J jL j|L j 
iPr&intion 6. 
■-ARLET 
'EVER 1-Cont. Diseases CONTAGIOUS DISEASES 
PREVENTION AND CURE Small children are the most frequent victims of many contagious diseases. CONTAGIOUS DISEASES 
Prevention 
and Cure 
By / 
R. MANNING CLARK, M. D. 
1924 
Planted in U. S. A. 
PACIFIC PRESS PUBLISHING ASSOCIATION 
MOUNTAIN VIEW, CALIFORNIA 
Portland, Oregon Omaha, Nebraska Cristobal, Canal Zone Copyright, 1924, by 
PACIFIC PRESS PUBLISHING ASSN. Contents 
Page 
Introduction 9 
Common Colds 11 
Tonsillitis 25 
Influenza 31 
Measles 45 
Mumps 51 
Whooping Cough . 55 
Scarlet Fever 61 
Chicken Pox 69 
Smallpox 75 
Infantile Paralysis 85 
Typhoid Fever 89 
Horne Treatments 110 
Hygiene 124 
7 Introduction 
Disease epidemics are very expensive, both to the 
nation and to the individual. Their economic waste 
can never be estimated. This is recognized by all 
civilized nations, and intelligent efforts to combat 
these epidemics have greatly reduced this waste. 
Every community now has its local board of health, 
which is in touch with the state board of health, and 
this in turn is in connection with the national author- 
ities. In recent years, many of our ablest statesmen 
have urged that the president's cabinet should have 
among its members one whose portfolio would be 
given over entirely to looking after the nation's 
needs along these lines. Undoubtedly this will soon 
be brought about. 
It is the patriotic duty of every citizen of any 
country to lend his support to such measures as the 
authorities may see fit to recommend or employ. 
He should be well informed upon such subjects, and 
take the best possible care of his physical well-being. 
Any course to the contrary is shortsighted, selfish, 
and inimical to the welfare of all concerned. 
This little book is written in the hope that it may 
aid in the understanding of some of these conditions, 
and in that cooperation which should exist between 
individual citizens and those who are devoting their 
time to the study and control of the epidemics that 
have often become such calamities to the world. 
9 Many of the public drinking fountains are far from sanitary. 
10 I. Common Colds 
G"OLDS, whether in the head or on the chest, are 
a germ infection, and are therefore prevent- 
iUBl able. An understanding of the causes and 
prevention of colds is certainly a fundamental mat- 
ter, in which all should be interested. Much time, 
energy, and efficiency are yearly sacrificed heedlessly 
because of a lack of knowledge of the cause and 
prevention of this common malady. 
Causes 
A bacteriological 
study of the mucous se- 
cretion from the air 
passages of a person 
suffering of a cold, 
shows many germs 
present. Most common 
among these are: 
Staphylococcus aureus 
Staphylococcus albus 
Streptococcus hemolyticus 
Pneumococcus 
Friedlander's bacillus 
These germs are 
present on the surfaces 
of the air passages in 
everyone. They are 
rather dormant and in- 
active; and in health, 
the individual lives 
above them. That is, 
SECTION OF HEAD, SHOWING IN- 
TERIOR SURFACE OF RIGHT HALF 
1. Frontal sinus 
2. Superior turbinate 
bone 
3. Middle turbinate 
bone 
4. Nasal cavity 
5. Inferior turbinate 
bone 
6. Bony palate 
7. Soft palate 
8. Uvula 
9? Sphenoidal sinus 
10. Orifice of Eusta- 
chian tube 
11. Nasal pharynx 
12. Tonsil 
13. Oral pharynx 
14. Esophagus 
15. Right vocal cord 
16. Larynx 
11 12 
Contagious Diseases 
the resistance of the body is greater than the in- 
vading power of the germ. As long as this is the 
case, there is freedom from colds, with a fairly 
normal condition of the air passages; but when 
anything occurs to reduce the vitality or resistance, 
either generally, or locally in the air passages, the 
germ at once becomes active and gains a foothold in 
the tissues. This results in inflammation, and other 
symptoms well known by all, such as chilly sensa- 
tions, sneezing, discharge from the nose, inability to 
breathe well through the nostrils, dryness in nose 
and pharynx, headache, redness of eyes and nose, 
and general head discomfort. If the cold is "on the 
chest," there is a feeling of tightness in the chest, 
with cough; also hoarseness and discomfort in speak- 
ing. The cough is at first dry and hard; but it 
"loosens up" as the cold progresses, and purulent 
mucus is expectorated with the cough. 
Influences That Help One to "Catch Cold" 
We reduce our vitality and resistance in many 
ways. The following are some of these ways: 
1. Loss of sleep. 
2. Living and sleeping in poorly ventilated rooms. 
3. Overwork. 
4. Improper and irregular eating. 
5. Poor hygiene. 
6. Lack of exercise in the open air. 
7. Any chilling of the surface of the body, as by - 
a. Perspiring freely and cooling off too rapidly. 
b. Improper clothing. 
c. Getting the feet wet. 
d. Sitting or standing inactively in a draft. 
1. Loss of Sleep: Without sufficient sleep, it is 
impossible to keep vitality and resistance at par. Common Colds 
13 
Sleep is a great energy builder and restorer. This 
is especially true in children. They should have 
eight to ten hours' sleep every night, and a short 
afternoon nap, until five years old. Many parents 
continually handicap their children by not enforcing 
necessary sleep habits. Adults are also prone to 
inflict the same handicap upon themselves, by work- 
ing or playing until wee small hours; and then they 
wonder why they take cold. Without sufficient 
sleep, the heart force is greatly weakened; and on 
this account, the circulation of the blood in any part 
of the body is not up to standard, and ideal condi- 
tions for taking cold are created. 
2, Poor Ventilation: Failure to have the largest 
available supply of fresh air is inexcusable. The air 
is inexhaustible in amount, and free alike to rich and 
to poor. "Cave dwelling" seems never to have gone 
out of fashion; for many still shut themselves in a 
"cave" about twelve by fourteen feet, and do the 
best they can to exclude what fresh air tries to get in. 
Breathing over and over again the same air is 
very harmful. The body excretes through the lungs, 
by means of expired air, as well as through any of 
the other excretory organs. The substances excreted 
through the lungs are very toxic; and after a short 
period of rebreathing, air is surcharged with these 
toxic materials. As a result, the blood becomes im- 
pure, because it is unable to eliminate, owing to lack 
of fresh air; and the impure air, constantly re- 
breathed, is a great irritant to the membranes lining 
the air passages. Under these conditions, the germs 
that cause colds, easily gain a foothold. 14 
Contagious Diseases 
Failure to have the largest available supply of fresh air is inexcusable. This little 
child, although living in a crowded city, is enjoying life in a window crib. 
Good ventilation of sleeping rooms is elearly im- 
portant, because during sleep, the heart and general 
circulation is much slower, and hence the ability to 
resist the attack of germs is lessened. 
3. Overwork: We can be intemperate in our 
work the same as in eating, drinking, and other 
things. Overwork, with insufficient sleep, recrea- 
tion, and mental relaxation, greatly reduces the 
body's resistance and vitality. Then one is more 
susceptible, not only to colds, but to any infection 
that may come along. Some people have repeated Common Colds 
15 
or almost constant colds, because they live at so low 
a state of vitality and resistance that they can not 
rise above the infection. 
4. Improper and Irregular Eating: This is a 
most prolific cause of colds. A person can get a 
simple sore throat from indigestion. The alimentary 
tract should receive constant attention from anyone 
who desires to live above colds. Eating between 
meals, eating too hurriedly, eating too much proteid, 
especially meat, overeating, and the use of strong 
condiments, are all direct causes of colds. Few 
people realize how much easier it is to take cold 
when fermentation and putrefaction are present in 
the tract. 
5. Poor Hygiene: Poor hygiene, such as neglect 
to bathe and change the clothing often enough, is 
very "helpful" if you 
want help in catching 
cold. The circulation 
in the skin influences 
the circulation in other 
parts of the body; and 
to keep the circulation 
in the skin in a proper 
condition, cleanliness is 
essential. Not only 
this, but cold baths, salt 
glows, and mitten fric- 
tions are great tonics to 
the skin, and aid in con- 
serving the vital forces 
of the body. 
SECTION OF SKIN HIGHLY 
MAGNIFIED 
1. Hair 
2. Epidermis 
3. Sebaceous or oil gland, 
and its duct 
4. True skin 
5. Roots of hair 
6. Sweat glands 16 
Contagious Diseases 
6. Lack of Exercise: We lose a great blessing, 
in this day of elevators, street cars, automobiles, etc., 
through failure to take sufficient exercise. Brisk 
walking in the fresh air, with deep breathing, in- 
creases the heart's action, strengthens the heart 
muscle, improves and equalizes the circulation, and 
thus tends to ward off colds. 
7. Chilling of the Surface of the Body: This is 
the most common known means of producing con- 
gestion elsewhere in the body. The lungs and the 
respiratory passages are the greatest sufferers from 
this cause. Therefore care should be taken to pre- 
vent chilling of the surface of the body. 
Perspiring freely and cooling off too rapidly is 
one of the surest methods of taking a cold; for the 
evaporation of the perspiration chills the surface of 
the body, and reflexly the surfaces of the air pas- 
sages are congested. After perspiring, one should 
take a bath immediately, or if this is not possible, 
should wrap up well, and every surface of the body 
should be protected until the skin is dry. 
Improper clothing is another source of chilling 
of the surface of the body, and consequent colds. 
Sleeveless and low-necked dresses worn in the open 
are prolific causes of colds, although this is often 
denied by those whose pride leads them to such in- 
discretions. When this same pride brings suffering 
upon children who know no better, the case is the 
more pitiable. Exposure of the knees of small chil- 
dren during the cold months of the year is inexcus- 
able. Frequently one sees on the street a child 
coughing loudly and wiping mucous discharges from Common Colds 
17 
its nose, and at the same time exposing bare knees 
that are blue with the cold, while the mother, walk- 
ing beside it, is warmly clad and bundled up in furs! 
We may contract a cold by coming in contact with some one who already 
has a respiratory infection. 
Sitting or standing inactive in a draft is harmful. 
No one need fear a draft of fresh cool air; yet it 
may do injury by bringing on a cold. When a per- 
son is active, no draft is likely to cause him trouble; 
but when he is sitting or standing inactive in a 
draft, then trouble starts. When one is not active, 18 
Contagious Diseases 
the heart action drops down to a minimum. The 
skin and the extremities then have the weakest circu- 
lation of the body; and some exposed part, as the 
back of the neck, being hit by the draft of air, is 
chilled sufficiently to prevent the proper circulation 
of the minimum amount of blood it was receiving. 
The result is lowered vitality, and congestion in 
some other part of the body. This opens the way 
for the ever-present germs; and inflammation starts, 
with its train of symptoms, so well known to the 
victim of colds. 
The Contagious Cold 
Even though we do nothing to reduce our vitality 
or injure our resisting power, still we may contract a 
cold. This is usually done by coming in contact with 
some one who already has a respiratory infection. 
Any person with a cold should make every effort 
to protect others from his infection. He should stay 
away from crowds, and especially from closed rooms 
that are artificially heated, such as theaters and 
churches, where people congregate. Aside from this, 
he should not breathe in the face of anyone, and 
when coughing or sneezing, should cover his nose 
and mouth with a handkerchief. He should sleep 
alone, and be in the open as much as possible. In 
this way, he can prevent, in a large measure, the 
passing on of his cold to others. 
On the other hand, the well should avoid contact 
with those who have a respiratory infection. Such 
infections are always obtainable in crowds; and for 
that reason, crowds should be shunned, particularly 
during the seasons when colds are more or less epi- Common Colds 
19 
demic. Sleeping cars are also a prolific source of 
such infections. 
As already explained, although we may do 
everything in our power to maintain our vitality and 
resistance, yet this will not always keep us from 
"catching cold" from others. The reason is simple: 
as soon as the germs start active growth and propa- 
gation in the tissues of an infected person, they 
immediately become more virulent, and their invad- 
ing power is greatly increased. At such a time, they 
are very different from the dormant germs always 
present in secretions from the air passages. This is 
why we can "catch cold" from one who is in the 
active stage of a cold, when we would not contract a 
cold in an ordinary way. In other words, the germ, 
by its growth in the tissues, has so increased its viru- 
lence that it gains immediate foothold in the air 
passages of the exposed person. Its invading power 
is beyond the resistance of the tissues upon which 
it falls. 
Treatment 
Surgery: Many people suffer of repeated and 
continuous colds, because there is something wrong 
locally in the nose or the throat. These people 
should go to a responsible nose and throat specialist 
and find out if there is local trouble. 
Adenoids and tonsils are the same in character 
and tissue. Everyone has them normally; but 
under certain circumstances, they become infected 
and inflamed. They are then swollen and enlarged, 
and contain pockets of pus, from which poisons are 
absorbed into the blood. Their increased size makes  Contagious Diseases 
20 
them out of proportion to the air passages in which 
they are situated. This condition sometimes be- 
comes so serious as to occlude the pharynx entirely, 
and prevent any breathing through the nose. Such 
a condition must result in heavy congestion of the 
mucous membranes of 
the air passages. All 
manner of germs are 
harbored in pus pockets, 
and the child suffers 
of one cold after an- 
other, or is never free 
from a cold. In these 
cases, the adenoids and 
the tonsils should be re- 
moved on the advice of 
a competent surgeon. Complete freedom from colds 
can often be obtained in this way. 
A deflected septum can cause colds and much 
local trouble. The dividing partition between the 
nostrils is sometimes pushed to one side, causing 
pressure on blood vessels, which results in chronic 
catarrh of the nose. This deflection may be due to 
accident, as a blow on the nose, and should never be 
neglected. Its correction is sometimes very impor- 
tant in stopping the tendency to colds. 
Good Hygiene: Nothing is of more importance 
in prevention or cure of colds, than intelligent care 
of the body. Neglect of frequent baths and change 
of clothing is a great handicap to those fighting a 
cold. Besides the bath for cleanliness, frequent cold 
The shaded portion shows the position of 
adenoids in the passageway between the 
nose and the throat. Common Colds 
21 
baths, with vigorous rubbing till the skin is red with 
reaction, are very beneficial in keeping up vitality. 
Good Ventilation of all living and sleeping rooms 
is a vital matter. Without it, your cold will last 
much longer. One can not recover well from a cold 
and constantly rebreathe the highly poisonous air 
that has been exhaled from the lungs. At night, we 
should have good, warm beds, and plenty of covers; 
but we should sleep in a cool room-much cooler 
than the living rooms for daytime-with every 
aperture thrown wide open to welcome an inex- 
haustible supply of fresh air. 
Attention to Diet is a great help toward recovery 
from a cold. The first thing of importance in this 
respect is to eat lightly. Overeating is harmful at 
any time, but especially during a cold. The old 
adage, "Stuff a cold and starve a fever," is wrong as 
far as the cold is concerned. When a person eats 
lightly, the entire digestive tract is rested, and the 
digestive juices and secretions get a fresh start. 
Also the work of the eliminative organs is lessened, 
and this is a direct help to the system in throwing 
off a cold. There should be reduction in hearty 
foods, as peas, beans, bread, potatoes, etc. If meat 
has been eaten, it should be stopped entirely until 
the cold is cured. Milk makes a good substitute for 
these foods at such a time. 
Fruits should be liberally increased, and fruit 
juices should be taken freely, the juices of lemon, 
orange, and grapefruit especially being taken 
copiously and often. In the acute stage of a cold, it 
is good to drink a glass an hour of hot lemonade or 22 
Contagious Diseases 
orangeade. If there is no sensation of chilliness, 
these beverages may be taken cold. 
Sometimes a "fruit day" goes well. By this is 
meant a day on which nothing but fruit is eaten. In 
such a case, fruit should be taken every hour, or at 
least every two hours. Fruit is laxative, and assists 
in elimination, both from the bowels and from the 
kidneys. It also reduces fermentation and putrefac- 
tion, and is generally beneficial. 
A Simple Cathartic, such as castor oil, is helpful, 
particularly if there is a tendency to constipation, or 
if the patient has recently eaten heavily. It should 
be taken at the beginning of a cold, and should not 
be repeated too many times, for habitual use of 
cathartics is objectionable. Following this, the diet 
should be light, and such as has before been suggested. 
Simple Treatments 
Very strong gargles, sprays, and washes are not 
the best. The simple ones are better. A solution 
of common salt, one teaspoonful to a pint of hot 
water, is a very good gargle. It should be used often. 
Throat Antiseptics: The hot gargle should be 
used every two hours, following which it is well to 
spray the throat with some oily preparation, by the 
use of an atomizer. A simple and common prescrip- 
tion is as follows: 
9 
Oil eucalyptus gr. 5 
Oil menthol gr. 5 
Liq. petrolatum oz. 1 
Use freely in an atomizer, following a gargle 
of hot salt water. Common Colds 
23 
Three times a day, after the gargle, swab or 
spray the throat with fifteen per cent argyrol, in- 
stead of using the oil spray. 
Hydrotherapy 
Fomentations to the face are an excellent means 
of helping to combat a cold in the head. For these, 
a large bath towel should be used, being wrung out 
of very hot water and applied to the entire face. By 
lifting the towel a little, a space may be bridged out 
at the end of the nose for breathing. The towel 
should be extra large, and should be applied much 
the same as a barber applies a hot towel before a 
shave. Renew the application several times, and 
after fifteen or twenty minutes of the hot applica- 
tions, bathe the face freely in cold tap water for two 
or three minutes. After thorough drying, plenty of 
talcum powder should be applied. Much help is 
derived from a repetition of this treatment every 
three hours. 
Hot Foot Baths: These assist by equalizing the 
circulation and drawing the blood to the extremities. 
This relieves congestion in the head and the chest. 
The foot bath should be taken in a deep bucket 
or pail, to bring the hot water as high up the ankles 
as possible. The addition of mustard or other medi- 
cines contributes nothing to the value of a hot foot 
bath. The heat is what does the work. This treat- 
ment should be taken often. Every three or four 
hours is a good interval for repeating it. When the 
feet are taken out of the hot water, they should be 
dashed with cold water thoroughly before drying. 24 
Contagious Diseases 
Hot Packs to the Chest: If the cold is "on the 
lungs," heat should be applied to the chest three 
times a day. This can be done with an electric pad. 
which can be screwed into any electric socket. If 
this is not available, hot packs applied by wringing 
cotton flannel out of hot water and changing at 
frequent intervals will be found beneficial. Specific 
directions for these remedies are given in the chapter 
on "Home Treatments," under the heading "Fo- 
mentations." When heat is applied to the chest, hot 
camphorated oil should be rubbed on both before and 
after the application. IL Tonsillitis 
is inflammation of the tonsils. 
V-/ It is a disease that is only slightly contagious, 
n Yet it does at times assume the epidemic 
form; that is, during the winter season, when it most 
frequently occurs, it is sometimes communicated 
from one member of the family to another. 
Symptoms 
The first symptom of the disease is a chill, with 
rising temperature following. The fever usually 
rises to 103, and in severe cases, to 104. There is an 
achy feeling in the muscles and the bones and the 
back. Headache also is a quite prominent symptom. 
Locally, in the throat there is soreness, and the ton- 
sils become enlarged, and have a red, angry look. 
Then after a few hours, there appear on the tonsils 
white patches, which increase in size until in some 
instances the tonsils are practically covered. The 
membrane has a grayish, dirty look. This mem- 
brane never appears on any other surface than that 
of the tonsils. A membrane seen on any other part of 
the throat than the tonsil, is a serious matter, and re- 
quires the immediate care of a trustworthy physician. 
In tonsillitis, there is difficulty in swallowing, and 
usually the lymph glands on the side of the neck 
enlarge enough to be felt. This is especially true 
in children. 
Complications 
It is not at all uncommon, in tonsillitis, to have 
complications in the middle ear. The reason is that 
the infection travels up the Eustachian tube, which 
25 26 
Contagious Diseases 
A membrane seen on any other part of the throat than the tonsil, is a serious 
matter. A patient is here shown undergoing treatment for diphtheria by 
means of an electric suction pump. The throat is nearly closed, but this 
instrument helps to keep the child breathing, and the life is saved. 
opens in the throat, very close to the tonsil. When- 
ever there is inflammation of any kind in the throat, 
earache should receive expert medical attention at 
once; for if pus gathers in the middle ear, it de- 
mands the services of an eye, ear, nose, and throat 
specialist without delay. 
As mentioned before, the lymph glands on the 
side of the neck may enlarge in tonsillitis. This en- 
largement is usually slight; but the glands may 
assume threatening proportions, and have to receive 
special attention. Tonsillitis 
27 
A Self-Limited Disease 
Tonsillitis is a self-limited disease; that is, if the 
patient has good hygienic care, and lives intelli- 
gently, the ailment will disappear of itself. There 
are, however, many things that can be done for the 
ease and comfort of the patient, and that will also 
hasten recovery. 
Treatment 
As soon as the nature of this malady is known, a 
mild cathartic should be given, to empty completely 
the stomach and bowel tract. Following this, only 
liquid foods should be allowed, until the fever is 
gone. Failure to re- 
gard this precaution 
makes the attack more 
severe. The patient 
should get into bed and 
remain there, drinking 
abundance of water, and 
especially of lemonade. 
Apply hot packs to 
the throat every three 
hours. (Directions for 
the giving of hot packs 
will be found in the 
chapter entitled "Home 
Treatments.") A hot 
foot bath in a deep 
bucket should be given 
at least three times a 
day. This relieves con- 
THE MOUTH AND THE THROAT 
1. Anterior pillar of fauces 
2. Posterior pillar of fauces 
3. Tonsil 
4. Soft palate 
5. Uvula 
6. Back wall of threat 
7. Tongue 28 
Contagious Diseases 
gestion in the throat and helps to combat the in- 
flammation. 
Local Treatment of the Throat: Strong gargles 
are not advisable. They do almost as much injury 
to the tissues as to the germs causing the infection. 
Milder gargles have found to be the best. A 
teaspoonful of common salt to a pint of hot water is 
very good indeed. If preferred, the same amount 
of common baking soda to the pint of hot water may 
be substituted. One or the other of these gargles 
should be used every two hours. It should be as 
hot as it can be held in the mouth without burning. 
Following its use, swab the tonsils and the throat 
with a twenty per cent solution of argyrol. Any 
competent person of the household can do this by 
depressing the tongue with a spoon handle and ap- 
plying the medicine with a swab of cotton on the 
end of a stick. The swabbing should be done after 
the gargle with the hot salt water, so as to leave the 
argyrol in contact with the throat until the next 
gargle is due, two hours later. 
The Heating Compress: Following the last hot 
pack to the throat at night, place on the throat a 
heating compress, to be worn throughout the night. 
This is done by wringing out several thicknesses of 
gauze from cold water. The compress should be put 
clear around the throat and covered thoroughly with 
flannel. (More specific directions for doing this will 
also be found in the chapter on "Home Treat- 
ments.") The next morning, resume fomentations 
or hot packs to the throat, and continue them every Tonsillitis 
29 
three hours throughout the day, with the heating 
coinpress at night, until the patient has recovered. 
If it seems necessary to give any medicines, be- 
cause of the fever, or to take anything internally in 
the way of medicines during the illness, a competent 
physician should be called before such a step is taken. The concentration of large bodies of troops, as in times of war, has always been favorable to the 
spread of epidemics. 
30 III. Influenza 
HE concentration of large bodies of troops, as 
in times of war, has always been favorable to 
isssl the spread of epidemics of various infectious 
diseases. Perfection of hygiene, sanitation, bacteri- 
ology, vaccination, etc., has in the past practically 
wiped out these scourges that followed in the trail of 
great armies. However, after the unprecedented 
mobilization of armies in the recent world war, there 
broke out an epidemic of influenza which science has 
been unable to control. It has encircled the globe, 
and in the United States alone has caused 400,000 
deaths. 
This epidemic made its first appearance in the 
United States at Chelsea, Massachusetts, on August 
28, 1918. Its progress over the country was rapid, 
despite frantic efforts on the part of those in au- 
thority to check it. Influenza has proved itself to be 
a disease of middle adult life, the extremes in age 
suffering less mortality from it than others. The 
epidemic is not causing as much comment and atten- 
tion as formerly, because we have grown used to it; 
but it is still present with us. In fact, since its 
beginning, most of the respiratory infections seem 
to have many of the characteristics of influenza. 
Symptoms 
Influenza is an acute febrile disease, character- 
ized by a somewhat sudden chill followed closely by 
rise of temperature, achy muscular pain, headache, 
backache, and severe prostration. Probably the 
most prominent symptom, in the minds of people in 
31 32 
Contagious Diseases 
general, is the aching pains in the entire body. As 
the temperature goes up, the patient suffers intensely 
from pains and aches in the muscles, especially in 
the back, legs, and head. These come on after a 
chill, and run in direct proportion to the severity of 
the fever. The patient is flushed in the face, and 
frequently has cold extremities although the fever 
may be high. 
Cough is a persistent symptom; for in a great 
majority of cases, the infection is in the respiratory 
passages. The cough is quite annoying and distress- 
ing to the patient. The material raised by the cough 
is usually a white, rather frothy mucus. The cough, 
in most instances, continues for some time after the 
subsidence of the acute symptoms that come with 
the onset of the disease. Sore throat is commonly 
present. There is difficulty in swallowing and talk- 
ing if the throat becomes very sore. Generally the 
throat looks very red and angry. 
Complications 
Influenza does not always attack the respiratory 
system alone. It sometimes attacks the stomach 
and bowel tract. This gastrointestinal type often- 
est occurs as a complication of the first infection 
in the air passages. The patient becomes ill in the 
regular way; and as the infected mucus that is 
raised by coughing is swallowed, the stomach and 
bowel tract becomes infected with the same germ. 
In most of these cases, the fever is higher than when 
the onset of the disease is in the air passages. The 
abdomen becomes very painful and tender. There Influenza 
33 
is a great deal of gas and distention, and there may 
be either constipation or diarrhea. It is possible for 
this condition to occur as the original infection, but 
it oftener conies as a complication to the respira- 
tory type. 
Pneumonia is probably the most common and 
dangerous complication. It may occur in the lungs 
from the very beginning of the disease, or as a later 
complication at any stage before the patient's re- 
covery. The symptoms pointing out its occurrence 
are, more severe pain in the lungs than before, in- 
crease in cough, spitting up of blood-tinged sputum, 
a more toxic appearance of the patient, with more 
rapid and shallow breathing. 
Inflammation in the middle ear is by no means 
an uncommon complication of influenza. It is caused 
by the infection traveling up the Eustachian tube 
from the throat, and starts with aching in the ear, 
which increases to well-nigh unbearable pain. It 
may be in one or both ears. 
Tuberculosis can hardly be regarded as a compli- 
cation of influenza. It is more rightly an after 
result. Large numbers of people contract their first 
tuberculosis infection in an attack of influenza. 
Hence good care of influenza cases is of the utmost 
importance. Even though the attack may seem a 
mild one, and the patient may feel strong and 
robust, and able to get along without "paying much 
attention" to the malady, it is not wise to adopt 
such a course, for a simple attack of influenza is 
capable of resulting in a tubercular condition which 
will develop as the months go by. 34 
Contagious Diseases 
Prevention 
When this epidemic first broke out in the United 
States, but little was known about it, and many 
bizarre and useless measures were put into effect in 
various localities in an effort to stem the tide of the 
disease. However, but little that was done had any 
effect. The most common and' most discussed regu- 
lation related to the wearing of the mask. This was 
quite generally enforced, but definite statistics com- 
piled by health departments have proved conclusively 
that the masks as worn during the epidemic were not 
effective. For instance, New York City did not 
wear the mask, but had a lower death rate than any 
of the other large cities of the country. 
Avoiding crowds is a measure of prme importance if you desire to 
escape influenza. In fluenza 
35 
The final conclusion regarding the wearing of 
masks is that they are ineffectual, and not worthy of 
consideration except by those who are in immediate 
attendance upon persons suffering of this malady. 
Nurses and others can wear them with a certain 
degree of protection while in the presence of the 
patient. At all other times, they should be laid off. 
Even this is an optional matter, and is not enforced 
by any state department of health, so far as the 
writer is aware. It is, however, voluntarily adopted 
by many in attendance upon influenza patients. 
Avoiding crowds is a measure of prime impor- 
tance if you desire to escape influenza. This malady 
is a "crowd" disease, and being in crowds is the 
surest way to contract it. During the big epidemics, 
churches, theaters, and even schools were closed, in 
an attempt to control the infection. This seemed to 
have very little influence upon the death rate, be- 
cause of the carelessness of individuals in refusing to 
stay away from crowds, private parties, etc. 
Sneezing and coughing in public during the time 
of an epidemic, is inexcusable. This is particularly 
true of one suffering of a cold. If sneezing or 
coughing is necessary, it should be done into a hand- 
kerchief that will completely cover the nose and the 
mouth and prevent droplets of saliva from flying in 
every direction. "Droplet infection" is conceded to 
be the most common method of spreading this dis- 
ease. On this account, it is well to avoid those who 
have any symptoms of a cold. 
Utensils used in the sick room should be care- 
fully scrubbed and boiled before use elsewhere. All 36 
Contagious Diseases 
articles should receive some kind of disinfection be- 
fore anyone else uses them, for it is possible for the 
disease to be spread by knives, forks, spoons, dishes, 
and handkerchiefs and other toilet articles. 
Isolation of the patient is a very important 
measure. In fact, many state boards of health 
depend upon this as the best weapon for fighting the 
epidemic. Influenza, in most states, is a reportable 
disease; that is, the physician or the head of the 
house is required by law to report cases of influenza 
to the health department. Complete quarantine is 
usually not required. The patient is simply isolated 
in a separate part of the house, and other members 
of the family are allowed to continue their work, 
provided they stay out of the sick room. It is, how- 
ever, within the power of most boards of health to 
enforce a full quarantine if they deem it necessary. 
If every case of influenza were strictly isolated, epi- 
demics would be much more successfully controlled. 
Wilford H. Kellogg, M. D., secretary and 
executive officer of the California State Board of 
Health, in a pamphlet issued after the epidemic, has 
the following to say regarding isolation: 
"It has already been stated that early isolation of cases is 
the most effective method known for preventing the spread of 
the disease, and it is here stated further that the application 
of this measure depends more upon the individual citizen than 
upon the health officer. The California State Board of Health 
has, in its printed instructions distributed throughout the state, 
placed emphasis upon the responsibility of the individual. The 
board has advised every person suffering from a cold to remain 
at home and to take every possible precaution not to come in 
contact with other persons. Many people suffering from so- 
called colds are in reality suffering from influenza in a mild 
form. Many severe cases of the disease have undoubtedly been These children are taking the sun and fresh air cure, and allowing nature to guide them back to physical perfection. 
Large numbers of people contract their first tuberculosis infection in an attack of influenza. 
37 38 
Contagious Diseases 
contracted from persons suffering from such colds. If each 
individual were to realize his personal responsibility in this 
matter, more good would be accomplished in the reduction of 
the prevalence of influenza than in any other way." 
The following is a copy of instructions put out 
by Dr. L. M. Powers, health commissioner of the 
city of Los Angeles, California, during the epidemic: 
"Instructions to Patients and Householders 
Where Influenza and Pneumonia Exist 
"No quarantine card is posted, but in cases where the orders 
of the health commissioner are not complied with, the depart- 
ment may, if necessary, enforce full quarantine. 
"Patient must be isolated until recovery, and care exer- 
cised to prevent the spread of the disease. 
"If any member of the household is handling food, he must 
remain away from premises until patient has recovered. 
"All children in the household are excluded from school 
until patient has recovered. (Normal temperature five days.) 
This includes all persons in attendance at universities, public 
or private schools, as pupils or employees. 
"If well children are removed to another address, they are 
excluded from school for a period of five days from last 
exposure. 
"School permits:-When last case in the household has 
recovered (normal temperature five days) children will present 
a note to that effect from their physician, . . . and health 
department physician will issue school permit card. 
"In apartment houses or hotels, only children of the im- 
mediate household or those coming in direct contact are 
excluded." 
The following pages are reproductions of copies 
of instructions prepared by the New York and Mas- 
sachusetts state departments of health. The latter 
was adopted by many states throughout the nation 
during the epidemic of influenza. They contain 
much valuable advice and information, and if fol- 
lowed, would be of great assistance in keeping down 
influenza. Public Health Is Purchasable. Within Natural -Limitations Any Community Can 
Determine Its Own Death Hate 
NEW YORK STATE DEPARTMENT OF HEALTH 
Albany, N. Y. 
HERMANN M. BIGGS. M. D. 
Commissioner 
EPIDEMIC INFLUENZA 
A highly infectious disease of unknown origin, spread by 
dissemination of discharges from the nose and throat chiefly 
through coughing and sneezing, and through physical contact 
between the sick and the well. 
How to avoid it 
Keep as far as possible from those who are coughing and 
sneezing unguardedly. 
Do not come in contact unnecessarily with those who may 
have the disease. 
When influenza is prevailing, avoid crowds. 
Do not use drinking or eating utensils used by others unless 
they have been washed in boiling water. 
Keep yourself in good condition by living and sleeping in 
rooms which are comfortably warm, but well ventilated. 
If you have it 
Call a physician. GO TO BED IMMEDIATELY in a warm 
and well ventilated room. If the services of a physician cannot 
be immediately secured take a laxative (tablespoonful of castor 
oil for an adult), and adhere to a liquid diet. 
Uncomplicated cases recover in a few days. If you would 
avoid complications, stay in bed at least three days after you 
feel perfectly well. 
For the protection of others cover your face when coughing 
or sneezing. 
If you are caring for a patient 
If there is a catarrhal discharge, see that it is received upon 
handkerchiefs and these promptly placed in water and boiled, 
or better still, furnish pieces of soft cloth which can be burned. 
Paper bags may be used temporarily to collect soiled cloths. 
Wash your hands with soap and water immediately after 
handling the patient or anything soiled with discharges. 
Avoid, if possible, close proximity to the patient when he is 
coughing or sneezing. 
If more than one patient is being cared for in the same 
room, remove them as far as possible from each other or separate 
their beds by hanging sheets or placing screens between them. 
While caring for patients avoid contact or association with 
other susceptible members of the household so far as possible. 
FORM C D-29 2-26-23-2000 (20-4146) • 
39 INFLUENZA ! 
How to Avoid It I How to Care for Those Who Have It! 
The following suggestions of the California State Board of 
Health may prove of immeasurable value to any man or woman 
who will read, remember and act upon them in the present great 
emergency. The counsel here set forth has been prepared after 
consultation with some of the ablest medical men in America. If 
you will follow the dictates of this official bulletin, you will be 
doing your duty to your fellow man and to yourself. 
What to Do Until the Doctor Comes 
If you feel a sudden chill, followed 
by muscular paiu, headache, backache, 
unusual tiredness and fever, go to bed 
at once. 
See that there is enough bed clothing 
to keep you warm. 
Open all windows in your bedroom 
and keep them open at all times, ex- 
cept in rainy weather. 
Take medicine to open the bowels 
freely. 
Take some nourishing food such as 
milk, egg-and-milk or broth every four 
hours. 
Stay in bed until a physician tells 
you that it is safe to get up. 
Allow no one else to sleep in the 
same room. 
Protect others by sneezing and 
coughing into handkerchiefs or cloths, 
which should be boiled or burned. 
Insist that whoever gives you water 
or food or enters the sick room for any 
other purpose shall wear a gauze mask, 
which may be obtained from the Red 
Cross or may be made at home of four 
to six folds of gauze and which should 
cover the nose and mouth and be tied 
behind the head. 
Remember that these masks must 
be kept clean, must be put on outside 
the sick room, must not be handled 
after they are tied on and must be 
boiled five minutes and thoroughly 
dried every time they are taken off. 
To Householders. 
Keep out of the sick room unless 
attendance is necessary. 
Do not handle articles coming 
from the sick room until they 
are boiled. 
Allow no visitors, and do not go 
visiting. 
Call a doctor for all inmates who 
show signs of beginning sick- 
ness. 
The usual symptoms are: Inflamed 
and watery eyes, discharging 
nose, backache, headache, mus- 
cular pain, and fever. 
Keep away from crowded places, 
such as '■movies," theaters, 
street cars. 
See to it that your children are 
kept warm and dry, both night 
and day. 
Have sufficient fire in your home 
to disperse the dampness. 
Open your wkidows at night. If 
cool weather prevails, add ex- 
tra bed clothing. 
To Workers. 
Walk to work if possible. 
Avoid the person who coughs or 
sneezes. 
Wash your hands before eating. 
Make full use of all available sun- 
shine. 
Do not use a common towel It 
spreads disease. 
Should you cough or sneeze, cover 
nose and mouth with a hand- 
kerchief. 
Keep out of crowded places. Walk 
bi the open air rather than go 
to crowded places of amuse- 
ment. 
Sleep is necessary for well-being 
-avoid over-exertion. Eat good, 
clean food. 
Keep away from houses where 
there are cases of influenza. 
If sick, no matter how slightly, 
see a physician. 
If you have had fiifluenza, stay 
in bed until your doctor says 
you can safely get up. 
To Nurses, 
Keep clean. Isolate your pa- 
tients. 
When In attendance upon patients, 
wear a mask which win cover 
both the nose and the mouth. 
When the mask is once in 
place, do not handle it. 
Change the mask every two hours. 
Owing to the scarcity of gauze, 
boil for 5 minutes and rinse, 
then use the gauze again. 
Wash your hands each time you 
come in contact with the pa- 
tient. Use bichloride of mer- 
cury, 1-1000, or Liquor Cresol 
compound, 1-100 for hand dis- 
infection. 
Obtain at least seven hours' sleep 
in each twenty-four hours. Eat 
plenty of good, clean food. 
Walk in the fresh air daily. 
Sleep with your windows open. 
Insist that the patient cough, 
sneeze or expectorate into 
cloths that may be disinfected 
or burned. 
Boil all dishes. 
Keep patients warm. 
For Copies of this Publication cApply to 
California State Board of Health, Sacramento 
(Prepared by Massachusetts State Department of Health) 
40 Influenza 
41 
Treatment 
A person suffering of influenza should immedi- 
ately go to bed, and remain there from three to five 
days after the last rise of temperature above normal. 
This rule is imperative, and should not be slighted. 
Failure to observe it, may mean the difference 
between a simple case of influenza and one compli- 
cated by pneumonia. 
If the illness starts with a hard chill, as it does 
in the majority of cases, extra covers shoidd be 
placed over the patient, and hot drinks, such as 
lemonade, should be taken freely until the chill is 
over and light perspiration is induced. He should 
then be cooled off gradually and the normal amount 
of covering left over him. 
A dose of castor oil (1 tablespoonful for adults) 
should be taken at once. There is no other cathartic 
as successful in emptying the canal or as helpful in 
such a time as this. During the stay in bed, the 
patient should remain* on a liquid diet. That is, he 
should take no solid food. The best foods are milk, 
soups, broths, strained gruels, fruit juices, malted 
milk, yogurt, buttermilk, etc. While on such a diet as 
this, the patient should be fed every two hours regu- 
larly, excepting during the sleeping hours at night. 
The taking of fluids is of the utmost conse- 
quence; it is impossible to drink too much. Aside 
from the fluid taken as food, the patient should 
drink a glass an hour of water or lemonade during 
the acute stage of the fever. This is most beneficial 
in helping to reduce the fever, and also helps to 
keep the body flushed out. It acts as a safeguard 42 
Contagious Diseases 
to prevent the high fever from injuring the delicate 
tissues of the body. The drinking of pure water is 
a remedy the value of which is appreciated by but few. 
Isolation of the patient is necessary from several 
standpoints. First, it saves the patient the irritation 
and excitement of having others around; and in the 
case of a very sick patient, this is an important 
matter. Secondly, it saves others from the danger 
of contamination. Those whose work does not bring 
them in contact with these cases, should stay away 
entirely. 
A glance at the little sheet put out by the New 
York Department of Health (page 39), and the one 
originated by the Massachusetts Board of Health, 
and put out by several states (page 40), will show 
how essential state boards of health consider isolation. 
A hot foot bath in a deep bucket is very bene- 
ficial, to relieve cough, soreness in the throat, and 
congestions in the lungs. It therefore is a curative 
measure, and should be employed regularly in these 
cases. Instructions for the giving of hot foot baths 
will be found in the chapter on "Home Treatments." 
Hot packs to the chest, both front and back, are 
also very helpful. These should be given every three 
hours, and the patient should be rubbed with hot 
camphorated oil before and after. Specific instruc- 
tions for this treatment also will be found in the 
chapter on "Home Treatments." In the case of 
infants and small children, it is rather difficult to 
give these treatments. In such a case, the little 
patient should be rubbed with hot camphorated oil, 
and then have a copious application of warm anti- Tubercular children of 
the Minneapolis public 
schools receive their 
"sun baths" indoors 
by electricity on rainy 
days. The rays of 
the sun are great 
germ killers. 
43 44 
Contagious Diseases 
phlogistine applied to be worn overnight. This 
should cover the chest front and back. Details re- 
garding this are given in the chapter on "Home 
Treatments." 
A gargle of hot salt water (one rounding tea- 
spoonfid of common table salt to a pint of water) 
should be used every two or three hours, as both a 
mouth wash and a gargle. If the throat is especially 
sore, it should be swabbed three times a day with 
fifteen per cent argyrol. This should be done fol- 
lowing the gargle with hot salt water. 
If it is necessary to administer any medicines 
internally, a physician should be in charge of the 
case. The indiscriminate giving of remedies recom- 
mended by well-meaning friends and neighbors, 
without the advice of a physician, is dangerous and 
should not be practiced. IV. Measles 
IpfTIEASLES is an infectious, contagious disease. 
The special symptoms characterizing it are, 
IwaM slight inflammations in the air passages, with 
discharge from the nose, and a little cough, a moder- 
ate fever, and an eruption of red papules appearing 
about the fourth day of illness. Measles is also 
called rubeola. 
A person who has been exposed to measles is not 
free from the danger of contracting the disease until 
fourteen days have elapsed. The average length of 
time is about eleven days. This is one of the most 
highly contagious diseases known. As a rule, im- 
munity is acquired by one attack; when a person has 
had measles once, it is not likely to recur. The 
infection is communicated by the "droplet method" 
mainly; that is, by coughing, sneezing, breathing, 
talking, etc., the patient ejects little particles of 
secretions, which are borne to other individuals. It 
is also carried by dishes, toilet articles, clothing, bed- 
ding, and other objects. This, though, is usually 
because these articles have become contaminated 
with the excretions from the body, chiefly sputum. 
Incubation 
Symptoms 
A measles patient may come down with a sharp 
chill, fever rising rapidly afterwards; hut more com- 
monly the disease starts gradually with a "little 
running at the nose," watering of the eyes, and a 
slight cough. In most cases, there is some hoarse- 
45 46 
Contagious Diseases 
ness and sneezing, and light is painful to the eyes. 
The cough increases as the disease progresses, and it 
becomes quite hard and dry. Fever is a constant 
symptom. As stated before, it usually develops 
gradually; 102 or 103 is the usual temperature, al- 
though it is not an alarming thing for a child to have 
a temperature of 104 at the height of the disease. 
Generally the highest temperature is reached just 
before the patient breaks out with the eruption and 
one day afterwards. 
One week is the ordi- 
nary length of time for 
fever. 
The eruption ap- 
pears three or four 
days after the patient 
becomes ill. It first 
breaks out around the 
hair line, and on the 
ears, the neck, and the 
forehead. From here it 
spreads to other parts. 
The eruption is slightly raised and has a dusky red ap- 
pearance. It is quite characteristic, and having been 
once seen, is easily distinguished. In severe cases, 
the eruption becomes so profuse sometimes as to run 
together and form blotches that have irregular edges. 
It may also break out in the mouth. This mouth 
eruption occurs in ninety per cent of the cases. It 
consists of little bluish white specks surrounded by 
an area of quite red-appearing inflammation. 
J 2 3 4-56 7 6 9 
106° 
105° 
104° 
103° 
102° 
101° 
100° 
99° 
98° 
Fever Chart in Measles Measles 
47 
The eruption usually lasts three or four or even 
five days. The week following eruption, there is a 
peeling of the skin. This is due to the fact that the 
inflammation in the skin has destroyed the life of the 
skin, and this comes off in little scales that are de- 
scribed as "branlike." Most patients improve rapidly 
after the disappearance of the rash, and at the end 
of ten days, feel as well as ever. It is not uncom- 
mon, however, for the severer cases to take two 
weeks or longer. 
Complications 
The most serious complication is pneumonia. As 
was explained under "Symptoms," a little catarrh, 
cough, and other symptoms of irritation in the lungs 
and the air passages, are present from the beginning 
of the disease. Because of this tendency of measles 
to irritate the air passages, there is always danger of 
its being complicated with pneumonia. When this 
happens, there is increased pain in the chest, in- 
creased cough, and the patient looks and feels worse 
from a very definite hour. 
Abscess in the middle ear is another very fre- 
quent complication. The infection travels from the 
throat through the Eustachian tube into the middle 
ear, causing pus to form. This requires the atten- 
tion of a specialist. 
It is also common to have complications in the 
eyes; that is, inflammation may develop there as a 
result of the irritating secretions during the height 
of the fever. On this account, strict attention should 
be paid to the instructions given under "Treatment," 
for the care of the eves. 48 
Contagious Diseases 
One of the greatest dangers following measles is, 
that if the patient has not had proper care, he may 
develop tuberculosis in the months following. To- 
day most of those who contract tuberculosis under 
twenty years of age have done so as a result of 
measles, whooping cough, or influenza. It is a grave 
mistake to say, "Oh, well, it is only measles," and 
let the children go without proper attention. Intel- 
ligent care during the progress of this disease may 
mean escape from the "great white plague" which 
can so easily follow. 
A person with measles should be placed in a 
well-ventilated room, but free from drafts. The 
temperature of the room should be about 70 degrees. 
No matter how light the attack, keep the patient in 
bed at least ten days. The eyes are too irritable to 
stand bright sunlight, therefore the room should be 
darkened sufficiently to prevent any discomfort from 
the light, in the eyes. If possible, keep a teakettle 
of hot water boiling in the room, to provide moisture 
in the air. This greatly lessens and eases the cough. 
The diet should be principally liquids. In the 
case of infants, their milk should be diluted much 
more than ordinarily. In addition to liquids, older 
children and adults may have raw eggs, soft eggs, 
cornstarch pudding, plain custard, junket, fruit 
juices, and hot drinks of any character. Water 
should be taken very freely. 
It is very seldom advisable to do much about the 
fever. If something has to be done for it, tepid 
sponging is best. Anything beyond this should be 
Treatment Measles 
49 
prescribed by the family physician. There is no 
treatment for the eruption except to increase the 
drinking of hot fluids and try to get the patient to 
perspire if eruption is delayed. In many cases, a 
hot bath is given, after which the patient is sur- 
rounded with hot water bottles in bed and caused to 
perspire. This assists greatly in bringing out the 
rash. Following this, if there is itching, olive oil 
may be used on the skin, for relief. 
The eyes should be washed frequently (every 
two hours) with a saturate solution of boric acid. 
If the lid is pulled away from the eyeball, the solu- 
tion can be washed under the lids by the use of a 
medicine dropper. This will prevent any complica- 
tions or permanent injury to the eyes. Bathing or 
washing out the eyes to remove the secretions is of 
more importance than darkening the room. If the 
room can not be darkened sufficiently for comfort, 
the patient may wear dark glasses. 
If the bowels do not move properly, enemas are 
better than cathartics during the length of time the 
patient is in bed. If the cough becomes bad, fomen- 
tations to the chest will relieve it a great deal. The 
hot foot bath also may be used to good advantage. 
Quarantine Regulations 
Measles is a disease of cold weather, and epi- 
demics oftenest occur in the middle of the season 
and of the school year. Control of such epidemics is 
very essential, and all regulations laid down by local 
health boards should be strictly observed. 50 
Contagious Diseases 
Most boards of health require that the patient 
remain in quarantine seven days after the appear- 
ance of the rash, and until the discharges from nose, 
ears, and throat have disappeared and the cough 
ceases. Some of these may hold a patient in quar- 
antine for a long period of time. Discharging ears 
especially do this. But these instructions should be 
obeyed. V. Mumps 
Im UMPS is an acute and highly contagious dis- 
ease. It is especially characterized by inflam- 
iwbwM mation and swelling of the salivary glands. The 
period of incubation is about eighteen days. The 
disease is highly contagious, and spreads with great 
rapidity in institutions where people congregate. It 
is not transmitted by a third person; direct contact 
is necessary. The infecting germ is probably con- 
tained in the saliva. The most common ages for 
mumps are between five and fifteen years. One 
attack usually confers immunity from the disease; 
that is, it is seldom contracted twice. 
Symptoms 
Mumps starts gradually. The patient usually 
feels somewhat chilly, with slight fever for a day or 
two, at the end of which time swelling starts in the 
parotid salivary gland. As soon as this occurs, there 
is aching, tenderness, and pain. The disease may 
affect only one side of the face; but in most in- 
stances, both sides are affected. One side may start 
the trouble two or three days later than the other 
side. The site of the swelling is much higher than 
is ordinarily supposed. It conies well up in front of 
the ear, to a point nearly level with the top of the 
ear. From here it goes down below the angle of 
the jaw. If the swelling extends to the submaxillary 
and sublingual glands, it reaches to the center un- 
derneath the chin. 
51 Injecting serum in a tubercular patient. Most of those who contract tuberculosis under twenty years of age have done so as a result 
of measles, whooping cough, or influenza. 
52 Mumps 
53 
The tasting of sour substances, such as lemon 
juice or vinegar, causes an excessive flow of saliva, 
accompanied by pain. Sometimes chewing or talk- 
ing, or anything that requires movement of the 
jaw, is painful. The fever seldom goes very high. 
In many cases, it never goes above 100 degrees; and 
102 is considered a high fever for mumps. The 
average attack lasts about two weeks. The fourth 
or fifth day is as a rule the worst time; from this on, 
it quite rapidly subsides. 
Complications 
The complications are few. The most frequent 
is an inflammation of the testicle or the ovary. The 
germ of this disease seems to have a special tendency 
to cause inflammation of these glands. For this 
reason, persons having mumps should stay off their 
feet, remaining quietly in bed, or at least not do 
much walking nor take much exercise of any kind. 
It is also important to avoid taking cold, getting the 
feet wet, or committing any other indiscretion that 
might bring about such a complication. 
Treatment 
The patient suffering of mumps should remain 
in bed until the fever and the swelling are gone. 
Since it is painful to chew, he should have a liquid 
or very soft diet. A dose of castor oil to empty the 
alimentary tract should be the first remedy admin- 
istered. Fomentations applied over the entire side 
of the face and jaw and neck will afford a great deal 
of relief from the pain in the glands. Hot foot 54 
Contagious Diseases 
baths also relieve the pain somewhat, because they 
draw blood from the head. In case of such a com- 
plication as inflammation of the testicle or ovary, a 
physician should be called. Isolation and quaran- 
tine of the disease by health authorities should have 
full support from a family or individual afflicted. 
The usual restrictions hold the patient in quaran- 
tine until two weeks after the appearance of the 
disease, or until there is no swelling left. VI. Whooping Cough 
HOOPING cough, or pertussis, is a conta- 
gious disease characterized by inflammation of 
n the respiratory tract, with a peculiar spas- 
modic cough, at the close of which there is a "whoop- 
ing" sound. The cough conies in paroxysms and 
frequently ends in vomiting. 
Incubation 
The period of incubation varies. It is never less 
than two days nor more than two weeks, the average 
being five days to a week. Whooping cough affects 
both sexes equally, and oftenest attacks children 
from six months to seven or eight years of age. It 
is contracted by direct contact with the patient. 
There is doubt as to whether a third person can 
convey the disease; but toys and other small articles 
that are likely to be placed in the mouth of a child, 
may convey it. One attack usually confers im- 
munity for life. 
Symptoms 
Whooping cough is a rather slow disease, and 
may continue for several months. Generally it be- 
gins with symptoms of an acute cold, a little chilli- 
ness, redness of the eyes, sneezing, a dry cough, and 
if the case is a severe one, some fever. All these 
symptoms increase until finally it is discovered that 
the cough comes in paroxysms, or brief attacks. 
From this on, the patient suffers mainly from 
the severity of these attacks of cough. A paroxysm 
may be precipitated by laughing, crying, shouting, 
exercising, etc. Often a child, upon recognizing 
the approach of a paroxysm, will run to some person 
55 56 
Contagious Diseases 
or object for support. The cough starts with a 
series of short, rapid expiratory efforts at coughing. 
No breath is drawn in between these coughs. This 
may continue so long that the child turns blue, the 
veins of the face and neck become enlarged, and on 
the whole, a very distressing picture is presented. 
At last, there is a long-drawn inspiration, which 
produces the peculiar noise that gives the disease 
its name. 
The mucus that is raised is very tenacious and 
clings to the throat. It is this that gags the child 
and causes him to vomit with these paroxysms. The 
condition may become so serious as to interfere with 
the child's nutrition; that is, the frequent vomiting- 
makes it difficult to keep enough nourishment in his 
stomach to prevent emaciation. The severity of 
these paroxysms of coughing will be realized when 
it is understood that often urine and feces are 
forced from the little patient. 
In mild cases, the characteristic "whoop" does 
not always develop; but usually there are sufficient 
symptoms for a diagnosis. Gradually it is observed 
that the paroxysms are less violent; the patient be- 
comes better able to control himself during an attack 
of coughing, and does not vomit so frequently; the 
cough becomes looser and the mucus more easily 
raised. Whooping cough lasts from six weeks to 
three months, and neglected or severe cases may 
continue for four months or more. 
Complications 
The gravest complication of whooping cough is 
pneumonia; and to prevent, if possible, this compli- Toys and other small articles that are likely to be placed in the mouth of a child may convey the germs of whooping cough. 
57 58 
Contagious Diseases 
cation, all whooping cough cases should be very 
carefully guarded against exposure, or taking cold, 
or anything that would reduce the vitality. 
Tuberculosis sometimes follows whooping cough. 
The vitality of the patient is greatly reduced during 
this long drawn out malady, the vomiting interferes 
with the nutrition, and the respiratory tract becomes 
an excellent field for a tubercular infection. On this 
account, it is very important that the patient be kept 
as well nourished as possible. 
Vomiting may be so severe as to constitute a real 
complication. What to do for it will be discussed 
under "Treatment." 
Treatment 
Fresh air, sunlight, warm clothing, proper pro- 
tection, and plenty of nourishing food constitute the 
fundamental treatment for whooping cough. It is 
a mistake to keep the patient in bed or even closely 
confined in the house, especially after the onset of 
the disease is over. He needs the fresh air and sun- 
light; and the paroxysms will be less violent than 
if the child is housed up all the time. He should be 
kept from violent exercise of any kind, or anything 
that would bring on the paroxysm. 
The diet should be very rich in milk, eggs, and 
fruit juices; and plenty of vegetables also should be 
given, with practically no meat at all. If the vomit- 
ing becomes worse, the number of feedings daily 
should be increased, to make up for the loss of food 
from this cause. In such a case, the feedings should 
be smaller. If much trouble is experienced along 
this line, predigested foods, such as malted milk, 
should be used. Any child suffering of whooping cough should be excluded from attendance at school. 
59 60 
Contagious Diseases 
Hot foot baths, and fomentations to the ehest 
and back, are of great assistance in warding off 
paroxysms, and also in lessening their severity. 
After these treatments, the mucus is much more 
easily raised, and the sleep at night is less disturbed. 
Serums and vaccines have become of considerable 
value in the treatment of this disease, and are now 
used with good results by many physicians. They 
should not be administered except upon the advice 
of a physician. 
It is the duty of the health officer to maintain a 
certain quarantine for whooping cough cases until 
there is no more cough and all discharge from nose, 
mouth, and ears has ceased. This may be a long 
time, and may work a hardship on the child because 
he loses so much time out of school; but the measure 
is absolutely necessary. 
It is the duty of persons in charge of any school, 
including Sunday schools, etc., to exclude from at- 
tendance any child suffering of whooping cough. 
For parents to try to cover up the true nature of 
mild cases, in order to permit their children to attend 
school, is a very unwise policy, not only because of 
tlie injury it does to the other children of the school, 
but doubly so because of the danger to the little 
patients themselves. Proper care is impossible 
while they are attending school, and the danger of 
pneumonia as a complication is much greater. 
Moreover, the danger of a chronic tubercular infec- 
tion following the whooping cough is greatly 
increased. Good care is the first line of defense in 
this matter, and should not be neglected. VII. Scarlet Fever 
fever, or scarlatina, is a contagious 
and infectious disease, the principal symptoms 
of which are high fever, sore throat, and a 
diffuse rash of a scarlet color. This disease has a 
great tendency to produce nephritis (inflammation 
of the kidneys) and inflammation of the middle ear. 
Incubation 
The period of incubation varies. In severe epi- 
demics, it may be but one day. In milder cases and 
under some conditions, it may be as long as eight 
days. The average is from two to four days. Those 
who have been exposed should be excluded from 
contact with all persons for one week. If they do 
not come down with the fever at the end of that 
time, they may be once more permitted to continue 
with their work or school. 
Scarlet fever is most epidemic in fall and winter. 
It is a virulent infection, and one regarding which 
the greatest caution should be exercised. It is con- 
tagious from the very beginning, at the onset of the 
fever. It is, however, most contagious during the 
time that the patient is broken out. Patients can 
communicate this disease as long as there is any dis- 
charge from the nose and throat and ear passages, 
or as long as there is any peeling of the skin. Thirty 
days or longer from the onset of the trouble is re- 
quired to get the average case free from the infect- 
ing agent or from danger of communicating the 
disease. It can be communicated by direct contact 
61 Scarlet fever is a virulent infection. It can be communicated by direct contact 
with the patient, or by articles of any nature, such as toys, bedding, clothing, etc. 
62 Scarlet Fever 
63 
with the patient, or by articles of any nature, such 
as toys, bedding, clothing, laundry, toilet articles, etc. 
Children between the ages of one and fifteen 
years are most susceptible to this malady, although 
it may attack any 
person from one year 
of age upward. The 
disease is very rarely 
contracted by a child 
younger than one year; 
there appears to be a 
certain immunity up to 
this age. Negroes seem 
less susceptible to scar- 
let fever than white people; and among East Indian 
and Japanese peoples, the disease is very rare. 
1 Z 3 4 5 b 7 8 9 10 >1 |£ 13 14 
104" ■ 
103" ■ 
102" ■ 
101° ■ 
100° ■ 
99° 
98° 
Fever Chart in Scarlet Fever 
Symptoms 
The onset of scarlet fever is quite sudden in 
most cases. There is somewhat heavy chilling, with 
sudden rise of temperature; and vomiting is a very 
early symptom. Vomiting may start with the chill. 
General prostration and bad feeling obtain from the 
first; and sore throat, with headache, develops rap- 
idly after the fever is established. This disease 
usually presents a high fever, ranging from 103 to 
104. The fever continues rather steady until the 
eruption begins to grow less. After this, the fever 
will gradually decline, taking three or four days to 
disappear after the eruption begins to grow less. 
The fever lasts from seven to ten days if there are 
no relapses nor complications. 64 
Contagions Diseases 
The pulse in this disease is rapid, as in fact it is 
in any disease that has fever; but in scarlet fever, it 
is out of proportion to the fever; that is, the pulse 
is more rapid than one would expect it to be, judg- 
ing from the degree of fever. 
The eruption may begin to appear on the first 
day, but it more commonly starts at the end of the 
first twenty-four hours. It is first noticed on the 
throat and upper chest, and from here spreads, in 
severe cases, to the entire body. It is a rash of 
bright red color, which gives the disease its name; 
though it may be dusky or even bluish. Ordinarily 
there are little red points scattered through the 
rash, that are a slightly darker shade of red than 
the background of the rash. Pressure with a plain 
piece of glass will make the red color disappear and 
leave a white skin, but it returns immediately upon 
removal of the pressure. Itching is always present, 
and in some cases, is quite annoying. Generally the 
eruption reaches its height about the fourth day and 
disappears at about the seventh or ninth day. 
As soon as the rash or redness of the skin disap- 
pears, peeling of the skin (desquamation) begins. 
The patient must stay in quarantine until this is 
thoroughly accomplished, although it sometimes 
takes a tedious amount of time. On the palms of 
the hands and the soles of the feet, where the cuticle, 
or outer skin, is very thick, the skin is peeled off in 
large flakes. Where the skin is thin, the peeling is 
more slight. In very severe cases, the hair may be 
lost entirely, and even the nails have been known to 
be shed. However, these return in due time. Scarlet Fever 
65 
Sore throat is an early and constant symptom. 
Swallowing and talking are painful, and the throat 
is badly swollen. There is no membrane present, 
but the throat is very red and angry-looking. In 
most instances, the soreness subsides about the same 
time as the rash. 
Complications 
Inflammation of the middle ear, with abscess 
formation, is very common in scarlet fever. This is 
because of the inflammation in the throat, which can 
so easily travel up the Eustachian tube. Whenever 
pain in the ears complicates this disease, they must 
receive immediate attention by a skilled specialist. 
Acute nephritis (inflammation of the kidneys, or 
acute Bright's disease) is a complication that fre- 
quently occurs in scarlet fever cases. The germ, or 
infecting agent, causing this disease, seems to have 
a special tendency to lodge in the kidneys, where it 
starts up a severe inflammation. This is one of the 
reasons why a competent physician should be in 
charge of every case of scarlet fever; for although 
the attack of fever may be light, the damage to the 
kidneys can be very serious. 
Treatment 
Rest in bed is a little more essential in scarlet 
fever than in most of the fevers. Even though the 
attack is a very mild one, it is dangerous for the 
patient to be out of bed, on account of the increased 
likelihood of complications in the kidneys. 
Water should be taken very freely. It not only 
serves the purpose of relieving the thirst incident to 66 
Contagious Diseases 
the high fever, but it helps in a measure to reduce 
the fever itself; and most of all, it is of great assist- 
ance to the kidneys, lessening in a marked degree 
the danger of complications in them. This is an 
important point, and one that should not be neg- 
lected. Water drinking is of the utmost importance. 
A dose of castor oil should be taken in the begin- 
ning, to empty the bowels; but other than this, all 
cathartics should be avoided, and if something is 
necessary to move the bowels, enemas should be used. 
The diet should be very largely milk. Junket, 
kumiss, ice cream, strained gruels, and fruit juices 
also may be used. The citrus fruits, such as oranges, 
lemons, grapefruit, tangerines, etc., provide the best 
juice for the use of these patients. The sore throat 
should be treated by use of a hot gargle of salt 
water (one rounding teaspoonful of common table 
salt to one pint of water). If the child is too young 
to be able to gargle, it is best not to attempt to have 
him do so. 
If the fever gets very high, control it by tepid 
sponging. Immersion in a tub for ten minutes, with 
the water at 105°, is very beneficial to reduce the 
high fever, and is also very quieting to the patient, 
and enables him to rest much better afterwards. 
The itching is best allayed by the use of cold cream, 
cocoa butter, or carbolized olive oil. 
No drugs or medicines of any kind should ever 
be given these patients except by the prescription of 
a reliable physician. This is true in any disease, but 
is especially true in scarlet fever. Scarlet Fever 
67 
Quarantine and Control 
On account of the ease with which this disease is 
spread, measures for its control are a little more 
strict than for other contagious diseases. All local 
health boards require that either the patient be re- 
moved to a contagion hospital or else the entire 
premises be quarantined. A placard is placed on the 
house, and no one is permitted to come and go ex- 
cept the physician and nurses or those who are 
needed to care for the sick. 
The California State Board of Health has put 
out a very interesting pamphlet regarding the con- 
trol of this disease. The matter could not be stated 
more concisely or accurately than therein. Rule 3 
from the law as quoted in this pamphlet is herewith 
reproduced: 
"Rule 3. Instructions to household. 
"It shall be the duty of the physician in attendance on a 
person having scarlet fever, or suspected of having scarlet 
fever, to instruct the members of the household in precaution- 
ary measures for preventing the spread of scarlet fever. 
"Note 1.- Scarlet fever is spread by the secretions from 
the noses and throats of patients and also by discharges 
from the ears or suppurating glands. ... It is prob- 
able that unrecognized mild cases and carriers play a 
large part in the spread of the disease. If milk is con- 
taminated by a person having scarlet fever the disease 
may spread to the people who drink it. In this way 
serious epidemics are sometimes caused. 
"Note 2.- The following instructions are required by 
Rule 3: 
"1. If the patient is not removed at once to a hospital, 
he shall have a separate bed in a room screened 
against flies. 
"2. All persons, except those having the necessary care 
of the patient, shall be excluded from the sick room. 
"3. Animals shall be excluded from the sick room. 68 
Contagious Diseases 
"4. The room should be kept well aired and clean. 
It should be freed from unnecessary carpets, 
draperies, and furniture before the patient is 
placed in it. Dust must be avoided by frequent 
moist cleansing of woodwork and floors. 
"5. The person caring for the patient shall avoid com- 
ing in contact with any other person within the 
household or elsewhere. 
"6. The person having the care of the patient shall 
wear a washable outer garment and shall thor- 
oughly wash the hands with soap and water after 
handling the patient or any object which he may 
have contaminated. On leaving the room in which 
the patient is isolated, the attendant shall take off 
the washable outer garment and leave it in the 
room until disinfected. 
"7. All discharges from the nose and mouth, ears and 
suppurating glands shall be burned or disinfected. 
It is recommended that these discharges be re- 
ceived on pieces of gauze or other soft cloth and be 
dropped in a paper bag which is conveniently 
placed. The bag and its contents can be easily 
burned. 
"8. Objects which may have been contaminated by the 
patient shall be disinfected before being removed 
to any place where they might become possible 
sources of infection. 
"(a) Clothing and bedding, including the washable 
outer garment of the attendant, should be 
boiled in water or soaked for one hour in 5 
per cent phenol or 10 per cent formalin solu- 
tion, before being sent to the laundry. 
"(b) Dishes and other utensils should be boiled in 
water or soaked for one hour in 5 per cent 
phenol or 10 per cent formalin solution. 
"(c) Remnants of food should be burned, or, if 
liquid, disinfected by boiling, or adding an 
equal volume of a 5 per cent phenol or 10 per 
cent solution of formalin and allowing to 
stand for one hour." VIII. Chicken Pox 
CHICKEN POX, or varicella, is an acute fever. 
It is infectious and contagious, but is a very 
iSi trivial disease when compared with smallpox 
and with many of the other children's infectious dis- 
eases. It is of short duration, and is characterized 
by a vesicular eruption which conies in repeated crops. 
Incubation 
The period of incubation is about two weeks. 
Young children are the most susceptible to chicken 
pox, and it oftenest occurs between the ages of one 
and six. Direct contact with one suffering of the 
disease is the most frequent source of infection, al- 
though a third person, or objects carried from the 
sick room, sometimes give it. This malady may be 
conveyed from the first onset of symptoms until 
after the disappearance of any scabs and of any 
scaling from the site of the pocks. It bears no rela- 
tion whatever to smallpox, and provides no immu- 
nity from that disease. It protects against second 
attacks of itself, but smallpox can be contracted just 
as easily as though the patient had not had 
chicken pox. 
Symptoms 
The fever with chicken pox is very light. In 
fact, the patient may not know there is anything 
wrong with him, until he sees the eruption. In some 
instances, there is a slight chill, with loss of appetite 
and general bad feeling, before the breaking out; 
but these symptoms are usually slight. The erup- 
tion consists of little hard papules, or pimples, that 
69 One child in a group of this size, with the germs of a contagious disease, could cause great 
havoc. However, measures for the control of disease are becoming more strict. It is 
within the power of most boards of health to enforce full quarantine if they deem 
it necessary. 
70 Chicken Pox 
71 
are red in color. These appear first on the back and 
on the face, after which, if the disease is severe, they 
spread to other parts of the body, especially over the 
trunk. The arms and the legs are affected very 
little, and the palms of the hands and the soles of 
the feet, in most cases, escape entirely. After the 
first day, the little hard papules of the eruption turn 
into vesicles; that is, the inside of the papule breaks 
down into a fluid. This fluid is transparent and 
clear as crystal. The $ize of the pocks varies 
greatly; they may be very small, or as large as a 
pea. At the end of the second day, the fluid in the 
papules contains pus, and is no longer transparent. 
Their surface then becomes puckered, dries up into 
bluish scabs, and sloughs off, leaving reddish marks 
on the skin, showing the site of the pocks. 
It is possible to see these pocks in all stages of 
progress, because they come in successive crops. 
New ones will start up each day for several days, so 
that when those which first came are clearing up, 
there are fresh ones just starting. 
This disease may be very slight, with not more 
than three to a dozen pocks; or it may cover the 
body. There is ordinarily some itching with it, and 
in a few cases, it breaks out on the mucous surfaces, 
as the mouth and the pharynx. A week is the usual 
length of time for these cases; but severe cases may 
last for three weeks. 
To differentiate chicken pox from smallpox is 
sometimes a rather hard problem, and may confuse 
even the physician for a time. It is of the utmost 
importance, however; for chicken pox is a mild 72 
Contagious Diseases 
ease, with no serious consequences, whereas smallpox 
is a very grave one, requiring stringent measures 
both for its treatment and for its control in quaran- 
tine. Whenever there is doubt about the matter, the 
community at large should have the benefit of the 
doubt. Any patient suffering of this malady, should 
be excluded from all contact with other persons, 
and the case should be reported at once to health 
authorities for their decision. To neglect any of 
these precautions is a great wrong to the community 
in which one is living. 
A discussion of the main points of difference 
between these diseases, that will assist in determining 
of which the patient is suffering, is given on page 
82, following the discussion of smallpox. 
Treatment 
Absolute rest in bed should be enforced. This is 
sometimes difficult with small children, but neverthe- 
less it is imperative. The child should be kept in 
night clothes and held strictly in bed until the 
malady is entirely over. The diet should be nutri- 
tious, and rich in milk, raw or very soft eggs, cereals, 
and fruit juices, especially orangeade and lemonade. 
Encourage water drinking, and give plenty of 
starchy foods, mainly cereals. 
If there is pain in the back, hot fomentations 
should be given, directions for which will be found 
in the chapter on "Home Treatments." If there is 
vomiting and nausea, the patient should be allowed 
to swallow small pieces of ice, and be kept very quiet 
until this stage passes. In case the fever reaches a 
height requiring attention, cold sponging, with ice Chicken Pox 
73 
bag to the head, is the best treatment. During the 
stage when pus appears in the vesieles, it is some- 
times necessary to wrap the patient in a cold wet 
sheet, renewing the moisture in the sheet as it dries 
out from the heat of the body. 
If the patient breaks out in the mouth, Dobell's 
solution should be used for washing the mouth. 
When this is not available, a two per cent solution 
of boric acid should be used as a gargle and mouth 
wash every hour. 
Keep the eyes clean by frequent washing with 
boric acid; and if there is any eruption in them, or 
distress of any kind, apply hot boric compresses over 
them for thirty minutes three times a day. This is 
done by wringing a thick pack of gauze or cheese- 
cloth out of hot saturate solution of boric acid, and 
placing it over the eyes and the forehead, renewing 
it every few minutes, to keep the compress as hot as 
the patient can bear. To relieve the itching of the 
eruption, it is best to use a compress of cold saturate 
solution of boric acid. This can be renewed as often 
as is necessary. The patient should be prevented 
from scratching the pocks, because this increases the 
scar left behind. 
Quarantine and Control 
The patient should be quarantined and isolated 
as soon as the nature of the malady is known. The 
case should be reported to health authorities, and all 
rules laid down by them should be rigidly observed. 
Quarantine is maintained until all crusts and scabs 
are removed and the skin is smooth. After this, the 
patient should have a bath with an antiseptic soap, 74 
Contagious Diseases 
be dressed in fresh clothes from the skin out, and be 
allowed to go about the affairs of life as usual. The 
room in which the patient was kept, along with all 
articles used by him, is then fumigated according to 
the instructions given by the local health officer. 
Although chicken pox is a mild disease, observance 
of strict rules is essential on account of the close 
resemblance it bears to smallpox. 
A father afflicted with smallpox, holding his young son, without 
danger to the child, who has been vaccinated, IX. Smallpox 
MALL POX, or variola, is a very acute and 
Highly infectious and contagious disease. Its 
M duration is from two to three weeks. It starts 
with an abrupt chill, vomiting, headache, and pain 
in the small of the back. It is characterized by an 
eruption that passes through the stages of papule, 
vesicle, pustule, and crust, successively. There is 
a high fever, which goes down after the eruption 
first comes out, and rises again during the stage 
when pus is in the eruption. 
Smallpox has existed as long as history has been 
written by men, but it did not occur in severe 
epidemics until about the sixth century. It was 
brought to America by the Spaniards in the six- 
teenth century; and in the eighteenth century, Lady 
Mary Wortley Montagu discovered that it could be 
prevented by inoculating the arm from the pocks of 
one suffering of the disease. This, however, was 
a rather deadly form; but Jenner, in 1798, discov- 
ered true vaccination with the virus of cowpox as a 
real and harmless protection against the disease. 
Before his discovery, smallpox destroyed two hun- 
dred thousand lives every year in Europe. It was 
the most dreaded disease that had ever attacked 
mankind. But it has since been brought "within 
bounds," and is now a negligible disease wherever 
vaccination is enforced. 
Probably no single discovery can compare with 
Jenner's as a blessing to mankind. It is harmless to 
the individual, and need be feared by no one. There 
75 76 
Contagious Diseases 
has been propaganda against it in recent years, but 
this arises from those who do not know the facts 
regarding its use nor fully understand the terrible- 
ness of this scourge before vaccination controlled it. 
Fathers and mothers should have no hesitancy in the 
vaccination of their children, and should comply with 
the regulations of the local board of health regarding 
this matter. One successful vaccination may protect 
a person for life; but it should be repeated every 
four or five years, and always during any threatened 
epidemic of the disease. If immunity still exists, the 
vaccination will not "take." If immunity does not 
exist, there will be a "take," and you are again 
protected. 
Incubation 
The average period of incubation is about twelve 
days. Its limits are from about eight to twenty 
days. Smallpox is highly contagious from the onset 
until all crusts are detached and the skin is smooth 
once more; and greater care should be exercised re- 
garding quarantine in this disease than in any other. 
The patient comes down with smallpox with 
marked suddenness. There is a chill, violent head- 
ache, and vomiting. The pain in the small of the 
back and in the lower extremities is always very 
severe, and the patient feels as though his "back 
would break." The temperature is rather high, 
ranging from 103 to 104, and may be 105. It sub- 
sides as soon as the eruption breaks out, and may go 
even to normal. It returns, however, as soon as pus 
Symptoms xV m allpox 
77 
appears in the vesicles. It often remains up for a 
week or more, depending upon the extent of the 
eruption. 
The eruption of smallpox begins with small red 
pimples. They occur first on the forehead and the 
wrists, spreading rapidly to arms, trunk, legs, and 
feet. The breaking out is most marked on the ex- 
posed surfaces. The original pimples soon develop 
into larger ones, which become hard, and feel like 
shot under the skin. After two or three days (the 
fifth or sixth day of the disease), these pimples turn 
into vesicles; that is, they have a fluid in the points. 
Around these vesicles, there is a red ring; and after 
the fluid has formed in a pimple, or papule, there is 
a depression in the center of it, called an umbilica- 
tion. On the sixth day of the eruption (the ninth 
day of the disease, or thereabouts), these vesicles be- 
come infected and turn into pustules. Fever returns 
or goes higher at this time. Pain and distress at this 
stage of the disease are usually severe. About the 
eighth day of the eruption (the eleventh day of the 
disease), the drying up process starts, and all that is 
left is crusts or scabs. It takes from one to two 
weeks from the setting in of this drying up process 
for the crusts to disappear entirely. During this 
stage, the itching is worst. Great care should be 
taken to prevent scratching and digging at the 
crusts, because the tearing away of these scabs at 
this time is what causes the permanent pock marks 
on the skin. Slight marking may occur even though 
the patient does not remove the crusts by scratching 
them, but it is much less than when this care is not 78 
Contagious Diseases 
exercised. Following severe attacks, both hair and 
nails sometimes are lost, although this is rare. 
The different varieties of smallpox are dependent 
upon the character of the eruption; that is, discrete 
smallpox is that where each pock remains separate. 
Confluent smallpox is that where the pocks run to- 
gether in large masses. Hemorrhagic smallpox is a 
form of the disease in which hemorrhages occur into 
the skin and the mucous membranes. This is a 
virulent type. 
Complications 
It is not uncommon, in the pustular stage, for 
the pocks to turn into real abscesses; that is, the pus 
of the pocks gets under the skin, forming an abscess, 
and the site of the pocks has to be lanced to let the 
pus out. This is not a grave complication, provided 
it receives proper attention. In more severe cases of 
smallpox, the heart is sometimes affected by inflam- 
mation, causing endocarditis. This is an inflamma- 
tion inside the heart, which leaves the valves of the 
heart leaking. In some epidemics, the disease tends 
to affect the ear. In this case, pus is formed in the 
middle ear, and the attention of a specialist is neces- 
sary to prevent permanent deafness. 
The outlook for those contracting smallpox is 
serious even in the present day, when knowledge 
regarding its care is at the best. The death rate is 
about thirty per cent in spite of the best care. The 
disease is practically fatal to pregnant women, and 
abortion and premature birth are the rule. It may 
attack those of all ages, but it is especially fatal 
under five years of age and in very old persons. It £ mall pox 
79 
sometimes occurs in people who have been vaccinated 
many years previously but have not been revacci- 
nated. In these cases, usually it is very mild and 
runs a light course. 
Treatment 
As soon as the patient becomes ill, he should be 
put immediately to bed, and placed on a liquid diet, 
with plenty of water to drink. The sick room should 
be a light, airy, well-ventilated room, with every 
window screened. The temperature of the room 
should be 68° to 70° F. The importance of drinking 
abundance of fluids, such as orangeade, lemonade, 
and water, can not be emphasized too much. When 
the patient is past the severe stage of the disease, 
eggs, cream, and well-cooked cereals may be added; 
and after these have been handled well and the fever 
has disappeared, baked potato and other light vege- 
tables may be eaten. 
Hot foot baths, and fomentations or hot packs to 
the small of the back, provide the best relief for the 
intense pain that occurs in the early stages of small- 
pox. Mustard plasters should not be used, because 
the pocks occur in masses on surfaces irritated by 
the application of mustard plasters. The patient 
should be allowed to swallow cracked ice, as it helps 
with the vomiting. 
The treatment of the fever should be managed 
by cold sponging and the application of ice bags to 
the head. If the fever is high, this treatment can be 
almost continuous, and affords great relief. The 
cold sponging does no harm to the eruption. The 80 
Contagious Diseases 
secondary fever that comes when pus is in the erup- 
tion, is best controlled by cool or tepid packs; that 
is, the patient can be covered by pr wrapped in a 
sheet which is kept moist. The drying of the sheet 
by the atmosphere produces a marked cooling of the 
body and relieves the fever. 
The eruption frequently occurs in the nose and 
the mouth. On this account, some solution should 
be used for cleansing both these cavities. Dobell's 
solution is good, or plain salt water (one teaspoon- 
ful to each pint of water) will do the work. Two 
per cent solution of boric acid is also commonly used. 
The mouth should be washed and rinsed often, and 
the nose should be sprayed with these solutions or 
gently swabbed. This is done to keep all secretions 
cleaned away, and it adds greatly to the comfort and 
well-being of the patient. The eyes should be 
washed out frequently with boric solution, and hot 
boric acid compresses should be applied to them. 
Directions for giving these will be found in the 
chapter on "Home Treatments." 
The burning and itching with the eruption are 
best relieved by applications of cold, either by the 
ice bag or by cold compresses of gauze or cheese- 
cloth. Cold compresses of boric acid should be kept 
over the face. These can be changed as often as is 
necessary. Medicines to relieve the itching should 
not be used without the order of a physician. When 
the acute stage of the disease is past and the patient 
is waiting for the crusts to drop off, the itching may 
be relieved by an application of cold cream or olive 
oil. This also hastens the removal of the crusts. m allpox 
81 
Characteristics Distinguishing Between 
Smallpox and Chicken Pox 
It is of the utmost importance that an accurate 
diagnosis be made in smallpox. It is not so impor- 
tant in chicken pox, because the disease is not so 
serious. On account of the similarity between these 
two diseases, it is sometimes difficult to distinguish 
between chicken pox and a mild case of smallpox. 
One mild case of smallpox left without quarantine 
or isolation may be responsible for a widespread 
epidemic. An epidemic is expensive to any commu- 
nity, and it is the patriotic duty of every citizen to 
have a care regarding these matters. The accom- 
panying page is taken from "Special Bulletin 
No. 36," issued by the California State Board of 
Health. This bulletin is cleverly arranged by Dr. 
Allen F. Gillihan, and is given over entirely to the 
points of difference between chicken pox and small- 
pox. It is certainly a page of condensed knowledge, 
and is worthy the study of any person. It will 
greatly assist those who desire to know these dis- 
tinguishing points. 
Quarantine 
As soon as it is determined that any member of 
the household has smallpox, the local health officer 
is required to place a placard in a conspicuous place 
at the principal entrance to the house, unless the 
patient is removed to a contagion hospital. This 
placard is left in place until the attending physician 
notifies the health officer that the patient is well, that 
all scabs or crusts are cleared off the skin, and that SIGNS 
SMALLPOX 
CHICKENPOX 
DISTRIBUTION OF RASH. 
1. Location of Rash 
Prefers Face and Extremities-Us- 
ually on the extremities the fur- 
ther away from the trunk the 
more profuse is the rash. 
Prefers trunk. 
2. Regions Preferred by Rash 
Exposed Surfaces-Outer surfaces 
preferred to inner, does not like 
protected places, such as arm 
pits, groins, sides of chest, abdo- 
men. 
No Preference-Except that usually 
on the extremities the further 
away from the trunk the less pro- 
fuse is the rash. 
3. Effect of Local Irritation-Such 
as bums, scratches, sores, 
bruises, poultices, etc 
May Modify Distribution-Nearly 
always there is a decided increase 
of the rash over irritated places. 
Occasionally a slight increase of rash 
over an irritated place; 
4. Comparison of Exposed and Pro- 
tected Surfaces-Seat patient 
in a good light, strip him to 
the waist, stand in front of 
him and observe rash. 
(a) Cross arms over chest, bend 
head well down 
(b) Bend head well back, extend 
arms over head 
In this position rash-shows promi- 
nently. 
In this position rash does not show. 
Rash hidden 
Rash exposed. 
5. Distribution of Scanty Eruption. 
(a) Count spots on both upper 
extremities 
(b) Count spots on trunk-- 
Many spots 
Few spots 
Few spots. 
Many spots. 
APPEARANCE AND GROWTH OF 
RASH. 
1. General Appearance 
AH spots in one area are very 
similar in size, in shape, and in 
age. 
Spots In one area variable, in size, 
shape and age. 
2. Where Rash First Appears 
Usually on face and forehead 
Usually on trunk. 
3. Growth of an individual spot 
Slowly--Requires several days to 
reach full size. 
Rapidly-Full size reached in a few 
hours. H 
4. Spreading of rash 
As a wave, traveling from faco to 
feet. 
New spots appear indiscriminately, 
scattered among older spots or on 
new area. 
HISTORY OF CASE. 
1. First evidence of illness 
Sudden sharp illness for several 
days, then feels better, then rash 
appears. 
Rash appears. 
2. In those recently successfully 
vaccinated 
Does not occur 
Does occur. 
Signs of No Relative Value in Diagnosis. 
1. Prodromal rash 
2. Secondary fever 
3. Umbilication of pustule 
4. Shot-like feel 
5. Effect of puncturing vesicle 
6. Rash on palms and soles 
Rarely occurs 
Depends on extent of rash 
May not occur 
May not be found 
May collapse 
May not occur - 
None. 
Fever with rash. 
May occur. 
May not collapse. 
Occasionally found. 
Important Diagnostic Differences Between Smallpox and Chickenpox. 
Facsimile of Special Bulletin No. 36, issued by the California State Board of Health 
giving points of difference between chicken pox and smallpox. 
82 Smallpox 
83 
all scars are completely healed. When this is done, 
the health officer removes the placard and disinfects 
the house. 
However, all unvaccinated persons are required 
to remain in quarantine for twelve days after the 
termination of the quarantine for the patient. When 
this time has elapsed, they have passed the danger 
of contracting the disease, and are in turn released. 
One state board of health that is very active in 
the control of smallpox has put out the following 
instructions to the household: 
"Rule 4. Instructions to the Household. 
"It shall be the duty of the physician in attendance on a 
person having smallpox, or suspected of having smallpox, to 
instruct the members of the household in precautionary 
measures for preventing the spread of smallpox. 
"Note.- The following instructions are required by Rule 4: 
"(1) If the patient is not removed at once to a hos- 
pital, he shall be isolated in a room screened 
against flies. 
"(2) All persons except those having the necessary 
care of the patient shall be excluded from the 
sick room. 
"(3) The persons caring for the patient shall be vacci- 
nated with fresh smallpox vaccine immediately 
prior to assuming such care. 
"(4) The persons having the care of the patients shall 
wear washable outer garments and shall thor- 
oughly wash the hands with soap and water after 
handling the patient or any object which he may 
have contaminated. On leaving the room in 
which the patient is isolated, the attendant shall 
take off the washable outer garment and leave it 
in the room until disinfected." Exercise in the open air builds up the vitality of the child. 
84 X. Infantile Paralysis 
SNFANTILE paralysis, or acute poliomyelitis, 
is an acute disease that is infectious and com- 
municable. It occurs chiefly in epidemics, but 
may break out sporadically. Children are the most 
frequently attacked. Its most prominent symptom 
is an acute stage of fever, followed by paralysis of 
certain muscles. 
In the past twenty-five years, there have been 
very serious outbreaks of this disease.' They have 
been especially severe in Norway, Sweden, Australia, 
and the United States. The worst epidemic known 
occurred in the United States in 1916. During this 
epidemic, thirty thousand persons were affected. 
Symptoms 
The disease comes on suddenly. There is seldom 
much evidence of chill, the fever rising from 100 to 
103 degrees at the onset. The little patients are 
generally quite drowsy. A good many of these cases 
have vomiting. There may be convulsions, but these 
are not a common symptom. The bowels are usually 
constipated, although diarrhea sometimes occurs. 
Sore throat is always present, and there is aching in 
head, back, and legs. As soon as these symptoms 
begin to subside, which may be any time from twelve 
hours to four or five days, the paralysis will be ob- 
served. Muscular weakness comes on first, and 
there is staggering in the gait, which progresses to 
an actual paralysis. The location of this paralysis 
is varied. It is oftenest in the legs. It may affect 
one leg, both legs, both legs and one arm, or all four 
85 86 
Contagious Diseases 
limbs. The arms, however, are not as much affected 
as the legs, and are never affected alone. 
The paralysis in these cases develops to a certain 
stage and then stops. The permanent paralysis is 
never as much as it appears to be at the height of 
the disease; in other words, the paralysis is exagger- 
ated during the acute stage of the illness, and the 
permanent injury to the patient is never as much as 
it threatens to be. In some cases, complete recovery 
occurs. This recovery draws out over a year or a 
year and a half. 
The more rapidly the paralysis disappears, the 
better the outlook is for the patient's recovery; the 
more slowly it disappears, the less hope there is for a 
complete recovery. 
Treatment 
It is of the most urgent importance that the local 
board of health be notified of every case of infantile 
paralysis in the community, in order that proper 
precautions may be taken. Failure on the part of 
anyone in this matter is criminal. The sick should 
be isolated from contact with any person. Their 
rooms should be screened against flies and other in- 
sects. The period of this isolation is never less than 
two weeks. Children who have had an intimate con- 
tact with a patient should be excluded from schools 
and public assemblies until it is fully demonstrated 
that they are not coming down with the disease. All 
discharges from the patient, especially those of the 
nose and the throat, should be disinfected with the 
utmost thoroughness, since these discharges carry 
the infecting agent. It is also highly probable that Infantile Paralysis 
87 
the disease finds entrance to the body through the 
mucous membranes of the air passages. Monkeys 
can be very easily inoculated in this way. 
These patients should be put to absolute rest in 
bed. Hot packs and hot baths of about 100° F. are 
very beneficial. They should be given about twice a 
day. Various serums have been tried in the treat- 
ment of this disease, and excellent reports are given 
regarding their use. However, it is not yet ad- 
vanced to a stage where accurate directions can be 
given. 
The diet of these patients should be entirely 
liquid. Milk is an ideal food. It should be given 
in small amounts and often until the acute symptoms 
of the disease are past. The mildest of cathartics 
should be used to overcome the constipation. Dras- 
tic purgatives are very harmful. 
The limb or limbs affected by the paralysis 
should be wrapped in cotton and supported in a 
normal position. Do not let the limb fall into an 
unnatural position because of the paralysis. This 
puts a strain on muscles not affected by the paraly- 
sis, and increases the deformity after the child's 
recovery. For instance, the feet are likely to be 
pressed over to one side by bedclothes, and then the 
position of the legs will be unnatural. They should 
be wrapped in cotton, and supported by pillows or 
any other comfortable support. 
After the acute symptoms are over, at the end of 
three or four weeks, active treatment to the paralysis 
may begin. This consists of massage and passive 
movements; that is, the one administering the treat- 88 
Contagious Diseases 
inent should take hold of the limb, bending the 
joints, and putting them through gentle exercises 
that simulate normal movements as nearly as pos- 
sible. The patient should also be urged to place the 
mind upon these movements, and constantly try to 
move the affected part. 
Electricity is another form of treatment. The 
faradic current is the best, but the galvanic current 
also may be used. The weakest current that will 
possibly cause a muscular contraction must be used. 
Otherwise, harm may be done. If the paralyzed 
muscles can not be made to contract without pain to 
the patient, the electricity should be discontinued, 
and dependence placed upon the massage, etc. 
After a year or more has gone by, and as much 
recovery has occurred as is possible, the patient 
should be taken to a surgeon; for much can be done 
to correct the deformity if the patient is in the hands 
of a surgeon who is especially skilled along this line. XL Typhoid Fever 
EFINITION: Typhoid fever is an acute in- 
fection caused by the bacillus typhosus. It is 
Oa characterized by long continued fever, diarrhea 
or constipation, marked emaciation, also rose-colored 
spots on chest and abdomen, before a final remission 
of the fever. The patient lies generally six weeks 
in bed. 
Historical: The first account of anything like 
typhoid fever, was furnished in 1643 by a man 
named Willis. He described an epidemic among 
soldiers, which appears to have been very similar to 
typhoid. He explained that it could be carried from 
one to another. He also told of a case that was 
fatal, probably because of perforation. Nothing 
further was written regarding the disease until about 
the eighteenth century. At that time, there was 
marked interest in the subject. Louis, a French 
physician, wrote extensively on it. A pupil of his, 
Gerhard, of Philadelphia, came back to America, 
and published papers that very clearly set forth 
typhoid fever as a specific disease. 
A man by the name of Murchison was the first 
to suggest that the infection was contained in the 
fecal matter of the patients; and in 1856 and 1860, 
Dr. Budd, of England, insisted that the fecal matter 
should be disinfected, and that in this way, the dis- 
ease could be stopped. This man was on the right 
track; and in 1880, Eberth discovered the typhoid 
bacillus as we now know it. He was able to grow 
it in the laboratory, and demonstrate that it was the 
89 90 
Contagious Diseases 
real cause of the disease. The discovery of this 
bacillus was a wonderful service to the world, for it 
has enabled mankind to combat typhoid successfully. 
The Typhoid Bacillus 
The typhoid bacillus is so small it can not be 
seen except with a high-power microscope. It is 
found only in man; in other words, it is a parasite. 
However, it can live in the soil and in water, but it 
only gets there through contamination with the dis- 
charges of the human body. It is most frequently 
carried by water, and can live as long as three 
months in rivers, ponds, etc. Where streams have 
been contaminated, and the source of contamination 
has been definitely known, the germ has been dis- 
covered as far as eighty-five miles downstream. The 
chief source of contamination of streams and lakes 
is fecal matter, and other discharges of the human 
body. This comes mainly from campers, hunters, 
and others who are careless about these things. 
It has been plainly shown that the typhoid ba- 
cillus will live as long as five months in privy vaults. 
When this material is spread on the ground as 
manure, it lasts only about two weeks, because of 
its drying up, and of the action of the sun's rays, 
which are a powerful bactericide. 
In the body, this little germ is found in the 
blood, the feces, and the urine. On account of its 
being confined to these three locations, the great 
danger of contamination is in the fecal matter and 
the urine of the patient suffering of typhoid. There 
is therefore urgent need that these discharges from Typhoid Fever 
91 
the human body, and especially from the body of a 
typhoid fever patient, receive the strictest attention. 
Carriers 
It is possible for a person to have typhoid fever 
and so far recover as to feel perfectly well, but still 
harbor tlie typhoid bacillus within the body. In 
these cases, the bacillus seems to live in the gall 
bladder, and is discharged with the bile into the 
intestinal tract, so that persons may be fully recov- 
ered, and yet be what we call carriers of the disease. 
Their body discharges may be loaded with the 
bacillus; and hence they can contaminate water, 
milk, and various other articles, causing widespread 
epidemics. Examples of how this may be, will be 
given later, in the discussion of "Epidemics and 
How They Are Started." 
Epidemics and How They Are Started 
Water: Typhoid fever is primarily a water-borne 
disease. Other sources of infection have been dis- 
covered, but water is blamable for most epidemics. 
This has been thoroughly demonstrated where large 
cities have been supplied with water that is safe- 
guarded in every respect, and therefore have re- 
mained practically free of typhoid fever. 
One of the most common methods of infecting 
the water ot a city is through leakage from sewer 
pipes. This gets into the soil, and drains into water 
pipes and reservoirs, thus infecting a large number 
of people. Again, rain washes discharges down 
from the sides of hills into creeks and rivers, whence 
they find their way into the cities' reservoirs. It is Typhoid fever is primarily a water-borne disease. The water supply for the home as 
well as for the city should be safeguarded. 
92 Typhoid Fever 
93 
of the utmost importance, therefore, that cities pro- 
tect their water supply from such contamination. 
A German doctor named Schuder has studied 
638 typhoid epidemics, and reports that seventy-one 
per cent of these were attributable to infected water. 
The city of Hamburg used to obtain its water from 
the river Elbe. From 1885 to 1888, a period of 
three years, there were 15,804 cases of typhoid fever 
in that city. Soon after this, a new water system, 
properly protected, was installed; and typhoid fever 
has almost totally disappeared from the city. In 
Chicago, in years past, there was a heavy annual 
epidemic of typhoid fever. This was because the 
sewage from that city was discharged into the same 
body of water from which the water supply was 
received. When this matter came to be understood, 
and a proper water supply was provided, typhoid 
almost wholly disappeared. 
Plymouth, Pennsylvania, is a town of about 
eight thousand inhabitants. Their water is obtained 
from two sources, the Susquehanna River, and a 
reservoir fed by a mountain stream. A short while 
ago, they were overtaken by a severe epidemic of 
typhoid fever, developing as many as one hundred 
new cases a day, the total number of cases being 
1,104. Investigation showed that the families who 
had typhoid fever had received their water from 
the reservoir; and those who received water from the 
Susquehanna River had been entirely free from 
the disease. Upon further investigation, a case 
of typhoid fever was found in a house very close to 
the shore of the stream from which water was run 94 
Contagious Diseases 
into the reservoir. The discharges from this pa- 
tient's body had been thrown upon the surface of the 
soil and into the stream. As soon as this practice 
was discontinued, the epidemic was stopped. 
After water, milk is one of the worst offenders; 
and the most common source of the infection of milk 
is some person who has had typhoid fever and is 
fully recovered, but still gives off the bacillus in the 
discharges of his body. He may work about a dairy, 
or live near one. He may wash cans and bottles, or 
handle the milk. When the cause of a typhoid epi- 
demic can not be found in the water, usually milk is 
the next thing that is investigated. 
The city of Washington, D. C., in 1908 had an 
epidemic of typhoid fever, running about 665 cases. 
Many of these cases were traced to milk infection. 
The United States Public Health Service of that 
city investigated the milk supply, and found on a 
near-by farm that supplied milk to certain stations 
in the city, a woman who had had typhoid fever 
eighteen years previously, and was still a carrier. 
The discharges of her body were loaded with typhoid 
germs. When the use of milk from that farm was 
stopped, the spread of typhoid fever in the city 
ceased. This good woman had been entirely unaware 
that she was doing any harm to anyone, yet unwit- 
tingly she had been the source of a great scourge. 
Milk 
Freezing does not destroy the typhoid baciili. 
On this account, typhoid fever may be carried by ice 
Ice Cream Ice may carry the typhoid bacillus and cause an epidemic. 
95 96 
Contagious Diseases 
cream, if the milk used therein is infected. This, 
however, is the same problem that has been discussed 
under "Milk"; so, if good milk or Pasteurized milk 
is used, there is no danger of typhoid fever from 
ice cream. 
Ice 
Ice may carry the typhoid bacillus and cause an 
epidemic. In Ogdensburg, New York, a small epi- 
demic in an institution was demonstrated to have 
been brought about by infected ice. But the ice 
supply of all cities is now very carefully protected. 
Flies 
There are many dangerous animals on earth; but 
lions, tigers, wolves, and bears sink into insignifi- 
cance compared with the common housefly. Where 
these other predatory animals have killed their thou- 
sands, the housefly has killed its hundreds of 
thousands. It is an enemy against which we can 
not be too strict. The fly is especially dangerous 
in camps and in rural communities where fecal mat- 
ter is kept in open latrines and privy vaults. Here 
the flies have access to the material infected with the 
bacillus typhosus, and after becoming contaminated, 
may alight upon food that is to be consumed by 
human beings. It has been demonstrated that a fly 
may carry the germs as long as twenty-four days 
after resting upon infected material. 
The only successful way to combat flies in such 
a menace as this, is to have all fecal matter com- 
pletely protected from flies. In addition to this, all 
dwelling houses, and particularly dining rooms and Typhoid Feuer 
97 
kitchens, should be securely screened against this 
terrible enemy, not only because of the food, but 
because the presence of the fly is dangerous to every- 
one concerned. 
Contact 
Aside from these sources of infection, it is pos- 
sible to get typhoid fever by contact with a person 
ill of this disease, by handling the patient, the bed- 
clothes, the night clothing, linen, catheters, ther- 
mometers, or, in fact, anything that has come in 
contact with the patient. These should be disin- 
fected and cared for under the direction of a person 
who understands this sort of thing. Any case of 
typhoid fever should be thoroughly isolated, and in 
the hands of a competent nurse and physician, in 
order that the patient may be properly cared for; 
but it is more important that the rest of the com- 
munity be protected from the infection, by intelli- 
gent care of the patient, and of those utensils around 
the sick room which might carry the infection. 
Prevalence of Typhoid Fever 
Records show that any city which supplies its 
people with clean water, and makes proper disposal 
of its sewage, wipes out typhoid fever. These two 
things are absolutely essential. 
MacLaughlin, of the United States Health 
Service, gives the annual death rate of typhoid to 
one hundred thousand population, in 1909 and 1910, 
as follows: 98 
Contagious Diseases 
RATE OF TEN LARGE EUROPEAN CITIES 
Stockholm 3.2 
Christiania 1.6 
Edinburgh 75 
Vienna 3.3 
Hamburg 3.7 
Berlin 3.5 
London 2.7 
Paris 7. 
Frankfort 1.2 
Atwood 1.7 
This gives an average annual mortality to this 
group, of 2.86 to one hundred thousand population. 
This group of European cities have made a long 
study of this problem, and have the best sewerage 
systems and water supplies possible for their cities. 
MacLaughlin makes comparison with ten American 
cities of similar size, that have not been able to reach 
the same state of excellence in water supply and 
sewage disposal. The list of American cities and 
their percentages are as follows: 
RATE OF TEN AMERICAN CITIES 
Chicago 13.2 
Washington, D. C 28.7 
New Orleans 29.9 
Minneapolis 39.8 
St. Louis, Mo 16.6 
New York 11.8 
Philadelphia 19.9 
Boston 12.6 
Kansas City, Mo 41.8 
Los Angeles 15.2 Typhoid Fever 
99 
This is an average mortality of about twenty- 
three to one hundred thousand population, or eight 
times that for the European cities listed. This is a 
demonstration of what can be done along these lines. 
In 1917 and 1918, these same American cities made 
a much better report. After having this matter 
called to their attention, and thoroughly understand- 
ing it, they reduced the rate to 7.6. This is very 
gratifying, and a monument to the intelligence and 
industry of the people who have corrected the con- 
dition. These figures provide the best evidence of 
what can be done toward combating typhoid fever. 
It is commonly said that typhoid kills more 
soldiers in times of war than do bullets. This is 
undoubtedly true. During our own Civil War, 
there were 75,000 cases of typhoid fever, with 27,000 
deaths. In the Franco-Prussian War, there were 
73,000 cases of typhoid fever, with 8,700 deaths. In 
the Turko-Russian War of 1877, the Russian army 
on the Danube had 25,000 cases of typhoid, with 
7,800 deaths, while the loss in battle was slightly less 
than 5,000. The American army in the Spanish 
War, with 107,973 men engaged, had 20,738 cases 
of typhoid fever, with 1,580 deaths. The total loss 
of life in battle was only 243. 
The following figures taken from the record of 
the United States army in the World War, show the 
advances that have been made in combating typhoid 
fever. The average strength of the army in the 
United States from September 1, 1917, to May 2, 
1919, was 1,130,052; and the total number of deaths 
from typhoid fever in the army was only 51. In 100 
Contagious Diseases 
the American expeditionary forces during the same 
time, with an average strength of 991,334, there were 
only 162 deaths from typhoid fever. Certainly this 
was a wonderful victory over that great marauder; 
and it is due entirely to the intelligent management 
of camps. 
Vaccination 
Typhoid vaccination is now required in all 
armies, and statistics of the recent World War 
prove its efficacy. During the first two years, of that 
war, there were only 1,501 cases of typhoid in the 
British army, with several million men in the field. 
Of these cases, 993 occurred among unvaccinated 
soldiers, leaving only 508 cases among the vacci- 
nated. These figures may he compared with the 
record of 57,684 cases in the English army in the 
Boer War, with a strength of only 380,605 troops. 
The use of typhoid vaccination in the American 
army is also deserving of special mention. It be- 
came routine in 1911. During the fiscal year ending 
June 30, 1918, 297 cases of typhoid comprised the 
entire list for the American army. When this record 
is compared with that of the Spanish-Amer lean 
War, where, in one division of 10,759, there were 
4,422 cases, it is certainly conclusive proof of the 
value of typhoid vaccine. 
Symptoms 
Typhoid fever is a serious disease; and let no one 
hope, from the slight consideration here given, to be 
able to care for a case without skilled help. How- 
ever, a brief discussion of the symptoms will enable 
persons in outlying districts to detect the disease. Typhoid Fever 
101 
The period of incubation is about two weeks. Dur- 
ing this time, there are prodromal symptoms, which 
are shown first in a sense of fatigue, headache, loss 
of appetite, and disturbed sleep. There is also 
backache and chilliness, and sometimes abdominal 
pain; and a little cough may appear, also tempera- 
ture. These symptoms are followed by nosebleed, 
and possibly a little diarrhea, or constipation. 
During the first week of the disease, the patient 
has severe headache, is feverish and thirsty, and be- 
comes apathetic and very restless. The temperature 
rises, during this week, to 103° or 104°. It reaches 
its height generally before the end of the first week. 
The temperature is also somewhat lower in the 
morning than in the evening. This change of tem- 
perature occurs daily. The tongue remains moist, 
but has a heavy whitish fur on its surface, and the 
breath is very fetid. The cough may continue, but 
does not amount to very much. In most cases, the 
abdomen is distended, and a light pressure reveals 
tenderness and pain in the lower right side. There 
is usually constipation or diarrhea, the stools some- 
times being described as resembling pea soup. Dur- 
ing the first week, the mental processes become 
slowed. They are confused, the hearing is dulled, 
and the patient is not acute in his perceptions in 
any way. 
In the second week, all the symptoms of the first 
week are aggravated. The temperature remains 
high, and holds a steady course, with the exception 
of the slight morning remission. The tongue tends 
to become dry and red. There is enlargement of the 102 
Contagious Diseases 
spleen, which sometimes can be felt in the abdomen. 
During this week, there is likely to be delirium. 
Early in the week, a characteristic rash, known as 
rose spots, appears, especially over the abdomen and 
the chest. It conies in successive crops, going away 
and reappearing. These rose spots may be few in 
number - three or four - or may be very profuse 
and cover the body. 
In the third week, the symptoms are the same as 
in the second week, but there is an increased gravity 
about the situation. Weakness and emaciation over- 
take the patient, and are prominent features. There 
seems to be a profound toxemia. The temperature 
continues high, and the pulse is rapid and feeble. 
The tongue is dry and brown, and becomes fissured. 
Other nervous symptoms, such as trembling of the 
limbs and twitching of the muscles, also set in, espe- 
cially if the case is a grave one. Diarrhea may be a 
very severe and constant symptom during this week, 
and the abdomen may become considerably distended. 
It is during the third week that perforation and 
hemorrhage of the bowel are most dangerous. 
In the fourth week, the ordinary case shows a 
gradual improvement. The fever drops until it is 
normal or even subnormal. The mouth and the 
tongue clean up, the appetite returns, and the pa- 
tient begins to gain a little strength. This usually 
continues until full recovery. However, there may 
be a recrudescence of the fever several times during 
recovery, which is slow and tedious. Strict attention 
to dietetics during this period is an important matter. Typhoid Fever 
103 
In cases which prove fatal, the fourth week, in- 
stead of showing improvement, shows continued 
advancement of symptoms; and in spite of anything 
that can be done, the patient becomes unconscious, 
and sinks into stupor, from which he does not rally. 
Irregular Cases 
Among the problems in every epidemic are the 
cases which are not regular; that is, which have 
symptoms other than those generally recognized. 
These cases oftenest take the form of what is known 
as "walking typhoid." The patients do not feel ill 
enough to go to bed, but by sheer force of will 
power, keep at their work. This is very dangerous, 
as they have typhoid fever just as truly as any of 
the very sick patients. They are disseminators of the 
germs, and are a menace to themselves, and to all 
with whom they come in contact. 
On careful observation, most cases of walking 
typhoid manifest all the symptoms that other cases 
have; but these symptoms are so mild that they 
escape detection. The patients, for the greater part, 
are persons of very strong will power, who are deter- 
mined not to give up, but to keep around. Many of 
them go through a regular case of typhoid, without 
stopping their work. Most of them have a light 
fever, and a little pain and tenderness in the abdo- 
men, and some enlargement of the spleen, and upon 
close examination, a few rose-colored spots upon the 
abdomen. They may have also a little diarrhea, or 
constipation. It is a thought to bear in mind, that 
these people are carriers and disseminators of germs, 
and spread the disease. 104 
Contagious Diseases 
Relapses from typhoid fever are not uncommon. 
That is, after the temperature has reached normal, or 
nearly so, it may again shoot up to a high level, and 
many of the distressing symptoms reappear, such as 
diarrhea, hemorrhage, headache, nosebleed, etc. 
Typhoid fever patients are very sick; and after 
being in bed so long, with such a high temperature, 
they are very weak. When they begin to recover, they 
are anxious to get along faster than is possible. 
This is one of the reasons for relapses. Overexertion 
must be scrupulously avoided, and the diet very 
carefully regulated, during recovery; for overdoing 
and errors in diet are often causes of relapse. It is 
best always to take plenty of time for complete 
recovery. This is one of the instances where the 
quotation applies, "The shortest way home is the 
longest way around." 
Complications 
The most frequent complications of typhoid 
fever are hemorrhage from the bowel, perforation of 
the bowel, and pneumonia. Little tinges of blood 
in the bowel movement are not rare in these cases; 
but when there is much hemorrhage, it is a serious 
matter. The patient falls into severe shock, the 
pulse becomes very rapid, and the diarrhea increases, 
sometimes until the discharge is almost clear blood. 
This condition requires constant attention on the 
part of physician and nurse. The symptoms of 
hemorrhage are, pallor, rapid pulse, great thirst, 
shock, and, in some instances, unconsciousness. Typhoid Fever 
105 
Perforation 
Perforation is a result of ulceration of the bowel. 
The ulceration may become so deep as to go through 
all the coats of the bowel, and let all the contents out 
into the abdominal cavity. The symptoms of this 
complication are sudden intense pain in the abdo- 
men, much more rapid pulse than usual, great dis- 
tention, and increased temperature. The patient 
also has severe shock, and looks very much more ill. 
Pneumonia sometimes occurs as a complication 
of typhoid fever. There is a little cough all along 
in cases of typhoid; but when pneumonia is threat- 
ened, the temperature goes higher, the cough in- 
creases, and the patient begins to spit bloody 
sputum. Pneumonia is not so common a complica- 
tion as perforation and hemorrhage; but indications 
of any increase of the cough, pain in the chest, or 
blood in the sputum, should receive attention at once 
from the physician and nurse in charge of the case. 
Pneumonia 
Treatment of Typhoid Fever 
Under this heading, we should discuss prevention 
of typhoid fever, as this is of the greatest impor- 
tance. If all the bacilli could be destroyed as they 
leave the. body, there would be no more typhoid 
fever. It is therefore essential that the patients know 
they are well before they go about their customary 
duties. Most boards of health require that cultures 
be made of the stools and the urine, and that these be 
found entirely free of the typhoid germs before the Contagious Diseases 
106 
patient is discharged. If this precaution could be 
strictly carried out, the disease might be better con- 
trolled than it is at the present time. 
In New York, before a person can obtain em- 
ployment as a handler of food, he has to get a 
certificate from the board of health, stating that he 
is free from typhoid fever and other like diseases. 
This is a great protection to people who are eating 
in hotels and restaurants. 
Disinfection of Stools, Urine, Hands, Linen, 
Clothing, etc. 
The simplest means of disinfecting stools and 
urine is to add a five per cent solution of carbolic 
acid, break up the stools thoroughly, and permit 
them to stand for several hours. After this, they 
may be buried or put into the sewer. From a pint 
to a quart of this solution should be used for each 
discharge. 
If no solution can be had at the time, the stools 
and the urine should be put into two quarts of boil- 
ing water, and allowed to stand one hour. After 
this, they are fairly well disinfected, and can be 
disposed of in the regular way. 
Those in attendance upon the patient, as nurse 
and physician, and others who have to go into the 
room, should scrub their hands to the elbow, with 
strong soap and water, for ten or fifteen minutes 
after working over the patient. Following this, 
hands and arms should be rinsed thoroughly, and 
then go through ninety-five per cent alcohol. Or, 
after the scrub, creosol or chloride of lime may be Typhoid Fever 
107 
used, one teaspoonful to the pint of water. Carbolic 
acid solution also, one teaspoonful to the pint of 
water, may be used for the same purpose. Merely 
dipping the hands for a moment in a strong disin- 
fectant will not effectually disinfect them. The pre- 
liminary scrubbing with a brush and strong soap 
Pollution of water is often a result of carelessness in locating the well. 
must not be neglected. This is often omitted by the 
busy people who are working about a patient; but it 
should be gone through vigorously, and the disin- 
fecting solution used afterwards. Bedding, towels, 
underclothing, etc., that have to be disinfected, should 
be placed in a solution of chloride of lime, two 
ounces of powder to one gallon of water. Here they 
should be allowed to stand for some length of time. 
If they are boiled, one half hour is sufficient; but if 108 
Contagious Diseases 
they are to be washed in the usual way, they should 
stand in the solution several hours before they are 
taken out. 
Water and Food Supply 
Whenever there is any doubt as to whether there 
are typhoid germs present in the water or food 
supply, all water that is to be used should be boiled, 
and every care should be taken with the food, to 
insure its freedom from possible infection, especially 
from flies. Not only should food be screened from 
flies, but typhoid patients should be carefully 
screened, so that flies can not carry the infection 
from the patient to the food. 
Vaccination 
Although vaccination has been discussed already, 
it should be mentioned here under "Treatment"; 
for all who come in contact with these cases should 
be vaccinated, even though they have previously had 
typhoid fever. This measure has not been in use 
long enough to enable the authorities to determine 
exactly how often it should be repeated; but the 
men in the United States army are now revaccinated 
yearly. Vaccination is of great value to those hav- 
ing the care of typhoid cases; and all should submit 
to it who are exposed to the disease. Persons who 
have been vaccinated, and have taken typhoid sub- 
sequently, have had it very lightly. 
Hospitalization 
It is no longer practical to care for typhoid fever 
cases in the home. The patients do not get along Tuphold. Fever 
109 
as well; and the danger to the community is much 
greater. 
Hospitals have every facility for the care of 
patients, and laboratories for the study of the stools 
and the blood; and trained attendants are always 
present, who know the symptoms of complications. 
A resident physician is at call, and the isolation of 
the patient is more thorough. So in every way, it is 
best that patients suffering of typhoid have hos- 
pital care. 
The expense of going into a hospital is no more 
than that of employing nurses in the home; and suc- 
cess is so much greater at the hospital, that treating 
patients in the homes is not worthy of consideration. 
As soon as it is determined that a person has typhoid 
fever, he should be transferred to a hospital where 
there is a physician who understands his care; and 
the authorities should be notified at once, in order 
that the source of infection may be found and other 
people protected from it. This is not only necessary 
for the protection of the life of the patient, but it is 
a duty which every citizen owes to the community 
in which he lives. XII. Home Treatments 
HERE are many things that can be done at 
home in the treatment of disease, that are very 
n helpful. It is unwise to attempt the adminis- 
tration of medicines, without the advice of a physi- 
cian; but members of the family can do much that 
will greatly assist nature in fortifying the recuper- 
ating powers, and healing congestions and inflam- 
mations that may have started in the body. A few 
simple treatments are described in this chapter, in 
sufficient detail to enable any intelligent person to 
carry them out without danger to the patient. 
The Foot Bath 
Foot baths should be 
given in as deep a bucket 
as can be obtained, in 
order that the water may 
come high up on the 
calves of the legs. The 
bucket should be large 
enough to permit both 
feet to rest comfortably 
in the bottom of it. 
The bath should be 
prepared of plain water, 
without any medicinal in- 
gredients placed in it, and 
should be of a moderate 
heat, so that the feet may 
be put into it without dis- 
comfort, no matter how 
The hot foot bath assists by equalizing 
the circulation and drawing the blood to 
the extremities. 
110 Home Treatments 
111 
cold they are. After the feet have been placed in 
the bath, add hot water until the temperature has 
been raised several degrees and the patient's feet and 
ankles are red as a result. Before additional water 
is put into the bath, the feet should be lifted out, to 
avoid any possibility of burning the skin. 
The bath should last about fifteen minutes. To 
continue it longer than this is not beneficial, because 
it leaves the blood vessels of the feet heavily dilated, 
and unable to regain their normal tone as rapidly as 
they should. To finish the bath, lift the feet out of 
the hot water and dash thoroughly with cold tap 
water. They should then be rubbed vigorously with 
a Turkish towel, and dried as rapidly as possible, 
and the patient returned to bed. 
Such a procedure as this, may well be repeated 
about every three hours, or every two hours if it is 
desired to push treatment. Cold should be applied 
to the head during this treatment, by means of either 
an ice bag or a towel wrung out of ice water. This 
should be renewed frequently during the treatment. 
F omentations 
Fomentations are a means of applying heat to 
any limited surface of the body, such as the chest, 
the throat, the abdomen, or the back. They are a 
valuable measure for combating inflammations and 
congestions, as well as excellent help in providing 
relief from pain. They are also of great assistance 
to the forces of nature which are always at work in 
the body to combat disease processes. 
The description given below will apply to fomen- 
tations for any part of the body, since the procedure 112 
Contagious Diseases 
is identical in all instances. The only changes neces- 
sary for other parts of the body relate to the size 
and shape of the materials used. For instance, to 
give fomentations to the throat, one could not use 
cloths as large as for the abdomen. 
The following description of fomentations, cold 
compresses, and heating compresses, is taken from 
"The H ome Physician and Guide to Health," a 
book published by the Pacific Press Publishing As- 
sociation, of Mountain View, California. The 
author knows of no better description of these simple 
treatments than is found in that book. The follow- 
ing is taken verbatim from its pages: 
"A fomentation is a local application of moist 
heat by means of cloths wrung from hot water. 
"Requisites: A deep dish pan or large kettle of 
water should be kept actively boiling over the fire. 
A large cover will be helpful in holding the heat. A 
set of six fomentation cloths, a Turkish towel, a 
hand towel, a sheet, and a bowl of cold or ice water 
are needed. 
"The Patient and the Bed: See that all clothing 
is removed, or at least bare a larger area than the 
part to be treated, and protect the clothing with 
large Turkish towels. See that the feet are warm, 
and kept so during treatment. If they are cold, a 
hot foot bath should be given, or hot water bottles 
applied. Protect the bedding by a blanket or sheet 
folded lengthwise and placed under the patient. 
After applying a fomentation, cover it with a dry 
cloth or newspaper, in order to protect the bedding 
over the patient. Home Treatments 
113 
"The Fomentation: Prepare a set of six fomen- 
tation cloths, thirty to thirty-six inches square. Four 
of these may be cut from a single blanket. The ma- 
terial should be half wool. Three cloths are neces- 
sary for one fomentation where they are to be very 
hot - one for the dry covering, and two to be wrung 
from boiling water for the inside wet part. Where 
less heat is required, one inside cloth may be suffi- 
cient. Two such fomentations are necessary, if the 
best results are to be obtained. Spread out on the 
table the cloth for the dry covering. Fold together 
in three thicknesses so as to make a long, narrow 
piece, the cloth or cloths to be used inside. Twist 
this as in wringing clothes, and immerse the entire 
cloth, except the two ends, in the boiling water. The 
ends may be held out of the water by applying the 
cover tightly over the kettle. Leave until thoroughly 
soaked with the boiling water, then wring quickly by 
firm twisting until water no longer runs from it. If 
held up by one end, the cloth will quickly untwist to 
its original one-third width. Place this across the 
middle of the dry fomentation cloth already spread 
out on the table. Fold the dry ends over the wet 
center, and then fold the dry outer cloth about the 
wet one. In the folding, the fomentation may be 
made the right size and shape for the part to be 
treated. 
"If the surface of the fomentation to be applied 
to the patient is again doubled together or rolled, it 
can be carried with less loss of heat. The fomenta- 
tion should be large enough to cover a much larger 
area than the part affected. The APPLICATION 
1. Spread out on the table 
the cloth for the dry covering. 
Fold together in three thick- 
nesses so as to make a long, 
narrow piece, the cloth or 
cloths to be used inside. Twist 
this as in wringing clothes, 
and immerse the entire cloth, 
except the two ends, in the 
boiling water. The ends may 
be held out of the water by 
applying the cover tightly 
over the kettle. Leave until 
thoroughly soaked with the 
boiling water. 
2. To wring, grasp the dry 
ends, twist the cloth several 
times, then stretch out. This 
wrings out the boiling water 
without burning the hands. 
3. Place the hot cloth on a 
dry one that is large enough 
to fold over well. 
4. Roll it up to retain the 
heat while carrying it to the 
patient. 
114 of FOMENTATIONS 
REQUISITES: A deep dish pan or large kettle of water should be 
kept actively boiling over the fire. A large cover will be helpful in 
holding the heat. A set of six fomentation cloths, a Turkish towel, 
a hand towel, a sheet, and a bowl of cold or ice water are needed. 
5. After placing a towel 
over the area to be treated, 
apply the fomentation, tuck- 
ing it in well; then, to protect 
the bedding from dampness, 
adjust another towel over the 
fomentation cloth. Keep an 
iced cloth on the head, chang- 
ing whenever it becomes 
warm. 
6. With a dry towel wrapped 
about the hand, reach under 
the fomentation and towel al- 
ready on the patient, and wipe 
off all moisture. The patient 
can endure a hotter fomenta- 
tion if the moisture from the 
preceding one is wiped off. 
7. To change the fomenta- 
tion: Have another rolled and 
ready to apply. Then put the 
hot fomentation, ready to un- 
roll, in place as the old one is 
taken off. When the fomen- 
tations are finished, wipe off 
the area with a cold wet 
towel; then dry. Three fo- 
mentations are called a set. 
More may be given if neces- 
sary to relieve pain. 
115 116 
Con tagious Diseases 
"Procedure: The fomentation should lie closely 
in contact with the skin, and be renewed in five or 
eight minutes, or in case of pain, as soon as it be- 
comes comfortable. If unbearably hot, rub with the 
hand the part under the fomentation, or remove the 
moisture by firm rubbing once or twice with a Turk- 
ish towel wrapped about the hand. The fomenta- 
tions may be applied over a towel in order to temper 
the heat. Always be careful to protect from chill- 
ing the area being treated, by keeping it covered 
with the fomentation cloth or a towel. 
"To renew the fomentation, prepare another 
similar one, and apply immediately after removing 
the moisture occasioned by the first. Never apply 
another fomentation until this is done, as the water 
on the skin makes it more difficult to endure the heat 
of the newly prepared fomentation. The second 
fomentation should be ready to apply before the first 
is removed. The removal of the inside cloth from 
the outer for purposes of renewal does not give the 
best results, although careful attention to details 
may still make the treatment very effective. 
"Unless otherwise indicated, three successive ap- 
plications are made. In all cases, however, they 
should be continued until the desired effect is ob- 
tained. After the last one, the part should be imme- 
diately cooled by a wet hand rub, a cold compress, or 
a rub with a cold wet towel. Dry thoroughly, and 
cover at once to prevent chilling. In some cases of 
pain, the part should be dried without the cold ap- 
plications. All changes should be made quickly, and 
the part treated should never be left uncovered. Home Treatments 
117 
"Precautions: In cases of unconsciousness, para- 
lyzed sensation, diabetes, or dropsy, great care must 
be taken to avoid burning. Each application should 
be tested by the back of the hand or by the face 
before being applied to the patient. In fomenta- 
tions to the face or other sensitive part, gauze should 
be placed next to the skin. 
"In case of general perspiration, a general cold 
friction, a wet hand rub, a wet towel rub, or an 
alcohol rub should be given. 
"Sensitive surfaces, especially bony prominences, 
such as the hip bones, the edge of the ribs, the collar 
bone, or the shoulder blade, may need to be pro- 
tected by extra coverings of flannel or Turkish towel. 
"When the patient is liable to congestion, and 
always in case of fever, apply cold compresses to the 
head, and also to the neck if needed. The same 
should be done where two or more different applica- 
tions of heat are made at the same time, or general 
perspiration is induced. In heart disease, usually in 
fever, and with rapid pulse from any cause, an ice 
bag should be placed over the heart. 
"In order to relieve pain, the fomentation must 
be very hot, as hot as can be borne, and renewed as 
soon as it becomes comfortable. In some cases of 
pain, the cold application at the close should be 
omitted, the part being dried and immediately cov- 
ered with flannel or other dry covering. 
"Effects: A test of the efficacy of such a treat- 
ment is the redness of the skin after removal of the 
fomentation. The fomentation is used, to relieve 
pain, remove congestion, dr as a preparation for cold 118 
Contagious Diseases 
treatment. Applied to the throat and the upper 
chest, it helps in relieving sore throat, tonsillitis, 
cough, bronchitis, and lung congestions. When ap- 
plied to the throat only, it should be folded so as to 
be about eight or ten inches wide, and as long as the 
full length of the cloth. To protect the lower part 
of the face, a towel may be placed across the neck, 
under the fomentation, which should be tucked close 
A patient in position for fomentations to the chest and side in pleurisy. 
up below the ears. For the chest only, the fomenta- 
tion should be folded nearly square, and as large as 
possible. For pleurisy, it should be applied to the 
chest under the arm of the affected side, from breast- 
bone to spine; for the kidneys and for lumbago, 
across the small of the back. For the spine, it should 
be long and narrow - about six inches wide. Fo- 
mentations to the spine help to promote sleep, and 
for this purpose should be only moderately hot. For 
a joint, as the knee, the cloth may be folded as for 
the spine; and being drawn under the knee, the two Home Treatments 
119 
ends are wrapped about the front of the knee, one 
above the other. 
"Where a patient must apply his own fomenta- 
tions, it may be best to use a hot water bottle placed 
over a wet compress, first covered with one piece of 
flannel so as to retain the accumulated heat. This is 
not as efficient as a properly applied fomentation, 
but trying to be both patient and nurse is never 
wholly satisfactory. 
"For such parts as the eye, a wound, or an in- 
fected part, hot compresses of cotton cloth, gauze, or 
cheesecloth are better than wool. Because they will 
usually be smaller, and because they are of cotton, 
the heat is not retained as long as with wool, and so* 
they must be changed oftener." 
"Cold Compresses 
"A cold compress is a local application of cold 
by means of a cloth wrung from cold water. Hand 
towels or ordinary cotton cloths may be used. These 
should be folded to the desired size, and wrung from 
cold water or ice water. The wringing should be 
just sufficient to prevent dripping. They will be 
colder if taken immediately from a block of ice. As 
a continuous cold application, the compress must be 
very frequently renewed, always before it is warmed 
to any great extent. The thicker the compress, the 
less frequently will it require renewal. A set of two 
compresses should be used, and renewed at intervals 
of from one to five minutes, depending on the thick- 
ness of the compress and the result to be obtained. 
Cold compresses may be applied to the head, the 120 
Contagious Diseases 
neck, over the heart or the lungs, to the abdomen, 
the spine, et cetera. When applied to the head, they 
should be pressed down firmly on the surface 
treated, especially over the forehead and the tem- 
poral arteries. The pillow should be protected by 
rubber cloth covered by a towel. When compresses 
are applied to the abdomen in typhoid fever, the 
bedding and the patient's garments should be pro- 
tected by Turkish towels. Unless the compress is 
very thick, and always when it is left longer than 
three to five minutes, the nature of the application 
changes, and it becomes a heating com press" 
"Heating Compresses 
"A heating compress is a cold compress so cov- 
ered that warming up soon occurs. The effect is 
therefore that of a mild application of moist heat. 
The heating chest pack. Left: the wet compress. Right: the dry covering. Ho me Treatments 
121 
"A heating pack or compress consists of an ap- 
plication of heat to the body by means of three or 
four thicknesses of gauze or one of linen or cotton 
cloth wrung from cold water, and. so perfectly cov- 
ered with dry flannel, or mackintosh and flannel, as 
to prevent the circulation of air and cause an accu- 
mulation of body heat. In case warming does not 
occur promptly, it should be aided by hot water 
bottles. It is usually left in place for several hours, 
between other treatments, or overnight. If left on 
overnight, it should be dry by morning, unless an 
impervious covering, such as mackintosh or oiled 
silk, is used. On removal of the compress, the part 
should be rubbed with cold water, and dried with 
a towel." 
Hot Boric Compress 
A saturate solution of boric acid is needed for 
the compress. To make this, water is poured over 
boric acid crystals and left standing until all the 
boric acid has been dissolved that the water will put 
into solution. The clear water from the top is then 
poured off and used for the hot compresses. 
About one quart of this solution should be placed 
in a large pan and brought to the boiling point. The 
compress should be made of a small towel or a pack 
of gauze or cheesecloth of corresponding size. This 
is wrung out of the hot boric solution by the ends, 
in the same manner as is explained under the 
heading of "Fomentations." This hot pack is then 
placed over the eyes or whatever part of the body 
it is desired to treat with boric compresses. As this 
compress is much smaller than the fomentation cloth, 122 
Contagious Diseases 
and loses its heat more rapidly, it has to be changed 
much oftener. The application should last about 
thirty minutes. Before it is discontinued, the skin 
should be red as a result of the heat. 
Antiphlogistine to the Chest 
In the case of very small infants, where fomen- 
tations and other hot treatments .are not practical or 
are very hard to give, antiphlogistine properly ap- 
plied is very beneficial in bronchitis, cold on the 
chest, cough, pneumonia, etc. 
The application is made as follows: Pieces of 
cloth are cut out to fit the chest, front and back, 
somewhat like an underwaist. These are spread out 
on a flat surface, and the warmed antiphlogistine is 
applied to them much as butter is spread on bread, 
and should be from a quarter to a half inch thick. 
(The antiphlogistine is warmed by setting the can 
in hot water.) The cloths with the antiphlogistine 
on them are then applied to the chest, both front and 
back. A shirt or some other garment is put on over 
these and securely fastened. Additional wrappings 
may be placed wherever it is necessary to have the 
antiphlogistine thoroughly covered. These may be 
of flannel or cotton flannel. This treatment is given 
at night; and in the morning, after the cloths are 
removed, the child should have a warm bath, then be 
dried thoroughly and rubbed briskly. A woolen 
shirt should be worn during the day, and the appli- 
cation repeated at night as many times as necessary. Home Treatments 
123 
Flies are the greatest carriers of disease that we have to contend with. Magnified 
as he is in this picture, does not this creature appear guilty of the charge? XIII. Hygiene 
X" N epidemics, as in most cases of 'disease, those 
who are uncleanly, or who live in surroundings 
OS1 that are not sanitary, are most affected. Un- 
sanitary and unhygienic conditions are not identical 
with poverty. Any of us may have unhygienic sur- 
roundings if we do not give intelligent attention to 
our living conditions. 
Ventilation 
Poor ventilation is a menace to anyone. This is 
true of living rooms, but is especially true of sleep- 
ing rooms. Rebreathing of the air in small rooms 
soon brings about a condition that is injurious to the 
health. Fresh air is in abundance everywhere; and 
to be deprived of it, is a great handicap. 
Bed coverings should be sufficient to maintain 
the body heat and keep the sleeper comfortable when 
all windows are thrown wide open, so that the freest 
possible circulation of air may be had. Failure to 
have plenty of fresh air while sleeping may be a 
direct cause of tuberculosis, poor circulation of the 
blood, or cold hands and feet. It may also be an 
indirect cause of indigestion, general lassitude, and 
ansemic conditions of the blood. 
Personal Cleanliness 
Cleanliness in everything we do is of prime im- 
portance. Bathing of the body should be practiced 
at frequent intervals. During the hot months, a 
bath should be taken daily. During the colder 
months, this is still beneficial, but not quite so neces- 
124 Hygiene 
125 
sary. Bathing promotes the circulation in the skin, 
improves the heart's action, and is an aid to every 
activity of the body. Those who neglect to bathe 
often enough are much more subject to disease than 
they otherwise would be. 
Cleanliness in the home is also of great impor- 
tance. Where dirt and dust collect, the air is con- 
stantly contaminated, and its impurities are breathed 
into the lungs, and are a menace to those who live in 
such surroundings. Beds and bed linen that are not 
kept clean, and also unclean clothing, harbor disease 
germs, and are never tolerated by those who intelli- 
gently desire to keep themselves in the best of health. 
Cleanliness of Food 
Cleanliness with regard to the handling of food 
can not be emphasized too strongly. Persons who 
have communicable diseases, especially tuberculosis, 
should use separate dishes, which should be boiled 
each time they are used. This prevents the danger 
to others which the use of such personal articles as 
spoons and dishes always causes. 
The food should not only be kept clean, but 
should be kept in coolers or refrigerators, to prevent 
decay, fermentation, and other deteriorating proc- 
esses. The eating of food not properly cared for 
produces great irritation to the digestive organs. It 
is within the experience of almost every person to 
have eaten some small quantity of partially spoiled 
food, and as a result, suffered of a severe diarrhea 
for a day or more. Such carelessness regarding 
food should never exist among intelligent people. 126 
Contagions Diseases 
Another important point in relation to foods is 
that they should always be protected from flies and 
other insects. Flies are the greatest carriers of dis- 
ease that we have to contend with. They light on 
all kinds of refuse and germ-laden materials. Mil- 
lions of bacteria may be re- 
covered from the feet of a 
fly; and if flies are allowed 
to light on food, the result- 
ant contamination may be 
a very serious matter. The 
exclusion of flies from our 
dwellings is of more conse- 
quence than the rugs on the 
floor or the paint on the 
house. Screens should al- 
ways be provided; and if 
economy has to be prac- 
ticed, let it be in some other 
line than this. Keeping 
flies from contaminating our food supply is essential 
from the standpoint of protecting the food from 
spoiling as a result of the germs left upon it by the 
flies; but it is more essential from the standpoint of 
definite disease. The fact is now well established, 
that both tuberculosis and typhoid fever are trans- 
mitted by flies. Not only these diseases, but many 
others, are carried in this manner. 
An Effective Flytrap 
Expectoration 
In days gone by, careless expectorating was a 
menace to the health of many; but thanks to the Hygiene 
127 
good work of the various boards of health, and of 
others who are interested in the public welfare, there 
are now very few people who do not understand that 
this filthy habit should not exist. Spitting upon the 
sidewalks, and upon the platforms of street cars and 
carriages, is prohibited by law, as indeed it should be. 
There is, however, no law to prevent a man from 
being careless in this respect in his own home. It 
hardly seems necessary to discuss this subject, since 
so much publicity has been given it that the practice 
is well-nigh wiped out. Still, it is yet possible to 
see ignorant loafers carelessly expectorate in such a 
manner as to endanger themselves and all around 
them. 
As a matter of personal hygiene, the care of the 
teeth should receive constant attention. A good 
dentifrice, recommended by a reliable dentist, should 
be used for brushing the teeth after every meal.as 
well as upon arising in the morning. This prevents 
decay of the enamel, and helps to prevent pyorrhea. 
Before handling food in its preparation for the 
family, and also before sitting down to the table to 
eat, one should always wash the hands thoroughly, 
to guard against contamination from germs and dirt 
that are always likely to be on the hands. 
Care of the Teeth The SCIENCE of 
FOOD and 
COOKERY 
by HANS S. 
ANDERSON 
Dietitian and Food Expert 
THE first requisite of health is good, appetizing food, prop- 
erly prepared. The duty, therefore, of all having to do 
with the preparing of food, is to know more about the 
value of various kinds of food, their constituent elements, how 
this food should be cooked, proper combinations, etc. ; in other 
words, to bring the sanitariums into your own home. 
Research by the scientific laboratories has shown that it is 
most essential that all who have to do with the preparation of 
food for the daily meal should understand the fundamental prin- 
ciples of food values and their proper combinations. 
This need is met in "The Science of Food and Cookery," in 
which you have not only a most practical cookbook, but also a 
simple, scientific consideration of the various food elements, 
their food values, and their proper combination in the planning 
of a meal. No other cookbook has ever attempted such a wide 
range of valuable and needful information. It is a much needed 
help in home dietetics. 
The first 97 pages of the book are given to a careful and 
comprehensive study of foods and their uses in the body, also a 
chapter outlining a course of thirty-five cooking lessons. There 
are 182 pages, containing over 500 recipes, covering every phase 
of the cooking art. Full instructions for preparation accompany 
each recipe. 
A valuable feature is in the 19 pages that are given to the 
subject of cooking for the sick and for those suffering of specific 
diseases. There are also 11 pages treating of the most approved 
methods of home canning and preserving. 
"The Science of Food and Cookery" contains 298 pages, 
printed in large, clear type, embellished with illustrations and 
especially drawn chapter and page headings. Bound in durable 
cloth cover, which is waterproof and easily cleaned with a damp 
cloth. Sent postpaid for only $2.00. 
PACIFIC PRESS PUBLISHING ASSOCIATION 
Mountain View, California The HOME PHYSICIAN 
and GUIDE TO HEALTH 
. FTl HE advice of thirty special- 
1 I ists is yours in this very 
latest, most practical and 
I®| dependable health book known. 
Pract'c'al because medical 
terms are avoided wherever pos- 
sible; because of the complete 
system of symptom and subject 
indexing; because result-produc- 
ing treatments are suggested 
--C' for all the commonly known ail- 
~ ' ~' ments and diseases. 
Dependable because the infor- 
mation given is based on actual 
experience and successful prac- 
tice in world-renowned sanita- 
riums for a period of many years. 
The high speed at which we work, the multiplied dangers 
on every side, the more frequent attacks of disease, and 
the apparent weakening of our resistance, call for pre- 
paredness. 
. How to care properly for the body, and to learn how to 
diagnose, to administer simple treatments, and intelligently 
to cooperate with the doctor when his services are needed, 
should be our aim. All this necessary information and 
instruction is found in "The Home Physician and Guide to 
Health." 
. Special emphasis is laid upon sanitation; the preserva- 
tion of health; the composition of foods, a balanced diet, 
vegetarianism; hydrotherapy; care of the child; and home 
treatments for all minor ailments. 
The book contains 864 pages, made up of 19 sections, 
which are divided into 77 chapters, and more than 1,100 
subjects. _ As an aid to a better understanding of the text, 
it is profusely illustrated, containing nearly 300 pictures, 
many of them in color. 
"The Home Physician and Guide to Health" is sold by 
subscription. The name of our nearest agency will be 
supplied on request. They will be glad to give further 
information without any obligation on your part. 
Pacific Press Publishing Association 
Mountain View, California 
Review ano Herald Pub. Assn. 
Takoma Park, D. C. 
Southern Publishing Assn. 
Nashville, Tenn.