Health on the Farm: A Manual of Rural Sanitation and Hygiene

In this connection mention should be made of the great evil of patent medicines containing, and in reality essentially consisting, of alcohol. A vast number of them are widely sold under the misleading statement that they relieve catarrh, cure diseases of the kidneys, and that they act as tonics and general invigorants of the entire system. Masquerading under one guise or another they are sold to the unsuspecting public—prohibitionists for the most part—who fondly imagine that their glass of “bitters,” “liver-regulator,” or “safe cure for the kidneys,” is entirely harmless. Let all such be warned that with scarcely an exception patent medicines of this class are nothing more nor less than poor whisky containing some bitter to disguise the taste, and that they are in fact taking a drink when they use nostrums of this kind. The ultimate effect of this kind of drinking is to produce serious and grave diseases.

This discussion of the effect of alcohol on the human body would not be complete without calling attention to the extraordinary fact that those peoples to whom we owe our modern civilization have from time immemorial, most of all others, consumed the greatest amount of alcohol. Explain it as we may, the fact remains that the greatest achievements of the world were brought about by a society in which a very large proportion of its members were in the habit of more or less constantly taking alcoholic beverages. Naturally, the query is forced upon us whether this drug may not have played some important part in the great results achieved. Unfortunately, no one can answer one way or another, but our very ignorance should emphasize the importance of looking at the question from every side, and not jumping at conclusions before they are warranted by facts. It is true that most of our positive knowledge on this subject would condemn alcohol as being the greatest curse of the ages, but it may be that it has played a beneficent part in the affairs of mankind through devious paths impossible to trace. Unquestionably a drug, the taking of which assists us in momentarily throwing our troubles aside, must be of a certain positive value to mankind. If only it possessed these good qualities with none of its bad ones!

Having considered very briefly the general effects of alcohol on the system a few remarks may be appropriately made concerning the several beverages commonly consumed in the United States for which it serves as a basis.

Whisky.—Under the term whisky will here be included all of those stronger alcoholic beverages that are the product of distillation. In addition to those commonly designated as such we may reckon brandy, gin, and rum, and at the same time those subtle combinations called mixed-drinks, for which they serve as a basis. It will, perhaps, startle the average reader when the statement is made that whisky and its near relatives just referred to, particularly when diluted by water, are by far the least harmful of all alcoholic drinks. Their bad reputation lies in the fact that on account of their large percentage of alcohol they are usually preferred by drunkards, and that when consumed in excessive amounts by those unaccustomed to their use there often follow those frightful crimes with which these particular forms of alcohol are so odiously associated. The facts are, however, that when taken in moderation they are much less prone to produce indigestion than wines or malt liquors, and where one is determined to drink, they should unquestionably receive the preference. It should not be understood that the writer is in any way advocating their use, but the facts of experience compel him to state frankly that the least harmful of all alcoholic beverages is whisky, or its near relatives.

Wines.—There are a large number of fermented juices of fruits that are known as wines. They are either sweet or acid in taste, and both are peculiarly prone to induce dyspepsia in persons with delicate stomachs. Irrespective of their delicate flavor, which, in many instances, appeals strongly to the palate, the only virtue that they may be said to possess is that they contain alcohol in small amounts; this, however, is off-set entirely by their large percentage of sugars and acids, causing them to be much more unwholesome than plain whisky.

Beers and Malt Liquors.—It is very fortunate that in those states of the American Union that have recently enacted prohibition laws, beer and other malt liquors are now being widely sold under the plea that they are non-intoxicating and that they are in no way unwholesome. While it is true that the former claim is in a measure correct, it is a fact well understood by those who have given the matter study that they are perhaps the most unwholesome of all alcoholic beverages. Those in the habit of using them are almost universally under the impression that they are harmless, and as the taste for them is easily cultivated, those who once acquire the habit are very apt to take them in greater or less quantities daily. As a result of this, chronic digestive disturbances are always sooner or later set up, and the victim in the course of time often acquires a gouty tendency, which is all the more dangerous for the reason that in America it scarcely ever manifests itself in acute joint inflammations. The patient gets into what has been called a “lithemic” state, which is but another name for gout, and sooner or later is exceedingly apt to develop a chronic form of Bright's disease. It is greatly to be deplored that some of our professional national school-masters do not address themselves to this subject rather than to appealing to the worst passions of the ignorant in attacking the great institutions of our country, and in assailing the fundamental principles of our government that come down to us as a priceless heritage from the wise and patriotic statesmen who first brought our nation into life.

In addition to the three great classes of alcoholic beverages already considered there are innumerable others, fortunately but little known to the general public, and prized only by connoisseurs in such matters. As we happily have no problem confronting us in any way similar to the absinthe-habit, so common in France, it is not deemed necessary here to do more than merely to refer to them.

CHAPTER XI

IMPORTANCE OF GOOD COOKING

Reference has already been made to certain misconceptions concerning cooking diligently circulated in recent years by various quacks. The victim is advised that he must take large quantities of raw eggs and milk, and at the same time is instructed to eat a number of other specially prepared articles furnished at a stiff price and certified as being raw by the “medical company” furnishing the “treatment.” Since it is quickly discovered by those who are entrapped by charlatans of this kind that the only raw foods that they can take with comfort and without disgust are milk and eggs, they naturally practically live on these alone, and as these foods are extremely digestible and nutritious, improvement in the patient's condition not uncommonly results.

Nevertheless, it is unquestionably true that the vast majority of foods are greatly improved in digestibility, and are rendered much more palatable by thorough cooking. After being properly cooked there develop in foods certain flavors and odors that are highly appetizing, and unquestionably aid in the subsequent digestion of the same. With but few exceptions, foods are so altered by heat that their proper mastication becomes much easier, and cooking, therefore, materially aids in reducing them to a state in which they are much more readily acted upon by the digestive juices. It should never be forgotten, also, that cooking is of the utmost importance from the standpoint of killing bacteria and animal parasites that may be present in food. If we were to adopt universally the habit of eating everything raw, the general mortality would certainly be considerably increased.

Cooking of Starchy Foods.—Nothing in the whole art and science of preparing food for the human being is of so much importance as the proper cooking of starches. As a result of the heat employed, certain chemical changes are induced in the starch-granules, as a consequence of which they are rendered digestible. It is of fundamental importance that at all times and under all circumstances the cooking of this class of foods should be as thorough as is possible, for when this is not done digestive disturbances are sure to follow, and much of the food is actually wasted. There are but few cardinal principles in the ordinary hygiene of life that are so commonly neglected as this, since it is the habit of a large proportion of the American people to consume three times a day masses of tenacious starch which has not been acted upon by heat sufficiently to render it digestible.

Of all the different methods of cooking starches, by far the most common, and, therefore, the most important, is the process called baking. While it is not possible in this volume to go into the subject with the thoroughness that it deserves, the principal points deserve some mention. They may be briefly stated as follows:

If the principles above enunciated be properly followed out, good wholesome bread will result. There are, of course, many details connected with the preparation of food known to expert cooks into which it will not be possible for us to go here, and for which the reader is referred to any good cook-book.

Some starchy foods such as rice and potatoes, do not lend themselves readily to the production of breads, and are consequently usually cooked in some other manner. It cannot be too strongly insisted upon that they should be rather steamed than boiled,—the process being usually carried out by placing a small amount of water with them and allowing it to boil away; we should remember also that the principles just insisted upon in connection with making bread apply here with equal force—we should cook thoroughly and serve both as dry as is possible.

Cooking of Meats.—Here again it is necessary to insist upon the necessity of thorough cooking. The error has long prevailed that raw meats are wholesome, but within recent years it has been clearly demonstrated that this old view is erroneous. The muscle-fibers that constitute the bulk of the nourishment of meats are separated from each other by a substance which cannot be acted upon by the juices of the stomach until it has been heated to a temperature which results in the cooking of the entire mass. It is true that the muscular substance proper may be digested without heat—resembling in this way the white of the egg, to which it is chemically closely related; by scraping meat with some dull instrument the muscle fibers may be separated in a more or less pure state—leaving the substance that requires heat in order to become digestible behind—and after having been removed in this way, of course, may be eaten in a raw or semi-cooked condition without ill effects. In preparing meat it is not absolutely essential that it be cooked until thoroughly “done”—a slight tinge of red being allowable.

Healthful Recipes.—In an Appendix to this volume will be found a series of recipes for the preparation of common foods, for which the author is indebted to Dr. Mary E. Lapham, of Highlands, N. C. They will be found extremely practicable for making not only very palatable but thoroughly wholesome dishes; and are earnestly recommended to young housewives, who err through ignorance, as a rule, rather than because of carelessness or of lack of good materials. It has often been said that the road to a man's heart lies through his stomach. It would not be surprising to learn that this aphorism fell first from the lips of some wise woman who had observed that in a great number of cases unhappiness in home-life had resulted primarily from lack of home-comfort, and chiefly from unvaried, unappetizing meals and table-service. Another point is well worth remembering, especially by young married women: a man whose home is pleasant and comfortable is likely to spend as much of his time there as he can—if it is otherwise, he will seek some place that has these desirable qualities, such as his club, or an arm-chair in some corner saloon. Furthermore, a man who is not only abundantly, but nicely fed, has far less desire for the stimulants which lead to drunkenness, than the man who is denied at home the properly cooked and seasonably varied food which his system craves. No better work in the “Temperance cause” can be done than to make an attractive home.

These are facts which many a young housewife needs to learn and keep in mind; and it is for her benefit that Dr. Lapham has prepared her simple but excellent cooking directions presented in the Appendix.

CHAPTER XII

SEVEN AVOIDABLE DISEASES

MALARIA FEVER.

Malaria, in its various manifestations, has ever constituted the principal obstacle to the civilization of all tropical and semi-tropical countries, and as a consequence vast tracts of the richest and fairest portions of the world have remained uncultivated and unredeemed from their primitive savage state. Recent investigations have shown that this disease can be easily prevented if the matter is taken up intelligently.

Malaria is a disease produced by a parasite belonging to the very lowest order of animal life—the Plasmodium malaria, which is conveyed from man to man by that genus of mosquitoes called the Anopheles. The parasite attacks and destroys the red cells of the blood, and produces a poison that causes the symptoms characteristic of malaria.

Course of the Disease.—The most common and well-recognized symptoms of malaria are those that occur in that variety of the disease which is known as malarial or intermittent fever. In this type the patient—who may or may not have at intervals for some days noticed chilly sensations, a feeling of fullness in the head, and general bodily depression—is suddenly seized with a chill followed by a high fever and subsequent profuse perspiration; after these symptoms subdue, which generally requires several hours, the patient returns to a practically normal condition and feels, on the whole, well until the next attack occurs. These chills-and-fever paroxysms occur at various intervals depending upon the character of the parasite inducing them, the most common form being that which produces a chill every day. In some instances the malady comes on more insidiously, there being no marked chills but only periodical elevations of temperature.

In the more chronic forms of the disease the unfortunate victim is frequently subjected for years to attacks of fever coming on at irregular intervals, the patient being more or less of an invalid throughout the course of the disease. In other instances the brain becomes affected, producing very alarming symptoms; and in quite a proportion of cases the malady ultimately terminates in chronic Bright's disease.

Treatment of the Disease.—Most fortunately, we have in quinine, when properly administered, a medicine that in practically all instances acts as a specific in this affection; but it should be used only on the advice and under the directions of a physician. In the more chronic forms of the disease, combinations of arsenic, with such tonics as nux vomica, iron, and small doses of some of the preparations of mercury, produce permanent cures where quinine has failed. It is of the utmost importance that attention be given to the treatment, as, so long as the patient remains with the parasites in his blood, so long is he a menace to his friends and neighbors.

Mode of Infection Through Mosquitoes.—The most brilliant triumph in modern medicine, and one of the most creditable achievements of human ingenuity, has been the absolute demonstration that malaria is carried from man to man by means of the Anopheles mosquito, and that the disease can, in nature, be produced in absolutely no other way. This is not a theory, but it is a fact which has been demonstrated in its every detail beyond dispute, and we are now happily in a condition to reject our venerable notions concerning bad air, miasma, etc.

Malaria Avoidable.—From the foregoing it is seen that the proper way to avoid malaria is so to screen houses that mosquitoes cannot enter them. Persons in malarial districts should not sit on open porches at night, and should be careful to sleep under properly constructed nets. If this be done, there is absolutely no danger of anyone ever contracting the disease. It will be well observed that these precautions are not necessary in the daytime, as the malarial mosquito rarely attempts to bite during this period.

It should be remembered by those who have the disease that they are a constant source of danger to people living in the vicinity, and they should be doubly careful as long as the disease persists to avoid being bitten by mosquitoes at night. It is furthermore their duty to vigorously treat the disease until the parasites are no longer present in their bodies, at which time they cease to be a menace to others.

Many children have malaria without showing symptoms, and, if allowed to sleep without being properly covered with a net, are very apt to infect a large number of malarial mosquitoes; the blood of children in malarial localities should be examined from time to time, and if the parasites be found, the children should be given the proper remedies until a cure is effected.

Particular attention should also be directed to the fact that almost all Negroes in malarial localities of the South harbor the parasites, though very few of them show symptoms of their attacks. It is, therefore, very important that they be treated properly, and their white neighbors should see to it, for their own safety, that they do not sleep in houses unprotected by nets.

If the precautions herein detailed were properly carried out, for even a few months, malaria would practically cease to exist wherever this was done, and would not recur unless individuals from other places suffering from the disease were to come into the districts where the Anopheles mosquito is present, and so give it to the gnats—to be by them recommunicated to humanity.

TUBERCULOSIS.

Of all the enemies of mankind, tuberculosis, in its various forms, takes the first rank. Of protean manifestations, occurring in almost every part of the body and producing diseases of the brain, of the nerves, of the bones, of the skin, and of all of the internal organs—pre-eminent is the terrible malady we call consumption, which is tuberculosis of the lungs. It has been estimated that one-seventh of all the people born into the world die as a result of this malady in some one of its various forms, and it is probable that one person out of every three dying between the ages of fifteen and sixty years, succumb to this disease. As a result of the labors of thousands of patient, self-sacrificing investigators—many of the most distinguished of whom have died of this disease while carrying on their work—the peculiarities of this affection are now fairly well understood, and if we were to apply the knowledge which we now possess in our attempts to free ourselves from its ravages, there is no question but that within a comparatively short period of time the disease would practically cease to exist.

Character and Course of the Disease.—Tuberculosis is produced by a minute vegetable parasite known as the Bacillus tuberculosis, a germ which not only occurs in the human being, but is widely distributed among the lower animals. Tuberculosis of the lungs (to restrict ourselves to this most important manifestation) generally comes on insidiously, there being usually no definite period from which the sufferer can date the onset of the malady. In the early stages there is usually loss of appetite and a pronounced feeling of weakness followed by a slight cough; the latter symptom frequently leads patients to erroneously believe that their trouble began with a bad cold, when as a matter of fact, the catarrhal trouble of the throat and bronchial tubes was originally produced by the germs of tuberculosis—there being no such thing as a cold changing into consumption. As the disease progresses the patient complains of fever and chills, these symptoms being oftentimes periodical, and lead to the belief that the trouble is malarial fever: this mistake is very common, and whenever such symptoms appear a good physician should be immediately consulted. The patient also suffers from exhausting night-sweats in many instances, though this is not invariable. A rapid loss of flesh is one of the earliest and most common symptoms. The symptoms above enumerated continue and grow worse, and in quite a proportion of the cases there is, in addition, spitting up blood, which in some instances may be so pronounced that it becomes a distinct hemorrhage. In the more rapid or “galloping” forms of the disease the patient frequently dies within a few weeks or a month or so, while in the less severe types the malady may persist for many years before death occurs.

Treatment.—The treatment of tuberculosis by drugs has proven an entire failure, but a large number of persons afflicted with this disease will recover, if placed under proper hygienic conditions.

The patient should be put on a porch or in a tent, whether it be winter or summer, and kept in bed at absolute rest as long as there is any fever, and should be fed in abundance with good, wholesome food. While this treatment appears simple it should always be carried out under the directions of a physician, as it is only possible for those having a thorough knowledge of the subject to give such directions as would lead to a rapid cure of the patient.

Modes of Infection.—Hereditary tuberculosis, notwithstanding a popular idea to the contrary, is very rare, but there is no question that those persons in whose family tuberculosis exists are much more prone to contract the disease than others. In just what manner the germ of consumption gains entrance to the human body, we are more or less uncertain, but there are reasons for the belief that in many instances they pass in by means of the inhaled air; there is no doubt that in a small percentage of cases the bacillus gains entrance to the body through an abrasion of the skin or of some mucous membrane; finally the bacteria are often taken in with the foods that we eat, or by putting objects upon which the germs are present into the mouth, or eating with hands which have been contaminated and not washed. Of the foods that contain the germs of consumption, milk is unquestionably the most common, as there can be no question that fully 25 per cent. of our cows have this disease, and under such circumstances their milk is usually infected with the bacillus that produces the malady; meats, likewise, often contain germs of this disease, but, as they are usually cooked, no harm, as a rule, results.

Of quite as much importance as the introduction of the germ into the body is the resisting power of the individual at the time when this occurs, since the disease can make no progress unless the tissues have become susceptible through lowered resistance. All things then that have the effect of lowering the vitality of the body act as predisposing causes to consumption; such, for example, as WANT OF PROPER FOOD, LACK OF SLEEP, IMPROPER CLOTHING IN COLD AND WET WEATHER, AND LIVING IN DAMP AND IMPROPERLY VENTILATED HOUSES; excesses, PARTICULARLY THE TAKING OF ALCOHOL, conduce to the development of the disease—long-continued inebriety being beyond doubt the cause that most frequently leads to consumption. It is a common error that alcoholic stimulants tend to ward off consumption, and it is absolutely certain that these substances not only do not act in a curative way in those who have already contracted the disease, but are positively detrimental. In order then to avoid consumption—and this is particularly of importance for those in whose family there is a predisposition to the disease—the individual should live soberly, should try at all times to obtain a reasonable amount of good food, should sleep a sufficient number of hours, and should be clothed properly, particularly in the winter. Those who devote their time and energy to the performance of their work—being careful of course not to labor excessively—are much more apt to escape consumption than those who do otherwise. It is particularly of importance that those who have a tendency towards consumption should early learn, and throughout life practice, the habit of BREATHING THROUGH THE NOSE: if this rule be followed a large percentage not only of the germs of consumption, but other bacteria as well, are filtered out during their passage through the nose and do not reach the lungs. Cleanliness is also of much importance—a bath taken each morning in moderately cold water being conducive to health, not only as regards consumption but other diseases as well. It is of course necessary that dwelling houses should be kept thoroughly clean.

TYPHOID FEVER.

Of all of the infectious diseases prevalent in the United States, typhoid fever is one of the most common and fatal. As a result of its ravages a vast amount of invalidism, suffering and financial loss is brought about each year, and a frightful mortality results. It has for some time been recognized that typhoid fever is among the most preventable of all diseases, and if our people would bestir themselves and carry out the comparatively simple rules that are necessary for its prevention, the scourge would, in a short time, practically cease to exist among us.

Character and Course of the Disease.—Typhoid fever, enteric fever, or abdominal typhus, is an infectious disease believed to be caused by a specific bacterial germ known as the Bacillus typhosus. It develops, as a rule, quite slowly, the first symptoms being loss of appetite, headache, and a marked fatigue on slight exertion. These symptoms gradually grow worse, fever develops, and the patient oftentimes suffers with chilly sensations; the temperature gradually rises, and in the course of from a few days to a week reaches a height of 102 degrees, 103 degrees, 104 degrees, or 105 degrees F. In many cases no symptoms exist that indicate trouble with the bowels, but in the severe forms of the disease diarrhœa generally comes on during the first week and continues throughout the course of the disease.

During the second week the symptoms above detailed continue, becoming often more severe, and there develops great nervousness and delirium. About this time there are frequently observed over the chest, abdomen and thighs, minute reddish spots resembling flea-bites; these spots last for a few days and then pass away and are followed by a fresh crop in other situations. During this period of the disease inflammation of the bronchial tubes frequently comes on, and now and then pneumonia develops. Bleeding from the bowels is an occasional highly characteristic symptom of the second week. When the disease follows a normal course, the symptoms during the third week begin gradually to abate; the fever lessens, and the patient, though much emaciated, gradually returns to a normal condition.

Modes of Infection.—It is clear that typhoid fever is the result of the entrance into the body of some minute form of germ-life, whether this be the bacterium generally supposed to induce the disease or not. This contagion is beyond question a living something which multiplies with great rapidity under proper conditions, and, escaping from the bodies of those infected with the disease, in one way or another, reaches other individuals. It is beyond question true that the virus passes from the body of those infected by means of the urine and feces, and it is likely that the secretions from the mouth and nose frequently contain the germs that cause the fever.

As the germs are certainly extraordinarily minute, a very small amount of any of these excretions might produce the disease in healthy individuals if it were to get into their bodies through water, milk, or any uncooked food, or if it were to find lodgment about the nose or mouth, or get upon the hands of other persons. It should also be remembered that the virus may easily get upon cooking-utensils, drinking-cups, bed-linen, and other articles with which we are constantly brought into close contact, and that the disease might be transmitted in this way. It is also true that the malady may be carried from place to place by insects, particularly flies; the latter may readily get enough infectious material upon their legs in various ways, and then, crawling over the food, leave the deadly poison deposited upon it.

Treatment of Typhoid Fever.—As soon as the symptoms appear, a physician should be called and his directions faithfully and carefully followed out. Nothing in this disease is of more importance than careful nursing, and it is absolutely necessary that the patient receive only liquid diet until the physician permits other food.

Wherever possible then, patients with typhoid fever should be completely isolated, since, if this is not done, other members of the family are almost sure to contract the malady—a result which almost everyone has seen who has had any experience with the disease. Wherever possible patients should be sent to a hospital, but where this cannot be done they should be placed in an outhouse, if practicable, or in an isolated room, which should be thoroughly disinfected after the patient's recovery. No one should visit a typhoid-fever patient, except when compelled to do so, and we should be particularly careful to prevent children from coming in contact with them, as it has been shown that they contract the disease much more readily than grown people. It is also of importance that persons should not sit for any length of time in the sick room, and, above all, under no circumstances, should cooking and eating be done there. The room in which the patient is placed should be furnished only with those things absolutely necessary, and it is particularly desirable that carpets and curtains should be removed. It is well to wash the floor each day with some antiseptic solution.

Those persons who come in contact with typhoid fever should wear outer clothing which can be easily washed and boiled. After touching the patient, or any of his clothing, the hands should be at once thoroughly scrubbed in an antiseptic solution. Of course, under no circumstances, should the nurse eat or drink from the same vessels that the patient does.

None of the excretions from persons afflicted with typhoid fever should ever be emptied until thoroughly disinfected with creo-carboline or strong lime-water, and under no circumstances should these be poured out in the neighborhood of springs or wells. Towels, handkerchiefs, and clothing that comes in contact with the patient should be thoroughly disinfected before being sent to the laundry. This is best accomplished by thorough boiling, but in cases where this can not be at once carried out, it is advisable to use some chemical antiseptic; of these, perhaps the best is creo-carboline, which may be employed in a 1-500 solution in water; where this solution is not obtainable, a 5-per-cent. solution of carbolic acid in water will answer. It should also be remembered that the water in which typhoid-fever patients are bathed necessarily becomes infected, and this should always be thoroughly disinfected before being emptied. These precautions should be carried out for some time after the patient has recovered, as it is well known that persons, under such circumstances, for some time frequently contain the poison in their evacuations.

HOOK-WORM DISEASE.

It has been only recently recognized that a large percentage of the invalidism and a great number of the deaths yearly in the southern portion of the United States are caused by a very small intestinal parasite known as the Necator americanus, or hook-worm. This parasite has unquestionably existed over the area just named since the advent of the Negro—recent investigations having shown that the worm is in all probability of African origin. This hook-worm disease is probably the most common of all the serious diseases prevalent in the South, and as it is easily curable, and can be readily prevented, there is no matter which should be of greater interest to the people in the infected regions, especially those who live in villages or on farms.

Character of the Disease.—The animal parasite called hook-worm closely resembles, externally, the pin-worm which so often occurs in children. The female, which is larger than the male, measures somewhat more than half an inch in length, and has the thickness of a knitting-needle; the male is between a quarter and three-eighths of an inch in length as a rule. The parasite possesses around its mouth a row of minute plates somewhat resembling hooklets, by means of which it grasps hold of the mucous membrane of the intestine and bruises it sufficiently to cause the blood to flow; with this blood the parasite nourishes itself. At the same time the worm injects into the tissues a poison which has much to do with the symptoms that occur in the disease that it produces.

These worms are usually present in great numbers, there being as a rule from 500 to 2,000 of them, and as they unquestionably live at least eight or ten years, the unfortunate victim suffers for a long period of time as a result of their presence. While living in the intestines the females lay enormous numbers of eggs which pass out with the feces, and under suitable conditions of temperature and moisture there develops within each of them, within from two to three days, a minute snake-like embryo which bursts through the shell of the egg and passes into the neighboring earth. Here the embryos live for considerable periods of time, and, ultimately, may infect other individuals, or those from whom the eggs were passed. There are at least two ways by which these embryos gain entrance into the human body. Some do so by getting into drinking-water and being swallowed; but, extraordinarily, they most frequently penetrate through the skin. When this happens the parasite, in passing through the skin, produces the disease known as “ground-itch.” The vast majority of the victims of this affection are children with whose skin the embryo comes in contact while they go barefooted during the summer months.

Course of the Disease.—Having entered through the skin, the embryos of the hook-worm, moving by a circuitous route finally reach the intestines, and, grasping hold of the mucous membrane with their saw-like teeth, they begin to suck blood and grow until they reach the size of the adult worm in about a month or six weeks. Depending upon the number which have gained entrance, and the susceptibility of the individual, there now begins to develop symptoms of profound anæmia; the skin of the child becomes very pale, and assumes a sort of yellowish hue, and in cases where there is a severe infection, the victim begins to suffer with shortness of breath and dropsy. When this occurs the patient sometimes dies, but more commonly death results from contracting some other disease, which, under ordinary conditions, would produce no serious results. One of the most unfortunate effects of this malady is that when children become infected they cease to grow, and frequently retain the appearance of early youth even after they have reached full maturity in years. These unfortunates are generally incorrectly regarded as dirt-eaters. The symptoms frequently last over a period of many years, as in the intestines of these victims the worms that originally infect them live certainly eight or ten years, and during this period it is beyond question true that additions to the original number are frequently received.

Diagnosis and Treatment.—There is no disease that can be diagnosticated with more ease and certainty; the eggs are present in the feces in great numbers, and by means of a microscope they can always be detected. In all cases where the disease is suspected, a half-teaspoonful of the feces of the person supposed to be infected should be placed in a bottle and sent to a competent microscopist for examination. This is done free of charge at the laboratories of most State Boards of Health in those parts of the country where the malady exists. Whenever an individual shows the symptoms above detailed, an intelligent physician should at once be called. We have medicines that act as specifics, and the disease can always be cured in a very short period of time.

Preventive Measures.—Of course the best method of preventing this disease is to administer to those already infected the proper medicines, and cause the expulsion from the intestines of the worms that lay the eggs.

The indiscriminate scattering of the feces around the stables, so very common in many districts, should be absolutely forbidden. Around the house where individuals have lived who have the disease every care should be taken to prevent contact with the earth in the neighborhood of places where the ground might have become infected. It would be advisable for children and others to wear shoes for at least a year after the last individual having the disease was cured; and as a precautionary measure it should be insisted upon that properly constructed privies or water-closets should be at every house, and that they should be used by everyone in whom there is a possibility that the disease exists.

DIPHTHERIA AND ITS TREATMENT.

Loeffler's discovery in 1884 of the germ of diphtheria, and its relation to the disease of the same name, established the specific infectious nature of this malady, and demonstrated beyond a doubt that membranous croup is not ordinarily an independent affection, but is almost always simply diphtheria of the wind-pipe. The discovery of antitoxin, some time later, reduced the mortality of diphtheria from an average of 30% to 10% in ten years; its use has also shortened the course of the disease, and decreased greatly the frequency of the paralytic conditions that not uncommonly follow this malady.

Character and Course of Diphtheria.—Diphtheria is an affection caused by a bacterial microbe which produces a poison that acts locally upon the tissues invaded, and also, as a result of its introduction into the general circulation, brings about more or less profound effects on the entire system.

The period of incubation is from two to ten days. The onset is generally characterized by a rise of temperature from 100°F. to 104°F., chilliness, headache, and pain in the back and limbs. Albuminuria is common. The glands of the neck often become swollen. In mild attacks a slight sore throat is all that is complained of. In the majority of cases the disease attacks the throat and tonsils, and is characterized locally by the appearance of a membrane, which is usually gray or yellowish-white, elastic, and adheres tightly to the surface upon which it lies. At times, however, the membrane is soft and pliable, and is easily separated from the tissue; such cases are frequently diagnosticated as follicular tonsillitis. A bad cold is occasionally the only symptom of the disease. The diagnosis should always be confirmed by bacteriologic examination. In some instances the wind-pipe is primarily attacked, but when the disease affects this part of the throat it is generally a consequence of the extension of the membrane downward from the region of the tonsils. In the former case the diagnosis is somewhat difficult, as cultures taken from the throat may not show the presence of diphtheria bacilli, though material that is coughed up may contain myriads of the germs; in this phase of the disease interference with respiration is the symptom most to be feared. The mucous membrane of the nose, eyes, ears and generative organs, may be affected. Wounds are also liable to become infected with this organism. In rare instances the membrane may extend down into the bronchial tubes and lungs, and has been found on post-mortem examination covering the inside of the stomach.

As complications we may have broncho-pneumonia, acute Bright's disease, inflammation of the internal structures of the ears, bleeding from the nose, inflammation of the valves of the heart, and sometimes paralysis of this organ, with death; the last named sequel of diphtheria comes on during convalescence, usually from two to four weeks after the subsidence of local symptoms, and is due to inflammation of the nerves that control the heart. Much less commonly paralytic conditions of the palate, throat, eye muscles and the nerves of taste occur, and under rare conditions, paralysis of the lower extremities. Paralysis of some kind follows in from ten per cent. to fifteen per cent. of the cases, and appears with equal frequency after the mildest as well as following the most severe cases.

Mode of Infection.—The germs of diphtheria may be carried in articles used by persons with the disease, or they may be communicated by direct contact. The micro-organism is found in the secretions from the mouth, throat, or nose, and in particles of detached membrane. Bedding, utensils, etc., used in the room where a patient has diphtheria, are liable to carry the germs if taken from the sick-room, and consequently should be always properly disinfected before being removed. Milk-bottles carried into the sick-room, or handled by persons caring for the patient, should never be returned to the dealer without being disinfected. Cats, and less frequently dogs, may contract the disease and convey it to those with whom they come in contact. Unrecognized mild cases are a frequent means of spreading the disease, as also is a too early release of patients after recovery. It is a much safer method of procedure to require at least two negative examinations before releasing a patient from quarantine, as during convalescence the germs may be entirely absent on one day and a few days later be quite abundant. The bacilli may remain in the throat from a few days to several years after the disease is apparently entirely well, and under such circumstances the persons carrying them become quite as great, if not a greater, menace to those with whom they came in contact as they were during the height of the disease. A thorough disinfection of the room and everything used about the sick person should be carried out after the patient is released. Complete isolation should be observed during the illness, and as long as the bacilli remains in the throat.

Treatment.—Diphtheria antitoxin is the specific treatment of this malady, and should be given early in the disease. The chances of recovery decrease in proportion to the length of time existing between the onset of the affection and the time of administration of the drug. Antitoxin may be repeated in six hours after the initial injection if improvement is not noticed, but ordinarily twenty-four hours should elapse between doses. It is well to remember that it is safer to give too much antitoxin than too little. The initial curative dose varies from 2,000 to 5,000 units, according to the age of the patient and the severity of the disease. When a case is seen late it is often advisable to begin with a large dose,—it being good practice under such circumstances to use at once as much as 10,000 units or even more. The average case requires from the beginning to the end of the treatment a total of from 10,000 to 20,000 units, but occasionally 50,000 or even 100,000 units may be necessary. There are very few risks in giving antitoxin. In a series of 50,000 cases treated with it only two deaths occurred sufficiently early after the injections to warrant the belief that this unhappy result was produced by the drug. It is worth remembering that asthmatic cases bear the administration of antitoxin very poorly; a marked and sometimes serious embarrassment of respiration, with cyanosis, unconsciousness, and general collapse may follow its use, but recovery is usual in such cases.