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+Project Gutenberg's The Eugenic Marriage, Volume IV. (of IV.), by Grant Hague
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume IV. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: Grant Hague
+
+Release Date: May 11, 2007 [EBook #21418]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Ross Wilburn, Bruce Albrecht
+and the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+Transcriber's notes: Obvious typographical errors have been corrected
+and a few punctuation usages have been normalized.
+
+[Illustration: Courtesy of New York World
+
+More Babies Like These
+
+These nine little tots are all sound, healthy stock. The generations
+behind them had unconsciously been practicing Eugenics through the
+process of natural selection. By luck, as it were, no strain was bred
+into the several families that would have caused these children to be
+unsound mentally, morally, or physically.
+
+It is through Eugenics that we shall have more babies like these, and
+shall eliminate the possibility of children like those shown in the
+other illustrations to this volume.]
+
+The
+Eugenic Marriage
+
+A Personal Guide to the
+New Science of Better
+Living and Better Babies
+
+By W. GRANT HAGUE, M.D.
+
+College of Physicians and Surgeons (Columbia
+University), New York; Member of County Medical
+Society, and of the American Medical Association
+
+In Four Volumes
+
+VOLUME IV
+
+New York
+THE REVIEW OF REVIEWS COMPANY
+1914
+
+Copyright, 1913, by
+W. GRANT HAGUE
+
+Copyright, 1914, by
+W. GRANT HAGUE
+
+
+       *       *       *       *       *
+
+
+
+TABLE OF CONTENTS
+
+
+ACCIDENTS AND EMERGENCIES
+
+CHAPTER XXXIV
+
+COMMON DISEASES OF THE NOSE, MOUTH AND CHEST
+
+                                                              PAGE
+
+"Catching cold"--Sitting on the floor--Kicking the bedclothes
+  off--Inadequate head covering--Subjecting baby to different
+  temperatures suddenly--Wearing rubbers--Direct
+  infection--Acute nasal catarrh--Acute coryza--Acute
+  rhinitis--"Cold in the head"--"Snuffles"--Treatment of
+  acute nasal catarrh, or rhinitis, or coryza, or "cold in the
+  head," or "snuffles"--Chronic nasal catarrh--Chronic
+  rhinitis--Chronic discharge from the nose--Nervous or
+  persistent cough--Adenoids as a cause of persistent
+  cough--Croup--Acute catarrhal laryngitis--Spasmodic
+  croup--False croup--Tonsilitis--Angina--Sore throat--Symptoms
+  of tonsilitis--Treatment of tonsilitis--Bronchitis
+  in infants--Bronchitis in older children--"Don'ts" in
+  bronchitis--Diet in bronchitis--Inhalations in bronchitis--
+  External applications in bronchitis--Drugs in bronchitis--
+  Chronic or recurrent bronchitis--Pneumonia--Acute
+  broncho-pneumonia--Symptoms of broncho-pneumonia--How
+  to tell when a child has broncho-pneumonia--Treatment
+  of broncho-pneumonia--The after treatment of
+  broncho-pneumonia--Adenoids--How to tell when a child
+  has adenoids--Treatment of adenoids--Nasal hemorrhage--
+  "Nose-bleeds"--Treatment of nose-bleeds--Quinsy--Hiccough--
+  Sore-mouth--Stomatitis--Treatment of ulcers   of the mouth--
+  Sprue--Thrush                                                497
+
+
+CHAPTER XXXV
+
+DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
+
+Inflammation of the stomach--Acute gastritis--Persistent
+  vomiting--Acute gastric indigestion--Iced champagne in
+  persistent vomiting--Acute intestinal diseases of children--
+  Conditions under which they exist and suggestions as
+  to remedial measures--Acute intestinal indigestion--Symptoms
+  of acute intestinal indigestion--Treatment of
+  acute intestinal indigestion--Children with whom milk
+  does not agree--Chronic, or persistent intestinal indigestion--
+  Acute ileo-colitis--Dysentery--Enteritis--Enter-colitis--
+  Inflammatory diarrhea--Chronic ileo-colitis--Chronic
+  colitis--Summer diarrhea--Cholera infantum--Gastro-enteritis--
+  Acute gastro-enteric infection--Gastro-enteric
+  intoxication--Colic--Appendicitis--Jaundice
+  in infants--Jaundice in older children--Catarrhal
+  jaundice--Gastro-duodenitis--Intestinal worms--Worms,
+  thread, pin and tape--Rupture                                 527
+
+
+CHAPTER XXXVI
+
+DISEASES OF CHILDREN (continued)
+
+PAGE
+
+Mastitis, or inflammation of the breasts in infancy--Mastitis
+  in young girls--Let your ears alone--Never box a child's
+  ears--Do not pick the ears--Earache--Inflammation of
+  the ear--Acute otitis--Swollen glands--Acute adenitis--
+  Swollen glands in the groin--Boils--Hives--Nettle rash--
+  Prickly Heat--Ringworm in the scalp--Eczema--Poor
+  blood--Simple anemia--Chlorosis--Severe anemia--Pernicious
+  anemia                                                       553
+
+CHAPTER XXXVII
+
+DISEASES OF CHILDREN (continued)
+
+Rheumatism--Malaria--Rashes of childhood--Pimples--Acne--
+  Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
+  Incontinence--Sleeplessness--Disturbed sleep--Nightmare--
+  Night terrors--Headache--Thumb sucking--Biting the finger
+  nails--Colon irrigation--How to wash out the bowels--A high
+  enema--Enema--Methods of reducing fever--Ice cap--Cold
+  sponging--Cold pack--The cold bath--Various baths--mustard
+  baths--Hot pack--Hot bath--Hot air, or vapor bath--Bran
+  bath--Tepid bath--Cold sponge--Shower bath--Poultices--Hot
+  fomentations--How to make and how to
+  apply a mustard paste--How to prepare and use the
+  mustard pack--Turpentine stupes--Oiled silk, what it is
+  and why it is used                                           569
+
+DISEASES OF CHILDREN
+
+CHAPTER XXXVIII
+
+INFECTIOUS OR CONTAGIOUS DISEASES
+
+Rules to be observed in the treatment of contagious diseases--
+  What isolation means--The contagious sick room--Conduct
+  and dress of the nurse--Feeding the patient and
+  nurse--How to disinfect the clothing and linen--How to
+  disinfect the urine and feces--How to disinfect the
+  hands--Disinfection of the room necessary--How to disinfect
+  the mouth and nose--How to disinfect the throat--Receptacle
+  for the sputum--Care of the skin in contagious
+  diseases--Convalescence after a contagious disease--Disinfecting
+  the sick chamber--The after treatment of a disinfected
+  room--How to disinfect the bed clothing and
+  clothes--Mumps--Epidemic parotitis--Chicken pox--
+  Varicella--La Grippe--Influenza--Diphtheria--Whooping
+  Cough--Pertussis--Measles--Koplik's spots--Department
+  of health rules in measles--Scarlet fever--Scarlatina--
+  Typhoid fever--Various solutions--Boracic
+  acid solution--Normal salt solution--Carron oil--Thiersch's
+  solution--Solution of bichloride of mercury--How
+  to make various solutions                                    599
+
+ACCIDENTS AND EMERGENCIES
+
+CHAPTER XXXIX
+
+ACCIDENTS AND EMERGENCIES
+
+Accidents and emergencies--Contents of the family medicine
+  chest--Foreign bodies in the eye--Foreign bodies in the
+  ear--Foreign bodies in the nose--Foreign bodies in the
+  throat--A bruise or contusion--Wounds--Arrest of
+  hemorrhage--Removal of foreign bodies from a wound--Cleansing
+  a wound--Closing and dressing wounds--The
+  condition of shock--Dog bites--Sprains--Dislocations--Wounds
+  of the scalp--Run-around--Felon--Whitlow--Burns
+  and scalds                                                   629
+
+MISCELLANEOUS
+
+CHAPTER XL
+
+MISCELLANEOUS
+
+The dangerous housefly--Diseases transmitted by flies--Homes
+  should be carefully screened and protected--The
+  breeding places of flies--Special care should be given to
+  stables, privy vaults, garbage, vacant lots, foodstuffs,
+  water fronts, drains--Precautions to be observed--How
+  to kill flies--Moths--What physicians are doing--Radium--X-Ray
+  treatment and X-Ray diagnosis--Aseptic surgery--New
+  anesthetics--Vaccine in typhoid fever--"606"--Transplanting
+  the organs of dead men into the living--Bacteria
+  that make soil barren or productive--Anti-meningitis
+  serum--A serum for malaria in sight                          645
+
+       *       *       *       *       *
+
+
+ACCIDENTS AND EMERGENCIES
+
+
+
+
+CHAPTER XXXIV
+
+
+COMMON DISEASES OF THE NOSE, MOUTH, AND CHEST
+
+"Catching Cold"--Sitting on the Floor--Kicking the Bed Clothes
+Off--Inadequate Head Covering--Subjecting Baby to Different
+Temperatures Suddenly--Wearing Rubbers--Direct Infection--Acute
+Nasal Catarrh--Acute Coryza--Acute Rhinitis--"Cold in the
+Head"--"Snuffles"--Treatment of Acute Nasal Catarrh, or Rhinitis,
+or Coryza, or "Cold in the Head," or "Snuffles"--Chronic Nasal
+Catarrh--Chronic Rhinitis--Chronic Discharge from the Nose--Nervous
+or Persistent Cough--Adenoids as a Cause of Persistent
+Cough--Croup--Acute Catarrhal Laryngitis--Spasmodic Croup--False
+Croup--Tonsilitis--Angina--Sore Throat--Symptoms of
+Tonsilitis--Treatment of Tonsilitis--Bronchitis in
+Infants--Bronchitis in Older Children--"Don'ts" in Bronchitis--Diet
+in Bronchitis--Inhalations in Bronchitis--External Applications in
+Bronchitis--Drugs in Bronchitis--Chronic or Recurrent
+Bronchitis--Pneumonia--Acute Broncho-pneumonia--Symptoms of
+Broncho-pneumonia--How to Tell When a Child has
+Broncho-pneumonia--Treatment of Broncho-pneumonia--The
+After-treatment of Broncho-pneumonia--Adenoids--How to Tell When a
+Child has Adenoids--Treatment of Adenoids--Nasal
+Hemorrhage--"Nose-bleeds"--Treatment of
+Nose-bleeds--Quinsy--Hiccough--Sore Mouth--Stomatitis--Treatment of
+Ulcers of the Mouth--Sprue--Thrush.
+
+
+"CATCHING COLDS"
+
+Mothers frequently wonder where their children get colds. Briefly we
+will point out some of the sources from which these apparently
+inexplicable colds may come.
+
+A. Sitting on the Floor.--Children should not be allowed to sit or
+crawl upon the floor at any season of the year, but especially during
+the winter months. There is always a draught of cold air near the floor.
+It is a bad habit to begin allowing a child to play with its toys on the
+floor. Use the bed or a sofa or a platform raised a foot from the
+floor.
+
+B. Kicking the Bed Clothes Off During the Night.--The bed
+clothes should be securely pinned to the mattress by large safety pins.
+When it is established as a habit a child who kicks off the bed clothes
+should wear a combination night suit with "feet," made of flannel during
+the winter and of cotton during the summer.
+
+C. Inadequate Head Covering.--Professor Kerley states that this is one
+of the "most frequent causes of disease of the respiratory tract in the
+young." He calls attention to the fact that "mothers carefully clothe
+the baby with ample coats, blankets, leggings, etc., before they take
+him out for the daily walk. They dress him in a warm room taking plenty
+of time to put on the extra clothes, during which time the baby frets
+and perspires. When all is ready they place upon the hot, almost bald
+head of the baby a light artistically decorated airy creation which is
+sold in the shops as children's caps. The child is then taken out of
+doors and because of the inadequate covering of the hot perspiring head,
+catches cold and the mother never knows how it came." Every baby and
+child should wear under such caps a skull cap of thin flannel,
+especially in cold weather. In summer or windy day a light silk
+handkerchief folded under the cap is a very excellent protection.
+
+D. Subjecting a Baby to Different Temperatures Suddenly, is liable to
+be followed by a cold--for example, taking the child from a warm room to
+a cold room, or through a cold hall, holding the child at an open window
+for a few moments.
+
+E. The Practice of Wearing Rubbers Needs Some Consideration.--They
+should never be worn indoors for even five minutes. They should not
+therefore be kept on in school, nor should they be worn by women in
+stores when they go shopping. When it is actually raining, or snowing,
+or when there is slush or wet mud they are needful; but they should not
+be worn simply because the weather is threatening or damp. Children
+should not put them on to play--worn for any length of time when active
+they are harmful. If worn to and from school they should be taken off at
+once when in school or at home. Wearing rubbers prevents free
+evaporation of the natural secretion of the skin, keeps the
+feet moist and invites colds and catarrh. In damp weather, or when
+children play during winter months, they should be shod with stout shoes
+with cork insoles.
+
+The same argument applies to storm coats of rubber, water-proof
+material. They should not be worn as overcoats all day, but only when
+going to and from school or business when it is actually storming.
+
+Underclothing or hosiery should not be heavy enough to cause moisture of
+the skin. Health demands a dry skin at all times. The necessary degree
+of body heat should be attained by the quality of the outer clothing,
+not by the quantity of the underclothing. Many men and women wear heavy
+underclothing which causes moisture when indoors, with the result that
+they get surface chills when they go outside if the weather is cold and
+as a result catch cold. The underclothing should be just heavy enough to
+be comfortable indoors and the extra warmth necessary when outside
+should be supplied by a good overcoat or furs.
+
+F. Direct Infection.--A baby may catch cold if kissed or "hugged" by
+an adult who has a cold.
+
+Catching cold while bathing is possible, but scarcely probable, if
+ordinary precautions are taken. It is very bad practice to permit
+children to use one another's handkerchiefs or the handkerchief of an
+adult. Certain children are predisposed to attacks of "cold in the head"
+or acute coryza or nasal catarrh (these being the medical names for this
+condition). Sometimes this is an inherited characteristic. There is no
+doubt, however, that most of these children acquire the habit by bad
+sanitary and hygienic surroundings. These children do not as a rule get
+enough fresh air. They are kept indoors most of the time in stuffy,
+overheated, badly ventilated rooms, unless the weather is absolutely
+perfect. The windows in their bedrooms are always kept closed, because
+they are "liable to catch cold." They are overdressed and perspire
+easily and as a result "catch cold." These conditions all tend to create
+an unhealthy condition of the nasal mucous membrane and of the throat,
+and this is rendered worse if the child lives in a damp,
+changeable climate, such as that of New York City. In these susceptible
+children the exciting cause of an attack may be trivial; exposure, cold
+or wet feet, inadequate head covering (as already pointed out), a
+draught of cold air even may excite sneezing and a nasal discharge;
+hence we have:
+
+Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis, "Cold in the Head",
+"Snuffles").--Acute nasal catarrh may accompany measles, diphtheria,
+influenza, and whooping cough.
+
+Symptoms.--The onset is sudden with sneezing, and difficulty in
+breathing through the nose. In a few hours, or it may be not for a day
+or two, a mucous, watery, nasal discharge appears. There are redness and
+slight swelling of the nose and upper lip, caused by the discharge.
+There is no fever as a general rule except in very young infants, in
+whom the fever may be very high. The discharge interferes with the
+nursing and the child suffers from lack of nourishment. The inflammation
+may extend to the eyes and ears, causing painful complications, or to
+the throat and bronchi, causing hoarseness and cough. Less frequently we
+have disturbances of the digestive tract with vomiting, or diarrhea.
+
+The mild form of the disease lasts for two or three days, the severe
+form from one to two weeks.
+
+Repeated attacks are said to contribute to the production of adenoid
+growths.
+
+An acute attack of this disease is seldom a serious affliction in older
+children; it may be, however, very serious and even dangerous in very
+young infants. The tendency of the disease to extend downward, causing
+bronchitis or pneumonia, explains in part the possible danger to a baby.
+Another reason is because it may seriously interfere with suckling and
+with breathing in these little patients. It may even cause sudden
+attacks of strangulation. An infant, therefore, suffering with an acute
+attack of rhinitis requires constant attention. It may be necessary to
+feed it with a spoon, and if necessary mother's milk should be so fed.
+Plenty of fresh air should be provided. It may be essential to keep the
+mouth open in order that it may get enough fresh air. Every effort
+should be made to keep the nostrils open. The secretions must be
+removed from time to time. Causing the child to sneeze by tickling the
+nose with a camel's hair brush will clear the nose for the time being.
+The physician may be compelled to use a solution of cocaine for this
+purpose.
+
+Treatment of Acute Rhinitis ("Taking Cold", Nasal Catarrh, Acute
+Coryza, "Snuffles").--A child suffering with an acute attack of "cold
+in the head" should be kept indoors in a room with a constant, uniform
+temperature; the particular reason for this is, that, if a child is
+exposed to cold at any time during an attack of "cold in the head," it
+may cause the disease to invade the chest,--a tendency which it has at
+all times. The bowels must be kept open; if they do not move every day
+of their own accord they must be made to move by means of an enema of
+sweet oil or of soap-suds. The amount of food should be reduced to suit
+the circumstances and the condition of the patient.
+
+We treat the local condition in the nose with a menthol mixture. The
+following is a very good one: Menthol, 30 grains; Camphor, 30 grains;
+White Vaseline, 1 ounce. Put some of this on the end of the finger and
+push it gently into each nostril. When the nostrils become blocked and
+the child cannot breathe through the nose, tickle the nose with a
+feather until it sneezes; this will clear the passage. Immediately after
+the sneeze place the menthol mixture in each nostril. When the child is
+about to sneeze place a handkerchief before the nose, as this discharge
+is full of germs and will infect others when dry. Internal remedies
+should not be used unless the child is distinctly sick and is running a
+fever, in which case a physician should look the child over and
+prescribe whatever is called for.
+
+The upper lip and the nostrils of the child should be protected, because
+the discharge very quickly irritates the parts and renders them raw and
+painful. Vaseline or cold cream is very suitable for this purpose.
+
+Mothers should not wash out the nose of a child with any solution
+advised for this purpose where force is used, as, for example, with a
+syringe. Any forceful irrigation of the nose is dangerous, because it
+would carry the infection into the deeper parts and set up a more
+serious condition.
+
+If the above treatment is carefully carried out and the child
+unexposed to a fresh cold, two or three days will be sufficient to
+cure the disease.
+
+It is not, however, the treatment of an acute attack of "cold in the
+head" that is important; it is intelligently to follow out a plan which
+will prevent these attacks from repeating themselves that is of
+consequence. The tendency to take cold is a real condition in childhood
+and a very common one. When mothers appreciate that it is possible to
+prevent this condition and to cure it when it is seemingly an
+established habit, more interest will undoubtedly be taken in the
+subject. Too frequently it is looked upon as an unfortunate affliction,
+but it is never regarded as a condition that is caused by neglect and
+ignorance.
+
+It is an exceedingly common occurence to find a mother worrying over her
+child's cold, dosing it with cod liver oil or some other unnecessary
+tonic, rubbing it with camphorated oil or plastering it over with
+certain useless patent plasters, dressing it with extra pieces of
+flannel on its chest and extra clothes pinned snugly around it, then
+shutting it up in a warm, stuffy, unsanitary, ill-smelling room, in
+order to keep it from "catching a fresh cold." Can you imagine anything
+else she could do to defeat her purpose?
+
+No quantity of cod liver oil, no medicine, no coddling, will remove the
+tendency to "catch cold." The child's life must be lived amidst sanitary
+surroundings and hygienic conditions first; then other expedients may be
+utilized if necessary. These children must be kept out of doors most of
+the time, unless during the severest wet weather. They should sleep in a
+room the windows of which are open at the top and bottom every night in
+the year. They should not, however, be in a draught. The rooms in which
+they live should be of a uniform temperature, never too hot and never
+too cold, between 68° and 70° F. These delicate catarrhal children
+should be accustomed to light clothing on their beds. Chest protectors,
+mufflers, cotton pads, and heavy wraps of any description should be
+absolutely prohibited. It is advisable to use flannel underwear winter
+and summer, light in summer and a medium weight in winter.
+During the summer months the mother should begin cold sponging of the
+face, throat, chest, and spine every morning and carry it into the
+winter. The entire process need take only a moment or two. Always dry
+thoroughly with a fairly rough towel. If the cold sponging is begun in
+the warm summer time the child will become so accustomed to it that no
+objection will be made when the cold weather comes.
+
+If the child continues to be "catarrhal," despite a course of this
+treatment, it would be well to investigate whether any adenoids or
+adenoid tissue exist in the naso-pharynx. If adenoids are found no
+treatment will be successful until they are removed.
+
+It is a wise plan to place a flannel cap on an infant who has an acute
+attack of "cold in the head" (snuffles). This will prevent catching a
+fresh cold and it will aid in the speedy cure of the attack from which
+it is suffering when it is put on.
+
+
+CHRONIC NASAL CATARRH--CHRONIC RHINITIS CHRONIC DISCHARGE FROM THE
+NOSE
+
+Some children have a nasal discharge during all of their childhood. It
+is usually worse during the winter months. It may be a thin, watery
+discharge or a thick, nasty, yellow discharge.
+
+It is a condition that is very frequently neglected even by the family
+physician. This is unfortunate because it may lead to serious disease,
+permanent damage sometimes being done to the hearing, the speech, the
+smell, and to the lungs of the child.
+
+It may be caused by adenoids; disease of the bones or tissues in the
+nose; foreign bodies in the nose; or it may occur in children whose
+nutrition is bad. It may result from frequent acute attacks of "cold in
+the head." It also occurs in other less important conditions. The
+foreign bodies which usually cause a chronic nasal discharge
+are,--buttons, peas, beans, beads, paper balls, flies and bugs,
+cherry-stones, small pieces of coal, or stone, cork or other material. A
+child gets hold of a shoe-button for example and pushes it into its
+nostrils. In the effort to get it out the child pushes it
+further in. It may or may not cause pain at the time, and it may be
+overlooked, but shortly the mother will notice a discharge from one
+nostril. This discharge becomes thick and foul and when an investigation
+is made the button is found embedded firmly in the nose. It is sometimes
+quite difficult to get the button out and this should always be done by
+a physician.
+
+Treatment.--Remove the cause first then treat the catarrh. If it is a
+product of a constitutional disease that causes general poor health,
+such as tuberculosis, syphilis, or scrofula, the child will need
+"building up" and a decided change of climate. Foreign bodies must be
+removed, adenoids taken out, large tonsils excised, and malformations of
+the nasal bones operated upon. The catarrh will in many cases be cured
+by removing its cause; if, however, it should persist it must be treated
+for some time with appropriate solutions. These solutions and the
+directions as to the method of giving them must be given by a physician,
+because there is great danger of carrying the disease to deeper
+structures if given wrongly.
+
+
+SUMMARY:--
+
+1st.--A chronic discharge from the nose is a sign that something is
+wrong and should be carefully and thoroughly investigated.
+
+2nd.--The cause can usually be found out and the proper treatment will
+cure it.
+
+3rd.--If the condition is neglected it may ruin the health of the child
+for the whole period of its life.
+
+
+NERVOUS OR PERSISTENT COUGH
+
+Cough in an infant or growing child is usually the result of a cold and
+the structure affected is some part of the nose, throat or bronchi. It
+is a comparatively simple matter to discover just where the trouble is
+and to prescribe the appropriate remedy and effect a cure.
+
+There is another type of cough, however, that is of quite a different
+character. This cough will begin as an ordinary cough and it
+will only be discovered that it is not an ordinary cough because nothing
+will apparently cure it. We mean that the child is given cough remedies
+that usually cure a cold, is kept in the house and carefully watched for
+a sufficiently long period to justify a cure, and yet, despite this care
+and attention, the cough remains the same. The child is not sick, the
+appetite is good, there is no fever, it plays and seems to enjoy good
+health, yet for weeks and frequently for months the annoying cough hangs
+on. It is as a rule worse at night. It begins soon after the child falls
+asleep and spoils the entire night's rest or a great part of it. It may
+be a dry, hard, hacking cough, or a croupy, harsh bark. It may come in
+spells with a considerable interval between them, during which time the
+child falls asleep, or it may be almost constant, not quite severe
+enough to rouse the child, but bad enough to spoil the child's rest and
+the rest of the mother. If this condition lasts for a long time, as it
+occasionally does, the health of the little patient is apt to suffer
+from loss of sleep.
+
+Treatment.--These children should be taken to a good physician and
+thoroughly examined. Special care should be devoted to investigating the
+condition of the nose, throat, ear, stomach, heart, and lungs.
+
+A very large majority of these coughs are caused by adenoid growths in
+the back part of the nose. The child may not look like an adenoid child,
+nor may it breathe through its mouth when asleep, and it may have had
+its adenoids removed, yet in spite of these contra-indications it may
+have enough loose adenoid tissue in its nose to cause this kind of
+persistent cough. This has been proved many times.
+
+It is not only useless but positively harmful to give these children
+cough remedies. The cause of the cough must be found and treated. The
+cough may be indirectly caused by anemia (poor blood) or heart or
+stomach trouble, or it may have a number of other causes. Whatever it is
+it must be found by a careful physical examination or a number of
+careful physical examinations, because these cases are as a rule obscure
+and difficult to diagnose, and even the most expert examiner
+cannot always tell where the trouble is without seeing the child a
+number of times. The parents must therefore have patience and confidence
+in the physician and must aid him all they can by watching and reporting
+all the symptoms, etc., to him. (See article on Adenoids).
+
+
+SUMMARY:--
+
+Coughs that resist careful treatment are not "ordinary coughs."
+
+Coughs of this type require special medical care.
+
+The usual cough medicines are not only useless in these coughs, but
+dangerous. Don't give them.
+
+
+ACUTE CATARRHAL LARYNGITIS: SPASMODIC CROUP: FALSE CROUP
+
+Croup is one of the common diseases of childhood. It usually follows a
+catarrhal "cold in the head" with a cough. Croup is most frequently
+associated with large tonsils and adenoids. It may come on gradually or
+it may occur suddenly. There is always fever with croup. One of the
+first symptoms is a hard, dry, croupy, barking cough, which gets worse
+toward night. If it occurs suddenly, the child will wake about midnight
+with the characteristic croupy cough. The disease may go no further than
+this and under the proper treatment is well in a few days. In other
+cases, however, there develops marked interference with breathing. Every
+inspiration is accompanied by a loud hissing or "crowing" sound. This
+feature of the disease is one that frightens the parents, though it
+seldom means anything serious. The child sits up in bed, frightened, and
+struggles for breath. It may clutch its throat with its hands as if
+something was tied round its neck. The lips may become slightly blue and
+the perspiration appears upon the child's brow. After some time,--it may
+be two or three hours,--the attack wears away and the child goes to
+sleep. Next morning it wakes up apparently well except for the croupy
+cough. The attack may repeat itself the next night and mildly on the
+third night.
+
+Treatment.--The object of treatment during an acute attack, when
+the child is struggling for breath, is to relax quickly the spasm of the
+larynx which interferes with the breathing. The simplest way is to give
+the child a teaspoonful of the fresh syrup of ipecac. If the child does
+not vomit in fifteen minutes, give another teaspoonful and keep on
+giving it every fifteen minutes till the child vomits. One or two doses
+is usually enough, but it must be given till the child vomits.
+
+If the attack comes suddenly during the night and there is no syrup of
+ipecac in the house, the physician should be sent for at once and
+informed that the child probably has croup, so he may know what to take
+with him. While waiting for the physician the mother should apply over
+the front of the neck (in the region of Adam's apple), hot applications.
+These are best made of flannel wrung out of quite hot water every two or
+three minutes: also a hot mustard foot bath. When the physician takes
+charge of the case he will also direct the treatment for the following
+day in order that the attack of the next night may be a very mild one,
+if it should came at all.
+
+Children who have a tendency to frequent attacks of croup should receive
+the same attention as the children do who are subject to attacks of
+tonsilitis and acute catarrhal rhinitis.
+
+
+SUMMARY:--
+
+1st. Spasmodic Croup always requires prompt and efficient treatment.
+
+2nd. It is called "false" croup, because "true" croup is always
+diphtheritic and is a very serious disease.
+
+3rd. For that reason a physician should always be called because if it
+is "true" croup antitoxin must be given at once.
+
+4th. Don't worry unnecessarily because, though "spasmodic croup" can
+make the child look exceedingly sick for a very short time, an
+uncomplicated case in a healthy child is seldom if ever dangerous.
+
+
+TONSILITIS: ANGINA: "SORE THROAT"
+
+This is one of the frequent diseases of childhood. We rarely see it in
+infants. It is caused by inhaling air which contains poisonous germs.
+These germs quickly develop when conditions are favorable. They lodge in
+the pores or follicles of the tonsils and set up an active inflammation.
+The tonsils swell up and the follicles exude a thick fluid which looks
+like curdled cream. This fluid sticks in the mouths of the follicles
+forming spots. If enough of this fluid is coming out, these spots join
+together forming patches, and the patches may join together forming
+membrane. This is why it is sometimes so difficult to tell whether the
+case is one of tonsilitis or diphtheria.
+
+Conditions are favorable to the development of tonsilitis if the child
+is not in good health when he happens to inhale the infection, when the
+feet are wet or cold, or when the child is allowed out during inclement
+weather and it becomes chilled or numbed from cold, when the child has a
+cold in the head and a running nose, or when its stomach is out of
+order. Any condition in which the child should be carefully watched and
+tended to, rather than allowed further liberties, or risks, conduces to
+sore throat of some kind.
+
+Some children have the disease a number of times; they seem to be
+predisposed toward a sore throat. These are children who have large
+tonsils or who are rheumatic. The tonsils should be removed in the one
+case, and the tendency to rheumatism should be the main treatment in the
+other case.
+
+These children should be encouraged to cleanse the throat and nose
+morning and night with a warm salt solution (half a teaspoonful of
+ordinary table salt to three-quarters of a cup of warm water). This will
+help greatly to prevent these chronic sore throats.
+
+Symptoms of Tonsilitis.--The disease begins suddenly. The child may
+have a chill or be seized with sudden vomiting or diarrhea. A very young
+infant may have a convulsion. The usual way is for the child to develop
+a fever quickly, to complain of being sick and tired. Muscular pains all
+over the body and a severe headache are constant symptoms. The
+fever is usually high from the beginning. The child will tell you its
+throat is sore, but there is as a rule very little pain in the throat.
+The little spots or patches can be seen on one or both tonsils. The
+general symptoms are more pronounced than the local throat symptoms. The
+amount of physical depression that is caused by a tonsilitis is out of
+all proportion to the seriousness of the disease.
+
+Tonsilitis lasts three days usually. The throat symptoms may take a day
+or two longer to clear up, and the patients feel more or less weak for
+some time after all the symptoms have disappeared.
+
+Tonsilitis is medically regarded as one of the mild diseases of
+childhood. It is, however, of very great importance because of its
+likeness to diphtheria, and inasmuch as a positive diagnosis must be
+promptly made, in the interest of the patient, it is given close
+attention and treated with considerable respect by the medical
+profession. The chief differences between the two diseases are as
+follows:
+
+Tonsilitis begins abruptly with pronounced prostration and a high fever
+the first day. The patient feels distinctly sick all over. The second
+day the patient feels somewhat better, the fever is lower and the
+prostration and pain are not so marked. The third day he feels better
+still, and but for a little weakness would feel well. Diphtheria begins
+slowly and insidiously, with very little prostration and a very low
+fever the first day. The patient scarcely feels sick. The second day
+more prostration is present, the fever climbs upward a little more, and
+the patient begins to feel sick. On the third day the prostration is
+much more profound, the fever is higher, and all the evidences of a
+serious sickness are present. Two very different pictures: The one
+begins bad and ends easy, the other begins easy and may end bad.
+
+The important fact, however, so far as the similarity of the two
+diseases is concerned, is, that we must make the diagnosis positive on
+the first or second day, because if we are dealing with a case of
+diphtheria we must give antitoxin at once. This is essential, because
+the efficacy of antitoxin is greatest when given early in the disease.
+By "early" we mean the first or second day of the disease. When
+antitoxin is given late (the third or fourth day of the disease) it is
+much less efficacious and must be given in relatively larger doses. The
+need, therefore, of a quick, positive diagnosis is a real one.
+
+Another important element involved in a speedy diagnosis is, that we
+must not take any chances of infecting other children. So important are
+these conditions that it is the proper treatment to give antitoxin at
+once in every case of tonsilitis that in the slightest way resembles
+diphtheria. An examination of the throat contents,--a culture of which
+is taken during the first visit of the physician,--will, of course,
+reveal the true condition and dictate the future use of the antitoxin.
+Antitoxin is absolutely harmless when given to a patient who has no
+diphtheria. Every case of tonsilitis should be quarantined when there
+are other children in the house.
+
+The local condition of the throat helps in the diagnosis: In tonsilitis
+(as the name implies) the disease is limited to the tonsils and on the
+tonsils (one or both) do we find the spots or patches. In diphtheria, on
+the other hand, the membrane is not limited to the tonsils, but may
+cover every part of the throat and extend into the nose and mouth. In
+tonsilitis it is spots or patches we see in the throat. In diphtheria it
+is membrane we see always. The difficulty here again is that if we wait
+till the diphtheritic membrane covers the whole throat, antitoxin will
+not be of much use.
+
+In diphtheria we have a characteristic odor, in tonsilitis we have no
+characteristic odor.
+
+The practical lesson to be learned from this uncertainty is, immediately
+to get a physician as soon as you find spots in the throat of your sick
+child, unless you are absolutely sure that the condition is not
+diphtheria and you are willing to take that chance.
+
+Treatment of an Acute Attack of Tonsilitis.--Put the child in bed at
+once and keep him on a light diet during the fever. Give him all the
+cool boiled water he wants to drink. If the fever is very high it can be
+controlled by sponging the body with cool water. If the patient is an
+infant the food should be reduced to one-half strength. Tonsilitis
+is a disease that runs a certain course and gets better, or the patient
+develops some other more serious conditions as a result of neglect or
+carelessness. We therefore try to make the patient comfortable and let
+the disease take care of itself.
+
+The throat can be gargled or sprayed with any mild antiseptic liquid, or
+it can be painted with tincture of iodine or 10 per cent. solution of
+silver nitrate. As a rule the gargles do not aid in the cure of the
+disease, though they contribute to the comfort of the patient.
+
+A cold compress made of half a dozen thicknesses of cloth, such as a
+table napkin, and put under the jaw (not round the neck), and covered
+with oiled silk and held in place with a bandage that meets and is tied
+on the top of the head, is of distinct usefulness.
+
+When it is known that the child is rheumatic, the heart must be
+carefully watched during the fever and anti-rheumatic remedies depended
+upon to effect a cure.
+
+
+SUMMARY:--
+
+Tonsilitis, because of its likeness to diphtheria, must be promptly and
+carefully diagnosed.
+
+A physician only is capable of making a diagnosis.
+
+Any sore throat in a child with spots or membrane is deserving of
+serious and immediate attention.
+
+A mistake may mean death. Don't take a chance.
+
+
+BRONCHITIS
+
+Bronchitis is one of the commonest diseases of childhood. It is the
+cause of many deaths. Exposure during inclement weather is as a rule the
+cause of it. It occurs in all classes and conditions of children. Poorly
+nourished and badly clothed children are more liable to get it than are
+others. It is more dangerous in young children and infants than in older
+children. A young child or an infant will get bronchitis quicker than
+those older and stronger under the same conditions.
+
+Bronchitis is often present while children are suffering from other
+diseases, measles, influenza, scarlet fever, typhoid fever, pneumonia,
+diphtheria, whooping-cough, for example. It may accompany any disease of
+childhood, however.
+
+Symptoms.--In infants bronchitis usually follows a "cold in the
+head," with running nose and a cough. The child is indisposed and
+peevish because of the cold. In a few days the cough becomes worse,
+fever develops, the breathing is quicker, and the baby looks and acts
+sick. The cough may be constant and severe; sometimes the cough does not
+seem to bother the baby, although this is exceptional. The breathing is
+quite rapid and is accompanied with a moist, rattling sound in the
+chest. The baby is restless and if the cough is severe it becomes
+exhausted. Vomiting or diarrhea may be present.
+
+Bronchitis in Older Children.--Bronchitis in older children comes on
+abruptly, with fever and cough. The child may complain of headache and
+pains in the chest or other parts of the body. It may begin with a chill
+or chilly feelings. These children "raise" with the cough. The
+expectoration may be quite profuse; at first it is a white, frothy
+mucus, then yellow, and later a yellowish green; it may be slightly
+tinged with blood.
+
+There is a mild form of bronchitis in these older children where the
+serious symptoms are absent. The children are not sick enough to go to
+bed, but they appear to have a "heavy cold" with, at first, a tight,
+hard cough, which is usually worse at night. Later the cough turns loose
+and the same expectoration occurs as in the severe type. It is these
+cases of mild bronchitis which do not receive the proper care and
+treatment that develop into the so-called "winter cough," which lasts
+for months.
+
+Treatment.--(See page 497 under heading, "Catching Colds.") Children
+who acquire bronchitis easily and frequently, should be built up. Cod
+liver oil should be given all winter. The sleeping apartment of these
+children should not be too cold, but it should be well aired through the
+day and well ventilated throughout the night. Flannel night clothes
+should be worn and the feet should be kept warm always. Mild attacks of
+"cold in the head" should be treated vigorously and not neglected.
+
+The following "Don'ts" may be profitably studied when your child or baby
+has bronchitis:--
+
+Don't keep the windows tightly closed; fresh air and good ventilation
+are absolutely necessary to the patient.
+
+Don't use a cotton jacket or oil silk.
+
+Don't wrap the child up in blankets and shawls.
+
+Don't carry the child around; keep it in bed.
+
+Don't dose the child with syrupy cough mixtures.
+
+Don't overheat the room.
+
+Don't let friends bother or annoy the baby.
+
+Don't reduce the diet unnecessarily.
+
+The child should be put to bed. The temperature of the room should be 70
+degrees F. all the time. The windows should be opened top and bottom
+according to the weather, and the room should be well aired every day,
+the patient being taken to another room while it is being done. The
+child should have its usual night clothes on, nothing more. If the child
+is not very sick and insists on sitting up, a bath robe can be worn but
+it should be always removed when it sleeps. It is advisable to change
+the position of the baby from time to time. Have it rest on one side,
+then on the other, as well as on the back. Give a dose of castor oil at
+the beginning of the sickness and keep the bowels open during the
+disease.
+
+Diet.--The diet will depend upon the severity of the disease. If the
+fever is high and the cough persistent, the strength of the food of
+nursing infants should be reduced. We can reduce the strength of the
+food by giving the child a drink of cool boiled water before each
+feeding and shortening the length of each feeding. Older children may be
+given toast, milk with lime water, cocoa with milk, broths, gruels,
+custards, cereals and fruit juices.
+
+Inhalations.--The value of inhalations in bronchitis is very great.
+The ordinary croup kettle, which can be bought in any good drug store,
+is the best method of giving them. Full directions come with each kettle
+as to the best way to use it. The best drug to use in the kettle is
+creosote (beechwood). Ten drops are added to one quart of boiling water
+and the steaming continued for thirty minutes. The interval between
+steaming is two hours and a half in bad cases day and night. In mild
+cases the night treatments can be dispensed with. Sheets rigged up over
+the top and sides of the crib, in the form of a tent, is the most
+desirable way to give the inhalations.
+
+External Applications.--Counter-irritation by means of mustard pastes
+are the best applications. They should be put back and front--one on
+back and one on the chest, overlapping at the sides beneath the arms.
+They should cover the entire body from the waist line to the neck. These
+pastes are made as follows:--Mix the mustard (English) and the flour in
+the following proportions, using a quantity according to the size of
+child and area to be covered; one tablespoonful mustard to three
+tablespoonfuls of flour. Mix with lukewarm water until a paste is
+formed, not too thick and not too thin. Spread on a cloth (put plenty
+on) and cover with one layer of cheesecloth and place the cheesecloth
+side next the skin. In order to guard against burning the skin it is
+advisable to rub the skin with vaseline, before and after putting on the
+paste. The paste should be left on until the skin is uniformly red. It
+may be applied from two to four times in the twenty-four hours according
+to the severity of the case. Mustard pastes are most effective during
+the first two or three days of the disease.
+
+Drugs.--Drugs are of very little value in the treatment of bronchitis.
+In the first stage of the disease, when the cough is hard and dry, small
+doses of castor oil and syrup of ipecac may be given to good advantage.
+The following dosage should be followed closely: 1st year, 2 drops
+castor oil, 2 drops syrup of ipecac, every two hours; 3rd year, 3 drops
+castor oil, 3 drops syrup of ipecac, every two hours; over 3 years, 4
+drops castor oil, 4 drops syrup of ipecac, every two hours.
+
+The benefits from this treatment will be obtained in the first two or
+three days, when it should be discontinued. The cough under this
+treatment and the use of the mustard paste and inhalations of creosote
+will be soft and loose in two or three days and the fever will be
+distinctly on the mend. The disease lasts from five to ten days. It may,
+however, last much longer according to the condition of the child, etc.
+
+There are other drugs that can be given, with good effect, but when
+other remedies are indicated a physician should be called to
+prescribe them according to indications.
+
+
+SUMMARY:--
+
+Bronchitis is one of the commonest diseases of childhood.
+
+It is the cause of many deaths.
+
+A large number of children have a tendency to bronchitis.
+
+These children need careful attention and "building up."
+
+Do not neglect a "little" cold. It means trouble.
+
+Chronic or Recurrent Bronchitis.--Bronchitis becomes chronic when the
+treatment of an acute attack fails to cure the condition. The failure
+usually is dependent upon the condition of the child. It may be
+suffering with some disease resulting from poor nourishment or poor
+sanitary and hygienic surroundings or both. The bronchitis, in other
+words, is dependent upon some other condition, and will not get wholly
+better until the cause is cured. These children should lead an active
+outdoor life when the weather is favorable. Their sleeping-room should
+be well aired and ventilated. Red meats are allowed twice a week only.
+Sugar is cut down to the lowest limit. Skimmed milk only should be
+taken--the cream being too rich for them. They can eat freely of fruits
+in season, green vegetables and cereals. The bowels must move freely
+every day. Patients must be given a lukewarm bath, followed by a brief
+spray of cold water, daily. The cold spray should not be too cold; about
+60 degrees F. is the suitable temperature of the water.
+
+An absolute change of climate, to a warmer inland atmosphere, is
+imperative before some of these patients will begin to improve.
+
+
+SUMMARY:--
+
+A child with chronic bronchitis, or with frequent attacks of bronchitis
+(or chronic colds), is usually suffering from some other diseased
+condition.
+
+The bronchitis, or the cold, will not get better until you find
+out what that "other diseased condition" is.
+
+It takes a physician to find that out.
+
+Having found the cause, cure it, and the bronchitis will disappear and
+the general health of the child will immediately improve.
+
+
+PNEUMONIA
+
+Pneumonia is a very common disease in childhood. It is the most frequent
+complication of the various acute infectious diseases. Pneumonia is an
+exceedingly important factor in the mortality of infancy.
+
+There are two kinds of pneumonia:--
+
+  1. Broncho-pneumonia.
+  2. Lobar-pneumonia.
+
+Acute Broncho-Pneumonia.--Up to the fourth year this is the form of
+pneumonia always present. It is the form that always complicates other
+diseases all through childhood.
+
+It is most apt to occur during the spring and winter months.
+
+It affects all classes, but especially those whose hygienic surroundings
+are poor. Catching cold is the exciting cause in a large percentage of
+primary pneumonias.
+
+Symptoms.--Broncho-pneumonia has no regular course. It may or it may
+not follow a cold or an attack of bronchitis. As a rule it begins
+suddenly with a high fever, frequently accompanied by vomiting, rapid
+respiration, cough, and prostration.
+
+The child does not maintain a high fever continuously; it varies
+considerably throughout each twenty-four hours. It lasts from one to
+three weeks, and subsides gradually.
+
+The respirations vary between 60 and 80 per minute, though they may be
+much more frequent than this. The child breathes with apparent
+difficulty, the soft parts of the cheeks and nose rising and falling as
+it breathes.
+
+The prostration becomes, as the disease progresses, more and more
+marked, until the child looks profoundly sick.
+
+Cough is a constant and incessant symptom. It disturbs rest and sleep
+and may cause frequent vomiting. There is no expectoration.
+A strong cough is a good symptom; if it stops it is a bad symptom.
+
+Pain is seldom present.
+
+Blueness of the skin is a bad sign and indicates failure of respiration
+and suggests constant and careful watching.
+
+Delirium may be present during the disease. It is not necessarily a bad
+sign. Accompanying stomach troubles are frequent if the patient is very
+young, and are very important. The bowels may be loose; they may be
+green in color and contain much mucus. Large quantities of gas may
+accumulate in the intestines and may cause much distress and
+convulsions. Death may occur at any time or the process may be arrested
+and recovery take place at any stage of the disease. Broncho-pneumonia
+is not necessarily a fatal disease in a fairly healthy child. It is,
+however, always a serious disease.
+
+Various complications may occur in the course of the disease. The most
+frequent are: pleurisy, emphysema, abscess of the lung, meningitis,
+heart disease, stomach troubles, thrush, intestinal disease.
+
+How to Tell When a Child Has Broncho-Pneumonia.--If a child develops a
+high fever, breathes rapidly, coughs, and is content to lie in bed
+because of the degree of prostration, broncho-pneumonia is almost
+certain to be the disease present. If in addition to these symptoms
+there is any blueness of the fingers or around the mouth it is more
+strongly suggestive of pneumonia.
+
+If the child has been suffering with bronchitis it is sometimes
+difficult to tell just when the pneumonia begins. The child will appear
+more profoundly sick, the fever will go higher, and the respiration will
+be more frequent when pneumonia sets in on top of bronchitis.
+
+Treatment.--The nursing of a little patient with pneumonia is the most
+important part. He must get plenty of fresh air; consequently he should
+be kept in a well-ventilated room. It is an excellent plan to change the
+patient twice daily from the sick room into another which has previously
+been thoroughly aired. While he is in this room the sick room should be
+as thoroughly aired as is possible. Keep this plan up all through the
+disease; change the position of the patient in bed every two
+hours. He should never be allowed to lie on his back for hours at a
+time. In this way the different parts of the lungs get a chance to air
+themselves,--the air cells expand and the oxygen in the air and the
+fresh blood tend to heal the parts more quickly.
+
+It would be distinctly wrong to go into the detailed symptomatic
+treatment of broncho-pneumonia in a book of this character. Inasmuch as
+this is one of the most serious diseases of infancy, no mother should
+attempt to treat it alone. A physician is absolutely necessary and the
+most the mother can hope to do is to follow out his directions to the
+letter.
+
+He may direct the use of mustard pastes but it is essential to know
+where to apply them. If he should request the use of the cotton jacket,
+the height and character of the fever must regulate its use. Stimulants
+are always necessary, whisky and strychnine being given in every case,
+but if given at the wrong time they may do more harm than good. Cough
+mixtures may be necessary, but frequently they are contra-indicated.
+Drugs and cold sponging may be used to reduce the fever, but they are
+dangerous if used when conditions do not justify their use.
+Complications must be diagnosed when they occur, and the correct methods
+of treatment promptly instituted. A competent physician alone can assume
+the responsibility of these various phases of the disease.
+
+Every mother should appreciate, however, that pneumonia is frequently
+the result of carelessness. It is a well-known fact that pneumonia is an
+infrequent disease among children of the well-to-do, because the
+hygienic surroundings of these children are better and because they
+receive competent attention if suffering with colds and bronchitis.
+Bronchitis is quite common in all classes of children, but in the lower
+walks of life it is the custom to allow children to run around while
+they give every sign of having a heavy cold, and a beginning bronchitis.
+These children should receive treatment and should be kept indoors and
+in bed if they have even a slight fever, as pneumonia is frequently the
+inevitable outcome. They should be carefully fed, and all signs of
+stomach or intestinal troubles attended to at once.
+
+[Illustration: By permission of Henry H. Goddard
+
+A Grim Result
+
+Isaac is 16, although mentally 10. He is a high-grade moron.
+
+     This is one of those all too frequent instances[A] "of a
+     feeble-minded woman with a husband who is alcoholic and the
+     offspring either feeble-minded or miscarriages."
+
+     "Isaac is exceedingly dangerous. He is a potential criminal or bad
+     man, or under the best conditions would at least marry and probably
+     become the father of defectives like himself."
+
+This and the succeeding pictures in this volume contrast vividly with
+the frontispiece. Terrible are the results when we disregard the
+inevitable laws of nature, and so mate ourselves that our children will
+be parasites on society.]
+
+[A] "Feeble-mindedness; Its Causes and Consequences", Goddard, The
+Macmillan Company.
+
+The After-Treatment of Pneumonia is important, and every detail
+has a distinct bearing on the ultimate recovery and establishment of
+good health. Careful feeding, a good tonic, and the proper attention to
+exercise, fresh air and bathing are requisite. A change of air after the
+fever is gone is more important than all other measures put together. A
+dry, warm climate where patients can be kept in the open air is
+preferable. The danger of allowing a slow, long drawn-out convalescence
+after pneumonia is the development of tuberculosis.
+
+
+ADENOIDS
+
+Adenoids are very common, almost popular, in childhood. The condition is
+one that causes more real trouble and discomfort than any other
+childhood affliction. Adenoids are associated with, and are responsible
+for, many of the ailments of childhood. They may be associated with
+enlarged tonsils or they may be independent of them. They may be present
+at birth or develop any time thereafter, though they are more frequent
+between the ages of two and six years. Children who have adenoids
+invariably suffer from chronic "head-colds" with a discharge from the
+nose. These chronic colds are caused by the adenoids. Nearly every
+disease, and every diseased, or abnormal, condition of the nose, throat,
+larynx, and lungs can be directly caused by the presence of adenoids.
+They are also responsible for numerous other conditions of very grave
+importance in the growing child. The accompanying "head-colds" may
+develop into a bronchitis which may keep the child indoors for a long
+period. Adenoids always interfere with respiration, thereby depriving
+the child of a normal quantity of oxygen, thus rendering the blood less
+pure, and, as a consequence, seriously interfering with the nourishment
+and general health. The impaired nourishment and poor health thus
+produced, as a direct result of adenoids, renders the child more liable
+to disease; he may thus acquire ailments that may affect his whole
+subsequent life. The mental side of a child's development is also
+affected by the presence of adenoids, so much so that actual statistics
+prove that these children cannot keep up with their classes in the
+public school.
+
+We must therefore regard the presence of adenoids as a serious
+menace to the health and comfort of the patient. It has already been
+pointed out in discussing other diseases that before a cure of these
+diseases could be permanently accomplished it would be absolutely
+necessary to remove the adenoids, which were, no doubt, the actual
+cause, or an important contributing cause, of the disease. Such
+conditions as catarrhal laryngitis, croup, chronic recurring winter
+coughs, acute catarrhal rhinitis, "snuffles", "cold in the head",
+chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting",
+"nose-bleeding", headaches in growing children, anemia, deafness, night
+terrors, defective speech, diphtheria, consumption, are frequently
+caused by the presence of adenoids.
+
+These patients contract certain diseases easier than other children, and
+when they do, they have them more severely; such diseases are
+diphtheria, tuberculosis, scarlet fever, measles, and whooping cough.
+
+Adenoid children are, as a rule, in better health during the warm,
+equable, summer weather than during the changeable, uncertain weather we
+have in the winter months. If the case is neglected, and if the adenoids
+have existed for a long time, the growth of the child is impaired. He
+remains small and stunted, and the expression of the face is dull and
+stupid. The temperament and disposition are affected also; such children
+are languid, listless and depressed.
+
+How to Tell When a Child Has Adenoids.--Children with well-developed
+adenoids are "mouth-breathers." Instead of breathing through the nose
+they breathe with the mouth open, especially when sound asleep. If a
+child has a discharge from its nose and a chronic cough, both of which
+resist treatment, and if in addition it is a mouth-breather, it is safe
+to investigate the naso-pharynx for adenoids. If a child with these
+symptoms is not in good health, is listless and depressed, looks stupid,
+snores at night, has difficulty in breathing and cannot blow its nose
+satisfactorily, is troubled occasionally with "nose bleeds" and
+headaches, we may be satisfied that the child has adenoids, as no other
+condition could produce such a picture.
+
+Adenoids, like enlarged tonsils, are dangerous, apart from the
+physical distress and disease which they cause, owing to the fact that
+they harbor deadly bacteria, and from these bacteria, which find a
+lodgment in the adenoids and tonsils, a fatal attack of diphtheria or
+consumption may have its beginning.
+
+Treatment of Adenoids.--Absolute removal is the only justifiable
+treatment. This is rendered imperative for so many reasons that it is
+unnecessary to go into details in justification of the procedure.
+
+The physical well-being, the mental development, the life of the child
+depend upon it. Any parent who would wittingly interpose an objection to
+the removal of his or her child's adenoids, after they have been
+demonstrated to exist, would be guilty of a grave crime.
+
+The operation itself is not at all dangerous. It is over in a few
+moments and the child is well in an hour or two, so far as any pain or
+suffering is concerned.
+
+Physicians are frequently asked if adenoids "grow" again after removal.
+The answer is, "Yes," they sometimes do. In a very small percentage of
+the cases they do return. The older the child is when they are removed
+the less chance there is of a recurrence. A child operated on before it
+is two years of age is more liable to a recurrence than a child operated
+on at six years of age. This must not, however, be construed as an
+excuse for putting an operation off, because if a child needs an
+operation at two years and it is postponed till later, its health will
+be permanently injured before it is four years of age.
+
+
+SUMMARY:--
+
+1. Adenoids cause more trouble and more actual disease than any other
+condition during childhood.
+
+2. It is a crime for a parent to refuse operation if the presence of
+adenoids has been proved.
+
+3. Removal is the only treatment and it should be done in every case as
+soon as possible.
+
+4. The operation is a trivial one and is free from danger.
+
+
+NASAL HEMORRHAGE--"NOSE BLEEDS"
+
+A hemorrhage from the nose may occur at any time from birth on. It
+depends upon the rupture of one or more blood vessels. The great
+majority of "nose-bleeds" are caused by adenoids, or by a small ulcer in
+the nose, or by an injury, such as a blow or fall. A nasal hemorrhage,
+however, may be caused by other, more serious conditions, and for that
+reason may justify a careful inquiry into the cause, especially if
+bleeding should occur a number of times, or be of a serious character
+the first time.
+
+Of the more common causes as given above, the adenoids should be
+removed, and the chronic catarrh which is invariably the cause of the
+ulcer should be cured.
+
+Treatment of an Acute Attack.--Have the patient sit erect; loosen all
+tight clothing around neck; fold the hands over the head; apply cold to
+the back of the neck and the nose. Pieces of ice can be put into the
+nostril and the ice bag to the nape of the neck, or a piece of ice can
+be put into a folded napkin and held on the back of the neck. Taking a
+long breath and holding it as long as possible and repeating it while
+the ice is being applied is an aid. Placing the feet in hot mustard
+water is of decided use. Another excellent expedient is to wrap
+absorbent cotton round a smooth probe (piece of whalebone, for example),
+dip the cotton in an alum-water mixture (half teaspoonful powdered alum
+in a half cupful of water), and then push it into the bleeding nostril
+as far as you can with gentle force. A valuable remedy is Peroxide of
+Hydrogen used full strength and freely dropped into the nostril. If
+these measures fail, send for a physician at once.
+
+
+SUMMARY:--
+
+1st. Nose bleeds may be caused by some serious condition.
+
+2nd. If they occur a number of times have the child examined.
+
+3rd. If the treatment outlined above does not stop the bleeding in a few
+moments send immediately for a physician.
+
+
+QUINSY
+
+Quinsy is not common in childhood. It usually follows tonsilitis when it
+is seen. The child complains of pain in the neck, extreme pain and
+difficulty upon swallowing, and inability to open the mouth as much as
+usual. There is a tendency to hold the head to one side. The treatment
+is to open the abscess at the earliest moment after pus is present.
+
+
+HICCOUGH
+
+Hiccough is, in most cases, in infancy and childhood caused by some
+irritation of the stomach, may be over-filled with food or gas. In these
+cases it is an unimportant incident and may be quickly relieved by
+giving the child an enema of soap-water and a laxative of rhubarb and
+soda.
+
+Infrequently hiccough may be the result of cold feet, or a surface
+chill. Simple methods of relief are, to hold the breath, to expire, or
+blow the breath out as long as possible before taking the next breath;
+to sip water from a cup held by another person while the tips of the two
+fore-fingers are in the ears.
+
+Hiccough is quite frequent in hysteria in girls, but it is of no
+consequence. When hiccoughs set in during the course of any serious
+disease it is a very unfavorable sign.
+
+
+SORE MOUTH: STOMATITIS
+
+Stomatitis is an inflammation of the mucous membrane (inner lining) of
+the mouth. The gums and the inner surface of the lips and cheeks may be
+red and angry-looking. There may be small grayish spots on any part of
+the mouth. If the case is very bad or if it has lasted some time and has
+been neglected, these spots grow larger and join together forming
+irregular grayish plaques. A large percentage of the cases never go
+further than this because the proper care and attention is given them.
+It is possible, however, for any case to progress further and become
+ulcerative. This will be observed first as a faint yellow line
+at the margin of the teeth and gum. Ulceration never takes place unless
+the child has teeth. The quantity of saliva is very greatly increased,
+so much so that it flows out of the mouth soiling the clothes. The
+saliva is intensely acid and it consequently irritates the skin, causing
+more or less eczema. The mouth is painful and hot. There is slight
+fever, but seldom any marked prostration. If, however, the ulceration
+should be severe, the fever may be quite high.
+
+There is one feature of these cases that sometimes proves vexatious and
+annoying. Because of the soreness of the mouth, the child cannot draw
+strongly enough on the nipple to get a normal feeding, and as a result
+the nutrition of the child is poor. These children are hungry and when
+offered the nipple grasp it greedily, draw a few mouthfuls then stop
+because of the pain and begin to cry.
+
+If the ulceration is extensive, there is usually an odor and the gums
+bleed easily. Sometimes the teeth fall out or have to be drawn out.
+
+Strong, well-fed children are as likely to develop stomatitis as are
+those who are weakly and ill fed.
+
+The disease is caused by infection and is contagious. Just what the
+infection is we do not know; we do, however, know that children whose
+mouths are carefully cleaned after each feeding do not have sore mouths
+of this character. When cleaning the mouth care must be observed not to
+injure the tender mucous membrane.
+
+Treatment.--As soon as the condition is observed mouth-washing should
+be systematically and thoroughly carried out. After each feeding the
+mouth should be washed with a saturated solution of boric acid in boiled
+water. (See page 626.)
+
+It is not necessary to use any further treatment, as a rule. Patients
+recover in four to eight days. Strict attention to cleanliness, however,
+is imperative. The feeding bottle and nipple, or the mother's nipple, if
+breast fed, must be kept scrupulously clean.
+
+The feeding of these children is sometimes a problem for a day or two,
+because, as stated above, of the soreness of the mouth. This is best
+overcome by feeding the baby with a spoon. If breast fed, it is
+necessary to pump the milk and then feed with the spoon. Children will
+take the milk better if it is fed cold. Cold boiled water is largely
+taken and is good for them at this time.
+
+Treatment for Ulcers in Mouth.--The ulcers should be touched with a
+camel's-hair brush which has been dipped into finely powdered burnt
+alum. If a stronger caustic is necessary, the solid stick of nitrate of
+silver may be used.
+
+A mouth wash may also be used in the ulcerative cases, composed of the
+peroxide of hydrogen diluted with two parts of water. If this is used
+wash the mouth out afterward with plain, cool, boiled water. The
+peroxide mouth wash can be used four or five times daily.
+
+In addition to the mouth washing in the ulcerative cases it is advisable
+to use internally chlorate of potash. The druggist should be requested
+to make a two-ounce saturated solution, and of this you can give
+one-half teaspoonful, largely diluted with cool water, every hour during
+the day for the first twenty-four hours, then every two hours until
+marked improvement is shown, when it can be further reduced by
+lengthening the interval between doses.
+
+
+SPRUE--THRUSH
+
+Sprue is a form of sore mouth. It is seen only during the first six
+months of life, as a rule. It affects the mucous membrane of the mouth;
+it appears in the form of small white spots that look like drops of
+curdled milk. They are on the inner surface of the cheek and may be all
+over the mouth, and on the tongue. The spots are firmly attached, and if
+forcibly removed the mucous membrane will bleed.
+
+The disease is caused by infection through lack of cleanliness and it
+invariably affects poorly nourished children, especially those who are
+bottle-fed.
+
+There are no symptoms other than those of the mouth; the child
+frequently refuses to nurse because of evident pain and distress while
+nursing. The condition is not contagious. It may be cured in from six to
+eight days without difficulty.
+
+Treatment.--Mouth irrigations of boracic acid are all that are
+necessary. They are given in the following way: Place the child on its
+side, roll around the index finger a piece of absorbent cotton, dip this
+in a saturated solution of boracic acid, and put into the mouth of the
+child. Let the cotton take up as much of the solution as it will hold,
+so that when it is lightly pressed on the tongue and cheeks it will flow
+out of the mouth, thus "irrigating the mouth." Repeat this a number of
+times, pressing the cotton to a different part each time. This should be
+gone through from four to six times daily.
+
+If the child is a bottle-fed baby, care should be taken in cleaning the
+nipples and bottles as directed on page 264. If the patient is
+breast-fed, care must be taken to note that the mother's nipples are
+clean. They should be washed with the same solution of boracic acid and
+not handled. If the child cannot nurse it is necessary to feed it with a
+spoon.
+
+In obstinate cases the parts may be touched with a one per cent.
+solution of formalin. Mothers should particularly note not to use honey
+and borax, as is often recommended by women who know no better, in any
+disease of the mouth in children.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXV
+
+DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
+
+Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting--Acute
+Gastric Indigestion--Iced Champagne in Persistent Vomiting--Acute
+Intestinal Diseases of Children--Conditions Under Which They Exist and
+Suggestions as to Remedial Measures--Acute Intestinal
+Indigestion--Symptoms of Acute Intestinal Indigestion--Treatment of
+Acute Intestinal Indigestion--Children with Whom Milk Does Not
+Agree--Chronic or Persistent Intestinal Indigestion--Acute
+Ileo-colitis--Dysentery--Enteritis--Entero-colitis--Inflammatory
+Diarrhea--Chronic Ileo-colitis--Chronic Colitis--Summer
+Diarrhea--Cholera Infantum--Gastro-enteritis--Acute Gastro-enteric
+Infection--Gastro-enteric Intoxication--Colic Appendicitis--Jaundice in
+Infants--Jaundice in Older Children--Catarrhal
+Jaundice--Gastro-duodenitis--Intestinal Worms--Worms, Thread, Pin and
+Tape--Rupture
+
+
+ACUTE GASTRIC INDIGESTION
+
+Acute Inflammation of the Stomach--Acute Gastritis--Persistent
+Vomiting
+
+An infant seldom has real inflammation of the stomach. Gastric, or
+stomach, indigestion is the better name, because it actually signifies
+the true condition. It is indigestion that causes a child to vomit,
+though it is possible to have a true inflammation caused by the taking
+of irritant or corrosive drugs.
+
+Gastric indigestion causes sudden, repeated vomiting, with prostration
+and occasional fever. It is caused by unsuitable food, the wrong
+quantity of food, irregular feeding, and food the quality of which is
+not good.
+
+Treatment.--The stomach should be immediately washed out. Until the
+physician arrives the mother can encourage the child to drink a large
+quantity of cool boiled water. This will be vomited and it will wash out
+the stomach at the same time. No further treatment may be necessary, as
+the vomiting may stop. All food should be withheld for at least
+twenty-four hours. A high rectal irrigation should now be given. It is
+essential to know that the bowel is absolutely clean in all vomiting
+cases. The normal salt solution is the best agent to use for a high
+enema in infants. (See page 586.)
+
+After twelve or twenty-four hours' abstinence from food, the child can
+be given teaspoonful doses every twenty minutes of cooled boiled water,
+or barley or albumen water, weak tea, or chicken broth. Cold liquids are
+better retained and more readily taken than those that are heated. If
+the liquid feedings are vomited, another twelve hours must elapse before
+trying stomach feedings. In these cases we must try to satisfy the
+thirst by giving cold colon flushings. If the case becomes protracted
+and we find it impossible to nourish the child by the mouth, we must
+wash the stomach out once every day with a five per cent. solution of
+bicarbonate of soda, and feed the child by the rectum. Sometimes we can
+feed through the stomach tube. Liquids will frequently be retained when
+put into the stomach through a tube when they will be vomited if
+swallowed.
+
+The best food by the rectum is plain peptonized milk.
+
+Drugs are absolutely useless. If the vomiting persists, despite the
+above efforts to stop it, there is nothing to be gained by
+experimenting. You will not only render the condition worse but you will
+weaken the child. Morphine given hypodermatically is the only remedy.
+Given in appropriate doses, according to age, it is absolutely harmless.
+It will not only stop the vomiting, but it will give the child a
+much-needed rest, by allowing it to go to sleep. When it wakes up it
+will be stronger and its stomach will most likely retain small doses of
+nourishment.
+
+Great care must be exercised, in getting the child back on a normal
+diet, not to try to go too fast.
+
+In cases of persistent vomiting in children I have found it advisable to
+use teaspoonful doses of ice-cold champagne. These children will
+sometimes keep this down when all other liquids will be vomited. It is
+absolutely necessary to keep the child lying down. If he is
+restless or sits up, the vomiting may begin all over again. The
+champagne not only is excellent nourishment for the child, but it quiets
+the stomach, allays irritability, and frequently favors sleep, during
+which time a cure very often results. The champagne must be drawn
+through a champagne siphon (procured in the drug store), and the bottle
+must be kept on ice with the mouth downward; otherwise it will get stale
+very quickly and be of no use. If kept as advised it will remain good to
+the end.
+
+
+SUMMARY:--
+
+1st. Persistent vomiting in a child means acute gastritis. Stop all food
+for twenty-four hours.
+
+2nd. Encourage the child to drink large quantities of slightly warm
+water; this will wash the stomach out and frequently stops the vomiting.
+
+3rd. When the child is quiet wash out the bowels.
+
+4th. If vomiting persists, use iced champagne as directed.
+
+
+ACUTE INTESTINAL DISEASES OF CHILDREN
+
+The large infant mortality that results from intestinal diseases during
+the summer months is deserving of the most careful consideration, both
+of the physician and the parent.
+
+Apart from the excessive heat of the summer, there is no doubt that an
+unfavorable environment, which means bad hygienic surroundings, bad
+sanitary conditions, bad food and home influences, contributes largely
+to the enormous number of these serious cases. Education, while it may
+be expected to influence favorably the sanitary and other conditions in
+the home, cannot change the home location. The child must continue to
+live in the same environment. It is in this class of cases that these
+summer diseases are so very fatal. Children in better circumstances can
+take advantage of conditions which are denied to the tenement child. The
+diseases must therefore be faced and treated under these existing
+conditions.
+
+In addition to the climate and the environment, there are certain
+factors that occur in all classes which result in intestinal
+derangement. If the stomach or bowels are not performing their function
+properly, or if the food or method of feeding is wrong, these, plus very
+hot, humid weather, invariably result in serious intestinal disease. The
+mother must be taught to interpret properly the meaning of a green,
+loose stool in the summertime; she must appreciate that it is the danger
+signal and must be regarded seriously.
+
+The very best preventive against summer diseases of the intestine is to
+guard particularly against any trouble with the child's stomach at all
+seasons of the year. A healthy stomach and bowel will resist disease,
+even in very hot weather.
+
+The most important food product which has a direct relationship to this
+class of diseases is milk. In a large city like New York it will remain
+impossible to solve the milk problem, despite the splendid efforts of
+the Health Department and the members of the medical profession, until
+the city itself shall establish milk depots and ice stations where safe
+milk, and ice to keep it safe, may be obtained at a nominal cost, or
+free, if the parents cannot afford to buy it. We, therefore, must
+recognize that the vast majority of children to-day are taking milk that
+is not suited to them, that is really not fit as a food for children.
+The mothers do not know this and no steps are taken to render the milk
+more safe for them to feed to their children. These mothers are willing
+to do what is essential in the interest of their children, but they do
+not know what should be done. These people cannot afford a physician or
+a nurse to teach them, nor do they even know that their methods are
+wrong or that they need any instruction. We must carry the information
+and the explanation to them. We must show them the need for a change of
+methods. This is the work for those charitably disposed women who desire
+some worthy purpose in life, who really wish to do some real good. All
+the equipment they need is good common sense. They will tell these
+mothers why it is necessary to pasteurize the milk before feeding it to
+the baby. They will show how to keep the nursing bottles clean,
+and the nipples sweet and fresh. They will instruct them how to dress
+the baby in the hot weather and impress them with the need of giving it
+all the cool, fresh air possible. In short, they will gain the
+confidence and the good will of these mothers in a tactful and
+diplomatic way, and they will tell them all they know in language which
+they will understand regarding the care of the baby. In every city in
+the country this work is needed and is waiting for the missionaries who
+will volunteer. To teach mothers the need for boiled water as a
+necessary drink for baby and older children is alone a worthy avocation.
+To impress upon one of these willing but ignorant mothers the absolute
+necessity for washing her hands before she prepares her baby's food,
+that she must keep a covered vessel in which the soiled napkins are
+placed until washed, that she should frequently sponge her baby in the
+hot weather, and explain thoroughly why these are important details, is
+a work of true religious charity. They should be specially taught to
+immediately discontinue milk at the first sign of intestinal trouble, to
+give a suitable dose of castor oil and to put the child on barley water
+as a food until the danger is passed. They should be taught to know the
+significance of a green, watery stool, they should know that is the one
+danger signal in the summer time that no mother can ignore without
+wilfully risking the life of her baby. They should be taught to prepare
+special articles of diet when they are needed. If every mother were
+educated to the extent as indicated in the above outline the appalling
+infant mortality would fall into insignificance. It is not a difficult
+task nor would it take a long time to carry it out; it is the work for
+willing women who have time and who perhaps spend that time in less
+desirable but more dramatic ways.
+
+It is the knowledge that aids in catching disease in its inception that
+counts. The worst infections begin as a mild condition and prompt
+treatment robs them of their sting. When treatment is delayed and the
+child is fed for twenty-four hours too long on milk, the condition which
+in the beginning could have been stopped promptly has developed and it
+becomes a fight for life.
+
+It will be seen from the above that all we need is education.
+Education of the mother primarily, but education of the missionary, the
+nurse, the physician, the municipality, and the State, each
+co-operating, each willing to work in the interest of a great cause, for
+the benefit of the human race and for the brotherhood of man.
+
+
+ACUTE INTESTINAL INDIGESTION
+
+Causes.--Overfeeding, unsuitable and improper food, irregular and
+indiscriminate feeding, sudden change from one food to another, as at
+weaning time, a change from a poor quality to a rich food, or vice
+versa. Conditions affecting the health of the child, especially the
+nervous system, such as hot weather, extreme cold, fatigue, or at the
+beginning of any of the acute diseases. Children sometimes are
+predisposed to attacks of intestinal indigestion; these children are
+delicate in health and have weak digestive ability. The slightest
+irregularity or error in diet will cause an attack in these children.
+
+Symptoms.--The attack may come on suddenly or it may develop slowly.
+The important constitutional symptoms are fever, prostration, and a
+general nervous irritability. The child is seized with pain in the
+abdomen. The pain is referred to the region around the navel. It is
+sharp, colicky, and severe, causing the child to cry out and draw up its
+legs in an effort to lessen its severity. The child is exceedingly
+restless and acts as if it were on the verge of a dangerous illness. Gas
+in the bowel is not present as a rule as frequently as it is in infants
+under the same circumstances. In a few hours diarrhea sets in, the
+stools may number from four to twelve or more in twenty-four hours. The
+stools are acid, sour, and the odor may be very foul. They are thinner
+than usual and frothy from the presence of gas.
+
+In very young infants suffering from a sudden attack of intestinal
+indigestion, the stomach, as well as the bowels, is invariably upset. If
+the indigestion is the result of a slower process, the stomach does not
+participate in the process. The color of the stools in infancy is yellow,
+then yellowish-green, and later grass-green. Undigested food is
+always present and in infants the curdled casein of the milk appears
+as white specks or lumps in the movements.
+
+The fever is high in the sudden cases and lower in the cases of gradual
+onset. The prostration is more severe when the onset is sudden and in
+infants may be very marked.
+
+The termination of the disease depends upon the cause, the treatment,
+and the previous health of the child. In healthy children promptly and
+properly treated it may be all over in a week. In delicate, poorly
+nourished children, and especially in the summer time, it may be the
+beginning of trouble that may eventuate in death.
+
+Treatment.--There is no condition in the whole realm of diseases of
+childhood where the knowledge of the mother may have such important
+results as this condition. The most effective time to treat these cases
+of intestinal indigestion is before the physician is called. There are
+few diseases in which time is so valuable, so far as final results are
+concerned, as it is here. Every mother should know the significance of a
+loose, green stool. She should be taught that it means danger and
+consequently demands prompt treatment. The first indication is to empty,
+thoroughly, the bowel. The best means for this purpose, if it is
+immediately procurable, is calomel. If calomel is not procurable at once
+give castor oil, two teaspoonfuls to an infant, one tablespoonful to an
+older child. Calomel should be given in one-eighth-grain doses, repeated
+every three-quarters of an hour for eight or twelve doses, until the
+bowel is thoroughly cleaned out. Don't be afraid of a few extra
+movements at the beginning. Better clean out thoroughly at the start
+than to be compelled to do it all over again after the child is weak and
+suffering from the poison of the disease. The next important thing to do
+is to stop milk at once. The thirst is usually intense and if vomiting
+is not present it can be moderately relieved by giving small quantities
+frequently of cool boiled water or mineral water or strained albumen or
+barley water. We quite often have to stop all food and liquids by the
+mouth for twenty-four hours.
+
+If the prostration is very great and the child looks as though it
+might collapse, it can be given brandy in cracked ice from time to time.
+
+After the bowels have been thoroughly cleaned out, never before, some
+medicinal agent may be given to stop the unnecessary diarrhea. In a very
+large number of promptly and properly treated cases this is not needed.
+If it is thought best to use it the physician will select the agent
+according to the conditions present and prescribe it.
+
+Breast-fed infants rarely have intestinal diseases of a severe type. If
+they should develop diarrhea they must be taken off the mother's milk
+for twenty-four hours. They should be given a dose of castor oil or
+calomel and fed on barley water in the interval. The feedings should be
+reduced in quantity and the interval doubled. The two-hour interval will
+become a four-hour feeding: the three or four ounces at each feeding can
+be reduced to two ounces. The intention is to simply give as little as
+possible while the diarrhea is under way.
+
+The mother's breasts must be pumped at the regular feeding time in order
+to preserve the flow, release the pressure, and keep the milk fresh.
+
+It is sometimes a problem to renew feedings of milk without exciting a
+relapse of the diarrhea. It should not be tried until the stools are
+normal in color and consistency. This may not be for three or four days.
+In resuming the milk it should be given in smaller amounts and diluted
+with lime water or barley water for the first day. Gruels may be given
+to which skimmed milk may be added: later add the ordinary milk. If it
+is well digested and does not cause any return of the diarrhea, the
+quantity of milk can be slowly increased until the former feedings are
+resumed. It is often of very great advantage to boil the milk for some
+time. Peptonized milk is safe and can be used in bottle-fed infants
+after diarrhea. In older children, meat, broths, eggs, boiled milk, and
+dry toast bread may be used sparingly for some time. Cereals,
+vegetables, fruits, should be withheld for a considerable time and
+watched carefully when resumed. Kumyss, buttermilk, matzoon, bacillac,
+and other fermented milks are better borne than plain milk. All of
+these children need rest, fresh air, change of air, frequent bathing,
+and tonics, as an attack of this kind leaves them depressed, weak,
+languid, and anemic.
+
+
+SUMMARY:--
+
+1st. When a child complains of sharp, colicky, severe pains in the
+abdomen, around navel, which are shortly followed by foul, sour, frothy
+diarrhea,--greenish in color, it has acute intestinal indigestion.
+
+2nd. Every mother should know that a green stool means danger. She
+should know to give at once a cathartic,--castor oil is good, but give a
+good large dose--then stop all food for twenty-four hours. If she learns
+this lesson she will have time to wait for the doctor; meantime, she may
+have saved her child's life.
+
+
+CHILDREN WITH WHOM MILK DOES NOT AGREE
+
+Contrary to the general belief, there are quite a large number of
+children in whom milk seems to act as a poison. These children are not
+necessarily constipated. They suffer, however, from a slow, continuous
+intestinal toxemia or poison. The symptoms of this condition are
+headache, disorders of speech, habitual sleep-talking, sleep-walking,
+and general nervous irritability without cause: they are listless,
+languid, and constantly tired. They may be bright in the morning and
+sleepy in the afternoon. They are irritable and cross and touchy.
+
+Treatment.--Milk must be wholly discontinued. Eggs must be restricted
+to one every second day, and meat but once daily. The use of green
+vegetables is particularly suitable and should be given daily. Cereals
+and fruit also are good. Malted milk, kumyss, or matzoon may be given in
+place of milk. If constipation is present, rhubarb and soda mixture is
+an excellent laxative in these cases. A tonic should be prescribed for
+all these children.
+
+
+DYSENTERY--ENTERITIS--ENTERO-COLITIS--INFLAMMATORY DIARRHEA
+
+Cause.--Any cause which has been mentioned as a cause of ordinary
+diarrhea may result in this disease. It may occur at any time of the
+year and at any age. It may follow the infectious diseases. It may
+follow any other disease of the intestines.
+
+Symptoms.--It may begin like an ordinary attack of acute intestinal
+indigestion. There is usually vomiting, fever, pain, and frequent yellow
+or green stools. The passages may be blood-stained and there may be
+little or much mucus. The stools at the beginning have no odor as a
+rule. The bowels move very frequently, often with little or nothing to
+pass. There may be pain with each movement. The blood may disappear in a
+few days, but the mucus remains, often in large quantity in each stool.
+
+At the beginning the fever is high, but it soon falls and remains low
+during the attack. The child loses weight, is irritable, has no
+appetite, and looks and acts sick. When the attack is over these
+children do not gain their strength as readily as we would like;
+recovery is slow.
+
+The acute symptoms usually last about one week, after this time the
+child begins to recover, but the process is a tedious one and one in
+which much care has to be exercised. It is an encouraging sign to note
+the disappearance of the blood in the stools and the return of the
+movements to the normal brown color. When these favorable signs are
+wanting the bowel is probably ulcerated and it will take a much longer
+time to return to normal and to be free from blood and mucus.
+
+The above is the ordinary form of this disease and it ends in recovery
+as a rule. There is a more severe form, however, which differs from the
+above in the following way:
+
+The fever is high and remains high; the stools are more frequent and
+there is more blood and more mucus in them; the child is much more
+irritable and is more profoundly sick. Death may occur at any time from
+the second day. If the little patient survives, the return to health is
+a very slow process; it often takes months and frequently years before a
+reasonable degree of strength is regained. Relapses are common, and
+they are very difficult to treat and care for. In some cases the child
+never wholly regains its former strength.
+
+There are children who have been the victims of other intestinal
+diseases or conditions who develop colitis. The colitis in these cases
+may come on suddenly with vomiting and high fever, or it begins slowly,
+with no vomiting and with little fever. Their appetite is poor, their
+digestion is feeble, their prostration is pronounced. They lose flesh
+rapidly and may be emaciated to a remarkable degree. Very few of these
+cases recover completely. Serious and sometimes fatal relapses may take
+place. The feeding of these children is a difficult task and the
+greatest care must be constantly taken; a very little mistake may cost
+the life of the child.
+
+Treatment.--All diseases of the intestine in childhood should be
+promptly and efficiently treated. If any form of diarrhea is neglected,
+it may result in the development of ileo-colitis with all its risks and
+uncertainty. When a child is seized with sudden bowel trouble, no matter
+what variety it is, it should be treated with the greatest care because
+"sudden" bowel trouble usually means plenty of trouble if it is
+neglected.
+
+Fresh air is essential in all these cases. A change of air is of decided
+value as soon as the immediate symptoms have abated. The diet is the
+same as for children who have gastro-enteric intoxication. Later, much
+difficulty will be met because these patients have absolutely no
+appetite,--peptonized skimmed milk is always good, beef broths are often
+well borne, liquid beef peptonoids may be tried. The food should be
+given every three hours. Boiled water and stimulants may be given
+between the feedings. Later in older children, raw beef, eggs, boiled
+milk, kumyss, or matzoon and gruels may be given. Great care has to be
+taken for months after an attack; relapses may be caused by changes of
+temperature, by fatigue, and, of course, by improper feeding. These
+children should avoid potatoes, tomatoes, fruits, corn, oatmeal, and a
+great many other things which an intelligent mother would not give any
+sick child, as candy, cakes, pastries, etc.
+
+Cases which begin with free vomiting, thin stools; and fever should be
+treated at once. The bowels must be thoroughly cleaned out, the colon
+should be thoroughly irrigated, and all food should be stopped. When
+there are bloody stools with mucus and pain we must depend upon castor
+oil, irrigations of the colon, and opium and bismuth by the mouth. A
+good big dose of oil at the beginning is always necessary. If, however,
+the stomach is irritable and will not tolerate castor oil, we may
+substitute calomel in one-fourth-grain doses every hour for six doses,
+to be followed by citrate of magnesium. Irrigation of the colon in these
+cases is one of the essential means of successful treatment; it should
+be done twice a day during the first few days of the disease.
+
+Stimulants are needed in all the cases. They help the heart, act as a
+food, and tend to quiet the general nervousness by favoring sleep. Good
+brandy given in boiled cool water is the best stimulant.
+
+After the child is over the worst of the acute symptoms all medicine
+should be withdrawn and the proper kind of food given. Tonics will aid
+in restoring the strength. Cod Liver Oil during the following winter is
+a very good plan to aid in building up the vitality of the weakened
+bowel, but it must not be given too soon.
+
+
+CHRONIC ILEO-COLITIS--CHRONIC COLITIS
+
+Chronic Ileo-colitis fellows the acute variety. Cases which are
+unusually severe or which have been badly managed are likely to become
+chronic. A child suffering from this disease presents the following
+picture: The patient is emaciated, the abdomen is usually enlarged with
+gas, the feet are cold, the circulation of the blood is poor, the fever
+is low or absent altogether except when the child is having a relapse,
+when it jumps up suddenly. The bowels are loose and contain mucus,
+frequently in large quantities. The mucus may stop for a few days; then
+it appears again with a rise of temperature accompanied with loose
+stools with foul odor. These children are exceedingly nervous and
+irritable and are very poor sleepers.
+
+Parents should be told it will be impossible to effect a rapid cure of
+these cases. It often takes months to get them started on the safe road.
+The slightest mistake or change in the weather will upset the progress
+of the cure and it will be necessary to begin all over again. The entire
+hope of cure rests with the mother. She must be faithful, patient, and
+must carry out the physician's instructions implicitly. The management
+consists in diet, change of climate, and such other treatment as the
+physician finds necessary in each individual case.
+
+Treatment.--In children under one year of age the only hope is breast
+milk, which must be given in small quantities. They do not do well on
+any starch food for a considerable period.
+
+Where breast milk is not available the whites of two or three eggs may
+be given daily. They may be beaten up and given in skimmed milk, or in
+plain water with a little salt added. Zwieback or bread crumbs may be
+given in small quantities. They should be fed at four-hour intervals.
+
+Older children may take skimmed milk, raw scraped beef, junket, and
+coddled white of egg or raw egg, bread crumbs, toasted, or zwieback.
+
+A rectal enema must be given every twenty-four hours if the bowels have
+not moved. If constipation is the habit a laxative should be given; the
+aromatic fluid extract of cascara sagrada or magnesia are suitable. At
+least one free movement every day is essential to success.
+
+Colon irrigations are only to be used when there is a rise of
+temperature, irrespective of whether the bowels have moved or not.
+
+When convalescence is established these children should be given a
+maximum of fresh air and should be treated as recommended in cases of
+malnutrition.
+
+
+SUMMER DIARRHEA
+
+As the name implies, this is the form of diarrhea that is so common,
+especially in cities, in summer. It is always preceded by some milder
+condition which paves the way for the more serious diarrhea. Acute
+indigestion is, as a general rule, the forerunner of cholera infantum.
+The influence of hot weather must always be kept in mind as the
+underlying factor which no doubt conduces to gastro-intestinal disease
+of infancy and childhood. The depression incident to a spell of hot and
+possibly humid weather tends to interfere with the digestive process of
+babies and children. When this function is carried on imperfectly, the
+strength and vitality of the child fails, and if immediate steps are not
+taken to check the process, diarrhea makes its appearance. If these
+children are improperly fed, or if their surroundings are not sanitary;
+if they are not getting fresh air enough, or if they suffer because of
+lack of attention, and have at the same time a little indigestion, it is
+only a step further to develop a full-fledged cholera infantum.
+
+The outcome of any case of summer diarrhea is questionable. It is not
+safe to make any promise. An apparently mild attack may prove quickly
+fatal. Much depends upon the previous history of the child. If it has
+been a strong, healthy child it has a very good chance if treated
+energetically and correctly. If it has previously suffered from bad
+nutrition, is not robust, has had trouble with its stomach, etc., the
+chances are against it.
+
+The one lesson to be learned by all mothers is, as stated above, to act
+quickly; to be on the watch all through the summer months for any
+trouble with the baby's stomach or bowels. It is much easier to treat
+and cure a little trouble than to battle against an established
+gastro-enteric intoxication. Overfeeding and indiscriminate feeding must
+be religiously avoided,--they are the two most prolific causes of
+stomach and intestinal troubles in childhood.
+
+Symptoms.--The onset is sudden and pronounced. The child begins to
+vomit and continues vomiting and retching persistently. The bowels are
+loose, and large, watery, greenish stools are frequent. The prostration
+is very marked, the child looks seriously sick, respiration is quick and
+shallow, the eyes sunken, the skin becomes ashen gray in color, and the
+pulse is soft and very rapid. The fever may be very high or it may
+remain low. The low febrile cases are the worst.
+
+If taken in hand quickly and if the treatment is energetic and if the
+child reacts, the case may go rapidly on to recovery and the child be
+wholly well in a few days; or it may not react, but be overwhelmed by
+the poison and sink and die in twenty-four hours.
+
+Treatment.--In the treatment of cholera infantum it must not be
+forgotten that the dangerous element is the poisoning of the system that
+is constantly going on. It is difficult for the non-medical mind to
+estimate the importance of this element. It is, of course, caused by the
+bacteria present in the gastro-intestinal canal. There are numberless
+millions of bacteria in the normal healthy bowel. A very large
+percentage of those germs are good for us, are there for a beneficent
+purpose, and can and do protect us from other germs which occasionally
+find their way into the bowel and whose purpose is not a peaceful one.
+When the bowel condition changes, as during an attack of summer
+diarrhea, it is invaded by multitudes of evil-intentioned germs. These
+germs find conditions in the diseased bowel exceedingly favorable to
+them, so they begin work in an active, energetic way. The result of
+their activity is highly poisonous, and, as the good germs are virtually
+out of business and are consequently not working in our interest, we are
+absolutely in the hands of the enemy. There is soon manufactured, by
+these invading germs, enough poison to poison the entire system of the
+child. It is this feature that we must combat in summer diarrhea.
+
+It is absolutely essential to keep these cases as much in the open fresh
+air as possible. No matter how sick they may be, this rule must be
+observed. Light clothing is advisable.
+
+If it is a city child that is affected and it does not show decided
+improvement in three or four days, it should, if possible, be sent to
+the country. There is always distinct danger of a relapse in every case,
+so the little victim should be given a change of air as soon as
+convalescence permits. The seashore is preferable to the mountains in
+all intestinal cases.
+
+In the care of these patients cleanliness is an important factor and
+counts much in the ultimate cure. The child, as well as the clothing,
+should be kept scrupulously clean. Napkins as soon as soiled should be
+removed and put into a disinfecting solution. The buttocks should be
+well powdered after each movement to prevent sores developing.
+
+Feeding must be stopped at once. No food of any kind should be given for
+at least twenty-four hours, or until the tendency to vomit subsides. The
+thirst must be allayed, however, so we give frequently small quantities
+of thin barley water or albumen water or cold boiled water. If these are
+vomited we must stop giving them altogether for twenty-four hours. If
+the fever is high and the skin dry, the child should be given a cool
+pack, 85° to 90° F., which can be moistened every half hour with water
+at this temperature; this will often control the fever satisfactorily.
+Hot-water bottles should be placed at the feet if they are cold.
+
+If, on the other hand, the fever is very low (below normal), the child's
+circulation poor, the skin blue and cold, a hot-water bath at 108° F.,
+for five minutes (rubbing the surface of the body while in the bath),
+will be of very great service. The bath may be repeated at half-hour
+intervals.
+
+If the patient is a breast-fed infant it can be allowed to nurse after
+the twenty-four-hour rest. The length of time it is permitted to stay at
+the breast should be about one-quarter of the time it was allowed before
+the attack began. If it does not vomit, the nursing can be repeated
+every four hours. As the case progresses toward recovery the interval
+between feedings can be shortened. Care, however, must be taken not to
+shorten the interval too rapidly.
+
+If the patient is artificially fed and is not over four months old, a
+substitute for the milk must be found. The best substitutes are rice or
+barley water, either plain or dextrinized, the malted foods, chicken or
+beef broths, liquid peptonoids or bovinine. Water (boiled and cooled)
+may be allowed at all times if not vomited.
+
+Older children are treated in the same way. All food is withheld while
+there is any vomiting. When vomiting stops begin with small quantities
+of beef broth, or chicken, or veal broth. Later kumyss or matzoon can be
+tried, and finally thin gruels made with milk.
+
+If vomiting persists the stomach must be washed out; this can be done by
+giving the infant or child a large drink of cool boiled water. This will
+be immediately vomited and it will clean the stomach at the same time.
+The stomach-pump may be used to better advantage. One washing is usually
+sufficient. The vomiting will stop after the stomach has been washed out
+and the patient may then be given, frequently, small quantities of cold
+albumen water or barley water.
+
+The bowel should be thoroughly cleaned out at the beginning of every
+summer diarrhea. Castor oil or calomel are the two best cathartics for
+this purpose. If the stomach is not upset use castor oil. If the stomach
+is upset use calomel; one-fourth of a grain every hour for eight doses
+will be sufficient. Give enough, however,--there is no danger at the
+beginning of the attack of too free movements of the bowel. Whatever
+cathartic is given, it should produce green, watery stools.
+
+Irrigation of the bowel is an exceedingly effective way of cleaning out
+the poison-laden large intestine. It should be done in every instance
+unless the movements are watery and of such frequency as to render
+irrigation unnecessary. Once or twice daily will be sufficient in even
+the worst cases. The irrigation should be given at the temperature of
+100° F, and should be the normal saline solution; a long rectal tube is
+used to give the irrigation.
+
+
+SUMMARY:--
+
+1st. Cholera infantum is one of the most dangerous, one of the most
+treacherous, and one of the quickest acting diseases of childhood.
+
+2nd. Don't temporize, don't delay, don't regard lightly any diarrhea
+during the summer time.
+
+3rd. Give a large dose of castor oil and withhold all nourishment until
+the doctor sees the little patient in every case of diarrhea during the
+warm weather.
+
+4th. Keep the child in a cool, quiet place and don't handle or annoy it.
+
+5th. Follow, your doctor's directions implicitly. The fight may be
+short, sharp, and decisive. Don't pave the way for regrets afterward. Do
+everything while you have the chance.
+
+
+COLIC
+
+Colic is a common condition in infancy. Very few children escape more or
+less colic during the first few months of life. It does not seem to
+injure permanently some infants; they go on growing according to
+standard, eat and sleep, and seem contented and happy despite occasional
+severe attacks of colic. Other children suffer seriously; the degree of
+indigestion is considerable, and the nutrition of the child is
+interfered with.
+
+Colic is much more frequent in bottle-fed infants than in those fed on
+breast milk. Cow's milk, no matter how skillfully it is prepared for
+their use, is at best an unsuitable diet and taxes the digestive ability
+of robust children. It is quite natural for an infant whose digestive
+organs are not strong to develop colic and intestinal indigestion if put
+on artificial food. Any condition that causes indigestion may likewise
+cause colic. Those children who are always overfeeding,--taking too much
+milk, too strong milk, or who are fed irregularly,--are the colicky
+babies.
+
+Constipation is frequently associated with colic and may be the actual
+cause. A daily movement of the bowel does not necessarily mean that the
+bowels are emptying themselves satisfactorily. Despite the daily
+movement, there may be considerable fecal matter left in the bowel which
+undergoes decomposition. This results in the evolution of large
+quantities of gas and severe attacks of colic. Indigestion is very often
+caused by conditions which effect the stability of the child's nervous
+organism; such conditions are fright, anger, fatigue, exhaustion,
+excitement.
+
+The origin of the colic in breast-fed children is very often caused by
+some nervous condition of the mother that affects her milk. Constipation
+in the mother may cause colic in the child.
+
+Symptoms.--A baby having an attack of colic will cry loudly from time
+to time and whine during the interval; it will pull up its legs and bear
+down. Its abdomen is tense and hard and distended with gas. With the
+expulsion of the gas the pain ceases and the child falls asleep. If the
+attack is very severe the prostration and exhaustion is marked; the feet
+are cold and the body is bathed in perspiration.
+
+If the colic is constant the child may be fretful and restless most of
+the time, being seemingly comfortable for only an hour or two in the
+twenty-four.
+
+In older children who cry because of severe pain in the abdomen the
+possibility of appendicitis must not be forgotten.
+
+Treatment.--Find out the cause of the colic if possible. If the cause
+is located in the mother, the remedy naturally must affect her.
+Regulation of her bowel, restriction of her diet, and proper exercise,
+may be sufficient to effect a cure of the colic in the infant.
+
+The object of treatment is to help the child get rid of the gas. The
+best and quickest means to effect this is to apply massage or give a
+rectal injection. An injection of two ounces of cold water in which a
+half or one teaspoonful of glycerine has been put, will act quickly. Dry
+heat applied to the abdomen in the form of the hot-water bottle or
+woolen cloths will aid in the expulsion of the gas. The feet should be
+kept warm.
+
+In cases of habitual colic in breast-fed babies the cause may be in the
+quality of the mother's milk. It should be examined and if found too
+strong should be diluted. This can be done by giving the child an ounce
+of plain boiled water or barley water before each feeding. If the child
+gets an ounce of liquid before each feeding he will not want as much of
+the breast milk; so we shall have the same total quantity, but a reduced
+quality, which may cure the colic at once.
+
+It is necessary, in order to cure colic, that the bowels move every day
+in a satisfactory manner. If any aid is needed, milk of magnesia is the
+best laxative. It may be given in teaspoonful doses in water previous to
+a feeding. Aromatic cascara sagrada in from ten to thirty-drop doses is
+a very good laxative, if a stronger remedy is needed.
+
+To relieve the acute attack, three drops of Hoffman's anodyne may be
+given in two teaspoonfuls of warm water and repeated in ten-minute
+intervals until relieved, to a baby under one year of age. From five to
+ten drops of gin, given in three teaspoonfuls of warm water, and
+repeated in fifteen minutes, is also satisfactory and harmless. A very
+good remedy which may be used with the above for quick relief, and to
+stop the child from crying, is the following: Fold a piece of flannel
+cloth (two thicknesses) the size of the baby's abdomen; wring out of
+very hot water and drop ten drops of turpentine over the surface,--at
+different spots,--of the flannel and lay on abdomen,--turpentine side
+next skin. Cover this with another piece of flannel,--two or three
+thicknesses, that has been dry-heated and allow to remain in place for
+about ten minutes.
+
+Colic, as a rule, disappears completely about the third month.
+
+
+APPENDICITIS
+
+Appendicitis is mentioned here merely to acquaint mothers with its
+prominent symptoms.
+
+When a child has what seems to be an attack of indigestion, but
+complains of pain and tenderness in the abdomen, vomits, and develops a
+fever, and is constipated, appendicitis may be suspected.
+
+The pain and tenderness are not referred to the region of the appendix
+but are more centrally located. If, however, the finger point is pressed
+over the appendix, distinct tenderness will be elicited in inflammation
+of that region. Constipation is the rule in appendicitis, but diarrhea
+occasionally accompanies it.
+
+The abdominal muscles may be rigid, that is, the abdomen does not feel
+soft as is usual; there is a feeling if they are pressed, as if they
+were hard and unyielding.
+
+Treatment.--Put the child in bed and send for the family physician at
+once. The condition is too serious and too uncertain to delay, or for a
+parent to make any effort at treatment. Appendicitis is a much more
+serious condition in infancy and childhood than it is in an adult.
+
+
+JAUNDICE IN INFANTS
+
+There are two types of jaundice in infants that deserve brief
+consideration.
+
+1st. There is a form of jaundice caused by a defect in the development
+of the bile or gall tubes. These infants develop jaundice a day or two
+after birth and become intensely jaundiced within a very brief time.
+They lose flesh and strength to a marked degree and die in a few weeks.
+It is not possible to affect this condition favorably by any method of
+treatment. This type of jaundice is not very common.
+
+2nd. There is a type of jaundice that appears between the second and
+fifth day of life that is very common. It lasts from one to two weeks
+and then disappears. It is never fatal and is not serious. It requires
+no treatment.
+
+
+JAUNDICE IN OLDER CHILDREN--CATARRHAL JAUNDICE--GASTRO DUODENITIS
+
+Symptoms.--This form of jaundice begins like an attack of ordinary
+indigestion. There are, as a rule, pain, fever, vomiting, and
+prostration. The pain is located in the upper part of the abdomen and
+may be quite severe. The vomiting may continue for a number of days. The
+bowels are usually constipated. After a few days the jaundice sets in
+and may be quite intense. After the jaundice is established the stools
+are gray or white in color and there is much gas in the bowel. The urine
+is very dark and may be yellow or yellowish-green in color. The child
+complains of headache, is dull and listless, and appears sick and weak.
+The condition lasts about two weeks, but the jaundice may last much
+longer. It is not a serious disease.
+
+Treatment.--The diet should be cut down in quantity and should consist
+of rare meat, fruit, and a small quantity of milk. If vomiting continues
+the milk may diluted with lime water or vichy water. The child should
+drink water or vichy water freely. No starchy foods, or fats, or sugars
+should be allowed. The bowels should be kept open with calomel,
+one-tenth of a grain every hour until ten are taken, to be followed by
+citrate of magnesia every morning. If the pain is severe it may be
+relieved by a mustard paste or a turpentine poultice. The child should
+be given acid hydrochloric diluted, eight drops in one-half glass of
+water, ten minutes before each meal--and kept on it for at least one
+month.
+
+
+INTESTINAL WORMS
+
+There are three types of intestinal worms; they are known as the
+round-worm, the thread-worm, and the tape worm.
+
+Round-Worm.--The round-worm is usually found in children of the
+run-about age. It is never seen in infancy. It occupies the small or
+upper intestine, and is from four to ten inches long. If there are
+round-worms in the bowel, there are usually a number of them and there
+may be hundreds.
+
+Symptoms.--Round-worms give no definite symptoms. The only possible
+way to tell if they are present is actually to see them in the stools of
+the child. They are of a light gray color.
+
+It is reasonable to expect that a child suffering from worms will have
+symptoms of abdominal distress from time to time; indigestion with colic
+and much gas may be present; children lose their appetites and are
+nervous and restless; sleep is disturbed; they may grind their teeth and
+talk in their sleep, and they may pick their noses unnecessarily during
+the day. These symptoms may, however, accompany other conditions when no
+worms are present in the bowel. My observation has been that in children
+in whom worms were present the nervous symptoms were distinctly
+accentuated. They are unreliable children; they seem well to-day and
+peevish to-morrow; they complain of headaches, dizziness, and chilly
+feelings. They are hysterical, noisy, uncontrollable. A child with these
+symptoms should be suspected of having worms and if no cause can be
+found to explain his temperamental vagaries he should be treated for
+worms. I have cured a number of children of excessive nervousness by
+giving them medicine for worms when no worms were present. Such results
+can only be explained on the assumption that these children were
+suffering from intestinal auto-toxemia or self-poisoning, and the
+thorough disinfection of the bowel apparently stopped the process by
+ridding the child's system of a mass of bacteria, which were undoubtedly
+causing the auto-toxemia and consequent nervousness.
+
+Treatment.--The most efficient remedy for removing round-worms is
+Santonin. The quantity necessary for the various ages is as follows:
+
+  Two to four years           2     grains.
+  Four to six years           3     grains.
+  Six to ten years            3-1/2 grains.
+
+The best way to give it is in divided doses, with an equal quantity of
+sugar of milk. For a child of six years the formula would therefore be,
+3-1/2 grains of Santonin, mixed with the same quantity of sugar of milk
+divided into three powders. These powders are given four hours apart in
+the following way. The child is given a light supper the evening before
+and one-half glass citrate of magnesia the following morning and the
+first powder one-half hour later; no breakfast being given. A light
+lunch, of milk and crackers, may be taken about noon. The second powder
+is given four hours after the first, and the third four hours after the
+second. Half an hour after the last powder, a dose of castor oil (one
+tablespoonful) is given. In a few moments the bowels will move; usually
+there are no worms in this movement. A little later they will move
+freely again and if worms are present they will be discharged in this
+movement.
+
+Thread-Worm, or Pin-Worm.--A thread-worm looks just like a little
+piece of white thread. They are found in the lower part of the bowel and
+in the rectum. They are usually present, if present at all, in large
+numbers.
+
+Symptoms.--The chief symptom is itching. It may be limited to the anus
+or it may involve the neighboring parts. Thread-worms may find their
+way out of the anus and in female children may find their way into the
+vagina. In these instances the child is tormented with itching of the
+privates and may establish the habit of self-abuse as a result of the
+constant itching and scratching. The itching is more intense at night
+soon after the child goes to bed. As a result of the local irritation in
+the lower part of the bowel and rectum there is set up a catarrh of the
+bowel which produces large quantities of mucus.
+
+Treatment.--The only medication by the mouth that is of any use is
+turpentine in one drop doses after meals, given in a teaspoonful of
+sugar. The best treatment, and in most cases the only treatment that is
+effective, is the use of rectal injections. The procedure is as
+follows:--The child first gets a cleaning injection of two quarts of
+warm water into which a teaspoonful of borax has been put. This will
+wash away any mucus or fecal matter that may have collected. This
+injection is best given with a No. 18 rectal catheter which is pushed
+into the rectum for about 10 inches, the water being allowed to run away
+as it enters. From six to eight ounces of the infusion of quassia is
+then passed, as high up as the catheter will reach. It is intended that
+the quassia will remain in as long as possible, for at least half an
+hour. In order to assure this there are two features that should be kept
+in mind: first, the water should be allowed to flow in slowly,
+consequently hold the bag low, not higher than two feet above the level
+of the bed on which the patient lies; second, after the water is all in
+remove the catheter very slowly and keep the child absolutely quiet.
+This treatment is repeated every second night for a week, then twice a
+week for four weeks.
+
+A solution of garlic is a very effective remedy and may be tried if the
+quassia fails, which is not likely if the treatment is carried out
+effectively and if the parts are kept scrupulously clean.
+
+Tape Worms.--Tape worms are obtained from eating raw meat, pork or
+sausage, rarely from fish, and from playing with cats and dogs.
+
+Symptoms.--No definite symptoms accompany the presence of tape worm.
+The children may have pains in the abdomen, diarrhea, a capricious
+appetite, foul breath, and they may suffer from anemia, sometimes quite
+severely. The only positive symptoms is the presence of links of the
+worm in the stools.
+
+Treatment.--Give a dose of castor oil at bed time. Two hours after
+breakfast next morning give one-half dram of the oleoresin of male-fern
+in emulsion or capsule. Very light nourishment should be taken during
+the day, composed of gruels and soups. When the worm is passed it should
+be examined to find if the head is present; if not, the treatment should
+be repeated in twenty-four hours.
+
+
+RUPTURE
+
+Rupture of any description is not a condition that any mother should
+attempt to treat. A physician should be called in every case. Any
+misdirected effort at manipulation or pressure may result in irreparable
+injury to the parts. External applications are useless and may be
+injurious.
+
+All ordinary forms of rupture in infancy and early childhood are curable
+if properly treated.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVI
+
+DISEASES OF CHILDREN, CONTINUED
+
+Mastitis or Inflammation of the Breasts in Infancy--Mastitis in Young
+Girls--Let Your Ears Alone--Never Box a Child's Ears--Do Not Pick the
+Ears--Earache--Inflammation of the Ear--Acute Otitis--Swollen
+Glands--Acute Adenitis--Swollen Glands in the
+Groin--Boils--Hives--Nettle Rash--Prickly Heat--Ringworm in the
+Scalp--Eczema--Poor Blood--Simple Anemia--Chlorosis--Severe
+Anemia--Pernicious Anemia
+
+
+MASTITIS, OR INFLAMMATION OF THE BREASTS IN INFANCY
+
+There are a few drops of a milky secretion in the breasts of infants
+when born. Occasionally the amount will be in excess of the normal
+quantity, and the breasts, around the nipple, may be swollen and
+slightly inflamed. Should this condition persist, it may be relieved by
+painting the parts with the tincture of belladonna. Under no
+circumstances should the breasts be manipulated or rubbed, as this is
+very apt to cause an inflammatory condition, and to result in mastitis.
+
+Mastitis begins, as a rule, during the second week of life. The breast
+becomes red, swollen, painful, and shows inflammatory changes. It may
+terminate without the formation of an abscess, or it may go on to
+suppuration. The child becomes extremely restless and irritable, it is
+disinclined to nurse, and suffers from loss of sleep and nourishment. It
+is possible for such a condition, in the female, to injure the breast to
+the extent of arresting its development and to render it useless in the
+future. If the suppuration is extensive the process may terminate
+fatally.
+
+Mastitis in infants is caused by unnecessary interference and
+manipulation and by want of cleanliness. When it occurs the parts should
+be kept absolutely clean and should not be handled in any way. Ichthyol
+25 per cent., Zinc Oxide Ointment, enough to make one ounce, spread
+upon old, clean, soft linen, and laid over the parts and changed every
+six hours, is an excellent healing application. A piece of oiled silk
+may be put outside the linen to prevent the ointment staining the
+clothing, and over this a layer of absorbent cotton and a binder,
+applied without pressure.
+
+If an abscess develops in spite of treatment, it must be freely opened
+and freely drained, and the general health of the patient supported by
+regular nourishment and tonics.
+
+Mastitis in Young Girls.--Pain and swelling of the breasts are
+sometimes complained of by girls between the twelfth and fifteenth
+years, though it may occur at an earlier or later date. If left alone
+the condition will invariably subside without treatment. Should bacteria
+find an entrance through the nipple at this time, an abscess may result.
+The whole breast is involved and it will be exceedingly painful and much
+swollen. There may be moderate fever, headache, and a pronounced feeling
+of indisposition. These patients should be given a laxative,--citrate of
+magnesia, or Pluto Water, and kept on a very light diet. An ice-bag
+should be kept constantly at the breast during the day, and a moist
+dressing of 1:5000 bichloride of mercury during the night.
+
+It may take a week before recovery takes place.
+
+
+LET YOUR EARS ALONE
+
+Never Box a Child's Ears.--A single blow may make a child deaf;
+repeated blows on their ears will certainly injure children's hearing.
+
+Thomas A. Edison, our greatest inventor, was made deaf when a lad by a
+surly brakeman, who soundly boxed his ears for some trivial or fancied
+offense.
+
+Boxing a child's ears is but one of a great many things you should never
+do to the ears. In fact, there are far more things you should not do to
+safeguard the hearing, than there are things you can do to benefit your
+ears.
+
+Do Not Pick the Ears.--Do not put cotton in the ears unless ordered to
+do so by a reputable physician. Do not syringe the ears without the
+doctor's orders. Put no poultices in the ears. Do not put drops of any
+kind in the ears unless prescribed by a doctor. Above all, do not use
+the advertised ear cures, as most of them are harmful. Never blow into a
+child's ear, never douche the nose without the doctor's orders, as this
+may wash germs into the tubes leading to the ears and bring about a
+serious condition.
+
+Riding in tunnels, especially in tunnels under water where the air
+pressure varies, has, through some recent investigation, been found to
+be injurious to the ears of a great many people.
+
+Conductors and other trainmen who run through many tunnels are apt to
+have ear trouble, as are the men who work underground a great depth
+where they are in motion, such as miners running underground trains.
+
+If you have an earache that continues for any length of time, take no
+chances, but consult a physician. And remember to care for the throat
+and nose, as ill conditions in those places result in ear troubles. Do
+not blow your nose too hard; it merely injures the inner sides of the
+ear drums. Adenoids in children frequently bring about a bad ear
+trouble. Even seasickness is due in a great measure to ear disturbances.
+
+If you have a running ear, attend to it at once by visiting a doctor. So
+serious is this that life insurance companies will not insure people in
+that condition.
+
+Earache.--When a child complains of earache its ear should be
+examined. In nearly every case of earache it is necessary to treat the
+throat, as this is, as a rule, the seat of the trouble. An antiseptic
+gargle of equal parts of Borolyptol and warm water is an excellent
+mixture. It should be used freely every two hours. Children suffering
+from earache should be kept indoors. If the examination should show that
+it is not necessary to lance the ear drum, some local measure may be
+adopted to allay the pain. Putting the child in bed with the head
+resting on a hot-water bottle may be all that will be necessary. The
+following procedure may be carried out, but only after a physician has
+made an examination and according to his directions: A hot water douche,
+given by means of a douche bag, is quite effective. The water should be
+110° F.; the bag should be held about two feet above the level of the
+child's head, and the irrigating point should not be pushed into the
+ear, but held so that the water will find its own way into the ear.
+
+When the earache does not respond to the above methods the ear should be
+closely watched and examined at intervals so that it may be opened at
+the right moment. This is very essential because, if it is neglected,
+the pus may find its way into the mastoid cells and set up the dangerous
+disease, mastoiditis. This disease may cause abscess of the brain and
+death. The moment a child develops fever in the course of an earache the
+ear should be examined and opened at once, if found necessary.
+
+Inflammation of the Ear. Acute Otitis.--Inflammation of the ear seldom
+occurs in childhood, unless as a complication, or as a result of some
+infectious disease. Any disease which affects the throat in any way may
+be the cause of the inflammation of the ear. Such diseases are, "cold in
+the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles,
+scarlet fever. It is much more common in children than in adults. The
+younger the child, the more liable it is to develop ear trouble when
+suffering from any of the above diseases. The presence of adenoids
+favors the development of ear complications.
+
+Symptoms.--There is one symptom present in all cases of inflammation
+of the ear; that is, fever. Pain may or may not be present; it is
+present in a majority of the cases. Children with inflammation of the
+ear are exceedingly restless and do not sleep long at a time nor do they
+sleep soundly.
+
+Treatment.--The treatment is to open the drum membrane, at the right
+time, which of course will always be done by a physician who has had
+some experience in this work.
+
+After Treatment.--The after treatment consists of washing or syringing
+the ear every three hours with eight or twelve ounces of a 1:10,000
+solution of corrosive sublimate. This will be kept up for four days;
+then the intervals between the washing will be extended to five hours,
+and kept up until the drum membrane closes. If the corrosive sublimate
+solution should cause any eruption around the ear, a normal salt
+solution (see page 627) may be used in the same way, and in the same
+quantity as above. A running ear will run for from three to six weeks.
+It may heal up at any time after ten days. If the discharge should
+suddenly stop and the fever rise, it indicates that the opening has
+become plugged or healed too quickly. In either case it will have to be
+opened again. As soon as the ear begins running again the symptoms will
+disappear. After syringing the ear it should be dried thoroughly with
+pieces of sterile absorbent cotton.
+
+The best syringe to use for washing out the ear is a one-ounce
+hard-rubber ear syringe with a soft rubber tip. An ordinary douche bag
+will do if a syringe of the above character cannot be obtained. The
+douche bag should not be held higher than two feet above the patient's
+head. The double-current ear irrigator is an excellent device for this
+purpose. The child should be on its back on a table. Its arms should be
+fastened down by its side. A basin can be placed under its ear and the
+irrigating done without causing any pain or discomfort.
+
+Any child addicted to disease of the ear should be closely watched and
+examined for tuberculosis. Scrofula may accompany this condition. These
+children need careful attention in every little detail, they need good
+nourishment, fresh air night and day, and they should not be pushed at
+school. During the winter they should be protected from "catching
+colds;" it is a good plan to put them on a cod-liver-oil mixture for the
+entire cold season. During the summer they should have a radical change
+of climate.
+
+
+SUMMARY:
+
+1st. Inflammation of the ear is frequently a complication of or follows
+some other disease which affects the throat.
+
+2nd. If a child with one of these diseases becomes restless, sleepless
+and feverish, be on the look-out for ear trouble.
+
+3rd. The ear must be lanced immediately when necessary.
+
+4th. The after treatment is very important, because the hearing of the
+child depends upon it.
+
+
+SWOLLEN GLANDS. ACUTE ADENITIS
+
+Swollen glands in infancy and childhood are usually seen below and
+behind the ear, less frequently in the groin. Their cause is, as a rule,
+local disturbance in the mouth or throat, as decayed teeth, enlarged
+tonsils, cold in the head, catarrh, adenoids, or some form of infection
+of the mouth, or throat, or scalp. They occasionally accompany scarlet
+fever, diphtheria, measles, and influenza. They seldom suppurate.
+
+Symptoms.--A swelling is noticed just below the angle of the jaw; it
+does not grow rapidly. There is a slight temperature and the child is
+more or less irritable. If the patient is an infant, the fever may be
+quite high and there may be considerable prostration. The trouble lasts
+from four to eight weeks.
+
+Treatment.--An ice-bag constantly applied is the best treatment. This
+not only relieves pain, but it prevents the possibility of the gland
+breaking down and suppurating. It is sometimes difficult to keep an
+ice-bag on an infant, in which case cold compresses should be applied.
+These are made by taking several layers of old linen or cheese cloth and
+laying them on ice. They should be applied frequently to the swollen
+gland. The following ointment may be applied, though the ice-bag is the
+better and more certain treatment: Ichthyol 25 per cent., Adeps Lanae
+one ounce. This is applied on cloth and renewed every six hours.
+
+This ointment is black and stains the clothing. For that reason it is
+advised to use oiled silk over the cloth to avoid staining the pillow or
+clothing.
+
+Children suffering from adenitis should use a spray of Dobell's solution
+in the nose and throat three or four times daily. If the cause of the
+swollen glands is known, treatment for its cure should be promptly
+instituted.
+
+In the event of pus forming the gland must be opened and drained.
+
+Swollen glands in the groin of a child are caused most frequently by
+some inflammatory condition of the privates, which should be discovered
+and treated.
+
+
+BOILS
+
+In some delicate children and in some children who do not seem to be
+delicate, repeated crops of boils may appear from time to time.
+
+It is necessary to open them as soon as pus is present. They should be
+pressed out and a gauze dressing, wet with a saturated solution of boric
+acid, bound over them. The dressing should be kept moist.
+
+I have in a number of instances successfully rid a child of the tendency
+to boils by the use of the following formula, which I can recommend
+highly as one of the best tonics I have ever used in the treatment of
+delicate and poorly nourished children: Tinct. Nux Vomica 4 drops, Acid
+Phosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make a
+two-ounce mixture and give to children over four years of age one
+teaspoonful after each meal; to younger children, one-half teaspoonful
+after each meal.
+
+It is necessary in these cases to keep the bowels open daily.
+
+
+HIVES. NETTLE-RASH
+
+Cause.--Contact with different plants, bites of insects, irritation
+from clothing, use of certain drugs. Certain articles of food, such as
+tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause
+hives.
+
+Dentition during warm weather and the presence of worms and chronic
+malarial poisoning have been known to cause hives.
+
+It is most frequently caused, however, in childhood by some disturbance
+in the stomach or bowels.
+
+It causes severe itching and loss of sleep and as a result of these the
+general health suffers.
+
+Treatment.--If caused by any external irritant, remove it. If it is
+caused by any special article of diet, prohibit its use. If no cause is
+apparent, give the child one tablespoonful of castor oil, and put it on
+the mildest diet possible of soups, broths, and dried stale bread. Give
+no milk. Use the following treatment on the erupted parts: Menthol, ten
+grains in one ounce of cold cream. Keep the bowels open.
+
+It is sometimes necessary to advise a change of air before complete cure
+results.
+
+
+PRICKLY HEAT
+
+This is a very common complaint in children during the summer months. It
+is so common that it is well known and easily recognized. It consists of
+a bright red eruption, composed of little papules, close together.
+
+The rash comes out quickly, so much so that mothers may be surprised and
+frightened by observing an angry looking rash on their baby some morning
+when none was there the night before. It most frequently appears upon
+the neck, back, chest, and forehead. It is exceedingly itchy and a child
+may scratch itself and cause extensive harm. Eczema, of a very obstinate
+type, frequently results from scratching.
+
+The rash of prickly heat is easily diagnosed from other rashes because
+it is accompanied by no other symptom, such as fever, which would
+suggest a more serious disease. The rash of prickly heat resembles the
+rash of scarlet fever more than any other rash, but it is quickly noted
+that when a child has scarlet fever it has every symptom of being
+profoundly sick, while prickly heat has no symptom other than the itch
+and discomfort. It is caused by overfeeding, being overclothed, and
+sweating in hot weather.
+
+Treatment.--Steps should be taken to prevent prickly heat in an
+infant. Use light, seasonable clothing, bathe frequently, and use plenty
+of good toilet powder. When the child actually has an attack, open its
+bowels freely with citrate of magnesia, and give some sweet spirits of
+niter, according to age. Protect the skin from the irritating underwear
+by interposing a soft piece of linen. In order to reduce the
+inflammation and cure the condition apply equal parts of starch and
+boric acid powder freely. Keep the patient on a light fluid diet. The
+bran bath is advisable if the little patient is addicted to these skin
+eruptions.
+
+
+RINGWORM OF THE SCALP
+
+Children of all ages are liable to "catch" ringworm of the scalp. It
+particularly affects those who are untidy, dirty, and badly cared for,
+though any child is apt to get it while attending the public schools.
+
+If a mother discovers scaly patches in the scalp, with loss of hair,
+ringworm should be immediately suspected. It is not, however, always
+easy to diagnose the condition, especially if the case is a mild one. If
+it is a severe attack, there is, as a rule, quite a little inflammation,
+and this may render the condition obscure for some time. The disease may
+be mistaken for dandruff, but dandruff covers a large area of the scalp,
+while ringworm is limited and sharply defined. Dandruff may cause a loss
+of hair; if it does, the hairs come out clean, while in ringworm they
+break off near the scalp.
+
+Treatment.--Ringworm is always curable, provided the patient is
+watched and treatment carried out thoroughly. It is always absolutely
+necessary to treat the condition, because it will not get better of
+itself, and the longer it is permitted to last, the worse it gets, and
+the more difficult it is to cure. If treatment is begun at once, it may
+take two months to cure it. If the case has lasted for some time, or if
+it has been neglected and not treated thoroughly, it will take from six
+months to one year to cure it. These facts are stated so that parents
+may not become discouraged.
+
+The first thing to do is to cut the hair as close to the scalp as
+possible, wherever the ringworm is, and for about an inch outside, and
+all around it. The entire scalp should be thoroughly washed three times
+a week. The scales should be kept soft by the use of carbolic soap.
+
+The hair should not be brushed at all, because brushing the hair may
+spread the disease to other parts of the scalp. Every child with
+ringworm of the scalp should wear a cap of muslin or one lined with
+paper, so that others may not be infected. These caps can be burned when
+dirty and new ones made. One of the best remedies to apply to the
+affected area is the following: Bichloride of mercury, 2 grains; olive
+oil, 2 teaspoonfuls; kerosene, 2 teaspoonfuls. This is rubbed in every
+day until the parts are sore and tender. It is a good plan to apply this
+mixture to the entire scalp every fourth day, to guard against other
+parts becoming infected. It is not necessary to rub it in when using it
+where there is no ringworm.
+
+When the scalp becomes sore from the application it can be stopped for a
+day or two, or until better; then begin again and repeat the treatment
+right along. If the kerosene in the above mixture is objected to, a very
+good mixture is bichloride of mercury, 2 grains, and tincture of iodine,
+1 ounce. This may be rubbed vigorously enough to produce a rash. If the
+disease shows a tendency to spread under this treatment it is best to
+apply the latter mixture to the entire scalp.
+
+Ringworm on any other part of the body is effectually treated by
+applying tincture of iodine. It should be painted on every day until the
+skin begins to peel, when the ringworm will disappear with the skin.
+
+
+ECZEMA
+
+Eczema is the most important skin disease of babyhood. It is probably
+the most frequent skin disease of infancy. Any baby may develop eczema.
+There are, however, some babies who seem to be very susceptible to it.
+The reason of this susceptibility seems to be due to the natural
+tenderness, or delicacy, of the skin. These children, because of the
+extreme sensitiveness of the skin, develop an eczema from a very slight
+degree of external irritation, or a trifling disturbance of digestion.
+Children of rheumatic or gouty parents are more liable to be victims of
+eczema than are others. Eczema of the face is quite common in children
+who are apparently healthy and fat. It does not seem to matter whether
+they are breast-fed or bottle-fed. The following conditions may be
+regarded as contributory to eczema:
+
+Exposure to winds; cold, dry air; heat; the use of hard water or strong
+soaps; lack of cleanliness, and the irritation of clothing. It
+frequently accompanies chronic constipation, indigestion, and other
+conditions of the intestinal canal; overfeeding; too early or too
+excessive use of starchy foods.
+
+Eczema of the Face:--Eczema Rubrum.--This is the most frequent form.
+It affects the cheeks, scalp, forehead, and sometimes the ears and the
+neck. It begins on the cheeks as small red papules. These join together
+and form a mass of moist, exuding crusts. They dry in time and may be so
+thick as to form a mask on the face. The skin may be much swollen. When
+the crusts are removed the face looks red and angry and bleeds easily.
+It is exceedingly itchy. It causes restlessness, loss of sleep, and it
+may affect the appetite, though, as a rule, the health remains good.
+Eczema of the face is exceedingly chronic; it improves from time to
+time, but it is cured with great difficulty only.
+
+Infants suffering with eczema of the face begin to improve about the
+middle of the second year and may be entirely cured about this time. The
+reason of this is the greater amount of exercise the child is getting at
+this period. If the disease continues longer it is because of the
+unnecessary amount of fat that the child has.
+
+Treatment.--Eczema is a notoriously tedious disease. There is very
+little tendency for it to improve, if left to itself. The age, the
+severity, and just how much you can rely upon the mother, or nurse,
+faithfully to carry out directions--upon these its cure depends. At
+best, the treatment may have to be carried out for months. If the eczema
+is accompanied with constipation and indigestion in infancy, very little
+can be done with the eczema until these conditions are removed.
+
+There exists in the minds of the laity, and in some physicians also, an
+idea that it is wrong, or dangerous, to cure, or "dry up," an eczema. It
+is never dangerous, but highly desirable, to cure an eczema, whenever
+possible. It is always wise, because it is always necessary, to get the
+child in perfect condition before you treat the eczema. Cure the
+constipation, or indigestion, or cold, or whatever is the matter with
+the child; then treat the eczema. This is the only plan that offers any
+success. It is not a simple matter to find out why a nursing child is
+having indigestion. The most minute care must be exercised to find out
+the element in the milk that is causing the eczema. It would, however,
+be foolish, and a waste of time, to apply pastes, etc., to an eczema of
+the face, while the real cause that produced it was still in existence.
+It will frequently be found necessary to change the food entirely.
+Strict attention to the bowels is essential, both in infants and in
+older children. Sometimes to cure the constipation means an immediate
+cure of the eczema.
+
+If the child is anemic, poorly nourished, and flabby, tonics are
+advisable. Cod liver oil is of use in quite a number of these cases.
+Eczematous children should not be taken out when the weather is very
+cold or when there are high winds. They should not be washed with plain
+water, or with castile soap and water. When washing is necessary, do it
+with milk and water, to which one teaspoonful of borax is added. The
+clothing must not be too heavy.
+
+In eczema of the face, the child must either wear a mask or heavy woolen
+gloves, so that he will not scratch the parts. Frequently these fail,
+and it will be necessary to restrain the child from scratching the face
+by the use of some mechanical device. A piece of strong pasteboard
+bandaged on the elbows, so as to prevent the child from bending them, is
+all that is necessary. If the child cannot bend the elbows he cannot
+scratch his face, yet he has the free use of his hands.
+
+The use of external remedies is imperative, as frequently the cause is
+mostly external, and in other cases it must be used in addition to the
+general treatment. Before external treatment is instituted, the crusts
+should be softened by applying olive oil to them for twenty-four hours,
+after which they can be removed with soap and water. If there is much
+inflammation, or if the face looks angry, a very good application is
+Lassar's paste.
+
+Later, when the inflammation has subsided and the itching is severe, a
+mixture of tar ointment, 3 teaspoonfuls; zinc oxide, 1-1/2 teaspoonfuls;
+rose water ointment, 6 teaspoonfuls has proved to be one of the very
+best.
+
+When the eczema on the face is of the weeping, or moist, variety, the
+application of bassorin paste gives splendid results.
+
+When an external remedy is applied to any eczematous surface it is
+necessary to apply it on a cloth. Simply to smear it on will do no good.
+
+In the treatment of eczema, when the children are breast-fed, it is well
+to remember that the real cause of the eczema may be in the mother. If
+the mother is constipated, or if her diet is too liberal, if she is
+drinking beer, or an excess of coffee, or is not taking exercise, the
+eczema may be caused by one or other or all of these.
+
+For eczema of the scalp the remedy to use is white-precipitate ointment,
+1 part; vaseline, 4 parts. Mix together and apply.
+
+
+POOR BLOOD. SIMPLE ANEMIA
+
+Causes.--There is what may be termed an unnatural tendency toward poor
+blood during infancy and childhood. The explanation of this anomalous
+condition is, that the tax or strain put upon the blood to provide for
+the growth of the child is severe, and is in addition to the great
+demands made upon it in the exercise of its regular duties. We must,
+therefore, always take this special duty into consideration, when the
+question of recuperation, convalescence, feeding, and the administration
+of blood foods and tonics comes up.
+
+It is not necessary to specify the diseases from which a child may
+suffer and recover, in an anemic condition. Any disease may leave a
+child with temporarily poor blood. The conditions which most frequently
+produce anemia in childhood are improper feeding and unhealthy
+surroundings. It is not fully appreciated how seriously these conditions
+can affect the health of growing children. There is one condition that
+every mother should be warned against, namely, the possibility of unduly
+prolonging breast-feeding. Children should be weaned at the end of the
+tenth month. By prolonging the breast-feeding a mother can undermine the
+vitality and strength of her baby and so impoverish its blood as to
+invite disease. A bottle-fed baby should be put upon a mixed diet at the
+same time. To continue feeding a child exclusively on milk for a year
+or two after weaning, simply because "it will not take anything else,"
+is criminal. Any woman guilty of such stupidity should never have become
+a mother. Once again it must be emphasized that every child must have an
+abundance of fresh air, must not be confined in close, hot, unsanitary
+rooms, and must have a daily, satisfactory movement of the bowels to be
+a healthy child with good blood in its body.
+
+Symptoms.--Children suffering from poor blood are flabby, constipated,
+hungry, weak specimens of childhood. They are under weight, complain of
+headache, pains, disturbed sleep, are nervous and irritable. They tire
+quickly, are short of breath, and may have a tendency to faint easily.
+The hands and feet are cold, the pulse is small and irregular. They may
+have attacks of nose-bleeding and of bed-wetting.
+
+Chlorosis.--Chlorosis is that form of anemia, of poor blood, which
+occurs in young girls about the time their sickness begins. It is most
+frequently seen between the fourteenth and seventeenth years, and more
+often in blondes than in brunettes. The cause is not known. It is
+thought to be due to constipation. Any occupation which is deleterious
+to health has a distinct influence on the condition. Employment in
+factories, confinement in badly ventilated rooms, bad or insufficient
+food, great grief, care, or a bad fright, mental strain, overstudy, may
+all produce, or contribute to the production of chlorosis.
+
+Symptoms.--The symptoms of chlorosis resemble those of simple anemia.
+Children suffering from anemia are pale; girls with chlorosis have a
+peculiar greenish yellow tint in the skin. They are short of breath,
+they have vertigo, palpitation, disturbances of digestion, constipation,
+cold hands and feet, and scanty or arrested monthly periods. They have
+various nervous disturbances, such as headache, pains in various parts
+of the body, neuralgia, especially over the eyes, hysterical attacks,
+and sometimes cholera. Ulcer of the stomach is sometimes seen in this
+condition.
+
+The disease lasts for a year or longer; it frequently lasts a number of
+years. Relapses are frequent.
+
+[Illustration: By permission of Henry H. Goddard
+
+"A Misfortune at Birth"]
+
+Warren is feeble-minded. His family said it was due to "a serious fall
+of the mother."
+
+     [A]"The family history is, however, exceedingly interesting.
+
+     "The paternal grandfather, whom we have called Nick, was of good
+     family, although he himself was totally different from the rest. He
+     was weak in every way, and to be considered feeble-minded. He
+     married into a family that was much lower socially than his own,
+     although we have no proof that it was a defective family. The
+     children of this couple were all mentally defective and low-grade,
+     morally as well as intellectually.
+
+     "Warren's father, Jake, a thoroughly disgraceful character, married
+     Sal, a woman somewhat older than he.
+
+     "The immorality of this family beggars description. A girl named
+     Moll was fifteen years old when Jake brought her into his home: his
+     wife, Sal, was so feeble-minded that she allowed the illicit
+     relations between these two. Moll's child was born in the hospital
+     after the mother had been sent away from one Home because of her
+     horrible syphilitic condition--from which she finally died.
+
+     "Our boy Warren's sister Liz with whom the father lived in
+     incestuous relations, was also allowed to live illicitly with a man
+     who worked for her father. She was so simple that she talked openly
+     about her relations with her father and with this man. When a child
+     was to be born the man married her.
+
+     "This is not all, but enough: and sufficient to show what
+     feeble-mindedness leads to when it takes the direction of sexual
+     abuses."
+
+[A] "Feeble-mindedness: Its Causes and Consequences, Goddard, The
+Macmillan Company.
+
+Severe Anemia: Pernicious Anemia.--This is the most severe form of
+anemia, or the condition in which we have the poorest blood. While this
+condition frequently results in death the others rarely ever do. This
+condition is not common in childhood.
+
+Symptoms.--There is intense weakness and prostration. The skin is very
+pale, the mucous membranes are bluish white. The breath is markedly
+short and there is often dropsy of the limbs and feet. Fever is often
+present and quite high. The disease lasts a number of months; the
+patient often feels better for a time, then relapses into a more serious
+condition than before.
+
+
+TREATMENT OF THE VARIOUS FORMS OF ANEMIA
+
+Simple Anemia.--Find the cause and stop it. In infancy special
+attention should be given to diet and hygiene, giving the child plenty
+of fresh air, and a change of air to the country or seashore if
+necessary. The general treatment is more important than any benefit that
+may be derived from drugs. The rules laid down in the articles on
+"Malnutrition" must be closely followed in these children.
+
+Chlorosis.--In this form of anemia, or poor blood, it is best to give
+iron. Change of air and change of scene are of special importance in
+these cases and will frequently cure. The general condition of course
+must not be overlooked. The diet, exercise, bowels, habits, should
+receive careful attention. Iron should be continued for a number of
+months after all traces of the anemia have disappeared.
+
+Pernicious Anemia.--For this condition arsenic is the one remedy
+needful. In all conditions of poor blood the most careful attention
+should be given to the general health. Colds must be guarded against.
+The patients should never get their feet or their clothes wet. Muscular
+exercise, because of the weak condition of the heart, should be
+moderate, and only given on the advice of a physician. It is frequently
+necessary to stop all forms of exercise and in many instances we get the
+best results by directing complete rest in bed for a considerable part
+of the day or for all day if the case demands it.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVII
+
+DISEASES OF CHILDREN, CONTINUED
+
+Rheumatism--Malaria--Rashes of Childhood--Pimples--Acne--
+Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
+Incontinence--Sleeplessness--Disturbed Sleep--Nightmare--Night Terrors--
+Headache--Thumb-sucking--Biting the Finger Nails--Colon Irrigation--
+How to Wash Out the Bowels--A High Enema--Enema--Methods of Reducing
+Fever--Ice Cap--Cold Sponging--Cold Pack--The Cold Bath--Various Baths--
+Mustard Baths--Hot Pack--Hot Bath--Hot Air, or Vapor Bath--Bran Bath--
+Tepid Bath--Cold Sponge--Shower Bath--Poultices--Hot Fomentations--How
+to Make and How to Apply a Mustard Paste--How to Prepare and Use the
+Mustard Pack--Turpentine Stupes--Oiled Silk, What it is and Why it is
+Used.
+
+
+RHEUMATISM
+
+This is a rather common disease of childhood. It occurs most frequently
+between the ages of nine and thirteen years. Children can have it,
+however, at any age.
+
+The symptoms of rheumatism in children are much the same, though
+somewhat milder, as when the disease is present in an adult. Children
+are not quite as sick, nor is the fever as high, nor is the pain as
+great as in a grown person. In children the disease does not last as
+long, as a rule. Sometimes it will jump from one joint to another, and
+may, as a consequence, become chronic. When a child has once had
+rheumatism, it has the same disposition to recur that it has in adults.
+The principal danger of rheumatism in children is its tendency to attack
+the heart. Even mild attacks of the disease can do serious damage to the
+heart.
+
+Children who have the rheumatic tendency invariably suffer from
+inflammatory conditions of the upper respiratory tract. They are prone
+to have recurring colds, tonsilitis, and sore throats. Treatment of
+conditions without regard to the underlying rheumatism is never
+satisfactory. These children complain of indefinite pains, now in one
+place, now in another. These pains are commonly known as "growing-pains"
+and, inasmuch as they are rheumatic and not "growing pains," they should
+be regarded seriously because of the heart damage they might do if
+ignored, and especially so since the mildest attacks of rheumatism,
+without any joint symptoms even, frequently leave the heart in very bad
+shape. As a general rule it will be found that when a child has had a
+number of attacks of bronchitis or asthma it is rheumatic and should
+receive treatment for the rheumatic tendency.
+
+Children with the tendency to rheumatism invariably eat too much red
+meats and sugar,--the latter in the form of candy or as an excess in the
+food.
+
+Treatment of an Acute Attack.--The child should be put in bed and kept
+warm. The bowels should be freely opened with citrate of magnesia. The
+diet should be very light: milk and lime water or milk and vichy water,
+with a piece of dry toast or zwieback, is all the child needs until the
+fever is relieved. When a single joint is affected local measures may be
+taken for its relief. Wraping the joints up with flannel cloths which
+have been wrung out of true oil of wintergreen, and outside of this
+oiled silk snugly bandaged on, is an excellent external application. The
+flannel cloths should be kept moist by adding a little of the
+wintergreen from time to time as it dries in. This can be done without
+removing the bandage. This application is kept in place for twenty-four
+hours and renewed if necessary. Such an external application will aid in
+the actual cure of the disease and will quickly relieve the patient of
+the pain. The oil of wintergreen used in this way should be the "true"
+oil, and should be so specified when bought in the drug store.
+
+Because of the great tendency to attack the heart a physician should
+take charge of every case of acute rheumatism in a child.
+
+To Treat the Tendency to Rheumatism.--Exclude red meats and sugar in
+all forms as much as is possible. Give green vegetables freely, potatoes
+boiled with the skins on, fish, eggs, and poultry. Cereals with milk,
+especially well cooked Scotch oatmeal, are exceedingly good for these
+children. By keeping up this diet after the acute attack has passed for
+a considerable time, it is possible to cure the various other complaints
+with which the child is afflicted,--tonsilitis, sore-throats, winter
+coughs, head-colds, bronchitis, asthma, etc.
+
+These children should wear woolen underwear all the year round. They
+should be encouraged to drink water or vichy freely between meals.
+
+In the treatment of an acute attack as given above it will be observed
+that no drugs are mentioned. This is intentional because it would be
+unjust to encourage the home treatment of a disease that is so
+treacherous, even in its mildest forms. Because of its tendency to recur
+and with each recurrence the danger of the heart being affected, it is
+advisable to put these children on cod liver oil or iron or some other
+good tonic. Every precaution should be taken to prevent these children
+from getting their feet wet or being out in the rain.
+
+
+SUMMARY:--
+
+Rheumatism is a dangerous disease in children.
+
+In its mildest forms it can affect the heart badly.
+
+It has a distinct tendency to recur.
+
+Rheumatic children are afflicted with a number of diseased conditions
+which do not respond to treatment unless the rheumatism is treated.
+
+Acute rheumatism should never be treated except by a physician because
+of its treacherous character.
+
+
+MALARIA. INTERMITTENT FEVER
+
+Malaria occurs quite often in infants and children. As a rule the child
+gives evidence of gastro-intestinal disturbance for a short period
+before the malarial symptoms appear. The chilly stage is often absent.
+Sometimes the hands and feet are cold and may be slightly blue and the
+child may appear to be in collapse. This stage may last for an hour or
+longer. The chilly stage may, however, be replaced by nervous
+symptoms,--restlessness, dizziness, irritability, nausea, etc.,--or a
+convulsion may take place. In the second stage the temperature may rise
+quite high, the pulse may be quite rapid; the child is flushed,
+restless, and cries. This period may last from half an hour to two
+hours. The sweating stage is not as a rule well marked in a child. It
+may be very slight or not at all.
+
+Between the attacks some children may be entirely well; others remain
+restless, have little appetite and poor digestion. Malaria in children
+does not always follow a typical course. We often see children suffering
+from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin
+eruptions, all due to the malarial condition. This often leads to a
+mistake in diagnosis. Intermittent fever is often mistaken for
+pneumonia. Malaria is not a favorable disease for an infant to have. It
+rapidly weakens the child and great debility and anemia follows.
+
+Treatment.--The treatment for malaria in children is by the
+administration of quinine as in adults. It must, however, be given with
+care and intelligence; for this reason no mother should begin dosing her
+child with it without consulting a physician.
+
+
+REGARDING MOSQUITOES
+
+The following is an extract from a circular in relation to the causation
+and prevention of malaria and the life history and extermination of
+mosquitoes issued by the Department of Health, City of New York:
+
+     Extermination and Prevention of Mosquitoes.--Mosquitoes require
+     for their development standing water. They cannot arise in any
+     other way. A single crop soon dies and disappears unless the
+     females find water on which their eggs may be laid. In order to
+     prevent mosquitoes, therefore, the requirement is simple.
+
+     No Standing Water.--Pools of rain water, duck ponds, ice ponds,
+     and temporary accumulations due to building; marshes, both of salt
+     and fresh water, and road-side drains; pots, kettles, tubs,
+     springs, barrels of water, and other back-yard collections, should
+     be drained, filled with earth, or emptied.
+
+     Running streams should have their margins carefully cleaned and
+     covered with gravel to prevent weeds and grass at the water's edge.
+
+     Lily ponds and fountain pools should, if possible, be abolished; if
+     not, the margins should be cemented or carefully graveled, a good
+     stock of minnows put in the water, and green slime (Algæ) regularly
+     cleaned out, as it collects.
+
+     Where tanks, cisterns, wells or springs are necessary to supply
+     water, the openings to them should be closely covered with wire
+     gauze (galvanized to prevent rusting), not the smallest aperture
+     being left.
+
+     When neither drainage nor covering is practicable, the surface of
+     the standing water should be covered with a film of light fuel oil
+     (or kerosene) which chokes and kills the larvæ. The oil may be
+     poured on from a can or from a sprinkler. It will spread itself.
+     One ounce of oil is sufficient to cover 15 square feet of water.
+     The oil should be renewed once a week during warm weather.
+
+     Particular attention should be paid to cess-pools. These pools when
+     uncovered breed mosquitoes in vast numbers; if not tightly closed
+     by a cemented top or by wire-gauze, they should be treated once a
+     week with an excess of kerosene or light fuel oil.
+
+     Certain simple precautions suffice to protect persons living in
+     malarial districts from infection:
+
+     First: Proper screening of the house to prevent the entrance of the
+     mosquitoes (after careful search for and destruction of all those
+     already present in the house), and screening of the bed at night.
+     The chief danger of infection is at night (the Anopheles bite
+     mostly at this time).
+
+     Second: The screening of persons in malarial districts who are
+     suffering from malarial fever, so that mosquitoes may not bite them
+     and thus become infected.
+
+     Third: The administration of quinine in full doses to malarial
+     patients to destroy the malarial organisms in the blood.
+
+     Fourth: The destruction of mosquitoes by one or more of the methods
+     already described.
+
+     These measures, if properly carried out, will greatly restrict the
+     prevalence of the disease, and will prevent the occurrence of new
+     malarial infections.
+
+     It must be remembered that when a person is once infected, the
+     organisms may remain in the body for many years, producing from
+     time to time relapses of the fever.
+
+     A case of malarial infection in a house (whether the person is
+     actively ill or the infection is latent) in a locality where
+     Anophele mosquitoes are present, is a constant source of danger,
+     not only to the inmates of the house, but to the immediate
+     neighborhood, if proper precautions are not taken. It should be
+     noted in this connection that the mosquitoes may remain in a house
+     through an entire winter and probably infect the inmates in the
+     spring upon the return of the warm weather.
+
+     Malarial fever is prevalent in certain boroughs of New York City,
+     and in view of the presence of standing water resulting from the
+     extensive excavations taking place in various parts of these
+     boroughs, is likely to extend, if means are not taken for its
+     prevention.
+
+
+REGULATIONS OF THE BOARD OF HEALTH, NEW YORK CITY, IN AID OF MOSQUITO
+EXTERMINATION AND THE PREVENTION OF MALARIAL FEVER
+
+(In Force from March 15 to October 15.)
+
+1. No rain-water barrel, cistern, or other receptacle for rain-water,
+shall be maintained without being tightly screened by netting, or so
+absolutely covered that no mosquito can enter.
+
+2. No cans, pails, or anything capable of holding water, shall be thrown
+out or allowed to remain unburied on or about any premises.
+
+3. Every uncovered cesspool or tank shall be kept in such condition that
+oil may be freely distributed so as to flow over the surface of the
+water. Covered cess-pools must have perfectly tight covers, and all
+openings must be screened.
+
+4. No waste or other water shall be thrown out or allowed to stand on or
+near premises.
+
+Information is requested as to the presence of standing water anywhere,
+so that the premises may be inspected and the legal remedies against the
+same be applied.
+
+The prompt coöperation of all persons in the enforcement of the above
+regulations is earnestly desired, and they are assured that in this way
+the breeding of mosquitoes on their premises may be prevented.
+
+Mosquitoes are, so far as known, the only means of conveying malaria.
+
+
+"RASHES" OF CHILDHOOD
+
+The following table gives all the characteristics of the rashes that
+accompany the eruptive fevers. The term "incubation" means the period of
+time which elapses between the time when the child was exposed to, or
+caught the disease, and the time when the child is taken sick. It is
+sometimes interesting to know where a child could have caught a disease;
+so if we know the incubation period we can tell exactly where the child
+was on the day, or days, when it was infected.
+
+-----------+------------+-----------+-----------------+----------+---------+
+Name       | Incubation |Day of Rash|Character of Rash|Rash fades|Duration
+-----------+------------+-----------+-----------------+----------+---------+
+Measles    | 10-14 days | 4th day   |Small red like   |On the    |6-10
+           |            |           |spots resembling |7th day   |days
+           |            |           |flea bites, first|of fever  |
+           |            |           |appearing on face|          |
+           |            |           |and forehead,    |          |
+           |            |           |forming blotches |          |
+           |            |           |with semi-lunar  |          |
+           |            |           |borders.         |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Scarlet    | 1-6 days   | 2d day of |Bright scarlet,  |On 5th    |8-9 days
+Fever      |occasionally|   fever   |rapidly diffused,|day of    |
+           | longer     |           |first on chest   |fever     |
+           |            |           |and upper        |          |
+           |            |           |extremities.     |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Chicken-pox| 4-12 days  | 2d day    |Small rose       |Slight    |6-7 days
+           |            |           |vesicles, which  |scab of   |
+           |            |           |do not become    |short     |
+           |            |           |pustular         |duration  |
+-----------+------------+-----------+-----------------+----------+---------+
+Typhoid    | 10-14 days | 7-14 days |Rose colored     |          |From
+Fever      |            |           |papules elevated,|          |21-35
+           |            |           |few in number,   |          |days
+           |            |           |limited to trunk,|          |
+           |            |           |disappear on     |          |
+           |            |           |pressure.        |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Smallpox   | 10-14 days | 3d day of |Small, round,    |9th day   |14-21
+(Variola)  |            | fever     |red, hard,       |scabs     |days
+           |            |           |papules forming  |form and  |
+           |            |           |vesicles then    |about     |
+           |            |           |pustules, first  |14th day  |
+           |            |           |appearing on face|fall off  |
+           |            |           |and wrists.      |          |
+-----------+------------+-----------+-----------------+----------+---------+
+
+Other Rashes.--There are so-called "stomach" rashes which are a source
+of much worry to mothers. These rashes may appear at any time and they
+may be limited to certain parts or may cover most of the body. They may
+be bright red, or they may be simply a general discoloration. They may
+appear as blotches or they may spread all over, like the rash of scarlet
+fever when at its height.
+
+These rashes are of no importance, except that they indicate some
+derangement of the gastro-intestinal tract. As a rule they indicate
+indiscriminate feeding or overfeeding. Children who have had too much
+candy or pastries, or who have been fed things which are unsuited to
+their age, frequently develop rashes. Such children should have a
+thorough cleaning out; a dose of castor oil is probably the best
+cathartic to give them.
+
+The mother may readily learn to know the difference between a rash that
+is unimportant and one that indicates one of the eruptive diseases, if
+she gives the matter a little careful thought. In the first place a
+child who is about to become the victim of one of the eruptive diseases
+will be sick, and will have a fever for two or three days before any
+rash appears; while on the other hand a child may go to bed in good
+health and may next morning be covered with a general rash, or with
+large blotches, without any fever and without any evidence of
+ill-health, except the skin condition. In the second place, if the
+mother gives the child a cathartic and restricts the diet for a day the
+rash will disappear, and good spirits and good health will be
+maintained; on the other hand, the giving of a cathartic to a child who
+is the victim of an eruptive disease will not tend to diminish the rash,
+but may accentuate it.
+
+Pimples: Blackheads (Acne).--This eruption is situated chiefly on the
+face. It may appear, however, on the back, shoulders, and on the chest.
+It is mostly seen in young men and women about the age of puberty. It
+appears as conical elevations of the size of a pea; they are red and
+tender on pressure, and have a tendency to form matter, or pus, in their
+center. In from four to ten days the matter is discharged but the red
+spots continue for some time longer.
+
+"Blackheads" appear as slightly elevated spots of a black color out of
+which a small worm-like substance may be pressed. Pimples and blackheads
+are due to inflammation of the glands of the skin. The mouths of these
+glands become filled with dust which acts as a plug causing the
+retention of the oily matter of the gland which becomes inflamed and
+hence the pimples and blackheads. Certain constitutional conditions
+favor the development of these skin blemishes. Constipation,
+indigestion, bad blood from unsanitary and bad hygienic surroundings,
+self-abuse and bad sexual habits favor the appearance of these skin
+affections.
+
+Treatment.--The patient must avoid tea, coffee, tobacco, alcohol,
+veal, pork, fats, candy, pastries, cheese, and all edibles that are
+known to disagree with the digestion of the patient. Constipation must
+be avoided; if necessary, laxatives may be taken to keep the bowel open.
+The blackheads must be squeezed out with an instrument made for the
+purpose, not with the finger nails. Pimples must be opened with a
+sterile needle. The parts should be washed three times a day with hot
+water and green soap, and the following mixture applied at night:--
+
+  Zinc Oxide            ounces    1/4
+  Powdered calamine     ounces    1/4
+  Lime water            ounces  6
+
+Mix and shake before applying to the skin.
+
+
+CONVULSIONS. FITS. SPASMS
+
+Convulsions are quite common in children, especially those under three
+years of age.
+
+A convulsion in an infant immediately, or within three months, after its
+birth is the result of injury, either at birth or later (a fall for
+example) which seriously affects the brain itself. After the third month
+the cause of fits or convulsions is, in a very large percentage of the
+cases, to be found in errors of diet resulting in disturbances in the
+stomach or bowels--eating of articles of food difficult to digest, as
+green or overripe fruit, salads, fresh bread, pickles, cheese, etc.
+Children of a nervous temperament are more liable to convulsions than
+are others. Females are more frequently victims of fits than are male
+children.
+
+In infants convulsions often result from changes in the mother's milk.
+Mental excitement, deep emotion, anger, frights, severe affliction and
+distress will so affect a woman's milk that it will cause convulsions in
+her child if she nurses it while under the influence of any of these
+conditions.
+
+Convulsions may result from any condition that disturbs the nutrition of
+the child, as, for example,--exhaustion, anemia, intestinal indigestion,
+blood poison, and general weakness resulting from some severe sickness,
+especially those of the digestive organs.
+
+Various forms of brain disease cause spasms and fits; the most common
+are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions
+may accompany certain conditions, as, the presence of worms, teething,
+severe burns, foreign bodies in the ear, whooping cough, pneumonia
+scarlet fever, malaria, sometimes measles, typhoid fever, and
+diphtheria. Children who are badly nourished and who live constantly in
+unsanitary surroundings are more apt to have convulsions than those who
+are well nourished and who live hygienically. One attack renders the
+patient more liable to another, and when the "habit" is established any
+trivial cause may incite a convulsion; persistent and systematic efforts
+should therefore be taken to prevent the attacks. The best preventives
+are:
+
+1st. To regulate the diet and the bowels.
+
+2nd. Remove adenoids and worms, if they exist.
+
+3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries,
+candies and all improper foods.
+
+4th. Guard the child against catching cold, infectious diseases and all
+fevers. In other words, save the child from the cause and the convulsion
+will not take place.
+
+By regulating the bowels we mean that everything the child eats must be
+seen by the mother, must be with the mother's permission, and must be
+suited to the child's age. If there is any question about the latter it
+will be advisable to have a physician write out a list of articles
+suitable to the child. It is generally necessary to eliminate meats,
+pastries, candies, sugar to a large extent, gravies, salads, sauces, and
+all the extras of the table, as pickles, mustard, relish, etc., as well
+as coffee, tea, cocoa, and alcohol.
+
+The child should live in the open air as much as possible; a daily warm
+bath, followed by a quick, cold sponge, is a necessity.
+
+Children subject to fits are possessed of a highly nervous temperament.
+They are difficult to manage unless managed with firmness and tact. It
+is not necessary to be harsh, but it is imperative to be firm and
+decided. They must be made to realize that they are not "the master,"
+that their will is not supreme, and the mother must exact this
+condition; otherwise these children will become dictators and selfish
+despots--ruining the discipline of the home, spoiling their own chance
+of physical health, and rendering unhappy everyone around them. The
+parents, therefore, have a definite duty to perform and it is not an
+easy one. The food should be so regulated that each day a natural
+movement of the bowels will take place. (See article on constipation,
+page 303.) If a day should pass without a movement the child should be
+given a hot rectal enema as described on page 586.
+
+The adenoids can be easily demonstrated to either exist or be absent.
+(See page 519.) If worms are known to be present in the child they
+should be at once removed. If they are simply suspected, the child
+should receive treatment for them, just the same. (See page 549.)
+
+By going a long time without a convulsion the nervous system will
+recuperate itself, and become so strong and healthy that what once would
+cause a fit will make no impression in its new strengthened state;
+therefore, if you "save the child from the cause," the convulsions will
+cure themselves, as it were.
+
+There are some cases of convulsions for which no satisfactory
+explanation can be found.
+
+Treatment.--When a child has a convulsion, remove its clothing and put
+it into a mustard bath. The temperature of the bath should be 105° F.
+Every part of the child should be under the water except the head, which
+is supported in the palm of the hand. While it is in the bath its body,
+and especially its arms and legs, should be briskly rubbed by the hands
+of an assistant in order to keep the circulation active. A rectal
+injection of soap suds or plain salt and water (see page 579) should be
+given while the child is in the bath, because, as explained above, a
+large percentage of these cases are caused by gastro-intestinal
+derangements. The rectal injection will likely remove the cause. An
+ordinary convulsion lasts from five to ten minutes. When the child is
+removed from the bath it should be placed in a warm, comfortable bed and
+kept absolutely quiet. A hot-water bottle may be put near its feet and
+an ice-bag or cold cloths should be kept on its head. It should be given
+a full dose of castor oil and allowed to go to sleep. Its diet should
+consist of light broths for two or three days and during this time it
+should not be disturbed or annoyed by too much attention. This is as far
+as it is wise or safe for any mother to go in the treatment of
+convulsions. A physician should be called in every instance, because a
+convulsion should never be regarded lightly. Many children have become
+idiots, others have been afflicted with paralysis, because of
+inattention at the proper time.
+
+
+SUMMARY:--
+
+1st. Convulsions must always be regarded as serious.
+
+2nd. Convulsions demand prompt treatment.
+
+3rd. Every mother should know that an English mustard bath--hot--is the
+first resort in convulsions.
+
+4th. While this is being done she can read the home treatment in this
+book and carry it out before the doctor comes.
+
+5th. If the fit is not caused by some stomach or intestinal trouble,
+have the physician find out the cause and tell you what to do, and do it
+faithfully, because if you neglect the proper treatment the child may
+become idiotic or paralyzed.
+
+
+BED WETTING. ENURESIS--INCONTINENCE
+
+Enuresis, or incontinence of urine, is customary in infancy. Just when
+urination becomes a voluntary act depends upon the development and
+training of the individual child. As a rule children can be taught to
+control this function during the day, or while awake, about the tenth
+month. It is not under control during sleep until a much later period,
+usually by the end of the second year, but lack of control should not be
+regarded as abnormal until the child has entered the fourth year. If the
+child fails to control the act of urination during the day at the end of
+the second year, and is addicted to habitual bed-wetting, some measures
+should be adopted to cure the condition.
+
+Boys under twelve years of age seem to be affected more frequently than
+girls. It is wrong to assume that it is caused by negligence or
+laziness, as some parents do. It has generally a special cause, and the
+cause usually can be found if it is carefully sought for. It may be the
+result of bad habits: exposure to cold in the night; lying on the back;
+drinking too much liquid in the afternoon or at bedtime. It may be due
+to too much acid in the urine, and if so it will be found necessary to
+reduce meats and eggs the child is eating. Worms, stone in the bladder,
+some anatomical abnormality or deficiency, may be responsible for it.
+The diet may be at fault; adenoids are supposed by some physicians to be
+the cause. No matter what the actual cause may be, it must be found and
+remedied before we can hope for a permanent cure. A very large majority
+of these cases are due to nervousness. These children are of a nervous
+temperament. They are not necessarily sickly children; they are simply
+of a nervous type. They are well-nourished, active, and lively.
+Incontinence of urine during the day and long-continued bed-wetting does
+not at all affect the health of the child. If they are in poor health,
+it is essential to treat their general condition before trying to cure
+the incontinence.
+
+It is absolutely wrong to punish or to crush the spirit of these
+children. Constant nagging and taunting, even if done in the hope of
+shaming the child into a cure, will simply make a coward of him and will
+not aid in improving matters, but will be distinctly detrimental.
+
+Scrupulous cleanliness must be constantly practiced or these children,
+if neglected, may develop ulcers and sores of a very obstinate
+character. The odor is also bad for the health of the child.
+
+Treatment.--Find and remove the cause if possible. If due to general
+poor health, give tonics, obtain a change of air, and build the child
+up. Reduce the total quantity of liquids, if in excess, and be very
+careful not to give any liquids near bedtime. Don't cover these children
+too much; they should never be "too warm"; they should sleep in a
+well-aired room, and they should receive a quick, cool sponge bath every
+morning. They should be taught to sleep on their sides, never on their
+backs. Their diet should be light but nourishing. When bed-wetting is
+established it will continue, if untreated, until the child is eight or
+ten years of age, and it frequently lasts much longer. When treatment is
+undertaken it should be distinctly understood by the mother that it will
+take many months to cure; and during these months she must give her
+constant attention to the child. If she does not undertake to do this,
+or if she fails to do it, the treatment should not be begun at all, as
+it will not succeed. Various plans should be tried to keep the child
+from sleeping on its back. The reason of this is because it has been
+found that the child wets the bed only when sleeping on its back and
+never when sleeping on its side. The simplest method, of tying a towel
+or cloth around the child with a knot over the spinal column, so that it
+will hurt and waken it, if it turns on its back, is a very good one and
+should be carefully tried for some time. The nervous system of these
+children should never be overtaxed at home or at school. Early hours and
+plenty of sleep are desirable. Certain articles of diet of a stimulating
+character should be entirely avoided,--for example, coffee, tea, beer,
+candies, sugars, and pickles. The best diet for these children is one
+composed exclusively of milk, vegetables, fruits, meats, and cereals.
+Meats, however, should be given only once every two days. It is a good
+plan to teach the child to hold his water during the day, as long as he
+can, to accustom the bladder to being full. Adenoid growths, which
+contribute to the nervousness of a naturally nervous child, should be
+removed. It is a good plan to take the child up when the parents go in
+bed and let him urinate. This often cures the condition in itself.
+
+Sometimes moral measures, such as the promise of a reward, will
+strengthen the will so that the child may overcome the tendency. Find
+out what the child most desires in the way of a toy, and promise it if
+he goes so long without wetting the bed. Aid and encourage him to make
+efforts to win the reward.
+
+If drugs have to be resorted to, it is necessary to call the family
+physician, as the only drugs that are of any use are very powerful and
+have to be given with great care and caution. It is the experience of
+most physicians and specialists, however, that in a large majority of
+cases the treatment, along the lines as given above, will be effective,
+without drugs, if faithfully persisted in by the mother.
+
+These children should be examined by a physician. The cause of the
+bed-wetting is frequently discovered to be produced by anatomical
+abnormalities which render circumcision imperative. In these cases no
+method of treatment will succeed until circumcision is performed.
+
+
+SLEEPLESSNESS. DISTURBED SLEEP
+
+Causes.--In babies, disturbed sleep is most frequently due to hunger
+or to indigestion. The latter is the result of overfeeding or improper
+feeding. Rocking the child to sleep, or feeding it during the night will
+cause sleeplessness. Teething, colic, or any pain will result in
+disturbed sleep. Nervous children are frequently poor sleepers.
+
+In older children, some digestive disturbance is, as a rule, the cause.
+Chronic intestinal indigestion, worms, adenoid growths, enlarged
+tonsils, lack of fresh air in the bedroom, cold feet, may, however, be
+the cause. Overstudy in school, poor blood, poor nourishment are always
+accompanied by inability to sleep soundly. Too strenuous play, exciting
+stories read before bedtime, may cause sleeplessness.
+
+Treatment.--The removal of the cause is absolutely necessary. In order
+to discover the cause it is sometimes essential to study the child's
+whole routine in order to be able to tell exactly just what is causing
+the apparent insomnia. It may be necessary to change the method of
+feeding, to regulate the studies and the exercises, and to suggest
+changes regarding the sanitary and hygienic environment of the child's
+life. Mothers must be warned against using drugs in the form of soothing
+syrups or teething mixtures. They are dangerous and absolutely forbidden
+under the above conditions.
+
+The nervous disposition of the child must be taken into consideration
+and treated if necessary. If bad habits exist they must be stopped. Poor
+blood and poor nutrition must receive the treatment suggested under
+these headings.
+
+
+NIGHTMARE. NIGHT TERRORS
+
+In a nightmare a child wakes suddenly in a state of fright and will
+inform you that it has had a bad dream. His mind seems clear and he
+recognizes those about him. He is not easily calmed and may cry for some
+time; finally he goes to sleep again. The next day he will remember the
+dream and most of the incidents of the night before. Such cases are
+quite frequent. They are to be treated in the same way as cases of
+disturbed sleep, as they really have the same cause. They are mostly due
+to digestive disturbances and errors of diet.
+
+Night-Terrors.--Cases under this heading form a distinct group by
+themselves. They are not frequent, but the condition is much more
+serious. The cause seems to be wholly nervous and may indicate an
+important nervous derangement. It seems to have some indefinite relation
+to such conditions as migraine, hysteria, epilepsy, and even insanity.
+The child wakes suddenly during the night and sits up, evidently in
+terror; he does not apparently regain his full consciousness. He talks
+of being scared, calls for his mother, trembles and shakes, cannot
+answer questions intelligently, and after a time goes to sleep. Next day
+he remembers nothing of the attack and does not seem to suffer in any
+way as a result of it.
+
+I am disposed to believe that all of these attacks are not due to a
+nervous condition. A number of them of exactly this type have been cured
+by absolutely withdrawing milk from the diet.
+
+It is a good plan to restrict the possibility of excessive play in these
+children. They are of the type whose play is work, and too much of it is
+too exhausting. Some person should sleep in the same room with these
+patients or in an adjoining room with the door open.
+
+If the condition occurs frequently the child should be subjected to a
+thorough physical examination, because it may be one evidence of a
+serious ailment.
+
+Sometimes these little patients have to be taken out of school and sent
+to the country, where they should remain for many months. It is far
+better to regard the condition as indicating an abnormality,--even
+though it may not have any deeper significance than that the digestive
+apparatus of the child is not quite right,--and make every effort to
+cure it, than to permit the child to go on under what really are unjust
+and unfavorable conditions.
+
+
+HEADACHE
+
+Headaches are not common in little children. The most frequent ones are
+caused by:
+
+  1. Chronic indigestion and constipation.
+
+  2. Anemia and malnutrition.
+
+  3. Nervous disorders.
+
+  4. Diseases of the eye, nose, throat.
+
+  5. Rheumatism and gout.
+
+  6. Disturbances of the genital tract.
+
+Those arising from anemia and poor nutrition are most frequently present
+in girls from ten to fifteen years of age. They may result from
+overcrowding of school work, which results in loss of appetite and poor
+sleep.
+
+Nervous headaches may be hereditary or acquired through unhygienic
+surroundings. Hysteria, epilepsy, disease of the brain, neuralgia from
+carious teeth, may result in nervous headaches.
+
+Headaches from disturbances of the genital tract may afflict girls about
+the time of puberty.
+
+Treatment.--To remove the cause is the only plan that promises any
+result. Each one must be investigated by itself and dealt with
+accordingly. For the headache itself a hot foot bath, cold to the head,
+and small doses of phenacetine (one grain every hour for four doses) are
+perhaps the most certain of all methods of treatment.
+
+
+THUMB-SUCKING
+
+The habit of sucking the thumb may be corrected by wearing a pair of
+white mittens, or gloves tied at the wrist. Should children attempt to
+suck the thumb with gloves on, as some do, it will be necessary to
+saturate the thumb and fingers of the gloves with tincture of aloes, or
+a solution of the bisulphate of quinine, one dram to two ounces of
+water.
+
+
+BITING THE FINGER NAILS
+
+Biting the finger nails may be stopped by the use of the same bitter
+remedies as are used in thumb-sucking.
+
+
+HOW TO WASH OUT THE BOWELS
+
+COLON IRRIGATION. A HIGH ENEMA
+
+Procure a soft rubber catheter,--No. 18 American is about right. It is
+not advisable to get too soft rubber for the reason that it will buckle
+when the child strains and it will be impossible to wash out the bowel.
+Fill half full an ordinary two-quart douche bag with water that is warm,
+but not too hot. Dissolve a heaping teaspoonful of table salt in a glass
+of hot water and add this to the water in the bag. Hang the bag about
+two feet above the level of the child, so that the water will not flow
+in with too strong a stream; otherwise the child will immediately try to
+eject it. If the water flows in gently, the child may not object to it
+to the extent of making strenuous efforts to force the catheter out.
+
+Use the small sized nozzle that comes with the douche bag. Place the
+rubber catheter over this nozzle, lubricate the catheter, place the
+child on its back over a douche pan, insert the catheter about two
+inches, let the water run and as it runs in push the catheter up gently
+until it is all in the bowel except the end on the douche tip. The
+object of letting the water run while pushing in the catheter is because
+it floats up with the water as it distends the bowel; there is no risk
+then of pushing the end into the intestinal wall or hurting the child.
+While the water is flowing into the bowel it is a good plan to compress
+the buttocks together to aid in holding the water, as the child is very
+apt to let it run out as soon as it feels uncomfortable.
+
+The temperature of the water for the ordinary rectal injection should be
+95° F. When the child is exhausted or very weak, or when the circulation
+is poor, the temperature of the water may be as high as 110° F. When, on
+the other hand, the fever is very high, the water may be much cooler; as
+low as 70° F. has been given with good results on the fever. If the
+irrigation is given with the intention of reducing the fever, it is best
+to begin with water around 90° F., and reduce it to 70° F., gradually.
+
+Indications for Irrigation of the Colon.--When it is desired to
+cleanse the bowel of any collection of matter a colon irrigation is
+indicated. This matter may be mucus, fecal substance, undigested food,
+or the decomposing waste products which may remain there as a result of
+disease or other conditions.
+
+When it is desired to medicate by putting fluids into the bowel we adopt
+the colon infusion.
+
+Every diseased condition of the bowel does not, however, indicate
+irrigation. If a child is having frequent loose movements every
+half-hour it is safe to assume that the bowel is being cleaned out
+sufficiently without any artificial aid. To irrigate in these cases
+would only irritate and would not accomplish anything. The cases which
+are benefited are those in which we have a fever with four or five green
+stools in the twenty-four hours, or where we have a high fever with no
+movement at all. To irrigate in these cases we not only get rid of the
+products of decomposition, but we prevent further decomposition and we
+reduce the fever, thereby contributing to the general welfare of the
+child.
+
+When the child is convalescing and when there is only mucus in the
+stools, with no fever--as in cases of chronic ileo-colitis--the colon
+irrigations should be stopped, as they tend to keep up the discharge of
+mucus in these cases. If, however, there is a relapse with fever, which
+would indicate a fresh infection with more discharging mucus and
+possibly green stools, the irrigation must be used until the fever
+subsides.
+
+Colon irrigations should always be given in every case of convulsions in
+infancy, first to clean out the bowel to prevent putrefaction, and
+second to empty the bowel on general principles because an overloaded
+bowel is very frequently the cause of convulsions in children.
+
+When irrigation of the bowel is given at all it must be given
+thoroughly. Enough water must pass into the bowel to wash it all out.
+For this reason it is essential that the catheter should be all in and
+in the bowel--not doubled on itself two or three inches in the bowel. If
+it is a serious case and the mother nervous, someone else should give
+the washing--preferably the physician himself. If the child objects
+strenuously, as often happens, it must be done with greater care to be
+successful. Remember that a colon irrigation is never given unless it is
+absolutely necessary and as a consequence it is given to accomplish a
+certain purpose; it must, therefore, be done thoroughly. If it is not,
+your child may miss the chance it has of getting over some immediate
+difficulty and if the moment of the "chance" is wasted or lost, that
+moment will not return. Be thorough, therefore.
+
+Enema.--Some physicians talk about a high enema and a low enema. A
+high enema is really an irrigation as described above. The following
+remarks apply to low enemas only.
+
+A so-called low enema is given to clean out the rectum of constipated
+matter, or for the introduction of food or medicine by rectum, when for
+various reasons it is necessary to spare the stomach.
+
+It may be given with the fountain syringe or with the ordinary bulb
+(baby) syringe. A catheter may be put on the tip of the syringe if it is
+thought best to inject higher up than in the rectum.
+
+When an enema is used in infants or older children for the relief of
+constipation, the best medium to use is glycerine. For an infant, one
+teaspoonful to an ounce of water is sufficient; for older children, one
+tablespoonful to two ounces of water, given with the bulb syringe, will
+give prompt results. If the constipation is pronounced, the fecal mass
+very hard, an enema of sweet oil, allowed to remain in for ten minutes,
+will soften it and permit a movement.
+
+Soap suds are often used. They are good but not as reliable as the
+glycerine or oil; if, however, neither of these two are at hand the soap
+suds may be given.
+
+Enemas should be carefully given and the liquid slowly injected. If the
+fountain syringe is used care must be exercised in not having the bag
+too high. If it is too high the liquid will flow in too strongly, either
+injuring the bowel wall or causing the child to strain immediately and
+pass out the injection before it has an opportunity of accomplishing its
+work.
+
+The temperature of the enema should be warm--not hot, and not cold,
+simply body heat.
+
+
+METHODS OF REDUCING FEVER
+
+During the course of acute illness it is frequently necessary to reduce
+the fever, if possible, without the use of drugs. The following means
+are often adopted. It is desirable that the mother should know just how
+to carry out these methods:
+
+Ice-Cap.--An ice-cap is used to protect the brain when a child or
+adult is running a very high fever. It is put on when the fever is above
+103° F. It may be used in other conditions--brain disease, or disease of
+the meninges or cord--in which case the physician will be in attendance
+and will direct what should be done.
+
+Ice-bags are procured in the drug stores. The best one is the flat
+French ice-bag. Fill it three-quarters full of finely chopped ice, put
+the ice-bag in a towel, and place on the patient's head. There should be
+only one thickness of the towel between the ice-bag and the head.
+
+It will be necessary to keep a record of the fever so that the ice-bag
+may be withdrawn when it falls below 103° F.
+
+When the ice melts the bag must be at once refilled. This is often
+overlooked by careless mothers.
+
+Cold Sponging.--Cold sponging is used to reduce fever or to allay
+nervous irritability. Equal parts of alcohol and water or vinegar and
+water are used. The temperature of the water should be 80° to 85° F.
+
+Infants to be sponged should be completely undressed and laid upon a
+blanket. The sponging should be done for about fifteen or twenty
+minutes, after which the child is wrapped in a dry blanket without
+further clothing except the diaper. To be effective it must be done
+frequently.
+
+Cold Pack.--The cold pack is used to reduce fever. It is one of the
+simplest and one of the best means we have. The child is undressed
+completely, and laid upon a blanket. It is completely covered with a
+small blanket (except its head) wrung out of water at 100° F. Outside
+of this the child is rubbed with a piece of ice, front and back, for a
+sufficiently long time to render the surface cool, but not cold.
+Children take kindly to this means of reducing fever; there is no shock
+and they are quieted by it.
+
+Just how long one will rub with the ice depends upon circumstances. From
+five to thirty minutes may be employed. The head should be sponged with
+cold water while this is being done and it is a good plan to have a
+hot-water bottle at the child's feet.
+
+The Cold Bath.--To reduce fever the cold bath is used in the following
+way: Water at a temperature of 100° F. is put into the bath and the
+child is first put into this water, then the water is reduced by putting
+into it shaved ice until it reaches 80° F. The child's body is well
+rubbed while it is in the bath and cold water is applied to its head.
+The bath is continued for five minutes, or sometimes with a robust child
+to ten minutes. On removal the child should be put into a warm blanket
+after being thoroughly dried.
+
+Rectal Irrigations.--These are sometimes given to reduce fever. They
+are very useful and very successful if they are given properly and
+without exciting the child too much. It is best to give water of an
+ordinary temperature at first and gradually reduce it to 70° F. It
+should be continued for ten minutes or longer. It may be repeated every
+three hours. (See page 586.)
+
+
+VARIOUS BATHS
+
+Every mother should know how to give any bath that may be directed by
+the physician.
+
+The Mustard Bath.--Take from three to four tablespoonfuls of English
+mustard; mix thoroughly in about one gallon of warm water. Add to this
+about five gallons of plain water at a temperature of 100° F. If it is
+necessary to raise the temperature of the water higher it may be done by
+adding water until the temperature reaches 105° or 110° F.
+
+The mustard bath is exceedingly effective in cases of shock, great
+sudden depression, collapse, heart failure, or in sudden congestion of
+the lungs or brain. The special use of the mustard bath is in the
+treatment of convulsions; it is also useful for nervous children who
+sleep badly. Two or three minutes in the mustard bath, followed by a
+quick rubbing, will induce refreshing sleep in these children. It is not
+necessary to have more than one tablespoonful of mustard in these cases.
+
+The Hot Bath.--A bath is prepared of water at a temperature of 100° F.
+After the child is in the bath the temperature of the water is raised to
+105°, or to 110° F. It is not safe to go above this point.
+
+The body of the child should be well rubbed while it is in the bath. In
+most cases it is advisable to apply cold water to the head while the
+child is in the bath. A bath thermometer should be kept in the water to
+see that it does not rise above the temperature desired.
+
+The hot bath, like the mustard bath, is used to promote reaction in
+cases of shock, collapse, etc., and in convulsions.
+
+The Hot Pack.--Remove all clothing from the baby and envelop the body
+in a sheet wrung out of water at a temperature of 100° F., to 105° F.,
+after which the body should be rolled in a thick blanket. Those hot
+applications may be changed every twenty minutes until free perspiration
+is produced. This condition may be kept up as long as is necessary.
+
+The hot pack is used mainly in disease of the kidney.
+
+The Hot-Air or Vapor Bath.--The child is put in bed wholly undressed
+with the bed clothing raised about twelve inches, and held in that
+position by a wicker support. The child's head is of course outside the
+bed clothing. Beneath the bed clothing hot air or vapor from a croup
+kettle is introduced. This will cause free perspiration in twenty
+minutes. It may be continued from twenty to thirty minutes at a time.
+
+The vapor bath is used in diseases of the kidney, as a rule.
+
+The Bran Bath.--In five gallons of water place a bag in which is put
+one quart of ordinary wheat bran. The bag is made of cheese cloth.
+Squeeze and manipulate the bran bag until the water resembles a thin
+porridge. The temperature of the water is usually about 95° F., though
+it may be given with any temperature of water.
+
+The bran bath is of great value in eczema, or in rashes about the
+buttocks, or in delicate skin conditions when plain water would
+irritate.
+
+The Tepid Bath.--This bath may be given at a temperature of 95°, or
+100° F. It is of distinct advantage in extremely nervous children. To
+induce sleep it is often better than drugs.
+
+The Cold Sponge or Shower Bath.--This bath should be given in the
+morning in a warm room. A tub should be provided with enough water in it
+to cover the child's feet. This water should be warm because when the
+feet are in warm water it prevents the shock which frequently comes when
+cold water is applied to any other part of the body.
+
+A large sponge is filled with water at a temperature of from 40° to 60°
+F. This is squeezed a number of times over the child's chest, shoulders,
+and back. While the cold water is being applied the body should be well
+rubbed with the free hand of the mother. The bath should not last longer
+than half a minute. When finished take the child out quickly and stand
+him on a bath towel and give him a brisk rubbing with a bath towel until
+the skin reacts. This is an exceedingly valuable tonic for a delicate
+child. It should not be used on younger children than eighteen months of
+age. In younger children a cold plunge is preferable.
+
+For the cold plunge water at a temperature of 55° F. is prepared. The
+child is lifted into this and given a single dip up to the neck. He is
+then briskly rubbed off as above.
+
+There are a very few children who do not take kindly to either the cold
+sponge or plunge. These children do not react; they remain pale or blue
+and pinched for some time after. It may be necessary to discontinue the
+procedure or to use water of a higher temperature.
+
+
+POULTICES
+
+Poultices are useful in inflammation and for the relief of pain. To be
+of any value they should be applied frequently--every ten or twenty
+minutes--and they should be applied hot.
+
+Ground flaxseed is the best material for poultices. It should be mixed
+with boiling water until the proper thickness is reached. It may be kept
+simmering on a fire. When one poultice is taken off it can be scraped
+into the pot and heated over if there is no discharge. Each poultice
+should be put into clean muslin, put on the part and covered with oiled
+silk. This will help to retain the heat and prevent the clothing or bed
+sheet from becoming wet.
+
+
+HOT FOMENTATIONS
+
+A hot fomentation is simply a clean poultice. Several thicknesses of
+flannel are taken, wrung out of very hot water, covered with cotton
+batting, and then with oiled silk.
+
+How to Make and How to Apply a Mustard Paste.--For infants: Take one
+part English mustard to six parts flour, mix with lukewarm water, and
+spread between two layers of cheesecloth.
+
+For older children and adults: Take one tablespoonful English mustard to
+three or four tablespoonfuls of flour, and mix as above.
+
+Mustard pastes should be made big enough. You can accomplish a great
+deal more by putting on a sufficiently large mustard paste than by
+simply putting on one the size of the palm of your hand.
+
+It should be left on until the skin is distinctly red. The length of
+time will depend, of course, upon the strength of the mustard. Mustard
+pastes may be put on every three hours, if necessary, and they may be
+used for a week at this interval if the conditions demand it.
+
+If they are used in pneumonia or other pulmonary diseases, they should
+be used large enough to go around the whole chest. If they are used in
+heart failure, they should be big enough to cover the whole trunk.
+
+When made with the white of an egg they will not blister. Or if the part
+is rubbed with white vaseline before applying, it will not blister and
+it will be just as effective. When a mustard paste is removed the red
+area should be rubbed with white vaseline and covered with a clean piece
+of flannel.
+
+How to Prepare and Use the Mustard Pack.--The child is stripped and
+laid upon a blanket, and the trunk is surrounded by a large towel or
+sheet saturated with mustard water. This is prepared as follows: Take
+one tablespoonful of English mustard and dissolve it in one quart of
+water, slightly warmed. Saturate a towel in this mixture and apply to
+the body of the child while it is dripping. The patient is then rolled
+in a blanket. Keep the child in this pack for ten or fifteen minutes.
+The mustard pack is not as good as the mustard bath, but it is all that
+is necessary in a number of various conditions. The physician will, of
+course, decide these matters. It is simply the duty of the mother to
+know how to carry out the physician's instructions.
+
+The Turpentine Stupe.--Take a piece of flannel, big enough to cover
+the area which it is desired to affect, wring it out of as hot water as
+it is possible. Upon this sprinkle twenty drops of spirits of
+turpentine. Place the stupe wherever it is desired and cover with a
+piece of oiled silk or dry flannel. The turpentine stupe is mostly used
+in pain of the abdominal cavity. In colic from acute indigestion it is a
+very convenient means of quieting the child by allaying the pain.
+
+Care should be taken not to allow this form of application to remain on
+too long. Take it off when the skin is red. For continuous use it is not
+as good as the mustard paste.
+
+
+OILED SILK. WHAT IT IS, AND WHY IT IS USED
+
+Oiled silk is sold in the drug stores by the yard. It is one yard wide.
+It is used to cover any local application to prevent evaporation into
+the air or to prevent the clothing from absorbing the medicament. If a
+liniment is applied on cloth to effect a certain result, it may take
+some time to do its work. If the wet cloth is covered with the clothing,
+the clothing will absorb the medicine quicker than the body will and
+thereby defeat the object in view, in addition to rendering the
+clothing wet and nasty. If the application is covered with oiled silk it
+cannot escape into the clothing, because the oiled silk is impervious.
+The body will be compelled to absorb the medicine and consequently
+results will be quicker and more certain. Many liniments are expensive;
+to permit them to be absorbed by the clothing is needless waste It is
+therefore economical to apply the oiled silk.
+
+
+
+
+DISEASES OF CHILDREN
+
+[Illustration: By permission of Henry H. Goddard.]
+
+
+The First Blight
+
+This is one of those truly unfortunate cases which, so far as present
+knowledge goes, cannot be guarded against. Eunice, age 31, mentally 2,
+is a low-grade imbecile. There is not in the whole family, for
+generations back, a single case of feeble-mindedness, nor of disease
+that would undermine the nervous organization. Close scrutiny does not
+reveal a single assignable cause. She came, as an accident, to blight an
+otherwise normal family.
+
+Such cases are few, but unfortunately they do occur. It is for Eugenics
+to materially reduce the possibility of such occurrences.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVIII
+
+INFECTIOUS OR CONTAGIOUS DISEASES
+
+
+Rules to be Observed in the Treatment of Contagious Diseases--What
+Isolation Means--The Contagious Sick Room--Conduct and Dress of the
+Nurse--Feeding the Patient and Nurse--How to Disinfect the Clothing and
+Linen--How to Disinfect the Urine and Feces--How to Disinfect the
+Hands--Disinfection of the Room Necessary--How to Disinfect the Mouth
+and Nose--How to Disinfect the Throat--Receptacle for the Sputum--Care
+of the Skin in Contagious Diseases--Convalescence After a Contagious
+Disease--Disinfecting the Sick Chamber--The After Treatment of a
+Disinfected Room--How to Disinfect the Bed Clothing and
+Clothes--Mumps--Epidemic Parotitis--Chicken Pox--Varicella--La
+Grippe--Influenza--Diphtheria--Whooping
+Cough--Pertussis--Measles--Koplik's Spots--Department of Health Rules in
+Measles--Scarlet Fever--Scarlatina--Typhoid Fever--Various
+Solutions--Boracic Acid Solution--Normal Salt Solution--Carron
+Oil--Thiersch's Solution--Solution of Bichloride of Mercury--How to Make
+Various Solutions.
+
+
+RULES TO BE OBSERVED IN THE TREATMENT OF CONTAGIOUS DISEASES
+
+
+Every mother should know the elementary principles involved in the
+treatment of contagious diseases. They are contagious because they may
+be conveyed from one individual to another or because a person nursing a
+victim of a contagious disease may carry that disease to another person
+without having the disease herself. For this reason, certain rules have
+been established by the medical profession, which experience has taught
+are necessary in order to preserve the health of the community when such
+diseases are prevalent.
+
+The very first rule to which the physician will direct the mother's
+attention, when there is a contagious disease, will be that the child
+must be "isolated."
+
+What Isolation Means.--Isolation means the complete seclusion of the
+patient in a room by himself, so that no one will see him or come in
+contact with him except the physician and the nurse or mother who will
+tend him during the entire course of the disease. Isolation implies more
+than it would seem to mean. It implies that every article used during
+the sickness will be thoroughly disinfected before it leaves the room in
+which the patient himself is isolated. Mothers must always remember that
+every article used by the patient may carry the germs of the disease to
+some other member of the family or to some other individual. These
+articles are the clothing of the child, the bedclothes, napkins,
+handkerchiefs, towels, dishes, knives and spoons, rags, the various
+discharges--sputum, urine, and bowel passages--and, we may add to this
+list, flies, insects, and domestic animals. Every precaution must,
+therefore, be taken to safeguard any dissemination of the disease by
+means of these articles.
+
+Thorough isolation also implies that the nurse shall frequently bathe
+and disinfect her person and her clothing, and that the sick-room itself
+shall be carefully dusted with a moist cloth and disinfected from time
+to time.
+
+The Contagious Sick-Room.--The contagious sick-room will be prepared
+in exactly the same way as the ordinary sick-room which has been
+previously described. In addition, however, it will be safeguarded in
+the following manner. A wet sheet will be hung up outside the door. This
+sheet will be kept constantly moistened with a solution of chloride of
+lime. One-half pound to an ordinary house-pail of water is the strength
+of the solution to use. Every window must be effectively screened to
+prevent the ingress and egress of flies and other insects.
+
+Conduct and Dress of the Nurse.--She will remain in the sick-room all
+the time unless when she takes outdoor exercise. Her dress will consist
+of a long gown which will entirely cover her person from the neck to the
+shoes and will be of plain, white, easily washed material, without tucks
+or ruffles or adornment of any kind. She should wear an ordinary pair of
+house slippers made of light leather. Her cap will be large enough to
+cover and include her hair and head. When she leaves the room, she will
+remove her cap, gown, and slippers, disinfect her hands in a
+disinfecting solution and wash her face, neck, and hands in soap and
+water. She should go directly out and in, without coming in contact with
+any occupant of the home.
+
+Feeding the Patient and Nurse.--The meals for the patient and nurse
+should be left on a table outside the door of the sick-room, from which
+place the nurse will then take them into the room. The utensils used for
+these meals should not be used by other members of the family during the
+entire sickness. After the patient and nurse have eaten, the utensils
+should be placed in a chloride of lime solution for disinfection. If any
+of the food is left over it should be put into a jar in which it may be
+disinfected and rendered harmless before being disposed of.
+
+How to Disinfect the Clothing and Linen.--All bed and body linen,
+towels, handkerchiefs, napkins, etc., should be immediately put into a
+large receptacle--a wash boiler, or tub, will answer the purpose
+admirably--containing a five per cent. solution of carbolic acid in
+which an adequate quantity of soft soap has been dissolved. They should
+remain in this mixture for two hours, after which they may be wrung out
+and taken to the laundry.
+
+How to Disinfect the Urine and Feces.--The urine and the stools should
+be passed into vessels containing a solution of four ounces of carbolic
+acid to the gallon of water. This vessel should be covered and the
+mixture allowed to stand for one hour, after which time it may be thrown
+out.
+
+How to Disinfect the Hands.--Any of the following solutions may be
+used for disinfection of the nurse's hands: Creolin, one teaspoonful to
+the quart of water; chloride of lime, one-half pound to a pail of water;
+formalin, thirty-two drops to a quart of water. A basin containing one
+of the above solutions should be constantly kept standing for the
+frequent disinfection of the nurse's hands. After disinfection, the
+hands should be washed in plain water and soap.
+
+Disinfection of Room Necessary.--The room in which a contagious
+patient is confined requires systematic attention on the part of the
+nurse. Every other day all flat or projecting surfaces should be
+disinfected. Mantels, window-sills, door knobs, picture moldings,
+furniture, chairs, and bed-railings, should be wiped with cloths
+moistened in a disinfecting solution. A suitable solution for this
+purpose is one containing one ounce of carbolic acid to the quart of
+water.
+
+How to Disinfect the Mouth and Nose.--In the course of all contagious
+diseases the mouth and throat of the patient and nurse should be
+thoroughly disinfected as a matter of routine. It should be done at
+least twice daily unless more frequent disinfection is called for
+because of the nature of the disease. In measles and diphtheria, for
+example, the nasal and throat conditions will undoubtedly call for more
+frequent and more thorough disinfection than twice daily. This may also
+apply to scarlet fever if the throat is involved as is often the case.
+
+Pocket handkerchiefs should never be used by a patient suffering from a
+contagious disease. The nose and mouth should be wiped with pieces of
+gauze or cheesecloth, cut into small squares for this purpose. These
+should be immediately burned after being used.
+
+To disinfect the throat, a solution of formalin, six drops to six ounces
+of water, is effective. To disinfect the nose, a solution of
+Glyco-Thymoline is suitable. These applications should be made by means
+of an atomizer, a different atomizer being used for the patient and
+nurse.
+
+Receptacle for the Sputum.--A cuspidor, or basin, should be constantly
+kept at the side of the bed in which the patient may conveniently
+expectorate. This utensil should contain the chloride of lime solution
+previously mentioned.
+
+Care of the Skin in Contagious Diseases.--As in all other sick
+conditions, the skin of the patient should be bathed frequently with an
+alcoholic solution. In the later stages of measles and scarlet fever it
+is essential to anoint the skin while the patient is scaling. This may
+be done with carbolated vaseline. Mothers should understand why this is
+necessary. These diseases have a distinct rash or eruption. This
+eruption practically kills the skin cells and at a certain period these
+cells are cast off by the new growth of skin underneath. This process is
+called scaling. In measles the scales are small, and are cast off in the
+form of bran like dust. In scarlet fever, the cells adhere together and
+are cast off in large scales. These scales are contagious. They are very
+light and will float in the air if dry. The movement of the patient,
+changing the bed clothing, etc., will waft a multitude of these
+contagious scales into the air of the room and infect every article they
+may land on. This would make the disinfection of the room difficult and
+tedious. In order to obviate this tendency experience has taught us that
+much of the difficulty and nearly all of the risk of contagion may be
+overcome by rubbing some oily or sticky substance on the skin. By this
+method the dust and scales are rendered heavier than the air, stick
+together and will not float. During the scaling period there is a
+constant itch present which irritates the little patient. By using
+carbolated vaseline to anoint the skin we accomplish two purposes. The
+carbolic acid in the vaseline relieves the itch, and the vaseline itself
+greases the skin so that the scales remain in the bed. Each day the
+nurse changes the bed-sheet, gathers the scales in the sheet and puts
+all in the disinfecting solution.
+
+Convalescence After a Contagious Disease.--Complete isolation must be
+kept up until all danger from contagion is passed. In diphtheria this
+period is not reached until the examination of the throat contents under
+the microscope is returned negative. In diseases Which have a rash this
+period is not reached until all scaling is completed. Even then, and for
+a number of days or weeks, the patient may be taken out for exercise
+daily, but must not be allowed to play with other children until his
+strength justifies active exercise. It takes a much longer period to rid
+the system of the poison of a contagious disease than most mothers
+appreciate. Many children have died from heart failure after they were
+considered well simply because the active exercise overtaxed the heart
+before the system was wholly free from the poison of the disease.
+
+Before the child is removed from the sick-room for the first time he
+should have a disinfecting bath. This bath should be in a solution of
+bichloride of mercury, the strength of which should be one part to five
+thousand parts of water. The towels used to dry the patient after the
+bath should be fresh and should not have been in the sick-room. He
+should then be dressed in clothing which has never been in the
+sick-room.
+
+
+DISINFECTING THE SICK-CHAMBER
+
+How to Disinfect a Room.--The most efficient way to disinfect a room
+is by means of formaldehyde gas. This, however, requires a special
+apparatus which can only be used by one familiar with the process. In
+all large cities the Department of Health usually undertakes the
+disinfection of rooms after any contagious disease. The next best method
+is by sulphur.
+
+When sulphur is employed it should be used in the form of powder or in
+small pieces. This is placed in a shallow iron pan set on a couple of
+boards in a tub partly filled with water. The sulphur is moistened with
+alcohol before it is set on fire.
+
+It is always necessary, of course, before disinfecting by any process to
+make the room as nearly air tight as is possible. To accomplish this the
+windows must be tightly closed, the doors locked, and the cracks and
+keyhole sealed with pieces of paper or adhesive paper. The room should
+remain closed for six or eight hours, after which it should be
+thoroughly aired for several days.
+
+The After Treatment of a Disinfected Room.--The walls, ceiling, and
+all flat surfaces, such as mantels, window-sills, etc., should be washed
+with a fresh chloride of lime solution. The floor should be scrubbed
+with a four per cent. soda solution. All carpets and curtains, if any,
+should be removed, taken to a vacant lot and thoroughly beaten and then
+exposed to direct sunlight for a number of hours. The room should then
+be well aired again for a couple of days before it is again occupied.
+
+How to Disinfect the Bed Clothing and Clothes.--The surest way is to
+boil them for half an hour; otherwise they may be left in the room while
+it is being disinfected. Spraying the clothes with a spray of
+formaldehyde is an effective way of disinfecting them.
+
+
+MUMPS: EPIDEMIC PAROTITIS
+
+Mumps is a contagious disease. It is most common between the fourth and
+sixth years. Infants are rarely affected. The disease is not very
+contagious, direct contact being necessary to communicate it. Every case
+should be isolated for a period of three weeks from the beginning of the
+disease.
+
+The seat of the affection is the parotid gland which is located in front
+of and on a level with the ear. One or both glands may be affected at
+the same time or one may follow the other in succumbing. The duration of
+the disease from the time the swelling becomes noticeable is about ten
+days. It is contagious for a week after the swelling subsides. The
+period of incubation is from one to three weeks.
+
+Symptoms.--In the majority of cases the first symptom is the swelling
+and the discomfort which it causes. In more severe cases the child feels
+sick and is listless for from twenty-four to forty-eight hours. There
+may be a headache, vomiting, pains in the back and limbs, and fever.
+There is pain in the swelling which is increased by movement of the jaws
+and by pressure. The degree of the swelling varies with the severity of
+the attack. It may be very little or it may be so great as to completely
+distort, and render unrecognizable, the face. It must be remembered
+that, though mumps is not regarded as an important or dangerous disease,
+it may assume dangerous characteristics.
+
+We sometimes see distressing complications with mumps. In boys,
+orchitis, or inflammation of the testicles, occasionally occur. In
+girls, ovaritis, or inflammation of the ovaries may be present. These
+complications may be avoided by keeping the patients in bed.
+
+Treatment.--Keep the child in bed until the fever is gone. Keep him
+in the house for one week after the swelling has entirely subsided. He
+should be put on a liquid diet while the fever lasts. The bowels should
+move each day.
+
+The mouth should be kept clean by an antiseptic mouth wash. If there is
+much pain in the swollen gland, warm, wet dressings give the best
+results. Sometimes it is advisable to paint the gland with belladonna
+ointment. If it is not very painful, the most comfortable way to dress
+the gland is simply to place over it a large pad of absorbent cotton
+held in place by a broad strip of flannel cloth.
+
+
+CHICKEN POX. VARICELLA
+
+Chicken pox is an affection almost entirely special to children, in whom
+it may be observed from their first year, although it is especially
+frequent from the ages of two to six. It appears often in the epidemical
+form and spreads by contagion.
+
+Some doctors are inclined to regard varicella as a very attenuated form
+of smallpox, hence the name "chicken pox," by which it is popularly
+known. This opinion is based merely on the analogy between the two types
+of skin eruptions and the coincidence sometimes observed between two
+epidemics of smallpox and chicken pox. But the theory falls on
+considering that, on the one hand, chicken pox offers no safeguard
+against infection by smallpox and does not prevent the effects of
+vaccination, and, on the other hand the disease may occur in children
+who have been vaccinated or who have had smallpox. Chicken pox, too,
+differs essentially from smallpox in the course of its development.
+
+After a period of incubation, extending over a fortnight, chicken pox
+becomes apparent by such symptoms as slight shivering, extreme fatigue
+and a general but not very intense condition of fever. In less than
+twenty-four hours small pink spots will appear on the skin, and these
+after a few hours are topped by a vesicle, and the next day the whole
+rash shows a vesiculous appearance.
+
+The vesicles are sometimes small and pointed, sometimes more voluminous
+and globular in form. They are filled with a limpid or a slightly
+yellowish liquid. Their base is sometimes surrounded by an inflammatory
+ring. By the third day the contents of the vesicle has become thicker
+and tends to become purulent. On the fourth day desiccation commences,
+and the vesicles shrivel and shrink in and form small brownish scabs,
+which fall about the eighth day. Frequently the child will scratch them
+off with the finger nails before they are entirely desiccated. The
+vesicles leave small reddish spots, which generally disappear gradually,
+almost always without a scar.
+
+An eruption of chicken pox does not burst out all over the body at once,
+but appears in successive rashes. It is not confined to any special
+parts of the body. It may begin and spread at the same time from the
+face, the trunk of the body or the limbs. A dozen pimples may be seen
+the first day, while three or even ten times as many may be visible the
+next day, and so on for several days in succession.
+
+Sometimes the vesicles appear on mucous membrane at different parts--the
+mouth, tongue, soft palate and tonsils--and may also invade the
+conjunctiva and cornea, or the larynx, where they will set up
+laryngitis.
+
+Owing to the very contagious nature of chicken pox, the first thing to
+be done is to provide for the complete isolation during a period of
+twelve to fifteen days of all patients attacked by the disease.
+
+The treatment of the disease is solely a matter of hygiene. The more
+severe the fever the stricter the diet should be, and in the case of
+great fever, the diet should be restricted to broth and milk. If there
+is no fever the child need not be placed on any special diet.
+
+If the intestines are sluggish, they may be stimulated by administering
+a dose of castor oil. It is advisable to make the patient rinse his
+mouth two or three times a day with a mouth wash. It is also well to
+apply a lotion around the eyes and face, consisting of two per cent.
+boracic acid solution with the chill taken off. Finally, in order to
+prevent the child scratching the sores and the consequent danger of
+inoculation by the finger nails, it is a good practice to rub a small
+amount of carbolated vaseline over the itching parts. It is frequently
+found necessary to have the little patient wear white woolen gloves to
+prevent scratching and infecting the sores. If a child scratches the
+sores on the face it will leave an unsightly mark which will stay for
+the rest of its life.
+
+The child, of course, should not be allowed to rejoin his playmates
+without having had a good bath, and having had his clothes completely
+disinfected.
+
+
+INFLUENZA: LA GRIPPE
+
+The most important feature with reference to influenza in children is
+its very active tendency to develop complications. These complications
+generally affect the respiratory tract. So we find in children suffering
+from grippe an easy disposition to get bronchitis or broncho-pneumonia.
+The younger the child the greater the danger.
+
+The disease itself, so long as it remains an uncomplicated influenza, is
+not of much importance or severity. The lesson to be learned, therefore,
+is to treat the disease with respect and take every precaution to avoid
+the possibility of developing a complication.
+
+La Grippe is a highly contagious disease. It prevails epidemically, and
+after an active epidemic it may remain in the vicinity for a number of
+years. It is more frequently seen in the late winter months and early
+spring. The poison of the disease clings to clothing and apartments as
+well as to railroad and street cars. The germ is found in the sputum and
+in the nasal secretions.
+
+Sneezing is one of its symptoms and it is one of the ways by which the
+disease is spread around. Children should never be brought near an adult
+suffering from influenza. One attack does not render the patient immune
+to a subsequent attack as is the case with most of the contagious
+diseases. The reverse is the rule with La Grippe because one attack
+favors the development of another attack. It is a common experience for
+many people to have influenza every winter or spring.
+
+Symptoms.--If a child "catches" grippe, it becomes quite sick
+abruptly. There is usually chilliness, pains in the muscles all over the
+body, more or less fever, sometimes nausea and vomiting. If the attack
+is a more severe one, the prostration is more marked, the temperature
+higher and the signs of shock and poisoning of the system are more in
+evidence. A child a few months old can get influenza so severely as to
+cause collapse and death in thirty-six hours. As a rule the type of
+grippe most common in infancy is of a very mild character. It lasts
+about a week. Children may be a little slow in convalescing and it may
+be three or four weeks before they regain their health.
+
+Complications.--As has been intimated, the most frequent complication
+is bronchitis and the most fatal one is broncho-pneumonia.
+
+A congestion of the entire mucous membrane of the respiratory tract,
+producing a nasal discharge, a sore and inflamed throat, pains and a
+feeling of compression, with a cough in the chest, may accompany the
+disease.
+
+Gastric symptoms, with vomiting, intestinal disturbance, diarrhea, with
+or without mucus and blood, are quite common in some epidemics.
+
+Not infrequently we have numerous cases in which the ear seems to be the
+vulnerable part. As a consequence running ears have to receive most of
+our attention. When the ears are affected, the glands of the neck become
+inflamed. They swell up and add considerable to the discomfort of the
+little patient.
+
+Treatment.--Cases of influenza should be isolated. Children should be
+put in a room by themselves and the other children of the family should
+not be permitted to see them. The rooms should be disinfected after the
+case is over. As complications are the dangerous element in grippe, we
+should try to prevent them. This can be best done by promptly putting
+the child in bed, making him comfortable, opening his bowels by castor
+oil or calomel. He should be made to drink hot lemonade. He should be
+kept on a light diet from which meat and vegetables are excluded.
+
+The above treatment will usually suffice in the ordinary uncomplicated
+grippe. If complications arise they must be treated according to the
+conditions.
+
+It is well to remember that the degree of prostration following a rather
+severe attack of grippe is out of all proportion to the extent of the
+disease. These little patients sometimes suffer considerably and do not
+regain their strength promptly. Experience has taught us that the best
+thing to do is to send them away. A change of climate will do wonders
+for them, more quickly and more thoroughly than all the medicine we can
+give them at home. The seashore is particularly good for them.
+
+
+DIPHTHERIA
+
+Diphtheria is an acute, specific, infectious, communicable disease. It
+affects the tonsils, throat, nose, or larynx. It is most frequently seen
+in children between the ages of two and five years, though it may appear
+at any time during life. The two sexes are equally liable to it. The
+same person may have the disease twice or more times at different ages.
+Children suffering from disease of the nose or throat are more likely to
+get it than are others. Such diseases are cold in the head with running
+nose, catarrh of the nose and throat, inflammation of the mucous
+membranes of the nose or throat.
+
+Diphtheria may occur at any time of the year, though it is more frequent
+during the cold months. The incubation, or the length of time between
+exposure to the disease and the development of the symptoms, is between
+two and five days. In its mild form the disease may be present without
+giving any constitutional symptoms. In its severe form, however, it is
+one of the most dangerous diseases of childhood. In large cities it is
+present all the year round with more or less frequent outbreaks in the
+form of local epidemics. In the country it is only seen in its epidemic
+form. It does not arise without a cause, that is, there is always a
+preceding case from which an epidemic springs, though it is not always
+easy to trace the connection. The child inhales the bacilli which cause
+the disease with the air it breathes. The bacilli may lodge on toys or
+other articles from which the child gets them. Direct infection is
+usually the mode of communication through which a child obtains the
+disease. The saliva and mucus from the nose contain the bacilli in large
+quantities and if a patient coughs or sneezes they are expelled in this
+way and infect others. Frequently a child suffering from a mild form of
+diphtheria may attend school and infect others without it being known
+that the child has the disease.
+
+Symptoms.--The symptoms vary with the severity of the attack. There
+are mild cases, as has been stated, that give no constitutional
+symptoms. There may be a small amount of local disturbance in the throat
+or nose and there may be some membrane present, but, for some reason,
+there does not seem to be any absorption of the poison into the system
+and the child escapes the systemic disturbance. Even as a local
+condition these cases vary. There is always a fever at the beginning,
+but the child never seems sick enough to go to bed. If the throat is
+examined it will be found to be red and slightly inflamed, there may be
+spots on the tonsils, or there may be a gray film over them. There is no
+discharge from the nose and the child does not complain of an excess of
+mucus from the throat. The spots may last for a week and then disappear.
+These cases are difficult to diagnose without making a culture, and if
+the physician insists upon keeping the child confined to bed while
+apparently well the family as a rule object, though it is absolutely
+necessary. These are the cases that do great harm in school, and no
+mother should object if the physician insists in taking preventative
+measures to stop an epidemic if the bacilli have been found in the
+child's throat. She should rather feel thankful that the child escaped
+so easily.
+
+Since the introduction of antitoxin we do not see the severe cases now,
+so that a description of them would not be of any use in a book of this
+character. Mothers should, however, know that it is absolutely criminal
+to take any chances with a "sore throat." Antitoxin is a prompt and an
+absolute remedy if used soon after the onset of the disease. It is more
+sure if used the first or second day, still reliable the third day, but
+its efficacy diminishes the longer we postpone its use from the date of
+the onset of the disease. When, therefore, a child complains of being
+sick and states that its throat hurts, medical aid should be at once
+sought.
+
+The disease may develop in one of two ways. It may begin as a slight
+indisposition for a day or two, and perhaps some soreness of the throat.
+The fever may be slight. The child will continue to be sick despite any
+treatment given and will get slowly worse until the fourth or fifth day,
+when it will be impossible to mistake the condition.
+
+At other times the disease begins abruptly. The child complains of being
+sick. It may vomit, or suffer from headache, chilly feelings, and a
+fever. The glands in the neck may swell and cause considerable
+disturbance. There is, as a rule, an abundant discharge from the nose
+and there is an excess of mucus in the throat. Membrane is seen in the
+throat. It may cover the tonsils and spread over the entire throat
+cavity, or it may extend up into the nose and over the roof of the
+mouth. All the parts are much swollen and breathing is interfered with,
+sometimes seriously. If the attack is very severe there is an active
+absorption of poison going on from the throat which soon renders the
+little patient intensely sick. There is marked weakness and prostration,
+the circulation becomes poor, the pulse rapid and the child falls into a
+stupor.
+
+The physician will, of course, have taken complete charge of the case
+before the patient has gone thus far. The nursing of the case, which may
+fall to the mother if no trained nurse is present, is most important.
+She should preserve absolute cleanliness of herself and of the sick
+room. She should never eat or sleep in the same room with the patient,
+and should use a gargle, which the physician should prescribe,
+frequently during the day. She should dress simply, so that whatever is
+worn can be changed often and washed easily. Every article of furniture
+must be taken out of the sick room that is not absolutely essential in
+the care of the case. If toys are allowed they should be burned as soon
+as the child is tired of them, never left around the house after the
+case is over. The room should be a large one and it should be thoroughly
+aired each day. The floor should be washed each day with a solution of
+bichloride of mercury, and all dusting should be done with a wet cloth.
+The bed linen and any rags or handkerchiefs used should be treated as in
+scarlet fever. All vessels in which the patient expectorates should have
+an antiseptic in them. The room must be disinfected after the case is
+over.
+
+The patient must be kept in bed during the entire attack. He must not be
+allowed to even sit up in bed until the physician gives him permission.
+This is a very important essential in the treatment of this disease, and
+the nurse must be held responsible for the conduct of the patient in
+this respect. Because of the character of the poison, there is a
+tendency to paralysis of the heart, and frequently children have been
+allowed to sit up too soon only to fall back dead in bed. The same thing
+has occurred later in the disease when children have been allowed to
+play too heartily before the poison had an opportunity to completely
+eliminate itself. Nursing children should be fed on breast milk pumped
+from the mother, but they must not nurse it themselves. Older children
+can take milk and should depend upon it mostly. The physician will give
+any other special directions that he may think necessary, the duty of
+the mother being to see that they are faithfully carried out.
+
+
+WHOOPING-COUGH
+
+Whooping-cough is usually seen in young children. It may, however,
+affect a person at any age. It is contagious. During infancy it is one
+of the most fatal diseases. During adult life it is a dangerous
+condition, while in childhood it is simply regarded as a mildly
+contagious disease.
+
+It is most contagious during the catarrhal stage,--the first ten days.
+Children suffering from whooping-cough should not be allowed to mix or
+play with other children for two months. After an exposure to the
+disease it takes about fourteen days for a case to develop. The danger
+of whooping-cough is the tendency to develop pneumonia or bronchitis.
+
+Symptoms.--During the first ten days the child acts as if suffering
+from an ordinary catarrhal cold with cough. This is called the catarrhal
+stage. There is no way of telling that whooping-cough is present until
+the child whoops. Most children do not whoop until the expiration of the
+catarrhal stage, though a very few do from the beginning of the disease.
+If a child is treated for an ordinary cold with cough and does not
+respond to treatment, and whooping-cough is epidemic, it is fair to
+assume that whooping-cough has been contracted. When the cough shows a
+distinct tendency to be worse at night it is further proof of this
+assumption.
+
+When they begin to cough in paroxysms, and whoop, the second, or
+spasmodic stage begins. These fits of paroxysmal coughing are much more
+severe than spells of ordinary coughing. These may only be three or four
+attacks daily, or the child may have from forty to fifty such attacks.
+When children feel these attacks coming on they seek support, holding on
+to chairs or they stand by the mother's knee. The coughing is explosive,
+rapid, and forceful, the child fails to catch its breath and is
+compelled to take a deep inspiration, which is the whoop; it then goes
+on coughing more. The face may become purple, the eyes protrude, and the
+veins of the face swell up. Near the end of the attack the child raises,
+or vomits a mass of stringy, glutinous mucus. After it is over the child
+is exhausted, there is a more or less profuse perspiration, and he may
+be quite dazed. These attacks are, as a rule, more frequent and more
+severe during the night. This stage lasts about one month and is then
+followed by the stage of decline, during which the disease subsides into
+what appears as an ordinary bronchial cold.
+
+It is quite common for these children to get relapses, especially during
+inclement winter weather, and go on whooping for two or three months
+longer. Their vitality suffers because their sleep and nourishment is
+interfered with, and they become nervous and difficult to manage.
+
+Treatment.--Inasmuch as there is no remedy known that will cure
+whooping-cough, the best we can do is to render the patient physically
+efficient to stand the severe strain of coughing, which is the worst
+feature of the disease. Experience has taught us that those children do
+best who spend their entire time out of doors. We, therefore, advise
+parents to encourage their children to play in the open air. There is no
+exception to this rule, even in winter weather, unless it is
+particularly inclement. If the weather is wet or raw, or if the child
+has bronchitis, or is running a fever, it would be more safe to keep the
+child indoors, in a well-aired room, until the temporary conditions pass
+over, when they could again resume the open-air treatment.
+
+Naturally delicate children if under two years of age should not risk
+staying out of doors too much in very cold or raw weather, even if not
+suffering from any of the above complications.
+
+The bedrooms of children suffering from whooping-cough should be large
+and thoroughly aired day and night.
+
+The nourishment in these cases is of great importance. They should be
+carefully fed, and if they vomit with the paroxysms of coughing, they
+should be fed small quantities frequently. Any form of digestive
+disturbance is very apt to accentuate the frequency of coughing. A fluid
+diet of milk is the best. Milk punches aid in keeping up the strength;
+malted milk and eggs beaten in milk are nutritious and easily digested.
+
+So far as internal medication is concerned, I have found pertussin to be
+the most efficacious remedy. If it is begun early and in sufficient
+dosage, it not only favors an early termination of the disease, but it
+lessens the frequency and the severity of the paroxysms. If it is
+suspected that the child has been exposed to whooping-cough, pertussin
+may be given during the catarrhal stage with the advantage that it will
+render the whole course of the disease milder. If it is given during the
+course of an ordinary catarrhal cold, it will in most cases be as
+effectual as any ordinary cough remedy. The dosage should be large
+enough to produce results. I have found a teaspoonful every two hours
+to a child of three years to be the average dose. In older children I
+give two teaspoonfuls every three hours. It is necessary to continue its
+use throughout the disease. The taste of pertussin is pleasant and young
+children take it willingly.
+
+When the disease is inclined to a protracted course, or when the cough
+does not subside, especially during unfavorable weather, it is of great
+importance to send the child away. A change of climate, preferably to
+the seashore, even for a short time, will act like a charm, and will
+cure the cough of whooping-cough quicker than any other possible
+measure.
+
+
+MEASLES
+
+Measles is the most widely prevalent, eruptive, contagious disease. With
+few exceptions, every human being "gets" measles. As an uncomplicated
+disease it is never fatal, and is not even regarded as dangerous.
+Because of this characteristic, however, parents are neglectful and
+complications occur, and these frequently prove fatal. One attack
+renders the patient immune. It is very highly contagious and spreads
+with great rapidity among those who have never had it. It is not
+possible to carry the disease any great distance by a third person or by
+means of living objects. It does not, however, cling to clothing or
+other objects as long as scarlet fever. Its period of incubation is from
+eleven to fourteen days.
+
+Symptoms.--The symptoms develop gradually. A severe cold in the head
+is the first and most characteristic symptom of the disease. There is a
+discharge from the nose, swollen and watery eyes, sneezing and a hoarse,
+harsh cough. The patient may complain of the throat being painful and
+examination will reveal a general congestion of the parts. There are
+also headache, lassitude, pains in the back, and there may be vomiting
+and diarrhea. Children in the early stages of measles are tired and
+sleepy.
+
+Koplik's Spots.--Three or four days, in rare cases somewhat longer,
+before the appearance of the rash there appears on the mucous membrane
+of the cheeks small, bluish white, or yellowish white points, the size
+of a small pin head. These points are surrounded with reddened areas
+which give the appearance of a general rash with fine white points upon
+it. These points resemble milk particles. They adhere firmly to the
+mucous membrane and when an effort is made to remove them it is found
+that the underlying surface is ulcerated and excoriated.
+
+The Koplik spots are not of much value to the mother other than that
+they may be relied upon to indicate the coming disease with which they
+child is affected. Physicians look for them as an aid in diagnosis
+before the rash would of itself indicate the disease.
+
+The rash appears on the third, fourth, or fifth day of the disease. From
+the day of the infection to the outbreak of the rash about thirteen days
+intervene. It is seen first at the roots of the hair on the forehead,
+behind the ears or on the neck. It may be seen first on the cheeks. The
+beginning rash appears as small, dark red, dull spots. At first there
+are only a few, but they soon become more numerous, they join together,
+and soon the surface looks inflamed as if entirely covered with the
+rash. The rash covers the entire body, including the soles and palms. In
+twenty-four hours it is at its height on the face. It spreads downward
+like a wave, first the face, then the neck and chest, then the abdomen
+and later the legs. By the time it invades the legs it has begun to fade
+on the face. It fades slowly in the order of its appearance. Its
+duration is about four days.
+
+The skin is swollen; it burns and itches. The eyes are swollen and red
+and intensely sensitive to light. There is usually a muco-pus discharge
+from them. The cough is invariably an annoying feature. The fever is
+high and reaches its highest point when the rash is at its height. As
+the rash fades the fever subsides.
+
+When the rash fades, the patient begins to "scale." The scales of
+measles are fine, like bran, never in large patches like the scales of
+scarlet fever. The amount of the scaling varies. It may be quite
+considerable or it may be so small as to be overlooked.
+
+Complications.--The most important and by far the most frequent
+complication of measles is broncho-pneumonia. There may be various
+conditions affecting the stomach, bowels, throat, ears, bronchi, and the
+nervous system, which may accompany the disease but are seldom of a
+serious or important character.
+
+Treatment.--Measles runs a certain course and will run that course, no
+matter what we may or may not do. We cannot stop it, or shorten it, or
+lessen its severity. We can only hope to make the patient comfortable
+and to prevent the development of complications.
+
+The child should be put in bed and kept comfortably warm but not too
+warm. The room should be kept at the ordinary temperature of the sick
+room, 68° to 70° F. It should be darkened but not dark. The food should
+be fluid and given regularly. The child may be given all the cool,--not
+cold,--water it wants to drink. The bowels should be kept open daily. If
+constipation occurs an enema may be given. The eyes must be carefully
+watched and washed every hour or two during the day with a boracic acid
+solution. If the cough is distressing, it may be rendered less
+distressing, though we cannot hope to stop it until the disease has run
+its course. The restlessness, headache and general discomfort can be
+much modified by suitable remedies. If the itching is acute, the body
+can be rubbed with carbolated vaseline. When the rash subsides and the
+patient is free from fever a daily warm bath should be given in order to
+facilitate scaling.
+
+Should complications arise they should be promptly cared for by the
+attending physician.
+
+
+SUMMARY:--
+
+     1. Measles is the most prevalent infectious disease of childhood.
+
+     2. The danger of measles has been and is underestimated. Because of
+     its prevalency many mothers treat it with less respect than they
+     should, with the result that fatal complications occur, or the
+     future health of the child is permanently injured.
+
+     3. Children with measles should be put in bed and kept in bed and
+     treated as directed above.
+
+The following rules have been formulated by the Department of Health of
+New York City, with reference to measles, and embody precautions that
+should find general observance:
+
+     1. All children in the family must be promptly excluded from school
+     attendance.
+
+     2. Careful and continued isolation of the patient must be enforced
+     until the case is terminated and fumigation has been ordered by the
+     medical inspector of the Department.
+
+     3. All secondary cases must be reported even if the first case is
+     still under surveillance of the Department of Health.
+
+     4. Suspected cases must be treated as contagious cases until a
+     sufficiently long observation has shown that the patient has a
+     non-contagious disease. All cases will be considered as measles, if
+     so reported. Any change in the original diagnosis must be made in
+     writing to the Department of Health and must be confirmed by a
+     diagnostician.
+
+     5. Physicians must not order the removal of patients to the
+     contagious disease hospital, or elsewhere, in cabs or other
+     vehicles, but must notify the Department of Health and the removal
+     will be effected by a coupé or ambulance of the Department.
+
+     6. Whenever there is a case of measles in rooms in the rear of, or
+     communicating with, a store, the inspector is required to have the
+     store closed at once, or to report the case for immediate removal
+     to the hospital.
+
+     7. A case of measles must not be removed from one house to another,
+     or even to a different apartment in the same house, without the
+     permission of the Department. Such removal is in direct violation
+     of the provisions of the Sanitary Code.
+
+     8. No case of measles shall be discharged from observation until
+     the Department has been notified, the case examined by an inspector
+     to see if desquamation is entirely completed, and the premises
+     ordered fumigated. This examination by the inspector is necessary
+     because the Department of Health must have official information as
+     to the completion of desquamation before a child is dismissed from
+     observation. Other people with children demand this protection. At
+     no other time is the inspector allowed to examine the patient. In
+     any case, however, where isolation has not been maintained and it
+     becomes necessary to remove the patient to the hospital, a
+     diagnostician will make an examination.
+
+     It is recommended that physicians provide a special washable gown
+     for each case of measles. This gown should be put on before
+     entering the sick-room and taken off outside the sick-room as soon
+     as the visit is completed. The gown should be kept in a closet or
+     suitable place, separate from all other clothing, and the gown, and
+     the closet should be fumigated after the termination of the case.
+
+     10. In private houses only fumigation may be performed under the
+     supervision of the attending physician; provided he follow
+     accurately the directions given in the following rules and
+     regulations. Upon request a blank will be provided upon which he
+     must state the manner and extent of the work performed under his
+     orders and supervision. If satisfactory to the Department, this
+     will be accepted in place of fumigation by the Department. It is
+     essential, however, that he should know that the disinfection has
+     been efficiently carried out.
+
+In every case of fumigation the following regulations must be complied
+with:
+
+     All cracks or crevices in rooms to be fumigated must be sealed or
+     calked, to prevent the escape of the disinfectant, and one of the
+     following disinfectants used in the quantities named:
+
+     a. Sulphur, 4 lbs., for every 1,000 cubic feet of air space, 8
+     hours' exposure.
+
+     b. Formaline, 6 oz. for every 1,000 cubic feet of air space, 4
+     hours' exposure.
+
+     c. Paraform, 1,000 grains for every 1,000 cubic feet of air space,
+     6 hours' exposure.
+
+     The following disinfecting solutions may be used for goods, which
+     are afterwards to be washed:
+
+     a. Carbolic acid, 2 to 5 per cent.
+
+     b. Bichloride of mercury, 1-1,000.
+
+
+SCARLET FEVER. SCARLATINA.
+
+Scarlet fever is an acute, contagious disease. It begins abruptly. The
+child may have a severe attack and be quite sick from the beginning, or
+he may have a mild attack and not be very sick. Usually the fever rises
+rapidly, the child vomits and complains of a sore throat. If the attack
+is very mild the throat symptoms may not cause any distress. Frequently,
+about the third day, there are patches on the tonsils. Prostration may
+be profound if the fever is very high. Convulsions and diarrhea are
+sometimes present in very young patients. It takes from two to six days
+to develop scarlet fever from the time the child is exposed to it. The
+disease may be caught at any time, but it is most contagious during the
+time the patient is scaling. It is not as contagious as measles. Some
+children seem to escape even though directly exposed to it. It is more
+frequent in the fall and during the winter, and it is more severe during
+the latter months.
+
+Eruption.--The eruption appears at any time after twelve hours. It may
+not, however, appear before the third or fourth day. It lasts from three
+to seven days, and only takes a few hours to cover the whole body after
+it is first seen. The rash is first seen on the neck or chest; it
+appears as a red, uniform blush, but, when examined closely, small
+reddish spots may be seen all over it. If the rash is very faint and of
+a doubtful character a hot bath may bring it out. A bright red,
+well-developed rash is a sign of good heart action. In the event of
+heart failure, the rash fades quickly. Itching is a constant symptom
+after the rash is fully out.
+
+About the eighth day the rash begins to scale or desquamate. It begins
+on the neck and chest. It takes from one to three weeks to scale
+completely, from the time it begins to peel. The hands and feet are the
+last spots to scale.
+
+It must always be kept in mind that mild cases are just as contagious as
+severe cases, and that a mild case may cause in another person a very
+severe attack.
+
+The throat may be mildly affected or it may be the most troublesome
+feature of the case. It is red and swollen and the child complains of
+pain during the act of swallowing. Patches may be seen on the tonsils on
+the third day. There is usually a discharge from the nose and this
+discharge may be contagious. While the fever is high, the child is
+restless, complains of thirst, and may be slightly delirious.
+
+One attack is usually all a child has during life, though there are
+exceptions to this rule. Complications are quite frequent with scarlet
+fever. Inflammation of the ears and kidneys is most often met.
+
+Measures to be Taken to Prevent Spread of Disease.--Every case, no
+matter how mild, should be isolated for four weeks. Many cases must be
+isolated longer,--until scaling is complete. Children should not play
+or sleep with other children for three or four weeks after all symptoms
+have been absent. Other children in the family, who have not been
+exposed, should be sent away. All clothing should be changed and washed
+in soap and water and then boiled in a carbolic solution. The nurse
+should not mix freely with other members of the family. The sick room
+should be kept clean, and well aired. It should be dusted with a wet
+cloth, and this should afterwards be burned. There should be no
+furniture, or hangings, or pictures in the room other than are
+absolutely necessary. The room should not be used after the case is over
+until it is thoroughly and completely disinfected.
+
+During the period of scaling the patient should be rubbed all over with
+carbolated vaseline. This allays itching and prevents the scales flying
+around. The bed sheet can be taken off daily with the scales in it, and
+immediately put in carbolic water and boiled.
+
+Treatment.--Inasmuch as scarlet fever is one of the most dangerous and
+one of the most treacherous diseases of childhood, we cannot afford to
+take any chances with it. Every child with scarlet fever should be put
+in bed, and kept there during the entire illness,--that is, from four to
+six weeks. Light, and the free circulation of fresh air are absolutely
+necessary for the proper care of a scarlet fever case. The child should
+be clothed only with the usual night gown and a light undershirt. No
+extra wraps or blankets are required.
+
+The diet should be reduced in quantity and strength. The bowels should
+move daily. If anything is necessary to accomplish this, citrate of
+magnesia is quite satisfactory. There is no special medicine for the
+treatment of this disease. Often it is not necessary to give any. Good
+nursing is more essential, and with proper attention to the bowels,
+diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result
+favorably. Quiet is essential. Consequently, two persons at a time
+should never be allowed in the room with the little patient.
+
+The family physician will prescribe whatever medicine is necessary in
+his judgment, and will meet any complication as it arises.
+
+
+TYPHOID FEVER
+
+Typhoid fever is an acute infectious disease. It is rare in infancy.
+After the fifth year it is more common. It is caused by drinking
+infected water or milk. It is not a serious disease in childhood, rarely
+being fatal.
+
+Symptoms.--It may begin suddenly or it may come on slowly. If
+suddenly, the child develops what appears to be an attack of
+indigestion, has fever, vomiting, and is prostrated. In cases developing
+slowly the child complains of being tired, has a headache, nausea, and
+fever. Vomiting is the suggestive and important symptom.
+
+Diarrhea is usually present. Constipation, however, may accompany the
+entire illness. Children may not complain of an excess of gas as do
+adults. The abdomen is tender. The typhoid eruption is rarely seen in
+children. They lose flesh steadily and then strength diminishes rapidly.
+Headache and delirium at night are quite common, and the child is dull
+and indifferent, and often in a state of semi-stupor.
+
+In order to tell definitely whether the child has typhoid, it is
+necessary to make a blood examination. There are so many intestinal
+conditions in children that simulate typhoid, that a blood examination
+is imperative.
+
+Treatment.--The patient should remain in bed during the time fever is
+present and for a few days after. A fluid diet, preferably milk, is the
+most suitable means of nourishing the child. It may be diluted or given
+plain according to the age of the patient. Water is essential and should
+be given freely.
+
+The discharges of the patient should be thoroughly disinfected in a
+solution of carbolic acid, 1-20. All clothing and bed linen should be
+boiled for two hours. If the fever remains high cold sponging is
+advisable. The attending physician should instruct regarding this
+feature, as some children do not stand cold applications well.
+
+The average duration of the disease is about six weeks.
+
+How to Keep From Getting and Spreading Typhoid Fever.--Typhoid fever
+is a communicable disease, but, if certain precautions are taken, its
+contraction and spread can almost certainly be prevented.
+
+The disease is caused by a specific germ known as the typhoid bacillus.
+These germs are found in the excreta (stools and urine) of persons ill
+with typhoid fever.
+
+Failure to properly disinfect these excreta and carelessness in the care
+of persons ill with typhoid fever lead to the transmission of the
+disease from the sick to the well by the infection of water, milk or
+food with the typhoid bacillus or by direct contact.
+
+The disease is contracted by taking into the mouth in some form the
+discharges from some previous case. There is no other way. It is,
+therefore, a disease of filth and someone is at fault somewhere for
+every case of typhoid fever that occurs.
+
+Bad sanitary conditions, such as lack of drainage, open cess-pools,
+sewer gas, decaying vegetable matter, etc., may favor the contraction of
+the disease, but cannot cause it unless the specific germ, the typhoid
+bacillus, is present.
+
+The water supply of a community becomes infected by the entrance into it
+of the excreta (stools and urine) of persons suffering from typhoid
+fever.
+
+Milk (in which typhoid bacilli grow and multiply very rapidly) usually
+becomes infected by washing out milk cans with water in which these
+bacilli are present, or from the presence of the bacilli on the hands or
+persons of those handling milk. Oysters spread the disease when they
+have been "freshed" in water rich in sewage and containing the typhoid
+bacillus. Flies, whose bodies have become foul with typhoid excreta, may
+infect food, milk, etc. Those who take care of typhoid patients may
+contract the disease if they do not at once disinfect their hands after
+handling the patient, or clothing or bedding which has become soiled
+with the discharges.
+
+How to Keep From Getting Typhoid Fever.--If the chance of infection is
+to be reduced to a minimum, all drinking water, concerning the character
+of which there may be the slightest doubt, should be boiled, and all
+milk, the handling and care of which is not absolutely beyond suspicion,
+should be pasteurized or boiled. All food supplies (meat, milk,
+vegetables, etc.), should be carefully protected against flies, and
+flies should not be permitted access to the sick-room, the kitchen nor
+to the room in which the meals are eaten. Bathing at all beaches which
+have sewers emptying in their immediate vicinity should be strictly
+avoided. In the majority of cases it is probable that the system must be
+slightly below par in order that the disease may be contracted;
+therefore, all indigestible food, green fruit, etc., which may set up
+indigestion or diarrhea, and so render the system more susceptible to
+infection, should be avoided. In addition, the elementary rules of
+cleanliness and hygiene, both as to the house and person, should be most
+strictly observed. No member of a household in which a case of typhoid
+fever occurs should take food in any form without previously washing the
+hands.
+
+Typhoid bacilli enter the body only through the mouth. If sufficient
+care be taken to prevent their entrance, the contraction of the disease
+can be absolutely prevented.
+
+How to Keep From Spreading the Disease.--In order to protect
+themselves and others in the household, persons caring for or in any way
+coming into contact with a case of typhoid fever must constantly bear in
+mind that the secretions and excretions (urine, stools, etc.), of the
+patient contain typhoid bacilli and are capable of transmitting the
+disease to others. The person who nurses the patient should not do the
+cooking for the family. The bedding used by the patient should be washed
+separately from that used by others. Special dishes, plates, knives,
+forks, etc., should be kept for the use of the patient alone, and should
+be washed separately and thoroughly. Particular attention should be paid
+to immediate disinfection of the stools and urine of the patients until
+the restoration of health is complete.
+
+The urine is especially dangerous. It may look entirely normal and yet
+contain typhoid bacilli for some time after recovery is apparently
+complete. In a few instances the typhoid bacilli may persist in the
+stools for weeks or months after recovery. Such persons are called
+"typhoid carriers," and constitute a grave menace to the health of the
+community. The best disinfectants are carbolic acid and freshly slacked
+lime; both are effectual, cheap and easily obtained. Urine or stools to
+which has been added one-third of their volume of a solution of one part
+of carbolic acid to twenty parts of water are, as a rule, sufficiently
+disinfected in half an hour, provided the mass of the stool is broken up
+and thoroughly mixed with the solutions. The best method is to keep the
+urinal of bed-pan partly filled with the disinfecting solution at all
+times. In this way any germs present in the urine or stools are almost
+instantly destroyed. Stools and urine should never be thrown out on the
+ground. If no system of drainage is at hand, they should be very
+thoroughly disinfected and emptied into a hole in the ground and covered
+with earth. All persons nursing or handling the patient in any way
+should be careful to wash their hands very thoroughly with soap and
+water before leaving the sick-room. They should never, while in the
+sick-room, touch any article of food or put their hands to their mouths.
+Careful observation of the above suggestions and precautions will almost
+certainly prevent contraction of typhoid fever or the spread of the
+disease.
+
+
+VARIOUS SOLUTIONS
+
+Boracic Acid Solution.--In the previous pages mothers are frequently
+told to use "a saturated solution of boracic acid." A saturated solution
+means that the water in the solution has dissolved all of the product
+that is put into it that it is capable of dissolving. When boracic acid
+is put into water, the water will dissolve it up to a certain point; if
+you add more the boracic acid will not dissolve; it will float if it is
+in the form of powder, or it will remain at the bottom of the glass if
+it is crystal--in other words the water is saturated to its limit and
+the solution is known as a saturated solution.
+
+The strength of a saturated solution of boracic acid is as follows:--
+
+  Boracic Acid         Ounces 1-1/2
+  Hot Sterile Water    Pints 2
+
+which means that 2 pints of hot water will completely dissolve 1-1/2
+ounces of boracic acid. If any more boracic acid is added the water
+will not dissolve it because it is already "saturated." Inasmuch,
+however, as boracic acid is harmless, it is perfectly safe to use the
+liquid part of a solution which contains some undissolved acid.
+
+A saturated solution is used in the eyes after it is strained.
+
+Normal Salt Solution.--A normal salt solution is made in the following
+proportions:--
+
+  Sodium Chloride (ordinary table salt)    Grains 128
+  Sterile Water                            Pints    2
+
+Normal salt solution is much used in irrigating the bowel. A mother may
+safely use it in the proportion of one heaping teaspoonful to two quarts
+of water--two quarts being the size of the ordinary fountain syringe.
+
+Carron Oil.--Lime water and raw linseed oil, equal parts. This mixture
+is much used in burns. It should be made fresh.
+
+Thiersch's Solution:--
+
+  Salicylic Acid            Drams  1/2
+  Boracic Acid              Drams 3
+  Sterile Water             Pints 2
+
+Thiersch's solution is a good, mild antiseptic solution, or wash.
+
+Solution of Bichloride of Mercury (1 to 1000):--
+
+  Bichloride of Mercury     Grains 15
+  Common Salt               Grains 15
+  Sterile Water             Pints   2
+
+Bichloride of mercury is one of the most powerful and poisonous drugs.
+Solutions made from it should never be used without special directions
+from a physician. In much weaker solutions than the above it is one of
+the best antiseptic washes known. It is used to disinfect wounds, for
+douches, and for various other purposes, but always by special direction
+of a physician.
+
+Other solutions.--Frequently mothers are directed to use solutions in
+the proportion of 1 to 500, or 1 to 1000.
+
+This means that there will be one part of the drug, or of the liquid
+medicine, to 500, or 1000 parts of water. For example if you were asked
+to make up a solution of bichloride of mercury in the strength of 1 to
+4000, you would use one ounce of bichloride of mercury to four thousand
+ounces of water, or one grain of the mercury to four thousand drops of
+water,--one grain being equivalent to one drop.
+
+Sometimes solutions are made up on the percentage basis. For example, a
+five per cent. solution of carbolic acid. In this case it would be
+necessary to take five ounces of carbolic to one hundred ounces of
+water, or five drops of carbolic to one hundred drops of water.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXIX
+
+ACCIDENTS AND EMERGENCIES
+
+
+Accidents and Emergencies--Contents of the Family Medicine
+Chest--Foreign Bodies in the Eye--Foreign Bodies in the Ear--Foreign
+Bodies in the Nose--Foreign Bodies in the Throat--A Bruise or
+Contusion--Wounds--Arrest of Hemorrhage--Removal of Foreign Bodies from
+a Wound--Cleansing a Wound--Closing and Dressing Wounds--The Condition
+of Shock--Dog Bites--Sprains--Dislocations--Wounds of the
+Scalp--Run-around--Felon--Whitlow--Burns and Scalds
+
+
+Contents of the Family Medicine Chest.--The family medicine cabinet
+should contain the following articles: a graduate, medicine droppers,
+hot water bags, a flat ice bag, a fountain syringe, a Davidson's
+syringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandages
+of various widths, a yard of oiled silk, one roll of one inch "Z O"
+adhesive plaster, a bottle of Pearson's creolin, hydrogen peroxide
+(fresh), one ounce tincture of iodine in an air-tight bottle, a can of
+Colman's mustard, two ounces of syrup of ipecac, a bottle of castor oil
+(fresh), one pound of boracic acid powder, one pound of boracic acid
+crystal, a bottle of glycerine, a bottle of white vaseline, a bath
+thermometer, some good whisky or brandy, aromatic spirits of ammonia,
+smelling salts, pure sodium bicarbonate, oil of cloves for an aching gum
+or toothache, a bottle of alkolol for mouth wash and gargle, and one
+ounce of the following ointment for use in the various emergencies which
+occur in all homes,--
+
+  Bismuth subnitrate             dram one
+  Zinc oxide                     dram one
+  Phenol (95%)                   drops twelve
+  Resinol ointment to make       ounce one
+
+This ointment may be applied to all cuts, bruises, skin eruptions,
+chafings and sores of minor importance. It is one of the best
+applications for chafing of the skin in babies.
+
+The medicine chest should also contain a small jar of Unguentine for
+burns; one-tenth grain calomel tablets for a cathartic for baby to be
+used as explained in the text of the book, or as advised by the
+physician. It may also contain tablets for colds and for other purposes
+as suggested by the family physician. It should never contain medicines
+the use of which is not thoroughly understood by the mother. It is a
+wrong practice for mothers to keep medicines to use for the same ailment
+at a subsequent time. The ailment may not be the same and frequently the
+medicine itself deteriorates, or it may get stronger with age. Many
+medicines are made with alcohol in them. If kept for some time the
+alcohol evaporates and leaves a concentrated mixture which, if given in
+the dose meant for the fresh preparation, may poison a child. Such cases
+of poisoning are on record. The same argument applies to powders.
+Certain drugs lose their strength, some absorb moisture, others change
+their chemical strength if kept mixed with other chemicals. They should
+be thrown away after the case is over if they have not been used. It is
+a dangerous practice to keep medicines around if there are children in
+the family.
+
+Foreign Bodies in the Eye.--Particles which accidentally lodge in the
+eye are usually located on the under surface of the upper lid. They are
+sometimes, however, found on the ball of the eye or on the inner aspect
+of the lower lid. Foreign bodies which are propelled into the eye with
+great force, as iron specks which railroad men frequently get sometimes
+imbed themselves into the eye-ball and have to be cut out or dug out.
+The entrance of the foreign particle is always accompanied by a flow of
+tears which is nature's way of removing them. The offending object may
+escape through the tear duct into the nose, or it may be simply washed
+out with the flow of tears. Rubbing the well eye will cause a flow of
+tears in both eyes and may facilitate removal of the foreign matter.
+Blowing the nose may force the particle into the tear duct. The use of
+the eye cup may help in ridding the eye of the body. The same object may
+be accomplished if the eyes are immersed in a basin of water and opened
+wide. Then by moving the eyes around the particle may be washed out. If
+the particle is located on the under surface of the upper lid it may be
+promptly removed by pulling the upper lid forcibly down and over the
+lower lid. The eyelashes of the lower lid act as a brush and as a rule
+quickly remove the irritant if the procedure is carried out adroitly.
+Everting the upper lid is a means of locating the body and in making
+possible its removal by a small camel's hair brush or corner of a
+handkerchief. To evert the upper lid it is necessary to employ a guide.
+A match stem may be used in an emergency. This is laid across the middle
+of the upper lid, the eye lashes are grasped with the fingers of the
+other hand and the lid is bent over the match stem and turned up thus
+everting or turning inside out the entire upper lid. The procedure may
+be facilitated if the patient is instructed to look down while the
+operator is drawing the eye-lid upward.
+
+If the particle cannot be easily removed by any of the above methods it
+is not safe for an uninstructed individual to go any further. The eye is
+an exceedingly delicate organ and may be permanently injured by
+unnecessary irritation. It is always safer and it may be cheaper in the
+long run to consult a competent oculist in such cases.
+
+After the removal of any object from the eye, it is desirable to
+frequently wash it out with a saturated solution of boracic acid. This
+mixture will allay any inflammation and will tend to restore the normal
+condition more quickly and more satisfactorily than if the eye were left
+to heal itself.
+
+Foreign Bodies in the Ear.--When a foreign body gets into the ear
+mothers are unnecessarily alarmed because of a failure to appreciate
+that the ear is a closed passage. It is impossible for any object to get
+into the ear itself; the depth of the external passage is only about one
+inch in an adult. At this point the passage is completely closed by the
+drum membrane. Most of the harm is done by ignorant meddling, not by the
+object itself.
+
+Children frequently put foreign bodies in the ear, as, buttons, pebbles,
+beans, cherry stones, coffee, etc. The very first thing for the mother
+to do when she learns that her child has put "something" in its ear is
+to keep cool, and try to find out what the something is. It is
+essential to know what the article is because different articles are
+treated differently. For example if we try to remove a bean or pea with
+a syringe, the liquid will cause the pea or bean to swell and result in
+wedging it in so firmly that it will be impossible to dislodge it in
+this way.
+
+If the object is hard, as a marble, button, pebble, bead, the greatest
+care must be exercised. Try to make the object fall out. To effect this,
+turn the child's head downward with the injured ear toward the floor.
+Then pull the lobe of the ear outward and backward so as to straighten
+the canal. A teaspoonful of olive oil poured into the ear will aid in
+its expulsion. If after the oil is poured in, the head is suddenly
+turned as above described the object will fall out. A very effective way
+to remove a hard object is to take a small camel's hair brush and coat
+the end with glue, or any other adhesive substance, then place it in
+contact with the object and permit it to remain long enough to become
+firmly attached after which it may be gently pulled out with the object
+attached. Never employ an instrument in the ear to remove a foreign
+body.
+
+When a live insect or fly enters the ear a number of safe methods may be
+developed. If the ear is immediately turned to a bright light the insect
+may come out of its own accord. It may be floated out with salt water,
+or it may be smothered with sweet oil or castor oil after which it may
+be floated or syringed out. If it is necessary to employ a syringe this
+should be used gently. A foreign body may remain in the ear for days or
+weeks without doing any harm. This suggests that any unnecessary poking
+or prying should not be undertaken, because this may wedge it in tighter
+and to injure the drum membrane.
+
+Foreign Bodies in the Nose.--Children may put any of these articles
+into the nose. Very often they do, and do not know enough to tell. If
+such is the case the first symptom calling attention to the fact that
+something is wrong is the appearance of a thick foul discharge from one
+nostril or some obstruction to breathing on the same side.
+
+When the foreign body may be seen the child should be made to blow the
+nose, first closing the well side with the finger. If this does not
+expel the object the child should be made to sneeze by tickling the free
+nostril with a feather or by taking snuff. The mother should never
+permit the use of instruments by one unskilled in an effort to rid the
+nose of an obstruction. There is great danger of seriously injuring the
+delicate structure of the nose in this way or of pushing the object so
+far in that it may necessitate an operation to extract it. It is much
+safer to seek medical aid before any damage is effected. It seldom does
+harm to wait until the right assistance is at hand; it often does
+serious harm to be too smart in these little matters.
+
+Foreign Bodies in the Throat.--If the foreign body is in the upper
+part of the throat and can be seen it may be removed with any instrument
+that can grasp it. The child may be immediately held up by its feet when
+the article may be shaken out. If it is further back or in the air
+passages the child should be made to vomit by tickling the throat with a
+feather or with the finger held in the throat till it does vomit.
+
+When the object interferes with breathing a physician should be sent for
+in a hurry. In the meantime the family may try to dislodge it by having
+the child bend forward or by holding it with the head downward and,
+while in this position, sharply striking the back with each cough.
+Striking the chest when in this position may effect the same purpose. If
+no success follows this procedure try the reverse position. Have the
+child bend backward over the arm of a sofa, for example, or put him in
+bed with the body hanging out of the bed face upward. If none of these
+effect relief you must depend upon the skill of the physician.
+
+A Bruise or Contusion.--A bruise or contusion is an injury to the
+tissues underneath the skin, but this does not imply that the skin
+itself is opened or damaged. In every bruise the small blood vessels are
+ruptured, and the blood collects in the tissues causing distention,
+swelling and pain. The blood is held in the tissues, it is stagnant,
+becomes dark in color and so produces the bluish discoloration that we
+see in all bruises. The color varies according to the extent of the
+collected blood. At first it is red and inflamed looking, then purple,
+then black, then greenish and finally citron. The so-called "black-eye"
+is a typical example of this degree of bruise. After a bruise the parts
+swell from the collection of blood and from the accompanying
+inflammation. This causes pain which persists for a day although the
+spot may be sore and tender for a week or more.
+
+In all mild varieties home remedies may suffice, but in the more serious
+and extensive bruises it is advisable to seek medical assistance. It is
+essential to completely put the part to rest and to elevate it. This
+will relieve the pain and favor the absorption of the exuded blood. If
+the bruise is on the foot, the leg should be elevated until the foot is
+higher than the hip. If, on the hand, it should be so held that it will
+be higher than the elbow and it may frequently be held higher than the
+shoulder to relieve the throbbing and the pain.
+
+As a rule, cold should be applied as soon after the injury as possible,
+cloths wrung out of ice water, or a piece of ice may be bound on the
+part for a short time. The object of the cold is to stop the internal
+bleeding. If the injury is slight, as are most of the injuries of the
+household, the mother may apply repeated cloths wrung out of very hot
+water. This procedure tends to aid the immediate absorption of the blood
+and prevents a discoloration of the part. If there is great pain relief
+may be afforded by applying a firm bandage saturated in the lead-water
+and laudanum mixture which may be obtained in the drug store under the
+name of lead and opium wash. The bruised part should be massaged every
+day and a simple ointment may be applied to soften the inflamed area.
+
+If any complication arises in the treatment of a bruise, it will be
+necessary to consult a physician.
+
+Wounds.--A wound implies an injury to the skin in addition to injury
+to the underlying parts to a lesser or greater extent. The skin may be
+opened by cutting, or stabbing wounds; or it may be punctured, torn,
+contused, or bruised open. These injuries are effected in various ways.
+We speak of machinery or mechanical wounds, or gunshot wounds, bites,
+cuts, stabs and other varieties of wounds.
+
+It is very important to know exactly how a wound is produced and the
+nature of the instrument which opened the skin. We try to obtain this
+information in order to estimate the probable degree of poison that may
+or may not have entered into the wound.
+
+The first thing to do in treating wounds is to stop the bleeding. If the
+patient is suffering from shock he should be given active treatment for
+this condition as described elsewhere. If the wound contains any foreign
+bodies these should be removed. The wound should then be cleansed,
+closed and dressed and kept at rest. If the wound is poisoned, or if
+there is any fear that lockjaw may arise, or if the wound has been
+caused by a mad dog it will require special treatment.
+
+It is far better not to interfere if you do not know what to do than to
+do harm. One should offer no advice if they are not qualified to give
+advice. Much harm has resulted from doing the wrong thing in these
+cases. The instruction in the following pages is given so that the
+average mother may know what to do in emergency but not with the
+intention that she may regard her knowledge as sufficient to dispense
+with the aid of the physician.
+
+Arrest of Hemorrhage.--When there is a wound there is always bleeding;
+this means that some blood vessels have been cut or torn open allowing
+blood to escape. The character of the hemorrhage will determine the
+nature of the treatment to be employed. On general principles, the first
+thing to do in the presence of bleeding is to elevate the part, if that
+is possible. If there is simply a general oozing of blood, it may be
+controlled and arrested by pressure. This pressure should be steady and
+prolonged. It is best accomplished by wetting a clean handkerchief or a
+pad of gauze in ice cold water, placing this on the part and binding it
+on firmly with a bandage.
+
+If the discharge of blood flows in a steady stream and is rather dark
+the hemorrhage is coming from a vein. We know that veins carry blood
+toward the heart so that any pressure or constriction employed to stop a
+venous hemorrhage should be tied on the side of the wound further
+removed from the heart. Inasmuch as veins have soft walls the right kind
+of pressure will in most instances stop the bleeding. The part should be
+elevated after the pad is adjusted in place. Any tight band on the limb
+as a garter or sleeve band should be removed as they tend to interrupt
+the return circulation.
+
+If the hemorrhage is from an artery the blood is bright red. It spurts
+out forcibly, is difficult to control and demands immediate attention.
+Arteries carry the blood from the heart to the extremities. They beat
+with every pulsation of the heart so that blood coming from an artery
+spurts with every pulse beat. Even a small artery may be responsible for
+a very considerable hemorrhage in a very short time. Whatever is done
+must be done quickly. The parts should be freed from all clothing and if
+possible elevated. Pressure may be tried, if it succeeds it must be
+strong and steady pressure. The point to press must be on the heart side
+of the bleeding artery since the blood stream is coming that way--this
+the mother will note is the reverse from treating bleeding from a vein
+as previously explained. The artery at this point may be felt beating.
+It is frequently necessary to clamp the whole limb to stop an arterial
+hemorrhage. This may be done in the following manner. Take a strong
+piece of cloth or bandage and tie above the bleeding point. Insert a
+short piece of stick between the bandage and the limb and twist around
+until the bleeding stops. This should not be kept on longer than one
+hour. A tourniquet of this character shuts off all the blood in the limb
+and if kept on too long the parts may mortify. The best means to stop a
+hemorrhage of this character is by means of a rubber bandage sold for
+the purpose. It is applied by stretching at every turn. It exerts
+uniform pressure and in this way does no injury to the parts. All these
+measures are, of course, only temporary expedients as the artery will
+finally have to be caught and tied by a physician.
+
+Removal of Foreign Bodies From a Wound.--When the foreign bodies are
+large enough to be seen they may be picked out with the fingers after
+the hands have been rendered sterile. Smaller bodies may be picked up
+with forceps, or they may be washed out with water that has been boiled
+and cooled slightly, or a bichloride of mercury solution in the strength
+of 1 to 2000 may be used; or a normal salt solution may be used. As a
+general rule the physician should be allowed to undertake this procedure
+so that you may not be blamed for something that may come up later.
+
+Cleansing a Wound.--The simplest way, and the most effective, to
+cleanse a wound, no matter how caused, is to procure a brush and paint
+it thoroughly with tincture of iodine. The iodine should be painted
+right into the raw wound, it is then bound up and left if it is small
+and does not need any stitching. When the physician comes he can attend
+to any further procedure that may be necessary.
+
+Closing and Dressing Wounds.--If the wound is small, its edges may be
+drawn together with narrow strips of adhesive bandage after it has been
+painted with iodine. It is then bound up and kept at rest. It should be
+inspected the following day to see if it is healing properly.
+
+If the wound is large or torn, it should be seen by a physician and
+dressed and closed by him. All wounds do better if they are kept at
+rest.
+
+The Condition of Shock.--When a person suffers a serious injury, loses
+a large quantity of blood, or is subjected to a profound emotion, it
+affects the vital powers to such an extent that the individual is said
+to be suffering from shock. Shock expresses itself in varying degrees of
+apathy. The patient may or may not be conscious. If conscious he gives
+no evidence of feeling, he is silent and motionless although he will
+respond to directions and may answer questions. The eyes are dull and
+listless, the face pale and pinched, and the general expression is
+apathetic. The skin is cold and there may be perspiration; the pulse is
+feeble and irregular, and the breathing is shallow. The whole attitude
+of the victim is one of indifference and apparent inability to
+appreciate the seriousness of the situation and a seeming immunity to
+pain or discomfort.
+
+When this condition exists it must always be regarded as serious because
+the patient may die as a direct result of the condition of shock. The
+various symptoms depend upon a temporary paralysis of the blood vessels
+which deprives the brain of blood. There is always a certain degree of
+shock with all injuries. Mothers should know what to do in these cases
+before the physician comes. The general treatment in all cases is to
+keep the patient warm and quiet, and to use stimulants carefully.
+
+The patient should be put in bed or on a flat surface with the feet
+higher than the head. If raising the feet should cause the face to
+become blue it will be advisable to restore the patient to the
+horizontal posture. Artificial heat must be applied to the patient's
+body and extremities by means of hot water bags, bottles, bricks,
+plates, or any other handy device. Blankets should be put around the
+patient and every possible means resorted to, to maintain body heat.
+Mustard plasters may be put to the heart, spine and shins. Stimulants
+are necessary, such as hot black coffee if possible or hot water, in
+which a small portion of brandy may be put. If brandy is not obtainable
+the patient may take aromatic spirits of ammonia in hot water every
+twenty minutes for a number of doses. In every case of shock a physician
+should be sent for immediately.
+
+Dog Bites.--When a child is bit by a dog every effort should be made
+to get the dog. It should be kept in a safe place for a week so that it
+may be definitely known whether it is sick or not. If the dog dies
+within a few days after biting anyone it may be assumed that he had
+rabies. Its head should be sent to the local health authorities who can
+tell after examination if it was mad. If there is any reason to assume
+that the dog was infected, the child should receive the Pasteur
+treatment. This treatment will, if conducted under favorable
+circumstances, absolutely prevent hydrophobia.
+
+The mother should sterilize the wound as thoroughly as possible. This
+may be done by using pure hydrogen peroxide. A little piece of absorbent
+cotton is wound round the end of a tooth-pick or match, dipped in the
+peroxide and the incision thoroughly rubbed clean. This may be done a
+number of times to ensure thorough cleansing. No effort should be made
+to cauterize the wound. It is not considered proper to employ this
+method with dog bites. When the physician examines the wound he may or
+may not open it further for more extensive inspection and sterilization.
+
+Mothers should remember that there are thousands of bites by dogs that
+never cause any trouble, and if it is known that the dog is healthy no
+worry need trouble the family. It is also wrong to inform the child of
+the probability of hydrophobia. The child may worry himself sick with
+fear and if the mother is nervous and excitable he is apt to be made
+sick with the dread of what may follow. It is better, therefore, to
+remain quiet, to keep cool, and not to excite the little patient at all.
+
+Sprains.--Every joint is held together by ligaments which are attached
+to the bones forming the joint. If these ligaments are subjected to a
+sudden twist in a direction in which the joint is not constructed to
+move, the resulting injury is known as a sprain. The ligaments are
+stretched, though they may be torn apart and even small pieces of the
+bone may be split off if the wrench is great enough. The injury is an
+exceedingly painful one and frequently renders the limb useless for some
+time. It is always accompanied with some degree of swelling and more or
+less inflammation.
+
+A sprained joint should be immediately put at absolute rest. The best
+dressing is the lead and opium wash. Two pints of it may be obtained at
+the drug store. Pour into a large bowl, saturate a large piece of thick
+absorbent cotton, wrap around the joint and bind in place. This dressing
+may be repeated as often as the cotton becomes dry. When the swelling
+has disappeared and the pain is gone, it is desirable to have the joint
+supported with strips of adhesive bandage. These must be put on in a
+certain way in order to properly support the joint. Consequently a
+physician should put them on. If a sprain is not attended to effectively
+there is danger of the joint being more or less incapacitated for life.
+
+Dislocations.--A dislocated joint is one that has been put out of
+place. It is best to allow a physician to treat a dislocation. Unskilled
+handling of a dislocated joint may not only increase the damage but it
+may permanently put the joint out of business. Until the physician
+arrives the part should be kept absolutely at rest.
+
+Wounds of the Scalp.--Children frequently get injuries of the scalp.
+These wounds bleed freely and as a rule they occasion a great deal of
+unnecessary worry and apprehension. Usually they are not of much
+importance. We must keep in mind, however, the probability of fracture
+as a consequence of severe injury. The first thing to do when there is
+bleeding from the scalp is to cut or shave away the hair surrounding the
+wound. This should be done for an inch around the wound so that thorough
+disinfection may be possible. The wound should now be cleansed as
+previously instructed and an effort made to stop the bleeding. The best
+method is to first apply pads of gauze wrung out of very hot water. When
+success is evident a pad made of boiled cotton should be placed on the
+wound and held tightly in place for some time. If the wound is of such a
+character as to demand stitches a physician should of course put them
+in.
+
+Run-Around: Felon: Whitlow.--When pus germs enter around a finger nail
+and lodge in the soft tissue a "run-around" is the result. It is
+accompanied with pain, swelling, redness and inflammation. The loss of
+the nail may follow.
+
+A felon or Whitlow is a more extensive and a more serious condition. It
+is not always possible to trace the cause of a felon. The fact that
+germs gain an entrance, however, is soon established. Sometimes a
+bruise, or scratch, or a wound is the primary cause. The last joint of
+any of the fingers may be the seat of a felon. A end of the finger
+becomes hot, tense, swollen and very painful; the pain is intense if the
+hand is held down. The surface may or may not be red. There is as a rule
+some fever. If the felon is on the little finger or thumb the condition
+is worse than on the others as a rule,--the inflammation extending to
+the hand and often into the arm. The condition affects the palmar
+surface of the fingers. If the felon results in the "death" of the bone,
+the last joint will have to be taken off and the hand may be distorted,
+crippled, and rendered permanently disabled. Blood poison may set in and
+death is possible as a result of this complication.
+
+Treatment.--Every effort should be made to abort a felon. Continuous
+application of equal parts of alcohol and water night and day may abort
+it. Tincture of iodine applied to the entire end of the finger may be
+effective. The hand must be at rest, carried in a sling during the day
+and slung over the head to the bed-board at night. If these efforts are
+not successful after twenty-four hours hot poultices should be resorted
+to, but they must be changed every twenty minutes. If, at the end of
+another twenty-four hours, there is no improvement the finger must be
+freely cut open by a surgeon and the poultices continued.
+
+Treatment of "Run-Around."--Apply iodine freely, cold applications,
+and if the inflammation persists use poultices. It is frequently
+necessary to incise the run-around. Patients suffering from either of
+these conditions need general tonic treatment and should be under the
+care of a physician.
+
+Burns and Scalds.--Burns result from undue exposure to dry heat.
+Scalds are produced by the action of hot liquids and steam.
+
+There are always produced two results from a burn or a scald. First the
+local effect, and, second, the general effect. The general effect may
+produce shock, the symptoms of which have been described in the previous
+pages. The degree of shock depends upon the extent of the local injury
+and may be severe enough to result in death. If the local injury covers
+more than two-thirds of the body death as a rule takes place within two
+days.
+
+How to Extinguish Burning Clothing.--The thought to keep in mind is to
+smother the flames effectively. If we deprive the flame of all air or
+oxygen it will immediately subside. This may be done quickly by wrapping
+the burning part in a carpet, rug, blanket, overcoat or any large woolen
+material at hand. If none of these articles are at hand the victim may
+roll on the floor and try to smother the flame by pressure, aided by the
+hands. It is a good plan to throw water on the patient immediately after
+the fire has been put out, so as to extinguish the smoldering fire.
+
+When a person is scalded by steam or boiling water or other liquid, it
+is advisable to pour cold water freely over the wound.
+
+How to Remove the Clothing.--When it is necessary to remove the
+clothing it is essential to be gentle in order not to do greater injury.
+The clothing must not be pulled. The garment should be cut so that they
+fall off. If any part sticks to the skin, it must be left, not torn
+away. Later, it may be removed by moistening it with salt water.
+
+Treatment of Scalds and Burns.--All slight burns or scalds may be
+effectively treated with Unguentine. This substance may be obtained in
+any drug store. It is spread on a cloth and applied directly to the
+injured part, bound securely on and renewed every day until the wound is
+healed. If Unguentine is not readily obtainable the part may be covered
+with any of the following mixtures or oils: carbolated vaseline, equal
+parts of linseed oil and lime water, olive oil, castor oil or kerosene,
+cloths soaked in a solution of baking soda, or a solution of phenol
+sodique.
+
+In severe burns or scalds the mother should not attempt to treat the
+child. A physician should be summoned at once. The child may be given a
+little whisky or brandy in warm water, and if the pain is great a dose
+of laudanum may be given. The dose of laudanum is one drop for each year
+of life. If the child has a chill he may be put into a warm bath of
+100°F. It is not wise to cut a burn blister. The water may be let out by
+puncturing with a sterile needle, but the skin must be left intact until
+the new skin is grown. The treatment of burns must be done with the
+greatest cleanliness because if infected with germs they may prove
+serious.
+
+       *       *       *       *       *
+
+
+MISCELLANEOUS
+
+
+
+
+CHAPTER XL
+
+MISCELLANEOUS
+
+
+The Dangerous House Fly--Diseases Transmitted by Flies--Homes Should be
+Carefully Screened and Protected--The Breeding Places of Flies--Special
+Care Should be Given to Stables, Privy Vaults, Garbage, Vacant Lots,
+Foodstuffs, Water Fronts, Drains--Precautions to be Observed--How to
+Kill Flies--Moths--What Physicians are Doing--Radium--X-Ray Treatment
+and X-Ray Diagnosis--Aseptic Surgery--New Anesthetics--Vaccine in
+Typhoid Fever--"606"--Transplanting the Organs of Dead Men into the
+Living--Bacteria that Make Soil Barren or Productive--Anti-meningitis
+Serum--A Serum for Malaria in Sight.
+
+
+THE DANGEROUS HOUSE FLY
+
+Mothers should become thoroughly acquainted with the grave consequences
+which may result from fly-infected foods, and from the possible carriage
+of disease by means of flies, even where foods are carefully protected.
+The transmission of the following diseases by means of flies has been
+conclusively proven: typhoid fever, tuberculosis, cholera, Oriental
+plague, inflammation of the eyelids, serious infection of wounds. Summer
+diarrhea of children is also transmitted in this way.
+
+Typhoid fever and summer diarrhea of children in this country, and
+cholera and Oriental plague in the countries in which those diseases
+exist, may be transmitted through the various foods that are eaten in an
+uncooked state, if infected by flies, through cooked foods infected by
+flies after the process of cooking, through drinking water which has
+been infected by flies, and through milk similarly infected. Fruits are
+especially likely to be infected by the small fruit fly commonly found
+around markets and stands. Fish may be infected by flies, and in
+consequence will undergo rapid decomposition. Decomposition caused in
+this way has resulted in many cases of diarrhea and dysentery. What is
+commonly known as fly speck is the excreta of the fly, and frequently
+contains virulent disease germs. These specks are often found on
+foodstuffs that have not been properly protected.
+
+Transmission of disease may also occur by the infection of open wounds
+through contact with infected flies. This is true of all pus formation
+in wounds. The simple contact of a fly infected with the disease may
+cause Oriental plague, sore eyes, and possibly granular eyelids. A fly
+infected with dysentery or typhoid fever may cause either of these
+diseases by simply coming in contact with the lips of susceptible
+persons.
+
+The fly in the house should be relentlessly pursued and destroyed. The
+house which is carefully screened and protected from flies is infinitely
+safer than one not so protected. In the spring of the year the house fly
+begins to take on life. Eggs which were laid the preceding fall begin to
+hatch. At first the fly is only a little worm wriggling in some pile of
+filth. The eggs are usually laid and the grub developed in a manure pile
+or some mass of garbage or other filth. Before the grub develops into
+the fly it is easily destroyed. If everything in and about the house
+were kept scrupulously clean, and if every manure pile were kept
+carefully screened or covered so as to protect it from flies, there
+would be no difficulty in preventing the fly nuisance. The most
+effective way to accomplish this is to destroy the breeding places. The
+importance of this may be seen when it is considered that one fly
+produces one hundred and twenty-five millions or more of its kind in one
+season.
+
+Stables.--Manure is by far the commonest material in which the fly
+lays her eggs. All stables should be kept scrupulously clean. No manure
+should be allowed to accumulate where it will be exposed to flies for
+even a few minutes. Immediately after it is dropped by an animal, it
+should be removed and covered. Manure may be treated with considerable
+quantities of lime without interfering with its fertilizing value, and
+in this way the development of the eggs laid in it by the flies can be
+practically prevented. The floors of stables should be thoroughly
+flushed with water at least once in every twenty-four hours.
+
+Privy Vaults.--Human excrement also affords an excellent breeding
+place for flies. In army camps the latrines are the points from which
+much infection is transmitted to troops, and thousands of the men have
+lost their lives by contracting typhoid fever transmitted in this
+manner. During the summer time all open vaults and dry closets should be
+treated continuously with lime, crude creolin or crude carbolic acid,
+and they should be carefully cleaned out at frequent intervals.
+
+Garbage.--As a medium for the development of flies, garbage may be
+considered next in importance to excreta. The eggs of the fly hatch in
+about twenty-four hours, and garbage which is retained in the kitchen
+for that length of time may contain flies in the grub stage. To prevent
+this development, all garbage should be covered and pails should be
+emptied as often as possible. In country districts garbage should be
+burned in the kitchen or buried in the garden at frequent intervals,
+twenty-four hours being the maximum time it should be retained.
+
+Vacant Lots.--Vacant lots frequently contain appreciable quantities of
+organic matter in a state of decomposition, affording favorable breeding
+places for flies. These vacant areas should be maintained in a state of
+scrupulous cleanliness.
+
+Foodstuffs.--In order to prevent contamination of foodstuffs, all
+foods that are eaten in the raw state and all foods that are exposed for
+sale after having been cooked should be carefully protected from contact
+with flies, by screens or covers.
+
+A point where rapid development of flies takes place is along the city's
+water front. This is due to the fact that many of the sewers do not
+discharge below the level of the water. All open drains should be
+eliminated, whether they be sewers, private house drains or drains from
+cess-pools.
+
+Precautions to be Observed.--Keep the house free from flies. Every fly
+should be considered a possible disease carrier and should be destroyed.
+
+Keep the windows of the house, especially the kitchen windows,
+carefully screened during the spring, summer and autumn.
+
+Protect children from exposure to flies, particularly children who are
+ill, and do not allow nursing bottles to be exposed to flies.
+
+Protect milk and other foodstuffs from contact with flies.
+
+Keep the garbage outside of the house, carefully covered.
+
+Abolish open drains near dwelling places.
+
+Stable manure should be frequently sprinkled with lime and kept covered.
+
+Earth closets and privy vaults should be treated with lime, crude
+creolin or crude carbolic acid at frequent intervals.
+
+Earth closets and privy vaults should be cleaned frequently in order to
+prevent excrement accumulating to an undue extent.
+
+To Kill Flies.--Dissolve one dram of bichromate of potash in two
+ounces of water, add a little sugar to this solution and put some of it
+in shallow dishes and place about the house. Sticky fly paper and fly
+traps may also be used.
+
+To clean the room where there are many flies, burn pyrethrum powder
+(Persian insect powder). This stupefies the flies and in this condition
+they may be swept up and burned.
+
+Probably the best and simplest fly killer is a weak solution of
+formaldehyde in water (two teaspoonfuls to the pint). This solution
+should be placed in plates or saucers throughout the house. Ten cents'
+worth of formaldehyde, obtained in the drug store, will last an ordinary
+family all summer. Don't smell formaldehyde in the pure state; it is
+very pungent and strong. In the solution of the strength used for flies
+it has no offensive smell. It is fatal to disease organisms, and is
+practically non-poisonous except to insects. Flies will not stay in the
+house when this solution is around.
+
+Moths.--Late spring and early summer is the time to guard against
+moths and beetles. Many of these fabric-destroying insects are brought
+into the house on flowers.
+
+May and June are especially bad months, as both moths and beetles are
+only dangerous to fabrics in their young or grub stage.
+
+These insects will destroy almost anything from coarse rugs to the
+finest of ball gowns and dress suits. Carpets that are rarely swept and
+garments that are seldom disturbed are most liable to damage.
+
+The substitution of the frequently removed and easily cleaned rugs for
+carpets will greatly lessen the danger from the destructive moth and
+beetle grubs. Carpets laid on tight floors are much less liable to
+injury than where numerous cracks furnish safe retreats for the insects.
+Tarred paper under a carpet is an excellent preventive.
+
+All clothes presses should be thoroughly cleaned at frequent intervals.
+The garments should be removed, aired and vigorously brushed. Any larvæ
+which are not dislodged in this way should be destroyed. It is a bad
+plan to keep odds and ends of woolen or other materials in attics where
+these pests can breed and thus spread to more valuable articles.
+
+Spraying with benzine two or three times during hot weather is a good
+way of preventing injury to furniture or carriage upholstery and other
+articles which are in storage or not in use for a long time. If you are
+certain that woolens and furs are free from the pests they may be stored
+in safety by placing them in tight paste board boxes and sealing the
+covers firmly with gummed paper.
+
+Both moths and carpet beetles are harmless at a temperature of 40
+degrees Fahrenheit--a fact very well known to advantage by the large fur
+storage companies. They cannot survive furthermore a temperature of 120
+decrees if subjected to it for about twenty minutes.
+
+What Physicians are Doing.--It is desirable that the ordinary
+non-medical individual should know what the science of medicine is doing
+and what it is accomplishing.
+
+During the past fifteen years the art of curing and preventing disease
+has taken on giant strides. The man or woman most ready to question the
+accomplishments and the ability of the humble family physician or the
+motive of the science of medicine, is the one who appreciates least that
+it is due to the skill and intelligence of the medical men of to-day
+that he owes his comfort, his health, and his freedom from pestilence,
+plague and disease. Unthinking people laud and praise some upstart whose
+ability lies in his faculty to fool the gullible, or they will rush to
+seek the false aid of some nondescript science, because it is popular
+and well advertised, while they pass by or ignore the men whose labors
+have made the world what it is, and who alone possess the ability to
+intelligently wage the battle in the interest of humanity against
+disease.
+
+The medical profession has repeatedly pointed out that there are, on an
+average, six hundred thousand lives lost every year in the United States
+from preventable disease and accidents. Six hundred thousand lives which
+medical science has at hand the remedy to save, but which the medical
+profession sacrificed because of inadequate legislation. Few people can
+comprehend just what six hundred thousand lives mean. Let us put it in
+another way. There are destroyed by preventable disease and accidents
+every day American lives equal in number to the crews of two battle
+ships, equal in three months to more than the total combined numbers of
+the Army and Navy of the United States; equal in one year to more than
+the total number of lives lost in all our wars since the Declaration of
+Independence.
+
+The Titanic disaster shocked the public for a moment, and seemed to
+impress them as though it was a terrible and unheard of waste of good
+human lives. Yet in the loss of life due to preventable causes we have
+in this country every day in the year a destruction of our citizens
+exceeding in magnitude that which occurred when the Titanic sank.
+Think of it! A Titanic disaster a day, and yet the public does not
+rise up and demand in a spirit of anger and determination that steps be
+taken at once to put an end to this appalling and unnecessary waste of
+lives.
+
+Under modern hygienic conditions, the average length of existence for an
+individual in Great Britain has increased ten years in the last half
+century. Among all the enlightened and advanced nations, the expectation
+of the individual for long survival is greater. Since the appearance of
+uncheckable and epidemic disorders is less frequent and the percentage
+of cures is greater.
+
+Since quarantine has been regularly established and the sewage system
+made efficient in large cities, and since the sanitary plumbing laws
+have been made compulsory, the general death rate has decreased
+enormously. These regulations have been the product of regularly
+educated medical or sanitary experts. No 'ism or 'ology has ever
+established any scientific principle which has contributed to the
+general welfare of the people. We no longer fear the plague, or typhus
+or yellow fever, cholera, diphtheria, typhoid, consumption, and other
+diseases which once were a constant menace to the race. The plague, for
+example, is practically limited to the Far East, where modern methods
+cannot evidently be introduced efficiently. At one time it periodically
+devastated Europe, where it cannot now get a foothold because of the
+introduction of sanitary systems and hygienic principles.
+
+Tetanus or lockjaw and hydrophobia are now amenable to cure while
+formerly all cases were practically fatal. The mortality of diphtheria
+has been reduced more than fifty per cent. Antiseptic precautions in
+surgical cases, first introduced by the famous surgeon, Lord Lister,
+have made possible and successful operations that formerly could not be
+undertaken, thus broadening the whole field of surgical possibilities.
+The Boer war and the war with Spain proved this truth in a way that
+could not be denied. Smallpox is almost a medical curiosity in New York
+City, where it once was a scourge. The mortality of childbirth has been
+reduced to about one-fifth of what it was by the introduction of
+antiseptics and anesthetics. The new methods of making and preparing
+drugs, the sterilization and inspection of milk, the methods devised for
+the care of and preparation of infant foods have all enormously
+contributed to checking disease, to preventing disease, and to
+increasing the length of life and its happiness.
+
+These are all facts which may be proved by any one, no matter how
+incompetent they may be. If we were to give up all these hard earned
+victories, cease to investigate or experiment, deny the existence of
+disease, and depend upon the questionable methods of hysterical
+emotionalists we would soon find ourselves facing all the horrors of the
+past. Can we afford to lose the priceless benefits we have achieved and
+are attaining? Can we sit still and permit the profession of medicine,
+which has always contained the best of the race in its membership, the
+best intellects, the most sympathetic and unselfish characters, the
+noblest and most steadfast souls, to be maligned and assailed, to have
+its means of well-doing assaulted and threatened, when we know that it
+should be supported and protected for the sake of all it has done in the
+past in the interest of humanity?
+
+Every mother should be acquainted with these facts so that she may lend
+her influence in behalf of honest effort and honest inquiry.
+
+The following summary comprises a brief review of what medicine has been
+doing in the recent past:
+
+Radium.--This element was discovered about fifteen years ago by
+Professor and Mme. Curie. It possesses the wonderful property of giving
+out inexhaustible stores of energy. It virtually possesses the property
+of perpetual motion. Professor Becquerel was the first one to suggest
+that it might possess therapeutic or healing powers. The suggestion came
+to him in a curious way. He carried a tube of radium in his vest pocket
+and was severely burnt as a consequence. The incident suggested to him
+that, if radium could attack healthy tissue in such a short time, it
+should be able to similarly attack diseased tissue. Experiments were
+soon instituted, and are still being conducted to exactly define its
+curative value and scope.
+
+It was hailed as a cure for cancer and other serious conditions, but we
+have found that it is not a cure for these ailments. It is, however,
+exceedingly valuable in the treatment of certain skin diseases. In
+lupus, epithelial tumors, ulcers, papillomata, angiomata and pruritus,
+it is being widely and successfully used. It was later discovered that
+it can quickly kill disease-producing bacteria. It is also well known
+that it will efficiently purify water.
+
+X-Ray Treatment and X-Ray Diagnosis.--Professor Roentgen gave to the
+world an exceedingly valuable discovery in the X-Ray. He discovered
+that a certain form of electrical energy, when applied in a certain way,
+would produce shadows that differentiated between a certain degrees of
+opacity. For example, it would, if directed upon the human hand, produce
+shadows that clearly indicated whether the substance through which the
+rays passed was bone or muscle. The chief value of the X-Rays has been
+found to be this property rather than any healing value which has been
+attributed to them. The fact that these shadows can be photographed has
+rendered them of supreme value in surgery and medicine. Previously it
+was essential that the surgeon should depend upon his own diagnosis,
+upon what he could learn from his sense of touch and from surrounding
+conditions. With the X-Rays at his disposal he can quite eliminate the
+personal equation. His pictures are precise and mathematically accurate;
+he can prove the truth of his diagnosis before he cuts. We can take
+pictures of fractured bones and from what we learn we can immediately
+tell how they should be set to attain the very best results. We can
+actually tell if there is a stone in the kidney before we subject the
+patient to a serious operation. We can actually take pictures of the
+stomach at various stages of digestion and tell what disease affects the
+individual with a degree of precision that was not possible before the
+X-Rays were introduced. These examples only suggest its use. There are a
+multiplicity of uses for these as yet unknown rays which have greatly
+aided in diagnosis and consequently in successful treatment.
+
+Aseptic Surgery.--The utility of the aseptic principle in surgery was
+demonstrated by the Japanese army surgeons during the war with Russia in
+1904-1905. Their success in preventing deaths from suppurating wounds
+amazed the world. Their method was to discard the use of antiseptics and
+to depend upon absolutely clean instruments, dressings and hands. The
+most terrible wounds healed under this method without festering. This
+is, of course, the method in vogue to-day all over the civilized world.
+The Japanese did not discover aseptic surgery, but they were the first
+to put it to actual test in a large way. The old method was to depend
+upon drugs to kill the germs which might find their way into wounds and
+operations. To-day we prevent the germs from getting into the wound and
+depend upon nature to do the rest.
+
+New Anesthetics.--Several important advances have been made in methods
+of giving anesthetics and in the nature of the products used. Temporary
+unconsciousness with electricity was induced in 1909 by Dr. Stephane
+Leduc. Stovaine was invented by Dr. Jonnesco, of Bucharest. He injected
+it into the spinal cord after the method made famous by Biers with
+cocaine in 1899. Dr. W. S. Schley invented novocaine for the same
+purpose. Temporary unconsciousness was accomplished by the use of epsom
+salts injected into the spinal cord by Dr. Samuel J. Meltzer. All of
+these efforts to discover a harmless anesthetic by spinal injection were
+made possible by investigations and experiments of Dr. J. Leonard
+Corning, of New York, who worked along this line as far back as 1885.
+The most revolutionary discovery, however, was that of Dr. S. J. Meltzer
+at the Rockefeller Institute, New York, when he inserted a tube into the
+windpipe, through which he pumped the anesthetic into the lungs. While
+doing this he at the same time pumped oxygen to aerate the blood, thus
+ensuring the patient against possible accident during the course of
+difficult and tedious operations on the lungs and heart.
+
+Vaccine in Typhoid Fever.--Inasmuch as typhoid fever has played an
+important part in the conduct of all wars, it has always been a source
+of much careful study by military and naval surgeons in every civilized
+country in the world. We had not, however, reached a stage when it was
+possible to hope for its extermination until medical science began to
+appreciate the possibilities of vaccine therapy. The Cuban, Boer and
+Russian wars, because of the terrible experiences of the soldiers with
+typhoid in each of them, stimulated inquiry along the line of
+discovering a serum of vaccine that would be effectual against it.
+American, British, French and Japanese military and naval surgeons
+instituted experiments simultaneously to discover an anti-typhoid
+vaccine. In the fall of 1909, American army surgeons were experimenting
+with a serum at Washington and on Governor's Island with success, but
+the first public announcement of an absolutely successful vaccine was
+made by Captain Vincent of the French navy on June 20th, 1910, before
+the Académie de Medicine in Paris. The final success of the anti-typhoid
+serum has been conclusively proved by elaborate tests upon soldiers and
+sailors in many nations.
+
+It is difficult for the ordinary individual to appreciate the
+significance and importance of a discovery of this character and
+magnitude. When one thinks calmly of the thousands and thousands of men
+who have lost their lives during wars because of typhoid epidemics, and
+of the thousands of others who have returned home practically invalided
+for life from the same cause, it is possible to, at least, conceive of
+the benefit to the race such a discovery promises. And when we learn
+that the discovery is a product of the same principle or method which
+gave to the world a cure for smallpox, diphtheria and syphilis, we must
+begin to believe that the medical profession is on the path which is
+unlimited in its field of promise so far as efficient treatment is
+concerned. Yet to-day we have people who do not believe in vaccination
+or in anti-diphtheritic serum. We may not live to see the time, but it
+is not far distant in the opinion of men qualified to speak with
+authority, when every disease will be amenable to the serum therapy, and
+when drugs will virtually be discarded by the human race.
+
+"606."--One of the most important discoveries in the history of
+medicine was recently given to the world by Dr. Paul Ehrlich.
+
+He called it "606," because it was the 606th experiment he had made with
+the same end in view. It was designed with the purpose of curing the
+most terrible disease known to man, syphilis. The name of the remedy is
+salvarsan. That it will do all that was first claimed for it is still
+doubtful, but salvarsan and its improvements, neosalvarsan, etc., are
+accepted by the profession as by far the best treatment yet devised for
+this dread disease. It points the way for improvement along the same
+line to an ultimate specific.
+
+Transplanting the Organs of Dead Men Into Living Men.--To take from a
+recently dead individual a kidney, or a bone, or an artery, and by
+immersing them in certain fluids thereby keeping them alive
+indefinitely, and later transplanting them in the body of a living
+individual so that they will continue to live and perform their function
+in the new environment, is a revolutionary and a seemingly incredible
+performance. Yet Dr. Alexis Carrel of the Rockefeller Institute, New
+York, has accomplished this wonderful task. The smallest imagination can
+picture the possibilities of this kind of surgery, but, inasmuch as the
+discovery is so recent and the opportunities for testing it upon human
+beings are so relatively few, that time alone can tell how far it may be
+possible to go.
+
+Anti-Meningitis Serum.--Another important discovery that has emanated
+from the Rockefeller Institute is the Anti-Meningitis serum. The death
+rate from spinal meningitis, before the introduction of the serum, was
+70 per cent., the use of the serum has reduced this percentage to 30. We
+owe this important contribution to Dr. Simon Flexner.
+
+A Serum for Malaria Now Possible.--Dr. C. C. Bass, of Tulane
+University, has succeeded in extracting malaria-producing parasites from
+human blood and keeping them alive in test tubes. This feat had been
+long attempted but never before with success. The significance of this
+achievement is that it is the first step toward preparing a serum that
+will give immunity to malaria.
+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume IV. (of
+IV.), by Grant Hague
+
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+  <head>
+    <meta http-equiv="Content-Type" content=
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+    <title>
+      The Project Gutenberg eBook of The Eugenic Marriage, Volume 4, by W. Grant Hague
+    </title>
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+<pre>
+
+Project Gutenberg's The Eugenic Marriage, Volume IV. (of IV.), by Grant Hague
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume IV. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: Grant Hague
+
+Release Date: May 11, 2007 [EBook #21418]
+
+Language: English
+
+Character set encoding: ISO-8859-1
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Ross Wilburn, Bruce Albrecht
+and the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+
+</pre>
+
+
+<table border="0" cellpadding="10" style="background-color: #ccccff;" summary="TN">
+  <tr>
+    <td width="25%" valign="top">
+      Transcriber's note:
+    </td>
+    <td>
+        Obvious typographical errors have been corrected and a few
+        punctuation variants have been normalized.
+    </td>
+  </tr>
+</table>
+
+ <div class="figcenter" style="width: 400px;">
+<a id="v4frontis" name="v4frontis"></a>
+<img src="images/v4frontis.jpg" width="400" height="178"
+         alt="More Babies Like These" title="More Babies Like These" />
+<span class="caption">Courtesy of New York World<br />
+<b>More Babies Like These</b></span>
+</div>
+
+<p style="margin-left: 20%; margin-right: 15%;">These nine little tots are all sound, healthy stock. The generations
+behind them had unconsciously been practicing Eugenics through the
+process of natural selection. By luck, as it were, no strain was
+bred into the several families that would have caused these children
+to be unsound mentally, morally, or physically.</p>
+
+<p style="margin-left: 20%; margin-right: 15%;">It is through Eugenics that we shall have more babies like these,
+and shall eliminate the possibility of children like those shown in
+the other illustrations to this volume.
+</p>
+
+<h1>The Eugenic Marriage</h1>
+
+<h2>A Personal Guide to the<br />
+New Science of Better<br />
+Living and Better Babies</h2>
+
+<h3>By W. GRANT HAGUE, M.D.</h3>
+
+<h4>College of Physicians and Surgeons (Columbia
+University), New York; Member of County Medical
+Society, and of the American Medical Association</h4>
+
+<h2>In Four Volumes</h2>
+
+<h2>VOLUME IV</h2>
+
+<h4>New York</h4>
+
+<h3>THE REVIEW OF REVIEWS COMPANY</h3>
+
+<h4>1914</h4>
+
+<p class="center" style="margin-top: 2em;">Copyright, 1913, by
+ <font class="sc">W. Grant Hague</font></p>
+
+<p class="center" style="margin-top: 2em;">Copyright, 1914, by
+ <font class="sc">W. Grant Hague</font></p>
+
+  <br clear="all" />
+<hr class="full" />
+
+
+<h3>TABLE OF CONTENTS</h3>
+<hr class="full" />
+
+<table border="0" cellpadding="2" summary="TOC">
+  <tr><td><h4><a href="#LIST_OF_ILLUSTRATIONS">LIST OF ILLUSTRATIONS</a></h4></td></tr>
+  <tr><td> <h4><font class="sc">Accidents and Emergencies</font></h4></td></tr>
+
+<tr><td><h4>CHAPTER XXXIV</h4></td></tr>
+<tr><td><h4><font class="sc">COMMON DISEASES OF THE NOSE, MOUTH,
+AND CHEST</font></h4></td><td>PAGE</td></tr>
+<tr><td><blockquote> <p>"Catching Cold"&mdash;Sitting on the Floor&mdash;Kicking the Bed
+Clothes Off&mdash;Inadequate Head Covering&mdash;Subjecting
+Baby to Different Temperatures Suddenly&mdash;Wearing
+Rubbers&mdash;Direct Infection&mdash;Acute Nasal Catarrh&mdash;Acute
+Coryza&mdash;Acute Rhinitis&mdash;"Cold in the Head"&mdash;
+"Snuffles"&mdash;Treatment of Acute Nasal Catarrh, or
+Rhinitis, or Coryza, or "Cold in the Head," or "Snuffles"&mdash;Chronic
+Nasal Catarrh&mdash;Chronic Rhinitis&mdash;Chronic
+Discharge from the Nose&mdash;Nervous or Persistent Cough&mdash;Adenoids
+as a Cause of Persistent Cough&mdash;Croup&mdash;Acute
+Catarrhal Laryngitis&mdash;Spasmodic Croup&mdash;False
+Croup&mdash;Tonsilitis&mdash;Angina&mdash;Sore Throat&mdash;Symptoms of
+Tonsilitis&mdash;Treatment of Tonsilitis&mdash;Bronchitis in
+Infants&mdash;Bronchitis in Older Children&mdash;"Don'ts" in
+Bronchitis&mdash;Diet in Bronchitis&mdash;Inhalations in Bronchitis&mdash;
+External Applications in Bronchitis&mdash;Drugs in Bronchitis&mdash;Chronic
+or Recurrent Bronchitis&mdash;Pneumonia&mdash;Acute
+Broncho-pneumonia&mdash;Symptoms of Broncho-pneumonia&mdash;How
+to Tell When a Child has Broncho-pneumonia&mdash;Treatment
+of Broncho-pneumonia&mdash;The After-treatment of Broncho-pneumonia&mdash;
+Adenoids&mdash;How to Tell When a Child has Adenoids&mdash;Treatment of
+Adenoids&mdash;Nasal Hemorrhage&mdash;"Nose-bleeds"&mdash;Treatment
+of Nose-bleeds&mdash;Quinsy&mdash;Hiccough&mdash;Sore Mouth&mdash;
+Stomatitis&mdash;Treatment of Ulcers of the Mouth&mdash;Sprue&mdash;
+Thrush...</p></blockquote></td>
+<td class="b"><a href="#Page_497">497</a></td></tr>
+
+<tr><td><h4>CHAPTER XXXV</h4></td></tr>
+
+<tr><td><h4><font class="sc">diseases of the stomach and gastro-intestinal
+canal</font></h4></td></tr>
+
+<tr><td><blockquote><p>Inflammation of the Stomach&mdash;Acute Gastritis&mdash;Persistent
+Vomiting&mdash;Acute Gastric Indigestion&mdash;Iced Champagne
+in Persistent Vomiting&mdash;Acute Intestinal Diseases of
+Children&mdash;Conditions Under Which They Exist and Suggestions
+as to Remedial Measures&mdash;Acute Intestinal
+Indigestion&mdash;Symptoms of Acute Intestinal Indigestion&mdash;Treatment
+of Acute Intestinal Indigestion&mdash;Children
+with Whom Milk Does Not Agree&mdash;Chronic or Persistent
+Intestinal Indigestion&mdash;Acute Ileo-colitis&mdash;Dysentery&mdash;
+Enteritis&mdash;Entero-colitis&mdash;Inflammatory Diarrhea&mdash;Chronic
+Ileo-colitis&mdash;Chronic Colitis&mdash;Summer Diarrhea&mdash;Cholera
+Infantum&mdash;Gastro-enteritis&mdash;Acute Gastro-enteric
+Infection&mdash;Gastro-enteric Intoxication&mdash;Colic
+Appendicitis&mdash;Jaundice in Infants&mdash;Jaundice in Older
+Children&mdash;Catarrhal Jaundice&mdash;Gastro-duodenitis&mdash;Intestinal
+Worms&mdash;Worms, Thread, Pin and Tape&mdash;Rupture...</p></blockquote></td>
+<td class="b"><a href="#Page_527">527</a></td></tr>
+
+<tr><td><h4>CHAPTER XXXVI</h4></td></tr>
+
+<tr><td><h4><font class="sc">diseases of children </font>(continued)</h4></td></tr>
+
+<tr><td><blockquote><p>Mastitis or Inflammation of the Breasts in Infancy&mdash;Mastitis
+in Young Girls&mdash;Let Your Ears Alone&mdash;Never Box
+a Child's Ears&mdash;Do Not Pick the Ears&mdash;Earache&mdash;Inflammation
+of the Ear&mdash;Acute Otitis&mdash;Swollen Glands&mdash;Acute
+Adenitis&mdash;Swollen Glands in the Groin&mdash;Boils&mdash;Hives&mdash;
+Nettle Rash&mdash;Prickly Heat&mdash;Ringworm in the
+Scalp&mdash;Eczema&mdash;Poor Blood&mdash;Simple Anemia&mdash;Chlorosis&mdash;
+Severe Anemia&mdash;Pernicious Anemia ...</p></blockquote></td>
+<td class="b"><a href="#Page_553">553</a></td></tr>
+
+<tr><td><h4>CHAPTER XXXVII</h4></td></tr>
+
+<tr><td><h4><font class="sc">diseases of children </font>(continued)</h4></td></tr>
+
+<tr><td><blockquote><p>Rheumatism&mdash;Malaria&mdash;Rashes of Childhood&mdash;Pimples&mdash;
+Acne&mdash;Blackheads&mdash;Convulsions&mdash;Fits&mdash;Spasms&mdash;
+Bed-wetting&mdash;Enuresis&mdash;Incontinence&mdash;Sleeplessness&mdash;Disturbed
+Sleep&mdash;Nightmare&mdash;Night Terrors&mdash;Headache&mdash;Thumb-sucking&mdash;Biting
+the Finger Nails&mdash;Colon Irrigation&mdash;How
+to Wash Out the Bowels&mdash;A High Enema&mdash;Enema&mdash;Methods
+of Reducing Fever&mdash;Ice Cap&mdash;Cold Sponging&mdash;Cold Pack&mdash;The
+Cold Bath&mdash;Various Baths&mdash;Mustard Baths&mdash;Hot Pack&mdash;Hot
+Bath&mdash;Hot Air, or Vapor Bath&mdash;Bran Bath&mdash;Tepid Bath&mdash;Cold
+Sponge&mdash;Shower Bath&mdash;Poultices&mdash;Hot Fomentations&mdash;How
+to Make and How to Apply a Mustard Paste&mdash;How to Prepare and Use the
+Mustard Pack&mdash;Turpentine Stupes&mdash;Oiled Silk, What it is and Why it
+is Used ...</p></blockquote></td>
+<td class="b"><a href="#Page_569">569</a></td></tr>
+
+<tr><td><h3><font class="sc">Diseases of Children</font></h3></td></tr>
+
+<tr><td><h4>CHAPTER XXXVIII</h4></td></tr>
+
+<tr><td><h4><font class="sc">infectious or contagious diseases</font></h4></td></tr>
+
+<tr><td><blockquote><p>Rules to be Observed in the Treatment of Contagious Diseases&mdash;What
+Isolation Means&mdash;The Contagious Sick
+Room&mdash;Conduct and Dress of the Nurse&mdash;Feeding the
+Patient and Nurse&mdash;How to Disinfect the Clothing and
+Linen&mdash;How to Disinfect the Urine and Feces&mdash;How to
+Disinfect the Hands&mdash;Disinfection of the Room Necessary&mdash;How
+to Disinfect the Mouth and Nose&mdash;How to
+Disinfect the Throat&mdash;Receptacle for the Sputum&mdash;Care
+of the Skin in Contagious Diseases&mdash;Convalescence After
+a Contagious Disease&mdash;Disinfecting the Sick Chamber&mdash;The
+After Treatment of a Disinfected Room&mdash;How to
+Disinfect the Bed Clothing and Clothes&mdash;Mumps&mdash;Epidemic
+Parotitis&mdash;Chicken Pox&mdash;Varicella&mdash;La Grippe&mdash;
+Influenza&mdash;Diphtheria&mdash;Whooping
+Cough&mdash;Pertussis&mdash;Measles&mdash;Koplik's
+Spots&mdash;Department of Health Rules
+in Measles&mdash;Scarlet Fever&mdash;Scarlatina&mdash;Typhoid Fever&mdash;
+Various Solutions&mdash;Boracic Acid Solution&mdash;Normal
+Salt Solution&mdash;Carron Oil&mdash;Thiersch's Solution&mdash;Solution
+of Bichloride of Mercury&mdash;How to Make Various
+Solutions ....</p></blockquote></td>
+<td class="b"><a href="#Page_599">599</a></td></tr>
+
+<tr><td><h3><font class="sc">Accidents and Emergencies</font></h3></td></tr>
+
+<tr><td><h4>CHAPTER XXXIX</h4></td></tr>
+
+<tr><td><h4><font class="sc">accidents and emergencies</font></h4></td></tr>
+
+<tr><td><blockquote><p>Accidents and Emergencies&mdash;Contents of the Family Medicine
+Chest&mdash;Foreign Bodies in the Eye&mdash;Foreign Bodies
+in the Ear&mdash;Foreign Bodies in the Nose&mdash;Foreign Bodies
+in the Throat&mdash;A Bruise or Contusion&mdash;Wounds&mdash;Arrest
+of Hemorrhage&mdash;Removal of Foreign Bodies
+from a Wound&mdash;Cleansing a Wound&mdash;Closing and
+Dressing Wounds&mdash;The Condition of Shock&mdash;Dog Bites&mdash;
+Sprains&mdash; Dislocations&mdash;Wounds   of the Scalp&mdash;
+Run-around&mdash;Felon&mdash; Whitlow&mdash;Burns and Scalds ...</p></blockquote></td>
+<td class="b"><a href="#Page_629">629</a></td></tr>
+
+<tr><td><h4><font class="sc">Miscellaneous</font></h4></td></tr>
+
+<tr><td><h4>CHAPTER XL</h4></td></tr>
+
+<tr><td><h4><font class="sc">miscellaneous</font></h4></td></tr>
+
+<tr><td><blockquote><p>The Dangerous House Fly&mdash;Diseases Transmitted by Flies&mdash;Homes
+Should be Carefully Screened and Protected&mdash;The
+Breeding Places of Flies&mdash;Special Care Should be
+Given to Stables, Privy Vaults, Garbage, Vacant Lots,
+Foodstuffs, Water Fronts, Drains&mdash;Precautions to be
+Observed&mdash;How to Kill Flies&mdash;Moths&mdash;What Physicians
+are Doing&mdash;Radium&mdash;X-Ray Treatment and X-Ray
+Diagnosis&mdash;Aseptic Surgery&mdash;New Anesthetics&mdash;Vaccine
+in Typhoid Fever&mdash;"606"&mdash;Transplanting the Organs of
+Dead Men into the Living&mdash;Bacteria that Make Soil
+Barren or Productive&mdash;Anti-meningitis Serum&mdash;A Serum
+for Malaria in Sight ...</p></blockquote></td>
+<td class="b"><a href="#Page_645">645</a></td></tr></table>
+
+<hr class="full" />
+
+<h3><a name="LIST_OF_ILLUSTRATIONS" id="LIST_OF_ILLUSTRATIONS"></a>
+LIST OF ILLUSTRATIONS</h3>
+<div class='center'>
+<table border="0" cellpadding="2" cellspacing="0" summary="LOI">
+
+<tr><td align='left'>&nbsp;</td><td align='right'>
+<span class="smcap">Page</span></td></tr>
+<tr><td align='left'>More Babies Like These</td>
+<td align='right'><a href="#v4frontis">Frontispiece</a></td></tr>
+<tr><td align='left'>A Grim Result</td>
+<td align='right'><a href="#v4pg518">(Facing 519)</a></td></tr>
+<tr><td align='left'>"A Misfortune at Birth"</td>
+<td align='right'><a href="#v4pg566">(Facing 567)</a></td></tr>
+<tr><td align='left'>The First Blight</td>
+<td align='right'><a href="#v4pg597">(Facing 599)</a></td></tr>
+</table></div>
+
+<hr class="full" />
+<h3>ACCIDENTS AND EMERGENCIES</h3>
+
+<hr style="width: 65%;" />
+
+<p><span class='pagenum'><a name="Page_497" id="Page_497">[497]</a></span>
+</p>
+<h2>CHAPTER XXXIV</h2>
+
+<h3>COMMON DISEASES OF THE NOSE, MOUTH,
+AND CHEST</h3>
+
+<div class="blockquote"><p>"Catching Cold"&mdash;Sitting on the Floor&mdash;
+Kicking the Bed Clothes Off&mdash;Inadequate Head Covering&mdash;Subjecting
+Baby to Different Temperatures Suddenly&mdash;Wearing
+Rubbers&mdash;Direct Infection&mdash;Acute Nasal Catarrh&mdash;Acute
+Coryza&mdash;Acute Rhinitis&mdash;"Cold in the Head"&mdash;"Snuffles"&mdash;
+Treatment of Acute Nasal Catarrh, or Rhinitis, or Coryza, or "Cold in the
+Head," or "Snuffles"&mdash;Chronic Nasal Catarrh&mdash;Chronic Rhinitis&mdash;
+Chronic Discharge from the Nose&mdash;Nervous or Persistent Cough&mdash;
+Adenoids as a Cause of Persistent Cough&mdash;Croup&mdash;Acute
+Catarrhal Laryngitis&mdash;Spasmodic Croup&mdash;False
+Croup&mdash;Tonsilitis&mdash;Angina&mdash;Sore Throat&mdash;Symptoms of
+Tonsilitis&mdash;Treatment of Tonsilitis&mdash;Bronchitis in Infants&mdash;
+Bronchitis in Older Children&mdash;"Don'ts" in Bronchitis&mdash;Diet
+in Bronchitis&mdash;Inhalations in Bronchitis&mdash;External
+Applications in Bronchitis&mdash;Drugs in Bronchitis&mdash;Chronic
+or Recurrent Bronchitis&mdash;Pneumonia&mdash;Acute
+Broncho-pneumonia&mdash;Symptoms of Broncho-pneumonia&mdash;How
+to Tell When a Child has Broncho-pneumonia&mdash;Treatment
+of Broncho-pneumonia&mdash;The
+After-treatment of Broncho-pneumonia&mdash;Adenoids&mdash;How
+to Tell When a Child has Adenoids&mdash;Treatment of
+Adenoids&mdash;Nasal Hemorrhage&mdash;"Nose-bleeds"&mdash;Treatment
+of Nose-bleeds&mdash;Quinsy&mdash;Hiccough&mdash;Sore Mouth&mdash;
+Stomatitis&mdash;Treatment of Ulcers of the Mouth&mdash;Sprue&mdash;Thrush.
+</p></div>
+
+<h3>"CATCHING COLDS"</h3>
+
+<p>Mothers frequently wonder where their children get
+colds. Briefly we will point out some of the sources from
+which these apparently inexplicable colds may come.</p>
+
+<p><b>A. Sitting on the Floor</b>.&mdash;Children should not be allowed
+to sit or crawl upon the floor at any season of the
+year, but especially during the winter months. There is
+always a draught of cold air near the floor. It is a bad
+habit to begin allowing a child to play with its toys on the
+floor. Use the bed or a sofa or a platform raised a foot
+from the floor.</p>
+
+<p><span class='pagenum'>[<a name="Page_498" id="Page_498">498</a>]</span>
+<b>B. Kicking the Bed Clothes Off During the Night</b>.&mdash;The
+bed clothes should be securely pinned to the mattress
+by large safety pins. When it is established as a habit
+a child who kicks off the bed clothes should wear a
+combination night suit with "feet," made of flannel during
+the winter and of cotton during the summer.</p>
+
+<p><b>C. Inadequate Head Covering</b>.&mdash;Professor Kerley
+states that this is one of the "most frequent causes of
+disease of the respiratory tract in the young." He calls
+attention to the fact that "mothers carefully clothe the
+baby with ample coats, blankets, leggings, etc., before
+they take him out for the daily walk. They dress him
+in a warm room taking plenty of time to put on the
+extra clothes, during which time the baby frets and
+perspires. When all is ready they place upon the hot,
+almost bald head of the baby a light artistically decorated
+airy creation which is sold in the shops as children's
+caps. The child is then taken out of doors and because of
+the inadequate covering of the hot perspiring head,
+catches cold and the mother never knows how it came."
+Every baby and child should wear under such caps a skull
+cap of thin flannel, especially in cold weather. In summer
+or windy day a light silk handkerchief folded under the
+cap is a very excellent protection.</p>
+
+<p><b>D. Subjecting a Baby to Different Temperatures
+Suddenly</b>, is liable to be followed by a cold&mdash;for example,
+taking the child from a warm room to a cold room, or
+through a cold hall, holding the child at an open window
+for a few moments.</p>
+
+<p><b>E. The Practice of Wearing Rubbers Needs Some
+Consideration</b>.&mdash;They should never be worn indoors for
+even five minutes. They should not therefore be kept on
+in school, nor should they be worn by women in stores
+when they go shopping. When it is actually raining, or
+snowing, or when there is slush or wet mud they are needful;
+but they should not be worn simply because the
+weather is threatening or damp. Children should not
+put them on to play&mdash;worn for any length of time when
+active they are harmful. If worn to and from school they
+should be taken off at once when in school or at home.
+Wearing rubbers prevents free evaporation of the natural
+<span class='pagenum'>[<a name="Page_499" id="Page_499">499</a>]</span>
+secretion of the skin, keeps the feet moist and invites
+colds and catarrh. In damp weather, or when children
+play during winter months, they should be shod with
+stout shoes with cork insoles.</p>
+
+<p>The same argument applies to storm coats of rubber,
+water-proof material. They should not be worn as overcoats
+all day, but only when going to and from school or
+business when it is actually storming.</p>
+
+<p>Underclothing or hosiery should not be heavy enough
+to cause moisture of the skin. Health demands a dry skin
+at all times. The necessary degree of body heat should be
+attained by the quality of the outer clothing, not by the
+quantity of the underclothing. Many men and women
+wear heavy underclothing which causes moisture when
+indoors, with the result that they get surface chills when
+they go outside if the weather is cold and as a result catch
+cold. The underclothing should be just heavy enough to
+be comfortable indoors and the extra warmth necessary
+when outside should be supplied by a good overcoat or
+furs.</p>
+
+<p><b>F. Direct Infection</b>.&mdash;A baby may catch cold if kissed
+or "hugged" by an adult who has a cold.</p>
+
+<p>Catching cold while bathing is possible, but scarcely
+probable, if ordinary precautions are taken. It is very
+bad practice to permit children to use one another's
+handkerchiefs or the handkerchief of an adult. Certain
+children are predisposed to attacks of "cold in the head"
+or acute coryza or nasal catarrh (these being the medical
+names for this condition). Sometimes this is an inherited
+characteristic. There is no doubt, however, that most
+of these children acquire the habit by bad sanitary and
+hygienic surroundings. These children do not as a rule
+get enough fresh air. They are kept indoors most of the
+time in stuffy, overheated, badly ventilated rooms, unless
+the weather is absolutely perfect. The windows in their
+bedrooms are always kept closed, because they are "liable
+to catch cold." They are overdressed and perspire easily
+and as a result "catch cold." These conditions all tend
+to create an unhealthy condition of the nasal mucous
+membrane and of the throat, and this is rendered worse
+if the child lives in a damp, changeable climate, such as
+<span class='pagenum'>[<a name="Page_500" id="Page_500">500</a>]</span>
+that of New York City. In these susceptible children the
+exciting cause of an attack may be trivial; exposure, cold
+or wet feet, inadequate head covering (as already pointed
+out), a draught of cold air even may excite sneezing
+and a nasal discharge; hence we have:</p>
+
+<p><b>Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis,
+"Cold in the Head", "Snuffles")</b>.&mdash;Acute nasal catarrh
+may accompany measles, diphtheria, influenza, and
+whooping cough.</p>
+
+<p><b>Symptoms</b>.&mdash;The onset is sudden with sneezing, and
+difficulty in breathing through the nose. In a few hours,
+or it may be not for a day or two, a mucous, watery, nasal
+discharge appears. There are redness and slight swelling
+of the nose and upper lip, caused by the discharge. There
+is no fever as a general rule except in very young
+infants, in whom the fever may be very high. The discharge
+interferes with the nursing and the child suffers
+from lack of nourishment. The inflammation may extend
+to the eyes and ears, causing painful complications, or to
+the throat and bronchi, causing hoarseness and cough.
+Less frequently we have disturbances of the digestive
+tract with vomiting, or diarrhea.</p>
+
+<p>The mild form of the disease lasts for two or three
+days, the severe form from one to two weeks.</p>
+
+<p>Repeated attacks are said to contribute to the production
+of adenoid growths.</p>
+
+<p>An acute attack of this disease is seldom a serious affliction
+in older children; it may be, however, very serious
+and even dangerous in very young infants. The tendency
+of the disease to extend downward, causing bronchitis or
+pneumonia, explains in part the possible danger to a baby.
+Another reason is because it may seriously interfere with
+suckling and with breathing in these little patients. It
+may even cause sudden attacks of strangulation. An
+infant, therefore, suffering with an acute attack of rhinitis
+requires constant attention. It may be necessary to feed
+it with a spoon, and if necessary mother's milk should
+be so fed. Plenty of fresh air should be provided. It may
+be essential to keep the mouth open in order that it may
+get enough fresh air. Every effort should be made to
+keep the nostrils open. The secretions must be removed
+<span class='pagenum'>[<a name="Page_501" id="Page_501">501</a>]</span>
+from time to time. Causing the child to sneeze by tickling
+the nose with a camel's hair brush will clear the nose for
+the time being. The physician may be compelled to use a
+solution of cocaine for this purpose.</p>
+
+<p><b>Treatment of Acute Rhinitis ("Taking Cold", Nasal
+Catarrh, Acute Coryza, "Snuffles")</b>.&mdash;A child suffering
+with an acute attack of "cold in the head" should be kept
+indoors in a room with a constant, uniform temperature;
+the particular reason for this is, that, if a child is exposed
+to cold at any time during an attack of "cold in the head,"
+it may cause the disease to invade the chest,&mdash;a tendency
+which it has at all times. The bowels must be kept open;
+if they do not move every day of their own accord they
+must be made to move by means of an enema of sweet oil
+or of soap-suds. The amount of food should be reduced
+to suit the circumstances and the condition of the patient.</p>
+
+<p>We treat the local condition in the nose with a menthol
+mixture. The following is a very good one: Menthol,
+30 grains; Camphor, 30 grains; White Vaseline, 1 ounce.
+Put some of this on the end of the finger and push it
+gently into each nostril. When the nostrils become
+blocked and the child cannot breathe through the nose,
+tickle the nose with a feather until it sneezes; this will
+clear the passage. Immediately after the sneeze place
+the menthol mixture in each nostril. When the child is
+about to sneeze place a handkerchief before the nose, as
+this discharge is full of germs and will infect others when
+dry. Internal remedies should not be used unless the
+child is distinctly sick and is running a fever, in which
+case a physician should look the child over and prescribe
+whatever is called for.</p>
+
+<p>The upper lip and the nostrils of the child should be
+protected, because the discharge very quickly irritates the
+parts and renders them raw and painful. Vaseline or cold
+cream is very suitable for this purpose.</p>
+
+<p>Mothers should not wash out the nose of a child with
+any solution advised for this purpose where force is used,
+as, for example, with a syringe. Any forceful irrigation
+of the nose is dangerous, because it would carry the infection
+into the deeper parts and set up a more serious
+condition.
+<span class='pagenum'>[<a name="Page_502" id="Page_502">502</a>]</span></p>
+
+<p>If the above treatment is carefully carried out and the
+child unexposed to a fresh cold, two or three days will be
+sufficient to cure the disease.</p>
+
+<p>It is not, however, the treatment of an acute attack of
+"cold in the head" that is important; it is intelligently to
+follow out a plan which will prevent these attacks from
+repeating themselves that is of consequence. The tendency
+to take cold is a real condition in childhood and a very
+common one. When mothers appreciate that it is possible
+to prevent this condition and to cure it when it is seemingly
+an established habit, more interest will undoubtedly
+be taken in the subject. Too frequently it is looked upon
+as an unfortunate affliction, but it is never regarded as a
+condition that is caused by neglect and ignorance.</p>
+
+<p>It is an exceedingly common occurence to find a mother
+worrying over her child's cold, dosing it with cod liver
+oil or some other unnecessary tonic, rubbing it with
+camphorated oil or plastering it over with certain useless
+patent plasters, dressing it with extra pieces of flannel on
+its chest and extra clothes pinned snugly around it, then
+shutting it up in a warm, stuffy, unsanitary, ill-smelling
+room, in order to keep it from "catching a fresh cold."
+Can you imagine anything else she could do to defeat her
+purpose?</p>
+
+<p>No quantity of cod liver oil, no medicine, no coddling,
+will remove the tendency to "catch cold." The child's
+life must be lived amidst sanitary surroundings and hygienic
+conditions first; then other expedients may be
+utilized if necessary. These children must be kept out
+of doors most of the time, unless during the severest wet
+weather. They should sleep in a room the windows of
+which are open at the top and bottom every night in the
+year. They should not, however, be in a draught. The
+rooms in which they live should be of a uniform temperature,
+never too hot and never too cold, between 68&deg;
+and 70&deg; F. These delicate catarrhal children should be
+accustomed to light clothing on their beds. Chest protectors,
+mufflers, cotton pads, and heavy wraps of any
+description should be absolutely prohibited. It is advisable
+to use flannel underwear winter and summer,
+light in summer and a medium weight in winter.
+<span class='pagenum'>[<a name="Page_503" id="Page_503">503</a>]</span>
+During the summer months the mother should begin cold
+sponging of the face, throat, chest, and spine every morning
+and carry it into the winter. The entire process need
+take only a moment or two. Always dry thoroughly
+with a fairly rough towel. If the cold sponging is begun
+in the warm summer time the child will become so
+accustomed to it that no objection will be made when
+the cold weather comes.</p>
+
+<p>If the child continues to be "catarrhal," despite a
+course of this treatment, it would be well to investigate
+whether any adenoids or adenoid tissue exist in the
+naso-pharynx. If adenoids are found no treatment will
+be successful until they are removed.</p>
+
+<p>It is a wise plan to place a flannel cap on an infant
+who has an acute attack of "cold in the head" (snuffles).
+This will prevent catching a fresh cold and it will aid
+in the speedy cure of the attack from which it is suffering
+when it is put on.</p>
+
+<h4>CHRONIC NASAL CATARRH&mdash;CHRONIC RHINITIS<br />
+CHRONIC DISCHARGE FROM THE NOSE</h4>
+
+<p>Some children have a nasal discharge during all of
+their childhood. It is usually worse during the winter
+months. It may be a thin, watery discharge or a thick,
+nasty, yellow discharge.</p>
+
+<p>It is a condition that is very frequently neglected even
+by the family physician. This is unfortunate because
+it may lead to serious disease, permanent damage sometimes
+being done to the hearing, the speech, the smell,
+and to the lungs of the child.</p>
+
+<p>It may be caused by adenoids; disease of the bones or
+tissues in the nose; foreign bodies in the nose; or it may
+occur in children whose nutrition is bad. It may result
+from frequent acute attacks of "cold in the head." It
+also occurs in other less important conditions. The foreign
+bodies which usually cause a chronic nasal discharge
+are,&mdash;buttons, peas, beans, beads, paper balls, flies and
+bugs, cherry-stones, small pieces of coal, or stone, cork
+or other material. A child gets hold of a shoe-button
+for example and pushes it into its nostrils. In the effort
+<span class='pagenum'>[<a name="Page_504" id="Page_504">504</a>]</span>
+to get it out the child pushes it further in. It may or
+may not cause pain at the time, and it may be overlooked,
+but shortly the mother will notice a discharge
+from one nostril. This discharge becomes thick and
+foul and when an investigation is made the button is
+found embedded firmly in the nose. It is sometimes
+quite difficult to get the button out and this should always
+be done by a physician.</p>
+
+<p><b>Treatment</b>.&mdash;Remove the cause first then treat the
+catarrh. If it is a product of a constitutional disease
+that causes general poor health, such as tuberculosis,
+syphilis, or scrofula, the child will need "building up"
+and a decided change of climate. Foreign bodies must
+be removed, adenoids taken out, large tonsils excised, and
+malformations of the nasal bones operated upon. The
+catarrh will in many cases be cured by removing its
+cause; if, however, it should persist it must be treated
+for some time with appropriate solutions. These solutions
+and the directions as to the method of giving them
+must be given by a physician, because there is great danger
+of carrying the disease to deeper structures if given
+wrongly.</p>
+
+<p><b>SUMMARY:</b>&mdash;</p>
+
+<blockquote><p>1st.&mdash;A chronic discharge from the nose is a sign that
+something is wrong and should be carefully and thoroughly
+investigated.</p>
+
+<p>2nd.&mdash;The cause can usually be found out and the proper
+treatment will cure it.</p>
+
+<p>3rd.&mdash;If the condition is neglected it may ruin the health
+of the child for the whole period of its life.</p></blockquote>
+
+<h4>NERVOUS OR PERSISTENT COUGH</h4>
+
+<p>Cough in an infant or growing child is usually the
+result of a cold and the structure affected is some part
+of the nose, throat or bronchi. It is a comparatively
+simple matter to discover just where the trouble is and
+to prescribe the appropriate remedy and effect a cure.</p>
+
+<p>There is another type of cough, however, that is of
+<span class='pagenum'>[<a name="Page_505" id="Page_505">505</a>]</span>
+quite a different character. This cough will begin as
+an ordinary cough and it will only be discovered that
+it is not an ordinary cough because nothing will apparently
+cure it. We mean that the child is given cough
+remedies that usually cure a cold, is kept in the house
+and carefully watched for a sufficiently long period
+to justify a cure, and yet, despite this care and attention,
+the cough remains the same. The child is not
+sick, the appetite is good, there is no fever, it plays and
+seems to enjoy good health, yet for weeks and frequently
+for months the annoying cough hangs on. It is as a rule
+worse at night. It begins soon after the child falls
+asleep and spoils the entire night's rest or a great part
+of it. It may be a dry, hard, hacking cough, or a croupy,
+harsh bark. It may come in spells with a considerable
+interval between them, during which time the child falls
+asleep, or it may be almost constant, not quite severe
+enough to rouse the child, but bad enough to spoil the
+child's rest and the rest of the mother. If this condition
+lasts for a long time, as it occasionally does, the health
+of the little patient is apt to suffer from loss of sleep.</p>
+
+<p><b>Treatment</b>.&mdash;These children should be taken to a good
+physician and thoroughly examined. Special care should
+be devoted to investigating the condition of the nose,
+throat, ear, stomach, heart, and lungs.</p>
+
+<p>A very large majority of these coughs are caused by
+adenoid growths in the back part of the nose. The child
+may not look like an adenoid child, nor may it breathe
+through its mouth when asleep, and it may have had its
+adenoids removed, yet in spite of these contra-indications
+it may have enough loose adenoid tissue in its
+nose to cause this kind of persistent cough. This has
+been proved many times.</p>
+
+<p>It is not only useless but positively harmful to give
+these children cough remedies. The cause of the cough
+must be found and treated. The cough may be indirectly
+caused by anemia (poor blood) or heart or stomach
+trouble, or it may have a number of other causes. Whatever
+it is it must be found by a careful physical examination
+or a number of careful physical examinations,
+because these cases are as a rule obscure and difficult
+<span class='pagenum'>[<a name="Page_506" id="Page_506">506</a>]</span>
+to diagnose, and even the most expert examiner cannot
+always tell where the trouble is without seeing the
+child a number of times. The parents must therefore
+have patience and confidence in the physician and must
+aid him all they can by watching and reporting all the
+symptoms, etc., to him. (See article on <a href="#Adenoids">Adenoids</a>).</p>
+
+
+<p><b>SUMMARY:</b>&mdash;</p>
+
+<blockquote><p>Coughs that resist careful treatment are not "ordinary
+coughs."</p>
+
+<p>Coughs of this type require special medical care.</p>
+
+<p>The usual cough medicines are not only useless in
+these coughs, but dangerous. Don't give them.</p></blockquote>
+
+
+<h4>ACUTE CATARRHAL LARYNGITIS: SPASMODIC
+CROUP: FALSE CROUP</h4>
+
+<p>Croup is one of the common diseases of childhood. It
+usually follows a catarrhal "cold in the head" with a
+cough. Croup is most frequently associated with large
+tonsils and adenoids. It may come on gradually or it
+may occur suddenly. There is always fever with croup.
+One of the first symptoms is a hard, dry, croupy, barking
+cough, which gets worse toward night. If it occurs suddenly,
+the child will wake about midnight with the characteristic
+croupy cough. The disease may go no further
+than this and under the proper treatment is well in a few
+days. In other cases, however, there develops marked interference
+with breathing. Every inspiration is accompanied
+by a loud hissing or "crowing" sound. This feature
+of the disease is one that frightens the parents,
+though it seldom means anything serious. The child sits
+up in bed, frightened, and struggles for breath. It may
+clutch its throat with its hands as if something was tied
+round its neck. The lips may become slightly blue and the
+perspiration appears upon the child's brow. After some
+time,&mdash;it may be two or three hours,&mdash;the attack wears
+away and the child goes to sleep. Next morning it wakes
+up apparently well except for the croupy cough. The attack
+may repeat itself the next night and mildly on the
+third night.
+<span class='pagenum'>[<a name="Page_507" id="Page_507">507</a>]</span></p>
+
+<p><b>Treatment</b>.&mdash;The object of treatment during an acute
+attack, when the child is struggling for breath, is to relax
+quickly the spasm of the larynx which interferes with the
+breathing. The simplest way is to give the child a teaspoonful
+of the fresh syrup of ipecac. If the child does
+not vomit in fifteen minutes, give another teaspoonful and
+keep on giving it every fifteen minutes till the child
+vomits. One or two doses is usually enough, but it must
+be given till the child vomits.</p>
+
+<p>If the attack comes suddenly during the night and
+there is no syrup of ipecac in the house, the physician
+should be sent for at once and informed that the child
+probably has croup, so he may know what to take with
+him. While waiting for the physician the mother should
+apply over the front of the neck (in the region of Adam's
+apple), hot applications. These are best made of flannel
+wrung out of quite hot water every two or three minutes:
+also a hot mustard foot bath. When the physician takes
+charge of the case he will also direct the treatment for
+the following day in order that the attack of the
+next night may be a very mild one, if it should
+came at all.</p>
+
+<p>Children who have a tendency to frequent attacks of
+croup should receive the same attention as the children do
+who are subject to attacks of tonsilitis and acute catarrhal
+rhinitis.</p>
+
+
+<p><b>SUMMARY:</b>&mdash;</p>
+
+<blockquote><p>1st. Spasmodic Croup always requires prompt and efficient
+treatment.</p>
+
+<p>2nd. It is called "false" croup, because "true" croup
+is always diphtheritic and is a very serious disease.</p>
+
+<p>3rd. For that reason a physician should always be
+called because if it is "true" croup antitoxin must be
+given at once.</p>
+
+<p>4th. Don't worry unnecessarily because, though "spasmodic
+croup" can make the child look exceedingly
+sick for a very short time, an uncomplicated case in
+a healthy child is seldom if ever dangerous.
+<span class='pagenum'>[<a name="Page_508" id="Page_508">508</a>]</span></p></blockquote>
+
+<h4>TONSILITIS: ANGINA: "SORE THROAT"</h4>
+
+<p>This is one of the frequent diseases of childhood. We
+rarely see it in infants. It is caused by inhaling air which
+contains poisonous germs. These germs quickly develop
+when conditions are favorable. They lodge in the pores
+or follicles of the tonsils and set up an active inflammation.
+The tonsils swell up and the follicles exude a thick
+fluid which looks like curdled cream. This fluid sticks in
+the mouths of the follicles forming spots. If enough of
+this fluid is coming out, these spots join together forming
+patches, and the patches may join together forming membrane.
+This is why it is sometimes so difficult to tell
+whether the case is one of tonsilitis or diphtheria.</p>
+
+<p>Conditions are favorable to the development of tonsilitis
+if the child is not in good health when he happens
+to inhale the infection, when the feet are wet or cold, or
+when the child is allowed out during inclement weather
+and it becomes chilled or numbed from cold, when the
+child has a cold in the head and a running nose, or when
+its stomach is out of order. Any condition in which the
+child should be carefully watched and tended to, rather
+than allowed further liberties, or risks, conduces to sore
+throat of some kind.</p>
+
+<p>Some children have the disease a number of times;
+they seem to be predisposed toward a sore throat. These
+are children who have large tonsils or who are rheumatic.
+The tonsils should be removed in the one case, and the
+tendency to rheumatism should be the main treatment in
+the other case.</p>
+
+<p>These children should be encouraged to cleanse the
+throat and nose morning and night with a warm salt solution
+(half a teaspoonful of ordinary table salt to three-quarters
+of a cup of warm water). This will help greatly
+to prevent these chronic sore throats.</p>
+
+<p><i>Symptoms of Tonsilitis</i>.&mdash;The disease begins suddenly.
+The child may have a chill or be seized with sudden
+vomiting or diarrhea. A very young infant may have a
+convulsion. The usual way is for the child to develop
+a fever quickly, to complain of being sick and tired.
+Muscular pains all over the body and a severe headache
+<span class='pagenum'>[<a name="Page_509" id="Page_509">509</a>]</span>
+are constant symptoms. The fever is usually high from
+the beginning. The child will tell you its throat is sore,
+but there is as a rule very little pain in the throat. The
+little spots or patches can be seen on one or both tonsils.
+The general symptoms are more pronounced than the
+local throat symptoms. The amount of physical depression
+that is caused by a tonsilitis is out of all proportion
+to the seriousness of the disease.</p>
+
+<p>Tonsilitis lasts three days usually. The throat symptoms
+may take a day or two longer to clear up, and the
+patients feel more or less weak for some time after all
+the symptoms have disappeared.</p>
+
+<p>Tonsilitis is medically regarded as one of the mild
+diseases of childhood. It is, however, of very great importance
+because of its likeness to diphtheria, and inasmuch
+as a positive diagnosis must be promptly made, in
+the interest of the patient, it is given close attention and
+treated with considerable respect by the medical profession.
+The chief differences between the two diseases are
+as follows:</p>
+
+<p>Tonsilitis begins abruptly with pronounced prostration
+and a high fever the first day. The patient feels distinctly
+sick all over. The second day the patient feels somewhat
+better, the fever is lower and the prostration and pain are
+not so marked. The third day he feels better still, and
+but for a little weakness would feel well. Diphtheria
+begins slowly and insidiously, with very little prostration
+and a very low fever the first day. The patient scarcely
+feels sick. The second day more prostration is present,
+the fever climbs upward a little more, and the patient
+begins to feel sick. On the third day the prostration is
+much more profound, the fever is higher, and all the evidences
+of a serious sickness are present. Two very different
+pictures: The one begins bad and ends easy, the
+other begins easy and may end bad.</p>
+
+<p>The important fact, however, so far as the similarity
+of the two diseases is concerned, is, that we must make
+the diagnosis positive on the first or second day, because
+if we are dealing with a case of diphtheria we must
+give antitoxin at once. This is essential, because the
+efficacy of antitoxin is greatest when given early in the
+<span class='pagenum'>[<a name="Page_510" id="Page_510">510</a>]</span>
+disease. By "early" we mean the first or second day
+of the disease. When antitoxin is given late (the third
+or fourth day of the disease) it is much less efficacious
+and must be given in relatively larger doses. The need,
+therefore, of a quick, positive diagnosis is a real one.</p>
+
+<p>Another important element involved in a speedy diagnosis
+is, that we must not take any chances of infecting
+other children. So important are these conditions that
+it is the proper treatment to give antitoxin at once in
+every case of tonsilitis that in the slightest way resembles
+diphtheria. An examination of the throat contents,&mdash;a
+culture of which is taken during the first visit of
+the physician,&mdash;will, of course, reveal the true condition
+and dictate the future use of the antitoxin. Antitoxin
+is absolutely harmless when given to a patient who
+has no diphtheria. Every case of tonsilitis should be
+quarantined when there are other children in the house.</p>
+
+<p>The local condition of the throat helps in the diagnosis:
+In tonsilitis (as the name implies) the disease is limited
+to the tonsils and on the tonsils (one or both) do we
+find the spots or patches. In diphtheria, on the other
+hand, the membrane is not limited to the tonsils, but
+may cover every part of the throat and extend into the
+nose and mouth. In tonsilitis it is spots or patches we
+see in the throat. In diphtheria it is membrane we see
+always. The difficulty here again is that if we wait till
+the diphtheritic membrane covers the whole throat, antitoxin
+will not be of much use.</p>
+
+<p>In diphtheria we have a characteristic odor, in tonsilitis
+we have no characteristic odor.</p>
+
+<p>The practical lesson to be learned from this uncertainty
+is, immediately to get a physician as soon as you
+find spots in the throat of your sick child, unless you are
+absolutely sure that the condition is not diphtheria and
+you are willing to take that chance.</p>
+
+<p><b>Treatment of an Acute Attack of Tonsilitis</b>.&mdash;Put the
+child in bed at once and keep him on a light diet during
+the fever. Give him all the cool boiled water he wants
+to drink. If the fever is very high it can be controlled
+by sponging the body with cool water. If the patient
+is an infant the food should be reduced to one-half
+<span class='pagenum'>[<a name="Page_511" id="Page_511">511</a>]</span>
+strength. Tonsilitis is a disease that runs a certain course
+and gets better, or the patient develops some other more
+serious conditions as a result of neglect or carelessness.
+We therefore try to make the patient comfortable and
+let the disease take care of itself.</p>
+
+<p>The throat can be gargled or sprayed with any mild
+antiseptic liquid, or it can be painted with tincture of
+iodine or 10 per cent. solution of silver nitrate. As a
+rule the gargles do not aid in the cure of the disease,
+though they contribute to the comfort of the patient.</p>
+
+<p>A cold compress made of half a dozen thicknesses of
+cloth, such as a table napkin, and put under the jaw
+(not round the neck), and covered with oiled silk and
+held in place with a bandage that meets and is tied on the
+top of the head, is of distinct usefulness.</p>
+
+<p>When it is known that the child is rheumatic, the
+heart must be carefully watched during the fever and
+anti-rheumatic remedies depended upon to effect a cure.</p>
+
+
+<p><b>SUMMARY:</b>&mdash;</p>
+
+<blockquote><p>Tonsilitis, because of its likeness to diphtheria, must
+be promptly and carefully diagnosed.</p>
+
+<p>A physician only is capable of making a diagnosis.</p>
+
+<p>Any sore throat in a child with spots or membrane
+is deserving of serious and immediate attention.</p>
+
+<p>A mistake may mean death. Don't take a chance.</p></blockquote>
+
+
+<h4>BRONCHITIS</h4>
+
+<p>Bronchitis is one of the commonest diseases of childhood.
+It is the cause of many deaths. Exposure during
+inclement weather is as a rule the cause of it. It
+occurs in all classes and conditions of children. Poorly
+nourished and badly clothed children are more liable to
+get it than are others. It is more dangerous in young
+children and infants than in older children. A young
+child or an infant will get bronchitis quicker than those
+older and stronger under the same conditions.</p>
+
+<p>Bronchitis is often present while children are suffering
+from other diseases, measles, influenza, scarlet fever,
+typhoid fever, pneumonia, diphtheria, whooping-cough,
+for example. It may accompany any disease of childhood,
+however.<span class='pagenum'>[<a name="Page_512" id="Page_512">512</a>]</span></p>
+
+<p><b>Symptoms</b>.&mdash;In infants bronchitis usually follows a
+"cold in the head," with running nose and a cough. The
+child is indisposed and peevish because of the cold. In
+a few days the cough becomes worse, fever develops,
+the breathing is quicker, and the baby looks and acts
+sick. The cough may be constant and severe; sometimes
+the cough does not seem to bother the baby, although
+this is exceptional. The breathing is quite rapid
+and is accompanied with a moist, rattling sound in the
+chest. The baby is restless and if the cough is severe it
+becomes exhausted. Vomiting or diarrhea may be present.</p>
+
+<p><b>Bronchitis in Older Children</b>.&mdash;Bronchitis in older
+children comes on abruptly, with fever and cough. The
+child may complain of headache and pains in the chest
+or other parts of the body. It may begin with a chill or
+chilly feelings. These children "raise" with the cough.
+The expectoration may be quite profuse; at first it is
+a white, frothy mucus, then yellow, and later a yellowish
+green; it may be slightly tinged with blood.</p>
+
+<p>There is a mild form of bronchitis in these older
+children where the serious symptoms are absent. The
+children are not sick enough to go to bed, but they appear
+to have a "heavy cold" with, at first, a tight, hard
+cough, which is usually worse at night. Later the cough
+turns loose and the same expectoration occurs as in the
+severe type. It is these cases of mild bronchitis which
+do not receive the proper care and treatment that develop
+into the so-called "winter cough," which lasts for
+months.</p>
+
+<p><b>Treatment.&mdash;</b>(See page <a href="#Page_497">497</a>
+under heading, "Catching Colds.") Children who acquire bronchitis easily and
+frequently, should be built up. Cod liver oil should be
+given all winter. The sleeping apartment of these children
+should not be too cold, but it should be well aired
+through the day and well ventilated throughout the
+night. Flannel night clothes should be worn and the feet
+should be kept warm always. Mild attacks of "cold in
+the head" should be treated vigorously and not neglected.</p>
+
+<p>The following "Don'ts" may be profitably studied when
+your child or baby has bronchitis:&mdash;</p>
+
+<p><span class='pagenum'>[<a name="Page_513" id="Page_513">513</a>]</span></p>
+<blockquote>Don't keep the windows tightly closed; fresh
+air and good ventilation are absolutely necessary to the patient.<br />
+
+Don't use a cotton jacket or oil silk.<br />
+
+Don't wrap the child up in blankets and shawls.<br />
+
+Don't carry the child around; keep it in bed.<br />
+
+Don't dose the child with syrupy cough mixtures.<br />
+
+Don't overheat the room.<br />
+
+Don't let friends bother or annoy the baby.<br />
+
+Don't reduce the diet unnecessarily.<br />
+</blockquote>
+
+<p>The child should be put to bed. The temperature of
+the room should be 70 degrees F. all the time. The windows
+should be opened top and bottom according to the
+weather, and the room should be well aired every day,
+the patient being taken to another room while it is being
+done. The child should have its usual night clothes
+on, nothing more. If the child is not very sick and insists
+on sitting up, a bath robe can be worn but it should
+be always removed when it sleeps. It is advisable to
+change the position of the baby from time to time. Have
+it rest on one side, then on the other, as well as on the
+back. Give a dose of castor oil at the beginning of the
+sickness and keep the bowels open during the disease.</p>
+
+<p><b>Diet.&mdash;</b>The diet will depend upon the severity of the
+disease. If the fever is high and the cough persistent,
+the strength of the food of nursing infants should be
+reduced. We can reduce the strength of the food by
+giving the child a drink of cool boiled water before
+each feeding and shortening the length of each feeding.
+Older children may be given toast, milk with lime water,
+cocoa with milk, broths, gruels, custards, cereals and
+fruit juices.</p>
+
+<p><b>Inhalations</b>.&mdash;The value of inhalations in bronchitis is
+very great. The ordinary croup kettle, which can be
+bought in any good drug store, is the best method of
+giving them. Full directions come with each kettle as
+to the best way to use it. The best drug to use in the
+kettle is creosote (beechwood). Ten drops are added to
+one quart of boiling water and the steaming continued
+for thirty minutes. The interval between steaming is
+two hours and a half in bad cases day and night. In
+mild cases the night treatments can be dispensed with.
+Sheets rigged up over the top and sides of the crib, in
+<span class='pagenum'>[<a name="Page_514" id="Page_514">514</a>]</span>
+the form of a tent, is the most desirable way to give
+the inhalations.</p>
+
+<p><b>External Applications</b>.&mdash;Counter-irritation by means
+of mustard pastes are the best applications. They should
+be put back and front&mdash;one on back and one on the chest,
+overlapping at the sides beneath the arms. They should
+cover the entire body from the waist line to the neck.
+These pastes are made as follows:&mdash;Mix the mustard
+(English) and the flour in the following proportions, using
+a quantity according to the size of child and area
+to be covered; one tablespoonful mustard to three tablespoonfuls
+of flour. Mix with lukewarm water until a
+paste is formed, not too thick and not too thin. Spread
+on a cloth (put plenty on) and cover with one layer
+of cheesecloth and place the cheesecloth side next the skin.
+In order to guard against burning the skin it is advisable
+to rub the skin with vaseline, before and after putting on
+the paste. The paste should be left on until the skin is
+uniformly red. It may be applied from two to four times
+in the twenty-four hours according to the severity of the
+case. Mustard pastes are most effective during the first
+two or three days of the disease.</p>
+
+<p><b>Drugs</b>.&mdash;Drugs are of very little value in the treatment
+of bronchitis. In the first stage of the disease,
+when the cough is hard and dry, small doses of castor
+oil and syrup of ipecac may be given to good advantage.
+The following dosage should be followed closely: 1st
+year, 2 drops castor oil, 2 drops syrup of ipecac, every
+two hours; 3rd year, 3 drops castor oil, 3 drops syrup
+of ipecac, every two hours; over 3 years, 4 drops castor
+oil, 4 drops syrup of ipecac, every two hours.</p>
+
+<p>The benefits from this treatment will be obtained in the
+first two or three days, when it should be discontinued.
+The cough under this treatment and the use of the mustard
+paste and inhalations of creosote will be soft and
+loose in two or three days and the fever will be distinctly
+on the mend. The disease lasts from five to ten days.
+It may, however, last much longer according to the
+condition of the child, etc.</p>
+
+<p>There are other drugs that can be given, with good effect,
+but when other remedies are indicated a physician
+<span class='pagenum'>[<a name="Page_515" id="Page_515">515</a>]</span>
+should be called to prescribe them according to indications.</p>
+
+
+<p><b>SUMMARY</b>:&mdash;</p>
+
+<blockquote><p>Bronchitis is one of the commonest diseases of childhood.</p>
+
+<p>It is the cause of many deaths.</p>
+
+<p>A large number of children have a tendency to bronchitis.</p>
+
+<p>These children need careful attention and "building
+up."</p>
+
+<p>Do not neglect a "little" cold. It means trouble.</p></blockquote>
+
+
+<p><b>Chronic or Recurrent Bronchitis</b>.&mdash;Bronchitis becomes
+chronic when the treatment of an acute attack fails to
+cure the condition. The failure usually is dependent
+upon the condition of the child. It may be suffering
+with some disease resulting from poor nourishment or
+poor sanitary and hygienic surroundings or both. The
+bronchitis, in other words, is dependent upon some other
+condition, and will not get wholly better until the cause
+is cured. These children should lead an active outdoor
+life when the weather is favorable. Their sleeping-room
+should be well aired and ventilated. Red meats are allowed
+twice a week only. Sugar is cut down to the
+lowest limit. Skimmed milk only should be taken&mdash;the
+cream being too rich for them. They can eat freely of
+fruits in season, green vegetables and cereals. The
+bowels must move freely every day. Patients must be
+given a lukewarm bath, followed by a brief spray of
+cold water, daily. The cold spray should not be too
+cold; about 60 degrees F. is the suitable temperature
+of the water.</p>
+
+<p>An absolute change of climate, to a warmer inland
+atmosphere, is imperative before some of these patients
+will begin to improve.</p>
+
+
+<p><b>SUMMARY</b>:&mdash;</p>
+
+<blockquote><p>A child with chronic bronchitis, or with frequent attacks
+of bronchitis (or chronic colds), is usually
+suffering from some other diseased condition.</p>
+
+<p>The bronchitis, or the cold, will not get better until
+<span class='pagenum'>[<a name="Page_516" id="Page_516">516</a>]</span>
+you find out what that "other diseased condition" is.</p>
+
+<p>It takes a physician to find that out.</p>
+
+<p>Having found the cause, cure it, and the bronchitis will
+disappear and the general health of the child will
+immediately improve.</p></blockquote>
+
+
+<h4>PNEUMONIA</h4>
+
+<p>Pneumonia is a very common disease in childhood. It
+is the most frequent complication of the various acute
+infectious diseases. Pneumonia is an exceedingly important
+factor in the mortality of infancy.</p>
+
+<p>There are two kinds of pneumonia:&mdash;</p>
+
+<blockquote><p>
+1. Broncho-pneumonia.<br />
+2. Lobar-pneumonia.<br />
+</p></blockquote>
+
+<p><b>Acute Broncho-Pneumonia</b>.&mdash;Up to the fourth year
+this is the form of pneumonia always present. It is the
+form that always complicates other diseases all through
+childhood.</p>
+
+<p>It is most apt to occur during the spring and winter
+months.</p>
+
+<p>It affects all classes, but especially those whose hygienic
+surroundings are poor. Catching cold is the exciting
+cause in a large percentage of primary pneumonias.</p>
+
+<p><b>Symptoms</b>.&mdash;Broncho-pneumonia has no regular
+course. It may or it may not follow a cold or an attack
+of bronchitis. As a rule it begins suddenly with a high
+fever, frequently accompanied by vomiting, rapid respiration,
+cough, and prostration.</p>
+
+<p>The child does not maintain a high fever continuously;
+it varies considerably throughout each twenty-four hours.
+It lasts from one to three weeks, and subsides gradually.</p>
+
+<p>The respirations vary between 60 and 80 per minute,
+though they may be much more frequent than this. The
+child breathes with apparent difficulty, the soft parts of
+the cheeks and nose rising and falling as it breathes.</p>
+
+<p>The prostration becomes, as the disease progresses,
+more and more marked, until the child looks profoundly
+sick.</p>
+
+<p>Cough is a constant and incessant symptom. It disturbs
+rest and sleep and may cause frequent vomiting.
+<span class='pagenum'>[<a name="Page_517" id="Page_517">517</a>]</span>
+There is no expectoration. A strong cough is a good
+symptom; if it stops it is a bad symptom.</p>
+
+<p>Pain is seldom present.</p>
+
+<p>Blueness of the skin is a bad sign and indicates failure
+of respiration and suggests constant and careful watching.</p>
+
+<p>Delirium may be present during the disease. It is not
+necessarily a bad sign. Accompanying stomach troubles
+are frequent if the patient is very young, and are very
+important. The bowels may be loose; they may be green
+in color and contain much mucus. Large quantities of
+gas may accumulate in the intestines and may cause much
+distress and convulsions. Death may occur at any time
+or the process may be arrested and recovery take place
+at any stage of the disease. Broncho-pneumonia is not
+necessarily a fatal disease in a fairly healthy child. It is,
+however, always a serious disease.</p>
+
+<p>Various complications may occur in the course of the
+disease. The most frequent are: pleurisy, emphysema,
+abscess of the lung, meningitis, heart disease, stomach
+troubles, thrush, intestinal disease.</p>
+
+<p><b>How to Tell When a Child Has Broncho-Pneumonia</b>.&mdash;If
+a child develops a high fever, breathes rapidly,
+coughs, and is content to lie in bed because of the degree
+of prostration, broncho-pneumonia is almost certain to be
+the disease present. If in addition to these symptoms
+there is any blueness of the fingers or around the mouth
+it is more strongly suggestive of pneumonia.</p>
+
+<p>If the child has been suffering with bronchitis it is
+sometimes difficult to tell just when the pneumonia begins.
+The child will appear more profoundly sick, the fever will
+go higher, and the respiration will be more frequent when
+pneumonia sets in on top of bronchitis.</p>
+
+<p><b>Treatment</b>.&mdash;The nursing of a little patient with pneumonia
+is the most important part. He must get plenty of
+fresh air; consequently he should be kept in a well-ventilated
+room. It is an excellent plan to change the patient
+twice daily from the sick room into another which has
+previously been thoroughly aired. While he is in this
+room the sick room should be as thoroughly aired as is
+possible. Keep this plan up all through the disease;
+change the position of the patient in bed every two hours.
+<span class='pagenum'>[<a name="Page_518" id="Page_518">518</a>]</span>
+He should never be allowed to lie on his back for hours
+at a time. In this way the different parts of the lungs
+get a chance to air themselves,&mdash;the air cells expand and
+the oxygen in the air and the fresh blood tend to heal the
+parts more quickly.</p>
+
+<p>It would be distinctly wrong to go into the detailed
+symptomatic treatment of broncho-pneumonia in a book
+of this character. Inasmuch as this is one of the most
+serious diseases of infancy, no mother should attempt to
+treat it alone. A physician is absolutely necessary and
+the most the mother can hope to do is to follow out his
+directions to the letter.</p>
+
+<p>He may direct the use of mustard pastes but it is essential
+to know where to apply them. If he should request
+the use of the cotton jacket, the height and character of
+the fever must regulate its use. Stimulants are always
+necessary, whisky and strychnine being given in every
+case, but if given at the wrong time they may do more
+harm than good. Cough mixtures may be necessary, but
+frequently they are contra-indicated. Drugs and cold
+sponging may be used to reduce the fever, but they are
+dangerous if used when conditions do not justify their
+use. Complications must be diagnosed when they occur,
+and the correct methods of treatment promptly instituted.
+A competent physician alone can assume the responsibility
+of these various phases of the disease.</p>
+
+<p>Every mother should appreciate, however, that pneumonia
+is frequently the result of carelessness. It is a well-known
+fact that pneumonia is an infrequent disease
+among children of the well-to-do, because the hygienic
+surroundings of these children are better and because
+they receive competent attention if suffering with colds
+and bronchitis. Bronchitis is quite common in all classes
+of children, but in the lower walks of life it is the custom
+to allow children to run around while they give every sign
+of having a heavy cold, and a beginning bronchitis. These
+children should receive treatment and should be kept indoors
+and in bed if they have even a slight fever, as
+pneumonia is frequently the inevitable outcome. They
+should be carefully fed, and all signs of stomach or intestinal
+troubles attended to at once.
+<span class='pagenum'>[518f]</span></p>
+
+<div class="figcenter" style="width: 400px;">
+<a id="v4pg518" name="v4pg518"></a>
+<img src="images/v4pg518.jpg" width="400" height="481" alt="A Grim Result"
+title="" />
+<span class="caption">By permission of Henry H. Goddard
+
+A Grim Result
+
+Isaac is 16, although mentally 10. He is a high-grade
+moron.</span></div>
+
+<p>This is one of those all too frequent instances<a href="#Footnote_A_1">[A]</a>
+"of a feeble-minded woman with a husband who is alcoholic and
+the offspring either feeble-minded or miscarriages."</p>
+
+<p>"Isaac is exceedingly dangerous. He is a potential criminal
+or bad man, or under the best conditions would at least marry
+and probably become the father of defectives like himself."</p>
+
+<p>This and the succeeding pictures in this volume
+contrast vividly with the frontispiece. Terrible are
+the results when we disregard the inevitable laws
+of nature, and so mate ourselves that our children
+will be parasites on society.</p>
+
+<div class="footnote"><p><a name="Footnote_A_1" id="Footnote_A_1"></a>
+<span class="label">[A]</span>"Feeble-mindedness;
+Its Causes and Consequences", Goddard, The Macmillan Company.</p></div>
+
+<p><span class='pagenum'><a name="Page_519" id="Page_519">[519]</a></span>
+
+<b>The After-Treatment of Pneumonia</b> is important, and
+every detail has a distinct bearing on the ultimate recovery
+and establishment of good health. Careful feeding,
+a good tonic, and the proper attention to exercise,
+fresh air and bathing are requisite. A change of air after
+the fever is gone is more important than all other measures
+put together. A dry, warm climate where patients
+can be kept in the open air is preferable. The danger of
+allowing a slow, long drawn-out convalescence after pneumonia
+is the development of tuberculosis.</p>
+
+
+<h4>ADENOIDS</h4>
+
+<p><a name="Adenoids" id="Adenoids"></a>Adenoids are very common, almost
+popular, in childhood. The condition is one that causes more real trouble
+and discomfort than any other childhood affliction. Adenoids
+are associated with, and are responsible for, many
+of the ailments of childhood. They may be associated
+with enlarged tonsils or they may be independent of
+them. They may be present at birth or develop any
+time thereafter, though they are more frequent between
+the ages of two and six years. Children who have adenoids
+invariably suffer from chronic "head-colds" with a discharge
+from the nose. These chronic colds are caused by
+the adenoids. Nearly every disease, and every diseased,
+or abnormal, condition of the nose, throat, larynx, and
+lungs can be directly caused by the presence of adenoids.
+They are also responsible for numerous other conditions
+of very grave importance in the growing child. The accompanying
+"head-colds" may develop into a bronchitis
+which may keep the child indoors for a long period. Adenoids
+always interfere with respiration, thereby depriving
+the child of a normal quantity of oxygen, thus rendering
+the blood less pure, and, as a consequence, seriously interfering
+with the nourishment and general health. The impaired
+nourishment and poor health thus produced, as a
+direct result of adenoids, renders the child more liable to
+disease; he may thus acquire ailments that may affect his
+whole subsequent life. The mental side of a child's development
+is also affected by the presence of adenoids, so
+much so that actual statistics prove that these children
+cannot keep up with their classes in the public school.
+<span class='pagenum'>[<a name="Page_520" id="Page_520">520</a>]</span></p>
+
+<p>We must therefore regard the presence of adenoids as
+a serious menace to the health and comfort of the patient.
+It has already been pointed out in discussing other diseases
+that before a cure of these diseases could be permanently
+accomplished it would be absolutely necessary
+to remove the adenoids, which were, no doubt, the actual
+cause, or an important contributing cause, of the disease.
+Such conditions as catarrhal laryngitis, croup, chronic recurring
+winter coughs, acute catarrhal rhinitis, "snuffles",
+"cold in the head", chronic catarrh, bronchial asthma, incontinence
+of urine, "bed-wetting", "nose-bleeding", headaches
+in growing children, anemia, deafness, night terrors,
+defective speech, diphtheria, consumption, are frequently
+caused by the presence of adenoids.</p>
+
+<p>These patients contract certain diseases easier than
+other children, and when they do, they have them more
+severely; such diseases are diphtheria, tuberculosis, scarlet
+fever, measles, and whooping cough.</p>
+
+<p>Adenoid children are, as a rule, in better health during
+the warm, equable, summer weather than during the
+changeable, uncertain weather we have in the winter
+months. If the case is neglected, and if the adenoids
+have existed for a long time, the growth of the child is
+impaired. He remains small and stunted, and the expression
+of the face is dull and stupid. The temperament
+and disposition are affected also; such children are
+languid, listless and depressed.</p>
+
+<p><b>How to Tell When a Child Has Adenoids</b>.&mdash;Children
+with well-developed adenoids are "mouth-breathers." Instead
+of breathing through the nose they breathe with
+the mouth open, especially when sound asleep. If a
+child has a discharge from its nose and a chronic cough,
+both of which resist treatment, and if in addition it is a
+mouth-breather, it is safe to investigate the naso-pharynx
+for adenoids. If a child with these symptoms is not in
+good health, is listless and depressed, looks stupid, snores
+at night, has difficulty in breathing and cannot blow its
+nose satisfactorily, is troubled occasionally with "nose
+bleeds" and headaches, we may be satisfied that the child
+has adenoids, as no other condition could produce such a
+picture.<span class='pagenum'>[<a name="Page_521" id="Page_521">521</a>]</span></p>
+
+<p>Adenoids, like enlarged tonsils, are dangerous, apart
+from the physical distress and disease which they cause,
+owing to the fact that they harbor deadly bacteria, and
+from these bacteria, which find a lodgment in the adenoids
+and tonsils, a fatal attack of diphtheria or consumption
+may have its beginning.</p>
+
+<p><b>Treatment of Adenoids</b>.&mdash;Absolute removal is the only
+justifiable treatment. This is rendered imperative for so
+many reasons that it is unnecessary to go into details in
+justification of the procedure.</p>
+
+<p>The physical well-being, the mental development, the
+life of the child depend upon it. Any parent who would
+wittingly interpose an objection to the removal of his or
+her child's adenoids, after they have been demonstrated
+to exist, would be guilty of a grave crime.</p>
+
+<p>The operation itself is not at all dangerous. It is over
+in a few moments and the child is well in an hour or two,
+so far as any pain or suffering is concerned.</p>
+
+<p>Physicians are frequently asked if adenoids "grow"
+again after removal. The answer is, "Yes," they sometimes
+do. In a very small percentage of the cases they do
+return. The older the child is when they are removed
+the less chance there is of a recurrence. A child operated
+on before it is two years of age is more liable to a recurrence
+than a child operated on at six years of age. This
+must not, however, be construed as an excuse for putting
+an operation off, because if a child needs an operation at
+two years and it is postponed till later, its health will be
+permanently injured before it is four years of age.</p>
+
+
+<p><b>SUMMARY</b>:&mdash;</p>
+
+<blockquote><p>1. Adenoids cause more trouble and more actual disease
+than any other condition during childhood.</p>
+
+<p>2. It is a crime for a parent to refuse operation if the
+presence of adenoids has been proved.</p>
+
+<p>3. Removal is the only treatment and it should be done
+in every case as soon as possible.</p>
+
+<p>4. The operation is a trivial one and is free from
+danger.</p></blockquote>
+<p><span class='pagenum'>[<a name="Page_522" id="Page_522">522</a>]</span></p>
+
+
+<h4>NASAL HEMORRHAGE&mdash;"NOSE BLEEDS"</h4>
+
+<p>A hemorrhage from the nose may occur at any time
+from birth on. It depends upon the rupture of one or
+more blood vessels. The great majority of "nose-bleeds"
+are caused by adenoids, or by a small ulcer in the nose, or
+by an injury, such as a blow or fall. A nasal hemorrhage,
+however, may be caused by other, more serious conditions,
+and for that reason may justify a careful inquiry
+into the cause, especially if bleeding should occur a number
+of times, or be of a serious character the first time.</p>
+
+<p>Of the more common causes as given above, the adenoids
+should be removed, and the chronic catarrh which
+is invariably the cause of the ulcer should be cured.</p>
+
+<p><b>Treatment of an Acute Attack</b>.&mdash;Have the patient sit
+erect; loosen all tight clothing around neck; fold the
+hands over the head; apply cold to the back of the neck
+and the nose. Pieces of ice can be put into the nostril
+and the ice bag to the nape of the neck, or a piece of ice
+can be put into a folded napkin and held on the back of
+the neck. Taking a long breath and holding it as long as
+possible and repeating it while the ice is being applied is
+an aid. Placing the feet in hot mustard water is of decided
+use. Another excellent expedient is to wrap absorbent
+cotton round a smooth probe (piece of whalebone,
+for example), dip the cotton in an alum-water mixture
+(half teaspoonful powdered alum in a half cupful of
+water), and then push it into the bleeding nostril as far as
+you can with gentle force. A valuable remedy is Peroxide
+of Hydrogen used full strength and freely dropped
+into the nostril. If these measures fail, send for a
+physician at once.</p>
+
+
+<p><b>SUMMARY</b>:&mdash;</p>
+
+<blockquote><p>1st. Nose bleeds may be caused by some serious condition.</p>
+
+<p>2nd. If they occur a number of times have the child
+examined.</p>
+
+<p>3rd. If the treatment outlined above does not stop the
+bleeding in a few moments send immediately for a
+physician.</p></blockquote>
+<p><span class='pagenum'>[<a name="Page_523" id="Page_523">523</a>]</span></p>
+
+
+<h4>QUINSY</h4>
+
+<p>Quinsy is not common in childhood. It usually follows
+tonsilitis when it is seen. The child complains of pain in
+the neck, extreme pain and difficulty upon swallowing,
+and inability to open the mouth as much as usual. There
+is a tendency to hold the head to one side. The treatment
+is to open the abscess at the earliest moment after
+pus is present.</p>
+
+
+<h4>HICCOUGH</h4>
+
+<p>Hiccough is, in most cases, in infancy and childhood
+caused by some irritation of the stomach, may be over-filled
+with food or gas. In these cases it is an unimportant
+incident and may be quickly relieved by giving
+the child an enema of soap-water and a laxative of rhubarb
+and soda.</p>
+
+<p>Infrequently hiccough may be the result of cold feet,
+or a surface chill. Simple methods of relief are, to hold
+the breath, to expire, or blow the breath out as long as
+possible before taking the next breath; to sip water from
+a cup held by another person while the tips of the two
+fore-fingers are in the ears.</p>
+
+<p>Hiccough is quite frequent in hysteria in girls, but it
+is of no consequence. When hiccoughs set in during
+the course of any serious disease it is a very unfavorable
+sign.</p>
+
+
+<h4>SORE MOUTH: STOMATITIS</h4>
+
+<p>Stomatitis is an inflammation of the mucous membrane
+(inner lining) of the mouth. The gums and the inner
+surface of the lips and cheeks may be red and angry-looking.
+There may be small grayish spots on any part
+of the mouth. If the case is very bad or if it has lasted
+some time and has been neglected, these spots grow
+larger and join together forming irregular grayish
+plaques. A large percentage of the cases never go further
+than this because the proper care and attention is
+given them. It is possible, however, for any case to
+progress further and become ulcerative. This will be
+<span class='pagenum'>[<a name="Page_524" id="Page_524">524</a>]</span>
+observed first as a faint yellow line at the margin of the
+teeth and gum. Ulceration never takes place unless the
+child has teeth. The quantity of saliva is very greatly
+increased, so much so that it flows out of the mouth soiling
+the clothes. The saliva is intensely acid and it consequently
+irritates the skin, causing more or less eczema.
+The mouth is painful and hot. There is slight fever,
+but seldom any marked prostration. If, however, the ulceration
+should be severe, the fever may be quite high.</p>
+
+<p>There is one feature of these cases that sometimes
+proves vexatious and annoying. Because of the soreness
+of the mouth, the child cannot draw strongly enough on
+the nipple to get a normal feeding, and as a result the
+nutrition of the child is poor. These children are hungry
+and when offered the nipple grasp it greedily, draw a few
+mouthfuls then stop because of the pain and begin to cry.</p>
+
+<p>If the ulceration is extensive, there is usually an odor
+and the gums bleed easily. Sometimes the teeth fall out
+or have to be drawn out.</p>
+
+<p>Strong, well-fed children are as likely to develop stomatitis
+as are those who are weakly and ill fed.</p>
+
+<p>The disease is caused by infection and is contagious.
+Just what the infection is we do not know; we do, however,
+know that children whose mouths are carefully
+cleaned after each feeding do not have sore mouths of
+this character. When cleaning the mouth care must be
+observed not to injure the tender mucous membrane.</p>
+
+<p><b>Treatment</b>.&mdash;As soon as the condition is observed
+mouth-washing should be systematically and thoroughly
+carried out. After each feeding the mouth should be
+washed with a saturated solution of boric acid in boiled
+water. (See page <a href="#Page_626">626</a>.)</p>
+
+<p>It is not necessary to use any further treatment, as a
+rule. Patients recover in four to eight days. Strict attention
+to cleanliness, however, is imperative. The feeding
+bottle and nipple, or the mother's nipple, if breast
+fed, must be kept scrupulously clean.</p>
+
+<p>The feeding of these children is sometimes a problem
+for a day or two, because, as stated above, of the soreness
+of the mouth. This is best overcome by feeding the baby
+with a spoon. If breast fed, it is necessary to pump the
+<span class='pagenum'>[<a name="Page_525" id="Page_525">525</a>]</span>
+milk and then feed with the spoon. Children will take the
+milk better if it is fed cold. Cold boiled water is largely
+taken and is good for them at this time.</p>
+
+<p><b>Treatment for Ulcers in Mouth</b>.&mdash;The ulcers should
+be touched with a camel's-hair brush which has been
+dipped into finely powdered burnt alum. If a stronger
+caustic is necessary, the solid stick of nitrate of silver
+may be used.</p>
+
+<p>A mouth wash may also be used in the ulcerative cases,
+composed of the peroxide of hydrogen diluted with two
+parts of water. If this is used wash the mouth out afterward
+with plain, cool, boiled water. The peroxide mouth
+wash can be used four or five times daily.</p>
+
+<p>In addition to the mouth washing in the ulcerative
+cases it is advisable to use internally chlorate of potash.
+The druggist should be requested to make a two-ounce
+saturated solution, and of this you can give one-half teaspoonful,
+largely diluted with cool water, every hour
+during the day for the first twenty-four hours, then
+every two hours until marked improvement is shown,
+when it can be further reduced by lengthening the interval
+between doses.</p>
+
+
+<h4>SPRUE&mdash;THRUSH</h4>
+
+<p>Sprue is a form of sore mouth. It is seen only during
+the first six months of life, as a rule. It affects the
+mucous membrane of the mouth; it appears in the form of
+small white spots that look like drops of curdled milk.
+They are on the inner surface of the cheek and may be
+all over the mouth, and on the tongue. The spots are
+firmly attached, and if forcibly removed the mucous membrane
+will bleed.</p>
+
+<p>The disease is caused by infection through lack of
+cleanliness and it invariably affects poorly nourished children,
+especially those who are bottle-fed.</p>
+
+<p>There are no symptoms other than those of the mouth;
+the child frequently refuses to nurse because of evident
+pain and distress while nursing. The condition is not
+contagious. It may be cured in from six to eight days
+without difficulty.</p>
+
+<p><b>Treatment</b>.&mdash;Mouth irrigations of boracic acid are all
+<span class='pagenum'>[<a name="Page_526" id="Page_526">526</a>]</span>
+that are necessary. They are given in the following way:
+Place the child on its side, roll around the index finger
+a piece of absorbent cotton, dip this in a saturated solution
+of boracic acid, and put into the mouth of the child.
+Let the cotton take up as much of the solution as it will
+hold, so that when it is lightly pressed on the tongue and
+cheeks it will flow out of the mouth, thus "irrigating the
+mouth." Repeat this a number of times, pressing the cotton
+to a different part each time. This should be gone
+through from four to six times daily.</p>
+
+<p>If the child is a bottle-fed baby, care should be taken
+in cleaning the nipples and bottles as directed on page
+264. If the patient is breast-fed, care must be taken to
+note that the mother's nipples are clean. They should
+be washed with the same solution of boracic acid and
+not handled. If the child cannot nurse it is necessary to
+feed it with a spoon.</p>
+
+<p>In obstinate cases the parts may be touched with a one
+per cent. solution of formalin. Mothers should particularly
+note not to use honey and borax, as is often recommended
+by women who know no better, in any disease of
+the mouth in children.
+<span class='pagenum'><a name="Page_527" id="Page_527">[527]</a></span></p>
+
+
+
+<hr style="width: 65%;" />
+<h2>CHAPTER XXXV</h2>
+
+<h3>DISEASES OF THE STOMACH AND GASTRO-INTESTINAL
+CANAL</h3>
+
+<div class="blockquot">Inflammation of the Stomach&mdash;Acute Gastritis&mdash;
+  Persistent   Vomiting&mdash;Acute Gastric Indigestion&mdash;Iced Champagne
+  in Persistent Vomiting&mdash;Acute Intestinal Diseases of
+  Children&mdash;Conditions Under Which They Exist and Suggestions
+  as to Remedial Measures&mdash;Acute Intestinal
+  Indigestion&mdash;Symptoms of Acute Intestinal Indigestion&mdash;Treatment
+  of Acute Intestinal Indigestion&mdash;Children
+  with Whom Milk Does Not Agree&mdash;Chronic or Persistent
+  Intestinal Indigestion&mdash;Acute Ileo-colitis&mdash;Dysentery&mdash;
+  Enteritis&mdash;Entero-colitis&mdash;Inflammatory Diarrhea&mdash;Chronic
+  Ileo-colitis&mdash;Chronic Colitis&mdash;Summer Diarrhea&mdash;Cholera
+  Infantum&mdash;Gastro-enteritis&mdash;Acute Gastro-enteric
+  Infection&mdash;Gastro-enteric Intoxication&mdash;Colic
+  Appendicitis&mdash;Jaundice in Infants&mdash;Jaundice in Older
+  Children&mdash;Catarrhal Jaundice&mdash;Gastro-duodenitis&mdash;Intestinal
+  Worms&mdash;Worms, Thread, Pin and Tape&mdash;Rupture</div>
+
+
+<h4>ACUTE GASTRIC INDIGESTION</h4>
+
+<h5>Acute Inflammation of the Stomach&mdash;Acute Gastritis&mdash;
+Persistent Vomiting</h5>
+
+<p>An infant seldom has real inflammation of the stomach.
+Gastric, or stomach, indigestion is the better name,
+because it actually signifies the true condition. It is indigestion
+that causes a child to vomit, though it is possible
+to have a true inflammation caused by the taking of irritant
+or corrosive drugs.</p>
+
+<p>Gastric indigestion causes sudden, repeated vomiting,
+with prostration and occasional fever. It is caused by
+unsuitable food, the wrong quantity of food, irregular
+feeding, and food the quality of which is not good.</p>
+
+<p><b>Treatment</b>.&mdash;The stomach should be immediately
+washed out. Until the physician arrives the mother can
+encourage the child to drink a large quantity of cool
+boiled water. This will be vomited and it will wash out
+the stomach at the same time. No further treatment
+<span class='pagenum'>[<a name="Page_528" id="Page_528">528</a>]</span>
+may be necessary, as the vomiting may stop. All food
+should be withheld for at least twenty-four hours. A
+high rectal irrigation should now be given. It is essential
+to know that the bowel is absolutely clean in all
+vomiting cases. The normal salt solution is the best
+agent to use for a high enema in infants. (See page <a href="#Page_586">
+586</a>.)</p>
+
+<p>After twelve or twenty-four hours' abstinence from
+food, the child can be given teaspoonful doses every
+twenty minutes of cooled boiled water, or barley or albumen
+water, weak tea, or chicken broth. Cold liquids
+are better retained and more readily taken than those
+that are heated. If the liquid feedings are vomited, another
+twelve hours must elapse before trying stomach
+feedings. In these cases we must try to satisfy the
+thirst by giving cold colon flushings. If the case becomes
+protracted and we find it impossible to nourish
+the child by the mouth, we must wash the stomach out
+once every day with a five per cent. solution of bicarbonate
+of soda, and feed the child by the rectum. Sometimes
+we can feed through the stomach tube. Liquids
+will frequently be retained when put into the stomach
+through a tube when they will be vomited if swallowed.</p>
+
+<p>The best food by the rectum is plain peptonized milk.</p>
+
+<p>Drugs are absolutely useless. If the vomiting persists,
+despite the above efforts to stop it, there is nothing to be
+gained by experimenting. You will not only render the
+condition worse but you will weaken the child. Morphine
+given hypodermatically is the only remedy. Given
+in appropriate doses, according to age, it is absolutely
+harmless. It will not only stop the vomiting, but it will
+give the child a much-needed rest, by allowing it to go to
+sleep. When it wakes up it will be stronger and its
+stomach will most likely retain small doses of nourishment.</p>
+
+<p>Great care must be exercised, in getting the child
+back on a normal diet, not to try to go too fast.</p>
+
+<p>In cases of persistent vomiting in children I have
+found it advisable to use teaspoonful doses of ice-cold
+champagne. These children will sometimes keep this
+down when all other liquids will be vomited. It is absolutely
+necessary to keep the child lying down. If he is
+<span class='pagenum'>[<a name="Page_529" id="Page_529">529</a>]</span>
+restless or sits up, the vomiting may begin all over again.
+The champagne not only is excellent nourishment for
+the child, but it quiets the stomach, allays irritability,
+and frequently favors sleep, during which time a cure
+very often results. The champagne must be drawn
+through a champagne siphon (procured in the drug
+store), and the bottle must be kept on ice with the
+mouth downward; otherwise it will get stale very quickly
+and be of no use. If kept as advised it will remain
+good to the end.</p>
+
+
+<p><b>SUMMARY:&mdash;</b></p>
+
+<blockquote><p>1st. Persistent vomiting in a child means acute gastritis.
+Stop all food for twenty-four hours.</p>
+
+<p>2nd. Encourage the child to drink large quantities of
+slightly warm water; this will wash the stomach
+out and frequently stops the vomiting.</p>
+
+<p>3rd. When the child is quiet wash out the bowels.</p>
+
+<p>4th. If vomiting persists, use iced champagne as directed.</p></blockquote>
+
+
+<h4>ACUTE INTESTINAL DISEASES OF CHILDREN</h4>
+
+<p>The large infant mortality that results from intestinal
+diseases during the summer months is deserving of the
+most careful consideration, both of the physician and the
+parent.</p>
+
+<p>Apart from the excessive heat of the summer, there
+is no doubt that an unfavorable environment, which
+means bad hygienic surroundings, bad sanitary conditions,
+bad food and home influences, contributes largely
+to the enormous number of these serious cases. Education,
+while it may be expected to influence favorably
+the sanitary and other conditions in the home, cannot
+change the home location. The child must continue to
+live in the same environment. It is in this class of cases
+that these summer diseases are so very fatal. Children
+in better circumstances can take advantage of conditions
+which are denied to the tenement child. The diseases
+must therefore be faced and treated under these existing
+conditions.
+<span class='pagenum'>[<a name="Page_530" id="Page_530">530</a>]</span></p>
+
+<p>In addition to the climate and the environment, there
+are certain factors that occur in all classes which result
+in intestinal derangement. If the stomach or bowels are
+not performing their function properly, or if the food
+or method of feeding is wrong, these, plus very hot,
+humid weather, invariably result in serious intestinal
+disease. The mother must be taught to interpret properly
+the meaning of a green, loose stool in the summertime;
+she must appreciate that it is the danger signal and
+must be regarded seriously.</p>
+
+<p>The very best preventive against summer diseases of
+the intestine is to guard particularly against any trouble
+with the child's stomach at all seasons of the year. A
+healthy stomach and bowel will resist disease, even in
+very hot weather.</p>
+
+<p>The most important food product which has a direct
+relationship to this class of diseases is milk. In a large
+city like New York it will remain impossible to solve the
+milk problem, despite the splendid efforts of the Health
+Department and the members of the medical profession,
+until the city itself shall establish milk depots and ice
+stations where safe milk, and ice to keep it safe, may be
+obtained at a nominal cost, or free, if the parents cannot
+afford to buy it. We, therefore, must recognize that the
+vast majority of children to-day are taking milk that is
+not suited to them, that is really not fit as a food for
+children. The mothers do not know this and no steps
+are taken to render the milk more safe for them to feed
+to their children. These mothers are willing to do what
+is essential in the interest of their children, but they do
+not know what should be done. These people cannot
+afford a physician or a nurse to teach them, nor do they
+even know that their methods are wrong or that they
+need any instruction. We must carry the information
+and the explanation to them. We must show them the
+need for a change of methods. This is the work for
+those charitably disposed women who desire some worthy
+purpose in life, who really wish to do some real good.
+All the equipment they need is good common sense.
+They will tell these mothers why it is necessary to pasteurize
+the milk before feeding it to the baby. They
+<span class='pagenum'>[<a name="Page_531" id="Page_531">531</a>]</span>
+will show how to keep the nursing bottles clean, and the
+nipples sweet and fresh. They will instruct them how
+to dress the baby in the hot weather and impress them
+with the need of giving it all the cool, fresh air possible.
+In short, they will gain the confidence and the good will
+of these mothers in a tactful and diplomatic way, and
+they will tell them all they know in language which they
+will understand regarding the care of the baby. In every
+city in the country this work is needed and is waiting for
+the missionaries who will volunteer. To teach mothers
+the need for boiled water as a necessary drink for baby
+and older children is alone a worthy avocation. To impress
+upon one of these willing but ignorant mothers
+the absolute necessity for washing her hands before she
+prepares her baby's food, that she must keep a covered
+vessel in which the soiled napkins are placed until
+washed, that she should frequently sponge her baby in
+the hot weather, and explain thoroughly why these are
+important details, is a work of true religious charity.
+They should be specially taught to immediately discontinue
+milk at the first sign of intestinal trouble, to give
+a suitable dose of castor oil and to put the child on barley
+water as a food until the danger is passed. They should
+be taught to know the significance of a green, watery
+stool, they should know that is the one danger signal in
+the summer time that no mother can ignore without wilfully
+risking the life of her baby. They should be taught
+to prepare special articles of diet when they are needed.
+If every mother were educated to the extent as indicated
+in the above outline the appalling infant mortality would
+fall into insignificance. It is not a difficult task nor
+would it take a long time to carry it out; it is the work
+for willing women who have time and who perhaps spend
+that time in less desirable but more dramatic ways.</p>
+
+<p>It is the knowledge that aids in catching disease in its
+inception that counts. The worst infections begin as a
+mild condition and prompt treatment robs them of their
+sting. When treatment is delayed and the child is fed
+for twenty-four hours too long on milk, the condition
+which in the beginning could have been stopped
+promptly has developed and it becomes a fight for life.
+<span class='pagenum'>[<a name="Page_532" id="Page_532">532</a>]</span></p>
+
+<p>It will be seen from the above that all we need is education.
+Education of the mother primarily, but education
+of the missionary, the nurse, the physician, the municipality,
+and the State, each co-operating, each willing
+to work in the interest of a great cause, for the benefit
+of the human race and for the brotherhood of man.</p>
+
+
+<h4>ACUTE INTESTINAL INDIGESTION</h4>
+
+<p><b>Causes</b>.&mdash;Overfeeding, unsuitable and improper food,
+irregular and indiscriminate feeding, sudden change
+from one food to another, as at weaning time, a change
+from a poor quality to a rich food, or vice versa. Conditions
+affecting the health of the child, especially the
+nervous system, such as hot weather, extreme cold,
+fatigue, or at the beginning of any of the acute diseases.
+Children sometimes are predisposed to attacks of intestinal
+indigestion; these children are delicate in health
+and have weak digestive ability. The slightest irregularity
+or error in diet will cause an attack in these
+children.</p>
+
+<p><b>Symptoms</b>.&mdash;The attack may come on suddenly or it
+may develop slowly. The important constitutional symptoms
+are fever, prostration, and a general nervous irritability.
+The child is seized with pain in the abdomen.
+The pain is referred to the region around the navel. It
+is sharp, colicky, and severe, causing the child to cry out
+and draw up its legs in an effort to lessen its severity.
+The child is exceedingly restless and acts as if it were
+on the verge of a dangerous illness. Gas in the bowel
+is not present as a rule as frequently as it is in infants
+under the same circumstances. In a few hours diarrhea
+sets in, the stools may number from four to twelve
+or more in twenty-four hours. The stools are acid, sour,
+and the odor may be very foul. They are thinner than
+usual and frothy from the presence of gas.</p>
+
+<p>In very young infants suffering from a sudden attack
+of intestinal indigestion, the stomach, as well as the
+bowels, is invariably upset. If the indigestion is the result
+of a slower process, the stomach does not participate
+in the process. The color of the stools in infancy is
+yellow, then yellowish-green, and later grass-green.
+<span class='pagenum'>[<a name="Page_533" id="Page_533">533</a>]</span>
+Undigested food is always present and in infants the curdled
+casein of the milk appears as white specks or lumps in
+the movements.</p>
+
+<p>The fever is high in the sudden cases and lower in
+the cases of gradual onset. The prostration is more
+severe when the onset is sudden and in infants may be
+very marked.</p>
+
+<p>The termination of the disease depends upon the
+cause, the treatment, and the previous health of the child.
+In healthy children promptly and properly treated it
+may be all over in a week. In delicate, poorly nourished
+children, and especially in the summer time, it may be
+the beginning of trouble that may eventuate in death.</p>
+
+<p><b>Treatment</b>.&mdash;There is no condition in the whole realm
+of diseases of childhood where the knowledge of the
+mother may have such important results as this condition.
+The most effective time to treat these cases of
+intestinal indigestion is before the physician is called.
+There are few diseases in which time is so valuable, so
+far as final results are concerned, as it is here. Every
+mother should know the significance of a loose, green
+stool. She should be taught that it means danger and
+consequently demands prompt treatment. The first indication
+is to empty, thoroughly, the bowel. The best
+means for this purpose, if it is immediately procurable,
+is calomel. If calomel is not procurable at once give
+castor oil, two teaspoonfuls to an infant, one tablespoonful
+to an older child. Calomel should be given in one-eighth-grain
+doses, repeated every three-quarters of an
+hour for eight or twelve doses, until the bowel is thoroughly
+cleaned out. Don't be afraid of a few extra
+movements at the beginning. Better clean out thoroughly
+at the start than to be compelled to do it all over
+again after the child is weak and suffering from the
+poison of the disease. The next important thing to do
+is to stop milk at once. The thirst is usually intense
+and if vomiting is not present it can be moderately relieved
+by giving small quantities frequently of cool boiled
+water or mineral water or strained albumen or barley
+water. We quite often have to stop all food and liquids
+by the mouth for twenty-four hours.
+<span class='pagenum'>[<a name="Page_534" id="Page_534">534</a>]</span></p>
+
+<p>If the prostration is very great and the child looks
+as though it might collapse, it can be given brandy in
+cracked ice from time to time.</p>
+
+<p>After the bowels have been thoroughly cleaned out,
+never before, some medicinal agent may be given to stop
+the unnecessary diarrhea. In a very large number of
+promptly and properly treated cases this is not needed.
+If it is thought best to use it the physician will select
+the agent according to the conditions present and prescribe
+it.</p>
+
+<p>Breast-fed infants rarely have intestinal diseases of
+a severe type. If they should develop diarrhea they
+must be taken off the mother's milk for twenty-four
+hours. They should be given a dose of castor oil or calomel
+and fed on barley water in the interval. The feedings
+should be reduced in quantity and the interval doubled.
+The two-hour interval will become a four-hour feeding:
+the three or four ounces at each feeding can be
+reduced to two ounces. The intention is to simply give
+as little as possible while the diarrhea is under way.</p>
+
+<p>The mother's breasts must be pumped at the regular
+feeding time in order to preserve the flow, release the
+pressure, and keep the milk fresh.</p>
+
+<p>It is sometimes a problem to renew feedings of milk
+without exciting a relapse of the diarrhea. It should
+not be tried until the stools are normal in color and consistency.
+This may not be for three or four days. In
+resuming the milk it should be given in smaller amounts
+and diluted with lime water or barley water for the first
+day. Gruels may be given to which skimmed milk may
+be added: later add the ordinary milk. If it is well digested
+and does not cause any return of the diarrhea,
+the quantity of milk can be slowly increased until the
+former feedings are resumed. It is often of very great
+advantage to boil the milk for some time. Peptonized
+milk is safe and can be used in bottle-fed infants after
+diarrhea. In older children, meat, broths, eggs, boiled
+milk, and dry toast bread may be used sparingly for
+some time. Cereals, vegetables, fruits, should be withheld
+for a considerable time and watched carefully when
+resumed. Kumyss, buttermilk, matzoon, bacillac, and
+<span class='pagenum'>[<a name="Page_535" id="Page_535">535</a>]</span>
+other fermented milks are better borne than plain milk.
+All of these children need rest, fresh air, change of air,
+frequent bathing, and tonics, as an attack of this kind
+leaves them depressed, weak, languid, and anemic.</p>
+
+
+<p><b>SUMMARY:&mdash;</b></p>
+
+<blockquote><p>1st. When a child complains of sharp, colicky, severe
+pains in the abdomen, around navel, which are shortly
+followed by foul, sour, frothy diarrhea,&mdash;greenish
+in color, it has acute intestinal indigestion.</p>
+
+<p>2nd. Every mother should know that a green stool
+means danger. She should know to give at once
+a cathartic,&mdash;castor oil is good, but give a good
+large dose&mdash;then stop all food for twenty-four
+hours. If she learns this lesson she will have time
+to wait for the doctor; meantime, she may have
+saved her child's life.</p></blockquote>
+
+
+<h4>CHILDREN WITH WHOM MILK DOES NOT AGREE</h4>
+
+<p>Contrary to the general belief, there are quite a large
+number of children in whom milk seems to act as a
+poison. These children are not necessarily constipated.
+They suffer, however, from a slow, continuous intestinal
+toxemia or poison. The symptoms of this condition are
+headache, disorders of speech, habitual sleep-talking,
+sleep-walking, and general nervous irritability without
+cause: they are listless, languid, and constantly tired.
+They may be bright in the morning and sleepy in the
+afternoon. They are irritable and cross and touchy.</p>
+
+<p><b>Treatment</b>.&mdash;Milk must be wholly discontinued. Eggs
+must be restricted to one every second day, and meat
+but once daily. The use of green vegetables is particularly
+suitable and should be given daily. Cereals and
+fruit also are good. Malted milk, kumyss, or matzoon
+may be given in place of milk. If constipation is present,
+rhubarb and soda mixture is an excellent laxative
+in these cases. A tonic should be prescribed for all
+these children.</p>
+
+
+<h4>DYSENTERY&mdash;ENTERITIS&mdash;ENTERO-COLITIS&mdash;INFLAMMATORY
+DIARRHEA</h4>
+
+<p><b>Cause</b>.&mdash;Any cause which has been mentioned as a
+<span class='pagenum'>[<a name="Page_536" id="Page_536">536</a>]</span>
+cause of ordinary diarrhea may result in this disease.
+It may occur at any time of the year and at any age.
+It may follow the infectious diseases. It may follow
+any other disease of the intestines.</p>
+
+<p><b>Symptoms</b>.&mdash;It may begin like an ordinary attack of
+acute intestinal indigestion. There is usually vomiting,
+fever, pain, and frequent yellow or green stools. The
+passages may be blood-stained and there may be little or
+much mucus. The stools at the beginning have no
+odor as a rule. The bowels move very frequently, often
+with little or nothing to pass. There may be pain with
+each movement. The blood may disappear in a few days,
+but the mucus remains, often in large quantity in each
+stool.</p>
+
+<p>At the beginning the fever is high, but it soon falls
+and remains low during the attack. The child loses
+weight, is irritable, has no appetite, and looks and acts
+sick. When the attack is over these children do not
+gain their strength as readily as we would like; recovery
+is slow.</p>
+
+<p>The acute symptoms usually last about one week,
+after this time the child begins to recover, but the process
+is a tedious one and one in which much care has to
+be exercised. It is an encouraging sign to note the disappearance
+of the blood in the stools and the return of
+the movements to the normal brown color. When these
+favorable signs are wanting the bowel is probably ulcerated
+and it will take a much longer time to return
+to normal and to be free from blood and mucus.</p>
+
+<p>The above is the ordinary form of this disease and it
+ends in recovery as a rule. There is a more severe form,
+however, which differs from the above in the following
+way:</p>
+
+<p>The fever is high and remains high; the stools are
+more frequent and there is more blood and more mucus
+in them; the child is much more irritable and is more
+profoundly sick. Death may occur at any time from
+the second day. If the little patient survives, the return
+to health is a very slow process; it often takes months
+and frequently years before a reasonable degree of
+strength is regained. Relapses are common, and they
+<span class='pagenum'>[<a name="Page_537" id="Page_537">537</a>]</span>
+are very difficult to treat and care for. In some cases
+the child never wholly regains its former strength.</p>
+
+<p>There are children who have been the victims of other
+intestinal diseases or conditions who develop colitis.
+The colitis in these cases may come on suddenly with
+vomiting and high fever, or it begins slowly, with no
+vomiting and with little fever. Their appetite is poor,
+their digestion is feeble, their prostration is pronounced.
+They lose flesh rapidly and may be emaciated to a remarkable
+degree. Very few of these cases recover completely.
+Serious and sometimes fatal relapses may take
+place. The feeding of these children is a difficult task
+and the greatest care must be constantly taken; a very
+little mistake may cost the life of the child.</p>
+
+<p><b>Treatment</b>.&mdash;All diseases of the intestine in childhood
+should be promptly and efficiently treated. If any form
+of diarrhea is neglected, it may result in the development
+of ileo-colitis with all its risks and uncertainty.
+When a child is seized with sudden bowel trouble, no
+matter what variety it is, it should be treated with the
+greatest care because "sudden" bowel trouble usually
+means plenty of trouble if it is neglected.</p>
+
+<p>Fresh air is essential in all these cases. A change of
+air is of decided value as soon as the immediate symptoms
+have abated. The diet is the same as for children
+who have gastro-enteric intoxication. Later, much difficulty
+will be met because these patients have absolutely
+no appetite,&mdash;peptonized skimmed milk is always good,
+beef broths are often well borne, liquid beef peptonoids
+may be tried. The food should be given every three
+hours. Boiled water and stimulants may be given between
+the feedings. Later in older children, raw beef,
+eggs, boiled milk, kumyss, or matzoon and gruels may
+be given. Great care has to be taken for months after
+an attack; relapses may be caused by changes of temperature,
+by fatigue, and, of course, by improper feeding.
+These children should avoid potatoes, tomatoes, fruits,
+corn, oatmeal, and a great many other things which
+an intelligent mother would not give any sick child, as
+candy, cakes, pastries, etc.</p>
+
+<p>Cases which begin with free vomiting, thin stools;
+<span class='pagenum'>[<a name="Page_538" id="Page_538">538</a>]</span>
+and fever should be treated at once. The bowels must
+be thoroughly cleaned out, the colon should be thoroughly
+irrigated, and all food should be stopped. When
+there are bloody stools with mucus and pain we must
+depend upon castor oil, irrigations of the colon, and
+opium and bismuth by the mouth. A good big dose of
+oil at the beginning is always necessary. If, however,
+the stomach is irritable and will not tolerate castor oil,
+we may substitute calomel in one-fourth-grain doses
+every hour for six doses, to be followed by citrate of
+magnesium. Irrigation of the colon in these cases is
+one of the essential means of successful treatment; it
+should be done twice a day during the first few days
+of the disease.</p>
+
+<p>Stimulants are needed in all the cases. They help
+the heart, act as a food, and tend to quiet the general
+nervousness by favoring sleep. Good brandy given in
+boiled cool water is the best stimulant.</p>
+
+<p>After the child is over the worst of the acute symptoms
+all medicine should be withdrawn and the proper
+kind of food given. Tonics will aid in restoring the
+strength. Cod Liver Oil during the following winter
+is a very good plan to aid in building up the vitality
+of the weakened bowel, but it must not be given too
+soon.</p>
+
+
+<h4>CHRONIC ILEO-COLITIS&mdash;CHRONIC COLITIS</h4>
+
+<p>Chronic Ileo-colitis fellows the acute variety. Cases
+which are unusually severe or which have been badly
+managed are likely to become chronic. A child suffering
+from this disease presents the following picture:
+The patient is emaciated, the abdomen is usually enlarged
+with gas, the feet are cold, the circulation of
+the blood is poor, the fever is low or absent altogether
+except when the child is having a relapse, when it jumps
+up suddenly. The bowels are loose and contain mucus,
+frequently in large quantities. The mucus may
+stop for a few days; then it appears again with a rise
+of temperature accompanied with loose stools with foul
+odor. These children are exceedingly nervous and irritable
+and are very poor sleepers.
+<span class='pagenum'>[<a name="Page_539" id="Page_539">539</a>]</span></p>
+
+<p>Parents should be told it will be impossible to effect
+a rapid cure of these cases. It often takes months to
+get them started on the safe road. The slightest mistake
+or change in the weather will upset the progress
+of the cure and it will be necessary to begin all over
+again. The entire hope of cure rests with the mother.
+She must be faithful, patient, and must carry out the
+physician's instructions implicitly. The management
+consists in diet, change of climate, and such other treatment
+as the physician finds necessary in each individual
+case.</p>
+
+<p><b>Treatment</b>.&mdash;In children under one year of age the
+only hope is breast milk, which must be given in small
+quantities. They do not do well on any starch food for
+a considerable period.</p>
+
+<p>Where breast milk is not available the whites of two
+or three eggs may be given daily. They may be beaten
+up and given in skimmed milk, or in plain water with
+a little salt added. Zwieback or bread crumbs may be
+given in small quantities. They should be fed at four-hour
+intervals.</p>
+
+<p>Older children may take skimmed milk, raw scraped
+beef, junket, and coddled white of egg or raw egg, bread
+crumbs, toasted, or zwieback.</p>
+
+<p>A rectal enema must be given every twenty-four hours
+if the bowels have not moved. If constipation is the
+habit a laxative should be given; the aromatic fluid extract
+of cascara sagrada or magnesia are suitable. At
+least one free movement every day is essential to success.</p>
+
+<p>Colon irrigations are only to be used when there is
+a rise of temperature, irrespective of whether the bowels
+have moved or not.</p>
+
+<p>When convalescence is established these children
+should be given a maximum of fresh air and should be
+treated as recommended in cases of malnutrition.</p>
+
+
+<h4>SUMMER DIARRHEA</h4>
+
+<p>As the name implies, this is the form of diarrhea that
+is so common, especially in cities, in summer. It is always
+preceded by some milder condition which paves
+the way for the more serious diarrhea. Acute
+<span class='pagenum'>[<a name="Page_540" id="Page_540">540</a>]</span>
+indigestion is, as a general rule, the forerunner of cholera
+infantum. The influence of hot weather must always
+be kept in mind as the underlying factor which no doubt
+conduces to gastro-intestinal disease of infancy and
+childhood. The depression incident to a spell of hot
+and possibly humid weather tends to interfere with the
+digestive process of babies and children. When this
+function is carried on imperfectly, the strength and vitality
+of the child fails, and if immediate steps are not
+taken to check the process, diarrhea makes its appearance.
+If these children are improperly fed, or if their
+surroundings are not sanitary; if they are not getting
+fresh air enough, or if they suffer because of lack of
+attention, and have at the same time a little indigestion,
+it is only a step further to develop a full-fledged cholera
+infantum.</p>
+
+<p>The outcome of any case of summer diarrhea is questionable.
+It is not safe to make any promise. An apparently
+mild attack may prove quickly fatal. Much
+depends upon the previous history of the child. If it
+has been a strong, healthy child it has a very good
+chance if treated energetically and correctly. If it has
+previously suffered from bad nutrition, is not robust,
+has had trouble with its stomach, etc., the chances are
+against it.</p>
+
+<p>The one lesson to be learned by all mothers is, as
+stated above, to act quickly; to be on the watch all
+through the summer months for any trouble with the
+baby's stomach or bowels. It is much easier to treat
+and cure a little trouble than to battle against an established
+gastro-enteric intoxication. Overfeeding and indiscriminate
+feeding must be religiously avoided,&mdash;they
+are the two most prolific causes of stomach and intestinal
+troubles in childhood.</p>
+
+<p><b>Symptoms</b>.&mdash;The onset is sudden and pronounced. The
+child begins to vomit and continues vomiting and retching
+persistently. The bowels are loose, and large,
+watery, greenish stools are frequent. The prostration
+is very marked, the child looks seriously sick, respiration
+is quick and shallow, the eyes sunken, the skin becomes
+ashen gray in color, and the pulse is soft and very
+<span class='pagenum'>[<a name="Page_541" id="Page_541">541</a>]</span>
+rapid. The fever may be very high or it may remain
+low. The low febrile cases are the worst.</p>
+
+<p>If taken in hand quickly and if the treatment is energetic
+and if the child reacts, the case may go rapidly
+on to recovery and the child be wholly well in a few
+days; or it may not react, but be overwhelmed by the
+poison and sink and die in twenty-four hours.</p>
+
+<p><b>Treatment</b>.&mdash;In the treatment of cholera infantum it
+must not be forgotten that the dangerous element is
+the poisoning of the system that is constantly going on.
+It is difficult for the non-medical mind to estimate the
+importance of this element. It is, of course, caused by
+the bacteria present in the gastro-intestinal canal. There
+are numberless millions of bacteria in the normal healthy
+bowel. A very large percentage of those germs are good
+for us, are there for a beneficent purpose, and can and
+do protect us from other germs which occasionally find
+their way into the bowel and whose purpose is not a
+peaceful one. When the bowel condition changes, as
+during an attack of summer diarrhea, it is invaded by
+multitudes of evil-intentioned germs. These germs find
+conditions in the diseased bowel exceedingly favorable
+to them, so they begin work in an active, energetic way.
+The result of their activity is highly poisonous, and, as
+the good germs are virtually out of business and are
+consequently not working in our interest, we are absolutely
+in the hands of the enemy. There is soon manufactured,
+by these invading germs, enough poison to
+poison the entire system of the child. It is this feature
+that we must combat in summer diarrhea.</p>
+
+<p>It is absolutely essential to keep these cases as much
+in the open fresh air as possible. No matter how sick
+they may be, this rule must be observed. Light clothing
+is advisable.</p>
+
+<p>If it is a city child that is affected and it does not
+show decided improvement in three or four days, it
+should, if possible, be sent to the country. There is always
+distinct danger of a relapse in every case, so the
+little victim should be given a change of air as soon as
+convalescence permits. The seashore is preferable to
+the mountains in all intestinal cases.
+<span class='pagenum'>[<a name="Page_542" id="Page_542">542</a>]</span></p>
+
+<p>In the care of these patients cleanliness is an important
+factor and counts much in the ultimate cure. The
+child, as well as the clothing, should be kept scrupulously
+clean. Napkins as soon as soiled should be removed and
+put into a disinfecting solution. The buttocks should
+be well powdered after each movement to prevent sores
+developing.</p>
+
+<p>Feeding must be stopped at once. No food of any
+kind should be given for at least twenty-four hours, or
+until the tendency to vomit subsides. The thirst must
+be allayed, however, so we give frequently small quantities
+of thin barley water or albumen water or cold boiled
+water. If these are vomited we must stop giving them
+altogether for twenty-four hours. If the fever is high
+and the skin dry, the child should be given a cool pack,
+85&deg; to 90&deg; F., which can be moistened every half hour
+with water at this temperature; this will often control
+the fever satisfactorily. Hot-water bottles should be
+placed at the feet if they are cold.</p>
+
+<p>If, on the other hand, the fever is very low (below
+normal), the child's circulation poor, the skin blue and
+cold, a hot-water bath at 108&deg; F., for five minutes (rubbing
+the surface of the body while in the bath), will be
+of very great service. The bath may be repeated at half-hour
+intervals.</p>
+
+<p>If the patient is a breast-fed infant it can be allowed
+to nurse after the twenty-four-hour rest. The length of
+time it is permitted to stay at the breast should be about
+one-quarter of the time it was allowed before the attack
+began. If it does not vomit, the nursing can be repeated
+every four hours. As the case progresses toward recovery
+the interval between feedings can be shortened.
+Care, however, must be taken not to shorten the interval
+too rapidly.</p>
+
+<p>If the patient is artificially fed and is not over four
+months old, a substitute for the milk must be found. The
+best substitutes are rice or barley water, either plain or
+dextrinized, the malted foods, chicken or beef broths,
+liquid peptonoids or bovinine. Water (boiled and
+cooled) may be allowed at all times if not vomited.</p>
+
+<p>Older children are treated in the same way. All food
+<span class='pagenum'>[<a name="Page_543" id="Page_543">543</a>]</span>
+is withheld while there is any vomiting. When vomiting
+stops begin with small quantities of beef broth, or
+chicken, or veal broth. Later kumyss or matzoon can
+be tried, and finally thin gruels made with milk.</p>
+
+<p>If vomiting persists the stomach must be washed out;
+this can be done by giving the infant or child a large
+drink of cool boiled water. This will be immediately
+vomited and it will clean the stomach at the same time.
+The stomach-pump may be used to better advantage.
+One washing is usually sufficient. The vomiting will
+stop after the stomach has been washed out and the
+patient may then be given, frequently, small quantities
+of cold albumen water or barley water.</p>
+
+<p>The bowel should be thoroughly cleaned out at the
+beginning of every summer diarrhea. Castor oil or calomel
+are the two best cathartics for this purpose. If the
+stomach is not upset use castor oil. If the stomach is
+upset use calomel; one-fourth of a grain every hour
+for eight doses will be sufficient. Give enough, however,&mdash;there
+is no danger at the beginning of the attack of
+too free movements of the bowel. Whatever cathartic is
+given, it should produce green, watery stools.</p>
+
+<p>Irrigation of the bowel is an exceedingly effective
+way of cleaning out the poison-laden large intestine. It
+should be done in every instance unless the movements
+are watery and of such frequency as to render irrigation
+unnecessary. Once or twice daily will be sufficient
+in even the worst cases. The irrigation should be given
+at the temperature of 100&deg; F, and should be the normal
+saline solution; a long rectal tube is used to give the
+irrigation.</p>
+
+
+<p><b>SUMMARY:&mdash;</b></p>
+
+<blockquote><p>1st. Cholera infantum is one of the most dangerous,
+one of the most treacherous, and one of the quickest
+acting diseases of childhood.</p>
+
+<p>2nd. Don't temporize, don't delay, don't regard lightly
+any diarrhea during the summer time.</p>
+
+<p>3rd. Give a large dose of castor oil and withhold
+all nourishment until the doctor sees the little
+<span class='pagenum'>[<a name="Page_544" id="Page_544">544</a>]</span>
+patient in every case of diarrhea during the warm
+weather.</p>
+
+<p>4th. Keep the child in a cool, quiet place and don't
+handle or annoy it.</p>
+
+<p>5th. Follow, your doctor's directions implicitly. The
+fight may be short, sharp, and decisive. Don't pave
+the way for regrets afterward. Do everything while
+you have the chance.</p></blockquote>
+
+
+<h4>COLIC</h4>
+
+<p>Colic is a common condition in infancy. Very few
+children escape more or less colic during the first few
+months of life. It does not seem to injure permanently
+some infants; they go on growing according to standard,
+eat and sleep, and seem contented and happy despite
+occasional severe attacks of colic. Other children suffer
+seriously; the degree of indigestion is considerable, and
+the nutrition of the child is interfered with.</p>
+
+<p>Colic is much more frequent in bottle-fed infants than
+in those fed on breast milk. Cow's milk, no matter
+how skillfully it is prepared for their use, is at best an
+unsuitable diet and taxes the digestive ability of robust
+children. It is quite natural for an infant whose digestive
+organs are not strong to develop colic and intestinal
+indigestion if put on artificial food. Any condition
+that causes indigestion may likewise cause colic.
+Those children who are always overfeeding,&mdash;taking too
+much milk, too strong milk, or who are fed irregularly,&mdash;are
+the colicky babies.</p>
+
+<p>Constipation is frequently associated with colic and
+may be the actual cause. A daily movement of the
+bowel does not necessarily mean that the bowels are
+emptying themselves satisfactorily. Despite the daily
+movement, there may be considerable fecal matter left in
+the bowel which undergoes decomposition. This results
+in the evolution of large quantities of gas and severe attacks
+of colic. Indigestion is very often caused by
+conditions which effect the stability of the child's nervous
+organism; such conditions are fright, anger, fatigue,
+exhaustion, excitement.</p>
+
+<p>The origin of the colic in breast-fed children is very
+<span class='pagenum'>[<a name="Page_545" id="Page_545">545</a>]</span>
+often caused by some nervous condition of the mother
+that affects her milk. Constipation in the mother may
+cause colic in the child.</p>
+
+<p><b>Symptoms</b>.&mdash;A baby having an attack of colic will
+cry loudly from time to time and whine during the interval;
+it will pull up its legs and bear down. Its abdomen
+is tense and hard and distended with gas. With
+the expulsion of the gas the pain ceases and the child
+falls asleep. If the attack is very severe the prostration
+and exhaustion is marked; the feet are cold and the
+body is bathed in perspiration.</p>
+
+<p>If the colic is constant the child may be fretful and
+restless most of the time, being seemingly comfortable
+for only an hour or two in the twenty-four.</p>
+
+<p>In older children who cry because of severe pain
+in the abdomen the possibility of appendicitis must not
+be forgotten.</p>
+
+<p><b>Treatment</b>.&mdash;Find out the cause of the colic if possible.
+If the cause is located in the mother, the remedy
+naturally must affect her. Regulation of her bowel, restriction
+of her diet, and proper exercise, may be sufficient
+to effect a cure of the colic in the infant.</p>
+
+<p>The object of treatment is to help the child get rid
+of the gas. The best and quickest means to effect this
+is to apply massage or give a rectal injection. An injection
+of two ounces of cold water in which a half or one
+teaspoonful of glycerine has been put, will act quickly.
+Dry heat applied to the abdomen in the form of the
+hot-water bottle or woolen cloths will aid in the expulsion
+of the gas. The feet should be kept warm.</p>
+
+<p>In cases of habitual colic in breast-fed babies the
+cause may be in the quality of the mother's milk. It
+should be examined and if found too strong should be
+diluted. This can be done by giving the child an ounce
+of plain boiled water or barley water before each feeding.
+If the child gets an ounce of liquid before each
+feeding he will not want as much of the breast milk; so
+we shall have the same total quantity, but a reduced
+quality, which may cure the colic at once.</p>
+
+<p>It is necessary, in order to cure colic, that the bowels
+move every day in a satisfactory manner. If any aid
+<span class='pagenum'>[<a name="Page_546" id="Page_546">546</a>]</span>
+is needed, milk of magnesia is the best laxative. It
+may be given in teaspoonful doses in water previous to
+a feeding. Aromatic cascara sagrada in from ten to
+thirty-drop doses is a very good laxative, if a stronger
+remedy is needed.</p>
+
+<p>To relieve the acute attack, three drops of Hoffman's
+anodyne may be given in two teaspoonfuls of warm
+water and repeated in ten-minute intervals until relieved,
+to a baby under one year of age. From five
+to ten drops of gin, given in three teaspoonfuls of
+warm water, and repeated in fifteen minutes, is also
+satisfactory and harmless. A very good remedy which
+may be used with the above for quick relief, and to
+stop the child from crying, is the following: Fold a
+piece of flannel cloth (two thicknesses) the size of the
+baby's abdomen; wring out of very hot water and drop
+ten drops of turpentine over the surface,&mdash;at different
+spots,&mdash;of the flannel and lay on abdomen,&mdash;turpentine
+side next skin. Cover this with another piece of flannel,&mdash;two
+or three thicknesses, that has been dry-heated and
+allow to remain in place for about ten minutes.</p>
+
+<p>Colic, as a rule, disappears completely about the third
+month.</p>
+
+
+<h4>APPENDICITIS</h4>
+
+<p>Appendicitis is mentioned here merely to acquaint
+mothers with its prominent symptoms.</p>
+
+<p>When a child has what seems to be an attack of indigestion,
+but complains of pain and tenderness in the
+abdomen, vomits, and develops a fever, and is constipated,
+appendicitis may be suspected.</p>
+
+<p>The pain and tenderness are not referred to the region
+of the appendix but are more centrally located.
+If, however, the finger point is pressed over the appendix,
+distinct tenderness will be elicited in inflammation
+of that region. Constipation is the rule in appendicitis,
+but diarrhea occasionally accompanies it.</p>
+
+<p>The abdominal muscles may be rigid, that is, the abdomen
+does not feel soft as is usual; there is a feeling
+if they are pressed, as if they were hard and unyielding.</p>
+
+<p><b>Treatment</b>.&mdash;Put the child in bed and send for the
+family physician at once. The condition is too serious
+<span class='pagenum'>[<a name="Page_547" id="Page_547">547</a>]</span>
+and too uncertain to delay, or for a parent to make any
+effort at treatment. Appendicitis is a much more serious
+condition in infancy and childhood than it is in
+an adult.</p>
+
+
+<h4>JAUNDICE IN INFANTS</h4>
+
+<p>There are two types of jaundice in infants that deserve
+brief consideration.</p>
+
+<p>1st. There is a form of jaundice caused by a defect in
+the development of the bile or gall tubes. These infants
+develop jaundice a day or two after birth and become
+intensely jaundiced within a very brief time. They
+lose flesh and strength to a marked degree and die in a
+few weeks. It is not possible to affect this condition
+favorably by any method of treatment. This type of
+jaundice is not very common.</p>
+
+<p>2nd. There is a type of jaundice that appears between
+the second and fifth day of life that is very
+common. It lasts from one to two weeks and then disappears.
+It is never fatal and is not serious. It requires
+no treatment.</p>
+
+
+<h4>JAUNDICE IN OLDER CHILDREN&mdash;CATARRHAL
+JAUNDICE&mdash;GASTRO DUODENITIS</h4>
+
+<p><b>Symptoms</b>.&mdash;This form of jaundice begins like an attack
+of ordinary indigestion. There are, as a rule, pain,
+fever, vomiting, and prostration. The pain is located
+in the upper part of the abdomen and may be quite
+severe. The vomiting may continue for a number of
+days. The bowels are usually constipated. After a
+few days the jaundice sets in and may be quite intense.
+After the jaundice is established the stools are gray
+or white in color and there is much gas in the bowel.
+The urine is very dark and may be yellow or yellowish-green
+in color. The child complains of headache, is
+dull and listless, and appears sick and weak. The condition
+lasts about two weeks, but the jaundice may last
+much longer. It is not a serious disease.</p>
+
+<p><b>Treatment</b>.&mdash;The diet should be cut down in quantity
+and should consist of rare meat, fruit, and a small
+quantity of milk. If vomiting continues the milk may
+diluted with lime water or vichy water. The child
+<span class='pagenum'>[<a name="Page_548" id="Page_548">548</a>]</span>
+should drink water or vichy water freely. No starchy
+foods, or fats, or sugars should be allowed. The bowels
+should be kept open with calomel, one-tenth of a grain
+every hour until ten are taken, to be followed by citrate
+of magnesia every morning. If the pain is severe it may
+be relieved by a mustard paste or a turpentine poultice.
+The child should be given acid hydrochloric diluted,
+eight drops in one-half glass of water, ten minutes before
+each meal&mdash;and kept on it for at least one month.</p>
+
+
+<h4>INTESTINAL WORMS</h4>
+
+<p>There are three types of intestinal worms; they are
+known as the round-worm, the thread-worm, and the
+tape worm.</p>
+
+<p><b>Round-Worm</b>.&mdash;The round-worm is usually found in
+children of the run-about age. It is never seen in
+infancy. It occupies the small or upper intestine, and
+is from four to ten inches long. If there are round-worms
+in the bowel, there are usually a number of
+them and there may be hundreds.</p>
+
+<p><b>Symptoms</b>.&mdash;Round-worms give no definite symptoms.
+The only possible way to tell if they are present is
+actually to see them in the stools of the child. They
+are of a light gray color.</p>
+
+<p>It is reasonable to expect that a child suffering from
+worms will have symptoms of abdominal distress from
+time to time; indigestion with colic and much gas may
+be present; children lose their appetites and are nervous
+and restless; sleep is disturbed; they may grind
+their teeth and talk in their sleep, and they may pick
+their noses unnecessarily during the day. These symptoms
+may, however, accompany other conditions when
+no worms are present in the bowel. My observation has
+been that in children in whom worms were present the
+nervous symptoms were distinctly accentuated. They
+are unreliable children; they seem well to-day and
+peevish to-morrow; they complain of headaches,
+dizziness, and chilly feelings. They are hysterical, noisy,
+uncontrollable. A child with these symptoms should
+be suspected of having worms and if no cause can be
+found to explain his temperamental vagaries he should
+<span class='pagenum'><a name="Page_549" id="Page_549">[549]</a></span>
+be treated for worms. I have cured a number of children
+of excessive nervousness by giving them medicine
+for worms when no worms were present. Such results
+can only be explained on the assumption that
+these children were suffering from intestinal auto-toxemia
+or self-poisoning, and the thorough disinfection
+of the bowel apparently stopped the process by ridding
+the child's system of a mass of bacteria, which were
+undoubtedly causing the auto-toxemia and consequent
+nervousness.</p>
+
+<p><b>Treatment</b>.&mdash;The most efficient remedy for removing
+round-worms is Santonin. The quantity necessary for
+the various ages is as follows:</p>
+
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Two to four years</td><td align='left'>2</td>
+<td align='left'>grains.</td></tr>
+<tr><td align='left'>Four to six years</td><td align='left'>3</td>
+<td align='left'>grains.</td></tr>
+<tr><td align='left'>Six to ten years</td><td align='left'>3-1/2</td>
+<td align='left'> grains.</td></tr>
+</table></div>
+
+<p>The best way to give it is in divided doses, with an
+equal quantity of sugar of milk. For a child of six
+years the formula would therefore be, 3-1/2 grains of
+Santonin, mixed with the same quantity of sugar of
+milk divided into three powders. These powders are
+given four hours apart in the following way. The
+child is given a light supper the evening before and one-half
+glass citrate of magnesia the following morning and
+the first powder one-half hour later; no breakfast being
+given. A light lunch, of milk and crackers, may be
+taken about noon. The second powder is given four
+hours after the first, and the third four hours after
+the second. Half an hour after the last powder, a dose
+of castor oil (one tablespoonful) is given. In a few
+moments the bowels will move; usually there are no
+worms in this movement. A little later they will move
+freely again and if worms are present they will be discharged
+in this movement.</p>
+
+<p><b>Thread-Worm, or Pin-Worm</b>.&mdash;A thread-worm looks
+just like a little piece of white thread. They are found
+in the lower part of the bowel and in the rectum. They
+are usually present, if present at all, in large numbers.</p>
+
+<p><b>Symptoms</b>.&mdash;The chief symptom is itching. It may
+be limited to the anus or it may involve the neighboring
+<span class='pagenum'>[<a name="Page_550" id="Page_550">550</a>]</span>
+parts. Thread-worms may find their way out of the
+anus and in female children may find their way into the
+vagina. In these instances the child is tormented with
+itching of the privates and may establish the habit of
+self-abuse as a result of the constant itching and scratching.
+The itching is more intense at night soon after the
+child goes to bed. As a result of the local irritation in
+the lower part of the bowel and rectum there is set up a
+catarrh of the bowel which produces large quantities of
+mucus.</p>
+
+<p><b>Treatment</b>.&mdash;The only medication by the mouth that
+is of any use is turpentine in one drop doses after meals,
+given in a teaspoonful of sugar. The best treatment,
+and in most cases the only treatment that is effective,
+is the use of rectal injections. The procedure is as follows:&mdash;The
+child first gets a cleaning injection of two
+quarts of warm water into which a teaspoonful of
+borax has been put. This will wash away any mucus
+or fecal matter that may have collected. This injection
+is best given with a No. 18 rectal catheter which is
+pushed into the rectum for about 10 inches, the water
+being allowed to run away as it enters. From six to
+eight ounces of the infusion of quassia is then passed,
+as high up as the catheter will reach. It is intended
+that the quassia will remain in as long as possible, for
+at least half an hour. In order to assure this there are
+two features that should be kept in mind: first, the
+water should be allowed to flow in slowly, consequently
+hold the bag low, not higher than two feet above the
+level of the bed on which the patient lies; second, after
+the water is all in remove the catheter very slowly and
+keep the child absolutely quiet. This treatment is repeated
+every second night for a week, then twice a
+week for four weeks.</p>
+
+<p>A solution of garlic is a very effective remedy and
+may be tried if the quassia fails, which is not likely if
+the treatment is carried out effectively and if the parts
+are kept scrupulously clean.</p>
+
+<p><b>Tape Worms</b>.&mdash;Tape worms are obtained from eating
+raw meat, pork or sausage, rarely from fish, and from
+playing with cats and dogs.
+<span class='pagenum'>[<a name="Page_551" id="Page_551">551</a>]</span></p>
+
+<p><b>Symptoms</b>.&mdash;No definite symptoms accompany the
+presence of tape worm. The children may have pains
+in the abdomen, diarrhea, a capricious appetite, foul
+breath, and they may suffer from anemia, sometimes
+quite severely. The only positive symptoms is the presence
+of links of the worm in the stools.</p>
+
+<p><b>Treatment</b>.&mdash;Give a dose of castor oil at bed time.
+Two hours after breakfast next morning give one-half
+dram of the oleoresin of male-fern in emulsion or capsule.
+Very light nourishment should be taken during the
+day, composed of gruels and soups. When the worm is
+passed it should be examined to find if the head is
+present; if not, the treatment should be repeated in
+twenty-four hours.</p>
+
+
+<h4>RUPTURE</h4>
+
+<p>Rupture of any description is not a condition that
+any mother should attempt to treat. A physician should
+be called in every case. Any misdirected effort at manipulation
+or pressure may result in irreparable injury to
+the parts. External applications are useless and may
+be injurious.</p>
+
+<p>All ordinary forms of rupture in infancy and early
+childhood are curable if properly treated.
+<span class='pagenum'><a name="Page_552" id="Page_552">[552]</a></span></p>
+<p><span class='pagenum'><a name="Page_553" id="Page_553">[553]</a></span></p>
+
+
+<hr style="width: 65%;" />
+<h2>CHAPTER XXXVI</h2>
+
+<h3>DISEASES OF CHILDREN, CONTINUED</h3>
+
+<div class="blockquot">Mastitis or Inflammation of the Breasts in
+Infancy&mdash;Mastitis in Young Girls&mdash;Let Your Ears Alone&mdash;
+Never Box a Child's Ears&mdash;Do Not Pick the Ears&mdash;Earache&mdash;Inflammation
+of the Ear&mdash;Acute Otitis&mdash;Swollen Glands&mdash;Acute
+Adenitis&mdash;Swollen Glands in the Groin&mdash;Boils&mdash;Hives&mdash;
+Nettle Rash&mdash;Prickly Heat&mdash;Ringworm in the Scalp&mdash;
+Eczema&mdash;Poor Blood&mdash;Simple Anemia&mdash;Chlorosis&mdash;Severe
+Anemia&mdash;Pernicious Anemia<br /></div>
+
+
+<h4>MASTITIS, OR INFLAMMATION OF THE BREASTS
+IN INFANCY</h4>
+
+<p>There are a few drops of a milky secretion in the
+breasts of infants when born. Occasionally the amount
+will be in excess of the normal quantity, and the breasts,
+around the nipple, may be swollen and slightly inflamed.
+Should this condition persist, it may be relieved by painting
+the parts with the tincture of belladonna. Under no
+circumstances should the breasts be manipulated or
+rubbed, as this is very apt to cause an inflammatory condition,
+and to result in mastitis.</p>
+
+<p>Mastitis begins, as a rule, during the second week of
+life. The breast becomes red, swollen, painful, and
+shows inflammatory changes. It may terminate without
+the formation of an abscess, or it may go on to suppuration.
+The child becomes extremely restless and irritable,
+it is disinclined to nurse, and suffers from loss of sleep
+and nourishment. It is possible for such a condition, in
+the female, to injure the breast to the extent of arresting
+its development and to render it useless in the future. If
+the suppuration is extensive the process may terminate
+fatally.</p>
+
+<p>Mastitis in infants is caused by unnecessary interference
+and manipulation and by want of cleanliness.
+When it occurs the parts should be kept absolutely clean
+and should not be handled in any way. Ichthyol 25 per
+<span class='pagenum'>[<a name="Page_554" id="Page_554">554</a>]</span>
+cent., Zinc Oxide Ointment, enough to make one ounce,
+spread upon old, clean, soft linen, and laid over the parts
+and changed every six hours, is an excellent healing application.
+A piece of oiled silk may be put outside the
+linen to prevent the ointment staining the clothing, and
+over this a layer of absorbent cotton and a binder, applied
+without pressure.</p>
+
+<p>If an abscess develops in spite of treatment, it must be
+freely opened and freely drained, and the general health
+of the patient supported by regular nourishment and
+tonics.</p>
+
+<p><b>Mastitis in Young Girls</b>.&mdash;Pain and swelling of the
+breasts are sometimes complained of by girls between the
+twelfth and fifteenth years, though it may occur at an
+earlier or later date. If left alone the condition will invariably
+subside without treatment. Should bacteria find
+an entrance through the nipple at this time, an abscess
+may result. The whole breast is involved and it will be
+exceedingly painful and much swollen. There may be
+moderate fever, headache, and a pronounced feeling of
+indisposition. These patients should be given a laxative,&mdash;citrate
+of magnesia, or Pluto Water, and kept on a
+very light diet. An ice-bag should be kept constantly
+at the breast during the day, and a moist dressing of
+1:5000 bichloride of mercury during the night.</p>
+
+<p>It may take a week before recovery takes place.</p>
+
+
+<h4>LET YOUR EARS ALONE</h4>
+
+<p><b>Never Box a Child's Ears</b>.&mdash;A single blow may make
+a child deaf; repeated blows on their ears will certainly
+injure children's hearing.</p>
+
+<p>Thomas A. Edison, our greatest inventor, was made
+deaf when a lad by a surly brakeman, who soundly boxed
+his ears for some trivial or fancied offense.</p>
+
+<p>Boxing a child's ears is but one of a great many things
+you should never do to the ears. In fact, there are far
+more things you should not do to safeguard the hearing,
+than there are things you can do to benefit your ears.</p>
+
+<p><b>Do Not Pick the Ears</b>.&mdash;Do not put cotton in the ears
+unless ordered to do so by a reputable physician. Do not
+<span class='pagenum'>[<a name="Page_555" id="Page_555">555</a>]</span>
+syringe the ears without the doctor's orders. Put no
+poultices in the ears. Do not put drops of any kind in
+the ears unless prescribed by a doctor. Above all, do not
+use the advertised ear cures, as most of them are harmful.
+Never blow into a child's ear, never douche the nose
+without the doctor's orders, as this may wash germs into
+the tubes leading to the ears and bring about a serious
+condition.</p>
+
+<p>Riding in tunnels, especially in tunnels under water
+where the air pressure varies, has, through some recent
+investigation, been found to be injurious to the ears of a
+great many people.</p>
+
+<p>Conductors and other trainmen who run through many
+tunnels are apt to have ear trouble, as are the men who
+work underground a great depth where they are in motion,
+such as miners running underground trains.</p>
+
+<p>If you have an earache that continues for any length
+of time, take no chances, but consult a physician. And
+remember to care for the throat and nose, as ill conditions
+in those places result in ear troubles. Do not blow
+your nose too hard; it merely injures the inner sides of
+the ear drums. Adenoids in children frequently bring
+about a bad ear trouble. Even seasickness is due in a
+great measure to ear disturbances.</p>
+
+<p>If you have a running ear, attend to it at once by visiting
+a doctor. So serious is this that life insurance companies
+will not insure people in that condition.</p>
+
+<p><b>Earache</b>.&mdash;When a child complains of earache its ear
+should be examined. In nearly every case of earache it
+is necessary to treat the throat, as this is, as a rule, the
+seat of the trouble. An antiseptic gargle of equal parts
+of Borolyptol and warm water is an excellent mixture. It
+should be used freely every two hours. Children suffering
+from earache should be kept indoors. If the examination
+should show that it is not necessary to lance the
+ear drum, some local measure may be adopted to allay the
+pain. Putting the child in bed with the head resting on
+a hot-water bottle may be all that will be necessary. The
+following procedure may be carried out, but only after a
+physician has made an examination and according to his
+directions: A hot water douche, given by means of a
+<span class='pagenum'>[<a name="Page_556" id="Page_556">556</a>]</span>
+douche bag, is quite effective. The water should be 110&deg;
+F.; the bag should be held about two feet above the level
+of the child's head, and the irrigating point should not be
+pushed into the ear, but held so that the water will find
+its own way into the ear.</p>
+
+<p>When the earache does not respond to the above
+methods the ear should be closely watched and examined
+at intervals so that it may be opened at the right moment.
+This is very essential because, if it is neglected, the pus
+may find its way into the mastoid cells and set up the
+dangerous disease, mastoiditis. This disease may cause
+abscess of the brain and death. The moment a child develops
+fever in the course of an earache the ear should be
+examined and opened at once, if found necessary.</p>
+
+<p><b>Inflammation of the Ear. Acute Otitis</b>.&mdash;Inflammation
+of the ear seldom occurs in childhood, unless as a
+complication, or as a result of some infectious disease.
+Any disease which affects the throat in any way may be
+the cause of the inflammation of the ear. Such diseases
+are, "cold in the head," tonsilitis, grippe, "sore throat," or
+pharyngitis, measles, scarlet fever. It is much more common
+in children than in adults. The younger the child,
+the more liable it is to develop ear trouble when suffering
+from any of the above diseases. The presence of adenoids
+favors the development of ear complications.</p>
+
+<p><b>Symptoms</b>.&mdash;There is one symptom present in all cases
+of inflammation of the ear; that is, fever. Pain may or
+may not be present; it is present in a majority of the
+cases. Children with inflammation of the ear are exceedingly
+restless and do not sleep long at a time nor do they
+sleep soundly.</p>
+
+<p><b>Treatment</b>.&mdash;The treatment is to open the drum membrane,
+at the right time, which of course will always be
+done by a physician who has had some experience in this
+work.</p>
+
+<p><b>After Treatment</b>.&mdash;The after treatment consists of
+washing or syringing the ear every three hours with
+eight or twelve ounces of a 1:10,000 solution of corrosive
+sublimate. This will be kept up for four days; then the
+intervals between the washing will be extended to five
+hours, and kept up until the drum membrane closes. If
+<span class='pagenum'>[<a name="Page_557" id="Page_557">557</a>]</span>
+the corrosive sublimate solution should cause any eruption
+around the ear, a normal salt solution (see page <a href="#Page_627">
+627</a>) may be used in the same way, and in the same quantity as
+above. A running ear will run for from three to six
+weeks. It may heal up at any time after ten days. If the
+discharge should suddenly stop and the fever rise, it
+indicates that the opening has become plugged or healed
+too quickly. In either case it will have to be opened
+again. As soon as the ear begins running again the
+symptoms will disappear. After syringing the ear it
+should be dried thoroughly with pieces of sterile absorbent
+cotton.</p>
+
+<p>The best syringe to use for washing out the ear is a
+one-ounce hard-rubber ear syringe with a soft rubber tip.
+An ordinary douche bag will do if a syringe of the above
+character cannot be obtained. The douche bag should not
+be held higher than two feet above the patient's head.
+The double-current ear irrigator is an excellent device
+for this purpose. The child should be on its back on a
+table. Its arms should be fastened down by its side. A
+basin can be placed under its ear and the irrigating done
+without causing any pain or discomfort.</p>
+
+<p>Any child addicted to disease of the ear should be
+closely watched and examined for tuberculosis. Scrofula
+may accompany this condition. These children need
+careful attention in every little detail, they need good
+nourishment, fresh air night and day, and they should
+not be pushed at school. During the winter they should
+be protected from "catching colds;" it is a good plan to
+put them on a cod-liver-oil mixture for the entire cold
+season. During the summer they should have a radical
+change of climate.</p>
+
+
+<p><b>SUMMARY:</b></p>
+
+<blockquote><p>1st. Inflammation of the ear is frequently a complication
+of or follows some other disease which affects
+the throat.</p>
+
+<p>2nd. If a child with one of these diseases becomes restless,
+sleepless and feverish, be on the look-out for ear
+trouble.
+<span class='pagenum'>[<a name="Page_558" id="Page_558">558</a>]</span></p>
+
+<p>3rd. The ear must be lanced immediately when necessary.</p>
+
+<p>4th. The after treatment is very important, because the
+hearing of the child depends upon it.</p></blockquote>
+
+
+<h4>SWOLLEN GLANDS. ACUTE ADENITIS</h4>
+
+<p>Swollen glands in infancy and childhood are usually
+seen below and behind the ear, less frequently in the
+groin. Their cause is, as a rule, local disturbance in the
+mouth or throat, as decayed teeth, enlarged tonsils, cold
+in the head, catarrh, adenoids, or some form of infection
+of the mouth, or throat, or scalp. They occasionally accompany
+scarlet fever, diphtheria, measles, and influenza.
+They seldom suppurate.</p>
+
+<p><b>Symptoms</b>.&mdash;A swelling is noticed just below the angle
+of the jaw; it does not grow rapidly. There is a slight
+temperature and the child is more or less irritable. If
+the patient is an infant, the fever may be quite high and
+there may be considerable prostration. The trouble lasts
+from four to eight weeks.</p>
+
+<p><b>Treatment</b>.&mdash;An ice-bag constantly applied is the best
+treatment. This not only relieves pain, but it prevents the
+possibility of the gland breaking down and suppurating.
+It is sometimes difficult to keep an ice-bag on an infant,
+in which case cold compresses should be applied. These
+are made by taking several layers of old linen or cheese
+cloth and laying them on ice. They should be applied frequently
+to the swollen gland. The following ointment
+may be applied, though the ice-bag is the better and more
+certain treatment: Ichthyol 25 per cent., Adeps Lanae
+one ounce. This is applied on cloth and renewed every
+six hours.</p>
+
+<p>This ointment is black and stains the clothing. For
+that reason it is advised to use oiled silk over the cloth to
+avoid staining the pillow or clothing.</p>
+
+<p>Children suffering from adenitis should use a spray of
+Dobell's solution in the nose and throat three or four
+times daily. If the cause of the swollen glands is known,
+treatment for its cure should be promptly instituted.</p>
+
+<p>In the event of pus forming the gland must be opened
+and drained.
+<span class='pagenum'>[<a name="Page_559" id="Page_559">559</a>]</span></p>
+
+<p>Swollen glands in the groin of a child are caused most
+frequently by some inflammatory condition of the
+privates, which should be discovered and treated.</p>
+
+
+<h4>BOILS</h4>
+
+<p>In some delicate children and in some children who do
+not seem to be delicate, repeated crops of boils may appear
+from time to time.</p>
+
+<p>It is necessary to open them as soon as pus is present.
+They should be pressed out and a gauze dressing, wet
+with a saturated solution of boric acid, bound over them.
+The dressing should be kept moist.</p>
+
+<p>I have in a number of instances successfully rid a child
+of the tendency to boils by the use of the following
+formula, which I can recommend highly as one of the
+best tonics I have ever used in the treatment of delicate
+and poorly nourished children: Tinct. Nux Vomica 4
+drops, Acid Phosphoric Dilute 8 drops, Syrup Hypophosphites,
+1 teaspoonful. Make a two-ounce mixture and
+give to children over four years of age one teaspoonful
+after each meal; to younger children, one-half teaspoonful
+after each meal.</p>
+
+<p>It is necessary in these cases to keep the bowels open
+daily.</p>
+
+
+<h4>HIVES. NETTLE-RASH</h4>
+
+<p><b>Cause</b>.&mdash;Contact with different plants, bites of insects,
+irritation from clothing, use of certain drugs. Certain
+articles of food, such as tomatoes, strawberries, oatmeal,
+buckwheat, have all been said to cause hives.</p>
+
+<p>Dentition during warm weather and the presence of
+worms and chronic malarial poisoning have been known
+to cause hives.</p>
+
+<p>It is most frequently caused, however, in childhood
+by some disturbance in the stomach or bowels.</p>
+
+<p>It causes severe itching and loss of sleep and as a
+result of these the general health suffers.</p>
+
+<p><b>Treatment</b>.&mdash;If caused by any external irritant, remove
+it. If it is caused by any special article of diet, prohibit
+its use. If no cause is apparent, give the child one tablespoonful
+of castor oil, and put it on the mildest diet possible
+of soups, broths, and dried stale bread. Give no
+<span class='pagenum'>[<a name="Page_560" id="Page_560">560</a>]</span>
+milk. Use the following treatment on the erupted parts:
+Menthol, ten grains in one ounce of cold cream. Keep
+the bowels open.</p>
+
+<p>It is sometimes necessary to advise a change of air
+before complete cure results.</p>
+
+
+<h4>PRICKLY HEAT</h4>
+
+<p>This is a very common complaint in children during
+the summer months. It is so common that it is well
+known and easily recognized. It consists of a bright red
+eruption, composed of little papules, close together.</p>
+
+<p>The rash comes out quickly, so much so that mothers
+may be surprised and frightened by observing an angry
+looking rash on their baby some morning when none
+was there the night before. It most frequently appears
+upon the neck, back, chest, and forehead. It is exceedingly
+itchy and a child may scratch itself and cause extensive
+harm. Eczema, of a very obstinate type, frequently
+results from scratching.</p>
+
+<p>The rash of prickly heat is easily diagnosed from other
+rashes because it is accompanied by no other symptom,
+such as fever, which would suggest a more serious disease.
+The rash of prickly heat resembles the rash of
+scarlet fever more than any other rash, but it is quickly
+noted that when a child has scarlet fever it has every
+symptom of being profoundly sick, while prickly heat
+has no symptom other than the itch and discomfort. It
+is caused by overfeeding, being overclothed, and sweating
+in hot weather.</p>
+
+<p><b>Treatment</b>.&mdash;Steps should be taken to prevent prickly
+heat in an infant. Use light, seasonable clothing, bathe
+frequently, and use plenty of good toilet powder. When
+the child actually has an attack, open its bowels freely
+with citrate of magnesia, and give some sweet spirits of
+niter, according to age. Protect the skin from the irritating
+underwear by interposing a soft piece of linen.
+In order to reduce the inflammation and cure the condition
+apply equal parts of starch and boric acid powder
+freely. Keep the patient on a light fluid diet. The bran
+bath is advisable if the little patient is addicted to these
+skin eruptions.
+<span class='pagenum'>[<a name="Page_561" id="Page_561">561</a>]</span></p>
+
+
+<h4>RINGWORM OF THE SCALP</h4>
+
+<p>Children of all ages are liable to "catch" ringworm
+of the scalp. It particularly affects those who are untidy,
+dirty, and badly cared for, though any child is apt to get
+it while attending the public schools.</p>
+
+<p>If a mother discovers scaly patches in the scalp, with
+loss of hair, ringworm should be immediately suspected.
+It is not, however, always easy to diagnose the condition,
+especially if the case is a mild one. If it is a severe attack,
+there is, as a rule, quite a little inflammation, and
+this may render the condition obscure for some time.
+The disease may be mistaken for dandruff, but dandruff
+covers a large area of the scalp, while ringworm is limited
+and sharply defined. Dandruff may cause a loss of
+hair; if it does, the hairs come out clean, while in ringworm
+they break off near the scalp.</p>
+
+<p><b>Treatment</b>.&mdash;Ringworm is always curable, provided
+the patient is watched and treatment carried out thoroughly.
+It is always absolutely necessary to treat the
+condition, because it will not get better of itself, and
+the longer it is permitted to last, the worse it gets, and
+the more difficult it is to cure. If treatment is begun at
+once, it may take two months to cure it. If the case has
+lasted for some time, or if it has been neglected and not
+treated thoroughly, it will take from six months to one
+year to cure it. These facts are stated so that parents
+may not become discouraged.</p>
+
+<p>The first thing to do is to cut the hair as close to the
+scalp as possible, wherever the ringworm is, and for
+about an inch outside, and all around it. The entire
+scalp should be thoroughly washed three times a week.
+The scales should be kept soft by the use of carbolic
+soap.</p>
+
+<p>The hair should not be brushed at all, because brushing
+the hair may spread the disease to other parts of the scalp.
+Every child with ringworm of the scalp should wear a
+cap of muslin or one lined with paper, so that others
+may not be infected. These caps can be burned when
+dirty and new ones made. One of the best remedies to
+apply to the affected area is the following: Bichloride
+<span class='pagenum'>[<a name="Page_562" id="Page_562">562</a>]</span>
+of mercury, 2 grains; olive oil, 2 teaspoonfuls; kerosene,
+2 teaspoonfuls. This is rubbed in every day until the
+parts are sore and tender. It is a good plan to apply
+this mixture to the entire scalp every fourth day, to guard
+against other parts becoming infected. It is not necessary
+to rub it in when using it where there is no ringworm.</p>
+
+<p>When the scalp becomes sore from the application it
+can be stopped for a day or two, or until better; then
+begin again and repeat the treatment right along. If
+the kerosene in the above mixture is objected to, a very
+good mixture is bichloride of mercury, 2 grains, and
+tincture of iodine, 1 ounce. This may be rubbed vigorously
+enough to produce a rash. If the disease shows a
+tendency to spread under this treatment it is best to
+apply the latter mixture to the entire scalp.</p>
+
+<p>Ringworm on any other part of the body is effectually
+treated by applying tincture of iodine. It should be
+painted on every day until the skin begins to peel, when
+the ringworm will disappear with the skin.</p>
+
+
+<h4>ECZEMA</h4>
+
+<p>Eczema is the most important skin disease of babyhood.
+It is probably the most frequent skin disease of
+infancy. Any baby may develop eczema. There are,
+however, some babies who seem to be very susceptible
+to it. The reason of this susceptibility seems to be due
+to the natural tenderness, or delicacy, of the skin. These
+children, because of the extreme sensitiveness of the skin,
+develop an eczema from a very slight degree of external
+irritation, or a trifling disturbance of digestion. Children
+of rheumatic or gouty parents are more liable to
+be victims of eczema than are others. Eczema of the
+face is quite common in children who are apparently
+healthy and fat. It does not seem to matter whether
+they are breast-fed or bottle-fed. The following conditions
+may be regarded as contributory to eczema:</p>
+
+<p>Exposure to winds; cold, dry air; heat; the use of
+hard water or strong soaps; lack of cleanliness, and the
+irritation of clothing. It frequently accompanies chronic
+constipation, indigestion, and other conditions of the
+<span class='pagenum'>[<a name="Page_563" id="Page_563">563</a>]</span>
+intestinal canal; overfeeding; too early or too excessive use
+of starchy foods.</p>
+
+<p><b>Eczema of the Face:&mdash;Eczema Rubrum</b>.&mdash;This is the
+most frequent form. It affects the cheeks, scalp, forehead,
+and sometimes the ears and the neck. It begins
+on the cheeks as small red papules. These join together
+and form a mass of moist, exuding crusts. They dry in
+time and may be so thick as to form a mask on the face.
+The skin may be much swollen. When the crusts are
+removed the face looks red and angry and bleeds easily.
+It is exceedingly itchy. It causes restlessness, loss of
+sleep, and it may affect the appetite, though, as a rule,
+the health remains good. Eczema of the face is exceedingly
+chronic; it improves from time to time, but it is
+cured with great difficulty only.</p>
+
+<p>Infants suffering with eczema of the face begin to
+improve about the middle of the second year and may
+be entirely cured about this time. The reason of this
+is the greater amount of exercise the child is getting
+at this period. If the disease continues longer it is
+because of the unnecessary amount of fat that the child
+has.</p>
+
+<p><b>Treatment</b>.&mdash;Eczema is a notoriously tedious disease.
+There is very little tendency for it to improve, if
+left to itself. The age, the severity, and just how much
+you can rely upon the mother, or nurse, faithfully to carry
+out directions&mdash;upon these its cure depends. At best, the
+treatment may have to be carried out for months. If the
+eczema is accompanied with constipation and indigestion
+in infancy, very little can be done with the eczema until
+these conditions are removed.</p>
+
+<p>There exists in the minds of the laity, and in some
+physicians also, an idea that it is wrong, or dangerous,
+to cure, or "dry up," an eczema. It is never dangerous,
+but highly desirable, to cure an eczema, whenever possible.
+It is always wise, because it is always necessary,
+to get the child in perfect condition before you treat
+the eczema. Cure the constipation, or indigestion, or
+cold, or whatever is the matter with the child; then treat
+the eczema. This is the only plan that offers any success.
+It is not a simple matter to find out why a nursing child
+<span class='pagenum'>[<a name="Page_564" id="Page_564">564</a>]</span>
+is having indigestion. The most minute care must be
+exercised to find out the element in the milk that is causing
+the eczema. It would, however, be foolish, and a
+waste of time, to apply pastes, etc., to an eczema of the
+face, while the real cause that produced it was still in existence.
+It will frequently be found necessary to change
+the food entirely. Strict attention to the bowels is essential,
+both in infants and in older children. Sometimes to
+cure the constipation means an immediate cure of the
+eczema.</p>
+
+<p>If the child is anemic, poorly nourished, and flabby,
+tonics are advisable. Cod liver oil is of use in quite a
+number of these cases. Eczematous children should not
+be taken out when the weather is very cold or when there
+are high winds. They should not be washed with plain
+water, or with castile soap and water. When washing
+is necessary, do it with milk and water, to which one
+teaspoonful of borax is added. The clothing must not
+be too heavy.</p>
+
+<p>In eczema of the face, the child must either wear a
+mask or heavy woolen gloves, so that he will not scratch
+the parts. Frequently these fail, and it will be necessary
+to restrain the child from scratching the face by the
+use of some mechanical device. A piece of strong pasteboard
+bandaged on the elbows, so as to prevent the child
+from bending them, is all that is necessary. If the child
+cannot bend the elbows he cannot scratch his face, yet
+he has the free use of his hands.</p>
+
+<p>The use of external remedies is imperative, as frequently
+the cause is mostly external, and in other cases
+it must be used in addition to the general treatment.
+Before external treatment is instituted, the crusts should
+be softened by applying olive oil to them for twenty-four
+hours, after which they can be removed with soap
+and water. If there is much inflammation, or if the face
+looks angry, a very good application is Lassar's paste.</p>
+
+<p>Later, when the inflammation has subsided and the
+itching is severe, a mixture of tar ointment, 3 teaspoonfuls;
+zinc oxide, 1-1/2 teaspoonfuls; rose water ointment,
+6 teaspoonfuls has proved to be one of the very best.</p>
+
+<p>When the eczema on the face is of the weeping, or
+<span class='pagenum'>[<a name="Page_565" id="Page_565">565</a>]</span>
+moist, variety, the application of bassorin paste gives
+splendid results.</p>
+
+<p>When an external remedy is applied to any eczematous
+surface it is necessary to apply it on a cloth. Simply to
+smear it on will do no good.</p>
+
+<p>In the treatment of eczema, when the children are
+breast-fed, it is well to remember that the real cause
+of the eczema may be in the mother. If the mother is
+constipated, or if her diet is too liberal, if she is drinking
+beer, or an excess of coffee, or is not taking exercise, the
+eczema may be caused by one or other or all of these.</p>
+
+<p>For eczema of the scalp the remedy to use is white-precipitate
+ointment, 1 part; vaseline, 4 parts. Mix
+together and apply.</p>
+
+
+<h4>POOR BLOOD. SIMPLE ANEMIA</h4>
+
+<p><b>Causes</b>.&mdash;There is what may be termed an unnatural
+tendency toward poor blood during infancy and childhood.
+The explanation of this anomalous condition is,
+that the tax or strain put upon the blood to provide for
+the growth of the child is severe, and is in addition to
+the great demands made upon it in the exercise of its
+regular duties. We must, therefore, always take this
+special duty into consideration, when the question of recuperation,
+convalescence, feeding, and the administration
+of blood foods and tonics comes up.</p>
+
+<p>It is not necessary to specify the diseases from which
+a child may suffer and recover, in an anemic condition.
+Any disease may leave a child with temporarily poor
+blood. The conditions which most frequently produce
+anemia in childhood are improper feeding and unhealthy
+surroundings. It is not fully appreciated how seriously
+these conditions can affect the health of growing children.
+There is one condition that every mother should be
+warned against, namely, the possibility of unduly prolonging
+breast-feeding. Children should be weaned at the end
+of the tenth month. By prolonging the breast-feeding a
+mother can undermine the vitality and strength of her
+baby and so impoverish its blood as to invite disease. A
+bottle-fed baby should be put upon a mixed diet at the
+same time. To continue feeding a child exclusively on
+<span class='pagenum'>[<a name="Page_566" id="Page_566">566</a>]</span>
+milk for a year or two after weaning, simply because "it
+will not take anything else," is criminal. Any woman
+guilty of such stupidity should never have become a
+mother. Once again it must be emphasized that every
+child must have an abundance of fresh air, must not be
+confined in close, hot, unsanitary rooms, and must have
+a daily, satisfactory movement of the bowels to be a
+healthy child with good blood in its body.</p>
+
+<p><b>Symptoms</b>.&mdash;Children suffering from poor blood are
+flabby, constipated, hungry, weak specimens of childhood.
+They are under weight, complain of headache, pains,
+disturbed sleep, are nervous and irritable. They tire
+quickly, are short of breath, and may have a tendency to
+faint easily. The hands and feet are cold, the pulse is
+small and irregular. They may have attacks of nose-bleeding
+and of bed-wetting.</p>
+
+<p><b>Chlorosis</b>.&mdash;Chlorosis is that form of anemia, of poor
+blood, which occurs in young girls about the time their
+sickness begins. It is most frequently seen between the
+fourteenth and seventeenth years, and more often in
+blondes than in brunettes. The cause is not known. It
+is thought to be due to constipation. Any occupation
+which is deleterious to health has a distinct influence on
+the condition. Employment in factories, confinement in
+badly ventilated rooms, bad or insufficient food, great
+grief, care, or a bad fright, mental strain, overstudy, may
+all produce, or contribute to the production of chlorosis.</p>
+
+<p><b>Symptoms</b>.&mdash;The symptoms of chlorosis resemble
+those of simple anemia. Children suffering from anemia
+are pale; girls with chlorosis have a peculiar greenish
+yellow tint in the skin. They are short of breath, they
+have vertigo, palpitation, disturbances of digestion, constipation,
+cold hands and feet, and scanty or arrested
+monthly periods. They have various nervous disturbances,
+such as headache, pains in various parts of the
+body, neuralgia, especially over the eyes, hysterical attacks,
+and sometimes cholera. Ulcer of the stomach is
+sometimes seen in this condition.</p>
+
+<p>The disease lasts for a year or longer; it frequently
+lasts a number of years. Relapses are frequent.</p>
+
+<div class="figcenter" style="width: 400px;">
+<a id="v4pg566" name="v4pg566"></a>
+<img src="images/v4pg566.jpg" width="400" height="479" alt="
+&quot;A Misfortune at Birth&quot;" title="" />
+<span class="caption">By permission of Henry H. Goddard</span></div>
+
+<div class="center">&quot;A Misfortune at Birth&quot;</div>
+
+<p>Warren is feeble-minded. His family said it was due to &quot;a serious
+fall of the mother.&quot;</p>
+
+<p><a href="#Footnote_A_2">[A]</a>
+"The family history is, however, exceedingly interesting.</p>
+
+<p>"The paternal grandfather, whom we have called Nick, was of good family,
+although he himself was totally different from the rest. He was weak in every
+way, and to be considered feeble-minded. He married into a family that was
+much lower socially than his own, although we have no proof that it was a
+defective family. The children of this couple were all mentally defective and
+low-grade, morally as well as intellectually.</p>
+
+<p>"Warren's father, Jake, a thoroughly disgraceful character, married Sal, a
+woman somewhat older than he.</p>
+
+<p>"The immorality of this family beggars description. A girl named Moll was
+fifteen years old when Jake brought her into his home: his wife, Sal, was so
+feeble-minded that she allowed the illicit relations between these two. Moll's
+child was born in the hospital after the mother had been sent away from one
+Home because of her horrible syphilitic condition&mdash;from which she finally
+died.</p>
+
+<p>"Our boy Warren's sister Liz with whom the father lived in incestuous
+relations, was also allowed to live illicitly with a man who worked for her
+father. She was so simple that she talked openly about her relations with her
+father and with this man. When a child was to be born the man married her.</p>
+
+<p>"This is not all, but enough: and sufficient to show what feeble-mindedness
+leads to when it takes the direction of sexual abuses."</p>
+<div class="footnote"><p><a name="Footnote_A_2" id="Footnote_A_2"></a>
+<span class="label">[A],</span>"Feeble-mindedness: Its Causes and Consequences,"
+Goddard, The Macmillan Company.</p></div>
+
+<p><span class='pagenum'>[<a name="Page_567" id="Page_567">567</a>]</span>
+<b>Severe Anemia: Pernicious Anemia</b>.&mdash;This is the
+most severe form of anemia, or the condition in which we
+have the poorest blood. While this condition frequently
+results in death the others rarely ever do. This condition
+is not common in childhood.</p>
+
+<p><b>Symptoms</b>.&mdash;There is intense weakness and prostration.
+The skin is very pale, the mucous membranes are
+bluish white. The breath is markedly short and there
+is often dropsy of the limbs and feet. Fever is often
+present and quite high. The disease lasts a number of
+months; the patient often feels better for a time, then
+relapses into a more serious condition than before.</p>
+
+
+<h4>TREATMENT OF THE VARIOUS FORMS OF ANEMIA</h4>
+
+<p><b>Simple Anemia</b>.&mdash;Find the cause and stop it. In infancy
+special attention should be given to diet and hygiene,
+giving the child plenty of fresh air, and a change of air
+to the country or seashore if necessary. The general
+treatment is more important than any benefit that may be
+derived from drugs. The rules laid down in the articles
+on "Malnutrition" must be closely followed in these children.</p>
+
+<p><b>Chlorosis</b>.&mdash;In this form of anemia, or poor blood, it
+is best to give iron. Change of air and change of scene
+are of special importance in these cases and will frequently
+cure. The general condition of course must not
+be overlooked. The diet, exercise, bowels, habits, should
+receive careful attention. Iron should be continued for a
+number of months after all traces of the anemia have disappeared.</p>
+
+<p><b>Pernicious Anemia</b>.&mdash;For this condition arsenic is the
+one remedy needful. In all conditions of poor blood the
+most careful attention should be given to the general
+health. Colds must be guarded against. The patients
+should never get their feet or their clothes wet. Muscular
+exercise, because of the weak condition of the heart,
+should be moderate, and only given on the advice of a
+physician. It is frequently necessary to stop all forms of
+exercise and in many instances we get the best results by
+directing complete rest in bed for a considerable part of
+the day or for all day if the case demands it.
+<span class='pagenum'><a name="Page_568" id="Page_568">[568]</a></span></p>
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'><a name="Page_569" id="Page_569">[569]</a></span></p>
+
+<h2>CHAPTER XXXVII</h2>
+
+<h3>DISEASES OF CHILDREN, CONTINUED</h3>
+
+<div class="blockquot"><p>Rheumatism&mdash;Malaria&mdash;Rashes of
+Childhood&mdash;Pimples&mdash;Acne&mdash;Blackheads&mdash;
+Convulsions&mdash;Fits&mdash;Spasms&mdash;Bed-wetting&mdash;Enuresis&mdash;
+Incontinence&mdash;Sleeplessness&mdash;Disturbed Sleep&mdash;Nightmare&mdash;
+Night Terrors&mdash;Headache&mdash;Thumb-sucking&mdash;Biting the Finger
+Nails&mdash;Colon Irrigation&mdash;How to Wash Out the Bowels
+&mdash;A High Enema&mdash;Enema&mdash;Methods of Reducing Fever
+&mdash;Ice Cap&mdash;Cold Sponging&mdash;Cold Pack&mdash;The Cold
+Bath&mdash;Various Baths&mdash;Mustard Baths&mdash;Hot Pack
+&mdash;Hot Bath&mdash;Hot Air, or Vapor Bath&mdash;Bran Bath
+&mdash;Tepid Bath&mdash;Cold Sponge&mdash;Shower Bath&mdash;Poultices
+&mdash;Hot Fomentations&mdash;How to Make and How to Apply a Mustard
+Paste&mdash;How to Prepare and Use the Mustard Pack&mdash;Turpentine
+Stupes&mdash;Oiled Silk, What it is and Why it is Used.</p><br /></div>
+
+
+<h4>RHEUMATISM</h4>
+
+<p>This is a rather common disease of childhood. It occurs
+most frequently between the ages of nine and
+thirteen years. Children can have it, however, at any age.</p>
+
+<p>The symptoms of rheumatism in children are much
+the same, though somewhat milder, as when the disease
+is present in an adult. Children are not quite as sick, nor
+is the fever as high, nor is the pain as great as in a grown
+person. In children the disease does not last as long, as a
+rule. Sometimes it will jump from one joint to another,
+and may, as a consequence, become chronic. When a
+child has once had rheumatism, it has the same disposition
+to recur that it has in adults. The principal danger
+of rheumatism in children is its tendency to attack the
+heart. Even mild attacks of the disease can do serious
+damage to the heart.</p>
+
+<p>Children who have the rheumatic tendency invariably
+suffer from inflammatory conditions of the upper
+respiratory tract. They are prone to have recurring
+colds, tonsilitis, and sore throats. Treatment of
+conditions without regard to the underlying
+<span class='pagenum'>[<a name="Page_570" id="Page_570">570</a>]</span>
+rheumatism is never satisfactory. These children complain of
+indefinite pains, now in one place, now in another. These
+pains are commonly known as "growing-pains" and, inasmuch
+as they are rheumatic and not "growing pains,"
+they should be regarded seriously because of the heart
+damage they might do if ignored, and especially so since
+the mildest attacks of rheumatism, without any joint
+symptoms even, frequently leave the heart in very bad
+shape. As a general rule it will be found that when a
+child has had a number of attacks of bronchitis or asthma
+it is rheumatic and should receive treatment for the
+rheumatic tendency.</p>
+
+<p>Children with the tendency to rheumatism invariably
+eat too much red meats and sugar,&mdash;the latter in the form
+of candy or as an excess in the food.</p>
+
+<p><b>Treatment of an Acute Attack</b>.&mdash;The child should be
+put in bed and kept warm. The bowels should be freely
+opened with citrate of magnesia. The diet should be very
+light: milk and lime water or milk and vichy water, with
+a piece of dry toast or zwieback, is all the child needs
+until the fever is relieved. When a single joint is affected
+local measures may be taken for its relief. Wraping
+the joints up with flannel cloths which have been
+wrung out of true oil of wintergreen, and outside of this
+oiled silk snugly bandaged on, is an excellent external application.
+The flannel cloths should be kept moist by
+adding a little of the wintergreen from time to time as
+it dries in. This can be done without removing the
+bandage. This application is kept in place for twenty-four
+hours and renewed if necessary. Such an external
+application will aid in the actual cure of the disease and
+will quickly relieve the patient of the pain. The oil of
+wintergreen used in this way should be the "true" oil, and
+should be so specified when bought in the drug store.</p>
+
+<p>Because of the great tendency to attack the heart a
+physician should take charge of every case of acute
+rheumatism in a child.</p>
+
+<p><b>To Treat the Tendency to Rheumatism</b>.&mdash;Exclude
+red meats and sugar in all forms as much as is possible.
+Give green vegetables freely, potatoes boiled with the
+skins on, fish, eggs, and poultry. Cereals with milk,
+<span class='pagenum'>[<a name="Page_571" id="Page_571">571</a>]</span>
+especially well cooked Scotch oatmeal, are exceedingly
+good for these children. By keeping up this diet after
+the acute attack has passed for a considerable time, it
+is possible to cure the various other complaints with which
+the child is afflicted,&mdash;tonsilitis, sore-throats, winter
+coughs, head-colds, bronchitis, asthma, etc.</p>
+
+<p>These children should wear woolen underwear all the
+year round. They should be encouraged to drink water
+or vichy freely between meals.</p>
+
+<p>In the treatment of an acute attack as given above
+it will be observed that no drugs are mentioned. This
+is intentional because it would be unjust to encourage the
+home treatment of a disease that is so treacherous, even
+in its mildest forms. Because of its tendency to recur
+and with each recurrence the danger of the heart being
+affected, it is advisable to put these children on cod liver
+oil or iron or some other good tonic. Every precaution
+should be taken to prevent these children from getting
+their feet wet or being out in the rain.</p>
+
+
+<p><b>SUMMARY:&mdash;</b></p>
+
+<blockquote><p>Rheumatism is a dangerous disease in children.</p>
+
+<p>In its mildest forms it can affect the heart badly.</p>
+
+<p>It has a distinct tendency to recur.</p>
+
+<p>Rheumatic children are afflicted with a number of diseased
+conditions which do not respond to treatment
+unless the rheumatism is treated.</p>
+
+<p>Acute rheumatism should never be treated except by a
+physician because of its treacherous character.</p></blockquote>
+
+
+<h4>MALARIA. INTERMITTENT FEVER</h4>
+
+<p>Malaria occurs quite often in infants and children. As
+a rule the child gives evidence of gastro-intestinal disturbance
+for a short period before the malarial symptoms appear.
+The chilly stage is often absent. Sometimes the
+hands and feet are cold and may be slightly blue and the
+child may appear to be in collapse. This stage may last
+for an hour or longer. The chilly stage may, however, be
+replaced by nervous symptoms,&mdash;restlessness, dizziness,
+<span class='pagenum'>[<a name="Page_572" id="Page_572">572</a>]</span>
+irritability, nausea, etc.,&mdash;or a convulsion may take place.
+In the second stage the temperature may rise quite high,
+the pulse may be quite rapid; the child is flushed, restless,
+and cries. This period may last from half an hour to two
+hours. The sweating stage is not as a rule well marked in
+a child. It may be very slight or not at all.</p>
+
+<p>Between the attacks some children may be entirely
+well; others remain restless, have little appetite and poor
+digestion. Malaria in children does not always follow a
+typical course. We often see children suffering from
+spasms, fainting spells, neuralgias, diarrhea, vomiting,
+and skin eruptions, all due to the malarial condition. This
+often leads to a mistake in diagnosis. Intermittent fever
+is often mistaken for pneumonia. Malaria is not a favorable
+disease for an infant to have. It rapidly weakens the
+child and great debility and anemia follows.</p>
+
+<p><b>Treatment</b>.&mdash;The treatment for malaria in children is
+by the administration of quinine as in adults. It must,
+however, be given with care and intelligence; for this
+reason no mother should begin dosing her child with it
+without consulting a physician.</p>
+
+
+<h4>REGARDING MOSQUITOES</h4>
+
+<p>The following is an extract from a circular in relation
+to the causation and prevention of malaria and the life
+history and extermination of mosquitoes issued by the
+Department of Health, City of New York:</p>
+
+<div class="blockquot"><p><b>Extermination and Prevention of Mosquitoes
+</b>.&mdash;Mosquitoes require for their development standing water. They
+cannot arise in any other way. A single crop soon dies and disappears
+unless the females find water on which their eggs may be laid. In order
+to prevent mosquitoes, therefore, the requirement is simple.</p>
+
+<p><b>No Standing Water</b>.&mdash;Pools of rain water, duck ponds, ice
+ponds, and temporary accumulations due to building; marshes,
+both of salt and fresh water, and road-side drains; pots, kettles,
+tubs, springs, barrels of water, and other back-yard collections,
+should be drained, filled with earth, or emptied.</p>
+
+<p>Running streams should have their margins carefully
+cleaned and covered with gravel to prevent weeds and grass
+at the water's edge.</p>
+
+<p>Lily ponds and fountain pools should, if possible, be abolished;
+if not, the margins should be cemented or carefully
+graveled, a good stock of minnows put in the water, and
+green slime (Alg&aelig;) regularly cleaned out, as it collects.
+<span class='pagenum'>[<a name="Page_573" id="Page_573">573</a>]</span></p>
+
+<p>Where tanks, cisterns, wells or springs are necessary to
+supply water, the openings to them should be closely covered
+with wire gauze (galvanized to prevent rusting), not the
+smallest aperture being left.</p>
+
+<p>When neither drainage nor covering is practicable, the surface
+of the standing water should be covered with a film of light
+fuel oil (or kerosene) which chokes and kills the larv&aelig;.
+The oil may be poured on from a can or from a sprinkler.
+It will spread itself. One ounce of oil is sufficient to cover
+15 square feet of water. The oil should be renewed once a
+week during warm weather.</p>
+
+<p>Particular attention should be paid to cess-pools. These
+pools when uncovered breed mosquitoes in vast numbers; if
+not tightly closed by a cemented top or by wire-gauze, they
+should be treated once a week with an excess of kerosene or
+light fuel oil.</p>
+
+<p>Certain simple precautions suffice to protect persons living
+in malarial districts from infection:</p>
+
+<p>First: Proper screening of the house to prevent the entrance
+of the mosquitoes (after careful search for and destruction
+of all those already present in the house), and
+screening of the bed at night. The chief danger of infection
+is at night (the Anopheles bite mostly at this time).</p>
+
+<p>Second: The screening of persons in malarial districts who
+are suffering from malarial fever, so that mosquitoes may not
+bite them and thus become infected.</p>
+
+<p>Third: The administration of quinine in full doses to malarial
+patients to destroy the malarial organisms in the
+blood.</p>
+
+<p>Fourth: The destruction of mosquitoes by one or more of
+the methods already described.</p>
+
+<p>These measures, if properly carried out, will greatly restrict
+the prevalence of the disease, and will prevent the occurrence
+of new malarial infections.</p>
+
+<p>It must be remembered that when a person is once infected,
+the organisms may remain in the body for many years, producing
+from time to time relapses of the fever.</p>
+
+<p>A case of malarial infection in a house (whether the person
+is actively ill or the infection is latent) in a locality
+where Anophele mosquitoes are present, is a constant source
+of danger, not only to the inmates of the house, but to the
+immediate neighborhood, if proper precautions are not taken.
+It should be noted in this connection that the mosquitoes
+may remain in a house through an entire winter and probably
+infect the inmates in the spring upon the return of the
+warm weather.</p>
+
+<p>Malarial fever is prevalent in certain boroughs of New
+York City, and in view of the presence of standing water
+resulting from the extensive excavations taking place in various
+parts of these boroughs, is likely to extend, if means are
+not taken for its prevention.</p></div>
+<p><span class='pagenum'>[<a name="Page_574" id="Page_574">574</a>]</span></p>
+
+
+<h4>REGULATIONS OF THE BOARD OF HEALTH, NEW
+YORK CITY, IN AID OF MOSQUITO EXTERMINATION
+AND THE PREVENTION
+OF MALARIAL FEVER</h4>
+
+<p class="center">(In Force from March 15 to October 15.)</p>
+
+<blockquote><p>1. No rain-water barrel, cistern, or other
+receptacle for rain-water, shall be maintained without being tightly
+screened by netting, or so absolutely covered that no mosquito can
+enter.</p>
+
+<p>2. No cans, pails, or anything capable of
+holding water, shall be thrown out or allowed to remain
+unburied on or about any premises.</p>
+
+<p>3. Every uncovered cesspool or tank shall be kept in
+such condition that oil may be freely distributed
+so as to flow over the surface of the water.
+Covered cess-pools must have perfectly tight
+covers, and all openings must be screened.</p>
+
+<p>4. No waste or other water shall be thrown out or allowed to stand
+on or near premises.</p>
+
+<p>Information is requested as to the presence of standing
+water anywhere, so that the premises may be inspected
+and the legal remedies against the same be applied.</p>
+
+<p>The prompt co&ouml;peration of all persons in the enforcement
+of the above regulations is earnestly desired, and
+they are assured that in this way the breeding of mosquitoes
+on their premises may be prevented.</p>
+
+<p>Mosquitoes are, so far as known, the only means of
+conveying malaria.</p></blockquote>
+
+
+<h4>"RASHES" OF CHILDHOOD</h4>
+
+<p>The following table gives all the characteristics of the
+rashes that accompany the eruptive fevers. The term
+"incubation" means the period of time which elapses between
+the time when the child was exposed to, or caught
+the disease, and the time when the child is taken sick. It is
+sometimes interesting to know where a child could have
+caught a disease; so if we know the incubation period we
+can tell exactly where the child was on the day, or days,
+when it was infected.
+<span class='pagenum'>[<a name="Page_575" id="Page_575">575</a>]</span></p>
+
+
+
+<div class='center'>
+<table class="tablecenter bt bb" cellpadding="4" cellspacing="0"
+summary="Rashes">
+<tr><td class="bb br" align='center'>Name</td>
+<td class="bb br" align='center'> Incubation</td>
+<td class="bb br" align='center'> Day of Rash</td>
+<td class="bb br" align='center'>Character of Rash</td>
+<td class="bb br" align='center'>Rash fades</td>
+<td class="bb" align='center'>Duration</td></tr>
+<tr><td class="br" align='center'>Measles</td>
+<td class="br" align='center'> 10-14<br /> days</td>
+<td class="br" align='center'> 4th day</td>
+<td class="br" align='left'>Small red like spots<br />
+resembling flea bites,<br />first appearing on face<br />
+and forehead, forming<br />blotches with semi-lunar<br />
+borders.</td>
+<td class="br" align='center'>On the 7th<br />day of<br />fever</td>
+<td align='center'>6-10<br />days</td></tr>
+
+<tr><td class="br" align='center'>Scarlet</td>
+<td class="br" align='center'>1-6 days<br />occasionally<br />longer</td>
+<td class="br" align='center'> 2d day of<br />fever</td>
+<td class="br" align='left'>Bright scarlet, rapidly<br />
+diffused, first on<br />chest and upper<br />extremities</td>
+<td class="br" align='center'>On 5th day<br />of fever</td>
+<td align='left'>8-9 days</td></tr>
+
+<tr><td class="br" align='center'>Chicken-pox</td>
+<td class="br" align='left'> 4-12 days</td>
+<td class="br" align='center'> 2d day</td>
+<td class="br" align='left'>Small rose vesicles,<br />which do not become
+<br /> pustular</td>
+<td class="br" align='center'>Slight scab of<br />short duration</td>
+<td align='left'>6-7 days</td></tr>
+
+<tr><td class="br" align='left'>Typhoid<br />Fever</td>
+<td class="br" align='center'> 10-14 days</td>
+<td class="br" align='center'> 7-14 days</td>
+<td class="br" align='left'>Rose colored papules<br />
+elevated, few in number,<br />limited to trunk,<br />disappear on pressure
+</td><td align='left'></td><td align='left'>From<br />21-35 days</td></tr>
+
+<tr><td class="br" align='left'>Smallpox<br />(Variola)</td>
+<td class="br" align='center'> 10-14 days</td>
+<td class="br" align='center'> 3d day of<br />fever</td>
+<td class="br" align='left'>Small, round, red<br />hard, papules forming<br />
+vescicles then pustules,<br />first appearing on face<br />
+and wrists</td>
+<td class="br" align='center'>9th day<br />scabs form<br />and about<br />
+14th day<br />fall off</td>
+<td align='left'>14-21<br />days</td></tr>
+</table></div>
+
+
+<p><b>Other Rashes</b>.&mdash;There are so-called "stomach" rashes
+which are a source of much worry to mothers. These
+rashes may appear at any time and they may be limited to
+certain parts or may cover most of the body. They may
+be bright red, or they may be simply a general discoloration.
+They may appear as blotches or they may spread
+all over, like the rash of scarlet fever when at its height.</p>
+
+<p>These rashes are of no importance, except that they indicate
+some derangement of the gastro-intestinal tract.
+As a rule they indicate indiscriminate feeding or overfeeding.
+Children who have had too much candy or pastries,
+or who have been fed things which are unsuited to
+their age, frequently develop rashes. Such children
+should have a thorough cleaning out; a dose of castor
+oil is probably the best cathartic to give them.</p>
+
+<p>The mother may readily learn to know the difference
+between a rash that is unimportant and one that indicates
+one of the eruptive diseases, if she gives the matter
+a little careful thought. In the first place a child
+who is about to become the victim of one of the eruptive
+diseases will be sick, and will have a fever for two or
+three days before any rash appears; while on the other
+<span class='pagenum'>[<a name="Page_576" id="Page_576">576</a>]</span>
+hand a child may go to bed in good health and may next
+morning be covered with a general rash, or with large
+blotches, without any fever and without any evidence of
+ill-health, except the skin condition. In the second place,
+if the mother gives the child a cathartic and restricts the
+diet for a day the rash will disappear, and good spirits
+and good health will be maintained; on the other hand,
+the giving of a cathartic to a child who is the victim of
+an eruptive disease will not tend to diminish the rash, but
+may accentuate it.</p>
+
+<p><b>Pimples: Blackheads (Acne)</b>.&mdash;This eruption is
+situated chiefly on the face. It may appear, however, on
+the back, shoulders, and on the chest. It is mostly seen in
+young men and women about the age of puberty. It appears
+as conical elevations of the size of a pea; they are
+red and tender on pressure, and have a tendency to form
+matter, or pus, in their center. In from four to ten days
+the matter is discharged but the red spots continue for
+some time longer.</p>
+
+<p><b>"Blackheads"</b> appear as slightly elevated spots of a
+black color out of which a small worm-like substance may
+be pressed. Pimples and blackheads are due to inflammation
+of the glands of the skin. The mouths of these
+glands become filled with dust which acts as a plug causing
+the retention of the oily matter of the gland which
+becomes inflamed and hence the pimples and blackheads.
+Certain constitutional conditions favor the development of
+these skin blemishes. Constipation, indigestion, bad blood
+from unsanitary and bad hygienic surroundings, self-abuse
+and bad sexual habits favor the appearance of these
+skin affections.</p>
+
+<p><b>Treatment</b>.&mdash;The patient must avoid tea, coffee,
+tobacco, alcohol, veal, pork, fats, candy, pastries, cheese,
+and all edibles that are known to disagree with the digestion
+of the patient. Constipation must be avoided; if
+necessary, laxatives may be taken to keep the bowel open.
+The blackheads must be squeezed out with an instrument
+made for the purpose, not with the finger nails. Pimples
+must be opened with a sterile needle. The parts should
+be washed three times a day with hot water and green
+soap, and the following mixture applied at night:&mdash;
+<span class='pagenum'>[<a name="Page_577" id="Page_577">577</a>]</span></p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Zinc Oxide</td><td align='left'>ounces</td>
+<td align='left'>1/4</td></tr>
+<tr><td align='left'>Powdered calamine</td><td align='left'>ounces</td>
+<td align='left'>1/4</td></tr>
+<tr><td align='left'>Lime water&nbsp;</td><td align='left'>ounce</td>
+<td align='left'>6</td></tr>
+</table></div>
+
+
+<p>Mix and shake before applying to the skin.</p>
+
+
+<h4>CONVULSIONS. FITS. SPASMS</h4>
+
+<p>Convulsions are quite common in children, especially
+those under three years of age.</p>
+
+<p>A convulsion in an infant immediately, or within three
+months, after its birth is the result of injury, either at
+birth or later (a fall for example) which seriously affects
+the brain itself. After the third month the cause of
+fits or convulsions is, in a very large percentage of the
+cases, to be found in errors of diet resulting in disturbances
+in the stomach or bowels&mdash;eating of articles of food
+difficult to digest, as green or overripe fruit, salads, fresh
+bread, pickles, cheese, etc. Children of a nervous temperament
+are more liable to convulsions than are others.
+Females are more frequently victims of fits than are male
+children.</p>
+
+<p>In infants convulsions often result from changes in the
+mother's milk. Mental excitement, deep emotion, anger,
+frights, severe affliction and distress will so affect a woman's
+milk that it will cause convulsions in her child if she
+nurses it while under the influence of any of these conditions.</p>
+
+<p>Convulsions may result from any condition that disturbs
+the nutrition of the child, as, for example,&mdash;exhaustion,
+anemia, intestinal indigestion, blood poison, and
+general weakness resulting from some severe sickness,
+especially those of the digestive organs.</p>
+
+<p>Various forms of brain disease cause spasms and fits;
+the most common are meningitis, tumors, hemorrhage,
+abscesses and injuries. Convulsions may accompany certain
+conditions, as, the presence of worms, teething, severe
+burns, foreign bodies in the ear, whooping cough,
+pneumonia scarlet fever, malaria, sometimes measles, typhoid
+fever, and diphtheria. Children who are badly
+nourished and who live constantly in unsanitary surroundings
+are more apt to have convulsions than those
+<span class='pagenum'>[<a name="Page_578" id="Page_578">578</a>]</span>
+who are well nourished and who live hygienically. One
+attack renders the patient more liable to another, and
+when the "habit" is established any trivial cause may incite
+a convulsion; persistent and systematic efforts should
+therefore be taken to prevent the attacks. The best preventives
+are:</p>
+
+<blockquote><p>1st. To regulate the diet and the bowels.</p>
+
+<p>2nd. Remove adenoids and worms, if they exist.</p>
+
+<p>3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper
+foods.</p>
+
+<p>4th. Guard the child against catching cold, infectious
+diseases and all fevers. In other words, save the child
+from the cause and the convulsion will not take place.</p></blockquote>
+
+<p>By regulating the bowels we mean that everything the
+child eats must be seen by the mother, must be with the
+mother's permission, and must be suited to the child's age.
+If there is any question about the latter it will be advisable
+to have a physician write out a list of articles suitable to
+the child. It is generally necessary to eliminate meats,
+pastries, candies, sugar to a large extent, gravies, salads,
+sauces, and all the extras of the table, as pickles, mustard,
+relish, etc., as well as coffee, tea, cocoa, and alcohol.</p>
+
+<p>The child should live in the open air as much as possible;
+a daily warm bath, followed by a quick, cold sponge,
+is a necessity.</p>
+
+<p>Children subject to fits are possessed of a highly nervous
+temperament. They are difficult to manage unless
+managed with firmness and tact. It is not necessary to
+be harsh, but it is imperative to be firm and decided. They
+must be made to realize that they are not "the master,"
+that their will is not supreme, and the mother must exact
+this condition; otherwise these children will become dictators
+and selfish despots&mdash;ruining the discipline of the
+home, spoiling their own chance of physical health, and
+rendering unhappy everyone around them. The parents,
+therefore, have a definite duty to perform and it is not
+an easy one. The food should be so regulated that each
+day a natural movement of the bowels will take place.
+(See article on constipation, page 303.) If a day should
+pass without a movement the child should be given a hot
+rectal enema as described on page<a href="#Page_586">586</a>.
+<span class='pagenum'><a name="Page_579" id="Page_579">[579]</a></span></p>
+
+<p>The adenoids can be easily demonstrated to either exist
+or be absent. (See page <a href="#Page_519">519</a>.) If worms are known to
+be present in the child they should be at once removed. If
+they are simply suspected, the child should receive treatment
+for them, just the same. (See page <a href="#Page_549">549</a>.)</p>
+
+<p>By going a long time without a convulsion the nervous
+system will recuperate itself, and become so strong and
+healthy that what once would cause a fit will make no impression
+in its new strengthened state; therefore, if you
+"save the child from the cause," the convulsions will cure
+themselves, as it were.</p>
+
+<p>There are some cases of convulsions for which no satisfactory
+explanation can be found.</p>
+
+<p><b>Treatment</b>.&mdash;When a child has a convulsion, remove
+its clothing and put it into a mustard bath. The temperature
+of the bath should be 105&deg; F. Every part of the
+child should be under the water except the head, which
+is supported in the palm of the hand. While it is in the
+bath its body, and especially its arms and legs, should
+be briskly rubbed by the hands of an assistant in order to
+keep the circulation active. A rectal injection of soap
+suds or plain salt and water (see page <a href="#Page_579">579</a>) should be
+given while the child is in the bath, because, as explained
+above, a large percentage of these cases are caused by gastro-intestinal
+derangements. The rectal injection will
+likely remove the cause. An ordinary convulsion lasts
+from five to ten minutes. When the child is removed
+from the bath it should be placed in a warm, comfortable
+bed and kept absolutely quiet. A hot-water bottle may
+be put near its feet and an ice-bag or cold cloths should
+be kept on its head. It should be given a full dose of
+castor oil and allowed to go to sleep. Its diet should
+consist of light broths for two or three days and during
+this time it should not be disturbed or annoyed by too
+much attention. This is as far as it is wise or safe for
+any mother to go in the treatment of convulsions. A
+physician should be called in every instance, because a
+convulsion should never be regarded lightly. Many children
+have become idiots, others have been afflicted with
+paralysis, because of inattention at the proper time.
+<span class='pagenum'>[<a name="Page_580" id="Page_580">580</a>]</span></p>
+
+
+<p><b>SUMMARY:&mdash;</b></p>
+
+<blockquote><p>1st. Convulsions must always be regarded as
+serious.</p>
+
+<p>2nd. Convulsions demand prompt treatment.</p>
+
+<p>3rd. Every mother should know that an English mustard
+bath&mdash;hot&mdash;is the first resort in convulsions.</p>
+
+<p>4th. While this is being done she can read the home treatment in
+this book and carry it out before the doctor comes.</p>
+
+<p>5th. If the fit is not caused by some stomach or intestinal
+trouble, have the physician find out the cause and tell you what to
+do, and do it faithfully, because if you neglect the proper treatment
+the child may become idiotic or paralyzed.</p></blockquote>
+
+
+<h4>BED WETTING. ENURESIS&mdash;INCONTINENCE</h4>
+
+<p>Enuresis, or incontinence of urine, is customary in infancy.
+Just when urination becomes a voluntary act depends
+upon the development and training of the individual
+child. As a rule children can be taught to control
+this function during the day, or while awake, about the
+tenth month. It is not under control during sleep until
+a much later period, usually by the end of the second
+year, but lack of control should not be regarded as abnormal
+until the child has entered the fourth year. If the
+child fails to control the act of urination during the day
+at the end of the second year, and is addicted to habitual
+bed-wetting, some measures should be adopted to cure the
+condition.</p>
+
+<p>Boys under twelve years of age seem to be affected
+more frequently than girls. It is wrong to assume that
+it is caused by negligence or laziness, as some parents do.
+It has generally a special cause, and the cause usually
+can be found if it is carefully sought for. It may be the
+result of bad habits: exposure to cold in the night; lying
+on the back; drinking too much liquid in the afternoon
+or at bedtime. It may be due to too much acid in the
+urine, and if so it will be found necessary to reduce
+meats and eggs the child is eating. Worms, stone in the
+bladder, some anatomical abnormality or deficiency, may
+<span class='pagenum'>[<a name="Page_581" id="Page_581">581</a>]</span>
+be responsible for it. The diet may be at fault; adenoids
+are supposed by some physicians to be the cause. No
+matter what the actual cause may be, it must be found
+and remedied before we can hope for a permanent cure.
+A very large majority of these cases are due to nervousness.
+These children are of a nervous temperament.
+They are not necessarily sickly children; they are simply
+of a nervous type. They are well-nourished, active, and
+lively. Incontinence of urine during the day and long-continued
+bed-wetting does not at all affect the health of
+the child. If they are in poor health, it is essential to
+treat their general condition before trying to cure the
+incontinence.</p>
+
+<p>It is absolutely wrong to punish or to crush the spirit
+of these children. Constant nagging and taunting, even
+if done in the hope of shaming the child into a cure, will
+simply make a coward of him and will not aid in improving
+matters, but will be distinctly detrimental.</p>
+
+<p>Scrupulous cleanliness must be constantly practiced or
+these children, if neglected, may develop ulcers and sores
+of a very obstinate character. The odor is also bad for
+the health of the child.</p>
+
+<p><b>Treatment</b>.&mdash;Find and remove the cause if possible.
+If due to general poor health, give tonics, obtain a change
+of air, and build the child up. Reduce the total quantity
+of liquids, if in excess, and be very careful not to give any
+liquids near bedtime. Don't cover these children too
+much; they should never be "too warm"; they should
+sleep in a well-aired room, and they should receive a
+quick, cool sponge bath every morning. They should be
+taught to sleep on their sides, never on their backs. Their
+diet should be light but nourishing. When bed-wetting
+is established it will continue, if untreated, until the child
+is eight or ten years of age, and it frequently lasts much
+longer. When treatment is undertaken it should be distinctly
+understood by the mother that it will take many
+months to cure; and during these months she must give
+her constant attention to the child. If she does not undertake
+to do this, or if she fails to do it, the treatment
+should not be begun at all, as it will not succeed. Various
+plans should be tried to keep the child from sleeping on
+<span class='pagenum'>[<a name="Page_582" id="Page_582">582</a>]</span>
+its back. The reason of this is because it has been found
+that the child wets the bed only when sleeping on its back
+and never when sleeping on its side. The simplest
+method, of tying a towel or cloth around the child with
+a knot over the spinal column, so that it will hurt and
+waken it, if it turns on its back, is a very good one and
+should be carefully tried for some time. The nervous
+system of these children should never be overtaxed at
+home or at school. Early hours and plenty of sleep are
+desirable. Certain articles of diet of a stimulating character
+should be entirely avoided,&mdash;for example, coffee,
+tea, beer, candies, sugars, and pickles. The best diet for
+these children is one composed exclusively of milk, vegetables,
+fruits, meats, and cereals. Meats, however, should
+be given only once every two days. It is a good plan to
+teach the child to hold his water during the day, as long
+as he can, to accustom the bladder to being full. Adenoid
+growths, which contribute to the nervousness of a
+naturally nervous child, should be removed. It is a good
+plan to take the child up when the parents go in bed
+and let him urinate. This often cures the condition in
+itself.</p>
+
+<p>Sometimes moral measures, such as the promise of a
+reward, will strengthen the will so that the child may
+overcome the tendency. Find out what the child most
+desires in the way of a toy, and promise it if he goes so
+long without wetting the bed. Aid and encourage him
+to make efforts to win the reward.</p>
+
+<p>If drugs have to be resorted to, it is necessary to call
+the family physician, as the only drugs that are of any
+use are very powerful and have to be given with great
+care and caution. It is the experience of most physicians
+and specialists, however, that in a large majority of cases
+the treatment, along the lines as given above, will be effective,
+without drugs, if faithfully persisted in by the
+mother.</p>
+
+<p>These children should be examined by a physician.
+The cause of the bed-wetting is frequently discovered to
+be produced by anatomical abnormalities which render
+circumcision imperative. In these cases no method of
+treatment will succeed until circumcision is performed.
+<span class='pagenum'>[<a name="Page_583" id="Page_583">583</a>]</span></p>
+
+
+<h4>SLEEPLESSNESS. DISTURBED SLEEP</h4>
+
+<p><b>Causes</b>.&mdash;In babies, disturbed sleep is most frequently
+due to hunger or to indigestion. The latter is the result
+of overfeeding or improper feeding. Rocking the child
+to sleep, or feeding it during the night will cause sleeplessness.
+Teething, colic, or any pain will result in disturbed
+sleep. Nervous children are frequently poor
+sleepers.</p>
+
+<p>In older children, some digestive disturbance is, as a
+rule, the cause. Chronic intestinal indigestion, worms,
+adenoid growths, enlarged tonsils, lack of fresh air in the
+bedroom, cold feet, may, however, be the cause. Overstudy
+in school, poor blood, poor nourishment are always
+accompanied by inability to sleep soundly. Too strenuous
+play, exciting stories read before bedtime, may cause
+sleeplessness.</p>
+
+<p><b>Treatment</b>.&mdash;The removal of the cause is absolutely
+necessary. In order to discover the cause it is sometimes
+essential to study the child's whole routine in order to
+be able to tell exactly just what is causing the apparent
+insomnia. It may be necessary to change the method
+of feeding, to regulate the studies and the exercises, and
+to suggest changes regarding the sanitary and hygienic
+environment of the child's life. Mothers must be warned
+against using drugs in the form of soothing syrups or
+teething mixtures. They are dangerous and absolutely
+forbidden under the above conditions.</p>
+
+<p>The nervous disposition of the child must be taken into
+consideration and treated if necessary. If bad habits exist
+they must be stopped. Poor blood and poor nutrition
+must receive the treatment suggested under these headings.</p>
+
+
+<h4>NIGHTMARE. NIGHT TERRORS</h4>
+
+<p>In a nightmare a child wakes suddenly in a state of
+fright and will inform you that it has had a bad dream.
+His mind seems clear and he recognizes those about him.
+He is not easily calmed and may cry for some time; finally
+he goes to sleep again. The next day he will remember
+<span class='pagenum'>[<a name="Page_584" id="Page_584">584</a>]</span>
+the dream and most of the incidents of the night
+before. Such cases are quite frequent. They are to be
+treated in the same way as cases of disturbed sleep, as
+they really have the same cause. They are mostly due
+to digestive disturbances and errors of diet.</p>
+
+<p><b>Night-Terrors</b>.&mdash;Cases under this heading form a
+distinct group by themselves. They are not frequent,
+but the condition is much more serious. The cause seems
+to be wholly nervous and may indicate an important nervous
+derangement. It seems to have some indefinite relation
+to such conditions as migraine, hysteria, epilepsy,
+and even insanity. The child wakes suddenly during the
+night and sits up, evidently in terror; he does not apparently
+regain his full consciousness. He talks of being
+scared, calls for his mother, trembles and shakes, cannot
+answer questions intelligently, and after a time goes to
+sleep. Next day he remembers nothing of the attack and
+does not seem to suffer in any way as a result of it.</p>
+
+<p>I am disposed to believe that all of these attacks are
+not due to a nervous condition. A number of them of
+exactly this type have been cured by absolutely withdrawing
+milk from the diet.</p>
+
+<p>It is a good plan to restrict the possibility of excessive
+play in these children. They are of the type whose
+play is work, and too much of it is too exhausting. Some
+person should sleep in the same room with these patients
+or in an adjoining room with the door open.</p>
+
+<p>If the condition occurs frequently the child should be
+subjected to a thorough physical examination, because
+it may be one evidence of a serious ailment.</p>
+
+<p>Sometimes these little patients have to be taken out
+of school and sent to the country, where they should
+remain for many months. It is far better to regard the
+condition as indicating an abnormality,&mdash;even though it
+may not have any deeper significance than that the digestive
+apparatus of the child is not quite right,&mdash;and
+make every effort to cure it, than to permit the child to
+go on under what really are unjust and unfavorable
+conditions.
+<span class='pagenum'>[<a name="Page_585" id="Page_585">585</a>]</span></p>
+
+
+<h4>HEADACHE</h4>
+
+<p>Headaches are not common in little children. The
+most frequent ones are caused by:</p>
+
+<span style="margin-left: 1em;">1. Chronic indigestion and constipation.</span>
+<br />
+
+<span style="margin-left: 1em;">2. Anemia and malnutrition.</span><br />
+
+<span style="margin-left: 1em;">3. Nervous disorders.</span><br />
+
+<span style="margin-left: 1em;">4. Diseases of the eye, nose, throat.</span>
+<br />
+
+<span style="margin-left: 1em;">5. Rheumatism and gout.</span><br />
+
+<span style="margin-left: 1em;">6. Disturbances of the genital tract.</span>
+<br />
+
+<p>Those arising from anemia and poor nutrition are
+most frequently present in girls from ten to fifteen years
+of age. They may result from overcrowding of school
+work, which results in loss of appetite and poor sleep.</p>
+
+<p>Nervous headaches may be hereditary or acquired
+through unhygienic surroundings. Hysteria, epilepsy,
+disease of the brain, neuralgia from carious teeth, may
+result in nervous headaches.</p>
+
+<p>Headaches from disturbances of the genital tract may
+afflict girls about the time of puberty.</p>
+
+<p><b>Treatment</b>.&mdash;To remove the cause is the only plan
+that promises any result. Each one must be investigated
+by itself and dealt with accordingly. For the headache
+itself a hot foot bath, cold to the head, and small doses
+of phenacetine (one grain every hour for four doses)
+are perhaps the most certain of all methods of treatment.</p>
+
+
+<h4>THUMB-SUCKING</h4>
+
+<p>The habit of sucking the thumb may be corrected by
+wearing a pair of white mittens, or gloves tied at the
+wrist. Should children attempt to suck the thumb with
+gloves on, as some do, it will be necessary to saturate the
+thumb and fingers of the gloves with tincture of aloes, or
+a solution of the bisulphate of quinine, one dram to two
+ounces of water.</p>
+
+
+<h4>BITING THE FINGER NAILS</h4>
+
+<p>Biting the finger nails may be stopped by the use of
+the same bitter remedies as are used in thumb-sucking.
+<span class='pagenum'><a name="Page_586" id="Page_586">[586]</a></span></p>
+
+
+<h4>HOW TO WASH OUT THE BOWELS</h4>
+
+<h4>COLON IRRIGATION. A HIGH ENEMA</h4>
+
+<p>Procure a soft rubber catheter,&mdash;No. 18 American is
+about right. It is not advisable to get too soft rubber
+for the reason that it will buckle when the child strains
+and it will be impossible to wash out the bowel. Fill half
+full an ordinary two-quart douche bag with water that
+is warm, but not too hot. Dissolve a heaping teaspoonful
+of table salt in a glass of hot water and add this to the
+water in the bag. Hang the bag about two feet above
+the level of the child, so that the water will not flow in
+with too strong a stream; otherwise the child will immediately
+try to eject it. If the water flows in gently,
+the child may not object to it to the extent of making
+strenuous efforts to force the catheter out.</p>
+
+<p>Use the small sized nozzle that comes with the douche
+bag. Place the rubber catheter over this nozzle, lubricate
+the catheter, place the child on its back over a
+douche pan, insert the catheter about two inches, let the
+water run and as it runs in push the catheter up gently
+until it is all in the bowel except the end on the douche
+tip. The object of letting the water run while pushing in
+the catheter is because it floats up with the water as it
+distends the bowel; there is no risk then of pushing the
+end into the intestinal wall or hurting the child. While
+the water is flowing into the bowel it is a good plan to
+compress the buttocks together to aid in holding the
+water, as the child is very apt to let it run out as soon
+as it feels uncomfortable.</p>
+
+<p>The temperature of the water for the ordinary rectal
+injection should be 95&deg; F. When the child is exhausted
+or very weak, or when the circulation is poor, the temperature
+of the water may be as high as 110&deg; F. When,
+on the other hand, the fever is very high, the water may
+be much cooler; as low as 70&deg; F. has been given with
+good results on the fever. If the irrigation is given with
+the intention of reducing the fever, it is best to begin
+with water around 90&deg; F., and reduce it to 70&deg; F.,
+gradually.
+<span class='pagenum'>[<a name="Page_587" id="Page_587">587</a>]</span></p>
+
+<p><b>Indications for Irrigation of the Colon</b>.&mdash;When it is
+desired to cleanse the bowel of any collection of matter
+a colon irrigation is indicated. This matter may be
+mucus, fecal substance, undigested food, or the decomposing
+waste products which may remain there as a result
+of disease or other conditions.</p>
+
+<p>When it is desired to medicate by putting fluids into
+the bowel we adopt the colon infusion.</p>
+
+<p>Every diseased condition of the bowel does not, however,
+indicate irrigation. If a child is having frequent
+loose movements every half-hour it is safe to assume that
+the bowel is being cleaned out sufficiently without any
+artificial aid. To irrigate in these cases would only irritate
+and would not accomplish anything. The cases
+which are benefited are those in which we have a fever
+with four or five green stools in the twenty-four hours,
+or where we have a high fever with no movement at
+all. To irrigate in these cases we not only get rid of
+the products of decomposition, but we prevent further
+decomposition and we reduce the fever, thereby contributing
+to the general welfare of the child.</p>
+
+<p>When the child is convalescing and when there is
+only mucus in the stools, with no fever&mdash;as in cases of
+chronic ileo-colitis&mdash;the colon irrigations should be
+stopped, as they tend to keep up the discharge of mucus
+in these cases. If, however, there is a relapse with fever,
+which would indicate a fresh infection with more discharging
+mucus and possibly green stools, the irrigation
+must be used until the fever subsides.</p>
+
+<p>Colon irrigations should always be given in every case
+of convulsions in infancy, first to clean out the bowel
+to prevent putrefaction, and second to empty the bowel
+on general principles because an overloaded bowel is
+very frequently the cause of convulsions in children.</p>
+
+<p>When irrigation of the bowel is given at all it must be
+given thoroughly. Enough water must pass into the
+bowel to wash it all out. For this reason it is essential
+that the catheter should be all in and in the bowel&mdash;not
+doubled on itself two or three inches in the bowel. If
+it is a serious case and the mother nervous, someone else
+should give the washing&mdash;preferably the physician himself.
+<span class='pagenum'>[<a name="Page_588" id="Page_588">588</a>]</span>
+If the child objects strenuously, as often happens,
+it must be done with greater care to be successful. Remember
+that a colon irrigation is never given unless it is
+absolutely necessary and as a consequence it is given to
+accomplish a certain purpose; it must, therefore, be done
+thoroughly. If it is not, your child may miss the chance
+it has of getting over some immediate difficulty and if
+the moment of the "chance" is wasted or lost, that
+moment will not return. Be thorough, therefore.</p>
+
+<p><b>Enema</b>.&mdash;Some physicians talk about a high enema and
+a low enema. A high enema is really an irrigation as
+described above. The following remarks apply to low
+enemas only.</p>
+
+<p>A so-called low enema is given to clean out the rectum
+of constipated matter, or for the introduction of food or
+medicine by rectum, when for various reasons it is necessary
+to spare the stomach.</p>
+
+<p>It may be given with the fountain syringe or with the
+ordinary bulb (baby) syringe. A catheter may be put
+on the tip of the syringe if it is thought best to inject
+higher up than in the rectum.</p>
+
+<p>When an enema is used in infants or older children for
+the relief of constipation, the best medium to use is
+glycerine. For an infant, one teaspoonful to an ounce of
+water is sufficient; for older children, one tablespoonful
+to two ounces of water, given with the bulb syringe, will
+give prompt results. If the constipation is pronounced,
+the fecal mass very hard, an enema of sweet oil, allowed
+to remain in for ten minutes, will soften it and permit
+a movement.</p>
+
+<p>Soap suds are often used. They are good but not
+as reliable as the glycerine or oil; if, however, neither
+of these two are at hand the soap suds may be
+given.</p>
+
+<p>Enemas should be carefully given and the liquid slowly
+injected. If the fountain syringe is used care must be exercised
+in not having the bag too high. If it is too high
+the liquid will flow in too strongly, either injuring the
+bowel wall or causing the child to strain immediately and
+pass out the injection before it has an opportunity of
+accomplishing its work.
+<span class='pagenum'>[<a name="Page_589" id="Page_589">589</a>]</span></p>
+
+<p>The temperature of the enema should be warm&mdash;not
+hot, and not cold, simply body heat.</p>
+
+
+<h4>METHODS OF REDUCING FEVER</h4>
+
+<p>During the course of acute illness it is frequently
+necessary to reduce the fever, if possible, without the
+use of drugs. The following means are often adopted.
+It is desirable that the mother should know just how to
+carry out these methods:</p>
+
+<p><b>Ice-Cap</b>.&mdash;An ice-cap is used to protect the brain when
+a child or adult is running a very high fever. It is put
+on when the fever is above 103&deg; F. It may be used in
+other conditions&mdash;brain disease, or disease of the
+meninges or cord&mdash;in which case the physician will be
+in attendance and will direct what should be done.</p>
+
+<p>Ice-bags are procured in the drug stores. The best one
+is the flat French ice-bag. Fill it three-quarters full of
+finely chopped ice, put the ice-bag in a towel, and place
+on the patient's head. There should be only one thickness
+of the towel between the ice-bag and the head.</p>
+
+<p>It will be necessary to keep a record of the fever so
+that the ice-bag may be withdrawn when it falls below
+103&deg; F.</p>
+
+<p>When the ice melts the bag must be at once refilled.
+This is often overlooked by careless mothers.</p>
+
+<p><b>Cold Sponging</b>.&mdash;Cold sponging is used to reduce fever
+or to allay nervous irritability. Equal parts of alcohol
+and water or vinegar and water are used. The temperature
+of the water should be 80&deg; to 85&deg; F.</p>
+
+<p>Infants to be sponged should be completely undressed
+and laid upon a blanket. The sponging should be done
+for about fifteen or twenty minutes, after which the child
+is wrapped in a dry blanket without further clothing
+except the diaper. To be effective it must be done frequently.</p>
+
+<p><b>Cold Pack</b>.&mdash;The cold pack is used to reduce fever. It
+is one of the simplest and one of the best means we have.
+The child is undressed completely, and laid upon a
+blanket. It is completely covered with a small blanket
+(except its head) wrung out of water at 100&deg; F. Outside
+<span class='pagenum'>[<a name="Page_590" id="Page_590">590</a>]</span>
+of this the child is rubbed with a piece of ice, front
+and back, for a sufficiently long time to render the surface
+cool, but not cold. Children take kindly to this
+means of reducing fever; there is no shock and they are
+quieted by it.</p>
+
+<p>Just how long one will rub with the ice depends upon
+circumstances. From five to thirty minutes may be employed.
+The head should be sponged with cold water
+while this is being done and it is a good plan to have a
+hot-water bottle at the child's feet.</p>
+
+<p><b>The Cold Bath</b>.&mdash;To reduce fever the cold bath is used
+in the following way: Water at a temperature of 100&deg; F.
+is put into the bath and the child is first put into this
+water, then the water is reduced by putting into it
+shaved ice until it reaches 80&deg; F. The child's body is
+well rubbed while it is in the bath and cold water is applied
+to its head. The bath is continued for five minutes,
+or sometimes with a robust child to ten minutes. On
+removal the child should be put into a warm blanket after
+being thoroughly dried.</p>
+
+<p><b>Rectal Irrigations</b>.&mdash;These are sometimes given to
+reduce fever. They are very useful and very successful
+if they are given properly and without exciting the child
+too much. It is best to give water of an ordinary temperature
+at first and gradually reduce it to 70&deg; F. It
+should be continued for ten minutes or longer. It may
+be repeated every three hours. (See page <a href="#Page_586">586</a>.)</p>
+
+
+<h4>VARIOUS BATHS</h4>
+
+<p>Every mother should know how to give any bath that
+may be directed by the physician.</p>
+
+<p><b>The Mustard Bath</b>.&mdash;Take from three to four tablespoonfuls
+of English mustard; mix thoroughly in about
+one gallon of warm water. Add to this about five gallons
+of plain water at a temperature of 100&deg; F. If it
+is necessary to raise the temperature of the water higher
+it may be done by adding water until the temperature
+reaches 105&deg; or 110&deg; F.</p>
+
+<p>The mustard bath is exceedingly effective in cases of
+shock, great sudden depression, collapse, heart failure,
+<span class='pagenum'>[<a name="Page_591" id="Page_591">591</a>]</span>
+or in sudden congestion of the lungs or brain. The special
+use of the mustard bath is in the treatment of convulsions;
+it is also useful for nervous children who sleep
+badly. Two or three minutes in the mustard bath, followed
+by a quick rubbing, will induce refreshing sleep
+in these children. It is not necessary to have more than
+one tablespoonful of mustard in these cases.</p>
+
+<p><b>The Hot Bath</b>.&mdash;A bath is prepared of water at a
+temperature of 100&deg; F. After the child is in the bath
+the temperature of the water is raised to 105&deg;, or to
+110&deg; F. It is not safe to go above this point.</p>
+
+<p>The body of the child should be well rubbed while it
+is in the bath. In most cases it is advisable to apply cold
+water to the head while the child is in the bath. A bath
+thermometer should be kept in the water to see that it
+does not rise above the temperature desired.</p>
+
+<p>The hot bath, like the mustard bath, is used to promote
+reaction in cases of shock, collapse, etc., and in
+convulsions.</p>
+
+<p><b>The Hot Pack</b>.&mdash;Remove all clothing from the baby
+and envelop the body in a sheet wrung out of water at a
+temperature of 100&deg; F., to 105&deg; F., after which the
+body should be rolled in a thick blanket. Those hot applications
+may be changed every twenty minutes until
+free perspiration is produced. This condition may be
+kept up as long as is necessary.</p>
+
+<p>The hot pack is used mainly in disease of the kidney.</p>
+
+<p><b>The Hot-Air or Vapor Bath</b>.&mdash;The child is put in bed
+wholly undressed with the bedclothing raised about twelve
+inches, and held in that position by a wicker support.
+The child's head is of course outside the bed clothing.
+Beneath the bed clothing hot air or vapor from a croup
+kettle is introduced. This will cause free perspiration in
+twenty minutes. It may be continued from twenty to
+thirty minutes at a time.</p>
+
+<p>The vapor bath is used in diseases of the kidney, as
+a rule.</p>
+
+<p><b>The Bran Bath</b>.&mdash;In five gallons of water place a bag
+in which is put one quart of ordinary wheat bran. The
+bag is made of cheese cloth. Squeeze and manipulate
+the bran bag until the water resembles a thin porridge.
+<span class='pagenum'>[<a name="Page_592" id="Page_592">592</a>]</span>
+The temperature of the water is usually about 95&deg; F.,
+though it may be given with any temperature of water.</p>
+
+<p>The bran bath is of great value in eczema, or in
+rashes about the buttocks, or in delicate skin conditions
+when plain water would irritate.</p>
+
+<p><b>The Tepid Bath</b>.&mdash;This bath may be given at a temperature
+of 95&deg;, or 100&deg; F. It is of distinct advantage
+in extremely nervous children. To induce sleep it is
+often better than drugs.</p>
+
+<p><b>The Cold Sponge or Shower Bath</b>.&mdash;This bath should
+be given in the morning in a warm room. A tub should
+be provided with enough water in it to cover the child's
+feet. This water should be warm because when the feet
+are in warm water it prevents the shock which frequently
+comes when cold water is applied to any other part of
+the body.</p>
+
+<p>A large sponge is filled with water at a temperature of
+from 40&deg; to 60&deg; F. This is squeezed a number of times
+over the child's chest, shoulders, and back. While the
+cold water is being applied the body should be well
+rubbed with the free hand of the mother. The bath
+should not last longer than half a minute. When finished
+take the child out quickly and stand him on a bath
+towel and give him a brisk rubbing with a bath towel
+until the skin reacts. This is an exceedingly valuable
+tonic for a delicate child. It should not be used on
+younger children than eighteen months of age. In
+younger children a cold plunge is preferable.</p>
+
+<p>For the cold plunge water at a temperature of 55&deg;
+F. is prepared. The child is lifted into this and given a
+single dip up to the neck. He is then briskly rubbed off
+as above.</p>
+
+<p>There are a very few children who do not take kindly
+to either the cold sponge or plunge. These children do
+not react; they remain pale or blue and pinched for some
+time after. It may be necessary to discontinue the procedure
+or to use water of a higher temperature.</p>
+
+
+<h4>POULTICES</h4>
+
+<p>Poultices are useful in inflammation and for the relief
+of pain. To be of any value they should be applied
+<span class='pagenum'>[<a name="Page_593" id="Page_593">593</a>]</span>
+frequently&mdash;every ten or twenty minutes&mdash;and they should
+be applied hot.</p>
+
+<p>Ground flaxseed is the best material for poultices. It
+should be mixed with boiling water until the proper
+thickness is reached. It may be kept simmering on a
+fire. When one poultice is taken off it can be scraped into
+the pot and heated over if there is no discharge. Each
+poultice should be put into clean muslin, put on the part
+and covered with oiled silk. This will help to retain the
+heat and prevent the clothing or bed sheet from becoming
+wet.</p>
+
+
+<h4>HOT FOMENTATIONS</h4>
+
+<p>A hot fomentation is simply a clean poultice. Several
+thicknesses of flannel are taken, wrung out of very hot
+water, covered with cotton batting, and then with oiled
+silk.</p>
+
+<p><b>How to Make and How to Apply a Mustard Paste</b>.&mdash;For
+infants: Take one part English mustard to six
+parts flour, mix with lukewarm water, and spread between
+two layers of cheesecloth.</p>
+
+<p>For older children and adults: Take one tablespoonful
+English mustard to three or four tablespoonfuls of
+flour, and mix as above.</p>
+
+<p>Mustard pastes should be made big enough. You can
+accomplish a great deal more by putting on a sufficiently
+large mustard paste than by simply putting on one the
+size of the palm of your hand.</p>
+
+<p>It should be left on until the skin is distinctly red. The
+length of time will depend, of course, upon the strength
+of the mustard. Mustard pastes may be put on every
+three hours, if necessary, and they may be used for a
+week at this interval if the conditions demand it.</p>
+
+<p>If they are used in pneumonia or other pulmonary
+diseases, they should be used large enough to go around
+the whole chest. If they are used in heart failure, they
+should be big enough to cover the whole trunk.</p>
+
+<p>When made with the white of an egg they will not
+blister. Or if the part is rubbed with white vaseline
+before applying, it will not blister and it will be just as
+<span class='pagenum'>[<a name="Page_594" id="Page_594">594</a>]</span>
+effective. When a mustard paste is removed the red
+area should be rubbed with white vaseline and covered
+with a clean piece of flannel.</p>
+
+<p><b>How to Prepare and Use the Mustard Pack</b>.&mdash;The
+child is stripped and laid upon a blanket, and the trunk is
+surrounded by a large towel or sheet saturated with mustard
+water. This is prepared as follows: Take one
+tablespoonful of English mustard and dissolve it in one
+quart of water, slightly warmed. Saturate a towel in
+this mixture and apply to the body of the child while
+it is dripping. The patient is then rolled in a blanket.
+Keep the child in this pack for ten or fifteen minutes.
+The mustard pack is not as good as the mustard bath,
+but it is all that is necessary in a number of various conditions.
+The physician will, of course, decide these matters.
+It is simply the duty of the mother to know how
+to carry out the physician's instructions.</p>
+
+<p><b>The Turpentine Stupe</b>.&mdash;Take a piece of flannel, big
+enough to cover the area which it is desired to affect,
+wring it out of as hot water as it is possible. Upon this
+sprinkle twenty drops of spirits of turpentine. Place
+the stupe wherever it is desired and cover with a piece
+of oiled silk or dry flannel. The turpentine stupe is
+mostly used in pain of the abdominal cavity. In colic
+from acute indigestion it is a very convenient means of
+quieting the child by allaying the pain.</p>
+
+<p>Care should be taken not to allow this form of application
+to remain on too long. Take it off when the skin
+is red. For continuous use it is not as good as the mustard
+paste.</p>
+
+
+<h4>OILED SILK. WHAT IT IS, AND WHY IT IS USED</h4>
+
+<p>Oiled silk is sold in the drug stores by the yard. It is
+one yard wide. It is used to cover any local application
+to prevent evaporation into the air or to prevent the
+clothing from absorbing the medicament. If a liniment
+is applied on cloth to effect a certain result, it may take
+some time to do its work. If the wet cloth is covered
+with the clothing, the clothing will absorb the medicine
+quicker than the body will and thereby defeat the object
+<span class='pagenum'>[<a name="Page_595" id="Page_595">595</a>]</span>
+in view, in addition to rendering the clothing wet and
+nasty. If the application is covered with oiled silk it
+cannot escape into the clothing, because the oiled silk is
+impervious. The body will be compelled to absorb the
+medicine and consequently results will be quicker and
+more certain. Many liniments are expensive; to permit
+them to be absorbed by the clothing is needless waste
+It is therefore economical to apply the oiled silk.
+</p>
+
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'>[<a name="Page_596" id="Page_596">596</a>]</span></p>
+
+<h2>DISEASES OF CHILDREN</h2>
+
+<p><span class='pagenum'>[<a name="Page_597" id="Page_597">597</a>]</span></p>
+<div class="figcenter" style="width: 400px;">
+<a id="v4pg597" name="v4pg597"></a>
+<img src="images/v4pg597.jpg" width="400" height="485" alt="The First Blight" title="" />
+<span class="caption">By permission of Henry H. Goddard.</span></div>
+
+<h4>The First Blight</h4>
+
+<p>This is one of those truly unfortunate cases
+which, so far as present knowledge goes, cannot be
+guarded against. Eunice, age 31, mentally 2, is a
+low-grade imbecile. There is not in the whole
+family, for generations back, a single case of feeble-mindedness,
+nor of disease that would undermine
+the nervous organization. Close scrutiny does
+not reveal a single assignable cause. She came, as
+an accident, to blight an otherwise normal family.</p>
+
+<p>Such cases are few, but unfortunately they do
+occur. It is for Eugenics to materially reduce the
+possibility of such occurrences.</p>
+<hr style="width: 65%;" />
+<p><span class='pagenum'>[<a name="Page_598" id="Page_598">598</a>]</span><br /></p>
+<p><span class='pagenum'><a name="Page_599" id="Page_599">[599]</a></span></p>
+
+<h2>CHAPTER XXXVIII</h2>
+
+<h4>INFECTIOUS OR CONTAGIOUS DISEASES</h4>
+
+
+<div class="blockquot"><p>Rules to be Observed in the Treatment of Contagious
+Diseases&mdash;What Isolation Means&mdash;The Contagious Sick
+Room&mdash;Conduct and Dress of the Nurse&mdash;Feeding the
+Patient and Nurse&mdash;How to Disinfect the Clothing and
+Linen&mdash;How to Disinfect the Urine and Feces&mdash;How to
+Disinfect the Hands&mdash;Disinfection of the Room Necessary&mdash;How
+to Disinfect the Mouth and Nose&mdash;How to Disinfect the Throat&mdash;
+Receptacle for the Sputum&mdash;Care of the Skin in Contagious
+Diseases&mdash;Convalescence After a Contagious Disease&mdash;Disinfecting
+the Sick Chamber&mdash;The After Treatment of a Disinfected Room&mdash;
+How to Disinfect the Bed Clothing and Clothes&mdash;Mumps&mdash;Epidemic
+Parotitis&mdash;Chicken Pox&mdash;Varicella&mdash;La Grippe&mdash;
+Influenza&mdash;Diphtheria&mdash;Whooping Cough&mdash;Pertussis&mdash;
+Measles&mdash;Koplik's Spots&mdash;Department of Health Rules
+in Measles&mdash;Scarlet Fever&mdash;Scarlatina&mdash;Typhoid Fever&mdash;
+Various Solutions&mdash;Boracic Acid Solution&mdash;Normal
+Salt Solution&mdash;Carron Oil&mdash;Thiersch's Solution&mdash;Solution
+of Bichloride of Mercury&mdash;How to Make Various
+Solutions.</p></div>
+
+
+<h4>RULES TO BE OBSERVED IN THE TREATMENT OF
+CONTAGIOUS DISEASES</h4>
+
+
+<p>Every mother should know the elementary principles
+involved in the treatment of contagious diseases. They
+are contagious because they may be conveyed from
+one individual to another or because a person nursing a
+victim of a contagious disease may carry that disease
+to another person without having the disease herself.
+For this reason, certain rules have been established by
+the medical profession, which experience has taught
+are necessary in order to preserve the health of the
+community when such diseases are prevalent.</p>
+
+<p>The very first rule to which the physician will direct
+the mother's attention, when there is a contagious
+disease, will be that the child must be "isolated."</p>
+
+<p><b>What Isolation Means</b>.&mdash;Isolation means the complete
+seclusion of the patient in a room by himself, so that
+<span class='pagenum'>[<a name="Page_600" id="Page_600">600</a>]</span>
+no one will see him or come in contact with him except
+the physician and the nurse or mother who will
+tend him during the entire course of the disease. Isolation
+implies more than it would seem to mean. It
+implies that every article used during the sickness will
+be thoroughly disinfected before it leaves the room in
+which the patient himself is isolated. Mothers must
+always remember that every article used by the patient
+may carry the germs of the disease to some other member
+of the family or to some other individual. These
+articles are the clothing of the child, the bedclothes,
+napkins, handkerchiefs, towels, dishes, knives and spoons,
+rags, the various discharges&mdash;sputum, urine, and bowel
+passages&mdash;and, we may add to this list, flies, insects, and
+domestic animals. Every precaution must, therefore, be
+taken to safeguard any dissemination of the disease by
+means of these articles.</p>
+
+<p>Thorough isolation also implies that the nurse shall
+frequently bathe and disinfect her person and her clothing,
+and that the sick-room itself shall be carefully
+dusted with a moist cloth and disinfected from time to
+time.</p>
+
+<p><b>The Contagious Sick-Room</b>.&mdash;The contagious sick-room
+will be prepared in exactly the same way as the
+ordinary sick-room which has been previously described.
+In addition, however, it will be safeguarded in the following
+manner. A wet sheet will be hung up outside the
+door. This sheet will be kept constantly moistened with
+a solution of chloride of lime. One-half pound to an
+ordinary house-pail of water is the strength of the solution
+to use. Every window must be effectively screened
+to prevent the ingress and egress of flies and other insects.</p>
+
+<p><b>Conduct and Dress of the Nurse</b>.&mdash;She will remain in
+the sick-room all the time unless when she takes outdoor
+exercise. Her dress will consist of a long gown
+which will entirely cover her person from the neck to
+the shoes and will be of plain, white, easily washed
+material, without tucks or ruffles or adornment of any
+kind. She should wear an ordinary pair of house slippers
+made of light leather. Her cap will be large enough
+<span class='pagenum'>[<a name="Page_601" id="Page_601">601</a>]</span>
+to cover and include her hair and head. When she
+leaves the room, she will remove her cap, gown, and slippers,
+disinfect her hands in a disinfecting solution and
+wash her face, neck, and hands in soap and water. She
+should go directly out and in, without coming in contact
+with any occupant of the home.</p>
+
+<p><b>Feeding the Patient and Nurse</b>.&mdash;The meals for the
+patient and nurse should be left on a table outside the
+door of the sick-room, from which place the nurse will
+then take them into the room. The utensils used for
+these meals should not be used by other members of
+the family during the entire sickness. After the patient
+and nurse have eaten, the utensils should be placed in
+a chloride of lime solution for disinfection. If any
+of the food is left over it should be put into a jar in
+which it may be disinfected and rendered harmless before
+being disposed of.</p>
+
+<p><b>How to Disinfect the Clothing and Linen</b>.&mdash;All bed
+and body linen, towels, handkerchiefs, napkins, etc.,
+should be immediately put into a large receptacle&mdash;a
+wash boiler, or tub, will answer the purpose admirably&mdash;containing
+a five per cent. solution of carbolic acid in
+which an adequate quantity of soft soap has been dissolved.
+They should remain in this mixture for two
+hours, after which they may be wrung out and taken
+to the laundry.</p>
+
+<p><b>How to Disinfect the Urine and Feces</b>.&mdash;The urine
+and the stools should be passed into vessels containing
+a solution of four ounces of carbolic acid to the gallon
+of water. This vessel should be covered and the mixture
+allowed to stand for one hour, after which time it may
+be thrown out.</p>
+
+<p><b>How to Disinfect the Hands</b>.&mdash;Any of the following
+solutions may be used for disinfection of the nurse's
+hands: Creolin, one teaspoonful to the quart of water;
+chloride of lime, one-half pound to a pail of water;
+formalin, thirty-two drops to a quart of water. A basin
+containing one of the above solutions should be constantly
+kept standing for the frequent disinfection of the
+nurse's hands. After disinfection, the hands should be
+washed in plain water and soap.
+<span class='pagenum'>[<a name="Page_602" id="Page_602">602</a>]</span></p>
+
+<p><b>Disinfection of Room Necessary</b>.&mdash;The room in which
+a contagious patient is confined requires systematic attention
+on the part of the nurse. Every other day all
+flat or projecting surfaces should be disinfected. Mantels,
+window-sills, door knobs, picture moldings, furniture,
+chairs, and bed-railings, should be wiped with cloths
+moistened in a disinfecting solution. A suitable solution
+for this purpose is one containing one ounce of carbolic
+acid to the quart of water.</p>
+
+<p><b>How to Disinfect the Mouth and Nose</b>.&mdash;In the
+course of all contagious diseases the mouth and throat
+of the patient and nurse should be thoroughly disinfected
+as a matter of routine. It should be done at
+least twice daily unless more frequent disinfection is
+called for because of the nature of the disease. In
+measles and diphtheria, for example, the nasal and throat
+conditions will undoubtedly call for more frequent and
+more thorough disinfection than twice daily. This may
+also apply to scarlet fever if the throat is involved as
+is often the case.</p>
+
+<p>Pocket handkerchiefs should never be used by a patient
+suffering from a contagious disease. The nose
+and mouth should be wiped with pieces of gauze or
+cheesecloth, cut into small squares for this purpose. These
+should be immediately burned after being used.</p>
+
+<p>To disinfect the throat, a solution of formalin, six
+drops to six ounces of water, is effective. To disinfect
+the nose, a solution of Glyco-Thymoline is suitable. These
+applications should be made by means of an atomizer, a
+different atomizer being used for the patient and nurse.</p>
+
+<p><b>Receptacle for the Sputum</b>.&mdash;A cuspidor, or basin,
+should be constantly kept at the side of the bed in which
+the patient may conveniently expectorate. This utensil
+should contain the chloride of lime solution previously
+mentioned.</p>
+
+<p><b>Care of the Skin in Contagious Diseases</b>.&mdash;As in all
+other sick conditions, the skin of the patient should be
+bathed frequently with an alcoholic solution. In the
+later stages of measles and scarlet fever it is essential
+to anoint the skin while the patient is scaling. This
+may be done with carbolated vaseline. Mothers should
+<span class='pagenum'>[<a name="Page_603" id="Page_603">603</a>]</span>
+understand why this is necessary. These diseases have
+a distinct rash or eruption. This eruption practically
+kills the skin cells and at a certain period these cells
+are cast off by the new growth of skin underneath. This
+process is called scaling. In measles the scales are small,
+and are cast off in the form of bran like dust. In scarlet
+fever, the cells adhere together and are cast off
+in large scales. These scales are contagious. They are
+very light and will float in the air if dry. The movement
+of the patient, changing the bed clothing, etc.,
+will waft a multitude of these contagious scales into the
+air of the room and infect every article they may land
+on. This would make the disinfection of the room difficult
+and tedious. In order to obviate this tendency experience
+has taught us that much of the difficulty and
+nearly all of the risk of contagion may be overcome by
+rubbing some oily or sticky substance on the skin. By
+this method the dust and scales are rendered heavier
+than the air, stick together and will not float. During
+the scaling period there is a constant itch present which
+irritates the little patient. By using carbolated vaseline
+to anoint the skin we accomplish two purposes. The
+carbolic acid in the vaseline relieves the itch, and the
+vaseline itself greases the skin so that the scales remain
+in the bed. Each day the nurse changes the
+bed-sheet, gathers the scales in the sheet and puts all
+in the disinfecting solution.</p>
+
+<p><b>Convalescence After a Contagious Disease</b>.&mdash;Complete
+isolation must be kept up until all danger from
+contagion is passed. In diphtheria this period is not
+reached until the examination of the throat contents
+under the microscope is returned negative. In diseases
+Which have a rash this period is not reached until all
+scaling is completed. Even then, and for a number of
+days or weeks, the patient may be taken out for exercise
+daily, but must not be allowed to play with
+other children until his strength justifies active exercise.
+It takes a much longer period to rid the system of the
+poison of a contagious disease than most mothers appreciate.
+Many children have died from heart failure
+after they were considered well simply because the active
+<span class='pagenum'>[<a name="Page_604" id="Page_604">604</a>]</span>
+exercise overtaxed the heart before the system was
+wholly free from the poison of the disease.</p>
+
+<p>Before the child is removed from the sick-room for
+the first time he should have a disinfecting bath. This
+bath should be in a solution of bichloride of mercury,
+the strength of which should be one part to five thousand
+parts of water. The towels used to dry the patient
+after the bath should be fresh and should not
+have been in the sick-room. He should then be dressed
+in clothing which has never been in the sick-room.</p>
+
+
+<h4>DISINFECTING THE SICK-CHAMBER</h4>
+
+<p><b>How to Disinfect a Room</b>.&mdash;The most efficient way
+to disinfect a room is by means of formaldehyde gas.
+This, however, requires a special apparatus which can
+only be used by one familiar with the process. In all
+large cities the Department of Health usually undertakes
+the disinfection of rooms after any contagious
+disease. The next best method is by sulphur.</p>
+
+<p>When sulphur is employed it should be used in the
+form of powder or in small pieces. This is placed in a
+shallow iron pan set on a couple of boards in a tub partly
+filled with water. The sulphur is moistened with alcohol
+before it is set on fire.</p>
+
+<p>It is always necessary, of course, before disinfecting
+by any process to make the room as nearly air tight as
+is possible. To accomplish this the windows must be
+tightly closed, the doors locked, and the cracks and keyhole
+sealed with pieces of paper or adhesive paper. The
+room should remain closed for six or eight hours, after
+which it should be thoroughly aired for several days.</p>
+
+<p><b>The After Treatment of a Disinfected Room</b>.&mdash;The
+walls, ceiling, and all flat surfaces, such as mantels, window-sills,
+etc., should be washed with a fresh chloride of
+lime solution. The floor should be scrubbed with a four
+per cent. soda solution. All carpets and curtains, if any,
+should be removed, taken to a vacant lot and thoroughly
+beaten and then exposed to direct sunlight for a number
+of hours. The room should then be well aired
+again for a couple of days before it is again occupied.
+<span class='pagenum'>[<a name="Page_605" id="Page_605">605</a>]</span></p>
+
+<p><b>How to Disinfect the Bed Clothing and Clothes</b>.&mdash;The
+surest way is to boil them for half an hour; otherwise
+they may be left in the room while it is being disinfected.
+Spraying the clothes with a spray of formaldehyde
+is an effective way of disinfecting them.</p>
+
+
+<h4>MUMPS: EPIDEMIC PAROTITIS</h4>
+
+<p>Mumps is a contagious disease. It is most common
+between the fourth and sixth years. Infants are rarely
+affected. The disease is not very contagious, direct
+contact being necessary to communicate it. Every case
+should be isolated for a period of three weeks from
+the beginning of the disease.</p>
+
+<p>The seat of the affection is the parotid gland which
+is located in front of and on a level with the ear. One
+or both glands may be affected at the same time or one
+may follow the other in succumbing. The duration of
+the disease from the time the swelling becomes noticeable
+is about ten days. It is contagious for a week
+after the swelling subsides. The period of incubation
+is from one to three weeks.</p>
+
+<p><b>Symptoms</b>.&mdash;In the majority of cases the first symptom
+is the swelling and the discomfort which it causes.
+In more severe cases the child feels sick and is listless
+for from twenty-four to forty-eight hours. There may
+be a headache, vomiting, pains in the back and limbs,
+and fever. There is pain in the swelling which is increased
+by movement of the jaws and by pressure. The
+degree of the swelling varies with the severity of the
+attack. It may be very little or it may be so great
+as to completely distort, and render unrecognizable, the
+face. It must be remembered that, though mumps is
+not regarded as an important or dangerous disease, it
+may assume dangerous characteristics.</p>
+
+<p>We sometimes see distressing complications with
+mumps. In boys, orchitis, or inflammation of the testicles,
+occasionally occur. In girls, ovaritis, or inflammation
+of the ovaries may be present. These complications may
+be avoided by keeping the patients in bed.</p>
+
+<p><b>Treatment</b>.&mdash;Keep the child in bed until the fever is
+<span class='pagenum'>[<a name="Page_606" id="Page_606">606</a>]</span>
+gone. Keep him in the house for one week after the
+swelling has entirely subsided. He should be put on
+a liquid diet while the fever lasts. The bowels should
+move each day.</p>
+
+<p>The mouth should be kept clean by an antiseptic mouth
+wash. If there is much pain in the swollen gland, warm,
+wet dressings give the best results. Sometimes it is
+advisable to paint the gland with belladonna ointment.
+If it is not very painful, the most comfortable way to
+dress the gland is simply to place over it a large pad
+of absorbent cotton held in place by a broad strip of
+flannel cloth.</p>
+
+
+<h4>CHICKEN POX. VARICELLA</h4>
+
+<p>Chicken pox is an affection almost entirely special
+to children, in whom it may be observed from their
+first year, although it is especially frequent from the
+ages of two to six. It appears often in the epidemical
+form and spreads by contagion.</p>
+
+<p>Some doctors are inclined to regard varicella as a
+very attenuated form of smallpox, hence the name
+"chicken pox," by which it is popularly known. This
+opinion is based merely on the analogy between the two
+types of skin eruptions and the coincidence sometimes
+observed between two epidemics of smallpox and chicken
+pox. But the theory falls on considering that, on the
+one hand, chicken pox offers no safeguard against infection
+by smallpox and does not prevent the effects
+of vaccination, and, on the other hand the disease may
+occur in children who have been vaccinated or who
+have had smallpox. Chicken pox, too, differs essentially
+from smallpox in the course of its development.</p>
+
+<p>After a period of incubation, extending over a fortnight,
+chicken pox becomes apparent by such symptoms
+as slight shivering, extreme fatigue and a general but
+not very intense condition of fever. In less than twenty-four
+hours small pink spots will appear on the skin, and
+these after a few hours are topped by a vesicle, and the
+next day the whole rash shows a vesiculous appearance.</p>
+
+<p>The vesicles are sometimes small and pointed, sometimes
+more voluminous and globular in form. They
+<span class='pagenum'>[<a name="Page_607" id="Page_607">607</a>]</span>
+are filled with a limpid or a slightly yellowish liquid.
+Their base is sometimes surrounded by an inflammatory
+ring. By the third day the contents of the vesicle has
+become thicker and tends to become purulent. On the
+fourth day desiccation commences, and the vesicles
+shrivel and shrink in and form small brownish scabs,
+which fall about the eighth day. Frequently the child
+will scratch them off with the finger nails before they
+are entirely desiccated. The vesicles leave small reddish
+spots, which generally disappear gradually, almost
+always without a scar.</p>
+
+<p>An eruption of chicken pox does not burst out all
+over the body at once, but appears in successive rashes.
+It is not confined to any special parts of the body. It
+may begin and spread at the same time from the face,
+the trunk of the body or the limbs. A dozen pimples
+may be seen the first day, while three or even ten times
+as many may be visible the next day, and so on for
+several days in succession.</p>
+
+<p>Sometimes the vesicles appear on mucous membrane at
+different parts&mdash;the mouth, tongue, soft palate and tonsils&mdash;and
+may also invade the conjunctiva and cornea, or
+the larynx, where they will set up laryngitis.</p>
+
+<p>Owing to the very contagious nature of chicken pox,
+the first thing to be done is to provide for the complete
+isolation during a period of twelve to fifteen days
+of all patients attacked by the disease.</p>
+
+<p>The treatment of the disease is solely a matter of
+hygiene. The more severe the fever the stricter the
+diet should be, and in the case of great fever, the diet
+should be restricted to broth and milk. If there is no
+fever the child need not be placed on any special diet.</p>
+
+<p>If the intestines are sluggish, they may be stimulated
+by administering a dose of castor oil. It is advisable to
+make the patient rinse his mouth two or three times
+a day with a mouth wash. It is also well to apply a
+lotion around the eyes and face, consisting of two per
+cent. boracic acid solution with the chill taken off.
+Finally, in order to prevent the child scratching the
+sores and the consequent danger of inoculation by the
+finger nails, it is a good practice to rub a small amount
+<span class='pagenum'>[<a name="Page_608" id="Page_608">608</a>]</span>
+of carbolated vaseline over the itching parts. It is frequently
+found necessary to have the little patient wear
+white woolen gloves to prevent scratching and infecting
+the sores. If a child scratches the sores on the face
+it will leave an unsightly mark which will stay for the
+rest of its life.</p>
+
+<p>The child, of course, should not be allowed to rejoin
+his playmates without having had a good bath, and having
+had his clothes completely disinfected.</p>
+
+
+<h4>INFLUENZA: LA GRIPPE</h4>
+
+<p>The most important feature with reference to influenza
+in children is its very active tendency to develop complications.
+These complications generally affect the respiratory
+tract. So we find in children suffering from
+grippe an easy disposition to get bronchitis or broncho-pneumonia.
+The younger the child the greater the
+danger.</p>
+
+<p>The disease itself, so long as it remains an uncomplicated
+influenza, is not of much importance or severity.
+The lesson to be learnt, therefore, is to treat the disease
+with respect and take every precaution to avoid the
+possibility of developing a complication.</p>
+
+<p>La Grippe is a highly contagious disease. It prevails
+epidemically, and after an active epidemic it may remain
+in the vicinity for a number of years. It is more frequently
+seen in the late winter months and early spring.
+The poison of the disease clings to clothing and apartments
+as well as to railroad and street cars. The germ
+is found in the sputum and in the nasal secretions.</p>
+
+<p>Sneezing is one of its symptoms and it is one of
+the ways by which the disease is spread around. Children
+should never be brought near an adult suffering
+from influenza. One attack does not render the patient
+immune to a subsequent attack as is the case with most
+of the contagious diseases. The reverse is the rule with
+La Grippe because one attack favors the development of
+another attack. It is a common experience for many
+people to have influenza every winter or spring.</p>
+
+<p><b>Symptoms</b>.&mdash;If a child "catches" grippe, it becomes
+<span class='pagenum'>[<a name="Page_609" id="Page_609">609</a>]</span>
+quite sick abruptly. There is usually chilliness, pains
+in the muscles all over the body, more or less fever,
+sometimes nausea and vomiting. If the attack is a more
+severe one, the prostration is more marked, the temperature
+higher and the signs of shock and poisoning of
+the system are more in evidence. A child a few months
+old can get influenza so severely as to cause collapse
+and death in thirty-six hours. As a rule the type of
+grippe most common in infancy is of a very mild character.
+It lasts about a week. Children may be a little
+slow in convalescing and it may be three or four weeks
+before they regain their health.</p>
+
+<p><b>Complications</b>.&mdash;As has been intimated, the most frequent
+complication is bronchitis and the most fatal one
+is broncho-pneumonia.</p>
+
+<p>A congestion of the entire mucous membrane of the
+respiratory tract, producing a nasal discharge, a sore
+and inflamed throat, pains and a feeling of compression,
+with a cough in the chest, may accompany the
+disease.</p>
+
+<p>Gastric symptoms, with vomiting, intestinal disturbance,
+diarrhea, with or without mucus and blood, are
+quite common in some epidemics.</p>
+
+<p>Not infrequently we have numerous cases in which
+the ear seems to be the vulnerable part. As a consequence
+running ears have to receive most of our attention.
+When the ears are affected, the glands of the neck
+become inflamed. They swell up and add considerable
+to the discomfort of the little patient.</p>
+
+<p><b>Treatment</b>.&mdash;Cases of influenza should be isolated.
+Children should be put in a room by themselves and
+the other children of the family should not be permitted
+to see them. The rooms should be disinfected after
+the case is over. As complications are the dangerous
+element in grippe, we should try to prevent them. This
+can be best done by promptly putting the child in bed,
+making him comfortable, opening his bowels by castor
+oil or calomel. He should be made to drink hot lemonade.
+He should be kept on a light diet from which meat
+and vegetables are excluded.</p>
+
+<p>The above treatment will usually suffice in the ordinary
+<span class='pagenum'>[<a name="Page_610" id="Page_610">610</a>]</span>
+uncomplicated grippe. If complications arise they
+must be treated according to the conditions.</p>
+
+<p>It is well to remember that the degree of prostration
+following a rather severe attack of grippe is out of all
+proportion to the extent of the disease. These little patients
+sometimes suffer considerably and do not regain
+their strength promptly. Experience has taught us that
+the best thing to do is to send them away. A change
+of climate will do wonders for them, more quickly and
+more thoroughly than all the medicine we can give them
+at home. The seashore is particularly good for them.</p>
+
+
+<h4>DIPHTHERIA</h4>
+
+<p>Diphtheria is an acute, specific, infectious, communicable
+disease. It affects the tonsils, throat, nose, or
+larynx. It is most frequently seen in children between
+the ages of two and five years, though it may appear at
+any time during life. The two sexes are equally liable
+to it. The same person may have the disease twice or
+more times at different ages. Children suffering from
+disease of the nose or throat are more likely to get it
+than are others. Such diseases are cold in the head
+with running nose, catarrh of the nose and throat, inflammation
+of the mucous membranes of the nose or
+throat.</p>
+
+<p>Diphtheria may occur at any time of the year, though
+it is more frequent during the cold months. The incubation,
+or the length of time between exposure to the
+disease and the development of the symptoms, is between
+two and five days. In its mild form the disease may be
+present without giving any constitutional symptoms. In
+its severe form, however, it is one of the most dangerous
+diseases of childhood. In large cities it is present all
+the year round with more or less frequent outbreaks
+in the form of local epidemics. In the country it is
+only seen in its epidemic form. It does not arise without
+a cause, that is, there is always a preceding case
+from which an epidemic springs, though it is not always
+easy to trace the connection. The child inhales the bacilli
+which cause the disease with the air it breathes. The
+<span class='pagenum'>[<a name="Page_611" id="Page_611">611</a>]</span>
+bacilli may lodge on toys or other articles from which
+the child gets them. Direct infection is usually the mode
+of communication through which a child obtains the disease.
+The saliva and mucus from the nose contain
+the bacilli in large quantities and if a patient coughs
+or sneezes they are expelled in this way and infect others.
+Frequently a child suffering from a mild form of diphtheria
+may attend school and infect others without it
+being known that the child has the disease.</p>
+
+<p><b>Symptoms</b>.&mdash;The symptoms vary with the severity of
+the attack. There are mild cases, as has been stated,
+that give no constitutional symptoms. There may be a
+small amount of local disturbance in the throat or nose
+and there may be some membrane present, but, for some
+reason, there does not seem to be any absorption of the
+poison into the system and the child escapes the systemic
+disturbance. Even as a local condition these cases vary.
+There is always a fever at the beginning, but the child
+never seems sick enough to go to bed. If the throat is
+examined it will be found to be red and slightly inflamed,
+there may be spots on the tonsils, or there may be
+a gray film over them. There is no discharge from the
+nose and the child does not complain of an excess of
+mucus from the throat. The spots may last for a
+week and then disappear. These cases are difficult to
+diagnose without making a culture, and if the physician
+insists upon keeping the child confined to bed while apparently
+well the family as a rule object, though it is
+absolutely necessary. These are the cases that do great
+harm in school, and no mother should object if the physician
+insists in taking preventative measures to stop
+an epidemic if the bacilli have been found in the child's
+throat. She should rather feel thankful that the child
+escaped so easily.</p>
+
+<p>Since the introduction of antitoxin we do not see the
+severe cases now, so that a description of them would
+not be of any use in a book of this character. Mothers
+should, however, know that it is absolutely criminal to
+take any chances with a "sore throat." Antitoxin is a
+prompt and an absolute remedy if used soon after the
+onset of the disease. It is more sure if used the first
+<span class='pagenum'>[<a name="Page_612" id="Page_612">612</a>]</span>
+or second day, still reliable the third day, but its efficacy
+diminishes the longer we postpone its use from the date
+of the onset of the disease. When, therefore, a child
+complains of being sick and states that its throat hurts,
+medical aid should be at once sought.</p>
+
+<p>The disease may develop in one of two ways. It
+may begin as a slight indisposition for a day or two,
+and perhaps some soreness of the throat. The fever may
+be slight. The child will continue to be sick despite
+any treatment given and will get slowly worse until the
+fourth or fifth day, when it will be impossible to mistake
+the condition.</p>
+
+<p>At other times the disease begins abruptly. The child
+complains of being sick. It may vomit, or suffer from
+headache, chilly feelings, and a fever. The glands in
+the neck may swell and cause considerable disturbance.
+There is, as a rule, an abundant discharge from the nose
+and there is an excess of mucus in the throat. Membrane
+is seen in the throat. It may cover the tonsils
+and spread over the entire throat cavity, or it may extend
+up into the nose and over the roof of the mouth.
+All the parts are much swollen and breathing is interfered
+with, sometimes seriously. If the attack is very
+severe there is an active absorption of poison going on
+from the throat which soon renders the little patient
+intensely sick. There is marked weakness and prostration,
+the circulation becomes poor, the pulse rapid and
+the child falls into a stupor.</p>
+
+<p>The physician will, of course, have taken complete
+charge of the case before the patient has gone thus far.
+The nursing of the case, which may fall to the mother
+if no trained nurse is present, is most important. She
+should preserve absolute cleanliness of herself and of
+the sick room. She should never eat or sleep in the
+same room with the patient, and should use a gargle,
+which the physician should prescribe, frequently during
+the day. She should dress simply, so that whatever is
+worn can be changed often and washed easily. Every
+article of furniture must be taken out of the sick room
+that is not absolutely essential in the care of the case.
+If toys are allowed they should be burned as soon as
+<span class='pagenum'>[<a name="Page_613" id="Page_613">613</a>]</span>
+the child is tired of them, never left around the house
+after the case is over. The room should be a large one
+and it should be thoroughly aired each day. The floor
+should be washed each day with a solution of bichloride
+of mercury, and all dusting should be done with a wet
+cloth. The bed linen and any rags or handkerchiefs
+used should be treated as in scarlet fever. All vessels
+in which the patient expectorates should have an antiseptic
+in them. The room must be disinfected after the
+case is over.</p>
+
+<p>The patient must be kept in bed during the entire attack.
+He must not be allowed to even sit up in bed until
+the physician gives him permission. This is a very important
+essential in the treatment of this disease, and
+the nurse must be held responsible for the conduct of
+the patient in this respect. Because of the character of
+the poison, there is a tendency to paralysis of the heart,
+and frequently children have been allowed to sit up too
+soon only to fall back dead in bed. The same thing has
+occurred later in the disease when children have been
+allowed to play too heartily before the poison had an
+opportunity to completely eliminate itself. Nursing children
+should be fed on breast milk pumped from the
+mother, but they must not nurse it themselves. Older
+children can take milk and should depend upon it mostly.
+The physician will give any other special directions that
+he may think necessary, the duty of the mother being
+to see that they are faithfully carried out.</p>
+
+
+<h4>WHOOPING-COUGH</h4>
+
+<p>Whooping-cough is usually seen in young children.
+It may, however, affect a person at any age. It is contagious.
+During infancy it is one of the most fatal diseases.
+During adult life it is a dangerous condition,
+while in childhood it is simply regarded as a mildly contagious
+disease.</p>
+
+<p>It is most contagious during the catarrhal stage,&mdash;the
+first ten days. Children suffering from whooping-cough
+should not be allowed to mix or play with other
+children for two months. After an exposure to the
+<span class='pagenum'>[<a name="Page_614" id="Page_614">614</a>]</span>
+disease it takes about fourteen days for a case to develop.
+The danger of whooping-cough is the tendency to develop
+pneumonia or bronchitis.</p>
+
+<p><b>Symptoms</b>.&mdash;During the first ten days the child acts
+as if suffering from an ordinary catarrhal cold with
+cough. This is called the catarrhal stage. There is no
+way of telling that whooping-cough is present until the
+child whoops. Most children do not whoop until the
+expiration of the catarrhal stage, though a very few
+do from the beginning of the disease. If a child is
+treated for an ordinary cold with cough and does not
+respond to treatment, and whooping-cough is epidemic,
+it is fair to assume that whooping-cough has been contracted.
+When the cough shows a distinct tendency to
+be worse at night it is further proof of this assumption.</p>
+
+<p>When they begin to cough in paroxysms, and whoop,
+the second, or spasmodic stage begins. These fits of
+paroxysmal coughing are much more severe than spells
+of ordinary coughing. These may only be three or four
+attacks daily, or the child may have from forty to fifty
+such attacks. When children feel these attacks coming
+on they seek support, holding on to chairs or they stand
+by the mother's knee. The coughing is explosive, rapid,
+and forceful, the child fails to catch its breath and is
+compelled to take a deep inspiration, which is the whoop;
+it then goes on coughing more. The face may become
+purple, the eyes protrude, and the veins of the face swell
+up. Near the end of the attack the child raises, or
+vomits a mass of stringy, glutinous mucus. After it
+is over the child is exhausted, there is a more or less
+profuse perspiration, and he may be quite dazed. These
+attacks are, as a rule, more frequent and more severe
+during the night. This stage lasts about one month and
+is then followed by the stage of decline, during which
+the disease subsides into what appears as an ordinary
+bronchial cold.</p>
+
+<p>It is quite common for these children to get relapses,
+especially during inclement winter weather, and go on
+whooping for two or three months longer. Their vitality
+suffers because their sleep and nourishment is interfered
+with, and they become nervous and difficult to manage.
+<span class='pagenum'>[<a name="Page_615" id="Page_615">615</a>]</span></p>
+
+<p><b>Treatment</b>.&mdash;Inasmuch as there is no remedy known
+that will cure whooping-cough, the best we can do is
+to render the patient physically efficient to stand the
+severe strain of coughing, which is the worst feature
+of the disease. Experience has taught us that those
+children do best who spend their entire time out of doors.
+We, therefore, advise parents to encourage their children
+to play in the open air. There is no exception to
+this rule, even in winter weather, unless it is particularly
+inclement. If the weather is wet or raw, or if the
+child has bronchitis, or is running a fever, it would be
+more safe to keep the child indoors, in a well-aired
+room, until the temporary conditions pass over, when
+they could again resume the open-air treatment.</p>
+
+<p>Naturally delicate children if under two years of age
+should not risk staying out of doors too much in very
+cold or raw weather, even if not suffering from any of
+the above complications.</p>
+
+<p>The bedrooms of children suffering from whooping-cough
+should be large and thoroughly aired day and
+night.</p>
+
+<p>The nourishment in these cases is of great importance.
+They should be carefully fed, and if they vomit with
+the paroxysms of coughing, they should be fed small
+quantities frequently. Any form of digestive disturbance
+is very apt to accentuate the frequency of coughing.
+A fluid diet of milk is the best. Milk punches
+aid in keeping up the strength; malted milk and eggs
+beaten in milk are nutritious and easily digested.</p>
+
+<p>So far as internal medication is concerned, I have
+found pertussin to be the most efficacious remedy. If
+it is begun early and in sufficient dosage, it not only
+favors an early termination of the disease, but it lessens
+the frequency and the severity of the paroxysms. If it
+is suspected that the child has been exposed to whooping-cough,
+pertussin may be given during the catarrhal
+stage with the advantage that it will render the whole
+course of the disease milder. If it is given during the
+course of an ordinary catarrhal cold, it will in most
+cases be as effectual as any ordinary cough remedy. The
+dosage should be large enough to produce results. I
+<span class='pagenum'>[<a name="Page_616" id="Page_616">616</a>]</span>
+have found a teaspoonful every two hours to a child of
+three years to be the average dose. In older children
+I give two teaspoonfuls every three hours. It is necessary
+to continue its use throughout the disease. The
+taste of pertussin is pleasant and young children take
+it willingly.</p>
+
+<p>When the disease is inclined to a protracted course,
+or when the cough does not subside, especially during
+unfavorable weather, it is of great importance to send
+the child away. A change of climate, preferably to the
+seashore, even for a short time, will act like a charm,
+and will cure the cough of whooping-cough quicker than
+any other possible measure.</p>
+
+
+<h4>MEASLES</h4>
+
+<p>Measles is the most widely prevalent, eruptive, contagious
+disease. With few exceptions, every human being
+"gets" measles. As an uncomplicated disease it is never
+fatal, and is not even regarded as dangerous. Because
+of this characteristic, however, parents are neglectful
+and complications occur, and these frequently prove fatal.
+One attack renders the patient immune. It is very
+highly contagious and spreads with great rapidity among
+those who have never had it. It is not possible to carry
+the disease any great distance by a third person or by
+means of living objects. It does not, however, cling to
+clothing or other objects as long as scarlet fever. Its
+period of incubation is from eleven to fourteen days.</p>
+
+<p><b>Symptoms</b>.&mdash;The symptoms develop gradually. A
+severe cold in the head is the first and most characteristic
+symptom of the disease. There is a discharge from the
+nose, swollen and watery eyes, sneezing and a hoarse,
+harsh cough. The patient may complain of the throat
+being painful and examination will reveal a general congestion
+of the parts. There are also headache, lassitude,
+pains in the back, and there may be vomiting and diarrhea.
+Children in the early stages of measles are tired
+and sleepy.</p>
+
+<p><b>Koplik's Spots</b>.&mdash;Three or four days, in rare cases
+somewhat longer, before the appearance of the rash there
+<span class='pagenum'>[<a name="Page_617" id="Page_617">617</a>]</span>
+appears on the mucous membrane of the cheeks small,
+bluish white, or yellowish white points, the size of a
+small pin head. These points are surrounded with reddened
+areas which give the appearance of a general rash
+with fine white points upon it. These points resemble
+milk particles. They adhere firmly to the mucous membrane
+and when an effort is made to remove them it is
+found that the underlying surface is ulcerated and excoriated.</p>
+
+<p>The Koplik spots are not of much value to the mother
+other than that they may be relied upon to indicate the
+coming disease with which they child is affected. Physicians
+look for them as an aid in diagnosis before the
+rash would of itself indicate the disease.</p>
+
+<p>The rash appears on the third, fourth, or fifth day of
+the disease. From the day of the infection to the outbreak
+of the rash about thirteen days intervene. It is
+seen first at the roots of the hair on the forehead, behind
+the ears or on the neck. It may be seen first on the
+cheeks. The beginning rash appears as small, dark red,
+dull spots. At first there are only a few, but they soon
+become more numerous, they join together, and soon the
+surface looks inflamed as if entirely covered with the
+rash. The rash covers the entire body, including the
+soles and palms. In twenty-four hours it is at its height
+on the face. It spreads downward like a wave, first the
+face, then the neck and chest, then the abdomen and later
+the legs. By the time it invades the legs it has begun
+to fade on the face. It fades slowly in the order of its
+appearance. Its duration is about four days.</p>
+
+<p>The skin is swollen; it burns and itches. The eyes
+are swollen and red and intensely sensitive to light.
+There is usually a muco-pus discharge from them. The
+cough is invariably an annoying feature. The fever is
+high and reaches its highest point when the rash is at
+its height. As the rash fades the fever subsides.</p>
+
+<p>When the rash fades, the patient begins to "scale."
+The scales of measles are fine, like bran, never in large
+patches like the scales of scarlet fever. The amount of
+the scaling varies. It may be quite considerable or it
+may be so small as to be overlooked.
+<span class='pagenum'>[<a name="Page_618" id="Page_618">618</a>]</span></p>
+
+<p><b>Complications</b>.&mdash;The most important and by far the
+most frequent complication of measles is broncho-pneumonia.
+There may be various conditions affecting the
+stomach, bowels, throat, ears, bronchi, and the nervous
+system, which may accompany the disease but are seldom
+of a serious or important character.</p>
+
+<p><b>Treatment</b>.&mdash;Measles runs a certain course and will
+run that course, no matter what we may or may not do.
+We cannot stop it, or shorten it, or lessen its severity.
+We can only hope to make the patient comfortable and
+to prevent the development of complications.</p>
+
+<p>The child should be put in bed and kept comfortably
+warm but not too warm. The room should be kept at
+the ordinary temperature of the sick room, 68&deg; to 70&deg; F.
+It should be darkened but not dark. The food should be
+fluid and given regularly. The child may be given all
+the cool,&mdash;not cold,&mdash;water it wants to drink. The bowels
+should be kept open daily. If constipation occurs an
+enema may be given. The eyes must be carefully
+watched and washed every hour or two during the day
+with a boracic acid solution. If the cough is distressing,
+it may be rendered less distressing, though we cannot
+hope to stop it until the disease has run its course. The
+restlessness, headache and general discomfort can be
+much modified by suitable remedies. If the itching is
+acute, the body can be rubbed with carbolated vaseline.
+When the rash subsides and the patient is free from
+fever a daily warm bath should be given in order to facilitate
+scaling.</p>
+
+<p>Should complications arise they should be promptly
+cared for by the attending physician.</p>
+
+
+<p><b>SUMMARY</b>:&mdash;</p>
+
+<blockquote><p>1. Measles is the most prevalent infectious disease
+of childhood.</p>
+
+<p>2. The danger of measles has been and is underestimated.
+Because of its prevalency many mothers
+treat it with less respect than they should, with
+the result that fatal complications occur, or the
+future health of the child is permanently injured.
+<span class='pagenum'>[<a name="Page_619" id="Page_619">619</a>]</span></p>
+
+
+<p>3. Children with measles should be put in bed and
+kept in bed and treated as directed above.</p></blockquote>
+
+<p>The following rules have been formulated by the Department
+of Health of New York City, with reference
+to measles, and embody precautions that should find general
+observance:</p>
+
+<blockquote><p>1. All children in the family must be promptly
+excluded from school attendance.</p>
+
+<p>2. Careful and continued isolation of the patient must be
+enforced until the case is terminated and fumigation has been
+ordered by the medical inspector of the Department.</p>
+
+<p>3. All secondary cases must be reported even if the first
+case is still under surveillance of the Department of Health.</p>
+
+<p>4. Suspected cases must be treated as contagious cases
+until a sufficiently long observation has shown that the patient
+has a non-contagious disease. All cases will be considered
+as measles, if so reported. Any change in the original
+diagnosis must be made in writing to the Department of
+Health and must be confirmed by a diagnostician.</p>
+
+<p>5. Physicians must not order the removal of patients to
+the contagious disease hospital, or elsewhere, in cabs or other
+vehicles, but must notify the Department of Health and the
+removal will be effected by a coup&eacute; or ambulance of the
+Department.</p>
+
+<p>6. Whenever there is a case of measles in rooms in the
+rear of, or communicating with, a store, the inspector is required
+to have the store closed at once, or to report the case
+for immediate removal to the hospital.</p>
+
+<p>7. A case of measles must not be removed from one house
+to another, or even to a different apartment in the same
+house, without the permission of the Department. Such removal
+is in direct violation of the provisions of the Sanitary
+Code.</p>
+
+<p>8. No case of measles shall be discharged from observation
+until the Department has been notified, the case examined
+by an inspector to see if desquamation is entirely
+completed, and the premises ordered fumigated. This examination
+by the inspector is necessary because the Department
+of Health must have official information as to the
+completion of desquamation before a child is dismissed from
+observation. Other people with children demand this protection.
+At no other time is the inspector allowed to examine
+the patient. In any case, however, where isolation
+has not been maintained and it becomes necessary to remove
+the patient to the hospital, a diagnostician will make
+an examination.</p>
+
+<p>It is recommended that physicians provide a special washable
+gown for each case of measles. This gown should be
+put on before entering the sick-room and taken off outside
+<span class='pagenum'>[<a name="Page_620" id="Page_620">620</a>]</span>
+the sick-room as soon as the visit is completed. The gown
+should be kept in a closet or suitable place, separate from all
+other clothing, and the gown, and the closet should be fumigated
+after the termination of the case.</p>
+
+<p>10. In private houses only fumigation may be performed
+under the supervision of the attending physician; provided
+he follow accurately the directions given in the following
+rules and regulations. Upon request a blank will be provided
+upon which he must state the manner and extent of the
+work performed under his orders and supervision. If satisfactory
+to the Department, this will be accepted in place of
+fumigation by the Department. It is essential, however, that
+he should know that the disinfection has been efficiently
+carried out.</p></blockquote>
+
+<p>In every case of fumigation the following regulations
+must be complied with:</p>
+
+<blockquote><p>All cracks or crevices in rooms to be fumigated
+must be sealed or calked, to prevent the escape of the disinfectant,
+and one of the following disinfectants used in the quantities
+named:</p>
+
+<p>a. Sulphur, 4 lbs., for every 1,000 cubic feet of air space, 8
+hours' exposure.</p>
+
+<p>b. Formaline, 6 oz. for every 1,000 cubic feet of air space,
+4 hours' exposure.</p>
+
+<p>c. Paraform, 1,000 grains for every 1,000 cubic feet of air
+space, 6 hours' exposure.</p>
+
+<p>The following disinfecting solutions may be used for
+goods, which are afterwards to be washed:</p>
+
+<p>a. Carbolic acid, 2 to 5 per cent.</p>
+
+<p>b. Bichloride of mercury, 1-1,000.</p></blockquote>
+
+
+<h4>SCARLET FEVER. SCARLATINA.</h4>
+
+<p>Scarlet fever is an acute, contagious disease. It begins
+abruptly. The child may have a severe attack and
+be quite sick from the beginning, or he may have a mild
+attack and not be very sick. Usually the fever rises
+rapidly, the child vomits and complains of a sore throat.
+If the attack is very mild the throat symptoms may not
+cause any distress. Frequently, about the third day,
+there are patches on the tonsils. Prostration may be
+profound if the fever is very high. Convulsions and
+diarrhea are sometimes present in very young patients.
+It takes from two to six days to develop scarlet fever
+from the time the child is exposed to it. The disease
+may be caught at any time, but it is most contagious
+<span class='pagenum'>[<a name="Page_621" id="Page_621">621</a>]</span>
+during the time the patient is scaling. It is not as contagious
+as measles. Some children seem to escape even
+though directly exposed to it. It is more frequent in
+the fall and during the winter, and it is more severe
+during the latter months.</p>
+
+<p><b>Eruption</b>.&mdash;The eruption appears at any time after
+twelve hours. It may not, however, appear before the
+third or fourth day. It lasts from three to seven days,
+and only takes a few hours to cover the whole body after
+it is first seen. The rash is first seen on the neck or
+chest; it appears as a red, uniform blush, but, when examined
+closely, small reddish spots may be seen all over
+it. If the rash is very faint and of a doubtful character
+a hot bath may bring it out. A bright red, well-developed
+rash is a sign of good heart action. In the event
+of heart failure, the rash fades quickly. Itching is a
+constant symptom after the rash is fully out.</p>
+
+<p>About the eighth day the rash begins to scale or desquamate.
+It begins on the neck and chest. It takes
+from one to three weeks to scale completely, from the
+time it begins to peel. The hands and feet are the last
+spots to scale.</p>
+
+<p>It must always be kept in mind that mild cases are
+just as contagious as severe cases, and that a mild case
+may cause in another person a very severe attack.</p>
+
+<p>The throat may be mildly affected or it may be the
+most troublesome feature of the case. It is red and
+swollen and the child complains of pain during the act
+of swallowing. Patches may be seen on the tonsils on
+the third day. There is usually a discharge from the
+nose and this discharge may be contagious. While the
+fever is high, the child is restless, complains of thirst,
+and may be slightly delirious.</p>
+
+<p>One attack is usually all a child has during life, though
+there are exceptions to this rule. Complications are
+quite frequent with scarlet fever. Inflammation of the
+ears and kidneys is most often met.</p>
+
+<p><b>Measures to be Taken to Prevent Spread of Disease</b>.&mdash;Every
+case, no matter how mild, should be isolated
+for four weeks. Many cases must be isolated longer,&mdash;until
+scaling is complete. Children should not play or
+<span class='pagenum'>[<a name="Page_622" id="Page_622">622</a>]</span>
+sleep with other children for three or four weeks after
+all symptoms have been absent. Other children in the
+family, who have not been exposed, should be sent away.
+All clothing should be changed and washed in soap and
+water and then boiled in a carbolic solution. The nurse
+should not mix freely with other members of the family.
+The sick room should be kept clean, and well aired. It
+should be dusted with a wet cloth, and this should afterwards
+be burned. There should be no furniture, or
+hangings, or pictures in the room other than are absolutely
+necessary. The room should not be used after
+the case is over until it is thoroughly and completely disinfected.</p>
+
+<p>During the period of scaling the patient should be
+rubbed all over with carbolated vaseline. This allays
+itching and prevents the scales flying around. The bed
+sheet can be taken off daily with the scales in it, and
+immediately put in carbolic water and boiled.</p>
+
+<p><b>Treatment</b>.&mdash;Inasmuch as scarlet fever is one of the
+most dangerous and one of the most treacherous diseases
+of childhood, we cannot afford to take any chances with
+it. Every child with scarlet fever should be put in bed,
+and kept there during the entire illness,&mdash;that is, from
+four to six weeks. Light, and the free circulation of
+fresh air are absolutely necessary for the proper care of
+a scarlet fever case. The child should be clothed only
+with the usual night gown and a light undershirt. No
+extra wraps or blankets are required.</p>
+
+<p>The diet should be reduced in quantity and strength.
+The bowels should move daily. If anything is necessary
+to accomplish this, citrate of magnesia is quite satisfactory.
+There is no special medicine for the treatment of
+this disease. Often it is not necessary to give any.
+Good nursing is more essential, and with proper attention
+to the bowels, diet, fresh air, clothing, sleep, and
+quiet, all will, as a rule, result favorably. Quiet is essential.
+Consequently, two persons at a time should
+never be allowed in the room with the little patient.</p>
+
+<p>The family physician will prescribe whatever medicine
+is necessary in his judgment, and will meet any complication
+as it arises.
+<span class='pagenum'>[<a name="Page_623" id="Page_623">623</a>]</span></p>
+
+<h4>TYPHOID FEVER</h4>
+
+<p>Typhoid fever is an acute infectious disease. It is
+rare in infancy. After the fifth year it is more common.
+It is caused by drinking infected water or milk. It is
+not a serious disease in childhood, rarely being fatal.</p>
+
+<p><b>Symptoms</b>.&mdash;It may begin suddenly or it may come on
+slowly. If suddenly, the child develops what appears
+to be an attack of indigestion, has fever, vomiting, and is
+prostrated. In cases developing slowly the child complains
+of being tired, has a headache, nausea, and fever.
+Vomiting is the suggestive and important symptom.</p>
+
+<p>Diarrhea is usually present. Constipation, however,
+may accompany the entire illness. Children may not
+complain of an excess of gas as do adults. The abdomen
+is tender. The typhoid eruption is rarely seen
+in children. They lose flesh steadily and then strength
+diminishes rapidly. Headache and delirium at night are
+quite common, and the child is dull and indifferent, and
+often in a state of semi-stupor.</p>
+
+<p>In order to tell definitely whether the child has typhoid,
+it is necessary to make a blood examination.
+There are so many intestinal conditions in children that
+simulate typhoid, that a blood examination is imperative.</p>
+
+<p><b>Treatment</b>.&mdash;The patient should remain in bed during
+the time fever is present and for a few days after. A
+fluid diet, preferably milk, is the most suitable means of
+nourishing the child. It may be diluted or given plain
+according to the age of the patient. Water is essential
+and should be given freely.</p>
+
+<p>The discharges of the patient should be thoroughly
+disinfected in a solution of carbolic acid, 1-20. All
+clothing and bed linen should be boiled for two hours.
+If the fever remains high cold sponging is advisable.
+The attending physician should instruct regarding this
+feature, as some children do not stand cold applications
+well.</p>
+
+<p>The average duration of the disease is about six weeks.</p>
+
+<p><b>How to Keep From Getting and Spreading Typhoid
+Fever</b>.&mdash;Typhoid fever is a communicable disease, but,
+if certain precautions are taken, its contraction
+and spread can almost certainly be prevented.
+<span class='pagenum'>[<a name="Page_624" id="Page_624">624</a>]</span></p>
+
+<p>The disease is caused by a specific germ known as the
+typhoid bacillus. These germs are found in the excreta
+(stools and urine) of persons ill with typhoid fever.</p>
+
+<p>Failure to properly disinfect these excreta and carelessness
+in the care of persons ill with typhoid fever
+lead to the transmission of the disease from the sick to
+the well by the infection of water, milk or food with the
+typhoid bacillus or by direct contact.</p>
+
+<p>The disease is contracted by taking into the mouth
+in some form the discharges from some previous case.
+There is no other way. It is, therefore, a disease of
+filth and someone is at fault somewhere for every case
+of typhoid fever that occurs.</p>
+
+<p>Bad sanitary conditions, such as lack of drainage, open
+cess-pools, sewer gas, decaying vegetable matter, etc.,
+may favor the contraction of the disease, but cannot
+cause it unless the specific germ, the typhoid bacillus,
+is present.</p>
+
+<p>The water supply of a community becomes infected
+by the entrance into it of the excreta (stools and urine)
+of persons suffering from typhoid fever.</p>
+
+<p>Milk (in which typhoid bacilli grow and multiply very
+rapidly) usually becomes infected by washing out milk
+cans with water in which these bacilli are present, or
+from the presence of the bacilli on the hands or persons
+of those handling milk. Oysters spread the disease when
+they have been "freshed" in water rich in sewage and
+containing the typhoid bacillus. Flies, whose bodies
+have become foul with typhoid excreta, may infect food,
+milk, etc. Those who take care of typhoid patients
+may contract the disease if they do not at once disinfect
+their hands after handling the patient, or clothing
+or bedding which has become soiled with the discharges.</p>
+
+<p><b>How to Keep From Getting Typhoid Fever</b>.&mdash;If the
+chance of infection is to be reduced to a minimum, all
+drinking water, concerning the character of which there
+may be the slightest doubt, should be boiled, and all milk,
+the handling and care of which is not absolutely beyond
+suspicion, should be pasteurized or boiled. All food
+supplies (meat, milk, vegetables, etc.), should be carefully
+<span class='pagenum'>[<a name="Page_625" id="Page_625">625</a>]</span>
+protected against flies, and flies should not be permitted
+access to the sick-room, the kitchen nor to the
+room in which the meals are eaten. Bathing at all
+beaches which have sewers emptying in their immediate
+vicinity should be strictly avoided. In the majority of
+cases it is probable that the system must be slightly below
+par in order that the disease may be contracted;
+therefore, all indigestible food, green fruit, etc., which
+may set up indigestion or diarrhea, and so render the
+system more susceptible to infection, should be avoided.
+In addition, the elementary rules of cleanliness and hygiene,
+both as to the house and person, should be most
+strictly observed. No member of a household in which
+a case of typhoid fever occurs should take food in any
+form without previously washing the hands.</p>
+
+<p>Typhoid bacilli enter the body only through the mouth.
+If sufficient care be taken to prevent their entrance, the
+contraction of the disease can be absolutely prevented.</p>
+
+<p><b>How to Keep From Spreading the Disease</b>.&mdash;In order
+to protect themselves and others in the household, persons
+caring for or in any way coming into contact with
+a case of typhoid fever must constantly bear in mind
+that the secretions and excretions (urine, stools, etc.),
+of the patient contain typhoid bacilli and are capable of
+transmitting the disease to others. The person who
+nurses the patient should not do the cooking for the
+family. The bedding used by the patient should be
+washed separately from that used by others. Special
+dishes, plates, knives, forks, etc., should be kept for the
+use of the patient alone, and should be washed separately
+and thoroughly. Particular attention should be paid to
+immediate disinfection of the stools and urine of the patients
+until the restoration of health is complete.</p>
+
+<p>The urine is especially dangerous. It may look entirely
+normal and yet contain typhoid bacilli for some
+time after recovery is apparently complete. In a few
+instances the typhoid bacilli may persist in the stools for
+weeks or months after recovery. Such persons are called
+"typhoid carriers," and constitute a grave menace to the
+health of the community. The best disinfectants are
+carbolic acid and freshly slacked lime; both are effectual,
+<span class='pagenum'><a name="Page_626" id="Page_626">[626]</a></span>
+cheap and easily obtained. Urine or stools to which has
+been added one-third of their volume of a solution of
+one part of carbolic acid to twenty parts of water are, as
+a rule, sufficiently disinfected in half an hour, provided
+the mass of the stool is broken up and thoroughly mixed
+with the solutions. The best method is to keep the urinal
+of bed-pan partly filled with the disinfecting solution
+at all times. In this way any germs present in the urine
+or stools are almost instantly destroyed. Stools and
+urine should never be thrown out on the ground. If no
+system of drainage is at hand, they should be very thoroughly
+disinfected and emptied into a hole in the ground
+and covered with earth. All persons nursing or handling
+the patient in any way should be careful to wash their
+hands very thoroughly with soap and water before leaving
+the sick-room. They should never, while in the sick-room,
+touch any article of food or put their hands to
+their mouths. Careful observation of the above suggestions
+and precautions will almost certainly prevent
+contraction of typhoid fever or the spread of the disease.</p>
+
+
+<h4>VARIOUS SOLUTIONS</h4>
+
+<p><b>Boracic Acid Solution</b>.&mdash;In the previous pages mothers
+are frequently told to use "a saturated solution of
+boracic acid." A saturated solution means that the water
+in the solution has dissolved all of the product that
+is put into it that it is capable of dissolving. When boracic
+acid is put into water, the water will dissolve it up
+to a certain point; if you add more the boracic acid will
+not dissolve; it will float if it is in the form of powder,
+or it will remain at the bottom of the glass if it is crystal&mdash;in
+other words the water is saturated to its limit and
+the solution is known as a saturated solution.</p>
+
+<p>The strength of a saturated solution of boracic acid is
+as follows:&mdash;</p>
+
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Boracic Acid</td><td align='left'>Ounces</td>
+<td align='left'>1-1/2</td></tr>
+<tr><td align='left'>Hot Sterile Water</td><td align='left'>Pints</td>
+<td align='left'>2</td></tr>
+</table></div>
+
+
+<p>which means that 2 pints of hot water will completely
+dissolve 1-1/2 ounces of boracic acid. If any more boracic
+<span class='pagenum'><a name="Page_627" id="Page_627">[627]</a></span>
+acid is added the water will not dissolve it because it is
+already "saturated." Inasmuch, however, as boracic acid
+is harmless, it is perfectly safe to use the liquid part of a
+solution which contains some undissolved acid.</p>
+
+<p>A saturated solution is used in the eyes after it is
+strained.</p>
+
+<p><b>Normal Salt Solution</b>.&mdash;A normal salt solution is made
+in the following proportions:&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Sodium Chloride (ordinary table salt)</td>
+<td align='left'>Grains</td><td align='left'>128</td></tr>
+<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td>
+<td align='left'>2</td></tr>
+</table></div>
+
+<p>Normal salt solution is much used in irrigating the
+bowel. A mother may safely use it in the proportion of
+one heaping teaspoonful to two quarts of water&mdash;two
+quarts being the size of the ordinary fountain syringe.</p>
+
+<p><b>Carron Oil</b>.&mdash;Lime water and raw linseed oil, equal
+parts. This mixture is much used in burns. It should
+be made fresh.</p>
+
+<p><b>Thiersch's Solution</b>:&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Salicylic Acid</td><td align='left'>Drams</td>
+<td align='left'>1/2</td></tr>
+<tr><td align='left'>Boracic Acid</td><td align='left'>Drams</td>
+<td align='left'>3</td></tr>
+<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td>
+<td align='left'>2</td></tr>
+</table></div>
+
+<p>Thiersch's solution is a good, mild antiseptic solution,
+or wash.</p>
+
+<p><b>Solution of Bichloride of Mercury (1 to 1000)</b>:&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Bichloride of Mercury</td><td align='left'>Grains
+15</td></tr>
+<tr><td align='left'>Common Salt</td><td align='left'>Grains</td>
+<td align='left'>15</td></tr>
+<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td>
+<td align='left'>2</td></tr>
+</table></div>
+
+<p>Bichloride of mercury is one of the most powerful
+and poisonous drugs. Solutions made from it should
+never be used without special directions from a physician.
+In much weaker solutions than the above it is one
+of the best antiseptic washes known. It is used to disinfect
+wounds, for douches, and for various other purposes,
+but always by special direction of a physician.</p>
+
+<p><b>Other solutions</b>.&mdash;Frequently mothers are directed to
+use solutions in the proportion of 1 to 500, or 1 to 1000.</p>
+
+<p>This means that there will be one part of the drug, or of
+<span class='pagenum'>[<a name="Page_628" id="Page_628">628</a>]</span>
+the liquid medicine, to 500, or 1000 parts of water. For
+example if you were asked to make up a solution of bichloride
+of mercury in the strength of 1 to 4000, you
+would use one ounce of bichloride of mercury to four
+thousand ounces of water, or one grain of the mercury
+to four thousand drops of water,&mdash;one grain being equivalent
+to one drop.</p>
+
+<p>Sometimes solutions are made up on the percentage
+basis. For example, a five per cent. solution of carbolic
+acid. In this case it would be necessary to take five
+ounces of carbolic to one hundred ounces of water, or
+five drops of carbolic to one hundred drops of water.</p>
+
+<hr style="width: 65%;" />
+<span class='pagenum'><a name="Page_629" id="Page_629">[629]</a></span>
+<h2>CHAPTER XXXIX</h2>
+
+<h4>ACCIDENTS AND EMERGENCIES</h4>
+
+
+<div class="blockquot">Accidents and Emergencies&mdash;Contents of the
+Family Medicine Chest&mdash;Foreign Bodies in the Eye&mdash;Foreign Bodies
+in the Ear&mdash;Foreign Bodies in the Nose&mdash;Foreign Bodies
+in the Throat&mdash;A Bruise or Contusion&mdash;Wounds&mdash;Arrest
+of Hemorrhage&mdash;Removal of Foreign Bodies from a Wound&mdash;Cleansing
+a Wound&mdash;Closing and Dressing Wounds&mdash;The Condition of
+Shock&mdash;Dog Bites&mdash;Sprains&mdash; Dislocations&mdash;Wounds
+of the Scalp&mdash;Run-around&mdash;Felon&mdash;Whitlow&mdash;Burns and Scalds
+</div>
+<p><b>Contents of the Family Medicine Chest</b>.&mdash;The family
+medicine cabinet should contain the following articles:
+a graduate, medicine droppers, hot water bags, a flat ice
+bag, a fountain syringe, a Davidson's syringe, a baby
+syringe, sterile gauze, absorbent cotton, gauze bandages
+of various widths, a yard of oiled silk, one roll of one
+inch "Z O" adhesive plaster, a bottle of Pearson's creolin,
+hydrogen peroxide (fresh), one ounce tincture of iodine
+in an air-tight bottle, a can of Colman's mustard, two
+ounces of syrup of ipecac, a bottle of castor oil (fresh),
+one pound of boracic acid powder, one pound of boracic
+acid crystal, a bottle of glycerine, a bottle of white vaseline,
+a bath thermometer, some good whisky or brandy,
+aromatic spirits of ammonia, smelling salts, pure sodium
+bicarbonate, oil of cloves for an aching gum or toothache,
+a bottle of alkolol for mouth wash and gargle, and one
+ounce of the following ointment for use in the various
+emergencies which occur in all homes,&mdash;</p>
+
+<div class='center'>
+<table border="0" cellpadding="4" cellspacing="0" summary="">
+<tr><td align='left'>Bismuth subnitrate</td><td align='left'>dram one</td>
+</tr>
+<tr><td align='left'>Zinc oxide</td><td align='left'>dram one</td></tr>
+<tr><td align='left'>Phenol (95%)</td><td align='left'>drops twelve</td>
+</tr>
+<tr><td align='left'>Resinol ointment to make</td><td align='left'>ounce
+one</td></tr>
+</table></div>
+
+<p>This ointment may be applied to all cuts, bruises, skin
+eruptions, chafings and sores of minor importance. It is
+one of the best applications for chafing of the skin in
+babies.
+<span class='pagenum'>[<a name="Page_630" id="Page_630">630</a>]</span></p>
+
+<p>The medicine chest should also contain a small jar of
+Unguentine for burns; one-tenth grain calomel tablets
+for a cathartic for baby to be used as explained in the text
+of the book, or as advised by the physician. It may also
+contain tablets for colds and for other purposes as suggested
+by the family physician. It should never contain
+medicines the use of which is not thoroughly understood
+by the mother. It is a wrong practice for mothers
+to keep medicines to use for the same ailment at a subsequent
+time. The ailment may not be the same and frequently
+the medicine itself deteriorates, or it may get
+stronger with age. Many medicines are made with alcohol
+in them. If kept for some time the alcohol evaporates
+and leaves a concentrated mixture which, if given in the
+dose meant for the fresh preparation, may poison a child.
+Such cases of poisoning are on record. The same argument
+applies to powders. Certain drugs lose their
+strength, some absorb moisture, others change their chemical
+strength if kept mixed with other chemicals. They
+should be thrown away after the case is over if they
+have not been used. It is a dangerous practice to keep
+medicines around if there are children in the family.</p>
+
+<p><b>Foreign Bodies in the Eye</b>.&mdash;Particles which accidentally
+lodge in the eye are usually located on the under
+surface of the upper lid. They are sometimes, however,
+found on the ball of the eye or on the inner aspect of
+the lower lid. Foreign bodies which are propelled into
+the eye with great force, as iron specks which railroad
+men frequently get sometimes imbed themselves into
+the eye-ball and have to be cut out or dug out. The
+entrance of the foreign particle is always accompanied by
+a flow of tears which is nature's way of removing them.
+The offending object may escape through the tear duct
+into the nose, or it may be simply washed out with the
+flow of tears. Rubbing the well eye will cause a flow of
+tears in both eyes and may facilitate removal of the foreign
+matter. Blowing the nose may force the particle
+into the tear duct. The use of the eye cup may help in
+ridding the eye of the body. The same object may be
+accomplished if the eyes are immersed in a basin of
+water and opened wide. Then by moving the eyes
+<span class='pagenum'>[<a name="Page_631" id="Page_631">631</a>]</span>
+around the particle may be washed out. If the particle is
+located on the under surface of the upper lid it may be
+promptly removed by pulling the upper lid forcibly down
+and over the lower lid. The eyelashes of the lower lid
+act as a brush and as a rule quickly remove the irritant if
+the procedure is carried out adroitly. Everting the
+upper lid is a means of locating the body and in making
+possible its removal by a small camel's hair brush or corner
+of a handkerchief. To evert the upper lid it is
+necessary to employ a guide. A match stem may be used
+in an emergency. This is laid across the middle of the
+upper lid, the eye lashes are grasped with the fingers of
+the other hand and the lid is bent over the match stem
+and turned up thus everting or turning inside out the
+entire upper lid. The procedure may be facilitated if the
+patient is instructed to look down while the operator is
+drawing the eye-lid upward.</p>
+
+<p>If the particle cannot be easily removed by any of the
+above methods it is not safe for an uninstructed individual
+to go any further. The eye is an exceedingly delicate
+organ and may be permanently injured by unnecessary
+irritation. It is always safer and it may be cheaper in the
+long run to consult a competent oculist in such cases.</p>
+
+<p>After the removal of any object from the eye, it is desirable
+to frequently wash it out with a saturated solution
+of boracic acid. This mixture will allay any inflammation
+and will tend to restore the normal condition more quickly
+and more satisfactorily than if the eye were left to heal
+itself.</p>
+
+<p><b>Foreign Bodies in the Ear</b>.&mdash;When a foreign body
+gets into the ear mothers are unnecessarily alarmed because
+of a failure to appreciate that the ear is a closed
+passage. It is impossible for any object to get into the
+ear itself; the depth of the external passage is only about
+one inch in an adult. At this point the passage is completely
+closed by the drum membrane. Most of the harm
+is done by ignorant meddling, not by the object itself.</p>
+
+<p>Children frequently put foreign bodies in the ear, as,
+buttons, pebbles, beans, cherry stones, coffee, etc. The
+very first thing for the mother to do when she learns that
+her child has put "something" in its ear is to keep cool,
+<span class='pagenum'>[<a name="Page_632" id="Page_632">632</a>]</span>
+and try to find out what the something is. It is essential
+to know what the article is because different articles are
+treated differently. For example if we try to remove a
+bean or pea with a syringe, the liquid will cause the
+pea or bean to swell and result in wedging it in so firmly
+that it will be impossible to dislodge it in this way.</p>
+
+<p>If the object is hard, as a marble, button, pebble, bead,
+the greatest care must be exercised. Try to make the
+object fall out. To effect this, turn the child's head
+downward with the injured ear toward the floor. Then
+pull the lobe of the ear outward and backward so as to
+straighten the canal. A teaspoonful of olive oil poured
+into the ear will aid in its expulsion. If after the oil is
+poured in, the head is suddenly turned as above described
+the object will fall out. A very effective way to remove
+a hard object is to take a small camel's hair brush and
+coat the end with glue, or any other adhesive substance,
+then place it in contact with the object and permit it
+to remain long enough to become firmly attached after
+which it may be gently pulled out with the object attached.
+Never employ an instrument in the ear to remove
+a foreign body.</p>
+
+<p>When a live insect or fly enters the ear a number of
+safe methods may be developed. If the ear is immediately
+turned to a bright light the insect may come out of
+its own accord. It may be floated out with salt water, or
+it may be smothered with sweet oil or castor oil after
+which it may be floated or syringed out. If it is necessary
+to employ a syringe this should be used gently. A
+foreign body may remain in the ear for days or weeks
+without doing any harm. This suggests that any unnecessary
+poking or prying should not be undertaken,
+because this may wedge it in tighter and to injure the
+drum membrane.</p>
+
+<p><b>Foreign Bodies in the Nose</b>.&mdash;Children may put any
+of these articles into the nose. Very often they do, and
+do not know enough to tell. If such is the case the first
+symptom calling attention to the fact that something is
+wrong is the appearance of a thick foul discharge from
+one nostril or some obstruction to breathing on the same
+side.
+<span class='pagenum'>[<a name="Page_633" id="Page_633">633</a>]</span></p>
+
+<p>When the foreign body may be seen the child should be
+made to blow the nose, first closing the well side with the
+finger. If this does not expel the object the child should
+be made to sneeze by tickling the free nostril with a
+feather or by taking snuff. The mother should never permit
+the use of instruments by one unskilled in an effort
+to rid the nose of an obstruction. There is great danger
+of seriously injuring the delicate structure of the nose in
+this way or of pushing the object so far in that it may
+necessitate an operation to extract it. It is much safer
+to seek medical aid before any damage is effected. It
+seldom does harm to wait until the right assistance is
+at hand; it often does serious harm to be too smart in
+these little matters.</p>
+
+<p><b>Foreign Bodies in the Throat</b>.&mdash;If the foreign body is
+in the upper part of the throat and can be seen it may
+be removed with any instrument that can grasp it. The
+child may be immediately held up by its feet when the
+article may be shaken out. If it is further back or in
+the air passages the child should be made to vomit by
+tickling the throat with a feather or with the finger held
+in the throat till it does vomit.</p>
+
+<p>When the object interferes with breathing a physician
+should be sent for in a hurry. In the meantime the
+family may try to dislodge it by having the child bend
+forward or by holding it with the head downward and,
+while in this position, sharply striking the back with each
+cough. Striking the chest when in this position may
+effect the same purpose. If no success follows this procedure
+try the reverse position. Have the child bend
+backward over the arm of a sofa, for example, or put
+him in bed with the body hanging out of the bed face
+upward. If none of these effect relief you must depend
+upon the skill of the physician.</p>
+
+<p><b>A Bruise or Contusion</b>.&mdash;A bruise or contusion is an
+injury to the tissues underneath the skin, but this does
+not imply that the skin itself is opened or damaged. In
+every bruise the small blood vessels are ruptured, and
+the blood collects in the tissues causing distention, swelling
+and pain. The blood is held in the tissues, it is stagnant,
+becomes dark in color and so produces the bluish
+<span class='pagenum'>[<a name="Page_634" id="Page_634">634</a>]</span>
+discoloration that we see in all bruises. The color varies
+according to the extent of the collected blood. At first it
+is red and inflamed looking, then purple, then black, then
+greenish and finally citron. The so-called "black-eye" is
+a typical example of this degree of bruise. After a
+bruise the parts swell from the collection of blood and
+from the accompanying inflammation. This causes pain
+which persists for a day although the spot may be sore
+and tender for a week or more.</p>
+
+<p>In all mild varieties home remedies may suffice, but
+in the more serious and extensive bruises it is advisable
+to seek medical assistance. It is essential to completely
+put the part to rest and to elevate it. This will relieve
+the pain and favor the absorption of the exuded blood.
+If the bruise is on the foot, the leg should be elevated until
+the foot is higher than the hip. If, on the hand, it
+should be so held that it will be higher than the elbow and
+it may frequently be held higher than the shoulder to relieve
+the throbbing and the pain.</p>
+
+<p>As a rule, cold should be applied as soon after the injury
+as possible, cloths wrung out of ice water, or a piece
+of ice may be bound on the part for a short time. The
+object of the cold is to stop the internal bleeding. If
+the injury is slight, as are most of the injuries of the
+household, the mother may apply repeated cloths wrung
+out of very hot water. This procedure tends to aid the
+immediate absorption of the blood and prevents a discoloration
+of the part. If there is great pain relief may
+be afforded by applying a firm bandage saturated in the
+lead-water and laudanum mixture which may be obtained
+in the drug store under the name of lead and opium
+wash. The bruised part should be massaged every day
+and a simple ointment may be applied to soften the inflamed
+area.</p>
+
+<p>If any complication arises in the treatment of a bruise,
+it will be necessary to consult a physician.</p>
+
+<p><b>Wounds</b>.&mdash;A wound implies an injury to the skin in
+addition to injury to the underlying parts to a lesser or
+greater extent. The skin may be opened by cutting, or
+stabbing wounds; or it may be punctured, torn, contused,
+or bruised open. These injuries are effected in
+<span class='pagenum'>[<a name="Page_635" id="Page_635">635</a>]</span>
+various ways. We speak of machinery or mechanical
+wounds, or gunshot wounds, bites, cuts, stabs and other
+varieties of wounds.</p>
+
+<p>It is very important to know exactly how a wound is
+produced and the nature of the instrument which opened
+the skin. We try to obtain this information in order to
+estimate the probable degree of poison that may or may
+not have entered into the wound.</p>
+
+<p>The first thing to do in treating wounds is to stop the
+bleeding. If the patient is suffering from shock he
+should be given active treatment for this condition as
+described elsewhere. If the wound contains any foreign
+bodies these should be removed. The wound
+should then be cleansed, closed and dressed and kept at
+rest. If the wound is poisoned, or if there is any fear
+that lockjaw may arise, or if the wound has been caused
+by a mad dog it will require special treatment.</p>
+
+<p>It is far better not to interfere if you do not know
+what to do than to do harm. One should offer no advice
+if they are not qualified to give advice. Much harm
+has resulted from doing the wrong thing in these cases.
+The instruction in the following pages is given so that
+the average mother may know what to do in emergency
+but not with the intention that she may regard her knowledge
+as sufficient to dispense with the aid of the physician.</p>
+
+<p><b>Arrest of Hemorrhage</b>.&mdash;When there is a wound there
+is always bleeding; this means that some blood vessels
+have been cut or torn open allowing blood to escape.
+The character of the hemorrhage will determine the nature
+of the treatment to be employed. On general principles,
+the first thing to do in the presence of bleeding is
+to elevate the part, if that is possible. If there is simply
+a general oozing of blood, it may be controlled and
+arrested by pressure. This pressure should be steady
+and prolonged. It is best accomplished by wetting a
+clean handkerchief or a pad of gauze in ice cold water,
+placing this on the part and binding it on firmly with a
+bandage.</p>
+
+<p>If the discharge of blood flows in a steady stream and
+is rather dark the hemorrhage is coming from a vein.
+<span class='pagenum'>[<a name="Page_636" id="Page_636">636</a>]</span>
+We know that veins carry blood toward the heart so
+that any pressure or constriction employed to stop a
+venous hemorrhage should be tied on the side of the
+wound further removed from the heart. Inasmuch as
+veins have soft walls the right kind of pressure will in
+most instances stop the bleeding. The part should be
+elevated after the pad is adjusted in place. Any tight
+band on the limb as a garter or sleeve band should be
+removed as they tend to interrupt the return circulation.</p>
+
+<p>If the hemorrhage is from an artery the blood is bright
+red. It spurts out forcibly, is difficult to control and demands
+immediate attention. Arteries carry the blood
+from the heart to the extremities. They beat with every
+pulsation of the heart so that blood coming from an
+artery spurts with every pulse beat. Even a small
+artery may be responsible for a very considerable hemorrhage
+in a very short time. Whatever is done must be
+done quickly. The parts should be freed from all clothing
+and if possible elevated. Pressure may be tried, if
+it succeeds it must be strong and steady pressure. The
+point to press must be on the heart side of the bleeding
+artery since the blood stream is coming that way&mdash;this
+the mother will note is the reverse from treating bleeding
+from a vein as previously explained. The artery
+at this point may be felt beating. It is frequently necessary
+to clamp the whole limb to stop an arterial hemorrhage.
+This may be done in the following manner.
+Take a strong piece of cloth or bandage and tie above
+the bleeding point. Insert a short piece of stick between
+the bandage and the limb and twist around until
+the bleeding stops. This should not be kept on longer
+than one hour. A tourniquet of this character shuts off
+all the blood in the limb and if kept on too long the parts
+may mortify. The best means to stop a hemorrhage of
+this character is by means of a rubber bandage sold for
+the purpose. It is applied by stretching at every turn. It
+exerts uniform pressure and in this way does no injury to
+the parts. All these measures are, of course, only temporary
+expedients as the artery will finally have to be
+caught and tied by a physician.</p>
+
+<p><b>Removal of Foreign Bodies From a Wound</b>.&mdash;When
+<span class='pagenum'>[<a name="Page_637" id="Page_637">637</a>]</span>
+the foreign bodies are large enough to be seen they may
+be picked out with the fingers after the hands have been
+rendered sterile. Smaller bodies may be picked up with
+forceps, or they may be washed out with water that has
+been boiled and cooled slightly, or a bichloride of mercury
+solution in the strength of 1 to 2000 may be used; or a
+normal salt solution may be used. As a general rule the
+physician should be allowed to undertake this procedure
+so that you may not be blamed for something that may
+come up later.</p>
+
+<p><b>Cleansing a Wound</b>.&mdash;The simplest way, and the most
+effective, to cleanse a wound, no matter how caused, is
+to procure a brush and paint it thoroughly with tincture
+of iodine. The iodine should be painted right into the
+raw wound, it is then bound up and left if it is small and
+does not need any stitching. When the physician comes
+he can attend to any further procedure that may be
+necessary.</p>
+
+<p><b>Closing and Dressing Wounds</b>.&mdash;If the wound is
+small, its edges may be drawn together with narrow
+strips of adhesive bandage after it has been painted with
+iodine. It is then bound up and kept at rest. It should
+be inspected the following day to see if it is healing
+properly.</p>
+
+<p>If the wound is large or torn, it should be seen by a
+physician and dressed and closed by him. All wounds
+do better if they are kept at rest.</p>
+
+<p><b>The Condition of Shock</b>.&mdash;When a person suffers a
+serious injury, loses a large quantity of blood, or is
+subjected to a profound emotion, it affects the vital
+powers to such an extent that the individual is said to
+be suffering from shock. Shock expresses itself in varying
+degrees of apathy. The patient may or may not be
+conscious. If conscious he gives no evidence of feeling,
+he is silent and motionless although he will respond to
+directions and may answer questions. The eyes are dull
+and listless, the face pale and pinched, and the general
+expression is apathetic. The skin is cold and there may
+be perspiration; the pulse is feeble and irregular, and
+the breathing is shallow. The whole attitude of the victim
+is one of indifference and apparent inability to
+<span class='pagenum'>[<a name="Page_638" id="Page_638">638</a>]</span>
+appreciate the seriousness of the situation and a seeming
+immunity to pain or discomfort.</p>
+
+<p>When this condition exists it must always be regarded
+as serious because the patient may die as a direct result
+of the condition of shock. The various symptoms depend
+upon a temporary paralysis of the blood vessels
+which deprives the brain of blood. There is always a
+certain degree of shock with all injuries. Mothers should
+know what to do in these cases before the physician
+comes. The general treatment in all cases is to keep the
+patient warm and quiet, and to use stimulants carefully.</p>
+
+<p>The patient should be put in bed or on a flat surface
+with the feet higher than the head. If raising the feet
+should cause the face to become blue it will be advisable
+to restore the patient to the horizontal posture. Artificial
+heat must be applied to the patient's body and extremities
+by means of hot water bags, bottles, bricks, plates, or
+any other handy device. Blankets should be put around
+the patient and every possible means resorted to, to maintain
+body heat. Mustard plasters may be put to the
+heart, spine and shins. Stimulants are necessary, such
+as hot black coffee if possible or hot water, in which a
+small portion of brandy may be put. If brandy is not
+obtainable the patient may take aromatic spirits of ammonia
+in hot water every twenty minutes for a number
+of doses. In every case of shock a physician should be
+sent for immediately.</p>
+
+<p><b>Dog Bites</b>.&mdash;When a child is bit by a dog every effort
+should be made to get the dog. It should be kept in a
+safe place for a week so that it may be definitely known
+whether it is sick or not. If the dog dies within a few
+days after biting anyone it may be assumed that he had
+rabies. Its head should be sent to the local health authorities
+who can tell after examination if it was mad. If there
+is any reason to assume that the dog was infected, the
+child should receive the Pasteur treatment. This treatment
+will, if conducted under favorable circumstances,
+absolutely prevent hydrophobia.</p>
+
+<p>The mother should sterilize the wound as thoroughly
+as possible. This may be done by using pure hydrogen
+peroxide. A little piece of absorbent cotton is wound
+<span class='pagenum'>[<a name="Page_639" id="Page_639">639</a>]</span>
+round the end of a tooth-pick or match, dipped in the
+peroxide and the incision thoroughly rubbed clean. This
+may be done a number of times to ensure thorough
+cleansing. No effort should be made to cauterize the
+wound. It is not considered proper to employ this
+method with dog bites. When the physician examines
+the wound he may or may not open it further for more
+extensive inspection and sterilization.</p>
+
+<p>Mothers should remember that there are thousands
+of bites by dogs that never cause any trouble, and if it
+is known that the dog is healthy no worry need trouble
+the family. It is also wrong to inform the child of the
+probability of hydrophobia. The child may worry himself
+sick with fear and if the mother is nervous and excitable
+he is apt to be made sick with the dread of what
+may follow. It is better, therefore, to remain quiet, to
+keep cool, and not to excite the little patient at all.</p>
+
+<p><b>Sprains</b>.&mdash;Every joint is held together by ligaments
+which are attached to the bones forming the joint. If
+these ligaments are subjected to a sudden twist in a direction
+in which the joint is not constructed to move, the
+resulting injury is known as a sprain. The ligaments
+are stretched, though they may be torn apart and even
+small pieces of the bone may be split off if the wrench
+is great enough. The injury is an exceedingly painful
+one and frequently renders the limb useless for some
+time. It is always accompanied with some degree of
+swelling and more or less inflammation.</p>
+
+<p>A sprained joint should be immediately put at absolute
+rest. The best dressing is the lead and opium wash.
+Two pints of it may be obtained at the drug store. Pour
+into a large bowl, saturate a large piece of thick absorbent
+cotton, wrap around the joint and bind in place.
+This dressing may be repeated as often as the cotton
+becomes dry. When the swelling has disappeared and
+the pain is gone, it is desirable to have the joint supported
+with strips of adhesive bandage. These must be put on
+in a certain way in order to properly support the joint.
+Consequently a physician should put them on. If a sprain
+is not attended to effectively there is danger of the joint
+being more or less incapacitated for life.
+<span class='pagenum'>[<a name="Page_640" id="Page_640">640</a>]</span></p>
+
+<p><b>Dislocations</b>.&mdash;A dislocated joint is one that has been
+put out of place. It is best to allow a physician to treat
+a dislocation. Unskilled handling of a dislocated joint
+may not only increase the damage but it may permanently
+put the joint out of business. Until the physician arrives
+the part should be kept absolutely at rest.</p>
+
+<p><b>Wounds of the Scalp</b>.&mdash;Children frequently get injuries
+of the scalp. These wounds bleed freely and as a
+rule they occasion a great deal of unnecessary worry
+and apprehension. Usually they are not of much importance.
+We must keep in mind, however, the probability
+of fracture as a consequence of severe injury. The
+first thing to do when there is bleeding from the scalp is
+to cut or shave away the hair surrounding the wound.
+This should be done for an inch around the wound so
+that thorough disinfection may be possible. The wound
+should now be cleansed as previously instructed and an
+effort made to stop the bleeding. The best method is to
+first apply pads of gauze wrung out of very hot water.
+When success is evident a pad made of boiled cotton
+should be placed on the wound and held tightly in place
+for some time. If the wound is of such a character as to
+demand stitches a physician should of course put them
+in.</p>
+
+<p><b>Run-Around: Felon: Whitlow</b>.&mdash;When pus germs
+enter around a finger nail and lodge in the soft tissue a
+"run-around" is the result. It is accompanied with pain,
+swelling, redness and inflammation. The loss of the nail
+may follow.</p>
+
+<p>A felon or Whitlow is a more extensive and a more
+serious condition. It is not always possible to trace
+the cause of a felon. The fact that germs gain an entrance,
+however, is soon established. Sometimes a bruise,
+or scratch, or a wound is the primary cause. The last joint
+of any of the fingers may be the seat of a felon. A
+end of the finger becomes hot, tense, swollen and very
+painful; the pain is intense if the hand is held down. The
+surface may or may not be red. There is as a rule some
+fever. If the felon is on the little finger or thumb the
+condition is worse than on the others as a rule,&mdash;the inflammation
+extending to the hand and often into the arm.
+<span class='pagenum'>[<a name="Page_641" id="Page_641">641</a>]</span>
+The condition affects the palmar surface of the fingers.
+If the felon results in the "death" of the bone, the last
+joint will have to be taken off and the hand may be
+distorted, crippled, and rendered permanently disabled.
+Blood poison may set in and death is possible as a result
+of this complication.</p>
+
+<p><b>Treatment</b>.&mdash;Every effort should be made to abort a
+felon. Continuous application of equal parts of alcohol
+and water night and day may abort it. Tincture of
+iodine applied to the entire end of the finger may be effective.
+The hand must be at rest, carried in a sling
+during the day and slung over the head to the bed-board
+at night. If these efforts are not successful after twenty-four
+hours hot poultices should be resorted to, but they
+must be changed every twenty minutes. If, at the end of
+another twenty-four hours, there is no improvement the
+finger must be freely cut open by a surgeon and the
+poultices continued.</p>
+
+<p><b>Treatment of "Run-Around."</b>&mdash;Apply iodine freely,
+cold applications, and if the inflammation persists use
+poultices. It is frequently necessary to incise the run-around.
+Patients suffering from either of these conditions
+need general tonic treatment and should be under
+the care of a physician.</p>
+
+<p><b>Burns and Scalds</b>.&mdash;Burns result from undue exposure
+to dry heat. Scalds are produced by the action of hot
+liquids and steam.</p>
+
+<p>There are always produced two results from a burn
+or a scald. First the local effect, and, second, the general
+effect. The general effect may produce shock, the
+symptoms of which have been described in the previous
+pages. The degree of shock depends upon the extent of
+the local injury and may be severe enough to result in
+death. If the local injury covers more than two-thirds
+of the body death as a rule takes place within two days.</p>
+
+<p><b>How to Extinguish Burning Clothing</b>.&mdash;The thought
+to keep in mind is to smother the flames effectively. If
+we deprive the flame of all air or oxygen it will immediately
+subside. This may be done quickly by wrapping
+the burning part in a carpet, rug, blanket, overcoat or
+any large woolen material at hand. If none of these
+<span class='pagenum'>[<a name="Page_642" id="Page_642">642</a>]</span>
+articles are at hand the victim may roll on the floor and
+try to smother the flame by pressure, aided by the hands.
+It is a good plan to throw water on the patient immediately
+after the fire has been put out, so as to extinguish
+the smoldering fire.</p>
+
+<p>When a person is scalded by steam or boiling water
+or other liquid, it is advisable to pour cold water freely
+over the wound.</p>
+
+<p><b>How to Remove the Clothing</b>.&mdash;When it is necessary
+to remove the clothing it is essential to be gentle in order
+not to do greater injury. The clothing must not be pulled.
+The garment should be cut so that they fall off. If any
+part sticks to the skin, it must be left, not torn away.
+Later, it may be removed by moistening it with salt
+water.</p>
+
+<p><b>Treatment of Scalds and Burns</b>.&mdash;All slight burns or
+scalds may be effectively treated with Unguentine. This
+substance may be obtained in any drug store. It is spread
+on a cloth and applied directly to the injured part, bound
+securely on and renewed every day until the wound is
+healed. If Unguentine is not readily obtainable the part
+may be covered with any of the following mixtures or
+oils: carbolated vaseline, equal parts of linseed oil and
+lime water, olive oil, castor oil or kerosene, cloths soaked
+in a solution of baking soda, or a solution of phenol
+sodique.</p>
+
+<p>In severe burns or scalds the mother should not attempt
+to treat the child. A physician should be summoned
+at once. The child may be given a little whisky or brandy
+in warm water, and if the pain is great a dose of laudanum
+may be given. The dose of laudanum is one drop for
+each year of life. If the child has a chill he may be put
+into a warm bath of 100&deg;F. It is not wise to cut a burn
+blister. The water may be let out by puncturing with a
+sterile needle, but the skin must be left intact until the
+new skin is grown. The treatment of burns must be done
+with the greatest cleanliness because if infected with
+germs they may prove serious.</p>
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'>[<a name="Page_643" id="Page_643">643</a>]</span>
+</p>
+
+<h2><a name="MISCELLANEOUS" id="MISCELLANEOUS"></a><b>MISCELLANEOUS</b></h2>
+
+<hr style="width: 65%;" />
+<p><span class='pagenum'>[<a name="Page_644" id="Page_644">644</a>]</span><br /></p>
+<p><span class='pagenum'><a name="Page_645" id="Page_645">[645]</a></span>
+</p>
+<h2>CHAPTER XL</h2>
+
+<h4>MISCELLANEOUS</h4>
+
+
+<div class="blockquot"><p>The Dangerous House Fly&mdash;Diseases Transmitted
+by Flies&mdash;Homes Should be Carefully Screened and Protected&mdash;The
+Breeding Places of Flies&mdash;Special Care Should be
+Given to Stables, Privy Vaults, Garbage, Vacant Lots,
+Foodstuffs, Water Fronts, Drains&mdash;Precautions to be
+Observed&mdash;How to Kill Flies&mdash;Moths&mdash;What Physicians
+are Doing&mdash;Radium&mdash;X-Ray Treatment and X-Ray
+Diagnosis&mdash;Aseptic Surgery&mdash;New Anesthetics&mdash;Vaccine
+in Typhoid Fever&mdash;"606"&mdash;Transplanting the Organs of
+Dead Men into the Living&mdash;Bacteria that Make Soil
+Barren or Productive&mdash;Anti-meningitis Serum&mdash;A Serum
+for Malaria in Sight.</p></div>
+
+
+<h4>THE DANGEROUS HOUSE FLY</h4>
+
+<p>Mothers should become thoroughly acquainted with
+the grave consequences which may result from fly-infected
+foods, and from the possible carriage of disease
+by means of flies, even where foods are carefully protected.
+The transmission of the following diseases by
+means of flies has been conclusively proven: typhoid
+fever, tuberculosis, cholera, Oriental plague, inflammation
+of the eyelids, serious infection of wounds. Summer
+diarrhea of children is also transmitted in this way.</p>
+
+<p>Typhoid fever and summer diarrhea of children in
+this country, and cholera and Oriental plague in the
+countries in which those diseases exist, may be transmitted
+through the various foods that are eaten in an uncooked
+state, if infected by flies, through cooked foods
+infected by flies after the process of cooking, through
+drinking water which has been infected by flies, and
+through milk similarly infected. Fruits are especially
+likely to be infected by the small fruit fly commonly
+found around markets and stands. Fish may be infected
+by flies, and in consequence will undergo rapid
+decomposition. Decomposition caused in this way has
+<span class='pagenum'>[<a name="Page_646" id="Page_646">646</a>]</span>
+resulted in many cases of diarrhea and dysentery. What
+is commonly known as fly speck is the excreta of the
+fly, and frequently contains virulent disease germs. These
+specks are often found on foodstuffs that have not been
+properly protected.</p>
+
+<p>Transmission of disease may also occur by the infection
+of open wounds through contact with infected flies.
+This is true of all pus formation in wounds. The simple
+contact of a fly infected with the disease may cause
+Oriental plague, sore eyes, and possibly granular eyelids.
+A fly infected with dysentery or typhoid fever may cause
+either of these diseases by simply coming in contact with
+the lips of susceptible persons.</p>
+
+<p>The fly in the house should be relentlessly pursued and
+destroyed. The house which is carefully screened and
+protected from flies is infinitely safer than one not so
+protected. In the spring of the year the house fly begins
+to take on life. Eggs which were laid the preceding fall
+begin to hatch. At first the fly is only a little worm wriggling
+in some pile of filth. The eggs are usually laid and
+the grub developed in a manure pile or some mass of
+garbage or other filth. Before the grub develops into
+the fly it is easily destroyed. If everything in and about
+the house were kept scrupulously clean, and if every
+manure pile were kept carefully screened or covered so
+as to protect it from flies, there would be no difficulty in
+preventing the fly nuisance. The most effective way to
+accomplish this is to destroy the breeding places. The
+importance of this may be seen when it is considered that
+one fly produces one hundred and twenty-five millions or
+more of its kind in one season.</p>
+
+<p><b>Stables</b>.&mdash;Manure is by far the commonest material in
+which the fly lays her eggs. All stables should be kept
+scrupulously clean. No manure should be allowed to accumulate
+where it will be exposed to flies for even a few
+minutes. Immediately after it is dropped by an animal,
+it should be removed and covered. Manure may be
+treated with considerable quantities of lime without interfering
+with its fertilizing value, and in this way the development
+of the eggs laid in it by the flies can be practically
+prevented. The floors of stables should be thoroughly
+<span class='pagenum'>[<a name="Page_647" id="Page_647">647</a>]</span>
+flushed with water at least once in every twenty-four
+hours.</p>
+
+<p><b>Privy Vaults</b>.&mdash;Human excrement also affords an excellent
+breeding place for flies. In army camps the
+latrines are the points from which much infection is transmitted
+to troops, and thousands of the men have lost
+their lives by contracting typhoid fever transmitted in this
+manner. During the summer time all open vaults and dry
+closets should be treated continuously with lime, crude
+creolin or crude carbolic acid, and they should be carefully
+cleaned out at frequent intervals.</p>
+
+<p><b>Garbage</b>.&mdash;As a medium for the development of flies,
+garbage may be considered next in importance to excreta.
+The eggs of the fly hatch in about twenty-four hours, and
+garbage which is retained in the kitchen for that length
+of time may contain flies in the grub stage. To prevent
+this development, all garbage should be covered and
+pails should be emptied as often as possible. In country
+districts garbage should be burned in the kitchen or
+buried in the garden at frequent intervals, twenty-four
+hours being the maximum time it should be retained.</p>
+
+<p><b>Vacant Lots</b>.&mdash;Vacant lots frequently contain appreciable
+quantities of organic matter in a state of decomposition,
+affording favorable breeding places for flies.
+These vacant areas should be maintained in a state of
+scrupulous cleanliness.</p>
+
+<p><b>Foodstuffs</b>.&mdash;In order to prevent contamination of
+foodstuffs, all foods that are eaten in the raw state and
+all foods that are exposed for sale after having been
+cooked should be carefully protected from contact with
+flies, by screens or covers.</p>
+
+<p>A point where rapid development of flies takes place
+is along the city's water front. This is due to the fact
+that many of the sewers do not discharge below the level
+of the water. All open drains should be eliminated,
+whether they be sewers, private house drains or drains
+from cess-pools.</p>
+
+<p><b>Precautions to be Observed</b>.&mdash;Keep the house free
+from flies. Every fly should be considered a possible
+disease carrier and should be destroyed.</p>
+
+<p>Keep the windows of the house, especially the kitchen
+<span class='pagenum'>[<a name="Page_648" id="Page_648">648</a>]</span>
+windows, carefully screened during the spring, summer
+and autumn.</p>
+
+<p>Protect children from exposure to flies, particularly
+children who are ill, and do not allow nursing bottles
+to be exposed to flies.</p>
+
+<p>Protect milk and other foodstuffs from contact with
+flies.</p>
+
+<p>Keep the garbage outside of the house, carefully
+covered.</p>
+
+<p>Abolish open drains near dwelling places.</p>
+
+<p>Stable manure should be frequently sprinkled with
+lime and kept covered.</p>
+
+<p>Earth closets and privy vaults should be treated with
+lime, crude creolin or crude carbolic acid at frequent
+intervals.</p>
+
+<p>Earth closets and privy vaults should be cleaned frequently
+in order to prevent excrement accumulating to an
+undue extent.</p>
+
+<p><b>To Kill Flies</b>.&mdash;Dissolve one dram of bichromate of
+potash in two ounces of water, add a little sugar to this
+solution and put some of it in shallow dishes and place
+about the house. Sticky fly paper and fly traps may also
+be used.</p>
+
+<p>To clean the room where there are many flies, burn
+pyrethrum powder (Persian insect powder). This stupefies
+the flies and in this condition they may be swept up
+and burned.</p>
+
+<p>Probably the best and simplest fly killer is a weak
+solution of formaldehyde in water (two teaspoonfuls to
+the pint). This solution should be placed in plates or
+saucers throughout the house. Ten cents' worth of formaldehyde,
+obtained in the drug store, will last an ordinary
+family all summer. Don't smell formaldehyde in
+the pure state; it is very pungent and strong. In the
+solution of the strength used for flies it has no offensive
+smell. It is fatal to disease organisms, and is practically
+non-poisonous except to insects. Flies will not
+stay in the house when this solution is around.</p>
+
+<p><b>Moths</b>.&mdash;Late spring and early summer is the time to
+guard against moths and beetles. Many of these fabric-destroying
+insects are brought into the house on flowers.
+<span class='pagenum'>[<a name="Page_649" id="Page_649">649</a>]</span></p>
+
+<p>May and June are especially bad months, as both moths
+and beetles are only dangerous to fabrics in their young
+or grub stage.</p>
+
+<p>These insects will destroy almost anything from coarse
+rugs to the finest of ball gowns and dress suits. Carpets
+that are rarely swept and garments that are seldom disturbed
+are most liable to damage.</p>
+
+<p>The substitution of the frequently removed and easily
+cleaned rugs for carpets will greatly lessen the danger
+from the destructive moth and beetle grubs. Carpets laid
+on tight floors are much less liable to injury than where
+numerous cracks furnish safe retreats for the insects.
+Tarred paper under a carpet is an excellent preventive.</p>
+
+<p>All clothes presses should be thoroughly cleaned at
+frequent intervals. The garments should be removed,
+aired and vigorously brushed. Any larv&aelig; which are not
+dislodged in this way should be destroyed. It is a bad
+plan to keep odds and ends of woolen or other materials
+in attics where these pests can breed and thus spread
+to more valuable articles.</p>
+
+<p>Spraying with benzine two or three times during hot
+weather is a good way of preventing injury to furniture
+or carriage upholstery and other articles which are in
+storage or not in use for a long time. If you are certain
+that woolens and furs are free from the pests they
+may be stored in safety by placing them in tight paste
+board boxes and sealing the covers firmly with gummed
+paper.</p>
+
+<p>Both moths and carpet beetles are harmless at a temperature
+of 40 degrees Fahrenheit&mdash;a fact very well
+known to advantage by the large fur storage companies.
+They cannot survive furthermore a temperature of 120
+decrees if subjected to it for about twenty minutes.</p>
+
+<p><b>What Physicians are Doing</b>.&mdash;It is desirable that the
+ordinary non-medical individual should know what the
+science of medicine is doing and what it is accomplishing.</p>
+
+<p>During the past fifteen years the art of curing and
+preventing disease has taken on giant strides. The man
+or woman most ready to question the accomplishments
+and the ability of the humble family physician or the
+<span class='pagenum'>[<a name="Page_650" id="Page_650">650</a>]</span>
+motive of the science of medicine, is the one who appreciates
+least that it is due to the skill and intelligence of
+the medical men of to-day that he owes his comfort, his
+health, and his freedom from pestilence, plague and disease.
+Unthinking people laud and praise some upstart
+whose ability lies in his faculty to fool the gullible, or they
+will rush to seek the false aid of some nondescript science,
+because it is popular and well advertised, while they pass
+by or ignore the men whose labors have made the world
+what it is, and who alone possess the ability to intelligently
+wage the battle in the interest of humanity against disease.</p>
+
+<p>The medical profession has repeatedly pointed out that
+there are, on an average, six hundred thousand lives lost
+every year in the United States from preventable disease
+and accidents. Six hundred thousand lives which medical
+science has at hand the remedy to save, but which the medical profession
+sacrificed because of inadequate legislation. Few people
+can comprehend just what six hundred thousand lives
+mean. Let us put it in another way. There are destroyed
+by preventable disease and accidents every day American
+lives equal in number to the crews of two battle ships,
+equal in three months to more than the total combined
+numbers of the Army and Navy of the United States;
+equal in one year to more than the total number of lives
+lost in all our wars since the Declaration of Independence.</p>
+
+<p>The <i>Titanic</i> disaster shocked the public for a moment,
+and seemed to impress them as though it was a terrible
+and unheard of waste of good human lives. Yet in the
+loss of life due to preventable causes we have in this country
+every day in the year a destruction of our citizens exceeding
+in magnitude that which occurred when the
+<i>Titanic</i> sank. Think of it! A <i>Titanic</i> disaster a day, and
+yet the public does not rise up and demand in a spirit of
+anger and determination that steps be taken at once to
+put an end to this appalling and unnecessary waste of
+lives.</p>
+
+<p>Under modern hygienic conditions, the average length of
+existence for an individual in Great Britain has increased
+ten years in the last half century. Among all the enlightened
+and advanced nations, the expectation of the individual
+for long survival is greater. Since the appearance of
+<span class='pagenum'>[<a name="Page_651" id="Page_651">651</a>]</span>
+uncheckable and epidemic disorders is less frequent and
+the percentage of cures is greater.</p>
+
+<p>Since quarantine has been regularly established and
+the sewage system made efficient in large cities, and since
+the sanitary plumbing laws have been made compulsory,
+the general death rate has decreased enormously. These
+regulations have been the product of regularly educated
+medical or sanitary experts. No 'ism or 'ology has ever
+established any scientific principle which has contributed
+to the general welfare of the people. We no longer fear
+the plague, or typhus or yellow fever, cholera, diphtheria,
+typhoid, consumption, and other diseases which once were
+a constant menace to the race. The plague, for example,
+is practically limited to the Far East, where modern
+methods cannot evidently be introduced efficiently. At
+one time it periodically devastated Europe, where it cannot
+now get a foothold because of the introduction of
+sanitary systems and hygienic principles.</p>
+
+<p>Tetanus or lockjaw and hydrophobia are now amenable
+to cure while formerly all cases were practically fatal.
+The mortality of diphtheria has been reduced more than
+fifty per cent. Antiseptic precautions in surgical cases,
+first introduced by the famous surgeon, Lord Lister, have
+made possible and successful operations that formerly
+could not be undertaken, thus broadening the whole field
+of surgical possibilities. The Boer war and the war with
+Spain proved this truth in a way that could not be denied.
+Smallpox is almost a medical curiosity in New York City,
+where it once was a scourge. The mortality of childbirth
+has been reduced to about one-fifth of what it was
+by the introduction of antiseptics and anesthetics. The
+new methods of making and preparing drugs, the sterilization
+and inspection of milk, the methods devised for the
+care of and preparation of infant foods have all enormously
+contributed to checking disease, to preventing disease,
+and to increasing the length of life and its happiness.</p>
+
+<p>These are all facts which may be proved by any one,
+no matter how incompetent they may be. If we were to
+give up all these hard earned victories, cease to investigate
+or experiment, deny the existence of disease, and depend
+<span class='pagenum'>[<a name="Page_652" id="Page_652">652</a>]</span>
+upon the questionable methods of hysterical emotionalists
+we would soon find ourselves facing all the horrors of the
+past. Can we afford to lose the priceless benefits we
+have achieved and are attaining? Can we sit still and
+permit the profession of medicine, which has always contained
+the best of the race in its membership, the best intellects,
+the most sympathetic and unselfish characters,
+the noblest and most steadfast souls, to be maligned and
+assailed, to have its means of well-doing assaulted and
+threatened, when we know that it should be supported
+and protected for the sake of all it has done in the past
+in the interest of humanity?</p>
+
+<p>Every mother should be acquainted with these facts
+so that she may lend her influence in behalf of honest
+effort and honest inquiry.</p>
+
+<p>The following summary comprises a brief review of
+what medicine has been doing in the recent past:</p>
+
+<p><b>Radium</b>.&mdash;This element was discovered about fifteen
+years ago by Professor and Mme. Curie. It possesses the
+wonderful property of giving out inexhaustible stores of
+energy. It virtually possesses the property of perpetual
+motion. Professor Becquerel was the first one to suggest
+that it might possess therapeutic or healing powers. The
+suggestion came to him in a curious way. He carried a
+tube of radium in his vest pocket and was severely burnt
+as a consequence. The incident suggested to him that, if
+radium could attack healthy tissue in such a short time, it
+should be able to similarly attack diseased tissue. Experiments
+were soon instituted, and are still being conducted
+to exactly define its curative value and scope.</p>
+
+<p>It was hailed as a cure for cancer and other serious
+conditions, but we have found that it is not a cure
+for these ailments. It is, however, exceedingly valuable
+in the treatment of certain skin diseases. In lupus,
+epithelial tumors, ulcers, papillomata, angiomata and pruritus,
+it is being widely and successfully used. It was
+later discovered that it can quickly kill disease-producing
+bacteria. It is also well known that it will efficiently
+purify water.</p>
+
+<p><b>X-Ray Treatment and X-Ray Diagnosis</b>.&mdash;Professor
+Roentgen gave to the world an exceedingly valuable discovery
+<span class='pagenum'>[<a name="Page_653" id="Page_653">653</a>]</span>
+in the X-Ray. He discovered that a certain form
+of electrical energy, when applied in a certain way, would
+produce shadows that differentiated between a certain
+degrees of opacity. For example, it would, if directed
+upon the human hand, produce shadows that clearly indicated
+whether the substance through which the rays
+passed was bone or muscle. The chief value of the
+X-Rays has been found to be this property rather than
+any healing value which has been attributed to them. The
+fact that these shadows can be photographed has rendered
+them of supreme value in surgery and medicine. Previously
+it was essential that the surgeon should depend
+upon his own diagnosis, upon what he could learn from
+his sense of touch and from surrounding conditions. With
+the X-Rays at his disposal he can quite eliminate the
+personal equation. His pictures are precise and mathematically
+accurate; he can prove the truth of his diagnosis
+before he cuts. We can take pictures of fractured bones
+and from what we learn we can immediately tell how they
+should be set to attain the very best results. We can
+actually tell if there is a stone in the kidney before we
+subject the patient to a serious operation. We can actually
+take pictures of the stomach at various stages of
+digestion and tell what disease affects the individual with
+a degree of precision that was not possible before the
+X-Rays were introduced. These examples only suggest
+its use. There are a multiplicity of uses for these as yet
+unknown rays which have greatly aided in diagnosis and
+consequently in successful treatment.</p>
+
+<p><b>Aseptic Surgery</b>.&mdash;The utility of the aseptic principle
+in surgery was demonstrated by the Japanese army surgeons
+during the war with Russia in 1904-1905. Their
+success in preventing deaths from suppurating wounds
+amazed the world. Their method was to discard the use
+of antiseptics and to depend upon absolutely clean instruments,
+dressings and hands. The most terrible wounds
+healed under this method without festering. This is, of
+course, the method in vogue to-day all over the civilized
+world. The Japanese did not discover aseptic surgery,
+but they were the first to put it to actual test in a large
+<span class='pagenum'>[<a name="Page_654" id="Page_654">654</a>]</span>
+way. The old method was to depend upon drugs to kill
+the germs which might find their way into wounds and
+operations. To-day we prevent the germs from getting
+into the wound and depend upon nature to do the rest.</p>
+
+<p><b>New Anesthetics</b>.&mdash;Several important advances have
+been made in methods of giving anesthetics and in the
+nature of the products used. Temporary unconsciousness
+with electricity was induced in 1909 by Dr. Stephane
+Leduc. Stovaine was invented by Dr. Jonnesco, of Bucharest.
+He injected it into the spinal cord after the
+method made famous by Biers with cocaine in 1899. Dr.
+W. S. Schley invented novocaine for the same purpose.
+Temporary unconsciousness was accomplished by the use
+of epsom salts injected into the spinal cord by Dr.
+Samuel J. Meltzer. All of these efforts to discover a
+harmless anesthetic by spinal injection were made possible
+by investigations and experiments of Dr. J. Leonard
+Corning, of New York, who worked along this line as far
+back as 1885. The most revolutionary discovery, however,
+was that of Dr. S. J. Meltzer at the Rockefeller Institute,
+New York, when he inserted a tube into the windpipe,
+through which he pumped the anesthetic into the
+lungs. While doing this he at the same time pumped
+oxygen to aerate the blood, thus ensuring the patient
+against possible accident during the course of difficult
+and tedious operations on the lungs and heart.</p>
+
+<p><b>Vaccine in Typhoid Fever</b>.&mdash;Inasmuch as typhoid
+fever has played an important part in the conduct of all
+wars, it has always been a source of much careful study
+by military and naval surgeons in every civilized country
+in the world. We had not, however, reached a stage
+when it was possible to hope for its extermination until
+medical science began to appreciate the possibilities of
+vaccine therapy. The Cuban, Boer and Russian wars, because
+of the terrible experiences of the soldiers with typhoid
+in each of them, stimulated inquiry along the line
+of discovering a serum of vaccine that would be effectual
+against it. American, British, French and Japanese military
+and naval surgeons instituted experiments simultaneously
+to discover an anti-typhoid vaccine. In the fall
+of 1909, American army surgeons were experimenting
+<span class='pagenum'>[<a name="Page_655" id="Page_655">655</a>]</span>
+with a serum at Washington and on Governor's Island
+with success, but the first public announcement of an
+absolutely successful vaccine was made by Captain Vincent
+of the French navy on June 20th, 1910, before the
+Acad&eacute;mie de Medicine in Paris. The final success of the
+anti-typhoid serum has been conclusively proved by elaborate
+tests upon soldiers and sailors in many nations.</p>
+
+<p>It is difficult for the ordinary individual to appreciate
+the significance and importance of a discovery of this
+character and magnitude. When one thinks calmly of
+the thousands and thousands of men who have lost their
+lives during wars because of typhoid epidemics, and of
+the thousands of others who have returned home practically
+invalided for life from the same cause, it is possible
+to, at least, conceive of the benefit to the race such
+a discovery promises. And when we learn that the discovery
+is a product of the same principle or method which
+gave to the world a cure for smallpox, diphtheria and
+syphilis, we must begin to believe that the medical profession
+is on the path which is unlimited in its field of
+promise so far as efficient treatment is concerned. Yet
+to-day we have people who do not believe in vaccination
+or in anti-diphtheritic serum. We may not live to see
+the time, but it is not far distant in the opinion of men
+qualified to speak with authority, when every disease will
+be amenable to the serum therapy, and when drugs will
+virtually be discarded by the human race.</p>
+
+<p><b>"606."</b>&mdash;One of the most important discoveries in the
+history of medicine was recently given to the world by
+Dr. Paul Ehrlich.</p>
+
+<p>He called it "606," because it was the 606th experiment
+he had made with the same end in view. It was designed
+with the purpose of curing the most terrible disease
+known to man, syphilis. The name of the remedy is
+salvarsan. That it will do all that was first claimed for
+it is still doubtful, but salvarsan and its improvements,
+neosalvarsan, etc., are accepted by the profession as by
+far the best treatment yet devised for this dread disease.
+It points the way for improvement along the same line
+to an ultimate specific.</p>
+
+<p><span class='pagenum'>[<a name="Page_656" id="Page_656">656</a>]</span></p>
+
+<p><b>Transplanting the Organs of Dead Men Into Living Men</b>.&mdash;To
+take from a recently dead individual a kidney,
+or a bone, or an artery, and by immersing them in certain
+fluids thereby keeping them alive indefinitely, and later
+transplanting them in the body of a living individual so
+that they will continue to live and perform their function
+in the new environment, is a revolutionary and a seemingly
+incredible performance. Yet Dr. Alexis Carrel of
+the Rockefeller Institute, New York, has accomplished
+this wonderful task. The smallest imagination can picture
+the possibilities of this kind of surgery, but, inasmuch
+as the discovery is so recent and the opportunities
+for testing it upon human beings are so relatively few,
+that time alone can tell how far it may be possible to go.</p>
+
+<p><b>Anti-Meningitis Serum</b>.&mdash;Another important discovery
+that has emanated from the Rockefeller Institute
+is the Anti-Meningitis serum. The death rate from spinal
+meningitis, before the introduction of the serum, was 70
+per cent., the use of the serum has reduced this percentage
+to 30. We owe this important contribution to Dr. Simon
+Flexner.</p>
+
+<p><b>A Serum for Malaria Now Possible</b>.&mdash;Dr. C. C. Bass,
+of Tulane University, has succeeded in extracting malaria-producing
+parasites from human blood and keeping
+them alive in test tubes. This feat had been long attempted
+but never before with success. The significance
+of this achievement is that it is the first step toward preparing
+a serum that will give immunity to malaria.</p>
+
+
+
+
+
+
+
+
+<pre>
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume IV. (of
+IV.), by Grant Hague
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+Project Gutenberg's The Eugenic Marriage, Volume IV. (of IV.), by Grant Hague
+
+This eBook is for the use of anyone anywhere at no cost and with
+almost no restrictions whatsoever.  You may copy it, give it away or
+re-use it under the terms of the Project Gutenberg License included
+with this eBook or online at www.gutenberg.org
+
+
+Title: The Eugenic Marriage, Volume IV. (of IV.)
+       A Personal Guide to the New Science of Better Living and Better Babies
+
+Author: Grant Hague
+
+Release Date: May 11, 2007 [EBook #21418]
+
+Language: English
+
+Character set encoding: ASCII
+
+*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE ***
+
+
+
+
+Produced by K.D. Thornton, Ross Wilburn, Bruce Albrecht
+and the Online Distributed Proofreading Team at
+http://www.pgdp.net
+
+
+
+
+
+Transcriber's notes: Obvious typographical errors have been corrected
+and a few punctuation usages have been normalized.
+
+[Illustration: Courtesy of New York World
+
+More Babies Like These
+
+These nine little tots are all sound, healthy stock. The generations
+behind them had unconsciously been practicing Eugenics through the
+process of natural selection. By luck, as it were, no strain was bred
+into the several families that would have caused these children to be
+unsound mentally, morally, or physically.
+
+It is through Eugenics that we shall have more babies like these, and
+shall eliminate the possibility of children like those shown in the
+other illustrations to this volume.]
+
+The
+Eugenic Marriage
+
+A Personal Guide to the
+New Science of Better
+Living and Better Babies
+
+By W. GRANT HAGUE, M.D.
+
+College of Physicians and Surgeons (Columbia
+University), New York; Member of County Medical
+Society, and of the American Medical Association
+
+In Four Volumes
+
+VOLUME IV
+
+New York
+THE REVIEW OF REVIEWS COMPANY
+1914
+
+Copyright, 1913, by
+W. GRANT HAGUE
+
+Copyright, 1914, by
+W. GRANT HAGUE
+
+
+       *       *       *       *       *
+
+
+
+TABLE OF CONTENTS
+
+
+ACCIDENTS AND EMERGENCIES
+
+CHAPTER XXXIV
+
+COMMON DISEASES OF THE NOSE, MOUTH AND CHEST
+
+                                                              PAGE
+
+"Catching cold"--Sitting on the floor--Kicking the bedclothes
+  off--Inadequate head covering--Subjecting baby to different
+  temperatures suddenly--Wearing rubbers--Direct
+  infection--Acute nasal catarrh--Acute coryza--Acute
+  rhinitis--"Cold in the head"--"Snuffles"--Treatment of
+  acute nasal catarrh, or rhinitis, or coryza, or "cold in the
+  head," or "snuffles"--Chronic nasal catarrh--Chronic
+  rhinitis--Chronic discharge from the nose--Nervous or
+  persistent cough--Adenoids as a cause of persistent
+  cough--Croup--Acute catarrhal laryngitis--Spasmodic
+  croup--False croup--Tonsilitis--Angina--Sore throat--Symptoms
+  of tonsilitis--Treatment of tonsilitis--Bronchitis
+  in infants--Bronchitis in older children--"Don'ts" in
+  bronchitis--Diet in bronchitis--Inhalations in bronchitis--
+  External applications in bronchitis--Drugs in bronchitis--
+  Chronic or recurrent bronchitis--Pneumonia--Acute
+  broncho-pneumonia--Symptoms of broncho-pneumonia--How
+  to tell when a child has broncho-pneumonia--Treatment
+  of broncho-pneumonia--The after treatment of
+  broncho-pneumonia--Adenoids--How to tell when a child
+  has adenoids--Treatment of adenoids--Nasal hemorrhage--
+  "Nose-bleeds"--Treatment of nose-bleeds--Quinsy--Hiccough--
+  Sore-mouth--Stomatitis--Treatment of ulcers   of the mouth--
+  Sprue--Thrush                                                497
+
+
+CHAPTER XXXV
+
+DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
+
+Inflammation of the stomach--Acute gastritis--Persistent
+  vomiting--Acute gastric indigestion--Iced champagne in
+  persistent vomiting--Acute intestinal diseases of children--
+  Conditions under which they exist and suggestions as
+  to remedial measures--Acute intestinal indigestion--Symptoms
+  of acute intestinal indigestion--Treatment of
+  acute intestinal indigestion--Children with whom milk
+  does not agree--Chronic, or persistent intestinal indigestion--
+  Acute ileo-colitis--Dysentery--Enteritis--Enter-colitis--
+  Inflammatory diarrhea--Chronic ileo-colitis--Chronic
+  colitis--Summer diarrhea--Cholera infantum--Gastro-enteritis--
+  Acute gastro-enteric infection--Gastro-enteric
+  intoxication--Colic--Appendicitis--Jaundice
+  in infants--Jaundice in older children--Catarrhal
+  jaundice--Gastro-duodenitis--Intestinal worms--Worms,
+  thread, pin and tape--Rupture                                 527
+
+
+CHAPTER XXXVI
+
+DISEASES OF CHILDREN (continued)
+
+PAGE
+
+Mastitis, or inflammation of the breasts in infancy--Mastitis
+  in young girls--Let your ears alone--Never box a child's
+  ears--Do not pick the ears--Earache--Inflammation of
+  the ear--Acute otitis--Swollen glands--Acute adenitis--
+  Swollen glands in the groin--Boils--Hives--Nettle rash--
+  Prickly Heat--Ringworm in the scalp--Eczema--Poor
+  blood--Simple anemia--Chlorosis--Severe anemia--Pernicious
+  anemia                                                       553
+
+CHAPTER XXXVII
+
+DISEASES OF CHILDREN (continued)
+
+Rheumatism--Malaria--Rashes of childhood--Pimples--Acne--
+  Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
+  Incontinence--Sleeplessness--Disturbed sleep--Nightmare--
+  Night terrors--Headache--Thumb sucking--Biting the finger
+  nails--Colon irrigation--How to wash out the bowels--A high
+  enema--Enema--Methods of reducing fever--Ice cap--Cold
+  sponging--Cold pack--The cold bath--Various baths--mustard
+  baths--Hot pack--Hot bath--Hot air, or vapor bath--Bran
+  bath--Tepid bath--Cold sponge--Shower bath--Poultices--Hot
+  fomentations--How to make and how to
+  apply a mustard paste--How to prepare and use the
+  mustard pack--Turpentine stupes--Oiled silk, what it is
+  and why it is used                                           569
+
+DISEASES OF CHILDREN
+
+CHAPTER XXXVIII
+
+INFECTIOUS OR CONTAGIOUS DISEASES
+
+Rules to be observed in the treatment of contagious diseases--
+  What isolation means--The contagious sick room--Conduct
+  and dress of the nurse--Feeding the patient and
+  nurse--How to disinfect the clothing and linen--How to
+  disinfect the urine and feces--How to disinfect the
+  hands--Disinfection of the room necessary--How to disinfect
+  the mouth and nose--How to disinfect the throat--Receptacle
+  for the sputum--Care of the skin in contagious
+  diseases--Convalescence after a contagious disease--Disinfecting
+  the sick chamber--The after treatment of a disinfected
+  room--How to disinfect the bed clothing and
+  clothes--Mumps--Epidemic parotitis--Chicken pox--
+  Varicella--La Grippe--Influenza--Diphtheria--Whooping
+  Cough--Pertussis--Measles--Koplik's spots--Department
+  of health rules in measles--Scarlet fever--Scarlatina--
+  Typhoid fever--Various solutions--Boracic
+  acid solution--Normal salt solution--Carron oil--Thiersch's
+  solution--Solution of bichloride of mercury--How
+  to make various solutions                                    599
+
+ACCIDENTS AND EMERGENCIES
+
+CHAPTER XXXIX
+
+ACCIDENTS AND EMERGENCIES
+
+Accidents and emergencies--Contents of the family medicine
+  chest--Foreign bodies in the eye--Foreign bodies in the
+  ear--Foreign bodies in the nose--Foreign bodies in the
+  throat--A bruise or contusion--Wounds--Arrest of
+  hemorrhage--Removal of foreign bodies from a wound--Cleansing
+  a wound--Closing and dressing wounds--The
+  condition of shock--Dog bites--Sprains--Dislocations--Wounds
+  of the scalp--Run-around--Felon--Whitlow--Burns
+  and scalds                                                   629
+
+MISCELLANEOUS
+
+CHAPTER XL
+
+MISCELLANEOUS
+
+The dangerous housefly--Diseases transmitted by flies--Homes
+  should be carefully screened and protected--The
+  breeding places of flies--Special care should be given to
+  stables, privy vaults, garbage, vacant lots, foodstuffs,
+  water fronts, drains--Precautions to be observed--How
+  to kill flies--Moths--What physicians are doing--Radium--X-Ray
+  treatment and X-Ray diagnosis--Aseptic surgery--New
+  anesthetics--Vaccine in typhoid fever--"606"--Transplanting
+  the organs of dead men into the living--Bacteria
+  that make soil barren or productive--Anti-meningitis
+  serum--A serum for malaria in sight                          645
+
+       *       *       *       *       *
+
+
+ACCIDENTS AND EMERGENCIES
+
+
+
+
+CHAPTER XXXIV
+
+
+COMMON DISEASES OF THE NOSE, MOUTH, AND CHEST
+
+"Catching Cold"--Sitting on the Floor--Kicking the Bed Clothes
+Off--Inadequate Head Covering--Subjecting Baby to Different
+Temperatures Suddenly--Wearing Rubbers--Direct Infection--Acute
+Nasal Catarrh--Acute Coryza--Acute Rhinitis--"Cold in the
+Head"--"Snuffles"--Treatment of Acute Nasal Catarrh, or Rhinitis,
+or Coryza, or "Cold in the Head," or "Snuffles"--Chronic Nasal
+Catarrh--Chronic Rhinitis--Chronic Discharge from the Nose--Nervous
+or Persistent Cough--Adenoids as a Cause of Persistent
+Cough--Croup--Acute Catarrhal Laryngitis--Spasmodic Croup--False
+Croup--Tonsilitis--Angina--Sore Throat--Symptoms of
+Tonsilitis--Treatment of Tonsilitis--Bronchitis in
+Infants--Bronchitis in Older Children--"Don'ts" in Bronchitis--Diet
+in Bronchitis--Inhalations in Bronchitis--External Applications in
+Bronchitis--Drugs in Bronchitis--Chronic or Recurrent
+Bronchitis--Pneumonia--Acute Broncho-pneumonia--Symptoms of
+Broncho-pneumonia--How to Tell When a Child has
+Broncho-pneumonia--Treatment of Broncho-pneumonia--The
+After-treatment of Broncho-pneumonia--Adenoids--How to Tell When a
+Child has Adenoids--Treatment of Adenoids--Nasal
+Hemorrhage--"Nose-bleeds"--Treatment of
+Nose-bleeds--Quinsy--Hiccough--Sore Mouth--Stomatitis--Treatment of
+Ulcers of the Mouth--Sprue--Thrush.
+
+
+"CATCHING COLDS"
+
+Mothers frequently wonder where their children get colds. Briefly we
+will point out some of the sources from which these apparently
+inexplicable colds may come.
+
+A. Sitting on the Floor.--Children should not be allowed to sit or
+crawl upon the floor at any season of the year, but especially during
+the winter months. There is always a draught of cold air near the floor.
+It is a bad habit to begin allowing a child to play with its toys on the
+floor. Use the bed or a sofa or a platform raised a foot from the
+floor.
+
+B. Kicking the Bed Clothes Off During the Night.--The bed
+clothes should be securely pinned to the mattress by large safety pins.
+When it is established as a habit a child who kicks off the bed clothes
+should wear a combination night suit with "feet," made of flannel during
+the winter and of cotton during the summer.
+
+C. Inadequate Head Covering.--Professor Kerley states that this is one
+of the "most frequent causes of disease of the respiratory tract in the
+young." He calls attention to the fact that "mothers carefully clothe
+the baby with ample coats, blankets, leggings, etc., before they take
+him out for the daily walk. They dress him in a warm room taking plenty
+of time to put on the extra clothes, during which time the baby frets
+and perspires. When all is ready they place upon the hot, almost bald
+head of the baby a light artistically decorated airy creation which is
+sold in the shops as children's caps. The child is then taken out of
+doors and because of the inadequate covering of the hot perspiring head,
+catches cold and the mother never knows how it came." Every baby and
+child should wear under such caps a skull cap of thin flannel,
+especially in cold weather. In summer or windy day a light silk
+handkerchief folded under the cap is a very excellent protection.
+
+D. Subjecting a Baby to Different Temperatures Suddenly, is liable to
+be followed by a cold--for example, taking the child from a warm room to
+a cold room, or through a cold hall, holding the child at an open window
+for a few moments.
+
+E. The Practice of Wearing Rubbers Needs Some Consideration.--They
+should never be worn indoors for even five minutes. They should not
+therefore be kept on in school, nor should they be worn by women in
+stores when they go shopping. When it is actually raining, or snowing,
+or when there is slush or wet mud they are needful; but they should not
+be worn simply because the weather is threatening or damp. Children
+should not put them on to play--worn for any length of time when active
+they are harmful. If worn to and from school they should be taken off at
+once when in school or at home. Wearing rubbers prevents free
+evaporation of the natural secretion of the skin, keeps the
+feet moist and invites colds and catarrh. In damp weather, or when
+children play during winter months, they should be shod with stout shoes
+with cork insoles.
+
+The same argument applies to storm coats of rubber, water-proof
+material. They should not be worn as overcoats all day, but only when
+going to and from school or business when it is actually storming.
+
+Underclothing or hosiery should not be heavy enough to cause moisture of
+the skin. Health demands a dry skin at all times. The necessary degree
+of body heat should be attained by the quality of the outer clothing,
+not by the quantity of the underclothing. Many men and women wear heavy
+underclothing which causes moisture when indoors, with the result that
+they get surface chills when they go outside if the weather is cold and
+as a result catch cold. The underclothing should be just heavy enough to
+be comfortable indoors and the extra warmth necessary when outside
+should be supplied by a good overcoat or furs.
+
+F. Direct Infection.--A baby may catch cold if kissed or "hugged" by
+an adult who has a cold.
+
+Catching cold while bathing is possible, but scarcely probable, if
+ordinary precautions are taken. It is very bad practice to permit
+children to use one another's handkerchiefs or the handkerchief of an
+adult. Certain children are predisposed to attacks of "cold in the head"
+or acute coryza or nasal catarrh (these being the medical names for this
+condition). Sometimes this is an inherited characteristic. There is no
+doubt, however, that most of these children acquire the habit by bad
+sanitary and hygienic surroundings. These children do not as a rule get
+enough fresh air. They are kept indoors most of the time in stuffy,
+overheated, badly ventilated rooms, unless the weather is absolutely
+perfect. The windows in their bedrooms are always kept closed, because
+they are "liable to catch cold." They are overdressed and perspire
+easily and as a result "catch cold." These conditions all tend to create
+an unhealthy condition of the nasal mucous membrane and of the throat,
+and this is rendered worse if the child lives in a damp,
+changeable climate, such as that of New York City. In these susceptible
+children the exciting cause of an attack may be trivial; exposure, cold
+or wet feet, inadequate head covering (as already pointed out), a
+draught of cold air even may excite sneezing and a nasal discharge;
+hence we have:
+
+Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis, "Cold in the Head",
+"Snuffles").--Acute nasal catarrh may accompany measles, diphtheria,
+influenza, and whooping cough.
+
+Symptoms.--The onset is sudden with sneezing, and difficulty in
+breathing through the nose. In a few hours, or it may be not for a day
+or two, a mucous, watery, nasal discharge appears. There are redness and
+slight swelling of the nose and upper lip, caused by the discharge.
+There is no fever as a general rule except in very young infants, in
+whom the fever may be very high. The discharge interferes with the
+nursing and the child suffers from lack of nourishment. The inflammation
+may extend to the eyes and ears, causing painful complications, or to
+the throat and bronchi, causing hoarseness and cough. Less frequently we
+have disturbances of the digestive tract with vomiting, or diarrhea.
+
+The mild form of the disease lasts for two or three days, the severe
+form from one to two weeks.
+
+Repeated attacks are said to contribute to the production of adenoid
+growths.
+
+An acute attack of this disease is seldom a serious affliction in older
+children; it may be, however, very serious and even dangerous in very
+young infants. The tendency of the disease to extend downward, causing
+bronchitis or pneumonia, explains in part the possible danger to a baby.
+Another reason is because it may seriously interfere with suckling and
+with breathing in these little patients. It may even cause sudden
+attacks of strangulation. An infant, therefore, suffering with an acute
+attack of rhinitis requires constant attention. It may be necessary to
+feed it with a spoon, and if necessary mother's milk should be so fed.
+Plenty of fresh air should be provided. It may be essential to keep the
+mouth open in order that it may get enough fresh air. Every effort
+should be made to keep the nostrils open. The secretions must be
+removed from time to time. Causing the child to sneeze by tickling the
+nose with a camel's hair brush will clear the nose for the time being.
+The physician may be compelled to use a solution of cocaine for this
+purpose.
+
+Treatment of Acute Rhinitis ("Taking Cold", Nasal Catarrh, Acute
+Coryza, "Snuffles").--A child suffering with an acute attack of "cold
+in the head" should be kept indoors in a room with a constant, uniform
+temperature; the particular reason for this is, that, if a child is
+exposed to cold at any time during an attack of "cold in the head," it
+may cause the disease to invade the chest,--a tendency which it has at
+all times. The bowels must be kept open; if they do not move every day
+of their own accord they must be made to move by means of an enema of
+sweet oil or of soap-suds. The amount of food should be reduced to suit
+the circumstances and the condition of the patient.
+
+We treat the local condition in the nose with a menthol mixture. The
+following is a very good one: Menthol, 30 grains; Camphor, 30 grains;
+White Vaseline, 1 ounce. Put some of this on the end of the finger and
+push it gently into each nostril. When the nostrils become blocked and
+the child cannot breathe through the nose, tickle the nose with a
+feather until it sneezes; this will clear the passage. Immediately after
+the sneeze place the menthol mixture in each nostril. When the child is
+about to sneeze place a handkerchief before the nose, as this discharge
+is full of germs and will infect others when dry. Internal remedies
+should not be used unless the child is distinctly sick and is running a
+fever, in which case a physician should look the child over and
+prescribe whatever is called for.
+
+The upper lip and the nostrils of the child should be protected, because
+the discharge very quickly irritates the parts and renders them raw and
+painful. Vaseline or cold cream is very suitable for this purpose.
+
+Mothers should not wash out the nose of a child with any solution
+advised for this purpose where force is used, as, for example, with a
+syringe. Any forceful irrigation of the nose is dangerous, because it
+would carry the infection into the deeper parts and set up a more
+serious condition.
+
+If the above treatment is carefully carried out and the child
+unexposed to a fresh cold, two or three days will be sufficient to
+cure the disease.
+
+It is not, however, the treatment of an acute attack of "cold in the
+head" that is important; it is intelligently to follow out a plan which
+will prevent these attacks from repeating themselves that is of
+consequence. The tendency to take cold is a real condition in childhood
+and a very common one. When mothers appreciate that it is possible to
+prevent this condition and to cure it when it is seemingly an
+established habit, more interest will undoubtedly be taken in the
+subject. Too frequently it is looked upon as an unfortunate affliction,
+but it is never regarded as a condition that is caused by neglect and
+ignorance.
+
+It is an exceedingly common occurence to find a mother worrying over her
+child's cold, dosing it with cod liver oil or some other unnecessary
+tonic, rubbing it with camphorated oil or plastering it over with
+certain useless patent plasters, dressing it with extra pieces of
+flannel on its chest and extra clothes pinned snugly around it, then
+shutting it up in a warm, stuffy, unsanitary, ill-smelling room, in
+order to keep it from "catching a fresh cold." Can you imagine anything
+else she could do to defeat her purpose?
+
+No quantity of cod liver oil, no medicine, no coddling, will remove the
+tendency to "catch cold." The child's life must be lived amidst sanitary
+surroundings and hygienic conditions first; then other expedients may be
+utilized if necessary. These children must be kept out of doors most of
+the time, unless during the severest wet weather. They should sleep in a
+room the windows of which are open at the top and bottom every night in
+the year. They should not, however, be in a draught. The rooms in which
+they live should be of a uniform temperature, never too hot and never
+too cold, between 68 deg. and 70 deg. F. These delicate catarrhal children
+should be accustomed to light clothing on their beds. Chest protectors,
+mufflers, cotton pads, and heavy wraps of any description should be
+absolutely prohibited. It is advisable to use flannel underwear winter
+and summer, light in summer and a medium weight in winter.
+During the summer months the mother should begin cold sponging of the
+face, throat, chest, and spine every morning and carry it into the
+winter. The entire process need take only a moment or two. Always dry
+thoroughly with a fairly rough towel. If the cold sponging is begun in
+the warm summer time the child will become so accustomed to it that no
+objection will be made when the cold weather comes.
+
+If the child continues to be "catarrhal," despite a course of this
+treatment, it would be well to investigate whether any adenoids or
+adenoid tissue exist in the naso-pharynx. If adenoids are found no
+treatment will be successful until they are removed.
+
+It is a wise plan to place a flannel cap on an infant who has an acute
+attack of "cold in the head" (snuffles). This will prevent catching a
+fresh cold and it will aid in the speedy cure of the attack from which
+it is suffering when it is put on.
+
+
+CHRONIC NASAL CATARRH--CHRONIC RHINITIS CHRONIC DISCHARGE FROM THE
+NOSE
+
+Some children have a nasal discharge during all of their childhood. It
+is usually worse during the winter months. It may be a thin, watery
+discharge or a thick, nasty, yellow discharge.
+
+It is a condition that is very frequently neglected even by the family
+physician. This is unfortunate because it may lead to serious disease,
+permanent damage sometimes being done to the hearing, the speech, the
+smell, and to the lungs of the child.
+
+It may be caused by adenoids; disease of the bones or tissues in the
+nose; foreign bodies in the nose; or it may occur in children whose
+nutrition is bad. It may result from frequent acute attacks of "cold in
+the head." It also occurs in other less important conditions. The
+foreign bodies which usually cause a chronic nasal discharge
+are,--buttons, peas, beans, beads, paper balls, flies and bugs,
+cherry-stones, small pieces of coal, or stone, cork or other material. A
+child gets hold of a shoe-button for example and pushes it into its
+nostrils. In the effort to get it out the child pushes it
+further in. It may or may not cause pain at the time, and it may be
+overlooked, but shortly the mother will notice a discharge from one
+nostril. This discharge becomes thick and foul and when an investigation
+is made the button is found embedded firmly in the nose. It is sometimes
+quite difficult to get the button out and this should always be done by
+a physician.
+
+Treatment.--Remove the cause first then treat the catarrh. If it is a
+product of a constitutional disease that causes general poor health,
+such as tuberculosis, syphilis, or scrofula, the child will need
+"building up" and a decided change of climate. Foreign bodies must be
+removed, adenoids taken out, large tonsils excised, and malformations of
+the nasal bones operated upon. The catarrh will in many cases be cured
+by removing its cause; if, however, it should persist it must be treated
+for some time with appropriate solutions. These solutions and the
+directions as to the method of giving them must be given by a physician,
+because there is great danger of carrying the disease to deeper
+structures if given wrongly.
+
+
+SUMMARY:--
+
+1st.--A chronic discharge from the nose is a sign that something is
+wrong and should be carefully and thoroughly investigated.
+
+2nd.--The cause can usually be found out and the proper treatment will
+cure it.
+
+3rd.--If the condition is neglected it may ruin the health of the child
+for the whole period of its life.
+
+
+NERVOUS OR PERSISTENT COUGH
+
+Cough in an infant or growing child is usually the result of a cold and
+the structure affected is some part of the nose, throat or bronchi. It
+is a comparatively simple matter to discover just where the trouble is
+and to prescribe the appropriate remedy and effect a cure.
+
+There is another type of cough, however, that is of quite a different
+character. This cough will begin as an ordinary cough and it
+will only be discovered that it is not an ordinary cough because nothing
+will apparently cure it. We mean that the child is given cough remedies
+that usually cure a cold, is kept in the house and carefully watched for
+a sufficiently long period to justify a cure, and yet, despite this care
+and attention, the cough remains the same. The child is not sick, the
+appetite is good, there is no fever, it plays and seems to enjoy good
+health, yet for weeks and frequently for months the annoying cough hangs
+on. It is as a rule worse at night. It begins soon after the child falls
+asleep and spoils the entire night's rest or a great part of it. It may
+be a dry, hard, hacking cough, or a croupy, harsh bark. It may come in
+spells with a considerable interval between them, during which time the
+child falls asleep, or it may be almost constant, not quite severe
+enough to rouse the child, but bad enough to spoil the child's rest and
+the rest of the mother. If this condition lasts for a long time, as it
+occasionally does, the health of the little patient is apt to suffer
+from loss of sleep.
+
+Treatment.--These children should be taken to a good physician and
+thoroughly examined. Special care should be devoted to investigating the
+condition of the nose, throat, ear, stomach, heart, and lungs.
+
+A very large majority of these coughs are caused by adenoid growths in
+the back part of the nose. The child may not look like an adenoid child,
+nor may it breathe through its mouth when asleep, and it may have had
+its adenoids removed, yet in spite of these contra-indications it may
+have enough loose adenoid tissue in its nose to cause this kind of
+persistent cough. This has been proved many times.
+
+It is not only useless but positively harmful to give these children
+cough remedies. The cause of the cough must be found and treated. The
+cough may be indirectly caused by anemia (poor blood) or heart or
+stomach trouble, or it may have a number of other causes. Whatever it is
+it must be found by a careful physical examination or a number of
+careful physical examinations, because these cases are as a rule obscure
+and difficult to diagnose, and even the most expert examiner
+cannot always tell where the trouble is without seeing the child a
+number of times. The parents must therefore have patience and confidence
+in the physician and must aid him all they can by watching and reporting
+all the symptoms, etc., to him. (See article on Adenoids).
+
+
+SUMMARY:--
+
+Coughs that resist careful treatment are not "ordinary coughs."
+
+Coughs of this type require special medical care.
+
+The usual cough medicines are not only useless in these coughs, but
+dangerous. Don't give them.
+
+
+ACUTE CATARRHAL LARYNGITIS: SPASMODIC CROUP: FALSE CROUP
+
+Croup is one of the common diseases of childhood. It usually follows a
+catarrhal "cold in the head" with a cough. Croup is most frequently
+associated with large tonsils and adenoids. It may come on gradually or
+it may occur suddenly. There is always fever with croup. One of the
+first symptoms is a hard, dry, croupy, barking cough, which gets worse
+toward night. If it occurs suddenly, the child will wake about midnight
+with the characteristic croupy cough. The disease may go no further than
+this and under the proper treatment is well in a few days. In other
+cases, however, there develops marked interference with breathing. Every
+inspiration is accompanied by a loud hissing or "crowing" sound. This
+feature of the disease is one that frightens the parents, though it
+seldom means anything serious. The child sits up in bed, frightened, and
+struggles for breath. It may clutch its throat with its hands as if
+something was tied round its neck. The lips may become slightly blue and
+the perspiration appears upon the child's brow. After some time,--it may
+be two or three hours,--the attack wears away and the child goes to
+sleep. Next morning it wakes up apparently well except for the croupy
+cough. The attack may repeat itself the next night and mildly on the
+third night.
+
+Treatment.--The object of treatment during an acute attack, when
+the child is struggling for breath, is to relax quickly the spasm of the
+larynx which interferes with the breathing. The simplest way is to give
+the child a teaspoonful of the fresh syrup of ipecac. If the child does
+not vomit in fifteen minutes, give another teaspoonful and keep on
+giving it every fifteen minutes till the child vomits. One or two doses
+is usually enough, but it must be given till the child vomits.
+
+If the attack comes suddenly during the night and there is no syrup of
+ipecac in the house, the physician should be sent for at once and
+informed that the child probably has croup, so he may know what to take
+with him. While waiting for the physician the mother should apply over
+the front of the neck (in the region of Adam's apple), hot applications.
+These are best made of flannel wrung out of quite hot water every two or
+three minutes: also a hot mustard foot bath. When the physician takes
+charge of the case he will also direct the treatment for the following
+day in order that the attack of the next night may be a very mild one,
+if it should came at all.
+
+Children who have a tendency to frequent attacks of croup should receive
+the same attention as the children do who are subject to attacks of
+tonsilitis and acute catarrhal rhinitis.
+
+
+SUMMARY:--
+
+1st. Spasmodic Croup always requires prompt and efficient treatment.
+
+2nd. It is called "false" croup, because "true" croup is always
+diphtheritic and is a very serious disease.
+
+3rd. For that reason a physician should always be called because if it
+is "true" croup antitoxin must be given at once.
+
+4th. Don't worry unnecessarily because, though "spasmodic croup" can
+make the child look exceedingly sick for a very short time, an
+uncomplicated case in a healthy child is seldom if ever dangerous.
+
+
+TONSILITIS: ANGINA: "SORE THROAT"
+
+This is one of the frequent diseases of childhood. We rarely see it in
+infants. It is caused by inhaling air which contains poisonous germs.
+These germs quickly develop when conditions are favorable. They lodge in
+the pores or follicles of the tonsils and set up an active inflammation.
+The tonsils swell up and the follicles exude a thick fluid which looks
+like curdled cream. This fluid sticks in the mouths of the follicles
+forming spots. If enough of this fluid is coming out, these spots join
+together forming patches, and the patches may join together forming
+membrane. This is why it is sometimes so difficult to tell whether the
+case is one of tonsilitis or diphtheria.
+
+Conditions are favorable to the development of tonsilitis if the child
+is not in good health when he happens to inhale the infection, when the
+feet are wet or cold, or when the child is allowed out during inclement
+weather and it becomes chilled or numbed from cold, when the child has a
+cold in the head and a running nose, or when its stomach is out of
+order. Any condition in which the child should be carefully watched and
+tended to, rather than allowed further liberties, or risks, conduces to
+sore throat of some kind.
+
+Some children have the disease a number of times; they seem to be
+predisposed toward a sore throat. These are children who have large
+tonsils or who are rheumatic. The tonsils should be removed in the one
+case, and the tendency to rheumatism should be the main treatment in the
+other case.
+
+These children should be encouraged to cleanse the throat and nose
+morning and night with a warm salt solution (half a teaspoonful of
+ordinary table salt to three-quarters of a cup of warm water). This will
+help greatly to prevent these chronic sore throats.
+
+Symptoms of Tonsilitis.--The disease begins suddenly. The child may
+have a chill or be seized with sudden vomiting or diarrhea. A very young
+infant may have a convulsion. The usual way is for the child to develop
+a fever quickly, to complain of being sick and tired. Muscular pains all
+over the body and a severe headache are constant symptoms. The
+fever is usually high from the beginning. The child will tell you its
+throat is sore, but there is as a rule very little pain in the throat.
+The little spots or patches can be seen on one or both tonsils. The
+general symptoms are more pronounced than the local throat symptoms. The
+amount of physical depression that is caused by a tonsilitis is out of
+all proportion to the seriousness of the disease.
+
+Tonsilitis lasts three days usually. The throat symptoms may take a day
+or two longer to clear up, and the patients feel more or less weak for
+some time after all the symptoms have disappeared.
+
+Tonsilitis is medically regarded as one of the mild diseases of
+childhood. It is, however, of very great importance because of its
+likeness to diphtheria, and inasmuch as a positive diagnosis must be
+promptly made, in the interest of the patient, it is given close
+attention and treated with considerable respect by the medical
+profession. The chief differences between the two diseases are as
+follows:
+
+Tonsilitis begins abruptly with pronounced prostration and a high fever
+the first day. The patient feels distinctly sick all over. The second
+day the patient feels somewhat better, the fever is lower and the
+prostration and pain are not so marked. The third day he feels better
+still, and but for a little weakness would feel well. Diphtheria begins
+slowly and insidiously, with very little prostration and a very low
+fever the first day. The patient scarcely feels sick. The second day
+more prostration is present, the fever climbs upward a little more, and
+the patient begins to feel sick. On the third day the prostration is
+much more profound, the fever is higher, and all the evidences of a
+serious sickness are present. Two very different pictures: The one
+begins bad and ends easy, the other begins easy and may end bad.
+
+The important fact, however, so far as the similarity of the two
+diseases is concerned, is, that we must make the diagnosis positive on
+the first or second day, because if we are dealing with a case of
+diphtheria we must give antitoxin at once. This is essential, because
+the efficacy of antitoxin is greatest when given early in the disease.
+By "early" we mean the first or second day of the disease. When
+antitoxin is given late (the third or fourth day of the disease) it is
+much less efficacious and must be given in relatively larger doses. The
+need, therefore, of a quick, positive diagnosis is a real one.
+
+Another important element involved in a speedy diagnosis is, that we
+must not take any chances of infecting other children. So important are
+these conditions that it is the proper treatment to give antitoxin at
+once in every case of tonsilitis that in the slightest way resembles
+diphtheria. An examination of the throat contents,--a culture of which
+is taken during the first visit of the physician,--will, of course,
+reveal the true condition and dictate the future use of the antitoxin.
+Antitoxin is absolutely harmless when given to a patient who has no
+diphtheria. Every case of tonsilitis should be quarantined when there
+are other children in the house.
+
+The local condition of the throat helps in the diagnosis: In tonsilitis
+(as the name implies) the disease is limited to the tonsils and on the
+tonsils (one or both) do we find the spots or patches. In diphtheria, on
+the other hand, the membrane is not limited to the tonsils, but may
+cover every part of the throat and extend into the nose and mouth. In
+tonsilitis it is spots or patches we see in the throat. In diphtheria it
+is membrane we see always. The difficulty here again is that if we wait
+till the diphtheritic membrane covers the whole throat, antitoxin will
+not be of much use.
+
+In diphtheria we have a characteristic odor, in tonsilitis we have no
+characteristic odor.
+
+The practical lesson to be learned from this uncertainty is, immediately
+to get a physician as soon as you find spots in the throat of your sick
+child, unless you are absolutely sure that the condition is not
+diphtheria and you are willing to take that chance.
+
+Treatment of an Acute Attack of Tonsilitis.--Put the child in bed at
+once and keep him on a light diet during the fever. Give him all the
+cool boiled water he wants to drink. If the fever is very high it can be
+controlled by sponging the body with cool water. If the patient is an
+infant the food should be reduced to one-half strength. Tonsilitis
+is a disease that runs a certain course and gets better, or the patient
+develops some other more serious conditions as a result of neglect or
+carelessness. We therefore try to make the patient comfortable and let
+the disease take care of itself.
+
+The throat can be gargled or sprayed with any mild antiseptic liquid, or
+it can be painted with tincture of iodine or 10 per cent. solution of
+silver nitrate. As a rule the gargles do not aid in the cure of the
+disease, though they contribute to the comfort of the patient.
+
+A cold compress made of half a dozen thicknesses of cloth, such as a
+table napkin, and put under the jaw (not round the neck), and covered
+with oiled silk and held in place with a bandage that meets and is tied
+on the top of the head, is of distinct usefulness.
+
+When it is known that the child is rheumatic, the heart must be
+carefully watched during the fever and anti-rheumatic remedies depended
+upon to effect a cure.
+
+
+SUMMARY:--
+
+Tonsilitis, because of its likeness to diphtheria, must be promptly and
+carefully diagnosed.
+
+A physician only is capable of making a diagnosis.
+
+Any sore throat in a child with spots or membrane is deserving of
+serious and immediate attention.
+
+A mistake may mean death. Don't take a chance.
+
+
+BRONCHITIS
+
+Bronchitis is one of the commonest diseases of childhood. It is the
+cause of many deaths. Exposure during inclement weather is as a rule the
+cause of it. It occurs in all classes and conditions of children. Poorly
+nourished and badly clothed children are more liable to get it than are
+others. It is more dangerous in young children and infants than in older
+children. A young child or an infant will get bronchitis quicker than
+those older and stronger under the same conditions.
+
+Bronchitis is often present while children are suffering from other
+diseases, measles, influenza, scarlet fever, typhoid fever, pneumonia,
+diphtheria, whooping-cough, for example. It may accompany any disease of
+childhood, however.
+
+Symptoms.--In infants bronchitis usually follows a "cold in the
+head," with running nose and a cough. The child is indisposed and
+peevish because of the cold. In a few days the cough becomes worse,
+fever develops, the breathing is quicker, and the baby looks and acts
+sick. The cough may be constant and severe; sometimes the cough does not
+seem to bother the baby, although this is exceptional. The breathing is
+quite rapid and is accompanied with a moist, rattling sound in the
+chest. The baby is restless and if the cough is severe it becomes
+exhausted. Vomiting or diarrhea may be present.
+
+Bronchitis in Older Children.--Bronchitis in older children comes on
+abruptly, with fever and cough. The child may complain of headache and
+pains in the chest or other parts of the body. It may begin with a chill
+or chilly feelings. These children "raise" with the cough. The
+expectoration may be quite profuse; at first it is a white, frothy
+mucus, then yellow, and later a yellowish green; it may be slightly
+tinged with blood.
+
+There is a mild form of bronchitis in these older children where the
+serious symptoms are absent. The children are not sick enough to go to
+bed, but they appear to have a "heavy cold" with, at first, a tight,
+hard cough, which is usually worse at night. Later the cough turns loose
+and the same expectoration occurs as in the severe type. It is these
+cases of mild bronchitis which do not receive the proper care and
+treatment that develop into the so-called "winter cough," which lasts
+for months.
+
+Treatment.--(See page 497 under heading, "Catching Colds.") Children
+who acquire bronchitis easily and frequently, should be built up. Cod
+liver oil should be given all winter. The sleeping apartment of these
+children should not be too cold, but it should be well aired through the
+day and well ventilated throughout the night. Flannel night clothes
+should be worn and the feet should be kept warm always. Mild attacks of
+"cold in the head" should be treated vigorously and not neglected.
+
+The following "Don'ts" may be profitably studied when your child or baby
+has bronchitis:--
+
+Don't keep the windows tightly closed; fresh air and good ventilation
+are absolutely necessary to the patient.
+
+Don't use a cotton jacket or oil silk.
+
+Don't wrap the child up in blankets and shawls.
+
+Don't carry the child around; keep it in bed.
+
+Don't dose the child with syrupy cough mixtures.
+
+Don't overheat the room.
+
+Don't let friends bother or annoy the baby.
+
+Don't reduce the diet unnecessarily.
+
+The child should be put to bed. The temperature of the room should be 70
+degrees F. all the time. The windows should be opened top and bottom
+according to the weather, and the room should be well aired every day,
+the patient being taken to another room while it is being done. The
+child should have its usual night clothes on, nothing more. If the child
+is not very sick and insists on sitting up, a bath robe can be worn but
+it should be always removed when it sleeps. It is advisable to change
+the position of the baby from time to time. Have it rest on one side,
+then on the other, as well as on the back. Give a dose of castor oil at
+the beginning of the sickness and keep the bowels open during the
+disease.
+
+Diet.--The diet will depend upon the severity of the disease. If the
+fever is high and the cough persistent, the strength of the food of
+nursing infants should be reduced. We can reduce the strength of the
+food by giving the child a drink of cool boiled water before each
+feeding and shortening the length of each feeding. Older children may be
+given toast, milk with lime water, cocoa with milk, broths, gruels,
+custards, cereals and fruit juices.
+
+Inhalations.--The value of inhalations in bronchitis is very great.
+The ordinary croup kettle, which can be bought in any good drug store,
+is the best method of giving them. Full directions come with each kettle
+as to the best way to use it. The best drug to use in the kettle is
+creosote (beechwood). Ten drops are added to one quart of boiling water
+and the steaming continued for thirty minutes. The interval between
+steaming is two hours and a half in bad cases day and night. In mild
+cases the night treatments can be dispensed with. Sheets rigged up over
+the top and sides of the crib, in the form of a tent, is the most
+desirable way to give the inhalations.
+
+External Applications.--Counter-irritation by means of mustard pastes
+are the best applications. They should be put back and front--one on
+back and one on the chest, overlapping at the sides beneath the arms.
+They should cover the entire body from the waist line to the neck. These
+pastes are made as follows:--Mix the mustard (English) and the flour in
+the following proportions, using a quantity according to the size of
+child and area to be covered; one tablespoonful mustard to three
+tablespoonfuls of flour. Mix with lukewarm water until a paste is
+formed, not too thick and not too thin. Spread on a cloth (put plenty
+on) and cover with one layer of cheesecloth and place the cheesecloth
+side next the skin. In order to guard against burning the skin it is
+advisable to rub the skin with vaseline, before and after putting on the
+paste. The paste should be left on until the skin is uniformly red. It
+may be applied from two to four times in the twenty-four hours according
+to the severity of the case. Mustard pastes are most effective during
+the first two or three days of the disease.
+
+Drugs.--Drugs are of very little value in the treatment of bronchitis.
+In the first stage of the disease, when the cough is hard and dry, small
+doses of castor oil and syrup of ipecac may be given to good advantage.
+The following dosage should be followed closely: 1st year, 2 drops
+castor oil, 2 drops syrup of ipecac, every two hours; 3rd year, 3 drops
+castor oil, 3 drops syrup of ipecac, every two hours; over 3 years, 4
+drops castor oil, 4 drops syrup of ipecac, every two hours.
+
+The benefits from this treatment will be obtained in the first two or
+three days, when it should be discontinued. The cough under this
+treatment and the use of the mustard paste and inhalations of creosote
+will be soft and loose in two or three days and the fever will be
+distinctly on the mend. The disease lasts from five to ten days. It may,
+however, last much longer according to the condition of the child, etc.
+
+There are other drugs that can be given, with good effect, but when
+other remedies are indicated a physician should be called to
+prescribe them according to indications.
+
+
+SUMMARY:--
+
+Bronchitis is one of the commonest diseases of childhood.
+
+It is the cause of many deaths.
+
+A large number of children have a tendency to bronchitis.
+
+These children need careful attention and "building up."
+
+Do not neglect a "little" cold. It means trouble.
+
+Chronic or Recurrent Bronchitis.--Bronchitis becomes chronic when the
+treatment of an acute attack fails to cure the condition. The failure
+usually is dependent upon the condition of the child. It may be
+suffering with some disease resulting from poor nourishment or poor
+sanitary and hygienic surroundings or both. The bronchitis, in other
+words, is dependent upon some other condition, and will not get wholly
+better until the cause is cured. These children should lead an active
+outdoor life when the weather is favorable. Their sleeping-room should
+be well aired and ventilated. Red meats are allowed twice a week only.
+Sugar is cut down to the lowest limit. Skimmed milk only should be
+taken--the cream being too rich for them. They can eat freely of fruits
+in season, green vegetables and cereals. The bowels must move freely
+every day. Patients must be given a lukewarm bath, followed by a brief
+spray of cold water, daily. The cold spray should not be too cold; about
+60 degrees F. is the suitable temperature of the water.
+
+An absolute change of climate, to a warmer inland atmosphere, is
+imperative before some of these patients will begin to improve.
+
+
+SUMMARY:--
+
+A child with chronic bronchitis, or with frequent attacks of bronchitis
+(or chronic colds), is usually suffering from some other diseased
+condition.
+
+The bronchitis, or the cold, will not get better until you find
+out what that "other diseased condition" is.
+
+It takes a physician to find that out.
+
+Having found the cause, cure it, and the bronchitis will disappear and
+the general health of the child will immediately improve.
+
+
+PNEUMONIA
+
+Pneumonia is a very common disease in childhood. It is the most frequent
+complication of the various acute infectious diseases. Pneumonia is an
+exceedingly important factor in the mortality of infancy.
+
+There are two kinds of pneumonia:--
+
+  1. Broncho-pneumonia.
+  2. Lobar-pneumonia.
+
+Acute Broncho-Pneumonia.--Up to the fourth year this is the form of
+pneumonia always present. It is the form that always complicates other
+diseases all through childhood.
+
+It is most apt to occur during the spring and winter months.
+
+It affects all classes, but especially those whose hygienic surroundings
+are poor. Catching cold is the exciting cause in a large percentage of
+primary pneumonias.
+
+Symptoms.--Broncho-pneumonia has no regular course. It may or it may
+not follow a cold or an attack of bronchitis. As a rule it begins
+suddenly with a high fever, frequently accompanied by vomiting, rapid
+respiration, cough, and prostration.
+
+The child does not maintain a high fever continuously; it varies
+considerably throughout each twenty-four hours. It lasts from one to
+three weeks, and subsides gradually.
+
+The respirations vary between 60 and 80 per minute, though they may be
+much more frequent than this. The child breathes with apparent
+difficulty, the soft parts of the cheeks and nose rising and falling as
+it breathes.
+
+The prostration becomes, as the disease progresses, more and more
+marked, until the child looks profoundly sick.
+
+Cough is a constant and incessant symptom. It disturbs rest and sleep
+and may cause frequent vomiting. There is no expectoration.
+A strong cough is a good symptom; if it stops it is a bad symptom.
+
+Pain is seldom present.
+
+Blueness of the skin is a bad sign and indicates failure of respiration
+and suggests constant and careful watching.
+
+Delirium may be present during the disease. It is not necessarily a bad
+sign. Accompanying stomach troubles are frequent if the patient is very
+young, and are very important. The bowels may be loose; they may be
+green in color and contain much mucus. Large quantities of gas may
+accumulate in the intestines and may cause much distress and
+convulsions. Death may occur at any time or the process may be arrested
+and recovery take place at any stage of the disease. Broncho-pneumonia
+is not necessarily a fatal disease in a fairly healthy child. It is,
+however, always a serious disease.
+
+Various complications may occur in the course of the disease. The most
+frequent are: pleurisy, emphysema, abscess of the lung, meningitis,
+heart disease, stomach troubles, thrush, intestinal disease.
+
+How to Tell When a Child Has Broncho-Pneumonia.--If a child develops a
+high fever, breathes rapidly, coughs, and is content to lie in bed
+because of the degree of prostration, broncho-pneumonia is almost
+certain to be the disease present. If in addition to these symptoms
+there is any blueness of the fingers or around the mouth it is more
+strongly suggestive of pneumonia.
+
+If the child has been suffering with bronchitis it is sometimes
+difficult to tell just when the pneumonia begins. The child will appear
+more profoundly sick, the fever will go higher, and the respiration will
+be more frequent when pneumonia sets in on top of bronchitis.
+
+Treatment.--The nursing of a little patient with pneumonia is the most
+important part. He must get plenty of fresh air; consequently he should
+be kept in a well-ventilated room. It is an excellent plan to change the
+patient twice daily from the sick room into another which has previously
+been thoroughly aired. While he is in this room the sick room should be
+as thoroughly aired as is possible. Keep this plan up all through the
+disease; change the position of the patient in bed every two
+hours. He should never be allowed to lie on his back for hours at a
+time. In this way the different parts of the lungs get a chance to air
+themselves,--the air cells expand and the oxygen in the air and the
+fresh blood tend to heal the parts more quickly.
+
+It would be distinctly wrong to go into the detailed symptomatic
+treatment of broncho-pneumonia in a book of this character. Inasmuch as
+this is one of the most serious diseases of infancy, no mother should
+attempt to treat it alone. A physician is absolutely necessary and the
+most the mother can hope to do is to follow out his directions to the
+letter.
+
+He may direct the use of mustard pastes but it is essential to know
+where to apply them. If he should request the use of the cotton jacket,
+the height and character of the fever must regulate its use. Stimulants
+are always necessary, whisky and strychnine being given in every case,
+but if given at the wrong time they may do more harm than good. Cough
+mixtures may be necessary, but frequently they are contra-indicated.
+Drugs and cold sponging may be used to reduce the fever, but they are
+dangerous if used when conditions do not justify their use.
+Complications must be diagnosed when they occur, and the correct methods
+of treatment promptly instituted. A competent physician alone can assume
+the responsibility of these various phases of the disease.
+
+Every mother should appreciate, however, that pneumonia is frequently
+the result of carelessness. It is a well-known fact that pneumonia is an
+infrequent disease among children of the well-to-do, because the
+hygienic surroundings of these children are better and because they
+receive competent attention if suffering with colds and bronchitis.
+Bronchitis is quite common in all classes of children, but in the lower
+walks of life it is the custom to allow children to run around while
+they give every sign of having a heavy cold, and a beginning bronchitis.
+These children should receive treatment and should be kept indoors and
+in bed if they have even a slight fever, as pneumonia is frequently the
+inevitable outcome. They should be carefully fed, and all signs of
+stomach or intestinal troubles attended to at once.
+
+[Illustration: By permission of Henry H. Goddard
+
+A Grim Result
+
+Isaac is 16, although mentally 10. He is a high-grade moron.
+
+     This is one of those all too frequent instances[A] "of a
+     feeble-minded woman with a husband who is alcoholic and the
+     offspring either feeble-minded or miscarriages."
+
+     "Isaac is exceedingly dangerous. He is a potential criminal or bad
+     man, or under the best conditions would at least marry and probably
+     become the father of defectives like himself."
+
+This and the succeeding pictures in this volume contrast vividly with
+the frontispiece. Terrible are the results when we disregard the
+inevitable laws of nature, and so mate ourselves that our children will
+be parasites on society.]
+
+[A] "Feeble-mindedness; Its Causes and Consequences", Goddard, The
+Macmillan Company.
+
+The After-Treatment of Pneumonia is important, and every detail
+has a distinct bearing on the ultimate recovery and establishment of
+good health. Careful feeding, a good tonic, and the proper attention to
+exercise, fresh air and bathing are requisite. A change of air after the
+fever is gone is more important than all other measures put together. A
+dry, warm climate where patients can be kept in the open air is
+preferable. The danger of allowing a slow, long drawn-out convalescence
+after pneumonia is the development of tuberculosis.
+
+
+ADENOIDS
+
+Adenoids are very common, almost popular, in childhood. The condition is
+one that causes more real trouble and discomfort than any other
+childhood affliction. Adenoids are associated with, and are responsible
+for, many of the ailments of childhood. They may be associated with
+enlarged tonsils or they may be independent of them. They may be present
+at birth or develop any time thereafter, though they are more frequent
+between the ages of two and six years. Children who have adenoids
+invariably suffer from chronic "head-colds" with a discharge from the
+nose. These chronic colds are caused by the adenoids. Nearly every
+disease, and every diseased, or abnormal, condition of the nose, throat,
+larynx, and lungs can be directly caused by the presence of adenoids.
+They are also responsible for numerous other conditions of very grave
+importance in the growing child. The accompanying "head-colds" may
+develop into a bronchitis which may keep the child indoors for a long
+period. Adenoids always interfere with respiration, thereby depriving
+the child of a normal quantity of oxygen, thus rendering the blood less
+pure, and, as a consequence, seriously interfering with the nourishment
+and general health. The impaired nourishment and poor health thus
+produced, as a direct result of adenoids, renders the child more liable
+to disease; he may thus acquire ailments that may affect his whole
+subsequent life. The mental side of a child's development is also
+affected by the presence of adenoids, so much so that actual statistics
+prove that these children cannot keep up with their classes in the
+public school.
+
+We must therefore regard the presence of adenoids as a serious
+menace to the health and comfort of the patient. It has already been
+pointed out in discussing other diseases that before a cure of these
+diseases could be permanently accomplished it would be absolutely
+necessary to remove the adenoids, which were, no doubt, the actual
+cause, or an important contributing cause, of the disease. Such
+conditions as catarrhal laryngitis, croup, chronic recurring winter
+coughs, acute catarrhal rhinitis, "snuffles", "cold in the head",
+chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting",
+"nose-bleeding", headaches in growing children, anemia, deafness, night
+terrors, defective speech, diphtheria, consumption, are frequently
+caused by the presence of adenoids.
+
+These patients contract certain diseases easier than other children, and
+when they do, they have them more severely; such diseases are
+diphtheria, tuberculosis, scarlet fever, measles, and whooping cough.
+
+Adenoid children are, as a rule, in better health during the warm,
+equable, summer weather than during the changeable, uncertain weather we
+have in the winter months. If the case is neglected, and if the adenoids
+have existed for a long time, the growth of the child is impaired. He
+remains small and stunted, and the expression of the face is dull and
+stupid. The temperament and disposition are affected also; such children
+are languid, listless and depressed.
+
+How to Tell When a Child Has Adenoids.--Children with well-developed
+adenoids are "mouth-breathers." Instead of breathing through the nose
+they breathe with the mouth open, especially when sound asleep. If a
+child has a discharge from its nose and a chronic cough, both of which
+resist treatment, and if in addition it is a mouth-breather, it is safe
+to investigate the naso-pharynx for adenoids. If a child with these
+symptoms is not in good health, is listless and depressed, looks stupid,
+snores at night, has difficulty in breathing and cannot blow its nose
+satisfactorily, is troubled occasionally with "nose bleeds" and
+headaches, we may be satisfied that the child has adenoids, as no other
+condition could produce such a picture.
+
+Adenoids, like enlarged tonsils, are dangerous, apart from the
+physical distress and disease which they cause, owing to the fact that
+they harbor deadly bacteria, and from these bacteria, which find a
+lodgment in the adenoids and tonsils, a fatal attack of diphtheria or
+consumption may have its beginning.
+
+Treatment of Adenoids.--Absolute removal is the only justifiable
+treatment. This is rendered imperative for so many reasons that it is
+unnecessary to go into details in justification of the procedure.
+
+The physical well-being, the mental development, the life of the child
+depend upon it. Any parent who would wittingly interpose an objection to
+the removal of his or her child's adenoids, after they have been
+demonstrated to exist, would be guilty of a grave crime.
+
+The operation itself is not at all dangerous. It is over in a few
+moments and the child is well in an hour or two, so far as any pain or
+suffering is concerned.
+
+Physicians are frequently asked if adenoids "grow" again after removal.
+The answer is, "Yes," they sometimes do. In a very small percentage of
+the cases they do return. The older the child is when they are removed
+the less chance there is of a recurrence. A child operated on before it
+is two years of age is more liable to a recurrence than a child operated
+on at six years of age. This must not, however, be construed as an
+excuse for putting an operation off, because if a child needs an
+operation at two years and it is postponed till later, its health will
+be permanently injured before it is four years of age.
+
+
+SUMMARY:--
+
+1. Adenoids cause more trouble and more actual disease than any other
+condition during childhood.
+
+2. It is a crime for a parent to refuse operation if the presence of
+adenoids has been proved.
+
+3. Removal is the only treatment and it should be done in every case as
+soon as possible.
+
+4. The operation is a trivial one and is free from danger.
+
+
+NASAL HEMORRHAGE--"NOSE BLEEDS"
+
+A hemorrhage from the nose may occur at any time from birth on. It
+depends upon the rupture of one or more blood vessels. The great
+majority of "nose-bleeds" are caused by adenoids, or by a small ulcer in
+the nose, or by an injury, such as a blow or fall. A nasal hemorrhage,
+however, may be caused by other, more serious conditions, and for that
+reason may justify a careful inquiry into the cause, especially if
+bleeding should occur a number of times, or be of a serious character
+the first time.
+
+Of the more common causes as given above, the adenoids should be
+removed, and the chronic catarrh which is invariably the cause of the
+ulcer should be cured.
+
+Treatment of an Acute Attack.--Have the patient sit erect; loosen all
+tight clothing around neck; fold the hands over the head; apply cold to
+the back of the neck and the nose. Pieces of ice can be put into the
+nostril and the ice bag to the nape of the neck, or a piece of ice can
+be put into a folded napkin and held on the back of the neck. Taking a
+long breath and holding it as long as possible and repeating it while
+the ice is being applied is an aid. Placing the feet in hot mustard
+water is of decided use. Another excellent expedient is to wrap
+absorbent cotton round a smooth probe (piece of whalebone, for example),
+dip the cotton in an alum-water mixture (half teaspoonful powdered alum
+in a half cupful of water), and then push it into the bleeding nostril
+as far as you can with gentle force. A valuable remedy is Peroxide of
+Hydrogen used full strength and freely dropped into the nostril. If
+these measures fail, send for a physician at once.
+
+
+SUMMARY:--
+
+1st. Nose bleeds may be caused by some serious condition.
+
+2nd. If they occur a number of times have the child examined.
+
+3rd. If the treatment outlined above does not stop the bleeding in a few
+moments send immediately for a physician.
+
+
+QUINSY
+
+Quinsy is not common in childhood. It usually follows tonsilitis when it
+is seen. The child complains of pain in the neck, extreme pain and
+difficulty upon swallowing, and inability to open the mouth as much as
+usual. There is a tendency to hold the head to one side. The treatment
+is to open the abscess at the earliest moment after pus is present.
+
+
+HICCOUGH
+
+Hiccough is, in most cases, in infancy and childhood caused by some
+irritation of the stomach, may be over-filled with food or gas. In these
+cases it is an unimportant incident and may be quickly relieved by
+giving the child an enema of soap-water and a laxative of rhubarb and
+soda.
+
+Infrequently hiccough may be the result of cold feet, or a surface
+chill. Simple methods of relief are, to hold the breath, to expire, or
+blow the breath out as long as possible before taking the next breath;
+to sip water from a cup held by another person while the tips of the two
+fore-fingers are in the ears.
+
+Hiccough is quite frequent in hysteria in girls, but it is of no
+consequence. When hiccoughs set in during the course of any serious
+disease it is a very unfavorable sign.
+
+
+SORE MOUTH: STOMATITIS
+
+Stomatitis is an inflammation of the mucous membrane (inner lining) of
+the mouth. The gums and the inner surface of the lips and cheeks may be
+red and angry-looking. There may be small grayish spots on any part of
+the mouth. If the case is very bad or if it has lasted some time and has
+been neglected, these spots grow larger and join together forming
+irregular grayish plaques. A large percentage of the cases never go
+further than this because the proper care and attention is given them.
+It is possible, however, for any case to progress further and become
+ulcerative. This will be observed first as a faint yellow line
+at the margin of the teeth and gum. Ulceration never takes place unless
+the child has teeth. The quantity of saliva is very greatly increased,
+so much so that it flows out of the mouth soiling the clothes. The
+saliva is intensely acid and it consequently irritates the skin, causing
+more or less eczema. The mouth is painful and hot. There is slight
+fever, but seldom any marked prostration. If, however, the ulceration
+should be severe, the fever may be quite high.
+
+There is one feature of these cases that sometimes proves vexatious and
+annoying. Because of the soreness of the mouth, the child cannot draw
+strongly enough on the nipple to get a normal feeding, and as a result
+the nutrition of the child is poor. These children are hungry and when
+offered the nipple grasp it greedily, draw a few mouthfuls then stop
+because of the pain and begin to cry.
+
+If the ulceration is extensive, there is usually an odor and the gums
+bleed easily. Sometimes the teeth fall out or have to be drawn out.
+
+Strong, well-fed children are as likely to develop stomatitis as are
+those who are weakly and ill fed.
+
+The disease is caused by infection and is contagious. Just what the
+infection is we do not know; we do, however, know that children whose
+mouths are carefully cleaned after each feeding do not have sore mouths
+of this character. When cleaning the mouth care must be observed not to
+injure the tender mucous membrane.
+
+Treatment.--As soon as the condition is observed mouth-washing should
+be systematically and thoroughly carried out. After each feeding the
+mouth should be washed with a saturated solution of boric acid in boiled
+water. (See page 626.)
+
+It is not necessary to use any further treatment, as a rule. Patients
+recover in four to eight days. Strict attention to cleanliness, however,
+is imperative. The feeding bottle and nipple, or the mother's nipple, if
+breast fed, must be kept scrupulously clean.
+
+The feeding of these children is sometimes a problem for a day or two,
+because, as stated above, of the soreness of the mouth. This is best
+overcome by feeding the baby with a spoon. If breast fed, it is
+necessary to pump the milk and then feed with the spoon. Children will
+take the milk better if it is fed cold. Cold boiled water is largely
+taken and is good for them at this time.
+
+Treatment for Ulcers in Mouth.--The ulcers should be touched with a
+camel's-hair brush which has been dipped into finely powdered burnt
+alum. If a stronger caustic is necessary, the solid stick of nitrate of
+silver may be used.
+
+A mouth wash may also be used in the ulcerative cases, composed of the
+peroxide of hydrogen diluted with two parts of water. If this is used
+wash the mouth out afterward with plain, cool, boiled water. The
+peroxide mouth wash can be used four or five times daily.
+
+In addition to the mouth washing in the ulcerative cases it is advisable
+to use internally chlorate of potash. The druggist should be requested
+to make a two-ounce saturated solution, and of this you can give
+one-half teaspoonful, largely diluted with cool water, every hour during
+the day for the first twenty-four hours, then every two hours until
+marked improvement is shown, when it can be further reduced by
+lengthening the interval between doses.
+
+
+SPRUE--THRUSH
+
+Sprue is a form of sore mouth. It is seen only during the first six
+months of life, as a rule. It affects the mucous membrane of the mouth;
+it appears in the form of small white spots that look like drops of
+curdled milk. They are on the inner surface of the cheek and may be all
+over the mouth, and on the tongue. The spots are firmly attached, and if
+forcibly removed the mucous membrane will bleed.
+
+The disease is caused by infection through lack of cleanliness and it
+invariably affects poorly nourished children, especially those who are
+bottle-fed.
+
+There are no symptoms other than those of the mouth; the child
+frequently refuses to nurse because of evident pain and distress while
+nursing. The condition is not contagious. It may be cured in from six to
+eight days without difficulty.
+
+Treatment.--Mouth irrigations of boracic acid are all that are
+necessary. They are given in the following way: Place the child on its
+side, roll around the index finger a piece of absorbent cotton, dip this
+in a saturated solution of boracic acid, and put into the mouth of the
+child. Let the cotton take up as much of the solution as it will hold,
+so that when it is lightly pressed on the tongue and cheeks it will flow
+out of the mouth, thus "irrigating the mouth." Repeat this a number of
+times, pressing the cotton to a different part each time. This should be
+gone through from four to six times daily.
+
+If the child is a bottle-fed baby, care should be taken in cleaning the
+nipples and bottles as directed on page 264. If the patient is
+breast-fed, care must be taken to note that the mother's nipples are
+clean. They should be washed with the same solution of boracic acid and
+not handled. If the child cannot nurse it is necessary to feed it with a
+spoon.
+
+In obstinate cases the parts may be touched with a one per cent.
+solution of formalin. Mothers should particularly note not to use honey
+and borax, as is often recommended by women who know no better, in any
+disease of the mouth in children.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXV
+
+DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
+
+Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting--Acute
+Gastric Indigestion--Iced Champagne in Persistent Vomiting--Acute
+Intestinal Diseases of Children--Conditions Under Which They Exist and
+Suggestions as to Remedial Measures--Acute Intestinal
+Indigestion--Symptoms of Acute Intestinal Indigestion--Treatment of
+Acute Intestinal Indigestion--Children with Whom Milk Does Not
+Agree--Chronic or Persistent Intestinal Indigestion--Acute
+Ileo-colitis--Dysentery--Enteritis--Entero-colitis--Inflammatory
+Diarrhea--Chronic Ileo-colitis--Chronic Colitis--Summer
+Diarrhea--Cholera Infantum--Gastro-enteritis--Acute Gastro-enteric
+Infection--Gastro-enteric Intoxication--Colic Appendicitis--Jaundice in
+Infants--Jaundice in Older Children--Catarrhal
+Jaundice--Gastro-duodenitis--Intestinal Worms--Worms, Thread, Pin and
+Tape--Rupture
+
+
+ACUTE GASTRIC INDIGESTION
+
+Acute Inflammation of the Stomach--Acute Gastritis--Persistent
+Vomiting
+
+An infant seldom has real inflammation of the stomach. Gastric, or
+stomach, indigestion is the better name, because it actually signifies
+the true condition. It is indigestion that causes a child to vomit,
+though it is possible to have a true inflammation caused by the taking
+of irritant or corrosive drugs.
+
+Gastric indigestion causes sudden, repeated vomiting, with prostration
+and occasional fever. It is caused by unsuitable food, the wrong
+quantity of food, irregular feeding, and food the quality of which is
+not good.
+
+Treatment.--The stomach should be immediately washed out. Until the
+physician arrives the mother can encourage the child to drink a large
+quantity of cool boiled water. This will be vomited and it will wash out
+the stomach at the same time. No further treatment may be necessary, as
+the vomiting may stop. All food should be withheld for at least
+twenty-four hours. A high rectal irrigation should now be given. It is
+essential to know that the bowel is absolutely clean in all vomiting
+cases. The normal salt solution is the best agent to use for a high
+enema in infants. (See page 586.)
+
+After twelve or twenty-four hours' abstinence from food, the child can
+be given teaspoonful doses every twenty minutes of cooled boiled water,
+or barley or albumen water, weak tea, or chicken broth. Cold liquids are
+better retained and more readily taken than those that are heated. If
+the liquid feedings are vomited, another twelve hours must elapse before
+trying stomach feedings. In these cases we must try to satisfy the
+thirst by giving cold colon flushings. If the case becomes protracted
+and we find it impossible to nourish the child by the mouth, we must
+wash the stomach out once every day with a five per cent. solution of
+bicarbonate of soda, and feed the child by the rectum. Sometimes we can
+feed through the stomach tube. Liquids will frequently be retained when
+put into the stomach through a tube when they will be vomited if
+swallowed.
+
+The best food by the rectum is plain peptonized milk.
+
+Drugs are absolutely useless. If the vomiting persists, despite the
+above efforts to stop it, there is nothing to be gained by
+experimenting. You will not only render the condition worse but you will
+weaken the child. Morphine given hypodermatically is the only remedy.
+Given in appropriate doses, according to age, it is absolutely harmless.
+It will not only stop the vomiting, but it will give the child a
+much-needed rest, by allowing it to go to sleep. When it wakes up it
+will be stronger and its stomach will most likely retain small doses of
+nourishment.
+
+Great care must be exercised, in getting the child back on a normal
+diet, not to try to go too fast.
+
+In cases of persistent vomiting in children I have found it advisable to
+use teaspoonful doses of ice-cold champagne. These children will
+sometimes keep this down when all other liquids will be vomited. It is
+absolutely necessary to keep the child lying down. If he is
+restless or sits up, the vomiting may begin all over again. The
+champagne not only is excellent nourishment for the child, but it quiets
+the stomach, allays irritability, and frequently favors sleep, during
+which time a cure very often results. The champagne must be drawn
+through a champagne siphon (procured in the drug store), and the bottle
+must be kept on ice with the mouth downward; otherwise it will get stale
+very quickly and be of no use. If kept as advised it will remain good to
+the end.
+
+
+SUMMARY:--
+
+1st. Persistent vomiting in a child means acute gastritis. Stop all food
+for twenty-four hours.
+
+2nd. Encourage the child to drink large quantities of slightly warm
+water; this will wash the stomach out and frequently stops the vomiting.
+
+3rd. When the child is quiet wash out the bowels.
+
+4th. If vomiting persists, use iced champagne as directed.
+
+
+ACUTE INTESTINAL DISEASES OF CHILDREN
+
+The large infant mortality that results from intestinal diseases during
+the summer months is deserving of the most careful consideration, both
+of the physician and the parent.
+
+Apart from the excessive heat of the summer, there is no doubt that an
+unfavorable environment, which means bad hygienic surroundings, bad
+sanitary conditions, bad food and home influences, contributes largely
+to the enormous number of these serious cases. Education, while it may
+be expected to influence favorably the sanitary and other conditions in
+the home, cannot change the home location. The child must continue to
+live in the same environment. It is in this class of cases that these
+summer diseases are so very fatal. Children in better circumstances can
+take advantage of conditions which are denied to the tenement child. The
+diseases must therefore be faced and treated under these existing
+conditions.
+
+In addition to the climate and the environment, there are certain
+factors that occur in all classes which result in intestinal
+derangement. If the stomach or bowels are not performing their function
+properly, or if the food or method of feeding is wrong, these, plus very
+hot, humid weather, invariably result in serious intestinal disease. The
+mother must be taught to interpret properly the meaning of a green,
+loose stool in the summertime; she must appreciate that it is the danger
+signal and must be regarded seriously.
+
+The very best preventive against summer diseases of the intestine is to
+guard particularly against any trouble with the child's stomach at all
+seasons of the year. A healthy stomach and bowel will resist disease,
+even in very hot weather.
+
+The most important food product which has a direct relationship to this
+class of diseases is milk. In a large city like New York it will remain
+impossible to solve the milk problem, despite the splendid efforts of
+the Health Department and the members of the medical profession, until
+the city itself shall establish milk depots and ice stations where safe
+milk, and ice to keep it safe, may be obtained at a nominal cost, or
+free, if the parents cannot afford to buy it. We, therefore, must
+recognize that the vast majority of children to-day are taking milk that
+is not suited to them, that is really not fit as a food for children.
+The mothers do not know this and no steps are taken to render the milk
+more safe for them to feed to their children. These mothers are willing
+to do what is essential in the interest of their children, but they do
+not know what should be done. These people cannot afford a physician or
+a nurse to teach them, nor do they even know that their methods are
+wrong or that they need any instruction. We must carry the information
+and the explanation to them. We must show them the need for a change of
+methods. This is the work for those charitably disposed women who desire
+some worthy purpose in life, who really wish to do some real good. All
+the equipment they need is good common sense. They will tell these
+mothers why it is necessary to pasteurize the milk before feeding it to
+the baby. They will show how to keep the nursing bottles clean,
+and the nipples sweet and fresh. They will instruct them how to dress
+the baby in the hot weather and impress them with the need of giving it
+all the cool, fresh air possible. In short, they will gain the
+confidence and the good will of these mothers in a tactful and
+diplomatic way, and they will tell them all they know in language which
+they will understand regarding the care of the baby. In every city in
+the country this work is needed and is waiting for the missionaries who
+will volunteer. To teach mothers the need for boiled water as a
+necessary drink for baby and older children is alone a worthy avocation.
+To impress upon one of these willing but ignorant mothers the absolute
+necessity for washing her hands before she prepares her baby's food,
+that she must keep a covered vessel in which the soiled napkins are
+placed until washed, that she should frequently sponge her baby in the
+hot weather, and explain thoroughly why these are important details, is
+a work of true religious charity. They should be specially taught to
+immediately discontinue milk at the first sign of intestinal trouble, to
+give a suitable dose of castor oil and to put the child on barley water
+as a food until the danger is passed. They should be taught to know the
+significance of a green, watery stool, they should know that is the one
+danger signal in the summer time that no mother can ignore without
+wilfully risking the life of her baby. They should be taught to prepare
+special articles of diet when they are needed. If every mother were
+educated to the extent as indicated in the above outline the appalling
+infant mortality would fall into insignificance. It is not a difficult
+task nor would it take a long time to carry it out; it is the work for
+willing women who have time and who perhaps spend that time in less
+desirable but more dramatic ways.
+
+It is the knowledge that aids in catching disease in its inception that
+counts. The worst infections begin as a mild condition and prompt
+treatment robs them of their sting. When treatment is delayed and the
+child is fed for twenty-four hours too long on milk, the condition which
+in the beginning could have been stopped promptly has developed and it
+becomes a fight for life.
+
+It will be seen from the above that all we need is education.
+Education of the mother primarily, but education of the missionary, the
+nurse, the physician, the municipality, and the State, each
+co-operating, each willing to work in the interest of a great cause, for
+the benefit of the human race and for the brotherhood of man.
+
+
+ACUTE INTESTINAL INDIGESTION
+
+Causes.--Overfeeding, unsuitable and improper food, irregular and
+indiscriminate feeding, sudden change from one food to another, as at
+weaning time, a change from a poor quality to a rich food, or vice
+versa. Conditions affecting the health of the child, especially the
+nervous system, such as hot weather, extreme cold, fatigue, or at the
+beginning of any of the acute diseases. Children sometimes are
+predisposed to attacks of intestinal indigestion; these children are
+delicate in health and have weak digestive ability. The slightest
+irregularity or error in diet will cause an attack in these children.
+
+Symptoms.--The attack may come on suddenly or it may develop slowly.
+The important constitutional symptoms are fever, prostration, and a
+general nervous irritability. The child is seized with pain in the
+abdomen. The pain is referred to the region around the navel. It is
+sharp, colicky, and severe, causing the child to cry out and draw up its
+legs in an effort to lessen its severity. The child is exceedingly
+restless and acts as if it were on the verge of a dangerous illness. Gas
+in the bowel is not present as a rule as frequently as it is in infants
+under the same circumstances. In a few hours diarrhea sets in, the
+stools may number from four to twelve or more in twenty-four hours. The
+stools are acid, sour, and the odor may be very foul. They are thinner
+than usual and frothy from the presence of gas.
+
+In very young infants suffering from a sudden attack of intestinal
+indigestion, the stomach, as well as the bowels, is invariably upset. If
+the indigestion is the result of a slower process, the stomach does not
+participate in the process. The color of the stools in infancy is yellow,
+then yellowish-green, and later grass-green. Undigested food is
+always present and in infants the curdled casein of the milk appears
+as white specks or lumps in the movements.
+
+The fever is high in the sudden cases and lower in the cases of gradual
+onset. The prostration is more severe when the onset is sudden and in
+infants may be very marked.
+
+The termination of the disease depends upon the cause, the treatment,
+and the previous health of the child. In healthy children promptly and
+properly treated it may be all over in a week. In delicate, poorly
+nourished children, and especially in the summer time, it may be the
+beginning of trouble that may eventuate in death.
+
+Treatment.--There is no condition in the whole realm of diseases of
+childhood where the knowledge of the mother may have such important
+results as this condition. The most effective time to treat these cases
+of intestinal indigestion is before the physician is called. There are
+few diseases in which time is so valuable, so far as final results are
+concerned, as it is here. Every mother should know the significance of a
+loose, green stool. She should be taught that it means danger and
+consequently demands prompt treatment. The first indication is to empty,
+thoroughly, the bowel. The best means for this purpose, if it is
+immediately procurable, is calomel. If calomel is not procurable at once
+give castor oil, two teaspoonfuls to an infant, one tablespoonful to an
+older child. Calomel should be given in one-eighth-grain doses, repeated
+every three-quarters of an hour for eight or twelve doses, until the
+bowel is thoroughly cleaned out. Don't be afraid of a few extra
+movements at the beginning. Better clean out thoroughly at the start
+than to be compelled to do it all over again after the child is weak and
+suffering from the poison of the disease. The next important thing to do
+is to stop milk at once. The thirst is usually intense and if vomiting
+is not present it can be moderately relieved by giving small quantities
+frequently of cool boiled water or mineral water or strained albumen or
+barley water. We quite often have to stop all food and liquids by the
+mouth for twenty-four hours.
+
+If the prostration is very great and the child looks as though it
+might collapse, it can be given brandy in cracked ice from time to time.
+
+After the bowels have been thoroughly cleaned out, never before, some
+medicinal agent may be given to stop the unnecessary diarrhea. In a very
+large number of promptly and properly treated cases this is not needed.
+If it is thought best to use it the physician will select the agent
+according to the conditions present and prescribe it.
+
+Breast-fed infants rarely have intestinal diseases of a severe type. If
+they should develop diarrhea they must be taken off the mother's milk
+for twenty-four hours. They should be given a dose of castor oil or
+calomel and fed on barley water in the interval. The feedings should be
+reduced in quantity and the interval doubled. The two-hour interval will
+become a four-hour feeding: the three or four ounces at each feeding can
+be reduced to two ounces. The intention is to simply give as little as
+possible while the diarrhea is under way.
+
+The mother's breasts must be pumped at the regular feeding time in order
+to preserve the flow, release the pressure, and keep the milk fresh.
+
+It is sometimes a problem to renew feedings of milk without exciting a
+relapse of the diarrhea. It should not be tried until the stools are
+normal in color and consistency. This may not be for three or four days.
+In resuming the milk it should be given in smaller amounts and diluted
+with lime water or barley water for the first day. Gruels may be given
+to which skimmed milk may be added: later add the ordinary milk. If it
+is well digested and does not cause any return of the diarrhea, the
+quantity of milk can be slowly increased until the former feedings are
+resumed. It is often of very great advantage to boil the milk for some
+time. Peptonized milk is safe and can be used in bottle-fed infants
+after diarrhea. In older children, meat, broths, eggs, boiled milk, and
+dry toast bread may be used sparingly for some time. Cereals,
+vegetables, fruits, should be withheld for a considerable time and
+watched carefully when resumed. Kumyss, buttermilk, matzoon, bacillac,
+and other fermented milks are better borne than plain milk. All of
+these children need rest, fresh air, change of air, frequent bathing,
+and tonics, as an attack of this kind leaves them depressed, weak,
+languid, and anemic.
+
+
+SUMMARY:--
+
+1st. When a child complains of sharp, colicky, severe pains in the
+abdomen, around navel, which are shortly followed by foul, sour, frothy
+diarrhea,--greenish in color, it has acute intestinal indigestion.
+
+2nd. Every mother should know that a green stool means danger. She
+should know to give at once a cathartic,--castor oil is good, but give a
+good large dose--then stop all food for twenty-four hours. If she learns
+this lesson she will have time to wait for the doctor; meantime, she may
+have saved her child's life.
+
+
+CHILDREN WITH WHOM MILK DOES NOT AGREE
+
+Contrary to the general belief, there are quite a large number of
+children in whom milk seems to act as a poison. These children are not
+necessarily constipated. They suffer, however, from a slow, continuous
+intestinal toxemia or poison. The symptoms of this condition are
+headache, disorders of speech, habitual sleep-talking, sleep-walking,
+and general nervous irritability without cause: they are listless,
+languid, and constantly tired. They may be bright in the morning and
+sleepy in the afternoon. They are irritable and cross and touchy.
+
+Treatment.--Milk must be wholly discontinued. Eggs must be restricted
+to one every second day, and meat but once daily. The use of green
+vegetables is particularly suitable and should be given daily. Cereals
+and fruit also are good. Malted milk, kumyss, or matzoon may be given in
+place of milk. If constipation is present, rhubarb and soda mixture is
+an excellent laxative in these cases. A tonic should be prescribed for
+all these children.
+
+
+DYSENTERY--ENTERITIS--ENTERO-COLITIS--INFLAMMATORY DIARRHEA
+
+Cause.--Any cause which has been mentioned as a cause of ordinary
+diarrhea may result in this disease. It may occur at any time of the
+year and at any age. It may follow the infectious diseases. It may
+follow any other disease of the intestines.
+
+Symptoms.--It may begin like an ordinary attack of acute intestinal
+indigestion. There is usually vomiting, fever, pain, and frequent yellow
+or green stools. The passages may be blood-stained and there may be
+little or much mucus. The stools at the beginning have no odor as a
+rule. The bowels move very frequently, often with little or nothing to
+pass. There may be pain with each movement. The blood may disappear in a
+few days, but the mucus remains, often in large quantity in each stool.
+
+At the beginning the fever is high, but it soon falls and remains low
+during the attack. The child loses weight, is irritable, has no
+appetite, and looks and acts sick. When the attack is over these
+children do not gain their strength as readily as we would like;
+recovery is slow.
+
+The acute symptoms usually last about one week, after this time the
+child begins to recover, but the process is a tedious one and one in
+which much care has to be exercised. It is an encouraging sign to note
+the disappearance of the blood in the stools and the return of the
+movements to the normal brown color. When these favorable signs are
+wanting the bowel is probably ulcerated and it will take a much longer
+time to return to normal and to be free from blood and mucus.
+
+The above is the ordinary form of this disease and it ends in recovery
+as a rule. There is a more severe form, however, which differs from the
+above in the following way:
+
+The fever is high and remains high; the stools are more frequent and
+there is more blood and more mucus in them; the child is much more
+irritable and is more profoundly sick. Death may occur at any time from
+the second day. If the little patient survives, the return to health is
+a very slow process; it often takes months and frequently years before a
+reasonable degree of strength is regained. Relapses are common, and
+they are very difficult to treat and care for. In some cases the child
+never wholly regains its former strength.
+
+There are children who have been the victims of other intestinal
+diseases or conditions who develop colitis. The colitis in these cases
+may come on suddenly with vomiting and high fever, or it begins slowly,
+with no vomiting and with little fever. Their appetite is poor, their
+digestion is feeble, their prostration is pronounced. They lose flesh
+rapidly and may be emaciated to a remarkable degree. Very few of these
+cases recover completely. Serious and sometimes fatal relapses may take
+place. The feeding of these children is a difficult task and the
+greatest care must be constantly taken; a very little mistake may cost
+the life of the child.
+
+Treatment.--All diseases of the intestine in childhood should be
+promptly and efficiently treated. If any form of diarrhea is neglected,
+it may result in the development of ileo-colitis with all its risks and
+uncertainty. When a child is seized with sudden bowel trouble, no matter
+what variety it is, it should be treated with the greatest care because
+"sudden" bowel trouble usually means plenty of trouble if it is
+neglected.
+
+Fresh air is essential in all these cases. A change of air is of decided
+value as soon as the immediate symptoms have abated. The diet is the
+same as for children who have gastro-enteric intoxication. Later, much
+difficulty will be met because these patients have absolutely no
+appetite,--peptonized skimmed milk is always good, beef broths are often
+well borne, liquid beef peptonoids may be tried. The food should be
+given every three hours. Boiled water and stimulants may be given
+between the feedings. Later in older children, raw beef, eggs, boiled
+milk, kumyss, or matzoon and gruels may be given. Great care has to be
+taken for months after an attack; relapses may be caused by changes of
+temperature, by fatigue, and, of course, by improper feeding. These
+children should avoid potatoes, tomatoes, fruits, corn, oatmeal, and a
+great many other things which an intelligent mother would not give any
+sick child, as candy, cakes, pastries, etc.
+
+Cases which begin with free vomiting, thin stools; and fever should be
+treated at once. The bowels must be thoroughly cleaned out, the colon
+should be thoroughly irrigated, and all food should be stopped. When
+there are bloody stools with mucus and pain we must depend upon castor
+oil, irrigations of the colon, and opium and bismuth by the mouth. A
+good big dose of oil at the beginning is always necessary. If, however,
+the stomach is irritable and will not tolerate castor oil, we may
+substitute calomel in one-fourth-grain doses every hour for six doses,
+to be followed by citrate of magnesium. Irrigation of the colon in these
+cases is one of the essential means of successful treatment; it should
+be done twice a day during the first few days of the disease.
+
+Stimulants are needed in all the cases. They help the heart, act as a
+food, and tend to quiet the general nervousness by favoring sleep. Good
+brandy given in boiled cool water is the best stimulant.
+
+After the child is over the worst of the acute symptoms all medicine
+should be withdrawn and the proper kind of food given. Tonics will aid
+in restoring the strength. Cod Liver Oil during the following winter is
+a very good plan to aid in building up the vitality of the weakened
+bowel, but it must not be given too soon.
+
+
+CHRONIC ILEO-COLITIS--CHRONIC COLITIS
+
+Chronic Ileo-colitis fellows the acute variety. Cases which are
+unusually severe or which have been badly managed are likely to become
+chronic. A child suffering from this disease presents the following
+picture: The patient is emaciated, the abdomen is usually enlarged with
+gas, the feet are cold, the circulation of the blood is poor, the fever
+is low or absent altogether except when the child is having a relapse,
+when it jumps up suddenly. The bowels are loose and contain mucus,
+frequently in large quantities. The mucus may stop for a few days; then
+it appears again with a rise of temperature accompanied with loose
+stools with foul odor. These children are exceedingly nervous and
+irritable and are very poor sleepers.
+
+Parents should be told it will be impossible to effect a rapid cure of
+these cases. It often takes months to get them started on the safe road.
+The slightest mistake or change in the weather will upset the progress
+of the cure and it will be necessary to begin all over again. The entire
+hope of cure rests with the mother. She must be faithful, patient, and
+must carry out the physician's instructions implicitly. The management
+consists in diet, change of climate, and such other treatment as the
+physician finds necessary in each individual case.
+
+Treatment.--In children under one year of age the only hope is breast
+milk, which must be given in small quantities. They do not do well on
+any starch food for a considerable period.
+
+Where breast milk is not available the whites of two or three eggs may
+be given daily. They may be beaten up and given in skimmed milk, or in
+plain water with a little salt added. Zwieback or bread crumbs may be
+given in small quantities. They should be fed at four-hour intervals.
+
+Older children may take skimmed milk, raw scraped beef, junket, and
+coddled white of egg or raw egg, bread crumbs, toasted, or zwieback.
+
+A rectal enema must be given every twenty-four hours if the bowels have
+not moved. If constipation is the habit a laxative should be given; the
+aromatic fluid extract of cascara sagrada or magnesia are suitable. At
+least one free movement every day is essential to success.
+
+Colon irrigations are only to be used when there is a rise of
+temperature, irrespective of whether the bowels have moved or not.
+
+When convalescence is established these children should be given a
+maximum of fresh air and should be treated as recommended in cases of
+malnutrition.
+
+
+SUMMER DIARRHEA
+
+As the name implies, this is the form of diarrhea that is so common,
+especially in cities, in summer. It is always preceded by some milder
+condition which paves the way for the more serious diarrhea. Acute
+indigestion is, as a general rule, the forerunner of cholera infantum.
+The influence of hot weather must always be kept in mind as the
+underlying factor which no doubt conduces to gastro-intestinal disease
+of infancy and childhood. The depression incident to a spell of hot and
+possibly humid weather tends to interfere with the digestive process of
+babies and children. When this function is carried on imperfectly, the
+strength and vitality of the child fails, and if immediate steps are not
+taken to check the process, diarrhea makes its appearance. If these
+children are improperly fed, or if their surroundings are not sanitary;
+if they are not getting fresh air enough, or if they suffer because of
+lack of attention, and have at the same time a little indigestion, it is
+only a step further to develop a full-fledged cholera infantum.
+
+The outcome of any case of summer diarrhea is questionable. It is not
+safe to make any promise. An apparently mild attack may prove quickly
+fatal. Much depends upon the previous history of the child. If it has
+been a strong, healthy child it has a very good chance if treated
+energetically and correctly. If it has previously suffered from bad
+nutrition, is not robust, has had trouble with its stomach, etc., the
+chances are against it.
+
+The one lesson to be learned by all mothers is, as stated above, to act
+quickly; to be on the watch all through the summer months for any
+trouble with the baby's stomach or bowels. It is much easier to treat
+and cure a little trouble than to battle against an established
+gastro-enteric intoxication. Overfeeding and indiscriminate feeding must
+be religiously avoided,--they are the two most prolific causes of
+stomach and intestinal troubles in childhood.
+
+Symptoms.--The onset is sudden and pronounced. The child begins to
+vomit and continues vomiting and retching persistently. The bowels are
+loose, and large, watery, greenish stools are frequent. The prostration
+is very marked, the child looks seriously sick, respiration is quick and
+shallow, the eyes sunken, the skin becomes ashen gray in color, and the
+pulse is soft and very rapid. The fever may be very high or it may
+remain low. The low febrile cases are the worst.
+
+If taken in hand quickly and if the treatment is energetic and if the
+child reacts, the case may go rapidly on to recovery and the child be
+wholly well in a few days; or it may not react, but be overwhelmed by
+the poison and sink and die in twenty-four hours.
+
+Treatment.--In the treatment of cholera infantum it must not be
+forgotten that the dangerous element is the poisoning of the system that
+is constantly going on. It is difficult for the non-medical mind to
+estimate the importance of this element. It is, of course, caused by the
+bacteria present in the gastro-intestinal canal. There are numberless
+millions of bacteria in the normal healthy bowel. A very large
+percentage of those germs are good for us, are there for a beneficent
+purpose, and can and do protect us from other germs which occasionally
+find their way into the bowel and whose purpose is not a peaceful one.
+When the bowel condition changes, as during an attack of summer
+diarrhea, it is invaded by multitudes of evil-intentioned germs. These
+germs find conditions in the diseased bowel exceedingly favorable to
+them, so they begin work in an active, energetic way. The result of
+their activity is highly poisonous, and, as the good germs are virtually
+out of business and are consequently not working in our interest, we are
+absolutely in the hands of the enemy. There is soon manufactured, by
+these invading germs, enough poison to poison the entire system of the
+child. It is this feature that we must combat in summer diarrhea.
+
+It is absolutely essential to keep these cases as much in the open fresh
+air as possible. No matter how sick they may be, this rule must be
+observed. Light clothing is advisable.
+
+If it is a city child that is affected and it does not show decided
+improvement in three or four days, it should, if possible, be sent to
+the country. There is always distinct danger of a relapse in every case,
+so the little victim should be given a change of air as soon as
+convalescence permits. The seashore is preferable to the mountains in
+all intestinal cases.
+
+In the care of these patients cleanliness is an important factor and
+counts much in the ultimate cure. The child, as well as the clothing,
+should be kept scrupulously clean. Napkins as soon as soiled should be
+removed and put into a disinfecting solution. The buttocks should be
+well powdered after each movement to prevent sores developing.
+
+Feeding must be stopped at once. No food of any kind should be given for
+at least twenty-four hours, or until the tendency to vomit subsides. The
+thirst must be allayed, however, so we give frequently small quantities
+of thin barley water or albumen water or cold boiled water. If these are
+vomited we must stop giving them altogether for twenty-four hours. If
+the fever is high and the skin dry, the child should be given a cool
+pack, 85 deg. to 90 deg. F., which can be moistened every half hour with water
+at this temperature; this will often control the fever satisfactorily.
+Hot-water bottles should be placed at the feet if they are cold.
+
+If, on the other hand, the fever is very low (below normal), the child's
+circulation poor, the skin blue and cold, a hot-water bath at 108 deg. F.,
+for five minutes (rubbing the surface of the body while in the bath),
+will be of very great service. The bath may be repeated at half-hour
+intervals.
+
+If the patient is a breast-fed infant it can be allowed to nurse after
+the twenty-four-hour rest. The length of time it is permitted to stay at
+the breast should be about one-quarter of the time it was allowed before
+the attack began. If it does not vomit, the nursing can be repeated
+every four hours. As the case progresses toward recovery the interval
+between feedings can be shortened. Care, however, must be taken not to
+shorten the interval too rapidly.
+
+If the patient is artificially fed and is not over four months old, a
+substitute for the milk must be found. The best substitutes are rice or
+barley water, either plain or dextrinized, the malted foods, chicken or
+beef broths, liquid peptonoids or bovinine. Water (boiled and cooled)
+may be allowed at all times if not vomited.
+
+Older children are treated in the same way. All food is withheld while
+there is any vomiting. When vomiting stops begin with small quantities
+of beef broth, or chicken, or veal broth. Later kumyss or matzoon can be
+tried, and finally thin gruels made with milk.
+
+If vomiting persists the stomach must be washed out; this can be done by
+giving the infant or child a large drink of cool boiled water. This will
+be immediately vomited and it will clean the stomach at the same time.
+The stomach-pump may be used to better advantage. One washing is usually
+sufficient. The vomiting will stop after the stomach has been washed out
+and the patient may then be given, frequently, small quantities of cold
+albumen water or barley water.
+
+The bowel should be thoroughly cleaned out at the beginning of every
+summer diarrhea. Castor oil or calomel are the two best cathartics for
+this purpose. If the stomach is not upset use castor oil. If the stomach
+is upset use calomel; one-fourth of a grain every hour for eight doses
+will be sufficient. Give enough, however,--there is no danger at the
+beginning of the attack of too free movements of the bowel. Whatever
+cathartic is given, it should produce green, watery stools.
+
+Irrigation of the bowel is an exceedingly effective way of cleaning out
+the poison-laden large intestine. It should be done in every instance
+unless the movements are watery and of such frequency as to render
+irrigation unnecessary. Once or twice daily will be sufficient in even
+the worst cases. The irrigation should be given at the temperature of
+100 deg. F, and should be the normal saline solution; a long rectal tube is
+used to give the irrigation.
+
+
+SUMMARY:--
+
+1st. Cholera infantum is one of the most dangerous, one of the most
+treacherous, and one of the quickest acting diseases of childhood.
+
+2nd. Don't temporize, don't delay, don't regard lightly any diarrhea
+during the summer time.
+
+3rd. Give a large dose of castor oil and withhold all nourishment until
+the doctor sees the little patient in every case of diarrhea during the
+warm weather.
+
+4th. Keep the child in a cool, quiet place and don't handle or annoy it.
+
+5th. Follow, your doctor's directions implicitly. The fight may be
+short, sharp, and decisive. Don't pave the way for regrets afterward. Do
+everything while you have the chance.
+
+
+COLIC
+
+Colic is a common condition in infancy. Very few children escape more or
+less colic during the first few months of life. It does not seem to
+injure permanently some infants; they go on growing according to
+standard, eat and sleep, and seem contented and happy despite occasional
+severe attacks of colic. Other children suffer seriously; the degree of
+indigestion is considerable, and the nutrition of the child is
+interfered with.
+
+Colic is much more frequent in bottle-fed infants than in those fed on
+breast milk. Cow's milk, no matter how skillfully it is prepared for
+their use, is at best an unsuitable diet and taxes the digestive ability
+of robust children. It is quite natural for an infant whose digestive
+organs are not strong to develop colic and intestinal indigestion if put
+on artificial food. Any condition that causes indigestion may likewise
+cause colic. Those children who are always overfeeding,--taking too much
+milk, too strong milk, or who are fed irregularly,--are the colicky
+babies.
+
+Constipation is frequently associated with colic and may be the actual
+cause. A daily movement of the bowel does not necessarily mean that the
+bowels are emptying themselves satisfactorily. Despite the daily
+movement, there may be considerable fecal matter left in the bowel which
+undergoes decomposition. This results in the evolution of large
+quantities of gas and severe attacks of colic. Indigestion is very often
+caused by conditions which effect the stability of the child's nervous
+organism; such conditions are fright, anger, fatigue, exhaustion,
+excitement.
+
+The origin of the colic in breast-fed children is very often caused by
+some nervous condition of the mother that affects her milk. Constipation
+in the mother may cause colic in the child.
+
+Symptoms.--A baby having an attack of colic will cry loudly from time
+to time and whine during the interval; it will pull up its legs and bear
+down. Its abdomen is tense and hard and distended with gas. With the
+expulsion of the gas the pain ceases and the child falls asleep. If the
+attack is very severe the prostration and exhaustion is marked; the feet
+are cold and the body is bathed in perspiration.
+
+If the colic is constant the child may be fretful and restless most of
+the time, being seemingly comfortable for only an hour or two in the
+twenty-four.
+
+In older children who cry because of severe pain in the abdomen the
+possibility of appendicitis must not be forgotten.
+
+Treatment.--Find out the cause of the colic if possible. If the cause
+is located in the mother, the remedy naturally must affect her.
+Regulation of her bowel, restriction of her diet, and proper exercise,
+may be sufficient to effect a cure of the colic in the infant.
+
+The object of treatment is to help the child get rid of the gas. The
+best and quickest means to effect this is to apply massage or give a
+rectal injection. An injection of two ounces of cold water in which a
+half or one teaspoonful of glycerine has been put, will act quickly. Dry
+heat applied to the abdomen in the form of the hot-water bottle or
+woolen cloths will aid in the expulsion of the gas. The feet should be
+kept warm.
+
+In cases of habitual colic in breast-fed babies the cause may be in the
+quality of the mother's milk. It should be examined and if found too
+strong should be diluted. This can be done by giving the child an ounce
+of plain boiled water or barley water before each feeding. If the child
+gets an ounce of liquid before each feeding he will not want as much of
+the breast milk; so we shall have the same total quantity, but a reduced
+quality, which may cure the colic at once.
+
+It is necessary, in order to cure colic, that the bowels move every day
+in a satisfactory manner. If any aid is needed, milk of magnesia is the
+best laxative. It may be given in teaspoonful doses in water previous to
+a feeding. Aromatic cascara sagrada in from ten to thirty-drop doses is
+a very good laxative, if a stronger remedy is needed.
+
+To relieve the acute attack, three drops of Hoffman's anodyne may be
+given in two teaspoonfuls of warm water and repeated in ten-minute
+intervals until relieved, to a baby under one year of age. From five to
+ten drops of gin, given in three teaspoonfuls of warm water, and
+repeated in fifteen minutes, is also satisfactory and harmless. A very
+good remedy which may be used with the above for quick relief, and to
+stop the child from crying, is the following: Fold a piece of flannel
+cloth (two thicknesses) the size of the baby's abdomen; wring out of
+very hot water and drop ten drops of turpentine over the surface,--at
+different spots,--of the flannel and lay on abdomen,--turpentine side
+next skin. Cover this with another piece of flannel,--two or three
+thicknesses, that has been dry-heated and allow to remain in place for
+about ten minutes.
+
+Colic, as a rule, disappears completely about the third month.
+
+
+APPENDICITIS
+
+Appendicitis is mentioned here merely to acquaint mothers with its
+prominent symptoms.
+
+When a child has what seems to be an attack of indigestion, but
+complains of pain and tenderness in the abdomen, vomits, and develops a
+fever, and is constipated, appendicitis may be suspected.
+
+The pain and tenderness are not referred to the region of the appendix
+but are more centrally located. If, however, the finger point is pressed
+over the appendix, distinct tenderness will be elicited in inflammation
+of that region. Constipation is the rule in appendicitis, but diarrhea
+occasionally accompanies it.
+
+The abdominal muscles may be rigid, that is, the abdomen does not feel
+soft as is usual; there is a feeling if they are pressed, as if they
+were hard and unyielding.
+
+Treatment.--Put the child in bed and send for the family physician at
+once. The condition is too serious and too uncertain to delay, or for a
+parent to make any effort at treatment. Appendicitis is a much more
+serious condition in infancy and childhood than it is in an adult.
+
+
+JAUNDICE IN INFANTS
+
+There are two types of jaundice in infants that deserve brief
+consideration.
+
+1st. There is a form of jaundice caused by a defect in the development
+of the bile or gall tubes. These infants develop jaundice a day or two
+after birth and become intensely jaundiced within a very brief time.
+They lose flesh and strength to a marked degree and die in a few weeks.
+It is not possible to affect this condition favorably by any method of
+treatment. This type of jaundice is not very common.
+
+2nd. There is a type of jaundice that appears between the second and
+fifth day of life that is very common. It lasts from one to two weeks
+and then disappears. It is never fatal and is not serious. It requires
+no treatment.
+
+
+JAUNDICE IN OLDER CHILDREN--CATARRHAL JAUNDICE--GASTRO DUODENITIS
+
+Symptoms.--This form of jaundice begins like an attack of ordinary
+indigestion. There are, as a rule, pain, fever, vomiting, and
+prostration. The pain is located in the upper part of the abdomen and
+may be quite severe. The vomiting may continue for a number of days. The
+bowels are usually constipated. After a few days the jaundice sets in
+and may be quite intense. After the jaundice is established the stools
+are gray or white in color and there is much gas in the bowel. The urine
+is very dark and may be yellow or yellowish-green in color. The child
+complains of headache, is dull and listless, and appears sick and weak.
+The condition lasts about two weeks, but the jaundice may last much
+longer. It is not a serious disease.
+
+Treatment.--The diet should be cut down in quantity and should consist
+of rare meat, fruit, and a small quantity of milk. If vomiting continues
+the milk may diluted with lime water or vichy water. The child should
+drink water or vichy water freely. No starchy foods, or fats, or sugars
+should be allowed. The bowels should be kept open with calomel,
+one-tenth of a grain every hour until ten are taken, to be followed by
+citrate of magnesia every morning. If the pain is severe it may be
+relieved by a mustard paste or a turpentine poultice. The child should
+be given acid hydrochloric diluted, eight drops in one-half glass of
+water, ten minutes before each meal--and kept on it for at least one
+month.
+
+
+INTESTINAL WORMS
+
+There are three types of intestinal worms; they are known as the
+round-worm, the thread-worm, and the tape worm.
+
+Round-Worm.--The round-worm is usually found in children of the
+run-about age. It is never seen in infancy. It occupies the small or
+upper intestine, and is from four to ten inches long. If there are
+round-worms in the bowel, there are usually a number of them and there
+may be hundreds.
+
+Symptoms.--Round-worms give no definite symptoms. The only possible
+way to tell if they are present is actually to see them in the stools of
+the child. They are of a light gray color.
+
+It is reasonable to expect that a child suffering from worms will have
+symptoms of abdominal distress from time to time; indigestion with colic
+and much gas may be present; children lose their appetites and are
+nervous and restless; sleep is disturbed; they may grind their teeth and
+talk in their sleep, and they may pick their noses unnecessarily during
+the day. These symptoms may, however, accompany other conditions when no
+worms are present in the bowel. My observation has been that in children
+in whom worms were present the nervous symptoms were distinctly
+accentuated. They are unreliable children; they seem well to-day and
+peevish to-morrow; they complain of headaches, dizziness, and chilly
+feelings. They are hysterical, noisy, uncontrollable. A child with these
+symptoms should be suspected of having worms and if no cause can be
+found to explain his temperamental vagaries he should be treated for
+worms. I have cured a number of children of excessive nervousness by
+giving them medicine for worms when no worms were present. Such results
+can only be explained on the assumption that these children were
+suffering from intestinal auto-toxemia or self-poisoning, and the
+thorough disinfection of the bowel apparently stopped the process by
+ridding the child's system of a mass of bacteria, which were undoubtedly
+causing the auto-toxemia and consequent nervousness.
+
+Treatment.--The most efficient remedy for removing round-worms is
+Santonin. The quantity necessary for the various ages is as follows:
+
+  Two to four years           2     grains.
+  Four to six years           3     grains.
+  Six to ten years            3-1/2 grains.
+
+The best way to give it is in divided doses, with an equal quantity of
+sugar of milk. For a child of six years the formula would therefore be,
+3-1/2 grains of Santonin, mixed with the same quantity of sugar of milk
+divided into three powders. These powders are given four hours apart in
+the following way. The child is given a light supper the evening before
+and one-half glass citrate of magnesia the following morning and the
+first powder one-half hour later; no breakfast being given. A light
+lunch, of milk and crackers, may be taken about noon. The second powder
+is given four hours after the first, and the third four hours after the
+second. Half an hour after the last powder, a dose of castor oil (one
+tablespoonful) is given. In a few moments the bowels will move; usually
+there are no worms in this movement. A little later they will move
+freely again and if worms are present they will be discharged in this
+movement.
+
+Thread-Worm, or Pin-Worm.--A thread-worm looks just like a little
+piece of white thread. They are found in the lower part of the bowel and
+in the rectum. They are usually present, if present at all, in large
+numbers.
+
+Symptoms.--The chief symptom is itching. It may be limited to the anus
+or it may involve the neighboring parts. Thread-worms may find their
+way out of the anus and in female children may find their way into the
+vagina. In these instances the child is tormented with itching of the
+privates and may establish the habit of self-abuse as a result of the
+constant itching and scratching. The itching is more intense at night
+soon after the child goes to bed. As a result of the local irritation in
+the lower part of the bowel and rectum there is set up a catarrh of the
+bowel which produces large quantities of mucus.
+
+Treatment.--The only medication by the mouth that is of any use is
+turpentine in one drop doses after meals, given in a teaspoonful of
+sugar. The best treatment, and in most cases the only treatment that is
+effective, is the use of rectal injections. The procedure is as
+follows:--The child first gets a cleaning injection of two quarts of
+warm water into which a teaspoonful of borax has been put. This will
+wash away any mucus or fecal matter that may have collected. This
+injection is best given with a No. 18 rectal catheter which is pushed
+into the rectum for about 10 inches, the water being allowed to run away
+as it enters. From six to eight ounces of the infusion of quassia is
+then passed, as high up as the catheter will reach. It is intended that
+the quassia will remain in as long as possible, for at least half an
+hour. In order to assure this there are two features that should be kept
+in mind: first, the water should be allowed to flow in slowly,
+consequently hold the bag low, not higher than two feet above the level
+of the bed on which the patient lies; second, after the water is all in
+remove the catheter very slowly and keep the child absolutely quiet.
+This treatment is repeated every second night for a week, then twice a
+week for four weeks.
+
+A solution of garlic is a very effective remedy and may be tried if the
+quassia fails, which is not likely if the treatment is carried out
+effectively and if the parts are kept scrupulously clean.
+
+Tape Worms.--Tape worms are obtained from eating raw meat, pork or
+sausage, rarely from fish, and from playing with cats and dogs.
+
+Symptoms.--No definite symptoms accompany the presence of tape worm.
+The children may have pains in the abdomen, diarrhea, a capricious
+appetite, foul breath, and they may suffer from anemia, sometimes quite
+severely. The only positive symptoms is the presence of links of the
+worm in the stools.
+
+Treatment.--Give a dose of castor oil at bed time. Two hours after
+breakfast next morning give one-half dram of the oleoresin of male-fern
+in emulsion or capsule. Very light nourishment should be taken during
+the day, composed of gruels and soups. When the worm is passed it should
+be examined to find if the head is present; if not, the treatment should
+be repeated in twenty-four hours.
+
+
+RUPTURE
+
+Rupture of any description is not a condition that any mother should
+attempt to treat. A physician should be called in every case. Any
+misdirected effort at manipulation or pressure may result in irreparable
+injury to the parts. External applications are useless and may be
+injurious.
+
+All ordinary forms of rupture in infancy and early childhood are curable
+if properly treated.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVI
+
+DISEASES OF CHILDREN, CONTINUED
+
+Mastitis or Inflammation of the Breasts in Infancy--Mastitis in Young
+Girls--Let Your Ears Alone--Never Box a Child's Ears--Do Not Pick the
+Ears--Earache--Inflammation of the Ear--Acute Otitis--Swollen
+Glands--Acute Adenitis--Swollen Glands in the
+Groin--Boils--Hives--Nettle Rash--Prickly Heat--Ringworm in the
+Scalp--Eczema--Poor Blood--Simple Anemia--Chlorosis--Severe
+Anemia--Pernicious Anemia
+
+
+MASTITIS, OR INFLAMMATION OF THE BREASTS IN INFANCY
+
+There are a few drops of a milky secretion in the breasts of infants
+when born. Occasionally the amount will be in excess of the normal
+quantity, and the breasts, around the nipple, may be swollen and
+slightly inflamed. Should this condition persist, it may be relieved by
+painting the parts with the tincture of belladonna. Under no
+circumstances should the breasts be manipulated or rubbed, as this is
+very apt to cause an inflammatory condition, and to result in mastitis.
+
+Mastitis begins, as a rule, during the second week of life. The breast
+becomes red, swollen, painful, and shows inflammatory changes. It may
+terminate without the formation of an abscess, or it may go on to
+suppuration. The child becomes extremely restless and irritable, it is
+disinclined to nurse, and suffers from loss of sleep and nourishment. It
+is possible for such a condition, in the female, to injure the breast to
+the extent of arresting its development and to render it useless in the
+future. If the suppuration is extensive the process may terminate
+fatally.
+
+Mastitis in infants is caused by unnecessary interference and
+manipulation and by want of cleanliness. When it occurs the parts should
+be kept absolutely clean and should not be handled in any way. Ichthyol
+25 per cent., Zinc Oxide Ointment, enough to make one ounce, spread
+upon old, clean, soft linen, and laid over the parts and changed every
+six hours, is an excellent healing application. A piece of oiled silk
+may be put outside the linen to prevent the ointment staining the
+clothing, and over this a layer of absorbent cotton and a binder,
+applied without pressure.
+
+If an abscess develops in spite of treatment, it must be freely opened
+and freely drained, and the general health of the patient supported by
+regular nourishment and tonics.
+
+Mastitis in Young Girls.--Pain and swelling of the breasts are
+sometimes complained of by girls between the twelfth and fifteenth
+years, though it may occur at an earlier or later date. If left alone
+the condition will invariably subside without treatment. Should bacteria
+find an entrance through the nipple at this time, an abscess may result.
+The whole breast is involved and it will be exceedingly painful and much
+swollen. There may be moderate fever, headache, and a pronounced feeling
+of indisposition. These patients should be given a laxative,--citrate of
+magnesia, or Pluto Water, and kept on a very light diet. An ice-bag
+should be kept constantly at the breast during the day, and a moist
+dressing of 1:5000 bichloride of mercury during the night.
+
+It may take a week before recovery takes place.
+
+
+LET YOUR EARS ALONE
+
+Never Box a Child's Ears.--A single blow may make a child deaf;
+repeated blows on their ears will certainly injure children's hearing.
+
+Thomas A. Edison, our greatest inventor, was made deaf when a lad by a
+surly brakeman, who soundly boxed his ears for some trivial or fancied
+offense.
+
+Boxing a child's ears is but one of a great many things you should never
+do to the ears. In fact, there are far more things you should not do to
+safeguard the hearing, than there are things you can do to benefit your
+ears.
+
+Do Not Pick the Ears.--Do not put cotton in the ears unless ordered to
+do so by a reputable physician. Do not syringe the ears without the
+doctor's orders. Put no poultices in the ears. Do not put drops of any
+kind in the ears unless prescribed by a doctor. Above all, do not use
+the advertised ear cures, as most of them are harmful. Never blow into a
+child's ear, never douche the nose without the doctor's orders, as this
+may wash germs into the tubes leading to the ears and bring about a
+serious condition.
+
+Riding in tunnels, especially in tunnels under water where the air
+pressure varies, has, through some recent investigation, been found to
+be injurious to the ears of a great many people.
+
+Conductors and other trainmen who run through many tunnels are apt to
+have ear trouble, as are the men who work underground a great depth
+where they are in motion, such as miners running underground trains.
+
+If you have an earache that continues for any length of time, take no
+chances, but consult a physician. And remember to care for the throat
+and nose, as ill conditions in those places result in ear troubles. Do
+not blow your nose too hard; it merely injures the inner sides of the
+ear drums. Adenoids in children frequently bring about a bad ear
+trouble. Even seasickness is due in a great measure to ear disturbances.
+
+If you have a running ear, attend to it at once by visiting a doctor. So
+serious is this that life insurance companies will not insure people in
+that condition.
+
+Earache.--When a child complains of earache its ear should be
+examined. In nearly every case of earache it is necessary to treat the
+throat, as this is, as a rule, the seat of the trouble. An antiseptic
+gargle of equal parts of Borolyptol and warm water is an excellent
+mixture. It should be used freely every two hours. Children suffering
+from earache should be kept indoors. If the examination should show that
+it is not necessary to lance the ear drum, some local measure may be
+adopted to allay the pain. Putting the child in bed with the head
+resting on a hot-water bottle may be all that will be necessary. The
+following procedure may be carried out, but only after a physician has
+made an examination and according to his directions: A hot water douche,
+given by means of a douche bag, is quite effective. The water should be
+110 deg. F.; the bag should be held about two feet above the level of the
+child's head, and the irrigating point should not be pushed into the
+ear, but held so that the water will find its own way into the ear.
+
+When the earache does not respond to the above methods the ear should be
+closely watched and examined at intervals so that it may be opened at
+the right moment. This is very essential because, if it is neglected,
+the pus may find its way into the mastoid cells and set up the dangerous
+disease, mastoiditis. This disease may cause abscess of the brain and
+death. The moment a child develops fever in the course of an earache the
+ear should be examined and opened at once, if found necessary.
+
+Inflammation of the Ear. Acute Otitis.--Inflammation of the ear seldom
+occurs in childhood, unless as a complication, or as a result of some
+infectious disease. Any disease which affects the throat in any way may
+be the cause of the inflammation of the ear. Such diseases are, "cold in
+the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles,
+scarlet fever. It is much more common in children than in adults. The
+younger the child, the more liable it is to develop ear trouble when
+suffering from any of the above diseases. The presence of adenoids
+favors the development of ear complications.
+
+Symptoms.--There is one symptom present in all cases of inflammation
+of the ear; that is, fever. Pain may or may not be present; it is
+present in a majority of the cases. Children with inflammation of the
+ear are exceedingly restless and do not sleep long at a time nor do they
+sleep soundly.
+
+Treatment.--The treatment is to open the drum membrane, at the right
+time, which of course will always be done by a physician who has had
+some experience in this work.
+
+After Treatment.--The after treatment consists of washing or syringing
+the ear every three hours with eight or twelve ounces of a 1:10,000
+solution of corrosive sublimate. This will be kept up for four days;
+then the intervals between the washing will be extended to five hours,
+and kept up until the drum membrane closes. If the corrosive sublimate
+solution should cause any eruption around the ear, a normal salt
+solution (see page 627) may be used in the same way, and in the same
+quantity as above. A running ear will run for from three to six weeks.
+It may heal up at any time after ten days. If the discharge should
+suddenly stop and the fever rise, it indicates that the opening has
+become plugged or healed too quickly. In either case it will have to be
+opened again. As soon as the ear begins running again the symptoms will
+disappear. After syringing the ear it should be dried thoroughly with
+pieces of sterile absorbent cotton.
+
+The best syringe to use for washing out the ear is a one-ounce
+hard-rubber ear syringe with a soft rubber tip. An ordinary douche bag
+will do if a syringe of the above character cannot be obtained. The
+douche bag should not be held higher than two feet above the patient's
+head. The double-current ear irrigator is an excellent device for this
+purpose. The child should be on its back on a table. Its arms should be
+fastened down by its side. A basin can be placed under its ear and the
+irrigating done without causing any pain or discomfort.
+
+Any child addicted to disease of the ear should be closely watched and
+examined for tuberculosis. Scrofula may accompany this condition. These
+children need careful attention in every little detail, they need good
+nourishment, fresh air night and day, and they should not be pushed at
+school. During the winter they should be protected from "catching
+colds;" it is a good plan to put them on a cod-liver-oil mixture for the
+entire cold season. During the summer they should have a radical change
+of climate.
+
+
+SUMMARY:
+
+1st. Inflammation of the ear is frequently a complication of or follows
+some other disease which affects the throat.
+
+2nd. If a child with one of these diseases becomes restless, sleepless
+and feverish, be on the look-out for ear trouble.
+
+3rd. The ear must be lanced immediately when necessary.
+
+4th. The after treatment is very important, because the hearing of the
+child depends upon it.
+
+
+SWOLLEN GLANDS. ACUTE ADENITIS
+
+Swollen glands in infancy and childhood are usually seen below and
+behind the ear, less frequently in the groin. Their cause is, as a rule,
+local disturbance in the mouth or throat, as decayed teeth, enlarged
+tonsils, cold in the head, catarrh, adenoids, or some form of infection
+of the mouth, or throat, or scalp. They occasionally accompany scarlet
+fever, diphtheria, measles, and influenza. They seldom suppurate.
+
+Symptoms.--A swelling is noticed just below the angle of the jaw; it
+does not grow rapidly. There is a slight temperature and the child is
+more or less irritable. If the patient is an infant, the fever may be
+quite high and there may be considerable prostration. The trouble lasts
+from four to eight weeks.
+
+Treatment.--An ice-bag constantly applied is the best treatment. This
+not only relieves pain, but it prevents the possibility of the gland
+breaking down and suppurating. It is sometimes difficult to keep an
+ice-bag on an infant, in which case cold compresses should be applied.
+These are made by taking several layers of old linen or cheese cloth and
+laying them on ice. They should be applied frequently to the swollen
+gland. The following ointment may be applied, though the ice-bag is the
+better and more certain treatment: Ichthyol 25 per cent., Adeps Lanae
+one ounce. This is applied on cloth and renewed every six hours.
+
+This ointment is black and stains the clothing. For that reason it is
+advised to use oiled silk over the cloth to avoid staining the pillow or
+clothing.
+
+Children suffering from adenitis should use a spray of Dobell's solution
+in the nose and throat three or four times daily. If the cause of the
+swollen glands is known, treatment for its cure should be promptly
+instituted.
+
+In the event of pus forming the gland must be opened and drained.
+
+Swollen glands in the groin of a child are caused most frequently by
+some inflammatory condition of the privates, which should be discovered
+and treated.
+
+
+BOILS
+
+In some delicate children and in some children who do not seem to be
+delicate, repeated crops of boils may appear from time to time.
+
+It is necessary to open them as soon as pus is present. They should be
+pressed out and a gauze dressing, wet with a saturated solution of boric
+acid, bound over them. The dressing should be kept moist.
+
+I have in a number of instances successfully rid a child of the tendency
+to boils by the use of the following formula, which I can recommend
+highly as one of the best tonics I have ever used in the treatment of
+delicate and poorly nourished children: Tinct. Nux Vomica 4 drops, Acid
+Phosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make a
+two-ounce mixture and give to children over four years of age one
+teaspoonful after each meal; to younger children, one-half teaspoonful
+after each meal.
+
+It is necessary in these cases to keep the bowels open daily.
+
+
+HIVES. NETTLE-RASH
+
+Cause.--Contact with different plants, bites of insects, irritation
+from clothing, use of certain drugs. Certain articles of food, such as
+tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause
+hives.
+
+Dentition during warm weather and the presence of worms and chronic
+malarial poisoning have been known to cause hives.
+
+It is most frequently caused, however, in childhood by some disturbance
+in the stomach or bowels.
+
+It causes severe itching and loss of sleep and as a result of these the
+general health suffers.
+
+Treatment.--If caused by any external irritant, remove it. If it is
+caused by any special article of diet, prohibit its use. If no cause is
+apparent, give the child one tablespoonful of castor oil, and put it on
+the mildest diet possible of soups, broths, and dried stale bread. Give
+no milk. Use the following treatment on the erupted parts: Menthol, ten
+grains in one ounce of cold cream. Keep the bowels open.
+
+It is sometimes necessary to advise a change of air before complete cure
+results.
+
+
+PRICKLY HEAT
+
+This is a very common complaint in children during the summer months. It
+is so common that it is well known and easily recognized. It consists of
+a bright red eruption, composed of little papules, close together.
+
+The rash comes out quickly, so much so that mothers may be surprised and
+frightened by observing an angry looking rash on their baby some morning
+when none was there the night before. It most frequently appears upon
+the neck, back, chest, and forehead. It is exceedingly itchy and a child
+may scratch itself and cause extensive harm. Eczema, of a very obstinate
+type, frequently results from scratching.
+
+The rash of prickly heat is easily diagnosed from other rashes because
+it is accompanied by no other symptom, such as fever, which would
+suggest a more serious disease. The rash of prickly heat resembles the
+rash of scarlet fever more than any other rash, but it is quickly noted
+that when a child has scarlet fever it has every symptom of being
+profoundly sick, while prickly heat has no symptom other than the itch
+and discomfort. It is caused by overfeeding, being overclothed, and
+sweating in hot weather.
+
+Treatment.--Steps should be taken to prevent prickly heat in an
+infant. Use light, seasonable clothing, bathe frequently, and use plenty
+of good toilet powder. When the child actually has an attack, open its
+bowels freely with citrate of magnesia, and give some sweet spirits of
+niter, according to age. Protect the skin from the irritating underwear
+by interposing a soft piece of linen. In order to reduce the
+inflammation and cure the condition apply equal parts of starch and
+boric acid powder freely. Keep the patient on a light fluid diet. The
+bran bath is advisable if the little patient is addicted to these skin
+eruptions.
+
+
+RINGWORM OF THE SCALP
+
+Children of all ages are liable to "catch" ringworm of the scalp. It
+particularly affects those who are untidy, dirty, and badly cared for,
+though any child is apt to get it while attending the public schools.
+
+If a mother discovers scaly patches in the scalp, with loss of hair,
+ringworm should be immediately suspected. It is not, however, always
+easy to diagnose the condition, especially if the case is a mild one. If
+it is a severe attack, there is, as a rule, quite a little inflammation,
+and this may render the condition obscure for some time. The disease may
+be mistaken for dandruff, but dandruff covers a large area of the scalp,
+while ringworm is limited and sharply defined. Dandruff may cause a loss
+of hair; if it does, the hairs come out clean, while in ringworm they
+break off near the scalp.
+
+Treatment.--Ringworm is always curable, provided the patient is
+watched and treatment carried out thoroughly. It is always absolutely
+necessary to treat the condition, because it will not get better of
+itself, and the longer it is permitted to last, the worse it gets, and
+the more difficult it is to cure. If treatment is begun at once, it may
+take two months to cure it. If the case has lasted for some time, or if
+it has been neglected and not treated thoroughly, it will take from six
+months to one year to cure it. These facts are stated so that parents
+may not become discouraged.
+
+The first thing to do is to cut the hair as close to the scalp as
+possible, wherever the ringworm is, and for about an inch outside, and
+all around it. The entire scalp should be thoroughly washed three times
+a week. The scales should be kept soft by the use of carbolic soap.
+
+The hair should not be brushed at all, because brushing the hair may
+spread the disease to other parts of the scalp. Every child with
+ringworm of the scalp should wear a cap of muslin or one lined with
+paper, so that others may not be infected. These caps can be burned when
+dirty and new ones made. One of the best remedies to apply to the
+affected area is the following: Bichloride of mercury, 2 grains; olive
+oil, 2 teaspoonfuls; kerosene, 2 teaspoonfuls. This is rubbed in every
+day until the parts are sore and tender. It is a good plan to apply this
+mixture to the entire scalp every fourth day, to guard against other
+parts becoming infected. It is not necessary to rub it in when using it
+where there is no ringworm.
+
+When the scalp becomes sore from the application it can be stopped for a
+day or two, or until better; then begin again and repeat the treatment
+right along. If the kerosene in the above mixture is objected to, a very
+good mixture is bichloride of mercury, 2 grains, and tincture of iodine,
+1 ounce. This may be rubbed vigorously enough to produce a rash. If the
+disease shows a tendency to spread under this treatment it is best to
+apply the latter mixture to the entire scalp.
+
+Ringworm on any other part of the body is effectually treated by
+applying tincture of iodine. It should be painted on every day until the
+skin begins to peel, when the ringworm will disappear with the skin.
+
+
+ECZEMA
+
+Eczema is the most important skin disease of babyhood. It is probably
+the most frequent skin disease of infancy. Any baby may develop eczema.
+There are, however, some babies who seem to be very susceptible to it.
+The reason of this susceptibility seems to be due to the natural
+tenderness, or delicacy, of the skin. These children, because of the
+extreme sensitiveness of the skin, develop an eczema from a very slight
+degree of external irritation, or a trifling disturbance of digestion.
+Children of rheumatic or gouty parents are more liable to be victims of
+eczema than are others. Eczema of the face is quite common in children
+who are apparently healthy and fat. It does not seem to matter whether
+they are breast-fed or bottle-fed. The following conditions may be
+regarded as contributory to eczema:
+
+Exposure to winds; cold, dry air; heat; the use of hard water or strong
+soaps; lack of cleanliness, and the irritation of clothing. It
+frequently accompanies chronic constipation, indigestion, and other
+conditions of the intestinal canal; overfeeding; too early or too
+excessive use of starchy foods.
+
+Eczema of the Face:--Eczema Rubrum.--This is the most frequent form.
+It affects the cheeks, scalp, forehead, and sometimes the ears and the
+neck. It begins on the cheeks as small red papules. These join together
+and form a mass of moist, exuding crusts. They dry in time and may be so
+thick as to form a mask on the face. The skin may be much swollen. When
+the crusts are removed the face looks red and angry and bleeds easily.
+It is exceedingly itchy. It causes restlessness, loss of sleep, and it
+may affect the appetite, though, as a rule, the health remains good.
+Eczema of the face is exceedingly chronic; it improves from time to
+time, but it is cured with great difficulty only.
+
+Infants suffering with eczema of the face begin to improve about the
+middle of the second year and may be entirely cured about this time. The
+reason of this is the greater amount of exercise the child is getting at
+this period. If the disease continues longer it is because of the
+unnecessary amount of fat that the child has.
+
+Treatment.--Eczema is a notoriously tedious disease. There is very
+little tendency for it to improve, if left to itself. The age, the
+severity, and just how much you can rely upon the mother, or nurse,
+faithfully to carry out directions--upon these its cure depends. At
+best, the treatment may have to be carried out for months. If the eczema
+is accompanied with constipation and indigestion in infancy, very little
+can be done with the eczema until these conditions are removed.
+
+There exists in the minds of the laity, and in some physicians also, an
+idea that it is wrong, or dangerous, to cure, or "dry up," an eczema. It
+is never dangerous, but highly desirable, to cure an eczema, whenever
+possible. It is always wise, because it is always necessary, to get the
+child in perfect condition before you treat the eczema. Cure the
+constipation, or indigestion, or cold, or whatever is the matter with
+the child; then treat the eczema. This is the only plan that offers any
+success. It is not a simple matter to find out why a nursing child is
+having indigestion. The most minute care must be exercised to find out
+the element in the milk that is causing the eczema. It would, however,
+be foolish, and a waste of time, to apply pastes, etc., to an eczema of
+the face, while the real cause that produced it was still in existence.
+It will frequently be found necessary to change the food entirely.
+Strict attention to the bowels is essential, both in infants and in
+older children. Sometimes to cure the constipation means an immediate
+cure of the eczema.
+
+If the child is anemic, poorly nourished, and flabby, tonics are
+advisable. Cod liver oil is of use in quite a number of these cases.
+Eczematous children should not be taken out when the weather is very
+cold or when there are high winds. They should not be washed with plain
+water, or with castile soap and water. When washing is necessary, do it
+with milk and water, to which one teaspoonful of borax is added. The
+clothing must not be too heavy.
+
+In eczema of the face, the child must either wear a mask or heavy woolen
+gloves, so that he will not scratch the parts. Frequently these fail,
+and it will be necessary to restrain the child from scratching the face
+by the use of some mechanical device. A piece of strong pasteboard
+bandaged on the elbows, so as to prevent the child from bending them, is
+all that is necessary. If the child cannot bend the elbows he cannot
+scratch his face, yet he has the free use of his hands.
+
+The use of external remedies is imperative, as frequently the cause is
+mostly external, and in other cases it must be used in addition to the
+general treatment. Before external treatment is instituted, the crusts
+should be softened by applying olive oil to them for twenty-four hours,
+after which they can be removed with soap and water. If there is much
+inflammation, or if the face looks angry, a very good application is
+Lassar's paste.
+
+Later, when the inflammation has subsided and the itching is severe, a
+mixture of tar ointment, 3 teaspoonfuls; zinc oxide, 1-1/2 teaspoonfuls;
+rose water ointment, 6 teaspoonfuls has proved to be one of the very
+best.
+
+When the eczema on the face is of the weeping, or moist, variety, the
+application of bassorin paste gives splendid results.
+
+When an external remedy is applied to any eczematous surface it is
+necessary to apply it on a cloth. Simply to smear it on will do no good.
+
+In the treatment of eczema, when the children are breast-fed, it is well
+to remember that the real cause of the eczema may be in the mother. If
+the mother is constipated, or if her diet is too liberal, if she is
+drinking beer, or an excess of coffee, or is not taking exercise, the
+eczema may be caused by one or other or all of these.
+
+For eczema of the scalp the remedy to use is white-precipitate ointment,
+1 part; vaseline, 4 parts. Mix together and apply.
+
+
+POOR BLOOD. SIMPLE ANEMIA
+
+Causes.--There is what may be termed an unnatural tendency toward poor
+blood during infancy and childhood. The explanation of this anomalous
+condition is, that the tax or strain put upon the blood to provide for
+the growth of the child is severe, and is in addition to the great
+demands made upon it in the exercise of its regular duties. We must,
+therefore, always take this special duty into consideration, when the
+question of recuperation, convalescence, feeding, and the administration
+of blood foods and tonics comes up.
+
+It is not necessary to specify the diseases from which a child may
+suffer and recover, in an anemic condition. Any disease may leave a
+child with temporarily poor blood. The conditions which most frequently
+produce anemia in childhood are improper feeding and unhealthy
+surroundings. It is not fully appreciated how seriously these conditions
+can affect the health of growing children. There is one condition that
+every mother should be warned against, namely, the possibility of unduly
+prolonging breast-feeding. Children should be weaned at the end of the
+tenth month. By prolonging the breast-feeding a mother can undermine the
+vitality and strength of her baby and so impoverish its blood as to
+invite disease. A bottle-fed baby should be put upon a mixed diet at the
+same time. To continue feeding a child exclusively on milk for a year
+or two after weaning, simply because "it will not take anything else,"
+is criminal. Any woman guilty of such stupidity should never have become
+a mother. Once again it must be emphasized that every child must have an
+abundance of fresh air, must not be confined in close, hot, unsanitary
+rooms, and must have a daily, satisfactory movement of the bowels to be
+a healthy child with good blood in its body.
+
+Symptoms.--Children suffering from poor blood are flabby, constipated,
+hungry, weak specimens of childhood. They are under weight, complain of
+headache, pains, disturbed sleep, are nervous and irritable. They tire
+quickly, are short of breath, and may have a tendency to faint easily.
+The hands and feet are cold, the pulse is small and irregular. They may
+have attacks of nose-bleeding and of bed-wetting.
+
+Chlorosis.--Chlorosis is that form of anemia, of poor blood, which
+occurs in young girls about the time their sickness begins. It is most
+frequently seen between the fourteenth and seventeenth years, and more
+often in blondes than in brunettes. The cause is not known. It is
+thought to be due to constipation. Any occupation which is deleterious
+to health has a distinct influence on the condition. Employment in
+factories, confinement in badly ventilated rooms, bad or insufficient
+food, great grief, care, or a bad fright, mental strain, overstudy, may
+all produce, or contribute to the production of chlorosis.
+
+Symptoms.--The symptoms of chlorosis resemble those of simple anemia.
+Children suffering from anemia are pale; girls with chlorosis have a
+peculiar greenish yellow tint in the skin. They are short of breath,
+they have vertigo, palpitation, disturbances of digestion, constipation,
+cold hands and feet, and scanty or arrested monthly periods. They have
+various nervous disturbances, such as headache, pains in various parts
+of the body, neuralgia, especially over the eyes, hysterical attacks,
+and sometimes cholera. Ulcer of the stomach is sometimes seen in this
+condition.
+
+The disease lasts for a year or longer; it frequently lasts a number of
+years. Relapses are frequent.
+
+[Illustration: By permission of Henry H. Goddard
+
+"A Misfortune at Birth"]
+
+Warren is feeble-minded. His family said it was due to "a serious fall
+of the mother."
+
+     [A]"The family history is, however, exceedingly interesting.
+
+     "The paternal grandfather, whom we have called Nick, was of good
+     family, although he himself was totally different from the rest. He
+     was weak in every way, and to be considered feeble-minded. He
+     married into a family that was much lower socially than his own,
+     although we have no proof that it was a defective family. The
+     children of this couple were all mentally defective and low-grade,
+     morally as well as intellectually.
+
+     "Warren's father, Jake, a thoroughly disgraceful character, married
+     Sal, a woman somewhat older than he.
+
+     "The immorality of this family beggars description. A girl named
+     Moll was fifteen years old when Jake brought her into his home: his
+     wife, Sal, was so feeble-minded that she allowed the illicit
+     relations between these two. Moll's child was born in the hospital
+     after the mother had been sent away from one Home because of her
+     horrible syphilitic condition--from which she finally died.
+
+     "Our boy Warren's sister Liz with whom the father lived in
+     incestuous relations, was also allowed to live illicitly with a man
+     who worked for her father. She was so simple that she talked openly
+     about her relations with her father and with this man. When a child
+     was to be born the man married her.
+
+     "This is not all, but enough: and sufficient to show what
+     feeble-mindedness leads to when it takes the direction of sexual
+     abuses."
+
+[A] "Feeble-mindedness: Its Causes and Consequences, Goddard, The
+Macmillan Company.
+
+Severe Anemia: Pernicious Anemia.--This is the most severe form of
+anemia, or the condition in which we have the poorest blood. While this
+condition frequently results in death the others rarely ever do. This
+condition is not common in childhood.
+
+Symptoms.--There is intense weakness and prostration. The skin is very
+pale, the mucous membranes are bluish white. The breath is markedly
+short and there is often dropsy of the limbs and feet. Fever is often
+present and quite high. The disease lasts a number of months; the
+patient often feels better for a time, then relapses into a more serious
+condition than before.
+
+
+TREATMENT OF THE VARIOUS FORMS OF ANEMIA
+
+Simple Anemia.--Find the cause and stop it. In infancy special
+attention should be given to diet and hygiene, giving the child plenty
+of fresh air, and a change of air to the country or seashore if
+necessary. The general treatment is more important than any benefit that
+may be derived from drugs. The rules laid down in the articles on
+"Malnutrition" must be closely followed in these children.
+
+Chlorosis.--In this form of anemia, or poor blood, it is best to give
+iron. Change of air and change of scene are of special importance in
+these cases and will frequently cure. The general condition of course
+must not be overlooked. The diet, exercise, bowels, habits, should
+receive careful attention. Iron should be continued for a number of
+months after all traces of the anemia have disappeared.
+
+Pernicious Anemia.--For this condition arsenic is the one remedy
+needful. In all conditions of poor blood the most careful attention
+should be given to the general health. Colds must be guarded against.
+The patients should never get their feet or their clothes wet. Muscular
+exercise, because of the weak condition of the heart, should be
+moderate, and only given on the advice of a physician. It is frequently
+necessary to stop all forms of exercise and in many instances we get the
+best results by directing complete rest in bed for a considerable part
+of the day or for all day if the case demands it.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVII
+
+DISEASES OF CHILDREN, CONTINUED
+
+Rheumatism--Malaria--Rashes of Childhood--Pimples--Acne--
+Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
+Incontinence--Sleeplessness--Disturbed Sleep--Nightmare--Night Terrors--
+Headache--Thumb-sucking--Biting the Finger Nails--Colon Irrigation--
+How to Wash Out the Bowels--A High Enema--Enema--Methods of Reducing
+Fever--Ice Cap--Cold Sponging--Cold Pack--The Cold Bath--Various Baths--
+Mustard Baths--Hot Pack--Hot Bath--Hot Air, or Vapor Bath--Bran Bath--
+Tepid Bath--Cold Sponge--Shower Bath--Poultices--Hot Fomentations--How
+to Make and How to Apply a Mustard Paste--How to Prepare and Use the
+Mustard Pack--Turpentine Stupes--Oiled Silk, What it is and Why it is
+Used.
+
+
+RHEUMATISM
+
+This is a rather common disease of childhood. It occurs most frequently
+between the ages of nine and thirteen years. Children can have it,
+however, at any age.
+
+The symptoms of rheumatism in children are much the same, though
+somewhat milder, as when the disease is present in an adult. Children
+are not quite as sick, nor is the fever as high, nor is the pain as
+great as in a grown person. In children the disease does not last as
+long, as a rule. Sometimes it will jump from one joint to another, and
+may, as a consequence, become chronic. When a child has once had
+rheumatism, it has the same disposition to recur that it has in adults.
+The principal danger of rheumatism in children is its tendency to attack
+the heart. Even mild attacks of the disease can do serious damage to the
+heart.
+
+Children who have the rheumatic tendency invariably suffer from
+inflammatory conditions of the upper respiratory tract. They are prone
+to have recurring colds, tonsilitis, and sore throats. Treatment of
+conditions without regard to the underlying rheumatism is never
+satisfactory. These children complain of indefinite pains, now in one
+place, now in another. These pains are commonly known as "growing-pains"
+and, inasmuch as they are rheumatic and not "growing pains," they should
+be regarded seriously because of the heart damage they might do if
+ignored, and especially so since the mildest attacks of rheumatism,
+without any joint symptoms even, frequently leave the heart in very bad
+shape. As a general rule it will be found that when a child has had a
+number of attacks of bronchitis or asthma it is rheumatic and should
+receive treatment for the rheumatic tendency.
+
+Children with the tendency to rheumatism invariably eat too much red
+meats and sugar,--the latter in the form of candy or as an excess in the
+food.
+
+Treatment of an Acute Attack.--The child should be put in bed and kept
+warm. The bowels should be freely opened with citrate of magnesia. The
+diet should be very light: milk and lime water or milk and vichy water,
+with a piece of dry toast or zwieback, is all the child needs until the
+fever is relieved. When a single joint is affected local measures may be
+taken for its relief. Wraping the joints up with flannel cloths which
+have been wrung out of true oil of wintergreen, and outside of this
+oiled silk snugly bandaged on, is an excellent external application. The
+flannel cloths should be kept moist by adding a little of the
+wintergreen from time to time as it dries in. This can be done without
+removing the bandage. This application is kept in place for twenty-four
+hours and renewed if necessary. Such an external application will aid in
+the actual cure of the disease and will quickly relieve the patient of
+the pain. The oil of wintergreen used in this way should be the "true"
+oil, and should be so specified when bought in the drug store.
+
+Because of the great tendency to attack the heart a physician should
+take charge of every case of acute rheumatism in a child.
+
+To Treat the Tendency to Rheumatism.--Exclude red meats and sugar in
+all forms as much as is possible. Give green vegetables freely, potatoes
+boiled with the skins on, fish, eggs, and poultry. Cereals with milk,
+especially well cooked Scotch oatmeal, are exceedingly good for these
+children. By keeping up this diet after the acute attack has passed for
+a considerable time, it is possible to cure the various other complaints
+with which the child is afflicted,--tonsilitis, sore-throats, winter
+coughs, head-colds, bronchitis, asthma, etc.
+
+These children should wear woolen underwear all the year round. They
+should be encouraged to drink water or vichy freely between meals.
+
+In the treatment of an acute attack as given above it will be observed
+that no drugs are mentioned. This is intentional because it would be
+unjust to encourage the home treatment of a disease that is so
+treacherous, even in its mildest forms. Because of its tendency to recur
+and with each recurrence the danger of the heart being affected, it is
+advisable to put these children on cod liver oil or iron or some other
+good tonic. Every precaution should be taken to prevent these children
+from getting their feet wet or being out in the rain.
+
+
+SUMMARY:--
+
+Rheumatism is a dangerous disease in children.
+
+In its mildest forms it can affect the heart badly.
+
+It has a distinct tendency to recur.
+
+Rheumatic children are afflicted with a number of diseased conditions
+which do not respond to treatment unless the rheumatism is treated.
+
+Acute rheumatism should never be treated except by a physician because
+of its treacherous character.
+
+
+MALARIA. INTERMITTENT FEVER
+
+Malaria occurs quite often in infants and children. As a rule the child
+gives evidence of gastro-intestinal disturbance for a short period
+before the malarial symptoms appear. The chilly stage is often absent.
+Sometimes the hands and feet are cold and may be slightly blue and the
+child may appear to be in collapse. This stage may last for an hour or
+longer. The chilly stage may, however, be replaced by nervous
+symptoms,--restlessness, dizziness, irritability, nausea, etc.,--or a
+convulsion may take place. In the second stage the temperature may rise
+quite high, the pulse may be quite rapid; the child is flushed,
+restless, and cries. This period may last from half an hour to two
+hours. The sweating stage is not as a rule well marked in a child. It
+may be very slight or not at all.
+
+Between the attacks some children may be entirely well; others remain
+restless, have little appetite and poor digestion. Malaria in children
+does not always follow a typical course. We often see children suffering
+from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin
+eruptions, all due to the malarial condition. This often leads to a
+mistake in diagnosis. Intermittent fever is often mistaken for
+pneumonia. Malaria is not a favorable disease for an infant to have. It
+rapidly weakens the child and great debility and anemia follows.
+
+Treatment.--The treatment for malaria in children is by the
+administration of quinine as in adults. It must, however, be given with
+care and intelligence; for this reason no mother should begin dosing her
+child with it without consulting a physician.
+
+
+REGARDING MOSQUITOES
+
+The following is an extract from a circular in relation to the causation
+and prevention of malaria and the life history and extermination of
+mosquitoes issued by the Department of Health, City of New York:
+
+     Extermination and Prevention of Mosquitoes.--Mosquitoes require
+     for their development standing water. They cannot arise in any
+     other way. A single crop soon dies and disappears unless the
+     females find water on which their eggs may be laid. In order to
+     prevent mosquitoes, therefore, the requirement is simple.
+
+     No Standing Water.--Pools of rain water, duck ponds, ice ponds,
+     and temporary accumulations due to building; marshes, both of salt
+     and fresh water, and road-side drains; pots, kettles, tubs,
+     springs, barrels of water, and other back-yard collections, should
+     be drained, filled with earth, or emptied.
+
+     Running streams should have their margins carefully cleaned and
+     covered with gravel to prevent weeds and grass at the water's edge.
+
+     Lily ponds and fountain pools should, if possible, be abolished; if
+     not, the margins should be cemented or carefully graveled, a good
+     stock of minnows put in the water, and green slime (Algae) regularly
+     cleaned out, as it collects.
+
+     Where tanks, cisterns, wells or springs are necessary to supply
+     water, the openings to them should be closely covered with wire
+     gauze (galvanized to prevent rusting), not the smallest aperture
+     being left.
+
+     When neither drainage nor covering is practicable, the surface of
+     the standing water should be covered with a film of light fuel oil
+     (or kerosene) which chokes and kills the larvae. The oil may be
+     poured on from a can or from a sprinkler. It will spread itself.
+     One ounce of oil is sufficient to cover 15 square feet of water.
+     The oil should be renewed once a week during warm weather.
+
+     Particular attention should be paid to cess-pools. These pools when
+     uncovered breed mosquitoes in vast numbers; if not tightly closed
+     by a cemented top or by wire-gauze, they should be treated once a
+     week with an excess of kerosene or light fuel oil.
+
+     Certain simple precautions suffice to protect persons living in
+     malarial districts from infection:
+
+     First: Proper screening of the house to prevent the entrance of the
+     mosquitoes (after careful search for and destruction of all those
+     already present in the house), and screening of the bed at night.
+     The chief danger of infection is at night (the Anopheles bite
+     mostly at this time).
+
+     Second: The screening of persons in malarial districts who are
+     suffering from malarial fever, so that mosquitoes may not bite them
+     and thus become infected.
+
+     Third: The administration of quinine in full doses to malarial
+     patients to destroy the malarial organisms in the blood.
+
+     Fourth: The destruction of mosquitoes by one or more of the methods
+     already described.
+
+     These measures, if properly carried out, will greatly restrict the
+     prevalence of the disease, and will prevent the occurrence of new
+     malarial infections.
+
+     It must be remembered that when a person is once infected, the
+     organisms may remain in the body for many years, producing from
+     time to time relapses of the fever.
+
+     A case of malarial infection in a house (whether the person is
+     actively ill or the infection is latent) in a locality where
+     Anophele mosquitoes are present, is a constant source of danger,
+     not only to the inmates of the house, but to the immediate
+     neighborhood, if proper precautions are not taken. It should be
+     noted in this connection that the mosquitoes may remain in a house
+     through an entire winter and probably infect the inmates in the
+     spring upon the return of the warm weather.
+
+     Malarial fever is prevalent in certain boroughs of New York City,
+     and in view of the presence of standing water resulting from the
+     extensive excavations taking place in various parts of these
+     boroughs, is likely to extend, if means are not taken for its
+     prevention.
+
+
+REGULATIONS OF THE BOARD OF HEALTH, NEW YORK CITY, IN AID OF MOSQUITO
+EXTERMINATION AND THE PREVENTION OF MALARIAL FEVER
+
+(In Force from March 15 to October 15.)
+
+1. No rain-water barrel, cistern, or other receptacle for rain-water,
+shall be maintained without being tightly screened by netting, or so
+absolutely covered that no mosquito can enter.
+
+2. No cans, pails, or anything capable of holding water, shall be thrown
+out or allowed to remain unburied on or about any premises.
+
+3. Every uncovered cesspool or tank shall be kept in such condition that
+oil may be freely distributed so as to flow over the surface of the
+water. Covered cess-pools must have perfectly tight covers, and all
+openings must be screened.
+
+4. No waste or other water shall be thrown out or allowed to stand on or
+near premises.
+
+Information is requested as to the presence of standing water anywhere,
+so that the premises may be inspected and the legal remedies against the
+same be applied.
+
+The prompt cooeperation of all persons in the enforcement of the above
+regulations is earnestly desired, and they are assured that in this way
+the breeding of mosquitoes on their premises may be prevented.
+
+Mosquitoes are, so far as known, the only means of conveying malaria.
+
+
+"RASHES" OF CHILDHOOD
+
+The following table gives all the characteristics of the rashes that
+accompany the eruptive fevers. The term "incubation" means the period of
+time which elapses between the time when the child was exposed to, or
+caught the disease, and the time when the child is taken sick. It is
+sometimes interesting to know where a child could have caught a disease;
+so if we know the incubation period we can tell exactly where the child
+was on the day, or days, when it was infected.
+
+-----------+------------+-----------+-----------------+----------+---------+
+Name       | Incubation |Day of Rash|Character of Rash|Rash fades|Duration
+-----------+------------+-----------+-----------------+----------+---------+
+Measles    | 10-14 days | 4th day   |Small red like   |On the    |6-10
+           |            |           |spots resembling |7th day   |days
+           |            |           |flea bites, first|of fever  |
+           |            |           |appearing on face|          |
+           |            |           |and forehead,    |          |
+           |            |           |forming blotches |          |
+           |            |           |with semi-lunar  |          |
+           |            |           |borders.         |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Scarlet    | 1-6 days   | 2d day of |Bright scarlet,  |On 5th    |8-9 days
+Fever      |occasionally|   fever   |rapidly diffused,|day of    |
+           | longer     |           |first on chest   |fever     |
+           |            |           |and upper        |          |
+           |            |           |extremities.     |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Chicken-pox| 4-12 days  | 2d day    |Small rose       |Slight    |6-7 days
+           |            |           |vesicles, which  |scab of   |
+           |            |           |do not become    |short     |
+           |            |           |pustular         |duration  |
+-----------+------------+-----------+-----------------+----------+---------+
+Typhoid    | 10-14 days | 7-14 days |Rose colored     |          |From
+Fever      |            |           |papules elevated,|          |21-35
+           |            |           |few in number,   |          |days
+           |            |           |limited to trunk,|          |
+           |            |           |disappear on     |          |
+           |            |           |pressure.        |          |
+-----------+------------+-----------+-----------------+----------+---------+
+Smallpox   | 10-14 days | 3d day of |Small, round,    |9th day   |14-21
+(Variola)  |            | fever     |red, hard,       |scabs     |days
+           |            |           |papules forming  |form and  |
+           |            |           |vesicles then    |about     |
+           |            |           |pustules, first  |14th day  |
+           |            |           |appearing on face|fall off  |
+           |            |           |and wrists.      |          |
+-----------+------------+-----------+-----------------+----------+---------+
+
+Other Rashes.--There are so-called "stomach" rashes which are a source
+of much worry to mothers. These rashes may appear at any time and they
+may be limited to certain parts or may cover most of the body. They may
+be bright red, or they may be simply a general discoloration. They may
+appear as blotches or they may spread all over, like the rash of scarlet
+fever when at its height.
+
+These rashes are of no importance, except that they indicate some
+derangement of the gastro-intestinal tract. As a rule they indicate
+indiscriminate feeding or overfeeding. Children who have had too much
+candy or pastries, or who have been fed things which are unsuited to
+their age, frequently develop rashes. Such children should have a
+thorough cleaning out; a dose of castor oil is probably the best
+cathartic to give them.
+
+The mother may readily learn to know the difference between a rash that
+is unimportant and one that indicates one of the eruptive diseases, if
+she gives the matter a little careful thought. In the first place a
+child who is about to become the victim of one of the eruptive diseases
+will be sick, and will have a fever for two or three days before any
+rash appears; while on the other hand a child may go to bed in good
+health and may next morning be covered with a general rash, or with
+large blotches, without any fever and without any evidence of
+ill-health, except the skin condition. In the second place, if the
+mother gives the child a cathartic and restricts the diet for a day the
+rash will disappear, and good spirits and good health will be
+maintained; on the other hand, the giving of a cathartic to a child who
+is the victim of an eruptive disease will not tend to diminish the rash,
+but may accentuate it.
+
+Pimples: Blackheads (Acne).--This eruption is situated chiefly on the
+face. It may appear, however, on the back, shoulders, and on the chest.
+It is mostly seen in young men and women about the age of puberty. It
+appears as conical elevations of the size of a pea; they are red and
+tender on pressure, and have a tendency to form matter, or pus, in their
+center. In from four to ten days the matter is discharged but the red
+spots continue for some time longer.
+
+"Blackheads" appear as slightly elevated spots of a black color out of
+which a small worm-like substance may be pressed. Pimples and blackheads
+are due to inflammation of the glands of the skin. The mouths of these
+glands become filled with dust which acts as a plug causing the
+retention of the oily matter of the gland which becomes inflamed and
+hence the pimples and blackheads. Certain constitutional conditions
+favor the development of these skin blemishes. Constipation,
+indigestion, bad blood from unsanitary and bad hygienic surroundings,
+self-abuse and bad sexual habits favor the appearance of these skin
+affections.
+
+Treatment.--The patient must avoid tea, coffee, tobacco, alcohol,
+veal, pork, fats, candy, pastries, cheese, and all edibles that are
+known to disagree with the digestion of the patient. Constipation must
+be avoided; if necessary, laxatives may be taken to keep the bowel open.
+The blackheads must be squeezed out with an instrument made for the
+purpose, not with the finger nails. Pimples must be opened with a
+sterile needle. The parts should be washed three times a day with hot
+water and green soap, and the following mixture applied at night:--
+
+  Zinc Oxide            ounces    1/4
+  Powdered calamine     ounces    1/4
+  Lime water            ounces  6
+
+Mix and shake before applying to the skin.
+
+
+CONVULSIONS. FITS. SPASMS
+
+Convulsions are quite common in children, especially those under three
+years of age.
+
+A convulsion in an infant immediately, or within three months, after its
+birth is the result of injury, either at birth or later (a fall for
+example) which seriously affects the brain itself. After the third month
+the cause of fits or convulsions is, in a very large percentage of the
+cases, to be found in errors of diet resulting in disturbances in the
+stomach or bowels--eating of articles of food difficult to digest, as
+green or overripe fruit, salads, fresh bread, pickles, cheese, etc.
+Children of a nervous temperament are more liable to convulsions than
+are others. Females are more frequently victims of fits than are male
+children.
+
+In infants convulsions often result from changes in the mother's milk.
+Mental excitement, deep emotion, anger, frights, severe affliction and
+distress will so affect a woman's milk that it will cause convulsions in
+her child if she nurses it while under the influence of any of these
+conditions.
+
+Convulsions may result from any condition that disturbs the nutrition of
+the child, as, for example,--exhaustion, anemia, intestinal indigestion,
+blood poison, and general weakness resulting from some severe sickness,
+especially those of the digestive organs.
+
+Various forms of brain disease cause spasms and fits; the most common
+are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions
+may accompany certain conditions, as, the presence of worms, teething,
+severe burns, foreign bodies in the ear, whooping cough, pneumonia
+scarlet fever, malaria, sometimes measles, typhoid fever, and
+diphtheria. Children who are badly nourished and who live constantly in
+unsanitary surroundings are more apt to have convulsions than those who
+are well nourished and who live hygienically. One attack renders the
+patient more liable to another, and when the "habit" is established any
+trivial cause may incite a convulsion; persistent and systematic efforts
+should therefore be taken to prevent the attacks. The best preventives
+are:
+
+1st. To regulate the diet and the bowels.
+
+2nd. Remove adenoids and worms, if they exist.
+
+3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries,
+candies and all improper foods.
+
+4th. Guard the child against catching cold, infectious diseases and all
+fevers. In other words, save the child from the cause and the convulsion
+will not take place.
+
+By regulating the bowels we mean that everything the child eats must be
+seen by the mother, must be with the mother's permission, and must be
+suited to the child's age. If there is any question about the latter it
+will be advisable to have a physician write out a list of articles
+suitable to the child. It is generally necessary to eliminate meats,
+pastries, candies, sugar to a large extent, gravies, salads, sauces, and
+all the extras of the table, as pickles, mustard, relish, etc., as well
+as coffee, tea, cocoa, and alcohol.
+
+The child should live in the open air as much as possible; a daily warm
+bath, followed by a quick, cold sponge, is a necessity.
+
+Children subject to fits are possessed of a highly nervous temperament.
+They are difficult to manage unless managed with firmness and tact. It
+is not necessary to be harsh, but it is imperative to be firm and
+decided. They must be made to realize that they are not "the master,"
+that their will is not supreme, and the mother must exact this
+condition; otherwise these children will become dictators and selfish
+despots--ruining the discipline of the home, spoiling their own chance
+of physical health, and rendering unhappy everyone around them. The
+parents, therefore, have a definite duty to perform and it is not an
+easy one. The food should be so regulated that each day a natural
+movement of the bowels will take place. (See article on constipation,
+page 303.) If a day should pass without a movement the child should be
+given a hot rectal enema as described on page 586.
+
+The adenoids can be easily demonstrated to either exist or be absent.
+(See page 519.) If worms are known to be present in the child they
+should be at once removed. If they are simply suspected, the child
+should receive treatment for them, just the same. (See page 549.)
+
+By going a long time without a convulsion the nervous system will
+recuperate itself, and become so strong and healthy that what once would
+cause a fit will make no impression in its new strengthened state;
+therefore, if you "save the child from the cause," the convulsions will
+cure themselves, as it were.
+
+There are some cases of convulsions for which no satisfactory
+explanation can be found.
+
+Treatment.--When a child has a convulsion, remove its clothing and put
+it into a mustard bath. The temperature of the bath should be 105 deg. F.
+Every part of the child should be under the water except the head, which
+is supported in the palm of the hand. While it is in the bath its body,
+and especially its arms and legs, should be briskly rubbed by the hands
+of an assistant in order to keep the circulation active. A rectal
+injection of soap suds or plain salt and water (see page 579) should be
+given while the child is in the bath, because, as explained above, a
+large percentage of these cases are caused by gastro-intestinal
+derangements. The rectal injection will likely remove the cause. An
+ordinary convulsion lasts from five to ten minutes. When the child is
+removed from the bath it should be placed in a warm, comfortable bed and
+kept absolutely quiet. A hot-water bottle may be put near its feet and
+an ice-bag or cold cloths should be kept on its head. It should be given
+a full dose of castor oil and allowed to go to sleep. Its diet should
+consist of light broths for two or three days and during this time it
+should not be disturbed or annoyed by too much attention. This is as far
+as it is wise or safe for any mother to go in the treatment of
+convulsions. A physician should be called in every instance, because a
+convulsion should never be regarded lightly. Many children have become
+idiots, others have been afflicted with paralysis, because of
+inattention at the proper time.
+
+
+SUMMARY:--
+
+1st. Convulsions must always be regarded as serious.
+
+2nd. Convulsions demand prompt treatment.
+
+3rd. Every mother should know that an English mustard bath--hot--is the
+first resort in convulsions.
+
+4th. While this is being done she can read the home treatment in this
+book and carry it out before the doctor comes.
+
+5th. If the fit is not caused by some stomach or intestinal trouble,
+have the physician find out the cause and tell you what to do, and do it
+faithfully, because if you neglect the proper treatment the child may
+become idiotic or paralyzed.
+
+
+BED WETTING. ENURESIS--INCONTINENCE
+
+Enuresis, or incontinence of urine, is customary in infancy. Just when
+urination becomes a voluntary act depends upon the development and
+training of the individual child. As a rule children can be taught to
+control this function during the day, or while awake, about the tenth
+month. It is not under control during sleep until a much later period,
+usually by the end of the second year, but lack of control should not be
+regarded as abnormal until the child has entered the fourth year. If the
+child fails to control the act of urination during the day at the end of
+the second year, and is addicted to habitual bed-wetting, some measures
+should be adopted to cure the condition.
+
+Boys under twelve years of age seem to be affected more frequently than
+girls. It is wrong to assume that it is caused by negligence or
+laziness, as some parents do. It has generally a special cause, and the
+cause usually can be found if it is carefully sought for. It may be the
+result of bad habits: exposure to cold in the night; lying on the back;
+drinking too much liquid in the afternoon or at bedtime. It may be due
+to too much acid in the urine, and if so it will be found necessary to
+reduce meats and eggs the child is eating. Worms, stone in the bladder,
+some anatomical abnormality or deficiency, may be responsible for it.
+The diet may be at fault; adenoids are supposed by some physicians to be
+the cause. No matter what the actual cause may be, it must be found and
+remedied before we can hope for a permanent cure. A very large majority
+of these cases are due to nervousness. These children are of a nervous
+temperament. They are not necessarily sickly children; they are simply
+of a nervous type. They are well-nourished, active, and lively.
+Incontinence of urine during the day and long-continued bed-wetting does
+not at all affect the health of the child. If they are in poor health,
+it is essential to treat their general condition before trying to cure
+the incontinence.
+
+It is absolutely wrong to punish or to crush the spirit of these
+children. Constant nagging and taunting, even if done in the hope of
+shaming the child into a cure, will simply make a coward of him and will
+not aid in improving matters, but will be distinctly detrimental.
+
+Scrupulous cleanliness must be constantly practiced or these children,
+if neglected, may develop ulcers and sores of a very obstinate
+character. The odor is also bad for the health of the child.
+
+Treatment.--Find and remove the cause if possible. If due to general
+poor health, give tonics, obtain a change of air, and build the child
+up. Reduce the total quantity of liquids, if in excess, and be very
+careful not to give any liquids near bedtime. Don't cover these children
+too much; they should never be "too warm"; they should sleep in a
+well-aired room, and they should receive a quick, cool sponge bath every
+morning. They should be taught to sleep on their sides, never on their
+backs. Their diet should be light but nourishing. When bed-wetting is
+established it will continue, if untreated, until the child is eight or
+ten years of age, and it frequently lasts much longer. When treatment is
+undertaken it should be distinctly understood by the mother that it will
+take many months to cure; and during these months she must give her
+constant attention to the child. If she does not undertake to do this,
+or if she fails to do it, the treatment should not be begun at all, as
+it will not succeed. Various plans should be tried to keep the child
+from sleeping on its back. The reason of this is because it has been
+found that the child wets the bed only when sleeping on its back and
+never when sleeping on its side. The simplest method, of tying a towel
+or cloth around the child with a knot over the spinal column, so that it
+will hurt and waken it, if it turns on its back, is a very good one and
+should be carefully tried for some time. The nervous system of these
+children should never be overtaxed at home or at school. Early hours and
+plenty of sleep are desirable. Certain articles of diet of a stimulating
+character should be entirely avoided,--for example, coffee, tea, beer,
+candies, sugars, and pickles. The best diet for these children is one
+composed exclusively of milk, vegetables, fruits, meats, and cereals.
+Meats, however, should be given only once every two days. It is a good
+plan to teach the child to hold his water during the day, as long as he
+can, to accustom the bladder to being full. Adenoid growths, which
+contribute to the nervousness of a naturally nervous child, should be
+removed. It is a good plan to take the child up when the parents go in
+bed and let him urinate. This often cures the condition in itself.
+
+Sometimes moral measures, such as the promise of a reward, will
+strengthen the will so that the child may overcome the tendency. Find
+out what the child most desires in the way of a toy, and promise it if
+he goes so long without wetting the bed. Aid and encourage him to make
+efforts to win the reward.
+
+If drugs have to be resorted to, it is necessary to call the family
+physician, as the only drugs that are of any use are very powerful and
+have to be given with great care and caution. It is the experience of
+most physicians and specialists, however, that in a large majority of
+cases the treatment, along the lines as given above, will be effective,
+without drugs, if faithfully persisted in by the mother.
+
+These children should be examined by a physician. The cause of the
+bed-wetting is frequently discovered to be produced by anatomical
+abnormalities which render circumcision imperative. In these cases no
+method of treatment will succeed until circumcision is performed.
+
+
+SLEEPLESSNESS. DISTURBED SLEEP
+
+Causes.--In babies, disturbed sleep is most frequently due to hunger
+or to indigestion. The latter is the result of overfeeding or improper
+feeding. Rocking the child to sleep, or feeding it during the night will
+cause sleeplessness. Teething, colic, or any pain will result in
+disturbed sleep. Nervous children are frequently poor sleepers.
+
+In older children, some digestive disturbance is, as a rule, the cause.
+Chronic intestinal indigestion, worms, adenoid growths, enlarged
+tonsils, lack of fresh air in the bedroom, cold feet, may, however, be
+the cause. Overstudy in school, poor blood, poor nourishment are always
+accompanied by inability to sleep soundly. Too strenuous play, exciting
+stories read before bedtime, may cause sleeplessness.
+
+Treatment.--The removal of the cause is absolutely necessary. In order
+to discover the cause it is sometimes essential to study the child's
+whole routine in order to be able to tell exactly just what is causing
+the apparent insomnia. It may be necessary to change the method of
+feeding, to regulate the studies and the exercises, and to suggest
+changes regarding the sanitary and hygienic environment of the child's
+life. Mothers must be warned against using drugs in the form of soothing
+syrups or teething mixtures. They are dangerous and absolutely forbidden
+under the above conditions.
+
+The nervous disposition of the child must be taken into consideration
+and treated if necessary. If bad habits exist they must be stopped. Poor
+blood and poor nutrition must receive the treatment suggested under
+these headings.
+
+
+NIGHTMARE. NIGHT TERRORS
+
+In a nightmare a child wakes suddenly in a state of fright and will
+inform you that it has had a bad dream. His mind seems clear and he
+recognizes those about him. He is not easily calmed and may cry for some
+time; finally he goes to sleep again. The next day he will remember the
+dream and most of the incidents of the night before. Such cases are
+quite frequent. They are to be treated in the same way as cases of
+disturbed sleep, as they really have the same cause. They are mostly due
+to digestive disturbances and errors of diet.
+
+Night-Terrors.--Cases under this heading form a distinct group by
+themselves. They are not frequent, but the condition is much more
+serious. The cause seems to be wholly nervous and may indicate an
+important nervous derangement. It seems to have some indefinite relation
+to such conditions as migraine, hysteria, epilepsy, and even insanity.
+The child wakes suddenly during the night and sits up, evidently in
+terror; he does not apparently regain his full consciousness. He talks
+of being scared, calls for his mother, trembles and shakes, cannot
+answer questions intelligently, and after a time goes to sleep. Next day
+he remembers nothing of the attack and does not seem to suffer in any
+way as a result of it.
+
+I am disposed to believe that all of these attacks are not due to a
+nervous condition. A number of them of exactly this type have been cured
+by absolutely withdrawing milk from the diet.
+
+It is a good plan to restrict the possibility of excessive play in these
+children. They are of the type whose play is work, and too much of it is
+too exhausting. Some person should sleep in the same room with these
+patients or in an adjoining room with the door open.
+
+If the condition occurs frequently the child should be subjected to a
+thorough physical examination, because it may be one evidence of a
+serious ailment.
+
+Sometimes these little patients have to be taken out of school and sent
+to the country, where they should remain for many months. It is far
+better to regard the condition as indicating an abnormality,--even
+though it may not have any deeper significance than that the digestive
+apparatus of the child is not quite right,--and make every effort to
+cure it, than to permit the child to go on under what really are unjust
+and unfavorable conditions.
+
+
+HEADACHE
+
+Headaches are not common in little children. The most frequent ones are
+caused by:
+
+  1. Chronic indigestion and constipation.
+
+  2. Anemia and malnutrition.
+
+  3. Nervous disorders.
+
+  4. Diseases of the eye, nose, throat.
+
+  5. Rheumatism and gout.
+
+  6. Disturbances of the genital tract.
+
+Those arising from anemia and poor nutrition are most frequently present
+in girls from ten to fifteen years of age. They may result from
+overcrowding of school work, which results in loss of appetite and poor
+sleep.
+
+Nervous headaches may be hereditary or acquired through unhygienic
+surroundings. Hysteria, epilepsy, disease of the brain, neuralgia from
+carious teeth, may result in nervous headaches.
+
+Headaches from disturbances of the genital tract may afflict girls about
+the time of puberty.
+
+Treatment.--To remove the cause is the only plan that promises any
+result. Each one must be investigated by itself and dealt with
+accordingly. For the headache itself a hot foot bath, cold to the head,
+and small doses of phenacetine (one grain every hour for four doses) are
+perhaps the most certain of all methods of treatment.
+
+
+THUMB-SUCKING
+
+The habit of sucking the thumb may be corrected by wearing a pair of
+white mittens, or gloves tied at the wrist. Should children attempt to
+suck the thumb with gloves on, as some do, it will be necessary to
+saturate the thumb and fingers of the gloves with tincture of aloes, or
+a solution of the bisulphate of quinine, one dram to two ounces of
+water.
+
+
+BITING THE FINGER NAILS
+
+Biting the finger nails may be stopped by the use of the same bitter
+remedies as are used in thumb-sucking.
+
+
+HOW TO WASH OUT THE BOWELS
+
+COLON IRRIGATION. A HIGH ENEMA
+
+Procure a soft rubber catheter,--No. 18 American is about right. It is
+not advisable to get too soft rubber for the reason that it will buckle
+when the child strains and it will be impossible to wash out the bowel.
+Fill half full an ordinary two-quart douche bag with water that is warm,
+but not too hot. Dissolve a heaping teaspoonful of table salt in a glass
+of hot water and add this to the water in the bag. Hang the bag about
+two feet above the level of the child, so that the water will not flow
+in with too strong a stream; otherwise the child will immediately try to
+eject it. If the water flows in gently, the child may not object to it
+to the extent of making strenuous efforts to force the catheter out.
+
+Use the small sized nozzle that comes with the douche bag. Place the
+rubber catheter over this nozzle, lubricate the catheter, place the
+child on its back over a douche pan, insert the catheter about two
+inches, let the water run and as it runs in push the catheter up gently
+until it is all in the bowel except the end on the douche tip. The
+object of letting the water run while pushing in the catheter is because
+it floats up with the water as it distends the bowel; there is no risk
+then of pushing the end into the intestinal wall or hurting the child.
+While the water is flowing into the bowel it is a good plan to compress
+the buttocks together to aid in holding the water, as the child is very
+apt to let it run out as soon as it feels uncomfortable.
+
+The temperature of the water for the ordinary rectal injection should be
+95 deg. F. When the child is exhausted or very weak, or when the circulation
+is poor, the temperature of the water may be as high as 110 deg. F. When, on
+the other hand, the fever is very high, the water may be much cooler; as
+low as 70 deg. F. has been given with good results on the fever. If the
+irrigation is given with the intention of reducing the fever, it is best
+to begin with water around 90 deg. F., and reduce it to 70 deg. F., gradually.
+
+Indications for Irrigation of the Colon.--When it is desired to
+cleanse the bowel of any collection of matter a colon irrigation is
+indicated. This matter may be mucus, fecal substance, undigested food,
+or the decomposing waste products which may remain there as a result of
+disease or other conditions.
+
+When it is desired to medicate by putting fluids into the bowel we adopt
+the colon infusion.
+
+Every diseased condition of the bowel does not, however, indicate
+irrigation. If a child is having frequent loose movements every
+half-hour it is safe to assume that the bowel is being cleaned out
+sufficiently without any artificial aid. To irrigate in these cases
+would only irritate and would not accomplish anything. The cases which
+are benefited are those in which we have a fever with four or five green
+stools in the twenty-four hours, or where we have a high fever with no
+movement at all. To irrigate in these cases we not only get rid of the
+products of decomposition, but we prevent further decomposition and we
+reduce the fever, thereby contributing to the general welfare of the
+child.
+
+When the child is convalescing and when there is only mucus in the
+stools, with no fever--as in cases of chronic ileo-colitis--the colon
+irrigations should be stopped, as they tend to keep up the discharge of
+mucus in these cases. If, however, there is a relapse with fever, which
+would indicate a fresh infection with more discharging mucus and
+possibly green stools, the irrigation must be used until the fever
+subsides.
+
+Colon irrigations should always be given in every case of convulsions in
+infancy, first to clean out the bowel to prevent putrefaction, and
+second to empty the bowel on general principles because an overloaded
+bowel is very frequently the cause of convulsions in children.
+
+When irrigation of the bowel is given at all it must be given
+thoroughly. Enough water must pass into the bowel to wash it all out.
+For this reason it is essential that the catheter should be all in and
+in the bowel--not doubled on itself two or three inches in the bowel. If
+it is a serious case and the mother nervous, someone else should give
+the washing--preferably the physician himself. If the child objects
+strenuously, as often happens, it must be done with greater care to be
+successful. Remember that a colon irrigation is never given unless it is
+absolutely necessary and as a consequence it is given to accomplish a
+certain purpose; it must, therefore, be done thoroughly. If it is not,
+your child may miss the chance it has of getting over some immediate
+difficulty and if the moment of the "chance" is wasted or lost, that
+moment will not return. Be thorough, therefore.
+
+Enema.--Some physicians talk about a high enema and a low enema. A
+high enema is really an irrigation as described above. The following
+remarks apply to low enemas only.
+
+A so-called low enema is given to clean out the rectum of constipated
+matter, or for the introduction of food or medicine by rectum, when for
+various reasons it is necessary to spare the stomach.
+
+It may be given with the fountain syringe or with the ordinary bulb
+(baby) syringe. A catheter may be put on the tip of the syringe if it is
+thought best to inject higher up than in the rectum.
+
+When an enema is used in infants or older children for the relief of
+constipation, the best medium to use is glycerine. For an infant, one
+teaspoonful to an ounce of water is sufficient; for older children, one
+tablespoonful to two ounces of water, given with the bulb syringe, will
+give prompt results. If the constipation is pronounced, the fecal mass
+very hard, an enema of sweet oil, allowed to remain in for ten minutes,
+will soften it and permit a movement.
+
+Soap suds are often used. They are good but not as reliable as the
+glycerine or oil; if, however, neither of these two are at hand the soap
+suds may be given.
+
+Enemas should be carefully given and the liquid slowly injected. If the
+fountain syringe is used care must be exercised in not having the bag
+too high. If it is too high the liquid will flow in too strongly, either
+injuring the bowel wall or causing the child to strain immediately and
+pass out the injection before it has an opportunity of accomplishing its
+work.
+
+The temperature of the enema should be warm--not hot, and not cold,
+simply body heat.
+
+
+METHODS OF REDUCING FEVER
+
+During the course of acute illness it is frequently necessary to reduce
+the fever, if possible, without the use of drugs. The following means
+are often adopted. It is desirable that the mother should know just how
+to carry out these methods:
+
+Ice-Cap.--An ice-cap is used to protect the brain when a child or
+adult is running a very high fever. It is put on when the fever is above
+103 deg. F. It may be used in other conditions--brain disease, or disease of
+the meninges or cord--in which case the physician will be in attendance
+and will direct what should be done.
+
+Ice-bags are procured in the drug stores. The best one is the flat
+French ice-bag. Fill it three-quarters full of finely chopped ice, put
+the ice-bag in a towel, and place on the patient's head. There should be
+only one thickness of the towel between the ice-bag and the head.
+
+It will be necessary to keep a record of the fever so that the ice-bag
+may be withdrawn when it falls below 103 deg. F.
+
+When the ice melts the bag must be at once refilled. This is often
+overlooked by careless mothers.
+
+Cold Sponging.--Cold sponging is used to reduce fever or to allay
+nervous irritability. Equal parts of alcohol and water or vinegar and
+water are used. The temperature of the water should be 80 deg. to 85 deg. F.
+
+Infants to be sponged should be completely undressed and laid upon a
+blanket. The sponging should be done for about fifteen or twenty
+minutes, after which the child is wrapped in a dry blanket without
+further clothing except the diaper. To be effective it must be done
+frequently.
+
+Cold Pack.--The cold pack is used to reduce fever. It is one of the
+simplest and one of the best means we have. The child is undressed
+completely, and laid upon a blanket. It is completely covered with a
+small blanket (except its head) wrung out of water at 100 deg. F. Outside
+of this the child is rubbed with a piece of ice, front and back, for a
+sufficiently long time to render the surface cool, but not cold.
+Children take kindly to this means of reducing fever; there is no shock
+and they are quieted by it.
+
+Just how long one will rub with the ice depends upon circumstances. From
+five to thirty minutes may be employed. The head should be sponged with
+cold water while this is being done and it is a good plan to have a
+hot-water bottle at the child's feet.
+
+The Cold Bath.--To reduce fever the cold bath is used in the following
+way: Water at a temperature of 100 deg. F. is put into the bath and the
+child is first put into this water, then the water is reduced by putting
+into it shaved ice until it reaches 80 deg. F. The child's body is well
+rubbed while it is in the bath and cold water is applied to its head.
+The bath is continued for five minutes, or sometimes with a robust child
+to ten minutes. On removal the child should be put into a warm blanket
+after being thoroughly dried.
+
+Rectal Irrigations.--These are sometimes given to reduce fever. They
+are very useful and very successful if they are given properly and
+without exciting the child too much. It is best to give water of an
+ordinary temperature at first and gradually reduce it to 70 deg. F. It
+should be continued for ten minutes or longer. It may be repeated every
+three hours. (See page 586.)
+
+
+VARIOUS BATHS
+
+Every mother should know how to give any bath that may be directed by
+the physician.
+
+The Mustard Bath.--Take from three to four tablespoonfuls of English
+mustard; mix thoroughly in about one gallon of warm water. Add to this
+about five gallons of plain water at a temperature of 100 deg. F. If it is
+necessary to raise the temperature of the water higher it may be done by
+adding water until the temperature reaches 105 deg. or 110 deg. F.
+
+The mustard bath is exceedingly effective in cases of shock, great
+sudden depression, collapse, heart failure, or in sudden congestion of
+the lungs or brain. The special use of the mustard bath is in the
+treatment of convulsions; it is also useful for nervous children who
+sleep badly. Two or three minutes in the mustard bath, followed by a
+quick rubbing, will induce refreshing sleep in these children. It is not
+necessary to have more than one tablespoonful of mustard in these cases.
+
+The Hot Bath.--A bath is prepared of water at a temperature of 100 deg. F.
+After the child is in the bath the temperature of the water is raised to
+105 deg., or to 110 deg. F. It is not safe to go above this point.
+
+The body of the child should be well rubbed while it is in the bath. In
+most cases it is advisable to apply cold water to the head while the
+child is in the bath. A bath thermometer should be kept in the water to
+see that it does not rise above the temperature desired.
+
+The hot bath, like the mustard bath, is used to promote reaction in
+cases of shock, collapse, etc., and in convulsions.
+
+The Hot Pack.--Remove all clothing from the baby and envelop the body
+in a sheet wrung out of water at a temperature of 100 deg. F., to 105 deg. F.,
+after which the body should be rolled in a thick blanket. Those hot
+applications may be changed every twenty minutes until free perspiration
+is produced. This condition may be kept up as long as is necessary.
+
+The hot pack is used mainly in disease of the kidney.
+
+The Hot-Air or Vapor Bath.--The child is put in bed wholly undressed
+with the bed clothing raised about twelve inches, and held in that
+position by a wicker support. The child's head is of course outside the
+bed clothing. Beneath the bed clothing hot air or vapor from a croup
+kettle is introduced. This will cause free perspiration in twenty
+minutes. It may be continued from twenty to thirty minutes at a time.
+
+The vapor bath is used in diseases of the kidney, as a rule.
+
+The Bran Bath.--In five gallons of water place a bag in which is put
+one quart of ordinary wheat bran. The bag is made of cheese cloth.
+Squeeze and manipulate the bran bag until the water resembles a thin
+porridge. The temperature of the water is usually about 95 deg. F., though
+it may be given with any temperature of water.
+
+The bran bath is of great value in eczema, or in rashes about the
+buttocks, or in delicate skin conditions when plain water would
+irritate.
+
+The Tepid Bath.--This bath may be given at a temperature of 95 deg., or
+100 deg. F. It is of distinct advantage in extremely nervous children. To
+induce sleep it is often better than drugs.
+
+The Cold Sponge or Shower Bath.--This bath should be given in the
+morning in a warm room. A tub should be provided with enough water in it
+to cover the child's feet. This water should be warm because when the
+feet are in warm water it prevents the shock which frequently comes when
+cold water is applied to any other part of the body.
+
+A large sponge is filled with water at a temperature of from 40 deg. to 60 deg.
+F. This is squeezed a number of times over the child's chest, shoulders,
+and back. While the cold water is being applied the body should be well
+rubbed with the free hand of the mother. The bath should not last longer
+than half a minute. When finished take the child out quickly and stand
+him on a bath towel and give him a brisk rubbing with a bath towel until
+the skin reacts. This is an exceedingly valuable tonic for a delicate
+child. It should not be used on younger children than eighteen months of
+age. In younger children a cold plunge is preferable.
+
+For the cold plunge water at a temperature of 55 deg. F. is prepared. The
+child is lifted into this and given a single dip up to the neck. He is
+then briskly rubbed off as above.
+
+There are a very few children who do not take kindly to either the cold
+sponge or plunge. These children do not react; they remain pale or blue
+and pinched for some time after. It may be necessary to discontinue the
+procedure or to use water of a higher temperature.
+
+
+POULTICES
+
+Poultices are useful in inflammation and for the relief of pain. To be
+of any value they should be applied frequently--every ten or twenty
+minutes--and they should be applied hot.
+
+Ground flaxseed is the best material for poultices. It should be mixed
+with boiling water until the proper thickness is reached. It may be kept
+simmering on a fire. When one poultice is taken off it can be scraped
+into the pot and heated over if there is no discharge. Each poultice
+should be put into clean muslin, put on the part and covered with oiled
+silk. This will help to retain the heat and prevent the clothing or bed
+sheet from becoming wet.
+
+
+HOT FOMENTATIONS
+
+A hot fomentation is simply a clean poultice. Several thicknesses of
+flannel are taken, wrung out of very hot water, covered with cotton
+batting, and then with oiled silk.
+
+How to Make and How to Apply a Mustard Paste.--For infants: Take one
+part English mustard to six parts flour, mix with lukewarm water, and
+spread between two layers of cheesecloth.
+
+For older children and adults: Take one tablespoonful English mustard to
+three or four tablespoonfuls of flour, and mix as above.
+
+Mustard pastes should be made big enough. You can accomplish a great
+deal more by putting on a sufficiently large mustard paste than by
+simply putting on one the size of the palm of your hand.
+
+It should be left on until the skin is distinctly red. The length of
+time will depend, of course, upon the strength of the mustard. Mustard
+pastes may be put on every three hours, if necessary, and they may be
+used for a week at this interval if the conditions demand it.
+
+If they are used in pneumonia or other pulmonary diseases, they should
+be used large enough to go around the whole chest. If they are used in
+heart failure, they should be big enough to cover the whole trunk.
+
+When made with the white of an egg they will not blister. Or if the part
+is rubbed with white vaseline before applying, it will not blister and
+it will be just as effective. When a mustard paste is removed the red
+area should be rubbed with white vaseline and covered with a clean piece
+of flannel.
+
+How to Prepare and Use the Mustard Pack.--The child is stripped and
+laid upon a blanket, and the trunk is surrounded by a large towel or
+sheet saturated with mustard water. This is prepared as follows: Take
+one tablespoonful of English mustard and dissolve it in one quart of
+water, slightly warmed. Saturate a towel in this mixture and apply to
+the body of the child while it is dripping. The patient is then rolled
+in a blanket. Keep the child in this pack for ten or fifteen minutes.
+The mustard pack is not as good as the mustard bath, but it is all that
+is necessary in a number of various conditions. The physician will, of
+course, decide these matters. It is simply the duty of the mother to
+know how to carry out the physician's instructions.
+
+The Turpentine Stupe.--Take a piece of flannel, big enough to cover
+the area which it is desired to affect, wring it out of as hot water as
+it is possible. Upon this sprinkle twenty drops of spirits of
+turpentine. Place the stupe wherever it is desired and cover with a
+piece of oiled silk or dry flannel. The turpentine stupe is mostly used
+in pain of the abdominal cavity. In colic from acute indigestion it is a
+very convenient means of quieting the child by allaying the pain.
+
+Care should be taken not to allow this form of application to remain on
+too long. Take it off when the skin is red. For continuous use it is not
+as good as the mustard paste.
+
+
+OILED SILK. WHAT IT IS, AND WHY IT IS USED
+
+Oiled silk is sold in the drug stores by the yard. It is one yard wide.
+It is used to cover any local application to prevent evaporation into
+the air or to prevent the clothing from absorbing the medicament. If a
+liniment is applied on cloth to effect a certain result, it may take
+some time to do its work. If the wet cloth is covered with the clothing,
+the clothing will absorb the medicine quicker than the body will and
+thereby defeat the object in view, in addition to rendering the
+clothing wet and nasty. If the application is covered with oiled silk it
+cannot escape into the clothing, because the oiled silk is impervious.
+The body will be compelled to absorb the medicine and consequently
+results will be quicker and more certain. Many liniments are expensive;
+to permit them to be absorbed by the clothing is needless waste It is
+therefore economical to apply the oiled silk.
+
+
+
+
+DISEASES OF CHILDREN
+
+[Illustration: By permission of Henry H. Goddard.]
+
+
+The First Blight
+
+This is one of those truly unfortunate cases which, so far as present
+knowledge goes, cannot be guarded against. Eunice, age 31, mentally 2,
+is a low-grade imbecile. There is not in the whole family, for
+generations back, a single case of feeble-mindedness, nor of disease
+that would undermine the nervous organization. Close scrutiny does not
+reveal a single assignable cause. She came, as an accident, to blight an
+otherwise normal family.
+
+Such cases are few, but unfortunately they do occur. It is for Eugenics
+to materially reduce the possibility of such occurrences.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXVIII
+
+INFECTIOUS OR CONTAGIOUS DISEASES
+
+
+Rules to be Observed in the Treatment of Contagious Diseases--What
+Isolation Means--The Contagious Sick Room--Conduct and Dress of the
+Nurse--Feeding the Patient and Nurse--How to Disinfect the Clothing and
+Linen--How to Disinfect the Urine and Feces--How to Disinfect the
+Hands--Disinfection of the Room Necessary--How to Disinfect the Mouth
+and Nose--How to Disinfect the Throat--Receptacle for the Sputum--Care
+of the Skin in Contagious Diseases--Convalescence After a Contagious
+Disease--Disinfecting the Sick Chamber--The After Treatment of a
+Disinfected Room--How to Disinfect the Bed Clothing and
+Clothes--Mumps--Epidemic Parotitis--Chicken Pox--Varicella--La
+Grippe--Influenza--Diphtheria--Whooping
+Cough--Pertussis--Measles--Koplik's Spots--Department of Health Rules in
+Measles--Scarlet Fever--Scarlatina--Typhoid Fever--Various
+Solutions--Boracic Acid Solution--Normal Salt Solution--Carron
+Oil--Thiersch's Solution--Solution of Bichloride of Mercury--How to Make
+Various Solutions.
+
+
+RULES TO BE OBSERVED IN THE TREATMENT OF CONTAGIOUS DISEASES
+
+
+Every mother should know the elementary principles involved in the
+treatment of contagious diseases. They are contagious because they may
+be conveyed from one individual to another or because a person nursing a
+victim of a contagious disease may carry that disease to another person
+without having the disease herself. For this reason, certain rules have
+been established by the medical profession, which experience has taught
+are necessary in order to preserve the health of the community when such
+diseases are prevalent.
+
+The very first rule to which the physician will direct the mother's
+attention, when there is a contagious disease, will be that the child
+must be "isolated."
+
+What Isolation Means.--Isolation means the complete seclusion of the
+patient in a room by himself, so that no one will see him or come in
+contact with him except the physician and the nurse or mother who will
+tend him during the entire course of the disease. Isolation implies more
+than it would seem to mean. It implies that every article used during
+the sickness will be thoroughly disinfected before it leaves the room in
+which the patient himself is isolated. Mothers must always remember that
+every article used by the patient may carry the germs of the disease to
+some other member of the family or to some other individual. These
+articles are the clothing of the child, the bedclothes, napkins,
+handkerchiefs, towels, dishes, knives and spoons, rags, the various
+discharges--sputum, urine, and bowel passages--and, we may add to this
+list, flies, insects, and domestic animals. Every precaution must,
+therefore, be taken to safeguard any dissemination of the disease by
+means of these articles.
+
+Thorough isolation also implies that the nurse shall frequently bathe
+and disinfect her person and her clothing, and that the sick-room itself
+shall be carefully dusted with a moist cloth and disinfected from time
+to time.
+
+The Contagious Sick-Room.--The contagious sick-room will be prepared
+in exactly the same way as the ordinary sick-room which has been
+previously described. In addition, however, it will be safeguarded in
+the following manner. A wet sheet will be hung up outside the door. This
+sheet will be kept constantly moistened with a solution of chloride of
+lime. One-half pound to an ordinary house-pail of water is the strength
+of the solution to use. Every window must be effectively screened to
+prevent the ingress and egress of flies and other insects.
+
+Conduct and Dress of the Nurse.--She will remain in the sick-room all
+the time unless when she takes outdoor exercise. Her dress will consist
+of a long gown which will entirely cover her person from the neck to the
+shoes and will be of plain, white, easily washed material, without tucks
+or ruffles or adornment of any kind. She should wear an ordinary pair of
+house slippers made of light leather. Her cap will be large enough to
+cover and include her hair and head. When she leaves the room, she will
+remove her cap, gown, and slippers, disinfect her hands in a
+disinfecting solution and wash her face, neck, and hands in soap and
+water. She should go directly out and in, without coming in contact with
+any occupant of the home.
+
+Feeding the Patient and Nurse.--The meals for the patient and nurse
+should be left on a table outside the door of the sick-room, from which
+place the nurse will then take them into the room. The utensils used for
+these meals should not be used by other members of the family during the
+entire sickness. After the patient and nurse have eaten, the utensils
+should be placed in a chloride of lime solution for disinfection. If any
+of the food is left over it should be put into a jar in which it may be
+disinfected and rendered harmless before being disposed of.
+
+How to Disinfect the Clothing and Linen.--All bed and body linen,
+towels, handkerchiefs, napkins, etc., should be immediately put into a
+large receptacle--a wash boiler, or tub, will answer the purpose
+admirably--containing a five per cent. solution of carbolic acid in
+which an adequate quantity of soft soap has been dissolved. They should
+remain in this mixture for two hours, after which they may be wrung out
+and taken to the laundry.
+
+How to Disinfect the Urine and Feces.--The urine and the stools should
+be passed into vessels containing a solution of four ounces of carbolic
+acid to the gallon of water. This vessel should be covered and the
+mixture allowed to stand for one hour, after which time it may be thrown
+out.
+
+How to Disinfect the Hands.--Any of the following solutions may be
+used for disinfection of the nurse's hands: Creolin, one teaspoonful to
+the quart of water; chloride of lime, one-half pound to a pail of water;
+formalin, thirty-two drops to a quart of water. A basin containing one
+of the above solutions should be constantly kept standing for the
+frequent disinfection of the nurse's hands. After disinfection, the
+hands should be washed in plain water and soap.
+
+Disinfection of Room Necessary.--The room in which a contagious
+patient is confined requires systematic attention on the part of the
+nurse. Every other day all flat or projecting surfaces should be
+disinfected. Mantels, window-sills, door knobs, picture moldings,
+furniture, chairs, and bed-railings, should be wiped with cloths
+moistened in a disinfecting solution. A suitable solution for this
+purpose is one containing one ounce of carbolic acid to the quart of
+water.
+
+How to Disinfect the Mouth and Nose.--In the course of all contagious
+diseases the mouth and throat of the patient and nurse should be
+thoroughly disinfected as a matter of routine. It should be done at
+least twice daily unless more frequent disinfection is called for
+because of the nature of the disease. In measles and diphtheria, for
+example, the nasal and throat conditions will undoubtedly call for more
+frequent and more thorough disinfection than twice daily. This may also
+apply to scarlet fever if the throat is involved as is often the case.
+
+Pocket handkerchiefs should never be used by a patient suffering from a
+contagious disease. The nose and mouth should be wiped with pieces of
+gauze or cheesecloth, cut into small squares for this purpose. These
+should be immediately burned after being used.
+
+To disinfect the throat, a solution of formalin, six drops to six ounces
+of water, is effective. To disinfect the nose, a solution of
+Glyco-Thymoline is suitable. These applications should be made by means
+of an atomizer, a different atomizer being used for the patient and
+nurse.
+
+Receptacle for the Sputum.--A cuspidor, or basin, should be constantly
+kept at the side of the bed in which the patient may conveniently
+expectorate. This utensil should contain the chloride of lime solution
+previously mentioned.
+
+Care of the Skin in Contagious Diseases.--As in all other sick
+conditions, the skin of the patient should be bathed frequently with an
+alcoholic solution. In the later stages of measles and scarlet fever it
+is essential to anoint the skin while the patient is scaling. This may
+be done with carbolated vaseline. Mothers should understand why this is
+necessary. These diseases have a distinct rash or eruption. This
+eruption practically kills the skin cells and at a certain period these
+cells are cast off by the new growth of skin underneath. This process is
+called scaling. In measles the scales are small, and are cast off in the
+form of bran like dust. In scarlet fever, the cells adhere together and
+are cast off in large scales. These scales are contagious. They are very
+light and will float in the air if dry. The movement of the patient,
+changing the bed clothing, etc., will waft a multitude of these
+contagious scales into the air of the room and infect every article they
+may land on. This would make the disinfection of the room difficult and
+tedious. In order to obviate this tendency experience has taught us that
+much of the difficulty and nearly all of the risk of contagion may be
+overcome by rubbing some oily or sticky substance on the skin. By this
+method the dust and scales are rendered heavier than the air, stick
+together and will not float. During the scaling period there is a
+constant itch present which irritates the little patient. By using
+carbolated vaseline to anoint the skin we accomplish two purposes. The
+carbolic acid in the vaseline relieves the itch, and the vaseline itself
+greases the skin so that the scales remain in the bed. Each day the
+nurse changes the bed-sheet, gathers the scales in the sheet and puts
+all in the disinfecting solution.
+
+Convalescence After a Contagious Disease.--Complete isolation must be
+kept up until all danger from contagion is passed. In diphtheria this
+period is not reached until the examination of the throat contents under
+the microscope is returned negative. In diseases Which have a rash this
+period is not reached until all scaling is completed. Even then, and for
+a number of days or weeks, the patient may be taken out for exercise
+daily, but must not be allowed to play with other children until his
+strength justifies active exercise. It takes a much longer period to rid
+the system of the poison of a contagious disease than most mothers
+appreciate. Many children have died from heart failure after they were
+considered well simply because the active exercise overtaxed the heart
+before the system was wholly free from the poison of the disease.
+
+Before the child is removed from the sick-room for the first time he
+should have a disinfecting bath. This bath should be in a solution of
+bichloride of mercury, the strength of which should be one part to five
+thousand parts of water. The towels used to dry the patient after the
+bath should be fresh and should not have been in the sick-room. He
+should then be dressed in clothing which has never been in the
+sick-room.
+
+
+DISINFECTING THE SICK-CHAMBER
+
+How to Disinfect a Room.--The most efficient way to disinfect a room
+is by means of formaldehyde gas. This, however, requires a special
+apparatus which can only be used by one familiar with the process. In
+all large cities the Department of Health usually undertakes the
+disinfection of rooms after any contagious disease. The next best method
+is by sulphur.
+
+When sulphur is employed it should be used in the form of powder or in
+small pieces. This is placed in a shallow iron pan set on a couple of
+boards in a tub partly filled with water. The sulphur is moistened with
+alcohol before it is set on fire.
+
+It is always necessary, of course, before disinfecting by any process to
+make the room as nearly air tight as is possible. To accomplish this the
+windows must be tightly closed, the doors locked, and the cracks and
+keyhole sealed with pieces of paper or adhesive paper. The room should
+remain closed for six or eight hours, after which it should be
+thoroughly aired for several days.
+
+The After Treatment of a Disinfected Room.--The walls, ceiling, and
+all flat surfaces, such as mantels, window-sills, etc., should be washed
+with a fresh chloride of lime solution. The floor should be scrubbed
+with a four per cent. soda solution. All carpets and curtains, if any,
+should be removed, taken to a vacant lot and thoroughly beaten and then
+exposed to direct sunlight for a number of hours. The room should then
+be well aired again for a couple of days before it is again occupied.
+
+How to Disinfect the Bed Clothing and Clothes.--The surest way is to
+boil them for half an hour; otherwise they may be left in the room while
+it is being disinfected. Spraying the clothes with a spray of
+formaldehyde is an effective way of disinfecting them.
+
+
+MUMPS: EPIDEMIC PAROTITIS
+
+Mumps is a contagious disease. It is most common between the fourth and
+sixth years. Infants are rarely affected. The disease is not very
+contagious, direct contact being necessary to communicate it. Every case
+should be isolated for a period of three weeks from the beginning of the
+disease.
+
+The seat of the affection is the parotid gland which is located in front
+of and on a level with the ear. One or both glands may be affected at
+the same time or one may follow the other in succumbing. The duration of
+the disease from the time the swelling becomes noticeable is about ten
+days. It is contagious for a week after the swelling subsides. The
+period of incubation is from one to three weeks.
+
+Symptoms.--In the majority of cases the first symptom is the swelling
+and the discomfort which it causes. In more severe cases the child feels
+sick and is listless for from twenty-four to forty-eight hours. There
+may be a headache, vomiting, pains in the back and limbs, and fever.
+There is pain in the swelling which is increased by movement of the jaws
+and by pressure. The degree of the swelling varies with the severity of
+the attack. It may be very little or it may be so great as to completely
+distort, and render unrecognizable, the face. It must be remembered
+that, though mumps is not regarded as an important or dangerous disease,
+it may assume dangerous characteristics.
+
+We sometimes see distressing complications with mumps. In boys,
+orchitis, or inflammation of the testicles, occasionally occur. In
+girls, ovaritis, or inflammation of the ovaries may be present. These
+complications may be avoided by keeping the patients in bed.
+
+Treatment.--Keep the child in bed until the fever is gone. Keep him
+in the house for one week after the swelling has entirely subsided. He
+should be put on a liquid diet while the fever lasts. The bowels should
+move each day.
+
+The mouth should be kept clean by an antiseptic mouth wash. If there is
+much pain in the swollen gland, warm, wet dressings give the best
+results. Sometimes it is advisable to paint the gland with belladonna
+ointment. If it is not very painful, the most comfortable way to dress
+the gland is simply to place over it a large pad of absorbent cotton
+held in place by a broad strip of flannel cloth.
+
+
+CHICKEN POX. VARICELLA
+
+Chicken pox is an affection almost entirely special to children, in whom
+it may be observed from their first year, although it is especially
+frequent from the ages of two to six. It appears often in the epidemical
+form and spreads by contagion.
+
+Some doctors are inclined to regard varicella as a very attenuated form
+of smallpox, hence the name "chicken pox," by which it is popularly
+known. This opinion is based merely on the analogy between the two types
+of skin eruptions and the coincidence sometimes observed between two
+epidemics of smallpox and chicken pox. But the theory falls on
+considering that, on the one hand, chicken pox offers no safeguard
+against infection by smallpox and does not prevent the effects of
+vaccination, and, on the other hand the disease may occur in children
+who have been vaccinated or who have had smallpox. Chicken pox, too,
+differs essentially from smallpox in the course of its development.
+
+After a period of incubation, extending over a fortnight, chicken pox
+becomes apparent by such symptoms as slight shivering, extreme fatigue
+and a general but not very intense condition of fever. In less than
+twenty-four hours small pink spots will appear on the skin, and these
+after a few hours are topped by a vesicle, and the next day the whole
+rash shows a vesiculous appearance.
+
+The vesicles are sometimes small and pointed, sometimes more voluminous
+and globular in form. They are filled with a limpid or a slightly
+yellowish liquid. Their base is sometimes surrounded by an inflammatory
+ring. By the third day the contents of the vesicle has become thicker
+and tends to become purulent. On the fourth day desiccation commences,
+and the vesicles shrivel and shrink in and form small brownish scabs,
+which fall about the eighth day. Frequently the child will scratch them
+off with the finger nails before they are entirely desiccated. The
+vesicles leave small reddish spots, which generally disappear gradually,
+almost always without a scar.
+
+An eruption of chicken pox does not burst out all over the body at once,
+but appears in successive rashes. It is not confined to any special
+parts of the body. It may begin and spread at the same time from the
+face, the trunk of the body or the limbs. A dozen pimples may be seen
+the first day, while three or even ten times as many may be visible the
+next day, and so on for several days in succession.
+
+Sometimes the vesicles appear on mucous membrane at different parts--the
+mouth, tongue, soft palate and tonsils--and may also invade the
+conjunctiva and cornea, or the larynx, where they will set up
+laryngitis.
+
+Owing to the very contagious nature of chicken pox, the first thing to
+be done is to provide for the complete isolation during a period of
+twelve to fifteen days of all patients attacked by the disease.
+
+The treatment of the disease is solely a matter of hygiene. The more
+severe the fever the stricter the diet should be, and in the case of
+great fever, the diet should be restricted to broth and milk. If there
+is no fever the child need not be placed on any special diet.
+
+If the intestines are sluggish, they may be stimulated by administering
+a dose of castor oil. It is advisable to make the patient rinse his
+mouth two or three times a day with a mouth wash. It is also well to
+apply a lotion around the eyes and face, consisting of two per cent.
+boracic acid solution with the chill taken off. Finally, in order to
+prevent the child scratching the sores and the consequent danger of
+inoculation by the finger nails, it is a good practice to rub a small
+amount of carbolated vaseline over the itching parts. It is frequently
+found necessary to have the little patient wear white woolen gloves to
+prevent scratching and infecting the sores. If a child scratches the
+sores on the face it will leave an unsightly mark which will stay for
+the rest of its life.
+
+The child, of course, should not be allowed to rejoin his playmates
+without having had a good bath, and having had his clothes completely
+disinfected.
+
+
+INFLUENZA: LA GRIPPE
+
+The most important feature with reference to influenza in children is
+its very active tendency to develop complications. These complications
+generally affect the respiratory tract. So we find in children suffering
+from grippe an easy disposition to get bronchitis or broncho-pneumonia.
+The younger the child the greater the danger.
+
+The disease itself, so long as it remains an uncomplicated influenza, is
+not of much importance or severity. The lesson to be learned, therefore,
+is to treat the disease with respect and take every precaution to avoid
+the possibility of developing a complication.
+
+La Grippe is a highly contagious disease. It prevails epidemically, and
+after an active epidemic it may remain in the vicinity for a number of
+years. It is more frequently seen in the late winter months and early
+spring. The poison of the disease clings to clothing and apartments as
+well as to railroad and street cars. The germ is found in the sputum and
+in the nasal secretions.
+
+Sneezing is one of its symptoms and it is one of the ways by which the
+disease is spread around. Children should never be brought near an adult
+suffering from influenza. One attack does not render the patient immune
+to a subsequent attack as is the case with most of the contagious
+diseases. The reverse is the rule with La Grippe because one attack
+favors the development of another attack. It is a common experience for
+many people to have influenza every winter or spring.
+
+Symptoms.--If a child "catches" grippe, it becomes quite sick
+abruptly. There is usually chilliness, pains in the muscles all over the
+body, more or less fever, sometimes nausea and vomiting. If the attack
+is a more severe one, the prostration is more marked, the temperature
+higher and the signs of shock and poisoning of the system are more in
+evidence. A child a few months old can get influenza so severely as to
+cause collapse and death in thirty-six hours. As a rule the type of
+grippe most common in infancy is of a very mild character. It lasts
+about a week. Children may be a little slow in convalescing and it may
+be three or four weeks before they regain their health.
+
+Complications.--As has been intimated, the most frequent complication
+is bronchitis and the most fatal one is broncho-pneumonia.
+
+A congestion of the entire mucous membrane of the respiratory tract,
+producing a nasal discharge, a sore and inflamed throat, pains and a
+feeling of compression, with a cough in the chest, may accompany the
+disease.
+
+Gastric symptoms, with vomiting, intestinal disturbance, diarrhea, with
+or without mucus and blood, are quite common in some epidemics.
+
+Not infrequently we have numerous cases in which the ear seems to be the
+vulnerable part. As a consequence running ears have to receive most of
+our attention. When the ears are affected, the glands of the neck become
+inflamed. They swell up and add considerable to the discomfort of the
+little patient.
+
+Treatment.--Cases of influenza should be isolated. Children should be
+put in a room by themselves and the other children of the family should
+not be permitted to see them. The rooms should be disinfected after the
+case is over. As complications are the dangerous element in grippe, we
+should try to prevent them. This can be best done by promptly putting
+the child in bed, making him comfortable, opening his bowels by castor
+oil or calomel. He should be made to drink hot lemonade. He should be
+kept on a light diet from which meat and vegetables are excluded.
+
+The above treatment will usually suffice in the ordinary uncomplicated
+grippe. If complications arise they must be treated according to the
+conditions.
+
+It is well to remember that the degree of prostration following a rather
+severe attack of grippe is out of all proportion to the extent of the
+disease. These little patients sometimes suffer considerably and do not
+regain their strength promptly. Experience has taught us that the best
+thing to do is to send them away. A change of climate will do wonders
+for them, more quickly and more thoroughly than all the medicine we can
+give them at home. The seashore is particularly good for them.
+
+
+DIPHTHERIA
+
+Diphtheria is an acute, specific, infectious, communicable disease. It
+affects the tonsils, throat, nose, or larynx. It is most frequently seen
+in children between the ages of two and five years, though it may appear
+at any time during life. The two sexes are equally liable to it. The
+same person may have the disease twice or more times at different ages.
+Children suffering from disease of the nose or throat are more likely to
+get it than are others. Such diseases are cold in the head with running
+nose, catarrh of the nose and throat, inflammation of the mucous
+membranes of the nose or throat.
+
+Diphtheria may occur at any time of the year, though it is more frequent
+during the cold months. The incubation, or the length of time between
+exposure to the disease and the development of the symptoms, is between
+two and five days. In its mild form the disease may be present without
+giving any constitutional symptoms. In its severe form, however, it is
+one of the most dangerous diseases of childhood. In large cities it is
+present all the year round with more or less frequent outbreaks in the
+form of local epidemics. In the country it is only seen in its epidemic
+form. It does not arise without a cause, that is, there is always a
+preceding case from which an epidemic springs, though it is not always
+easy to trace the connection. The child inhales the bacilli which cause
+the disease with the air it breathes. The bacilli may lodge on toys or
+other articles from which the child gets them. Direct infection is
+usually the mode of communication through which a child obtains the
+disease. The saliva and mucus from the nose contain the bacilli in large
+quantities and if a patient coughs or sneezes they are expelled in this
+way and infect others. Frequently a child suffering from a mild form of
+diphtheria may attend school and infect others without it being known
+that the child has the disease.
+
+Symptoms.--The symptoms vary with the severity of the attack. There
+are mild cases, as has been stated, that give no constitutional
+symptoms. There may be a small amount of local disturbance in the throat
+or nose and there may be some membrane present, but, for some reason,
+there does not seem to be any absorption of the poison into the system
+and the child escapes the systemic disturbance. Even as a local
+condition these cases vary. There is always a fever at the beginning,
+but the child never seems sick enough to go to bed. If the throat is
+examined it will be found to be red and slightly inflamed, there may be
+spots on the tonsils, or there may be a gray film over them. There is no
+discharge from the nose and the child does not complain of an excess of
+mucus from the throat. The spots may last for a week and then disappear.
+These cases are difficult to diagnose without making a culture, and if
+the physician insists upon keeping the child confined to bed while
+apparently well the family as a rule object, though it is absolutely
+necessary. These are the cases that do great harm in school, and no
+mother should object if the physician insists in taking preventative
+measures to stop an epidemic if the bacilli have been found in the
+child's throat. She should rather feel thankful that the child escaped
+so easily.
+
+Since the introduction of antitoxin we do not see the severe cases now,
+so that a description of them would not be of any use in a book of this
+character. Mothers should, however, know that it is absolutely criminal
+to take any chances with a "sore throat." Antitoxin is a prompt and an
+absolute remedy if used soon after the onset of the disease. It is more
+sure if used the first or second day, still reliable the third day, but
+its efficacy diminishes the longer we postpone its use from the date of
+the onset of the disease. When, therefore, a child complains of being
+sick and states that its throat hurts, medical aid should be at once
+sought.
+
+The disease may develop in one of two ways. It may begin as a slight
+indisposition for a day or two, and perhaps some soreness of the throat.
+The fever may be slight. The child will continue to be sick despite any
+treatment given and will get slowly worse until the fourth or fifth day,
+when it will be impossible to mistake the condition.
+
+At other times the disease begins abruptly. The child complains of being
+sick. It may vomit, or suffer from headache, chilly feelings, and a
+fever. The glands in the neck may swell and cause considerable
+disturbance. There is, as a rule, an abundant discharge from the nose
+and there is an excess of mucus in the throat. Membrane is seen in the
+throat. It may cover the tonsils and spread over the entire throat
+cavity, or it may extend up into the nose and over the roof of the
+mouth. All the parts are much swollen and breathing is interfered with,
+sometimes seriously. If the attack is very severe there is an active
+absorption of poison going on from the throat which soon renders the
+little patient intensely sick. There is marked weakness and prostration,
+the circulation becomes poor, the pulse rapid and the child falls into a
+stupor.
+
+The physician will, of course, have taken complete charge of the case
+before the patient has gone thus far. The nursing of the case, which may
+fall to the mother if no trained nurse is present, is most important.
+She should preserve absolute cleanliness of herself and of the sick
+room. She should never eat or sleep in the same room with the patient,
+and should use a gargle, which the physician should prescribe,
+frequently during the day. She should dress simply, so that whatever is
+worn can be changed often and washed easily. Every article of furniture
+must be taken out of the sick room that is not absolutely essential in
+the care of the case. If toys are allowed they should be burned as soon
+as the child is tired of them, never left around the house after the
+case is over. The room should be a large one and it should be thoroughly
+aired each day. The floor should be washed each day with a solution of
+bichloride of mercury, and all dusting should be done with a wet cloth.
+The bed linen and any rags or handkerchiefs used should be treated as in
+scarlet fever. All vessels in which the patient expectorates should have
+an antiseptic in them. The room must be disinfected after the case is
+over.
+
+The patient must be kept in bed during the entire attack. He must not be
+allowed to even sit up in bed until the physician gives him permission.
+This is a very important essential in the treatment of this disease, and
+the nurse must be held responsible for the conduct of the patient in
+this respect. Because of the character of the poison, there is a
+tendency to paralysis of the heart, and frequently children have been
+allowed to sit up too soon only to fall back dead in bed. The same thing
+has occurred later in the disease when children have been allowed to
+play too heartily before the poison had an opportunity to completely
+eliminate itself. Nursing children should be fed on breast milk pumped
+from the mother, but they must not nurse it themselves. Older children
+can take milk and should depend upon it mostly. The physician will give
+any other special directions that he may think necessary, the duty of
+the mother being to see that they are faithfully carried out.
+
+
+WHOOPING-COUGH
+
+Whooping-cough is usually seen in young children. It may, however,
+affect a person at any age. It is contagious. During infancy it is one
+of the most fatal diseases. During adult life it is a dangerous
+condition, while in childhood it is simply regarded as a mildly
+contagious disease.
+
+It is most contagious during the catarrhal stage,--the first ten days.
+Children suffering from whooping-cough should not be allowed to mix or
+play with other children for two months. After an exposure to the
+disease it takes about fourteen days for a case to develop. The danger
+of whooping-cough is the tendency to develop pneumonia or bronchitis.
+
+Symptoms.--During the first ten days the child acts as if suffering
+from an ordinary catarrhal cold with cough. This is called the catarrhal
+stage. There is no way of telling that whooping-cough is present until
+the child whoops. Most children do not whoop until the expiration of the
+catarrhal stage, though a very few do from the beginning of the disease.
+If a child is treated for an ordinary cold with cough and does not
+respond to treatment, and whooping-cough is epidemic, it is fair to
+assume that whooping-cough has been contracted. When the cough shows a
+distinct tendency to be worse at night it is further proof of this
+assumption.
+
+When they begin to cough in paroxysms, and whoop, the second, or
+spasmodic stage begins. These fits of paroxysmal coughing are much more
+severe than spells of ordinary coughing. These may only be three or four
+attacks daily, or the child may have from forty to fifty such attacks.
+When children feel these attacks coming on they seek support, holding on
+to chairs or they stand by the mother's knee. The coughing is explosive,
+rapid, and forceful, the child fails to catch its breath and is
+compelled to take a deep inspiration, which is the whoop; it then goes
+on coughing more. The face may become purple, the eyes protrude, and the
+veins of the face swell up. Near the end of the attack the child raises,
+or vomits a mass of stringy, glutinous mucus. After it is over the child
+is exhausted, there is a more or less profuse perspiration, and he may
+be quite dazed. These attacks are, as a rule, more frequent and more
+severe during the night. This stage lasts about one month and is then
+followed by the stage of decline, during which the disease subsides into
+what appears as an ordinary bronchial cold.
+
+It is quite common for these children to get relapses, especially during
+inclement winter weather, and go on whooping for two or three months
+longer. Their vitality suffers because their sleep and nourishment is
+interfered with, and they become nervous and difficult to manage.
+
+Treatment.--Inasmuch as there is no remedy known that will cure
+whooping-cough, the best we can do is to render the patient physically
+efficient to stand the severe strain of coughing, which is the worst
+feature of the disease. Experience has taught us that those children do
+best who spend their entire time out of doors. We, therefore, advise
+parents to encourage their children to play in the open air. There is no
+exception to this rule, even in winter weather, unless it is
+particularly inclement. If the weather is wet or raw, or if the child
+has bronchitis, or is running a fever, it would be more safe to keep the
+child indoors, in a well-aired room, until the temporary conditions pass
+over, when they could again resume the open-air treatment.
+
+Naturally delicate children if under two years of age should not risk
+staying out of doors too much in very cold or raw weather, even if not
+suffering from any of the above complications.
+
+The bedrooms of children suffering from whooping-cough should be large
+and thoroughly aired day and night.
+
+The nourishment in these cases is of great importance. They should be
+carefully fed, and if they vomit with the paroxysms of coughing, they
+should be fed small quantities frequently. Any form of digestive
+disturbance is very apt to accentuate the frequency of coughing. A fluid
+diet of milk is the best. Milk punches aid in keeping up the strength;
+malted milk and eggs beaten in milk are nutritious and easily digested.
+
+So far as internal medication is concerned, I have found pertussin to be
+the most efficacious remedy. If it is begun early and in sufficient
+dosage, it not only favors an early termination of the disease, but it
+lessens the frequency and the severity of the paroxysms. If it is
+suspected that the child has been exposed to whooping-cough, pertussin
+may be given during the catarrhal stage with the advantage that it will
+render the whole course of the disease milder. If it is given during the
+course of an ordinary catarrhal cold, it will in most cases be as
+effectual as any ordinary cough remedy. The dosage should be large
+enough to produce results. I have found a teaspoonful every two hours
+to a child of three years to be the average dose. In older children I
+give two teaspoonfuls every three hours. It is necessary to continue its
+use throughout the disease. The taste of pertussin is pleasant and young
+children take it willingly.
+
+When the disease is inclined to a protracted course, or when the cough
+does not subside, especially during unfavorable weather, it is of great
+importance to send the child away. A change of climate, preferably to
+the seashore, even for a short time, will act like a charm, and will
+cure the cough of whooping-cough quicker than any other possible
+measure.
+
+
+MEASLES
+
+Measles is the most widely prevalent, eruptive, contagious disease. With
+few exceptions, every human being "gets" measles. As an uncomplicated
+disease it is never fatal, and is not even regarded as dangerous.
+Because of this characteristic, however, parents are neglectful and
+complications occur, and these frequently prove fatal. One attack
+renders the patient immune. It is very highly contagious and spreads
+with great rapidity among those who have never had it. It is not
+possible to carry the disease any great distance by a third person or by
+means of living objects. It does not, however, cling to clothing or
+other objects as long as scarlet fever. Its period of incubation is from
+eleven to fourteen days.
+
+Symptoms.--The symptoms develop gradually. A severe cold in the head
+is the first and most characteristic symptom of the disease. There is a
+discharge from the nose, swollen and watery eyes, sneezing and a hoarse,
+harsh cough. The patient may complain of the throat being painful and
+examination will reveal a general congestion of the parts. There are
+also headache, lassitude, pains in the back, and there may be vomiting
+and diarrhea. Children in the early stages of measles are tired and
+sleepy.
+
+Koplik's Spots.--Three or four days, in rare cases somewhat longer,
+before the appearance of the rash there appears on the mucous membrane
+of the cheeks small, bluish white, or yellowish white points, the size
+of a small pin head. These points are surrounded with reddened areas
+which give the appearance of a general rash with fine white points upon
+it. These points resemble milk particles. They adhere firmly to the
+mucous membrane and when an effort is made to remove them it is found
+that the underlying surface is ulcerated and excoriated.
+
+The Koplik spots are not of much value to the mother other than that
+they may be relied upon to indicate the coming disease with which they
+child is affected. Physicians look for them as an aid in diagnosis
+before the rash would of itself indicate the disease.
+
+The rash appears on the third, fourth, or fifth day of the disease. From
+the day of the infection to the outbreak of the rash about thirteen days
+intervene. It is seen first at the roots of the hair on the forehead,
+behind the ears or on the neck. It may be seen first on the cheeks. The
+beginning rash appears as small, dark red, dull spots. At first there
+are only a few, but they soon become more numerous, they join together,
+and soon the surface looks inflamed as if entirely covered with the
+rash. The rash covers the entire body, including the soles and palms. In
+twenty-four hours it is at its height on the face. It spreads downward
+like a wave, first the face, then the neck and chest, then the abdomen
+and later the legs. By the time it invades the legs it has begun to fade
+on the face. It fades slowly in the order of its appearance. Its
+duration is about four days.
+
+The skin is swollen; it burns and itches. The eyes are swollen and red
+and intensely sensitive to light. There is usually a muco-pus discharge
+from them. The cough is invariably an annoying feature. The fever is
+high and reaches its highest point when the rash is at its height. As
+the rash fades the fever subsides.
+
+When the rash fades, the patient begins to "scale." The scales of
+measles are fine, like bran, never in large patches like the scales of
+scarlet fever. The amount of the scaling varies. It may be quite
+considerable or it may be so small as to be overlooked.
+
+Complications.--The most important and by far the most frequent
+complication of measles is broncho-pneumonia. There may be various
+conditions affecting the stomach, bowels, throat, ears, bronchi, and the
+nervous system, which may accompany the disease but are seldom of a
+serious or important character.
+
+Treatment.--Measles runs a certain course and will run that course, no
+matter what we may or may not do. We cannot stop it, or shorten it, or
+lessen its severity. We can only hope to make the patient comfortable
+and to prevent the development of complications.
+
+The child should be put in bed and kept comfortably warm but not too
+warm. The room should be kept at the ordinary temperature of the sick
+room, 68 deg. to 70 deg. F. It should be darkened but not dark. The food should
+be fluid and given regularly. The child may be given all the cool,--not
+cold,--water it wants to drink. The bowels should be kept open daily. If
+constipation occurs an enema may be given. The eyes must be carefully
+watched and washed every hour or two during the day with a boracic acid
+solution. If the cough is distressing, it may be rendered less
+distressing, though we cannot hope to stop it until the disease has run
+its course. The restlessness, headache and general discomfort can be
+much modified by suitable remedies. If the itching is acute, the body
+can be rubbed with carbolated vaseline. When the rash subsides and the
+patient is free from fever a daily warm bath should be given in order to
+facilitate scaling.
+
+Should complications arise they should be promptly cared for by the
+attending physician.
+
+
+SUMMARY:--
+
+     1. Measles is the most prevalent infectious disease of childhood.
+
+     2. The danger of measles has been and is underestimated. Because of
+     its prevalency many mothers treat it with less respect than they
+     should, with the result that fatal complications occur, or the
+     future health of the child is permanently injured.
+
+     3. Children with measles should be put in bed and kept in bed and
+     treated as directed above.
+
+The following rules have been formulated by the Department of Health of
+New York City, with reference to measles, and embody precautions that
+should find general observance:
+
+     1. All children in the family must be promptly excluded from school
+     attendance.
+
+     2. Careful and continued isolation of the patient must be enforced
+     until the case is terminated and fumigation has been ordered by the
+     medical inspector of the Department.
+
+     3. All secondary cases must be reported even if the first case is
+     still under surveillance of the Department of Health.
+
+     4. Suspected cases must be treated as contagious cases until a
+     sufficiently long observation has shown that the patient has a
+     non-contagious disease. All cases will be considered as measles, if
+     so reported. Any change in the original diagnosis must be made in
+     writing to the Department of Health and must be confirmed by a
+     diagnostician.
+
+     5. Physicians must not order the removal of patients to the
+     contagious disease hospital, or elsewhere, in cabs or other
+     vehicles, but must notify the Department of Health and the removal
+     will be effected by a coupe or ambulance of the Department.
+
+     6. Whenever there is a case of measles in rooms in the rear of, or
+     communicating with, a store, the inspector is required to have the
+     store closed at once, or to report the case for immediate removal
+     to the hospital.
+
+     7. A case of measles must not be removed from one house to another,
+     or even to a different apartment in the same house, without the
+     permission of the Department. Such removal is in direct violation
+     of the provisions of the Sanitary Code.
+
+     8. No case of measles shall be discharged from observation until
+     the Department has been notified, the case examined by an inspector
+     to see if desquamation is entirely completed, and the premises
+     ordered fumigated. This examination by the inspector is necessary
+     because the Department of Health must have official information as
+     to the completion of desquamation before a child is dismissed from
+     observation. Other people with children demand this protection. At
+     no other time is the inspector allowed to examine the patient. In
+     any case, however, where isolation has not been maintained and it
+     becomes necessary to remove the patient to the hospital, a
+     diagnostician will make an examination.
+
+     It is recommended that physicians provide a special washable gown
+     for each case of measles. This gown should be put on before
+     entering the sick-room and taken off outside the sick-room as soon
+     as the visit is completed. The gown should be kept in a closet or
+     suitable place, separate from all other clothing, and the gown, and
+     the closet should be fumigated after the termination of the case.
+
+     10. In private houses only fumigation may be performed under the
+     supervision of the attending physician; provided he follow
+     accurately the directions given in the following rules and
+     regulations. Upon request a blank will be provided upon which he
+     must state the manner and extent of the work performed under his
+     orders and supervision. If satisfactory to the Department, this
+     will be accepted in place of fumigation by the Department. It is
+     essential, however, that he should know that the disinfection has
+     been efficiently carried out.
+
+In every case of fumigation the following regulations must be complied
+with:
+
+     All cracks or crevices in rooms to be fumigated must be sealed or
+     calked, to prevent the escape of the disinfectant, and one of the
+     following disinfectants used in the quantities named:
+
+     a. Sulphur, 4 lbs., for every 1,000 cubic feet of air space, 8
+     hours' exposure.
+
+     b. Formaline, 6 oz. for every 1,000 cubic feet of air space, 4
+     hours' exposure.
+
+     c. Paraform, 1,000 grains for every 1,000 cubic feet of air space,
+     6 hours' exposure.
+
+     The following disinfecting solutions may be used for goods, which
+     are afterwards to be washed:
+
+     a. Carbolic acid, 2 to 5 per cent.
+
+     b. Bichloride of mercury, 1-1,000.
+
+
+SCARLET FEVER. SCARLATINA.
+
+Scarlet fever is an acute, contagious disease. It begins abruptly. The
+child may have a severe attack and be quite sick from the beginning, or
+he may have a mild attack and not be very sick. Usually the fever rises
+rapidly, the child vomits and complains of a sore throat. If the attack
+is very mild the throat symptoms may not cause any distress. Frequently,
+about the third day, there are patches on the tonsils. Prostration may
+be profound if the fever is very high. Convulsions and diarrhea are
+sometimes present in very young patients. It takes from two to six days
+to develop scarlet fever from the time the child is exposed to it. The
+disease may be caught at any time, but it is most contagious during the
+time the patient is scaling. It is not as contagious as measles. Some
+children seem to escape even though directly exposed to it. It is more
+frequent in the fall and during the winter, and it is more severe during
+the latter months.
+
+Eruption.--The eruption appears at any time after twelve hours. It may
+not, however, appear before the third or fourth day. It lasts from three
+to seven days, and only takes a few hours to cover the whole body after
+it is first seen. The rash is first seen on the neck or chest; it
+appears as a red, uniform blush, but, when examined closely, small
+reddish spots may be seen all over it. If the rash is very faint and of
+a doubtful character a hot bath may bring it out. A bright red,
+well-developed rash is a sign of good heart action. In the event of
+heart failure, the rash fades quickly. Itching is a constant symptom
+after the rash is fully out.
+
+About the eighth day the rash begins to scale or desquamate. It begins
+on the neck and chest. It takes from one to three weeks to scale
+completely, from the time it begins to peel. The hands and feet are the
+last spots to scale.
+
+It must always be kept in mind that mild cases are just as contagious as
+severe cases, and that a mild case may cause in another person a very
+severe attack.
+
+The throat may be mildly affected or it may be the most troublesome
+feature of the case. It is red and swollen and the child complains of
+pain during the act of swallowing. Patches may be seen on the tonsils on
+the third day. There is usually a discharge from the nose and this
+discharge may be contagious. While the fever is high, the child is
+restless, complains of thirst, and may be slightly delirious.
+
+One attack is usually all a child has during life, though there are
+exceptions to this rule. Complications are quite frequent with scarlet
+fever. Inflammation of the ears and kidneys is most often met.
+
+Measures to be Taken to Prevent Spread of Disease.--Every case, no
+matter how mild, should be isolated for four weeks. Many cases must be
+isolated longer,--until scaling is complete. Children should not play
+or sleep with other children for three or four weeks after all symptoms
+have been absent. Other children in the family, who have not been
+exposed, should be sent away. All clothing should be changed and washed
+in soap and water and then boiled in a carbolic solution. The nurse
+should not mix freely with other members of the family. The sick room
+should be kept clean, and well aired. It should be dusted with a wet
+cloth, and this should afterwards be burned. There should be no
+furniture, or hangings, or pictures in the room other than are
+absolutely necessary. The room should not be used after the case is over
+until it is thoroughly and completely disinfected.
+
+During the period of scaling the patient should be rubbed all over with
+carbolated vaseline. This allays itching and prevents the scales flying
+around. The bed sheet can be taken off daily with the scales in it, and
+immediately put in carbolic water and boiled.
+
+Treatment.--Inasmuch as scarlet fever is one of the most dangerous and
+one of the most treacherous diseases of childhood, we cannot afford to
+take any chances with it. Every child with scarlet fever should be put
+in bed, and kept there during the entire illness,--that is, from four to
+six weeks. Light, and the free circulation of fresh air are absolutely
+necessary for the proper care of a scarlet fever case. The child should
+be clothed only with the usual night gown and a light undershirt. No
+extra wraps or blankets are required.
+
+The diet should be reduced in quantity and strength. The bowels should
+move daily. If anything is necessary to accomplish this, citrate of
+magnesia is quite satisfactory. There is no special medicine for the
+treatment of this disease. Often it is not necessary to give any. Good
+nursing is more essential, and with proper attention to the bowels,
+diet, fresh air, clothing, sleep, and quiet, all will, as a rule, result
+favorably. Quiet is essential. Consequently, two persons at a time
+should never be allowed in the room with the little patient.
+
+The family physician will prescribe whatever medicine is necessary in
+his judgment, and will meet any complication as it arises.
+
+
+TYPHOID FEVER
+
+Typhoid fever is an acute infectious disease. It is rare in infancy.
+After the fifth year it is more common. It is caused by drinking
+infected water or milk. It is not a serious disease in childhood, rarely
+being fatal.
+
+Symptoms.--It may begin suddenly or it may come on slowly. If
+suddenly, the child develops what appears to be an attack of
+indigestion, has fever, vomiting, and is prostrated. In cases developing
+slowly the child complains of being tired, has a headache, nausea, and
+fever. Vomiting is the suggestive and important symptom.
+
+Diarrhea is usually present. Constipation, however, may accompany the
+entire illness. Children may not complain of an excess of gas as do
+adults. The abdomen is tender. The typhoid eruption is rarely seen in
+children. They lose flesh steadily and then strength diminishes rapidly.
+Headache and delirium at night are quite common, and the child is dull
+and indifferent, and often in a state of semi-stupor.
+
+In order to tell definitely whether the child has typhoid, it is
+necessary to make a blood examination. There are so many intestinal
+conditions in children that simulate typhoid, that a blood examination
+is imperative.
+
+Treatment.--The patient should remain in bed during the time fever is
+present and for a few days after. A fluid diet, preferably milk, is the
+most suitable means of nourishing the child. It may be diluted or given
+plain according to the age of the patient. Water is essential and should
+be given freely.
+
+The discharges of the patient should be thoroughly disinfected in a
+solution of carbolic acid, 1-20. All clothing and bed linen should be
+boiled for two hours. If the fever remains high cold sponging is
+advisable. The attending physician should instruct regarding this
+feature, as some children do not stand cold applications well.
+
+The average duration of the disease is about six weeks.
+
+How to Keep From Getting and Spreading Typhoid Fever.--Typhoid fever
+is a communicable disease, but, if certain precautions are taken, its
+contraction and spread can almost certainly be prevented.
+
+The disease is caused by a specific germ known as the typhoid bacillus.
+These germs are found in the excreta (stools and urine) of persons ill
+with typhoid fever.
+
+Failure to properly disinfect these excreta and carelessness in the care
+of persons ill with typhoid fever lead to the transmission of the
+disease from the sick to the well by the infection of water, milk or
+food with the typhoid bacillus or by direct contact.
+
+The disease is contracted by taking into the mouth in some form the
+discharges from some previous case. There is no other way. It is,
+therefore, a disease of filth and someone is at fault somewhere for
+every case of typhoid fever that occurs.
+
+Bad sanitary conditions, such as lack of drainage, open cess-pools,
+sewer gas, decaying vegetable matter, etc., may favor the contraction of
+the disease, but cannot cause it unless the specific germ, the typhoid
+bacillus, is present.
+
+The water supply of a community becomes infected by the entrance into it
+of the excreta (stools and urine) of persons suffering from typhoid
+fever.
+
+Milk (in which typhoid bacilli grow and multiply very rapidly) usually
+becomes infected by washing out milk cans with water in which these
+bacilli are present, or from the presence of the bacilli on the hands or
+persons of those handling milk. Oysters spread the disease when they
+have been "freshed" in water rich in sewage and containing the typhoid
+bacillus. Flies, whose bodies have become foul with typhoid excreta, may
+infect food, milk, etc. Those who take care of typhoid patients may
+contract the disease if they do not at once disinfect their hands after
+handling the patient, or clothing or bedding which has become soiled
+with the discharges.
+
+How to Keep From Getting Typhoid Fever.--If the chance of infection is
+to be reduced to a minimum, all drinking water, concerning the character
+of which there may be the slightest doubt, should be boiled, and all
+milk, the handling and care of which is not absolutely beyond suspicion,
+should be pasteurized or boiled. All food supplies (meat, milk,
+vegetables, etc.), should be carefully protected against flies, and
+flies should not be permitted access to the sick-room, the kitchen nor
+to the room in which the meals are eaten. Bathing at all beaches which
+have sewers emptying in their immediate vicinity should be strictly
+avoided. In the majority of cases it is probable that the system must be
+slightly below par in order that the disease may be contracted;
+therefore, all indigestible food, green fruit, etc., which may set up
+indigestion or diarrhea, and so render the system more susceptible to
+infection, should be avoided. In addition, the elementary rules of
+cleanliness and hygiene, both as to the house and person, should be most
+strictly observed. No member of a household in which a case of typhoid
+fever occurs should take food in any form without previously washing the
+hands.
+
+Typhoid bacilli enter the body only through the mouth. If sufficient
+care be taken to prevent their entrance, the contraction of the disease
+can be absolutely prevented.
+
+How to Keep From Spreading the Disease.--In order to protect
+themselves and others in the household, persons caring for or in any way
+coming into contact with a case of typhoid fever must constantly bear in
+mind that the secretions and excretions (urine, stools, etc.), of the
+patient contain typhoid bacilli and are capable of transmitting the
+disease to others. The person who nurses the patient should not do the
+cooking for the family. The bedding used by the patient should be washed
+separately from that used by others. Special dishes, plates, knives,
+forks, etc., should be kept for the use of the patient alone, and should
+be washed separately and thoroughly. Particular attention should be paid
+to immediate disinfection of the stools and urine of the patients until
+the restoration of health is complete.
+
+The urine is especially dangerous. It may look entirely normal and yet
+contain typhoid bacilli for some time after recovery is apparently
+complete. In a few instances the typhoid bacilli may persist in the
+stools for weeks or months after recovery. Such persons are called
+"typhoid carriers," and constitute a grave menace to the health of the
+community. The best disinfectants are carbolic acid and freshly slacked
+lime; both are effectual, cheap and easily obtained. Urine or stools to
+which has been added one-third of their volume of a solution of one part
+of carbolic acid to twenty parts of water are, as a rule, sufficiently
+disinfected in half an hour, provided the mass of the stool is broken up
+and thoroughly mixed with the solutions. The best method is to keep the
+urinal of bed-pan partly filled with the disinfecting solution at all
+times. In this way any germs present in the urine or stools are almost
+instantly destroyed. Stools and urine should never be thrown out on the
+ground. If no system of drainage is at hand, they should be very
+thoroughly disinfected and emptied into a hole in the ground and covered
+with earth. All persons nursing or handling the patient in any way
+should be careful to wash their hands very thoroughly with soap and
+water before leaving the sick-room. They should never, while in the
+sick-room, touch any article of food or put their hands to their mouths.
+Careful observation of the above suggestions and precautions will almost
+certainly prevent contraction of typhoid fever or the spread of the
+disease.
+
+
+VARIOUS SOLUTIONS
+
+Boracic Acid Solution.--In the previous pages mothers are frequently
+told to use "a saturated solution of boracic acid." A saturated solution
+means that the water in the solution has dissolved all of the product
+that is put into it that it is capable of dissolving. When boracic acid
+is put into water, the water will dissolve it up to a certain point; if
+you add more the boracic acid will not dissolve; it will float if it is
+in the form of powder, or it will remain at the bottom of the glass if
+it is crystal--in other words the water is saturated to its limit and
+the solution is known as a saturated solution.
+
+The strength of a saturated solution of boracic acid is as follows:--
+
+  Boracic Acid         Ounces 1-1/2
+  Hot Sterile Water    Pints 2
+
+which means that 2 pints of hot water will completely dissolve 1-1/2
+ounces of boracic acid. If any more boracic acid is added the water
+will not dissolve it because it is already "saturated." Inasmuch,
+however, as boracic acid is harmless, it is perfectly safe to use the
+liquid part of a solution which contains some undissolved acid.
+
+A saturated solution is used in the eyes after it is strained.
+
+Normal Salt Solution.--A normal salt solution is made in the following
+proportions:--
+
+  Sodium Chloride (ordinary table salt)    Grains 128
+  Sterile Water                            Pints    2
+
+Normal salt solution is much used in irrigating the bowel. A mother may
+safely use it in the proportion of one heaping teaspoonful to two quarts
+of water--two quarts being the size of the ordinary fountain syringe.
+
+Carron Oil.--Lime water and raw linseed oil, equal parts. This mixture
+is much used in burns. It should be made fresh.
+
+Thiersch's Solution:--
+
+  Salicylic Acid            Drams  1/2
+  Boracic Acid              Drams 3
+  Sterile Water             Pints 2
+
+Thiersch's solution is a good, mild antiseptic solution, or wash.
+
+Solution of Bichloride of Mercury (1 to 1000):--
+
+  Bichloride of Mercury     Grains 15
+  Common Salt               Grains 15
+  Sterile Water             Pints   2
+
+Bichloride of mercury is one of the most powerful and poisonous drugs.
+Solutions made from it should never be used without special directions
+from a physician. In much weaker solutions than the above it is one of
+the best antiseptic washes known. It is used to disinfect wounds, for
+douches, and for various other purposes, but always by special direction
+of a physician.
+
+Other solutions.--Frequently mothers are directed to use solutions in
+the proportion of 1 to 500, or 1 to 1000.
+
+This means that there will be one part of the drug, or of the liquid
+medicine, to 500, or 1000 parts of water. For example if you were asked
+to make up a solution of bichloride of mercury in the strength of 1 to
+4000, you would use one ounce of bichloride of mercury to four thousand
+ounces of water, or one grain of the mercury to four thousand drops of
+water,--one grain being equivalent to one drop.
+
+Sometimes solutions are made up on the percentage basis. For example, a
+five per cent. solution of carbolic acid. In this case it would be
+necessary to take five ounces of carbolic to one hundred ounces of
+water, or five drops of carbolic to one hundred drops of water.
+
+       *       *       *       *       *
+
+
+CHAPTER XXXIX
+
+ACCIDENTS AND EMERGENCIES
+
+
+Accidents and Emergencies--Contents of the Family Medicine
+Chest--Foreign Bodies in the Eye--Foreign Bodies in the Ear--Foreign
+Bodies in the Nose--Foreign Bodies in the Throat--A Bruise or
+Contusion--Wounds--Arrest of Hemorrhage--Removal of Foreign Bodies from
+a Wound--Cleansing a Wound--Closing and Dressing Wounds--The Condition
+of Shock--Dog Bites--Sprains--Dislocations--Wounds of the
+Scalp--Run-around--Felon--Whitlow--Burns and Scalds
+
+
+Contents of the Family Medicine Chest.--The family medicine cabinet
+should contain the following articles: a graduate, medicine droppers,
+hot water bags, a flat ice bag, a fountain syringe, a Davidson's
+syringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandages
+of various widths, a yard of oiled silk, one roll of one inch "Z O"
+adhesive plaster, a bottle of Pearson's creolin, hydrogen peroxide
+(fresh), one ounce tincture of iodine in an air-tight bottle, a can of
+Colman's mustard, two ounces of syrup of ipecac, a bottle of castor oil
+(fresh), one pound of boracic acid powder, one pound of boracic acid
+crystal, a bottle of glycerine, a bottle of white vaseline, a bath
+thermometer, some good whisky or brandy, aromatic spirits of ammonia,
+smelling salts, pure sodium bicarbonate, oil of cloves for an aching gum
+or toothache, a bottle of alkolol for mouth wash and gargle, and one
+ounce of the following ointment for use in the various emergencies which
+occur in all homes,--
+
+  Bismuth subnitrate             dram one
+  Zinc oxide                     dram one
+  Phenol (95%)                   drops twelve
+  Resinol ointment to make       ounce one
+
+This ointment may be applied to all cuts, bruises, skin eruptions,
+chafings and sores of minor importance. It is one of the best
+applications for chafing of the skin in babies.
+
+The medicine chest should also contain a small jar of Unguentine for
+burns; one-tenth grain calomel tablets for a cathartic for baby to be
+used as explained in the text of the book, or as advised by the
+physician. It may also contain tablets for colds and for other purposes
+as suggested by the family physician. It should never contain medicines
+the use of which is not thoroughly understood by the mother. It is a
+wrong practice for mothers to keep medicines to use for the same ailment
+at a subsequent time. The ailment may not be the same and frequently the
+medicine itself deteriorates, or it may get stronger with age. Many
+medicines are made with alcohol in them. If kept for some time the
+alcohol evaporates and leaves a concentrated mixture which, if given in
+the dose meant for the fresh preparation, may poison a child. Such cases
+of poisoning are on record. The same argument applies to powders.
+Certain drugs lose their strength, some absorb moisture, others change
+their chemical strength if kept mixed with other chemicals. They should
+be thrown away after the case is over if they have not been used. It is
+a dangerous practice to keep medicines around if there are children in
+the family.
+
+Foreign Bodies in the Eye.--Particles which accidentally lodge in the
+eye are usually located on the under surface of the upper lid. They are
+sometimes, however, found on the ball of the eye or on the inner aspect
+of the lower lid. Foreign bodies which are propelled into the eye with
+great force, as iron specks which railroad men frequently get sometimes
+imbed themselves into the eye-ball and have to be cut out or dug out.
+The entrance of the foreign particle is always accompanied by a flow of
+tears which is nature's way of removing them. The offending object may
+escape through the tear duct into the nose, or it may be simply washed
+out with the flow of tears. Rubbing the well eye will cause a flow of
+tears in both eyes and may facilitate removal of the foreign matter.
+Blowing the nose may force the particle into the tear duct. The use of
+the eye cup may help in ridding the eye of the body. The same object may
+be accomplished if the eyes are immersed in a basin of water and opened
+wide. Then by moving the eyes around the particle may be washed out. If
+the particle is located on the under surface of the upper lid it may be
+promptly removed by pulling the upper lid forcibly down and over the
+lower lid. The eyelashes of the lower lid act as a brush and as a rule
+quickly remove the irritant if the procedure is carried out adroitly.
+Everting the upper lid is a means of locating the body and in making
+possible its removal by a small camel's hair brush or corner of a
+handkerchief. To evert the upper lid it is necessary to employ a guide.
+A match stem may be used in an emergency. This is laid across the middle
+of the upper lid, the eye lashes are grasped with the fingers of the
+other hand and the lid is bent over the match stem and turned up thus
+everting or turning inside out the entire upper lid. The procedure may
+be facilitated if the patient is instructed to look down while the
+operator is drawing the eye-lid upward.
+
+If the particle cannot be easily removed by any of the above methods it
+is not safe for an uninstructed individual to go any further. The eye is
+an exceedingly delicate organ and may be permanently injured by
+unnecessary irritation. It is always safer and it may be cheaper in the
+long run to consult a competent oculist in such cases.
+
+After the removal of any object from the eye, it is desirable to
+frequently wash it out with a saturated solution of boracic acid. This
+mixture will allay any inflammation and will tend to restore the normal
+condition more quickly and more satisfactorily than if the eye were left
+to heal itself.
+
+Foreign Bodies in the Ear.--When a foreign body gets into the ear
+mothers are unnecessarily alarmed because of a failure to appreciate
+that the ear is a closed passage. It is impossible for any object to get
+into the ear itself; the depth of the external passage is only about one
+inch in an adult. At this point the passage is completely closed by the
+drum membrane. Most of the harm is done by ignorant meddling, not by the
+object itself.
+
+Children frequently put foreign bodies in the ear, as, buttons, pebbles,
+beans, cherry stones, coffee, etc. The very first thing for the mother
+to do when she learns that her child has put "something" in its ear is
+to keep cool, and try to find out what the something is. It is
+essential to know what the article is because different articles are
+treated differently. For example if we try to remove a bean or pea with
+a syringe, the liquid will cause the pea or bean to swell and result in
+wedging it in so firmly that it will be impossible to dislodge it in
+this way.
+
+If the object is hard, as a marble, button, pebble, bead, the greatest
+care must be exercised. Try to make the object fall out. To effect this,
+turn the child's head downward with the injured ear toward the floor.
+Then pull the lobe of the ear outward and backward so as to straighten
+the canal. A teaspoonful of olive oil poured into the ear will aid in
+its expulsion. If after the oil is poured in, the head is suddenly
+turned as above described the object will fall out. A very effective way
+to remove a hard object is to take a small camel's hair brush and coat
+the end with glue, or any other adhesive substance, then place it in
+contact with the object and permit it to remain long enough to become
+firmly attached after which it may be gently pulled out with the object
+attached. Never employ an instrument in the ear to remove a foreign
+body.
+
+When a live insect or fly enters the ear a number of safe methods may be
+developed. If the ear is immediately turned to a bright light the insect
+may come out of its own accord. It may be floated out with salt water,
+or it may be smothered with sweet oil or castor oil after which it may
+be floated or syringed out. If it is necessary to employ a syringe this
+should be used gently. A foreign body may remain in the ear for days or
+weeks without doing any harm. This suggests that any unnecessary poking
+or prying should not be undertaken, because this may wedge it in tighter
+and to injure the drum membrane.
+
+Foreign Bodies in the Nose.--Children may put any of these articles
+into the nose. Very often they do, and do not know enough to tell. If
+such is the case the first symptom calling attention to the fact that
+something is wrong is the appearance of a thick foul discharge from one
+nostril or some obstruction to breathing on the same side.
+
+When the foreign body may be seen the child should be made to blow the
+nose, first closing the well side with the finger. If this does not
+expel the object the child should be made to sneeze by tickling the free
+nostril with a feather or by taking snuff. The mother should never
+permit the use of instruments by one unskilled in an effort to rid the
+nose of an obstruction. There is great danger of seriously injuring the
+delicate structure of the nose in this way or of pushing the object so
+far in that it may necessitate an operation to extract it. It is much
+safer to seek medical aid before any damage is effected. It seldom does
+harm to wait until the right assistance is at hand; it often does
+serious harm to be too smart in these little matters.
+
+Foreign Bodies in the Throat.--If the foreign body is in the upper
+part of the throat and can be seen it may be removed with any instrument
+that can grasp it. The child may be immediately held up by its feet when
+the article may be shaken out. If it is further back or in the air
+passages the child should be made to vomit by tickling the throat with a
+feather or with the finger held in the throat till it does vomit.
+
+When the object interferes with breathing a physician should be sent for
+in a hurry. In the meantime the family may try to dislodge it by having
+the child bend forward or by holding it with the head downward and,
+while in this position, sharply striking the back with each cough.
+Striking the chest when in this position may effect the same purpose. If
+no success follows this procedure try the reverse position. Have the
+child bend backward over the arm of a sofa, for example, or put him in
+bed with the body hanging out of the bed face upward. If none of these
+effect relief you must depend upon the skill of the physician.
+
+A Bruise or Contusion.--A bruise or contusion is an injury to the
+tissues underneath the skin, but this does not imply that the skin
+itself is opened or damaged. In every bruise the small blood vessels are
+ruptured, and the blood collects in the tissues causing distention,
+swelling and pain. The blood is held in the tissues, it is stagnant,
+becomes dark in color and so produces the bluish discoloration that we
+see in all bruises. The color varies according to the extent of the
+collected blood. At first it is red and inflamed looking, then purple,
+then black, then greenish and finally citron. The so-called "black-eye"
+is a typical example of this degree of bruise. After a bruise the parts
+swell from the collection of blood and from the accompanying
+inflammation. This causes pain which persists for a day although the
+spot may be sore and tender for a week or more.
+
+In all mild varieties home remedies may suffice, but in the more serious
+and extensive bruises it is advisable to seek medical assistance. It is
+essential to completely put the part to rest and to elevate it. This
+will relieve the pain and favor the absorption of the exuded blood. If
+the bruise is on the foot, the leg should be elevated until the foot is
+higher than the hip. If, on the hand, it should be so held that it will
+be higher than the elbow and it may frequently be held higher than the
+shoulder to relieve the throbbing and the pain.
+
+As a rule, cold should be applied as soon after the injury as possible,
+cloths wrung out of ice water, or a piece of ice may be bound on the
+part for a short time. The object of the cold is to stop the internal
+bleeding. If the injury is slight, as are most of the injuries of the
+household, the mother may apply repeated cloths wrung out of very hot
+water. This procedure tends to aid the immediate absorption of the blood
+and prevents a discoloration of the part. If there is great pain relief
+may be afforded by applying a firm bandage saturated in the lead-water
+and laudanum mixture which may be obtained in the drug store under the
+name of lead and opium wash. The bruised part should be massaged every
+day and a simple ointment may be applied to soften the inflamed area.
+
+If any complication arises in the treatment of a bruise, it will be
+necessary to consult a physician.
+
+Wounds.--A wound implies an injury to the skin in addition to injury
+to the underlying parts to a lesser or greater extent. The skin may be
+opened by cutting, or stabbing wounds; or it may be punctured, torn,
+contused, or bruised open. These injuries are effected in various ways.
+We speak of machinery or mechanical wounds, or gunshot wounds, bites,
+cuts, stabs and other varieties of wounds.
+
+It is very important to know exactly how a wound is produced and the
+nature of the instrument which opened the skin. We try to obtain this
+information in order to estimate the probable degree of poison that may
+or may not have entered into the wound.
+
+The first thing to do in treating wounds is to stop the bleeding. If the
+patient is suffering from shock he should be given active treatment for
+this condition as described elsewhere. If the wound contains any foreign
+bodies these should be removed. The wound should then be cleansed,
+closed and dressed and kept at rest. If the wound is poisoned, or if
+there is any fear that lockjaw may arise, or if the wound has been
+caused by a mad dog it will require special treatment.
+
+It is far better not to interfere if you do not know what to do than to
+do harm. One should offer no advice if they are not qualified to give
+advice. Much harm has resulted from doing the wrong thing in these
+cases. The instruction in the following pages is given so that the
+average mother may know what to do in emergency but not with the
+intention that she may regard her knowledge as sufficient to dispense
+with the aid of the physician.
+
+Arrest of Hemorrhage.--When there is a wound there is always bleeding;
+this means that some blood vessels have been cut or torn open allowing
+blood to escape. The character of the hemorrhage will determine the
+nature of the treatment to be employed. On general principles, the first
+thing to do in the presence of bleeding is to elevate the part, if that
+is possible. If there is simply a general oozing of blood, it may be
+controlled and arrested by pressure. This pressure should be steady and
+prolonged. It is best accomplished by wetting a clean handkerchief or a
+pad of gauze in ice cold water, placing this on the part and binding it
+on firmly with a bandage.
+
+If the discharge of blood flows in a steady stream and is rather dark
+the hemorrhage is coming from a vein. We know that veins carry blood
+toward the heart so that any pressure or constriction employed to stop a
+venous hemorrhage should be tied on the side of the wound further
+removed from the heart. Inasmuch as veins have soft walls the right kind
+of pressure will in most instances stop the bleeding. The part should be
+elevated after the pad is adjusted in place. Any tight band on the limb
+as a garter or sleeve band should be removed as they tend to interrupt
+the return circulation.
+
+If the hemorrhage is from an artery the blood is bright red. It spurts
+out forcibly, is difficult to control and demands immediate attention.
+Arteries carry the blood from the heart to the extremities. They beat
+with every pulsation of the heart so that blood coming from an artery
+spurts with every pulse beat. Even a small artery may be responsible for
+a very considerable hemorrhage in a very short time. Whatever is done
+must be done quickly. The parts should be freed from all clothing and if
+possible elevated. Pressure may be tried, if it succeeds it must be
+strong and steady pressure. The point to press must be on the heart side
+of the bleeding artery since the blood stream is coming that way--this
+the mother will note is the reverse from treating bleeding from a vein
+as previously explained. The artery at this point may be felt beating.
+It is frequently necessary to clamp the whole limb to stop an arterial
+hemorrhage. This may be done in the following manner. Take a strong
+piece of cloth or bandage and tie above the bleeding point. Insert a
+short piece of stick between the bandage and the limb and twist around
+until the bleeding stops. This should not be kept on longer than one
+hour. A tourniquet of this character shuts off all the blood in the limb
+and if kept on too long the parts may mortify. The best means to stop a
+hemorrhage of this character is by means of a rubber bandage sold for
+the purpose. It is applied by stretching at every turn. It exerts
+uniform pressure and in this way does no injury to the parts. All these
+measures are, of course, only temporary expedients as the artery will
+finally have to be caught and tied by a physician.
+
+Removal of Foreign Bodies From a Wound.--When the foreign bodies are
+large enough to be seen they may be picked out with the fingers after
+the hands have been rendered sterile. Smaller bodies may be picked up
+with forceps, or they may be washed out with water that has been boiled
+and cooled slightly, or a bichloride of mercury solution in the strength
+of 1 to 2000 may be used; or a normal salt solution may be used. As a
+general rule the physician should be allowed to undertake this procedure
+so that you may not be blamed for something that may come up later.
+
+Cleansing a Wound.--The simplest way, and the most effective, to
+cleanse a wound, no matter how caused, is to procure a brush and paint
+it thoroughly with tincture of iodine. The iodine should be painted
+right into the raw wound, it is then bound up and left if it is small
+and does not need any stitching. When the physician comes he can attend
+to any further procedure that may be necessary.
+
+Closing and Dressing Wounds.--If the wound is small, its edges may be
+drawn together with narrow strips of adhesive bandage after it has been
+painted with iodine. It is then bound up and kept at rest. It should be
+inspected the following day to see if it is healing properly.
+
+If the wound is large or torn, it should be seen by a physician and
+dressed and closed by him. All wounds do better if they are kept at
+rest.
+
+The Condition of Shock.--When a person suffers a serious injury, loses
+a large quantity of blood, or is subjected to a profound emotion, it
+affects the vital powers to such an extent that the individual is said
+to be suffering from shock. Shock expresses itself in varying degrees of
+apathy. The patient may or may not be conscious. If conscious he gives
+no evidence of feeling, he is silent and motionless although he will
+respond to directions and may answer questions. The eyes are dull and
+listless, the face pale and pinched, and the general expression is
+apathetic. The skin is cold and there may be perspiration; the pulse is
+feeble and irregular, and the breathing is shallow. The whole attitude
+of the victim is one of indifference and apparent inability to
+appreciate the seriousness of the situation and a seeming immunity to
+pain or discomfort.
+
+When this condition exists it must always be regarded as serious because
+the patient may die as a direct result of the condition of shock. The
+various symptoms depend upon a temporary paralysis of the blood vessels
+which deprives the brain of blood. There is always a certain degree of
+shock with all injuries. Mothers should know what to do in these cases
+before the physician comes. The general treatment in all cases is to
+keep the patient warm and quiet, and to use stimulants carefully.
+
+The patient should be put in bed or on a flat surface with the feet
+higher than the head. If raising the feet should cause the face to
+become blue it will be advisable to restore the patient to the
+horizontal posture. Artificial heat must be applied to the patient's
+body and extremities by means of hot water bags, bottles, bricks,
+plates, or any other handy device. Blankets should be put around the
+patient and every possible means resorted to, to maintain body heat.
+Mustard plasters may be put to the heart, spine and shins. Stimulants
+are necessary, such as hot black coffee if possible or hot water, in
+which a small portion of brandy may be put. If brandy is not obtainable
+the patient may take aromatic spirits of ammonia in hot water every
+twenty minutes for a number of doses. In every case of shock a physician
+should be sent for immediately.
+
+Dog Bites.--When a child is bit by a dog every effort should be made
+to get the dog. It should be kept in a safe place for a week so that it
+may be definitely known whether it is sick or not. If the dog dies
+within a few days after biting anyone it may be assumed that he had
+rabies. Its head should be sent to the local health authorities who can
+tell after examination if it was mad. If there is any reason to assume
+that the dog was infected, the child should receive the Pasteur
+treatment. This treatment will, if conducted under favorable
+circumstances, absolutely prevent hydrophobia.
+
+The mother should sterilize the wound as thoroughly as possible. This
+may be done by using pure hydrogen peroxide. A little piece of absorbent
+cotton is wound round the end of a tooth-pick or match, dipped in the
+peroxide and the incision thoroughly rubbed clean. This may be done a
+number of times to ensure thorough cleansing. No effort should be made
+to cauterize the wound. It is not considered proper to employ this
+method with dog bites. When the physician examines the wound he may or
+may not open it further for more extensive inspection and sterilization.
+
+Mothers should remember that there are thousands of bites by dogs that
+never cause any trouble, and if it is known that the dog is healthy no
+worry need trouble the family. It is also wrong to inform the child of
+the probability of hydrophobia. The child may worry himself sick with
+fear and if the mother is nervous and excitable he is apt to be made
+sick with the dread of what may follow. It is better, therefore, to
+remain quiet, to keep cool, and not to excite the little patient at all.
+
+Sprains.--Every joint is held together by ligaments which are attached
+to the bones forming the joint. If these ligaments are subjected to a
+sudden twist in a direction in which the joint is not constructed to
+move, the resulting injury is known as a sprain. The ligaments are
+stretched, though they may be torn apart and even small pieces of the
+bone may be split off if the wrench is great enough. The injury is an
+exceedingly painful one and frequently renders the limb useless for some
+time. It is always accompanied with some degree of swelling and more or
+less inflammation.
+
+A sprained joint should be immediately put at absolute rest. The best
+dressing is the lead and opium wash. Two pints of it may be obtained at
+the drug store. Pour into a large bowl, saturate a large piece of thick
+absorbent cotton, wrap around the joint and bind in place. This dressing
+may be repeated as often as the cotton becomes dry. When the swelling
+has disappeared and the pain is gone, it is desirable to have the joint
+supported with strips of adhesive bandage. These must be put on in a
+certain way in order to properly support the joint. Consequently a
+physician should put them on. If a sprain is not attended to effectively
+there is danger of the joint being more or less incapacitated for life.
+
+Dislocations.--A dislocated joint is one that has been put out of
+place. It is best to allow a physician to treat a dislocation. Unskilled
+handling of a dislocated joint may not only increase the damage but it
+may permanently put the joint out of business. Until the physician
+arrives the part should be kept absolutely at rest.
+
+Wounds of the Scalp.--Children frequently get injuries of the scalp.
+These wounds bleed freely and as a rule they occasion a great deal of
+unnecessary worry and apprehension. Usually they are not of much
+importance. We must keep in mind, however, the probability of fracture
+as a consequence of severe injury. The first thing to do when there is
+bleeding from the scalp is to cut or shave away the hair surrounding the
+wound. This should be done for an inch around the wound so that thorough
+disinfection may be possible. The wound should now be cleansed as
+previously instructed and an effort made to stop the bleeding. The best
+method is to first apply pads of gauze wrung out of very hot water. When
+success is evident a pad made of boiled cotton should be placed on the
+wound and held tightly in place for some time. If the wound is of such a
+character as to demand stitches a physician should of course put them
+in.
+
+Run-Around: Felon: Whitlow.--When pus germs enter around a finger nail
+and lodge in the soft tissue a "run-around" is the result. It is
+accompanied with pain, swelling, redness and inflammation. The loss of
+the nail may follow.
+
+A felon or Whitlow is a more extensive and a more serious condition. It
+is not always possible to trace the cause of a felon. The fact that
+germs gain an entrance, however, is soon established. Sometimes a
+bruise, or scratch, or a wound is the primary cause. The last joint of
+any of the fingers may be the seat of a felon. A end of the finger
+becomes hot, tense, swollen and very painful; the pain is intense if the
+hand is held down. The surface may or may not be red. There is as a rule
+some fever. If the felon is on the little finger or thumb the condition
+is worse than on the others as a rule,--the inflammation extending to
+the hand and often into the arm. The condition affects the palmar
+surface of the fingers. If the felon results in the "death" of the bone,
+the last joint will have to be taken off and the hand may be distorted,
+crippled, and rendered permanently disabled. Blood poison may set in and
+death is possible as a result of this complication.
+
+Treatment.--Every effort should be made to abort a felon. Continuous
+application of equal parts of alcohol and water night and day may abort
+it. Tincture of iodine applied to the entire end of the finger may be
+effective. The hand must be at rest, carried in a sling during the day
+and slung over the head to the bed-board at night. If these efforts are
+not successful after twenty-four hours hot poultices should be resorted
+to, but they must be changed every twenty minutes. If, at the end of
+another twenty-four hours, there is no improvement the finger must be
+freely cut open by a surgeon and the poultices continued.
+
+Treatment of "Run-Around."--Apply iodine freely, cold applications,
+and if the inflammation persists use poultices. It is frequently
+necessary to incise the run-around. Patients suffering from either of
+these conditions need general tonic treatment and should be under the
+care of a physician.
+
+Burns and Scalds.--Burns result from undue exposure to dry heat.
+Scalds are produced by the action of hot liquids and steam.
+
+There are always produced two results from a burn or a scald. First the
+local effect, and, second, the general effect. The general effect may
+produce shock, the symptoms of which have been described in the previous
+pages. The degree of shock depends upon the extent of the local injury
+and may be severe enough to result in death. If the local injury covers
+more than two-thirds of the body death as a rule takes place within two
+days.
+
+How to Extinguish Burning Clothing.--The thought to keep in mind is to
+smother the flames effectively. If we deprive the flame of all air or
+oxygen it will immediately subside. This may be done quickly by wrapping
+the burning part in a carpet, rug, blanket, overcoat or any large woolen
+material at hand. If none of these articles are at hand the victim may
+roll on the floor and try to smother the flame by pressure, aided by the
+hands. It is a good plan to throw water on the patient immediately after
+the fire has been put out, so as to extinguish the smoldering fire.
+
+When a person is scalded by steam or boiling water or other liquid, it
+is advisable to pour cold water freely over the wound.
+
+How to Remove the Clothing.--When it is necessary to remove the
+clothing it is essential to be gentle in order not to do greater injury.
+The clothing must not be pulled. The garment should be cut so that they
+fall off. If any part sticks to the skin, it must be left, not torn
+away. Later, it may be removed by moistening it with salt water.
+
+Treatment of Scalds and Burns.--All slight burns or scalds may be
+effectively treated with Unguentine. This substance may be obtained in
+any drug store. It is spread on a cloth and applied directly to the
+injured part, bound securely on and renewed every day until the wound is
+healed. If Unguentine is not readily obtainable the part may be covered
+with any of the following mixtures or oils: carbolated vaseline, equal
+parts of linseed oil and lime water, olive oil, castor oil or kerosene,
+cloths soaked in a solution of baking soda, or a solution of phenol
+sodique.
+
+In severe burns or scalds the mother should not attempt to treat the
+child. A physician should be summoned at once. The child may be given a
+little whisky or brandy in warm water, and if the pain is great a dose
+of laudanum may be given. The dose of laudanum is one drop for each year
+of life. If the child has a chill he may be put into a warm bath of
+100 deg.F. It is not wise to cut a burn blister. The water may be let out by
+puncturing with a sterile needle, but the skin must be left intact until
+the new skin is grown. The treatment of burns must be done with the
+greatest cleanliness because if infected with germs they may prove
+serious.
+
+       *       *       *       *       *
+
+
+MISCELLANEOUS
+
+
+
+
+CHAPTER XL
+
+MISCELLANEOUS
+
+
+The Dangerous House Fly--Diseases Transmitted by Flies--Homes Should be
+Carefully Screened and Protected--The Breeding Places of Flies--Special
+Care Should be Given to Stables, Privy Vaults, Garbage, Vacant Lots,
+Foodstuffs, Water Fronts, Drains--Precautions to be Observed--How to
+Kill Flies--Moths--What Physicians are Doing--Radium--X-Ray Treatment
+and X-Ray Diagnosis--Aseptic Surgery--New Anesthetics--Vaccine in
+Typhoid Fever--"606"--Transplanting the Organs of Dead Men into the
+Living--Bacteria that Make Soil Barren or Productive--Anti-meningitis
+Serum--A Serum for Malaria in Sight.
+
+
+THE DANGEROUS HOUSE FLY
+
+Mothers should become thoroughly acquainted with the grave consequences
+which may result from fly-infected foods, and from the possible carriage
+of disease by means of flies, even where foods are carefully protected.
+The transmission of the following diseases by means of flies has been
+conclusively proven: typhoid fever, tuberculosis, cholera, Oriental
+plague, inflammation of the eyelids, serious infection of wounds. Summer
+diarrhea of children is also transmitted in this way.
+
+Typhoid fever and summer diarrhea of children in this country, and
+cholera and Oriental plague in the countries in which those diseases
+exist, may be transmitted through the various foods that are eaten in an
+uncooked state, if infected by flies, through cooked foods infected by
+flies after the process of cooking, through drinking water which has
+been infected by flies, and through milk similarly infected. Fruits are
+especially likely to be infected by the small fruit fly commonly found
+around markets and stands. Fish may be infected by flies, and in
+consequence will undergo rapid decomposition. Decomposition caused in
+this way has resulted in many cases of diarrhea and dysentery. What is
+commonly known as fly speck is the excreta of the fly, and frequently
+contains virulent disease germs. These specks are often found on
+foodstuffs that have not been properly protected.
+
+Transmission of disease may also occur by the infection of open wounds
+through contact with infected flies. This is true of all pus formation
+in wounds. The simple contact of a fly infected with the disease may
+cause Oriental plague, sore eyes, and possibly granular eyelids. A fly
+infected with dysentery or typhoid fever may cause either of these
+diseases by simply coming in contact with the lips of susceptible
+persons.
+
+The fly in the house should be relentlessly pursued and destroyed. The
+house which is carefully screened and protected from flies is infinitely
+safer than one not so protected. In the spring of the year the house fly
+begins to take on life. Eggs which were laid the preceding fall begin to
+hatch. At first the fly is only a little worm wriggling in some pile of
+filth. The eggs are usually laid and the grub developed in a manure pile
+or some mass of garbage or other filth. Before the grub develops into
+the fly it is easily destroyed. If everything in and about the house
+were kept scrupulously clean, and if every manure pile were kept
+carefully screened or covered so as to protect it from flies, there
+would be no difficulty in preventing the fly nuisance. The most
+effective way to accomplish this is to destroy the breeding places. The
+importance of this may be seen when it is considered that one fly
+produces one hundred and twenty-five millions or more of its kind in one
+season.
+
+Stables.--Manure is by far the commonest material in which the fly
+lays her eggs. All stables should be kept scrupulously clean. No manure
+should be allowed to accumulate where it will be exposed to flies for
+even a few minutes. Immediately after it is dropped by an animal, it
+should be removed and covered. Manure may be treated with considerable
+quantities of lime without interfering with its fertilizing value, and
+in this way the development of the eggs laid in it by the flies can be
+practically prevented. The floors of stables should be thoroughly
+flushed with water at least once in every twenty-four hours.
+
+Privy Vaults.--Human excrement also affords an excellent breeding
+place for flies. In army camps the latrines are the points from which
+much infection is transmitted to troops, and thousands of the men have
+lost their lives by contracting typhoid fever transmitted in this
+manner. During the summer time all open vaults and dry closets should be
+treated continuously with lime, crude creolin or crude carbolic acid,
+and they should be carefully cleaned out at frequent intervals.
+
+Garbage.--As a medium for the development of flies, garbage may be
+considered next in importance to excreta. The eggs of the fly hatch in
+about twenty-four hours, and garbage which is retained in the kitchen
+for that length of time may contain flies in the grub stage. To prevent
+this development, all garbage should be covered and pails should be
+emptied as often as possible. In country districts garbage should be
+burned in the kitchen or buried in the garden at frequent intervals,
+twenty-four hours being the maximum time it should be retained.
+
+Vacant Lots.--Vacant lots frequently contain appreciable quantities of
+organic matter in a state of decomposition, affording favorable breeding
+places for flies. These vacant areas should be maintained in a state of
+scrupulous cleanliness.
+
+Foodstuffs.--In order to prevent contamination of foodstuffs, all
+foods that are eaten in the raw state and all foods that are exposed for
+sale after having been cooked should be carefully protected from contact
+with flies, by screens or covers.
+
+A point where rapid development of flies takes place is along the city's
+water front. This is due to the fact that many of the sewers do not
+discharge below the level of the water. All open drains should be
+eliminated, whether they be sewers, private house drains or drains from
+cess-pools.
+
+Precautions to be Observed.--Keep the house free from flies. Every fly
+should be considered a possible disease carrier and should be destroyed.
+
+Keep the windows of the house, especially the kitchen windows,
+carefully screened during the spring, summer and autumn.
+
+Protect children from exposure to flies, particularly children who are
+ill, and do not allow nursing bottles to be exposed to flies.
+
+Protect milk and other foodstuffs from contact with flies.
+
+Keep the garbage outside of the house, carefully covered.
+
+Abolish open drains near dwelling places.
+
+Stable manure should be frequently sprinkled with lime and kept covered.
+
+Earth closets and privy vaults should be treated with lime, crude
+creolin or crude carbolic acid at frequent intervals.
+
+Earth closets and privy vaults should be cleaned frequently in order to
+prevent excrement accumulating to an undue extent.
+
+To Kill Flies.--Dissolve one dram of bichromate of potash in two
+ounces of water, add a little sugar to this solution and put some of it
+in shallow dishes and place about the house. Sticky fly paper and fly
+traps may also be used.
+
+To clean the room where there are many flies, burn pyrethrum powder
+(Persian insect powder). This stupefies the flies and in this condition
+they may be swept up and burned.
+
+Probably the best and simplest fly killer is a weak solution of
+formaldehyde in water (two teaspoonfuls to the pint). This solution
+should be placed in plates or saucers throughout the house. Ten cents'
+worth of formaldehyde, obtained in the drug store, will last an ordinary
+family all summer. Don't smell formaldehyde in the pure state; it is
+very pungent and strong. In the solution of the strength used for flies
+it has no offensive smell. It is fatal to disease organisms, and is
+practically non-poisonous except to insects. Flies will not stay in the
+house when this solution is around.
+
+Moths.--Late spring and early summer is the time to guard against
+moths and beetles. Many of these fabric-destroying insects are brought
+into the house on flowers.
+
+May and June are especially bad months, as both moths and beetles are
+only dangerous to fabrics in their young or grub stage.
+
+These insects will destroy almost anything from coarse rugs to the
+finest of ball gowns and dress suits. Carpets that are rarely swept and
+garments that are seldom disturbed are most liable to damage.
+
+The substitution of the frequently removed and easily cleaned rugs for
+carpets will greatly lessen the danger from the destructive moth and
+beetle grubs. Carpets laid on tight floors are much less liable to
+injury than where numerous cracks furnish safe retreats for the insects.
+Tarred paper under a carpet is an excellent preventive.
+
+All clothes presses should be thoroughly cleaned at frequent intervals.
+The garments should be removed, aired and vigorously brushed. Any larvae
+which are not dislodged in this way should be destroyed. It is a bad
+plan to keep odds and ends of woolen or other materials in attics where
+these pests can breed and thus spread to more valuable articles.
+
+Spraying with benzine two or three times during hot weather is a good
+way of preventing injury to furniture or carriage upholstery and other
+articles which are in storage or not in use for a long time. If you are
+certain that woolens and furs are free from the pests they may be stored
+in safety by placing them in tight paste board boxes and sealing the
+covers firmly with gummed paper.
+
+Both moths and carpet beetles are harmless at a temperature of 40
+degrees Fahrenheit--a fact very well known to advantage by the large fur
+storage companies. They cannot survive furthermore a temperature of 120
+decrees if subjected to it for about twenty minutes.
+
+What Physicians are Doing.--It is desirable that the ordinary
+non-medical individual should know what the science of medicine is doing
+and what it is accomplishing.
+
+During the past fifteen years the art of curing and preventing disease
+has taken on giant strides. The man or woman most ready to question the
+accomplishments and the ability of the humble family physician or the
+motive of the science of medicine, is the one who appreciates least that
+it is due to the skill and intelligence of the medical men of to-day
+that he owes his comfort, his health, and his freedom from pestilence,
+plague and disease. Unthinking people laud and praise some upstart whose
+ability lies in his faculty to fool the gullible, or they will rush to
+seek the false aid of some nondescript science, because it is popular
+and well advertised, while they pass by or ignore the men whose labors
+have made the world what it is, and who alone possess the ability to
+intelligently wage the battle in the interest of humanity against
+disease.
+
+The medical profession has repeatedly pointed out that there are, on an
+average, six hundred thousand lives lost every year in the United States
+from preventable disease and accidents. Six hundred thousand lives which
+medical science has at hand the remedy to save, but which the medical
+profession sacrificed because of inadequate legislation. Few people can
+comprehend just what six hundred thousand lives mean. Let us put it in
+another way. There are destroyed by preventable disease and accidents
+every day American lives equal in number to the crews of two battle
+ships, equal in three months to more than the total combined numbers of
+the Army and Navy of the United States; equal in one year to more than
+the total number of lives lost in all our wars since the Declaration of
+Independence.
+
+The Titanic disaster shocked the public for a moment, and seemed to
+impress them as though it was a terrible and unheard of waste of good
+human lives. Yet in the loss of life due to preventable causes we have
+in this country every day in the year a destruction of our citizens
+exceeding in magnitude that which occurred when the Titanic sank.
+Think of it! A Titanic disaster a day, and yet the public does not
+rise up and demand in a spirit of anger and determination that steps be
+taken at once to put an end to this appalling and unnecessary waste of
+lives.
+
+Under modern hygienic conditions, the average length of existence for an
+individual in Great Britain has increased ten years in the last half
+century. Among all the enlightened and advanced nations, the expectation
+of the individual for long survival is greater. Since the appearance of
+uncheckable and epidemic disorders is less frequent and the percentage
+of cures is greater.
+
+Since quarantine has been regularly established and the sewage system
+made efficient in large cities, and since the sanitary plumbing laws
+have been made compulsory, the general death rate has decreased
+enormously. These regulations have been the product of regularly
+educated medical or sanitary experts. No 'ism or 'ology has ever
+established any scientific principle which has contributed to the
+general welfare of the people. We no longer fear the plague, or typhus
+or yellow fever, cholera, diphtheria, typhoid, consumption, and other
+diseases which once were a constant menace to the race. The plague, for
+example, is practically limited to the Far East, where modern methods
+cannot evidently be introduced efficiently. At one time it periodically
+devastated Europe, where it cannot now get a foothold because of the
+introduction of sanitary systems and hygienic principles.
+
+Tetanus or lockjaw and hydrophobia are now amenable to cure while
+formerly all cases were practically fatal. The mortality of diphtheria
+has been reduced more than fifty per cent. Antiseptic precautions in
+surgical cases, first introduced by the famous surgeon, Lord Lister,
+have made possible and successful operations that formerly could not be
+undertaken, thus broadening the whole field of surgical possibilities.
+The Boer war and the war with Spain proved this truth in a way that
+could not be denied. Smallpox is almost a medical curiosity in New York
+City, where it once was a scourge. The mortality of childbirth has been
+reduced to about one-fifth of what it was by the introduction of
+antiseptics and anesthetics. The new methods of making and preparing
+drugs, the sterilization and inspection of milk, the methods devised for
+the care of and preparation of infant foods have all enormously
+contributed to checking disease, to preventing disease, and to
+increasing the length of life and its happiness.
+
+These are all facts which may be proved by any one, no matter how
+incompetent they may be. If we were to give up all these hard earned
+victories, cease to investigate or experiment, deny the existence of
+disease, and depend upon the questionable methods of hysterical
+emotionalists we would soon find ourselves facing all the horrors of the
+past. Can we afford to lose the priceless benefits we have achieved and
+are attaining? Can we sit still and permit the profession of medicine,
+which has always contained the best of the race in its membership, the
+best intellects, the most sympathetic and unselfish characters, the
+noblest and most steadfast souls, to be maligned and assailed, to have
+its means of well-doing assaulted and threatened, when we know that it
+should be supported and protected for the sake of all it has done in the
+past in the interest of humanity?
+
+Every mother should be acquainted with these facts so that she may lend
+her influence in behalf of honest effort and honest inquiry.
+
+The following summary comprises a brief review of what medicine has been
+doing in the recent past:
+
+Radium.--This element was discovered about fifteen years ago by
+Professor and Mme. Curie. It possesses the wonderful property of giving
+out inexhaustible stores of energy. It virtually possesses the property
+of perpetual motion. Professor Becquerel was the first one to suggest
+that it might possess therapeutic or healing powers. The suggestion came
+to him in a curious way. He carried a tube of radium in his vest pocket
+and was severely burnt as a consequence. The incident suggested to him
+that, if radium could attack healthy tissue in such a short time, it
+should be able to similarly attack diseased tissue. Experiments were
+soon instituted, and are still being conducted to exactly define its
+curative value and scope.
+
+It was hailed as a cure for cancer and other serious conditions, but we
+have found that it is not a cure for these ailments. It is, however,
+exceedingly valuable in the treatment of certain skin diseases. In
+lupus, epithelial tumors, ulcers, papillomata, angiomata and pruritus,
+it is being widely and successfully used. It was later discovered that
+it can quickly kill disease-producing bacteria. It is also well known
+that it will efficiently purify water.
+
+X-Ray Treatment and X-Ray Diagnosis.--Professor Roentgen gave to the
+world an exceedingly valuable discovery in the X-Ray. He discovered
+that a certain form of electrical energy, when applied in a certain way,
+would produce shadows that differentiated between a certain degrees of
+opacity. For example, it would, if directed upon the human hand, produce
+shadows that clearly indicated whether the substance through which the
+rays passed was bone or muscle. The chief value of the X-Rays has been
+found to be this property rather than any healing value which has been
+attributed to them. The fact that these shadows can be photographed has
+rendered them of supreme value in surgery and medicine. Previously it
+was essential that the surgeon should depend upon his own diagnosis,
+upon what he could learn from his sense of touch and from surrounding
+conditions. With the X-Rays at his disposal he can quite eliminate the
+personal equation. His pictures are precise and mathematically accurate;
+he can prove the truth of his diagnosis before he cuts. We can take
+pictures of fractured bones and from what we learn we can immediately
+tell how they should be set to attain the very best results. We can
+actually tell if there is a stone in the kidney before we subject the
+patient to a serious operation. We can actually take pictures of the
+stomach at various stages of digestion and tell what disease affects the
+individual with a degree of precision that was not possible before the
+X-Rays were introduced. These examples only suggest its use. There are a
+multiplicity of uses for these as yet unknown rays which have greatly
+aided in diagnosis and consequently in successful treatment.
+
+Aseptic Surgery.--The utility of the aseptic principle in surgery was
+demonstrated by the Japanese army surgeons during the war with Russia in
+1904-1905. Their success in preventing deaths from suppurating wounds
+amazed the world. Their method was to discard the use of antiseptics and
+to depend upon absolutely clean instruments, dressings and hands. The
+most terrible wounds healed under this method without festering. This
+is, of course, the method in vogue to-day all over the civilized world.
+The Japanese did not discover aseptic surgery, but they were the first
+to put it to actual test in a large way. The old method was to depend
+upon drugs to kill the germs which might find their way into wounds and
+operations. To-day we prevent the germs from getting into the wound and
+depend upon nature to do the rest.
+
+New Anesthetics.--Several important advances have been made in methods
+of giving anesthetics and in the nature of the products used. Temporary
+unconsciousness with electricity was induced in 1909 by Dr. Stephane
+Leduc. Stovaine was invented by Dr. Jonnesco, of Bucharest. He injected
+it into the spinal cord after the method made famous by Biers with
+cocaine in 1899. Dr. W. S. Schley invented novocaine for the same
+purpose. Temporary unconsciousness was accomplished by the use of epsom
+salts injected into the spinal cord by Dr. Samuel J. Meltzer. All of
+these efforts to discover a harmless anesthetic by spinal injection were
+made possible by investigations and experiments of Dr. J. Leonard
+Corning, of New York, who worked along this line as far back as 1885.
+The most revolutionary discovery, however, was that of Dr. S. J. Meltzer
+at the Rockefeller Institute, New York, when he inserted a tube into the
+windpipe, through which he pumped the anesthetic into the lungs. While
+doing this he at the same time pumped oxygen to aerate the blood, thus
+ensuring the patient against possible accident during the course of
+difficult and tedious operations on the lungs and heart.
+
+Vaccine in Typhoid Fever.--Inasmuch as typhoid fever has played an
+important part in the conduct of all wars, it has always been a source
+of much careful study by military and naval surgeons in every civilized
+country in the world. We had not, however, reached a stage when it was
+possible to hope for its extermination until medical science began to
+appreciate the possibilities of vaccine therapy. The Cuban, Boer and
+Russian wars, because of the terrible experiences of the soldiers with
+typhoid in each of them, stimulated inquiry along the line of
+discovering a serum of vaccine that would be effectual against it.
+American, British, French and Japanese military and naval surgeons
+instituted experiments simultaneously to discover an anti-typhoid
+vaccine. In the fall of 1909, American army surgeons were experimenting
+with a serum at Washington and on Governor's Island with success, but
+the first public announcement of an absolutely successful vaccine was
+made by Captain Vincent of the French navy on June 20th, 1910, before
+the Academie de Medicine in Paris. The final success of the anti-typhoid
+serum has been conclusively proved by elaborate tests upon soldiers and
+sailors in many nations.
+
+It is difficult for the ordinary individual to appreciate the
+significance and importance of a discovery of this character and
+magnitude. When one thinks calmly of the thousands and thousands of men
+who have lost their lives during wars because of typhoid epidemics, and
+of the thousands of others who have returned home practically invalided
+for life from the same cause, it is possible to, at least, conceive of
+the benefit to the race such a discovery promises. And when we learn
+that the discovery is a product of the same principle or method which
+gave to the world a cure for smallpox, diphtheria and syphilis, we must
+begin to believe that the medical profession is on the path which is
+unlimited in its field of promise so far as efficient treatment is
+concerned. Yet to-day we have people who do not believe in vaccination
+or in anti-diphtheritic serum. We may not live to see the time, but it
+is not far distant in the opinion of men qualified to speak with
+authority, when every disease will be amenable to the serum therapy, and
+when drugs will virtually be discarded by the human race.
+
+"606."--One of the most important discoveries in the history of
+medicine was recently given to the world by Dr. Paul Ehrlich.
+
+He called it "606," because it was the 606th experiment he had made with
+the same end in view. It was designed with the purpose of curing the
+most terrible disease known to man, syphilis. The name of the remedy is
+salvarsan. That it will do all that was first claimed for it is still
+doubtful, but salvarsan and its improvements, neosalvarsan, etc., are
+accepted by the profession as by far the best treatment yet devised for
+this dread disease. It points the way for improvement along the same
+line to an ultimate specific.
+
+Transplanting the Organs of Dead Men Into Living Men.--To take from a
+recently dead individual a kidney, or a bone, or an artery, and by
+immersing them in certain fluids thereby keeping them alive
+indefinitely, and later transplanting them in the body of a living
+individual so that they will continue to live and perform their function
+in the new environment, is a revolutionary and a seemingly incredible
+performance. Yet Dr. Alexis Carrel of the Rockefeller Institute, New
+York, has accomplished this wonderful task. The smallest imagination can
+picture the possibilities of this kind of surgery, but, inasmuch as the
+discovery is so recent and the opportunities for testing it upon human
+beings are so relatively few, that time alone can tell how far it may be
+possible to go.
+
+Anti-Meningitis Serum.--Another important discovery that has emanated
+from the Rockefeller Institute is the Anti-Meningitis serum. The death
+rate from spinal meningitis, before the introduction of the serum, was
+70 per cent., the use of the serum has reduced this percentage to 30. We
+owe this important contribution to Dr. Simon Flexner.
+
+A Serum for Malaria Now Possible.--Dr. C. C. Bass, of Tulane
+University, has succeeded in extracting malaria-producing parasites from
+human blood and keeping them alive in test tubes. This feat had been
+long attempted but never before with success. The significance of this
+achievement is that it is the first step toward preparing a serum that
+will give immunity to malaria.
+
+
+
+
+
+
+End of the Project Gutenberg EBook of The Eugenic Marriage, Volume IV. (of
+IV.), by Grant Hague
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