minute. The tongue, at first moist and red or white coated, soon becomes dry and brown, and dark-colored crusts (sordes) may form on the teeth, lips, and nostrils. Delirium or coma is apt to set in. Prostration is extreme, and the patient may die in this early stage before the bubo attains any considerable size, or, as in the septicemic form of the disease, without the appearance of the bubo at all.

In some cases on the third or fourth day the temperature drops a degree or two, but generally rises again until about the fifth or sixth day, when it suddenly drops to normal or subnormal. Death may or may not take place in this stage. More frequently there is a sudden rise in the temperature immediately preceding death, and in favorable cases the temperature falls to the normal gradually.

About 70 per cent of all cases die within the first six days. Survival of the sixth day may therefore be regarded as a hopeful sign. In cases which tend to recovery the symptoms improve gradually. Convalescense is slow, and at the seat of the bubo an indolent sore may be left, which is very slow to heal.

Prevention. The patient should be immediately isolated in a clean and well-ventilated compartment, and all parts of the house or ship should be thoroughly fumigated with sulphur to kill rats and fleas. (See p. 65.) The discharges from the patient-urine, feces, vomit, or sputum should be passed into bowls or pots containing a solution of carbolic acid, compound cresol, or bleaching powder. (See p. 104.)

The person detailed to wait on the patient should be free from sores or scratches of any kind, and should exercise the most scrupulous care of his hands, and all articles brought into contact with the patient should be disinfected. (See p. 104.) In pneumonic plague the nurse should wear a mask to protect himself from inhaling the plague bacillus when the patient coughs or sneezes.

A ship with plague on board should be taken to the nearest quarantine for necessary treatment, and to give the survivors the best chance for life.

Treatment.-Constipation should be relieved by calomel, 5 grains, followed in five hours by a dose of Rochelle or Epsom salt. The food should be concentrated and nourishing. If diarrhea is persistent, it may be relieved by salol in 5-grain doses, given every three hours.

Ice or cold water should be applied to the aching head and the hot body sponged with cold or tepid water. In the earlier stage of the buboes the local application of ice is useful. Later on, if softened, they should be incised and dressed with iodo form gauze. Pain and restlessness may be relieved by morphine, one-sixth grain, repeated in two hours if necessary.

BERIBERI (THE KAKKE OF JAPAN).

Beriberi is a form of multiple-neuritis (inflammation of nerves), characterized by numbness, tenderness, and edema (dropsical swelling) of the legs and other parts of the body; by irritability of the heart, extreme weakness, and paralysis. It is a disease which occurs mostly in tropical climates, but is frequently carried by ships into temperate latitudes. A warm climate, however, is not necessary to develop the disease, as a number of years ago it was present among Gloucester fishermen. A diet of polished rice may produce the disease. (See p. 75.) Cases are often found where a one-sided diet is supplied. Four forms of the disease are recognized:

(1) The mild or rudimentary form begins with a feeling of weakness and numbness of the extremities, with edema of the skin and tenderness of the muscles, especially of the calves, uneasiness in the belly, shortness of breath, and palpitation of the heart. These symptoms may last only a few days or several weeks and then disappear, but recurrences are common.

(2) In the dry or atrophic form there is no edema, but the other symptoms are marked and more rapidly develop. Instead of edema and puffiness there is atrophy of the parts. The tendon reflexes are lost. The muscles of the legs and arms and sometimes of the face are paralyzed and painful. All the muscles of the body waste away. The patient presents a pitiful, shrunken appearance, suffers intense pain, is sensitive to the slightest touch, and may die from general exhaustion or, after lingering many months, gradually improve and get well.

(3) The wet or dropsical form begins with symptoms similar to those of the mild form, but the edema soon extends over the entire body, watery effusions into the serous sacs take place; there is marked shortness of breath, frequently nausea and vomiting, and always weakness of the heart. Death may occur from heart failure or from paralysis of respiration. On the other hand, the dropsy may gradually or rapidly disappear and leave the patient in essentially the same condition as that described under the head of the dry or atrophic form.

(4) The most serious or dangerous form of beriberi is called the acute pernicious cardiac form. In this the general symptoms of the disease may be only slightly developed, but the cardiac (heart) symptoms are marked. The disease in this form usually lasts several days or weeks, but death may occur from heart failure within 24 hours from the onset.

Prevention and treatment. The diet should be immediately changed. Wheat flour and oatmeal should be substituted for rice. Fresh meat and vegetables should be supplied if they can be obtained;

onions, dried beans, and peas should be eaten; potatoes should be cooked in their jackets; as few canned goods as possible should be taken. When a vessel is being fitted out for a long voyage care should be exercised to provide food which contains ingredients necessary to health. A man who is ill with the disease should be relieved of duty and kept in bed, as there is danger of heart failure if he is permitted to exert himself in any way.

SCURVY.

Scurvy is a disease produced by improper or unsuitable food. Many years ago it was of frequent occurrence among seafaring men on long voyages. Now it is a comparatively rare disease, thanks to better provisions and better methods in issuing food supplies.

Symptoms. Swelling, sponginess, and bleeding of the gums. The teeth become loose and frequently drop out. The breath is foul, the tongue swollen. The skin becomes dry and scaly. Hemorrhages (small dark red spots) occur under the skin, first on the legs and then on the arms and other parts of the body. Bleeding from the nose frequently occurs. Swelling about the ankles is common. The skin of the legs is frequently discolored in large blotches, and there is often a peculiar hardness or induration of the muscles of the calf of the leg. The complexion is frequently of greenish or dirty-yellow hue. The pulse is rapid and weak. There may or may not be slight fever. The bowels may be constipated or there may be a troublesome diarrhea.

In severe cases debility and emaciation are quite marked. The mind wanders, and occasionally there is wild delirium.

Prevention and treatment. This consists almost wholly in a change of diet. Give fresh vegetables, fresh milk, fresh beef, oranges, lemons, limes, or lime juice. Begin with small quantities at short intervals, and increase the allowance as rapidly as the stomach can take care of it. Pickles, onions, sauerkraut, raw potatoes, and raw cabbage are valuable articles in the make-up of a varied diet.

Potassium chlorate dissolved in water should be used as a mouth wash, and the gums should be frequently painted with tincture of myrrh. The skin should be kept in good condition by frequent bathing. The sleeping quarters should be clean and well ventilated.

TAPEWORMS.

A tapeworm consists of a head, neck, and a ribbon-like trunk made up of segments. As it grows new segments are formed while the hindmost segments, containing the eggs, are thrown off. If the cast-off segments are eaten by animals the eggs develop into embryos

which bore through the intestinal wall of the animal, enter the blood stream and become lodged in its tissues. Here each embryo is surrounded by a capsule, and if the meat of the animal is eaten by a human being the capsule is digested and the worm is set free. It attaches itself to the intestinal wall and it again begins to develop into an adult worm.

Beef tapeworm (Tania saginata).—This is the commonest of the large tapeworms and occurs in man after eating raw or uncooked beef containing the embryo. Beef tongues are especially liable to be infected. The head of the worm is small and hardly visible to the naked eye. Under the microscope the head is seen to have four suckers by which it attaches itself to the intestinal wall. This worm sometimes reaches a length of 30 feet, and is often one-third of an inch broad as its thickest part. The segments vary from 18 to 30 in number.

Pork tapeworm (Tœnia solium).—This tapeworm is not as common as the beef tapeworm. It develops in the small intestines after eating raw or underdone "measly" pork, and ranges from 6 to 13 feet in length. The head, besides 4 suckers, has a circle of 26 long and short hooks by which the worm holds on to the lining membrane of the bowel.

Symptoms.-Tapeworms may develop in man at any time of life. They do not cause symptoms until about three months after the infected meat has been swallowed. It is a popular idea that tapeworms cause many symptoms, but the disturbances caused by the worms are limited to the abdomen. The infected persons usually have voracious appetites, and they are liable to attacks of constipation alternating with diarrhea, pains in the abdomen, indigestion, nausea, and vomiting. The presence of a tapeworm is known by the passage of the segments, which may be seen in the stools, or found in the bed or clothes of the patient.

Prevention.-Care should be taken not to eat undercooked beef or pork. Cattle and hogs should not be allowed to drink water which has been contaminated with discharges from privies or water-closets, as this water may contain tapeworm eggs from the human body. Animals who drink this water may become infected, and the tapeworm may then be transmitted to persons who eat the meat of these animals. For this reason a tapeworm that has been discharged by a person should be burned and should not be thrown out where it can be eaten by animals.

Treatment.-Treatment consists first in starving the tapeworm, and then dislodging it by medicines which make it let go its hold upon the lining membrane of the intestine. The patient should not eat anything except a light diet of milk and soup for two days prior

to taking the medicine and nothing should be eaten the evening of the day before the drug is taken. There should be no breakfast in the morning, and the medicine should be taken about 10 o'clock. Various curative substances are used, the best probably being a fresh preparation of the extract of male fern. The dose for an adult is onehalf to 1 dram. It should be given in capsules and should be followed in a few hours by a dose of salts. If there is pain and the bowels do not move easily, an injection of warm water is administered. Instead of male fern, a decoction of pomegranate bark may be used. This is made by adding 4 ounces of pomegranate bark to a quart of water. This mixture should be allowed to stand for 24 hours and then boiled until it is reduced to 5 ounces. The whole amount of the pomegranate bark should be taken in three or four doses at short intervals. Pumpkin seed mashed up and made into a paste with sugar is also a useful remedy. The seeds should be deprived of their envelopes. About 4 tablespoonfuls should be taken.

ROUNDWORMS.

Roundworm (Ascaris lumbricoides).

This worm is of a yellowish or reddish brown color and measures from 7 to 14 inches in length. It is about the diameter of a goose quill. There may be only a single worm or several may inhabit the intestines. The eggs gain entrance into the human body through drinking water and food.

Symptoms. They may not cause any symptoms and their presence may only become known when they are passed in the bowels. They may, however, give rise to pain in the abdomen, and cause diarrhea and loss of appetite. Occasionally a worm will pass up into the stomach, where it will cause nausea and vomiting, or will enter the bile duct, and produce jaundice. If the worms are present in large numbers, the bowels may be obstructed, with accompanying serious symptoms.

Prevention.—All worms should be burned immediately after they are passed from the body so that their eggs can not get into water used for drinking purposes. The fact that these worms may infect the human body through drinking water should be remembered so that care may be taken to obtain only water from the purest sources or that which has been passed through a purifying plant.

Treatment.-A light diet should be taken while medicine is being administered. Santonin is efficient, given in doses of one-fourth to 1 grain to a child and 2 to 4 grains to an adult. This dose should be given twice a day for several days and should be followed by a purgative, such as 1 or 2 grains of calomel.