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be applied to the head if there is delirium. If there is distension of the abdomen hot turpentine stupes should be applied. This is done by wringing a double layer of thin flannel out of hot water with which a teaspoonful of turpentine has been mixed. An injection of a pint of warm water containing a teaspoonful of turpentine is also beneficial. The bowels should be kept open by injections of warm soapy water. In case of collapse give coffee or inject hot coffee or salt solution (one teaspoonful of salt to a pint of water) into the bowel.

TYPHUS FEVER.

Typhus fever, also known as hospital fever, spotted fever, jail fever, camp fever, Tabardillo, and ship fever, is a disease which causes great mortality when it becomes epidemic among persons infested with lice. The cause of the disease is not known, but it has been shown that the principal method of transmission is by the body louse.

Symptoms.-Incubation period is less than 12 days. The symptoms resemble those of typhoid fever but the onset is much more abrupt. It begins with a chill, headache, and pains in the back and legs; there is marked prostration so that the patient has to go to bed at once; there is high fever from the beginning, the tongue is furred and white, the face is flushed, and the bowels are constipated. Nervous symptoms are pronounced; the sick person may lie with his eyes open but be in an unconscious condition; he may pick at the bed clothes; there may be intense delirium, the patient trying to get out of bed. The eruption appears on the third to the fifth day; it consists of a number of dark red papules; there may be small hemorrhages under the skin. The rashes and the hemorrhages give the skin a curiously mottled appearance. The fever generally falls suddenly about the fourteenth day. In favorable cases it does not return, but preceding a fatal termination it may again rise very high. Prevention. It is necessary to be sure that all lice and their eggs on the patient's body and clothes are killed. It is better to remove the patient's clothing in an outer room. His body should then be annointed with a mixture composed of one-third gasoline and twothirds vaseline. His hair should be soaked in a mixture of equal parts of vinegar and kerosene and his clothes wrapped in a sheet, after which they should either be destroyed or sterilized by boiling or steaming (see p. 58). The patient should then be put to bed in another room and the room in which he undressed should be scrubbed with a hot solution (3 per cent) of compound cresol solution (see p. 104). The body and clothing of persons who have lived with the sick man should be treated in the same manner. The doctors and nurses should take special precautions to prevent being bitten by

lice; they should wear rubber gloves and completely cover their bodies with gowns when going near the patient; a tight fitting cap should be worn so as to entirely cover the hair.

Treatment.-Patients are best treated in tents in the open air. There not only seems to be less liability of other persons becoming infected under these conditions, but it is much more beneficial to the patient. Sponge baths should be frequently given to keep the temperature as low as possible. An ice bag applied to the head is often of value. The bowels should be kept open by giving small doses of salts. The patient should be fed every two hours, being given a half glass of milk or a small bowl of soup. Water should be given freely and small pieces of ice allowed to dissolve in the mouth.

DYSENTERY.

Dysentery, or bloody flux, as it is sometimes called, is an affection —an inflammation and ulceration of the mucous membrane of the large bowel. It occurs in different degrees of severity. It may be acute or chronic. There are different varieties. Its severest form is met with in tropical countries, where it frequently occurs in widespread epidemics. Epidemics also occur in temperate regions. Sporadic cases may be found almost everywhere. The disease prevails in summer and autumn.

Bad food, unripe fruit, impure drinking water, exposure to cold and dampness, while probably not in themselves the direct cause of dysentery, doubtless favor the operation of other causes.

Symptoms. The onset may be sudden or gradual. There may or may not be chills or chilliness. There is usually some feverishness. The tongue is furred and moist, but soon becomes red and dry or brownish and glazed.

The first stools may be like those of an ordinary diarrhea. After a day or two, or maybe within a few hours, these are replaced with small mucous stools frequently mixed with blood and small particles of fecal matter. Soon the evacuations consist of mucus alone, or of blood and mucus, or of a jellylike matter and small white clumps of mucus. Later they may be shreddy, and brownish or greenish in color. The patient complains of cramps and "colicky" pains in his belly, a burning sensation in the rectum, with a feeling as if something must be expelled, and of a constant desire to go to stool. The evacuations may number from 10 to 20, or 40 to 50, or even 100 or more a day, according to the severity of the case. The quantity of each may not exceed a teaspoonful.

In mild cases there is a gradual change to normal, and patient may recover after a period of a week or 10 days. Severer cases continue for several weeks or longer and then recover or become chronic. Death may occur from general weakness.

Tropical dysentery, the variety which occurs most frequently and in epidemic form in tropical or subtropical regions, but also occasionally in temperate climates, is produced by a microorganism which enters the system in drinking water or food contaminated by the hands of those who have the disease.

The symptoms in this form of dysentery are similar to those already described. The burning sensation and bearing-down pain, however, are less marked. The stools are less frequent, but they are larger and more watery-at times more like diarrhea than typical dysentery. The disease in favorable cases runs a course of from 6 to 12 weeks. Recovery is always slow. Death may occur from exhaustion or from abscess of the liver, which is a common complication. In some epidemics the course of the disease is rapid.

Prevention.-In tropical climates or in places where the disease abounds water should be boiled before drinking, or it should be disinfected in accordance with the method described on page 25. As persons who have had the disease may still have the germ in their stools without showing any symptoms, care should be taken to examine all persons who handle food, as such persons may transmit the disease to other persons. The precautions described under typhoid fever should be taken by a person caring for a patient suffering from dysentery in order to prevent its spread.

Treatment. Rest in bed. If possible, the patient should use the bedpan instead of the commode or closet, so as to insure the greatest amount of rest, which is important. Stop all solid food. Give 2 tablespoonfuls of castor oil and 15 drops of laudanum in one dose, and, if necessary, repeat the dose in six hours, or give smaller doses at intervals of four hours. After the bowels have been thoroughly cleared out, a pill of camphor and opium should be given every three hours. Hot applications should be placed on the abdomen. The bearing-down pain and the burning sensation may be relieved by washing out the rectum with a pint of warm water and by injecting 2 ounces of thin starch containing 25 or 30 drops of laudanum.

In place of the castor oil, Epsom salt may be given in tablespoonful doses, repeated every two hours until a free and large action of the bowels results, and then the pill of camphor and opium given every three hours. Or, instead of the camphor and opium pills, bismuth subnitrate may be given in 30 or 40 grain doses.

After two or three days, if the disease continues, the castor oil or the Epsom salt may be repeated, and after its effect is produced the same line of treatment continued.

The diet should be limited to the lightest articles, such as thin porridge, milk, and broths. And even in the lightest cases the patient should be kept warm in bed.

Tropical dysentery should be treated by injections into the bowel of large amounts of cold water (45° F.) containing 1 part of sulphate of quinine to 5,000 parts of water (3 grains of sulphate of quinine to 1 quart of water). Three-grain doses of emetine bismuth iodide given by the mouth every night before retiring for 12 nights is, however, the best treatment. When this drug can not be obtained salol-coated capsules of powdered ipecac may be used instead.

PNEUMONIA.

When a person suddenly has a severe chill followed by a high fever, flushed face, difficult breathing, and a pain in his chest, he may be suffering from pneumonia, and as this is a dangerous disease the services of a physician should be obtained at once.

Causes. The disease is due to a germ known as the pneumococcus. It is a constant inhabitant of the throats of healthy people and apparently does no harm until the resistance of the body is lowered by disease, lack of food, drunkenness, or exhaustion due to severe physical exercise. Persons frequenting badly ventilated stores, factories, theaters, street cars, or other places where there are crowds are liable to contract pneumonia. Chilling of the body when overheated may bring on an attack. Many elderly persons suffering from chronic diseases die of pneumonia, the disease being often spoken of then as a terminal pneumonia.

Symptoms. The sputum is abundant, tenacious, and of a reddishbrown color, whence the name "rusty sputum." The color is due to the admixture of small quantities of blood. The pulse at first is full and bounding, but later may become weak, rapid, and barely perceptible at the wrist. Breathing is embarrassed, the respiratory movements are rapid, 30 to 50 per minute, the patient is restless and often can not lie down but has to be propped up in bed or sit in a chair. There may be delirium, and if not watched the patient may jump out of a window and injure himself severely. The fever in a typical case remains high until the seventh or ninth day, when it will frequently drop to normal in a few hours. This is called the crisis, and if there are no complications it is followed by great improvement in the patient's condition and he generally goes on to recovery. In other cases the temperature does not return to normal, but only falls a degree or two for a short time and then rises again. This is called the false crisis and is of unfavorable import, especially if accompanied by profuse sweat and blueness of the skin.

Complications.-The disease is nearly always accompanied by pleurisy, which is an inflammation of the serous membrane covering the lung. This is the cause of the pain in the side. There also may

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