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[Illustration: Courtesy of New York World
More Babies Like These
These nine little tots are all sound, healthy stock. The generations
behind them had unconsciously been practicing Eugenics through the
process of natural selection. By luck, as it were, no strain was bred
into the several families that would have caused these children to be
unsound mentally, morally, or physically.
It is through Eugenics that we shall have more babies like these, and
shall eliminate the possibility of children like those shown in the
other illustrations to this volume.]
The
Eugenic Marriage
A Personal Guide to the
New Science of Better
Living and Better Babies
By W. GRANT HAGUE, M.D.
College of Physicians and Surgeons (Columbia
University), New York; Member of County Medical
Society, and of the American Medical Association
In Four Volumes
VOLUME IV
New York
THE REVIEW OF REVIEWS COMPANY
1914
Copyright, 1913, by
W. GRANT HAGUE
Copyright, 1914, by
W. GRANT HAGUE
* * * * *
TABLE OF CONTENTS
ACCIDENTS AND EMERGENCIES
CHAPTER XXXIV
COMMON DISEASES OF THE NOSE, MOUTH AND CHEST
PAGE
"Catching cold"--Sitting on the floor--Kicking the bedclothes
off--Inadequate head covering--Subjecting baby to different
temperatures suddenly--Wearing rubbers--Direct
infection--Acute nasal catarrh--Acute coryza--Acute
rhinitis--"Cold in the head"--"Snuffles"--Treatment of
acute nasal catarrh, or rhinitis, or coryza, or "cold in the
head," or "snuffles"--Chronic nasal catarrh--Chronic
rhinitis--Chronic discharge from the nose--Nervous or
persistent cough--Adenoids as a cause of persistent
cough--Croup--Acute catarrhal laryngitis--Spasmodic
croup--False croup--Tonsilitis--Angina--Sore throat--Symptoms
of tonsilitis--Treatment of tonsilitis--Bronchitis
in infants--Bronchitis in older children--"Don'ts" in
bronchitis--Diet in bronchitis--Inhalations in bronchitis--
External applications in bronchitis--Drugs in bronchitis--
Chronic or recurrent bronchitis--Pneumonia--Acute
broncho-pneumonia--Symptoms of broncho-pneumonia--How
to tell when a child has broncho-pneumonia--Treatment
of broncho-pneumonia--The after treatment of
broncho-pneumonia--Adenoids--How to tell when a child
has adenoids--Treatment of adenoids--Nasal hemorrhage--
"Nose-bleeds"--Treatment of nose-bleeds--Quinsy--Hiccough--
Sore-mouth--Stomatitis--Treatment of ulcers of the mouth--
Sprue--Thrush 497
CHAPTER XXXV
DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
Inflammation of the stomach--Acute gastritis--Persistent
vomiting--Acute gastric indigestion--Iced champagne in
persistent vomiting--Acute intestinal diseases of children--
Conditions under which they exist and suggestions as
to remedial measures--Acute intestinal indigestion--Symptoms
of acute intestinal indigestion--Treatment of
acute intestinal indigestion--Children with whom milk
does not agree--Chronic, or persistent intestinal indigestion--
Acute ileo-colitis--Dysentery--Enteritis--Enter-colitis--
Inflammatory diarrhea--Chronic ileo-colitis--Chronic
colitis--Summer diarrhea--Cholera infantum--Gastro-enteritis--
Acute gastro-enteric infection--Gastro-enteric
intoxication--Colic--Appendicitis--Jaundice
in infants--Jaundice in older children--Catarrhal
jaundice--Gastro-duodenitis--Intestinal worms--Worms,
thread, pin and tape--Rupture 527
CHAPTER XXXVI
DISEASES OF CHILDREN (continued)
PAGE
Mastitis, or inflammation of the breasts in infancy--Mastitis
in young girls--Let your ears alone--Never box a child's
ears--Do not pick the ears--Earache--Inflammation of
the ear--Acute otitis--Swollen glands--Acute adenitis--
Swollen glands in the groin--Boils--Hives--Nettle rash--
Prickly Heat--Ringworm in the scalp--Eczema--Poor
blood--Simple anemia--Chlorosis--Severe anemia--Pernicious
anemia 553
CHAPTER XXXVII
DISEASES OF CHILDREN (continued)
Rheumatism--Malaria--Rashes of childhood--Pimples--Acne--
Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
Incontinence--Sleeplessness--Disturbed sleep--Nightmare--
Night terrors--Headache--Thumb sucking--Biting the finger
nails--Colon irrigation--How to wash out the bowels--A high
enema--Enema--Methods of reducing fever--Ice cap--Cold
sponging--Cold pack--The cold bath--Various baths--mustard
baths--Hot pack--Hot bath--Hot air, or vapor bath--Bran
bath--Tepid bath--Cold sponge--Shower bath--Poultices--Hot
fomentations--How to make and how to
apply a mustard paste--How to prepare and use the
mustard pack--Turpentine stupes--Oiled silk, what it is
and why it is used 569
DISEASES OF CHILDREN
CHAPTER XXXVIII
INFECTIOUS OR CONTAGIOUS DISEASES
Rules to be observed in the treatment of contagious diseases--
What isolation means--The contagious sick room--Conduct
and dress of the nurse--Feeding the patient and
nurse--How to disinfect the clothing and linen--How to
disinfect the urine and feces--How to disinfect the
hands--Disinfection of the room necessary--How to disinfect
the mouth and nose--How to disinfect the throat--Receptacle
for the sputum--Care of the skin in contagious
diseases--Convalescence after a contagious disease--Disinfecting
the sick chamber--The after treatment of a disinfected
room--How to disinfect the bed clothing and
clothes--Mumps--Epidemic parotitis--Chicken pox--
Varicella--La Grippe--Influenza--Diphtheria--Whooping
Cough--Pertussis--Measles--Koplik's spots--Department
of health rules in measles--Scarlet fever--Scarlatina--
Typhoid fever--Various solutions--Boracic
acid solution--Normal salt solution--Carron oil--Thiersch's
solution--Solution of bichloride of mercury--How
to make various solutions 599
ACCIDENTS AND EMERGENCIES
CHAPTER XXXIX
ACCIDENTS AND EMERGENCIES
Accidents and emergencies--Contents of the family medicine
chest--Foreign bodies in the eye--Foreign bodies in the
ear--Foreign bodies in the nose--Foreign bodies in the
throat--A bruise or contusion--Wounds--Arrest of
hemorrhage--Removal of foreign bodies from a wound--Cleansing
a wound--Closing and dressing wounds--The
condition of shock--Dog bites--Sprains--Dislocations--Wounds
of the scalp--Run-around--Felon--Whitlow--Burns
and scalds 629
MISCELLANEOUS
CHAPTER XL
MISCELLANEOUS
The dangerous housefly--Diseases transmitted by flies--Homes
should be carefully screened and protected--The
breeding places of flies--Special care should be given to
stables, privy vaults, garbage, vacant lots, foodstuffs,
water fronts, drains--Precautions to be observed--How
to kill flies--Moths--What physicians are doing--Radium--X-Ray
treatment and X-Ray diagnosis--Aseptic surgery--New
anesthetics--Vaccine in typhoid fever--"606"--Transplanting
the organs of dead men into the living--Bacteria
that make soil barren or productive--Anti-meningitis
serum--A serum for malaria in sight 645
* * * * *
ACCIDENTS AND EMERGENCIES
CHAPTER XXXIV
COMMON DISEASES OF THE NOSE, MOUTH, AND CHEST
"Catching Cold"--Sitting on the Floor--Kicking the Bed Clothes
Off--Inadequate Head Covering--Subjecting Baby to Different
Temperatures Suddenly--Wearing Rubbers--Direct Infection--Acute
Nasal Catarrh--Acute Coryza--Acute Rhinitis--"Cold in the
Head"--"Snuffles"--Treatment of Acute Nasal Catarrh, or Rhinitis,
or Coryza, or "Cold in the Head," or "Snuffles"--Chronic Nasal
Catarrh--Chronic Rhinitis--Chronic Discharge from the Nose--Nervous
or Persistent Cough--Adenoids as a Cause of Persistent
Cough--Croup--Acute Catarrhal Laryngitis--Spasmodic Croup--False
Croup--Tonsilitis--Angina--Sore Throat--Symptoms of
Tonsilitis--Treatment of Tonsilitis--Bronchitis in
Infants--Bronchitis in Older Children--"Don'ts" in Bronchitis--Diet
in Bronchitis--Inhalations in Bronchitis--External Applications in
Bronchitis--Drugs in Bronchitis--Chronic or Recurrent
Bronchitis--Pneumonia--Acute Broncho-pneumonia--Symptoms of
Broncho-pneumonia--How to Tell When a Child has
Broncho-pneumonia--Treatment of Broncho-pneumonia--The
After-treatment of Broncho-pneumonia--Adenoids--How to Tell When a
Child has Adenoids--Treatment of Adenoids--Nasal
Hemorrhage--"Nose-bleeds"--Treatment of
Nose-bleeds--Quinsy--Hiccough--Sore Mouth--Stomatitis--Treatment of
Ulcers of the Mouth--Sprue--Thrush.
"CATCHING COLDS"
Mothers frequently wonder where their children get colds. Briefly we
will point out some of the sources from which these apparently
inexplicable colds may come.
A. Sitting on the Floor.--Children should not be allowed to sit or
crawl upon the floor at any season of the year, but especially during
the winter months. There is always a draught of cold air near the floor.
It is a bad habit to begin allowing a child to play with its toys on the
floor. Use the bed or a sofa or a platform raised a foot from the
floor.
B. Kicking the Bed Clothes Off During the Night.--The bed
clothes should be securely pinned to the mattress by large safety pins.
When it is established as a habit a child who kicks off the bed clothes
should wear a combination night suit with "feet," made of flannel during
the winter and of cotton during the summer.
C. Inadequate Head Covering.--Professor Kerley states that this is one
of the "most frequent causes of disease of the respiratory tract in the
young." He calls attention to the fact that "mothers carefully clothe
the baby with ample coats, blankets, leggings, etc., before they take
him out for the daily walk. They dress him in a warm room taking plenty
of time to put on the extra clothes, during which time the baby frets
and perspires. When all is ready they place upon the hot, almost bald
head of the baby a light artistically decorated airy creation which is
sold in the shops as children's caps. The child is then taken out of
doors and because of the inadequate covering of the hot perspiring head,
catches cold and the mother never knows how it came." Every baby and
child should wear under such caps a skull cap of thin flannel,
especially in cold weather. In summer or windy day a light silk
handkerchief folded under the cap is a very excellent protection.
D. Subjecting a Baby to Different Temperatures Suddenly, is liable to
be followed by a cold--for example, taking the child from a warm room to
a cold room, or through a cold hall, holding the child at an open window
for a few moments.
E. The Practice of Wearing Rubbers Needs Some Consideration.--They
should never be worn indoors for even five minutes. They should not
therefore be kept on in school, nor should they be worn by women in
stores when they go shopping. When it is actually raining, or snowing,
or when there is slush or wet mud they are needful; but they should not
be worn simply because the weather is threatening or damp. Children
should not put them on to play--worn for any length of time when active
they are harmful. If worn to and from school they should be taken off at
once when in school or at home. Wearing rubbers prevents free
evaporation of the natural secretion of the skin, keeps the
feet moist and invites colds and catarrh. In damp weather, or when
children play during winter months, they should be shod with stout shoes
with cork insoles.
The same argument applies to storm coats of rubber, water-proof
material. They should not be worn as overcoats all day, but only when
going to and from school or business when it is actually storming.
Underclothing or hosiery should not be heavy enough to cause moisture of
the skin. Health demands a dry skin at all times. The necessary degree
of body heat should be attained by the quality of the outer clothing,
not by the quantity of the underclothing. Many men and women wear heavy
underclothing which causes moisture when indoors, with the result that
they get surface chills when they go outside if the weather is cold and
as a result catch cold. The underclothing should be just heavy enough to
be comfortable indoors and the extra warmth necessary when outside
should be supplied by a good overcoat or furs.
F. Direct Infection.--A baby may catch cold if kissed or "hugged" by
an adult who has a cold.
Catching cold while bathing is possible, but scarcely probable, if
ordinary precautions are taken. It is very bad practice to permit
children to use one another's handkerchiefs or the handkerchief of an
adult. Certain children are predisposed to attacks of "cold in the head"
or acute coryza or nasal catarrh (these being the medical names for this
condition). Sometimes this is an inherited characteristic. There is no
doubt, however, that most of these children acquire the habit by bad
sanitary and hygienic surroundings. These children do not as a rule get
enough fresh air. They are kept indoors most of the time in stuffy,
overheated, badly ventilated rooms, unless the weather is absolutely
perfect. The windows in their bedrooms are always kept closed, because
they are "liable to catch cold." They are overdressed and perspire
easily and as a result "catch cold." These conditions all tend to create
an unhealthy condition of the nasal mucous membrane and of the throat,
and this is rendered worse if the child lives in a damp,
changeable climate, such as that of New York City. In these susceptible
children the exciting cause of an attack may be trivial; exposure, cold
or wet feet, inadequate head covering (as already pointed out), a
draught of cold air even may excite sneezing and a nasal discharge;
hence we have:
Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis, "Cold in the Head",
"Snuffles").--Acute nasal catarrh may accompany measles, diphtheria,
influenza, and whooping cough.
Symptoms.--The onset is sudden with sneezing, and difficulty in
breathing through the nose. In a few hours, or it may be not for a day
or two, a mucous, watery, nasal discharge appears. There are redness and
slight swelling of the nose and upper lip, caused by the discharge.
There is no fever as a general rule except in very young infants, in
whom the fever may be very high. The discharge interferes with the
nursing and the child suffers from lack of nourishment. The inflammation
may extend to the eyes and ears, causing painful complications, or to
the throat and bronchi, causing hoarseness and cough. Less frequently we
have disturbances of the digestive tract with vomiting, or diarrhea.
The mild form of the disease lasts for two or three days, the severe
form from one to two weeks.
Repeated attacks are said to contribute to the production of adenoid
growths.
An acute attack of this disease is seldom a serious affliction in older
children; it may be, however, very serious and even dangerous in very
young infants. The tendency of the disease to extend downward, causing
bronchitis or pneumonia, explains in part the possible danger to a baby.
Another reason is because it may seriously interfere with suckling and
with breathing in these little patients. It may even cause sudden
attacks of strangulation. An infant, therefore, suffering with an acute
attack of rhinitis requires constant attention. It may be necessary to
feed it with a spoon, and if necessary mother's milk should be so fed.
Plenty of fresh air should be provided. It may be essential to keep the
mouth open in order that it may get enough fresh air. Every effort
should be made to keep the nostrils open. The secretions must be
removed from time to time. Causing the child to sneeze by tickling the
nose with a camel's hair brush will clear the nose for the time being.
The physician may be compelled to use a solution of cocaine for this
purpose.
Treatment of Acute Rhinitis ("Taking Cold", Nasal Catarrh, Acute
Coryza, "Snuffles").--A child suffering with an acute attack of "cold
in the head" should be kept indoors in a room with a constant, uniform
temperature; the particular reason for this is, that, if a child is
exposed to cold at any time during an attack of "cold in the head," it
may cause the disease to invade the chest,--a tendency which it has at
all times. The bowels must be kept open; if they do not move every day
of their own accord they must be made to move by means of an enema of
sweet oil or of soap-suds. The amount of food should be reduced to suit
the circumstances and the condition of the patient.
We treat the local condition in the nose with a menthol mixture. The
following is a very good one: Menthol, 30 grains; Camphor, 30 grains;
White Vaseline, 1 ounce. Put some of this on the end of the finger and
push it gently into each nostril. When the nostrils become blocked and
the child cannot breathe through the nose, tickle the nose with a
feather until it sneezes; this will clear the passage. Immediately after
the sneeze place the menthol mixture in each nostril. When the child is
about to sneeze place a handkerchief before the nose, as this discharge
is full of germs and will infect others when dry. Internal remedies
should not be used unless the child is distinctly sick and is running a
fever, in which case a physician should look the child over and
prescribe whatever is called for.
The upper lip and the nostrils of the child should be protected, because
the discharge very quickly irritates the parts and renders them raw and
painful. Vaseline or cold cream is very suitable for this purpose.
Mothers should not wash out the nose of a child with any solution
advised for this purpose where force is used, as, for example, with a
syringe. Any forceful irrigation of the nose is dangerous, because it
would carry the infection into the deeper parts and set up a more
serious condition.
If the above treatment is carefully carried out and the child
unexposed to a fresh cold, two or three days will be sufficient to
cure the disease.
It is not, however, the treatment of an acute attack of "cold in the
head" that is important; it is intelligently to follow out a plan which
will prevent these attacks from repeating themselves that is of
consequence. The tendency to take cold is a real condition in childhood
and a very common one. When mothers appreciate that it is possible to
prevent this condition and to cure it when it is seemingly an
established habit, more interest will undoubtedly be taken in the
subject. Too frequently it is looked upon as an unfortunate affliction,
but it is never regarded as a condition that is caused by neglect and
ignorance.
It is an exceedingly common occurence to find a mother worrying over her
child's cold, dosing it with cod liver oil or some other unnecessary
tonic, rubbing it with camphorated oil or plastering it over with
certain useless patent plasters, dressing it with extra pieces of
flannel on its chest and extra clothes pinned snugly around it, then
shutting it up in a warm, stuffy, unsanitary, ill-smelling room, in
order to keep it from "catching a fresh cold." Can you imagine anything
else she could do to defeat her purpose?
No quantity of cod liver oil, no medicine, no coddling, will remove the
tendency to "catch cold." The child's life must be lived amidst sanitary
surroundings and hygienic conditions first; then other expedients may be
utilized if necessary. These children must be kept out of doors most of
the time, unless during the severest wet weather. They should sleep in a
room the windows of which are open at the top and bottom every night in
the year. They should not, however, be in a draught. The rooms in which
they live should be of a uniform temperature, never too hot and never
too cold, between 68° and 70° F. These delicate catarrhal children
should be accustomed to light clothing on their beds. Chest protectors,
mufflers, cotton pads, and heavy wraps of any description should be
absolutely prohibited. It is advisable to use flannel underwear winter
and summer, light in summer and a medium weight in winter.
During the summer months the mother should begin cold sponging of the
face, throat, chest, and spine every morning and carry it into the
winter. The entire process need take only a moment or two. Always dry
thoroughly with a fairly rough towel. If the cold sponging is begun in
the warm summer time the child will become so accustomed to it that no
objection will be made when the cold weather comes.
If the child continues to be "catarrhal," despite a course of this
treatment, it would be well to investigate whether any adenoids or
adenoid tissue exist in the naso-pharynx. If adenoids are found no
treatment will be successful until they are removed.
It is a wise plan to place a flannel cap on an infant who has an acute
attack of "cold in the head" (snuffles). This will prevent catching a
fresh cold and it will aid in the speedy cure of the attack from which
it is suffering when it is put on.
CHRONIC NASAL CATARRH--CHRONIC RHINITIS CHRONIC DISCHARGE FROM THE
NOSE
Some children have a nasal discharge during all of their childhood. It
is usually worse during the winter months. It may be a thin, watery
discharge or a thick, nasty, yellow discharge.
It is a condition that is very frequently neglected even by the family
physician. This is unfortunate because it may lead to serious disease,
permanent damage sometimes being done to the hearing, the speech, the
smell, and to the lungs of the child.
It may be caused by adenoids; disease of the bones or tissues in the
nose; foreign bodies in the nose; or it may occur in children whose
nutrition is bad. It may result from frequent acute attacks of "cold in
the head." It also occurs in other less important conditions. The
foreign bodies which usually cause a chronic nasal discharge
are,--buttons, peas, beans, beads, paper balls, flies and bugs,
cherry-stones, small pieces of coal, or stone, cork or other material. A
child gets hold of a shoe-button for example and pushes it into its
nostrils. In the effort to get it out the child pushes it
further in. It may or may not cause pain at the time, and it may be
overlooked, but shortly the mother will notice a discharge from one
nostril. This discharge becomes thick and foul and when an investigation
is made the button is found embedded firmly in the nose. It is sometimes
quite difficult to get the button out and this should always be done by
a physician.
Treatment.--Remove the cause first then treat the catarrh. If it is a
product of a constitutional disease that causes general poor health,
such as tuberculosis, syphilis, or scrofula, the child will need
"building up" and a decided change of climate. Foreign bodies must be
removed, adenoids taken out, large tonsils excised, and malformations of
the nasal bones operated upon. The catarrh will in many cases be cured
by removing its cause; if, however, it should persist it must be treated
for some time with appropriate solutions. These solutions and the
directions as to the method of giving them must be given by a physician,
because there is great danger of carrying the disease to deeper
structures if given wrongly.
SUMMARY:--
1st.--A chronic discharge from the nose is a sign that something is
wrong and should be carefully and thoroughly investigated.
2nd.--The cause can usually be found out and the proper treatment will
cure it.
3rd.--If the condition is neglected it may ruin the health of the child
for the whole period of its life.
NERVOUS OR PERSISTENT COUGH
Cough in an infant or growing child is usually the result of a cold and
the structure affected is some part of the nose, throat or bronchi. It
is a comparatively simple matter to discover just where the trouble is
and to prescribe the appropriate remedy and effect a cure.
There is another type of cough, however, that is of quite a different
character. This cough will begin as an ordinary cough and it
will only be discovered that it is not an ordinary cough because nothing
will apparently cure it. We mean that the child is given cough remedies
that usually cure a cold, is kept in the house and carefully watched for
a sufficiently long period to justify a cure, and yet, despite this care
and attention, the cough remains the same. The child is not sick, the
appetite is good, there is no fever, it plays and seems to enjoy good
health, yet for weeks and frequently for months the annoying cough hangs
on. It is as a rule worse at night. It begins soon after the child falls
asleep and spoils the entire night's rest or a great part of it. It may
be a dry, hard, hacking cough, or a croupy, harsh bark. It may come in
spells with a considerable interval between them, during which time the
child falls asleep, or it may be almost constant, not quite severe
enough to rouse the child, but bad enough to spoil the child's rest and
the rest of the mother. If this condition lasts for a long time, as it
occasionally does, the health of the little patient is apt to suffer
from loss of sleep.
Treatment.--These children should be taken to a good physician and
thoroughly examined. Special care should be devoted to investigating the
condition of the nose, throat, ear, stomach, heart, and lungs.
A very large majority of these coughs are caused by adenoid growths in
the back part of the nose. The child may not look like an adenoid child,
nor may it breathe through its mouth when asleep, and it may have had
its adenoids removed, yet in spite of these contra-indications it may
have enough loose adenoid tissue in its nose to cause this kind of
persistent cough. This has been proved many times.
It is not only useless but positively harmful to give these children
cough remedies. The cause of the cough must be found and treated. The
cough may be indirectly caused by anemia (poor blood) or heart or
stomach trouble, or it may have a number of other causes. Whatever it is
it must be found by a careful physical examination or a number of
careful physical examinations, because these cases are as a rule obscure
and difficult to diagnose, and even the most expert examiner
cannot always tell where the trouble is without seeing the child a
number of times. The parents must therefore have patience and confidence
in the physician and must aid him all they can by watching and reporting
all the symptoms, etc., to him. (See article on Adenoids).
SUMMARY:--
Coughs that resist careful treatment are not "ordinary coughs."
Coughs of this type require special medical care.
The usual cough medicines are not only useless in these coughs, but
dangerous. Don't give them.
ACUTE CATARRHAL LARYNGITIS: SPASMODIC CROUP: FALSE CROUP
Croup is one of the common diseases of childhood. It usually follows a
catarrhal "cold in the head" with a cough. Croup is most frequently
associated with large tonsils and adenoids. It may come on gradually or
it may occur suddenly. There is always fever with croup. One of the
first symptoms is a hard, dry, croupy, barking cough, which gets worse
toward night. If it occurs suddenly, the child will wake about midnight
with the characteristic croupy cough. The disease may go no further than
this and under the proper treatment is well in a few days. In other
cases, however, there develops marked interference with breathing. Every
inspiration is accompanied by a loud hissing or "crowing" sound. This
feature of the disease is one that frightens the parents, though it
seldom means anything serious. The child sits up in bed, frightened, and
struggles for breath. It may clutch its throat with its hands as if
something was tied round its neck. The lips may become slightly blue and
the perspiration appears upon the child's brow. After some time,--it may
be two or three hours,--the attack wears away and the child goes to
sleep. Next morning it wakes up apparently well except for the croupy
cough. The attack may repeat itself the next night and mildly on the
third night.
Treatment.--The object of treatment during an acute attack, when
the child is struggling for breath, is to relax quickly the spasm of the
larynx which interferes with the breathing. The simplest way is to give
the child a teaspoonful of the fresh syrup of ipecac. If the child does
not vomit in fifteen minutes, give another teaspoonful and keep on
giving it every fifteen minutes till the child vomits. One or two doses
is usually enough, but it must be given till the child vomits.
If the attack comes suddenly during the night and there is no syrup of
ipecac in the house, the physician should be sent for at once and
informed that the child probably has croup, so he may know what to take
with him. While waiting for the physician the mother should apply over
the front of the neck (in the region of Adam's apple), hot applications.
These are best made of flannel wrung out of quite hot water every two or
three minutes: also a hot mustard foot bath. When the physician takes
charge of the case he will also direct the treatment for the following
day in order that the attack of the next night may be a very mild one,
if it should came at all.
Children who have a tendency to frequent attacks of croup should receive
the same attention as the children do who are subject to attacks of
tonsilitis and acute catarrhal rhinitis.
SUMMARY:--
1st. Spasmodic Croup always requires prompt and efficient treatment.
2nd. It is called "false" croup, because "true" croup is always
diphtheritic and is a very serious disease.
3rd. For that reason a physician should always be called because if it
is "true" croup antitoxin must be given at once.
4th. Don't worry unnecessarily because, though "spasmodic croup" can
make the child look exceedingly sick for a very short time, an
uncomplicated case in a healthy child is seldom if ever dangerous.
TONSILITIS: ANGINA: "SORE THROAT"
This is one of the frequent diseases of childhood. We rarely see it in
infants. It is caused by inhaling air which contains poisonous germs.
These germs quickly develop when conditions are favorable. They lodge in
the pores or follicles of the tonsils and set up an active inflammation.
The tonsils swell up and the follicles exude a thick fluid which looks
like curdled cream. This fluid sticks in the mouths of the follicles
forming spots. If enough of this fluid is coming out, these spots join
together forming patches, and the patches may join together forming
membrane. This is why it is sometimes so difficult to tell whether the
case is one of tonsilitis or diphtheria.
Conditions are favorable to the development of tonsilitis if the child
is not in good health when he happens to inhale the infection, when the
feet are wet or cold, or when the child is allowed out during inclement
weather and it becomes chilled or numbed from cold, when the child has a
cold in the head and a running nose, or when its stomach is out of
order. Any condition in which the child should be carefully watched and
tended to, rather than allowed further liberties, or risks, conduces to
sore throat of some kind.
Some children have the disease a number of times; they seem to be
predisposed toward a sore throat. These are children who have large
tonsils or who are rheumatic. The tonsils should be removed in the one
case, and the tendency to rheumatism should be the main treatment in the
other case.
These children should be encouraged to cleanse the throat and nose
morning and night with a warm salt solution (half a teaspoonful of
ordinary table salt to three-quarters of a cup of warm water). This will
help greatly to prevent these chronic sore throats.
Symptoms of Tonsilitis.--The disease begins suddenly. The child may
have a chill or be seized with sudden vomiting or diarrhea. A very young
infant may have a convulsion. The usual way is for the child to develop
a fever quickly, to complain of being sick and tired. Muscular pains all
over the body and a severe headache are constant symptoms. The
fever is usually high from the beginning. The child will tell you its
throat is sore, but there is as a rule very little pain in the throat.
The little spots or patches can be seen on one or both tonsils. The
general symptoms are more pronounced than the local throat symptoms. The
amount of physical depression that is caused by a tonsilitis is out of
all proportion to the seriousness of the disease.
Tonsilitis lasts three days usually. The throat symptoms may take a day
or two longer to clear up, and the patients feel more or less weak for
some time after all the symptoms have disappeared.
Tonsilitis is medically regarded as one of the mild diseases of
childhood. It is, however, of very great importance because of its
likeness to diphtheria, and inasmuch as a positive diagnosis must be
promptly made, in the interest of the patient, it is given close
attention and treated with considerable respect by the medical
profession. The chief differences between the two diseases are as
follows:
Tonsilitis begins abruptly with pronounced prostration and a high fever
the first day. The patient feels distinctly sick all over. The second
day the patient feels somewhat better, the fever is lower and the
prostration and pain are not so marked. The third day he feels better
still, and but for a little weakness would feel well. Diphtheria begins
slowly and insidiously, with very little prostration and a very low
fever the first day. The patient scarcely feels sick. The second day
more prostration is present, the fever climbs upward a little more, and
the patient begins to feel sick. On the third day the prostration is
much more profound, the fever is higher, and all the evidences of a
serious sickness are present. Two very different pictures: The one
begins bad and ends easy, the other begins easy and may end bad.
The important fact, however, so far as the similarity of the two
diseases is concerned, is, that we must make the diagnosis positive on
the first or second day, because if we are dealing with a case of
diphtheria we must give antitoxin at once. This is essential, because
the efficacy of antitoxin is greatest when given early in the disease.
By "early" we mean the first or second day of the disease. When
antitoxin is given late (the third or fourth day of the disease) it is
much less efficacious and must be given in relatively larger doses. The
need, therefore, of a quick, positive diagnosis is a real one.
Another important element involved in a speedy diagnosis is, that we
must not take any chances of infecting other children. So important are
these conditions that it is the proper treatment to give antitoxin at
once in every case of tonsilitis that in the slightest way resembles
diphtheria. An examination of the throat contents,--a culture of which
is taken during the first visit of the physician,--will, of course,
reveal the true condition and dictate the future use of the antitoxin.
Antitoxin is absolutely harmless when given to a patient who has no
diphtheria. Every case of tonsilitis should be quarantined when there
are other children in the house.
The local condition of the throat helps in the diagnosis: In tonsilitis
(as the name implies) the disease is limited to the tonsils and on the
tonsils (one or both) do we find the spots or patches. In diphtheria, on
the other hand, the membrane is not limited to the tonsils, but may
cover every part of the throat and extend into the nose and mouth. In
tonsilitis it is spots or patches we see in the throat. In diphtheria it
is membrane we see always. The difficulty here again is that if we wait
till the diphtheritic membrane covers the whole throat, antitoxin will
not be of much use.
In diphtheria we have a characteristic odor, in tonsilitis we have no
characteristic odor.
The practical lesson to be learned from this uncertainty is, immediately
to get a physician as soon as you find spots in the throat of your sick
child, unless you are absolutely sure that the condition is not
diphtheria and you are willing to take that chance.
Treatment of an Acute Attack of Tonsilitis.--Put the child in bed at
once and keep him on a light diet during the fever. Give him all the
cool boiled water he wants to drink. If the fever is very high it can be
controlled by sponging the body with cool water. If the patient is an
infant the food should be reduced to one-half strength. Tonsilitis
is a disease that runs a certain course and gets better, or the patient
develops some other more serious conditions as a result of neglect or
carelessness. We therefore try to make the patient comfortable and let
the disease take care of itself.
The throat can be gargled or sprayed with any mild antiseptic liquid, or
it can be painted with tincture of iodine or 10 per cent. solution of
silver nitrate. As a rule the gargles do not aid in the cure of the
disease, though they contribute to the comfort of the patient.
A cold compress made of half a dozen thicknesses of cloth, such as a
table napkin, and put under the jaw (not round the neck), and covered
with oiled silk and held in place with a bandage that meets and is tied
on the top of the head, is of distinct usefulness.
When it is known that the child is rheumatic, the heart must be
carefully watched during the fever and anti-rheumatic remedies depended
upon to effect a cure.
SUMMARY:--
Tonsilitis, because of its likeness to diphtheria, must be promptly and
carefully diagnosed.
A physician only is capable of making a diagnosis.
Any sore throat in a child with spots or membrane is deserving of
serious and immediate attention.
A mistake may mean death. Don't take a chance.
BRONCHITIS
Bronchitis is one of the commonest diseases of childhood. It is the
cause of many deaths. Exposure during inclement weather is as a rule the
cause of it. It occurs in all classes and conditions of children. Poorly
nourished and badly clothed children are more liable to get it than are
others. It is more dangerous in young children and infants than in older
children. A young child or an infant will get bronchitis quicker than
those older and stronger under the same conditions.
Bronchitis is often present while children are suffering from other
diseases, measles, influenza, scarlet fever, typhoid fever, pneumonia,
diphtheria, whooping-cough, for example. It may accompany any disease of
childhood, however.
Symptoms.--In infants bronchitis usually follows a "cold in the
head," with running nose and a cough. The child is indisposed and
peevish because of the cold. In a few days the cough becomes worse,
fever develops, the breathing is quicker, and the baby looks and acts
sick. The cough may be constant and severe; sometimes the cough does not
seem to bother the baby, although this is exceptional. The breathing is
quite rapid and is accompanied with a moist, rattling sound in the
chest. The baby is restless and if the cough is severe it becomes
exhausted. Vomiting or diarrhea may be present.
Bronchitis in Older Children.--Bronchitis in older children comes on
abruptly, with fever and cough. The child may complain of headache and
pains in the chest or other parts of the body. It may begin with a chill
or chilly feelings. These children "raise" with the cough. The
expectoration may be quite profuse; at first it is a white, frothy
mucus, then yellow, and later a yellowish green; it may be slightly
tinged with blood.
There is a mild form of bronchitis in these older children where the
serious symptoms are absent. The children are not sick enough to go to
bed, but they appear to have a "heavy cold" with, at first, a tight,
hard cough, which is usually worse at night. Later the cough turns loose
and the same expectoration occurs as in the severe type. It is these
cases of mild bronchitis which do not receive the proper care and
treatment that develop into the so-called "winter cough," which lasts
for months.
Treatment.--(See page 497 under heading, "Catching Colds.") Children
who acquire bronchitis easily and frequently, should be built up. Cod
liver oil should be given all winter. The sleeping apartment of these
children should not be too cold, but it should be well aired through the
day and well ventilated throughout the night. Flannel night clothes
should be worn and the feet should be kept warm always. Mild attacks of
"cold in the head" should be treated vigorously and not neglected.
The following "Don'ts" may be profitably studied when your child or baby
has bronchitis:--
Don't keep the windows tightly closed; fresh air and good ventilation
are absolutely necessary to the patient.
Don't use a cotton jacket or oil silk.
Don't wrap the child up in blankets and shawls.
Don't carry the child around; keep it in bed.
Don't dose the child with syrupy cough mixtures.
Don't overheat the room.
Don't let friends bother or annoy the baby.
Don't reduce the diet unnecessarily.
The child should be put to bed. The temperature of the room should be 70
degrees F. all the time. The windows should be opened top and bottom
according to the weather, and the room should be well aired every day,
the patient being taken to another room while it is being done. The
child should have its usual night clothes on, nothing more. If the child
is not very sick and insists on sitting up, a bath robe can be worn but
it should be always removed when it sleeps. It is advisable to change
the position of the baby from time to time. Have it rest on one side,
then on the other, as well as on the back. Give a dose of castor oil at
the beginning of the sickness and keep the bowels open during the
disease.
Diet.--The diet will depend upon the severity of the disease. If the
fever is high and the cough persistent, the strength of the food of
nursing infants should be reduced. We can reduce the strength of the
food by giving the child a drink of cool boiled water before each
feeding and shortening the length of each feeding. Older children may be
given toast, milk with lime water, cocoa with milk, broths, gruels,
custards, cereals and fruit juices.
Inhalations.--The value of inhalations in bronchitis is very great.
The ordinary croup kettle, which can be bought in any good drug store,
is the best method of giving them. Full directions come with each kettle
as to the best way to use it. The best drug to use in the kettle is
creosote (beechwood). Ten drops are added to one quart of boiling water
and the steaming continued for thirty minutes. The interval between
steaming is two hours and a half in bad cases day and night. In mild
cases the night treatments can be dispensed with. Sheets rigged up over
the top and sides of the crib, in the form of a tent, is the most
desirable way to give the inhalations.
External Applications.--Counter-irritation by means of mustard pastes
are the best applications. They should be put back and front--one on
back and one on the chest, overlapping at the sides beneath the arms.
They should cover the entire body from the waist line to the neck. These
pastes are made as follows:--Mix the mustard (English) and the flour in
the following proportions, using a quantity according to the size of
child and area to be covered; one tablespoonful mustard to three
tablespoonfuls of flour. Mix with lukewarm water until a paste is
formed, not too thick and not too thin. Spread on a cloth (put plenty
on) and cover with one layer of cheesecloth and place the cheesecloth
side next the skin. In order to guard against burning the skin it is
advisable to rub the skin with vaseline, before and after putting on the
paste. The paste should be left on until the skin is uniformly red. It
may be applied from two to four times in the twenty-four hours according
to the severity of the case. Mustard pastes are most effective during
the first two or three days of the disease.
Drugs.--Drugs are of very little value in the treatment of bronchitis.
In the first stage of the disease, when the cough is hard and dry, small
doses of castor oil and syrup of ipecac may be given to good advantage.
The following dosage should be followed closely: 1st year, 2 drops
castor oil, 2 drops syrup of ipecac, every two hours; 3rd year, 3 drops
castor oil, 3 drops syrup of ipecac, every two hours; over 3 years, 4
drops castor oil, 4 drops syrup of ipecac, every two hours.
The benefits from this treatment will be obtained in the first two or
three days, when it should be discontinued. The cough under this
treatment and the use of the mustard paste and inhalations of creosote
will be soft and loose in two or three days and the fever will be
distinctly on the mend. The disease lasts from five to ten days. It may,
however, last much longer according to the condition of the child, etc.
There are other drugs that can be given, with good effect, but when
other remedies are indicated a physician should be called to
prescribe them according to indications.
SUMMARY:--
Bronchitis is one of the commonest diseases of childhood.
It is the cause of many deaths.
A large number of children have a tendency to bronchitis.
These children need careful attention and "building up."
Do not neglect a "little" cold. It means trouble.
Chronic or Recurrent Bronchitis.--Bronchitis becomes chronic when the
treatment of an acute attack fails to cure the condition. The failure
usually is dependent upon the condition of the child. It may be
suffering with some disease resulting from poor nourishment or poor
sanitary and hygienic surroundings or both. The bronchitis, in other
words, is dependent upon some other condition, and will not get wholly
better until the cause is cured. These children should lead an active
outdoor life when the weather is favorable. Their sleeping-room should
be well aired and ventilated. Red meats are allowed twice a week only.
Sugar is cut down to the lowest limit. Skimmed milk only should be
taken--the cream being too rich for them. They can eat freely of fruits
in season, green vegetables and cereals. The bowels must move freely
every day. Patients must be given a lukewarm bath, followed by a brief
spray of cold water, daily. The cold spray should not be too cold; about
60 degrees F. is the suitable temperature of the water.
An absolute change of climate, to a warmer inland atmosphere, is
imperative before some of these patients will begin to improve.
SUMMARY:--
A child with chronic bronchitis, or with frequent attacks of bronchitis
(or chronic colds), is usually suffering from some other diseased
condition.
The bronchitis, or the cold, will not get better until you find
out what that "other diseased condition" is.
It takes a physician to find that out.
Having found the cause, cure it, and the bronchitis will disappear and
the general health of the child will immediately improve.
PNEUMONIA
Pneumonia is a very common disease in childhood. It is the most frequent
complication of the various acute infectious diseases. Pneumonia is an
exceedingly important factor in the mortality of infancy.
There are two kinds of pneumonia:--
1. Broncho-pneumonia.
2. Lobar-pneumonia.
Acute Broncho-Pneumonia.--Up to the fourth year this is the form of
pneumonia always present. It is the form that always complicates other
diseases all through childhood.
It is most apt to occur during the spring and winter months.
It affects all classes, but especially those whose hygienic surroundings
are poor. Catching cold is the exciting cause in a large percentage of
primary pneumonias.
Symptoms.--Broncho-pneumonia has no regular course. It may or it may
not follow a cold or an attack of bronchitis. As a rule it begins
suddenly with a high fever, frequently accompanied by vomiting, rapid
respiration, cough, and prostration.
The child does not maintain a high fever continuously; it varies
considerably throughout each twenty-four hours. It lasts from one to
three weeks, and subsides gradually.
The respirations vary between 60 and 80 per minute, though they may be
much more frequent than this. The child breathes with apparent
difficulty, the soft parts of the cheeks and nose rising and falling as
it breathes.
The prostration becomes, as the disease progresses, more and more
marked, until the child looks profoundly sick.
Cough is a constant and incessant symptom. It disturbs rest and sleep
and may cause frequent vomiting. There is no expectoration.
A strong cough is a good symptom; if it stops it is a bad symptom.
Pain is seldom present.
Blueness of the skin is a bad sign and indicates failure of respiration
and suggests constant and careful watching.
Delirium may be present during the disease. It is not necessarily a bad
sign. Accompanying stomach troubles are frequent if the patient is very
young, and are very important. The bowels may be loose; they may be
green in color and contain much mucus. Large quantities of gas may
accumulate in the intestines and may cause much distress and
convulsions. Death may occur at any time or the process may be arrested
and recovery take place at any stage of the disease. Broncho-pneumonia
is not necessarily a fatal disease in a fairly healthy child. It is,
however, always a serious disease.
Various complications may occur in the course of the disease. The most
frequent are: pleurisy, emphysema, abscess of the lung, meningitis,
heart disease, stomach troubles, thrush, intestinal disease.
How to Tell When a Child Has Broncho-Pneumonia.--If a child develops a
high fever, breathes rapidly, coughs, and is content to lie in bed
because of the degree of prostration, broncho-pneumonia is almost
certain to be the disease present. If in addition to these symptoms
there is any blueness of the fingers or around the mouth it is more
strongly suggestive of pneumonia.
If the child has been suffering with bronchitis it is sometimes
difficult to tell just when the pneumonia begins. The child will appear
more profoundly sick, the fever will go higher, and the respiration will
be more frequent when pneumonia sets in on top of bronchitis.
Treatment.--The nursing of a little patient with pneumonia is the most
important part. He must get plenty of fresh air; consequently he should
be kept in a well-ventilated room. It is an excellent plan to change the
patient twice daily from the sick room into another which has previously
been thoroughly aired. While he is in this room the sick room should be
as thoroughly aired as is possible. Keep this plan up all through the
disease; change the position of the patient in bed every two
hours. He should never be allowed to lie on his back for hours at a
time. In this way the different parts of the lungs get a chance to air
themselves,--the air cells expand and the oxygen in the air and the
fresh blood tend to heal the parts more quickly.
It would be distinctly wrong to go into the detailed symptomatic
treatment of broncho-pneumonia in a book of this character. Inasmuch as
this is one of the most serious diseases of infancy, no mother should
attempt to treat it alone. A physician is absolutely necessary and the
most the mother can hope to do is to follow out his directions to the
letter.
He may direct the use of mustard pastes but it is essential to know
where to apply them. If he should request the use of the cotton jacket,
the height and character of the fever must regulate its use. Stimulants
are always necessary, whisky and strychnine being given in every case,
but if given at the wrong time they may do more harm than good. Cough
mixtures may be necessary, but frequently they are contra-indicated.
Drugs and cold sponging may be used to reduce the fever, but they are
dangerous if used when conditions do not justify their use.
Complications must be diagnosed when they occur, and the correct methods
of treatment promptly instituted. A competent physician alone can assume
the responsibility of these various phases of the disease.
Every mother should appreciate, however, that pneumonia is frequently
the result of carelessness. It is a well-known fact that pneumonia is an
infrequent disease among children of the well-to-do, because the
hygienic surroundings of these children are better and because they
receive competent attention if suffering with colds and bronchitis.
Bronchitis is quite common in all classes of children, but in the lower
walks of life it is the custom to allow children to run around while
they give every sign of having a heavy cold, and a beginning bronchitis.
These children should receive treatment and should be kept indoors and
in bed if they have even a slight fever, as pneumonia is frequently the
inevitable outcome. They should be carefully fed, and all signs of
stomach or intestinal troubles attended to at once.
[Illustration: By permission of Henry H. Goddard
A Grim Result
Isaac is 16, although mentally 10. He is a high-grade moron.
This is one of those all too frequent instances[A] "of a
feeble-minded woman with a husband who is alcoholic and the
offspring either feeble-minded or miscarriages."
"Isaac is exceedingly dangerous. He is a potential criminal or bad
man, or under the best conditions would at least marry and probably
become the father of defectives like himself."
This and the succeeding pictures in this volume contrast vividly with
the frontispiece. Terrible are the results when we disregard the
inevitable laws of nature, and so mate ourselves that our children will
be parasites on society.]
[A] "Feeble-mindedness; Its Causes and Consequences", Goddard, The
Macmillan Company.
The After-Treatment of Pneumonia is important, and every detail
has a distinct bearing on the ultimate recovery and establishment of
good health. Careful feeding, a good tonic, and the proper attention to
exercise, fresh air and bathing are requisite. A change of air after the
fever is gone is more important than all other measures put together. A
dry, warm climate where patients can be kept in the open air is
preferable. The danger of allowing a slow, long drawn-out convalescence
after pneumonia is the development of tuberculosis.
ADENOIDS
Adenoids are very common, almost popular, in childhood. The condition is
one that causes more real trouble and discomfort than any other
childhood affliction. Adenoids are associated with, and are responsible
for, many of the ailments of childhood. They may be associated with
enlarged tonsils or they may be independent of them. They may be present
at birth or develop any time thereafter, though they are more frequent
between the ages of two and six years. Children who have adenoids
invariably suffer from chronic "head-colds" with a discharge from the
nose. These chronic colds are caused by the adenoids. Nearly every
disease, and every diseased, or abnormal, condition of the nose, throat,
larynx, and lungs can be directly caused by the presence of adenoids.
They are also responsible for numerous other conditions of very grave
importance in the growing child. The accompanying "head-colds" may
develop into a bronchitis which may keep the child indoors for a long
period. Adenoids always interfere with respiration, thereby depriving
the child of a normal quantity of oxygen, thus rendering the blood less
pure, and, as a consequence, seriously interfering with the nourishment
and general health. The impaired nourishment and poor health thus
produced, as a direct result of adenoids, renders the child more liable
to disease; he may thus acquire ailments that may affect his whole
subsequent life. The mental side of a child's development is also
affected by the presence of adenoids, so much so that actual statistics
prove that these children cannot keep up with their classes in the
public school.
We must therefore regard the presence of adenoids as a serious
menace to the health and comfort of the patient. It has already been
pointed out in discussing other diseases that before a cure of these
diseases could be permanently accomplished it would be absolutely
necessary to remove the adenoids, which were, no doubt, the actual
cause, or an important contributing cause, of the disease. Such
conditions as catarrhal laryngitis, croup, chronic recurring winter
coughs, acute catarrhal rhinitis, "snuffles", "cold in the head",
chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting",
"nose-bleeding", headaches in growing children, anemia, deafness, night
terrors, defective speech, diphtheria, consumption, are frequently
caused by the presence of adenoids.
These patients contract certain diseases easier than other children, and
when they do, they have them more severely; such diseases are
diphtheria, tuberculosis, scarlet fever, measles, and whooping cough.
Adenoid children are, as a rule, in better health during the warm,
equable, summer weather than during the changeable, uncertain weather we
have in the winter months. If the case is neglected, and if the adenoids
have existed for a long time, the growth of the child is impaired. He
remains small and stunted, and the expression of the face is dull and
stupid. The temperament and disposition are affected also; such children
are languid, listless and depressed.
How to Tell When a Child Has Adenoids.--Children with well-developed
adenoids are "mouth-breathers." Instead of breathing through the nose
they breathe with the mouth open, especially when sound asleep. If a
child has a discharge from its nose and a chronic cough, both of which
resist treatment, and if in addition it is a mouth-breather, it is safe
to investigate the naso-pharynx for adenoids. If a child with these
symptoms is not in good health, is listless and depressed, looks stupid,
snores at night, has difficulty in breathing and cannot blow its nose
satisfactorily, is troubled occasionally with "nose bleeds" and
headaches, we may be satisfied that the child has adenoids, as no other
condition could produce such a picture.
Adenoids, like enlarged tonsils, are dangerous, apart from the
physical distress and disease which they cause, owing to the fact that
they harbor deadly bacteria, and from these bacteria, which find a
lodgment in the adenoids and tonsils, a fatal attack of diphtheria or
consumption may have its beginning.
Treatment of Adenoids.--Absolute removal is the only justifiable
treatment. This is rendered imperative for so many reasons that it is
unnecessary to go into details in justification of the procedure.
The physical well-being, the mental development, the life of the child
depend upon it. Any parent who would wittingly interpose an objection to
the removal of his or her child's adenoids, after they have been
demonstrated to exist, would be guilty of a grave crime.
The operation itself is not at all dangerous. It is over in a few
moments and the child is well in an hour or two, so far as any pain or
suffering is concerned.
Physicians are frequently asked if adenoids "grow" again after removal.
The answer is, "Yes," they sometimes do. In a very small percentage of
the cases they do return. The older the child is when they are removed
the less chance there is of a recurrence. A child operated on before it
is two years of age is more liable to a recurrence than a child operated
on at six years of age. This must not, however, be construed as an
excuse for putting an operation off, because if a child needs an
operation at two years and it is postponed till later, its health will
be permanently injured before it is four years of age.
SUMMARY:--
1. Adenoids cause more trouble and more actual disease than any other
condition during childhood.
2. It is a crime for a parent to refuse operation if the presence of
adenoids has been proved.
3. Removal is the only treatment and it should be done in every case as
soon as possible.
4. The operation is a trivial one and is free from danger.
NASAL HEMORRHAGE--"NOSE BLEEDS"
A hemorrhage from the nose may occur at any time from birth on. It
depends upon the rupture of one or more blood vessels. The great
majority of "nose-bleeds" are caused by adenoids, or by a small ulcer in
the nose, or by an injury, such as a blow or fall. A nasal hemorrhage,
however, may be caused by other, more serious conditions, and for that
reason may justify a careful inquiry into the cause, especially if
bleeding should occur a number of times, or be of a serious character
the first time.
Of the more common causes as given above, the adenoids should be
removed, and the chronic catarrh which is invariably the cause of the
ulcer should be cured.
Treatment of an Acute Attack.--Have the patient sit erect; loosen all
tight clothing around neck; fold the hands over the head; apply cold to
the back of the neck and the nose. Pieces of ice can be put into the
nostril and the ice bag to the nape of the neck, or a piece of ice can
be put into a folded napkin and held on the back of the neck. Taking a
long breath and holding it as long as possible and repeating it while
the ice is being applied is an aid. Placing the feet in hot mustard
water is of decided use. Another excellent expedient is to wrap
absorbent cotton round a smooth probe (piece of whalebone, for example),
dip the cotton in an alum-water mixture (half teaspoonful powdered alum
in a half cupful of water), and then push it into the bleeding nostril
as far as you can with gentle force. A valuable remedy is Peroxide of
Hydrogen used full strength and freely dropped into the nostril. If
these measures fail, send for a physician at once.
SUMMARY:--
1st. Nose bleeds may be caused by some serious condition.
2nd. If they occur a number of times have the child examined.
3rd. If the treatment outlined above does not stop the bleeding in a few
moments send immediately for a physician.
QUINSY
Quinsy is not common in childhood. It usually follows tonsilitis when it
is seen. The child complains of pain in the neck, extreme pain and
difficulty upon swallowing, and inability to open the mouth as much as
usual. There is a tendency to hold the head to one side. The treatment
is to open the abscess at the earliest moment after pus is present.
HICCOUGH
Hiccough is, in most cases, in infancy and childhood caused by some
irritation of the stomach, may be over-filled with food or gas. In these
cases it is an unimportant incident and may be quickly relieved by
giving the child an enema of soap-water and a laxative of rhubarb and
soda.
Infrequently hiccough may be the result of cold feet, or a surface
chill. Simple methods of relief are, to hold the breath, to expire, or
blow the breath out as long as possible before taking the next breath;
to sip water from a cup held by another person while the tips of the two
fore-fingers are in the ears.
Hiccough is quite frequent in hysteria in girls, but it is of no
consequence. When hiccoughs set in during the course of any serious
disease it is a very unfavorable sign.
SORE MOUTH: STOMATITIS
Stomatitis is an inflammation of the mucous membrane (inner lining) of
the mouth. The gums and the inner surface of the lips and cheeks may be
red and angry-looking. There may be small grayish spots on any part of
the mouth. If the case is very bad or if it has lasted some time and has
been neglected, these spots grow larger and join together forming
irregular grayish plaques. A large percentage of the cases never go
further than this because the proper care and attention is given them.
It is possible, however, for any case to progress further and become
ulcerative. This will be observed first as a faint yellow line
at the margin of the teeth and gum. Ulceration never takes place unless
the child has teeth. The quantity of saliva is very greatly increased,
so much so that it flows out of the mouth soiling the clothes. The
saliva is intensely acid and it consequently irritates the skin, causing
more or less eczema. The mouth is painful and hot. There is slight
fever, but seldom any marked prostration. If, however, the ulceration
should be severe, the fever may be quite high.
There is one feature of these cases that sometimes proves vexatious and
annoying. Because of the soreness of the mouth, the child cannot draw
strongly enough on the nipple to get a normal feeding, and as a result
the nutrition of the child is poor. These children are hungry and when
offered the nipple grasp it greedily, draw a few mouthfuls then stop
because of the pain and begin to cry.
If the ulceration is extensive, there is usually an odor and the gums
bleed easily. Sometimes the teeth fall out or have to be drawn out.
Strong, well-fed children are as likely to develop stomatitis as are
those who are weakly and ill fed.
The disease is caused by infection and is contagious. Just what the
infection is we do not know; we do, however, know that children whose
mouths are carefully cleaned after each feeding do not have sore mouths
of this character. When cleaning the mouth care must be observed not to
injure the tender mucous membrane.
Treatment.--As soon as the condition is observed mouth-washing should
be systematically and thoroughly carried out. After each feeding the
mouth should be washed with a saturated solution of boric acid in boiled
water. (See page 626.)
It is not necessary to use any further treatment, as a rule. Patients
recover in four to eight days. Strict attention to cleanliness, however,
is imperative. The feeding bottle and nipple, or the mother's nipple, if
breast fed, must be kept scrupulously clean.
The feeding of these children is sometimes a problem for a day or two,
because, as stated above, of the soreness of the mouth. This is best
overcome by feeding the baby with a spoon. If breast fed, it is
necessary to pump the milk and then feed with the spoon. Children will
take the milk better if it is fed cold. Cold boiled water is largely
taken and is good for them at this time.
Treatment for Ulcers in Mouth.--The ulcers should be touched with a
camel's-hair brush which has been dipped into finely powdered burnt
alum. If a stronger caustic is necessary, the solid stick of nitrate of
silver may be used.
A mouth wash may also be used in the ulcerative cases, composed of the
peroxide of hydrogen diluted with two parts of water. If this is used
wash the mouth out afterward with plain, cool, boiled water. The
peroxide mouth wash can be used four or five times daily.
In addition to the mouth washing in the ulcerative cases it is advisable
to use internally chlorate of potash. The druggist should be requested
to make a two-ounce saturated solution, and of this you can give
one-half teaspoonful, largely diluted with cool water, every hour during
the day for the first twenty-four hours, then every two hours until
marked improvement is shown, when it can be further reduced by
lengthening the interval between doses.
SPRUE--THRUSH
Sprue is a form of sore mouth. It is seen only during the first six
months of life, as a rule. It affects the mucous membrane of the mouth;
it appears in the form of small white spots that look like drops of
curdled milk. They are on the inner surface of the cheek and may be all
over the mouth, and on the tongue. The spots are firmly attached, and if
forcibly removed the mucous membrane will bleed.
The disease is caused by infection through lack of cleanliness and it
invariably affects poorly nourished children, especially those who are
bottle-fed.
There are no symptoms other than those of the mouth; the child
frequently refuses to nurse because of evident pain and distress while
nursing. The condition is not contagious. It may be cured in from six to
eight days without difficulty.
Treatment.--Mouth irrigations of boracic acid are all that are
necessary. They are given in the following way: Place the child on its
side, roll around the index finger a piece of absorbent cotton, dip this
in a saturated solution of boracic acid, and put into the mouth of the
child. Let the cotton take up as much of the solution as it will hold,
so that when it is lightly pressed on the tongue and cheeks it will flow
out of the mouth, thus "irrigating the mouth." Repeat this a number of
times, pressing the cotton to a different part each time. This should be
gone through from four to six times daily.
If the child is a bottle-fed baby, care should be taken in cleaning the
nipples and bottles as directed on page 264. If the patient is
breast-fed, care must be taken to note that the mother's nipples are
clean. They should be washed with the same solution of boracic acid and
not handled. If the child cannot nurse it is necessary to feed it with a
spoon.
In obstinate cases the parts may be touched with a one per cent.
solution of formalin. Mothers should particularly note not to use honey
and borax, as is often recommended by women who know no better, in any
disease of the mouth in children.
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