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be four hours, after which the doors and windows should be opened and the gas allowed to blow out. The room should then be thoroughly cleaned and aired for several days. Mattress, curtains, rugs, and carpet should be taken out of the room after fumigation, hung in the sunshine, and well beaten before being used again.

SCARLET FEVER.

Scarlet fever is a communicable disease characterized by fever, sore throat, and a red rash. When the disease is mild it is called scarlatina or scarlet rash. The incubation period is from two to four days. It begins with headache, vomiting, faintness, and occasionally convulsions in children. The mouth and throat are deeply congested. There is pain on swallowing or talking. The tongue has the color of a ripe strawberry. The inflammation may extend from the throat to the ears. The glands of the neck often become swollen. The rash appears on the second day of the disease, and in mild cases may be the first symptom noticed. It occurs as a diffuse redness, which, upon close observation, will be found to be due to fine red papules. After four or five days the skin commences to shed. Sometimes it is cast off in large flakes.

Complications.-Inflammation of many organs of the body may follow scarlet fever. There may be pneumonia, pleurisy, ulceration. of the throat, abscesses in the neck, and inflammation of the lining membrane of the heart. Nephritis or inflammation of the kidneys frequently occurs from the second to the fourth week. In this complication there is diminution or suppression of urine, with puffiness under the eyes, swelling of the hands and ankles, or general dropsy. There may be convulsions, and the case may quickly terminate fatally. In other cases the secretion of urine is reestablished and the person either recovers entirely or the disease persists in a chronic form. There may be pain, swelling, and redness of the joints. Careful watch should be kept for symptoms of inflammation of the middle ear. These are pain in the ear, tenderness over the bony prominence behind the ear, and drowsiness. The child may moan in its sleep and be hard to arouse. If the drum membrane breaks, the pent-up pus escapes from the ear opening, and if the inflammation is mild the symptoms then abate; otherwise an abscess forms in the bony cells behind the ear, which if not opened may break into the cranial cavity or spread downward along the deep tissues of the neck.

Varieties.-Mild cases may not be recognized until some unusual occurrence, such as a swelling in the neck, the shedding of skin, the onset of nephritis, or illness in another child who has been in company with the patient, calls attention to the fact that the child has had an attack of scarlet fever. The rash may be absent or present on only a portion of the body. The mild form may give rise to a

severe attack in another person. In a malignant case there may be high fever, delirium, coma, gangrene of the throat with a foul discharge from the nose and mouth, the patient dying in one or two days.

Death is rare in cases that receive proper care and attention, although many persons succumb to the complications produced by scarlet fever, and it is often the starting point of chronic disease of the heart, ears, or kidneys, which cause death in afterlife. It is more fatal to children less than 6 years old.

Prevention. All persons suffering from scarlet fever should be isolated and should not be allowed to communicate with other people, except those attending upon them, as long as there are any discharges from the mouth, throat, ears, or other parts of the body. Physicians attending upon scarlet fever patients should wear a gown which covers their clothing when going into the sick room and should thoroughly disinfect their hands after each visit. The person caring for the sick child should not mingle with other persons, and all dishes should be scalded before being again used.

Treatment. Keep the room warm, with a window partly open for ventilation. Put the patient in bed but do not cover him up with too much bed clothing. If the child has convulsions, give him a hot bath; if the fever is high, sponge him off with cold water. If there is vomiting, apply a small mustard plaster over the upper part of the stomach and give him a cup of hot water in which has been placed a teaspoonful of sodium bicarbonate. If there is severe headache, give 10 grains of aspirin if the patient is an adult; if a child, give 3 to 5 grains. Cold compresses should be applied to the neck. The mouth should be rinsed frequently with a saturated solution of boric acid (one teaspoonful of boric acid in a glass of water) and the throat kept clean by gargling with a solution composed of peroxide of hydrogen one part, water two parts. This solution may also be applied with a swab made by tying a small piece of cotton onto a small stick. If no peroxide of hydrogen is obtainable, a salt solution made by placing a teaspoonful of salt to a pint of water may be employed in its place. One tablet of calomel, each one-half of a grain, should be given every half hour until four are taken. This should be followed in four or five hours by a Seidlitz powder or a dose of salts. If there is earache, hot compresses should be applied to the side of the head, and ear drops (carbolic acid 1 fluid dram, glycerin 7 fluid drams, mixed well together) should be placed in the ear. If possible, a physician should be called immediately; if the drum membrane is opened early the hearing of the patient may often be preserved.

The patient should have a light diet with plenty of water to drink, especially if there is any sign of dropsy. If this develops, hot com

presses should be applied to the back, and hot water (temperature from 110° to 120° F.) should be injected slowly into the bowels, several quarts at one time. If the excretion of urine is greatly diminished, it may be necessary to put the patient into a hot pack. This is done by wringing out a sheet in hot water and immediately wrapping the patient in it and covering him with blankets. If electricity is available, the patient may be made to sweat by placing several light bulbs, connected with lamp socket, between the blankets on the patient's bed and turning on the light. The patient should not be considered well until the skin has ceased peeling and all discharge of pus has ceased. He may then be allowed to mingle with other persons. The room and its contents should be disinfected as directed under "Measles."

GERMAN MEASLES.

German measles is an acute contagious disease of mild character that comes on from 10 to 16 days after exposure to the person who is suffering from it.

Symptoms. The temperature seldom rises over 100° F. The rash first occurs upon the face. It consists of pale red papules, which do not assume any regular form or shape. There is considerable itching of the skin. The rash appears on different parts of the body in succession, fading in one part while appearing in another. It lasts from two to five days and is followed by a slight peeling of the skin. The glands of the neck may become enlarged and there is frequently sore throat and a dry cough, but these symptoms are not apt to be severe.

Prevention.-The child should be isolated and the same precautions taken against the spread of the disease as noted under scarlet fever. It does not spread as rapidly amongst children as measles, and the percentage of adults attacked is larger than in that disease. Treatment. The treatment prescribed for measles is applicable to this disease.

WHOOPING COUGH.

Whooping cough is a contagious disease characterized by an inflammation of the nose, throat, and bronchial tubes, associated with a peculiar spasmodic cough, ending in a long-drawn-out inspiration accompanied by a sound known as the "whoop," from which the disease gets its name.

It is caused by a germ present in the discharges from the nose and mouth, which is disseminated through the air during the spells of coughing. Most cases occur before the tenth year, and one attack is usually protective for the rest of life. It is believed that girls are more liable to contract the disease than boys.

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Symptoms.-The incubation period is from 4 to 14 days. In the beginning the symptoms are like those of a severe cold. There is redness of the lining membrane of the nose and throat, profuse discharge from this membrane, and a hoarse, dry cough. The face is swollen, the eyes suffused and watery, the eyelids swollen and pink in color. The cough is severe and out of all proportion to the other physical signs. There is fever, but the temperature does not, as a rule, remain above normal after the first few days. After these symptoms have existed for 10 days or 2 weeks the cough changes in character. It occurs in paroxysms which consist of a number of short, quick coughs, followed by a long-drawn-out inhalation of air accompanied by the noise known as the whoop. The coughing spell often terminates with vomiting.

Inflammation of the kidneys may be present, and the child generally loses fat and presents a run-down appearance. Consumption not infrequently follows an attack of this disease, and great care should be taken to prevent a child suffering from whooping cough from coming in contact with consumptives. The exhaustion caused by whooping cough makes it more liable to contract consumption.

Prevention. As patients continue to spread infection six weeks after recovery, it is very difficult to control the spread of whooping cough. As, however, it is such a distressing disease, every effort should be made to keep well children from associating with those having the disease. Children with the disease should be allowed to go outdoors, but should not be permitted to go to school or to moving-picture shows or ride in street cars or in any public vehicle where they may come in contact with other children.

Treatment.-An outdoor life during the course of the disease should be encouraged, and if convenient the child should be taken to the seashore. Children in cities, on account of dust and the presence of harmful gases in the atmosphere, suffer more than children in the country. The child should gargle his throat several times a day with a solution of hydrogen peroxide (hydrogen peroxide, 1 part; water, 3 parts). A broad bandage placed tightly around the chest and stomach may make the patient feel more comfortable.

MUMPS.

Mumps is an acute infectious disease usually affecting children, but may occur in adults. It affects the partoid gland, which is situated just below the ear on each side. It is conveyed by contact from one patient to another; hence the patient should be isolated in a room, and children should not be exposed to the disease. Only the adults directly in charge of the case should be admitted to the room unless they have been protected by a previous attack. An attack usually comes on about 15 days after the exposure to the disease.

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Symptoms.-The chief symptoms are pain and swelling in the parotid region under the ear. Movements of the jaw, such as chewing and talking, will be painful. Swelling may occur on one or both sides, but nearly always both are involved. It is worst about the third day, and may gradually disappear after that. It is usually a mild disease, but swelling of the testicle is a frequent complication in the male.

Treatment.-Light diet, such as broths, eggs, milk, rice puddings, etc., should be given. Sour food and acid drinks will be found to give considerable pain if taken in the mouth; hence they should be avoided. Hot applications may be placed over the swollen glands if there is very much pain. No internal medicines are indicated. If the bowels are constipated, a tablespoonful of Epsom salt may be administered with benefit.

CONSUMPTION (TUBERCULOSIS).

Consumption, or, as it is often called, tuberculosis, is due to the tubercle bacillus, a small organism which attacks various parts of the body. The infection may be general or it may be localized to a particular portion of the body, such as the lungs, the intestines, the bones, the glands, the nervous tissue. The only form that will be considered in this book is consumption (tuberculosis) of the lungs. Symptoms. The first noticeable symptom of tuberculosis of the lungs may be a hemorrhage, the blood being coughed up, but the onset is usually gradual. The patient has a slight cough, feels weak, and indisposed to do anything, loses weight, and has very little appetite. If the temperature is taken in the evening, it will often be found that he has a slight fever. In a few weeks or months the emaciation becomes more marked, the fever is higher, there are sweats at night, severe cough, shortness of breath, and a large amount of mucopurulent matter is expectorated. There may be severe diarhea from extension of the disease to the bowel, or the larynx may be involved, causing the voice to be husky and swallowing extremely painful. The patient's sleep is disturbed by the coughing spells, which are violent and protracted. As the disease progresses the symptoms increase in severity and the patient is confined to his bed until death brings him relief from his suffering.

Prevention.-Many physicians believe that consumption is contracted only during childhood and that a large number of persons become infected with the organism and recover. This belief is strengthened by the fact that healed lesions of tuberculosis are often found in persons who have died of other diseases. The presence of tuberculosis in adults is explained by the theory that the germs of this disease gain a foothold in the body in childhood, but do not cause disease until later in life. Tubercular germs which enter the

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