronchitis tent have frequently been obtained by substitutes of various kinds, and generally with very satisfac- tory results. One resourceful mother, whose little APPARATUS USED IN TREATMENT. 83 girl was seized with a very sudden and alarming attack of croup, devised an emergency tent and kettle that deserve mention. Hastily filling a pitcher with boiling water, and calling to her husband to bring the requisite medicine, she clasped the child in her arms, seated herself in a low chair and drew a sheet over herself, the child and the steaming pitcher. Together they inhaled the medicated steam, and both are still very much alive. A pitcher of boiling water set on an improvised shelf in the bronchitis tent, or on a stand drawn within its limits will, if frequently renewed, furnish an abundance of steam for a mild case, and allows the use of any suitable drugs. Inhalation of steam, medicated or not, is easily secured for brief periods by filling a pitcher two- thirds full of boiling water, adding any required drug, holding the face over the pitcher, and covering both head and pitcher with a towel. Care must be taken that the patient, especially if a child, is not scalded. A paper cone may be held over the pitcher and the vapor thus directed to the mouth and nose of the patient. By this mode there is no danger of suffering from the heat. After using any of these steam inhalations, exposure to cold must be abso- lutely avoided, or the last state of that patient may be vastly worse than the first. By keeping the croup kettle briskly boiling, the air of the whole room is easily filled with steamy 84 COLDS, COUGHS AND SORE THROATS. vapor. Large lumps of unslaked lime, dropped in a pail or tub of water, will give a vapor that is considered very beneficial in case of croup. Pocket inhalers and menthol cones are familiar to every one. They may be obtained at any drug store, and fulfil a useful mission in averting or modifying mild colds. If a glass tube can be se- cured two or three inches in length and of such diameter that the ends may be closed with small corks, a very good pocket inhaler can be made at home. A few grains of menthol, a larger quantity of ammonium chloride or a few crystals of cam- phor, may be placed in the middle of the tube. A small, loose plug of absorbent cotton, or other light, porous substance, is pushed into each end and the corks fitted to the ends. To use, withdraw both corks, place one end of the tube in the nostrils, hold the other nostril with finger or thumb, and inhale deeply. Repeat the process with the other nostril, and replace the corks tightly when through. Atomizers, nebulizers and vaporizers are forms of apparatus designed to throw fluids, watery or oily, medicated or otherwise, into the nasal and other respiratory passages. The ordinary hand at- omizer consists of a rubber bulb which acts as an air forcing pump, a reservoir for the fluid, and the necessary tubing, tips, etc., to connect the parts and fit it for its work. A small tube, usually of glass or hard rubber, extends from near the bottom APPARATUS USED IN TREATMENT. 85 of the reservoir through its cap or stopper, where it meets a similar tube from the rubber bulb. Some- times the two tubes run side by side, at other times the tube for fluid is contained in the other. The arrangement is such that the air under pressure passes in front of the opening of the tube from the fluid reservoir. This causes a vacuum which draws the fluid from the reservoir into the air current, where it is finely divided and carried forward in the form of a spray. Compressing the rubber bulb in the hand starts the atomizer to working, and the spray may be directed to any part of the upper air passages. In the oil atomizers and nebulizers, air is forced into the reservoir and throws a portion of the liquid against the sides thereof. This forms a vapory cloud, which is made still finer by being taken up in the outgoing current of air so that it gives the appearance of a fine mist or a small cloud. Steam vaporizers are pretty little instruments and do their work well. They are more complicated than the others and perhaps less desirable on this account. Some form of vaporizer or nebulizer should be used when it is desired to reach the deeper parts of the respiratory passages, and deep breaths should also be taken when they are used, so as to draw the misty vapor deeply inwards. Cotton swabs, or applicators, are made by wrap- ping a small piece of cotton firmly on the end of 86 COLDS, COUGHS AND SORE THROATS. a slender stick, or a light metal rod especially made for the purpose. A match stick, with the phos- phorus removed, will answer for applications to the interior parts of the nasal passages. A small piece of cotton (absorbent cotton should be used) is pulled into a thin sheet, a half inch or less in width and about an inch in length. The end of the applicator is laid on the cotton close to one edge, and in such position that about half the sheet of cotton will extend beyond the applicator. The cotton is now wound or rolled very closely on to the applicator and gives a soft, cottony swab, which can be used about the delicate membranes of the mouth, nose or throat without any danger of injury. Medicine droppers are probably familiar to every one. They are used perhaps as extensively for fill^ ing fountain pens as for dropping medicines, and can be secured for a few cents apiece at any drug store. They are very convenient in securing proper dilution of small quantities of any kind of fluid, one dropper full of the required fluid being added to as many dropperfuls of water as is required in the dilution. Douche instruments are receptacles of such ar- rangements that a stream of water, or other liquid, may be directed against any part of the body, or into any of the body cavities. The smaller ones hold a half ounce or less, while the fountain syringe holds several quarts. The Birmingham pattern af- APPARATUS USED IN TREATMENT. 8/ fords very handy douches for nose use. They are much Hke small vials with the neck drawn out al- most to a point, and a larger opening in the side to admit liquids. When in use, a finger held over the side opening regulates the flow, and any desired amount of the liquid can be allowed to escape. The Thudicum douche is practically a flat-bottomed bottle, with an opening near the bottom connecting with a rubber tube which carries a tip suitable for use in irrigating nose, throat, or other parts. The siphon douche needs only a rubber tube carrying a suitable tip at one end. The tube is filled with the liquid to be used, the open end is dropped in any kind of vessel containing the fluid and the tip low- ered. Siphonage of course occurs and the douche instrument works perfectly. Of all the douche in- struments, however, the familiar fountain syringe is probably the most convenient and efficient and is to be recommended for any purpose requiring more than two or three ounces of liquid. Numberless other appliances might be mentioned, many of them as useful as those herein referred to. The aim has been to mention a few of the more prominent and more generally useful. Different cases call for different apparatus and whatever will aid in giving the patient comfort and relief should be supplied if possible. CHAPTER VL Medicinal Remedies and Their Doses. The object of this chapter is to give a few gene- ral directions as to dosage and the methods of ad- ministering medicines, and to speak of certain valu- able remedies a little more fully than can be done in the body of the work. The directions for taking any liquid medicine usually specify that so many drops, or a teaspoon- ful, a desert-spoonful, or one or more tablespoon- fuls, are to be taken at certain intervals. The little medicine droppers, found in all drug stores, afford the most convenient method of meas- uring by drops. A drop is supposed to equal one minim of the Apothecary's fluid measure. In the case of water this is about correct, but denser liquids, such as syrups, may give drops of double this size, while tinctures and other lighter fluids often yield two or more drops to the minim. The form and size of the containing vessel also influence the size of a drop. For these reasons none of the very powerful and dangerous remedies are given by drops. A teaspoonful is supposed to equal a fluid drachm, which is one-eighth of a fluid ounce. The ordinary teaspoon really contains a little more than a fluid 88 MEDICINAL REMEDIES AND THEIR DOSES. 89 drachm. Two teaspoonfuls equal one desert-spoon- ful and four teaspoonfuls, or two desert-spoonfuls equal one tablespoonful. The tablespoonful is sup- posed to equal half a fluid ounce. It really contains a little over this amount. In a few instances, medicines that occur in solid form (crystals or powders) are directed to be taken in spoonful doses. Epsom salts furnishes a familiar example. Usually such medicines are directed to be taken in doses of so many grains, or so many fractions of a grain. At the present day, exact doses of most of the solid medicines are easily se- cured by the use of pills, tablets, tablet triturates or lozenges. Of these various forms, the tablet triturates are perhaps most desirable. A tablet can be secured of almost any desired size, and by using two or more for larger doses and dividing a tablet into any required number of parts for smaller doses, all ages can be properly suited. Whether pill, tablet or lozenge be used, it should be one prepared by some well established and reliable firm, and be rea- sonably fresh at the time of purchase. A dust- covered package, or a bottle with stained label and partially decayed cork, is a poor recommendation for the efficacy of the contained drug. All medicines should be kept in carefully closed and accurately labeled containers, in a dark and moderately cool place, and preferably under lock and key. If children, or other irresponsible per- sons, have access to pow^erful drugs, accidents may 90 COLDS^ COUGHS AND SORE THROATS. be expected as a matter of course. One reliable person should have full charge of the medicine chest, closet or shelf, and in sickness only such remedies should be taken out as are needed for the case in hand, and somewhat similar precautions should be observed with whatever is thus in use. Medicines, and all apparatus used in their prepa- ration, should be kept out of the patient's sight, excepting for just what time is required for actual administration. All spoons, glasses, measures and other utensils used in connection with medicines should be kept scrupulously clean. Medicine bot- tles should be occasionally wiped off with a damp cloth, and when corks or stoppers get sticky or otherwise unpleasant they should be replaced by fresh ones. If a disagreeable taste can be disguised by a pleasant and harmless flavoring substance it should always be done. A small piece of candy will often induce a child to take its medicine without fretting or trouble, while without it an unpleasant scene, harmful to the patient and trying to the nurse, cannot be avoided. One of the most troublesome problems connected with the giving of medicine is to find the proper dose for a child at any given age. Dr. Young's method, epitomized as "Age over age, plus twelve," is one of the most widely known methods of solving this problem. The age is used as the numerator, and the age, plus twelve, as the denominator of a MEDICINAL REMEDIES AND THEIR DOSES. 9 1 fraction which represents the proper part of the adult dose to be given the child in question. To illustrate : suppose the child is four years old. Four is the numerator and sixteen (four plus twelve) the denominator, and the resulting fraction, four- sixteenths (4-i6=j4)> reduced to its lowest terms, gives the proper part of the adult dose for the four- year-old child; hence it receives one-quarter of the adult dose. By Dr. Cowle's rule, the age at the next birthday is used as the numerator and twenty-four as the denominator of a determining fraction. In other words, one-twenty-fourth of the adult dose for each year of the child's age at its next birthday gives the proper dose. Suppose the child is five years old. It will be six at its next birthday, hence its proper dose is six-twenty-fourths, or one-fourth of the adult dose. Many people prefer Dr. Cowle's rule, the doses averaging somewhat smaller than under Dr. Young's method, but usually proving abundant- ly sufficient. Of course, a proper degree of judgment and common sense must be used in the application of these rules. A large, hearty child of four may require as large a dose as a puny weakling of eight, and if there is any known peculiarity of the child in regard to certain drugs this must be taken into consideration. Children bear opiates badly, hence doses of this class of remedies must be smaller than either of the 92 COLDS^ COUGHS AND SORE THROATS. above rules would indicate, while, on the contrary, their doses of the ordinary purgatives must be con siderably larger than the rules would allow. In speaking of particular medicines, they will be referred to in alphabetical order. All of the remedies here spoken of are mentioned in the body of the book in connection with one or more of the diseases in which they are used. Albolene, or Liquid Vaseline, Of very great value as a protective to the mucous membranes of the nose and throat. Should be applied from an oil atomizer, or nebulizer, as it will quickly clog an ordinary atomizer. May be used to protect the tissues and prolong the effect of constringing ap- plications such as adrenalin chloride, but is a very useful means of preventing colds without other ap- plications of any kind. If on damp and foggy mornings the nasal passages are cleansed by the use of some mild alkaline spray, or by merely sniffing water into the nostrils from the hand and then blow- ing the nose, and albolene is applied before going into the colder outside air, the tendency to take cold will be largely counteracted and overcome. To those who breathe the smoky and often damp and impure air of our larger cities, the use of albo- lene as a preventive of colds is worth a large amount of good hard cash and repays a hundredfold or more the slight expense and trouble involved. Albumen. White of tgg. An article of diet rather than a medicine. Of much use when a pa- tient cannot take milk, or fails to derive benefit MEDICINAL REMEDIES AND THEIR DOSES. 93 from it. Prepared by straining the whites of two or three eggs through a cloth and mixing with an equal quantity of water. May be flavored with lemon juice, or used as a vehicle for stimulants such as whiskey or brandy. From Dr. Osier we get the following prescription for the use of chil- dren. Stir the whites of two or three eggs in a pint of water, with a teaspoonful of brandy and a little salt. Children will usually take this freely, and it is both stimulating and nourishing. Adrenalin Chloride, The solution of adrenalin chloride, one to one thousand, comes in dark colored one-ounce bottles, enclosed in neat pasteboard boxes. It should be kept in a cool, dark place and used with much care to avoid waste. Only sufficient for one day's use should be prepared at one time. It is somewhat expensive, but a very little goes a long way, and the relief it affords in congested conditions of the respiratory mucous membranes is wonderful. One part of the solution to ten parts of water is usually abundantly strong, and for the larynx and bronchial tubes still greater dilution is advisable. By using the medicine dropper, taking it one-third full of the solution and adding this amount to three or four dropperfuls of water, small quantities may be easily prepared, and an ounce will last for a long time. This dilution may be applied to the nasal passages by an atomizer, which is the best way, or by dropping it in from a medi- cine dropper, applying with a camel's hair brush 94 COLDS^ COUGHS AND SORE THROATS. or cotton swab, or by merely sniffing it up from the hand. This application should be followed by one of albolene, as this greatly prolongs the relief and is in itself a great protective. The adrenalin chlo- ride solution should not be used more than four or five times a day, and usually this is more than suffi- cient. In bleeding from the nose this same dilution will check the hemorrhage almost immediately, and is one of the best remedies at our command. Where the deeper respiratory passages are to be reached it must be applied in the finest possible spray, direct- ed to the back of the throat, and the breath must be drawn deeply in at the same time. Ammonia. Chloride of ammonium is one of the standard remedies for coughs and bronchial trou- bles. Its great field of usefulness is when consider- able matter is secreted, but of a sticky, viscid char- acter, so that it is coughed up with difficulty. When the cough becomes loose and the matter is easily raised the chloride of ammonium should be discon- tinued or given at much greater intervals. It may be given in lozenges or tablets containing five grains each. One or two of these tablets make a good- sized adult dose, to be taken every four hours, and a good drink of water must always be taken at the same time to avoid irritant action on the stomach. For a child of two years old, one or two of the five-grain tablets may be dissolved in twenty-four teaspoonfuls of water, and a teaspoon- MEDICINAL REMEDIES AND THEIR DOSES. 95 ful of the mixture, well diluted, given every two hours. Antiphlogistine, Antiphlogistine, used as a dressing in inflamed conditions of the lungs, comes in cans, which are set in warm water until the con- tents are thoroughly warmed, when a heavy layer is spread on a piece of cloth cut to fit the affected part, which should be well covered in. It is often used in pleurisy and pneumonia, and for strong, hearty patients is of much use. For weakly pa- tients or children its advantages are considered doubtful, and a lighter dressing is to be preferred. Asafoetida. A drug most obnoxious as to odor, but in the form of Dewee's carminative, and the mixture of asafoetida, very useful notwithstanding the scent. Dr. Anders considers the mixture of asafoetida highly beneficial in whooping cough. He gives it in doses of a half teaspoonful to a child of four years, repeated every two hours. This dose might be reduced somewhat. Atropine. This, or any other form of bella- donna, is to be used with caution, and in case of children, only under medical direction. As atropine sulphate or the solid extract of belladonna are found in our most effective coryza tablets, a knowledge of their action is desirable. Coryza tablets are usually directed to be taken at intervals of a half hour, an hour, or two hours, according to the amount of atropine contained, until the throat begins to feel slightly dry, then at longer intervals so as to main- 96 COLDS^ COUGHS AND SORE THROATS. tain this effect. Signs of greater sufficiency are a peculiar bright redness of the cheeks and dilation of the pupils. In treating colds, the first symptom, dryness of the throat, should not be exceeded, and even this should not be allowed to become very marked. Calomel, One of our best remedies for over- coming the constipation that so frequently accom- panies respiratory diseases. Administered accord- ing to modern methods, salivation is hardly possible. Best given in four to six doses, at intervals of a half hour or hour, the last dose to be followed in two or four hours by a rousing dose of salts. Tab- let triturates are the best form, containing for an adult from a quarter to a half grain of calomel and a small amount of sodium bicarbonate (common baking soda). Of these six may be taken at hourly intervals and be followed by the salts as above mentioned. A favorite mode is to take the tablets so that the last dose falls at bedtime, then take the salts on awaking next morning. For children delightful little tablets are made containing calomel and aromatics. These are of a pinkish color, taste like candy, and are eagerly eaten by the little patient without a thought of their being medicine. These tablets usually contain one-tenth grain of calomel and are taken at the same intervals as in case of the adult. For infants under one year, a single tablet (one-tenth grain) may be broken into four or six parts, each part representing one of the bro- MEDICINAL REMEDIES AND THEIR DOSES. 97 ken doses, and for children castor oil is more com- monly used than salts. In small children, under two years, the castor oil may be replaced by olive oil, which is sweet and nutritious, and a laxative of no mean value. C. C, Pills. Compound Cathartic Pills. A rather harsh, but very effective and handy cathartic medi- cine. Adult dose, one to three pills at bedtime. Castor Oil. One of the good old home remedies. Good, however, does not apply to the taste. A tablespoonful is an average dose for an adult. A teaspoonful will do for children from one year up to five or six, and two teaspoonfuls (or a desert- spoonful) up to the age of ten or twelve. If the dose given does not operate in four or five hours, it may be repeated. Camphor, Camphor gum is sometimes used in a pocket inhaler, or a small lump is kept in a box or bottle and occasionally sniffed at. In this way it does some good in a mild cold or headache. In either condition a bottle of the spirits of camphor is more effective. Camphorated oil is a good ap- plication for the chest and neck of a child suffering from bronchitis, pneumonia or croup, and either this oil or the camphor liniment acts well when rubbed into the painful muscles in la grippe, tonsillitis, or other affections characterized by aches and pains. Epsom Salts. See ''Salts and Salines.'' Fever Pozvders. Fever or Headache Powders afford a fine example of the abuse of a good thing. 98 COLDS, COUGHS AND SORE THROATS. Acetanilid is the commonest active ingredient and its value is unquestioned. Given, however, in huge doses by well-meaning people, who only know that it will reduce fever promptly and surely, it has undoubtedly occasioned loss of life and years of sickness and misery. Have nothing to do with fever powders, unless a thoroughly good physician tells you exactly how to use them. Flaxseed Tea, This friend of our childhood is a pleasant and useful addition to the treatment of any form of sore throat. To prepare it, add three heaping teaspoonfuls of flaxseed to a little over a half pint of boiling water. A teaspoonful of pow- dered gum arabic should be added and it may be flavored with lemon. It should be set on a warm part of the stove for an hour or two, but must not be allowed to boil. Guaiac. Gum guaiac is highly esteemed in dis- eases of the throat. Five-grain guaiac lozenges may be procured, and one of these allowed to slowly dissolve in the mouth, thus reaching all inflamed parts. For children the lozenges may be divided to give the proper sized dose. The ammoniated tincture of guaiac is considered highly efficacious in cases of sore throat and will frequently cure a chronic pharyngitis. Small and frequently repeated doses will sometimes entirely check an oncoming attack of tonsillitis. Adult dose from ten drops to a teaspoonful. Its very disagreeable taste renders it impossil)le for some persons to take. MEDICINAL REMEDIES AND THEIR DOSES. 99 Iron, A most popular and useful tonic. Usually employed in the form of the tincture (Tincture Ferri Chloridi). The adult dose is ten. to thirty drops, usually taken three times a day after meals. It should be well diluted and taken through a glass tube in order to avoid injury to the teeth. Syrup of the Iodide of Iron. A very useful form of iron for children. It should always be given in plenty of water and is usually taken three times a day, after meals. Half of a drop for each year of the patient's age, up to ten years, is about the right sized dose. Menthol Obtained from peppermint and some- times called Mint Camphor. One grain of menthol dissolved in an ounce (two tablespoonfuls) of wa- ter, and applied by means of an atomizer, markedly relieves congestion of the nasal passages in coryza. Three grains in a half ounce (one tablespoonful) of albolene, and applied by an oil atomizer, gives even better results. If used too freely headache is apt to follow. 0/7^. External Use. The external application of oily substances is a form of medication that has not received the attention it deserves. The un- avoidable soiling of clothing has undoubtedly ren- dered it less popular than its merits warrant. Olive oil, goose grease, codliver oil, and various animals' fats are used for this purpose, and weakly children sometimes improve most wonderfully under this treatment. Where it is desired to make use of L.OFC 100 COLDS, COUGHS AND SORE THROATS. inunction, the child should be undressed, before a good fire in winter, in the warm sunshine in sum- mer, and the whole body, excepting the head, thor- oughly annointed. The oil should be allowed to soak in for twenty minutes or longer, aided by gentle massage if desired. After this the child should be well rubbed with soft, warm rags until the oil is removed, and a suit of old underclothing may be used until time for the daily bath. This method may be varied as desired, but the main points are, to use good, pure oils, animal fats as a rule, and allow them to soak in under the influence of warmth for some little time, aiding by massage if desired. Onions, The homely old onion is believed to have great influence over diseases of the respiratory tract, and many mothers rely entirely on this honest and odoriferous vegetable in their treatment of colds, coughs and sore throats. Onion syrup is the form in which it is most frequently used. This is prepared by cutting up one or two large onions in rather chunky pieces, which are placed in a large cup or a bowl and sprinkled thickly with sugar. As the juice exudes it mixes with the sugar, form- ing a syrup, which is given as it forms, in spoonful doses. If the case is mild use one onion, if bad two or more of the bulbs. In bronchitis it will often exercise a most beneficial influence. The onion poultice is another favorite preparation, often used in conjunction with the syrup. To form this the MEDICINAL REMEDIES AND THEIR DOSES. lOI onions are sometimes partially boiled and made into a pasty mass, which is placed between two layers of cloth and applied as warm as it can be borne with comfort. Sometimes the raw onions are pounded to a pulp, which is applied in the same manner. Garlic soup, made by boiling garlic in milk, is often given with asserted advantage in chronic colds. The milk is strained off and given to the child as a drink. As an article of diet, onions are credited with marvelous powers in the prevention of respiratory diseases. To what extent this belief is justified, the author has never been able to determine. It is so widespread that there must be some foundation for it, but the writer's experience, personal and professional, has not been satisfactory in this re- spect. Quinine. This is one of the good old stand-byes. Its chief use in diseases of the respiratory tract is as a tonic, and as a tonic it is strictly first class. A cold may often be checked by a full dose of quinine taken at the first appearance of symptoms, and where there is a marked tendency to take cold easily, small doses of quinine once, twice or three times daily, will often enable the system to overcome this tendency. When a cold has been checked, small tonic doses three times a day for . a week are advisable. If unusual exposure is to be under- gone, a good dose of quinine, taken before the exposure occurs, will often enable the person to go I02 COLDS, COUGHS AND SORE THROATS. safely through what would have inevitably resulted in some form of cold without this precaution. The Standard full dose of quinine is ten to fifteen grains, but this varies greatly according to individual pecu- liarity. Five grains or even less will be a full dose for one person, while fifteen or twenty is only mod- erate dosage for another. Salts and Salines. By salts, we ordinarily mean Epsom salts. Its purgative action is well known, and it has been a household remedy of great value for generations. A heaping tablespoonful in a cup of warm water is the average adult dose. Of other salines, Rochelle salts is almost as familiar as Epsom salts. It may be taken in somewhat larger dose than the Epsom salts, but is more apt to disorder the stomach. Many efifervescent salines are offered as substitutes for the good old Epsom remedy, and some of them are fully as efficient and much more agreeable, both as to taste and mode of action SaloL An intestinal antiseptic of much value. It is supposed to have a peculiarly good effect in rheumatic conditions, tonsillitis and certain forms of sore throat. The adult dose is five to ten grains three or four times daily. It should be taken preferably an hour or two after meals. Used after cathartic remedies its effects are excellent, and it deserves to be more widely used. Sulphocarbolates. The sulphocarbolates of cal- cium, sodium and zinc are very efficient and satis- MEDICINAL REMEDIES AND THEIR DOSES. IO3 factory intestinal antiseptics. Whenever the bowel evacuations are unusually offensive they should be used until all such offensiveness is removed. In many cases where ^'bloating'' or an unpleasant feel- ing of fullness after eating occurs, a few small doses of sodium sulphocarbolate will remedy the condition completely. Sodium sulphocarbolate is the most generally useful and most easily taken of the three. The calcium salt is supposed to be especially useful in rhacitic or otherwise illy de- veloped children, and the zinc sulphocarbolate when diarrhoea is obstinately present. The dose of any one of them is from five to ten grains, taken an hour or so after eating. In serious conditions these doses may be taken much more frequently for short peri- ods, or until the conditions are modified. The above is not intended as an exhaustive refer- ence to remedies found useful in diseases of the respiratory tract. Such reference would require a book of itself, and a large book at that. Here the object has been merely to speak more at length of a few useful remedies than was practicable under the heading of any special disease in which one or more of the medicines spoken of may be found useful. PART II. — Respiratory Diseases and Their Treatment. CHAPTER VIL COLD IN THE HEAD. CoRYZA. Acute Nasal Catarrh. Acute Rhinitis. The old familiar cold in the head is also known as acute nasal catarrh, acute rhinitis and coryza. For the sake of brevity we shall call it by this last and shortest name. Coryza is familiar to us all. Scarcely one in a million of our entire population but has experienced it; a very few once or twice in a lifetime, many more two or three times a year, while other unfortunates hardly recover from one attack before another is on hand. The usual definition of coryza is ''An acute in- flammation of the nasal mucous membranes." The nasal passages are the air channels which extend through the external or visible nose, and continue for nearly, or quite, two inches further backwards, at which point they open into the naso-pharynx, 104 COLD IN THE HEAD. IO5 or upper part of the throat. The nasal mucous membranes line these passages throughout their entire extent, so that considerable surface is involv- ed in an ordinary cold, and it is emphatically "in the head/' Lowered vitality predisposes strongly to coryza. Moreover, the usual condition of the nasal mem- branes has much to do with taking cold. These delicate tissues are exposed to greater changes of temperature, more dust, smoke and other airborne impurities, and generally to greater contact with the coarseness of the outer world than is the case with any other of the mucous membranes. Owing to this constant exposure to influences which in civilization are unnaturally harsh, the best authori- ties believe that in the greater number of cases the nasal membranes are in a state of chronic or con- tinuous inflammation, so slight in degree as ordi- narily to pass unnoticed, but sufficient to offer a point of least resistance where circulatory disorders may most easily manifest themselves. Any of the ordinary exciting causes of colds will bring on coryza. Getting the feet wet is a widely recognized cause, and even getting them chilled, as from a damp pavement, is frequently sufficient. Exposure to drafts, getting caught in a shower of rain, an attack of indigestion, sometimes merely the change from country air to a city atmosphere, variations in the weather or imprudent changes in I06 COLDS^ COUGHS AND SORE THROATS. the underclothing, are among the commoner excit- ing causes. Sometimes the disease seems to be epidemic; that is, it spreads through a whole com- munity. At other times it seems to be contagious, and many instances are cited in which it has spread from person to person. Probably in these cases the contagion is due to the later sufferer breathing air which has been contaminated by passing through the respiratory passages of a prior victim to coryza. In view of these facts, belief is gaining ground in the existence of a particular microbe, or more proba- bly of a number of organisms, the activity of any one of which may result in coryza. It is also well to bear in mind that what appears to be a simple coryza may be the first stage of some more serious disease, as measles, la grippe or whoop- ' ing cough. In any event, the attempt should be made to check it as if we knew it to be neither more nor less than a cold in the head, but we should remember this possibility lest some lurking foe take us by surprise and gain firm foothold ere we sus- pect its presence. The likelihood of such an occur- rence is, of course, vastly greater when contagious diseases, such as those named, prevail in the neigh- borhood. The initial symptoms of coryza' vary in different cases. Sometimes an attack commences with sneez- ing, two or three severe sneezes being the first inti- mation of a cold. In other cases sneezing is pre- COLD IN THE HEAD. lO/ ceded by a feeling of general discomfort, shortly followed by ''cold creeps" up and down the back, or some other manifestation of chilliness. Rarely there may be a distinct chill. At first the nose and perhaps the throat feel dry and uncomfortable, but as soon as the sneezing stage commences a thin, watery and often irritating discharge from the nostrils necessitates the almost constant use of the handkerchief, and frequently renders the upper lip below the nose very raw and tender. Headache and slight fever are experienced and, owing to the swollen and congested condition of the nasal mem- branes, breathing is difficult and largely through the mouth. In colds of unusual severity there may be much backache and general pains throughout the body and all the limbs. This is the time to use simple remedies, and if promptly applied, right at the beginning, these are exceedingly effective. Constipation exists in almost every case and, as the first and most important step, it must be overcome. The method differs somewhat according to the degree of disorder. Sometimes a seidlitz powder or a dose of salts will be abundantly sufficient, but ordinarily the best plan is to take two or three grains of calomel in divided doses, following the last dose in three or four hours with a good dose of some saline laxative. Calomel tablets of any size desired, and manufactured by the best chemists of the country, may be had at I08 COLDS, COUGHS AND SORE THROATS. any drug store. Six tablets, each containing half a grain of calomel and a little sodium bicarbonate, will make about the right quantity for an average adult. One of these tablets should be taken every half hour (the interval may be an hour if preferred) until all are used. Three or four hours after the last tablet, take a heaping tablespoon of Epsom salts dissolved in a cup of warm water. If in two or three hours the bowels do not move, and move well, repeat the dose of Epsom salts, and continue to repeat at intervals of two or three hours until they do act. A much smaller dose of salts will answer in some cases, and when this is known to be so, the smaller dose should always be used. Ro- chelle salts, a seidlitz powder, or any of the effer- vescent saline laxatives may be used instead of the Epsom salts if desired, and the dose of calomel may be larger or smaller according to individual susceptibility. Six quarter-grain doses may be suffi- cient for one person while another may require full grain doses. A very good combination for a robust patient, or one whose bowels are hard to move, is a quarter of a grain of calomel, a twelfth of a grain of podophyllin and a little soda, six tab- lets being used, and the salts following as in the other cases. If preferred, one or two of the good old C. C. (compound cathartic) pills may be taken at bedtime. As a rule salts are unneccessary when these pills are used. COLD IN THE HEAD. IO9 Castor oil is usually the children's laxative. A teaspoonful or two, according to age, will generally prove effective, or if necessary the dose may be repeated in three or four hours. The compound licorice powder is a much pleasanter medicine and usually abundantly effective in doses of from a quar- ter of a spoonful to a half. Cascara cordials are usually excellent medicines for children, and the flavor is agreeable. They are not bad laxatives for grown people either, and the proper dose for any age is given on the label of each bottle. These laxative medicines are to be used as soon as the first symptoms of a cold accompanied by constipa- tion, are observed, and their use may be continued while the measures for producing profuse sweating, which follow, are carried out, as the two processes do not interfere with each other at all. Each of these modes of treatment should be instituted as early as circumstances will allow. The cold itself may be sweated out, that is to say, circulation and heat production may be brought back to natural activity and proper relationship by means of heat, applied externally and internally. When these applications result in profuse perspira- tion the desired result is believed to be accomplished and the cold is generally cured. The hot mustard foot-bath, combined with warm drinks and favor- ing drugs, is the best method of accomplishing this and it is managed as follows, preferably at bed- time, though it may be used at any time of day. no COLDS^ COUGHS AND SORE THROATS. A small tub, or a large pail, nearly filled with water as hot as can be borne, is set before the fire- place, the open oven door, or whatever other pecu- liarly warm and comfortable spot the house affords, near enough the patient's bed for him to get from bath to bed without the slightest danger of being chilled. If from a teaspoonful to several heaping tablespoonfuls of ordinary ground mustard be stirred in the hot water it makes it that much better. Very little mustard is sufficient for a thin-skinned person. The patient, barefoot, but otherwise warmly clad, or wrapped in blankets, sits beside the pail, and for from twenty minutes to half an hour bathes and soaks the feet and legs, hot water being added from time to time so as to keep the temperature as high as he can bear it. The bath completed, feet and legs are rubbed quickly and vigorously until thoroughly dry with a warm, soft towel and the patient gets quickly into a well warmed bed between blankets, drinks a tumblerful of hot lemon- ade with a dash of good whiskey, or a teaspoonful of sweet spirits of niter added, takes ten to fifteen grains of quinine, if so large a dose can be borne, and keeps snugly tucked in while the sweating pro- gresses and until sleep comes. Some persons will find this dose of quinine entirely too large, and when this is known to be the case a smaller quantity should be used. Of course, for children the dose COLD IN THE HEAD. Ill should be considerably smaller. Five grains of Dover's powder, or, if the patient be a robust adult, better ten, may be taken instead of the lemonade or in addition to it. There must be no chilling or checking of perspiration at any stage of the pro- cedure, the bedclothes must be light but warm, somewhat more in quantity than the usual amount, and tossing them off must be avoided. The object is to cause plentiful sweating and it must cease naturally and without being checked. The sweat- ing will probably be profuse in less, often consider- ably less, than an hour after going to bed. There are various modifications of the hot foot bath, the pleasantest and best perhaps being Bos- worth's, as follows : The patient is divested of cloth- ing, warmly wrapped in blankets, and then takes the foot bath as above described, sipping his hot toddy while soaking his feet and keeping on with the bath until perspiration is fully developed. He may also take the quinine and Dover's powder while the bath is in progress. When sweating is profuse, this being the evidence of re-established circulatory equilibrium, he is carefully and com- pletely dried by brisk rubbing with coarse towels, and the rubbing is continued until he is not only dry but the skin is in a warm glow, when he again wraps up in dry blankets, or if so inclined, goes immediately to bed. There will be no harm in sitting up a little longer if so disposed, but there 112 COLDS, COUGHS AND SORE THROATS. must be no chilling. It is not desirable that per- spiration should occur after going to bed, but it cannot always be avoided. However, there is no need for more than the usual amount of bedclothes. Any form of bath that will produce free perspira- tion answers all requirements, the full bath, hot air- bath, or whatever else may be preferred, but as a rule the foot bath is the more convenient and prac- ticable mode of inducing profuse diaphoresis. Next day the patient will in all probability be well, and if need be he can go about his ordinary business. Care must be taken, however, to avoid a fresh cold, and if the weather is bad it might be better if a day, or a part of a day, could be spent in doors. In any event he should take two or three grains of quinine three times a day for about a week, it being a mild and effective tonic supposed to be particularly antagonistic to colds. This is the good old standard treatment, and if taken soon enough will knock forty out of forty-one colds higher than a kite. To those who are so situated that the above treatment is impracticable, we would recommend the ''Traveler's Treatment," given in full in the latter part of this chapter. It may be said briefly here that a full dose of laxative medicine should always be taken at the first opportunity. Very often this and the use of any good coryza tablet will be sufficient to dispel an incipient cold. Some per- COLD IN THE HEAD. II3 sons find quinine, in as large doses as can be toler- ated, an almost certain cure. Others find five or ten grains of Dover's powders, taken on going to bed, a reliable remedy. Among the cowboys a heroic, but usually effect- ive m.ode of treatment for colds was to take several of the compound cathartic pills, followed by two or three of the largest capsules they could get hold of, two-thirds full of quinine, one-third full of cayenne pepper. Both cap and body of the capsule were so tightly packed (the body of the capsule with quinine, the cap with pepper) that they were joined with difficulty. This monstrous dose was repeated in two or three hours, or on going to bed, and was very likely to break up the cold. With doses reduced to suit less robust individuals, the mode of treatment is good, and may be easily adapted to individual requirements. When a cold is allowed to run its course, or fails to yield to late or imperfect treatment, or hangs on by reason of repeated exposures, or for any other cause, probably the greatest discomfort arises from the congestion and swelling in the nasal pas- sages. This causes stuffiness, difficulty in breathing, and an unpleasant discharge, at first watery and flowing almost continuously, but later on becoming so thick and tenacious that it is only gotten rid of by vigorous nose-blowing or the use of douche, atomizer or other cleansing device. When this con- 114 COLDS, COUGHS AND SORE THROATS. dition prevails, a relief which is simply marvelous is obtainable by the use of solutions of cocaine or adrenalin chloride. The adrenalin is preferable as being free from danger and unpleasant after effects, as effective as the cocaine or even more so, and without the slightest danger of inducing a drug habit. Adrenalin chloride comes in liquid form in what is known as the one to one-thousand solution, in one-ounce bottles, and should be kept from heat and too much light to avoid chemical change and de- terioration. One part of the adrenalin solution should be added to eight or ten parts of water, the purest that can be obtained. It is better to boil the water and allow it to cool before using, and it is claimed that a small amount of salt, a scant teaspoonful to a quart, added before the boiling, improves the water for this use. Only enough of the adrenalin solution for present use should be prepared at one time, say a teaspoonful or two. To get the right proportions a graduated medicine glass may be used, but probably the easiest and quickest method is to use one of the small medicine or eye-droppers found in all drug stores. If this plan is followed, fill the dropper half full of the adrenalin chloride solution and empty into a small vial. Then add four or five droppers full of water to get the eight or ten volumes required, and the fluid is ready for use. It may be desirable in a COLD IN THE HEAD. IIS given case to make the solution weaker or stronger, but this is a good strength for a first trial and is sure to give relief. When the solution is used the nostrils should first be cleansed by gently blowing the nose if that will suffice. If not, warm water (it is better to add a pinch or two of soda to each cupful) may be sniffed up the nostrils and expelled until they are sufficiently clear of mucous, or an atomizer or douche may be used with any mild alkaline wash. The adrenalin solution is most conveniently applied by means of an atomizer, but very gratifying re- sults are obtained by using it with a small swab, formed by wrapping a bit of cotton around the end of a match. Dip this into the solution and thrust it into each nostril in turn, at the same time inhaling gently. After an interval of a minute or two, re- peat the process in order to reach the parts at first hidden, but now exposed by reduction of the swelling. These applications may be made three or four times daily, but should be used with some caution, as, if too frequent, they cause headache. The good effect is prolonged by following the use of the adrenalin solution by a similar application of albo- lene (liquid vaseline), which may be used either in an oil atomizer or by the swab. The albolene protects the delicate membranes from dust and other irritants, and to some extent from the cold, Il6 COLDS^ COUGHS AND SORE THROATS. as well as remedying dryness and harshness. If the albolene is not used the patient should not go out into the cold for some little time after the ap- plication of the adrenalin spray, or fresh cold will be caught. The addition of from three or four up to ten or twenty grains of menthol to each ounce of liquid greatly improves albolene for this use, as the menthol prolongs the relief and also exer- cises a decided soothing and curative influence of its own. Both the solution of adrenalin chloride and the albolene may be applied by means of the little medi- cine or eye-droppers already referred to, or any other spray treatment may be given in this manner, the patient lying down and turning the head from side to side, so as to favor the application. The pocket inhalers found in all drug stores usually containing menthol come in handily here, and materially lighten the discomfort of a cold. To relieve the excoriated and tender upper lip, cleanse thoroughly and apply any simple ointment. Cold cream is excellent, vaseline answers well, sweet oil will do, or any mild, unirritating substance of an oily or greasy nature may be used. In an ordinary coryza, the fever is usually too slight to require much attention, and with the relief of the other symptoms it disappears. Cool water to drink, and, in severe cases, an occasional spong- ing of arms and chest, form all the treatment that is apt to be needed. COLD IN THE HEAD. II7 Headache in connection with coryza is rarely severe enough to be important, and generally yields to the treatment designed for the general condition. Occasionally, owing to involvement of the frontal sinus, it overshadows other symptoms and calls for a physician's care. Ordinarily, however, smelling salts, spirits of camphor, inhaled and applied ex- ternally, or compresses kept wet with cool or hot v/ater, are all that will be needed. Bosworth says that a compress wrung out of water as hot as can be borne, applied to the forehead, and continually renewed as it cools, will often not only relieve the local symptoms but even cure the cold. If either hot or cold applications are noticeably uncomfort- able to the patient, stop their use at once. If a cold has several days' start the treatment of the special symptoms just described should be followed. Constipation, if it exists, demands a cathartic; coryza tablets (see pages 118-121) may be taken in strict accordance with the directions for the brand used. If needed, the adrenalin chloride solution, followed by albolene, may be applied as directed, and a Dover's powder at night will help the good work to some extent. In addition to these remedies, take rather large tonic doses of quinine, three to five grains, three times a day, and even if the cold is not completely cured its discomforts will be decidedly alleviated and its duration shortened. A "Traveler's Treatment" of coryza must of Il8 COLDS, COUGHS AND SORE THROATS. necessity vary somewhat from that laid down. We have said that the prompt use of a cathartic and a hot foot bath will break up nine out of ten colds. But suppose one feels a cold coming on when forty, fifty, or maybe five hundred miles from home and among strangers — possibly in some backwoods shanty where so much hot water as a whole pailful at one time is an unheard of quantity, not to be procured except on infrequent wash days or at hog- killing time — must the victim necessarily give up and suffer the cold to run its course? By no man- ner of means. An assortment of remedies may be carried in very small compass sufficient to drive out any ordinary cold, if taken promptly in its earliest stages. Let us suppose that when packing for your jour- ney you have had the wisdom, as every traveler' should, to put a few of the more frequently needed medicines in grip or suit case, but not in some un- get-at-able trunk or box of luggage. You may have put in both calomel and Epsom salts, or you may have chosen in their place a box of C. C. (compound cathartic) pills, a very effective but somewhat harsh remedy. You should also have quinine in two or three-grain capsules, and Dover's powder, put up in five-grain powders ready for use. In addition you should have some good make of coryza or rhinitis tablets, such as may be found in any good drug store. COLD IN THE HEAD, 1 19 A common and very excellent formula for these is the one containing from one-eighth to one-quar- ter of a minim of the fluid extract of belladonna root, or an equivalent amount of atropine sulphate, and a grain each of quinine and camphor. Pro- portions may be varied, but with these ingredients we get a very effective tablet. The formula and full directions should be on each package of the remedy. If you get less than a package, see the formula anyhow, and get the directions very carefully. With the atropine or belladonna tablets, the direc- tions will probably be somewhat on this order: ''One or two tablets every half hour (or it may be every hour or every two hours) until the throat feels dry, after which take one or two tablets every five or six hours until six doses have been taken." The sensation of dryness in the throat must not become very marked, and if at any time it does, or if the face is much flushed, make the intervals quite a little longer between doses, or stop taking them altogether. There are excellent coryza tab- lets and granules on the market which depend on other drugs than atropine for their activity, but whatever tablet you get, make sure of your direc- tions and then follow them. On the first suspicion of a cold take the proper dose of your coryza tablets, and fifteen or twenty minutes later take your cathartic medicine. If you prefer the C. C. pills, one to three is the regular I20 COLDS^ COUGHS AND SORE THROATS. dose, but the average individual will find three entirely too many. At bedtime take five or ten grains of Dover's powder. Quinine should be taken too, as directed in the home treatment of a cold, but if your coryza tablets contain quinine and atro- pine, reduce the dose of quinine, taking, say from three to six grains. Then you may go to sleep with an easy conscience; you have done your duty and probably cured the cold. With some individuals quinine by itself, either in a single dose of ten to fifteen grains, or in a half dozen smaller ones of two to three grains each, is sufficient to break up a cold. In other cases a ten- grain dose of Dover's powder taken on going to bed is all that is necessary. Or again, these two may be combined, and quinine and Dover's powder work together as kindly as two old plow horses. Add to this team a lively little old lead mule, in the shape of a brisk cathartic, and you have an outfit that will mighty near jerk Mr. Coryza out of his boots any day of the week at all, or even on a Sunday. All three of these remedies are easily procured, easily carried and easily taken. The coryza tablets may be added to the list without trouble, and then you have a strong combination, which will prove effective for a large proportion of cases. Frequently coryza tablets alone are markedly successful in the treatment of coryza, and personally COLD IN THE HEAD. 121 I have many times checked an oncoming cold by a single dose containing the one-hundred-and- twentieth part of a grain of atropine. Other per- sons depend on the hot foot bath, with or without hot drinks, and still others make different combina- tions of various parts of the regular treatment. It is essential for the success of these partial treat- ments that they should be used in the early stages. Of course if you know that one, two or more of these parts are all that you need, there is neither use nor sense in taking the v/hole treatment. Sometimes a cold hangs on and on, ''and will not down,'' and there is no obvious reason for this persistence. In a child this should give rise to a suspicion of adenoids (see Chapter VIII), and if other confirmatory symptoms are noted an exami- nation by a thoroughly good physician should be made. If adenoids are not found, or in the cases of either children or adults where it is known that no such condition exists, tonic treatment should be promptly inaugurated. The tonics given in the following list may be easily obtained, and will gene- rally be found satisfactory. For a child, codliver oil and the syrup of the iodide of iron can hardly be excelled, and the cod- liver oil is a good tonic for adults as well. These remedies should always be accompanied by plenty of out-of-doors exercise, with an abundance of nutritious and easily digested food, and the general health should be carefully looked after. 122 COLDS, COUGHS AND SORE THROATS. According to age, a half teaspoonful to two tea- spoonfuls of codliver oil will be a good dose for a child. For an adult from a tablespoonful to two or three times this amount may be taken. It is best to take small quantities when beginning its use, and it is advisable that at the first a single dose be given just before bedtime. Afterwards a dose may be given at this time and also an hour or two after breakfast, and as tolerance is estab- lished a dose may follow each meal (an hour or two after eating is the best rule), and precede going to bed. If the patient is nauseated, or unable to digest the oil, harm rather than good is being done, and if smaller doses or change in the time of ad- ministration fail to correct these evils, the oil must be given up and other tonics used. Various expedients are adopted to disguise the taste of codliver oil or overcome the repugnance to it. A child may often be bribed to take the dose by a small peppermint lozenge before and after tak- ing it, while adults often find a chaser of port wine serviceable in removing the flavor. It is sometimes taken in whiskey or in milk, the oil floating of itself to the mid-surface of the liquid, and being taken without coming in contact with either the tumbler or the patient's mouth. Syrup of the iodide of iron is an excellent remedy for pale and weakly children, whether particularly subject to colds or not. It may be given in a dose COLD IN THE HEAD. 1 23 of one or two drops in a few spoonfuls of water to a child of two years, and from fifteen drops to a half spoonful in a cup of water to an adult, these doses being taken three times a day. The external application of oils and oily substances may be used in this condition with the greatest benefit. For mode of application see Chapter VI, ''Medicinal Remedies and Their Uses." For older children and for adults many excellent tonics are found in the drug stores, containing iron, quinine and strychnine, or any one of them in vari- ous combinations. Never get them unless the com- ponent drugs and their proportions are specified on the label. In any event, it is better to ask your physician's advice, in order to get a medicine whose value lies in the substances contained and not in a fancy label or an odd shaped bottle; also, in order to ensure proper doses for the person using it. With some people catching cold seems to be a sort of habit. Hardly are they recovered from one before another appears, and they are almost con- stantly suffering from colds. Dr. Hare says that these unfortunate individuals may be divided into two classes. In sufferers of the one class the mucous membranes are at fault, being delicate and very susceptible to irritation. Such persons do well on small doses of arsenous acid, continued for weeks. In those of the other class, the skin is at fault, the peripheral capillaries 124 COLDS, COUGHS AND SORE THROATS. lacking tone, and the Turkish bath offers a cure. Either of these means should be used only under intelligent medical direction, and the condition, whatever it may be, should be as promptly and as thoroughly remedied as is possible, for colds long continued, or continually renewed, undoubtedly es- tablish and maintain a condition favorable to the development of certain most dangerous respiratory ailments. The possibility of adenoids, as the cause of this super-susceptibility, should also be borne in mind. Such patients should also pay much atten- tion to general health, their diet should be nutri- tious and such as agrees best with their digestive powers, they should avoid undue exposure to cold and dampness, should remedy constipation or any other diseased condition to which they may be sub- ject, and in every way should strive to improve and tone up the general physical system. The tonics, codliver oil, iron, etc., recommended for ''Colds that will not cure," may well be em- ployed in this condition also. For a malady so nearly universal as coryza there must needs be many irregular methods of treat- ment, some fairly good, some ludicrous, some bad or even dangerous, and it will do no harm to de- vote a few pages to their consideration. ''One-Day Cold Cures/' These are markedly noticeable among the irregular remedies. They stare us in the face at every street corner, nor is COLD IN THE HEAD. 125 it even necessary that a drug store be at the afore- said corner. Any cigar stand, general merchandise store, eating house or confectionery may carry them in stock, and faiHng all these, the street peddlei; dins their reputed virtues in our ears. Some of these remedies contain standard and familiar drugs such as quinine and cascara sagrada, which can hardly do harm in any reasonable or probable dose, and their constituents are honestly proclaimed along with the directions. There is no harm in such a "cure,'' and some of them do cure, although not always in one day. Avoid those containing drugs of whose powers and uses you are ignorant, and be especially wary of the coal tar preparations, aceta- nilid, phenacetin, antipyrin and their congeners. All are fine medicines when used aright, but you cannot use them rightly unless you are thoroughly familiar with their powers and dangers. And never use a cold cure, or any other medicine, whose for- mula is concealed, unless you are acting under strict- ly professional advice. A method of treatment at which many of us have laughed, although many claim to have used it with success, is a stocking worn around the neck at night. The stocking, warm from the foot, is fastened about the neck on going to bed and re- moved on rising. Although myself preferring a coryza granule or two, I should use this plan if all else were lacking. It is much akin to the flannel 126 COLDS^ COUGHS AND SORE THROATS. bandage of our childhood, and to be successful must be used early in the game. Its greatest draw- back lies in the gross injustice of making one stock- ing work so largely overtime. Deep Breathing. Occasionally some enthusiast will be found to claim that he can break up any cold in its beginning by taking deep and repeated breaths, with shoulders back and chest well out. This remedy will hardly be found an unfailing success, but breathing deeply through the nostrils is undoubtedly beneficial and may arrest a cold. For narrow-chested and stoop-shouldered individ- uals I would most heartily recommend it, and very much more so if they will take the cure regularly and persistently, long before the cold is caught. Back Against Fire. One of the authors of a previous generation assures us that any cold may be infallibly cured in its incipiency by standing with the back against the fire, or against the hot stove- pipe, or any similarly adequate source of heat, claim- ing that the cold enters at the back and the heat must be sent after it in the same direction. It is probably a very good remedy; at any rate it would be lots of fun for the rest of the family and any visiting friends and neighbors. And now, in conclusion, what do we gather as to our conduct toward and treatment of this con- dition known as coryza^ or cold in the head ? First COLD IN THE HEAD. 12/ and best of all, let us become so strong and healthy that we cannot take cold, but this we cannot all of us do. Second, let us avoid the causes that lead to taking cold; this, too, is not always prac- ticable, and yet there are few of us who do not take more chances along this line than there is either need or reason for doing. Third, when we have taken cold, let us as quickly as may be possible break that cold completely: (i) By seeing that the bowels act properly. (2) By a hot foot bath with a hot drink and a resulting and unchecked sweat, taking in addition, about ten grains of Dover's powder with as much or more of quinine, and following all of this by a long night's rest. (3) And we shall do well to take small tonic doses of quinine three times a day for a week longer, and guard carefully against a fresh cold. That is how we may treat our cold when we are at home, but when we must use only those small medicines that we may carry with us we should (i) Take one or two C. C. pills. (2) Take some good make of coryza tablet, strictly accord- ing to the directions for that particular kind of tablet. (3) Take a small dose, say from two to six grains, of quinine, with the regular five or ten- grain dose of Dover's powder on going to bed, and follow this with small tonic doses of quinine for a week. 128 COLDS, COUGHS AND SORE THROATS. And now this chapter is ended and we are willing to let Brother Coryza alone, if he will reciprocate and let us and our friends alone, which is a good promise, but a short one. CHAPTER VIII. SORE THROAT (Common Forms). Naso-Pharyngitis. Adenoids. Pharyngitis. Laryngitis. The throat includes all that part of the respiratory and digestive passages located behind the nose and mouth, and reaching to the oesophagus and larynx. This is the anatomical meaning of the word phar- ynx or throat, but in every-day language we also include the larynx, and the front of the external neck, while the naso-pharynx, or that part above the level of the mouth, is not included. In speak- ing of a sore throat the word is made to include also the tonsils and the soft palate which forms the dividing line between the mouth and the throat proper, and also the larynx; in short, all those parts and organs with which the air in ordinary respiration comes in contact between the nose and windpipe. Naso-Pharyngitis, The naso-pharynx includes all that part of the respiratory passages above the part of the throat visible from the front when the mouth is open, and lying behind the posterior open- ings of the nasal passages. Most of the naso- 129 130 COLDS, COUGHS AND SORE THROATS. pharynx is entirely above the mouth and is a com- pletely hidden portion of the respiratory passages. The nasal passages open directly into the naso- pharynx and at each side a little behind these open- ings the Eustachian tubes lead to the middle ear. These tubes regulate the air supply of this portion of the ear and prevent undue pressure on either side of the ear-drum. When closed, as often happens in coryza or naso-pharyngitis, various ear disturb- ances and sometimes diseases occur. Situated in the middle of the upper portion is the pharyngeal tonsil, which normally includes but a small amount of lymphoid tissue, but in adenoid hypertrophy, these tissues are enormously increased and altered in structure. Even in an ordinary cold or in naso- pharyngitis, there is much swelling and considerable secretion here. Naso-pharyngitis is an acute inflammation of this part of the throat and is almost invariably associ- ated with other inflammation in its immediate neighborhood. It is very frequently an extension of coryza, but it may follow or accompany an ordi- nary sore throat. In fact, so commonly is it associ- ated with coryza or pharyngitis that it is hardly considered a separate disease. Its causes are almost identical with those of coryza, the only symptom in which it markedly differs being the secretion of mucous in this region, which is gotten rid of by hawking or clearing the throat. The only necessary SORE THROAT (COMMON FORMS). I3I difference in treatment is that an effort must be made to make the sprays reach the naso-pharynx, instead of merely applying them to the nasal pas- sages. The sprays should be thrown far back into the nostrils and then drawn on down into the throat, passing over the parts involved. Adenoids, As already stated, the naso-pharynx forms the arching roof of the throat, lying above those portions that are visible when the mouth is widely opened. It is effectually hidden from in front by the tonsils and dependent parts of the soft palate, and can only be seen by the use of reflected light and laryngeal mirrors. Thus securely hidden from ordinary vision, it forms an ideal lurking place for that most baleful disease condition known as adenoid growths, the unsuspected proximity of which to vital processes affords it the fullest oppor- tunity to work out present misery and future in- capacity, or even death. In its milder forms it merely makes the victim markedly susceptible to colds and coughs, something of a mouth breather, and rather irritable and stupid. In fuller develop- ment it changes a naturally bright and lovable child into a dull, heavy and semi-imbecile dwarf, or it may extend the process even to the limits of ap- parent idiocy. In other cases the victim may be a peculiarly bright and active child, and the only out- ward symptoms are an apparently delicate consti- tution and a very marked susceptibility to colds, 132 COLDS, COUGHS AND SORE THROATS. coughs and sore throats of almost every known variety. Normally there is a small amount of lymphoid tissue in this region, known as Luschka's tonsil, or the third, or pharyngeal tonsil, but in adenoid overgrowth it is enormously increased, usually taking on the form of fungoid vegetations, which crowd upon each other and attain such di- mensions that finally the nasal passages and Eusta- chian tubes may be completely closed. The condi- tion is most frequent in children from three to fifteen years of age, but it may be met with in adults or in mere babies. When these abnormal tissues are markedly de- veloped, physical growth is sometimes so seriously interfered with that the child is actually dwarfed. The face is stupid and expressionless, the mouth is constantly open, with snoring at night and rest- less, disturbed sleep, while, owing to the enforced mouth breathing, colds and coughs of all varieties are so easily acquired that the victim is rarely free from some complaint of this kind. The lips are thick, nose pinched, the voice disagreeably nasal, and the child is not only stunted in body, but in mind as well, becoming semi-imbecile or apparently idiotic. Taking all these things into consideration, it is easy to see how the mediaeval belief of fairy change- lings (a peevish, sickly goblin brat being substituted, in the mother's absence, for a healthy human child) SORE THROAT (COMMON FORMS). I33 obtained ready credence in the days when witchcraft was an article of church behef and adenoids had not been heard of. The orthodox treatment in those days consisted in shaking the puny sufferer over a bed of red-hot coals in a sieve, in the behef that the gobhn would fly up the chimney with a horrible howl and in a burst of flame and smoke, while the human child would be restored. The howl was undoubtedly forthcoming under this treatment, but the rest of the program was much of a failure, and it remained for modern surgery to devise a more efiicient and rational method of restoring the normal child. When the adenoid condition is well developed, the symptoms are so marked and so numerous that they should infallibly lead to a suspicion of the true state of affairs, and examination by any good physician will make the diagnosis certain. There is but one proper treatment and that is surgical. While the operation looks severe, in competent hands the danger is slight, not to be compared with that which certainly exists as long as the condi- tion lasts. The natural and unavoidable repugnance to surgical procedures should therefore fade into insignificance in view of the undoubted results of neglect. To find a thoroughly competent surgeon is not always easy, but none other should be allowed to operate, and there are few sections of our coun- try where a moderate journey will not take one to 134 COLDS^ COUGHS AND SORE THROATS. a hospital and the best of surgical skill. When the operation is well done, recovery is rapid and the real child is restored as if by magic. The dull, heavy features of the goblin brat fade and are replaced by those of the rightful owner, normal intelligence resumes its sway, and both physical and mental growth go on as if no such hideous inter- ruption had occurred. In those cases where an operation will not be tolerated, such tonics as codliver oil and the syrup of the iodide of iron should be administered, the child should be encouraged to take much out-of- doors exercise, diet should be plain but nutritious, and the throat, nose and mouth should always be kept most scrupulously clean. There is a natural tendency to partial or complete recovery at about fifteen years of age, as the respiratory cavities in- crease in size at this time, while the adenoid growths show a decided tendency to shrinkage. Pharyngitis. This is an acute inflammation of the mucous membranes of the pharynx. It usually includes all that part of the throat which can be seen when the mouth is widely opened, and in ad- dition there is more or less swelling of the tonsils and soft palate. This is probably the commonest and mildest form of sore throat, but it is often complicated by laryngitis or coryza, and may end in a severe attack of tonsillitis or other inflamma- tion. SORE THROAT (COMMON FORMS). 1 35 Acute pharyngitis ordinarily lasts from three or four days to one or two weeks. The predisposing causes are lowered vitality, a rheumatic tendency, excessive use of alcohol, to- bacco or unduly rich foods, poor ventilation, mouth breathing and too much or too little clothing. The exciting causes are cold and damp air, get- ting the feet wet, a cold draft on the back of the neck or other sensitive part of the body, and irri- tating fumes and vapors. Sometimes it seems to be contagious or even epidemic. It may start with a distinct chill, but more often there are merely chilly sensations followed by slight fever and headache, and some degree of weakness. There is a feeling of dry discomfort in the throat, which later gives place to marked secretion, ac- companied with frequent cough. A sharp, pene- trating pain is felt, properly at the back of the throat, but often changing its location in a most puzzling manner. At one time this pain is on one side of the throat, in a short time it is on the other side, then lower down and at the back, and so on. There is a feeling as of a "lump" at the back of the throat, which causes constant but ineffectual efforts at swallowing and may interfere with real swallowing and the taking of food. The tonsils are often slightly inflamed and the uvula, or cen- tral dependent part of the soft palate, may be swol- len and very sensitive, causing a troublesome tick- 136 COLDS^ COUGHS AND SORE THROATS. ling sensation, which gives rise to considerable coughing when lying down, especially at night. Treatment should be directed to the general sys- tem and directly to the inflamed throat. Unless the bowels are perfectly regular, take from one and a half to three grains of calomel, combined with twice as much soda, divided into six doses, a half hour apart, and two hours after the last dose take a heaping tablespoonful of Epsom salts dissolved in a cup of warm water. Or arrange to take the last dose of calomel at bed time and the salts the first thing in the morning. (See Chapter VI, "Medicinal Remedies.") A hot mustard foot bath may be taken at night with warm drinks and a dose of Dover's powders, and these measures are very likely to break up the attack. The next day, however, if not quite sure that it is checked, ten grains of salol may be given every three hours for three or four doses. A towel soaked in cold water and laid about the throat, renewed often enough to keep it continually cool, sometimes gives great relief. Bits of ice kept in the mouth will relieve some patients, but it is considered better to gargle frequently with water as hot as can be borne. When children are the sufferers a flannel bandage about the neck, soaked either in camphorated oil, or a mixture of one part of turpentine to three parts of olive oil, will be found useful. Lozenges of licorice, red gum or SORE THROAT (COMMON FORMS). I37 slippery elm, ease the pain and divert the minds of the smaller sufferers, hence they are doubly useful. Lozenges of gum guaiac, each containing two to five grains of guaiac, may be obtained at the larger drug stores and will sometimes relieve a sore throat wonderfully. One lozenge is allowed to dissolve in the mouth three or four times daily. Laryngitis, This is an acute inflammation of the mucous membrane of the larynx. It ordinarily lasts about a week or ten days, but may hang on for two or three weeks and is frequently compli- cated with pharyngitis and coryza, or the inflamma- tion may extend downward and wind up with an attack of bronchitis. Predisposing causes are lowered vitality, any ob- struction to nasal respiration, sedentary life, poor ventilation and digestive disturbances. Exciting causes are getting the feet wet, cold drafts, especially on or about the neck (and it is claimed that those who are most careful to wrap the neck warmly in mufflers, or turn up the coat collar and button it tight on the slightest exposure are far more prone to this affection than others), too long continued or severe use of the voice, as in singing or public speaking, the inhalation of steam, smoke or irritating vapors, or the swallow- ing of too hot drinks, acids or other corrosives, and, as in all other respiratory diseases, some form of infective germ. The old fashioned Christmas 138 COLDS, COUGHS AND SORE THROATS. or New Year's celebration, in which parties of young, middle-aged or even old men, went from place to place, drinking without much moderation and whooping and yelling like Commanches as they came from a warm room to the cold outside air, was a particularly effective mode of contracting a severe sore throat. Extension from coryza or bron- chitis is also a frequent source of laryngitis. The onset is sometimes with a distinct chill, oftener with chilliness, and there is fever, usually mild in type. Constipation is the rule and head- ache, pains in the limbs and general discomfort are common. The usual raw, dry feeling which ushers in any form of cold is felt in the throat, with a tickling irritation that induces a rough, harsh cough. The voice becomes husky and may be re- duced to a whisper or entirely lost. Owing to ex- tension of the inflammation downwards, soreness and pain are often felt in the median line under the breast bone. At first very little matter is coughed up, but in a day or two a sticky, white-of-egg like substance is brought up in considerable amount, becoming thicker and more cloudy in appearance as the disease progresses. In children the symptoms are sometimes of much greater severity and there is marked difficulty in breathing, with a hoarse, croupy cough, worse at night, and sometimes suffocative attacks that are very alarming to relatives. SORE THROAT (COMMON FORMS) . I39 Treatment is commenced by a cathartic. A dose of salts may be given, but calomel with a little soda and followed by a dose of salts, or castor oil is preferable. If the hot mustard foot bath, warm drinks, quinine and Dover's powder are made use of on the first day of the attack, they are very likely to result in a quick cure, and if the succeeding day can be spent largely or entirely in doors there will be no ill results. If the trouble is not broken up at the start, the patient should, if possible, be kept in a room of uniform temperature, and the air should be kept moist by means of the croup kettle or an ordinary tea kettle on the stove. A tablespoonful of compound tincture of benzoin may be added to the boiling water every two or three hours with decided benefit. A towel, or other large, loose cloth, wrung out of water as hot as the pa- tient can bear, wrapped about the throat and fre- quently renewed so as to avoid cooling, is highly recommended. Turpentine, pure for a hearty, tough-skinned adult, but mixed with an equal amount of sweet oil for a thinner-skinned individual, well rubbed into the upper chest and neck until some redness is pro- duced, is an excellent counter-irritant and may be employed, either after, or in place of the hot, wet towel. For a child the mixture should consist of one part of turpentine to three or four of oil. The adrenalin solution, much weaker than used in 140 COLDS, COUGHS AND SORE THROATS. coryza, say one part of adrenalin chloride to ten or fifteen of water, may be used once or twice daily with very good results if applied right. It is diffi- cult to direct a spray directly to the parts, and even if this is successfully done, they naturally close on the approach of anything of this nature, hence, it is necessary for the patient to breathe inward deeply while it is being applied, and it is better to use a nebulizer or an oil atomizer when attempting to reach those parts of the throat. The lozenges mentioned in treatment of pharyngitis, frequently also serve a good purpose in this form of sore throat. The different forms of cold and sore throat thus far considered are closely related, and the rules for diet apply to all alike. In the earlier stages the patients rarely have much appetite, which is nature's indication that, at this stage, little nutriment is needed. The patient should not be urged to eat, but when he displays any inclination to do so, he should be given small quantities of light and easily digested food. Milk is excellent, and to avoid monotony it may be prepared in various forms, as custards, boiled or baked, junket, whey, curds, etc. Buttermilk is highly recommended, and may be relished by some who do not care for fresh milk. Eggs, poached or lightly boiled, are very nourish- ing. When for any reason they cannot be taken in these ways, they will sometimes be tolerated if SORE THROAT (COMMON FORMS ) . I4I given in eggnog. Milk toast, gruels, broths, tapioca, sago, rice, arrowroot, and corn starch and gelatine preparations are all familiar foods for this condi- tion, and by selecting from among these a sufficient variety may be obtained. As soon as appetite re- turns, which will usually indicate that convalescence is established, the diet should be more nutritious than usual. The patient, .however, should exercise some caution at this stage, as the appetite often calls for more than the enfeebled system can as- similate. CHAPTER IX. SORE THROAT (Severe Forms). Diphtheria. Membranous Croup. Diphtheria, This is an acute, infectious, very- contagious and very dangerous disease. It affects children far more frequently than adults, but occurs at all ages, from extreme infancy to extreme old age. It is most common from the second to the fifteenth year and claims most victims between the ages of two and seven years. One particular variety of bacterium, the Klebs- Loffler bacillus, causes diphtheria. This bacillus effects a lodgment on and in the mucous membrane of the mouth, nose or throat, and causes the death of the membrane at the point of contact. Tissue elements and various liquid substances are thrown out from the blood vessels and other neighboring structures in an effort to destroy the germs and limit their ravages, coagulation of the fluids occurs, and bacteria, portions of the membrane, and cells from the surrounding tissues are bound together, forming the characteristic false membrane. In spite of this attempt at defense the bacteria multiply, the false membrane grows and spreads, and the bac- 142 SORE THROAT (SEVERE FORMS). I43 teria in their growth and multiplication throw off poisonous substances (toxins) of great power and violence. These toxins, taken up by the blood and lymph currents, are carried to all parts of the body and by their harmful influence produce the great depression which characterizes this disease. The false membrane itself is dangerous only when it stops up some portion of the respiratory passages, usually the larynx, or when in its formation the walls of some blood vessel are involved and de- stroyed. The liberated poisons (toxins), however, are abundantly sufficient to cause death in very many cases. Lowered vitality is a predisposing cause of diph- theria, and diseased conditions of the mucous mem- branes of the mouth, nose and throat are especially favorable to the lodgment and development of the bacteria. Any scratch or wound in these mem- branes favors the reception and growth of the germs, and some authorities even claim that diph- theria cannot occur where the membranes are healthy and unbroken. Enlarged tonsils, adenoid hypertrophy or any inflammation of the membranes of mouth, nose or throat predispose, and this is one of the strongest reasons for promptly correcting any condition of this kind in children before they are subject to sucli contagion. When, however, diphtheria or any sim- ilar disease is known to be prevalent, no operative 144 COLDS, COUGHS AND SORE THROATS. procedure should be attempted, as the wounded surfaces would invite contagion. Decaying and unclean teeth induce inflammation in the adjacent mucous membranes, and for this reason, while the mouth should at all times be kept clean and whole- some, it is doubly necessary when such diseases as diphtheria prevail. In every case of diphtheria there has been ex- posure to the contagion, even though the infected article may have received the contagion months before and at a distance of hundreds of miles. Sometimes diphtheria develops when no exposure can be remembered or discovered, as when it comes from some toy, garment, book or utensil, packed away for months, or obtained from some store, perhaps in what are called ''rummage sales," where all sorts of second-hand articles, partially worn clothes and other articles of questionable cleanliness are sold. In other cases some individual, perfectly healthy himself, carries the deadly germs harmlessly for months in his own respiratory passages, but is nevertheless capable of imparting the contagion and starting a fatal case of diphtheria in some other person. Three forms of diphtheria are commonly de- scribed, the pharyngeal or tonsillar, the laryngeal and the nasal. The most noticeable difference is in the location of the false membrane, but other important differences exist and call for some varia- tion in treatment. SORE THROAT (SEVERE FORMS). I45 Pharyngeal, or Tonsillar Form, In this form of diphtheria, the symptoms develop in from two to seven days after exposure to the contagion, though in a very few cases the period may be two or three days longer. Usually in a child there is listless- ness and dullness; he does not care to play, com- plains of feeling tired, is chilly and has a mild headache, and there may be pains in the back and limbs. In younger children convulsions sometimes occur. There is fever, but it is not high, and the throat is sore, but not more so than in ordinary sore throat or pharyngitis. In a short time the membrane begins to form. At first there may be a single small spot, mouse-colored, grayish-white or yellowish, with a marked tendency to spread. It usually appears first on one tonsil, but may ap- pear on both tonsils simultaneously, or on the back of the throat, or on the soft palate, and in a few days it may involve all of these structures. Fre- quently the mucous membrane at the margins of the false membrane shows a peculiar purplish or maroon tint. The rest of the throat is red and inflamed and often much swollen, the glands under the angles of the jaw on one or both sides become enlarged, hard and painful, and the tonsils swell in greater or less degree. In the meantime the child becomes decidedly sick. The fever in mild cases is not very high, about loi to 102 degrees, but depression and dullness are marked, appetite 146 COLDS, COUGHS AND SORE THROATS. fails and the pulse is rapid and feeble. If the case ends favorably, in about a week the symptoms im- prove and the false membrane separates and is thrown off, leaving an inflamed, red surface. Re- covery is slow and not complete for many weeks, and even mild cases leave the patient very susceptible to other diseases, while paralysis or other alarming sequelae may develop a week or two after apparent recovery commences. In the severest form, the symptoms are greatly intensified. For a day or two the course is much like that of the milder cases, and then the condi- tion suddenly becomes alarming. The temperature reaches 103 or 104, vomiting may be severe, the glands at the angles of the jaw swell rapidly, form- ing hard, painful masses, the throat is greatly swollen in all its parts, and the false membrane is extensive, ragged, and has a strong tendency to slough, or fall away from the adjacent tissues. The pulse is very feeble and rapid, the face, neck and chest become puffy and dropsical, and death may occur in two or three days or within one or two weeks. In the tonsillar or pharyngeal form of diphtheria the chief danger lies in the action of the poisons set free by the bacteria, but it is always possible for the membrane to extend downward and involve the larynx, in which case the added danger of suffocation, the great characteristic of laryngeal diphtheria, must be contended with. SORE THROAT (SEVERE FORMS). I47 Laryngeal Form. In the laryngeal form the preliminary symptoms are like those of the pharyn- geal type already considered, but the false mem- brane is formed directly in the larynx and mechani- cally closes the narrow chink of the glottis, causing death by interference with respiration. This is the form in which intubation or tracheotomy sometimes becomes necessary. The danger of suffocation is the characteristic feature of this form of diphtheria, but even when this is overcome the poisoning of the entire system still gives a serious condition to deal with. In its tendency to cause death by sudden suffocation this disease resembles non-diphtheritic membranous croup, with which it is often con- founded, and which will be more fully considered later. Nasal Diphtheria is that form in which the false membrane is formed in the nasal cavities. There IS a mild form in which the principal symptom is obstruction of the nostrils, and yet according to the bacteriological test it is genuine diphtheria. In this mild form the disease is only feebly contagious, and there are no marked general symptoms. Too frequently, however, it assumes a more serious character and becomes extremely dangerous. The lymphatics and blood vessels about the nasal cavities are very numerous and active, and in the severe form of nasal disease the poisonous substances formed by the bacteria are taken up by these vessels, 148 COLDS, COUGHS AND SORE THROATS. and in the blood and lymph streams are carried to all parts of the body, so that the victim is quickly overwhelmed with these violent poisons. The glands at the angles of the jaw are swollen to a great degree, stonily hard and extremely painful and the general symptoms are very severe, quickly reaching a climax marked by the death of the patient. Treatment, Diphtheria is in no way, shape nor manner a disease for home treatment. If a good doctor can be obtained, send for him at once and let him take complete charge of the case, carrying out his instructions to the minutest particular and seconding his endeavors in every possible way. Antitoxin has revolutionized the treatment of diph- theria, but to secure its fullest benefit it should be administered very early in the course of the disease, so the sooner the doctor arrives the better the chance for a favorable termination. If a good doctor can not be obtained, then and then only, home treat- ment must suffice, and should be administered as energetically and intelligently as circumstances ren- der possible. As all of the patient's vigor is needed to contend with the overwhelming depression which character- izes this disease, a very important part of the treat- ment is to keep up his strength and vitality. At one and the same time he must be guarded against exhausting what strength he has, and must be given SORE THROAT (SEVERE FORMS). I49 such nourishment and other treatment as will tend to increase his vital forces. To secure the first end the patient should be kept strictly in bed, not leav- ing it for any purpose. All fussing and worrying are injurious. On this account the character of the nurse is of much importance. She should not only be calm and of an even temperament herself, but capable of soothing the patient when he be- comes restless or nervous. For the same reason, as well as to limit the possibilities of contagion, no one but the nurse must be allowed in the room, and excitement of every kind must be avoided. The sick room should be bright and sunny, but may be darkened when the patient is restless or when darkness will aid in restfulness or sleep. The room should be well ventilated, but drafts are not to be tolerated. The temperature should be that which is most comfortable to the patient, ordinarily from 68 to ^2 degrees. A sponge bath, carefully given, with the water at blood-heat, will add ma- terially to the comfort of the patient and should be made use of daily. Even twice a day does good in many cases. Owing to the condition of the throat, foods are necessarily liquid, or semi-liquid, but should be as nourishing as possible. Milk, buttermilk, concen- trated broths, and eggs, raw or so slightly cooked as to be easily swallowed, are all suitable for this disease. Food should be given at regular intervals. 150 COLDS, COUGHS AND SORE THROATS. more frequently than in health but in smaller quan- tities, and when the patient is lethargic and dull, it is often necessary to insist on his taking nourish- ment at the proper times. Alcoholic liquors are very highly recommended in diphtheria, their usefulness being greater in pro- portion to the weakness of the patient and the strength of the disease. Two tablespoonfuls of good whiskey in twenty-four hours, well diluted, for a child of four years, is a good average for mild cases ; in the severest form eight or ten times as much is not only justifiable but advisable. For an older child the amount should be proportionately larger. In fact, in this disease, the only limit to the use of liquor is the ability of the patient to take it without symptoms of disgust or nausea. As few of these smaller patients are fond of liquor diluted only with water, it is well when it is necessary to give these large amounts to administer it in other articles of food, as in the form of milk punch or eggnog. At the very beginning of the disease, calomel should be given in quarter-grain tablet triturates, one every half hour until the bowels are thoroughly moved. Tincture of the chloride of iron is a tonic remedy of great value. An excellent combination is one part of the tincture to four parts of glycerin, of which mixture fifteen drops in water are to be given SORE THROAT (SEVERE FORMS). I5I to a child of one year every two hours, and thirty drops to a child over two years old. No food or liquid of any kind must be given after this medicine for at least ten or fifteen minutes, as the tincture of iron exercises a highly beneficial local effect on the diseased throat through its astringent and tonic properties. In very severe cases where alcoholic stimulants are used in large quantities the iron tonic must be omitted, as the digestive organs cannot assimilate both, and in these desperate cases the alcohol is more necessary and useful. The tonic treatment, both iron mixture and alco- hol, should be continued until convalescence is well established. The doses, however, may be gradually diminished, and especially is this true of the alco- holic stimulant when it has been used in the enor- mous amounts required in a highly dangerous case. In any form of diphtheria the swollen glands and neck may cause much pain and discomfort. In older children the application of an ice bag or of cloths wrung out of very cold water will sometimes give great relief. In younger children the swollen sur- faces may be gently rubbed with warm camphorated oil. Plain olive or cottonseed oil will also serve a useful purpose in this way, or cloths wrung out of hot water and often changed may be used. In any form of diphtheria the air of the sick room may be kept moist by dropping large pieces of unslaked lime in a tub or large pail of water. 152 COLDS, COUGHS AND SORE THROATS. sufficiently often to keep the air fairly full of the limy vapor. This is peculiarly beneficial whenever there is danger of the laryngeal form developing. In the tonsillar or pharyngeal form the throat may be swabbed, sprayed or gargled with hydrogen peroxide, full strength if it can be tolerated, or mixed with an equal quantity of water. This pro- cess may need to be repeated every hour in severe cases, but ordinarily two or three times a day is sufficient. Care must be taken that the healthy membrane is not injured in this process, and where the child struggles much and the false membrane is not spreading rapidly it may have to be omitted. A mother of two children lost one by diphtheria. More fearful of this scourge than of a lurking tiger (and remembering the difficulty in administering proper medication) she taught the remaining boy to take medicine and use throat washes by seeing which could swallow the most bread pills and which could gargle most thoroughly and protractedly with warm water. In process of time the child so taught was attacked by diphtheria and the attending phy- sician (this was before the days of antitoxin) ex- pressed surprise at the facility with which the little patient used the gargles, declaring that this fact probably saved his life. In all operations or procedures about the nose or throat of a diphtheria patient, great care must be taken that no particles from the diseased structures SORE THROAT (SEVERE FORMS). I53 lodge in the face of the nurse, and the hands should always be disinfected after each manipulation. In the laryngeal form of diphtheria, or when the membrane extends to the larynx from a case originally of the pharyngeal type, a bronchitis tent should be hastily constructed over the bed, steam supplied from a bronchitis kettle, or from an ordi- nary tea kettle, to the spout of which rubber tubing may be connected and led into the tent, and ten grains of calomel should be placed in a metal spoon and held over the flame of a candle in the tent until the calomel is completely vaporized. An abundance of steam should be supplied until all danger of suffocation is past, and the vaporization of a similar quantity of calomel should be repeated every three or four hours imtil breathing is easy and natural. If these measures do not quickly relieve the diffi- culty in breathing, an emetic may be necessary and there should be no hesitancy in making use of it. The yellow subsulphate of mercury, often known as "turpeth mineral," is highly recommended in this emergency. It is a quickly acting emetic and it is claimed that it does not produce depression, a peculiarity which renders it especially valuable in diphtheria. The dose for a two-year-old child is two to three grains, repeated in fifteen minutes if it does not act in that time. More than two doses should never be administered, and if vomiting is 154 COLDS, COUGHS AND SORE THROATS. not produced in ten or fifteen minutes after the second dose, use some other emetic at once. Mus- tard flour mixed with warm water, two tablespoon- fuls to a glass of warm water, makes a safe and prompt emetic that will rarely fail. If the turpeth mineral is not at hand mustard probably will be, and the old familiar scheme of tickling the back of the throat with a feather may be used if mustard or other household emetic is lacking. The vomiting usually causes the expulsion of the false membrane and reopens the larynx. In the nasal form of diphtheria, or when the membrane reaches the nose by extension from the throat, the nasal passages are largely occluded, frequently completely blocked, compelling mouth breathing, and quickly producing symptoms of toxic absorption. The general treatment is similar to that of the other forms, but the local obstruction calls for persistent irrigation of the nasal passages in order to keep the false membrane washed away and prevent, or largely check, the formation and absorption of the poisonous substances. An ordi- nary fountain syringe can be used to good effect for this purpose. It should be provided with a nozzle of hard rubber large enough to fit the nostril closely and should be so held that the stream flows directly backward toward the throat; if directed upward so that the stream flows towards the top of the head it fails, largely or entirely, of the desired SORE THROAT (SEVERE FORMS). 1 55 effect. A teaspoonful of fine table salt dissolved in a quart of warm water makes a suitable irrigating fluid, and for use should be fairly warm — no to 115 degrees is recommended. The water bag should be held from one to five feet above the nostrils, according to the amount of pressure required to wash out the membrane, and the stream should return through the other nostril. After successfully clearing one nostril, insert the nozzle in the other nostril and repeat the process. In severe cases the nostrils may have to be washed out in this way every hour for several days; in milder cases once in twelve hours is often sufficient. In case of a young child who does not understand and will not submit, the entire body, arms and legs may be wrapped in a blanket, thus preventing struggling, and the irrigation may be made with the child lying on its side, a rubber blanket being so spread as to convey the fluid to a vessel on the floor. Convalescence is protracted and various after effects may occur. Sudden heart failure, broncho- pneumonia and paralysis, more or less sudden, are numbered among them. There is always weakness and anemia, so that in severe cases the patient should be kept in bed several weeks after the most serious symptoms have moderated, and careful nursing and feeding will have to be continued until the patient is manifestly stronger and prepared once more to take an active interest in life and his sur- 156 COLDS^ COUGHS AND SORE THROATS. roundings. Very little exertion should be allowed on the part of the patient for several weeks after convalescence is surely established, as sudden heart failure sometimes occurs on very slight apparent cause even a week or two after the change for the better. Diphtheria is a disease in which too much care cannot be exercised, both as regards the patient himself and the danger of contagion to other par- ties, and the rules for prevention of contagion, as laid down in Chapter IV, should be most carefully observed. Remember that throughout the disease every care must be taken to prevent needless exertion on the part of the patient and to add to his sorely tried strength by the most nourishing food, the kindliest nursing and the most watchful care. Membranous Croup. This disease is so closely related to laryngeal diphtheria that the possibility of a non-diphtheritic croup was for a long time denied by many most excellent physicians. When non-diphtheritic it is caused by some other organ- ism, most commonly the streptococcus pyogenes, but a false membrane is formed in the larynx ex- actly as in laryngeal diphtheria, differing from the diphtheritic membrane in not being so closely ad- herent to the structures on which it is formed. The disease also differs from the diphtheritic type in its sudden onset and in not being contagious. SORE THROAT (SEVERE FORMS). I57 Membranous croup is most common in children, though adults are sometimes attacked, and it de- stroys life by suffocation. The child is usually in fair health or but mildly sick. Towards evening a harsh, brassy cough is heard, which is usually the first intimation of danger. During the night the little patient wakes in imminent danger of stran- gulation, the "croupy'' cough is very marked, the breathing loud and stridulous, and the attempts to secure sufficient air are pitiful and violent. If not quickly relieved, lips and fingers become bluish, the face livid, respiration gradually becomes slower and the child falls into a state of stupor ending in death. This is a disease in which quick action is neces- sary in order to save life. The treatment is the same as that for an acute attack of laryngeal diphtheria. A bronchitis tent is constructed over the bed and filled with steam, calo- mel is vaporized every two or three hours, and if strangulation seems imminent an emetic must be administered. If there is any trouble in forming the tent, or while constructing it, the air of the room may be moistened by boiling water in a tea kettle over an alcohol lamp, stove or any other means at hand, or by dropping unslaked lime in a tub or large pail of water, which will keep the entire room full of limy vapor, which it is claimed is particularly beneficial in these croupy cases, both diphtheritic and non-diphtheritic. When the bron- 158 COLDS, COUGHS AND SORE THROATS. chitis tent is used care must be taken that sufficient air mingles with the steam, and for this purpose one side of the tent may be left open or the side withdrawn sufficiently often to supply a proper amount of air. CHAPTER X. SORE THROAT (Severe Forms). Tonsillitis. Tonsillitis. This disease is an acute inflammation of the tonsils and pharynx. The tonsils are also called amygdalae, from amygdala, an almond, and from this we get the term amygdalitis, synonymous with tonsillitis. In tonsillitis the substance, as well as the mucous membranes of the tonsils, is involved, and they sometimes swell to two or three times their ordi- nary size. Indeed, they may meet and press against each other in the middle line, interfering with breathing and making it impossible to swallow. The pharynx, or back of the throat, is also con- gested and inflamed, so that the discomfort of an ordinary sore throat is added to that caused by the tonsils themselves, and the soft palate, particularly the uvula or middle dependent portion thereof, par- ticipates in the general inflammation and adds a third factor of unrest. There are two forms of acute tonsillitis. In follicular or lacunar tonsillitis the mucous mem- branes and the parts lying under and close to it 159 l6o COLDS, COUGHS AND SORE THROATS. are principally involved. In the suppurative form, also called true tonsillitis and quinsy, either the substance of the tonsil itself, or the loose tissues surrounding it are inflamed and pus formation occurs. This form usually terminates by the pus breaking through the tissues and discharging into the mouth and throat, just as a boil discharges on an external surface. In either form, though more commonly in the follicular variety, an exudate may form on the sur- face of the tonsil, so closely resembling the false membrane of diphtheria that this more deadly rela- tive is often suspected, and in this case it is the part of wisdom to consider it as diphtheria until satisfied to the contrary. Predisposing causes are lowered vitality, the rheumatic tendency, damp or poorly ventilated liv- ing or working rooms, mental worry and general depression. The exciting causes are getting damp or otherwise chilled, getting the feet wet, drafts of cold air, especially on the neck or side of the face, indigestion and constipation, vitiated air, or the inhalation of smoke or vapors. The follicular form is considered mildly contagious, and both varieties are believed to depend on bacterial activity. Follicular tonsillitis usually begins with a chill or chilly sensations, with fever quickly reaching 103 or even 105 degrees. Sometimes the onset is with aches and pains in all the muscles, growing SORE THROAT (SEVERE FORMS). l6l more and more severe until the victim is sore all over and feels as if he has been run through a thresh- ing machine. At other times it begins as an ordi- nary pharyngitis, the symptoms at first being those of a severe sore throat. Headache is often severe, the tongue is coated and the breath foul, while swallowing is painful or impossible. The voice is hoarse and the neck stiff and moved with diffi- culty. Constipation is the rule, and the urine is scanty and high colored. The fever and severe general symptoms last three or four days, but if one tonsil is first attacked and as it returns to nor- mal, the other tonsil takes up the process, the symp- toms are correspondingly lengthened. The tonsils usually show spots or patches of exudate, white or yellowish in color, and not infrequently these run together and cover the tonsil, giving rise to a suspicion of diphtheria. In quinsy, or suppurative tonsillitis, there is much more pain in the immediate neighborhood of the affected tonsil, and the glands of the neck and under the jaw swell more markedly, but in this form the general symptoms are less severe. There is keen pain radiating toward the ear, and the stiff and painful neck is more markedly in evidence. Swallowing is frequently so painful as to prevent eating. Pus gradually forms and in four or five days breaks through the tissues, when it is either swallowed or ejected. After this the symptoms l62 COLDS, COUGHS AND SORE THROATS. abate and the patient usually makes a good re- covery. Tonsillitis is a disease that well justifies the pres- ence of the doctor. The milder attacks may do well under home treatment, but a severe case calls for all the relief that medicine can give. The suppura- tive form should have the relief of lancing, and if there is even a suspicion of diphtheria, medical intervention is imperative. Diphtheria comes on slowly and is usually pre- ceded by dullness and depression but no chill. Ton- sillitis is sharp and sudden in its attack, very com- monly there is a chill, and the fever is usually higher. Probably, however, the greatest distinction is in the false membrane. That of diphtheria is a dirty grayish or grayish yellow color, is tough and adherent, can only be removed by forceps or other violent means, and leaves a bleeding surface on which the membrane quickly forms again. That of tonsillitis is not a real membrane at all, is usually whitish or yellow, can be easily removed by a bit of cloth or a little cotton wound on an applicator or small stick, and leaves a smooth, red, swollen surface, without any bleeding. In some cases, how- ever, these points vary, and it is only by bacterial cultures, or by the use of a microscope, that the true nature of the disease can be surely determined. At the very commencement of any form of sore throat it is a good plan to try to check it by the SORE THROAT (SEVERE FORMS). 163 use of antiseptic sprays or gargles. Listerine, di- luted with two or three times its volume of water, makes a safe, pleasant and efficient spray. Hydro- gen dioxide, pure or diluted with an equal volume of water, is probably one of the best, but when employed as a spray must be used with a glass- tipped spray tube, as it destroys the ordinary rubber tubing and tips. A heaping teaspoonful of soda in a glass of water also makes a good spray fluid or gargle. After the disease is fully developed, these appli- cations still serve a good purpose in cleansing the throat, and should be continued for that purpose. Either sodium salicylate or common baking soda, rubbed on the tonsils with the finger, gives some re- lief and is distinctly beneficial. As in other colds, overcome constipation promptly with calomel and salts and keep the bowels free while the disease lasts. Rochelle salts and common baking soda, mixed in equal parts, should be given three times a day, a teaspoonful at each dose. This aids in keeping the bowels open, overcomes the acidity of the urine and helps all around. Sodium salicylate is con- sidered almost a specific (a sure cure) for those cases with a marked rheumatic tendency, and should be given in the dose of ten to fifteen grains, every two hours for ten or twelve doses. Guaiac lozenges, each containing two or three grains of the guaiac resin, may be obtained at any 164 COLDS^ COUGHS AND SORE THROATS. large drug store, and one of these allowed to dis- solve in the mouth once in two or three hours will give great relief. Some people, however, do not tolerate this drug and should rather use sodium salicylate. In the follicular form of tonsillitis an ice bag (a small rubber bag, or a sheep's or pig's bladder, filled with pounded ice and securely fasten- ed) should be kept over the angle of the jaw, as nearly as may be, covering the affected tonsil. A towel should be laid between the ice bag and skin to avoid too great cold and to absorb moisture. In suppurative tonsillitis hot compresses usually give great relief. They may be improvised by wringing large towels or other cloths out of water as hot as can be borne, and should be frequently changed be- fore they cool. Sometimes bits of ice, held in the mouth, seem to do good; in other cases gargling' the throat with water as hot as can be borne gives the greatest relief. In the suppurative form, lancing the abscess as soon as it points, shortens and lessens the pain most markedly, but this should only be attempted by some one who understands it, and naturally this falls to the doctor. When lancing is not resorted to it usually breaks of its own accord a little later, and recovery is the rule. During the severity of the attack, the intense pain of swallowing makes liquid food a necessity. Cold milk is the commonest bill of fare and ice cream is SORE THROAT (SEVERE FORMS). 165 claimed to be a safe and pleasant food. Custards and soft boiled or poached eggs are sometimes well taken, and as recovery advances the diet should be nutritious and tonics should be used. The ordinary diet may be gradually resumed. In all forms of sore throat it is well to use the gargles or sprays referred to in this chapter, and they are most effective when used as soon as symp- toms are felt. If this course is followed, many sore throats which might develop into serious diseases may be checked in their incipiency. If, however, they persist, the cathartic and hot foot bath should be made use of, and if these do not end the trouble, the treatment appropriate for whatever form of cold, cough or sore throat develops should be applied.. CHAPTER XI. COUGH (Cold on the Chest). Bronchitis. As coryza is our common cold, so is bronchitis, tracheo-bronchitis, or, as some of the good old ladies call it, ''brown skeeters," our common cough. Bronchitis itself signifies an inflammation of the bronchi, which are the divisions of the windpipe leading to the lungs. Tracheo is prefixed to bron- chitis, giving the term tracheo-bronchitis, because the trachea, which is the windpipe, is almost in- variably and unavoidably a partaker in the inflam- mation. The disease is also called cold on the chest because of the rawness and soreness in and on the chest. The definition of bronchitis is an ''acute catarrhal inflammation of the mucous membranes of the trachea and bronchi." Acute indicates that it comes on with some degree of suddenness, catarrhal, that there is increased secretion, and inflammation de- scribes the feverish, swollen and congested condition of the afifected membranes. The tissues involved in bronchitis are parts of what is frequently spoken of as the respiratory i66 BRONCHITIS. 167 tree. Now, in order that we may get an approxi- mate idea of where these tissues He, let us do a little supposing, and instead of trachea we will say trunk, and instead of bronchi we will say branches. Sup- pose, then, that we have a stout, stubby little tree, the trunk about an inch in diameter at the base and extending without branches from three and a half to four and a half inches high. Here, however, it divides into two main branches, each of which rapidly divides and subdivides until the finest twigs terminate, each in a little bunch of somewhat cherry- like, but microscopically small fruit (the alveoli or air cells of the lungs). Further, suppose that every part, trunk, branches, twigs and fruit, is hollow, and that this hollow little animal tree is turned upside down and set in the throat and chest, the trunk joined to the larynx. (The larynx is easily located in the throat, its upper edge forming the most prominent external part, the Adam's ap- ple.) Behind the breast bone and about an inch lower than the notch which marks its top the trachea divides into two branches, one extending to the right, the other to the left. These are the right and left bronchi and divide and subdivide until the finest twigs (capillary bronchioles) penetrate every part of the lung structure and terminate in the hol- low fruit, the walls of which are so fine and thin that the waste matters brought to their outer sur- faces by the blood are easily exchanged through l68 COLDS^ COUGHS AND SORE THROATS. these delicate membranes for the life-giving oxygen brought to their inner surfaces in the air we breathe. The mucous membranes of the trachea and bron- chi (the trunk and larger branches of our respira- tory tree) are the parts involved in bronchitis. The predisposing causes of bronchitis are much the same as those of coryza.^ Lowered vitality is the prin- cipal predisposing cause, and this is greatly favored by the pampering we give our precious selves. Overheating of offices and living rooms, wearing too many and too heavy clothes, especially too much muffling of the neck and throat, and the use of chest protectors all predispose. Careless eating and digestive disorders aid in the bad work, while lack of exercise adds the finishing touch and leaves the whole physical system out of tune. Heart and kid- ney diseases weaken and interfere with the circula- tion, hence are effective predisposing causes. Also, many of the acute diseases affecting the respiratory organs, such as la grippe, measles, whooping cough and the pneumonias, predispose so strongly that bronchitis is always to be guarded against in their later stages. Coryza, or cold in the head, is a very effective exciting cause of bronchitis, either by extension of the inflammation to the throat and so on down to the trachea and bronchi, or by inducing mouth breathing, which supplies colder, drier and less pure air than that which has been properly drawn through BRONCHITIS. 169 the warming, moistening, and dust and microbe retaining nasal cavities. From an ordinary sore throat (pharyngitis or laryngitis), the inflammation may readily extend downward and give rise to bronchitis. The other primary exciting causes are much like those of other colds and coughs. Cold and damp- ness, especially when accompanied by searching winds, and sudden and marked changes of temper- ature, are among the commoner exciting causes, and as these are characteristic of the late winter and early spring, so is bronchitis prevalent at these seasons. -(irritant vapors and gases, dust laden air, heavy fog, and even a superabundance of tobacco smoke, or smoking, may furnish a satisfactory starting point.^ But at this point an auxiliary set of exciting causes make their appearance, in the shape of a host of microbes, variegated as to kind and names. Certain of the severer respiratory diseases, as in- fluenza, diphtheria, and whooping cough, are each due to a specific organism ; that is, to one especial kind of bacterium whose activity always results in the one special disease and nothing else, but bron- chitis and probably its forerunners, coryza, pharyn- gitis and laryngitis, rejoice in the proud distinction of being polymicrobic; that is, any one of them may be caused by any one or more varieties of a whole raft of the skulking little reprobates, the dis- 170 COLDS, COUGHS AND SORE THROATS. ease depending on the location rather than on the organism that aids in the inflammation. In vigorous patients, from youth up to the Hmits of middle age, bronchitis usually lasts two or three weeks and is not of itself a dangerous disease. Very frequently it follows coryza or a sore throat, but it sometimes starts as an independent disease. In this case there may be a day or two of lassitude, or ''feeling mean," or it may begin with a chill, or chilliness, and fever, ordinarily slight, but some- times running up to 103 or 104 degrees. The first, or dry stage, lasts from a day to two or three days, during which nothing is coughed up. There is a cough, however, rough, irritating and sometimes very severe. Often there are paroxysms of cough- ing which strain the muscles and rack the entire chest so that even the external surface is tender and painful to the touch, and there may be lines of tenderness corresponding to the course of the bron- chi and their larger branches. There is a raw, tearing soreness in the middle and upper part of the chest under the breast-bone, and a feeling of tightness and constriction across the outer surface. Following this is the stage of secretion. The cough becomes looser, the pain, tenderness and constriction are less, and matter is coughed up, at first scanty, viscid, almost transparent, or frothy, and sometimes slightly streaked with blood, owing to rupture of small blood vessels in the congested BRONCHITIS. 171 mucous membranes under the strain of coughing. In a day or two the coughed-up matter becomes much freer and more abundant, of a yellowish, or greenish yellow color, much thicker and more tena- cious. The coughing gradually becomes less fre- quent and less severe, the other symptoms moderate, and in from a week to two or three weeks the patient is practically over the attack, although some degree of cough and expectoration may last for several weeks longer. In these vigorous patients, bronchitis may be broken up at the very beginning, exactly as a cold in the head may, by a laxative, if needed (and it almost always is), the hot mustard foot bath, with warm drinks, quinine and Dover's powder, and an unchecked sweat. In addition the chest may be well rubbed with camphor liniment, camphorated oil, or what is perhaps better, with turpentine and sweet oil, half or two-thirds of the mixture being turpentine for a hearty adult, but one part of tur- pentine to three or four of the olive oil for a child. If on the morning following these measures, the cough, soreness and other symptoms are not broken up and abolished, other remedies must be used. For the dry, irritative cough, mix one fluid ounce (two tablespoonfuls) of syrup of ipecac, one-half fluid ounce (one tablespoonful) of sweet spirits of niter and an ounce and a half (three tablespoonfuls) of water, making three ounces of the mixture. Two 172 COLDS, COUGHS AND SORE THROATS. teaspoonfuls of this mixture should be given every four hours until the cough becomes loose. Inhala- tions of steam are very useful at this stage. For this purpose from a pint to a quart of boiling water should be put into a pitcher, and from a teaspoon- ful to a tablespoonful of the compound tincture of benzoin added. The patient should bend over the pitcher, and a towel be laid over his head, covering it and the pitcher. Care must be taken that the steam does not scald, especially if the patient be a child. He should remain under this improvised cover, breathing the rising vapor, for about ten minutes. This process may be repeated frequently, even hourly if the patient seems to need it, but when taking it he must be careful not to expose himself in any way, as by going out of doors or into an unwarmed room. Less frequent inhalations usually suffice. The tincture of benzoin may be omitted and the steam alone used if desired. If the patient objects to the use of the towel, the same result may be secured by putting over the pitcher a cone of paper, the upper end being directed to- ward the patient's face, so that he may readily ^jn- hale the steam. The mixture of syrup of ipecac, sweet spirits of niter and water is about as good as anything we can scare up while the cough is dry and the sputum scanty, but in a day or two the cough becomes looser and matter is continually coughed up and BRONCHITIS. 173 Spat out. This matter is viscid, tenacious and raised with difficulty, and we need something which will loosen things up, so that the cough will become easier and the matter may be raised with less effort. One of the most successful cough mixtures for this stage is composed of one dram each of am- monium chloride, ammonium carbonate and am- monium bromide, four drams of the fluid extract of licorice, and water enough to bring the quantity up to six fluid ounces. This may be put up at any drug store. The dose for an adult is two tea- spoonfuls every three or four hours. If preferable, lozenges of ammonium chloride and licorice, each lozenge containing two grains of am- monium chloride, may be easily obtained and will answer the same purpose. Two or three of these should be taken every four hours. Gradually the cough becomes free and the expec- torated matter is easily gotten rid of, and when this occurs these remedies should be discontinued, or used at much longer intervals. Some form of tonic is advantageously employed as convalescence pro- gresses. For those who can take it, codliver oil is excellent at this stage. Any good form of iron tonic is useful, and perhaps the best is the tincture of the chloride, which should be taken in ten-drop doses in water three times a day after meals. Small doses of quinine, two or three grains three times a day, may also be taken with advantage. 174 COLDS^ COUGHS AND SORE THROATS. In using these remedies, keep the end in view. The Steam inhalations are advantageous through the two earHer stages of the disease, in which the ipecac and ammonia compounds are employed. The medicines in which ipecac is the main factor are to be exchanged for the ammonia compounds as soon as the matter on the lungs is freely formed, and the ammonia compounds are to be used only until the cough becomes easy and the matter is coughed up without straining or exertion. After this, the severity of the disease is over, and the patient only needs to recover strength and get back to his normal condition, so tonics and attention to the general health are the things needed. In old people and in very young children, the disease manifests itself by slightly different symp- toms, and as, owing to infancy or advanced age, the power of resistance is less, it is far more likely to prove dangerous. Small children may not have a chill, or it may pass unnoticed ; they do not cough out the sputum, but swallow it, and they cannot describe their sub- jective symptoms, so that increased rapidity of respiration is perhaps the most valuable and trust- worthy sign of bronchitis in this class of patients. They naturally breathe much more rapidly than adults, so that thirty or forty respirations per min- ute may not be alarming, but when it reaches fifty, sixty or even seventy, it is a danger signal and BRONCHITIS. 175 you may be sure that something is wrong. When there is also fever, usually higher than in adults, and a cough, the probabilities are in favor of bron- chitis or some form of pneumonia, and you had better send for a doctor. In the aged, as in children, bronchitis is a dan- gerous disease, liable at any time to run into bron- cho-pneumonia. Fever is not marked but weakness is, and the breathing is very rapid. Whereas chil- dren do not cough out matter because they swallow it, in old age there is actual inability to raise the matter at all, and this adds to the danger. For old people the chief difference in treatment from that prescribed in the case of hearty adults is the greater usefulness of the bronchitis tent, to be described hereafter. The remedies used and the doses given should be as indicated above, but the bronchitis tent should be substituted for the steam inhalations. For children, however, while the same remedies should be used, the doses should be materially smaller. The ipecac mixture should be diluted to half its strength (in other words, add its own volume of water) for their use. For a child of one year, give a teaspoonful every four hours, and to children of two years and over, two teaspoonfuls at the same intervals. For a child of from eight to twelve, the same doses may be given as to an adult, using the diluted mixture instead of the full strength. When the ammonia compound becomes 176 COLDS, COUGHS AND SORE THROATS. necessary, make the dose for a child of twelve years half that prescribed for an adult; for one of six reduce it to a quarter, decreasing it proportionately for still younger children, and giving it in water to lessen the strong, salty taste. For both small children and old people a physi- cian should be in charge, but when this is not possi- ble, it is well to make use of the bronchitis tent and croup kettle all through the attack, and until the patient is decidedly on the way to recovery. Time is of little value to these patients, and the complete rest involved is in itself beneficial. This treatment is not elaborate, involving only the arrangement over the bed of the patient of a tent-like structure which is useful in retaining steam or other medicated vapors, in keeping a uniform temperature and in preventing drafts. It may be made from home material, or may be constructed of unbleached muslin or other cheap cloth. A piece of scantling, a pole, or even a broomstick, is fasten- ed to each bedpost so as to extend three or four feet above the mattress, cross pieces are fastened between each two posts, and a single sheet fastened over the top of all with pins or coarse stitches. Other sheets or cloths are fastened, falling lower than the mattress at each end and on one side, while on the remaining side two sheets are arranged like curtains, thus furnishing an opening about the middle for ventilation, and to prevent too complete BRONCHITIS. 177 isolation of the patient. The whole arrangement forms a neat Httle room, the size of the bed, in which the patient makes his home during the ill- ness, and in which children may have their pictures and toys, while the aged have their books, writing, sewing, or whatever else they are interested in. The croup kettle is a device for generating steam in the sick room or for inhalation, and does not materially differ from an ordinary tea kettle. As sold in the stores it usually consists of a cylindrical kettle to contain the water, with a close-fitting lid in which are two openings. The larger opening is funnel shaped for reception of the water and whatever drug may be added, and is closed with a large cork or a metal plug; the other is in the form of a spout. Extra joints, much like those of a stovepipe, are provided so that this spout may be lengthened and the steam liberated under the bron- chitis tent, near the face of the patient or wherever most convenient. The heating device is an alcohol lamp, and a partial cylinder of metal fits the bottom of the kettle, like a pan of the same diameter as the kettle and enclosing the lower end of the same. One side is open to permit of lighting the lamp, or removing it for filling or other purposes. The croup kettle may be used in the invalid's room without the bronchitis tent, or it may be set near the tent with the lengthened spout running under the canopy, and thus keep the air constantly 178 COLDS^ COUGHS AND SORE THROATS. moist and, if so desired, medicated. The compound tincture of benzoin is a favorite medication for use in the croup kettle, a teaspoonful to a tablespoonful to each pint or quart of water placed in the kettle, or ten to twenty grains of menthol to the quart of water may be used. To summarize: Bronchitis is a painful and pos- sibly dangerous disease at any age, but the chances of danger are much increased when it attacks a young child or an old person. At any age, the first steps should be to overcome constipation and induce free perspiration. When this treatment is not im- mediately successful, the ipecac mixture prescribed above should be taken, in doses varying according to age, until the cough is no longer dry, and there is much matter to be raised. At this stage the ammonia compound should be given, and continued until the secreted matter is raised easily, when it should be discontinued and tonic treatment adopted. For both the very young and the old the danger of unfavorable complications is best guarded against by the free and continued use of the bronchitis tent with the croup kettle. For either of these classes, however, a physician should be in attend- ance. CHAPTER XII. COUGH (Cold on the Chest^ Severer Forms). Pneumonia. Broncho-Pneumonia. Pleurisy. These acute inflammations of the lung structure itself, or of its investing membrane, are all danger- ous diseases, and in them home treatment should only be attempted when the presence of a good doctor is an absolute impossibility. Lobar Pneumonia. This, the common form of pneumonia, is also known as lung fever and cold on the chest. It is an acute, infectious disease, characterized by inflammation of the lung substance. Its onset is usually with a severe and protracted chill and fever, sharp, stabbing pain in the chest, persistent and painful cough, and rapid, painful respiration. Lowered vitality is the greatest predisposing cause, and for this reason chronic drunkards fall easy victims. Old people, feeble individuals and young children, when exposed to low temperatures, are also frequently attacked, and in all of these cases the disease is very dangerous. Exposure to cold was formerly regarded as the commonest exciting cause of pneumonia^ but it is 179 l8o COLDS, COUGHS AND SORE THROATS. now believed to be only a predisposing cause, act- ing by lowering the vitality. However this may be, sudden chilling or long exposure to low temper- ature is frequently followed with much promptness by an attack of pneumonia, and one attack pre- disposes to another by leaving the victim in a con- dition of lowered vitality which favors a fresh onslaught. The real exciting cause is a bacterium, variously known as the micrococcus lanceolatus, the pneumo- coccus or the diplococcus pneumoniae. Other or- ganisms may be able to produce pneumonia, but that this wicked and ever-present germ is able to do the business there can be no doubt. How long it takes after exposure to infection for the disease to develop has not been determined. The period is probably very short, always provided the patient is in a condition of lowered vitality, which allows the bacteria to multiply. The germs of pneumonia are found in the mouths of a large percentage of ordinarily healthy persons, and in such cases when- ever anything depresses vitality sufficiently, the germs become active and the person becomes sick, and the name of his disease is pneumonia. Another cause that puts the tissues themselves in such condition of lowered vitality that the bac- terium is able to do his nefarious work, is any bruise or injury to the chest walls. Pneumonia originating in this way is known as traumatic or contusion pneumonia. PNEUMONIA^ ETC. l8l The onset of lobar pneumonia is usually with great suddenness. Sometimes there are symptoms of a slight cold for a day or two preceding the direct attack; at other times there are no premoni- tory symptoms at all. The chill comes on with considerable severity. Sometimes a person goes to bed and to sleep, apparently in perfect health, and awakes in the night in the midst of a very severe chill. At other times the chill attacks in the midst of the duties of the day, and with such violence that it is hard work for the patient to get home. And the chill is not only of great severity, but is also long in duration, perhaps lasting a half hour or more. The fever rises rapidly and in ten or twelve hours may be as high as 104 or 105 de- grees, and high it remains till the disease is spent. Pulse and respirations both advance with the tem- perature, the pulse to about 100 or 120, the respi- rations to 30, 40 or even 50, and in children to 80 or even 100. Headache and pains in the limbs and back are common at this stage, and in a few hours from the time of the chill, pain in the side, stabbing, severe and agonizing, and made worse by breathing, coughing or change of position, comes on. It is accompanied by a short, dry cough and rapid breathing, both of which greatly intensify this agonizing ^'stitch in the side." This pain is due to a certain amount of pleurisy which accompa- nies and is dependent on the inflammation of the 1 82 COLDS, COUGHS AND SORE THROATS. lung. The rapid breathing is of course very pain- ful, while the cough makes the poor victim wince, or even cry out. Usually the cheek on the affected side is much flushed, but occasionally both cheeks show this feverish brilliancy. The patient lies on the affected side in an effort to restrict its motion and so lessen the pain. In children the onset is often with a convulsion instead of the severe chill, and there may be vomit- ing. In drunkards and old people the disease may come on gradually and without chill, and in these classes there may be little or no cough. In drunk- ards the symptoms are often those of delirium tremens, and it is only on taking the temperature that a suspicion of the real trouble arises. The sputum, or coughed-up matter, in pneumonia is peculiar. At first scanty, it soon becomes more plentiful, but is so tenacious that a cup nearly full of the matter may be turned upside down and held in that position for some seconds without spilling. In hearty adults it is usually blood-streaked or tinged, changing in a day or two to the "rusty sputum" so characteristic of pneumonia. In drunk- ards and very debilitated subjects, often in the aged, it may be dark-colored and fluid, what is known as ''prune-juice" expectoration. Constipation is apt to be present in pneumonia, digestion disturbed and the tongue coated. The fever is remarkably steady, varying but little either PNEUMONIA, ETC. 183 in the course of the day or in the course of the disease, and the other symptoms remain nearly the same for a variable number of days, which is sin- gularly almost always an odd number. In excep- tionally fortunate cases the third day witnesses the crisis; usually this occurs on the fifth or seventh day, but sometimes on the ninth or eleventh. A slight rise of temperature may precede the crisis, but when this point is reached the fever declines rapidly, and in from five to twelve hours has fallen to normal, or perhaps a trifle below. A free per- spiration accompanies the fall of temperature and all the symptoms are greatly mitigated, so that from extreme pain the patient passes into a condition of comparatively delicious comfort. Sometimes this change takes place in the course of a single hour. From this period, in favorable cases, recovery is rapid and satisfactory.^ The patient should occupy a bright, cheerful room, thoroughly well ventilated and allowing plenty of sunshine if possible. Only one or two persons should be allowed in the room at a time and in this, as in all other diseases, the pernicious habit of making the sick room a reception chamber for afternoon callers should be discouraged. The patient should be carefully sponged with tepid water once or twice daily, a process which, if managed properly, need cause but slight disturbance. The mouth and teeth should be kept clean, both as a 184 COLDS, COUGHS AND SORE THROATS. measure of comfort and to prevent further infection either of the patient or others. The bowels must be kept regular and rather free. Water or lemon- ade should be given freely. If, as sometimes hap- pens, the patient should become delirious or other- wise incapable of making his wants known, plenty of water or lemonade should be given just as medi- cine is given, and at stated intervals. Food should be liquid or semi-liquid and easily digested. Milk, alone or mixed with food prepared from cereals, is usually well taken, and eggs soft-boiled or raw are excellent. When a physician is in charge the almost in- tolerable pain in the side may best be relieved by morphine. This very useful, but very dangerous drug, is not as a rule considered a safe one to handle in the household. Dover's powders, how- ever, in three to five-grain doses, may be used, and after the disease is established these powders give much relief, especially when the cough is trouble- some. Either hot or cold applications to the affect- ed side may give great relief. Whether to use heat or cold should be decided by the feelings of the patient. Heat may be applied by means of a small flattish bag of salt or sand, five or six inches square, which may be heated on the stove or in the oven, laying it on blocks of wood to avoid burning the bag. Care must be taken that it is not hot enough to pain or harm the patient. If the patient finds PNEUMONIA, ETC. 185 cold the more comfortable application, an ice bag, or the bladder of a pig or sheep filled with pounded ice and tightly tied, may be laid over the seat of pain. These ice-containers must be wrapped in a towel or other moderately thick cloth, to prevent too much chilling and to absorb moisture. Either hot or cold applications may be conveniently made by means of compresses (towels or sheets of flannel folded to a suitable thickness), wrung out of either very hot or very cold water and laid over the painful point. The cold compresses must be frequently renewed, while the hot applications may be covered with oiled silk, rubber cloth or other impervious fabric which will retain the heat for some time. Poultices are still used in many parts of the coun- try and when properly managed they certainly seem to do good. The cotton jacket is also serviceable in the case of aged patients or others deficient in bodily warmth. It consists of one or two layers of cotton batting stitched on to a thin undershirt so as to make a complete covering for the chest, the outer part being covered with oiled silk. For younger patients, a light flannel garment is ordi- narily more comfortable, and there is less danger of a fresh cold when it is removed. Cold sponging, or in case of weakly patients, sponging with tepid water, should be used for the relief of fever. It may be done limb by limb so that the patient is not much disturbed, and the effect l86 COLDS, COUGHS AND SORE THROATS. is always good. In a majority of the cases of pneumonia, alcoholic stimulants may be used with advantage. It may not be required at the beginning of the disease, but in a day or two its need will become apparent. Tw^o or three ounces of whiskey in twenty-four hours will be about right for a robust adult, but if the pulse becomes weak or other evi- dences of failing strength appear, the quantity may well be increased, even to ten or twelve ounces in a day. Broncho-Pneumonia, Bronchitis signifies inflam- mation of the bronchi; pneumonia, inflammation of the lungs. Broncho-pneumonia means an in- flammation which involves parts of both structures. To explain how broncho-pneumonia differs from lobar pneumonia, a little consideration of the lung structure is necessary. Each lung is made up of large separable masses called lobes. The right lung contains three of these masses, the upper, middle and lower lobes, while the left lung contains but two, the upper and lower lobes. Where one would naturally expect to find a left middle lobe, he finds the heart, which unfortunate organ, owing to the needs of novelists and other romancers, has very little tendency to the right and is always getting left. Each lobe of each lung is composed of in- numerable lobules, each lobule consisting of a ter- minal bronchus and its group of air-cells. These lobules (terminal bronchioles and air cells) are the PNEUMONIA^ ETC. 187 parts attacked in broncho-pneumonia, and the re- sulting hmited areas of inflammation are found scattered about in both lungs, favoring as a rule the lower lobes. In lobar pneumonia, on the con- trary, the inflammation is usually confined to one or two lobes of one lung, and all parts of the affected lobe participate in the inflammation. Broncho- pneumonia is called lobular pneumonia from the structures attacked, bilaterial pneumonia because it is found on both sides (whereas lobar pneumonia, as a rule, is limited to one side), and capillary bronchitis from the minute size of the bronchi in- volved. There are at least three forms of broncho-pneu- monia, differing in causes, symptoms and to a con- siderable extent in danger. Primary acute broncho- pneumonia is very much like lobar pneumonia, in causes, symptoms and treatment. It is considered especially dangerous to the very young, and to old or feeble persons. Secondary broncho-pneumonia attacks the vic- tims of other diseases at a time when the vital forces are low from severe or long continued sick- ness, and is very fatal. In this form there is no initial chill, but the disease comes on gradually, and according to Dr. Osier, in measles, diphtheria, whooping cough, scarlet fever, smallpox, erysipelas and typhoid fever, kills more than die directly from the original disease. l88 COLDS, COUGHS AND SORE THROATS. There is still another form called deglutition or aspiration pneumonia, which is common after oper- ations on the nose and mouth in which chloroform or ether has been used. It is caused by particles of food, mucous or other secretions passing into the larynx and finally lodging in the minute bronchioles where a dangerous and often fatal inflammation is started. All forms of broncho-pneumonia are caused by bacterial infection, although as we have just seen, the causes leading to the degree of lowered vitality which permits of bacterial activity may be very different. Primary acute broncho-pneumonia may set in with much suddenness, as does lobar pneumonia, with a chill or convulsion. Fever rises rapidly and remains high, cough may be severe and painful, and the termination by crisis as in the lobar form. In the secondary form the chill or convulsion is absent. Fever rises gradually, shortness of breath and increased rapidity of respiration become mark- ed, and a hard, dry cough becomes very annoying. The difficulty of breathing becomes more and more decided, fingers and lips take on a bluish shade, and the patient is restless and evidently suffering from lack of oxygen. If the case terminates fatally, drowsiness from deficient air supply takes the place of restlessness, all the symptoms decline and finally cease in death. PNEUMONIA, ETC. 189 In the primary form, where the symptoms largely resemble lobar pneumonia, the treatment is similar. In the secondary form, coming on after exhaustive disease, treatment is similar but more care must be given to keeping up the strength, and where there is difficulty in breathing, the air of the room should be kept moist as in bronchitis or membranous croup. A kettle of water may be kept constantly boiling in the room or large lumps of unslaked lime occasion- ally dropped in a pail or tub of water. Small doses of Dover's powder may be used when the cough is distressing, the bowels must be kept regular, as in lobar pneumonia, and stimulants are even more necessary. Plenty of cold water or lemonade must be constantly supplied, and white of tgg, mixed with cold water and sugar, makes an admirable vehicle for stimulants. If suffocation threatens, a prompt emetic should be administered as in mem- branous croup. (See Chapter IX.) The best possible treatment of broncho-pneumo- nia in the household consists of prevention. No- where else is the old adage, *^An ounce of prevention is worth a pound of cure," of greater applicability. In all acute diseases the possibility, even probability, of this disastrous termination must be remembered, and after any such disease too early exposure to ordinarily harmless cold or dampness must be avoid- ed. Dr. Osier lays great stress on the tendency of children to kick off the bed clothes and get the 190 COLDS, COUGHS AND SORE THROATS. night robes bundled under the arms, exposing a large part of the body to chilling in the colder part of the night. As a remedy for this trouble he recommends the use of union suits, in which drawers and waist being all in one piece, such bunching is impossible, and closer watchfulness, especially of the sick, as a remedy for the removal of bed cloth- ing. Early recognition of sickness and extra care at this stage will prevent many children from the worst part of the attack, and careful cleansing of nose and mouth in health, and more particularly in disease, is an efficient means of limiting many dangerous maladies. Pleurisy, The pleura is a delicate membrane which covers and is closely adherent to each lung. It also lines and is closely adherent to those parts of the inner chest wall and diaphragm which sur- round and enclose the lung. The two parts of the pleura — that covering the lung, and that lining the chest cavity — are continuous, passing from lung to chest wall at that part of the lung where the bron- chus and great blood vessels enter. Thus it will be seen that the pleura forms a closed sac, inter- posed between the lung and those structures against which it presses and rubs in the process of breathing. The pleura of one lung is entirely separate and independent of that of the other, these two closed sacs only meeting and touching in a portion of the mid line in front. PNEUMONIA^ ETC. I9I In a normal and healthy individual this lining and investing membrane secretes a viscid, yellowish fluid, which lubricates opposing surfaces and so nearly prevents friction that everything moves smoothly and without a suspicion of pain. Acute pleurisy is an inflammation of this lining and investing membrane, with a decreased and changed secretion, so that the swollen and tender surface of the pleura surrounding the lung rubs against that lining the chest, resulting in excruciat- ing pain, which gives the characteristic ''stitch in the side.'' In some cases the sound made by the rubbing of these roughened surfaces is distinct enough to be easily heard by the unaided ear; in other cases the trained physician with delicate and appropriate instruments cannot detect it. Breath- ing, coughing, or any movement of the body that brings these surfaces together, causes the most in- tense shooting or stabbing pain; hence the victim usually lies on the affected side, restrains the breath- ing, and tries to stifle the cough. Fortunately the cough in pleurisy is not as constant and severe as in pneumonia. Pleurisy is almost always present in greater or less degree in pneumonia, and causes this same sharp, stabbing pain. Exposure to cold or dampness is the commonest cause of pleurisy. As in pneumonia, however, a localized injury to the chest wall may so lower the vitality of the damaged tissues as to cause an at- 192 COLDS, COUGHS AND SORE THROATS. tack. It is quite probable that bacteria of some kind are always a necessary factor in the causation of pleurisy, but as they only become active when exposure or other debilitating circumstances have sufificiently lowered the vitality of the individual, or when a bruise or other injury has lowered the vitali- ty of the pleura itself, it seems only fair to account the exposure or injury as the primary exciting cause, and the bacteria a secondary cause. The pneumococcus, or micrococcus lanceolatus, the organism that most commonly causes lobar pneumonia, is very frequently the active agent in producing an attack of pleurisy, but other forms of germ life are abundantly effective factors. Tu- berculosis is frequently first manifested in an attack of pleurisy, and in this case the bacillus tuberculosis is, of course, the guilty party; likewise the disease is prone to become chronic and last indefinitely. Pleurisy may set in suddenly with a chill, fol- lowed by fever and the characteristic stabbing pain in the side. At other times it commences gradually, pain and fever developing slowly. Cough is a com- mon symptom in the early stage, but it is not so severe as in pneumonia, and the fever is not only slow in development, but fails to reach as high a point as in pneumonia, 102 to 103 degrees being ordinarily its height. The pain in the side is the most characteristic symptom. It is commonly lo- cated at the side of the chest a little below the PNEUMONIA^ ETC. I93 nipple. It may, however, occur at other points, at the back, in front, or even at some point in the abdomen. Appendicitis has more than once been diagnosed when the real trouble was pleurisy. This stage of pleurisy is known as dry or fibri- nous pleurisy, because the secretion of the pleura is comparatively dry and tenacious. In fortunate cases this is the extent of the disease, and recovery takes place promptly. Yet, even when it terminates at this stage, adhesions are liable to take place be- tween the two layers of pleura, the sticky, tenacious secretion takes on an organized structure binding lung surface to chest wall and a certain limitation of movement lasts through life. More commonly, after the dry stage has lasted a few days, the secretion becomes more liquid and copious. Fluid accumulates between the layers of the pleura and the stabbing pain ceases as the pleural layers are separated by the accumulating fluid. If much effusion takes place there is a noticeable bulg- ing of the chest wall, and breathing becomes diffi- cult because of pressure on the lungs. This is what is known as serofibrinous pleurisy, or pleurisy with effusion. After a variable time, a few days or two or three weeks, the fluid ^*s gradually absorbed, the other symptoms abate arid recovery takes place, but probably with more of adhesion between the pleural layers than in the usually more circumscribed dry or fibrinous pleurisy. 194 COLDS, COUGHS AND SORE THROATS. If this fluid instead of disappearing takes on a purulent form, that is, becomes largely changed to pus, or if in the first instance pus accumulates in- stead of serous fluid, we have a third and more serious form of pleurisy, known as empyema, or purulent pleurisy. If a physician is in attendance he may strap the chest to relieve the pain in the dry form. If the effusion is great in quantity in the second form he will probably tap it; that is, insert a hollow needle joined to a rubber tube, or to some apparatus de- signed to exercise pneumatic pressure in withdraw- ing the fluid. In the third form he will probably have to cut out a portion of one rib to withdraw the semisolid pus. In addition, he will give reme- dies to control the fever, use morphine for the pain, alleviate the cough and give whatever other medi- cation the case requires. If the case must be treated at home, a bandage may be drawn around the chest, partially restraining movement in respiration, but unless it surely ren- ders the patient more comfortable it had better be taken off. The patient naturally lies on the affected side in dry pleurisy, and usually on the sound side in pleurisy with effusion, and this he must be al- lowed to do. If the fever is high, cold sponging or bathing in tepid water, as may be most pleasant to the patient, may be resorted to. Plenty of cold water or lemonade must be supplied for drinking PNEUMONIA, ETC. I95 purposes, and if the pulse grows weak, give alcohol as in pneumonia. The diet must be largely liquid but nourishing, and whatever can be done to give the patient relief must be attended to. To summarize: In the case of such serious dis- eases as pneumonia and pleurisy, the great point is to be able to recognize them in their early stages. Then, having recognized them, there is but one thing to do : secure the best medical skill available. Only where this is an impossibility should home treatment be considered. Whenever very rapid respiration, fever and a high pulse occur in one individual, there is ground for suspecting the existence of lung trouble. If these symptoms come on with some degree of sud- denness, and especially if stabbing pain in the side accompanies them, the suspicion becomes almost a certainty, and a doctor should be sent for at once. Where a physician cannot be obtained, careful nursing is the most important thing. There should be plenty of fresh air without drafts or chilling, sunlight whenever it is agreeable to the patient, light bed clothes, and not too many of them, quiet restfulness for the invalid, very few others allowed in the room, and none at all save one nurse when- ever the patient can gain rest and sleep. Plenty of good cool water, lemonade or other thirst-allevi- ating drinks should be allowed the patient. The food should be light and nutritious in character, 196 COLDS, COUGHS AND SORE THROATS. and daintily prepared and served, little of it in the onset of a disease characterized by fever, and more and stronger diet as the fever subsides and appetite makes itself felt. Such care as this will often save where medical skill and application, without these home adjuncts, must surely fail. Slight precautions have often much effect in avoiding or preventing attacks of these diseases. Cleanliness of mouth and nose is important as a preventive measure. A little care in avoidance of exposure may save a dangerous illness, especially in the cases of children and elderly people. CHAPTER XIII. La Grippe or Influenza. This disease of many manifestations has also many names. Of these, perhaps la grippe, or the grip, is the commonest. It is also known as in- fluenza, epidemic catarrhal fever and catarrhal in- fluenza. In its commonest form it very much re- sembles a severe case of our familiar old cold in the head, nasal catarrh or coryza. The main differ- ence is that la grippe is so much worse, and in almost all instances extends to other parts of the upper respiratory tract so that cough, hoarseness, substernal pain and rawness, and often other symp- toms, so varied that no one description can apply to every case, are an almost invariable accompani- ment. An ordinary cold in the head is regarded as simply troublesome, whereas la grippe is often dangerous, sometimes fatal, and always depressing and exhausting. The authorities tell us that la grippe itself rarely proves fatal, but as they always add that the victim is quite likely to die of complications or sequelae, this is little consolation to the ordinary individual who doesn't care much whether his obituary reads "la grippe" or something else, and when the afore- 197 198 COLDS, COUGHS AND SORE THROATS. said individual does die it is hard for his friends to believe that la grippe should not be charged up with the damage. However, this does not affect the practical point, which is to avoid la grippe, or if that is impossible, so modify or ameliorate it that the victim does not die, either of it or something else for which it is responsible. La grippe is supposed to bear much the same relation to our domestic coryza that Asiatic cholera bears to cholera morbus. While it is believed that at some times and under some circumstances bac- teria may either cause or intensify either of the home-grown complaints, it is known that each of these malignant invaders from the East depends for its existence on the activity of a specific micro- organism, and also in each instance that the foreign visitant may be of much greater severity and danger than the domestic plague. La grippe, in its commonest form, resembles an intensified coryza with an inevitable extension to other parts of the upper respiratory tract. It sets in with a distinct chill, fever of loi to 104 degrees following. There are commonly severe muscular pains in legs and back, sometimes in all the mus- cles, headache is apt to be of great severity, ear- ache is common, and deep-set pain back of the eye- balls is supposed to be almost characteristic. Muscu- lar weakness and mental depression are so common and so marked that one eminent authority says, LA GRIPPE OR INFLUENZA. 1 99 "It is this striking feature of extreme mental and bodily depression and weakness which distinguishes true grippe from the ordinary catarrhal cold/' Se- vere sneezing comes on, the eyes are red and swollen and cannot tolerate light, cough, hoarseness and pain back of the breast-bone follow, and the pulse is weak and rapid. The fever may be of only two or three days' duration or may last for a week, two weeks or even longer. After it leaves, recovery, tedious and exasperatingly slow, commences. In other cases, as in coryza, sneezing, more severe than in the milder complaint, is the first symptom, followed by chilliness, fever, sore throat and cough, the latter so irritable and painful as to frequently prevent sleep. There are also other forms, the neu- ralgic commencing with intense headache and shooting pains; and an abdominal type marked by vomiting and diarrhoea, intestinal cramps and other symptoms in the region of the stomach and intes- tines, but in any form various symptoms properly belonging to some other type may manifest them- selves, so that la grippe may be and often is of so many and various symptoms that no description will fit every case, and it is rightly styled a disease of protean manifestations. La grippe in its severer forms is a disease of so much gravity, so prone to complications and unfor- tunate sequelae, ofttimes so refractory to treatment and so uncertain in its course and termination, that home treatment is hardly advisable- 200 COLDS^ COUGHS AND SORE THROATS. At the outset the same remedies should be used as for an ordinary coryza. Calomel and salts should be given to secure free bowel action ; a hot mustard foot bath to bring on free perspiration, and a glass of hot toddy or lemonade, finishing up the sweat between warm blankets, with a good d^ose of quinine and Dover's powders after getting into bed. Fre- quently these measures, if taken at the very begin- ning, will be effective and la grippe, robbed of his terrors, goes sulkily in search of a more heedless victim. To this extent we believe in home treat- ment. At this point, however, if the disease per- sists with any degree of severity, secure the best medical skill at command, and give the same care and attention as if dealing with typhoid, smallpox or yellow fever. If, however, from force of circumstances, home treatment must be continued, very much is possible. Of first importance is rest, as nearly absolute as can be secured, and it may almost be said that this is the greatest and most important part of the treat- ment. Add to this careful nursing and suitable diet and you have the three greatest points of home treatment. Drugs, however, must not be neglected Properly administered they are agents of great use- fulness, but — first, rest; second, careful nursing, and third, judiciously careful feeding; then drugs, few in number, given with full knowledge of what they are expected to accomplish — these comprise the domestic treatment of la grippe. LA GRIPPE OR INFLUENZA. 201 As in all other diseases where constipation is likely to prove troublesome, at least one good bowel movement should be secured daily. In grippe, how- ever, more care must be taken than in most diseases to guard against too much purgation, since this exhausts the strength, and to conserve all possible strength is one of the most important points in this markedly prostrating disease. After the initial dose of calomel and salts, some mild laxative must be chosen and the dosage carefully graduated to the case. Suppose one of the cascara cordials is the selected remedy. A teaspoonful being given the first night may produce too much purging. Then next night give half a teaspoonful, while if a tea- spoonful fails to produce sufficient results, one and a half teaspoonfuls may be given the next night, or a half spoonful given in the morning. Or sup- pose one of the tonic cathartic pills has been given without results. Then in the morning give another, or at night give two, or one and the half of another. To get exactly the proper dose, neither more or less, is worth all this attention, as the strength must not be reduced by any excess of purgation, and at the same time we want no retained poisons to weaken the vital forces and aid the disease. Salol may be given in five-grain tablets, or in the same dose in capsules, three or four times a day. This acts as an intestinal antiseptic and seems to be particularly useful in this disease. 202 COLDS, COUGHS AND SORE THROATS. If the fever is high, cold sponging is the most reHable remedy, and after the sponging the skin must in all cases be rubbed till dry and if possible in a glow. The after rubbing is of fully as much importance as the application of the cold water, and, if any large surface is involved, should never be neglected. If fever powders or other antipyretics are used it should be under the direction of a skilled physician, and they should be obtained and used under their proper names, as acetanilid, phenacetin, or whatever may be chosen. Thus used they are excellent, but to get some unknown combination of these powerful, and, if wrongly used, dangerous drugs and give without full knowledge as to their action is, to say the very least of it, injudicious to an extreme. Sweet spirits of niter is a very safe and mild fever remedy and a great favorite in many households. It may be given in teaspoon- ful doses to adults, repeated in an hour or two if necessary. A child a year old can take as much as five or ten drops, and for patients between these ages the dose should be modified proportionately. It should always be given in water. For the severe pains in the back and limbs any good liniment is beneficial. At night a Dover's powder may be given for the double purpose of relieving the pain and securing rest. As soon as the bowels are free and the fever is LA GRIPPE OR INFLUENZA. 2O3 subdued, tonics may be given. An excellent tonic mixture is composed of three drachms of the citrate of iron and quinia, four fluid drachms of the tinc- ture of nux vomica and simple elixir enough to make up a six-ounce mixture. Of this a teaspoon- ful, in water, after each meal, is the adult dose. Diet is a matter of great importance. For the first few days it should be as nearly liquid as possi- ble. If milk agrees with the patient he may almost live on it, and as time goes on and he desires change, broths may be added, and such preparations of milk and eggs as custards, junket, curds and whey and so on. Eggnog is fine when convalescing, and a solid diet may be gradually resumed. With treatment such as outlined above an ordi- nary and not too severe case of grippe should do well, but care must be taken not to hasten conva- lescence. It is better to remain in bed a day or two longer than necessary than to get up too soon, and after rising ordinary duties should be resumed only by degrees and in accordance with the return of strength. Tonic medication should be continued until re- covery is fully assured and for some time the patient must be careful of any unnecessary exposure or unusual exertion, always remembering that one at- tack, instead of conferring immunity, rather pre- disposes to another attack or to a relapse. If the nasal secretions are increased and the 204 COLDS, COUGHS AND SORE THROATS. mucous membranes swollen, the nose stuffed up and breathing interfered with, as is most likely to hap- pen, adrenalin sprays and albolene by a nebulizer should be used, as recommended in the treatment of coryza. For the irritative cough heroin hydro- chloride in one-twelfth-grain tablets may be taken three or more times a day. Or a tablespoon- ful of the compound tincture of benzoin may be dropped into a pitcher of boiling water and the steam inhaled by holding the face over the mouth of the pitcher and laying a towel over head, pitcher and all while the medicated steam is inhaled. These inhalations may last for from five to ten minutes at a time, and be repeated six or eight times in the course of the day. Care should be taken not to scald the face in the process. It is worth repeating here that a severe case of genuine grippe or influenza i§ not a disease for home treatment, and if the initial sweating fails to stop it, medical care should be secured if circum- stances allow it. If, however, one is fifty or a hundred miles from a doctor, or in other ways medical skill is unobtainable, home treatment may become a necessity and should be carried out as carefully as if a doctor were in charge, remember- ing that rest, careful nursing and suitable diet are at least half the battle and that what medicines are given should be given with a definite purpose, not simply to be doing something in the hope that it may prove good. LA GRIPPE OR INFLUENZA. 205 There is one admirable thing about this otherwise villainous disease — its approach is not insidious and stealthy; it advances like an invading army with blare of trumpets heralding its approach, and fair warning is given those who wish to fight or to flee. Frequently, in the severe epidemics, those whose means allow it send the aged and children to moun- tain and seaside resorts, out of the usual lines of travel, and this is a course to be commended. Those whose duties require them to face the disease can do much in the way of avoiding crowded halls, theaters, churches and lecture rooms, crowded cars or other conveyances, and restricting social inter- course in the height of the malady. Antiseptic sprays for mouth, throat, nose and even eyes are often used with some measure of success, and a lit- tle extra care of the general health and strength is very decidedly advisable. In many cases of what is probably true grippe, the symptoms are so slight as to amount to little or nothing more than a bad cold, and in many cases a common cold is called la grippe for no other reason than that it sounds a little more imposing. In such cases as these, if a common cold is of un- usual severity it will do no harm to treat it as a mild case of la grippe, and if true grippe is so mild as to amount to no more than a common cold, no harm is done if treatment is proportionately mild, but genuine old fashioned la grippe, characterized 206 COLDS^ COUGHS AND SORE THROATS. by prostration and extreme wretchedness from the start, with great and increasing weakness as it pro- ceeds, must always be looked on as a serious disease and worthy of the best skill and care that can be obtained. CHAPTER XIV. Hay Fever. Hay fever rejoices in a multitude of names, among which may be noted vaso-motor rhinitis, hay asthma, rose cold, rose fever, autumnal catarrh, catarrhus sestivus and ragweed fever. It is commonly claimed that this singular disease attacks only individuals of a neurotic or highly nervous temperament, and that this nervous tem- perament, together with a special susceptibility in the nerve endings of the nasal mucous membrane, are the principal predisposing causes. One very accurate observer, however, claims that some of the sufferers are individuals of originally placid tem- perament rendered neurotic solely by the keen dis- comfort of the disease, so there you are. ''You pays your money and you takes your choice,'' but, if you suffered as they do, no doubt your tempera- ment, no matter how placid at this moment, would quickly become as neurotic as theirs. Hay fever is a combination of coryza, grippe-like in its intensity, with the agonizing paroxysms of genuine asthma, and this mixture of two of the most painful ailments, each of full strength and as ready to do business as if the other partner were 207 208 COLDS, COUGHS AND SORE THROATS. absent, naturally renders the victims most wretched. That same accurate observer already quoted as to the neurotic temperament, further comments, 'The patient feels so wretched that he becomes extremely restless, irritable and melancholic, even, in rare cases, to the verge of suicide.'' The exciting cause is a mere external irritant, ordinarily the pollen or vegetable dust from roses, ragweed, golden-rod or other familiar every-day flower or weed. In certain individuals a somewhat similar condition is brought about by smoke, dust, fine air-borne particles of substances used in the arts and industries, or chemical fumes and odors. A remarkable feature is the extreme regularity of its annual recurrence. Frequently the patient can tell the very day of the month when the attack will commence, and in some cases where time and money are at command the attack is avoided by a sojourn at some mountain resort or other place where the exciting irritant is not found. A sea voyage always secures immunity and even after the seizure two or three days at sea will put an end to the distressing symptoms and the patient is again free from his incubus. Ordinarily an attack begins much like coryza. There may be a dryness of nasal membranes and conjunctivae, burning and itching, follow^ed by ex- cessive sneezing and a thin watery discharge from the nose, while the swollen and congested eyes HAY FEVER. 20g find some relief in an abundant tearfulness. At other times sneezing, incessant and long continued, is the first intimation, while again the patient may awake at night in the agonies of an asthmatic par- oxysm. After a few days of utter misery there may be a brief intermission, followed by a longer and even more severe exhibition of the same symp- toms, or the disease may run steadily on for from two or three to eight or ten weeks. The only absolute cure or preventive of hay fever, applicable to all cases, is, as already mentioned, a sea voyage, but there are numerous resorts in our own country where most cases find relief. Promi- nent among these are the Adirondacks, the moun- tainous region of western North Carolina, the White Mountains, the Green Mountains, and some of the lake resorts. Investigations having for their object the dis- covery of an anti-hay-fever serum, are being rapidly pushed and it is believed with a large measure of success. In the meantime the greatest relief may be obtained by the use of adrenalin chloride solu- tion, first cleansing the nasal passages with some mild alkaline solution, a little soda or boric acid dissolved in warm water, for instance. Follow this by the use of adrenalin solution as set forth in the article on coryza, not neglecting to follow with albolene by nebulizer, this being especially necessary here in order to protect the membranes from more of the original irritant. 2IO COLDS, COUGHS AND SORE THROATS. As defects or diseases of the respiratory passages are often a powerful factor in producing this dis- order, the nose and throat of every hay fever vic- tim should be carefully examined by an expert specialist, who may be able to detect and correct some formi of chronic rhinitis, one or more devi- ations or spurs of the septum, thickening or adhe- sions of portions of the nasal membranes, nasal polypi, or adenoids, the removal or correction of which will reduce the liability to this affection, or perhaps do away with it altogether. Whatever increases the general bodily vigor les- sens the liability to this disease, hence careful atten- tion to the laws of healthful living would seem peculiarly advisable for these sufferers. Tonic treatment for some wxeks or months before the expected time of attack sometimes gives it check- mate. Quinine in five-grain doses three times a day, beginning a month before the attack, sometimes succeeds, and under medical advice two to five drops of Fowler's solution three times a day for several weeks, will sometimes be effectual. For children the old stand-byes, codliver oil and the syrup of the iodide of iron are as good as anything that can be given. CHAPTER XV. Whooping Cough. (Pertussis.) This is an acute and very contagious disease, chiefly of childhood, and Hable to be found wher- ever children are. It takes its name from the peculiar long-drawn whoop which follows the par- oxysms of coughing when the disease is at its height. It occurs with greatest frequency in winter and early spring when children are gathered to- gether in school houses, which in cold and damp weather are tightly closed and vary in temperature from very chilly to much too warm. Instances are recorded (about a dozen cases all told) of its oc- curring the second time, but usually one attack protects, and this, combined with its being so very contagious, gives it the reputation of being a dis- ease of childhood. If any one really escapes in early years he is still susceptible to the disease, but mild attacks are not uncommon in which the characteristic whoop may not appear at all or not markedly enough to be recognized, and the fortu- nate subject of such an attack never knows the real cause of his immunity. Whooping cough and measles are so frequently associated with each other (usually the attack of 211 212 COLDS, COUGHS AND SORE THROATS. whooping cough following shortly after that of measles) that they are believed to be somehow related. Both diseases are believed to be of germ origin, but as the germs have not yet been surely detected in either case, their exact relationship can not be determined. The great danger in whooping cough lies in its preparing the way for other diseases, and, though it ranks very high as a cause of death in infancy and childhood, so high an authority as Dr. Hare says it is not in itself fatal, and if complications can be prevented the patients always get well. Broncho-pneumonia and pulmonary tuberculosis (consumption) are its most dreaded and commonly fatal complications, and the fact of its paving the way for these deadly diseases indicates very clearly the importance we should attach to whooping cough itself. General convulsions are a complication sometimes brought on by the severity of the par- oxysms of coughing, and this has resulted fatally. Whatever lowers vitality predisposes to whoop- ing cough, and its frequent occurrence after an at- tack of measles has already been referred to. The exciting cause is, of course, exposure to the con- tagion, that is, coming into contact with some one who has the disease, or with some article or person who has been so exposed. The period of incubation, which is the time elapsing between exposure and the beginning of the sickness, varies from two days to two weeks. WHOOPING COUGH. (PERTUSSIS.) 213 It usuall)^ commences like a mild cold in the head, with which cough is soon associated, or the cough may appear before the coryza, and in the early stages there is moderate fever as in any other cold. It may remain in this form, but with the cough increasing, for about two weeks, and during this time it is impossible to tell that it is anything more than an ordinary cough or cold, but as the number of coughs in a series increases, the effort to regain breath develops the whoop and the true character of the disease is known. At the beginning of the whooping stage two or three coughs may be all that occur in a paroxysm, and, aside from the following whoop, their only peculiarity is the suddenness with which the coughing spell bursts out, but the number in each series increases until twenty or more may follow in such rapid succession that the lungs are apparently emptied of air, giving rise to distress- ing symptoms of beginning suffocation and fol- lowed immediately by the spasmodic intake of air which causes the whoop. Sometimes the spasmodic effort to regain breath and the inrush of air which causes the whoop apparently excite a fresh attack, so that two or three series of coughs, each succeeded by the characteristic whoop, occur in quick succes- sion, or it might be described as one long series of coughs interrupted by several whoops. When vomiting follows, as it very often does, and the paroxysms are of much violence and very frequent, 214 COLDS, COUGHS AND SORE THROATS. it becomes a matter of great difficulty for food to be retained long enough to do any good, and death by starvation and exhaustion threatens. In addition, rest and sleep are almost impossible and the condition becomes very dangerous. As a rule but little matter is coughed up, but more follows in the vomiting and it is very sticky and tenacious. The severity of the paroxysms causes congestion of the blood vessels of the head, the face is deeply flushed, tears run from the eyes, and frequently small vessels in the mucous membrane of the nose are ruptured and nose-bleeding is added to the other symptoms. Ordinarily a small sore appears on the under surface of the tongue where it strikes the teeth in the coughing spells. In some of the rural districts whooping cough in the summer time is regarded as a matter of little consequence, and parents will intentionally expose their children to the disease in order that they may have it ''in a good time.'' The youngsters stay out of doors almost all of the day time, the doors and windows are all open at night, and ill results are, as a rule, neither expected nor encountered. The best possible treatment is largely indicated by this so-to-speak natural method. With an abundance of pure, fresh air and sunshine, nothing to excite or worry the patient, possibly some mild cough remedy and moderate doses of quinine, medical skill cannot much improve on it. But unless the WHOOPING COUGH. (PERTUSSIS.) 21 5 disease is mild in type and runs a favorable course a doctor should surely be secured. Sunshine and fresh air in abundance are consider- ed of prime importance in this disease, and if the weather is cold or inclement a large, well ventilated room must be made as near a substitute as possible. The temperature must be uniformly maintained at about seventy degrees, and the air kept moist by a constantly boiling kettle, or by dropping large lumps of unslaked lime in a pail or tub of water. If plenty of fresh air cannot be secured without drafts, the bronchitis tent should be used and the air kept moist by steam, as described in Chapter V. It is highly recommended that two rooms should be de- voted to the whooping cough patient, one to be used as a sleeping room, the other occupied during the day, each room being abundantly aired and ventilated while the other is occupied. If the sleep- ing room is liable to slight drafts, a mosquito bar over the bed will afford sufficient protection, and ventilation must be good. Diet should be light and nourishing. Where the paroxysms of coughing are close together and fol- lowed by vomiting, try a teaspoonful or two of milk after each paroxysm, keeping the little patient from gulping or swallowing in haste and avoid giving enough to provoke another fit of coughing. Custards, broths, a little wine whey, an egg so soft that it can be swallowed as a liquid, and other 2l6 COLDS, COUGHS AND SORE THROATS. articles of this character, must be used while the intensity of the disease remains, and as the cough- ing spells become fewer and farther apart, solider diet may be given. Of medicines directed to the cough, quinine, bella- donna, antipyrin and inhalations of chloroform are the most favored. Quinine may be given in the dose of one to one and a half grains for each year of the child's age up to five or six years, and this dose should be given three times a day, the first at six in the morning, the second at two in the afternoon and the third at ten at night. One or two grains of quinine dissolved in an ounce of water may be used as a spray, the nozzle of the atomizer being directed to all parts of the back of the mouth. It is believed that this treatment given to the other children of the household will prevent them from contracting the disease. It should be used every three or four hours. Hydrogen peroxide with an equal amount of glycerine and three or four times as much water, sprayed through the nose, is of benefit. The emulsion of asafoetida in the dose of a half teaspoonful every two hours is said to be very advantageous in relieving the coughing spells. Belladonna, antipyrin and chloroform should be used only under medical direction, as all are power- ful drugs and easily capable of doing harm. Chloroform is used by pouring a small quantity on WHOOPING COUGH. (PERTUSSIS.) 21 7 the back of the hand and bringing the hand under the child's nose during the paroxysm of coughing, or immediately before it, if, as often happens, the child feels that the attack is coming on. It should never be given in any other way unless a doctor be present to direct the operation, and if chloroform is needed the doctor is, too. Owing to the severity of whooping cough itself, and the great danger of fatal complications, a physi- cian should invariably have charge of the case, and home treatment should only be resorted to as a matter of necessity. Fresh air and sunshine should be secured in abundance if possible, but get- ting damp or chilled must be most carefully guarded against. If the patient must be kept indoors, secure fresh air anyhow, and let it be moistened by croup kettle, tea kettle, or pails of boiling water renewed as they cease to steam. Use the bronchitis tent if necessary to keep an equable temperature (about 70 degrees), and keep other children from the pa- tient until a week or two after the cough has ceased. Sometimes, however, the cough persists long after the disease is past, or it may return later on, being then known as '*the cough of habit.'' This cough, though sometimes very severe, is not considered dangerous, nor is there any risk of contagion. CHAPTER XVI. GENERAL TREATMENT. Constipation. Diarrhoea. While each of the different conditions included under the general heading ''Colds" has some dis- tinctive features of its own, yet some features are common to all, or nearly all forms, and in all forms require the same treatment both as regards medi- cine and the equally important matters of diet and general care. The treatment of these common features may well be grouped together, while the treatment that pertains only to particular ailments is appropriately considered in connection with the discussion of those particular ailments. As a rule, the first matter to be attended to in any form of cold or in any other disease, is the condition of the bowels, and constipation is such a constant attendant upon catarrhal inflammations (which are colds) that it is usually the point to which treatment should first be directed. It is al- most useless to attempt the removal of other disease conditions until this one is remedied. Not only does constipation interfere most seriously with the general nutrition, but poisons from the retained 218 CONSTIPATION. DIARRHOEA. 219 waste matters are carried into the blood current, while the clogged and sodden condition of the ali- mentary canal prevents absorption either of neces- sary nutriment or of medicinal remedies. Or if partial absorption does occur, the hoped-for bene- ficial results are neutralized in great degree by poisonous materials already held in the blood. What may be considered by the patient himself a very slight degree of constipation may be abundant- ly sufficient to defeat all attempted measures of relief, hence the first effort must be to clear out waste matters and put the digestive tract into a condition of healthful activity. Since the world began there have been various and sundry ways of doing the same thing, hence if any reader knows a better mode of overcoming constipation than the one herein given, there is no reason he should not use it. The point aimed at is simply to restore a condition of wholesome activi- ty in the alimentary canal. For the following method, suffice it to say that it has been followed for generations by physicians and by private indi- viduals as well, with almost invariably good results. So soon, therefore, as a condition of disease is recognized in which constipation is a factor, begin the use of calomel in divided doses, followed after a proper interval by a dose of salts. Calomel pills, powders or tablets of any desired size and prepared by the best manufacturing chemists in. the world 220 COLDS, COUGHS AND SORE THROATS. may be had of any good druggist. For an adult probably the best form is a compressed tablet con- taining from one-quarter to one-half grain of calo- mel and several times as much sodium bicarbonate, which is common baking soda, and aids the action of the calomel materially. Of these tablets, six should be taken, one at a dose, at intervals of from a half hour to an hour apart, the last dose being followed in three or four hours by a heaping table- spoonful of Epsom salts dissolved in a glass of warm water. If in three or four hours more the bowels do not move and move well, repeat the salts and continue to repeat every three or four hours until the proper action is produced. Rochelle salts or any of the effervescent saline laxatives, in corre- sponding dose, may be svibstituted for the Epsom salts if desired. With many people, a much smaller dose of the salts is amply sufficient. Whenever this is known to be the case, the smaller dose should be used. If the bowel evacuations are very dark, or much yellowness of the skin and whites of the eyes appears, or if the patient be robust and re- quires stronger dosage, a little podophyllin may well be added to the calomel and a tablet be used containing, say, one-quarter of a grain of calomel, one-twelfth grain of podophyllin and a little soda, six being used as before ; or give alternately a tablet of calomel and one of calomel and podophyllin combined. A very favorite mode in some of the CONSTIPATION. DIARRHOEA. 221 country districts is to take the calomel powders or tablets an hour apart, arranging for the last dose to fall at bedtime, and then the salts are taken the first thing on awakening in the morning. After the bowels have moved well an intestinal antiseptic should be given. The special indications for their use are, first and most marked, an un- usually offensive odor to the evacuations, and of almost equal importance, flatulence, abdominal dis- tention, rumbling and painful movements in the bowels and a general sense of uneasiness in this region. These symptoms all point to undue mi- crobic activity, and the intestinal antiseptics destroy this excess of bacterial life and neutralize their un- wholesome products. When the evacuations become of normal odor and consistency and abdominal distension and uneasiness cease, it indicates that sufficient of the antiseptic medicine has been taken, and the doses may be decreased in size or be taken at greater intervals. Sodium sulphocarbolate (preferably Merck's preparation) is a favorite anti- septic with many physicians, moderate in price, not too disagreeable in taste and very effective. Five to ten grains, or roughly, what may be made to lie on a silver dime, is a fair adult dose, which should be taken every two hours for the first five or six doses, then three or four times a day, after meals and at bedtime, say, but the effect must be noted and dosage governed accordingly. In cases 222 COLDS, COUGHS AND SORE THROATS. of tonsillitis and some other forms of sore throat, and where there is a rheumatic tendency, salol is an intestinal antiseptic which seems to be specially indicated and to have a peculiarly good effect. Salol can be bought in tablet form, and a five-grain tablet makes a good dose, to be taken at the same intervals as indicated for the sodium sulphocarbo- late. There are a number of good intestinal anti- septics put out by reliable manufacturers, with formulas and directions on the packages, all of which have the same effect of removing any excess of ill odor from the evacuations and of restoring them to proper consistency, also of relieving in- testinal distress and distension. The initial constipation being overcome, a proper freedom of the bowels must be maintained. At least one free evacuation from the bowels should be assured each twenty-four hours, and with many people, especially during sickness, two movements seem to be required. Too free purgation, how- ever, must be guarded against, as it is weakening, and in exhausting diseases, as la grippe or diph- theria, might easily become serious. Taking all things into consideration, cascara sagrada is probably the best known medicine for insuring proper freedom of the bowels. It rare- ly gripes, but moves the bowels easily and naturally. Far from inducing a drug habit, it is a genuine tonic, the necessary dose having to be gradually diminish- CONSTIPATION. DIARRHOEA, 223 ed from the fact that the digestive organs are strengthened and toned up by its use. There is much Hberty of choice as to the cascara preparation to be used. It may be soHd or Hquid, of bitter taste or of pleasant flavor, a cordial, an extract, a tablet or a pill, and if prepared by a reliable firm the effect will be the same. To most people the tablet form will be the m.ore convenient, and three to five-grain tablets of the solid extract, plain, sugar or chocolate coated, are as handy as a pocket in a shirt. One to two of the three-grain tablets makes the usual dose for an adult, and a tablet can be cut up so as to make doses of any size. For an infant of one year, one of the three- grain tablets may be cut into twelve equal parts, one or two of which will make the proper dose. A good cascara cordial, however, is preferable for the little ones. The usual dose of the cordial is a half to a whole teaspoonful for an adult and from three to five drops for a one-year-old child. Most of the preparations give the proper doses for differ- ent ages on the label or wrapper. Having chosen the preparation, it is a matter of much importance to find the smallest dose that will produce the full effect desired. After this minimum quantity has been ascertained by careful and repeated trials, the dose should be kept at or near that point until its tonic effect allows a reduc- tion of the dose with equally good results. Suppose 224 COLDS^ COUGHS AND SORE THROATS. the solid extract is chosen and a three-grain tablet is taken the first night. If the results are thoroughly satisfactory, consider that the proper dose. If one tablet is not sufficient, take a tablet and a half the next night; while if too active, try three-quarters or a half tablet, and so on until the proper dose is found. An hour or two after supper or on going to bed is the time usually selected for taking these medicines. If, on any particular day, a free bowel movement does not take place at the proper time, a small dose of salts may be given to help matters along, or, what is probably better under such con- ditions, an enema should be administered. Then the next dose of the regular laxative should be somewhat increased. There is a class of laxative or cathartic pills, consisting mainly, sometimes entirely of aloin, strychnine and belladonna, which have this same tonic effect on the digestive organs so that the dose may be gradually decreased and finally abolished. As they are very small, easily carried and easily taken, they may be preferred by those who are not ill enough to remain in bed, while others may find them better adapted to their individual wants than the cascara preparations. They are to be found in all drug stores and the formula with full directions for use is on each package. For children suffering with constipation it is often considered better to begin medication with a tea- CONSTIPATION. DIARRHOEA. 225 Spoonful or two of castor oil, repeated in four or five hours if the first dose does not take effect, after which one of the cascara cordials is a very agreeable medicine to keep up free action of the bowels. Castor oil itself cannot be used for any length of time, as after the first cathartic effect, it has a decided tendency to cause constipation. For very small children, olive oil is a mild, safe and pleasant laxative, given in teaspoonful doses as often as may be necessary. It acts well with adults in the dose of a half ounce to an ounce. The com- pound licorice powder is another efficient child's laxative, and owing to its pleasant taste is very easily administered. From a quarter to a half tea- spoonful is usually sufficient. A small glycerine suppository, such as can be found in any drug store, often acts well with a child, or a suppository formed from a small piece of Castile, or other bland soap, will accomplish the same object. Very often constipation, whether in adults or children, is of mild type, only requiring one or two doses of some simple laxative to remedy the condi- tion. In such cases almost any of the remedies named are sufficient to give relief. The good old seidlitz powder is a favorite with many; others may prefer Epsom salts or some of the effervescent salines ; still others calomel followed by salts, and yet others a cascara tablet or a dose of one of the cascara cordials. 226 COLDS, COUGHS AND SORE THROATS. f But suppose that diarrhoea rather than consti- pation is the trouble. Even here, in cases mild enough to justify home treatment, it is a good plan to commence treatment by a good big dose of castor oil, which often removes the cause of diarrhoea by sweeping irritating substances out of the intestines. Castor oil is chosen because, after its primary cathartic effect, it is constipating, and if for an adult a drop or two of laudanum be added to the dose, it aids the effect and also checks griping, to which castor oil is prone. If diarrhoea still persists, teaspoonful doses of blackberry brandy or of blackberry cordial given after each movement of the bowels will usually end it very quickly, and care is necessary lest too much be given and the opposite condition be induced. When no source of bowel irritation exists, paregoric will usually check any mild case of diarrhoea. One to two drops is a sufficient dose for an infant, five or ten drops for an older child, say up to ten years of age, and a teaspoonful or two for an adult. While the use of paregoric or any other compound of opium to quiet fretfulness or put a child to sleep cannot be too strongly condemned, its careful use in the treatment of diarrhoea is perfectly admissible. CHAPTER XVII. GENERAL TREATMENT. Fever. Fever, in greater or less degree, is a symptom of so much frequency in the first stages of acute res- piratory diseases, that a few words as to its home treatment will not be out of place. As fever is characterized by high temperature, hot, dry skin, and much thirst, it would seem no more than ordinary common sense to combat it with low temperature, cool or cold applications to the external body and plenty of cool water to drink, and, guarding against the excessive or improper use of these remedies, the deduction is strictly cor- rect. Strange as it may appear, for long, long years this most rational and natural method of meeting fever was considered wholly wrong, and there is no doubt that many thousands of fever patients died in the horrible torments of thirst, while the few drops of cold water that would have eased their sufferings and saved their lives were refused them, in some instances even snatched from their eager hands by their dearest friends, acting, ^ as they be- 228 COLDS^ COUGHS AND SORE THROATS. lieved, under the soundest medical advice. It is pleasant to record the fact that in a number of cases some fond, weak mother or silly, affectionate old colored aunty, or other relative or acquaintance, unable to bear the sight of such keen and easily alleviated suffering, secretly supplied the forbidden fluid and saved the patient's life. In other cases water was stealthily obtained by the patient him- self, and in yet others some cross-grained, hard- headed old sinner refused to sacrifice common sense to the dictum of medical science and obstinately in- sisted that a thirsty man must drink, so again the torture ended and the victim lived. Finally such a mass of evidence accumulated along these lines that so-called science had to give way to facts, and water was no longer an unattainable luxury to those who needed it most. How often, then, should a fever patient be given water? As often as he asks for it. In some cases, indeed, as where a patient lies in apathy or stupor, not realizing either hunger or thirst, it must be given as a matter of routine, just as food is given in such conditions. Sometimes a fever patient will call almost ceaselessly for cold water and drink it in huge gulps if allowed, but this is so easily reme- died that it is only mentioned in passing. Large draughts of very cold water may do much harm, but small and frequent drinks will not, and these should be given whenever asked for. The colder FEVER. 229 the water the smaller the quantity at one time, and in case of a peevish child who seems to be calling for water more as an expression of fretfulness than from real need, a teaspoonful at a time will often satisfy as quickly as if tumblerfuls were given. For adults and children old enough to refrain from swallowing it, small lumps of ice held in the mouth and sucked or allowed to dissolve, will sometimes relieve more quickly and completely than a much greater quantity of water. Sponging arms, face and chest with cool or cold water often reduces thirst to a considerable degree, and a towel wrung out of cold water and applied to the forehead, re- newed as it becomes warm, will markedly alleviate a feverish headache and favorably influence the fever itself. A few good sour lemon drops to a child, or ice cold lemonade to child or adult, sipped, not gulped, will often prove refreshing and grate- ful. When the throat is persistently dry and the tongue parched, glycerine and water in equal parts make a cleansing and refreshing mouth wash and gargle, and if the teeth and gums are rubbed with a soft cloth moistened with this mixture it will keep the mouth in far better shape and the breath from foulness to some degree. A little lemon juice added to the above mixture is an improvement. In this condition, also, the homely expedients of chewing gum, slippery elm bark and kindred substances often ■give marked relief. 230 COLDS^ COUGHS AND SORE THROATS. Usually when water is spoken of as a fever remedy, its external use is intended, and here it is indeed ''A helper in the time of need/' When the temperature gets into the neighborhood of the dan- ger point, say above 105 degrees, cold water is the one reliable remedy, and even where the fever may be controlled by drugs it is as certainly combated by this every-day necessity. One point should never be overlooked ; whenever the entire body, or a large part of it, has the tem- perature suddenly reduced, as by the use of cold water, it should be immediately followed by ener- getic friction, as rubbing with a coarse towel or its equivalent, until the skin is again brought to a healthful glow. In cases of fevered headache with congested eyes that seem to burn in their sockets, and also in the highly inflamed joints of acute articular rheumatism, cold water may be applied by means of a compress (a towel or similar article folded to proper size) wrung out of cold water and constantly renewed as it becomes warm, and no subsequent rubbing is considered necessary, but these are limited areas, and sudden chilling of any large portion must be quickly succeeded by vigorous rubbing to restore the normal tone. The rubbing is perhaps the more necessary part of the bath, as the cold water drives the blood to the internal parts that receive no such cooling application, and the circulation must be restored to the external parts FEVER. 231 and the reduction of temperature equalized if we expect the best results. Suppose the patient is too weak to render it ad- visable for him to leave the bed or himself under- take the bath, what then? Take a basin or pail of cold water, as cold as he can stand it without dis- comfort, and with a sponge or towel, not wet enough to allow water to drop or run about, but damp enough to insure water coming into contact with every part of the body subjected to its action, go over the arms, chest, neck and front of the body, rubbing with a dry towel as each part is bathed until the skin is again normally warm and in a healthful glow. Then, rolling him gently over, repeat the process on the remainder of the body. Give at least twice the amount of bathing along the back that the rest of the body receives with a corresponding amount of towel work afterwards, in order that the large muscles, thick skin and deep-seated blood ves- sels found in this location may have a fair share of the beneficial process. After bringing the skin to the required warmth and glow, the patient will enjoy a season of comparative rest and comfort and very likely a refreshing sleep. If only the arms and along the spine can be attended to in this fash- ion at one time, it is so much to the good, and other parts can be bathed at another time. If a patient is too weak or too delicate to stand cool or cold water he may be sponged^ with luke- 232 COLDS^ COUGHS AND SORE THROATS. warm water, or better, water and alcohol in equal parts, and as in this case there is little chilling the vigorous rubbing is not necessary. This is a splen- did form of bath when the patient is restless, fever- ish and cannot sleep, and will often secure an entire night's refreshing slumber. Lukewarm water and alcohol in equal parts also makes the proper bath for a fevered baby, but if alcohol cannot be obtained the water must needs answer, or it may have a little salt dissolved in it. Sweet spirits of niter (spiritus setheris nitrosi) is one of the safest medicinal remedies for fever, but is nevertheless of great value. For adults a half or even a whole teaspoonful at a dose is not too much. It should be given in hot water or lemonade, and the patient kept warmly covered until perspiration occurs. If necessary the dose may be repeated in two or three hours until the fever is broken up. For a child of one year, three or four drops may be given in cool water and re- peated every two or three hours while the fever lasts. A favorite method of administration to children in country neighborhoods is to put ten drops in a tumblerful of water and give a teaspoon- ful every hour. Even this small dose proves bene- ficial, and when a good dose of castor oil is also administered a mild fever often yields. Among medicinal remedies for fever probably nothing compares with aconite, but it requires con- FEVER. 233 siderable medical knowledge for its proper use and should not be handled unless thoroughly understood. 'Tever powders/' as too often used in the house- hold, are a thousand times more dangerous than aconite, and untold harm is done by their injudi- cious administration. That they will ordinarily re- duce fever quickly and completely is undoubtedly true; that they may and often do kill the patient is every whit as certain, and their home use, merely to allay fever and restlessness and without any knowledge of their further action, cannot be too strongly condemned. The drugs of which they are usually composed are valuable medicines if rightly used; otherwise a tame rattlesnake is a far safer and less objectionable adjunct to the sick room. A cool, well ventilated room is a necessity in fever, and though drafts or much wind must be avoided, the more fresh air the better. In summer time, or at other times if temperature allows, a tent with the sides raised so as to admit a great abundance of fresh air while shielding from winds and too much sunshine, is the best possible arrange- ment. Warm and stuffy bedding is to be avoided. A feather bed is an abomination. The mattress should be neither hard nor soft, and the pillows for the head rather hard, while several soft, light pillows to place about in such wise as to support the weight of different parts of the body in different postures 234 COLDS, COUGHS AND SORE THROATS. add much to rest and comfort. The best coverings are thin, Hght blankets, with heavier coverings to be used when a tent is occupied and nights are cold. Diet rules in fever are much the same as in all disease ; very little and that liquid at the start, and from that grade up to solid food again as recovery progresses. Slow or protracted fevers form an ex- ception. In these food must often be given when appetite is absent, and much care and skill are need- ed to adapt diet to the needs of the case, to aid digestion and to conserve and increase the patient's strength. PART III.— Hygiene. CHAPTER XVni. Fresh Air and Sunshine. That a few chapters on hygiene, or the science of health, should be included in a work on colds, coughs and sore throats, needs no apology and but little explanation. The most satisfactory and abso- lute preventive of all diseases of this character is a good strong constitution, and a continued condition of good health, such as is only attainable by con- formity to the rules of hygiene. The value of good health is universally recog- nized. A thoroughly healthy man or woman can hardly be unhappy ; a thoroughly unhealthy one can hardly be happy under any conditions. And health is largely a matter that is in our own keeping. The world was made for man to live in, and all things necessary for healthful living are furnished in abundance. It is our place to know how to obtain and properly use what has already been created for that especial purpose. Hygiene, the science of the care and preservation 235 236 COLDS, COUGHS AND SORE THROATS. of the health, should be properly taught in every primary school. More than that, it should be taught in the home before the child is old enough to go to school. Every man, woman and child should have at least a general knowledge of the laws of health, and how to apply them. Houses, schools, factories, offices, and all other buildings intended for the use of men, should be constructed with due regard for healthfulness. Food should be chosen and prepared with a view to obtaining health and strength from its use, and in all things, the vitally important matter of health should be taken into consideration. As things are, hygiene, often of a very poor and impracticable brand, is taught in a small percentage of the primary schools. In the home, very fre- quently, it is not taught at all. Most of our Ameri- can citizens do know enough to come in out of the rain, but many of them do not know enough to go out into the fresh air and sunshine. Houses are built to hold the greatest number of people in the smallest amount of space, and in the cities, build- ings intended for homes so crowd each other that a small dooryard is a luxury, while a dwelling house with free access of air on every side marks the residence of a man of wealth. If clothing *'looks weir' on a man, or is ''pretty'' on a woman, it fulfills its mission, and food is procured to tempt the appetite rather than to minister to health and strength. FRESH AIR AND SUNSHINE. 237 Lest this picture seem too gloomy, let us add that matters in regard to hygiene are in far better condition now than fifty years ago. At this present time more attention is given to healthfulness than at any previous period of our history, and, in this respect at least, the world is steadily growing better. Two of the prime requisites of healthful living are fresh air and sunshine. Nature furnishes them in inexhaustible abundance, yet thousands pine and die and countless millions suffer for want of their own small share of the unlimited oceans of sunshine and fresh air that are all around us. The history of many a noisome dungeon cell bears silent wit- ness to the fact that life can be maintained for long years without these necessities, but healthful human life is not possible under such conditions for any time at all. A human being ought to have pure, fresh air during twenty-four hours of every day he lives. If it is out of his power to have fresh air for twenty-four hours, then let him have it for as many hours as it is possible. If, as is the case with many who dwell in cities, fresh air is only a comparative term, and the choice is between pollu- ted air and air less polluted, that which is less objectionable should be chosen for just as large a proportion of the time as circumstances will allow. A very important point, and one that is by far too frequently neglected, is to get the full benefit of what air is at our disposal. If the shoulders 238 COLDS, COUGHS AND SORE THROATS. droop and the chest is narrow and contracted, the lung capacity is necessarily less than Nature intend- ed, arid vigorous physical life becomes, to most of us, an impossibility. An upright bodily carriage, and well developed chests and lungs, are not as yet among our national characteristics. The right time to establish correct habits in this respect is during the growing years of childhood and youth, and there are few points in the training of young people that deserve more attention than this. Let the child be taught to sit and stand erect, and to breathe deeply and fully, expanding the lungs properly and thoroughly oxygenating the blood. Encourage the healthful sports of childhood and youth that tend to such habits ; also the breathing exercises and calisthenics that are fortunately in- cluded in the curriculum of many of the lower grade schools. All teachers, from those of primary grades to college professors should understand this matter fully, make a point of proper bodily carriage, and reprove for unhealthful and slouchy positions of the body more promptly than for failure in recita- tions. If any child, or older student of either sex, is really too weak to hold the body properly erect, that one is surely too weak to be confined in the school room at all. The long hours of labor in factories and kindred institutions to which some children are subjected are a blot upon civilization and cannot l)e reprehended too strongly. Correct FRESH AIR AND SUNSHINE. 239 physical development is an impossibility under such conditions, and the only remedy is to put a stop to all such abuses by the strong arm of the law, reinforced by the vastly more potent force of in- dignant public opinion. But even grown people, and those well advanced in years, can do much to aid Nature. Regular periods of deep, full breathing, indulged in once or twice daily, will increase the chest capacity and do much to establish better habits of breathing all through the day, and it is never too late to make some improvement in the carriage and habitual position of the body. Dwellers in the country can, as a rule, secure pure, fresh air in abundance. They are, however, great sinners in the matter of closed bedroom win- dows. Why any one should wish to shut out healthful, sweet and wholesome air, and sleep un- easily in a polluted atmosphere is a puzzle for the psychologists; it is too much for the medical men. The old superstition that night air is poison- ous may have something to do with it, or it may date back to days when the powers of evil were believed to prowl at night and to find open windows more convenient than key holes. If any one really dreads the night air, let him experiment with a small quantity, lowering a window from the top ever so slightly at first, and gradually allowing more fresh air to enter as he finds it not only harm- 240 COLDS, COUGHS AND SORE THROATS. less but wholesome and very pleasant. Or if drafts be feared, slip a small plank beneath the bottom sash of each window, thus separating the sashes and allowing a certain amount of fresh air to enter without the possibility of a draft. Or, what is still better, have a false sash, in which some light cloth replaces the glass, made to fill at least one- fourth of the window space, and raise the lower sash to give the false one place. Either of these devices may be used for ventilation during the day- time, and are especially useful in cold weather or in dusty localities. On rising in the morning it is always a good plan to set every door and window of the sleeping room widely open, for a few minutes at any rate. This usually secures a complete change of air and freshens things up wonderfully. And if any' of our lady friends wish to keep a few flowers in the sleeping room, do not let any idea that such is an unhealthful procedure deter them from it. The contrary is rather the case. Women in the country suffer from poor venti- lation and bad air much more than the men. Their work is largely indoors, and country houses are sometimes far from perfect as regards ventilation and the sanitary condition of their surroundings. In building new houses in the farming country, the opportunity to secure proper ventilation and satis- factory sanitary conditions is too good to be lost. FRESH AIR AND SUNSHINE. 24I Under such circumstances these objects should never be lost sight of. Houses already constructed can often be made much brighter and more wholesome by slight alter- ations. Perhaps one or two extra windows will admit a flood of sunlight and an abundance of fresh air to some room or rooms that have heretofore been close and dark. Or a porch may be added to the house, making a delightful open-air place for the performance of much of the work of the house- hold. Of course unsanitary surroundings should be modified as thoroughly as possible wherever they exist. A little ditching may drain some unhealthful pool of standing water. Considerable labor and much drain pipe can be very profitably expended in rendering a damp, musty cellar dry and sweet. Ill-smelling swill pails can be replaced by galvan- ized iron pails, emptied and scalded often enough to keep them reasonably clean, and a small, easily constructed trough will carry the drip from the well spout and prevent an unsightly and unsanitary pud- dle at that point. Then, about the barns and stables, a small amount of work will often make a wonderful difference in cleanliness and purity. The too common foul-odor- ed, muddy hog pen should not be tolerated one day longer than will suffice to replace it. Plenty of yard room and a shed with boarded floor and straw or waste hay for bedding for the pigs will pay 242 COLDS, COUGHS AND SORE THROATS. many times their cost in healthfulness to the entire neighborhood, and in the thrift of the animals themselves. That horses and cattle should be forced to stand and sleep in filth is a disgrace, even to our very imperfect civilization. Not only does it give rise to unhealthful conditions in a place where much of the daily work must be performed, but where the family or neighborhood supply of milk comes from cows so stabled, the farmer, his family and his customers will infallibly swallow a portion of the stall contents. Of sunshine, the men of the farm often get en- tirely too much ; the women, sometimes a sufficiency. To work hard for from ten to fourteen hours a day, exposed to the burning sun for the larger part of a July day is a severe trial to the strongest man. The negro farmers who work in the early morning, sleep or loaf through the hottest part of the day, and then work through the evening, and in some cases well into the night, show a better appreciation of their environment than the thrifty white man, who perhaps loses several weeks of the busiest season from sunstroke or some fevered con- dition brought on by overmuch exposure. But the heat in many a farm kitchen is worse in summer time than that of the hottest field. Fre- quently it is the hottest part of the house, even without the fire, and in the warmer portion of the year becomes simply unendurable. A summer FRESH AIR AND SUNSHINE. 243 kitchen, entirely separate from the main house, thoroughly ventilated, and if possible, set in the shade of trees, will often give the farmer's wife a new lease of life, while some farmers' wives have simply put their stoves and cooking utensils under the trees in summer, with no other protection. This is far better than remaining indoors, but it is ad- visable to have some sort of roof or canopy in case of rain. It is a great pity that the benefits of tent life are not more appreciated and enjoyed by those who have an opportunity for such luxuries. Where an old fashioned house with few and small windows will be close and stuffy in spite of all available ventilation, a tent will give cool, refreshing slumber, and, during the day time, with sides raised, will make an almost ideal place for sewing, preparing meals, and a number of household duties, too often performed in close, hot quarters. The fact that many an invalid has entered upon a rapid and permanent convalescence immediately after exchanging a bed room for a tent, proves conclusively its healthfulness. But in fine weather, where good shade trees are available, no tent is needed. A table or two, a few chairs, a set of shelves or a locker or two to accommodate the arrangements for domestic work, offer fresh air advantages that can hardly be surpassed, and the tiniest toddlers can play about in the fullest enjoy- 244 COLDS^ COUGHS AND SORE THROATS. ment of out-of-doors life, and yet be under the mother's watchful care while she performs her household duties. If trees do not already grow about the house, they should certainly be planted. Those of rapid growth will yield shade enough for much enjoy- ment in the course of a very few years, and slower growing varieties can gradually add their propor- tion of comfort and beauty. If, on the other hand, trees and shrubbery so encompass the house that sunlight and fresh air are largely excluded, a part should certainly be removed. It is far easier to cut down a tree or shrub than to grow one, but that furnishes no valid reason for allowing the home to stand in what is practically a gloomy thicket, as is sometimes the case. That abomination of modern civilization, the combined bath room and water closet, supplying the only facilities of the kind, cannot be too severely condemned. Where other closet arrangements are accessible to every one in the house there are no objections to such a room, but only under such circumstances should it be tolerated at all. There are certain necessary functions of physical life that must be attended to promptly when need arises, and if through lack of conveniences they are post- poned for varying and indefinite periods of time, it is surely at the expense of health and comfort. Notwithstanding this fact, the convenience of hot FRESH AIR AND SUNSHINE. 245 and cold water at will, and the good, large, auto- matically emptying tub of the bath room is some- times too great for a busy female to resist, and such an one will carry through a good sized washing in this place, taking perhaps several consecutive hours for its completion. Usually in a household where this occurs there are no other toilet accom- modations and the proper uses of the bath room are suspended meanwhile. Or perhaps some self- indulgent member of the family will occupy it for nearly as long a time in an indolently luxurious bath. Frequently it is used by the men of the household for a shaving parlor and general dress- ing room, and the children in a crowded boarding house will not seldom hold the bath room each for the other until every mother's son (and daughter) of them all has had the weekly bath. No comment is necessary. The closet arrangements found in the country are ''just tolable'' — neither very good nor yet very bad. Very often they can be made vastly better by a little thought and exertion. They should always be set well away from the water supply, and an excavation is not an essential. An abundance of dry road dust, sifted ashes or other absorbent ma- terial should be kept at hand, and by its regular and liberal use the contents of the closet can be kept odorless and dry, and in this condition can be easily hauled off to some field or out-lot at proper intervals. 246 COLDS, COUGHS AND SORE THROATS. A bath room, or at least a room that can be used for bathing purposes, should be an adjunct to every house, whether in the city or country. Where the usual bath room is not possible a small room can be set aside for this purpose, and yet remain of much use for other purposes. In the country a separate building, large enough for this purpose, can be erected at small cost. It should contain a stove, kettle or other device for heating water, a set of shelves or other arrangement for clothing, towels, etc., and as large and convenient a tub as circumstances allow. In the cities the problem of securing fresh air and sunshine is a vastly more complex one than it is in the country. Parks for grown people and babies are, however, far more plentiful than they were forty years ago. And the younger people of both sexes boat and bathe, play golf, bicycle and in various other ways secure out-of-doors exercise, with its accompaniments of fresh air and sunshine. Suburban homes are more plentiful than ever before and steady improvement in transportation facilities causes corresponding increase of this mode of life. Summer vacations are a rule in modern life to an extent unheard of forty years ago, and all along the line there is a tendency to appreciate and enjoy these out-of-doors advantages that bodes well for the future. The huddling together of city dwellings is an FRESH AIR AND SUNSHINE. 247 evil of great magnitude and one that will be hard to overcome. ''God made the country, man the town/' shows forth in this respect most glaringly. Until our entire population is educated to an extent as yet undreamed of, houses will probably be built chock-a-block, human beings will continue to occupy den-like rooms, and the problem of sufficient sun- shine and fresh air will continue to be the hardest that confronts the inhabitant of a city. And to each of you, ye poor cooped up dwellers in the cells of civilization, the problem becomes a personal one. Each individual must secure for himself and for those dependent on him as much of the wonderful blessings of sunlight and fresh air as circumstances allow and his knowledge of their importance de- mands. Whenever practicable the city worker should se- cure a suburban home. For you to whom the sub- urban life is an impossibility — window ventilation of offices and bed rooms, a rustic seat in the hand's- breadth dooryard, a stroll on the street or in a city park, occasional outings and excursions, and what- ever vacation can be secured, spent in the most healthful country you can get to — these and what- ever else of out-of-door advantages you are able to obtain, must satisfy your soul, and may health and good fortune attend you in spite of your lack of the best that life can of¥er. CHAPTER XIX. The Food We Eat. Of the different varieties of food, we need at least four. Breadstuffs, meats, vegetables and fruits should all enter into a healthful and well regulated diet. Eggs, milk, butter and cheese would of course come into such a list under the heading of meats. As to the best articles of diet for each individual, and likewise as to the quantities that should be eaten, each individual must be himself the judge. No person with a reasonable degree of intelligence can fail to note the fact that certain foods agree with him better than others. Carry this sort • of observation further so that you will find out defi- nitely all along the line what articles give best re- sults in health and strength, and then apply the facts so ascertained to the selection and use of food stuffs, and no book or scientist in the world can give you one-half as good directions as you can formu- late for yourself. For children, of course, the parents should exer- cise this care and judgment. The young of the human race are more directly under their parents' observation and guidance than is the case with any other kind of animal, and it is self evident that on 248 THE FOOD WE EAT. 249 the parents falls the responsibility until the children arrive at years of discretion. A few general principles, however, can be laid down. The man who is performing hard physical labor requires more and heartier food than he whose work is at a desk, and his digestion is correspondingly more active. The man who sits at a desk for from six to eight hours a day must choose a lighter and more easily digestible diet than his sturdier brother of the fields or woods, and even then he must take some amount of vigorous exer- cise if he wishes to maintain any degree of health. Growing children, like all other young animals, take much exercise and never lack for appetite. A little food midway between meals is not likely to hurt the healthy child, especially if it be of simple character, as a slice of bread and butter. As much cannot, however, be said of the continual ^^piecing'' in which some children are indulged, which cannot fail to be harmful, especially when the food so eaten between meals consists mainly of sweetmeats, cakes, pickles, or other somewhat doubtful articles, as is frequently the case. Milk is a grand article of diet for growing children and one that they usually appreciate. Good wheat bread with butter is also a standard, and continues to be so all through life. Corn bread and corn meal mush, oatmeal once in a while, and the various excellent breakfast foods, give abundant variety in breadstuffs. 250 COLDS, COUGHS AND SORE THROATS. Of meats growing children should not eat too heavily, and they are better off without coffee or tea. Vegetables they should have in plenty, and fruit should always be at command. Throughout the summer time fresh fruits of whatever varieties are in season should be supplied them. In winter baked apples with a little cream is one of the best fruit dishes, though many others are excellent. The child's taste should not be totally disregarded, neither should too much weight be given to whim- sical fancies. If a child manifests a strong and persistent aversion to any particular article of food it is downright cruelty to force it on him, and may have harmful results. There is an old but a good story of a small boy whose kind old aunt, under the idea of proper train- ing, forced him to eat whatever he particularly dis- liked. She explained that he might be where such articles were on the table and it would be impolite to refuse them. One morning on turning her plate over she was horrified to discover a small dead mouse. In reply to her indignant demand for an explana- tion, the small boy gravely responded that she might some day find herself in China, where, as both of them devoutly believed, dead rats and mice were eaten raw, and therefore she should accustom her- self to this form of dainty. Whether the good lady had sense enough to make the application the story does not record, but it is to be hoped she saw the THE FOOD WE EAT. 25 1 point and respected the child's prejudices to a rea- sonable extent thereafter. Children are so thor- oughly under the care and constant notice of their parents that if watchful and intelligent observation is given in regard to diet, it would seem impossible to err to any great extent. Their food should be simple, nourishing and appetizing. Further than that, the individual peculiarities and needs of the child should determine the character of his food. Healthful children, enjoying plenty of out-of-doors exercise, are not usually hard to suit, and it is worth much trouble to insure them healthful food. With grown people, occupation is one of the greatest determining factors as to the character of their diet. An office worker may find a cup of coffee, or some substitute therefor if he chooses, a dish of any one of the excellent breakfast foods, with cream or rich milk, an egg and a small slice of bacon, an abundance. The man who chopped a cord of wood yesterday and expects to do still better today will want two or three cups of coffee (better if he drank milk), considerably more of meat, plenty of good wheat or corn bread with butter, and a plate of potatoes. There is enough of food and enough of variety to suit every taste and every need, but each indi- vidual must be the judge of what and how much is proper for his own individual requirements. A little intelligent observation will soon put a man 252 COLDS, COUGHS AND SORE THROATS. on the right track, and continuance of the same process will enable him to eat for health and strength with a fair measure of success. There is, however, in modern civilization, a great tendency to multiply dishes — to serve a dozen or more different foods at a single meal, sometimes thereby disguising poor quality and poor cooking by multiplicity of tastes and flavors. Bread, and if desired some other form of cereal food, good butter, one kind of good meat, one or two vege- tables and one simple dessert — is not this enough for any man in a dozen dukedoms ? The quality of the food we eat is a matter of considerable importance. Go to the public markets in any large city, and note the meat there exposed for sale. Some is first rate, firm in texture, bright in color, odorless, or but faintly so, and generally pleasing in appearance. Much is far from first rate, loose in texture, flabby to the touch, pale or purplish in color, and not infrequently offensive to the nos- trils. Yet somebody eats it. Poultry is often worse. The custom of putting poultry and game in cold storage without removing the entrails results in a food article that is properly described as disgust- ing. Fortunately this custom is prohibited by law in some of our cities, but it ought to be put down everywhere by force of public opinion. Fruit and vegetables generally make a better showing in the markets. Much, how^ever, is exposed that is hardly THE FOOD WE EAT. 253 fit for human use. Nevertheless these articles are sold and presumably eaten. Even if food is secured that is good in the raw- state, it may be ruined in the cooking. The best roast that ever graced a butcher's stall may come on the table fit only for the dogs, and the same is true of all other food articles. Every mother should educate her daughters to choose food articles with good judgm.ent and to cook or otherwise prepare them properly. Her daughters may not have to cook, but they will know how, and the knowledge will not come amiss. And every man should so educate himself that he may purchase meat, game, poultry, fruit or vegetables of such quality that he need not be ashamed of them when they appear at the table, for on the good man of the house- hold the purchasing very often and very properly falls. There is a popular idea that all of us habitually eat too much. This is much of a fallacy. Some there may be who are gross and gluttonous feeders, but they are a small minority and are generally well acquainted with their own failing. Most of us do not eat too much, but, among the indoor people at least, many do take too little exercise and suffer from indigestion accordingly. A certain amount of active physical exercise, taken daily, is a requisite with all of us if we wish to enjoy good health. Man was not formed to sit at a desk 254 COLDS^ COUGHS AND SORE THROATS. through the business hours of each day and spend the rest of the time in idleness or sedentary pleasure. We are animals, cultivate the mind and neglect the body as much as we may, and animal life invariably calls for a certain amount of physical exertion. If this fact is neglected, all the dieting in the world will not result in good health, but if a proper amount of exercise is taken, moderate eating is enjoyable and healthful. In this matter, as in diet- ing, each individual must find out his own needs, noting what amount of exercise is requisite for healthful life, and governing himself accordingly. In changing from a vigorous physical life to one of more sedentary character, the appetite, however, often demands enough for the active life, while the digestion can only take care of what is needed under the new regime. The usual illustration of this chain of circumstances is the young man going from the harvest field to the college. The habitual amount of nourishment is taken, the habitual amount of exercise is neglected. Naturally the youth becomes bilious and suffers with various digestive troubles. It generally results in a doctor being summoned, who gives the young man a good dose of physic and an equally good dose of advice, and the young man recovers and goes on his way, a wiser, but not necessarily sadder man. Ordinarily, if we eat simple, wholesome food, in such amount as our occupation and habits de- THE FOOD WE EAT. 255 mand, and take a reasonable amount of exercise, the appetite is a very reliable guide. Reason, how- ever, must superintend the whole business, both as to quantity and quality of food and the requisite degree of daily exercise, and each reasonable indi- vidual must recognize these facts, accept the re- sponsibility for his own health and govern his life accordingly. CHAPTER XX. Exercise. At the present day the fact is very generally recognized that bodily exercise is an absolute neces- sity for the maintenance of a proper degree of health. A state of complete inactivity would soon result in atrophy, or wasting of the muscles, and a general failure of physical health. This wasting of the muscles is well shown in paralysis, where the parts affected shrink away to little more than skin and bone. Also in the condition of a broken limb after enforced inactivity during the process of repair. The greater physical development and more ro- bust health of those people who make up the labor- ing classes, as compared with clerks and office em- ployees, is a matter of daily observation. This difference, however, is less marked than twenty years ago, and is continually becoming less notice- able as the benefits of regular and systematic exer- cise are more fully appreciated. But, while all intelligent persons recognize the necessity of physical exercise, many take but a minimum thereof, and far too little to keep the body 256 EXERCISE. 257 in good working order. There are various causes for this condition of affairs. Some do not take exercise because of sheer laziness. Some lack facili- ties, or, having the facilities, do not quite know how to take advantage of them. Others are physi- cally weak and can barely summon up enough energy to crawl wearily through their daily tasks. Still others are discouraged with life generally, and have given up all hope of ever bettering their con- dition, either physically, mentally, morally or finan- cially. On the other hand, among the laboring classes, those who literally ''Eat their bread in the sweat of their brows," many really get more exercise than is necessary for health. But even these sturdy brethren can do much to improve their bodily con- dition. If any among them will make the erect bodily position habitual, and also acquire the habit of breathing deeply and fully, their physical im- provement will be marked and gratifying. Because a man stoops over the plow handles for ten or twelve hours a day during forty or more days of the year, is it any reason that he should stoop for the remaining three hundred and twenty-five days ? Or is it really necessary that he should stoop at all ? Indeed many kinds of physical labor can be made to favor correct position and proper breathing. Chopping wood requires the fullest expansion of the chest, and many other kinds of work can be made 258 COLDS, COUGHS AND SORE THROATS. helpful in this respect if attention is given to the matter. And, in the present day, when so many of the more laborious processes, especially in farming, are carried on by horses or steam power, is there any reason why the man who directs these powerful forces should not be ''straight as a soldier''? Those who are too lazy to take a proper amount of exercise are a rather hopeless class. Advice and example are alike wasted on them, and they must e'en pursue their own slothful mode of life until death relieves the community of their cumbersome presence. Yet even the apparently hopelessly indo- lent do sometimes reform and become both useful and ornamental members of society. But now for that large class who realize the necessity of physical exercise and are willing to devote some amount of time and trouble to securing it. Many of these have already satisfactorily solved the problem, so far as they are individually con- cerned, as is evidenced by the constantly increasing number of strong, straight young men and women whom we nowadays meet on our city streets. What exercise can our office men take without too great an expenditure of time and money? Of course this will vary with different individuals. For some gymnasiums, conveniently at hand with special instructors in attendance, will answer the question. To others perhaps walking may be the only available out-of-doors exercise. Walking is EXERCISE. 259 better than nothing, and if the walk is brisk, so that quite a swing is given the upper part of the body, it may fill the requirements, especially if supple- mented by suitable indoors work. It is advisable that there shall be some objective point, some reason for the walk, that it may seem less like a mere task, or a tread-mill sort of drudgery. Meals may be taken at some distance from the lodging room, or the noonday lunch may be made the occasion for a moderate amount of exercise. Or there may be some park at such distance from the ordinary haunts that it requires much pedal exercise to reach it, and then a good rest out of doors may be enjoyed before the homeward trip. Whenever out-of-doors exercise is of such limited description, indoor work for the upper part of the body should be made use of. Dumb bells, Indian clubs and whole hosts of patent exercisers give much choice along these lines. See to it that this exercise be not too heavy for the muscular develop- ment of the individual who is using it, or it may work harm rather than good. Do not try to emu- late the feats of some friend who ^^never touches a dumb bell under ten pounds,'' when very likely a two-pound bell should be your limit. Also when indoors exercise must be taken, let it approximate out-of-doors work as nearly as is practicable. Throw open doors and windows, or, still better, take your apparatus out on the porch or into the 26o COLDS^ COUGHS AND SORE THROATS. yard, under a tree or other place where it really becomes out of doors. The bicycle has opened a wide field for those who desire invigorating out-of-doors exercise, and it has the great advantage of carrying you swiftly from the city streets. Bicycling clubs are often formed, and the larger enjoyment of a shared pleasure comes to those who thus unite. For those who live near a river or lake, there are the vigorous and enjoyable exercises that may be derived from boating. Canoes, row-boats and sailing vessels — all are at command. And here again a number of persons of like tastes can much increase their facili- ties and their enjoyment by combining together for that purpose. If there be good swimming and bath- ing places near at hand, these sports offer healthful exercise to any degree. A suburban home affords abundant and varied opportunity for physical exercise. Gardening alone will engross one man's attention and give him all sorts of exercise and any amount thereof. Another adds the care of chickens to his scope of labor, and perhaps keeps a horse and cow. Indeed, more often the suburbanite complains of a superabund- ance of exercise than of the reverse condition. The possibility of over-exercising is to be guard- ed against with much care. Physical directors of gymnasiums, who are supposed to be thoroughly posted on such matters, have frequently over-exer- EXERCISE. 261 cised frail young men to such degree as to bring on severe sickness, simply because they did not recog- nize the fact that a fair amount of exertion for a robust and well developed youth may prove a bur- den far too heavy for weaker and smaller lads, even though they may be of the same age. And not infrequently some enthusiastic advocate of exercise draws the conclusion that if a moderate amount of exertion is good, a greater amount is correspond- ingly beneficial. Acting on this conviction he over- exercises, becomes unnecessarily fatigued, and in disgust concludes that physical exercise was not his need and gives it all up. Keep well within your limitations in this respect, and if it be considered desirable to increase the amount of exercise, be con- tent to increase it by very slow degrees. So long as a man eats well, sleeps well and generally enjoys life, there is no danger that he is overdoing physical exercise. If, on the contrary, after severe muscular exertion, appetite fails, sleep is restless and broken and there is general nervous- ness and unrest, try less exercise and note if there is improvement. And always, when an unusual amount of exercise has been taken, whether volun- tarily or through force of circumstances, it is a wise plan to put in a good deal of time immediately thereafter in the most perfect rest practicable, lying down if much exhausted, reclining in an easy chair, or otherwise taking life easy. If, however, the tired 262 COLDS^ COUGHS AND SORE THROATS. feeling is an habitual condition and no extra exer- tion has been made that warrants it, try a httle more exercise or consult a physician. The proper amount of rest is often of fully as much importance as a proper amount of exercise. Do not be afraid of lying down in the day time if conditions permit. Rather if rest seems needed arrange if you can to have a couch or cot where you can secure its use, and take all the rest you feel any desire for. Or have an easy chair handy and see to it that it serves the purpose for which it was intended. In olden days an after-dinner nap was a frequent custom, and those who thus indulged themselves were usually vigorous and healthful individuals. The importance of comfortable, well ventilated sleeping rooms, screens or mosquito bars to prevent annoyance by insect pests, and all other means for securing peaceful and uninterrupted repose at proper times should be fully recognized and acted upon. Especially with growing children should this matter of adequate rest, as well as an abundance of healthful exercise, be given due consideration. Very often a rapidly developing child is reproved for lying on the floor, or adopting a slouchy atti- tude, when there is real need for rest and when it would be wiser to advise taking a quilt or blanket into a quiet room or under some shady tree and indulging in a good nap. EXERCISE. 263 Children require more exercise, proportionately, than grown people, and as a rule are very keen to take it. If time and opportunity are afforded them they will usually select their own sports with very good judgment, and take the full measure of muscular exertion needed. Very often with chil- dren in a city the choice lies between exercise on the public streets, with their questionable associa- tions, or an unhealthful amount of confinement in- doors. It is a hard alternative and one in which advice is not easily given. Where there are public playgrounds, or the privilege of playing in the parks is accorded the young, there is much less difficulty, and such conditions should be encouraged to the fullest limits. In choosing your exercise, select some form in which a lively interest can be taken. If daily exer- cise is carried through dully and as a matter of routine, being regarded as merely so much labor to be performed, it is apt to become an unpleasant duty, and as such is soon shirked or in some manner evaded. Even if the sense of duty prevails and the task is grudgingly carried through, much of enjoy- ment is lost, and a goodly portion of the benefit is missed. The hardest labor becomes easy when per- formed with zest and interest, and the lightest ex- ercise becomes hard and disagreeable when opposite conditions prevail. There are so many forms of exercise that among them any one should be able 264 COLDS^ COUGHS AND SORE THROATS. to select one or more forms that will prove enjoy- able and of keen interest. If, after a time, the chosen method palls, another can be taken, though too much changing in this respect is not advisable. And always in choosing your exercise select some form that will allow of upright bodily carriage and abundant breathing capacity. Then see to it that the breathing capacity is used aright and that the lungs are fully and frequently expanded with the purest air that can be drawn into them. Walking, if properly performed, demands the upright posi- tion, with shoulders well back and chest out. In bicycling the position should approximate that of the cavalry soldier. The scorcher's position, hump- ed over the handle bars like a monkey on a pole, largely detracts from the healthfulness of the pastime, to say nothing of appearances and the effect on habitual posture. Rowing, while it con- tracts the chest on the forward reach, yet expands it grandly toward the end of the stroke. Those who row should, however, be especially careful of posi- tion at other times. Horseback riding, ball playing and most of the field games call for upright bodily carriage, and this should be one of the points most carefully attended to in all exercise. Breathing exercises alone are fine training for many people, and while requiring but little time, they yield most excellent results. Dr. Hare, in his work on therapeutics, handles this subject in such EXERCISE. 265 masterly style that we cannot do better than to quote from him in regard to this matter. He says : '' The first form of inhalation to be studied is that which is devoted to proper respiratory exer- cises. These exercises are required by patients who because of faulty development do not properly ex- pand certain portions of the chest in the function of respiration and by those who have acquired im- paired respiratory movements by the following of certain occupations, or as a result of attacks of disease. '' There can be no doubt that pulmonary tuber- culosis may be prevented, or even arrested in its early stages, by causing a patient to use proper thoracic exercises, which must usually be directed toward producing expansion of the apices of the lungs, a part of these organs which in many in- stances is but poorly filled and equally ineffectively emptied under ordinary conditions of life. The following inhalation exercises are to be directed for such cases : '' The patient stands with his back against the wall, holding himself as erect as possible and bring- ing his shoulder blades flat against the plane behind him. He now takes a slow, deep and full inspira- tion, drawing the air into the chest in a steady stream, and not by a sudden jerk of his respiratory muscles. The inspired air is then to be held in the chest while the patient mentally counts three, and 266 COLDS, COUGHS AND SORE THROATS. then allowed to escape gradually, and not be forced out of the chest by sudden muscular effort. Usually four or five such movements night and morning are quite sufficient for good results for the first week. After that they may be gradually increased in number. * 'Another movement may be added to that just ^ described. The patient, standing with his back against the wall and the shoulders well thrown back, raises his arms, which are completely extend- ed, from his sides until the hands are on a level with the shoulders, thereby fully expanding the sides of the chest. As expiration begins the arms are allowed to fall gradually to the sides. After this the arms may be carried above the head into a perpendicular position. ''A third exercise consists in inhaling as deeply as possible and then exhaling against resistance produced by closing the lips and forcing the air between them. " The fourth exercise consists in lying down upon a firm bed with a small pillow under the hollow of the back and no pillow under the head, and then taking slow, long-drawn inspirations and expira- tions as already described. '' These exercises are not only useful in persons with faulty chest development, but in those who have poor expansion of a lung after pneumonia, pleurisy or empyema. EXERCISE. 267 " The increase in the volume of air respired under gentle but persistently taken exercises of this char- acter is quite remarkable, and they often increase the appetite, the quantity of haemoglobin, and the general health of the patient." This closing remark shows plainly that Dr. Hare considers these respiratory exercises as exercises in every sense of the word. If we can increase the appetite and general health and improve the quality of the blood, we have accomplished about what our exercise is intended for. That such exercises are particularly beneficial to those predisposed to consumption does not detract from their usefulness to others. There is also a phrase in the above quotation to which we would call especial attention. It is, **Un- der gentle but persistently taken exercises.'' Per- sistence is what counts, in exercise or any other worthy undertaking, and it is for lack of this quality that so many fail of the full benefits of exercise. If for one reason at one time, and another reason at another time, the exercise is shirked or post- poned, in many cases it will finally be entirely neg- lected, and exercise for health will become a mere memory of the past. To recapitulate : A certain amount of muscular exertion is essential to the maintenance of good health. If the business in which you are engaged does not furnish sufficient exercise to meet this 268 COLDS^ COUGHS AND SORE THROATS. demand, join a gymnasium or choose some agree- able pastime or pursuit of such nature that the deficiency is supplied. In selecting exercise, select some form that is agreeable and in which you can take a lively interest. Let the exercise chosen al- ways be of an out-of-doors nature if possible. If this is not possible, throw doors and windows wide open and approximate the out-of-doors condition as nearly as may be. Whenever practicable associ- ate yourself with others of like habits and tastes. By thus combining, enjoyment is enhanced and greater benefits are secured. Find out by experi- ment what amount of exercise is required in your own individual case, then stick to it persistently and steadily. And finally, supplement exercise by an abundance of rest. CHAPTER XXL Clothing, Bathing and Sleep. Clothing. Here, as elsewhere, each person must make use of his own common sense, and adapt his raiment to his own particular needs. There are no general rules that will suit all persons alike. Woolen underwear is undoubtedly the best for those who can wear it with comfort, but many cannot. Pro- bably mixed goods, containing cotton and wool in varying proportions and often sold as ^^strictly all wooV^ suit the greatest* number. Cotton and linen goods make delightfully cool underwear but quickly grow cold and clammy if perspiration is at all con- siderable. Generally speaking, comfort is a pretty good guide. If your garments keep you warm in winter and allow you to keep reasonably cool in summer, if they fit well and feel all right, it is pro- bable that you have about what you need. Children who are too small to express their dis- comfort or too young to have their protests heeded are apt to be sufferers, especially in warm weather. Many a time the doctor is called to see a sick infant and finds it swathed in layer upon layer of warm, close-wrapped clothing, with often a shawl or other wrap over all, beads of perspiration covering its 269 270 COLDS^ COUGHS AND SORE THROATS. face, and the rest of its body bathed in warm, un- healthful moisture. The doctor has the clothing removed, the fevered body bathed in tepid water, and one or two abundantly sufficient wraps replace the pile of swaddling clothes, whereupon baby falls peacefully asleep. Then, likely as not, the anxious mother would cover it with a heavy quilt or blanket did not the doctor interfere. So the parents pay a doctor's fee for a lesson in the very rudiments of common sense, and if they lay it to heart the money could not be spent to better advantage. As cold weather draws on it is the older children who fall victims to a lack of ordinary judgment, or to false ideas as to toughening them. With the grown folks wearing a grade or two heavier under- wear than they found comfortable in summer, the boy or girl of six or eight years still goes bare armed and bare legged, and with scanty covering for the rest of the body. Of course this is all wrong, and when the older members of the family don heavier garments the children should be looked after, too. The idea of hardening a child by ex- posing it to greater cold than its parents can bear with safety is as mistaken as it is cruel, and can- not be too severely reprehended. It is far more likely to lay the foundations of future illness, or cause an early death. There are some who advocate the same weight of underwear the year around. We cannot believe CLOTHING, BATHING AND SLEEP. 27I this to be other than a mistaken and harmful idea. It is largely based on the fact that our living and ofifice rooms are kept at too high temperatures dur- ing the colder parts of the year, and that most of our time is spent in these overheated rooms. It is better to wear somewhat heavier clothing, to spend more time out of doors, and to keep the indoors temperature at a more healthful degree. 68 to ^2 degrees Farenheit should be a high enough tem- perature for dwelling and business rooms at any season of the year, and this will admit of under- garments which will be vastly more comfortable and healthful when out of doors than our sum- mer robing. To those who wear chest protectors, we would say one word, ''Don't.'' If one is already worn, trim it down with the scissors, a little at a time, till nothing is left, for any sudden change to much lighter wear, even over a limited portion of the body, is liable to produce bad results. Too much muffling of the neck is another custom to be avoided, but, as with the chest protector, the habit is to be abolished with caution. If the undershirt is made to fit the neck snugly and comfortably, never tightly, the need for chest protector or muffler will often be done away with. For a general rule, be sure that every part of your clothing fits well, loosely rather than the con- trary, and especially avoid tightness, or constriction about the neck, the waist and the feet. 2.^2 COLDS, COUGHS AND SORE THROATS. Baths and Bathing. Baths are a necessity, a luxury or a superfluity, according to the views of those who indulge therein, or who forego such in- dulgence. Civilized people, as a rule, regard them as both a necessity and a luxury, but there are people, many of whom belong to civilized nations, who have as great an aversion to a bath as a cat has to a plunge in the creek, and they avoid it with equal care. The hot, or rather the warm bath, is suited to the aged, the very young, and to all who have not enough of physical vigor to react promptly and fully to the stimulating influence of the cold bath. Its great object is cleanliness, and to this end it is thoroughly and completely adapted. A large bath tub full of comfortably warm water, a good sponge or wash cloth, plenty of good soap and clean towels, and there you have all the requisites, and can enjoy as luxurious a bath as any human being need want. But suppose the large bath tub is wanting; does that preclude a good warm bath ? Not at all. A pitcher of hot water, a wash basin, and sponge, soap and towel, will give facilities for as much of a bath as is really needed, and in the early days of our Republic thousands found these conveniences all that was required for personal cleanliness and comfort. And, indeed, this is of necessity still true in many sections of our country at the present day. Those who perform hard physical labor should CLOTHING^ BATHING AND SLEEP. 273 always, when practicable, take a warm bath at the close of the working day. With the perspiration and grime of the day's toil and exposure removed, the surface of the body flushed with invigorated blood, and the nervous system calm.ed and soothed, the laborer emerges from his bath, a new man almost, and life takes on a rosy hue that a few minutes before was altogether wanting. In the warmer part of the year those who do not indulge in cold bathing will find a warm bath taken toward the close of the day a very healthful, refreshing and comfortable procedure. In colder weather many get along with one good bath a week. This seems sufficient for health but more frequent bathing will certainly do no harm. It must not be forgotten, however, that bathing may be carried to an extreme, although the reverse condition is more frequently encountered. Dr. Hare tells us that he has seen cases of nervous exhaustion and general loss of vivacity and vitality occur as the result of too frequent bathing, and more espe- cially so in case of daily bathers who soak them- selves in hot or warm fresh water in the morning. He also says : 'Tt is proper to call attention to the fact that a very large proportion of children who are bathed daily are allowed to lie and soak in the tub, and as a result become debilitated and fretful, only to recover when the bath is used once or twice a week, and replaced in the interval by a nightly 274 COLDS, COUGHS AND SORE THROATS. Sponging off with salt and whiskey or salt and water." The cold bath is one of the greatest tonic agencies at our command. It is adapted to all who are physically sound and have vitality enough to react promptly and fully to the initial shock. The water must be cold enough to produce a distinct, though not necessarily severe shock, which is evidenced by the breath coming in gasps and a primary sensa- tion of chill. As nearly as practical the cold water should be brought into contact with the whole body surface at once, though where adequate means for producing this result are lacking, rapid application by a large sponge or cloth, frequently wrung out and refilled, will give most excellent results. The sudden chilling, and consequent contraction of all the vessels of the skin sends the surface blood in- wards. Then, as the reaction commences, warm blood is forced into the surface yessels which are filled and expanded, and a sensation of warmth and comfort, ''the glow'' is experienced throughout the entire system. Thus the functions of the skin are stimulated, the circulation toned up, the nervous system invigorated and the whole organism re- ceives a stimulating and tonic impulse that is of the greatest value. The reaction, of which the ''glow'' is the outward and visible sign, is en- couraged and increased by vigorous rubbing with a coarse towel, which must immediately follow the bath. CLOTHING, BATHING AND SLEEP. 275 A plunge into some almost icily cold mountain lake or stream, with perhaps a very short vigorous swim, an immediate return to shore, and a brisk rubbing down with a coarse towel, would be the ideal cold bath. The shower bath is probably the next best form for the cold bath, but a bath tub full of cold water will furnish a good substitute, or a basin with only a quart or two of cold water may be made to serve the purpose. Early morning is the time for the cold bath, and brisk and thorough towel work must immediately follow the plunge. With regard to the influence of this process on respiratory diseases, let us quote Dr. Harrington. He says : ''Not the least in importance of the effects of cold bathing is the immunity which its devotees appear to enjoy against taking cold. Many of those who practice cold bathing the year round have no experience whatever with colds, and can withstand exposure which, to others, is productive of much illness." Those in whom the reaction does not occur promptly and satisfactorily had better be content with warm bathing. And there are many who are physically capable of taking the cold bath but who lack time, inclination or facilities, who find the warm bath sufficient for all their needs, and are well content with the cleanly sense of comfort which it yields, without striving for any greater degree of healthfulness. 276 COLDS, COUGHS AND SORE THROATS. Sleep, For most of us from six to eight, or even more hours, of sound refreshing slumber must be secured, if possible, out of each twenty-four. Supposing then, that any given individual pos- sesses a healthy body, a quiet mind and an easy conscience; what more is needed to secure this g'rand restorer of strength and vigor? In the first place a clean and comfortable bed, then a quiet, well ventilated room, and the absence of light for from six to ten or more hours daily. All of the day-time clothing should be removed and replaced by suitable night garments on going to bed. The form of night robing is of little im- portance. That its wearer find it comfortable and healthful is the main point to be observed. The union suits of underclothing are recommended as night garments for children who kick off the cover- ings and bunch night robes under the arms, thus exposing vital parts to the cold. Woolen night gar- ments for those who can wear them with comfort, and mixed goods for the rest of us, is probably about as near right as we can get in the way of fabrics. The bed room should, of course, be as quiet and well ventilated as possible. Windows should be kept open, summer and winter alike, wide open for those who can stand it without discomfort, while barely open is better than closed. During the w^armer portion of the year windows and doors CLOTHING, BATHING AND SLEEP. 2^^ should always be screened, and the room kept free from insect pests of every kind. Wherever prac- ticable, each person should have a bed to himself. In many cases this is an impossibility, but the single bed is far more healthful when it can be secured. A separate room to each sleeper is desirable, but if ventilation is good, is hardly a necessity. And when you go to bed, remember that you go there to sleep. Do not allow yourself to fret over the worries of the day, the uncertainties of the future or the failures of the past. As the aged French lady said to her profanely agitated son, a lieutenant of the army, hindered by a break down on the way to his wedding: ^^Compose yourself, my angel, compose yourself.'' CHAPTER XXII. Conclusion and Conclusions. In the standing armies of our great nations, or any similar aggregations of men, where each indi- vidual must conform to fixed standards as to age, height, weight, physical development and bodily health, and where all follow much the same mode of life, it is quite possible to formulate rules of health, by strict enforcement of which a high de- gree of vitality may be maintained. In private life this is manifestly impossible. The community at large comprises individuals of all ages, all condi- tions as to health and physical fitness, and all occu- pations, habits and modes of life. Hence it comes that experience and intelligence will furnish the private individual a far better hygiene than any he can learn from books, and unless he does sup- plement by his own observation and judgment, all that the books and the doctors can tell him of the rules of health, he will fall short of that degree of physical vigor to which he should attain. In the preceding chapters the broad rules and general principles of hygiene have been given. These apply, more or less, to every member of the human race, but the particular application rests 278 CONCLUSION AND CONCLUSIONS. 279 wholly with the individual himself. The primary principles of hygiene are the same for all. Every human being requires an adequate supply of good food properly prepared, an abundance of pure air and reasonably pure water, with sunshine, exercise, recreation and rest in proper amount, and all must observe some degree of cleanliness. So far soldier and civilian, bookkeeper and trapper, cowboy and clerk, are alike in their hygienic requirements. But when it comes to the amount and kind of food best suited to the needs of each, there is a wide margin of difference, and so also of sleep, exercise, cloth- ing and all other necessaries of life. The kind and amount of food that would suit a cowboy on the round-up would be death and destruction to a quiet, sedentary bookkeeper, while the cowboy would laugh at such rules for exercise as would fit the case of the bookkeeper. In regard to the effects of different kinds and amounts of the requisites of healthful life, each one of us has had a lengthy and varied experience, numbered as to years by those of our present ex- istences, and this experience will continue day after day until our sands of life are run and we lose all interest in this little one-horse star which people call the earth. Can any one ask a finer opportunity to study the science of personal hygiene, or the rightful use of those things needed in our daily lives? It is the merest matter of observation and memory. If something we eat disagrees with us, 28o COLDS, COUGHS AND SORE THROATS. or causes sleeplessness or other ill effects, and if similar effects follow every time that particular article appears on the bill of fare, what more is needed to formulate a rule of diet so far as that article is concerned. If eight hours of sleep leaves us still tired and with a great desire to rest longer, it is certainly worth while to try the effect of rising a little later or going to bed a little earlier. And SO it is all along the line. The general rules of hygiene are all right, but if they do not fit your own particular case it is your place to so modify them that they do fit, and you can do it if you choose. And, with it all, let your daily lives be cheerful. King Solomon said, ''A merry heart doeth good like a medicine," and he might have added that it doeth it without the disagreeable effects which of- ten attend other kinds of medicine. There is a hygiene of the mind as well as of the body, and what sunshine is to the material part of us cheer- fulness is to the mind. Cut out the gloomy recol- lections, overlook the minor discomforts, laugh at the little annoyances and ignore the trivial and often vmintentional slights. The past is gone, the present is here, and "de future am a-comin'," and these two last named are, and will be, very much what you make them. Take a whole lot of interest in life, the simple, daily life that is going on right now and all about you. It is the best life you know CONCLUSION AND CONCLUSIONS. 28 1 anything about and the more of interest you take in it the brighter and more cheerful it will be, and the easier to keep in good health and physical vigor. And if good health and physical vigor are yours you have the best that this world can give, and ought to be happy and contented, whether you are or whether you are not. At any rate this is our conclusion. INDEX. A. Adenoids, 41, 121, 131-134. (See Sore Throat, Ch. VIII.) Adrenalin Chloride, 93, 94, 114-116, 139, 140, 204. Air, Fresh, 25-27, 32, 33, 61. Impure, 41, 42, 43, 105. Albolene, 92, 115, 116, 204. Albumen, 92, 93. Ammonia, 94, 95. Anatomy of Larynx, 11, 12. Naso-Pharynx, 9, 10, 129, 130. Nose, 8, 9. Pharynx, 9, 10. Throat, 9-11. Antiphlogistine, 95. Antitoxin, 148. Apparatus Used in the Treatment of Respiratory Diseases (Ch. V), 76-87. Furniture and Utensils, "]"], 78. Thermometer, ']'^, 79. Hot Water Bottle, 79, 80. Ice Bags, 80, 81. Compresses, 81. Heaters, 81, 82. Croup Kettle, 82, 83. Bronchitis Tent, 82, 83. Inhalation of Steam, 83. Inhalers, 84. Atomizers, etc., 84, 85. Applicators, 85, 86. Medicine Droppers, 86. Douche Instruments, 86, 87. ^ 283 284 INDEX. Applicators, 85, 86. Asafoetida, 95. Atomizers, etc., 84, 85. Atropine, 95, 96, 119-121. Autumnal Catarrh. (See Hay Fever, Ch. XIV.) Avoidance of Infection, 60-62, 65-75. B. Bacteria, 21, 34, 35, 40, 45-65, 142, I43, 169, 170, 180, 192, 198, 221. Bacteria and Their Relation to Disease (Ch. Ill), 45-62. Description of, 45-52. Utility of, 52-54. Effect of, 53-59. Parasitic Bacteria, 54-57. Lockjaw, 55, 56. [58-62. Relation to Diseases of the Respiratory Tract, Action of, 59, 60. Infection from, 59, 60. Avoidance of, 60-62. Bathing, 272-275. Breathing, Deep, 126, 238, 239. Exercises, 264-267. Mouth, 40, 41, 44. Bronchitis, 166-178. (See Cough, Ch. XI.) Bronchitis Tent, 82, 83, 153, 176, 177. Broncho-Pneumonia, 186-190. (See Cough, Ch. XII.) C. Calomel, 96, 97, 107, 108, 219-221. Camphor, 97, 119, 171. Cascara Sagrada, 222-224. Castor Oil, 97, 109, 225. Catarrh, Nasal. (See Cold in Head, Ch. VII.) Cathartics, 96, 97, 107-109, 119, 120, 200, 201, 222-225. INDEX. 285 Causes of Bronchitis, 168-170. Broncho-Pneumonia, 188. Colds, 15, 16, 19-21, 23-44, 105, 10^. Coryza, 105, 106. Coughs, 13. Diphtheria, 142-144. Hay Fever, 208. La Grippe or Influenza, 198. Laryngitis, 137, 138. Membranous Croup, 156. Naso-Pharyngitis, 130. Pharyngitis, 135. Pleurisy, 191, 192. Pneumonia, 179, 180. Sore Throat, 160. Whooping Cough, 212. Causes of Colds, Coughs and Sore Throats (Ch. II), 23-44. Predisposing Causes, 23-34. Lowered Vitality, 24, 25, 33. Infancy and Childhood, 25. Old Age, 25. [s2, 33, Neglect of Fresh Air and Sunshine, 25-27, Lack of Exercise, 27-29. Over-exertion, 28, 32. Diet, 29, 30. Worry, 30, 31. Unsanitary Surroundings, 32-34. Self-indulgence, 33. Exciting Causes, 23, 24, 34-44. Bacteria, 34, 35, 40. Exposure, 35-39- Mouth Breathing, 40, 41, 44. Indigestion and Constipation, 41. Impure Air, 41-43. Hay Fever, 42. Unknown Constituents in Air, 42, 43. Resume, 43, 44. 286 INDEX. Chest Protectors, 271. Children, 25. Adenoids, 131-134. Bathing, 272, 273. Clothing for, 269, 270. Constipation of, 224, 225. Diet, 249-251. [232. Doses for, 90-92, 94, 96-99, 109, I39, 150, 151, 201, Exercise for, 262, 263. Tonics for, 121-123. Training, 238. Clothing, Bathing and Sleep (Ch. XXI), 269-277. Clothing, 269-271. Underwear, 269-271. Children's, 269, 270. Chest Protectors, 271. Bathing, 272-275. Warm Bath, 272, 273. Cold Bath, 274, 275. Sleep, 276, 277. Night Garments, 2'j6. Bed Rooms, 276, 2"]^, Cod Liver Oil, 121, 122, 134, 210. Cold Bathing, 274, 275. Cold in the Head (Ch. VII), 104-128. Description, 104, 105. Causes, 105, 106. Symptoms, 106, 107. Home Treatment, 107-117. Cathartics, 107-109. Sweating out, 109-112. Use of Adrenalin, 114-116. Use of Albolene, 115, 116. Headache, 117. Summary, 117. Traveler's Treatment, 117-121. Remedies, 118, 119. Treatment, 119-121. INDEX. 287 Cold in the Head. — Continued. Persistent Colds, 121-123. Children, 121-123. Adults, 122, 123. Tonics, 121-123. Catching Cold Habit, 123, 124. Irregular Treatment, 124-126. One Day Cold Cures, 124, 125. Stocking Cure, 125, 126. Deep Breathing, 126. Heating Back, 126. Summary, 126-128. Home Treatment, 127. Traveler's Treatment, 127. Colds, Causes of, 15, 16, 19-21, 23-44, 105, 106. Description of, 12, 15, 16, 104, 105. Persistent, 121-123. Prevention of, 19. Treatment, 17, 18, 22, 107-121. Varieties of, 13, 14. Compound Cathartic Pills, 97. Compresses, 81, 117, 185. Conclusion and Conclusions (Ch. XXII), 278-281. General Rules, 278-280. Individual Variations, 279, 280. Cheerfulness, 280, 281. Constipation, 41, 107, 201, 218-225. [IV.) Contagious Diseases. (See Infectious, etc., Diseases, Ch. Coryza. (See Cold in the Head.) Coryza Tablets, 95, 96, 118-121. Cough, Causes of, 13. Description, 13. [Ch. XV.) Whooping, 211-217. (See Whooping Cough, Cough (Cold on Chest), (Ch. XI), 166-178. Bronchitis, 166-178. Description, 166-168. Trachea and Bronchi, 167, 168. 288 INDEX. Cough (Cold on the Chest). — Continued. Causes, 168-170. Bacteria, 169, 170. Symptoms, 170. Course of Disease, 170, 171. Treatment, 171-178. Bronchitis Tent, 176, 177. Croup Kettle, 177, 178. Summary, 178. Cough (Cold on Chest, Severer Forms), (Ch. XII), 179-196. Pneumonia (Lobar), 179-186. Description, 179. Causes, 179, 180. Symptoms, 179, 181-183. Treatment, 183-186. Broncho-Pneumonia, 186-190. Description, 186-188. Causes, 188. Symptoms, 188. Treatment, 189, 190. Pleurisy, 190-196. Description, 190, 191. Causes, 191, 192. Symptoms, 192-194. Treatment, 194, 195. Summary, 195, 196. Croup Kettle, 82, S3, 157, I77, 178. Croup, Membranous, 156-158. Cure or Prevention of Hay Fever, 209. D. Deep Breathing, 126, 238, 239, 264-267. Diarrhoea, 226. Diet, 29, 30. (See Food, Ch. XIX.) in Colds and Sore Throat, 140, 141. Diphtheria, 149, 150. Fever, 234, INDEX. 289 Diet. — Continued. La Grippe, 203. Tonsillitis, 164, 165. Whooping Cough, 215, 216. Diphtheria, 142-156. (See Sore Throat, Ch. IX.) Laryngeal Form, 147, 153, 154. Nasal Form, 147, 148, 154, 155. Pharyngeal Form, 145, 146, 152. Disinfectants, 74, 75. Disinfection, 71-75. Doctor, When to send for, 17-19, 148, 176, 178. [VL) Doses. (See Medicinal Remedies and Their Doses, Ch. Douche Instruments, 86, 87. Dovers' Powders, iii, 113, 118, 120, 127, 171, 184. Droppers, Medicine, 86, 116. E. Epsom Salts, 97, 102, 108. Eustachian Tubes, 10, 130. Exciting Causes of Colds, Coughs, etc., 2^, 24, 34-44. Exercise, 27-29, 253-268. Exercise (Ch. XX), 256-268. Modern Practice, 256-258. Suggestions as to Exercise, 258-260. Over-exercise, 260-262. Rest and Sleep, 262. Children's Exercise, 262, 263. Forms of Exercise, 263, 264. Breathing Exercises, 264-267. Exposure as Cause of Disease, 28, 35-39, 43, 44, 105, 106. F. Fever, 227-234. Hay, 16, 42, 207-210. Fever Powders, 97, 98, 233. Flaxseed Tea, 98. Food (The Food We Eat, Ch. XIX), 248-255. Varieties, 248. General Principles, 249. 290 INDEX. Food (The Food We Eat). — Continued. Diet for Children, 249-251. Diet for Adults, 251-253. Good Cooking, 253. Exercise, 253-255. Foot Bath, Hot, 109-112, 171. Fresh Air and Sunshine, Neglect of, 25-27, 32, :^:^, 61. Fresh Air and Sunshine (Ch. XVIII), 235-247. Hygiene, 235-237. Necessity of, 237. Training Children, 238. Deep Breathing, 238, 239. Ventilation, 239-241. Healthful Arrangements, 241-244. Sanitary Conveniences, 244-246. Furniture and Utensils, 77, 7S. G. General Treatment (Ch. XVI), 218-226. Constipation, 218-225. Dangers of, 218, 219. Use of Calomel, 219-221. Intestinal Antiseptics, 221, 222. Use of Cascara Sagrada, 222-224. Other Laxatives, 224, 225. Children, 224, 225. Diarrhoea, 226. General Treatment (Ch. XVII), 227-234. Fever, 227-234. Symptoms, 227. Treatment, 227-234. Use of Water, 227-232. Other Remedies, 232, 233. Bedding, 233, 234. Diet, 234. Germs. (See Bacteria.) Gum Guaiac, 98, 137, 163. INDEX. 291 H. Hay Fever, 16, 42, 207-210. Hay Fever (Ch. XIV), 207-210. Description, 207, 208. Causes, 208. Symptoms, 208, 209. Cure or Prevention, 209. Treatment, 209, 210. Headache, 117. Heaters, 81, 82. Home Treatment, 17, 18, 22, 107-117, 127, 194, 195. Hot Water Bottle, 79, 80. Hygiene (Part III), 235-281. I. Ice Bags, 80, 81. Impure Air, 41-43, 105. Indigestion and Constipation, 41. Infants, 25. Infection, Bacterial, 20, 21, 59, 60, 63-65, 188. Avoidance of, 60-62, 65-75. Infectious and Contagious Diseases (Ch. IV), 63-75. Description, 6^. Incubation, 64. Effects, 64, 65. Avoidance of, 65-75. Respiratory Diseases, 66, 67. Rules for, 68-75. Methods of Disinfection, 71-73. Disinfectants, 74, 75. Influenza, 197-206. (See La Grippe or Influenza, Ch. XIII.) Inhalation of Steam, 83, 172, 204. Inhalers, 84. Iron, 99, 121-123, 134, 150, 151, 210. J. 292 INDEX. K. L. La Grippe or Influenza (Ch. XIII), 197-206. Description, 197-199. Causes, 198. Symptoms, 198, 199. Treatment, 199-204. Preliminary, 200. For Constipation, 201. For Fever, 202. Tonics, 203. Diet, 203. Prevention, 205. Laryngeal Diphtheria, 147, 153, 154. Laryngitis, 137-140. Larynx, Anatomy of, 11, 12. Liquid Vaseline. (See Albolene.) Lockjaw, 55, 56. M. Medicinal Remedies and Their Doses (Ch. VI), 88-103. Measures and Doses, 88, 89. Keeping Medicines, 89, 90. Children's Doses, 90-92, 94, 96-99. Abolene, 92. Albumen, 92, 93. Adrenalin Chloride, 93, 94. Ammonia, 94, 95. Antiphlogistine, 95. Asafoetida, 95. Atropine, 95, 96. Calomel, 96, 97. Compound Cathartic Pills, 97. Castor Oil, 97. INDEX. 293 Medicinal Remedies and Their Doses. — Continued. Camphor, 97. Epsom Salts, 97, 102. Fever Powders, 97, 98. Flaxseed Tea, 98. Guaiac, 98. Iron, 99. Menthol, 99. Oils, 99, 100. Onions, 100, loi. Quinine, loi, 102. Salts and Salines, 102. Salol, 102. Sulphocarbolates, 102, 103. Medicine Droppers, 86, 116. Membranous Croup, 156-158. Menthol, 99, 116. Inhalers, 84. Microbes. (See Bacteria.) Mouth Breathing, 40, 41, 44, 131, 132. Mucous Membrane, 8, 166, 168. N. Nasal Diphtheria, 147, 148, 154, 155. Naso-Pharyngitis, 129-131. Naso-Pharynx, 9, 10, 129, 130. Nebulizers, 84, 85. Neglect of Fresh Air and Sunshine, 25-27, s^^ ;^S} 61. Nose, Anatomy of, 8, 9. O. Oils, 99, 100. Castor, 97, 109, 225. Cod Liver, 121, 122, 134, 210. One Day Cold Cures, 124, 125. Onions, 100, loi. 294 INDEX. Oro-Pharynx, lo, ii. Over-Exertion, 28, 32, 260-262. P. Parasitic Bacteria, 54-57. Pertussis. (See Whooping Cough, Ch. XV..) Pharyngeal Diphtheria, 145, 146, 152. Pharyngitis, 134-137. Pharynx, Anatomy of, 9, 10. Pleurisy, 190-196. (See Cough, Ch. XII.) Pneumonia, 179-186. (See Cough, Ch. XII.) Pocket Inhalers, 84. Predisposing Causes of Colds, Coughs, etc., 23-34, 105. Prevention of Colds, 19. Hay Fever, 209. La Grippe or Influenza, 205. Q. Quinine, loi, 102, 111-113, 120, 210, 216. Quinsy, 160, 161. R. Ragweed Fever. (See Hay Fever, Ch. XIV.) Remedies. (See Medicinal Remedies and Their Doses, Ch. VI.) Remedies, Traveler's, 118, 119. [234. Respiratory Diseases and Their Treatment (Part II), 104- Respiratory Tract and Its Diseases (Ch. I), 7-22. Description, 7-12. Nose, Anatomy of, 8, 9. Throat, Anatomy of, 9-1 1. Sore, 12. Cold, Defined, 12. Varieties of, 13, 14. Cough, 13. Causes, 13. INDEX. 295 Respiratory Tract and Its Diseases. — Continued. Causes of Colds, 15, 16, 19-21. Hay Fever, 16. Home Treatment of Colds, 17, 18, 22. Prevention, 19. Rest and Sleep, 262. Rhinitis, Acute. (See Cold in Head, Ch, VII.) Rose Cold. (See Hay Fever, Ch. XIV.) Salol, 102. Salts and Salines, 102. Sanitary Conveniences, 244-246. Self-indulgence, SS- Sleep, 262, 276, 277. Sore Throat, 12, 129-165. Sore Throat (Common Forms), (Ch. Vlll). 129-141. Organs Included, 129. Naso-Pharyngitis, 129-131. Description, 130. Causes, 130. Symptoms, 130. Treatment, 131. Adenoids, 131-134. Description, 131, 132. Symptoms, 131-133. Effects, 132, 133. Treatment, 133, 134. Surgical, 133, 134. Medical, 134. Pharyngitis, 134-137. Description, 134-136. Causes, 135. Symptoms, 135. Treatment, 136, 137. Laryngitis, 137-140. Description, 137. 296 INDEX. Sore Throat (Common Forms). — Continued. Laryngitis. — Continued. Causes, 137, 138. Symptoms, 138. Treatment, 139, 140. Diet, 140, 141. Sore Throat (Severe Forms), (Ch. IX), 142-158. Diphtheria, 142-156. Action of Bacteria, 142, 143. Causes, 142-1.^4. Pharyngeal Form, 145, 146, 152. Symptoms, 145, 146. Course of Disease, 146. Danger from, 146. Laryngeal Form, 147, 153, 154. Symptoms, 147. Danger from, 147. Nasal Diphtheria, 147, 148, 154, 155. Mild Form, 147. Symptoms, 147, 148. Danger from, 147, 148. Treatment, 148-156. Antitoxin, 148. Nursing, 148, 149. Diet, 149, 150. Medicine, 150-155. Convalescence, 155, 156. Membranous Croup, 156-158. Description, 156, 157. Causes, 156. Symptoms, 157. Treatment, 157, 158. Sore Throat (Severe Forms), (Ch. X), 159-165. Tonsillitis, 159-165. Description, 159, 160. Forms, 159, 160. Causes, 160. INDEX. 297 Sore Throat (Severe Forms). — Continued. Tonsillitis. — Continued. Symptoms, 160-162. Treatment, 162-164. Diet, 164, 165. Steam, Inhalation of, 83, 172, 204. Stocking Cure for Cold, 125, 126. Sulphocarbolates, 102, 103. Sunshine. (See Fresh Air and Sunshine, Ch. XVIII.) Symptoms of Adenoids, 131-133. Bronchitis, 170. Broncho-Pneumonia, 188. Coryza, 106, 107. Coughs, 170. Diphtheria, Laryngeal, 147. Nasal, 147, 148. Pharyngeal, 145, 146. Fever, 22^. Hay Fever, 208, 209. La Grippe or Influenza, 198, 199. Laryngitis, 138. Membranous Croup, 159. Naso-Pharyngitis, 130. Pharyngitis, 135. Pleurisy, 192-194. Pneumonia, 179, 181-183. Sore Throat, 160-162. Whooping Cough, 213, 214. T. Tablets, Coryza, 95, 96, 118-121. The Food We Eat. (See Food.) Thermometers, 78, 79. Throat, Anatomy of, 9-1 1. Sore, 12. (See Sore Throat, Chs.-VIII, IX, X.) Tonics, 99, 121-123, 134, 150, 151, 203, 210. Tonsillitis, 159-165. ^ 298 INDEX. Traveler's Treatment of Colds, 117-121, 127. Treatment, Adenoids, 133, 134. Apparatus Used in, 76-87. Bronchitis, 171-178. Broncho-Pneumonia, 189, 190. Constipation, 128-225. Colds, 17, 18, 22. Coryza, 107-121. Cough, 172-174. Diarrhoea, 226. Diphtheria, 148-156. Fever, 227-234. Hay Fever, 209, 210. Home, 17, 18, 22, 107-117, 127, 194, 195. La Grippe or Influenza, 199-204. Laryngitis, 139, 140. Membranous Croup, 157, 158. Naso-Pharyngitis, 131. Pharyngitis, 136, 137. Pleurisy, 194, 195. Pneumonia, 183-186. Tonsillitis, 162-164. Traveler's, 117-121, 127. Whooping Cough, 214-217. Treatment, General (Ch. XVI), 218-226. Constipation, 218-225. Dangers of, 218, 219. Use of Calomel, 219-221. Intestinal Antiseptics, 221, 222. Use of Cascara Sagrada, 222-224. Other Laxatives, 224, 225. Children, 224, 225. Diarrhoea, 226. Treatment, General (Ch. XVH), 227-234. Fever, 227-234. Symptoms, 22"]. Treatment, 227-234. INDEX. 299 / Treatment, General. — Continued. Fever. — Continued. Treatment. — Continued. Use of Water, 227-232. Other Remedies, 232, 233. Bedding, 233, 234. Diet, 234. Treatment of Respiratory Diseases, Apparatus Used (Ch. V), 76-87. Furniture and Utensils, '/T, 78. Thermometer, ^%, 79. Hot Water Bottle, 79, 80. Ice Bags, 80, 81. Compresses, 81. Heaters, 81, 82. Croup Kettle, 82, 83. Bronchitis Tent, 82, 83. Inhalation of Steam, 83. Inhalers, 84. Atomizers, etc., 84, 85. Applicators, 85, 86. Medicine Droppers, 86. Douche Instruments, 86, 87. Turpentine, 139. U. Underwear, 269-271. Unsanitary Surroundings, 32-34. V. Vaporizers, 84, 85. Vaseline, Liquid. (See Albolene.) Ventilation, 25-27, 32, 239-241, 276. Vitality, High, z^, 27, 44- Lowered, 24, 25, Z3, 105, I43, 160, 168, 179, 212, 273. 300 INDEX. W. Warm Bathing, 272, 273. When to Send for Doctor, 17-19, 148, 176, 178. Whooping Cough (Pertussis), (Ch. XV), 211-217. Description, 211, 212. Danger of, 212. Causes, 212. Symptoms, 213, 214. Treatment, 214-217. Diet, 215, 216. Remedies, 216, 217. Worry, 30, 31. OCr 8 i9^6