special hospitals, free dispensaries, and visiting nurses for
charity cases; free examination of expectoration and early
diagnosis, free dispensing of sputum cups, medicines and
food, and disinfection of all premises occupied by con-
sumptives. By far the most important of all measures to
prevent the spread of tuberculosis is the segregation of
advanced cases in hospitals, and this has been the chief
means all over the world of lessening the number of patients
and, therefore, the mortality.

As we have seen, chronically enlarged glands in the neck
in children are very common and usually are tuberculous,
and in course of time the germs find their way into the
blood and may in the end lead to disease of the lungs.
Therefore it is extremely important to cure enlarged glands.
Removal of diseased tonsils and adenoids in children,
x-ray treatment of the glands, combined with a diet of
milk and eggs, and living and sleeping outdoors, will
usually cure the glandular swellings in the neck. In
adults removal by the knife is commonly advisable.

To prevent tuberculosis in children cows' milk should
be pasteurized. The cleanest milk is best, certified if



TUBERCULOSIS 129

possible. Home pasteurization is safest unless one is sure
of the dealer. Fill the outer part of a 2-quart double
boiler as high as possible with water and bring it to the
boiling-point. Then take off the fire and place a quart of
milk in the inner part of the boiler and insert this in outer
part. Put on the cover and let the double boiler stand
with a cloth over it in a warm place for forty-five minutes.
Then cool the milk and keep the milk covered on ice. The
milk should be kept at 145 F. for thirty minutes, and to
secure this it is well to test it with a thermometer during
the heating process.

Cleaning and disinfecting rooms occupied by con-
sumptives are of great importance. Mattresses and car-
pets which cannot be sterilized by a municipal steam plant
should be burned.

Disinfection by formalin is most effective, followed by
general cleaning and renovation. For this the furniture
should be moved from the walls, rugs lifted from the floor,
and clothing exposed.

Then 2 cups (^ pint) of formalin are mixed with a cup
of water in a water pitcher, and to this is slowly added
3 fluidounces of commercial sulphuric acid.

One pound of quicklime is placed in a large enamel basin
on some bricks in the center of the room and the solution
in the pitcher is poured over the lime and the door quickly
closed and sealed by strips of paper pasted over the cracks.
This quantity of chemicals is sufficient for an ordinary small
bedroom (10 x 10 x 10 feet 1000 cu. ft.) which is reason-
ably tight. After the room has been closed for twelve
hours it should be aired and everything possible washed
with soap and water containing a generous tablespoonful
of compound cresol solution to the quart. Then the walls
and ceiling may be calcimined or prepared so as to secure
the most complete renovation. All fabrics and bed or body

9



130 THE PREVENTION OF DISEASE

clothing should be boiled for twenty minutes, or soaked in
1 : 1000 corrosive sublimate solution over night.

The prevention of overcrowding in factories and work-
shops, and medical examination at regular intervals of
employees in stores and in buildings in which large numbers
of persons are working, are of great value in limiting the
ravages of tuberculosis.

The chief measures of prevention are three: 1. Segrega-
tion of advanced cases to avert distribution of enormous
numbers of germs. 2. Early diagnosis. 3. Improvement
of individual health.

COLD IN THE HEAD

Colds are due, in the first instance, to changes in the
circulation, and, secondly, to the presence of certain germs
in the nose and throat.

Thus, in the classic experiments of Rossbach, who opened
the windpipes of rabbits and placed ice on their bellies, it
was found that the cold on the outside of the body pro-
duced intense congestion in the air-passages. It is well
known that exposure to cold or wet (the same thing) is
likely to cause a "cold," especially if one is overheated at
the time. Other conditions leading to abnormal conges-
tion of the mucous membranes likewise favor colds, as
chronic catarrh from any cause commonly nasal obstruc-
tions, diseased tonsils, and adenoid growths, particularly
in children. Irritation of the mucous membranes of the
nose and throat is also occasioned by hot, dry air, as from
the effect of hot-air furnaces and by dust, and, apparently,
by some forms of indigestion and debility. If the resist-
ance of the mucous membranes to germs is not lowered by
the foregoing means then the presence of germs which are
ordinarily found in the air-passages may do no harm. Or,
again, the transmission of actively infectious germs from a



COLD IN THE HEAD 131

patient may lead to an attack of cold in healthy persons.
A variety of germs are commonly found in the nasal dis-
charges of those with colds, one or the other preponder-
ating, according to season and place. These may be germs
causing true influenza, or those producing pneumonia
(when they may attack the lung, which they ordinarily
do not in colds), or those responsible for inflammation of
wounds (pus germs) , or a special germ (Micrococcus catar-
rhalis), which is the sole source of some colds.

Thus, two factors are essential for the production of
colds congestion of the mucous membranes and the
presence of certain germs and apparently both are neces-
sary. In places free from germs, as on mountain tops and
in arctic regions, exposure to cold and wet does not ordi-
narily induce colds on account of the absence of germs;
while, on the other hand, our nasal passages may contain
the same germs found in the discharges of those with
severe colds, and yet we may remain absolutely well if we
keep our mucous membranes in good condition.

To avoid colds we must, then, avoid chronic catarrh, dry
overheated air, city dust, indigestion, dissipation, or any
causes lowering the general tone or the local tone of the
mucous membranes. In children removal of enlarged
tonsils and adenoids are often required, and removal of
nasal obstructions in adults. Vaccines made of all the
varieties of (killed) germs which are found in the nasal dis-
charges of persons with colds are now used to induce im-
munity in those subject to repeated attacks and also in
treatment of an existing cold. Their use is harmless, but
how much value may be attributed to them it is yet too
early to affirm. It is difficult to understand why vaccines
should afford immunity to colds when the having of a cold
affords no protection to the patient against taking another.
They are beginning to be used extensively, however.



132 THE PREVENTION OF DISEASE

What shall be done on the first premonition of a cold
when one feels a stuffiness in the nose, sneezes frequently,
has a roughness or dryness and discomfort in the upper part
of the throat, and chilliness.

Both general and local measures are advisable. General
treatment consists in increasing the normal secretions of
the skin, bowels, and kidneys. Thus, one should take a
laxative one-half to one bottle of effervescing citrate of
magnesia should drink a quart or so of hot lemonade, and
take a hot bath before retiring, or a Turkish bath may be
taken if one can drive directly home without exposure and
go to bed at once. Capsules, each containing 1 grain of
quinin, \ grain of camphor, and -fa grain of extract of
belladonna, are useful in the very beginning of a cold.

One should be taken each hour until four or five have
been swallowed, unless there is much dryness of the
mouth, when it is well to stop them.

If the nose is much obstructed it is well to take a few of
these tablets at any time to lessen the swelling in the nose,
by causing contraction of the blood-vessels of the mucous
membrane. Taking a 2-grain capsule of quinin hourly,
until three, four, or five doses are swallowed, or until there
is ringing in the ears, appears to have some influence in
preventing colds, but is less effective than the above com-
bination.

Among the local remedies the dropping of half a medicine-
dropperful of a freshly made 20 per cent, watery solution of
argyrol in each nostril the writer has found most useful in
aborting a cold if used a few times at three-hour intervals
at the first suggestion of the trouble. The head should be
thrown well back, and a medicine-dropper is filled half-full
of the solution, which is allowed to flow slowly into the
nose and so on into the throat.

The solution is harmless if swallowed. It is well not to



COLD IN THE HEAD 133

blow the nose afterward more than possible, and to use
pieces of cheese-cloth or old bits of cotton, which may be
thrown away as soon as used, for the solution will stain the
handkerchief badly. These stains may be immediately
removed, however, by a 1 : 1000 solution of corrosive sub-
limate made with the ordinary surgical tablet. Argyrol
is a most useful agent in preventing the growth of germs
when locally applied, and will prevent the occurrence of
the most dangerous inflammations of the eye and of the
sexual organs (see page 191). When there is much obstruc-
tion in the nose and breathing through it becomes difficult
one may sniff up occasionally into the nostrils a little
Pond's extract or witchhazel from the hand, which will be
found very effective. But this is not a dissertation on the
treatment of cold, and we must stick to our subject of
prevention. The argyrol solution may be dropped into the
nostrils of infants or children while they are lying in bed
without causing distress or subjecting the patient to the
slightest danger from swallowing the medicine. As the
solution does not keep well for longer than a week, one may
use in its place a solution of 1\ grains each of menthol and
camphor in an ounce of liquid albolene (similar to liquid
vaselin), dropped into each nostril in the same manner,
and this solution is useful throughout a cold when dropped
in the nose four times daily, and for children is preferable,
in that it will not stain the clothing as does the argyrol.
This is also absolutely harmless if swallowed.

The best treatment of all severe colds is that secured by
remaining in bed. While the temperature is over 99| F.
one is always safer in bed with a cold. The even warmth
of the coverings tends to bring the blood to the surface of
the body and relieve the congestion in the air-passages.
It is the direct opposite of Rossbach's cold applied to the
outside of the abdomen in producing congestion in the



134 THE PREVENTION OF DISEASE

breathing apparatus. For persons subject to colds the
daily sniffing of a solution made from Seller's alkaline
antiseptic tablets (one tablet to half a cup of warm water)
into the nostrils, and the gargling of the throat with a half
pint of cold water twice daily, are of great benefit in cleans-
ing these parts of germs. Then, as is well known, the
hardening of the skin by daily cold baths, showers, or cold
sponging (in delicate persons while standing in warm
water) will be of great service. Persons with bald heads
may bathe their heads in cold water.

Cold baths should not be taken unless a warm reaction
follows, and the use of a very warm bathroom greatly
favors this result. Also light underclothing is of advantage
in hardening the skin, and many persons catch cold by the
opposite process through wearing too warm underclothing
in cold weather. The material is not of so much im-
portance; light wool is best, but many do as well with
cotton or linen. So children should be brought up to
scorn drafts, unless the skin is moist from perspiration.
It does one good to get used to sitting in drafts and thus
harden the skin to cold, with the above exception. Germ-
laden dust is one of the most prolific sources of colds and
pneumonia in cities. Clean pavements will prevent this
danger. In Seattle the streets are paved with brick or
asphalt, and are washed daily with a hose in the business
sections, and this city has the lowest death-rate in the
United States. Infants should not be taken out in cities
when the air is filled with dust unless the face is well pro-
tected by a veil. The general precautions which are ad-
vised herein will apply as preventive measures against dis-
eases of the air-passages and lungs as a whole, including
bronchitis and pneumonia.

There is one favorite preventive against cold, recom-
mended by the justly famous Dr. Alonzo Clark, which we



INFLUENZA, LA GRIPPE 135

have omitted. It consisted in hanging one's hat on the
bedpost and drinking whisky and water until one sees
two hats. Times have changed, and neither present mor-
als nor scientific teaching favor this, to some, agreeable

treatment.

INFLUENZA, LA GRIPPE

It is difficult to define what influenza is. Many doctors
call any severe cold with fever influenza. Since Pfeiffer's
discovery (in 1893) of a special germ as the sole cause of
influenza, one would naturally limit the cases of influenza
to those in which the Pfeiffer germ is present. But the
influenza germ is found in the nose and throat secretions
in many persons who are suffering from other diseases, as
bronchitis and consumption, or chronic cough, while,
on the other hand, there are many other germs which pro-
duce exactly the same symptoms as those caused by the
true influenza bacillus. Thus, severe influenza-like colds
are due commonly to the same germs which produce blood-
poisoning in wounds (pus germs) , or to those which under
other conditions will occasion pneumonia, or to a third kind
of germ peculiar to severe colds. In the wide-spread epi-
demics of influenza which after an interval of often many
years extend over the civilized world the sole cause appears
to be the true Pfeiffer bacillus, or influenza germ. During
the periods of freedom from these great outbreaks attacks
precisely resembling influenza may be either due to the
influenza germ or to the others already noted. It is well
to regard all severe catarrhal colds with fever as influenza
because they also are contagious and should be treated as
influenza.

Influenza is a very contagious disease, and is communi-
cated by contact of one person (carrying the influenza germ
in his nose or throat secretions) with another susceptible
individual. It was formerly thought that the disease was



136 THE PREVENTION OF DISEASE

communicated through the air, because influenza might
suddenly appear in persons in a remote island or other
place away from the general source of infection. But now
that we know that persons carry about influenza germs
in the secretions of their nose, throat, and bronchial tubes
for years there is nothing to prevent such an one from
communicating the disease in an active form to any sus-
ceptible individuals at any time.

Yet it is only when influenza is prevalent that one can in
some measure use preventive means to avoid the disease.
These consist in attending to the general health, refraining
from fatigue and undue exposure, and keeping from
crowded rooms or cars or buildings. It is thought by some
that taking 1\ grains of quinin in capsules three times
daily at mealtimes or, in case this does not agree, 1\ grains
of urotropin in a whole glass of water thrice daily between
meals, will protect an adult against the disease. To pro-
tect healthy persons in the same house with the sick it is
necessary to isolate influenza patients in a room and burn
all the secretions from the nose or throat which may be
received on paper handkerchiefs, pieces of gauze, or cloth.

Then the patient's bed and body clothing should be
boiled before being laundered, and the drinking and eating
utensils should also be placed in boiling water after use.
An attack does not protect one from another; in fact,
unlike most contagious diseases, instead of the patient
being made more or less immune, he appears to be made
more susceptible to the disease.

The feeble, aged, and children should be protected from
influenza, as far as possible, by isolation in their rooms or,
better, outdoors away from the crowd. So many persons
go alx)ut with influenza that it is not possible to avoid
them in crowded places during epidemics. Among
thousands of fishermen at sea none contracted influenza



CEREBROSPINAL MENINGITIS 137

except immediately after leaving port or after mixing with
the crews of other vessels. The time of development,
from exposure to the appearance of the first symptoms, is
usually only two to three days. As Dr. Lord, of Boston,
has found the true influenza germs in 25 to 59 per cent, of
all persons with cough and expectoration (at other times
than during influenza outbreaks), the frequency with
which exposure is possible becomes alarming. The moral
is to treat all coughs and colds as contagious, and destroy
the secretions by burning or boiling the material on which
they are collected, while the patient should absent himself
as much as possible from society. Nothing is more exas-
perating than to have a friendly (?) visitor introduce a bad
cold into a home and leave a long trail of sickness, suffering,
and expense behind him.

CEREBROSPINAL MENINGITIS

This is a disease due to a special germ (meningococcus).
It frequently occurs in epidemics and in the country rather
than in cities. Children are more often attacked, although
adults, particularly those living in squalor or crowded to-
gether as in military camps, are quite susceptible. It is not
a very contagious disease, there being seldom more than
one or two cases in a house. However, it is such a dreadful
malady that all possible precautions should be observed.
Meningitis usually comes on suddenly with headache, pains
in the back and limbs, chills, and vomiting. So far it
resembles "grippe," but its peculiar characteristics include
stiffness and rigidity of the muscles of the neck and back,
with a drawing backward of the head, and the whole body
may be so stiff that a person can be lifted like a statue.
There are also tremblings or spasms of the muscles of the
arms and legs. Delirium and stupor occur, the eyes are
sensitive to light and often squint, the pupils are large, and



138 THE PREVENTION OF DISEASE

a rash often appears on the body. The wonderful work of
Simon Flexner in producing a serum by injecting into the
blood-vessels of the horse, first, a solution of dissolved, dead
germs of cerebrospinal meningitis and, later, the living
virulent germs has revolutionized the treatment of the dis-
ease. After receiving increasing doses about four months
the horse is bled and the clear fluid (serum), resulting from
clotting of the blood, is injected into the space surrounding
the spinal cord of human patients at the earliest possible
moment.

In meningitis the normal fluid surrounding the spinal
cord is increased greatly in amount and becomes cloudy
from "matter" or pus.

This fluid should be withdrawn from the spinal canal in
the beginning of suspected meningitis, in order to abso-
lutely verify the diagnosis, by finding the special germs
with the microscope; and, again, the removal of this
fluid relieves the pressure on the spinal cord and brain
and may occasion a corresponding improvement in
the symptoms, as headache, delirium, stupor, etc. This
result is accomplished by inserting a strong, hollow needle
through the muscles over the spine in the lower part of the
back, directly into the space surrounding the spinal cord.
After the fluid flows out through the needle the curative
serum is allowed to flow into the needle from a funnel
connected with the needle by a rubber tube. The amount
of spinal fluid removed and serum injected are controlled
by the fall of blood-pressure caused by both these pro-
cedures. Serum is also injected under the skin, and the
serum treatment is generally repeated daily for three or
four doses.

Cerebrospinal meningitis is a very fatal disease, death
occurring in 70 to 90 per cent, of cases without the serum
treatment. To secure the best results the serum must be



CEREBROSPINAL MENINGITIS 139

given within the first three days of the disease, when the
average death-rate is reduced to 34 per cent., and the dura-
tion of the disease shortened from many weeks to one or
two. One authority (Sophian) has reported a mortality
of only 15.5 per cent, in 161 cases of cerebrospinal menin-
gitis by the most skilful use of serum.

Prevention. The special germs (meningococci) are not
found outside the human body, and they die within a few
hours when dry or exposed to sunlight. The germs may
be found in 90 per cent, of patients in the nose and throat.
The disease is spread by patients and healthy persons
exposed to patients who carry the germs about in the nose
and throat without suffering any inconvenience, or, at
most, only from cold in the head. It has been found that
55 per cent, of healthy persons exposed to the disease be-
come carriers, or that there are ten carriers for every case
of meningitis.

Carriers may communicate the germs to persons, who, in
turn, may either become carriers or take the disease.
Meningitis germs may live but a few days in the nose and
throat of carriers, or they may mostly disappear and later
reappear in large numbers, or, if the carrier becomes
depressed in vitality, the meningitis germs may invade his
blood and induce a real attack of the disease; or, finally,
the meningitis germs may persist in the nose and throat of
carriers for months or years. In the case of patients the
germs are not only present in the secretions of the nose and
throat, but in the urine, and in discharges from the eyes,
ears, or skin eruptions.

Patients should always be isolated in a well-ventilated
and lighted room, stripped of carpet and unnecessary fur-
nishings. The other members of the household who have
been exposed should also be quarantined in the house,
away from the patient, for a week, or until cultures taken



140 THE PREVENTION OF DISEASE

from the nose and throat on two occasions show the absence
of meningitis germs. The cultures are taken exactly as in
the case of diphtheria. In order to get rid of the meningitis
germs in the nose and throat one should spray these parts
with a solution containing 5 grains of common salt to
2 tablespoonfuls of water, or with Seller's or Dobell's
tablets dissolved in water according to directions, three
times daily, and after a few days the desired result will
usually be accomplished. Children should not be per-
mitted to use any but personal handkerchiefs, pencils,
eating utensils, food, etc.

The discharges of patients should be burned and the
urine disinfected, as advised under Typhoid Fever. All
handkerchiefs, bed and body clothing, and eating utensils
used by patients should be boiled after use. It is not
necessary to disinfect rooms after occupation by the sick,
as sunlight and ventilation are sufficient. During an
epidemic the congregation of persons in public should not
be allowed and schools may be closed. Care should be
taken to avoid colds or to have them carefully treated,
and close intimacy in talking, sneezing, coughing, and kiss-
ing are inadvisable. Children should not use articles
which have been in the mouths of others, as cups, pen-
cils, handkerchiefs, food, gum, etc. One should avoid
close contact with persons having colds, and handker-
chiefs which have been used by them should be boiled.
Plenty of fresh air and sunshine soon kill the germ
in the house. Nurses should wear gowns and caps
in attending the sick, and cover their faces with gauze
when exposed to the breath of patients. Taking 10
grains of urotropin in a glass of water three times daily
will protect healthy persons against the disease to a
certain extent by acting as an antiseptic on the various
secretions and excretions of the body. There are two



INFANTILE PARALYSIS (POLIOMYELITIS) 141

special preventives which are more effective than all
others. Vaccines, as in typhoid fever, composed of the
dead bodies of meningitis germs in solution are injected
under the skin at intervals of a week or ten days in three
doses. The first dose is one-fifth (100,000,000 germs) that
used for typhoid fever. This treatment is as yet in its
infancy, but in 5000 persons thus protected in the 1913
Texas epidemic there were no cases of disease and the treat-
ment is without danger. In severe epidemics the injec-
tion of the serum described above will protect the indi-
vidual for two or three weeks when given in small doses
(about one teaspoonful) under the skin. Vaccination
requires some weeks to secure protection, but it is then of