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diff --git a/21418-h/21418-h.htm b/21418-h/21418-h.htm new file mode 100644 index 0000000..4de180b --- /dev/null +++ b/21418-h/21418-h.htm @@ -0,0 +1,8084 @@ + +<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" + "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd"> + +<html xmlns="http://www.w3.org/1999/xhtml"> + <head> + <meta http-equiv="Content-Type" content= + "text/html; charset=iso-8859-1" /> + <title> + The Project Gutenberg eBook of The Eugenic Marriage, Volume 4, by W. Grant Hague + </title> + + <style type="text/css"> + +<!-- + p { margin-top: .75em; + text-align: justify; + margin-bottom: .75em; + } + h1,h2,h3,h4,h5,h6 { + text-align: center; /* all headings centered */ + } + hr {text-align: center; width: 50%;} + hr.full {width: 100%;} + hr.short {text-align: center; width: 20%;} + body { margin-left: 10%; + margin-right: 10%; + } + .tablecenter {margin-left: auto; margin-right: auto;} + + a {text-decoration:none} + + .author {text-align: right; margin-top: -1em; margin-right: 5%;} + .center {text-align: center; } + .right {text-align: right; } + .t {vertical-align: top; } + .tr {vertical-align: top;} + .tc {vertical-align: top;} + .tr p {text-align: right;} + .tc p {text-align: center;} + .m {vertical-align: middle; } + .mr {vertical-align: middle;} + .mc {vertical-align: middle;} + .mr p {text-align: right;} + .mc p {text-align: center;} + .b {vertical-align: bottom; } + .vol {/*font-weight: bold;*/ font-size: small;} + + sup {font-style: normal; font-size: small;} + + .sc {font-variant: small-caps; } + .linenum {position: absolute; top: auto; left: 60%;} /* poetry number */ + blockquote {margin-left: 2em; margin-right: 2em; } + blockquote.small {font-size: small; } + .bb {border-bottom: solid black 1px;} + .bt {border-top: solid black 1px;} + .br {border-right: solid black 1px;} + .pagenum {position: absolute; left: 92%; font-size: smaller; + text-align: right; font-style: normal;} /* page numbers */ + + .note {margin-left: 2em; margin-right: 2em; + } /* footnote - removed font-size: small; */ + .hang {margin-left: 2em; text-indent: -2em;} + .red {color: red;} + .figcenter + {padding: 1em; margin: auto; text-align: center; font-size: 0.8em;} + + + // --> + </style> + </head> + +<body> + + +<pre> + +Project Gutenberg's The Eugenic Marriage, Volume IV. (of IV.), by Grant Hague + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: The Eugenic Marriage, Volume IV. (of IV.) + A Personal Guide to the New Science of Better Living and Better Babies + +Author: Grant Hague + +Release Date: May 11, 2007 [EBook #21418] + +Language: English + +Character set encoding: ISO-8859-1 + +*** START OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE *** + + + + +Produced by K.D. Thornton, Ross Wilburn, Bruce Albrecht +and the Online Distributed Proofreading Team at +http://www.pgdp.net + + + + + + +</pre> + + +<table border="0" cellpadding="10" style="background-color: #ccccff;" summary="TN"> + <tr> + <td width="25%" valign="top"> + Transcriber's note: + </td> + <td> + Obvious typographical errors have been corrected and a few + punctuation variants have been normalized. + </td> + </tr> +</table> + + <div class="figcenter" style="width: 400px;"> +<a id="v4frontis" name="v4frontis"></a> +<img src="images/v4frontis.jpg" width="400" height="178" + alt="More Babies Like These" title="More Babies Like These" /> +<span class="caption">Courtesy of New York World<br /> +<b>More Babies Like These</b></span> +</div> + +<p style="margin-left: 20%; margin-right: 15%;">These nine little tots are all sound, healthy stock. The generations +behind them had unconsciously been practicing Eugenics through the +process of natural selection. By luck, as it were, no strain was +bred into the several families that would have caused these children +to be unsound mentally, morally, or physically.</p> + +<p style="margin-left: 20%; margin-right: 15%;">It is through Eugenics that we shall have more babies like these, +and shall eliminate the possibility of children like those shown in +the other illustrations to this volume. +</p> + +<h1>The Eugenic Marriage</h1> + +<h2>A Personal Guide to the<br /> +New Science of Better<br /> +Living and Better Babies</h2> + +<h3>By W. GRANT HAGUE, M.D.</h3> + +<h4>College of Physicians and Surgeons (Columbia +University), New York; Member of County Medical +Society, and of the American Medical Association</h4> + +<h2>In Four Volumes</h2> + +<h2>VOLUME IV</h2> + +<h4>New York</h4> + +<h3>THE REVIEW OF REVIEWS COMPANY</h3> + +<h4>1914</h4> + +<p class="center" style="margin-top: 2em;">Copyright, 1913, by + <font class="sc">W. Grant Hague</font></p> + +<p class="center" style="margin-top: 2em;">Copyright, 1914, by + <font class="sc">W. Grant Hague</font></p> + + <br clear="all" /> +<hr class="full" /> + + +<h3>TABLE OF CONTENTS</h3> +<hr class="full" /> + +<table border="0" cellpadding="2" summary="TOC"> + <tr><td><h4><a href="#LIST_OF_ILLUSTRATIONS">LIST OF ILLUSTRATIONS</a></h4></td></tr> + <tr><td> <h4><font class="sc">Accidents and Emergencies</font></h4></td></tr> + +<tr><td><h4>CHAPTER XXXIV</h4></td></tr> +<tr><td><h4><font class="sc">COMMON DISEASES OF THE NOSE, MOUTH, +AND CHEST</font></h4></td><td>PAGE</td></tr> +<tr><td><blockquote> <p>"Catching Cold"—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...</p></blockquote></td> +<td class="b"><a href="#Page_497">497</a></td></tr> + +<tr><td><h4>CHAPTER XXXV</h4></td></tr> + +<tr><td><h4><font class="sc">diseases of the stomach and gastro-intestinal +canal</font></h4></td></tr> + +<tr><td><blockquote><p>Inflammation of the Stomach—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...</p></blockquote></td> +<td class="b"><a href="#Page_527">527</a></td></tr> + +<tr><td><h4>CHAPTER XXXVI</h4></td></tr> + +<tr><td><h4><font class="sc">diseases of children </font>(continued)</h4></td></tr> + +<tr><td><blockquote><p>Mastitis or Inflammation of the Breasts in Infancy—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 ...</p></blockquote></td> +<td class="b"><a href="#Page_553">553</a></td></tr> + +<tr><td><h4>CHAPTER XXXVII</h4></td></tr> + +<tr><td><h4><font class="sc">diseases of children </font>(continued)</h4></td></tr> + +<tr><td><blockquote><p>Rheumatism—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 ...</p></blockquote></td> +<td class="b"><a href="#Page_569">569</a></td></tr> + +<tr><td><h3><font class="sc">Diseases of Children</font></h3></td></tr> + +<tr><td><h4>CHAPTER XXXVIII</h4></td></tr> + +<tr><td><h4><font class="sc">infectious or contagious diseases</font></h4></td></tr> + +<tr><td><blockquote><p>Rules to be Observed in the Treatment of Contagious Diseases—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 ....</p></blockquote></td> +<td class="b"><a href="#Page_599">599</a></td></tr> + +<tr><td><h3><font class="sc">Accidents and Emergencies</font></h3></td></tr> + +<tr><td><h4>CHAPTER XXXIX</h4></td></tr> + +<tr><td><h4><font class="sc">accidents and emergencies</font></h4></td></tr> + +<tr><td><blockquote><p>Accidents and Emergencies—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 ...</p></blockquote></td> +<td class="b"><a href="#Page_629">629</a></td></tr> + +<tr><td><h4><font class="sc">Miscellaneous</font></h4></td></tr> + +<tr><td><h4>CHAPTER XL</h4></td></tr> + +<tr><td><h4><font class="sc">miscellaneous</font></h4></td></tr> + +<tr><td><blockquote><p>The Dangerous House Fly—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 ...</p></blockquote></td> +<td class="b"><a href="#Page_645">645</a></td></tr></table> + +<hr class="full" /> + +<h3><a name="LIST_OF_ILLUSTRATIONS" id="LIST_OF_ILLUSTRATIONS"></a> +LIST OF ILLUSTRATIONS</h3> +<div class='center'> +<table border="0" cellpadding="2" cellspacing="0" summary="LOI"> + +<tr><td align='left'> </td><td align='right'> +<span class="smcap">Page</span></td></tr> +<tr><td align='left'>More Babies Like These</td> +<td align='right'><a href="#v4frontis">Frontispiece</a></td></tr> +<tr><td align='left'>A Grim Result</td> +<td align='right'><a href="#v4pg518">(Facing 519)</a></td></tr> +<tr><td align='left'>"A Misfortune at Birth"</td> +<td align='right'><a href="#v4pg566">(Facing 567)</a></td></tr> +<tr><td align='left'>The First Blight</td> +<td align='right'><a href="#v4pg597">(Facing 599)</a></td></tr> +</table></div> + +<hr class="full" /> +<h3>ACCIDENTS AND EMERGENCIES</h3> + +<hr style="width: 65%;" /> + +<p><span class='pagenum'><a name="Page_497" id="Page_497">[497]</a></span> +</p> +<h2>CHAPTER XXXIV</h2> + +<h3>COMMON DISEASES OF THE NOSE, MOUTH, +AND CHEST</h3> + +<div class="blockquote"><p>"Catching Cold"—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. +</p></div> + +<h3>"CATCHING COLDS"</h3> + +<p>Mothers frequently wonder where their children get +colds. Briefly we will point out some of the sources from +which these apparently inexplicable colds may come.</p> + +<p><b>A. Sitting on the Floor</b>.—Children should not be allowed +to sit or crawl upon the floor at any season of the +year, but especially during the winter months. There is +always a draught of cold air near the floor. It is a bad +habit to begin allowing a child to play with its toys on the +floor. Use the bed or a sofa or a platform raised a foot +from the floor.</p> + +<p><span class='pagenum'>[<a name="Page_498" id="Page_498">498</a>]</span> +<b>B. Kicking the Bed Clothes Off During the Night</b>.—The +bed clothes should be securely pinned to the mattress +by large safety pins. When it is established as a habit +a child who kicks off the bed clothes should wear a +combination night suit with "feet," made of flannel during +the winter and of cotton during the summer.</p> + +<p><b>C. Inadequate Head Covering</b>.—Professor Kerley +states that this is one of the "most frequent causes of +disease of the respiratory tract in the young." He calls +attention to the fact that "mothers carefully clothe the +baby with ample coats, blankets, leggings, etc., before +they take him out for the daily walk. They dress him +in a warm room taking plenty of time to put on the +extra clothes, during which time the baby frets and +perspires. When all is ready they place upon the hot, +almost bald head of the baby a light artistically decorated +airy creation which is sold in the shops as children's +caps. The child is then taken out of doors and because of +the inadequate covering of the hot perspiring head, +catches cold and the mother never knows how it came." +Every baby and child should wear under such caps a skull +cap of thin flannel, especially in cold weather. In summer +or windy day a light silk handkerchief folded under the +cap is a very excellent protection.</p> + +<p><b>D. Subjecting a Baby to Different Temperatures +Suddenly</b>, is liable to be followed by a cold—for example, +taking the child from a warm room to a cold room, or +through a cold hall, holding the child at an open window +for a few moments.</p> + +<p><b>E. The Practice of Wearing Rubbers Needs Some +Consideration</b>.—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 +<span class='pagenum'>[<a name="Page_499" id="Page_499">499</a>]</span> +secretion of the skin, keeps the feet moist and invites +colds and catarrh. In damp weather, or when children +play during winter months, they should be shod with +stout shoes with cork insoles.</p> + +<p>The same argument applies to storm coats of rubber, +water-proof material. They should not be worn as overcoats +all day, but only when going to and from school or +business when it is actually storming.</p> + +<p>Underclothing or hosiery should not be heavy enough +to cause moisture of the skin. Health demands a dry skin +at all times. The necessary degree of body heat should be +attained by the quality of the outer clothing, not by the +quantity of the underclothing. Many men and women +wear heavy underclothing which causes moisture when +indoors, with the result that they get surface chills when +they go outside if the weather is cold and as a result catch +cold. The underclothing should be just heavy enough to +be comfortable indoors and the extra warmth necessary +when outside should be supplied by a good overcoat or +furs.</p> + +<p><b>F. Direct Infection</b>.—A baby may catch cold if kissed +or "hugged" by an adult who has a cold.</p> + +<p>Catching cold while bathing is possible, but scarcely +probable, if ordinary precautions are taken. It is very +bad practice to permit children to use one another's +handkerchiefs or the handkerchief of an adult. Certain +children are predisposed to attacks of "cold in the head" +or acute coryza or nasal catarrh (these being the medical +names for this condition). Sometimes this is an inherited +characteristic. There is no doubt, however, that most +of these children acquire the habit by bad sanitary and +hygienic surroundings. These children do not as a rule +get enough fresh air. They are kept indoors most of the +time in stuffy, overheated, badly ventilated rooms, unless +the weather is absolutely perfect. The windows in their +bedrooms are always kept closed, because they are "liable +to catch cold." They are overdressed and perspire easily +and as a result "catch cold." These conditions all tend +to create an unhealthy condition of the nasal mucous +membrane and of the throat, and this is rendered worse +if the child lives in a damp, changeable climate, such as +<span class='pagenum'>[<a name="Page_500" id="Page_500">500</a>]</span> +that of New York City. In these susceptible children the +exciting cause of an attack may be trivial; exposure, cold +or wet feet, inadequate head covering (as already pointed +out), a draught of cold air even may excite sneezing +and a nasal discharge; hence we have:</p> + +<p><b>Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis, +"Cold in the Head", "Snuffles")</b>.—Acute nasal catarrh +may accompany measles, diphtheria, influenza, and +whooping cough.</p> + +<p><b>Symptoms</b>.—The onset is sudden with sneezing, and +difficulty in breathing through the nose. In a few hours, +or it may be not for a day or two, a mucous, watery, nasal +discharge appears. There are redness and slight swelling +of the nose and upper lip, caused by the discharge. There +is no fever as a general rule except in very young +infants, in whom the fever may be very high. The discharge +interferes with the nursing and the child suffers +from lack of nourishment. The inflammation may extend +to the eyes and ears, causing painful complications, or to +the throat and bronchi, causing hoarseness and cough. +Less frequently we have disturbances of the digestive +tract with vomiting, or diarrhea.</p> + +<p>The mild form of the disease lasts for two or three +days, the severe form from one to two weeks.</p> + +<p>Repeated attacks are said to contribute to the production +of adenoid growths.</p> + +<p>An acute attack of this disease is seldom a serious affliction +in older children; it may be, however, very serious +and even dangerous in very young infants. The tendency +of the disease to extend downward, causing bronchitis or +pneumonia, explains in part the possible danger to a baby. +Another reason is because it may seriously interfere with +suckling and with breathing in these little patients. It +may even cause sudden attacks of strangulation. An +infant, therefore, suffering with an acute attack of rhinitis +requires constant attention. It may be necessary to feed +it with a spoon, and if necessary mother's milk should +be so fed. Plenty of fresh air should be provided. It may +be essential to keep the mouth open in order that it may +get enough fresh air. Every effort should be made to +keep the nostrils open. The secretions must be removed +<span class='pagenum'>[<a name="Page_501" id="Page_501">501</a>]</span> +from time to time. Causing the child to sneeze by tickling +the nose with a camel's hair brush will clear the nose for +the time being. The physician may be compelled to use a +solution of cocaine for this purpose.</p> + +<p><b>Treatment of Acute Rhinitis ("Taking Cold", Nasal +Catarrh, Acute Coryza, "Snuffles")</b>.—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.</p> + +<p>We treat the local condition in the nose with a menthol +mixture. The following is a very good one: Menthol, +30 grains; Camphor, 30 grains; White Vaseline, 1 ounce. +Put some of this on the end of the finger and push it +gently into each nostril. When the nostrils become +blocked and the child cannot breathe through the nose, +tickle the nose with a feather until it sneezes; this will +clear the passage. Immediately after the sneeze place +the menthol mixture in each nostril. When the child is +about to sneeze place a handkerchief before the nose, as +this discharge is full of germs and will infect others when +dry. Internal remedies should not be used unless the +child is distinctly sick and is running a fever, in which +case a physician should look the child over and prescribe +whatever is called for.</p> + +<p>The upper lip and the nostrils of the child should be +protected, because the discharge very quickly irritates the +parts and renders them raw and painful. Vaseline or cold +cream is very suitable for this purpose.</p> + +<p>Mothers should not wash out the nose of a child with +any solution advised for this purpose where force is used, +as, for example, with a syringe. Any forceful irrigation +of the nose is dangerous, because it would carry the infection +into the deeper parts and set up a more serious +condition. +<span class='pagenum'>[<a name="Page_502" id="Page_502">502</a>]</span></p> + +<p>If the above treatment is carefully carried out and the +child unexposed to a fresh cold, two or three days will be +sufficient to cure the disease.</p> + +<p>It is not, however, the treatment of an acute attack of +"cold in the head" that is important; it is intelligently to +follow out a plan which will prevent these attacks from +repeating themselves that is of consequence. The tendency +to take cold is a real condition in childhood and a very +common one. When mothers appreciate that it is possible +to prevent this condition and to cure it when it is seemingly +an established habit, more interest will undoubtedly +be taken in the subject. Too frequently it is looked upon +as an unfortunate affliction, but it is never regarded as a +condition that is caused by neglect and ignorance.</p> + +<p>It is an exceedingly common occurence to find a mother +worrying over her child's cold, dosing it with cod liver +oil or some other unnecessary tonic, rubbing it with +camphorated oil or plastering it over with certain useless +patent plasters, dressing it with extra pieces of flannel on +its chest and extra clothes pinned snugly around it, then +shutting it up in a warm, stuffy, unsanitary, ill-smelling +room, in order to keep it from "catching a fresh cold." +Can you imagine anything else she could do to defeat her +purpose?</p> + +<p>No quantity of cod liver oil, no medicine, no coddling, +will remove the tendency to "catch cold." The child's +life must be lived amidst sanitary surroundings and hygienic +conditions first; then other expedients may be +utilized if necessary. These children must be kept out +of doors most of the time, unless during the severest wet +weather. They should sleep in a room the windows of +which are open at the top and bottom every night in the +year. They should not, however, be in a draught. The +rooms in which they live should be of a uniform temperature, +never too hot and never too cold, between 68° +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. +<span class='pagenum'>[<a name="Page_503" id="Page_503">503</a>]</span> +During the summer months the mother should begin cold +sponging of the face, throat, chest, and spine every morning +and carry it into the winter. The entire process need +take only a moment or two. Always dry thoroughly +with a fairly rough towel. If the cold sponging is begun +in the warm summer time the child will become so +accustomed to it that no objection will be made when +the cold weather comes.</p> + +<p>If the child continues to be "catarrhal," despite a +course of this treatment, it would be well to investigate +whether any adenoids or adenoid tissue exist in the +naso-pharynx. If adenoids are found no treatment will +be successful until they are removed.</p> + +<p>It is a wise plan to place a flannel cap on an infant +who has an acute attack of "cold in the head" (snuffles). +This will prevent catching a fresh cold and it will aid +in the speedy cure of the attack from which it is suffering +when it is put on.</p> + +<h4>CHRONIC NASAL CATARRH—CHRONIC RHINITIS<br /> +CHRONIC DISCHARGE FROM THE NOSE</h4> + +<p>Some children have a nasal discharge during all of +their childhood. It is usually worse during the winter +months. It may be a thin, watery discharge or a thick, +nasty, yellow discharge.</p> + +<p>It is a condition that is very frequently neglected even +by the family physician. This is unfortunate because +it may lead to serious disease, permanent damage sometimes +being done to the hearing, the speech, the smell, +and to the lungs of the child.</p> + +<p>It may be caused by adenoids; disease of the bones or +tissues in the nose; foreign bodies in the nose; or it may +occur in children whose nutrition is bad. It may result +from frequent acute attacks of "cold in the head." It +also occurs in other less important conditions. The foreign +bodies which usually cause a chronic nasal discharge +are,—buttons, peas, beans, beads, paper balls, flies and +bugs, cherry-stones, small pieces of coal, or stone, cork +or other material. A child gets hold of a shoe-button +for example and pushes it into its nostrils. In the effort +<span class='pagenum'>[<a name="Page_504" id="Page_504">504</a>]</span> +to get it out the child pushes it further in. It may or +may not cause pain at the time, and it may be overlooked, +but shortly the mother will notice a discharge +from one nostril. This discharge becomes thick and +foul and when an investigation is made the button is +found embedded firmly in the nose. It is sometimes +quite difficult to get the button out and this should always +be done by a physician.</p> + +<p><b>Treatment</b>.—Remove the cause first then treat the +catarrh. If it is a product of a constitutional disease +that causes general poor health, such as tuberculosis, +syphilis, or scrofula, the child will need "building up" +and a decided change of climate. Foreign bodies must +be removed, adenoids taken out, large tonsils excised, and +malformations of the nasal bones operated upon. The +catarrh will in many cases be cured by removing its +cause; if, however, it should persist it must be treated +for some time with appropriate solutions. These solutions +and the directions as to the method of giving them +must be given by a physician, because there is great danger +of carrying the disease to deeper structures if given +wrongly.</p> + +<p><b>SUMMARY:</b>—</p> + +<blockquote><p>1st.—A chronic discharge from the nose is a sign that +something is wrong and should be carefully and thoroughly +investigated.</p> + +<p>2nd.—The cause can usually be found out and the proper +treatment will cure it.</p> + +<p>3rd.—If the condition is neglected it may ruin the health +of the child for the whole period of its life.</p></blockquote> + +<h4>NERVOUS OR PERSISTENT COUGH</h4> + +<p>Cough in an infant or growing child is usually the +result of a cold and the structure affected is some part +of the nose, throat or bronchi. It is a comparatively +simple matter to discover just where the trouble is and +to prescribe the appropriate remedy and effect a cure.</p> + +<p>There is another type of cough, however, that is of +<span class='pagenum'>[<a name="Page_505" id="Page_505">505</a>]</span> +quite a different character. This cough will begin as +an ordinary cough and it will only be discovered that +it is not an ordinary cough because nothing will apparently +cure it. We mean that the child is given cough +remedies that usually cure a cold, is kept in the house +and carefully watched for a sufficiently long period +to justify a cure, and yet, despite this care and attention, +the cough remains the same. The child is not +sick, the appetite is good, there is no fever, it plays and +seems to enjoy good health, yet for weeks and frequently +for months the annoying cough hangs on. It is as a rule +worse at night. It begins soon after the child falls +asleep and spoils the entire night's rest or a great part +of it. It may be a dry, hard, hacking cough, or a croupy, +harsh bark. It may come in spells with a considerable +interval between them, during which time the child falls +asleep, or it may be almost constant, not quite severe +enough to rouse the child, but bad enough to spoil the +child's rest and the rest of the mother. If this condition +lasts for a long time, as it occasionally does, the health +of the little patient is apt to suffer from loss of sleep.</p> + +<p><b>Treatment</b>.—These children should be taken to a good +physician and thoroughly examined. Special care should +be devoted to investigating the condition of the nose, +throat, ear, stomach, heart, and lungs.</p> + +<p>A very large majority of these coughs are caused by +adenoid growths in the back part of the nose. The child +may not look like an adenoid child, nor may it breathe +through its mouth when asleep, and it may have had its +adenoids removed, yet in spite of these contra-indications +it may have enough loose adenoid tissue in its +nose to cause this kind of persistent cough. This has +been proved many times.</p> + +<p>It is not only useless but positively harmful to give +these children cough remedies. The cause of the cough +must be found and treated. The cough may be indirectly +caused by anemia (poor blood) or heart or stomach +trouble, or it may have a number of other causes. Whatever +it is it must be found by a careful physical examination +or a number of careful physical examinations, +because these cases are as a rule obscure and difficult +<span class='pagenum'>[<a name="Page_506" id="Page_506">506</a>]</span> +to diagnose, and even the most expert examiner cannot +always tell where the trouble is without seeing the +child a number of times. The parents must therefore +have patience and confidence in the physician and must +aid him all they can by watching and reporting all the +symptoms, etc., to him. (See article on <a href="#Adenoids">Adenoids</a>).</p> + + +<p><b>SUMMARY:</b>—</p> + +<blockquote><p>Coughs that resist careful treatment are not "ordinary +coughs."</p> + +<p>Coughs of this type require special medical care.</p> + +<p>The usual cough medicines are not only useless in +these coughs, but dangerous. Don't give them.</p></blockquote> + + +<h4>ACUTE CATARRHAL LARYNGITIS: SPASMODIC +CROUP: FALSE CROUP</h4> + +<p>Croup is one of the common diseases of childhood. It +usually follows a catarrhal "cold in the head" with a +cough. Croup is most frequently associated with large +tonsils and adenoids. It may come on gradually or it +may occur suddenly. There is always fever with croup. +One of the first symptoms is a hard, dry, croupy, barking +cough, which gets worse toward night. If it occurs suddenly, +the child will wake about midnight with the characteristic +croupy cough. The disease may go no further +than this and under the proper treatment is well in a few +days. In other cases, however, there develops marked interference +with breathing. Every inspiration is accompanied +by a loud hissing or "crowing" sound. This feature +of the disease is one that frightens the parents, +though it seldom means anything serious. The child sits +up in bed, frightened, and struggles for breath. It may +clutch its throat with its hands as if something was tied +round its neck. The lips may become slightly blue and the +perspiration appears upon the child's brow. After some +time,—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. +<span class='pagenum'>[<a name="Page_507" id="Page_507">507</a>]</span></p> + +<p><b>Treatment</b>.—The object of treatment during an acute +attack, when the child is struggling for breath, is to relax +quickly the spasm of the larynx which interferes with the +breathing. The simplest way is to give the child a teaspoonful +of the fresh syrup of ipecac. If the child does +not vomit in fifteen minutes, give another teaspoonful and +keep on giving it every fifteen minutes till the child +vomits. One or two doses is usually enough, but it must +be given till the child vomits.</p> + +<p>If the attack comes suddenly during the night and +there is no syrup of ipecac in the house, the physician +should be sent for at once and informed that the child +probably has croup, so he may know what to take with +him. While waiting for the physician the mother should +apply over the front of the neck (in the region of Adam's +apple), hot applications. These are best made of flannel +wrung out of quite hot water every two or three minutes: +also a hot mustard foot bath. When the physician takes +charge of the case he will also direct the treatment for +the following day in order that the attack of the +next night may be a very mild one, if it should +came at all.</p> + +<p>Children who have a tendency to frequent attacks of +croup should receive the same attention as the children do +who are subject to attacks of tonsilitis and acute catarrhal +rhinitis.</p> + + +<p><b>SUMMARY:</b>—</p> + +<blockquote><p>1st. Spasmodic Croup always requires prompt and efficient +treatment.</p> + +<p>2nd. It is called "false" croup, because "true" croup +is always diphtheritic and is a very serious disease.</p> + +<p>3rd. For that reason a physician should always be +called because if it is "true" croup antitoxin must be +given at once.</p> + +<p>4th. Don't worry unnecessarily because, though "spasmodic +croup" can make the child look exceedingly +sick for a very short time, an uncomplicated case in +a healthy child is seldom if ever dangerous. +<span class='pagenum'>[<a name="Page_508" id="Page_508">508</a>]</span></p></blockquote> + +<h4>TONSILITIS: ANGINA: "SORE THROAT"</h4> + +<p>This is one of the frequent diseases of childhood. We +rarely see it in infants. It is caused by inhaling air which +contains poisonous germs. These germs quickly develop +when conditions are favorable. They lodge in the pores +or follicles of the tonsils and set up an active inflammation. +The tonsils swell up and the follicles exude a thick +fluid which looks like curdled cream. This fluid sticks in +the mouths of the follicles forming spots. If enough of +this fluid is coming out, these spots join together forming +patches, and the patches may join together forming membrane. +This is why it is sometimes so difficult to tell +whether the case is one of tonsilitis or diphtheria.</p> + +<p>Conditions are favorable to the development of tonsilitis +if the child is not in good health when he happens +to inhale the infection, when the feet are wet or cold, or +when the child is allowed out during inclement weather +and it becomes chilled or numbed from cold, when the +child has a cold in the head and a running nose, or when +its stomach is out of order. Any condition in which the +child should be carefully watched and tended to, rather +than allowed further liberties, or risks, conduces to sore +throat of some kind.</p> + +<p>Some children have the disease a number of times; +they seem to be predisposed toward a sore throat. These +are children who have large tonsils or who are rheumatic. +The tonsils should be removed in the one case, and the +tendency to rheumatism should be the main treatment in +the other case.</p> + +<p>These children should be encouraged to cleanse the +throat and nose morning and night with a warm salt solution +(half a teaspoonful of ordinary table salt to three-quarters +of a cup of warm water). This will help greatly +to prevent these chronic sore throats.</p> + +<p><i>Symptoms of Tonsilitis</i>.—The disease begins suddenly. +The child may have a chill or be seized with sudden +vomiting or diarrhea. A very young infant may have a +convulsion. The usual way is for the child to develop +a fever quickly, to complain of being sick and tired. +Muscular pains all over the body and a severe headache +<span class='pagenum'>[<a name="Page_509" id="Page_509">509</a>]</span> +are constant symptoms. The fever is usually high from +the beginning. The child will tell you its throat is sore, +but there is as a rule very little pain in the throat. The +little spots or patches can be seen on one or both tonsils. +The general symptoms are more pronounced than the +local throat symptoms. The amount of physical depression +that is caused by a tonsilitis is out of all proportion +to the seriousness of the disease.</p> + +<p>Tonsilitis lasts three days usually. The throat symptoms +may take a day or two longer to clear up, and the +patients feel more or less weak for some time after all +the symptoms have disappeared.</p> + +<p>Tonsilitis is medically regarded as one of the mild +diseases of childhood. It is, however, of very great importance +because of its likeness to diphtheria, and inasmuch +as a positive diagnosis must be promptly made, in +the interest of the patient, it is given close attention and +treated with considerable respect by the medical profession. +The chief differences between the two diseases are +as follows:</p> + +<p>Tonsilitis begins abruptly with pronounced prostration +and a high fever the first day. The patient feels distinctly +sick all over. The second day the patient feels somewhat +better, the fever is lower and the prostration and pain are +not so marked. The third day he feels better still, and +but for a little weakness would feel well. Diphtheria +begins slowly and insidiously, with very little prostration +and a very low fever the first day. The patient scarcely +feels sick. The second day more prostration is present, +the fever climbs upward a little more, and the patient +begins to feel sick. On the third day the prostration is +much more profound, the fever is higher, and all the evidences +of a serious sickness are present. Two very different +pictures: The one begins bad and ends easy, the +other begins easy and may end bad.</p> + +<p>The important fact, however, so far as the similarity +of the two diseases is concerned, is, that we must make +the diagnosis positive on the first or second day, because +if we are dealing with a case of diphtheria we must +give antitoxin at once. This is essential, because the +efficacy of antitoxin is greatest when given early in the +<span class='pagenum'>[<a name="Page_510" id="Page_510">510</a>]</span> +disease. By "early" we mean the first or second day +of the disease. When antitoxin is given late (the third +or fourth day of the disease) it is much less efficacious +and must be given in relatively larger doses. The need, +therefore, of a quick, positive diagnosis is a real one.</p> + +<p>Another important element involved in a speedy diagnosis +is, that we must not take any chances of infecting +other children. So important are these conditions that +it is the proper treatment to give antitoxin at once in +every case of tonsilitis that in the slightest way resembles +diphtheria. An examination of the throat contents,—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.</p> + +<p>The local condition of the throat helps in the diagnosis: +In tonsilitis (as the name implies) the disease is limited +to the tonsils and on the tonsils (one or both) do we +find the spots or patches. In diphtheria, on the other +hand, the membrane is not limited to the tonsils, but +may cover every part of the throat and extend into the +nose and mouth. In tonsilitis it is spots or patches we +see in the throat. In diphtheria it is membrane we see +always. The difficulty here again is that if we wait till +the diphtheritic membrane covers the whole throat, antitoxin +will not be of much use.</p> + +<p>In diphtheria we have a characteristic odor, in tonsilitis +we have no characteristic odor.</p> + +<p>The practical lesson to be learned from this uncertainty +is, immediately to get a physician as soon as you +find spots in the throat of your sick child, unless you are +absolutely sure that the condition is not diphtheria and +you are willing to take that chance.</p> + +<p><b>Treatment of an Acute Attack of Tonsilitis</b>.—Put the +child in bed at once and keep him on a light diet during +the fever. Give him all the cool boiled water he wants +to drink. If the fever is very high it can be controlled +by sponging the body with cool water. If the patient +is an infant the food should be reduced to one-half +<span class='pagenum'>[<a name="Page_511" id="Page_511">511</a>]</span> +strength. Tonsilitis is a disease that runs a certain course +and gets better, or the patient develops some other more +serious conditions as a result of neglect or carelessness. +We therefore try to make the patient comfortable and +let the disease take care of itself.</p> + +<p>The throat can be gargled or sprayed with any mild +antiseptic liquid, or it can be painted with tincture of +iodine or 10 per cent. solution of silver nitrate. As a +rule the gargles do not aid in the cure of the disease, +though they contribute to the comfort of the patient.</p> + +<p>A cold compress made of half a dozen thicknesses of +cloth, such as a table napkin, and put under the jaw +(not round the neck), and covered with oiled silk and +held in place with a bandage that meets and is tied on the +top of the head, is of distinct usefulness.</p> + +<p>When it is known that the child is rheumatic, the +heart must be carefully watched during the fever and +anti-rheumatic remedies depended upon to effect a cure.</p> + + +<p><b>SUMMARY:</b>—</p> + +<blockquote><p>Tonsilitis, because of its likeness to diphtheria, must +be promptly and carefully diagnosed.</p> + +<p>A physician only is capable of making a diagnosis.</p> + +<p>Any sore throat in a child with spots or membrane +is deserving of serious and immediate attention.</p> + +<p>A mistake may mean death. Don't take a chance.</p></blockquote> + + +<h4>BRONCHITIS</h4> + +<p>Bronchitis is one of the commonest diseases of childhood. +It is the cause of many deaths. Exposure during +inclement weather is as a rule the cause of it. It +occurs in all classes and conditions of children. Poorly +nourished and badly clothed children are more liable to +get it than are others. It is more dangerous in young +children and infants than in older children. A young +child or an infant will get bronchitis quicker than those +older and stronger under the same conditions.</p> + +<p>Bronchitis is often present while children are suffering +from other diseases, measles, influenza, scarlet fever, +typhoid fever, pneumonia, diphtheria, whooping-cough, +for example. It may accompany any disease of childhood, +however.<span class='pagenum'>[<a name="Page_512" id="Page_512">512</a>]</span></p> + +<p><b>Symptoms</b>.—In infants bronchitis usually follows a +"cold in the head," with running nose and a cough. The +child is indisposed and peevish because of the cold. In +a few days the cough becomes worse, fever develops, +the breathing is quicker, and the baby looks and acts +sick. The cough may be constant and severe; sometimes +the cough does not seem to bother the baby, although +this is exceptional. The breathing is quite rapid +and is accompanied with a moist, rattling sound in the +chest. The baby is restless and if the cough is severe it +becomes exhausted. Vomiting or diarrhea may be present.</p> + +<p><b>Bronchitis in Older Children</b>.—Bronchitis in older +children comes on abruptly, with fever and cough. The +child may complain of headache and pains in the chest +or other parts of the body. It may begin with a chill or +chilly feelings. These children "raise" with the cough. +The expectoration may be quite profuse; at first it is +a white, frothy mucus, then yellow, and later a yellowish +green; it may be slightly tinged with blood.</p> + +<p>There is a mild form of bronchitis in these older +children where the serious symptoms are absent. The +children are not sick enough to go to bed, but they appear +to have a "heavy cold" with, at first, a tight, hard +cough, which is usually worse at night. Later the cough +turns loose and the same expectoration occurs as in the +severe type. It is these cases of mild bronchitis which +do not receive the proper care and treatment that develop +into the so-called "winter cough," which lasts for +months.</p> + +<p><b>Treatment.—</b>(See page <a href="#Page_497">497</a> +under heading, "Catching Colds.") Children who acquire bronchitis easily and +frequently, should be built up. Cod liver oil should be +given all winter. The sleeping apartment of these children +should not be too cold, but it should be well aired +through the day and well ventilated throughout the +night. Flannel night clothes should be worn and the feet +should be kept warm always. Mild attacks of "cold in +the head" should be treated vigorously and not neglected.</p> + +<p>The following "Don'ts" may be profitably studied when +your child or baby has bronchitis:—</p> + +<p><span class='pagenum'>[<a name="Page_513" id="Page_513">513</a>]</span></p> +<blockquote>Don't keep the windows tightly closed; fresh +air and good ventilation are absolutely necessary to the patient.<br /> + +Don't use a cotton jacket or oil silk.<br /> + +Don't wrap the child up in blankets and shawls.<br /> + +Don't carry the child around; keep it in bed.<br /> + +Don't dose the child with syrupy cough mixtures.<br /> + +Don't overheat the room.<br /> + +Don't let friends bother or annoy the baby.<br /> + +Don't reduce the diet unnecessarily.<br /> +</blockquote> + +<p>The child should be put to bed. The temperature of +the room should be 70 degrees F. all the time. The windows +should be opened top and bottom according to the +weather, and the room should be well aired every day, +the patient being taken to another room while it is being +done. The child should have its usual night clothes +on, nothing more. If the child is not very sick and insists +on sitting up, a bath robe can be worn but it should +be always removed when it sleeps. It is advisable to +change the position of the baby from time to time. Have +it rest on one side, then on the other, as well as on the +back. Give a dose of castor oil at the beginning of the +sickness and keep the bowels open during the disease.</p> + +<p><b>Diet.—</b>The diet will depend upon the severity of the +disease. If the fever is high and the cough persistent, +the strength of the food of nursing infants should be +reduced. We can reduce the strength of the food by +giving the child a drink of cool boiled water before +each feeding and shortening the length of each feeding. +Older children may be given toast, milk with lime water, +cocoa with milk, broths, gruels, custards, cereals and +fruit juices.</p> + +<p><b>Inhalations</b>.—The value of inhalations in bronchitis is +very great. The ordinary croup kettle, which can be +bought in any good drug store, is the best method of +giving them. Full directions come with each kettle as +to the best way to use it. The best drug to use in the +kettle is creosote (beechwood). Ten drops are added to +one quart of boiling water and the steaming continued +for thirty minutes. The interval between steaming is +two hours and a half in bad cases day and night. In +mild cases the night treatments can be dispensed with. +Sheets rigged up over the top and sides of the crib, in +<span class='pagenum'>[<a name="Page_514" id="Page_514">514</a>]</span> +the form of a tent, is the most desirable way to give +the inhalations.</p> + +<p><b>External Applications</b>.—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.</p> + +<p><b>Drugs</b>.—Drugs are of very little value in the treatment +of bronchitis. In the first stage of the disease, +when the cough is hard and dry, small doses of castor +oil and syrup of ipecac may be given to good advantage. +The following dosage should be followed closely: 1st +year, 2 drops castor oil, 2 drops syrup of ipecac, every +two hours; 3rd year, 3 drops castor oil, 3 drops syrup +of ipecac, every two hours; over 3 years, 4 drops castor +oil, 4 drops syrup of ipecac, every two hours.</p> + +<p>The benefits from this treatment will be obtained in the +first two or three days, when it should be discontinued. +The cough under this treatment and the use of the mustard +paste and inhalations of creosote will be soft and +loose in two or three days and the fever will be distinctly +on the mend. The disease lasts from five to ten days. +It may, however, last much longer according to the +condition of the child, etc.</p> + +<p>There are other drugs that can be given, with good effect, +but when other remedies are indicated a physician +<span class='pagenum'>[<a name="Page_515" id="Page_515">515</a>]</span> +should be called to prescribe them according to indications.</p> + + +<p><b>SUMMARY</b>:—</p> + +<blockquote><p>Bronchitis is one of the commonest diseases of childhood.</p> + +<p>It is the cause of many deaths.</p> + +<p>A large number of children have a tendency to bronchitis.</p> + +<p>These children need careful attention and "building +up."</p> + +<p>Do not neglect a "little" cold. It means trouble.</p></blockquote> + + +<p><b>Chronic or Recurrent Bronchitis</b>.—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.</p> + +<p>An absolute change of climate, to a warmer inland +atmosphere, is imperative before some of these patients +will begin to improve.</p> + + +<p><b>SUMMARY</b>:—</p> + +<blockquote><p>A child with chronic bronchitis, or with frequent attacks +of bronchitis (or chronic colds), is usually +suffering from some other diseased condition.</p> + +<p>The bronchitis, or the cold, will not get better until +<span class='pagenum'>[<a name="Page_516" id="Page_516">516</a>]</span> +you find out what that "other diseased condition" is.</p> + +<p>It takes a physician to find that out.</p> + +<p>Having found the cause, cure it, and the bronchitis will +disappear and the general health of the child will +immediately improve.</p></blockquote> + + +<h4>PNEUMONIA</h4> + +<p>Pneumonia is a very common disease in childhood. It +is the most frequent complication of the various acute +infectious diseases. Pneumonia is an exceedingly important +factor in the mortality of infancy.</p> + +<p>There are two kinds of pneumonia:—</p> + +<blockquote><p> +1. Broncho-pneumonia.<br /> +2. Lobar-pneumonia.<br /> +</p></blockquote> + +<p><b>Acute Broncho-Pneumonia</b>.—Up to the fourth year +this is the form of pneumonia always present. It is the +form that always complicates other diseases all through +childhood.</p> + +<p>It is most apt to occur during the spring and winter +months.</p> + +<p>It affects all classes, but especially those whose hygienic +surroundings are poor. Catching cold is the exciting +cause in a large percentage of primary pneumonias.</p> + +<p><b>Symptoms</b>.—Broncho-pneumonia has no regular +course. It may or it may not follow a cold or an attack +of bronchitis. As a rule it begins suddenly with a high +fever, frequently accompanied by vomiting, rapid respiration, +cough, and prostration.</p> + +<p>The child does not maintain a high fever continuously; +it varies considerably throughout each twenty-four hours. +It lasts from one to three weeks, and subsides gradually.</p> + +<p>The respirations vary between 60 and 80 per minute, +though they may be much more frequent than this. The +child breathes with apparent difficulty, the soft parts of +the cheeks and nose rising and falling as it breathes.</p> + +<p>The prostration becomes, as the disease progresses, +more and more marked, until the child looks profoundly +sick.</p> + +<p>Cough is a constant and incessant symptom. It disturbs +rest and sleep and may cause frequent vomiting. +<span class='pagenum'>[<a name="Page_517" id="Page_517">517</a>]</span> +There is no expectoration. A strong cough is a good +symptom; if it stops it is a bad symptom.</p> + +<p>Pain is seldom present.</p> + +<p>Blueness of the skin is a bad sign and indicates failure +of respiration and suggests constant and careful watching.</p> + +<p>Delirium may be present during the disease. It is not +necessarily a bad sign. Accompanying stomach troubles +are frequent if the patient is very young, and are very +important. The bowels may be loose; they may be green +in color and contain much mucus. Large quantities of +gas may accumulate in the intestines and may cause much +distress and convulsions. Death may occur at any time +or the process may be arrested and recovery take place +at any stage of the disease. Broncho-pneumonia is not +necessarily a fatal disease in a fairly healthy child. It is, +however, always a serious disease.</p> + +<p>Various complications may occur in the course of the +disease. The most frequent are: pleurisy, emphysema, +abscess of the lung, meningitis, heart disease, stomach +troubles, thrush, intestinal disease.</p> + +<p><b>How to Tell When a Child Has Broncho-Pneumonia</b>.—If +a child develops a high fever, breathes rapidly, +coughs, and is content to lie in bed because of the degree +of prostration, broncho-pneumonia is almost certain to be +the disease present. If in addition to these symptoms +there is any blueness of the fingers or around the mouth +it is more strongly suggestive of pneumonia.</p> + +<p>If the child has been suffering with bronchitis it is +sometimes difficult to tell just when the pneumonia begins. +The child will appear more profoundly sick, the fever will +go higher, and the respiration will be more frequent when +pneumonia sets in on top of bronchitis.</p> + +<p><b>Treatment</b>.—The nursing of a little patient with pneumonia +is the most important part. He must get plenty of +fresh air; consequently he should be kept in a well-ventilated +room. It is an excellent plan to change the patient +twice daily from the sick room into another which has +previously been thoroughly aired. While he is in this +room the sick room should be as thoroughly aired as is +possible. Keep this plan up all through the disease; +change the position of the patient in bed every two hours. +<span class='pagenum'>[<a name="Page_518" id="Page_518">518</a>]</span> +He should never be allowed to lie on his back for hours +at a time. In this way the different parts of the lungs +get a chance to air themselves,—the air cells expand and +the oxygen in the air and the fresh blood tend to heal the +parts more quickly.</p> + +<p>It would be distinctly wrong to go into the detailed +symptomatic treatment of broncho-pneumonia in a book +of this character. Inasmuch as this is one of the most +serious diseases of infancy, no mother should attempt to +treat it alone. A physician is absolutely necessary and +the most the mother can hope to do is to follow out his +directions to the letter.</p> + +<p>He may direct the use of mustard pastes but it is essential +to know where to apply them. If he should request +the use of the cotton jacket, the height and character of +the fever must regulate its use. Stimulants are always +necessary, whisky and strychnine being given in every +case, but if given at the wrong time they may do more +harm than good. Cough mixtures may be necessary, but +frequently they are contra-indicated. Drugs and cold +sponging may be used to reduce the fever, but they are +dangerous if used when conditions do not justify their +use. Complications must be diagnosed when they occur, +and the correct methods of treatment promptly instituted. +A competent physician alone can assume the responsibility +of these various phases of the disease.</p> + +<p>Every mother should appreciate, however, that pneumonia +is frequently the result of carelessness. It is a well-known +fact that pneumonia is an infrequent disease +among children of the well-to-do, because the hygienic +surroundings of these children are better and because +they receive competent attention if suffering with colds +and bronchitis. Bronchitis is quite common in all classes +of children, but in the lower walks of life it is the custom +to allow children to run around while they give every sign +of having a heavy cold, and a beginning bronchitis. These +children should receive treatment and should be kept indoors +and in bed if they have even a slight fever, as +pneumonia is frequently the inevitable outcome. They +should be carefully fed, and all signs of stomach or intestinal +troubles attended to at once. +<span class='pagenum'>[518f]</span></p> + +<div class="figcenter" style="width: 400px;"> +<a id="v4pg518" name="v4pg518"></a> +<img src="images/v4pg518.jpg" width="400" height="481" alt="A Grim Result" +title="" /> +<span class="caption">By permission of Henry H. Goddard + +A Grim Result + +Isaac is 16, although mentally 10. He is a high-grade +moron.</span></div> + +<p>This is one of those all too frequent instances<a href="#Footnote_A_1">[A]</a> +"of a feeble-minded woman with a husband who is alcoholic and +the offspring either feeble-minded or miscarriages."</p> + +<p>"Isaac is exceedingly dangerous. He is a potential criminal +or bad man, or under the best conditions would at least marry +and probably become the father of defectives like himself."</p> + +<p>This and the succeeding pictures in this volume +contrast vividly with the frontispiece. Terrible are +the results when we disregard the inevitable laws +of nature, and so mate ourselves that our children +will be parasites on society.</p> + +<div class="footnote"><p><a name="Footnote_A_1" id="Footnote_A_1"></a> +<span class="label">[A]</span>"Feeble-mindedness; +Its Causes and Consequences", Goddard, The Macmillan Company.</p></div> + +<p><span class='pagenum'><a name="Page_519" id="Page_519">[519]</a></span> + +<b>The After-Treatment of Pneumonia</b> is important, and +every detail has a distinct bearing on the ultimate recovery +and establishment of good health. Careful feeding, +a good tonic, and the proper attention to exercise, +fresh air and bathing are requisite. A change of air after +the fever is gone is more important than all other measures +put together. A dry, warm climate where patients +can be kept in the open air is preferable. The danger of +allowing a slow, long drawn-out convalescence after pneumonia +is the development of tuberculosis.</p> + + +<h4>ADENOIDS</h4> + +<p><a name="Adenoids" id="Adenoids"></a>Adenoids are very common, almost +popular, in childhood. The condition is one that causes more real trouble +and discomfort than any other childhood affliction. Adenoids +are associated with, and are responsible for, many +of the ailments of childhood. They may be associated +with enlarged tonsils or they may be independent of +them. They may be present at birth or develop any +time thereafter, though they are more frequent between +the ages of two and six years. Children who have adenoids +invariably suffer from chronic "head-colds" with a discharge +from the nose. These chronic colds are caused by +the adenoids. Nearly every disease, and every diseased, +or abnormal, condition of the nose, throat, larynx, and +lungs can be directly caused by the presence of adenoids. +They are also responsible for numerous other conditions +of very grave importance in the growing child. The accompanying +"head-colds" may develop into a bronchitis +which may keep the child indoors for a long period. Adenoids +always interfere with respiration, thereby depriving +the child of a normal quantity of oxygen, thus rendering +the blood less pure, and, as a consequence, seriously interfering +with the nourishment and general health. The impaired +nourishment and poor health thus produced, as a +direct result of adenoids, renders the child more liable to +disease; he may thus acquire ailments that may affect his +whole subsequent life. The mental side of a child's development +is also affected by the presence of adenoids, so +much so that actual statistics prove that these children +cannot keep up with their classes in the public school. +<span class='pagenum'>[<a name="Page_520" id="Page_520">520</a>]</span></p> + +<p>We must therefore regard the presence of adenoids as +a serious menace to the health and comfort of the patient. +It has already been pointed out in discussing other diseases +that before a cure of these diseases could be permanently +accomplished it would be absolutely necessary +to remove the adenoids, which were, no doubt, the actual +cause, or an important contributing cause, of the disease. +Such conditions as catarrhal laryngitis, croup, chronic recurring +winter coughs, acute catarrhal rhinitis, "snuffles", +"cold in the head", chronic catarrh, bronchial asthma, incontinence +of urine, "bed-wetting", "nose-bleeding", headaches +in growing children, anemia, deafness, night terrors, +defective speech, diphtheria, consumption, are frequently +caused by the presence of adenoids.</p> + +<p>These patients contract certain diseases easier than +other children, and when they do, they have them more +severely; such diseases are diphtheria, tuberculosis, scarlet +fever, measles, and whooping cough.</p> + +<p>Adenoid children are, as a rule, in better health during +the warm, equable, summer weather than during the +changeable, uncertain weather we have in the winter +months. If the case is neglected, and if the adenoids +have existed for a long time, the growth of the child is +impaired. He remains small and stunted, and the expression +of the face is dull and stupid. The temperament +and disposition are affected also; such children are +languid, listless and depressed.</p> + +<p><b>How to Tell When a Child Has Adenoids</b>.—Children +with well-developed adenoids are "mouth-breathers." Instead +of breathing through the nose they breathe with +the mouth open, especially when sound asleep. If a +child has a discharge from its nose and a chronic cough, +both of which resist treatment, and if in addition it is a +mouth-breather, it is safe to investigate the naso-pharynx +for adenoids. If a child with these symptoms is not in +good health, is listless and depressed, looks stupid, snores +at night, has difficulty in breathing and cannot blow its +nose satisfactorily, is troubled occasionally with "nose +bleeds" and headaches, we may be satisfied that the child +has adenoids, as no other condition could produce such a +picture.<span class='pagenum'>[<a name="Page_521" id="Page_521">521</a>]</span></p> + +<p>Adenoids, like enlarged tonsils, are dangerous, apart +from the physical distress and disease which they cause, +owing to the fact that they harbor deadly bacteria, and +from these bacteria, which find a lodgment in the adenoids +and tonsils, a fatal attack of diphtheria or consumption +may have its beginning.</p> + +<p><b>Treatment of Adenoids</b>.—Absolute removal is the only +justifiable treatment. This is rendered imperative for so +many reasons that it is unnecessary to go into details in +justification of the procedure.</p> + +<p>The physical well-being, the mental development, the +life of the child depend upon it. Any parent who would +wittingly interpose an objection to the removal of his or +her child's adenoids, after they have been demonstrated +to exist, would be guilty of a grave crime.</p> + +<p>The operation itself is not at all dangerous. It is over +in a few moments and the child is well in an hour or two, +so far as any pain or suffering is concerned.</p> + +<p>Physicians are frequently asked if adenoids "grow" +again after removal. The answer is, "Yes," they sometimes +do. In a very small percentage of the cases they do +return. The older the child is when they are removed +the less chance there is of a recurrence. A child operated +on before it is two years of age is more liable to a recurrence +than a child operated on at six years of age. This +must not, however, be construed as an excuse for putting +an operation off, because if a child needs an operation at +two years and it is postponed till later, its health will be +permanently injured before it is four years of age.</p> + + +<p><b>SUMMARY</b>:—</p> + +<blockquote><p>1. Adenoids cause more trouble and more actual disease +than any other condition during childhood.</p> + +<p>2. It is a crime for a parent to refuse operation if the +presence of adenoids has been proved.</p> + +<p>3. Removal is the only treatment and it should be done +in every case as soon as possible.</p> + +<p>4. The operation is a trivial one and is free from +danger.</p></blockquote> +<p><span class='pagenum'>[<a name="Page_522" id="Page_522">522</a>]</span></p> + + +<h4>NASAL HEMORRHAGE—"NOSE BLEEDS"</h4> + +<p>A hemorrhage from the nose may occur at any time +from birth on. It depends upon the rupture of one or +more blood vessels. The great majority of "nose-bleeds" +are caused by adenoids, or by a small ulcer in the nose, or +by an injury, such as a blow or fall. A nasal hemorrhage, +however, may be caused by other, more serious conditions, +and for that reason may justify a careful inquiry +into the cause, especially if bleeding should occur a number +of times, or be of a serious character the first time.</p> + +<p>Of the more common causes as given above, the adenoids +should be removed, and the chronic catarrh which +is invariably the cause of the ulcer should be cured.</p> + +<p><b>Treatment of an Acute Attack</b>.—Have the patient sit +erect; loosen all tight clothing around neck; fold the +hands over the head; apply cold to the back of the neck +and the nose. Pieces of ice can be put into the nostril +and the ice bag to the nape of the neck, or a piece of ice +can be put into a folded napkin and held on the back of +the neck. Taking a long breath and holding it as long as +possible and repeating it while the ice is being applied is +an aid. Placing the feet in hot mustard water is of decided +use. Another excellent expedient is to wrap absorbent +cotton round a smooth probe (piece of whalebone, +for example), dip the cotton in an alum-water mixture +(half teaspoonful powdered alum in a half cupful of +water), and then push it into the bleeding nostril as far as +you can with gentle force. A valuable remedy is Peroxide +of Hydrogen used full strength and freely dropped +into the nostril. If these measures fail, send for a +physician at once.</p> + + +<p><b>SUMMARY</b>:—</p> + +<blockquote><p>1st. Nose bleeds may be caused by some serious condition.</p> + +<p>2nd. If they occur a number of times have the child +examined.</p> + +<p>3rd. If the treatment outlined above does not stop the +bleeding in a few moments send immediately for a +physician.</p></blockquote> +<p><span class='pagenum'>[<a name="Page_523" id="Page_523">523</a>]</span></p> + + +<h4>QUINSY</h4> + +<p>Quinsy is not common in childhood. It usually follows +tonsilitis when it is seen. The child complains of pain in +the neck, extreme pain and difficulty upon swallowing, +and inability to open the mouth as much as usual. There +is a tendency to hold the head to one side. The treatment +is to open the abscess at the earliest moment after +pus is present.</p> + + +<h4>HICCOUGH</h4> + +<p>Hiccough is, in most cases, in infancy and childhood +caused by some irritation of the stomach, may be over-filled +with food or gas. In these cases it is an unimportant +incident and may be quickly relieved by giving +the child an enema of soap-water and a laxative of rhubarb +and soda.</p> + +<p>Infrequently hiccough may be the result of cold feet, +or a surface chill. Simple methods of relief are, to hold +the breath, to expire, or blow the breath out as long as +possible before taking the next breath; to sip water from +a cup held by another person while the tips of the two +fore-fingers are in the ears.</p> + +<p>Hiccough is quite frequent in hysteria in girls, but it +is of no consequence. When hiccoughs set in during +the course of any serious disease it is a very unfavorable +sign.</p> + + +<h4>SORE MOUTH: STOMATITIS</h4> + +<p>Stomatitis is an inflammation of the mucous membrane +(inner lining) of the mouth. The gums and the inner +surface of the lips and cheeks may be red and angry-looking. +There may be small grayish spots on any part +of the mouth. If the case is very bad or if it has lasted +some time and has been neglected, these spots grow +larger and join together forming irregular grayish +plaques. A large percentage of the cases never go further +than this because the proper care and attention is +given them. It is possible, however, for any case to +progress further and become ulcerative. This will be +<span class='pagenum'>[<a name="Page_524" id="Page_524">524</a>]</span> +observed first as a faint yellow line at the margin of the +teeth and gum. Ulceration never takes place unless the +child has teeth. The quantity of saliva is very greatly +increased, so much so that it flows out of the mouth soiling +the clothes. The saliva is intensely acid and it consequently +irritates the skin, causing more or less eczema. +The mouth is painful and hot. There is slight fever, +but seldom any marked prostration. If, however, the ulceration +should be severe, the fever may be quite high.</p> + +<p>There is one feature of these cases that sometimes +proves vexatious and annoying. Because of the soreness +of the mouth, the child cannot draw strongly enough on +the nipple to get a normal feeding, and as a result the +nutrition of the child is poor. These children are hungry +and when offered the nipple grasp it greedily, draw a few +mouthfuls then stop because of the pain and begin to cry.</p> + +<p>If the ulceration is extensive, there is usually an odor +and the gums bleed easily. Sometimes the teeth fall out +or have to be drawn out.</p> + +<p>Strong, well-fed children are as likely to develop stomatitis +as are those who are weakly and ill fed.</p> + +<p>The disease is caused by infection and is contagious. +Just what the infection is we do not know; we do, however, +know that children whose mouths are carefully +cleaned after each feeding do not have sore mouths of +this character. When cleaning the mouth care must be +observed not to injure the tender mucous membrane.</p> + +<p><b>Treatment</b>.—As soon as the condition is observed +mouth-washing should be systematically and thoroughly +carried out. After each feeding the mouth should be +washed with a saturated solution of boric acid in boiled +water. (See page <a href="#Page_626">626</a>.)</p> + +<p>It is not necessary to use any further treatment, as a +rule. Patients recover in four to eight days. Strict attention +to cleanliness, however, is imperative. The feeding +bottle and nipple, or the mother's nipple, if breast +fed, must be kept scrupulously clean.</p> + +<p>The feeding of these children is sometimes a problem +for a day or two, because, as stated above, of the soreness +of the mouth. This is best overcome by feeding the baby +with a spoon. If breast fed, it is necessary to pump the +<span class='pagenum'>[<a name="Page_525" id="Page_525">525</a>]</span> +milk and then feed with the spoon. Children will take the +milk better if it is fed cold. Cold boiled water is largely +taken and is good for them at this time.</p> + +<p><b>Treatment for Ulcers in Mouth</b>.—The ulcers should +be touched with a camel's-hair brush which has been +dipped into finely powdered burnt alum. If a stronger +caustic is necessary, the solid stick of nitrate of silver +may be used.</p> + +<p>A mouth wash may also be used in the ulcerative cases, +composed of the peroxide of hydrogen diluted with two +parts of water. If this is used wash the mouth out afterward +with plain, cool, boiled water. The peroxide mouth +wash can be used four or five times daily.</p> + +<p>In addition to the mouth washing in the ulcerative +cases it is advisable to use internally chlorate of potash. +The druggist should be requested to make a two-ounce +saturated solution, and of this you can give one-half teaspoonful, +largely diluted with cool water, every hour +during the day for the first twenty-four hours, then +every two hours until marked improvement is shown, +when it can be further reduced by lengthening the interval +between doses.</p> + + +<h4>SPRUE—THRUSH</h4> + +<p>Sprue is a form of sore mouth. It is seen only during +the first six months of life, as a rule. It affects the +mucous membrane of the mouth; it appears in the form of +small white spots that look like drops of curdled milk. +They are on the inner surface of the cheek and may be +all over the mouth, and on the tongue. The spots are +firmly attached, and if forcibly removed the mucous membrane +will bleed.</p> + +<p>The disease is caused by infection through lack of +cleanliness and it invariably affects poorly nourished children, +especially those who are bottle-fed.</p> + +<p>There are no symptoms other than those of the mouth; +the child frequently refuses to nurse because of evident +pain and distress while nursing. The condition is not +contagious. It may be cured in from six to eight days +without difficulty.</p> + +<p><b>Treatment</b>.—Mouth irrigations of boracic acid are all +<span class='pagenum'>[<a name="Page_526" id="Page_526">526</a>]</span> +that are necessary. They are given in the following way: +Place the child on its side, roll around the index finger +a piece of absorbent cotton, dip this in a saturated solution +of boracic acid, and put into the mouth of the child. +Let the cotton take up as much of the solution as it will +hold, so that when it is lightly pressed on the tongue and +cheeks it will flow out of the mouth, thus "irrigating the +mouth." Repeat this a number of times, pressing the cotton +to a different part each time. This should be gone +through from four to six times daily.</p> + +<p>If the child is a bottle-fed baby, care should be taken +in cleaning the nipples and bottles as directed on page +264. If the patient is breast-fed, care must be taken to +note that the mother's nipples are clean. They should +be washed with the same solution of boracic acid and +not handled. If the child cannot nurse it is necessary to +feed it with a spoon.</p> + +<p>In obstinate cases the parts may be touched with a one +per cent. solution of formalin. Mothers should particularly +note not to use honey and borax, as is often recommended +by women who know no better, in any disease of +the mouth in children. +<span class='pagenum'><a name="Page_527" id="Page_527">[527]</a></span></p> + + + +<hr style="width: 65%;" /> +<h2>CHAPTER XXXV</h2> + +<h3>DISEASES OF THE STOMACH AND GASTRO-INTESTINAL +CANAL</h3> + +<div class="blockquot">Inflammation of the Stomach—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</div> + + +<h4>ACUTE GASTRIC INDIGESTION</h4> + +<h5>Acute Inflammation of the Stomach—Acute Gastritis— +Persistent Vomiting</h5> + +<p>An infant seldom has real inflammation of the stomach. +Gastric, or stomach, indigestion is the better name, +because it actually signifies the true condition. It is indigestion +that causes a child to vomit, though it is possible +to have a true inflammation caused by the taking of irritant +or corrosive drugs.</p> + +<p>Gastric indigestion causes sudden, repeated vomiting, +with prostration and occasional fever. It is caused by +unsuitable food, the wrong quantity of food, irregular +feeding, and food the quality of which is not good.</p> + +<p><b>Treatment</b>.—The stomach should be immediately +washed out. Until the physician arrives the mother can +encourage the child to drink a large quantity of cool +boiled water. This will be vomited and it will wash out +the stomach at the same time. No further treatment +<span class='pagenum'>[<a name="Page_528" id="Page_528">528</a>]</span> +may be necessary, as the vomiting may stop. All food +should be withheld for at least twenty-four hours. A +high rectal irrigation should now be given. It is essential +to know that the bowel is absolutely clean in all +vomiting cases. The normal salt solution is the best +agent to use for a high enema in infants. (See page <a href="#Page_586"> +586</a>.)</p> + +<p>After twelve or twenty-four hours' abstinence from +food, the child can be given teaspoonful doses every +twenty minutes of cooled boiled water, or barley or albumen +water, weak tea, or chicken broth. Cold liquids +are better retained and more readily taken than those +that are heated. If the liquid feedings are vomited, another +twelve hours must elapse before trying stomach +feedings. In these cases we must try to satisfy the +thirst by giving cold colon flushings. If the case becomes +protracted and we find it impossible to nourish +the child by the mouth, we must wash the stomach out +once every day with a five per cent. solution of bicarbonate +of soda, and feed the child by the rectum. Sometimes +we can feed through the stomach tube. Liquids +will frequently be retained when put into the stomach +through a tube when they will be vomited if swallowed.</p> + +<p>The best food by the rectum is plain peptonized milk.</p> + +<p>Drugs are absolutely useless. If the vomiting persists, +despite the above efforts to stop it, there is nothing to be +gained by experimenting. You will not only render the +condition worse but you will weaken the child. Morphine +given hypodermatically is the only remedy. Given +in appropriate doses, according to age, it is absolutely +harmless. It will not only stop the vomiting, but it will +give the child a much-needed rest, by allowing it to go to +sleep. When it wakes up it will be stronger and its +stomach will most likely retain small doses of nourishment.</p> + +<p>Great care must be exercised, in getting the child +back on a normal diet, not to try to go too fast.</p> + +<p>In cases of persistent vomiting in children I have +found it advisable to use teaspoonful doses of ice-cold +champagne. These children will sometimes keep this +down when all other liquids will be vomited. It is absolutely +necessary to keep the child lying down. If he is +<span class='pagenum'>[<a name="Page_529" id="Page_529">529</a>]</span> +restless or sits up, the vomiting may begin all over again. +The champagne not only is excellent nourishment for +the child, but it quiets the stomach, allays irritability, +and frequently favors sleep, during which time a cure +very often results. The champagne must be drawn +through a champagne siphon (procured in the drug +store), and the bottle must be kept on ice with the +mouth downward; otherwise it will get stale very quickly +and be of no use. If kept as advised it will remain +good to the end.</p> + + +<p><b>SUMMARY:—</b></p> + +<blockquote><p>1st. Persistent vomiting in a child means acute gastritis. +Stop all food for twenty-four hours.</p> + +<p>2nd. Encourage the child to drink large quantities of +slightly warm water; this will wash the stomach +out and frequently stops the vomiting.</p> + +<p>3rd. When the child is quiet wash out the bowels.</p> + +<p>4th. If vomiting persists, use iced champagne as directed.</p></blockquote> + + +<h4>ACUTE INTESTINAL DISEASES OF CHILDREN</h4> + +<p>The large infant mortality that results from intestinal +diseases during the summer months is deserving of the +most careful consideration, both of the physician and the +parent.</p> + +<p>Apart from the excessive heat of the summer, there +is no doubt that an unfavorable environment, which +means bad hygienic surroundings, bad sanitary conditions, +bad food and home influences, contributes largely +to the enormous number of these serious cases. Education, +while it may be expected to influence favorably +the sanitary and other conditions in the home, cannot +change the home location. The child must continue to +live in the same environment. It is in this class of cases +that these summer diseases are so very fatal. Children +in better circumstances can take advantage of conditions +which are denied to the tenement child. The diseases +must therefore be faced and treated under these existing +conditions. +<span class='pagenum'>[<a name="Page_530" id="Page_530">530</a>]</span></p> + +<p>In addition to the climate and the environment, there +are certain factors that occur in all classes which result +in intestinal derangement. If the stomach or bowels are +not performing their function properly, or if the food +or method of feeding is wrong, these, plus very hot, +humid weather, invariably result in serious intestinal +disease. The mother must be taught to interpret properly +the meaning of a green, loose stool in the summertime; +she must appreciate that it is the danger signal and +must be regarded seriously.</p> + +<p>The very best preventive against summer diseases of +the intestine is to guard particularly against any trouble +with the child's stomach at all seasons of the year. A +healthy stomach and bowel will resist disease, even in +very hot weather.</p> + +<p>The most important food product which has a direct +relationship to this class of diseases is milk. In a large +city like New York it will remain impossible to solve the +milk problem, despite the splendid efforts of the Health +Department and the members of the medical profession, +until the city itself shall establish milk depots and ice +stations where safe milk, and ice to keep it safe, may be +obtained at a nominal cost, or free, if the parents cannot +afford to buy it. We, therefore, must recognize that the +vast majority of children to-day are taking milk that is +not suited to them, that is really not fit as a food for +children. The mothers do not know this and no steps +are taken to render the milk more safe for them to feed +to their children. These mothers are willing to do what +is essential in the interest of their children, but they do +not know what should be done. These people cannot +afford a physician or a nurse to teach them, nor do they +even know that their methods are wrong or that they +need any instruction. We must carry the information +and the explanation to them. We must show them the +need for a change of methods. This is the work for +those charitably disposed women who desire some worthy +purpose in life, who really wish to do some real good. +All the equipment they need is good common sense. +They will tell these mothers why it is necessary to pasteurize +the milk before feeding it to the baby. They +<span class='pagenum'>[<a name="Page_531" id="Page_531">531</a>]</span> +will show how to keep the nursing bottles clean, and the +nipples sweet and fresh. They will instruct them how +to dress the baby in the hot weather and impress them +with the need of giving it all the cool, fresh air possible. +In short, they will gain the confidence and the good will +of these mothers in a tactful and diplomatic way, and +they will tell them all they know in language which they +will understand regarding the care of the baby. In every +city in the country this work is needed and is waiting for +the missionaries who will volunteer. To teach mothers +the need for boiled water as a necessary drink for baby +and older children is alone a worthy avocation. To impress +upon one of these willing but ignorant mothers +the absolute necessity for washing her hands before she +prepares her baby's food, that she must keep a covered +vessel in which the soiled napkins are placed until +washed, that she should frequently sponge her baby in +the hot weather, and explain thoroughly why these are +important details, is a work of true religious charity. +They should be specially taught to immediately discontinue +milk at the first sign of intestinal trouble, to give +a suitable dose of castor oil and to put the child on barley +water as a food until the danger is passed. They should +be taught to know the significance of a green, watery +stool, they should know that is the one danger signal in +the summer time that no mother can ignore without wilfully +risking the life of her baby. They should be taught +to prepare special articles of diet when they are needed. +If every mother were educated to the extent as indicated +in the above outline the appalling infant mortality would +fall into insignificance. It is not a difficult task nor +would it take a long time to carry it out; it is the work +for willing women who have time and who perhaps spend +that time in less desirable but more dramatic ways.</p> + +<p>It is the knowledge that aids in catching disease in its +inception that counts. The worst infections begin as a +mild condition and prompt treatment robs them of their +sting. When treatment is delayed and the child is fed +for twenty-four hours too long on milk, the condition +which in the beginning could have been stopped +promptly has developed and it becomes a fight for life. +<span class='pagenum'>[<a name="Page_532" id="Page_532">532</a>]</span></p> + +<p>It will be seen from the above that all we need is education. +Education of the mother primarily, but education +of the missionary, the nurse, the physician, the municipality, +and the State, each co-operating, each willing +to work in the interest of a great cause, for the benefit +of the human race and for the brotherhood of man.</p> + + +<h4>ACUTE INTESTINAL INDIGESTION</h4> + +<p><b>Causes</b>.—Overfeeding, unsuitable and improper food, +irregular and indiscriminate feeding, sudden change +from one food to another, as at weaning time, a change +from a poor quality to a rich food, or vice versa. Conditions +affecting the health of the child, especially the +nervous system, such as hot weather, extreme cold, +fatigue, or at the beginning of any of the acute diseases. +Children sometimes are predisposed to attacks of intestinal +indigestion; these children are delicate in health +and have weak digestive ability. The slightest irregularity +or error in diet will cause an attack in these +children.</p> + +<p><b>Symptoms</b>.—The attack may come on suddenly or it +may develop slowly. The important constitutional symptoms +are fever, prostration, and a general nervous irritability. +The child is seized with pain in the abdomen. +The pain is referred to the region around the navel. It +is sharp, colicky, and severe, causing the child to cry out +and draw up its legs in an effort to lessen its severity. +The child is exceedingly restless and acts as if it were +on the verge of a dangerous illness. Gas in the bowel +is not present as a rule as frequently as it is in infants +under the same circumstances. In a few hours diarrhea +sets in, the stools may number from four to twelve +or more in twenty-four hours. The stools are acid, sour, +and the odor may be very foul. They are thinner than +usual and frothy from the presence of gas.</p> + +<p>In very young infants suffering from a sudden attack +of intestinal indigestion, the stomach, as well as the +bowels, is invariably upset. If the indigestion is the result +of a slower process, the stomach does not participate +in the process. The color of the stools in infancy is +yellow, then yellowish-green, and later grass-green. +<span class='pagenum'>[<a name="Page_533" id="Page_533">533</a>]</span> +Undigested food is always present and in infants the curdled +casein of the milk appears as white specks or lumps in +the movements.</p> + +<p>The fever is high in the sudden cases and lower in +the cases of gradual onset. The prostration is more +severe when the onset is sudden and in infants may be +very marked.</p> + +<p>The termination of the disease depends upon the +cause, the treatment, and the previous health of the child. +In healthy children promptly and properly treated it +may be all over in a week. In delicate, poorly nourished +children, and especially in the summer time, it may be +the beginning of trouble that may eventuate in death.</p> + +<p><b>Treatment</b>.—There is no condition in the whole realm +of diseases of childhood where the knowledge of the +mother may have such important results as this condition. +The most effective time to treat these cases of +intestinal indigestion is before the physician is called. +There are few diseases in which time is so valuable, so +far as final results are concerned, as it is here. Every +mother should know the significance of a loose, green +stool. She should be taught that it means danger and +consequently demands prompt treatment. The first indication +is to empty, thoroughly, the bowel. The best +means for this purpose, if it is immediately procurable, +is calomel. If calomel is not procurable at once give +castor oil, two teaspoonfuls to an infant, one tablespoonful +to an older child. Calomel should be given in one-eighth-grain +doses, repeated every three-quarters of an +hour for eight or twelve doses, until the bowel is thoroughly +cleaned out. Don't be afraid of a few extra +movements at the beginning. Better clean out thoroughly +at the start than to be compelled to do it all over +again after the child is weak and suffering from the +poison of the disease. The next important thing to do +is to stop milk at once. The thirst is usually intense +and if vomiting is not present it can be moderately relieved +by giving small quantities frequently of cool boiled +water or mineral water or strained albumen or barley +water. We quite often have to stop all food and liquids +by the mouth for twenty-four hours. +<span class='pagenum'>[<a name="Page_534" id="Page_534">534</a>]</span></p> + +<p>If the prostration is very great and the child looks +as though it might collapse, it can be given brandy in +cracked ice from time to time.</p> + +<p>After the bowels have been thoroughly cleaned out, +never before, some medicinal agent may be given to stop +the unnecessary diarrhea. In a very large number of +promptly and properly treated cases this is not needed. +If it is thought best to use it the physician will select +the agent according to the conditions present and prescribe +it.</p> + +<p>Breast-fed infants rarely have intestinal diseases of +a severe type. If they should develop diarrhea they +must be taken off the mother's milk for twenty-four +hours. They should be given a dose of castor oil or calomel +and fed on barley water in the interval. The feedings +should be reduced in quantity and the interval doubled. +The two-hour interval will become a four-hour feeding: +the three or four ounces at each feeding can be +reduced to two ounces. The intention is to simply give +as little as possible while the diarrhea is under way.</p> + +<p>The mother's breasts must be pumped at the regular +feeding time in order to preserve the flow, release the +pressure, and keep the milk fresh.</p> + +<p>It is sometimes a problem to renew feedings of milk +without exciting a relapse of the diarrhea. It should +not be tried until the stools are normal in color and consistency. +This may not be for three or four days. In +resuming the milk it should be given in smaller amounts +and diluted with lime water or barley water for the first +day. Gruels may be given to which skimmed milk may +be added: later add the ordinary milk. If it is well digested +and does not cause any return of the diarrhea, +the quantity of milk can be slowly increased until the +former feedings are resumed. It is often of very great +advantage to boil the milk for some time. Peptonized +milk is safe and can be used in bottle-fed infants after +diarrhea. In older children, meat, broths, eggs, boiled +milk, and dry toast bread may be used sparingly for +some time. Cereals, vegetables, fruits, should be withheld +for a considerable time and watched carefully when +resumed. Kumyss, buttermilk, matzoon, bacillac, and +<span class='pagenum'>[<a name="Page_535" id="Page_535">535</a>]</span> +other fermented milks are better borne than plain milk. +All of these children need rest, fresh air, change of air, +frequent bathing, and tonics, as an attack of this kind +leaves them depressed, weak, languid, and anemic.</p> + + +<p><b>SUMMARY:—</b></p> + +<blockquote><p>1st. When a child complains of sharp, colicky, severe +pains in the abdomen, around navel, which are shortly +followed by foul, sour, frothy diarrhea,—greenish +in color, it has acute intestinal indigestion.</p> + +<p>2nd. Every mother should know that a green stool +means danger. She should know to give at once +a cathartic,—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.</p></blockquote> + + +<h4>CHILDREN WITH WHOM MILK DOES NOT AGREE</h4> + +<p>Contrary to the general belief, there are quite a large +number of children in whom milk seems to act as a +poison. These children are not necessarily constipated. +They suffer, however, from a slow, continuous intestinal +toxemia or poison. The symptoms of this condition are +headache, disorders of speech, habitual sleep-talking, +sleep-walking, and general nervous irritability without +cause: they are listless, languid, and constantly tired. +They may be bright in the morning and sleepy in the +afternoon. They are irritable and cross and touchy.</p> + +<p><b>Treatment</b>.—Milk must be wholly discontinued. Eggs +must be restricted to one every second day, and meat +but once daily. The use of green vegetables is particularly +suitable and should be given daily. Cereals and +fruit also are good. Malted milk, kumyss, or matzoon +may be given in place of milk. If constipation is present, +rhubarb and soda mixture is an excellent laxative +in these cases. A tonic should be prescribed for all +these children.</p> + + +<h4>DYSENTERY—ENTERITIS—ENTERO-COLITIS—INFLAMMATORY +DIARRHEA</h4> + +<p><b>Cause</b>.—Any cause which has been mentioned as a +<span class='pagenum'>[<a name="Page_536" id="Page_536">536</a>]</span> +cause of ordinary diarrhea may result in this disease. +It may occur at any time of the year and at any age. +It may follow the infectious diseases. It may follow +any other disease of the intestines.</p> + +<p><b>Symptoms</b>.—It may begin like an ordinary attack of +acute intestinal indigestion. There is usually vomiting, +fever, pain, and frequent yellow or green stools. The +passages may be blood-stained and there may be little or +much mucus. The stools at the beginning have no +odor as a rule. The bowels move very frequently, often +with little or nothing to pass. There may be pain with +each movement. The blood may disappear in a few days, +but the mucus remains, often in large quantity in each +stool.</p> + +<p>At the beginning the fever is high, but it soon falls +and remains low during the attack. The child loses +weight, is irritable, has no appetite, and looks and acts +sick. When the attack is over these children do not +gain their strength as readily as we would like; recovery +is slow.</p> + +<p>The acute symptoms usually last about one week, +after this time the child begins to recover, but the process +is a tedious one and one in which much care has to +be exercised. It is an encouraging sign to note the disappearance +of the blood in the stools and the return of +the movements to the normal brown color. When these +favorable signs are wanting the bowel is probably ulcerated +and it will take a much longer time to return +to normal and to be free from blood and mucus.</p> + +<p>The above is the ordinary form of this disease and it +ends in recovery as a rule. There is a more severe form, +however, which differs from the above in the following +way:</p> + +<p>The fever is high and remains high; the stools are +more frequent and there is more blood and more mucus +in them; the child is much more irritable and is more +profoundly sick. Death may occur at any time from +the second day. If the little patient survives, the return +to health is a very slow process; it often takes months +and frequently years before a reasonable degree of +strength is regained. Relapses are common, and they +<span class='pagenum'>[<a name="Page_537" id="Page_537">537</a>]</span> +are very difficult to treat and care for. In some cases +the child never wholly regains its former strength.</p> + +<p>There are children who have been the victims of other +intestinal diseases or conditions who develop colitis. +The colitis in these cases may come on suddenly with +vomiting and high fever, or it begins slowly, with no +vomiting and with little fever. Their appetite is poor, +their digestion is feeble, their prostration is pronounced. +They lose flesh rapidly and may be emaciated to a remarkable +degree. Very few of these cases recover completely. +Serious and sometimes fatal relapses may take +place. The feeding of these children is a difficult task +and the greatest care must be constantly taken; a very +little mistake may cost the life of the child.</p> + +<p><b>Treatment</b>.—All diseases of the intestine in childhood +should be promptly and efficiently treated. If any form +of diarrhea is neglected, it may result in the development +of ileo-colitis with all its risks and uncertainty. +When a child is seized with sudden bowel trouble, no +matter what variety it is, it should be treated with the +greatest care because "sudden" bowel trouble usually +means plenty of trouble if it is neglected.</p> + +<p>Fresh air is essential in all these cases. A change of +air is of decided value as soon as the immediate symptoms +have abated. The diet is the same as for children +who have gastro-enteric intoxication. Later, much difficulty +will be met because these patients have absolutely +no appetite,—peptonized skimmed milk is always good, +beef broths are often well borne, liquid beef peptonoids +may be tried. The food should be given every three +hours. Boiled water and stimulants may be given between +the feedings. Later in older children, raw beef, +eggs, boiled milk, kumyss, or matzoon and gruels may +be given. Great care has to be taken for months after +an attack; relapses may be caused by changes of temperature, +by fatigue, and, of course, by improper feeding. +These children should avoid potatoes, tomatoes, fruits, +corn, oatmeal, and a great many other things which +an intelligent mother would not give any sick child, as +candy, cakes, pastries, etc.</p> + +<p>Cases which begin with free vomiting, thin stools; +<span class='pagenum'>[<a name="Page_538" id="Page_538">538</a>]</span> +and fever should be treated at once. The bowels must +be thoroughly cleaned out, the colon should be thoroughly +irrigated, and all food should be stopped. When +there are bloody stools with mucus and pain we must +depend upon castor oil, irrigations of the colon, and +opium and bismuth by the mouth. A good big dose of +oil at the beginning is always necessary. If, however, +the stomach is irritable and will not tolerate castor oil, +we may substitute calomel in one-fourth-grain doses +every hour for six doses, to be followed by citrate of +magnesium. Irrigation of the colon in these cases is +one of the essential means of successful treatment; it +should be done twice a day during the first few days +of the disease.</p> + +<p>Stimulants are needed in all the cases. They help +the heart, act as a food, and tend to quiet the general +nervousness by favoring sleep. Good brandy given in +boiled cool water is the best stimulant.</p> + +<p>After the child is over the worst of the acute symptoms +all medicine should be withdrawn and the proper +kind of food given. Tonics will aid in restoring the +strength. Cod Liver Oil during the following winter +is a very good plan to aid in building up the vitality +of the weakened bowel, but it must not be given too +soon.</p> + + +<h4>CHRONIC ILEO-COLITIS—CHRONIC COLITIS</h4> + +<p>Chronic Ileo-colitis fellows the acute variety. Cases +which are unusually severe or which have been badly +managed are likely to become chronic. A child suffering +from this disease presents the following picture: +The patient is emaciated, the abdomen is usually enlarged +with gas, the feet are cold, the circulation of +the blood is poor, the fever is low or absent altogether +except when the child is having a relapse, when it jumps +up suddenly. The bowels are loose and contain mucus, +frequently in large quantities. The mucus may +stop for a few days; then it appears again with a rise +of temperature accompanied with loose stools with foul +odor. These children are exceedingly nervous and irritable +and are very poor sleepers. +<span class='pagenum'>[<a name="Page_539" id="Page_539">539</a>]</span></p> + +<p>Parents should be told it will be impossible to effect +a rapid cure of these cases. It often takes months to +get them started on the safe road. The slightest mistake +or change in the weather will upset the progress +of the cure and it will be necessary to begin all over +again. The entire hope of cure rests with the mother. +She must be faithful, patient, and must carry out the +physician's instructions implicitly. The management +consists in diet, change of climate, and such other treatment +as the physician finds necessary in each individual +case.</p> + +<p><b>Treatment</b>.—In children under one year of age the +only hope is breast milk, which must be given in small +quantities. They do not do well on any starch food for +a considerable period.</p> + +<p>Where breast milk is not available the whites of two +or three eggs may be given daily. They may be beaten +up and given in skimmed milk, or in plain water with +a little salt added. Zwieback or bread crumbs may be +given in small quantities. They should be fed at four-hour +intervals.</p> + +<p>Older children may take skimmed milk, raw scraped +beef, junket, and coddled white of egg or raw egg, bread +crumbs, toasted, or zwieback.</p> + +<p>A rectal enema must be given every twenty-four hours +if the bowels have not moved. If constipation is the +habit a laxative should be given; the aromatic fluid extract +of cascara sagrada or magnesia are suitable. At +least one free movement every day is essential to success.</p> + +<p>Colon irrigations are only to be used when there is +a rise of temperature, irrespective of whether the bowels +have moved or not.</p> + +<p>When convalescence is established these children +should be given a maximum of fresh air and should be +treated as recommended in cases of malnutrition.</p> + + +<h4>SUMMER DIARRHEA</h4> + +<p>As the name implies, this is the form of diarrhea that +is so common, especially in cities, in summer. It is always +preceded by some milder condition which paves +the way for the more serious diarrhea. Acute +<span class='pagenum'>[<a name="Page_540" id="Page_540">540</a>]</span> +indigestion is, as a general rule, the forerunner of cholera +infantum. The influence of hot weather must always +be kept in mind as the underlying factor which no doubt +conduces to gastro-intestinal disease of infancy and +childhood. The depression incident to a spell of hot +and possibly humid weather tends to interfere with the +digestive process of babies and children. When this +function is carried on imperfectly, the strength and vitality +of the child fails, and if immediate steps are not +taken to check the process, diarrhea makes its appearance. +If these children are improperly fed, or if their +surroundings are not sanitary; if they are not getting +fresh air enough, or if they suffer because of lack of +attention, and have at the same time a little indigestion, +it is only a step further to develop a full-fledged cholera +infantum.</p> + +<p>The outcome of any case of summer diarrhea is questionable. +It is not safe to make any promise. An apparently +mild attack may prove quickly fatal. Much +depends upon the previous history of the child. If it +has been a strong, healthy child it has a very good +chance if treated energetically and correctly. If it has +previously suffered from bad nutrition, is not robust, +has had trouble with its stomach, etc., the chances are +against it.</p> + +<p>The one lesson to be learned by all mothers is, as +stated above, to act quickly; to be on the watch all +through the summer months for any trouble with the +baby's stomach or bowels. It is much easier to treat +and cure a little trouble than to battle against an established +gastro-enteric intoxication. Overfeeding and indiscriminate +feeding must be religiously avoided,—they +are the two most prolific causes of stomach and intestinal +troubles in childhood.</p> + +<p><b>Symptoms</b>.—The onset is sudden and pronounced. The +child begins to vomit and continues vomiting and retching +persistently. The bowels are loose, and large, +watery, greenish stools are frequent. The prostration +is very marked, the child looks seriously sick, respiration +is quick and shallow, the eyes sunken, the skin becomes +ashen gray in color, and the pulse is soft and very +<span class='pagenum'>[<a name="Page_541" id="Page_541">541</a>]</span> +rapid. The fever may be very high or it may remain +low. The low febrile cases are the worst.</p> + +<p>If taken in hand quickly and if the treatment is energetic +and if the child reacts, the case may go rapidly +on to recovery and the child be wholly well in a few +days; or it may not react, but be overwhelmed by the +poison and sink and die in twenty-four hours.</p> + +<p><b>Treatment</b>.—In the treatment of cholera infantum it +must not be forgotten that the dangerous element is +the poisoning of the system that is constantly going on. +It is difficult for the non-medical mind to estimate the +importance of this element. It is, of course, caused by +the bacteria present in the gastro-intestinal canal. There +are numberless millions of bacteria in the normal healthy +bowel. A very large percentage of those germs are good +for us, are there for a beneficent purpose, and can and +do protect us from other germs which occasionally find +their way into the bowel and whose purpose is not a +peaceful one. When the bowel condition changes, as +during an attack of summer diarrhea, it is invaded by +multitudes of evil-intentioned germs. These germs find +conditions in the diseased bowel exceedingly favorable +to them, so they begin work in an active, energetic way. +The result of their activity is highly poisonous, and, as +the good germs are virtually out of business and are +consequently not working in our interest, we are absolutely +in the hands of the enemy. There is soon manufactured, +by these invading germs, enough poison to +poison the entire system of the child. It is this feature +that we must combat in summer diarrhea.</p> + +<p>It is absolutely essential to keep these cases as much +in the open fresh air as possible. No matter how sick +they may be, this rule must be observed. Light clothing +is advisable.</p> + +<p>If it is a city child that is affected and it does not +show decided improvement in three or four days, it +should, if possible, be sent to the country. There is always +distinct danger of a relapse in every case, so the +little victim should be given a change of air as soon as +convalescence permits. The seashore is preferable to +the mountains in all intestinal cases. +<span class='pagenum'>[<a name="Page_542" id="Page_542">542</a>]</span></p> + +<p>In the care of these patients cleanliness is an important +factor and counts much in the ultimate cure. The +child, as well as the clothing, should be kept scrupulously +clean. Napkins as soon as soiled should be removed and +put into a disinfecting solution. The buttocks should +be well powdered after each movement to prevent sores +developing.</p> + +<p>Feeding must be stopped at once. No food of any +kind should be given for at least twenty-four hours, or +until the tendency to vomit subsides. The thirst must +be allayed, however, so we give frequently small quantities +of thin barley water or albumen water or cold boiled +water. If these are vomited we must stop giving them +altogether for twenty-four hours. If the fever is high +and the skin dry, the child should be given a cool pack, +85° 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.</p> + +<p>If, on the other hand, the fever is very low (below +normal), the child's circulation poor, the skin blue and +cold, a hot-water bath at 108° F., for five minutes (rubbing +the surface of the body while in the bath), will be +of very great service. The bath may be repeated at half-hour +intervals.</p> + +<p>If the patient is a breast-fed infant it can be allowed +to nurse after the twenty-four-hour rest. The length of +time it is permitted to stay at the breast should be about +one-quarter of the time it was allowed before the attack +began. If it does not vomit, the nursing can be repeated +every four hours. As the case progresses toward recovery +the interval between feedings can be shortened. +Care, however, must be taken not to shorten the interval +too rapidly.</p> + +<p>If the patient is artificially fed and is not over four +months old, a substitute for the milk must be found. The +best substitutes are rice or barley water, either plain or +dextrinized, the malted foods, chicken or beef broths, +liquid peptonoids or bovinine. Water (boiled and +cooled) may be allowed at all times if not vomited.</p> + +<p>Older children are treated in the same way. All food +<span class='pagenum'>[<a name="Page_543" id="Page_543">543</a>]</span> +is withheld while there is any vomiting. When vomiting +stops begin with small quantities of beef broth, or +chicken, or veal broth. Later kumyss or matzoon can +be tried, and finally thin gruels made with milk.</p> + +<p>If vomiting persists the stomach must be washed out; +this can be done by giving the infant or child a large +drink of cool boiled water. This will be immediately +vomited and it will clean the stomach at the same time. +The stomach-pump may be used to better advantage. +One washing is usually sufficient. The vomiting will +stop after the stomach has been washed out and the +patient may then be given, frequently, small quantities +of cold albumen water or barley water.</p> + +<p>The bowel should be thoroughly cleaned out at the +beginning of every summer diarrhea. Castor oil or calomel +are the two best cathartics for this purpose. If the +stomach is not upset use castor oil. If the stomach is +upset use calomel; one-fourth of a grain every hour +for eight doses will be sufficient. Give enough, however,—there +is no danger at the beginning of the attack of +too free movements of the bowel. Whatever cathartic is +given, it should produce green, watery stools.</p> + +<p>Irrigation of the bowel is an exceedingly effective +way of cleaning out the poison-laden large intestine. It +should be done in every instance unless the movements +are watery and of such frequency as to render irrigation +unnecessary. Once or twice daily will be sufficient +in even the worst cases. The irrigation should be given +at the temperature of 100° F, and should be the normal +saline solution; a long rectal tube is used to give the +irrigation.</p> + + +<p><b>SUMMARY:—</b></p> + +<blockquote><p>1st. Cholera infantum is one of the most dangerous, +one of the most treacherous, and one of the quickest +acting diseases of childhood.</p> + +<p>2nd. Don't temporize, don't delay, don't regard lightly +any diarrhea during the summer time.</p> + +<p>3rd. Give a large dose of castor oil and withhold +all nourishment until the doctor sees the little +<span class='pagenum'>[<a name="Page_544" id="Page_544">544</a>]</span> +patient in every case of diarrhea during the warm +weather.</p> + +<p>4th. Keep the child in a cool, quiet place and don't +handle or annoy it.</p> + +<p>5th. Follow, your doctor's directions implicitly. The +fight may be short, sharp, and decisive. Don't pave +the way for regrets afterward. Do everything while +you have the chance.</p></blockquote> + + +<h4>COLIC</h4> + +<p>Colic is a common condition in infancy. Very few +children escape more or less colic during the first few +months of life. It does not seem to injure permanently +some infants; they go on growing according to standard, +eat and sleep, and seem contented and happy despite +occasional severe attacks of colic. Other children suffer +seriously; the degree of indigestion is considerable, and +the nutrition of the child is interfered with.</p> + +<p>Colic is much more frequent in bottle-fed infants than +in those fed on breast milk. Cow's milk, no matter +how skillfully it is prepared for their use, is at best an +unsuitable diet and taxes the digestive ability of robust +children. It is quite natural for an infant whose digestive +organs are not strong to develop colic and intestinal +indigestion if put on artificial food. Any condition +that causes indigestion may likewise cause colic. +Those children who are always overfeeding,—taking too +much milk, too strong milk, or who are fed irregularly,—are +the colicky babies.</p> + +<p>Constipation is frequently associated with colic and +may be the actual cause. A daily movement of the +bowel does not necessarily mean that the bowels are +emptying themselves satisfactorily. Despite the daily +movement, there may be considerable fecal matter left in +the bowel which undergoes decomposition. This results +in the evolution of large quantities of gas and severe attacks +of colic. Indigestion is very often caused by +conditions which effect the stability of the child's nervous +organism; such conditions are fright, anger, fatigue, +exhaustion, excitement.</p> + +<p>The origin of the colic in breast-fed children is very +<span class='pagenum'>[<a name="Page_545" id="Page_545">545</a>]</span> +often caused by some nervous condition of the mother +that affects her milk. Constipation in the mother may +cause colic in the child.</p> + +<p><b>Symptoms</b>.—A baby having an attack of colic will +cry loudly from time to time and whine during the interval; +it will pull up its legs and bear down. Its abdomen +is tense and hard and distended with gas. With +the expulsion of the gas the pain ceases and the child +falls asleep. If the attack is very severe the prostration +and exhaustion is marked; the feet are cold and the +body is bathed in perspiration.</p> + +<p>If the colic is constant the child may be fretful and +restless most of the time, being seemingly comfortable +for only an hour or two in the twenty-four.</p> + +<p>In older children who cry because of severe pain +in the abdomen the possibility of appendicitis must not +be forgotten.</p> + +<p><b>Treatment</b>.—Find out the cause of the colic if possible. +If the cause is located in the mother, the remedy +naturally must affect her. Regulation of her bowel, restriction +of her diet, and proper exercise, may be sufficient +to effect a cure of the colic in the infant.</p> + +<p>The object of treatment is to help the child get rid +of the gas. The best and quickest means to effect this +is to apply massage or give a rectal injection. An injection +of two ounces of cold water in which a half or one +teaspoonful of glycerine has been put, will act quickly. +Dry heat applied to the abdomen in the form of the +hot-water bottle or woolen cloths will aid in the expulsion +of the gas. The feet should be kept warm.</p> + +<p>In cases of habitual colic in breast-fed babies the +cause may be in the quality of the mother's milk. It +should be examined and if found too strong should be +diluted. This can be done by giving the child an ounce +of plain boiled water or barley water before each feeding. +If the child gets an ounce of liquid before each +feeding he will not want as much of the breast milk; so +we shall have the same total quantity, but a reduced +quality, which may cure the colic at once.</p> + +<p>It is necessary, in order to cure colic, that the bowels +move every day in a satisfactory manner. If any aid +<span class='pagenum'>[<a name="Page_546" id="Page_546">546</a>]</span> +is needed, milk of magnesia is the best laxative. It +may be given in teaspoonful doses in water previous to +a feeding. Aromatic cascara sagrada in from ten to +thirty-drop doses is a very good laxative, if a stronger +remedy is needed.</p> + +<p>To relieve the acute attack, three drops of Hoffman's +anodyne may be given in two teaspoonfuls of warm +water and repeated in ten-minute intervals until relieved, +to a baby under one year of age. From five +to ten drops of gin, given in three teaspoonfuls of +warm water, and repeated in fifteen minutes, is also +satisfactory and harmless. A very good remedy which +may be used with the above for quick relief, and to +stop the child from crying, is the following: Fold a +piece of flannel cloth (two thicknesses) the size of the +baby's abdomen; wring out of very hot water and drop +ten drops of turpentine over the surface,—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.</p> + +<p>Colic, as a rule, disappears completely about the third +month.</p> + + +<h4>APPENDICITIS</h4> + +<p>Appendicitis is mentioned here merely to acquaint +mothers with its prominent symptoms.</p> + +<p>When a child has what seems to be an attack of indigestion, +but complains of pain and tenderness in the +abdomen, vomits, and develops a fever, and is constipated, +appendicitis may be suspected.</p> + +<p>The pain and tenderness are not referred to the region +of the appendix but are more centrally located. +If, however, the finger point is pressed over the appendix, +distinct tenderness will be elicited in inflammation +of that region. Constipation is the rule in appendicitis, +but diarrhea occasionally accompanies it.</p> + +<p>The abdominal muscles may be rigid, that is, the abdomen +does not feel soft as is usual; there is a feeling +if they are pressed, as if they were hard and unyielding.</p> + +<p><b>Treatment</b>.—Put the child in bed and send for the +family physician at once. The condition is too serious +<span class='pagenum'>[<a name="Page_547" id="Page_547">547</a>]</span> +and too uncertain to delay, or for a parent to make any +effort at treatment. Appendicitis is a much more serious +condition in infancy and childhood than it is in +an adult.</p> + + +<h4>JAUNDICE IN INFANTS</h4> + +<p>There are two types of jaundice in infants that deserve +brief consideration.</p> + +<p>1st. There is a form of jaundice caused by a defect in +the development of the bile or gall tubes. These infants +develop jaundice a day or two after birth and become +intensely jaundiced within a very brief time. They +lose flesh and strength to a marked degree and die in a +few weeks. It is not possible to affect this condition +favorably by any method of treatment. This type of +jaundice is not very common.</p> + +<p>2nd. There is a type of jaundice that appears between +the second and fifth day of life that is very +common. It lasts from one to two weeks and then disappears. +It is never fatal and is not serious. It requires +no treatment.</p> + + +<h4>JAUNDICE IN OLDER CHILDREN—CATARRHAL +JAUNDICE—GASTRO DUODENITIS</h4> + +<p><b>Symptoms</b>.—This form of jaundice begins like an attack +of ordinary indigestion. There are, as a rule, pain, +fever, vomiting, and prostration. The pain is located +in the upper part of the abdomen and may be quite +severe. The vomiting may continue for a number of +days. The bowels are usually constipated. After a +few days the jaundice sets in and may be quite intense. +After the jaundice is established the stools are gray +or white in color and there is much gas in the bowel. +The urine is very dark and may be yellow or yellowish-green +in color. The child complains of headache, is +dull and listless, and appears sick and weak. The condition +lasts about two weeks, but the jaundice may last +much longer. It is not a serious disease.</p> + +<p><b>Treatment</b>.—The diet should be cut down in quantity +and should consist of rare meat, fruit, and a small +quantity of milk. If vomiting continues the milk may +diluted with lime water or vichy water. The child +<span class='pagenum'>[<a name="Page_548" id="Page_548">548</a>]</span> +should drink water or vichy water freely. No starchy +foods, or fats, or sugars should be allowed. The bowels +should be kept open with calomel, one-tenth of a grain +every hour until ten are taken, to be followed by citrate +of magnesia every morning. If the pain is severe it may +be relieved by a mustard paste or a turpentine poultice. +The child should be given acid hydrochloric diluted, +eight drops in one-half glass of water, ten minutes before +each meal—and kept on it for at least one month.</p> + + +<h4>INTESTINAL WORMS</h4> + +<p>There are three types of intestinal worms; they are +known as the round-worm, the thread-worm, and the +tape worm.</p> + +<p><b>Round-Worm</b>.—The round-worm is usually found in +children of the run-about age. It is never seen in +infancy. It occupies the small or upper intestine, and +is from four to ten inches long. If there are round-worms +in the bowel, there are usually a number of +them and there may be hundreds.</p> + +<p><b>Symptoms</b>.—Round-worms give no definite symptoms. +The only possible way to tell if they are present is +actually to see them in the stools of the child. They +are of a light gray color.</p> + +<p>It is reasonable to expect that a child suffering from +worms will have symptoms of abdominal distress from +time to time; indigestion with colic and much gas may +be present; children lose their appetites and are nervous +and restless; sleep is disturbed; they may grind +their teeth and talk in their sleep, and they may pick +their noses unnecessarily during the day. These symptoms +may, however, accompany other conditions when +no worms are present in the bowel. My observation has +been that in children in whom worms were present the +nervous symptoms were distinctly accentuated. They +are unreliable children; they seem well to-day and +peevish to-morrow; they complain of headaches, +dizziness, and chilly feelings. They are hysterical, noisy, +uncontrollable. A child with these symptoms should +be suspected of having worms and if no cause can be +found to explain his temperamental vagaries he should +<span class='pagenum'><a name="Page_549" id="Page_549">[549]</a></span> +be treated for worms. I have cured a number of children +of excessive nervousness by giving them medicine +for worms when no worms were present. Such results +can only be explained on the assumption that +these children were suffering from intestinal auto-toxemia +or self-poisoning, and the thorough disinfection +of the bowel apparently stopped the process by ridding +the child's system of a mass of bacteria, which were +undoubtedly causing the auto-toxemia and consequent +nervousness.</p> + +<p><b>Treatment</b>.—The most efficient remedy for removing +round-worms is Santonin. The quantity necessary for +the various ages is as follows:</p> + + + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Two to four years</td><td align='left'>2</td> +<td align='left'>grains.</td></tr> +<tr><td align='left'>Four to six years</td><td align='left'>3</td> +<td align='left'>grains.</td></tr> +<tr><td align='left'>Six to ten years</td><td align='left'>3-1/2</td> +<td align='left'> grains.</td></tr> +</table></div> + +<p>The best way to give it is in divided doses, with an +equal quantity of sugar of milk. For a child of six +years the formula would therefore be, 3-1/2 grains of +Santonin, mixed with the same quantity of sugar of +milk divided into three powders. These powders are +given four hours apart in the following way. The +child is given a light supper the evening before and one-half +glass citrate of magnesia the following morning and +the first powder one-half hour later; no breakfast being +given. A light lunch, of milk and crackers, may be +taken about noon. The second powder is given four +hours after the first, and the third four hours after +the second. Half an hour after the last powder, a dose +of castor oil (one tablespoonful) is given. In a few +moments the bowels will move; usually there are no +worms in this movement. A little later they will move +freely again and if worms are present they will be discharged +in this movement.</p> + +<p><b>Thread-Worm, or Pin-Worm</b>.—A thread-worm looks +just like a little piece of white thread. They are found +in the lower part of the bowel and in the rectum. They +are usually present, if present at all, in large numbers.</p> + +<p><b>Symptoms</b>.—The chief symptom is itching. It may +be limited to the anus or it may involve the neighboring +<span class='pagenum'>[<a name="Page_550" id="Page_550">550</a>]</span> +parts. Thread-worms may find their way out of the +anus and in female children may find their way into the +vagina. In these instances the child is tormented with +itching of the privates and may establish the habit of +self-abuse as a result of the constant itching and scratching. +The itching is more intense at night soon after the +child goes to bed. As a result of the local irritation in +the lower part of the bowel and rectum there is set up a +catarrh of the bowel which produces large quantities of +mucus.</p> + +<p><b>Treatment</b>.—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.</p> + +<p>A solution of garlic is a very effective remedy and +may be tried if the quassia fails, which is not likely if +the treatment is carried out effectively and if the parts +are kept scrupulously clean.</p> + +<p><b>Tape Worms</b>.—Tape worms are obtained from eating +raw meat, pork or sausage, rarely from fish, and from +playing with cats and dogs. +<span class='pagenum'>[<a name="Page_551" id="Page_551">551</a>]</span></p> + +<p><b>Symptoms</b>.—No definite symptoms accompany the +presence of tape worm. The children may have pains +in the abdomen, diarrhea, a capricious appetite, foul +breath, and they may suffer from anemia, sometimes +quite severely. The only positive symptoms is the presence +of links of the worm in the stools.</p> + +<p><b>Treatment</b>.—Give a dose of castor oil at bed time. +Two hours after breakfast next morning give one-half +dram of the oleoresin of male-fern in emulsion or capsule. +Very light nourishment should be taken during the +day, composed of gruels and soups. When the worm is +passed it should be examined to find if the head is +present; if not, the treatment should be repeated in +twenty-four hours.</p> + + +<h4>RUPTURE</h4> + +<p>Rupture of any description is not a condition that +any mother should attempt to treat. A physician should +be called in every case. Any misdirected effort at manipulation +or pressure may result in irreparable injury to +the parts. External applications are useless and may +be injurious.</p> + +<p>All ordinary forms of rupture in infancy and early +childhood are curable if properly treated. +<span class='pagenum'><a name="Page_552" id="Page_552">[552]</a></span></p> +<p><span class='pagenum'><a name="Page_553" id="Page_553">[553]</a></span></p> + + +<hr style="width: 65%;" /> +<h2>CHAPTER XXXVI</h2> + +<h3>DISEASES OF CHILDREN, CONTINUED</h3> + +<div class="blockquot">Mastitis or Inflammation of the Breasts in +Infancy—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<br /></div> + + +<h4>MASTITIS, OR INFLAMMATION OF THE BREASTS +IN INFANCY</h4> + +<p>There are a few drops of a milky secretion in the +breasts of infants when born. Occasionally the amount +will be in excess of the normal quantity, and the breasts, +around the nipple, may be swollen and slightly inflamed. +Should this condition persist, it may be relieved by painting +the parts with the tincture of belladonna. Under no +circumstances should the breasts be manipulated or +rubbed, as this is very apt to cause an inflammatory condition, +and to result in mastitis.</p> + +<p>Mastitis begins, as a rule, during the second week of +life. The breast becomes red, swollen, painful, and +shows inflammatory changes. It may terminate without +the formation of an abscess, or it may go on to suppuration. +The child becomes extremely restless and irritable, +it is disinclined to nurse, and suffers from loss of sleep +and nourishment. It is possible for such a condition, in +the female, to injure the breast to the extent of arresting +its development and to render it useless in the future. If +the suppuration is extensive the process may terminate +fatally.</p> + +<p>Mastitis in infants is caused by unnecessary interference +and manipulation and by want of cleanliness. +When it occurs the parts should be kept absolutely clean +and should not be handled in any way. Ichthyol 25 per +<span class='pagenum'>[<a name="Page_554" id="Page_554">554</a>]</span> +cent., Zinc Oxide Ointment, enough to make one ounce, +spread upon old, clean, soft linen, and laid over the parts +and changed every six hours, is an excellent healing application. +A piece of oiled silk may be put outside the +linen to prevent the ointment staining the clothing, and +over this a layer of absorbent cotton and a binder, applied +without pressure.</p> + +<p>If an abscess develops in spite of treatment, it must be +freely opened and freely drained, and the general health +of the patient supported by regular nourishment and +tonics.</p> + +<p><b>Mastitis in Young Girls</b>.—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.</p> + +<p>It may take a week before recovery takes place.</p> + + +<h4>LET YOUR EARS ALONE</h4> + +<p><b>Never Box a Child's Ears</b>.—A single blow may make +a child deaf; repeated blows on their ears will certainly +injure children's hearing.</p> + +<p>Thomas A. Edison, our greatest inventor, was made +deaf when a lad by a surly brakeman, who soundly boxed +his ears for some trivial or fancied offense.</p> + +<p>Boxing a child's ears is but one of a great many things +you should never do to the ears. In fact, there are far +more things you should not do to safeguard the hearing, +than there are things you can do to benefit your ears.</p> + +<p><b>Do Not Pick the Ears</b>.—Do not put cotton in the ears +unless ordered to do so by a reputable physician. Do not +<span class='pagenum'>[<a name="Page_555" id="Page_555">555</a>]</span> +syringe the ears without the doctor's orders. Put no +poultices in the ears. Do not put drops of any kind in +the ears unless prescribed by a doctor. Above all, do not +use the advertised ear cures, as most of them are harmful. +Never blow into a child's ear, never douche the nose +without the doctor's orders, as this may wash germs into +the tubes leading to the ears and bring about a serious +condition.</p> + +<p>Riding in tunnels, especially in tunnels under water +where the air pressure varies, has, through some recent +investigation, been found to be injurious to the ears of a +great many people.</p> + +<p>Conductors and other trainmen who run through many +tunnels are apt to have ear trouble, as are the men who +work underground a great depth where they are in motion, +such as miners running underground trains.</p> + +<p>If you have an earache that continues for any length +of time, take no chances, but consult a physician. And +remember to care for the throat and nose, as ill conditions +in those places result in ear troubles. Do not blow +your nose too hard; it merely injures the inner sides of +the ear drums. Adenoids in children frequently bring +about a bad ear trouble. Even seasickness is due in a +great measure to ear disturbances.</p> + +<p>If you have a running ear, attend to it at once by visiting +a doctor. So serious is this that life insurance companies +will not insure people in that condition.</p> + +<p><b>Earache</b>.—When a child complains of earache its ear +should be examined. In nearly every case of earache it +is necessary to treat the throat, as this is, as a rule, the +seat of the trouble. An antiseptic gargle of equal parts +of Borolyptol and warm water is an excellent mixture. It +should be used freely every two hours. Children suffering +from earache should be kept indoors. If the examination +should show that it is not necessary to lance the +ear drum, some local measure may be adopted to allay the +pain. Putting the child in bed with the head resting on +a hot-water bottle may be all that will be necessary. The +following procedure may be carried out, but only after a +physician has made an examination and according to his +directions: A hot water douche, given by means of a +<span class='pagenum'>[<a name="Page_556" id="Page_556">556</a>]</span> +douche bag, is quite effective. The water should be 110° +F.; the bag should be held about two feet above the level +of the child's head, and the irrigating point should not be +pushed into the ear, but held so that the water will find +its own way into the ear.</p> + +<p>When the earache does not respond to the above +methods the ear should be closely watched and examined +at intervals so that it may be opened at the right moment. +This is very essential because, if it is neglected, the pus +may find its way into the mastoid cells and set up the +dangerous disease, mastoiditis. This disease may cause +abscess of the brain and death. The moment a child develops +fever in the course of an earache the ear should be +examined and opened at once, if found necessary.</p> + +<p><b>Inflammation of the Ear. Acute Otitis</b>.—Inflammation +of the ear seldom occurs in childhood, unless as a +complication, or as a result of some infectious disease. +Any disease which affects the throat in any way may be +the cause of the inflammation of the ear. Such diseases +are, "cold in the head," tonsilitis, grippe, "sore throat," or +pharyngitis, measles, scarlet fever. It is much more common +in children than in adults. The younger the child, +the more liable it is to develop ear trouble when suffering +from any of the above diseases. The presence of adenoids +favors the development of ear complications.</p> + +<p><b>Symptoms</b>.—There is one symptom present in all cases +of inflammation of the ear; that is, fever. Pain may or +may not be present; it is present in a majority of the +cases. Children with inflammation of the ear are exceedingly +restless and do not sleep long at a time nor do they +sleep soundly.</p> + +<p><b>Treatment</b>.—The treatment is to open the drum membrane, +at the right time, which of course will always be +done by a physician who has had some experience in this +work.</p> + +<p><b>After Treatment</b>.—The after treatment consists of +washing or syringing the ear every three hours with +eight or twelve ounces of a 1:10,000 solution of corrosive +sublimate. This will be kept up for four days; then the +intervals between the washing will be extended to five +hours, and kept up until the drum membrane closes. If +<span class='pagenum'>[<a name="Page_557" id="Page_557">557</a>]</span> +the corrosive sublimate solution should cause any eruption +around the ear, a normal salt solution (see page <a href="#Page_627"> +627</a>) may be used in the same way, and in the same quantity as +above. A running ear will run for from three to six +weeks. It may heal up at any time after ten days. If the +discharge should suddenly stop and the fever rise, it +indicates that the opening has become plugged or healed +too quickly. In either case it will have to be opened +again. As soon as the ear begins running again the +symptoms will disappear. After syringing the ear it +should be dried thoroughly with pieces of sterile absorbent +cotton.</p> + +<p>The best syringe to use for washing out the ear is a +one-ounce hard-rubber ear syringe with a soft rubber tip. +An ordinary douche bag will do if a syringe of the above +character cannot be obtained. The douche bag should not +be held higher than two feet above the patient's head. +The double-current ear irrigator is an excellent device +for this purpose. The child should be on its back on a +table. Its arms should be fastened down by its side. A +basin can be placed under its ear and the irrigating done +without causing any pain or discomfort.</p> + +<p>Any child addicted to disease of the ear should be +closely watched and examined for tuberculosis. Scrofula +may accompany this condition. These children need +careful attention in every little detail, they need good +nourishment, fresh air night and day, and they should +not be pushed at school. During the winter they should +be protected from "catching colds;" it is a good plan to +put them on a cod-liver-oil mixture for the entire cold +season. During the summer they should have a radical +change of climate.</p> + + +<p><b>SUMMARY:</b></p> + +<blockquote><p>1st. Inflammation of the ear is frequently a complication +of or follows some other disease which affects +the throat.</p> + +<p>2nd. If a child with one of these diseases becomes restless, +sleepless and feverish, be on the look-out for ear +trouble. +<span class='pagenum'>[<a name="Page_558" id="Page_558">558</a>]</span></p> + +<p>3rd. The ear must be lanced immediately when necessary.</p> + +<p>4th. The after treatment is very important, because the +hearing of the child depends upon it.</p></blockquote> + + +<h4>SWOLLEN GLANDS. ACUTE ADENITIS</h4> + +<p>Swollen glands in infancy and childhood are usually +seen below and behind the ear, less frequently in the +groin. Their cause is, as a rule, local disturbance in the +mouth or throat, as decayed teeth, enlarged tonsils, cold +in the head, catarrh, adenoids, or some form of infection +of the mouth, or throat, or scalp. They occasionally accompany +scarlet fever, diphtheria, measles, and influenza. +They seldom suppurate.</p> + +<p><b>Symptoms</b>.—A swelling is noticed just below the angle +of the jaw; it does not grow rapidly. There is a slight +temperature and the child is more or less irritable. If +the patient is an infant, the fever may be quite high and +there may be considerable prostration. The trouble lasts +from four to eight weeks.</p> + +<p><b>Treatment</b>.—An ice-bag constantly applied is the best +treatment. This not only relieves pain, but it prevents the +possibility of the gland breaking down and suppurating. +It is sometimes difficult to keep an ice-bag on an infant, +in which case cold compresses should be applied. These +are made by taking several layers of old linen or cheese +cloth and laying them on ice. They should be applied frequently +to the swollen gland. The following ointment +may be applied, though the ice-bag is the better and more +certain treatment: Ichthyol 25 per cent., Adeps Lanae +one ounce. This is applied on cloth and renewed every +six hours.</p> + +<p>This ointment is black and stains the clothing. For +that reason it is advised to use oiled silk over the cloth to +avoid staining the pillow or clothing.</p> + +<p>Children suffering from adenitis should use a spray of +Dobell's solution in the nose and throat three or four +times daily. If the cause of the swollen glands is known, +treatment for its cure should be promptly instituted.</p> + +<p>In the event of pus forming the gland must be opened +and drained. +<span class='pagenum'>[<a name="Page_559" id="Page_559">559</a>]</span></p> + +<p>Swollen glands in the groin of a child are caused most +frequently by some inflammatory condition of the +privates, which should be discovered and treated.</p> + + +<h4>BOILS</h4> + +<p>In some delicate children and in some children who do +not seem to be delicate, repeated crops of boils may appear +from time to time.</p> + +<p>It is necessary to open them as soon as pus is present. +They should be pressed out and a gauze dressing, wet +with a saturated solution of boric acid, bound over them. +The dressing should be kept moist.</p> + +<p>I have in a number of instances successfully rid a child +of the tendency to boils by the use of the following +formula, which I can recommend highly as one of the +best tonics I have ever used in the treatment of delicate +and poorly nourished children: Tinct. Nux Vomica 4 +drops, Acid Phosphoric Dilute 8 drops, Syrup Hypophosphites, +1 teaspoonful. Make a two-ounce mixture and +give to children over four years of age one teaspoonful +after each meal; to younger children, one-half teaspoonful +after each meal.</p> + +<p>It is necessary in these cases to keep the bowels open +daily.</p> + + +<h4>HIVES. NETTLE-RASH</h4> + +<p><b>Cause</b>.—Contact with different plants, bites of insects, +irritation from clothing, use of certain drugs. Certain +articles of food, such as tomatoes, strawberries, oatmeal, +buckwheat, have all been said to cause hives.</p> + +<p>Dentition during warm weather and the presence of +worms and chronic malarial poisoning have been known +to cause hives.</p> + +<p>It is most frequently caused, however, in childhood +by some disturbance in the stomach or bowels.</p> + +<p>It causes severe itching and loss of sleep and as a +result of these the general health suffers.</p> + +<p><b>Treatment</b>.—If caused by any external irritant, remove +it. If it is caused by any special article of diet, prohibit +its use. If no cause is apparent, give the child one tablespoonful +of castor oil, and put it on the mildest diet possible +of soups, broths, and dried stale bread. Give no +<span class='pagenum'>[<a name="Page_560" id="Page_560">560</a>]</span> +milk. Use the following treatment on the erupted parts: +Menthol, ten grains in one ounce of cold cream. Keep +the bowels open.</p> + +<p>It is sometimes necessary to advise a change of air +before complete cure results.</p> + + +<h4>PRICKLY HEAT</h4> + +<p>This is a very common complaint in children during +the summer months. It is so common that it is well +known and easily recognized. It consists of a bright red +eruption, composed of little papules, close together.</p> + +<p>The rash comes out quickly, so much so that mothers +may be surprised and frightened by observing an angry +looking rash on their baby some morning when none +was there the night before. It most frequently appears +upon the neck, back, chest, and forehead. It is exceedingly +itchy and a child may scratch itself and cause extensive +harm. Eczema, of a very obstinate type, frequently +results from scratching.</p> + +<p>The rash of prickly heat is easily diagnosed from other +rashes because it is accompanied by no other symptom, +such as fever, which would suggest a more serious disease. +The rash of prickly heat resembles the rash of +scarlet fever more than any other rash, but it is quickly +noted that when a child has scarlet fever it has every +symptom of being profoundly sick, while prickly heat +has no symptom other than the itch and discomfort. It +is caused by overfeeding, being overclothed, and sweating +in hot weather.</p> + +<p><b>Treatment</b>.—Steps should be taken to prevent prickly +heat in an infant. Use light, seasonable clothing, bathe +frequently, and use plenty of good toilet powder. When +the child actually has an attack, open its bowels freely +with citrate of magnesia, and give some sweet spirits of +niter, according to age. Protect the skin from the irritating +underwear by interposing a soft piece of linen. +In order to reduce the inflammation and cure the condition +apply equal parts of starch and boric acid powder +freely. Keep the patient on a light fluid diet. The bran +bath is advisable if the little patient is addicted to these +skin eruptions. +<span class='pagenum'>[<a name="Page_561" id="Page_561">561</a>]</span></p> + + +<h4>RINGWORM OF THE SCALP</h4> + +<p>Children of all ages are liable to "catch" ringworm +of the scalp. It particularly affects those who are untidy, +dirty, and badly cared for, though any child is apt to get +it while attending the public schools.</p> + +<p>If a mother discovers scaly patches in the scalp, with +loss of hair, ringworm should be immediately suspected. +It is not, however, always easy to diagnose the condition, +especially if the case is a mild one. If it is a severe attack, +there is, as a rule, quite a little inflammation, and +this may render the condition obscure for some time. +The disease may be mistaken for dandruff, but dandruff +covers a large area of the scalp, while ringworm is limited +and sharply defined. Dandruff may cause a loss of +hair; if it does, the hairs come out clean, while in ringworm +they break off near the scalp.</p> + +<p><b>Treatment</b>.—Ringworm is always curable, provided +the patient is watched and treatment carried out thoroughly. +It is always absolutely necessary to treat the +condition, because it will not get better of itself, and +the longer it is permitted to last, the worse it gets, and +the more difficult it is to cure. If treatment is begun at +once, it may take two months to cure it. If the case has +lasted for some time, or if it has been neglected and not +treated thoroughly, it will take from six months to one +year to cure it. These facts are stated so that parents +may not become discouraged.</p> + +<p>The first thing to do is to cut the hair as close to the +scalp as possible, wherever the ringworm is, and for +about an inch outside, and all around it. The entire +scalp should be thoroughly washed three times a week. +The scales should be kept soft by the use of carbolic +soap.</p> + +<p>The hair should not be brushed at all, because brushing +the hair may spread the disease to other parts of the scalp. +Every child with ringworm of the scalp should wear a +cap of muslin or one lined with paper, so that others +may not be infected. These caps can be burned when +dirty and new ones made. One of the best remedies to +apply to the affected area is the following: Bichloride +<span class='pagenum'>[<a name="Page_562" id="Page_562">562</a>]</span> +of mercury, 2 grains; olive oil, 2 teaspoonfuls; kerosene, +2 teaspoonfuls. This is rubbed in every day until the +parts are sore and tender. It is a good plan to apply +this mixture to the entire scalp every fourth day, to guard +against other parts becoming infected. It is not necessary +to rub it in when using it where there is no ringworm.</p> + +<p>When the scalp becomes sore from the application it +can be stopped for a day or two, or until better; then +begin again and repeat the treatment right along. If +the kerosene in the above mixture is objected to, a very +good mixture is bichloride of mercury, 2 grains, and +tincture of iodine, 1 ounce. This may be rubbed vigorously +enough to produce a rash. If the disease shows a +tendency to spread under this treatment it is best to +apply the latter mixture to the entire scalp.</p> + +<p>Ringworm on any other part of the body is effectually +treated by applying tincture of iodine. It should be +painted on every day until the skin begins to peel, when +the ringworm will disappear with the skin.</p> + + +<h4>ECZEMA</h4> + +<p>Eczema is the most important skin disease of babyhood. +It is probably the most frequent skin disease of +infancy. Any baby may develop eczema. There are, +however, some babies who seem to be very susceptible +to it. The reason of this susceptibility seems to be due +to the natural tenderness, or delicacy, of the skin. These +children, because of the extreme sensitiveness of the skin, +develop an eczema from a very slight degree of external +irritation, or a trifling disturbance of digestion. Children +of rheumatic or gouty parents are more liable to +be victims of eczema than are others. Eczema of the +face is quite common in children who are apparently +healthy and fat. It does not seem to matter whether +they are breast-fed or bottle-fed. The following conditions +may be regarded as contributory to eczema:</p> + +<p>Exposure to winds; cold, dry air; heat; the use of +hard water or strong soaps; lack of cleanliness, and the +irritation of clothing. It frequently accompanies chronic +constipation, indigestion, and other conditions of the +<span class='pagenum'>[<a name="Page_563" id="Page_563">563</a>]</span> +intestinal canal; overfeeding; too early or too excessive use +of starchy foods.</p> + +<p><b>Eczema of the Face:—Eczema Rubrum</b>.—This is the +most frequent form. It affects the cheeks, scalp, forehead, +and sometimes the ears and the neck. It begins +on the cheeks as small red papules. These join together +and form a mass of moist, exuding crusts. They dry in +time and may be so thick as to form a mask on the face. +The skin may be much swollen. When the crusts are +removed the face looks red and angry and bleeds easily. +It is exceedingly itchy. It causes restlessness, loss of +sleep, and it may affect the appetite, though, as a rule, +the health remains good. Eczema of the face is exceedingly +chronic; it improves from time to time, but it is +cured with great difficulty only.</p> + +<p>Infants suffering with eczema of the face begin to +improve about the middle of the second year and may +be entirely cured about this time. The reason of this +is the greater amount of exercise the child is getting +at this period. If the disease continues longer it is +because of the unnecessary amount of fat that the child +has.</p> + +<p><b>Treatment</b>.—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.</p> + +<p>There exists in the minds of the laity, and in some +physicians also, an idea that it is wrong, or dangerous, +to cure, or "dry up," an eczema. It is never dangerous, +but highly desirable, to cure an eczema, whenever possible. +It is always wise, because it is always necessary, +to get the child in perfect condition before you treat +the eczema. Cure the constipation, or indigestion, or +cold, or whatever is the matter with the child; then treat +the eczema. This is the only plan that offers any success. +It is not a simple matter to find out why a nursing child +<span class='pagenum'>[<a name="Page_564" id="Page_564">564</a>]</span> +is having indigestion. The most minute care must be +exercised to find out the element in the milk that is causing +the eczema. It would, however, be foolish, and a +waste of time, to apply pastes, etc., to an eczema of the +face, while the real cause that produced it was still in existence. +It will frequently be found necessary to change +the food entirely. Strict attention to the bowels is essential, +both in infants and in older children. Sometimes to +cure the constipation means an immediate cure of the +eczema.</p> + +<p>If the child is anemic, poorly nourished, and flabby, +tonics are advisable. Cod liver oil is of use in quite a +number of these cases. Eczematous children should not +be taken out when the weather is very cold or when there +are high winds. They should not be washed with plain +water, or with castile soap and water. When washing +is necessary, do it with milk and water, to which one +teaspoonful of borax is added. The clothing must not +be too heavy.</p> + +<p>In eczema of the face, the child must either wear a +mask or heavy woolen gloves, so that he will not scratch +the parts. Frequently these fail, and it will be necessary +to restrain the child from scratching the face by the +use of some mechanical device. A piece of strong pasteboard +bandaged on the elbows, so as to prevent the child +from bending them, is all that is necessary. If the child +cannot bend the elbows he cannot scratch his face, yet +he has the free use of his hands.</p> + +<p>The use of external remedies is imperative, as frequently +the cause is mostly external, and in other cases +it must be used in addition to the general treatment. +Before external treatment is instituted, the crusts should +be softened by applying olive oil to them for twenty-four +hours, after which they can be removed with soap +and water. If there is much inflammation, or if the face +looks angry, a very good application is Lassar's paste.</p> + +<p>Later, when the inflammation has subsided and the +itching is severe, a mixture of tar ointment, 3 teaspoonfuls; +zinc oxide, 1-1/2 teaspoonfuls; rose water ointment, +6 teaspoonfuls has proved to be one of the very best.</p> + +<p>When the eczema on the face is of the weeping, or +<span class='pagenum'>[<a name="Page_565" id="Page_565">565</a>]</span> +moist, variety, the application of bassorin paste gives +splendid results.</p> + +<p>When an external remedy is applied to any eczematous +surface it is necessary to apply it on a cloth. Simply to +smear it on will do no good.</p> + +<p>In the treatment of eczema, when the children are +breast-fed, it is well to remember that the real cause +of the eczema may be in the mother. If the mother is +constipated, or if her diet is too liberal, if she is drinking +beer, or an excess of coffee, or is not taking exercise, the +eczema may be caused by one or other or all of these.</p> + +<p>For eczema of the scalp the remedy to use is white-precipitate +ointment, 1 part; vaseline, 4 parts. Mix +together and apply.</p> + + +<h4>POOR BLOOD. SIMPLE ANEMIA</h4> + +<p><b>Causes</b>.—There is what may be termed an unnatural +tendency toward poor blood during infancy and childhood. +The explanation of this anomalous condition is, +that the tax or strain put upon the blood to provide for +the growth of the child is severe, and is in addition to +the great demands made upon it in the exercise of its +regular duties. We must, therefore, always take this +special duty into consideration, when the question of recuperation, +convalescence, feeding, and the administration +of blood foods and tonics comes up.</p> + +<p>It is not necessary to specify the diseases from which +a child may suffer and recover, in an anemic condition. +Any disease may leave a child with temporarily poor +blood. The conditions which most frequently produce +anemia in childhood are improper feeding and unhealthy +surroundings. It is not fully appreciated how seriously +these conditions can affect the health of growing children. +There is one condition that every mother should be +warned against, namely, the possibility of unduly prolonging +breast-feeding. Children should be weaned at the end +of the tenth month. By prolonging the breast-feeding a +mother can undermine the vitality and strength of her +baby and so impoverish its blood as to invite disease. A +bottle-fed baby should be put upon a mixed diet at the +same time. To continue feeding a child exclusively on +<span class='pagenum'>[<a name="Page_566" id="Page_566">566</a>]</span> +milk for a year or two after weaning, simply because "it +will not take anything else," is criminal. Any woman +guilty of such stupidity should never have become a +mother. Once again it must be emphasized that every +child must have an abundance of fresh air, must not be +confined in close, hot, unsanitary rooms, and must have +a daily, satisfactory movement of the bowels to be a +healthy child with good blood in its body.</p> + +<p><b>Symptoms</b>.—Children suffering from poor blood are +flabby, constipated, hungry, weak specimens of childhood. +They are under weight, complain of headache, pains, +disturbed sleep, are nervous and irritable. They tire +quickly, are short of breath, and may have a tendency to +faint easily. The hands and feet are cold, the pulse is +small and irregular. They may have attacks of nose-bleeding +and of bed-wetting.</p> + +<p><b>Chlorosis</b>.—Chlorosis is that form of anemia, of poor +blood, which occurs in young girls about the time their +sickness begins. It is most frequently seen between the +fourteenth and seventeenth years, and more often in +blondes than in brunettes. The cause is not known. It +is thought to be due to constipation. Any occupation +which is deleterious to health has a distinct influence on +the condition. Employment in factories, confinement in +badly ventilated rooms, bad or insufficient food, great +grief, care, or a bad fright, mental strain, overstudy, may +all produce, or contribute to the production of chlorosis.</p> + +<p><b>Symptoms</b>.—The symptoms of chlorosis resemble +those of simple anemia. Children suffering from anemia +are pale; girls with chlorosis have a peculiar greenish +yellow tint in the skin. They are short of breath, they +have vertigo, palpitation, disturbances of digestion, constipation, +cold hands and feet, and scanty or arrested +monthly periods. They have various nervous disturbances, +such as headache, pains in various parts of the +body, neuralgia, especially over the eyes, hysterical attacks, +and sometimes cholera. Ulcer of the stomach is +sometimes seen in this condition.</p> + +<p>The disease lasts for a year or longer; it frequently +lasts a number of years. Relapses are frequent.</p> + +<div class="figcenter" style="width: 400px;"> +<a id="v4pg566" name="v4pg566"></a> +<img src="images/v4pg566.jpg" width="400" height="479" alt=" +"A Misfortune at Birth"" title="" /> +<span class="caption">By permission of Henry H. Goddard</span></div> + +<div class="center">"A Misfortune at Birth"</div> + +<p>Warren is feeble-minded. His family said it was due to "a serious +fall of the mother."</p> + +<p><a href="#Footnote_A_2">[A]</a> +"The family history is, however, exceedingly interesting.</p> + +<p>"The paternal grandfather, whom we have called Nick, was of good family, +although he himself was totally different from the rest. He was weak in every +way, and to be considered feeble-minded. He married into a family that was +much lower socially than his own, although we have no proof that it was a +defective family. The children of this couple were all mentally defective and +low-grade, morally as well as intellectually.</p> + +<p>"Warren's father, Jake, a thoroughly disgraceful character, married Sal, a +woman somewhat older than he.</p> + +<p>"The immorality of this family beggars description. A girl named Moll was +fifteen years old when Jake brought her into his home: his wife, Sal, was so +feeble-minded that she allowed the illicit relations between these two. Moll's +child was born in the hospital after the mother had been sent away from one +Home because of her horrible syphilitic condition—from which she finally +died.</p> + +<p>"Our boy Warren's sister Liz with whom the father lived in incestuous +relations, was also allowed to live illicitly with a man who worked for her +father. She was so simple that she talked openly about her relations with her +father and with this man. When a child was to be born the man married her.</p> + +<p>"This is not all, but enough: and sufficient to show what feeble-mindedness +leads to when it takes the direction of sexual abuses."</p> +<div class="footnote"><p><a name="Footnote_A_2" id="Footnote_A_2"></a> +<span class="label">[A],</span>"Feeble-mindedness: Its Causes and Consequences," +Goddard, The Macmillan Company.</p></div> + +<p><span class='pagenum'>[<a name="Page_567" id="Page_567">567</a>]</span> +<b>Severe Anemia: Pernicious Anemia</b>.—This is the +most severe form of anemia, or the condition in which we +have the poorest blood. While this condition frequently +results in death the others rarely ever do. This condition +is not common in childhood.</p> + +<p><b>Symptoms</b>.—There is intense weakness and prostration. +The skin is very pale, the mucous membranes are +bluish white. The breath is markedly short and there +is often dropsy of the limbs and feet. Fever is often +present and quite high. The disease lasts a number of +months; the patient often feels better for a time, then +relapses into a more serious condition than before.</p> + + +<h4>TREATMENT OF THE VARIOUS FORMS OF ANEMIA</h4> + +<p><b>Simple Anemia</b>.—Find the cause and stop it. In infancy +special attention should be given to diet and hygiene, +giving the child plenty of fresh air, and a change of air +to the country or seashore if necessary. The general +treatment is more important than any benefit that may be +derived from drugs. The rules laid down in the articles +on "Malnutrition" must be closely followed in these children.</p> + +<p><b>Chlorosis</b>.—In this form of anemia, or poor blood, it +is best to give iron. Change of air and change of scene +are of special importance in these cases and will frequently +cure. The general condition of course must not +be overlooked. The diet, exercise, bowels, habits, should +receive careful attention. Iron should be continued for a +number of months after all traces of the anemia have disappeared.</p> + +<p><b>Pernicious Anemia</b>.—For this condition arsenic is the +one remedy needful. In all conditions of poor blood the +most careful attention should be given to the general +health. Colds must be guarded against. The patients +should never get their feet or their clothes wet. Muscular +exercise, because of the weak condition of the heart, +should be moderate, and only given on the advice of a +physician. It is frequently necessary to stop all forms of +exercise and in many instances we get the best results by +directing complete rest in bed for a considerable part of +the day or for all day if the case demands it. +<span class='pagenum'><a name="Page_568" id="Page_568">[568]</a></span></p> + +<hr style="width: 65%;" /> +<p><span class='pagenum'><a name="Page_569" id="Page_569">[569]</a></span></p> + +<h2>CHAPTER XXXVII</h2> + +<h3>DISEASES OF CHILDREN, CONTINUED</h3> + +<div class="blockquot"><p>Rheumatism—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.</p><br /></div> + + +<h4>RHEUMATISM</h4> + +<p>This is a rather common disease of childhood. It occurs +most frequently between the ages of nine and +thirteen years. Children can have it, however, at any age.</p> + +<p>The symptoms of rheumatism in children are much +the same, though somewhat milder, as when the disease +is present in an adult. Children are not quite as sick, nor +is the fever as high, nor is the pain as great as in a grown +person. In children the disease does not last as long, as a +rule. Sometimes it will jump from one joint to another, +and may, as a consequence, become chronic. When a +child has once had rheumatism, it has the same disposition +to recur that it has in adults. The principal danger +of rheumatism in children is its tendency to attack the +heart. Even mild attacks of the disease can do serious +damage to the heart.</p> + +<p>Children who have the rheumatic tendency invariably +suffer from inflammatory conditions of the upper +respiratory tract. They are prone to have recurring +colds, tonsilitis, and sore throats. Treatment of +conditions without regard to the underlying +<span class='pagenum'>[<a name="Page_570" id="Page_570">570</a>]</span> +rheumatism is never satisfactory. These children complain of +indefinite pains, now in one place, now in another. These +pains are commonly known as "growing-pains" and, inasmuch +as they are rheumatic and not "growing pains," +they should be regarded seriously because of the heart +damage they might do if ignored, and especially so since +the mildest attacks of rheumatism, without any joint +symptoms even, frequently leave the heart in very bad +shape. As a general rule it will be found that when a +child has had a number of attacks of bronchitis or asthma +it is rheumatic and should receive treatment for the +rheumatic tendency.</p> + +<p>Children with the tendency to rheumatism invariably +eat too much red meats and sugar,—the latter in the form +of candy or as an excess in the food.</p> + +<p><b>Treatment of an Acute Attack</b>.—The child should be +put in bed and kept warm. The bowels should be freely +opened with citrate of magnesia. The diet should be very +light: milk and lime water or milk and vichy water, with +a piece of dry toast or zwieback, is all the child needs +until the fever is relieved. When a single joint is affected +local measures may be taken for its relief. Wraping +the joints up with flannel cloths which have been +wrung out of true oil of wintergreen, and outside of this +oiled silk snugly bandaged on, is an excellent external application. +The flannel cloths should be kept moist by +adding a little of the wintergreen from time to time as +it dries in. This can be done without removing the +bandage. This application is kept in place for twenty-four +hours and renewed if necessary. Such an external +application will aid in the actual cure of the disease and +will quickly relieve the patient of the pain. The oil of +wintergreen used in this way should be the "true" oil, and +should be so specified when bought in the drug store.</p> + +<p>Because of the great tendency to attack the heart a +physician should take charge of every case of acute +rheumatism in a child.</p> + +<p><b>To Treat the Tendency to Rheumatism</b>.—Exclude +red meats and sugar in all forms as much as is possible. +Give green vegetables freely, potatoes boiled with the +skins on, fish, eggs, and poultry. Cereals with milk, +<span class='pagenum'>[<a name="Page_571" id="Page_571">571</a>]</span> +especially well cooked Scotch oatmeal, are exceedingly +good for these children. By keeping up this diet after +the acute attack has passed for a considerable time, it +is possible to cure the various other complaints with which +the child is afflicted,—tonsilitis, sore-throats, winter +coughs, head-colds, bronchitis, asthma, etc.</p> + +<p>These children should wear woolen underwear all the +year round. They should be encouraged to drink water +or vichy freely between meals.</p> + +<p>In the treatment of an acute attack as given above +it will be observed that no drugs are mentioned. This +is intentional because it would be unjust to encourage the +home treatment of a disease that is so treacherous, even +in its mildest forms. Because of its tendency to recur +and with each recurrence the danger of the heart being +affected, it is advisable to put these children on cod liver +oil or iron or some other good tonic. Every precaution +should be taken to prevent these children from getting +their feet wet or being out in the rain.</p> + + +<p><b>SUMMARY:—</b></p> + +<blockquote><p>Rheumatism is a dangerous disease in children.</p> + +<p>In its mildest forms it can affect the heart badly.</p> + +<p>It has a distinct tendency to recur.</p> + +<p>Rheumatic children are afflicted with a number of diseased +conditions which do not respond to treatment +unless the rheumatism is treated.</p> + +<p>Acute rheumatism should never be treated except by a +physician because of its treacherous character.</p></blockquote> + + +<h4>MALARIA. INTERMITTENT FEVER</h4> + +<p>Malaria occurs quite often in infants and children. As +a rule the child gives evidence of gastro-intestinal disturbance +for a short period before the malarial symptoms appear. +The chilly stage is often absent. Sometimes the +hands and feet are cold and may be slightly blue and the +child may appear to be in collapse. This stage may last +for an hour or longer. The chilly stage may, however, be +replaced by nervous symptoms,—restlessness, dizziness, +<span class='pagenum'>[<a name="Page_572" id="Page_572">572</a>]</span> +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.</p> + +<p>Between the attacks some children may be entirely +well; others remain restless, have little appetite and poor +digestion. Malaria in children does not always follow a +typical course. We often see children suffering from +spasms, fainting spells, neuralgias, diarrhea, vomiting, +and skin eruptions, all due to the malarial condition. This +often leads to a mistake in diagnosis. Intermittent fever +is often mistaken for pneumonia. Malaria is not a favorable +disease for an infant to have. It rapidly weakens the +child and great debility and anemia follows.</p> + +<p><b>Treatment</b>.—The treatment for malaria in children is +by the administration of quinine as in adults. It must, +however, be given with care and intelligence; for this +reason no mother should begin dosing her child with it +without consulting a physician.</p> + + +<h4>REGARDING MOSQUITOES</h4> + +<p>The following is an extract from a circular in relation +to the causation and prevention of malaria and the life +history and extermination of mosquitoes issued by the +Department of Health, City of New York:</p> + +<div class="blockquot"><p><b>Extermination and Prevention of Mosquitoes +</b>.—Mosquitoes require for their development standing water. They +cannot arise in any other way. A single crop soon dies and disappears +unless the females find water on which their eggs may be laid. In order +to prevent mosquitoes, therefore, the requirement is simple.</p> + +<p><b>No Standing Water</b>.—Pools of rain water, duck ponds, ice +ponds, and temporary accumulations due to building; marshes, +both of salt and fresh water, and road-side drains; pots, kettles, +tubs, springs, barrels of water, and other back-yard collections, +should be drained, filled with earth, or emptied.</p> + +<p>Running streams should have their margins carefully +cleaned and covered with gravel to prevent weeds and grass +at the water's edge.</p> + +<p>Lily ponds and fountain pools should, if possible, be abolished; +if not, the margins should be cemented or carefully +graveled, a good stock of minnows put in the water, and +green slime (Algæ) regularly cleaned out, as it collects. +<span class='pagenum'>[<a name="Page_573" id="Page_573">573</a>]</span></p> + +<p>Where tanks, cisterns, wells or springs are necessary to +supply water, the openings to them should be closely covered +with wire gauze (galvanized to prevent rusting), not the +smallest aperture being left.</p> + +<p>When neither drainage nor covering is practicable, the surface +of the standing water should be covered with a film of light +fuel oil (or kerosene) which chokes and kills the larvæ. +The oil may be poured on from a can or from a sprinkler. +It will spread itself. One ounce of oil is sufficient to cover +15 square feet of water. The oil should be renewed once a +week during warm weather.</p> + +<p>Particular attention should be paid to cess-pools. These +pools when uncovered breed mosquitoes in vast numbers; if +not tightly closed by a cemented top or by wire-gauze, they +should be treated once a week with an excess of kerosene or +light fuel oil.</p> + +<p>Certain simple precautions suffice to protect persons living +in malarial districts from infection:</p> + +<p>First: Proper screening of the house to prevent the entrance +of the mosquitoes (after careful search for and destruction +of all those already present in the house), and +screening of the bed at night. The chief danger of infection +is at night (the Anopheles bite mostly at this time).</p> + +<p>Second: The screening of persons in malarial districts who +are suffering from malarial fever, so that mosquitoes may not +bite them and thus become infected.</p> + +<p>Third: The administration of quinine in full doses to malarial +patients to destroy the malarial organisms in the +blood.</p> + +<p>Fourth: The destruction of mosquitoes by one or more of +the methods already described.</p> + +<p>These measures, if properly carried out, will greatly restrict +the prevalence of the disease, and will prevent the occurrence +of new malarial infections.</p> + +<p>It must be remembered that when a person is once infected, +the organisms may remain in the body for many years, producing +from time to time relapses of the fever.</p> + +<p>A case of malarial infection in a house (whether the person +is actively ill or the infection is latent) in a locality +where Anophele mosquitoes are present, is a constant source +of danger, not only to the inmates of the house, but to the +immediate neighborhood, if proper precautions are not taken. +It should be noted in this connection that the mosquitoes +may remain in a house through an entire winter and probably +infect the inmates in the spring upon the return of the +warm weather.</p> + +<p>Malarial fever is prevalent in certain boroughs of New +York City, and in view of the presence of standing water +resulting from the extensive excavations taking place in various +parts of these boroughs, is likely to extend, if means are +not taken for its prevention.</p></div> +<p><span class='pagenum'>[<a name="Page_574" id="Page_574">574</a>]</span></p> + + +<h4>REGULATIONS OF THE BOARD OF HEALTH, NEW +YORK CITY, IN AID OF MOSQUITO EXTERMINATION +AND THE PREVENTION +OF MALARIAL FEVER</h4> + +<p class="center">(In Force from March 15 to October 15.)</p> + +<blockquote><p>1. No rain-water barrel, cistern, or other +receptacle for rain-water, shall be maintained without being tightly +screened by netting, or so absolutely covered that no mosquito can +enter.</p> + +<p>2. No cans, pails, or anything capable of +holding water, shall be thrown out or allowed to remain +unburied on or about any premises.</p> + +<p>3. Every uncovered cesspool or tank shall be kept in +such condition that oil may be freely distributed +so as to flow over the surface of the water. +Covered cess-pools must have perfectly tight +covers, and all openings must be screened.</p> + +<p>4. No waste or other water shall be thrown out or allowed to stand +on or near premises.</p> + +<p>Information is requested as to the presence of standing +water anywhere, so that the premises may be inspected +and the legal remedies against the same be applied.</p> + +<p>The prompt 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.</p> + +<p>Mosquitoes are, so far as known, the only means of +conveying malaria.</p></blockquote> + + +<h4>"RASHES" OF CHILDHOOD</h4> + +<p>The following table gives all the characteristics of the +rashes that accompany the eruptive fevers. The term +"incubation" means the period of time which elapses between +the time when the child was exposed to, or caught +the disease, and the time when the child is taken sick. It is +sometimes interesting to know where a child could have +caught a disease; so if we know the incubation period we +can tell exactly where the child was on the day, or days, +when it was infected. +<span class='pagenum'>[<a name="Page_575" id="Page_575">575</a>]</span></p> + + + +<div class='center'> +<table class="tablecenter bt bb" cellpadding="4" cellspacing="0" +summary="Rashes"> +<tr><td class="bb br" align='center'>Name</td> +<td class="bb br" align='center'> Incubation</td> +<td class="bb br" align='center'> Day of Rash</td> +<td class="bb br" align='center'>Character of Rash</td> +<td class="bb br" align='center'>Rash fades</td> +<td class="bb" align='center'>Duration</td></tr> +<tr><td class="br" align='center'>Measles</td> +<td class="br" align='center'> 10-14<br /> days</td> +<td class="br" align='center'> 4th day</td> +<td class="br" align='left'>Small red like spots<br /> +resembling flea bites,<br />first appearing on face<br /> +and forehead, forming<br />blotches with semi-lunar<br /> +borders.</td> +<td class="br" align='center'>On the 7th<br />day of<br />fever</td> +<td align='center'>6-10<br />days</td></tr> + +<tr><td class="br" align='center'>Scarlet</td> +<td class="br" align='center'>1-6 days<br />occasionally<br />longer</td> +<td class="br" align='center'> 2d day of<br />fever</td> +<td class="br" align='left'>Bright scarlet, rapidly<br /> +diffused, first on<br />chest and upper<br />extremities</td> +<td class="br" align='center'>On 5th day<br />of fever</td> +<td align='left'>8-9 days</td></tr> + +<tr><td class="br" align='center'>Chicken-pox</td> +<td class="br" align='left'> 4-12 days</td> +<td class="br" align='center'> 2d day</td> +<td class="br" align='left'>Small rose vesicles,<br />which do not become +<br /> pustular</td> +<td class="br" align='center'>Slight scab of<br />short duration</td> +<td align='left'>6-7 days</td></tr> + +<tr><td class="br" align='left'>Typhoid<br />Fever</td> +<td class="br" align='center'> 10-14 days</td> +<td class="br" align='center'> 7-14 days</td> +<td class="br" align='left'>Rose colored papules<br /> +elevated, few in number,<br />limited to trunk,<br />disappear on pressure +</td><td align='left'></td><td align='left'>From<br />21-35 days</td></tr> + +<tr><td class="br" align='left'>Smallpox<br />(Variola)</td> +<td class="br" align='center'> 10-14 days</td> +<td class="br" align='center'> 3d day of<br />fever</td> +<td class="br" align='left'>Small, round, red<br />hard, papules forming<br /> +vescicles then pustules,<br />first appearing on face<br /> +and wrists</td> +<td class="br" align='center'>9th day<br />scabs form<br />and about<br /> +14th day<br />fall off</td> +<td align='left'>14-21<br />days</td></tr> +</table></div> + + +<p><b>Other Rashes</b>.—There are so-called "stomach" rashes +which are a source of much worry to mothers. These +rashes may appear at any time and they may be limited to +certain parts or may cover most of the body. They may +be bright red, or they may be simply a general discoloration. +They may appear as blotches or they may spread +all over, like the rash of scarlet fever when at its height.</p> + +<p>These rashes are of no importance, except that they indicate +some derangement of the gastro-intestinal tract. +As a rule they indicate indiscriminate feeding or overfeeding. +Children who have had too much candy or pastries, +or who have been fed things which are unsuited to +their age, frequently develop rashes. Such children +should have a thorough cleaning out; a dose of castor +oil is probably the best cathartic to give them.</p> + +<p>The mother may readily learn to know the difference +between a rash that is unimportant and one that indicates +one of the eruptive diseases, if she gives the matter +a little careful thought. In the first place a child +who is about to become the victim of one of the eruptive +diseases will be sick, and will have a fever for two or +three days before any rash appears; while on the other +<span class='pagenum'>[<a name="Page_576" id="Page_576">576</a>]</span> +hand a child may go to bed in good health and may next +morning be covered with a general rash, or with large +blotches, without any fever and without any evidence of +ill-health, except the skin condition. In the second place, +if the mother gives the child a cathartic and restricts the +diet for a day the rash will disappear, and good spirits +and good health will be maintained; on the other hand, +the giving of a cathartic to a child who is the victim of +an eruptive disease will not tend to diminish the rash, but +may accentuate it.</p> + +<p><b>Pimples: Blackheads (Acne)</b>.—This eruption is +situated chiefly on the face. It may appear, however, on +the back, shoulders, and on the chest. It is mostly seen in +young men and women about the age of puberty. It appears +as conical elevations of the size of a pea; they are +red and tender on pressure, and have a tendency to form +matter, or pus, in their center. In from four to ten days +the matter is discharged but the red spots continue for +some time longer.</p> + +<p><b>"Blackheads"</b> appear as slightly elevated spots of a +black color out of which a small worm-like substance may +be pressed. Pimples and blackheads are due to inflammation +of the glands of the skin. The mouths of these +glands become filled with dust which acts as a plug causing +the retention of the oily matter of the gland which +becomes inflamed and hence the pimples and blackheads. +Certain constitutional conditions favor the development of +these skin blemishes. Constipation, indigestion, bad blood +from unsanitary and bad hygienic surroundings, self-abuse +and bad sexual habits favor the appearance of these +skin affections.</p> + +<p><b>Treatment</b>.—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:— +<span class='pagenum'>[<a name="Page_577" id="Page_577">577</a>]</span></p> + + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Zinc Oxide</td><td align='left'>ounces</td> +<td align='left'>1/4</td></tr> +<tr><td align='left'>Powdered calamine</td><td align='left'>ounces</td> +<td align='left'>1/4</td></tr> +<tr><td align='left'>Lime water </td><td align='left'>ounce</td> +<td align='left'>6</td></tr> +</table></div> + + +<p>Mix and shake before applying to the skin.</p> + + +<h4>CONVULSIONS. FITS. SPASMS</h4> + +<p>Convulsions are quite common in children, especially +those under three years of age.</p> + +<p>A convulsion in an infant immediately, or within three +months, after its birth is the result of injury, either at +birth or later (a fall for example) which seriously affects +the brain itself. After the third month the cause of +fits or convulsions is, in a very large percentage of the +cases, to be found in errors of diet resulting in disturbances +in the stomach or bowels—eating of articles of food +difficult to digest, as green or overripe fruit, salads, fresh +bread, pickles, cheese, etc. Children of a nervous temperament +are more liable to convulsions than are others. +Females are more frequently victims of fits than are male +children.</p> + +<p>In infants convulsions often result from changes in the +mother's milk. Mental excitement, deep emotion, anger, +frights, severe affliction and distress will so affect a woman's +milk that it will cause convulsions in her child if she +nurses it while under the influence of any of these conditions.</p> + +<p>Convulsions may result from any condition that disturbs +the nutrition of the child, as, for example,—exhaustion, +anemia, intestinal indigestion, blood poison, and +general weakness resulting from some severe sickness, +especially those of the digestive organs.</p> + +<p>Various forms of brain disease cause spasms and fits; +the most common are meningitis, tumors, hemorrhage, +abscesses and injuries. Convulsions may accompany certain +conditions, as, the presence of worms, teething, severe +burns, foreign bodies in the ear, whooping cough, +pneumonia scarlet fever, malaria, sometimes measles, typhoid +fever, and diphtheria. Children who are badly +nourished and who live constantly in unsanitary surroundings +are more apt to have convulsions than those +<span class='pagenum'>[<a name="Page_578" id="Page_578">578</a>]</span> +who are well nourished and who live hygienically. One +attack renders the patient more liable to another, and +when the "habit" is established any trivial cause may incite +a convulsion; persistent and systematic efforts should +therefore be taken to prevent the attacks. The best preventives +are:</p> + +<blockquote><p>1st. To regulate the diet and the bowels.</p> + +<p>2nd. Remove adenoids and worms, if they exist.</p> + +<p>3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper +foods.</p> + +<p>4th. Guard the child against catching cold, infectious +diseases and all fevers. In other words, save the child +from the cause and the convulsion will not take place.</p></blockquote> + +<p>By regulating the bowels we mean that everything the +child eats must be seen by the mother, must be with the +mother's permission, and must be suited to the child's age. +If there is any question about the latter it will be advisable +to have a physician write out a list of articles suitable to +the child. It is generally necessary to eliminate meats, +pastries, candies, sugar to a large extent, gravies, salads, +sauces, and all the extras of the table, as pickles, mustard, +relish, etc., as well as coffee, tea, cocoa, and alcohol.</p> + +<p>The child should live in the open air as much as possible; +a daily warm bath, followed by a quick, cold sponge, +is a necessity.</p> + +<p>Children subject to fits are possessed of a highly nervous +temperament. They are difficult to manage unless +managed with firmness and tact. It is not necessary to +be harsh, but it is imperative to be firm and decided. They +must be made to realize that they are not "the master," +that their will is not supreme, and the mother must exact +this condition; otherwise these children will become dictators +and selfish despots—ruining the discipline of the +home, spoiling their own chance of physical health, and +rendering unhappy everyone around them. The parents, +therefore, have a definite duty to perform and it is not +an easy one. The food should be so regulated that each +day a natural movement of the bowels will take place. +(See article on constipation, page 303.) If a day should +pass without a movement the child should be given a hot +rectal enema as described on page<a href="#Page_586">586</a>. +<span class='pagenum'><a name="Page_579" id="Page_579">[579]</a></span></p> + +<p>The adenoids can be easily demonstrated to either exist +or be absent. (See page <a href="#Page_519">519</a>.) If worms are known to +be present in the child they should be at once removed. If +they are simply suspected, the child should receive treatment +for them, just the same. (See page <a href="#Page_549">549</a>.)</p> + +<p>By going a long time without a convulsion the nervous +system will recuperate itself, and become so strong and +healthy that what once would cause a fit will make no impression +in its new strengthened state; therefore, if you +"save the child from the cause," the convulsions will cure +themselves, as it were.</p> + +<p>There are some cases of convulsions for which no satisfactory +explanation can be found.</p> + +<p><b>Treatment</b>.—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 <a href="#Page_579">579</a>) should be +given while the child is in the bath, because, as explained +above, a large percentage of these cases are caused by gastro-intestinal +derangements. The rectal injection will +likely remove the cause. An ordinary convulsion lasts +from five to ten minutes. When the child is removed +from the bath it should be placed in a warm, comfortable +bed and kept absolutely quiet. A hot-water bottle may +be put near its feet and an ice-bag or cold cloths should +be kept on its head. It should be given a full dose of +castor oil and allowed to go to sleep. Its diet should +consist of light broths for two or three days and during +this time it should not be disturbed or annoyed by too +much attention. This is as far as it is wise or safe for +any mother to go in the treatment of convulsions. A +physician should be called in every instance, because a +convulsion should never be regarded lightly. Many children +have become idiots, others have been afflicted with +paralysis, because of inattention at the proper time. +<span class='pagenum'>[<a name="Page_580" id="Page_580">580</a>]</span></p> + + +<p><b>SUMMARY:—</b></p> + +<blockquote><p>1st. Convulsions must always be regarded as +serious.</p> + +<p>2nd. Convulsions demand prompt treatment.</p> + +<p>3rd. Every mother should know that an English mustard +bath—hot—is the first resort in convulsions.</p> + +<p>4th. While this is being done she can read the home treatment in +this book and carry it out before the doctor comes.</p> + +<p>5th. If the fit is not caused by some stomach or intestinal +trouble, have the physician find out the cause and tell you what to +do, and do it faithfully, because if you neglect the proper treatment +the child may become idiotic or paralyzed.</p></blockquote> + + +<h4>BED WETTING. ENURESIS—INCONTINENCE</h4> + +<p>Enuresis, or incontinence of urine, is customary in infancy. +Just when urination becomes a voluntary act depends +upon the development and training of the individual +child. As a rule children can be taught to control +this function during the day, or while awake, about the +tenth month. It is not under control during sleep until +a much later period, usually by the end of the second +year, but lack of control should not be regarded as abnormal +until the child has entered the fourth year. If the +child fails to control the act of urination during the day +at the end of the second year, and is addicted to habitual +bed-wetting, some measures should be adopted to cure the +condition.</p> + +<p>Boys under twelve years of age seem to be affected +more frequently than girls. It is wrong to assume that +it is caused by negligence or laziness, as some parents do. +It has generally a special cause, and the cause usually +can be found if it is carefully sought for. It may be the +result of bad habits: exposure to cold in the night; lying +on the back; drinking too much liquid in the afternoon +or at bedtime. It may be due to too much acid in the +urine, and if so it will be found necessary to reduce +meats and eggs the child is eating. Worms, stone in the +bladder, some anatomical abnormality or deficiency, may +<span class='pagenum'>[<a name="Page_581" id="Page_581">581</a>]</span> +be responsible for it. The diet may be at fault; adenoids +are supposed by some physicians to be the cause. No +matter what the actual cause may be, it must be found +and remedied before we can hope for a permanent cure. +A very large majority of these cases are due to nervousness. +These children are of a nervous temperament. +They are not necessarily sickly children; they are simply +of a nervous type. They are well-nourished, active, and +lively. Incontinence of urine during the day and long-continued +bed-wetting does not at all affect the health of +the child. If they are in poor health, it is essential to +treat their general condition before trying to cure the +incontinence.</p> + +<p>It is absolutely wrong to punish or to crush the spirit +of these children. Constant nagging and taunting, even +if done in the hope of shaming the child into a cure, will +simply make a coward of him and will not aid in improving +matters, but will be distinctly detrimental.</p> + +<p>Scrupulous cleanliness must be constantly practiced or +these children, if neglected, may develop ulcers and sores +of a very obstinate character. The odor is also bad for +the health of the child.</p> + +<p><b>Treatment</b>.—Find and remove the cause if possible. +If due to general poor health, give tonics, obtain a change +of air, and build the child up. Reduce the total quantity +of liquids, if in excess, and be very careful not to give any +liquids near bedtime. Don't cover these children too +much; they should never be "too warm"; they should +sleep in a well-aired room, and they should receive a +quick, cool sponge bath every morning. They should be +taught to sleep on their sides, never on their backs. Their +diet should be light but nourishing. When bed-wetting +is established it will continue, if untreated, until the child +is eight or ten years of age, and it frequently lasts much +longer. When treatment is undertaken it should be distinctly +understood by the mother that it will take many +months to cure; and during these months she must give +her constant attention to the child. If she does not undertake +to do this, or if she fails to do it, the treatment +should not be begun at all, as it will not succeed. Various +plans should be tried to keep the child from sleeping on +<span class='pagenum'>[<a name="Page_582" id="Page_582">582</a>]</span> +its back. The reason of this is because it has been found +that the child wets the bed only when sleeping on its back +and never when sleeping on its side. The simplest +method, of tying a towel or cloth around the child with +a knot over the spinal column, so that it will hurt and +waken it, if it turns on its back, is a very good one and +should be carefully tried for some time. The nervous +system of these children should never be overtaxed at +home or at school. Early hours and plenty of sleep are +desirable. Certain articles of diet of a stimulating character +should be entirely avoided,—for example, coffee, +tea, beer, candies, sugars, and pickles. The best diet for +these children is one composed exclusively of milk, vegetables, +fruits, meats, and cereals. Meats, however, should +be given only once every two days. It is a good plan to +teach the child to hold his water during the day, as long +as he can, to accustom the bladder to being full. Adenoid +growths, which contribute to the nervousness of a +naturally nervous child, should be removed. It is a good +plan to take the child up when the parents go in bed +and let him urinate. This often cures the condition in +itself.</p> + +<p>Sometimes moral measures, such as the promise of a +reward, will strengthen the will so that the child may +overcome the tendency. Find out what the child most +desires in the way of a toy, and promise it if he goes so +long without wetting the bed. Aid and encourage him +to make efforts to win the reward.</p> + +<p>If drugs have to be resorted to, it is necessary to call +the family physician, as the only drugs that are of any +use are very powerful and have to be given with great +care and caution. It is the experience of most physicians +and specialists, however, that in a large majority of cases +the treatment, along the lines as given above, will be effective, +without drugs, if faithfully persisted in by the +mother.</p> + +<p>These children should be examined by a physician. +The cause of the bed-wetting is frequently discovered to +be produced by anatomical abnormalities which render +circumcision imperative. In these cases no method of +treatment will succeed until circumcision is performed. +<span class='pagenum'>[<a name="Page_583" id="Page_583">583</a>]</span></p> + + +<h4>SLEEPLESSNESS. DISTURBED SLEEP</h4> + +<p><b>Causes</b>.—In babies, disturbed sleep is most frequently +due to hunger or to indigestion. The latter is the result +of overfeeding or improper feeding. Rocking the child +to sleep, or feeding it during the night will cause sleeplessness. +Teething, colic, or any pain will result in disturbed +sleep. Nervous children are frequently poor +sleepers.</p> + +<p>In older children, some digestive disturbance is, as a +rule, the cause. Chronic intestinal indigestion, worms, +adenoid growths, enlarged tonsils, lack of fresh air in the +bedroom, cold feet, may, however, be the cause. Overstudy +in school, poor blood, poor nourishment are always +accompanied by inability to sleep soundly. Too strenuous +play, exciting stories read before bedtime, may cause +sleeplessness.</p> + +<p><b>Treatment</b>.—The removal of the cause is absolutely +necessary. In order to discover the cause it is sometimes +essential to study the child's whole routine in order to +be able to tell exactly just what is causing the apparent +insomnia. It may be necessary to change the method +of feeding, to regulate the studies and the exercises, and +to suggest changes regarding the sanitary and hygienic +environment of the child's life. Mothers must be warned +against using drugs in the form of soothing syrups or +teething mixtures. They are dangerous and absolutely +forbidden under the above conditions.</p> + +<p>The nervous disposition of the child must be taken into +consideration and treated if necessary. If bad habits exist +they must be stopped. Poor blood and poor nutrition +must receive the treatment suggested under these headings.</p> + + +<h4>NIGHTMARE. NIGHT TERRORS</h4> + +<p>In a nightmare a child wakes suddenly in a state of +fright and will inform you that it has had a bad dream. +His mind seems clear and he recognizes those about him. +He is not easily calmed and may cry for some time; finally +he goes to sleep again. The next day he will remember +<span class='pagenum'>[<a name="Page_584" id="Page_584">584</a>]</span> +the dream and most of the incidents of the night +before. Such cases are quite frequent. They are to be +treated in the same way as cases of disturbed sleep, as +they really have the same cause. They are mostly due +to digestive disturbances and errors of diet.</p> + +<p><b>Night-Terrors</b>.—Cases under this heading form a +distinct group by themselves. They are not frequent, +but the condition is much more serious. The cause seems +to be wholly nervous and may indicate an important nervous +derangement. It seems to have some indefinite relation +to such conditions as migraine, hysteria, epilepsy, +and even insanity. The child wakes suddenly during the +night and sits up, evidently in terror; he does not apparently +regain his full consciousness. He talks of being +scared, calls for his mother, trembles and shakes, cannot +answer questions intelligently, and after a time goes to +sleep. Next day he remembers nothing of the attack and +does not seem to suffer in any way as a result of it.</p> + +<p>I am disposed to believe that all of these attacks are +not due to a nervous condition. A number of them of +exactly this type have been cured by absolutely withdrawing +milk from the diet.</p> + +<p>It is a good plan to restrict the possibility of excessive +play in these children. They are of the type whose +play is work, and too much of it is too exhausting. Some +person should sleep in the same room with these patients +or in an adjoining room with the door open.</p> + +<p>If the condition occurs frequently the child should be +subjected to a thorough physical examination, because +it may be one evidence of a serious ailment.</p> + +<p>Sometimes these little patients have to be taken out +of school and sent to the country, where they should +remain for many months. It is far better to regard the +condition as indicating an abnormality,—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. +<span class='pagenum'>[<a name="Page_585" id="Page_585">585</a>]</span></p> + + +<h4>HEADACHE</h4> + +<p>Headaches are not common in little children. The +most frequent ones are caused by:</p> + +<span style="margin-left: 1em;">1. Chronic indigestion and constipation.</span> +<br /> + +<span style="margin-left: 1em;">2. Anemia and malnutrition.</span><br /> + +<span style="margin-left: 1em;">3. Nervous disorders.</span><br /> + +<span style="margin-left: 1em;">4. Diseases of the eye, nose, throat.</span> +<br /> + +<span style="margin-left: 1em;">5. Rheumatism and gout.</span><br /> + +<span style="margin-left: 1em;">6. Disturbances of the genital tract.</span> +<br /> + +<p>Those arising from anemia and poor nutrition are +most frequently present in girls from ten to fifteen years +of age. They may result from overcrowding of school +work, which results in loss of appetite and poor sleep.</p> + +<p>Nervous headaches may be hereditary or acquired +through unhygienic surroundings. Hysteria, epilepsy, +disease of the brain, neuralgia from carious teeth, may +result in nervous headaches.</p> + +<p>Headaches from disturbances of the genital tract may +afflict girls about the time of puberty.</p> + +<p><b>Treatment</b>.—To remove the cause is the only plan +that promises any result. Each one must be investigated +by itself and dealt with accordingly. For the headache +itself a hot foot bath, cold to the head, and small doses +of phenacetine (one grain every hour for four doses) +are perhaps the most certain of all methods of treatment.</p> + + +<h4>THUMB-SUCKING</h4> + +<p>The habit of sucking the thumb may be corrected by +wearing a pair of white mittens, or gloves tied at the +wrist. Should children attempt to suck the thumb with +gloves on, as some do, it will be necessary to saturate the +thumb and fingers of the gloves with tincture of aloes, or +a solution of the bisulphate of quinine, one dram to two +ounces of water.</p> + + +<h4>BITING THE FINGER NAILS</h4> + +<p>Biting the finger nails may be stopped by the use of +the same bitter remedies as are used in thumb-sucking. +<span class='pagenum'><a name="Page_586" id="Page_586">[586]</a></span></p> + + +<h4>HOW TO WASH OUT THE BOWELS</h4> + +<h4>COLON IRRIGATION. A HIGH ENEMA</h4> + +<p>Procure a soft rubber catheter,—No. 18 American is +about right. It is not advisable to get too soft rubber +for the reason that it will buckle when the child strains +and it will be impossible to wash out the bowel. Fill half +full an ordinary two-quart douche bag with water that +is warm, but not too hot. Dissolve a heaping teaspoonful +of table salt in a glass of hot water and add this to the +water in the bag. Hang the bag about two feet above +the level of the child, so that the water will not flow in +with too strong a stream; otherwise the child will immediately +try to eject it. If the water flows in gently, +the child may not object to it to the extent of making +strenuous efforts to force the catheter out.</p> + +<p>Use the small sized nozzle that comes with the douche +bag. Place the rubber catheter over this nozzle, lubricate +the catheter, place the child on its back over a +douche pan, insert the catheter about two inches, let the +water run and as it runs in push the catheter up gently +until it is all in the bowel except the end on the douche +tip. The object of letting the water run while pushing in +the catheter is because it floats up with the water as it +distends the bowel; there is no risk then of pushing the +end into the intestinal wall or hurting the child. While +the water is flowing into the bowel it is a good plan to +compress the buttocks together to aid in holding the +water, as the child is very apt to let it run out as soon +as it feels uncomfortable.</p> + +<p>The temperature of the water for the ordinary rectal +injection should be 95° 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. +<span class='pagenum'>[<a name="Page_587" id="Page_587">587</a>]</span></p> + +<p><b>Indications for Irrigation of the Colon</b>.—When it is +desired to cleanse the bowel of any collection of matter +a colon irrigation is indicated. This matter may be +mucus, fecal substance, undigested food, or the decomposing +waste products which may remain there as a result +of disease or other conditions.</p> + +<p>When it is desired to medicate by putting fluids into +the bowel we adopt the colon infusion.</p> + +<p>Every diseased condition of the bowel does not, however, +indicate irrigation. If a child is having frequent +loose movements every half-hour it is safe to assume that +the bowel is being cleaned out sufficiently without any +artificial aid. To irrigate in these cases would only irritate +and would not accomplish anything. The cases +which are benefited are those in which we have a fever +with four or five green stools in the twenty-four hours, +or where we have a high fever with no movement at +all. To irrigate in these cases we not only get rid of +the products of decomposition, but we prevent further +decomposition and we reduce the fever, thereby contributing +to the general welfare of the child.</p> + +<p>When the child is convalescing and when there is +only mucus in the stools, with no fever—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.</p> + +<p>Colon irrigations should always be given in every case +of convulsions in infancy, first to clean out the bowel +to prevent putrefaction, and second to empty the bowel +on general principles because an overloaded bowel is +very frequently the cause of convulsions in children.</p> + +<p>When irrigation of the bowel is given at all it must be +given thoroughly. Enough water must pass into the +bowel to wash it all out. For this reason it is essential +that the catheter should be all in and in the bowel—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. +<span class='pagenum'>[<a name="Page_588" id="Page_588">588</a>]</span> +If the child objects strenuously, as often happens, +it must be done with greater care to be successful. Remember +that a colon irrigation is never given unless it is +absolutely necessary and as a consequence it is given to +accomplish a certain purpose; it must, therefore, be done +thoroughly. If it is not, your child may miss the chance +it has of getting over some immediate difficulty and if +the moment of the "chance" is wasted or lost, that +moment will not return. Be thorough, therefore.</p> + +<p><b>Enema</b>.—Some physicians talk about a high enema and +a low enema. A high enema is really an irrigation as +described above. The following remarks apply to low +enemas only.</p> + +<p>A so-called low enema is given to clean out the rectum +of constipated matter, or for the introduction of food or +medicine by rectum, when for various reasons it is necessary +to spare the stomach.</p> + +<p>It may be given with the fountain syringe or with the +ordinary bulb (baby) syringe. A catheter may be put +on the tip of the syringe if it is thought best to inject +higher up than in the rectum.</p> + +<p>When an enema is used in infants or older children for +the relief of constipation, the best medium to use is +glycerine. For an infant, one teaspoonful to an ounce of +water is sufficient; for older children, one tablespoonful +to two ounces of water, given with the bulb syringe, will +give prompt results. If the constipation is pronounced, +the fecal mass very hard, an enema of sweet oil, allowed +to remain in for ten minutes, will soften it and permit +a movement.</p> + +<p>Soap suds are often used. They are good but not +as reliable as the glycerine or oil; if, however, neither +of these two are at hand the soap suds may be +given.</p> + +<p>Enemas should be carefully given and the liquid slowly +injected. If the fountain syringe is used care must be exercised +in not having the bag too high. If it is too high +the liquid will flow in too strongly, either injuring the +bowel wall or causing the child to strain immediately and +pass out the injection before it has an opportunity of +accomplishing its work. +<span class='pagenum'>[<a name="Page_589" id="Page_589">589</a>]</span></p> + +<p>The temperature of the enema should be warm—not +hot, and not cold, simply body heat.</p> + + +<h4>METHODS OF REDUCING FEVER</h4> + +<p>During the course of acute illness it is frequently +necessary to reduce the fever, if possible, without the +use of drugs. The following means are often adopted. +It is desirable that the mother should know just how to +carry out these methods:</p> + +<p><b>Ice-Cap</b>.—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.</p> + +<p>Ice-bags are procured in the drug stores. The best one +is the flat French ice-bag. Fill it three-quarters full of +finely chopped ice, put the ice-bag in a towel, and place +on the patient's head. There should be only one thickness +of the towel between the ice-bag and the head.</p> + +<p>It will be necessary to keep a record of the fever so +that the ice-bag may be withdrawn when it falls below +103° F.</p> + +<p>When the ice melts the bag must be at once refilled. +This is often overlooked by careless mothers.</p> + +<p><b>Cold Sponging</b>.—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.</p> + +<p>Infants to be sponged should be completely undressed +and laid upon a blanket. The sponging should be done +for about fifteen or twenty minutes, after which the child +is wrapped in a dry blanket without further clothing +except the diaper. To be effective it must be done frequently.</p> + +<p><b>Cold Pack</b>.—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 +<span class='pagenum'>[<a name="Page_590" id="Page_590">590</a>]</span> +of this the child is rubbed with a piece of ice, front +and back, for a sufficiently long time to render the surface +cool, but not cold. Children take kindly to this +means of reducing fever; there is no shock and they are +quieted by it.</p> + +<p>Just how long one will rub with the ice depends upon +circumstances. From five to thirty minutes may be employed. +The head should be sponged with cold water +while this is being done and it is a good plan to have a +hot-water bottle at the child's feet.</p> + +<p><b>The Cold Bath</b>.—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.</p> + +<p><b>Rectal Irrigations</b>.—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 <a href="#Page_586">586</a>.)</p> + + +<h4>VARIOUS BATHS</h4> + +<p>Every mother should know how to give any bath that +may be directed by the physician.</p> + +<p><b>The Mustard Bath</b>.—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.</p> + +<p>The mustard bath is exceedingly effective in cases of +shock, great sudden depression, collapse, heart failure, +<span class='pagenum'>[<a name="Page_591" id="Page_591">591</a>]</span> +or in sudden congestion of the lungs or brain. The special +use of the mustard bath is in the treatment of convulsions; +it is also useful for nervous children who sleep +badly. Two or three minutes in the mustard bath, followed +by a quick rubbing, will induce refreshing sleep +in these children. It is not necessary to have more than +one tablespoonful of mustard in these cases.</p> + +<p><b>The Hot Bath</b>.—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.</p> + +<p>The body of the child should be well rubbed while it +is in the bath. In most cases it is advisable to apply cold +water to the head while the child is in the bath. A bath +thermometer should be kept in the water to see that it +does not rise above the temperature desired.</p> + +<p>The hot bath, like the mustard bath, is used to promote +reaction in cases of shock, collapse, etc., and in +convulsions.</p> + +<p><b>The Hot Pack</b>.—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.</p> + +<p>The hot pack is used mainly in disease of the kidney.</p> + +<p><b>The Hot-Air or Vapor Bath</b>.—The child is put in bed +wholly undressed with the bedclothing raised about twelve +inches, and held in that position by a wicker support. +The child's head is of course outside the bed clothing. +Beneath the bed clothing hot air or vapor from a croup +kettle is introduced. This will cause free perspiration in +twenty minutes. It may be continued from twenty to +thirty minutes at a time.</p> + +<p>The vapor bath is used in diseases of the kidney, as +a rule.</p> + +<p><b>The Bran Bath</b>.—In five gallons of water place a bag +in which is put one quart of ordinary wheat bran. The +bag is made of cheese cloth. Squeeze and manipulate +the bran bag until the water resembles a thin porridge. +<span class='pagenum'>[<a name="Page_592" id="Page_592">592</a>]</span> +The temperature of the water is usually about 95° F., +though it may be given with any temperature of water.</p> + +<p>The bran bath is of great value in eczema, or in +rashes about the buttocks, or in delicate skin conditions +when plain water would irritate.</p> + +<p><b>The Tepid Bath</b>.—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.</p> + +<p><b>The Cold Sponge or Shower Bath</b>.—This bath should +be given in the morning in a warm room. A tub should +be provided with enough water in it to cover the child's +feet. This water should be warm because when the feet +are in warm water it prevents the shock which frequently +comes when cold water is applied to any other part of +the body.</p> + +<p>A large sponge is filled with water at a temperature of +from 40° 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.</p> + +<p>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.</p> + +<p>There are a very few children who do not take kindly +to either the cold sponge or plunge. These children do +not react; they remain pale or blue and pinched for some +time after. It may be necessary to discontinue the procedure +or to use water of a higher temperature.</p> + + +<h4>POULTICES</h4> + +<p>Poultices are useful in inflammation and for the relief +of pain. To be of any value they should be applied +<span class='pagenum'>[<a name="Page_593" id="Page_593">593</a>]</span> +frequently—every ten or twenty minutes—and they should +be applied hot.</p> + +<p>Ground flaxseed is the best material for poultices. It +should be mixed with boiling water until the proper +thickness is reached. It may be kept simmering on a +fire. When one poultice is taken off it can be scraped into +the pot and heated over if there is no discharge. Each +poultice should be put into clean muslin, put on the part +and covered with oiled silk. This will help to retain the +heat and prevent the clothing or bed sheet from becoming +wet.</p> + + +<h4>HOT FOMENTATIONS</h4> + +<p>A hot fomentation is simply a clean poultice. Several +thicknesses of flannel are taken, wrung out of very hot +water, covered with cotton batting, and then with oiled +silk.</p> + +<p><b>How to Make and How to Apply a Mustard Paste</b>.—For +infants: Take one part English mustard to six +parts flour, mix with lukewarm water, and spread between +two layers of cheesecloth.</p> + +<p>For older children and adults: Take one tablespoonful +English mustard to three or four tablespoonfuls of +flour, and mix as above.</p> + +<p>Mustard pastes should be made big enough. You can +accomplish a great deal more by putting on a sufficiently +large mustard paste than by simply putting on one the +size of the palm of your hand.</p> + +<p>It should be left on until the skin is distinctly red. The +length of time will depend, of course, upon the strength +of the mustard. Mustard pastes may be put on every +three hours, if necessary, and they may be used for a +week at this interval if the conditions demand it.</p> + +<p>If they are used in pneumonia or other pulmonary +diseases, they should be used large enough to go around +the whole chest. If they are used in heart failure, they +should be big enough to cover the whole trunk.</p> + +<p>When made with the white of an egg they will not +blister. Or if the part is rubbed with white vaseline +before applying, it will not blister and it will be just as +<span class='pagenum'>[<a name="Page_594" id="Page_594">594</a>]</span> +effective. When a mustard paste is removed the red +area should be rubbed with white vaseline and covered +with a clean piece of flannel.</p> + +<p><b>How to Prepare and Use the Mustard Pack</b>.—The +child is stripped and laid upon a blanket, and the trunk is +surrounded by a large towel or sheet saturated with mustard +water. This is prepared as follows: Take one +tablespoonful of English mustard and dissolve it in one +quart of water, slightly warmed. Saturate a towel in +this mixture and apply to the body of the child while +it is dripping. The patient is then rolled in a blanket. +Keep the child in this pack for ten or fifteen minutes. +The mustard pack is not as good as the mustard bath, +but it is all that is necessary in a number of various conditions. +The physician will, of course, decide these matters. +It is simply the duty of the mother to know how +to carry out the physician's instructions.</p> + +<p><b>The Turpentine Stupe</b>.—Take a piece of flannel, big +enough to cover the area which it is desired to affect, +wring it out of as hot water as it is possible. Upon this +sprinkle twenty drops of spirits of turpentine. Place +the stupe wherever it is desired and cover with a piece +of oiled silk or dry flannel. The turpentine stupe is +mostly used in pain of the abdominal cavity. In colic +from acute indigestion it is a very convenient means of +quieting the child by allaying the pain.</p> + +<p>Care should be taken not to allow this form of application +to remain on too long. Take it off when the skin +is red. For continuous use it is not as good as the mustard +paste.</p> + + +<h4>OILED SILK. WHAT IT IS, AND WHY IT IS USED</h4> + +<p>Oiled silk is sold in the drug stores by the yard. It is +one yard wide. It is used to cover any local application +to prevent evaporation into the air or to prevent the +clothing from absorbing the medicament. If a liniment +is applied on cloth to effect a certain result, it may take +some time to do its work. If the wet cloth is covered +with the clothing, the clothing will absorb the medicine +quicker than the body will and thereby defeat the object +<span class='pagenum'>[<a name="Page_595" id="Page_595">595</a>]</span> +in view, in addition to rendering the clothing wet and +nasty. If the application is covered with oiled silk it +cannot escape into the clothing, because the oiled silk is +impervious. The body will be compelled to absorb the +medicine and consequently results will be quicker and +more certain. Many liniments are expensive; to permit +them to be absorbed by the clothing is needless waste +It is therefore economical to apply the oiled silk. +</p> + + +<hr style="width: 65%;" /> +<p><span class='pagenum'>[<a name="Page_596" id="Page_596">596</a>]</span></p> + +<h2>DISEASES OF CHILDREN</h2> + +<p><span class='pagenum'>[<a name="Page_597" id="Page_597">597</a>]</span></p> +<div class="figcenter" style="width: 400px;"> +<a id="v4pg597" name="v4pg597"></a> +<img src="images/v4pg597.jpg" width="400" height="485" alt="The First Blight" title="" /> +<span class="caption">By permission of Henry H. Goddard.</span></div> + +<h4>The First Blight</h4> + +<p>This is one of those truly unfortunate cases +which, so far as present knowledge goes, cannot be +guarded against. Eunice, age 31, mentally 2, is a +low-grade imbecile. There is not in the whole +family, for generations back, a single case of feeble-mindedness, +nor of disease that would undermine +the nervous organization. Close scrutiny does +not reveal a single assignable cause. She came, as +an accident, to blight an otherwise normal family.</p> + +<p>Such cases are few, but unfortunately they do +occur. It is for Eugenics to materially reduce the +possibility of such occurrences.</p> +<hr style="width: 65%;" /> +<p><span class='pagenum'>[<a name="Page_598" id="Page_598">598</a>]</span><br /></p> +<p><span class='pagenum'><a name="Page_599" id="Page_599">[599]</a></span></p> + +<h2>CHAPTER XXXVIII</h2> + +<h4>INFECTIOUS OR CONTAGIOUS DISEASES</h4> + + +<div class="blockquot"><p>Rules to be Observed in the Treatment of Contagious +Diseases—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.</p></div> + + +<h4>RULES TO BE OBSERVED IN THE TREATMENT OF +CONTAGIOUS DISEASES</h4> + + +<p>Every mother should know the elementary principles +involved in the treatment of contagious diseases. They +are contagious because they may be conveyed from +one individual to another or because a person nursing a +victim of a contagious disease may carry that disease +to another person without having the disease herself. +For this reason, certain rules have been established by +the medical profession, which experience has taught +are necessary in order to preserve the health of the +community when such diseases are prevalent.</p> + +<p>The very first rule to which the physician will direct +the mother's attention, when there is a contagious +disease, will be that the child must be "isolated."</p> + +<p><b>What Isolation Means</b>.—Isolation means the complete +seclusion of the patient in a room by himself, so that +<span class='pagenum'>[<a name="Page_600" id="Page_600">600</a>]</span> +no one will see him or come in contact with him except +the physician and the nurse or mother who will +tend him during the entire course of the disease. Isolation +implies more than it would seem to mean. It +implies that every article used during the sickness will +be thoroughly disinfected before it leaves the room in +which the patient himself is isolated. Mothers must +always remember that every article used by the patient +may carry the germs of the disease to some other member +of the family or to some other individual. These +articles are the clothing of the child, the bedclothes, +napkins, handkerchiefs, towels, dishes, knives and spoons, +rags, the various discharges—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.</p> + +<p>Thorough isolation also implies that the nurse shall +frequently bathe and disinfect her person and her clothing, +and that the sick-room itself shall be carefully +dusted with a moist cloth and disinfected from time to +time.</p> + +<p><b>The Contagious Sick-Room</b>.—The contagious sick-room +will be prepared in exactly the same way as the +ordinary sick-room which has been previously described. +In addition, however, it will be safeguarded in the following +manner. A wet sheet will be hung up outside the +door. This sheet will be kept constantly moistened with +a solution of chloride of lime. One-half pound to an +ordinary house-pail of water is the strength of the solution +to use. Every window must be effectively screened +to prevent the ingress and egress of flies and other insects.</p> + +<p><b>Conduct and Dress of the Nurse</b>.—She will remain in +the sick-room all the time unless when she takes outdoor +exercise. Her dress will consist of a long gown +which will entirely cover her person from the neck to +the shoes and will be of plain, white, easily washed +material, without tucks or ruffles or adornment of any +kind. She should wear an ordinary pair of house slippers +made of light leather. Her cap will be large enough +<span class='pagenum'>[<a name="Page_601" id="Page_601">601</a>]</span> +to cover and include her hair and head. When she +leaves the room, she will remove her cap, gown, and slippers, +disinfect her hands in a disinfecting solution and +wash her face, neck, and hands in soap and water. She +should go directly out and in, without coming in contact +with any occupant of the home.</p> + +<p><b>Feeding the Patient and Nurse</b>.—The meals for the +patient and nurse should be left on a table outside the +door of the sick-room, from which place the nurse will +then take them into the room. The utensils used for +these meals should not be used by other members of +the family during the entire sickness. After the patient +and nurse have eaten, the utensils should be placed in +a chloride of lime solution for disinfection. If any +of the food is left over it should be put into a jar in +which it may be disinfected and rendered harmless before +being disposed of.</p> + +<p><b>How to Disinfect the Clothing and Linen</b>.—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.</p> + +<p><b>How to Disinfect the Urine and Feces</b>.—The urine +and the stools should be passed into vessels containing +a solution of four ounces of carbolic acid to the gallon +of water. This vessel should be covered and the mixture +allowed to stand for one hour, after which time it may +be thrown out.</p> + +<p><b>How to Disinfect the Hands</b>.—Any of the following +solutions may be used for disinfection of the nurse's +hands: Creolin, one teaspoonful to the quart of water; +chloride of lime, one-half pound to a pail of water; +formalin, thirty-two drops to a quart of water. A basin +containing one of the above solutions should be constantly +kept standing for the frequent disinfection of the +nurse's hands. After disinfection, the hands should be +washed in plain water and soap. +<span class='pagenum'>[<a name="Page_602" id="Page_602">602</a>]</span></p> + +<p><b>Disinfection of Room Necessary</b>.—The room in which +a contagious patient is confined requires systematic attention +on the part of the nurse. Every other day all +flat or projecting surfaces should be disinfected. Mantels, +window-sills, door knobs, picture moldings, furniture, +chairs, and bed-railings, should be wiped with cloths +moistened in a disinfecting solution. A suitable solution +for this purpose is one containing one ounce of carbolic +acid to the quart of water.</p> + +<p><b>How to Disinfect the Mouth and Nose</b>.—In the +course of all contagious diseases the mouth and throat +of the patient and nurse should be thoroughly disinfected +as a matter of routine. It should be done at +least twice daily unless more frequent disinfection is +called for because of the nature of the disease. In +measles and diphtheria, for example, the nasal and throat +conditions will undoubtedly call for more frequent and +more thorough disinfection than twice daily. This may +also apply to scarlet fever if the throat is involved as +is often the case.</p> + +<p>Pocket handkerchiefs should never be used by a patient +suffering from a contagious disease. The nose +and mouth should be wiped with pieces of gauze or +cheesecloth, cut into small squares for this purpose. These +should be immediately burned after being used.</p> + +<p>To disinfect the throat, a solution of formalin, six +drops to six ounces of water, is effective. To disinfect +the nose, a solution of Glyco-Thymoline is suitable. These +applications should be made by means of an atomizer, a +different atomizer being used for the patient and nurse.</p> + +<p><b>Receptacle for the Sputum</b>.—A cuspidor, or basin, +should be constantly kept at the side of the bed in which +the patient may conveniently expectorate. This utensil +should contain the chloride of lime solution previously +mentioned.</p> + +<p><b>Care of the Skin in Contagious Diseases</b>.—As in all +other sick conditions, the skin of the patient should be +bathed frequently with an alcoholic solution. In the +later stages of measles and scarlet fever it is essential +to anoint the skin while the patient is scaling. This +may be done with carbolated vaseline. Mothers should +<span class='pagenum'>[<a name="Page_603" id="Page_603">603</a>]</span> +understand why this is necessary. These diseases have +a distinct rash or eruption. This eruption practically +kills the skin cells and at a certain period these cells +are cast off by the new growth of skin underneath. This +process is called scaling. In measles the scales are small, +and are cast off in the form of bran like dust. In scarlet +fever, the cells adhere together and are cast off +in large scales. These scales are contagious. They are +very light and will float in the air if dry. The movement +of the patient, changing the bed clothing, etc., +will waft a multitude of these contagious scales into the +air of the room and infect every article they may land +on. This would make the disinfection of the room difficult +and tedious. In order to obviate this tendency experience +has taught us that much of the difficulty and +nearly all of the risk of contagion may be overcome by +rubbing some oily or sticky substance on the skin. By +this method the dust and scales are rendered heavier +than the air, stick together and will not float. During +the scaling period there is a constant itch present which +irritates the little patient. By using carbolated vaseline +to anoint the skin we accomplish two purposes. The +carbolic acid in the vaseline relieves the itch, and the +vaseline itself greases the skin so that the scales remain +in the bed. Each day the nurse changes the +bed-sheet, gathers the scales in the sheet and puts all +in the disinfecting solution.</p> + +<p><b>Convalescence After a Contagious Disease</b>.—Complete +isolation must be kept up until all danger from +contagion is passed. In diphtheria this period is not +reached until the examination of the throat contents +under the microscope is returned negative. In diseases +Which have a rash this period is not reached until all +scaling is completed. Even then, and for a number of +days or weeks, the patient may be taken out for exercise +daily, but must not be allowed to play with +other children until his strength justifies active exercise. +It takes a much longer period to rid the system of the +poison of a contagious disease than most mothers appreciate. +Many children have died from heart failure +after they were considered well simply because the active +<span class='pagenum'>[<a name="Page_604" id="Page_604">604</a>]</span> +exercise overtaxed the heart before the system was +wholly free from the poison of the disease.</p> + +<p>Before the child is removed from the sick-room for +the first time he should have a disinfecting bath. This +bath should be in a solution of bichloride of mercury, +the strength of which should be one part to five thousand +parts of water. The towels used to dry the patient +after the bath should be fresh and should not +have been in the sick-room. He should then be dressed +in clothing which has never been in the sick-room.</p> + + +<h4>DISINFECTING THE SICK-CHAMBER</h4> + +<p><b>How to Disinfect a Room</b>.—The most efficient way +to disinfect a room is by means of formaldehyde gas. +This, however, requires a special apparatus which can +only be used by one familiar with the process. In all +large cities the Department of Health usually undertakes +the disinfection of rooms after any contagious +disease. The next best method is by sulphur.</p> + +<p>When sulphur is employed it should be used in the +form of powder or in small pieces. This is placed in a +shallow iron pan set on a couple of boards in a tub partly +filled with water. The sulphur is moistened with alcohol +before it is set on fire.</p> + +<p>It is always necessary, of course, before disinfecting +by any process to make the room as nearly air tight as +is possible. To accomplish this the windows must be +tightly closed, the doors locked, and the cracks and keyhole +sealed with pieces of paper or adhesive paper. The +room should remain closed for six or eight hours, after +which it should be thoroughly aired for several days.</p> + +<p><b>The After Treatment of a Disinfected Room</b>.—The +walls, ceiling, and all flat surfaces, such as mantels, window-sills, +etc., should be washed with a fresh chloride of +lime solution. The floor should be scrubbed with a four +per cent. soda solution. All carpets and curtains, if any, +should be removed, taken to a vacant lot and thoroughly +beaten and then exposed to direct sunlight for a number +of hours. The room should then be well aired +again for a couple of days before it is again occupied. +<span class='pagenum'>[<a name="Page_605" id="Page_605">605</a>]</span></p> + +<p><b>How to Disinfect the Bed Clothing and Clothes</b>.—The +surest way is to boil them for half an hour; otherwise +they may be left in the room while it is being disinfected. +Spraying the clothes with a spray of formaldehyde +is an effective way of disinfecting them.</p> + + +<h4>MUMPS: EPIDEMIC PAROTITIS</h4> + +<p>Mumps is a contagious disease. It is most common +between the fourth and sixth years. Infants are rarely +affected. The disease is not very contagious, direct +contact being necessary to communicate it. Every case +should be isolated for a period of three weeks from +the beginning of the disease.</p> + +<p>The seat of the affection is the parotid gland which +is located in front of and on a level with the ear. One +or both glands may be affected at the same time or one +may follow the other in succumbing. The duration of +the disease from the time the swelling becomes noticeable +is about ten days. It is contagious for a week +after the swelling subsides. The period of incubation +is from one to three weeks.</p> + +<p><b>Symptoms</b>.—In the majority of cases the first symptom +is the swelling and the discomfort which it causes. +In more severe cases the child feels sick and is listless +for from twenty-four to forty-eight hours. There may +be a headache, vomiting, pains in the back and limbs, +and fever. There is pain in the swelling which is increased +by movement of the jaws and by pressure. The +degree of the swelling varies with the severity of the +attack. It may be very little or it may be so great +as to completely distort, and render unrecognizable, the +face. It must be remembered that, though mumps is +not regarded as an important or dangerous disease, it +may assume dangerous characteristics.</p> + +<p>We sometimes see distressing complications with +mumps. In boys, orchitis, or inflammation of the testicles, +occasionally occur. In girls, ovaritis, or inflammation +of the ovaries may be present. These complications may +be avoided by keeping the patients in bed.</p> + +<p><b>Treatment</b>.—Keep the child in bed until the fever is +<span class='pagenum'>[<a name="Page_606" id="Page_606">606</a>]</span> +gone. Keep him in the house for one week after the +swelling has entirely subsided. He should be put on +a liquid diet while the fever lasts. The bowels should +move each day.</p> + +<p>The mouth should be kept clean by an antiseptic mouth +wash. If there is much pain in the swollen gland, warm, +wet dressings give the best results. Sometimes it is +advisable to paint the gland with belladonna ointment. +If it is not very painful, the most comfortable way to +dress the gland is simply to place over it a large pad +of absorbent cotton held in place by a broad strip of +flannel cloth.</p> + + +<h4>CHICKEN POX. VARICELLA</h4> + +<p>Chicken pox is an affection almost entirely special +to children, in whom it may be observed from their +first year, although it is especially frequent from the +ages of two to six. It appears often in the epidemical +form and spreads by contagion.</p> + +<p>Some doctors are inclined to regard varicella as a +very attenuated form of smallpox, hence the name +"chicken pox," by which it is popularly known. This +opinion is based merely on the analogy between the two +types of skin eruptions and the coincidence sometimes +observed between two epidemics of smallpox and chicken +pox. But the theory falls on considering that, on the +one hand, chicken pox offers no safeguard against infection +by smallpox and does not prevent the effects +of vaccination, and, on the other hand the disease may +occur in children who have been vaccinated or who +have had smallpox. Chicken pox, too, differs essentially +from smallpox in the course of its development.</p> + +<p>After a period of incubation, extending over a fortnight, +chicken pox becomes apparent by such symptoms +as slight shivering, extreme fatigue and a general but +not very intense condition of fever. In less than twenty-four +hours small pink spots will appear on the skin, and +these after a few hours are topped by a vesicle, and the +next day the whole rash shows a vesiculous appearance.</p> + +<p>The vesicles are sometimes small and pointed, sometimes +more voluminous and globular in form. They +<span class='pagenum'>[<a name="Page_607" id="Page_607">607</a>]</span> +are filled with a limpid or a slightly yellowish liquid. +Their base is sometimes surrounded by an inflammatory +ring. By the third day the contents of the vesicle has +become thicker and tends to become purulent. On the +fourth day desiccation commences, and the vesicles +shrivel and shrink in and form small brownish scabs, +which fall about the eighth day. Frequently the child +will scratch them off with the finger nails before they +are entirely desiccated. The vesicles leave small reddish +spots, which generally disappear gradually, almost +always without a scar.</p> + +<p>An eruption of chicken pox does not burst out all +over the body at once, but appears in successive rashes. +It is not confined to any special parts of the body. It +may begin and spread at the same time from the face, +the trunk of the body or the limbs. A dozen pimples +may be seen the first day, while three or even ten times +as many may be visible the next day, and so on for +several days in succession.</p> + +<p>Sometimes the vesicles appear on mucous membrane at +different parts—the mouth, tongue, soft palate and tonsils—and +may also invade the conjunctiva and cornea, or +the larynx, where they will set up laryngitis.</p> + +<p>Owing to the very contagious nature of chicken pox, +the first thing to be done is to provide for the complete +isolation during a period of twelve to fifteen days +of all patients attacked by the disease.</p> + +<p>The treatment of the disease is solely a matter of +hygiene. The more severe the fever the stricter the +diet should be, and in the case of great fever, the diet +should be restricted to broth and milk. If there is no +fever the child need not be placed on any special diet.</p> + +<p>If the intestines are sluggish, they may be stimulated +by administering a dose of castor oil. It is advisable to +make the patient rinse his mouth two or three times +a day with a mouth wash. It is also well to apply a +lotion around the eyes and face, consisting of two per +cent. boracic acid solution with the chill taken off. +Finally, in order to prevent the child scratching the +sores and the consequent danger of inoculation by the +finger nails, it is a good practice to rub a small amount +<span class='pagenum'>[<a name="Page_608" id="Page_608">608</a>]</span> +of carbolated vaseline over the itching parts. It is frequently +found necessary to have the little patient wear +white woolen gloves to prevent scratching and infecting +the sores. If a child scratches the sores on the face +it will leave an unsightly mark which will stay for the +rest of its life.</p> + +<p>The child, of course, should not be allowed to rejoin +his playmates without having had a good bath, and having +had his clothes completely disinfected.</p> + + +<h4>INFLUENZA: LA GRIPPE</h4> + +<p>The most important feature with reference to influenza +in children is its very active tendency to develop complications. +These complications generally affect the respiratory +tract. So we find in children suffering from +grippe an easy disposition to get bronchitis or broncho-pneumonia. +The younger the child the greater the +danger.</p> + +<p>The disease itself, so long as it remains an uncomplicated +influenza, is not of much importance or severity. +The lesson to be learnt, therefore, is to treat the disease +with respect and take every precaution to avoid the +possibility of developing a complication.</p> + +<p>La Grippe is a highly contagious disease. It prevails +epidemically, and after an active epidemic it may remain +in the vicinity for a number of years. It is more frequently +seen in the late winter months and early spring. +The poison of the disease clings to clothing and apartments +as well as to railroad and street cars. The germ +is found in the sputum and in the nasal secretions.</p> + +<p>Sneezing is one of its symptoms and it is one of +the ways by which the disease is spread around. Children +should never be brought near an adult suffering +from influenza. One attack does not render the patient +immune to a subsequent attack as is the case with most +of the contagious diseases. The reverse is the rule with +La Grippe because one attack favors the development of +another attack. It is a common experience for many +people to have influenza every winter or spring.</p> + +<p><b>Symptoms</b>.—If a child "catches" grippe, it becomes +<span class='pagenum'>[<a name="Page_609" id="Page_609">609</a>]</span> +quite sick abruptly. There is usually chilliness, pains +in the muscles all over the body, more or less fever, +sometimes nausea and vomiting. If the attack is a more +severe one, the prostration is more marked, the temperature +higher and the signs of shock and poisoning of +the system are more in evidence. A child a few months +old can get influenza so severely as to cause collapse +and death in thirty-six hours. As a rule the type of +grippe most common in infancy is of a very mild character. +It lasts about a week. Children may be a little +slow in convalescing and it may be three or four weeks +before they regain their health.</p> + +<p><b>Complications</b>.—As has been intimated, the most frequent +complication is bronchitis and the most fatal one +is broncho-pneumonia.</p> + +<p>A congestion of the entire mucous membrane of the +respiratory tract, producing a nasal discharge, a sore +and inflamed throat, pains and a feeling of compression, +with a cough in the chest, may accompany the +disease.</p> + +<p>Gastric symptoms, with vomiting, intestinal disturbance, +diarrhea, with or without mucus and blood, are +quite common in some epidemics.</p> + +<p>Not infrequently we have numerous cases in which +the ear seems to be the vulnerable part. As a consequence +running ears have to receive most of our attention. +When the ears are affected, the glands of the neck +become inflamed. They swell up and add considerable +to the discomfort of the little patient.</p> + +<p><b>Treatment</b>.—Cases of influenza should be isolated. +Children should be put in a room by themselves and +the other children of the family should not be permitted +to see them. The rooms should be disinfected after +the case is over. As complications are the dangerous +element in grippe, we should try to prevent them. This +can be best done by promptly putting the child in bed, +making him comfortable, opening his bowels by castor +oil or calomel. He should be made to drink hot lemonade. +He should be kept on a light diet from which meat +and vegetables are excluded.</p> + +<p>The above treatment will usually suffice in the ordinary +<span class='pagenum'>[<a name="Page_610" id="Page_610">610</a>]</span> +uncomplicated grippe. If complications arise they +must be treated according to the conditions.</p> + +<p>It is well to remember that the degree of prostration +following a rather severe attack of grippe is out of all +proportion to the extent of the disease. These little patients +sometimes suffer considerably and do not regain +their strength promptly. Experience has taught us that +the best thing to do is to send them away. A change +of climate will do wonders for them, more quickly and +more thoroughly than all the medicine we can give them +at home. The seashore is particularly good for them.</p> + + +<h4>DIPHTHERIA</h4> + +<p>Diphtheria is an acute, specific, infectious, communicable +disease. It affects the tonsils, throat, nose, or +larynx. It is most frequently seen in children between +the ages of two and five years, though it may appear at +any time during life. The two sexes are equally liable +to it. The same person may have the disease twice or +more times at different ages. Children suffering from +disease of the nose or throat are more likely to get it +than are others. Such diseases are cold in the head +with running nose, catarrh of the nose and throat, inflammation +of the mucous membranes of the nose or +throat.</p> + +<p>Diphtheria may occur at any time of the year, though +it is more frequent during the cold months. The incubation, +or the length of time between exposure to the +disease and the development of the symptoms, is between +two and five days. In its mild form the disease may be +present without giving any constitutional symptoms. In +its severe form, however, it is one of the most dangerous +diseases of childhood. In large cities it is present all +the year round with more or less frequent outbreaks +in the form of local epidemics. In the country it is +only seen in its epidemic form. It does not arise without +a cause, that is, there is always a preceding case +from which an epidemic springs, though it is not always +easy to trace the connection. The child inhales the bacilli +which cause the disease with the air it breathes. The +<span class='pagenum'>[<a name="Page_611" id="Page_611">611</a>]</span> +bacilli may lodge on toys or other articles from which +the child gets them. Direct infection is usually the mode +of communication through which a child obtains the disease. +The saliva and mucus from the nose contain +the bacilli in large quantities and if a patient coughs +or sneezes they are expelled in this way and infect others. +Frequently a child suffering from a mild form of diphtheria +may attend school and infect others without it +being known that the child has the disease.</p> + +<p><b>Symptoms</b>.—The symptoms vary with the severity of +the attack. There are mild cases, as has been stated, +that give no constitutional symptoms. There may be a +small amount of local disturbance in the throat or nose +and there may be some membrane present, but, for some +reason, there does not seem to be any absorption of the +poison into the system and the child escapes the systemic +disturbance. Even as a local condition these cases vary. +There is always a fever at the beginning, but the child +never seems sick enough to go to bed. If the throat is +examined it will be found to be red and slightly inflamed, +there may be spots on the tonsils, or there may be +a gray film over them. There is no discharge from the +nose and the child does not complain of an excess of +mucus from the throat. The spots may last for a +week and then disappear. These cases are difficult to +diagnose without making a culture, and if the physician +insists upon keeping the child confined to bed while apparently +well the family as a rule object, though it is +absolutely necessary. These are the cases that do great +harm in school, and no mother should object if the physician +insists in taking preventative measures to stop +an epidemic if the bacilli have been found in the child's +throat. She should rather feel thankful that the child +escaped so easily.</p> + +<p>Since the introduction of antitoxin we do not see the +severe cases now, so that a description of them would +not be of any use in a book of this character. Mothers +should, however, know that it is absolutely criminal to +take any chances with a "sore throat." Antitoxin is a +prompt and an absolute remedy if used soon after the +onset of the disease. It is more sure if used the first +<span class='pagenum'>[<a name="Page_612" id="Page_612">612</a>]</span> +or second day, still reliable the third day, but its efficacy +diminishes the longer we postpone its use from the date +of the onset of the disease. When, therefore, a child +complains of being sick and states that its throat hurts, +medical aid should be at once sought.</p> + +<p>The disease may develop in one of two ways. It +may begin as a slight indisposition for a day or two, +and perhaps some soreness of the throat. The fever may +be slight. The child will continue to be sick despite +any treatment given and will get slowly worse until the +fourth or fifth day, when it will be impossible to mistake +the condition.</p> + +<p>At other times the disease begins abruptly. The child +complains of being sick. It may vomit, or suffer from +headache, chilly feelings, and a fever. The glands in +the neck may swell and cause considerable disturbance. +There is, as a rule, an abundant discharge from the nose +and there is an excess of mucus in the throat. Membrane +is seen in the throat. It may cover the tonsils +and spread over the entire throat cavity, or it may extend +up into the nose and over the roof of the mouth. +All the parts are much swollen and breathing is interfered +with, sometimes seriously. If the attack is very +severe there is an active absorption of poison going on +from the throat which soon renders the little patient +intensely sick. There is marked weakness and prostration, +the circulation becomes poor, the pulse rapid and +the child falls into a stupor.</p> + +<p>The physician will, of course, have taken complete +charge of the case before the patient has gone thus far. +The nursing of the case, which may fall to the mother +if no trained nurse is present, is most important. She +should preserve absolute cleanliness of herself and of +the sick room. She should never eat or sleep in the +same room with the patient, and should use a gargle, +which the physician should prescribe, frequently during +the day. She should dress simply, so that whatever is +worn can be changed often and washed easily. Every +article of furniture must be taken out of the sick room +that is not absolutely essential in the care of the case. +If toys are allowed they should be burned as soon as +<span class='pagenum'>[<a name="Page_613" id="Page_613">613</a>]</span> +the child is tired of them, never left around the house +after the case is over. The room should be a large one +and it should be thoroughly aired each day. The floor +should be washed each day with a solution of bichloride +of mercury, and all dusting should be done with a wet +cloth. The bed linen and any rags or handkerchiefs +used should be treated as in scarlet fever. All vessels +in which the patient expectorates should have an antiseptic +in them. The room must be disinfected after the +case is over.</p> + +<p>The patient must be kept in bed during the entire attack. +He must not be allowed to even sit up in bed until +the physician gives him permission. This is a very important +essential in the treatment of this disease, and +the nurse must be held responsible for the conduct of +the patient in this respect. Because of the character of +the poison, there is a tendency to paralysis of the heart, +and frequently children have been allowed to sit up too +soon only to fall back dead in bed. The same thing has +occurred later in the disease when children have been +allowed to play too heartily before the poison had an +opportunity to completely eliminate itself. Nursing children +should be fed on breast milk pumped from the +mother, but they must not nurse it themselves. Older +children can take milk and should depend upon it mostly. +The physician will give any other special directions that +he may think necessary, the duty of the mother being +to see that they are faithfully carried out.</p> + + +<h4>WHOOPING-COUGH</h4> + +<p>Whooping-cough is usually seen in young children. +It may, however, affect a person at any age. It is contagious. +During infancy it is one of the most fatal diseases. +During adult life it is a dangerous condition, +while in childhood it is simply regarded as a mildly contagious +disease.</p> + +<p>It is most contagious during the catarrhal stage,—the +first ten days. Children suffering from whooping-cough +should not be allowed to mix or play with other +children for two months. After an exposure to the +<span class='pagenum'>[<a name="Page_614" id="Page_614">614</a>]</span> +disease it takes about fourteen days for a case to develop. +The danger of whooping-cough is the tendency to develop +pneumonia or bronchitis.</p> + +<p><b>Symptoms</b>.—During the first ten days the child acts +as if suffering from an ordinary catarrhal cold with +cough. This is called the catarrhal stage. There is no +way of telling that whooping-cough is present until the +child whoops. Most children do not whoop until the +expiration of the catarrhal stage, though a very few +do from the beginning of the disease. If a child is +treated for an ordinary cold with cough and does not +respond to treatment, and whooping-cough is epidemic, +it is fair to assume that whooping-cough has been contracted. +When the cough shows a distinct tendency to +be worse at night it is further proof of this assumption.</p> + +<p>When they begin to cough in paroxysms, and whoop, +the second, or spasmodic stage begins. These fits of +paroxysmal coughing are much more severe than spells +of ordinary coughing. These may only be three or four +attacks daily, or the child may have from forty to fifty +such attacks. When children feel these attacks coming +on they seek support, holding on to chairs or they stand +by the mother's knee. The coughing is explosive, rapid, +and forceful, the child fails to catch its breath and is +compelled to take a deep inspiration, which is the whoop; +it then goes on coughing more. The face may become +purple, the eyes protrude, and the veins of the face swell +up. Near the end of the attack the child raises, or +vomits a mass of stringy, glutinous mucus. After it +is over the child is exhausted, there is a more or less +profuse perspiration, and he may be quite dazed. These +attacks are, as a rule, more frequent and more severe +during the night. This stage lasts about one month and +is then followed by the stage of decline, during which +the disease subsides into what appears as an ordinary +bronchial cold.</p> + +<p>It is quite common for these children to get relapses, +especially during inclement winter weather, and go on +whooping for two or three months longer. Their vitality +suffers because their sleep and nourishment is interfered +with, and they become nervous and difficult to manage. +<span class='pagenum'>[<a name="Page_615" id="Page_615">615</a>]</span></p> + +<p><b>Treatment</b>.—Inasmuch as there is no remedy known +that will cure whooping-cough, the best we can do is +to render the patient physically efficient to stand the +severe strain of coughing, which is the worst feature +of the disease. Experience has taught us that those +children do best who spend their entire time out of doors. +We, therefore, advise parents to encourage their children +to play in the open air. There is no exception to +this rule, even in winter weather, unless it is particularly +inclement. If the weather is wet or raw, or if the +child has bronchitis, or is running a fever, it would be +more safe to keep the child indoors, in a well-aired +room, until the temporary conditions pass over, when +they could again resume the open-air treatment.</p> + +<p>Naturally delicate children if under two years of age +should not risk staying out of doors too much in very +cold or raw weather, even if not suffering from any of +the above complications.</p> + +<p>The bedrooms of children suffering from whooping-cough +should be large and thoroughly aired day and +night.</p> + +<p>The nourishment in these cases is of great importance. +They should be carefully fed, and if they vomit with +the paroxysms of coughing, they should be fed small +quantities frequently. Any form of digestive disturbance +is very apt to accentuate the frequency of coughing. +A fluid diet of milk is the best. Milk punches +aid in keeping up the strength; malted milk and eggs +beaten in milk are nutritious and easily digested.</p> + +<p>So far as internal medication is concerned, I have +found pertussin to be the most efficacious remedy. If +it is begun early and in sufficient dosage, it not only +favors an early termination of the disease, but it lessens +the frequency and the severity of the paroxysms. If it +is suspected that the child has been exposed to whooping-cough, +pertussin may be given during the catarrhal +stage with the advantage that it will render the whole +course of the disease milder. If it is given during the +course of an ordinary catarrhal cold, it will in most +cases be as effectual as any ordinary cough remedy. The +dosage should be large enough to produce results. I +<span class='pagenum'>[<a name="Page_616" id="Page_616">616</a>]</span> +have found a teaspoonful every two hours to a child of +three years to be the average dose. In older children +I give two teaspoonfuls every three hours. It is necessary +to continue its use throughout the disease. The +taste of pertussin is pleasant and young children take +it willingly.</p> + +<p>When the disease is inclined to a protracted course, +or when the cough does not subside, especially during +unfavorable weather, it is of great importance to send +the child away. A change of climate, preferably to the +seashore, even for a short time, will act like a charm, +and will cure the cough of whooping-cough quicker than +any other possible measure.</p> + + +<h4>MEASLES</h4> + +<p>Measles is the most widely prevalent, eruptive, contagious +disease. With few exceptions, every human being +"gets" measles. As an uncomplicated disease it is never +fatal, and is not even regarded as dangerous. Because +of this characteristic, however, parents are neglectful +and complications occur, and these frequently prove fatal. +One attack renders the patient immune. It is very +highly contagious and spreads with great rapidity among +those who have never had it. It is not possible to carry +the disease any great distance by a third person or by +means of living objects. It does not, however, cling to +clothing or other objects as long as scarlet fever. Its +period of incubation is from eleven to fourteen days.</p> + +<p><b>Symptoms</b>.—The symptoms develop gradually. A +severe cold in the head is the first and most characteristic +symptom of the disease. There is a discharge from the +nose, swollen and watery eyes, sneezing and a hoarse, +harsh cough. The patient may complain of the throat +being painful and examination will reveal a general congestion +of the parts. There are also headache, lassitude, +pains in the back, and there may be vomiting and diarrhea. +Children in the early stages of measles are tired +and sleepy.</p> + +<p><b>Koplik's Spots</b>.—Three or four days, in rare cases +somewhat longer, before the appearance of the rash there +<span class='pagenum'>[<a name="Page_617" id="Page_617">617</a>]</span> +appears on the mucous membrane of the cheeks small, +bluish white, or yellowish white points, the size of a +small pin head. These points are surrounded with reddened +areas which give the appearance of a general rash +with fine white points upon it. These points resemble +milk particles. They adhere firmly to the mucous membrane +and when an effort is made to remove them it is +found that the underlying surface is ulcerated and excoriated.</p> + +<p>The Koplik spots are not of much value to the mother +other than that they may be relied upon to indicate the +coming disease with which they child is affected. Physicians +look for them as an aid in diagnosis before the +rash would of itself indicate the disease.</p> + +<p>The rash appears on the third, fourth, or fifth day of +the disease. From the day of the infection to the outbreak +of the rash about thirteen days intervene. It is +seen first at the roots of the hair on the forehead, behind +the ears or on the neck. It may be seen first on the +cheeks. The beginning rash appears as small, dark red, +dull spots. At first there are only a few, but they soon +become more numerous, they join together, and soon the +surface looks inflamed as if entirely covered with the +rash. The rash covers the entire body, including the +soles and palms. In twenty-four hours it is at its height +on the face. It spreads downward like a wave, first the +face, then the neck and chest, then the abdomen and later +the legs. By the time it invades the legs it has begun +to fade on the face. It fades slowly in the order of its +appearance. Its duration is about four days.</p> + +<p>The skin is swollen; it burns and itches. The eyes +are swollen and red and intensely sensitive to light. +There is usually a muco-pus discharge from them. The +cough is invariably an annoying feature. The fever is +high and reaches its highest point when the rash is at +its height. As the rash fades the fever subsides.</p> + +<p>When the rash fades, the patient begins to "scale." +The scales of measles are fine, like bran, never in large +patches like the scales of scarlet fever. The amount of +the scaling varies. It may be quite considerable or it +may be so small as to be overlooked. +<span class='pagenum'>[<a name="Page_618" id="Page_618">618</a>]</span></p> + +<p><b>Complications</b>.—The most important and by far the +most frequent complication of measles is broncho-pneumonia. +There may be various conditions affecting the +stomach, bowels, throat, ears, bronchi, and the nervous +system, which may accompany the disease but are seldom +of a serious or important character.</p> + +<p><b>Treatment</b>.—Measles runs a certain course and will +run that course, no matter what we may or may not do. +We cannot stop it, or shorten it, or lessen its severity. +We can only hope to make the patient comfortable and +to prevent the development of complications.</p> + +<p>The child should be put in bed and kept comfortably +warm but not too warm. The room should be kept at +the ordinary temperature of the sick room, 68° 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.</p> + +<p>Should complications arise they should be promptly +cared for by the attending physician.</p> + + +<p><b>SUMMARY</b>:—</p> + +<blockquote><p>1. Measles is the most prevalent infectious disease +of childhood.</p> + +<p>2. The danger of measles has been and is underestimated. +Because of its prevalency many mothers +treat it with less respect than they should, with +the result that fatal complications occur, or the +future health of the child is permanently injured. +<span class='pagenum'>[<a name="Page_619" id="Page_619">619</a>]</span></p> + + +<p>3. Children with measles should be put in bed and +kept in bed and treated as directed above.</p></blockquote> + +<p>The following rules have been formulated by the Department +of Health of New York City, with reference +to measles, and embody precautions that should find general +observance:</p> + +<blockquote><p>1. All children in the family must be promptly +excluded from school attendance.</p> + +<p>2. Careful and continued isolation of the patient must be +enforced until the case is terminated and fumigation has been +ordered by the medical inspector of the Department.</p> + +<p>3. All secondary cases must be reported even if the first +case is still under surveillance of the Department of Health.</p> + +<p>4. Suspected cases must be treated as contagious cases +until a sufficiently long observation has shown that the patient +has a non-contagious disease. All cases will be considered +as measles, if so reported. Any change in the original +diagnosis must be made in writing to the Department of +Health and must be confirmed by a diagnostician.</p> + +<p>5. Physicians must not order the removal of patients to +the contagious disease hospital, or elsewhere, in cabs or other +vehicles, but must notify the Department of Health and the +removal will be effected by a coupé or ambulance of the +Department.</p> + +<p>6. Whenever there is a case of measles in rooms in the +rear of, or communicating with, a store, the inspector is required +to have the store closed at once, or to report the case +for immediate removal to the hospital.</p> + +<p>7. A case of measles must not be removed from one house +to another, or even to a different apartment in the same +house, without the permission of the Department. Such removal +is in direct violation of the provisions of the Sanitary +Code.</p> + +<p>8. No case of measles shall be discharged from observation +until the Department has been notified, the case examined +by an inspector to see if desquamation is entirely +completed, and the premises ordered fumigated. This examination +by the inspector is necessary because the Department +of Health must have official information as to the +completion of desquamation before a child is dismissed from +observation. Other people with children demand this protection. +At no other time is the inspector allowed to examine +the patient. In any case, however, where isolation +has not been maintained and it becomes necessary to remove +the patient to the hospital, a diagnostician will make +an examination.</p> + +<p>It is recommended that physicians provide a special washable +gown for each case of measles. This gown should be +put on before entering the sick-room and taken off outside +<span class='pagenum'>[<a name="Page_620" id="Page_620">620</a>]</span> +the sick-room as soon as the visit is completed. The gown +should be kept in a closet or suitable place, separate from all +other clothing, and the gown, and the closet should be fumigated +after the termination of the case.</p> + +<p>10. In private houses only fumigation may be performed +under the supervision of the attending physician; provided +he follow accurately the directions given in the following +rules and regulations. Upon request a blank will be provided +upon which he must state the manner and extent of the +work performed under his orders and supervision. If satisfactory +to the Department, this will be accepted in place of +fumigation by the Department. It is essential, however, that +he should know that the disinfection has been efficiently +carried out.</p></blockquote> + +<p>In every case of fumigation the following regulations +must be complied with:</p> + +<blockquote><p>All cracks or crevices in rooms to be fumigated +must be sealed or calked, to prevent the escape of the disinfectant, +and one of the following disinfectants used in the quantities +named:</p> + +<p>a. Sulphur, 4 lbs., for every 1,000 cubic feet of air space, 8 +hours' exposure.</p> + +<p>b. Formaline, 6 oz. for every 1,000 cubic feet of air space, +4 hours' exposure.</p> + +<p>c. Paraform, 1,000 grains for every 1,000 cubic feet of air +space, 6 hours' exposure.</p> + +<p>The following disinfecting solutions may be used for +goods, which are afterwards to be washed:</p> + +<p>a. Carbolic acid, 2 to 5 per cent.</p> + +<p>b. Bichloride of mercury, 1-1,000.</p></blockquote> + + +<h4>SCARLET FEVER. SCARLATINA.</h4> + +<p>Scarlet fever is an acute, contagious disease. It begins +abruptly. The child may have a severe attack and +be quite sick from the beginning, or he may have a mild +attack and not be very sick. Usually the fever rises +rapidly, the child vomits and complains of a sore throat. +If the attack is very mild the throat symptoms may not +cause any distress. Frequently, about the third day, +there are patches on the tonsils. Prostration may be +profound if the fever is very high. Convulsions and +diarrhea are sometimes present in very young patients. +It takes from two to six days to develop scarlet fever +from the time the child is exposed to it. The disease +may be caught at any time, but it is most contagious +<span class='pagenum'>[<a name="Page_621" id="Page_621">621</a>]</span> +during the time the patient is scaling. It is not as contagious +as measles. Some children seem to escape even +though directly exposed to it. It is more frequent in +the fall and during the winter, and it is more severe +during the latter months.</p> + +<p><b>Eruption</b>.—The eruption appears at any time after +twelve hours. It may not, however, appear before the +third or fourth day. It lasts from three to seven days, +and only takes a few hours to cover the whole body after +it is first seen. The rash is first seen on the neck or +chest; it appears as a red, uniform blush, but, when examined +closely, small reddish spots may be seen all over +it. If the rash is very faint and of a doubtful character +a hot bath may bring it out. A bright red, well-developed +rash is a sign of good heart action. In the event +of heart failure, the rash fades quickly. Itching is a +constant symptom after the rash is fully out.</p> + +<p>About the eighth day the rash begins to scale or desquamate. +It begins on the neck and chest. It takes +from one to three weeks to scale completely, from the +time it begins to peel. The hands and feet are the last +spots to scale.</p> + +<p>It must always be kept in mind that mild cases are +just as contagious as severe cases, and that a mild case +may cause in another person a very severe attack.</p> + +<p>The throat may be mildly affected or it may be the +most troublesome feature of the case. It is red and +swollen and the child complains of pain during the act +of swallowing. Patches may be seen on the tonsils on +the third day. There is usually a discharge from the +nose and this discharge may be contagious. While the +fever is high, the child is restless, complains of thirst, +and may be slightly delirious.</p> + +<p>One attack is usually all a child has during life, though +there are exceptions to this rule. Complications are +quite frequent with scarlet fever. Inflammation of the +ears and kidneys is most often met.</p> + +<p><b>Measures to be Taken to Prevent Spread of Disease</b>.—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 +<span class='pagenum'>[<a name="Page_622" id="Page_622">622</a>]</span> +sleep with other children for three or four weeks after +all symptoms have been absent. Other children in the +family, who have not been exposed, should be sent away. +All clothing should be changed and washed in soap and +water and then boiled in a carbolic solution. The nurse +should not mix freely with other members of the family. +The sick room should be kept clean, and well aired. It +should be dusted with a wet cloth, and this should afterwards +be burned. There should be no furniture, or +hangings, or pictures in the room other than are absolutely +necessary. The room should not be used after +the case is over until it is thoroughly and completely disinfected.</p> + +<p>During the period of scaling the patient should be +rubbed all over with carbolated vaseline. This allays +itching and prevents the scales flying around. The bed +sheet can be taken off daily with the scales in it, and +immediately put in carbolic water and boiled.</p> + +<p><b>Treatment</b>.—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.</p> + +<p>The diet should be reduced in quantity and strength. +The bowels should move daily. If anything is necessary +to accomplish this, citrate of magnesia is quite satisfactory. +There is no special medicine for the treatment of +this disease. Often it is not necessary to give any. +Good nursing is more essential, and with proper attention +to the bowels, diet, fresh air, clothing, sleep, and +quiet, all will, as a rule, result favorably. Quiet is essential. +Consequently, two persons at a time should +never be allowed in the room with the little patient.</p> + +<p>The family physician will prescribe whatever medicine +is necessary in his judgment, and will meet any complication +as it arises. +<span class='pagenum'>[<a name="Page_623" id="Page_623">623</a>]</span></p> + +<h4>TYPHOID FEVER</h4> + +<p>Typhoid fever is an acute infectious disease. It is +rare in infancy. After the fifth year it is more common. +It is caused by drinking infected water or milk. It is +not a serious disease in childhood, rarely being fatal.</p> + +<p><b>Symptoms</b>.—It may begin suddenly or it may come on +slowly. If suddenly, the child develops what appears +to be an attack of indigestion, has fever, vomiting, and is +prostrated. In cases developing slowly the child complains +of being tired, has a headache, nausea, and fever. +Vomiting is the suggestive and important symptom.</p> + +<p>Diarrhea is usually present. Constipation, however, +may accompany the entire illness. Children may not +complain of an excess of gas as do adults. The abdomen +is tender. The typhoid eruption is rarely seen +in children. They lose flesh steadily and then strength +diminishes rapidly. Headache and delirium at night are +quite common, and the child is dull and indifferent, and +often in a state of semi-stupor.</p> + +<p>In order to tell definitely whether the child has typhoid, +it is necessary to make a blood examination. +There are so many intestinal conditions in children that +simulate typhoid, that a blood examination is imperative.</p> + +<p><b>Treatment</b>.—The patient should remain in bed during +the time fever is present and for a few days after. A +fluid diet, preferably milk, is the most suitable means of +nourishing the child. It may be diluted or given plain +according to the age of the patient. Water is essential +and should be given freely.</p> + +<p>The discharges of the patient should be thoroughly +disinfected in a solution of carbolic acid, 1-20. All +clothing and bed linen should be boiled for two hours. +If the fever remains high cold sponging is advisable. +The attending physician should instruct regarding this +feature, as some children do not stand cold applications +well.</p> + +<p>The average duration of the disease is about six weeks.</p> + +<p><b>How to Keep From Getting and Spreading Typhoid +Fever</b>.—Typhoid fever is a communicable disease, but, +if certain precautions are taken, its contraction +and spread can almost certainly be prevented. +<span class='pagenum'>[<a name="Page_624" id="Page_624">624</a>]</span></p> + +<p>The disease is caused by a specific germ known as the +typhoid bacillus. These germs are found in the excreta +(stools and urine) of persons ill with typhoid fever.</p> + +<p>Failure to properly disinfect these excreta and carelessness +in the care of persons ill with typhoid fever +lead to the transmission of the disease from the sick to +the well by the infection of water, milk or food with the +typhoid bacillus or by direct contact.</p> + +<p>The disease is contracted by taking into the mouth +in some form the discharges from some previous case. +There is no other way. It is, therefore, a disease of +filth and someone is at fault somewhere for every case +of typhoid fever that occurs.</p> + +<p>Bad sanitary conditions, such as lack of drainage, open +cess-pools, sewer gas, decaying vegetable matter, etc., +may favor the contraction of the disease, but cannot +cause it unless the specific germ, the typhoid bacillus, +is present.</p> + +<p>The water supply of a community becomes infected +by the entrance into it of the excreta (stools and urine) +of persons suffering from typhoid fever.</p> + +<p>Milk (in which typhoid bacilli grow and multiply very +rapidly) usually becomes infected by washing out milk +cans with water in which these bacilli are present, or +from the presence of the bacilli on the hands or persons +of those handling milk. Oysters spread the disease when +they have been "freshed" in water rich in sewage and +containing the typhoid bacillus. Flies, whose bodies +have become foul with typhoid excreta, may infect food, +milk, etc. Those who take care of typhoid patients +may contract the disease if they do not at once disinfect +their hands after handling the patient, or clothing +or bedding which has become soiled with the discharges.</p> + +<p><b>How to Keep From Getting Typhoid Fever</b>.—If the +chance of infection is to be reduced to a minimum, all +drinking water, concerning the character of which there +may be the slightest doubt, should be boiled, and all milk, +the handling and care of which is not absolutely beyond +suspicion, should be pasteurized or boiled. All food +supplies (meat, milk, vegetables, etc.), should be carefully +<span class='pagenum'>[<a name="Page_625" id="Page_625">625</a>]</span> +protected against flies, and flies should not be permitted +access to the sick-room, the kitchen nor to the +room in which the meals are eaten. Bathing at all +beaches which have sewers emptying in their immediate +vicinity should be strictly avoided. In the majority of +cases it is probable that the system must be slightly below +par in order that the disease may be contracted; +therefore, all indigestible food, green fruit, etc., which +may set up indigestion or diarrhea, and so render the +system more susceptible to infection, should be avoided. +In addition, the elementary rules of cleanliness and hygiene, +both as to the house and person, should be most +strictly observed. No member of a household in which +a case of typhoid fever occurs should take food in any +form without previously washing the hands.</p> + +<p>Typhoid bacilli enter the body only through the mouth. +If sufficient care be taken to prevent their entrance, the +contraction of the disease can be absolutely prevented.</p> + +<p><b>How to Keep From Spreading the Disease</b>.—In order +to protect themselves and others in the household, persons +caring for or in any way coming into contact with +a case of typhoid fever must constantly bear in mind +that the secretions and excretions (urine, stools, etc.), +of the patient contain typhoid bacilli and are capable of +transmitting the disease to others. The person who +nurses the patient should not do the cooking for the +family. The bedding used by the patient should be +washed separately from that used by others. Special +dishes, plates, knives, forks, etc., should be kept for the +use of the patient alone, and should be washed separately +and thoroughly. Particular attention should be paid to +immediate disinfection of the stools and urine of the patients +until the restoration of health is complete.</p> + +<p>The urine is especially dangerous. It may look entirely +normal and yet contain typhoid bacilli for some +time after recovery is apparently complete. In a few +instances the typhoid bacilli may persist in the stools for +weeks or months after recovery. Such persons are called +"typhoid carriers," and constitute a grave menace to the +health of the community. The best disinfectants are +carbolic acid and freshly slacked lime; both are effectual, +<span class='pagenum'><a name="Page_626" id="Page_626">[626]</a></span> +cheap and easily obtained. Urine or stools to which has +been added one-third of their volume of a solution of +one part of carbolic acid to twenty parts of water are, as +a rule, sufficiently disinfected in half an hour, provided +the mass of the stool is broken up and thoroughly mixed +with the solutions. The best method is to keep the urinal +of bed-pan partly filled with the disinfecting solution +at all times. In this way any germs present in the urine +or stools are almost instantly destroyed. Stools and +urine should never be thrown out on the ground. If no +system of drainage is at hand, they should be very thoroughly +disinfected and emptied into a hole in the ground +and covered with earth. All persons nursing or handling +the patient in any way should be careful to wash their +hands very thoroughly with soap and water before leaving +the sick-room. They should never, while in the sick-room, +touch any article of food or put their hands to +their mouths. Careful observation of the above suggestions +and precautions will almost certainly prevent +contraction of typhoid fever or the spread of the disease.</p> + + +<h4>VARIOUS SOLUTIONS</h4> + +<p><b>Boracic Acid Solution</b>.—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.</p> + +<p>The strength of a saturated solution of boracic acid is +as follows:—</p> + + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Boracic Acid</td><td align='left'>Ounces</td> +<td align='left'>1-1/2</td></tr> +<tr><td align='left'>Hot Sterile Water</td><td align='left'>Pints</td> +<td align='left'>2</td></tr> +</table></div> + + +<p>which means that 2 pints of hot water will completely +dissolve 1-1/2 ounces of boracic acid. If any more boracic +<span class='pagenum'><a name="Page_627" id="Page_627">[627]</a></span> +acid is added the water will not dissolve it because it is +already "saturated." Inasmuch, however, as boracic acid +is harmless, it is perfectly safe to use the liquid part of a +solution which contains some undissolved acid.</p> + +<p>A saturated solution is used in the eyes after it is +strained.</p> + +<p><b>Normal Salt Solution</b>.—A normal salt solution is made +in the following proportions:—</p> + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Sodium Chloride (ordinary table salt)</td> +<td align='left'>Grains</td><td align='left'>128</td></tr> +<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td> +<td align='left'>2</td></tr> +</table></div> + +<p>Normal salt solution is much used in irrigating the +bowel. A mother may safely use it in the proportion of +one heaping teaspoonful to two quarts of water—two +quarts being the size of the ordinary fountain syringe.</p> + +<p><b>Carron Oil</b>.—Lime water and raw linseed oil, equal +parts. This mixture is much used in burns. It should +be made fresh.</p> + +<p><b>Thiersch's Solution</b>:—</p> + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Salicylic Acid</td><td align='left'>Drams</td> +<td align='left'>1/2</td></tr> +<tr><td align='left'>Boracic Acid</td><td align='left'>Drams</td> +<td align='left'>3</td></tr> +<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td> +<td align='left'>2</td></tr> +</table></div> + +<p>Thiersch's solution is a good, mild antiseptic solution, +or wash.</p> + +<p><b>Solution of Bichloride of Mercury (1 to 1000)</b>:—</p> + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Bichloride of Mercury</td><td align='left'>Grains +15</td></tr> +<tr><td align='left'>Common Salt</td><td align='left'>Grains</td> +<td align='left'>15</td></tr> +<tr><td align='left'>Sterile Water</td><td align='left'>Pints</td> +<td align='left'>2</td></tr> +</table></div> + +<p>Bichloride of mercury is one of the most powerful +and poisonous drugs. Solutions made from it should +never be used without special directions from a physician. +In much weaker solutions than the above it is one +of the best antiseptic washes known. It is used to disinfect +wounds, for douches, and for various other purposes, +but always by special direction of a physician.</p> + +<p><b>Other solutions</b>.—Frequently mothers are directed to +use solutions in the proportion of 1 to 500, or 1 to 1000.</p> + +<p>This means that there will be one part of the drug, or of +<span class='pagenum'>[<a name="Page_628" id="Page_628">628</a>]</span> +the liquid medicine, to 500, or 1000 parts of water. For +example if you were asked to make up a solution of bichloride +of mercury in the strength of 1 to 4000, you +would use one ounce of bichloride of mercury to four +thousand ounces of water, or one grain of the mercury +to four thousand drops of water,—one grain being equivalent +to one drop.</p> + +<p>Sometimes solutions are made up on the percentage +basis. For example, a five per cent. solution of carbolic +acid. In this case it would be necessary to take five +ounces of carbolic to one hundred ounces of water, or +five drops of carbolic to one hundred drops of water.</p> + +<hr style="width: 65%;" /> +<span class='pagenum'><a name="Page_629" id="Page_629">[629]</a></span> +<h2>CHAPTER XXXIX</h2> + +<h4>ACCIDENTS AND EMERGENCIES</h4> + + +<div class="blockquot">Accidents and Emergencies—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 +</div> +<p><b>Contents of the Family Medicine Chest</b>.—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,—</p> + +<div class='center'> +<table border="0" cellpadding="4" cellspacing="0" summary=""> +<tr><td align='left'>Bismuth subnitrate</td><td align='left'>dram one</td> +</tr> +<tr><td align='left'>Zinc oxide</td><td align='left'>dram one</td></tr> +<tr><td align='left'>Phenol (95%)</td><td align='left'>drops twelve</td> +</tr> +<tr><td align='left'>Resinol ointment to make</td><td align='left'>ounce +one</td></tr> +</table></div> + +<p>This ointment may be applied to all cuts, bruises, skin +eruptions, chafings and sores of minor importance. It is +one of the best applications for chafing of the skin in +babies. +<span class='pagenum'>[<a name="Page_630" id="Page_630">630</a>]</span></p> + +<p>The medicine chest should also contain a small jar of +Unguentine for burns; one-tenth grain calomel tablets +for a cathartic for baby to be used as explained in the text +of the book, or as advised by the physician. It may also +contain tablets for colds and for other purposes as suggested +by the family physician. It should never contain +medicines the use of which is not thoroughly understood +by the mother. It is a wrong practice for mothers +to keep medicines to use for the same ailment at a subsequent +time. The ailment may not be the same and frequently +the medicine itself deteriorates, or it may get +stronger with age. Many medicines are made with alcohol +in them. If kept for some time the alcohol evaporates +and leaves a concentrated mixture which, if given in the +dose meant for the fresh preparation, may poison a child. +Such cases of poisoning are on record. The same argument +applies to powders. Certain drugs lose their +strength, some absorb moisture, others change their chemical +strength if kept mixed with other chemicals. They +should be thrown away after the case is over if they +have not been used. It is a dangerous practice to keep +medicines around if there are children in the family.</p> + +<p><b>Foreign Bodies in the Eye</b>.—Particles which accidentally +lodge in the eye are usually located on the under +surface of the upper lid. They are sometimes, however, +found on the ball of the eye or on the inner aspect of +the lower lid. Foreign bodies which are propelled into +the eye with great force, as iron specks which railroad +men frequently get sometimes imbed themselves into +the eye-ball and have to be cut out or dug out. The +entrance of the foreign particle is always accompanied by +a flow of tears which is nature's way of removing them. +The offending object may escape through the tear duct +into the nose, or it may be simply washed out with the +flow of tears. Rubbing the well eye will cause a flow of +tears in both eyes and may facilitate removal of the foreign +matter. Blowing the nose may force the particle +into the tear duct. The use of the eye cup may help in +ridding the eye of the body. The same object may be +accomplished if the eyes are immersed in a basin of +water and opened wide. Then by moving the eyes +<span class='pagenum'>[<a name="Page_631" id="Page_631">631</a>]</span> +around the particle may be washed out. If the particle is +located on the under surface of the upper lid it may be +promptly removed by pulling the upper lid forcibly down +and over the lower lid. The eyelashes of the lower lid +act as a brush and as a rule quickly remove the irritant if +the procedure is carried out adroitly. Everting the +upper lid is a means of locating the body and in making +possible its removal by a small camel's hair brush or corner +of a handkerchief. To evert the upper lid it is +necessary to employ a guide. A match stem may be used +in an emergency. This is laid across the middle of the +upper lid, the eye lashes are grasped with the fingers of +the other hand and the lid is bent over the match stem +and turned up thus everting or turning inside out the +entire upper lid. The procedure may be facilitated if the +patient is instructed to look down while the operator is +drawing the eye-lid upward.</p> + +<p>If the particle cannot be easily removed by any of the +above methods it is not safe for an uninstructed individual +to go any further. The eye is an exceedingly delicate +organ and may be permanently injured by unnecessary +irritation. It is always safer and it may be cheaper in the +long run to consult a competent oculist in such cases.</p> + +<p>After the removal of any object from the eye, it is desirable +to frequently wash it out with a saturated solution +of boracic acid. This mixture will allay any inflammation +and will tend to restore the normal condition more quickly +and more satisfactorily than if the eye were left to heal +itself.</p> + +<p><b>Foreign Bodies in the Ear</b>.—When a foreign body +gets into the ear mothers are unnecessarily alarmed because +of a failure to appreciate that the ear is a closed +passage. It is impossible for any object to get into the +ear itself; the depth of the external passage is only about +one inch in an adult. At this point the passage is completely +closed by the drum membrane. Most of the harm +is done by ignorant meddling, not by the object itself.</p> + +<p>Children frequently put foreign bodies in the ear, as, +buttons, pebbles, beans, cherry stones, coffee, etc. The +very first thing for the mother to do when she learns that +her child has put "something" in its ear is to keep cool, +<span class='pagenum'>[<a name="Page_632" id="Page_632">632</a>]</span> +and try to find out what the something is. It is essential +to know what the article is because different articles are +treated differently. For example if we try to remove a +bean or pea with a syringe, the liquid will cause the +pea or bean to swell and result in wedging it in so firmly +that it will be impossible to dislodge it in this way.</p> + +<p>If the object is hard, as a marble, button, pebble, bead, +the greatest care must be exercised. Try to make the +object fall out. To effect this, turn the child's head +downward with the injured ear toward the floor. Then +pull the lobe of the ear outward and backward so as to +straighten the canal. A teaspoonful of olive oil poured +into the ear will aid in its expulsion. If after the oil is +poured in, the head is suddenly turned as above described +the object will fall out. A very effective way to remove +a hard object is to take a small camel's hair brush and +coat the end with glue, or any other adhesive substance, +then place it in contact with the object and permit it +to remain long enough to become firmly attached after +which it may be gently pulled out with the object attached. +Never employ an instrument in the ear to remove +a foreign body.</p> + +<p>When a live insect or fly enters the ear a number of +safe methods may be developed. If the ear is immediately +turned to a bright light the insect may come out of +its own accord. It may be floated out with salt water, or +it may be smothered with sweet oil or castor oil after +which it may be floated or syringed out. If it is necessary +to employ a syringe this should be used gently. A +foreign body may remain in the ear for days or weeks +without doing any harm. This suggests that any unnecessary +poking or prying should not be undertaken, +because this may wedge it in tighter and to injure the +drum membrane.</p> + +<p><b>Foreign Bodies in the Nose</b>.—Children may put any +of these articles into the nose. Very often they do, and +do not know enough to tell. If such is the case the first +symptom calling attention to the fact that something is +wrong is the appearance of a thick foul discharge from +one nostril or some obstruction to breathing on the same +side. +<span class='pagenum'>[<a name="Page_633" id="Page_633">633</a>]</span></p> + +<p>When the foreign body may be seen the child should be +made to blow the nose, first closing the well side with the +finger. If this does not expel the object the child should +be made to sneeze by tickling the free nostril with a +feather or by taking snuff. The mother should never permit +the use of instruments by one unskilled in an effort +to rid the nose of an obstruction. There is great danger +of seriously injuring the delicate structure of the nose in +this way or of pushing the object so far in that it may +necessitate an operation to extract it. It is much safer +to seek medical aid before any damage is effected. It +seldom does harm to wait until the right assistance is +at hand; it often does serious harm to be too smart in +these little matters.</p> + +<p><b>Foreign Bodies in the Throat</b>.—If the foreign body is +in the upper part of the throat and can be seen it may +be removed with any instrument that can grasp it. The +child may be immediately held up by its feet when the +article may be shaken out. If it is further back or in +the air passages the child should be made to vomit by +tickling the throat with a feather or with the finger held +in the throat till it does vomit.</p> + +<p>When the object interferes with breathing a physician +should be sent for in a hurry. In the meantime the +family may try to dislodge it by having the child bend +forward or by holding it with the head downward and, +while in this position, sharply striking the back with each +cough. Striking the chest when in this position may +effect the same purpose. If no success follows this procedure +try the reverse position. Have the child bend +backward over the arm of a sofa, for example, or put +him in bed with the body hanging out of the bed face +upward. If none of these effect relief you must depend +upon the skill of the physician.</p> + +<p><b>A Bruise or Contusion</b>.—A bruise or contusion is an +injury to the tissues underneath the skin, but this does +not imply that the skin itself is opened or damaged. In +every bruise the small blood vessels are ruptured, and +the blood collects in the tissues causing distention, swelling +and pain. The blood is held in the tissues, it is stagnant, +becomes dark in color and so produces the bluish +<span class='pagenum'>[<a name="Page_634" id="Page_634">634</a>]</span> +discoloration that we see in all bruises. The color varies +according to the extent of the collected blood. At first it +is red and inflamed looking, then purple, then black, then +greenish and finally citron. The so-called "black-eye" is +a typical example of this degree of bruise. After a +bruise the parts swell from the collection of blood and +from the accompanying inflammation. This causes pain +which persists for a day although the spot may be sore +and tender for a week or more.</p> + +<p>In all mild varieties home remedies may suffice, but +in the more serious and extensive bruises it is advisable +to seek medical assistance. It is essential to completely +put the part to rest and to elevate it. This will relieve +the pain and favor the absorption of the exuded blood. +If the bruise is on the foot, the leg should be elevated until +the foot is higher than the hip. If, on the hand, it +should be so held that it will be higher than the elbow and +it may frequently be held higher than the shoulder to relieve +the throbbing and the pain.</p> + +<p>As a rule, cold should be applied as soon after the injury +as possible, cloths wrung out of ice water, or a piece +of ice may be bound on the part for a short time. The +object of the cold is to stop the internal bleeding. If +the injury is slight, as are most of the injuries of the +household, the mother may apply repeated cloths wrung +out of very hot water. This procedure tends to aid the +immediate absorption of the blood and prevents a discoloration +of the part. If there is great pain relief may +be afforded by applying a firm bandage saturated in the +lead-water and laudanum mixture which may be obtained +in the drug store under the name of lead and opium +wash. The bruised part should be massaged every day +and a simple ointment may be applied to soften the inflamed +area.</p> + +<p>If any complication arises in the treatment of a bruise, +it will be necessary to consult a physician.</p> + +<p><b>Wounds</b>.—A wound implies an injury to the skin in +addition to injury to the underlying parts to a lesser or +greater extent. The skin may be opened by cutting, or +stabbing wounds; or it may be punctured, torn, contused, +or bruised open. These injuries are effected in +<span class='pagenum'>[<a name="Page_635" id="Page_635">635</a>]</span> +various ways. We speak of machinery or mechanical +wounds, or gunshot wounds, bites, cuts, stabs and other +varieties of wounds.</p> + +<p>It is very important to know exactly how a wound is +produced and the nature of the instrument which opened +the skin. We try to obtain this information in order to +estimate the probable degree of poison that may or may +not have entered into the wound.</p> + +<p>The first thing to do in treating wounds is to stop the +bleeding. If the patient is suffering from shock he +should be given active treatment for this condition as +described elsewhere. If the wound contains any foreign +bodies these should be removed. The wound +should then be cleansed, closed and dressed and kept at +rest. If the wound is poisoned, or if there is any fear +that lockjaw may arise, or if the wound has been caused +by a mad dog it will require special treatment.</p> + +<p>It is far better not to interfere if you do not know +what to do than to do harm. One should offer no advice +if they are not qualified to give advice. Much harm +has resulted from doing the wrong thing in these cases. +The instruction in the following pages is given so that +the average mother may know what to do in emergency +but not with the intention that she may regard her knowledge +as sufficient to dispense with the aid of the physician.</p> + +<p><b>Arrest of Hemorrhage</b>.—When there is a wound there +is always bleeding; this means that some blood vessels +have been cut or torn open allowing blood to escape. +The character of the hemorrhage will determine the nature +of the treatment to be employed. On general principles, +the first thing to do in the presence of bleeding is +to elevate the part, if that is possible. If there is simply +a general oozing of blood, it may be controlled and +arrested by pressure. This pressure should be steady +and prolonged. It is best accomplished by wetting a +clean handkerchief or a pad of gauze in ice cold water, +placing this on the part and binding it on firmly with a +bandage.</p> + +<p>If the discharge of blood flows in a steady stream and +is rather dark the hemorrhage is coming from a vein. +<span class='pagenum'>[<a name="Page_636" id="Page_636">636</a>]</span> +We know that veins carry blood toward the heart so +that any pressure or constriction employed to stop a +venous hemorrhage should be tied on the side of the +wound further removed from the heart. Inasmuch as +veins have soft walls the right kind of pressure will in +most instances stop the bleeding. The part should be +elevated after the pad is adjusted in place. Any tight +band on the limb as a garter or sleeve band should be +removed as they tend to interrupt the return circulation.</p> + +<p>If the hemorrhage is from an artery the blood is bright +red. It spurts out forcibly, is difficult to control and demands +immediate attention. Arteries carry the blood +from the heart to the extremities. They beat with every +pulsation of the heart so that blood coming from an +artery spurts with every pulse beat. Even a small +artery may be responsible for a very considerable hemorrhage +in a very short time. Whatever is done must be +done quickly. The parts should be freed from all clothing +and if possible elevated. Pressure may be tried, if +it succeeds it must be strong and steady pressure. The +point to press must be on the heart side of the bleeding +artery since the blood stream is coming that way—this +the mother will note is the reverse from treating bleeding +from a vein as previously explained. The artery +at this point may be felt beating. It is frequently necessary +to clamp the whole limb to stop an arterial hemorrhage. +This may be done in the following manner. +Take a strong piece of cloth or bandage and tie above +the bleeding point. Insert a short piece of stick between +the bandage and the limb and twist around until +the bleeding stops. This should not be kept on longer +than one hour. A tourniquet of this character shuts off +all the blood in the limb and if kept on too long the parts +may mortify. The best means to stop a hemorrhage of +this character is by means of a rubber bandage sold for +the purpose. It is applied by stretching at every turn. It +exerts uniform pressure and in this way does no injury to +the parts. All these measures are, of course, only temporary +expedients as the artery will finally have to be +caught and tied by a physician.</p> + +<p><b>Removal of Foreign Bodies From a Wound</b>.—When +<span class='pagenum'>[<a name="Page_637" id="Page_637">637</a>]</span> +the foreign bodies are large enough to be seen they may +be picked out with the fingers after the hands have been +rendered sterile. Smaller bodies may be picked up with +forceps, or they may be washed out with water that has +been boiled and cooled slightly, or a bichloride of mercury +solution in the strength of 1 to 2000 may be used; or a +normal salt solution may be used. As a general rule the +physician should be allowed to undertake this procedure +so that you may not be blamed for something that may +come up later.</p> + +<p><b>Cleansing a Wound</b>.—The simplest way, and the most +effective, to cleanse a wound, no matter how caused, is +to procure a brush and paint it thoroughly with tincture +of iodine. The iodine should be painted right into the +raw wound, it is then bound up and left if it is small and +does not need any stitching. When the physician comes +he can attend to any further procedure that may be +necessary.</p> + +<p><b>Closing and Dressing Wounds</b>.—If the wound is +small, its edges may be drawn together with narrow +strips of adhesive bandage after it has been painted with +iodine. It is then bound up and kept at rest. It should +be inspected the following day to see if it is healing +properly.</p> + +<p>If the wound is large or torn, it should be seen by a +physician and dressed and closed by him. All wounds +do better if they are kept at rest.</p> + +<p><b>The Condition of Shock</b>.—When a person suffers a +serious injury, loses a large quantity of blood, or is +subjected to a profound emotion, it affects the vital +powers to such an extent that the individual is said to +be suffering from shock. Shock expresses itself in varying +degrees of apathy. The patient may or may not be +conscious. If conscious he gives no evidence of feeling, +he is silent and motionless although he will respond to +directions and may answer questions. The eyes are dull +and listless, the face pale and pinched, and the general +expression is apathetic. The skin is cold and there may +be perspiration; the pulse is feeble and irregular, and +the breathing is shallow. The whole attitude of the victim +is one of indifference and apparent inability to +<span class='pagenum'>[<a name="Page_638" id="Page_638">638</a>]</span> +appreciate the seriousness of the situation and a seeming +immunity to pain or discomfort.</p> + +<p>When this condition exists it must always be regarded +as serious because the patient may die as a direct result +of the condition of shock. The various symptoms depend +upon a temporary paralysis of the blood vessels +which deprives the brain of blood. There is always a +certain degree of shock with all injuries. Mothers should +know what to do in these cases before the physician +comes. The general treatment in all cases is to keep the +patient warm and quiet, and to use stimulants carefully.</p> + +<p>The patient should be put in bed or on a flat surface +with the feet higher than the head. If raising the feet +should cause the face to become blue it will be advisable +to restore the patient to the horizontal posture. Artificial +heat must be applied to the patient's body and extremities +by means of hot water bags, bottles, bricks, plates, or +any other handy device. Blankets should be put around +the patient and every possible means resorted to, to maintain +body heat. Mustard plasters may be put to the +heart, spine and shins. Stimulants are necessary, such +as hot black coffee if possible or hot water, in which a +small portion of brandy may be put. If brandy is not +obtainable the patient may take aromatic spirits of ammonia +in hot water every twenty minutes for a number +of doses. In every case of shock a physician should be +sent for immediately.</p> + +<p><b>Dog Bites</b>.—When a child is bit by a dog every effort +should be made to get the dog. It should be kept in a +safe place for a week so that it may be definitely known +whether it is sick or not. If the dog dies within a few +days after biting anyone it may be assumed that he had +rabies. Its head should be sent to the local health authorities +who can tell after examination if it was mad. If there +is any reason to assume that the dog was infected, the +child should receive the Pasteur treatment. This treatment +will, if conducted under favorable circumstances, +absolutely prevent hydrophobia.</p> + +<p>The mother should sterilize the wound as thoroughly +as possible. This may be done by using pure hydrogen +peroxide. A little piece of absorbent cotton is wound +<span class='pagenum'>[<a name="Page_639" id="Page_639">639</a>]</span> +round the end of a tooth-pick or match, dipped in the +peroxide and the incision thoroughly rubbed clean. This +may be done a number of times to ensure thorough +cleansing. No effort should be made to cauterize the +wound. It is not considered proper to employ this +method with dog bites. When the physician examines +the wound he may or may not open it further for more +extensive inspection and sterilization.</p> + +<p>Mothers should remember that there are thousands +of bites by dogs that never cause any trouble, and if it +is known that the dog is healthy no worry need trouble +the family. It is also wrong to inform the child of the +probability of hydrophobia. The child may worry himself +sick with fear and if the mother is nervous and excitable +he is apt to be made sick with the dread of what +may follow. It is better, therefore, to remain quiet, to +keep cool, and not to excite the little patient at all.</p> + +<p><b>Sprains</b>.—Every joint is held together by ligaments +which are attached to the bones forming the joint. If +these ligaments are subjected to a sudden twist in a direction +in which the joint is not constructed to move, the +resulting injury is known as a sprain. The ligaments +are stretched, though they may be torn apart and even +small pieces of the bone may be split off if the wrench +is great enough. The injury is an exceedingly painful +one and frequently renders the limb useless for some +time. It is always accompanied with some degree of +swelling and more or less inflammation.</p> + +<p>A sprained joint should be immediately put at absolute +rest. The best dressing is the lead and opium wash. +Two pints of it may be obtained at the drug store. Pour +into a large bowl, saturate a large piece of thick absorbent +cotton, wrap around the joint and bind in place. +This dressing may be repeated as often as the cotton +becomes dry. When the swelling has disappeared and +the pain is gone, it is desirable to have the joint supported +with strips of adhesive bandage. These must be put on +in a certain way in order to properly support the joint. +Consequently a physician should put them on. If a sprain +is not attended to effectively there is danger of the joint +being more or less incapacitated for life. +<span class='pagenum'>[<a name="Page_640" id="Page_640">640</a>]</span></p> + +<p><b>Dislocations</b>.—A dislocated joint is one that has been +put out of place. It is best to allow a physician to treat +a dislocation. Unskilled handling of a dislocated joint +may not only increase the damage but it may permanently +put the joint out of business. Until the physician arrives +the part should be kept absolutely at rest.</p> + +<p><b>Wounds of the Scalp</b>.—Children frequently get injuries +of the scalp. These wounds bleed freely and as a +rule they occasion a great deal of unnecessary worry +and apprehension. Usually they are not of much importance. +We must keep in mind, however, the probability +of fracture as a consequence of severe injury. The +first thing to do when there is bleeding from the scalp is +to cut or shave away the hair surrounding the wound. +This should be done for an inch around the wound so +that thorough disinfection may be possible. The wound +should now be cleansed as previously instructed and an +effort made to stop the bleeding. The best method is to +first apply pads of gauze wrung out of very hot water. +When success is evident a pad made of boiled cotton +should be placed on the wound and held tightly in place +for some time. If the wound is of such a character as to +demand stitches a physician should of course put them +in.</p> + +<p><b>Run-Around: Felon: Whitlow</b>.—When pus germs +enter around a finger nail and lodge in the soft tissue a +"run-around" is the result. It is accompanied with pain, +swelling, redness and inflammation. The loss of the nail +may follow.</p> + +<p>A felon or Whitlow is a more extensive and a more +serious condition. It is not always possible to trace +the cause of a felon. The fact that germs gain an entrance, +however, is soon established. Sometimes a bruise, +or scratch, or a wound is the primary cause. The last joint +of any of the fingers may be the seat of a felon. A +end of the finger becomes hot, tense, swollen and very +painful; the pain is intense if the hand is held down. The +surface may or may not be red. There is as a rule some +fever. If the felon is on the little finger or thumb the +condition is worse than on the others as a rule,—the inflammation +extending to the hand and often into the arm. +<span class='pagenum'>[<a name="Page_641" id="Page_641">641</a>]</span> +The condition affects the palmar surface of the fingers. +If the felon results in the "death" of the bone, the last +joint will have to be taken off and the hand may be +distorted, crippled, and rendered permanently disabled. +Blood poison may set in and death is possible as a result +of this complication.</p> + +<p><b>Treatment</b>.—Every effort should be made to abort a +felon. Continuous application of equal parts of alcohol +and water night and day may abort it. Tincture of +iodine applied to the entire end of the finger may be effective. +The hand must be at rest, carried in a sling +during the day and slung over the head to the bed-board +at night. If these efforts are not successful after twenty-four +hours hot poultices should be resorted to, but they +must be changed every twenty minutes. If, at the end of +another twenty-four hours, there is no improvement the +finger must be freely cut open by a surgeon and the +poultices continued.</p> + +<p><b>Treatment of "Run-Around."</b>—Apply iodine freely, +cold applications, and if the inflammation persists use +poultices. It is frequently necessary to incise the run-around. +Patients suffering from either of these conditions +need general tonic treatment and should be under +the care of a physician.</p> + +<p><b>Burns and Scalds</b>.—Burns result from undue exposure +to dry heat. Scalds are produced by the action of hot +liquids and steam.</p> + +<p>There are always produced two results from a burn +or a scald. First the local effect, and, second, the general +effect. The general effect may produce shock, the +symptoms of which have been described in the previous +pages. The degree of shock depends upon the extent of +the local injury and may be severe enough to result in +death. If the local injury covers more than two-thirds +of the body death as a rule takes place within two days.</p> + +<p><b>How to Extinguish Burning Clothing</b>.—The thought +to keep in mind is to smother the flames effectively. If +we deprive the flame of all air or oxygen it will immediately +subside. This may be done quickly by wrapping +the burning part in a carpet, rug, blanket, overcoat or +any large woolen material at hand. If none of these +<span class='pagenum'>[<a name="Page_642" id="Page_642">642</a>]</span> +articles are at hand the victim may roll on the floor and +try to smother the flame by pressure, aided by the hands. +It is a good plan to throw water on the patient immediately +after the fire has been put out, so as to extinguish +the smoldering fire.</p> + +<p>When a person is scalded by steam or boiling water +or other liquid, it is advisable to pour cold water freely +over the wound.</p> + +<p><b>How to Remove the Clothing</b>.—When it is necessary +to remove the clothing it is essential to be gentle in order +not to do greater injury. The clothing must not be pulled. +The garment should be cut so that they fall off. If any +part sticks to the skin, it must be left, not torn away. +Later, it may be removed by moistening it with salt +water.</p> + +<p><b>Treatment of Scalds and Burns</b>.—All slight burns or +scalds may be effectively treated with Unguentine. This +substance may be obtained in any drug store. It is spread +on a cloth and applied directly to the injured part, bound +securely on and renewed every day until the wound is +healed. If Unguentine is not readily obtainable the part +may be covered with any of the following mixtures or +oils: carbolated vaseline, equal parts of linseed oil and +lime water, olive oil, castor oil or kerosene, cloths soaked +in a solution of baking soda, or a solution of phenol +sodique.</p> + +<p>In severe burns or scalds the mother should not attempt +to treat the child. A physician should be summoned +at once. The child may be given a little whisky or brandy +in warm water, and if the pain is great a dose of laudanum +may be given. The dose of laudanum is one drop for +each year of life. If the child has a chill he may be put +into a warm bath of 100°F. It is not wise to cut a burn +blister. The water may be let out by puncturing with a +sterile needle, but the skin must be left intact until the +new skin is grown. The treatment of burns must be done +with the greatest cleanliness because if infected with +germs they may prove serious.</p> + +<hr style="width: 65%;" /> +<p><span class='pagenum'>[<a name="Page_643" id="Page_643">643</a>]</span> +</p> + +<h2><a name="MISCELLANEOUS" id="MISCELLANEOUS"></a><b>MISCELLANEOUS</b></h2> + +<hr style="width: 65%;" /> +<p><span class='pagenum'>[<a name="Page_644" id="Page_644">644</a>]</span><br /></p> +<p><span class='pagenum'><a name="Page_645" id="Page_645">[645]</a></span> +</p> +<h2>CHAPTER XL</h2> + +<h4>MISCELLANEOUS</h4> + + +<div class="blockquot"><p>The Dangerous House Fly—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.</p></div> + + +<h4>THE DANGEROUS HOUSE FLY</h4> + +<p>Mothers should become thoroughly acquainted with +the grave consequences which may result from fly-infected +foods, and from the possible carriage of disease +by means of flies, even where foods are carefully protected. +The transmission of the following diseases by +means of flies has been conclusively proven: typhoid +fever, tuberculosis, cholera, Oriental plague, inflammation +of the eyelids, serious infection of wounds. Summer +diarrhea of children is also transmitted in this way.</p> + +<p>Typhoid fever and summer diarrhea of children in +this country, and cholera and Oriental plague in the +countries in which those diseases exist, may be transmitted +through the various foods that are eaten in an uncooked +state, if infected by flies, through cooked foods +infected by flies after the process of cooking, through +drinking water which has been infected by flies, and +through milk similarly infected. Fruits are especially +likely to be infected by the small fruit fly commonly +found around markets and stands. Fish may be infected +by flies, and in consequence will undergo rapid +decomposition. Decomposition caused in this way has +<span class='pagenum'>[<a name="Page_646" id="Page_646">646</a>]</span> +resulted in many cases of diarrhea and dysentery. What +is commonly known as fly speck is the excreta of the +fly, and frequently contains virulent disease germs. These +specks are often found on foodstuffs that have not been +properly protected.</p> + +<p>Transmission of disease may also occur by the infection +of open wounds through contact with infected flies. +This is true of all pus formation in wounds. The simple +contact of a fly infected with the disease may cause +Oriental plague, sore eyes, and possibly granular eyelids. +A fly infected with dysentery or typhoid fever may cause +either of these diseases by simply coming in contact with +the lips of susceptible persons.</p> + +<p>The fly in the house should be relentlessly pursued and +destroyed. The house which is carefully screened and +protected from flies is infinitely safer than one not so +protected. In the spring of the year the house fly begins +to take on life. Eggs which were laid the preceding fall +begin to hatch. At first the fly is only a little worm wriggling +in some pile of filth. The eggs are usually laid and +the grub developed in a manure pile or some mass of +garbage or other filth. Before the grub develops into +the fly it is easily destroyed. If everything in and about +the house were kept scrupulously clean, and if every +manure pile were kept carefully screened or covered so +as to protect it from flies, there would be no difficulty in +preventing the fly nuisance. The most effective way to +accomplish this is to destroy the breeding places. The +importance of this may be seen when it is considered that +one fly produces one hundred and twenty-five millions or +more of its kind in one season.</p> + +<p><b>Stables</b>.—Manure is by far the commonest material in +which the fly lays her eggs. All stables should be kept +scrupulously clean. No manure should be allowed to accumulate +where it will be exposed to flies for even a few +minutes. Immediately after it is dropped by an animal, +it should be removed and covered. Manure may be +treated with considerable quantities of lime without interfering +with its fertilizing value, and in this way the development +of the eggs laid in it by the flies can be practically +prevented. The floors of stables should be thoroughly +<span class='pagenum'>[<a name="Page_647" id="Page_647">647</a>]</span> +flushed with water at least once in every twenty-four +hours.</p> + +<p><b>Privy Vaults</b>.—Human excrement also affords an excellent +breeding place for flies. In army camps the +latrines are the points from which much infection is transmitted +to troops, and thousands of the men have lost +their lives by contracting typhoid fever transmitted in this +manner. During the summer time all open vaults and dry +closets should be treated continuously with lime, crude +creolin or crude carbolic acid, and they should be carefully +cleaned out at frequent intervals.</p> + +<p><b>Garbage</b>.—As a medium for the development of flies, +garbage may be considered next in importance to excreta. +The eggs of the fly hatch in about twenty-four hours, and +garbage which is retained in the kitchen for that length +of time may contain flies in the grub stage. To prevent +this development, all garbage should be covered and +pails should be emptied as often as possible. In country +districts garbage should be burned in the kitchen or +buried in the garden at frequent intervals, twenty-four +hours being the maximum time it should be retained.</p> + +<p><b>Vacant Lots</b>.—Vacant lots frequently contain appreciable +quantities of organic matter in a state of decomposition, +affording favorable breeding places for flies. +These vacant areas should be maintained in a state of +scrupulous cleanliness.</p> + +<p><b>Foodstuffs</b>.—In order to prevent contamination of +foodstuffs, all foods that are eaten in the raw state and +all foods that are exposed for sale after having been +cooked should be carefully protected from contact with +flies, by screens or covers.</p> + +<p>A point where rapid development of flies takes place +is along the city's water front. This is due to the fact +that many of the sewers do not discharge below the level +of the water. All open drains should be eliminated, +whether they be sewers, private house drains or drains +from cess-pools.</p> + +<p><b>Precautions to be Observed</b>.—Keep the house free +from flies. Every fly should be considered a possible +disease carrier and should be destroyed.</p> + +<p>Keep the windows of the house, especially the kitchen +<span class='pagenum'>[<a name="Page_648" id="Page_648">648</a>]</span> +windows, carefully screened during the spring, summer +and autumn.</p> + +<p>Protect children from exposure to flies, particularly +children who are ill, and do not allow nursing bottles +to be exposed to flies.</p> + +<p>Protect milk and other foodstuffs from contact with +flies.</p> + +<p>Keep the garbage outside of the house, carefully +covered.</p> + +<p>Abolish open drains near dwelling places.</p> + +<p>Stable manure should be frequently sprinkled with +lime and kept covered.</p> + +<p>Earth closets and privy vaults should be treated with +lime, crude creolin or crude carbolic acid at frequent +intervals.</p> + +<p>Earth closets and privy vaults should be cleaned frequently +in order to prevent excrement accumulating to an +undue extent.</p> + +<p><b>To Kill Flies</b>.—Dissolve one dram of bichromate of +potash in two ounces of water, add a little sugar to this +solution and put some of it in shallow dishes and place +about the house. Sticky fly paper and fly traps may also +be used.</p> + +<p>To clean the room where there are many flies, burn +pyrethrum powder (Persian insect powder). This stupefies +the flies and in this condition they may be swept up +and burned.</p> + +<p>Probably the best and simplest fly killer is a weak +solution of formaldehyde in water (two teaspoonfuls to +the pint). This solution should be placed in plates or +saucers throughout the house. Ten cents' worth of formaldehyde, +obtained in the drug store, will last an ordinary +family all summer. Don't smell formaldehyde in +the pure state; it is very pungent and strong. In the +solution of the strength used for flies it has no offensive +smell. It is fatal to disease organisms, and is practically +non-poisonous except to insects. Flies will not +stay in the house when this solution is around.</p> + +<p><b>Moths</b>.—Late spring and early summer is the time to +guard against moths and beetles. Many of these fabric-destroying +insects are brought into the house on flowers. +<span class='pagenum'>[<a name="Page_649" id="Page_649">649</a>]</span></p> + +<p>May and June are especially bad months, as both moths +and beetles are only dangerous to fabrics in their young +or grub stage.</p> + +<p>These insects will destroy almost anything from coarse +rugs to the finest of ball gowns and dress suits. Carpets +that are rarely swept and garments that are seldom disturbed +are most liable to damage.</p> + +<p>The substitution of the frequently removed and easily +cleaned rugs for carpets will greatly lessen the danger +from the destructive moth and beetle grubs. Carpets laid +on tight floors are much less liable to injury than where +numerous cracks furnish safe retreats for the insects. +Tarred paper under a carpet is an excellent preventive.</p> + +<p>All clothes presses should be thoroughly cleaned at +frequent intervals. The garments should be removed, +aired and vigorously brushed. Any larvæ which are not +dislodged in this way should be destroyed. It is a bad +plan to keep odds and ends of woolen or other materials +in attics where these pests can breed and thus spread +to more valuable articles.</p> + +<p>Spraying with benzine two or three times during hot +weather is a good way of preventing injury to furniture +or carriage upholstery and other articles which are in +storage or not in use for a long time. If you are certain +that woolens and furs are free from the pests they +may be stored in safety by placing them in tight paste +board boxes and sealing the covers firmly with gummed +paper.</p> + +<p>Both moths and carpet beetles are harmless at a temperature +of 40 degrees Fahrenheit—a fact very well +known to advantage by the large fur storage companies. +They cannot survive furthermore a temperature of 120 +decrees if subjected to it for about twenty minutes.</p> + +<p><b>What Physicians are Doing</b>.—It is desirable that the +ordinary non-medical individual should know what the +science of medicine is doing and what it is accomplishing.</p> + +<p>During the past fifteen years the art of curing and +preventing disease has taken on giant strides. The man +or woman most ready to question the accomplishments +and the ability of the humble family physician or the +<span class='pagenum'>[<a name="Page_650" id="Page_650">650</a>]</span> +motive of the science of medicine, is the one who appreciates +least that it is due to the skill and intelligence of +the medical men of to-day that he owes his comfort, his +health, and his freedom from pestilence, plague and disease. +Unthinking people laud and praise some upstart +whose ability lies in his faculty to fool the gullible, or they +will rush to seek the false aid of some nondescript science, +because it is popular and well advertised, while they pass +by or ignore the men whose labors have made the world +what it is, and who alone possess the ability to intelligently +wage the battle in the interest of humanity against disease.</p> + +<p>The medical profession has repeatedly pointed out that +there are, on an average, six hundred thousand lives lost +every year in the United States from preventable disease +and accidents. Six hundred thousand lives which medical +science has at hand the remedy to save, but which the medical profession +sacrificed because of inadequate legislation. Few people +can comprehend just what six hundred thousand lives +mean. Let us put it in another way. There are destroyed +by preventable disease and accidents every day American +lives equal in number to the crews of two battle ships, +equal in three months to more than the total combined +numbers of the Army and Navy of the United States; +equal in one year to more than the total number of lives +lost in all our wars since the Declaration of Independence.</p> + +<p>The <i>Titanic</i> disaster shocked the public for a moment, +and seemed to impress them as though it was a terrible +and unheard of waste of good human lives. Yet in the +loss of life due to preventable causes we have in this country +every day in the year a destruction of our citizens exceeding +in magnitude that which occurred when the +<i>Titanic</i> sank. Think of it! A <i>Titanic</i> disaster a day, and +yet the public does not rise up and demand in a spirit of +anger and determination that steps be taken at once to +put an end to this appalling and unnecessary waste of +lives.</p> + +<p>Under modern hygienic conditions, the average length of +existence for an individual in Great Britain has increased +ten years in the last half century. Among all the enlightened +and advanced nations, the expectation of the individual +for long survival is greater. Since the appearance of +<span class='pagenum'>[<a name="Page_651" id="Page_651">651</a>]</span> +uncheckable and epidemic disorders is less frequent and +the percentage of cures is greater.</p> + +<p>Since quarantine has been regularly established and +the sewage system made efficient in large cities, and since +the sanitary plumbing laws have been made compulsory, +the general death rate has decreased enormously. These +regulations have been the product of regularly educated +medical or sanitary experts. No 'ism or 'ology has ever +established any scientific principle which has contributed +to the general welfare of the people. We no longer fear +the plague, or typhus or yellow fever, cholera, diphtheria, +typhoid, consumption, and other diseases which once were +a constant menace to the race. The plague, for example, +is practically limited to the Far East, where modern +methods cannot evidently be introduced efficiently. At +one time it periodically devastated Europe, where it cannot +now get a foothold because of the introduction of +sanitary systems and hygienic principles.</p> + +<p>Tetanus or lockjaw and hydrophobia are now amenable +to cure while formerly all cases were practically fatal. +The mortality of diphtheria has been reduced more than +fifty per cent. Antiseptic precautions in surgical cases, +first introduced by the famous surgeon, Lord Lister, have +made possible and successful operations that formerly +could not be undertaken, thus broadening the whole field +of surgical possibilities. The Boer war and the war with +Spain proved this truth in a way that could not be denied. +Smallpox is almost a medical curiosity in New York City, +where it once was a scourge. The mortality of childbirth +has been reduced to about one-fifth of what it was +by the introduction of antiseptics and anesthetics. The +new methods of making and preparing drugs, the sterilization +and inspection of milk, the methods devised for the +care of and preparation of infant foods have all enormously +contributed to checking disease, to preventing disease, +and to increasing the length of life and its happiness.</p> + +<p>These are all facts which may be proved by any one, +no matter how incompetent they may be. If we were to +give up all these hard earned victories, cease to investigate +or experiment, deny the existence of disease, and depend +<span class='pagenum'>[<a name="Page_652" id="Page_652">652</a>]</span> +upon the questionable methods of hysterical emotionalists +we would soon find ourselves facing all the horrors of the +past. Can we afford to lose the priceless benefits we +have achieved and are attaining? Can we sit still and +permit the profession of medicine, which has always contained +the best of the race in its membership, the best intellects, +the most sympathetic and unselfish characters, +the noblest and most steadfast souls, to be maligned and +assailed, to have its means of well-doing assaulted and +threatened, when we know that it should be supported +and protected for the sake of all it has done in the past +in the interest of humanity?</p> + +<p>Every mother should be acquainted with these facts +so that she may lend her influence in behalf of honest +effort and honest inquiry.</p> + +<p>The following summary comprises a brief review of +what medicine has been doing in the recent past:</p> + +<p><b>Radium</b>.—This element was discovered about fifteen +years ago by Professor and Mme. Curie. It possesses the +wonderful property of giving out inexhaustible stores of +energy. It virtually possesses the property of perpetual +motion. Professor Becquerel was the first one to suggest +that it might possess therapeutic or healing powers. The +suggestion came to him in a curious way. He carried a +tube of radium in his vest pocket and was severely burnt +as a consequence. The incident suggested to him that, if +radium could attack healthy tissue in such a short time, it +should be able to similarly attack diseased tissue. Experiments +were soon instituted, and are still being conducted +to exactly define its curative value and scope.</p> + +<p>It was hailed as a cure for cancer and other serious +conditions, but we have found that it is not a cure +for these ailments. It is, however, exceedingly valuable +in the treatment of certain skin diseases. In lupus, +epithelial tumors, ulcers, papillomata, angiomata and pruritus, +it is being widely and successfully used. It was +later discovered that it can quickly kill disease-producing +bacteria. It is also well known that it will efficiently +purify water.</p> + +<p><b>X-Ray Treatment and X-Ray Diagnosis</b>.—Professor +Roentgen gave to the world an exceedingly valuable discovery +<span class='pagenum'>[<a name="Page_653" id="Page_653">653</a>]</span> +in the X-Ray. He discovered that a certain form +of electrical energy, when applied in a certain way, would +produce shadows that differentiated between a certain +degrees of opacity. For example, it would, if directed +upon the human hand, produce shadows that clearly indicated +whether the substance through which the rays +passed was bone or muscle. The chief value of the +X-Rays has been found to be this property rather than +any healing value which has been attributed to them. The +fact that these shadows can be photographed has rendered +them of supreme value in surgery and medicine. Previously +it was essential that the surgeon should depend +upon his own diagnosis, upon what he could learn from +his sense of touch and from surrounding conditions. With +the X-Rays at his disposal he can quite eliminate the +personal equation. His pictures are precise and mathematically +accurate; he can prove the truth of his diagnosis +before he cuts. We can take pictures of fractured bones +and from what we learn we can immediately tell how they +should be set to attain the very best results. We can +actually tell if there is a stone in the kidney before we +subject the patient to a serious operation. We can actually +take pictures of the stomach at various stages of +digestion and tell what disease affects the individual with +a degree of precision that was not possible before the +X-Rays were introduced. These examples only suggest +its use. There are a multiplicity of uses for these as yet +unknown rays which have greatly aided in diagnosis and +consequently in successful treatment.</p> + +<p><b>Aseptic Surgery</b>.—The utility of the aseptic principle +in surgery was demonstrated by the Japanese army surgeons +during the war with Russia in 1904-1905. Their +success in preventing deaths from suppurating wounds +amazed the world. Their method was to discard the use +of antiseptics and to depend upon absolutely clean instruments, +dressings and hands. The most terrible wounds +healed under this method without festering. This is, of +course, the method in vogue to-day all over the civilized +world. The Japanese did not discover aseptic surgery, +but they were the first to put it to actual test in a large +<span class='pagenum'>[<a name="Page_654" id="Page_654">654</a>]</span> +way. The old method was to depend upon drugs to kill +the germs which might find their way into wounds and +operations. To-day we prevent the germs from getting +into the wound and depend upon nature to do the rest.</p> + +<p><b>New Anesthetics</b>.—Several important advances have +been made in methods of giving anesthetics and in the +nature of the products used. Temporary unconsciousness +with electricity was induced in 1909 by Dr. Stephane +Leduc. Stovaine was invented by Dr. Jonnesco, of Bucharest. +He injected it into the spinal cord after the +method made famous by Biers with cocaine in 1899. Dr. +W. S. Schley invented novocaine for the same purpose. +Temporary unconsciousness was accomplished by the use +of epsom salts injected into the spinal cord by Dr. +Samuel J. Meltzer. All of these efforts to discover a +harmless anesthetic by spinal injection were made possible +by investigations and experiments of Dr. J. Leonard +Corning, of New York, who worked along this line as far +back as 1885. The most revolutionary discovery, however, +was that of Dr. S. J. Meltzer at the Rockefeller Institute, +New York, when he inserted a tube into the windpipe, +through which he pumped the anesthetic into the +lungs. While doing this he at the same time pumped +oxygen to aerate the blood, thus ensuring the patient +against possible accident during the course of difficult +and tedious operations on the lungs and heart.</p> + +<p><b>Vaccine in Typhoid Fever</b>.—Inasmuch as typhoid +fever has played an important part in the conduct of all +wars, it has always been a source of much careful study +by military and naval surgeons in every civilized country +in the world. We had not, however, reached a stage +when it was possible to hope for its extermination until +medical science began to appreciate the possibilities of +vaccine therapy. The Cuban, Boer and Russian wars, because +of the terrible experiences of the soldiers with typhoid +in each of them, stimulated inquiry along the line +of discovering a serum of vaccine that would be effectual +against it. American, British, French and Japanese military +and naval surgeons instituted experiments simultaneously +to discover an anti-typhoid vaccine. In the fall +of 1909, American army surgeons were experimenting +<span class='pagenum'>[<a name="Page_655" id="Page_655">655</a>]</span> +with a serum at Washington and on Governor's Island +with success, but the first public announcement of an +absolutely successful vaccine was made by Captain Vincent +of the French navy on June 20th, 1910, before the +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.</p> + +<p>It is difficult for the ordinary individual to appreciate +the significance and importance of a discovery of this +character and magnitude. When one thinks calmly of +the thousands and thousands of men who have lost their +lives during wars because of typhoid epidemics, and of +the thousands of others who have returned home practically +invalided for life from the same cause, it is possible +to, at least, conceive of the benefit to the race such +a discovery promises. And when we learn that the discovery +is a product of the same principle or method which +gave to the world a cure for smallpox, diphtheria and +syphilis, we must begin to believe that the medical profession +is on the path which is unlimited in its field of +promise so far as efficient treatment is concerned. Yet +to-day we have people who do not believe in vaccination +or in anti-diphtheritic serum. We may not live to see +the time, but it is not far distant in the opinion of men +qualified to speak with authority, when every disease will +be amenable to the serum therapy, and when drugs will +virtually be discarded by the human race.</p> + +<p><b>"606."</b>—One of the most important discoveries in the +history of medicine was recently given to the world by +Dr. Paul Ehrlich.</p> + +<p>He called it "606," because it was the 606th experiment +he had made with the same end in view. It was designed +with the purpose of curing the most terrible disease +known to man, syphilis. The name of the remedy is +salvarsan. That it will do all that was first claimed for +it is still doubtful, but salvarsan and its improvements, +neosalvarsan, etc., are accepted by the profession as by +far the best treatment yet devised for this dread disease. +It points the way for improvement along the same line +to an ultimate specific.</p> + +<p><span class='pagenum'>[<a name="Page_656" id="Page_656">656</a>]</span></p> + +<p><b>Transplanting the Organs of Dead Men Into Living Men</b>.—To +take from a recently dead individual a kidney, +or a bone, or an artery, and by immersing them in certain +fluids thereby keeping them alive indefinitely, and later +transplanting them in the body of a living individual so +that they will continue to live and perform their function +in the new environment, is a revolutionary and a seemingly +incredible performance. Yet Dr. Alexis Carrel of +the Rockefeller Institute, New York, has accomplished +this wonderful task. The smallest imagination can picture +the possibilities of this kind of surgery, but, inasmuch +as the discovery is so recent and the opportunities +for testing it upon human beings are so relatively few, +that time alone can tell how far it may be possible to go.</p> + +<p><b>Anti-Meningitis Serum</b>.—Another important discovery +that has emanated from the Rockefeller Institute +is the Anti-Meningitis serum. The death rate from spinal +meningitis, before the introduction of the serum, was 70 +per cent., the use of the serum has reduced this percentage +to 30. We owe this important contribution to Dr. Simon +Flexner.</p> + +<p><b>A Serum for Malaria Now Possible</b>.—Dr. C. C. Bass, +of Tulane University, has succeeded in extracting malaria-producing +parasites from human blood and keeping +them alive in test tubes. This feat had been long attempted +but never before with success. The significance +of this achievement is that it is the first step toward preparing +a serum that will give immunity to malaria.</p> + + + + + + + + +<pre> + + + + + +End of the Project Gutenberg EBook of The Eugenic Marriage, Volume IV. (of +IV.), by Grant Hague + +*** END OF THIS PROJECT GUTENBERG EBOOK EUGENIC MARRIAGE *** + +***** This file should be named 21418-h.htm or 21418-h.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. 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