diff options
Diffstat (limited to '21418-8.txt')
| -rw-r--r-- | 21418-8.txt | 6558 |
1 files changed, 6558 insertions, 0 deletions
diff --git a/21418-8.txt b/21418-8.txt new file mode 100644 index 0000000..8c3322a --- /dev/null +++ b/21418-8.txt @@ -0,0 +1,6558 @@ +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 (Algć) 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 larvć. 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 larvć +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 + +*** END OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE *** + +***** This file should be named 21418-8.txt or 21418-8.zip ***** +This and all associated files of various formats will be found in: + http://www.gutenberg.org/2/1/4/1/21418/ + +Produced by K.D. Thornton, Ross Wilburn, Bruce Albrecht +and the Online Distributed Proofreading Team at +http://www.pgdp.net + + +Updated editions will replace the previous one--the old editions +will be renamed. + +Creating the works from public domain print editions means that no +one owns a United States copyright in these works, so the Foundation +(and you!) can copy and distribute it in the United States without +permission and without paying copyright royalties. Special rules, +set forth in the General Terms of Use part of this license, apply to +copying and distributing Project Gutenberg-tm electronic works to +protect the PROJECT GUTENBERG-tm concept and trademark. Project +Gutenberg is a registered trademark, and may not be used if you +charge for the eBooks, unless you receive specific permission. If you +do not charge anything for copies of this eBook, complying with the +rules is very easy. You may use this eBook for nearly any purpose +such as creation of derivative works, reports, performances and +research. They may be modified and printed and given away--you may do +practically ANYTHING with public domain eBooks. Redistribution is +subject to the trademark license, especially commercial +redistribution. + + + +*** START: FULL LICENSE *** + +THE FULL PROJECT GUTENBERG LICENSE +PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK + +To protect the Project Gutenberg-tm mission of promoting the free +distribution of electronic works, by using or distributing this work +(or any other work associated in any way with the phrase "Project +Gutenberg"), you agree to comply with all the terms of the Full Project +Gutenberg-tm License (available with this file or online at +http://gutenberg.org/license). + + +Section 1. General Terms of Use and Redistributing Project Gutenberg-tm +electronic works + +1.A. By reading or using any part of this Project Gutenberg-tm +electronic work, you indicate that you have read, understand, agree to +and accept all the terms of this license and intellectual property +(trademark/copyright) agreement. If you do not agree to abide by all +the terms of this agreement, you must cease using and return or destroy +all copies of Project Gutenberg-tm electronic works in your possession. +If you paid a fee for obtaining a copy of or access to a Project +Gutenberg-tm electronic work and you do not agree to be bound by the +terms of this agreement, you may obtain a refund from the person or +entity to whom you paid the fee as set forth in paragraph 1.E.8. + +1.B. "Project Gutenberg" is a registered trademark. It may only be +used on or associated in any way with an electronic work by people who +agree to be bound by the terms of this agreement. There are a few +things that you can do with most Project Gutenberg-tm electronic works +even without complying with the full terms of this agreement. See +paragraph 1.C below. There are a lot of things you can do with Project +Gutenberg-tm electronic works if you follow the terms of this agreement +and help preserve free future access to Project Gutenberg-tm electronic +works. See paragraph 1.E below. + +1.C. The Project Gutenberg Literary Archive Foundation ("the Foundation" +or PGLAF), owns a compilation copyright in the collection of Project +Gutenberg-tm electronic works. Nearly all the individual works in the +collection are in the public domain in the United States. If an +individual work is in the public domain in the United States and you are +located in the United States, we do not claim a right to prevent you from +copying, distributing, performing, displaying or creating derivative +works based on the work as long as all references to Project Gutenberg +are removed. Of course, we hope that you will support the Project +Gutenberg-tm mission of promoting free access to electronic works by +freely sharing Project Gutenberg-tm works in compliance with the terms of +this agreement for keeping the Project Gutenberg-tm name associated with +the work. You can easily comply with the terms of this agreement by +keeping this work in the same format with its attached full Project +Gutenberg-tm License when you share it without charge with others. + +1.D. The copyright laws of the place where you are located also govern +what you can do with this work. Copyright laws in most countries are in +a constant state of change. If you are outside the United States, check +the laws of your country in addition to the terms of this agreement +before downloading, copying, displaying, performing, distributing or +creating derivative works based on this work or any other Project +Gutenberg-tm work. The Foundation makes no representations concerning +the copyright status of any work in any country outside the United +States. + +1.E. Unless you have removed all references to Project Gutenberg: + +1.E.1. The following sentence, with active links to, or other immediate +access to, the full Project Gutenberg-tm License must appear prominently +whenever any copy of a Project Gutenberg-tm work (any work on which the +phrase "Project Gutenberg" appears, or with which the phrase "Project +Gutenberg" is associated) is accessed, displayed, performed, viewed, +copied or distributed: + +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 + +1.E.2. If an individual Project Gutenberg-tm electronic work is derived +from the public domain (does not contain a notice indicating that it is +posted with permission of the copyright holder), the work can be copied +and distributed to anyone in the United States without paying any fees +or charges. If you are redistributing or providing access to a work +with the phrase "Project Gutenberg" associated with or appearing on the +work, you must comply either with the requirements of paragraphs 1.E.1 +through 1.E.7 or obtain permission for the use of the work and the +Project Gutenberg-tm trademark as set forth in paragraphs 1.E.8 or +1.E.9. + +1.E.3. If an individual Project Gutenberg-tm electronic work is posted +with the permission of the copyright holder, your use and distribution +must comply with both paragraphs 1.E.1 through 1.E.7 and any additional +terms imposed by the copyright holder. Additional terms will be linked +to the Project Gutenberg-tm License for all works posted with the +permission of the copyright holder found at the beginning of this work. + +1.E.4. Do not unlink or detach or remove the full Project Gutenberg-tm +License terms from this work, or any files containing a part of this +work or any other work associated with Project Gutenberg-tm. + +1.E.5. Do not copy, display, perform, distribute or redistribute this +electronic work, or any part of this electronic work, without +prominently displaying the sentence set forth in paragraph 1.E.1 with +active links or immediate access to the full terms of the Project +Gutenberg-tm License. + +1.E.6. You may convert to and distribute this work in any binary, +compressed, marked up, nonproprietary or proprietary form, including any +word processing or hypertext form. However, if you provide access to or +distribute copies of a Project Gutenberg-tm work in a format other than +"Plain Vanilla ASCII" or other format used in the official version +posted on the official Project Gutenberg-tm web site (www.gutenberg.org), +you must, at no additional cost, fee or expense to the user, provide a +copy, a means of exporting a copy, or a means of obtaining a copy upon +request, of the work in its original "Plain Vanilla ASCII" or other +form. Any alternate format must include the full Project Gutenberg-tm +License as specified in paragraph 1.E.1. + +1.E.7. Do not charge a fee for access to, viewing, displaying, +performing, copying or distributing any Project Gutenberg-tm works +unless you comply with paragraph 1.E.8 or 1.E.9. + +1.E.8. You may charge a reasonable fee for copies of or providing +access to or distributing Project Gutenberg-tm electronic works provided +that + +- You pay a royalty fee of 20% of the gross profits you derive from + the use of Project Gutenberg-tm works calculated using the method + you already use to calculate your applicable taxes. The fee is + owed to the owner of the Project Gutenberg-tm trademark, but he + has agreed to donate royalties under this paragraph to the + Project Gutenberg Literary Archive Foundation. Royalty payments + must be paid within 60 days following each date on which you + prepare (or are legally required to prepare) your periodic tax + returns. Royalty payments should be clearly marked as such and + sent to the Project Gutenberg Literary Archive Foundation at the + address specified in Section 4, "Information about donations to + the Project Gutenberg Literary Archive Foundation." + +- You provide a full refund of any money paid by a user who notifies + you in writing (or by e-mail) within 30 days of receipt that s/he + does not agree to the terms of the full Project Gutenberg-tm + License. You must require such a user to return or + destroy all copies of the works possessed in a physical medium + and discontinue all use of and all access to other copies of + Project Gutenberg-tm works. + +- You provide, in accordance with paragraph 1.F.3, a full refund of any + money paid for a work or a replacement copy, if a defect in the + electronic work is discovered and reported to you within 90 days + of receipt of the work. + +- You comply with all other terms of this agreement for free + distribution of Project Gutenberg-tm works. + +1.E.9. If you wish to charge a fee or distribute a Project Gutenberg-tm +electronic work or group of works on different terms than are set +forth in this agreement, you must obtain permission in writing from +both the Project Gutenberg Literary Archive Foundation and Michael +Hart, the owner of the Project Gutenberg-tm trademark. Contact the +Foundation as set forth in Section 3 below. + +1.F. + +1.F.1. Project Gutenberg volunteers and employees expend considerable +effort to identify, do copyright research on, transcribe and proofread +public domain works in creating the Project Gutenberg-tm +collection. Despite these efforts, Project Gutenberg-tm electronic +works, and the medium on which they may be stored, may contain +"Defects," such as, but not limited to, incomplete, inaccurate or +corrupt data, transcription errors, a copyright or other intellectual +property infringement, a defective or damaged disk or other medium, a +computer virus, or computer codes that damage or cannot be read by +your equipment. + +1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the "Right +of Replacement or Refund" described in paragraph 1.F.3, the Project +Gutenberg Literary Archive Foundation, the owner of the Project +Gutenberg-tm trademark, and any other party distributing a Project +Gutenberg-tm electronic work under this agreement, disclaim all +liability to you for damages, costs and expenses, including legal +fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT +LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE +PROVIDED IN PARAGRAPH F3. YOU AGREE THAT THE FOUNDATION, THE +TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE +LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR +INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH +DAMAGE. + +1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a +defect in this electronic work within 90 days of receiving it, you can +receive a refund of the money (if any) you paid for it by sending a +written explanation to the person you received the work from. If you +received the work on a physical medium, you must return the medium with +your written explanation. The person or entity that provided you with +the defective work may elect to provide a replacement copy in lieu of a +refund. If you received the work electronically, the person or entity +providing it to you may choose to give you a second opportunity to +receive the work electronically in lieu of a refund. If the second copy +is also defective, you may demand a refund in writing without further +opportunities to fix the problem. + +1.F.4. Except for the limited right of replacement or refund set forth +in paragraph 1.F.3, this work is provided to you 'AS-IS' WITH NO OTHER +WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO +WARRANTIES OF MERCHANTIBILITY OR FITNESS FOR ANY PURPOSE. + +1.F.5. Some states do not allow disclaimers of certain implied +warranties or the exclusion or limitation of certain types of damages. +If any disclaimer or limitation set forth in this agreement violates the +law of the state applicable to this agreement, the agreement shall be +interpreted to make the maximum disclaimer or limitation permitted by +the applicable state law. The invalidity or unenforceability of any +provision of this agreement shall not void the remaining provisions. + +1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the +trademark owner, any agent or employee of the Foundation, anyone +providing copies of Project Gutenberg-tm electronic works in accordance +with this agreement, and any volunteers associated with the production, +promotion and distribution of Project Gutenberg-tm electronic works, +harmless from all liability, costs and expenses, including legal fees, +that arise directly or indirectly from any of the following which you do +or cause to occur: (a) distribution of this or any Project Gutenberg-tm +work, (b) alteration, modification, or additions or deletions to any +Project Gutenberg-tm work, and (c) any Defect you cause. + + +Section 2. Information about the Mission of Project Gutenberg-tm + +Project Gutenberg-tm is synonymous with the free distribution of +electronic works in formats readable by the widest variety of computers +including obsolete, old, middle-aged and new computers. It exists +because of the efforts of hundreds of volunteers and donations from +people in all walks of life. + +Volunteers and financial support to provide volunteers with the +assistance they need, is critical to reaching Project Gutenberg-tm's +goals and ensuring that the Project Gutenberg-tm collection will +remain freely available for generations to come. In 2001, the Project +Gutenberg Literary Archive Foundation was created to provide a secure +and permanent future for Project Gutenberg-tm and future generations. +To learn more about the Project Gutenberg Literary Archive Foundation +and how your efforts and donations can help, see Sections 3 and 4 +and the Foundation web page at http://www.pglaf.org. + + +Section 3. Information about the Project Gutenberg Literary Archive +Foundation + +The Project Gutenberg Literary Archive Foundation is a non profit +501(c)(3) educational corporation organized under the laws of the +state of Mississippi and granted tax exempt status by the Internal +Revenue Service. The Foundation's EIN or federal tax identification +number is 64-6221541. Its 501(c)(3) letter is posted at +http://pglaf.org/fundraising. Contributions to the Project Gutenberg +Literary Archive Foundation are tax deductible to the full extent +permitted by U.S. federal laws and your state's laws. + +The Foundation's principal office is located at 4557 Melan Dr. S. +Fairbanks, AK, 99712., but its volunteers and employees are scattered +throughout numerous locations. Its business office is located at +809 North 1500 West, Salt Lake City, UT 84116, (801) 596-1887, email +business@pglaf.org. Email contact links and up to date contact +information can be found at the Foundation's web site and official +page at http://pglaf.org + +For additional contact information: + Dr. Gregory B. Newby + Chief Executive and Director + gbnewby@pglaf.org + + +Section 4. Information about Donations to the Project Gutenberg +Literary Archive Foundation + +Project Gutenberg-tm depends upon and cannot survive without wide +spread public support and donations to carry out its mission of +increasing the number of public domain and licensed works that can be +freely distributed in machine readable form accessible by the widest +array of equipment including outdated equipment. Many small donations +($1 to $5,000) are particularly important to maintaining tax exempt +status with the IRS. + +The Foundation is committed to complying with the laws regulating +charities and charitable donations in all 50 states of the United +States. Compliance requirements are not uniform and it takes a +considerable effort, much paperwork and many fees to meet and keep up +with these requirements. We do not solicit donations in locations +where we have not received written confirmation of compliance. To +SEND DONATIONS or determine the status of compliance for any +particular state visit http://pglaf.org + +While we cannot and do not solicit contributions from states where we +have not met the solicitation requirements, we know of no prohibition +against accepting unsolicited donations from donors in such states who +approach us with offers to donate. + +International donations are gratefully accepted, but we cannot make +any statements concerning tax treatment of donations received from +outside the United States. U.S. laws alone swamp our small staff. + +Please check the Project Gutenberg Web pages for current donation +methods and addresses. Donations are accepted in a number of other +ways including checks, online payments and credit card donations. +To donate, please visit: http://pglaf.org/donate + + +Section 5. General Information About Project Gutenberg-tm electronic +works. + +Professor Michael S. Hart is the originator of the Project Gutenberg-tm +concept of a library of electronic works that could be freely shared +with anyone. For thirty years, he produced and distributed Project +Gutenberg-tm eBooks with only a loose network of volunteer support. + + +Project Gutenberg-tm eBooks are often created from several printed +editions, all of which are confirmed as Public Domain in the U.S. +unless a copyright notice is included. Thus, we do not necessarily +keep eBooks in compliance with any particular paper edition. + + +Most people start at our Web site which has the main PG search facility: + + http://www.gutenberg.org + +This Web site includes information about Project Gutenberg-tm, +including how to make donations to the Project Gutenberg Literary +Archive Foundation, how to help produce our new eBooks, and how to +subscribe to our email newsletter to hear about new eBooks. |