272- Missouri Agricultural Report. 



The mouth should be rinsed frequently and always before and after 

 taking any form of food, with some simple alkaline wash, as soda or 

 borax — readily found in any household. "Wlien the patient is too ill 

 to do this for himself wind a pencil with soft table linen and saturate 

 it in the solution and clean the mouth thoroughly, changing the cloth 

 frequently and never dipping it twice in the solution. Oil the lips with 

 cold cream or vaseline and be sure the corners of the mouth are well 

 dried and oiled or they will fissure. If the piitient is delirious the mouth 

 must be prized open and cleaned at least three times daily. I may seem 

 to stress this point unduly but if you could see one of the vivid pictures 

 that hangs on the wall of my memory you would understand ivhy this 

 point appeals to me with so much force. 



I see a wilful, petulant girl of 14 cared for by a doting mother 

 through four weeks of typhoid fever. At the end of the fourth week 

 her temperature dropped to normal but her delirium in place of dis- 

 appearing, increased. The family, now worn out and alarmed, yielded 

 to the doctor's demands and called a graduate nurse. I responded, 

 driving ten miles into the country after leaving the train. I found a 

 dilapidated and dirty farm-house around which the December winds 

 wailed dismally. The mother and older sister were worn out, in- 

 efficient and spiritless. I found what I have always considered absolute 

 necessities lacking — no clean linen or bedding — not even night dresses — 

 no protection for the bed whatever and the patient well nigh out of 

 view in deep excavation in a moist feather bed. The patient's hair — 

 long dark curls — was matted almost hopelessly, the mother saying weak- 

 ly that the girl had not allowed it combed for weeks. All this I might 

 have overlooked, but when I opened the child's mouth I was filled with 

 contempt and pity for the weak mother. Wlien I asked her ivhy the 

 doctor's orders for cleaning the girl's mouth had not been carried out she 

 answered dejectedly, "She just wouldn't let me clean her mouth," "You 

 should have used force if necessary." "Oh, I couldn't do that with 

 my little girl." In twenty-four hours I saw she had done worse — her 

 lack of firmness had cost the girl her life. The usual typhoid symptoms 

 had disappeared but the bacillus that caused the disease had entered the 

 middle ear through the eustachian tube, leading from an unclean mouth 

 and had set up an otitis media. The same infection had occurred 

 through the ducts leading from the salivary glands and when death 

 came, 9 days later, to the child's relief, both parotid glands had abcessed 

 deeply and the sub-lingual and sub-maxillary were involved. Both ears 

 were discharging freely — the shock and pain were too great and nature 

 gave way under it. 



