bath, go to bed, drink hot lemonade or hot weak tea, and cover himself up well until a good perspiration is induced. Care should be taken next day to wrap up carefully if he goes out of the house, as otherwise the symptoms may return in greater severity. Aspirin in doses of 5 to 10 grains every three hours may be taken during a cold if there is headache or pain in the limbs. Menthol drops are useful (p. 310).

CROUP.

There are two kinds of croup-true croup, which is the same as diphtheria (described on p. 113), and false croup, which is a nervous affection and occurs in spasms, usually at night.

Prevention.-Local applications of ice water or a cold compress will often prevent attacks. A mild mustard plaster applied to the throat and chest may act in the same way. If a child is especially subject to this condition, it is sometimes best to use steam from the so-called "croup kettle." This is arranged by covering the top of the bed with sheets, which should be raised some distance above the child's head. The steam from the kettle, heated by alcohol, is then conveyed into this space. The steam keeps the air moist and prevents the spasm. Care should be taken the next day to see that the child does not go out of doors and is not exposed to drafts, in order that he may be prevented from catching more cold.

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Symptoms. The attack is preceded by hoarseness and a loud, rough cough, which, from its peculiar sound, has been called a croupy" cough. The attack comes on usually about midnight. The child is awakened from a sound sleep by coughing and violent efforts to get his breath. The face becomes blue and presents an anxious expression. These symptoms usually cease abruptly in an hour or two and the child resumes its slumber. The attack may be repeated on subsequent nights.

Treatment.-Simple means often have a wonderful effect in relieving a spasm. Sometimes passing the finger down the throat will have this effect. A warm bath may break up an attack. The best method, however, is to give a teaspoonful of tincture of ipecac, followed by a little milk. This causes vomiting and relieves the condition.

BRONCHO-PNEUMONIA.

This is a disease that occurs principally in young children. It differs from lobar pneumonia (described on p. 110) in that it attacks both lungs, whereas lobar pneumonia usually attacks only one lung. Although broncho-pneumonia may affect an entire lobe, it usually confines itself to some of the small endings of the bronchial tubes and the air vesicles in immediate relation thereto. It is due to the. same germ-pneumococcus-which causes lobar pneumonia.

Symptoms.-The symptoms are similar to those of a severe bronchitis, which has been described under "Coughs and colds," on page 157. They consist of a loud, harsh cough, accompanied by pain, shortness of breath, and fever. The cough is attended with a glairy and tenacious expectoration, which may be blood tinged. The temperature may rise as high as 104° or 105° F. The shortness of breath is very distressing; the respirations sometimes amount to as high as 60 or 80 per minute. The pulse is frequent and may be rapid, feeble, and irregular. Recovery generally occurs in two or three days, but many cases last for several weeks.

Prevention. Other children should be kept away from the patient and care should be taken to boil all sheets, pillowcases, and other articles which come immediately in contact with the patient. Separate dishes should be used, and they should be scalded with hot water after being in the sick room. The child's mouth should be carefully wiped with tissue paper, and the paper immediately burned. This condition frequently follows measles, whooping cough, and common colds. Children suffering from these affections should be given careful attention and not be allowed to expose themselves to cold until they have fully recovered; otherwise this form of pneumonia may develop.

Treatment. The sick room should be well ventilated with the temperature kept at about 70° F. A croup kettle (described on p. 158) should be employed to keep the air around the bed moist. A large mustard plaster may be applied over the chest. This should be made in accordance with instructions given on page 310 and should be allowed to remain on only a sufficient length of time to redden the skin. One grain of calomel should be given in broken doses, one-tenth of a grain every 10 minutes until the whole amount has been administered. The calomel should be followed in a few hours by a Seidletz powder or a small dose of salts. In cases where it is not possible to give the salts on account of the quick breathing of the child, a glycerin suppository may be employed instead. If there is very much pain, a Dover's powder may be given, 3 grains being a dose for a child 5 years of age. This may be repeated several times, but it is not best to give it very often, as it interferes with the discharge of the secretion from the lungs. In some instances, this secretion blocks up the lungs and the child becomes blue. In that case a teaspoonful of sirup of ipecac should be given with a little milk to produce vomiting. Vomiting assists the bronchioles in clearing themselves of the secretion. One of the best expectorants is compound sirup of squills in doses of 4 drops for a child 5 years of age. This may be given every two hours, but if it produces nausea the dose should be reduced.

PLEURISY.

Pleurisy is caused by exposure to cold or wet. In nearly all cases, however, there is an underlying diseased condition present, such as tuberculosis, rheumatism, gout, chronic alcoholism, or heart or kidney disease. It may arise as an extension of inflammation from the lungs and their neighboring organs, being more common with lung fever, the pneumonia of adults, than with bronchial pneumonia, the pneumonia of children. Pleurisy may also follow injury to the chest wall.

Symptoms. The first sign is a pain in the chest, often called a "stitch in the side," which is worse when breathing rapidly or moving around. There is a dry distressing cough which the patient tries to restrain in order to avoid the pain which it causes. The usual signs of fever, such as an increased pulse rate, hot skin, and flushed face are present. After a day or two there may be an effusion of fluid into the pleural sac. When this occurs pain will be less but the breathing will be more difficult. In favorable cases, this fluid is absorbed in a few weeks and the patient recovers; when this does not occur, the physician has to draw it off through a hollow needle.

Prevention. The best way to prevent pleurisy is to keep the body as healthy as possible; then it is not so liable to be affected by cold and wet. Every person should live out doors as much as he can and see that there is plenty of fresh air present when he has to remain indoors. During sleeping hours, windows in bedrooms should be kept open. Persons who suffer from gout or rheumatism should be especially careful not to expose themselves to inclement weather.

Treatment. In order to lessen the pain the patient should be put to bed and the affected side should be strapped with strips of adhesive plaster. This is done by taking 4-inch strips and applying them as tightly as possible from the middle of the chest in front to the center of the back. Other strips are then applied, each one slightly overlapping the one above until five or six of the strips have been placed in position. Cold applied to the side by means of ice or ice water in a rubber bag will often relieve pain. In some cases morphine has to be given in doses of one-sixth to one-fourth of a grain, but this should not be used if it can be avoided and the dose should not be repeated unless the severity of the pain demands it. One-half a teaspoonful of paregoric may be given instead of the morphine.

HEART DISEASE.

Heart disease is a condition which often follows syphilis, diphtheria, scarlet fever, acute rheumatism, chorea, or tonsillitis. It may be caused by the persistent use of alcoholic liquors, or by the absorption

of small quantities of lead, as in the case of house painters, those who use hair dyes or drink water from lead pipes. It may be a part of a general process, known as arteriosclerosis, in which there is a hardening and loss of elasticity of the walls of the arteries, including the arteries which supply the heart muscle.

Symptoms.-The symptoms of heart disease are due to a dilatation of the chambers of the heart caused by the backing up of blood in them; this results from imperfect closure of the heart valves or from weakening of the heart muscle. In some cases thickening of the muscular walls of the heart occurs, which compensates for the enlargement of its cavities, as the extra strength of the heart muscle enables it to force out at each contraction of the heart the additional amount of blood contained in its cavities. In such cases there may be no symptoms, but when the heart muscle begins to fail the symptoms appear. There is shortness of breath, coughing, spitting of blood, indigestion, headache, dizziness, blueness of the skin, dropsy, irritability, delusions, delirium, or melancholia. Besides these symptoms there are special symptoms referable to the organ itself, such as:

Palpitation.-Palpitation means that the heart beats are irregular, rapid in action, and perceptible to the patient. It may be accompanied by shortness of breath. Its chief causes are mental excitement, excessive smoking, dyspepsia, overindulgence in tea, coffee, or alcoholic liquors. It often occurs in young soldiers, athletes, and those whose duties require inordinate muscular exertion. Breast pang (angina pectoris).-There are two forms of breast pang, one in which the patient is seized with a sudden, violent pain of the heart, attended by a sense of impending death. The face is pale, the skin is covered with a cold sweat, and the breathing is shallow or it may even stop while the pain lasts. This pain radiates over the left shoulder and arm and usually passes off in a few seconds or minutes. The person may die during the attack or the attack may recur after an interval of a few days or not for many years. The other, or mild form of angina pectoris, occurs mostly in nervous persons and is usually due to overexertion or indiscretion is eating. The pain is less intense, but lasts longer and is usually relieved by the eructation of gas from the stomach.

Fainting. This is caused by anemia of the brain due to inefficient action of the heart or vascular relaxation. During the fainting fit the patient is often unconscious. The spell may be preceded by a short period of vertigo or the patient may complain that everything has turned black before his eyes.

Prevention.-Children should not be allowed to take active exercise after they have had measles, scarlet fever, or diphtheria; after

an attack of acute rheumatism the patient should be kept quiet until all danger of injury to the heart is passed. Those who suffer from infected tonsils should have the latter removed. A dentist should be consulted frequently in order to ascertain if there is any pus around the roots of the teeth. Such pus, if discovered, should be drained to prevent the absorption of poisons which may injure the heart. Alcohol and tobacco should not be indulged in to excess as irregularity of the heart's action often follows their use. Persons who have led sedentary lives should not suddenly take up athletics or engage in occupations which require sustained muscular effort as the heart muscle is liable to be injured thereby. Such a change, if made, should be a gradual one in order that the heart may accommodate itself to the extra work required of it.

Treatment.-Special care should be taken not to eat indigestible articles, as gas produced in the stomach and intestines by the fermentation of such food may cause pressure on the heart and interfere with its action. Only such work or exercise should be undertaken as will not put a strain upon the heart as otherwise compensation may be broken and serious symptoms result. Such symptoms may be relieved by administering a teaspoonful of aromatic spirits of ammonia in water or a teaspoonful of bicarbonate of soda in a glass of hot water. It may be necessary to give a quarter of a grain of morphine sulphate with a one one-hundred-and-twentieth of a grain of atropine sulphate. If the patient faints, her clothes should be loosened and she should be laid flat upon a couch or the floor with the head lowered. When there is shortness of breath the patient is usually more comfortable sitting up and should be allowed to rest in an easy chair or be propped up in bed. Every person with chronic heart disease should place himself under the care of a physician and follow his directions.

SORE MOUTH.

This condition is met with more in children than in grown persons. Its chief causes are improper cleansing of the mouth, bad teeth, excessive use of mercury, and occasionally it accompanies scarlet fever, measles, tonsillitis, or sore throat.

Symptoms.-There is redness of the lining membrane of the mouth. The lips and gums may be swollen and the tongue indented by teeth marks. The saliva is increased and often dribbles from the corner of the mouth. The changes in this secretion may produce a disagreeable taste and cause the breath to be foul. There is pain and distress on taking food. Little white spots may appear, which in bad cases may terminate in small ulcers.

Treatment. The baby's mouth should be carefully cleansed at least once each day with a clean cloth soaked in a solution of boric