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not in any way to strain them. A generally lowered tone of the system may persist for some time.

Roseola, or German Measles, is a fugitive eruption, lasting a few hours or days, very mild, but supposed to be contagious. A second attack of either this or true measles is rare.

Acute Meningitis is a disease also most common in children under five years of age. The symptoms vary very much. It most often comes on gradually, with wasting of the body, disordered bowels, capricious appetite, nausea, headache, fever, irritability, intolerance of light and noise. The child may seem constantly drowsy, but the sleep is restless and disturbed. Squinting and enlarged glassy pupils are common symptoms. As the disease progresses, convulsions or paralysis may occur, or the patient sink into a comatose condition. Perfect quiet is an essential part of the treatment. Keep the child in a dark room, in bed, with the head elevated. Do not rock or walk about with him, or in any way move him unnecessarily. Do not startle or excite him. Cold applications to the head will probably be ordered, and purgatives. Only the lightest food should be given.

CHAPTER XXII.

Special medical cases-Bronchitis — Pneumonia — Other pulmonary troubles-Asthma-Diphtheria-Peritonitis-Strangulated hernia -Bright's disease-Diabetes-Dysentery-Cholera morbus-Cholera-Typhoid fever-Typhus-Scarlet fever-Small-pox-Acute rheumatism-The use of stimulants in fevers-Restraint in delirium-Delirium tremens.

THERE are a few special diseases for the care of which some special directions may be needed, supplementary to the general directions for nursing in all cases. Although a slight attempt is made at describing them, it is not to be expected that any given case will correspond exactly with the type except in general features. Variations and complications are endless, and clinical diagnosis is not expected of you, but you will find it an advantage to know what course a disease naturally takes, and what dangers are especially to be guarded against.

Bronchitis is an inflammation of the bronchial tubes, acute or chronic. Capillary bronchitis is the most dangerous form. The acute disease begins with a heavy cold, sometimes ushered in by slight chills. There is fullness in the head, sore throat, general malaise, with pain in the chest and cough, at first dry and then accompanied by watery sputa, which later become viscid and purulent. As the dyspnoea increases, there may be high fever, rapid pulse, and profuse perspiration. The pa

tient must be kept in one room, well aired, at an even temperature not higher than 65° Fahr. Free action of the skin is to be secured, and the bowels opened. A mustard plaster on the chest may relieve the pain, and inhalations of steam allay the cough. Full diet may be allowed.

Pneumonia, inflammation of the lung substance, is one of the most serious of the pulmonary affections. One or both sides may be affected, more often the right lung alone. It is usually initiated by a chill, or sense of chilliness with deep-seated pain, and shortness of breath. High fever follows with flushed face, often of one side only, headache and restlessness. The cough is short and hacking, the expectoration at first scanty. After twelve or eighteen hours, it may be expected to increase in quantity, and to assume a tough tenacious quality, highly characteristic. It may be rust colored or streaked with blood. The sputa should be carefully preserved for the doctor's inspection. The disease

reaches its height by the end of the first week; in those cases which terminate by resolution-gradual restoration of the inflamed part to a normal condition-the febrile symptoms rapidly decline. When suppuration takes place, the fever is likely to continue a week or two longer. The great danger is failure of the heart. The patient must be kept in bed, absolutely quiet, and on fluid diet. Be careful not to overload the stomach. Save his strength in every possible way; do not allow unnecessary talking, or any exertion. Convalescence, once established, will be rapid. An oil-silk jacket is often ordered to protect the chest. This should be lined throughout with flannel, and should extend from the neck to the lower ribs, fitting snugly. The safest way to remove this is by cutting off an inch from the bottom every day.

Pneumonia often occurs in combination with bronchitis and with pleurisy. The latter is an inflammation of the pleura, the serous membrane covering the lungs, and is intensely painful. Empyema is a variety of pleurisy characterized by an accumulation of pus in the pleural cavity. Pleurodynia is a rheumatic affection of the muscles of the thoracic wall. Tubercular phthisis is a disease characterized by a morbid deposit in the lung.

Asthma is a form of dyspnoea, caused by spasmodic contraction of the bronchial tubes, for which you should know the popular remedies in case of emergency. It is rarely dangerous but always distressing. The patient gasps violently for air, his expression anxious, pulse feeble, the skin cold and pale or cyanosed. Elevate the arms, and give all the air possible. A drachm of Hoffmann's anodyne may be administered, and repeated after half an hour, if the condition is not relieved. It may last for several hours, and is usually concluded by a paroxysm of coughing, and a free expectoration of mucus. Blotting-paper which has been saturated with a strong solution of saltpetre, and dried, affords, when burned, fumes that may give relief; stramonium leaves rolled into cigarettes, or smoked in a pipe like tobacco, are sometimes ordered.

Another spasmodic affection of the respiratory organs is laryngismus stridulus or false croup. This is laryngitis with spasm of the glottis, and is almost exclusively a disease of childhood. True croup is laryngitis with an exudation of lymph.

Diphtheria is a form of blood-poisoning, often resulting from imperfect sewerage. It is first manifested by feverishness, symptoms of a cold, difficulty in swallowing, and swelling of the tonsils, followed by an exu

dation of false membrane in white patches on the throat. The discharge from the mouth and nostrils is likely to be abundant; it should be wiped away on soft cloths and immediately burned, as it is highly infectious. Take every precaution against infection, and follow all orders to the letter. Give plenty of fluid nourishment. Nutritive enemata may be necessary. The patient may be choked by the obstruction of the throat, but as great a danger is of paralysis of the heart, which may occasion a fatal termination, even after convalescence from the disease is well established. The horizontal position must be maintained for a long while. Tracheotomy is sometimes resorted to, but there is danger that the membrane will continue to form below the point of incision.

Peritonitis, inflammation of its lining membrane, is one of the most painful and dangerous diseases attacking the abdominal cavity, almost invariably the result of some internal injury. It is characterized by severe pain, great depression, and high fever. The pain resembles that of colic, but the latter moves about from point to point, is not accompanied by fever, and is relieved by pressure, whereas pressure, even of the bedclothes, is unendurable with peritonitis. The abdomen is swollen and tympanitic. The patient lies on his back with his knees drawn up, the whole attitude and appearance indicative of suffering. There is obstinate constipation, often vomiting, sometimes retention or suppression of urine. Any applications ordered to the abdomen must be very light. Hot fomentations will sometimes be grateful. The patient should not be allowed to make any effort to relieve the bowels. Suppositories of opium will usually be given. Feed sparingly and with great care.

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