tially close the nasal and throat air passages so that the baby can not breathe freely. Later the same causes may lead to deafness and other defects, which very seriously hinder the child's growth, both of body and mind. All babies who show any signs of trouble of this kind should be examined by a competent physician, who will decide how early the operation for the removal of these growths may be performed. Children suffer so seriously from this disease that no parent should be willing to have a child start out under such a handicap. In the hands of a careful surgeon the operation is a slight one, and in many cases the relief is immediate. The illustration on page 70, taken from the New Zealand pamphlet on the Feeding and Care of the Baby, shows how the air passages are blocked by adenoid growths and how the hearing may be affected by the partial closing of the tube leading to the ear.1

CONTAGIOUS DISEASES.*

Happily, nursing infants are less liable to these diseases than older children; still, babies have them to a considerable extent. The general symptoms of this class of diseases are fever, vomiting, persistent discharges from the nose, reddened eyes, sore throat, and skin rashes. If such symptoms appear, the child should be kept away from other children and the doctor summoned at once.

Measles. This disease is never to be regarded as of small consequence, and it is particularly fatal in the first year of life. It is especially to be avoided on account of the complications which may accompany or follow it. Some of these possible complications are bronchitis, pneumonia, tuberculosis, or troubles with the kidneys, eyes, or ears. The disease first appears as a cold in the head. The eyes are red, swollen, and watery; there is running at the nose, and the throat is dry. This stage is followed by a cough and at last, usually after three or four days, the skin breaks out in a profuse rash, which, if it is a mild case, fades away in a few days. The child will be drowsy and fretful and should be kept in bed until the eruption is over.

The eyes are apt to be sensitive in this disease and the crib should be turned so that the baby will not face the windows. It is so essential to have a constant and generous supply of fresh air for the little patient that the windows should not be darkened, as by doing this the ventilation will be cut off to a large extent. Additional protection for eyes may be secured by placing a dark screen about the crib.

The baby should be covered warmly in cold weather. A liquid diet will be the rule. This, however, and all the medical treatment should

1 From Feeding and Care of the Baby, New Zealand, 1913.

2 Contagious diseases. Supplement to Public Health Reports No. 6.

3 Measles.

Supplement to Public Health Reports No. 1 (1913).

be under the direction of a physician, whose care is especially needed to save the child from the complications of the disease.

Whooping cough.'-Few illnesses to which infants and young children are liable are more dangerous than this, and the greatest pains should be taken to protect them from this infection. It is frequently fatal, and at best it is an exhausting disease, often very obstinate, and it may be followed by other distressing sicknesses, such as bronchitis, pneumonia, and tuberculosis. The disease shows the symptoms of a cold in the head, accompanied by a cough which gradually grows worse until the characteristic whooping sound appears. The attack lasts from three to eight weeks, but often leaves behind it a bronchitis which may persist all winter, if the attack has occurred in the fall. The child should be kept out of doors as much as possible, being protected against cold and exposure by suitable clothing and shelter. Indoors the windows should be open day and night. The bowels should move every day, and the diet should be light but nutritious. Medical advice should always be secured, as under the best treatment the course of the disease may be shortened and the danger of complications greatly lessened. Parents of children suffering from this and other contagious diseases are usually legally and always morally bound to recognize the menace which their sick child is to the well children about, and to respect all necessary precautions and to maintain such quarantine measures as will protect others from exposure. It is believed that this disease, as well as many other contagious diseases, is chiefly communicated by the discharges of the mouth, nose, and throat. Therefore, children suffering from it should, when old enough, use paper napkins for handkerchiefs, and should be urged to use them freely and taught to burn them or put them where they may be burned at once. The mother should use them in the care of the baby. It would undoubtedly save much of the spread of contagious disease if the use of singleservice paper handkerchiefs were obligatory in schools.

Pillowcases, towels, and napkins used about the patient may carry the germs from his nose and throat, and should never be used for anyone else until they have been thoroughly disinfected by boiling. Syphilis.-This disease is one of the most serious with which children can be affected, and, if it is to be cured, involves long and persistent treatment. The prevention of this disease is of first importance. In the vast majority of cases babies are infected from their own parents, and any control of this scourge can be brought about only through the education of parents in their responsibility in this matter. If syphilis makes its appearance in one baby, thoughtful parents will undergo the necessary treatment and see to it that they are both entirely free from disease, as indicated by the most

1 Whooping Cough: Its nature and prevention. Reprint from Public Health Reports No. 100.

delicate tests, before permitting themselves to produce another child. The baby should also undergo treatment for his own sake and to prevent infection of others.

Tuberculosis.-This is one of the common and fatal diseases of childhood. Prevention is of the greatest importance. Babies and children should be protected from infection by every possible means. The germs are distributed from the sputum of those suffering from the disease, and infants usually contract it from an infected parent or caretaker. The germ may be directly conveyed by kissing or by coughing or sneezing in the baby's face, by using an infected handkerchief for the child, and in other ways. These and other similar ways of infecting the baby suggest the care that is necessary to prevent it. Fresh air, sunshine, and good food are indispensable, both in the prevention of the disease and in its treatment. A tuberculous mother should never attempt to nurse her baby. In case the mother has the disease, both mother and child should live constantly out of doors, and whenever possible city families among whom the disease exists should remove to the country, where the conditions are most favorable to out-of-door life. Public agencies for the relief and prevention of the disease exist in nearly all States, and should be appealed to for instruction and advice.

Hookworm disease. This disease belongs especially to the southern part of the United States, but travel and the movement of population are distributing it more or less widely. It prevails particularly in sandy soils and in country districts and is caused by a tiny worm which grows in polluted soil and is taken into the body through the skin. Among children the worm finds it way into the body usually through the soles of bare feet. Possibly, also, it is taken into the body in drinking water or on uncooked vegetables, such as salads. The worm is particularly active just after a rain or a heavy dew, and in warm moist places. This disease is manifested by dry hair, tallowlike skin, paleness, headache, swollen abdomen, sores on the legs, and the like. There will be little red swollen places where the worm enters the flesh. The disease usually responds promptly to medical treatment, and if a child is discovered scratching his toes or feet he should be taken at once to a physician.

Prevention is of first importance. A circular giving a full description of the disease, its causes, and how to prevent it, may be had, free of charge, by applying to the Public Health Service, Washington, D. C.1

The spread of the hookworm is due to the pollution of the soil by the use of open privies or by the scattering of the bowel movements of persons infected with the worm. The use of sanitary closets is abso

1 Hookworm Disease: Its nature, treatment, and prevention. Public Health Bull. 32.

lutely necessary if the disease is to be controlled. Models of such closets are given in the bulletin already referred to. (See Appendix

for additional publications on the subject of sanitary privies.) Vulvovaginitis.-The principal signs of the disease are a yellowish white vaginal discharge. There is apt to be some redness of the parts, and if the discharge is profuse, the adjacent skin of the thighs may be reddened by irritation. The baby should be taken to the doctor at the first appearance of the symptoms.

It is a very contagious disease which is spreading with alarming rapidity throughout the country. When one little girl contracts it there is grave danger of its being transmitted to every other little girl in the house. Only absolute separation, not only of the infected child but of all of her clothing, her towels, wash cloths, soap, etc., can prevent its spread. The hands of the mother should have a thorough scrubbing with soap and brush and should then be washed in a disinfecting solution.1

Under no circumstances should the infected child sleep with any member of the household. Great care must be taken not to carry the disease to the eyes, either of mother or baby, by the fingers. The mother must not touch her own or the baby's face until her hands have been cleansed as above, and she must continually guard the baby against doing so. The baby should wear a vulval pad as long as the discharge lasts.

All the infected child's clothing should be placed in a disinfecting solution and then boiled.

Trachoma.-This is a dangerous infectious disease of the eyes which is spreading alarmingly in certain parts of the country and which is responsible for much blindness. It is first shown by swollen, reddened lids with a discharge of pus from the eyes, which are highly sensitive to the light.

The disease spreads from one person to another by the use of a common washbasin, towels, handkerchiefs, and the like, so that children and even infants are as likely to be infected as grown persons. There can never be any effective control over this and many other diseases until parents generally learn what is required, not only for their cure, but, most of all, for their prevention.

When trachoma appears or is suspected in a community, parents should appeal to the local health authorities and other physicians to see that the proper measures are undertaken for the treatment of these and the prevention of other cases, and State authorities may be called upon, as well. The Public Health Service of the United States publishes free literature on the subject. (See Appendix.)

1 See Appendix for disinfectants.

GENERAL HEALTH CONDITIONS.

GERMS.

Infectious diseases are due to harmful germs or microscopic plants of very simple structure, which are present in the excretions of persons suffering with such diseases, and may be transferred by flies or other means to milk, water, and other foods. Disease germs are removed by disinfection, which means simply cleanliness. Sunshine, fresh air, hot water and soap are the best ordinary disinfectants. If there is contagious illness in the house, or if some member of the family has inflamed eyes, or a sore or wound of any sort to be dressed, the mother should scrub her hands thoroughly in hot water, using plenty of soap and a stiff brush. In addition she should dip them in alcohol or some other disinfecting solution. She should thus cleanse her hands both before and after attending to the sore part, to prevent carrying any harmful germ to the wound or to her own or another's eyes or body.1

FLIES.

Some forms of infantile diarrhea and other diseases are caused by germs which may be carried about by flies. It is therefore of great importance to the health and the life of every baby not only to protect him from flies but to keep them away from his food, dishes, and utensils. To accomplish this all the doors and windows should be screened, and when the baby is taken out of doors he should be protected, especially while asleep. For this purpose a screened bed of some sort is necessary.

The conditions which favor the growth of flies should be done away with to the greatest possible extent. The favorite breeding ground of the common housefly is in horse manure, and with the partial elimination of the horse by the extensive use of automobiles and the consequent decrease of stables the number of flies has noticeably diminished. One stable, however, will furnish flies enough to infest a considerable district, and in most of our cities at the present time there are stringent regulations regarding the care and disposal of manure which it is to the interest of every health-loving citizen to assist the authorities in enforcing. Since the period required to produce a full-grown fly from the egg is about 8 days, the manure should be disposed of at least as often as once a week. When this can not be done, it should be disinfected with Paris green, borax, copperas, or cresol solutions to kill the maggots. Recent experiments indicate that borax is the best and cheapest disinfectant for this purpose.

After the flies have hatched they seek feeding places, which they find in uncovered garbage pails, foul drains, privies, and in decaying matter of every sort, as well as in the household food which may

1 See Appendix for disinfectants.