DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL
Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting--Acute
Gastric Indigestion--Iced Champagne in Persistent Vomiting--Acute
Intestinal Diseases of Children--Conditions Under Which They Exist and
Suggestions as to Remedial Measures--Acute Intestinal
Indigestion--Symptoms of Acute Intestinal Indigestion--Treatment of
Acute Intestinal Indigestion--Children with Whom Milk Does Not
Agree--Chronic or Persistent Intestinal Indigestion--Acute
Ileo-colitis--Dysentery--Enteritis--Entero-colitis--Inflammatory
Diarrhea--Chronic Ileo-colitis--Chronic Colitis--Summer
Diarrhea--Cholera Infantum--Gastro-enteritis--Acute Gastro-enteric
Infection--Gastro-enteric Intoxication--Colic Appendicitis--Jaundice in
Infants--Jaundice in Older Children--Catarrhal
Jaundice--Gastro-duodenitis--Intestinal Worms--Worms, Thread, Pin and
Tape--Rupture
ACUTE GASTRIC INDIGESTION
Acute Inflammation of the Stomach--Acute Gastritis--Persistent
Vomiting
An infant seldom has real inflammation of the stomach. Gastric, or
stomach, indigestion is the better name, because it actually signifies
the true condition. It is indigestion that causes a child to vomit,
though it is possible to have a true inflammation caused by the taking
of irritant or corrosive drugs.
Gastric indigestion causes sudden, repeated vomiting, with prostration
and occasional fever. It is caused by unsuitable food, the wrong
quantity of food, irregular feeding, and food the quality of which is
not good.
Treatment.--The stomach should be immediately washed out. Until the
physician arrives the mother can encourage the child to drink a large
quantity of cool boiled water. This will be vomited and it will wash out
the stomach at the same time. No further treatment may be necessary, as
the vomiting may stop. All food should be withheld for at least
twenty-four hours. A high rectal irrigation should now be given. It is
essential to know that the bowel is absolutely clean in all vomiting
cases. The normal salt solution is the best agent to use for a high
enema in infants. (See page 586.)
After twelve or twenty-four hours' abstinence from food, the child can
be given teaspoonful doses every twenty minutes of cooled boiled water,
or barley or albumen water, weak tea, or chicken broth. Cold liquids are
better retained and more readily taken than those that are heated. If
the liquid feedings are vomited, another twelve hours must elapse before
trying stomach feedings. In these cases we must try to satisfy the
thirst by giving cold colon flushings. If the case becomes protracted
and we find it impossible to nourish the child by the mouth, we must
wash the stomach out once every day with a five per cent. solution of
bicarbonate of soda, and feed the child by the rectum. Sometimes we can
feed through the stomach tube. Liquids will frequently be retained when
put into the stomach through a tube when they will be vomited if
swallowed.
The best food by the rectum is plain peptonized milk.
Drugs are absolutely useless. If the vomiting persists, despite the
above efforts to stop it, there is nothing to be gained by
experimenting. You will not only render the condition worse but you will
weaken the child. Morphine given hypodermatically is the only remedy.
Given in appropriate doses, according to age, it is absolutely harmless.
It will not only stop the vomiting, but it will give the child a
much-needed rest, by allowing it to go to sleep. When it wakes up it
will be stronger and its stomach will most likely retain small doses of
nourishment.
Great care must be exercised, in getting the child back on a normal
diet, not to try to go too fast.
In cases of persistent vomiting in children I have found it advisable to
use teaspoonful doses of ice-cold champagne. These children will
sometimes keep this down when all other liquids will be vomited. It is
absolutely necessary to keep the child lying down. If he is
restless or sits up, the vomiting may begin all over again. The
champagne not only is excellent nourishment for the child, but it quiets
the stomach, allays irritability, and frequently favors sleep, during
which time a cure very often results. The champagne must be drawn
through a champagne siphon (procured in the drug store), and the bottle
must be kept on ice with the mouth downward; otherwise it will get stale
very quickly and be of no use. If kept as advised it will remain good to
the end.
SUMMARY:--
1st. Persistent vomiting in a child means acute gastritis. Stop all food
for twenty-four hours.
2nd. Encourage the child to drink large quantities of slightly warm
water; this will wash the stomach out and frequently stops the vomiting.
3rd. When the child is quiet wash out the bowels.
4th. If vomiting persists, use iced champagne as directed.
ACUTE INTESTINAL DISEASES OF CHILDREN
The large infant mortality that results from intestinal diseases during
the summer months is deserving of the most careful consideration, both
of the physician and the parent.
Apart from the excessive heat of the summer, there is no doubt that an
unfavorable environment, which means bad hygienic surroundings, bad
sanitary conditions, bad food and home influences, contributes largely
to the enormous number of these serious cases. Education, while it may
be expected to influence favorably the sanitary and other conditions in
the home, cannot change the home location. The child must continue to
live in the same environment. It is in this class of cases that these
summer diseases are so very fatal. Children in better circumstances can
take advantage of conditions which are denied to the tenement child. The
diseases must therefore be faced and treated under these existing
conditions.
In addition to the climate and the environment, there are certain
factors that occur in all classes which result in intestinal
derangement. If the stomach or bowels are not performing their function
properly, or if the food or method of feeding is wrong, these, plus very
hot, humid weather, invariably result in serious intestinal disease. The
mother must be taught to interpret properly the meaning of a green,
loose stool in the summertime; she must appreciate that it is the danger
signal and must be regarded seriously.
The very best preventive against summer diseases of the intestine is to
guard particularly against any trouble with the child's stomach at all
seasons of the year. A healthy stomach and bowel will resist disease,
even in very hot weather.
The most important food product which has a direct relationship to this
class of diseases is milk. In a large city like New York it will remain
impossible to solve the milk problem, despite the splendid efforts of
the Health Department and the members of the medical profession, until
the city itself shall establish milk depots and ice stations where safe
milk, and ice to keep it safe, may be obtained at a nominal cost, or
free, if the parents cannot afford to buy it. We, therefore, must
recognize that the vast majority of children to-day are taking milk that
is not suited to them, that is really not fit as a food for children.
The mothers do not know this and no steps are taken to render the milk
more safe for them to feed to their children. These mothers are willing
to do what is essential in the interest of their children, but they do
not know what should be done. These people cannot afford a physician or
a nurse to teach them, nor do they even know that their methods are
wrong or that they need any instruction. We must carry the information
and the explanation to them. We must show them the need for a change of
methods. This is the work for those charitably disposed women who desire
some worthy purpose in life, who really wish to do some real good. All
the equipment they need is good common sense. They will tell these
mothers why it is necessary to pasteurize the milk before feeding it to
the baby. They will show how to keep the nursing bottles clean,
and the nipples sweet and fresh. They will instruct them how to dress
the baby in the hot weather and impress them with the need of giving it
all the cool, fresh air possible. In short, they will gain the
confidence and the good will of these mothers in a tactful and
diplomatic way, and they will tell them all they know in language which
they will understand regarding the care of the baby. In every city in
the country this work is needed and is waiting for the missionaries who
will volunteer. To teach mothers the need for boiled water as a
necessary drink for baby and older children is alone a worthy avocation.
To impress upon one of these willing but ignorant mothers the absolute
necessity for washing her hands before she prepares her baby's food,
that she must keep a covered vessel in which the soiled napkins are
placed until washed, that she should frequently sponge her baby in the
hot weather, and explain thoroughly why these are important details, is
a work of true religious charity. They should be specially taught to
immediately discontinue milk at the first sign of intestinal trouble, to
give a suitable dose of castor oil and to put the child on barley water
as a food until the danger is passed. They should be taught to know the
significance of a green, watery stool, they should know that is the one
danger signal in the summer time that no mother can ignore without
wilfully risking the life of her baby. They should be taught to prepare
special articles of diet when they are needed. If every mother were
educated to the extent as indicated in the above outline the appalling
infant mortality would fall into insignificance. It is not a difficult
task nor would it take a long time to carry it out; it is the work for
willing women who have time and who perhaps spend that time in less
desirable but more dramatic ways.
It is the knowledge that aids in catching disease in its inception that
counts. The worst infections begin as a mild condition and prompt
treatment robs them of their sting. When treatment is delayed and the
child is fed for twenty-four hours too long on milk, the condition which
in the beginning could have been stopped promptly has developed and it
becomes a fight for life.
It will be seen from the above that all we need is education.
Education of the mother primarily, but education of the missionary, the
nurse, the physician, the municipality, and the State, each
co-operating, each willing to work in the interest of a great cause, for
the benefit of the human race and for the brotherhood of man.
ACUTE INTESTINAL INDIGESTION
Causes.--Overfeeding, unsuitable and improper food, irregular and
indiscriminate feeding, sudden change from one food to another, as at
weaning time, a change from a poor quality to a rich food, or vice
versa. Conditions affecting the health of the child, especially the
nervous system, such as hot weather, extreme cold, fatigue, or at the
beginning of any of the acute diseases. Children sometimes are
predisposed to attacks of intestinal indigestion; these children are
delicate in health and have weak digestive ability. The slightest
irregularity or error in diet will cause an attack in these children.
Symptoms.--The attack may come on suddenly or it may develop slowly.
The important constitutional symptoms are fever, prostration, and a
general nervous irritability. The child is seized with pain in the
abdomen. The pain is referred to the region around the navel. It is
sharp, colicky, and severe, causing the child to cry out and draw up its
legs in an effort to lessen its severity. The child is exceedingly
restless and acts as if it were on the verge of a dangerous illness. Gas
in the bowel is not present as a rule as frequently as it is in infants
under the same circumstances. In a few hours diarrhea sets in, the
stools may number from four to twelve or more in twenty-four hours. The
stools are acid, sour, and the odor may be very foul. They are thinner
than usual and frothy from the presence of gas.
In very young infants suffering from a sudden attack of intestinal
indigestion, the stomach, as well as the bowels, is invariably upset. If
the indigestion is the result of a slower process, the stomach does not
participate in the process. The color of the stools in infancy is yellow,
then yellowish-green, and later grass-green. Undigested food is
always present and in infants the curdled casein of the milk appears
as white specks or lumps in the movements.
The fever is high in the sudden cases and lower in the cases of gradual
onset. The prostration is more severe when the onset is sudden and in
infants may be very marked.
The termination of the disease depends upon the cause, the treatment,
and the previous health of the child. In healthy children promptly and
properly treated it may be all over in a week. In delicate, poorly
nourished children, and especially in the summer time, it may be the
beginning of trouble that may eventuate in death.
Treatment.--There is no condition in the whole realm of diseases of
childhood where the knowledge of the mother may have such important
results as this condition. The most effective time to treat these cases
of intestinal indigestion is before the physician is called. There are
few diseases in which time is so valuable, so far as final results are
concerned, as it is here. Every mother should know the significance of a
loose, green stool. She should be taught that it means danger and
consequently demands prompt treatment. The first indication is to empty,
thoroughly, the bowel. The best means for this purpose, if it is
immediately procurable, is calomel. If calomel is not procurable at once
give castor oil, two teaspoonfuls to an infant, one tablespoonful to an
older child. Calomel should be given in one-eighth-grain doses, repeated
every three-quarters of an hour for eight or twelve doses, until the
bowel is thoroughly cleaned out. Don't be afraid of a few extra
movements at the beginning. Better clean out thoroughly at the start
than to be compelled to do it all over again after the child is weak and
suffering from the poison of the disease. The next important thing to do
is to stop milk at once. The thirst is usually intense and if vomiting
is not present it can be moderately relieved by giving small quantities
frequently of cool boiled water or mineral water or strained albumen or
barley water. We quite often have to stop all food and liquids by the
mouth for twenty-four hours.
If the prostration is very great and the child looks as though it
might collapse, it can be given brandy in cracked ice from time to time.
After the bowels have been thoroughly cleaned out, never before, some
medicinal agent may be given to stop the unnecessary diarrhea. In a very
large number of promptly and properly treated cases this is not needed.
If it is thought best to use it the physician will select the agent
according to the conditions present and prescribe it.
Breast-fed infants rarely have intestinal diseases of a severe type. If
they should develop diarrhea they must be taken off the mother's milk
for twenty-four hours. They should be given a dose of castor oil or
calomel and fed on barley water in the interval. The feedings should be
reduced in quantity and the interval doubled. The two-hour interval will
become a four-hour feeding: the three or four ounces at each feeding can
be reduced to two ounces. The intention is to simply give as little as
possible while the diarrhea is under way.
The mother's breasts must be pumped at the regular feeding time in order
to preserve the flow, release the pressure, and keep the milk fresh.
It is sometimes a problem to renew feedings of milk without exciting a
relapse of the diarrhea. It should not be tried until the stools are
normal in color and consistency. This may not be for three or four days.
In resuming the milk it should be given in smaller amounts and diluted
with lime water or barley water for the first day. Gruels may be given
to which skimmed milk may be added: later add the ordinary milk. If it
is well digested and does not cause any return of the diarrhea, the
quantity of milk can be slowly increased until the former feedings are
resumed. It is often of very great advantage to boil the milk for some
time. Peptonized milk is safe and can be used in bottle-fed infants
after diarrhea. In older children, meat, broths, eggs, boiled milk, and
dry toast bread may be used sparingly for some time. Cereals,
vegetables, fruits, should be withheld for a considerable time and
watched carefully when resumed. Kumyss, buttermilk, matzoon, bacillac,
and other fermented milks are better borne than plain milk. All of
these children need rest, fresh air, change of air, frequent bathing,
and tonics, as an attack of this kind leaves them depressed, weak,
languid, and anemic.
SUMMARY:--
1st. When a child complains of sharp, colicky, severe pains in the
abdomen, around navel, which are shortly followed by foul, sour, frothy
diarrhea,--greenish in color, it has acute intestinal indigestion.
2nd. Every mother should know that a green stool means danger. She
should know to give at once a cathartic,--castor oil is good, but give a
good large dose--then stop all food for twenty-four hours. If she learns
this lesson she will have time to wait for the doctor; meantime, she may
have saved her child's life.
CHILDREN WITH WHOM MILK DOES NOT AGREE
Contrary to the general belief, there are quite a large number of
children in whom milk seems to act as a poison. These children are not
necessarily constipated. They suffer, however, from a slow, continuous
intestinal toxemia or poison. The symptoms of this condition are
headache, disorders of speech, habitual sleep-talking, sleep-walking,
and general nervous irritability without cause: they are listless,
languid, and constantly tired. They may be bright in the morning and
sleepy in the afternoon. They are irritable and cross and touchy.
Treatment.--Milk must be wholly discontinued. Eggs must be restricted
to one every second day, and meat but once daily. The use of green
vegetables is particularly suitable and should be given daily. Cereals
and fruit also are good. Malted milk, kumyss, or matzoon may be given in
place of milk. If constipation is present, rhubarb and soda mixture is
an excellent laxative in these cases. A tonic should be prescribed for
all these children.
DYSENTERY--ENTERITIS--ENTERO-COLITIS--INFLAMMATORY DIARRHEA
Cause.--Any cause which has been mentioned as a cause of ordinary
diarrhea may result in this disease. It may occur at any time of the
year and at any age. It may follow the infectious diseases. It may
follow any other disease of the intestines.
Symptoms.--It may begin like an ordinary attack of acute intestinal
indigestion. There is usually vomiting, fever, pain, and frequent yellow
or green stools. The passages may be blood-stained and there may be
little or much mucus. The stools at the beginning have no odor as a
rule. The bowels move very frequently, often with little or nothing to
pass. There may be pain with each movement. The blood may disappear in a
few days, but the mucus remains, often in large quantity in each stool.
At the beginning the fever is high, but it soon falls and remains low
during the attack. The child loses weight, is irritable, has no
appetite, and looks and acts sick. When the attack is over these
children do not gain their strength as readily as we would like;
recovery is slow.
The acute symptoms usually last about one week, after this time the
child begins to recover, but the process is a tedious one and one in
which much care has to be exercised. It is an encouraging sign to note
the disappearance of the blood in the stools and the return of the
movements to the normal brown color. When these favorable signs are
wanting the bowel is probably ulcerated and it will take a much longer
time to return to normal and to be free from blood and mucus.
The above is the ordinary form of this disease and it ends in recovery
as a rule. There is a more severe form, however, which differs from the
above in the following way:
The fever is high and remains high; the stools are more frequent and
there is more blood and more mucus in them; the child is much more
irritable and is more profoundly sick. Death may occur at any time from
the second day. If the little patient survives, the return to health is
a very slow process; it often takes months and frequently years before a
reasonable degree of strength is regained. Relapses are common, and
they are very difficult to treat and care for. In some cases the child
never wholly regains its former strength.
There are children who have been the victims of other intestinal
diseases or conditions who develop colitis. The colitis in these cases
may come on suddenly with vomiting and high fever, or it begins slowly,
with no vomiting and with little fever. Their appetite is poor, their
digestion is feeble, their prostration is pronounced. They lose flesh
rapidly and may be emaciated to a remarkable degree. Very few of these
cases recover completely. Serious and sometimes fatal relapses may take
place. The feeding of these children is a difficult task and the
greatest care must be constantly taken; a very little mistake may cost
the life of the child.
Treatment.--All diseases of the intestine in childhood should be
promptly and efficiently treated. If any form of diarrhea is neglected,
it may result in the development of ileo-colitis with all its risks and
uncertainty. When a child is seized with sudden bowel trouble, no matter
what variety it is, it should be treated with the greatest care because
"sudden" bowel trouble usually means plenty of trouble if it is
neglected.
Fresh air is essential in all these cases. A change of air is of decided
value as soon as the immediate symptoms have abated. The diet is the
same as for children who have gastro-enteric intoxication. Later, much
difficulty will be met because these patients have absolutely no
appetite,--peptonized skimmed milk is always good, beef broths are often
well borne, liquid beef peptonoids may be tried. The food should be
given every three hours. Boiled water and stimulants may be given
between the feedings. Later in older children, raw beef, eggs, boiled
milk, kumyss, or matzoon and gruels may be given. Great care has to be
taken for months after an attack; relapses may be caused by changes of
temperature, by fatigue, and, of course, by improper feeding. These
children should avoid potatoes, tomatoes, fruits, corn, oatmeal, and a
great many other things which an intelligent mother would not give any
sick child, as candy, cakes, pastries, etc.
Cases which begin with free vomiting, thin stools; and fever should be
treated at once. The bowels must be thoroughly cleaned out, the colon
should be thoroughly irrigated, and all food should be stopped. When
there are bloody stools with mucus and pain we must depend upon castor
oil, irrigations of the colon, and opium and bismuth by the mouth. A
good big dose of oil at the beginning is always necessary. If, however,
the stomach is irritable and will not tolerate castor oil, we may
substitute calomel in one-fourth-grain doses every hour for six doses,
to be followed by citrate of magnesium. Irrigation of the colon in these
cases is one of the essential means of successful treatment; it should
be done twice a day during the first few days of the disease.
Stimulants are needed in all the cases. They help the heart, act as a
food, and tend to quiet the general nervousness by favoring sleep. Good
brandy given in boiled cool water is the best stimulant.
After the child is over the worst of the acute symptoms all medicine
should be withdrawn and the proper kind of food given. Tonics will aid
in restoring the strength. Cod Liver Oil during the following winter is
a very good plan to aid in building up the vitality of the weakened
bowel, but it must not be given too soon.
CHRONIC ILEO-COLITIS--CHRONIC COLITIS
Chronic Ileo-colitis fellows the acute variety. Cases which are
unusually severe or which have been badly managed are likely to become
chronic. A child suffering from this disease presents the following
picture: The patient is emaciated, the abdomen is usually enlarged with
gas, the feet are cold, the circulation of the blood is poor, the fever
is low or absent altogether except when the child is having a relapse,
when it jumps up suddenly. The bowels are loose and contain mucus,
frequently in large quantities. The mucus may stop for a few days; then
it appears again with a rise of temperature accompanied with loose
stools with foul odor. These children are exceedingly nervous and
irritable and are very poor sleepers.
Parents should be told it will be impossible to effect a rapid cure of
these cases. It often takes months to get them started on the safe road.
The slightest mistake or change in the weather will upset the progress
of the cure and it will be necessary to begin all over again. The entire
hope of cure rests with the mother. She must be faithful, patient, and
must carry out the physician's instructions implicitly. The management
consists in diet, change of climate, and such other treatment as the
physician finds necessary in each individual case.
Treatment.--In children under one year of age the only hope is breast
milk, which must be given in small quantities. They do not do well on
any starch food for a considerable period.
Where breast milk is not available the whites of two or three eggs may
be given daily. They may be beaten up and given in skimmed milk, or in
plain water with a little salt added. Zwieback or bread crumbs may be
given in small quantities. They should be fed at four-hour intervals.
Older children may take skimmed milk, raw scraped beef, junket, and
coddled white of egg or raw egg, bread crumbs, toasted, or zwieback.
A rectal enema must be given every twenty-four hours if the bowels have
not moved. If constipation is the habit a laxative should be given; the
aromatic fluid extract of cascara sagrada or magnesia are suitable. At
least one free movement every day is essential to success.
Colon irrigations are only to be used when there is a rise of
temperature, irrespective of whether the bowels have moved or not.
When convalescence is established these children should be given a
maximum of fresh air and should be treated as recommended in cases of
malnutrition.
SUMMER DIARRHEA
As the name implies, this is the form of diarrhea that is so common,
especially in cities, in summer. It is always preceded by some milder
condition which paves the way for the more serious diarrhea. Acute
indigestion is, as a general rule, the forerunner of cholera infantum.
The influence of hot weather must always be kept in mind as the
underlying factor which no doubt conduces to gastro-intestinal disease
of infancy and childhood. The depression incident to a spell of hot and
possibly humid weather tends to interfere with the digestive process of
babies and children. When this function is carried on imperfectly, the
strength and vitality of the child fails, and if immediate steps are not
taken to check the process, diarrhea makes its appearance. If these
children are improperly fed, or if their surroundings are not sanitary;
if they are not getting fresh air enough, or if they suffer because of
lack of attention, and have at the same time a little indigestion, it is
only a step further to develop a full-fledged cholera infantum.
The outcome of any case of summer diarrhea is questionable. It is not
safe to make any promise. An apparently mild attack may prove quickly
fatal. Much depends upon the previous history of the child. If it has
been a strong, healthy child it has a very good chance if treated
energetically and correctly. If it has previously suffered from bad
nutrition, is not robust, has had trouble with its stomach, etc., the
chances are against it.
The one lesson to be learned by all mothers is, as stated above, to act
quickly; to be on the watch all through the summer months for any
trouble with the baby's stomach or bowels. It is much easier to treat
and cure a little trouble than to battle against an established
gastro-enteric intoxication. Overfeeding and indiscriminate feeding must
be religiously avoided,--they are the two most prolific causes of
stomach and intestinal troubles in childhood.
Symptoms.--The onset is sudden and pronounced. The child begins to
vomit and continues vomiting and retching persistently. The bowels are
loose, and large, watery, greenish stools are frequent. The prostration
is very marked, the child looks seriously sick, respiration is quick and
shallow, the eyes sunken, the skin becomes ashen gray in color, and the
pulse is soft and very rapid. The fever may be very high or it may
remain low. The low febrile cases are the worst.
If taken in hand quickly and if the treatment is energetic and if the
child reacts, the case may go rapidly on to recovery and the child be
wholly well in a few days; or it may not react, but be overwhelmed by
the poison and sink and die in twenty-four hours.
Treatment.--In the treatment of cholera infantum it must not be
forgotten that the dangerous element is the poisoning of the system that
is constantly going on. It is difficult for the non-medical mind to
estimate the importance of this element. It is, of course, caused by the
bacteria present in the gastro-intestinal canal. There are numberless
millions of bacteria in the normal healthy bowel. A very large
percentage of those germs are good for us, are there for a beneficent
purpose, and can and do protect us from other germs which occasionally
find their way into the bowel and whose purpose is not a peaceful one.
When the bowel condition changes, as during an attack of summer
diarrhea, it is invaded by multitudes of evil-intentioned germs. These
germs find conditions in the diseased bowel exceedingly favorable to
them, so they begin work in an active, energetic way. The result of
their activity is highly poisonous, and, as the good germs are virtually
out of business and are consequently not working in our interest, we are
absolutely in the hands of the enemy. There is soon manufactured, by
these invading germs, enough poison to poison the entire system of the
child. It is this feature that we must combat in summer diarrhea.
It is absolutely essential to keep these cases as much in the open fresh
air as possible. No matter how sick they may be, this rule must be
observed. Light clothing is advisable.
If it is a city child that is affected and it does not show decided
improvement in three or four days, it should, if possible, be sent to
the country. There is always distinct danger of a relapse in every case,
so the little victim should be given a change of air as soon as
convalescence permits. The seashore is preferable to the mountains in
all intestinal cases.
In the care of these patients cleanliness is an important factor and
counts much in the ultimate cure. The child, as well as the clothing,
should be kept scrupulously clean. Napkins as soon as soiled should be
removed and put into a disinfecting solution. The buttocks should be
well powdered after each movement to prevent sores developing.
Feeding must be stopped at once. No food of any kind should be given for
at least twenty-four hours, or until the tendency to vomit subsides. The
thirst must be allayed, however, so we give frequently small quantities
of thin barley water or albumen water or cold boiled water. If these are
vomited we must stop giving them altogether for twenty-four hours. If
the fever is high and the skin dry, the child should be given a cool
pack, 85° to 90° F., which can be moistened every half hour with water
at this temperature; this will often control the fever satisfactorily.
Hot-water bottles should be placed at the feet if they are cold.
If, on the other hand, the fever is very low (below normal), the child's
circulation poor, the skin blue and cold, a hot-water bath at 108° F.,
for five minutes (rubbing the surface of the body while in the bath),
will be of very great service. The bath may be repeated at half-hour
intervals.
If the patient is a breast-fed infant it can be allowed to nurse after
the twenty-four-hour rest. The length of time it is permitted to stay at
the breast should be about one-quarter of the time it was allowed before
the attack began. If it does not vomit, the nursing can be repeated
every four hours. As the case progresses toward recovery the interval
between feedings can be shortened. Care, however, must be taken not to
shorten the interval too rapidly.
If the patient is artificially fed and is not over four months old, a
substitute for the milk must be found. The best substitutes are rice or
barley water, either plain or dextrinized, the malted foods, chicken or
beef broths, liquid peptonoids or bovinine. Water (boiled and cooled)
may be allowed at all times if not vomited.
Older children are treated in the same way. All food is withheld while
there is any vomiting. When vomiting stops begin with small quantities
of beef broth, or chicken, or veal broth. Later kumyss or matzoon can be
tried, and finally thin gruels made with milk.
If vomiting persists the stomach must be washed out; this can be done by
giving the infant or child a large drink of cool boiled water. This will
be immediately vomited and it will clean the stomach at the same time.
The stomach-pump may be used to better advantage. One washing is usually
sufficient. The vomiting will stop after the stomach has been washed out
and the patient may then be given, frequently, small quantities of cold
albumen water or barley water.
The bowel should be thoroughly cleaned out at the beginning of every
summer diarrhea. Castor oil or calomel are the two best cathartics for
this purpose. If the stomach is not upset use castor oil. If the stomach
is upset use calomel; one-fourth of a grain every hour for eight doses
will be sufficient. Give enough, however,--there is no danger at the
beginning of the attack of too free movements of the bowel. Whatever
cathartic is given, it should produce green, watery stools.
Irrigation of the bowel is an exceedingly effective way of cleaning out
the poison-laden large intestine. It should be done in every instance
unless the movements are watery and of such frequency as to render
irrigation unnecessary. Once or twice daily will be sufficient in even
the worst cases. The irrigation should be given at the temperature of
100° F, and should be the normal saline solution; a long rectal tube is
used to give the irrigation.
SUMMARY:--
1st. Cholera infantum is one of the most dangerous, one of the most
treacherous, and one of the quickest acting diseases of childhood.
2nd. Don't temporize, don't delay, don't regard lightly any diarrhea
during the summer time.
3rd. Give a large dose of castor oil and withhold all nourishment until
the doctor sees the little patient in every case of diarrhea during the
warm weather.
4th. Keep the child in a cool, quiet place and don't handle or annoy it.
5th. Follow, your doctor's directions implicitly. The fight may be
short, sharp, and decisive. Don't pave the way for regrets afterward. Do
everything while you have the chance.
COLIC
Colic is a common condition in infancy. Very few children escape more or
less colic during the first few months of life. It does not seem to
injure permanently some infants; they go on growing according to
standard, eat and sleep, and seem contented and happy despite occasional
severe attacks of colic. Other children suffer seriously; the degree of
indigestion is considerable, and the nutrition of the child is
interfered with.
Colic is much more frequent in bottle-fed infants than in those fed on
breast milk. Cow's milk, no matter how skillfully it is prepared for
their use, is at best an unsuitable diet and taxes the digestive ability
of robust children. It is quite natural for an infant whose digestive
organs are not strong to develop colic and intestinal indigestion if put
on artificial food. Any condition that causes indigestion may likewise
cause colic. Those children who are always overfeeding,--taking too much
milk, too strong milk, or who are fed irregularly,--are the colicky
babies.
Constipation is frequently associated with colic and may be the actual
cause. A daily movement of the bowel does not necessarily mean that the
bowels are emptying themselves satisfactorily. Despite the daily
movement, there may be considerable fecal matter left in the bowel which
undergoes decomposition. This results in the evolution of large
quantities of gas and severe attacks of colic. Indigestion is very often
caused by conditions which effect the stability of the child's nervous
organism; such conditions are fright, anger, fatigue, exhaustion,
excitement.
The origin of the colic in breast-fed children is very often caused by
some nervous condition of the mother that affects her milk. Constipation
in the mother may cause colic in the child.
Symptoms.--A baby having an attack of colic will cry loudly from time
to time and whine during the interval; it will pull up its legs and bear
down. Its abdomen is tense and hard and distended with gas. With the
expulsion of the gas the pain ceases and the child falls asleep. If the
attack is very severe the prostration and exhaustion is marked; the feet
are cold and the body is bathed in perspiration.
If the colic is constant the child may be fretful and restless most of
the time, being seemingly comfortable for only an hour or two in the
twenty-four.
In older children who cry because of severe pain in the abdomen the
possibility of appendicitis must not be forgotten.
Treatment.--Find out the cause of the colic if possible. If the cause
is located in the mother, the remedy naturally must affect her.
Regulation of her bowel, restriction of her diet, and proper exercise,
may be sufficient to effect a cure of the colic in the infant.
The object of treatment is to help the child get rid of the gas. The
best and quickest means to effect this is to apply massage or give a
rectal injection. An injection of two ounces of cold water in which a
half or one teaspoonful of glycerine has been put, will act quickly. Dry
heat applied to the abdomen in the form of the hot-water bottle or
woolen cloths will aid in the expulsion of the gas. The feet should be
kept warm.
In cases of habitual colic in breast-fed babies the cause may be in the
quality of the mother's milk. It should be examined and if found too
strong should be diluted. This can be done by giving the child an ounce
of plain boiled water or barley water before each feeding. If the child
gets an ounce of liquid before each feeding he will not want as much of
the breast milk; so we shall have the same total quantity, but a reduced
quality, which may cure the colic at once.
It is necessary, in order to cure colic, that the bowels move every day
in a satisfactory manner. If any aid is needed, milk of magnesia is the
best laxative. It may be given in teaspoonful doses in water previous to
a feeding. Aromatic cascara sagrada in from ten to thirty-drop doses is
a very good laxative, if a stronger remedy is needed.
To relieve the acute attack, three drops of Hoffman's anodyne may be
given in two teaspoonfuls of warm water and repeated in ten-minute
intervals until relieved, to a baby under one year of age. From five to
ten drops of gin, given in three teaspoonfuls of warm water, and
repeated in fifteen minutes, is also satisfactory and harmless. A very
good remedy which may be used with the above for quick relief, and to
stop the child from crying, is the following: Fold a piece of flannel
cloth (two thicknesses) the size of the baby's abdomen; wring out of
very hot water and drop ten drops of turpentine over the surface,--at
different spots,--of the flannel and lay on abdomen,--turpentine side
next skin. Cover this with another piece of flannel,--two or three
thicknesses, that has been dry-heated and allow to remain in place for
about ten minutes.
Colic, as a rule, disappears completely about the third month.
APPENDICITIS
Appendicitis is mentioned here merely to acquaint mothers with its
prominent symptoms.
When a child has what seems to be an attack of indigestion, but
complains of pain and tenderness in the abdomen, vomits, and develops a
fever, and is constipated, appendicitis may be suspected.
The pain and tenderness are not referred to the region of the appendix
but are more centrally located. If, however, the finger point is pressed
over the appendix, distinct tenderness will be elicited in inflammation
of that region. Constipation is the rule in appendicitis, but diarrhea
occasionally accompanies it.
The abdominal muscles may be rigid, that is, the abdomen does not feel
soft as is usual; there is a feeling if they are pressed, as if they
were hard and unyielding.
Treatment.--Put the child in bed and send for the family physician at
once. The condition is too serious and too uncertain to delay, or for a
parent to make any effort at treatment. Appendicitis is a much more
serious condition in infancy and childhood than it is in an adult.
JAUNDICE IN INFANTS
There are two types of jaundice in infants that deserve brief
consideration.
1st. There is a form of jaundice caused by a defect in the development
of the bile or gall tubes. These infants develop jaundice a day or two
after birth and become intensely jaundiced within a very brief time.
They lose flesh and strength to a marked degree and die in a few weeks.
It is not possible to affect this condition favorably by any method of
treatment. This type of jaundice is not very common.
2nd. There is a type of jaundice that appears between the second and
fifth day of life that is very common. It lasts from one to two weeks
and then disappears. It is never fatal and is not serious. It requires
no treatment.
JAUNDICE IN OLDER CHILDREN--CATARRHAL JAUNDICE--GASTRO DUODENITIS
Symptoms.--This form of jaundice begins like an attack of ordinary
indigestion. There are, as a rule, pain, fever, vomiting, and
prostration. The pain is located in the upper part of the abdomen and
may be quite severe. The vomiting may continue for a number of days. The
bowels are usually constipated. After a few days the jaundice sets in
and may be quite intense. After the jaundice is established the stools
are gray or white in color and there is much gas in the bowel. The urine
is very dark and may be yellow or yellowish-green in color. The child
complains of headache, is dull and listless, and appears sick and weak.
The condition lasts about two weeks, but the jaundice may last much
longer. It is not a serious disease.
Treatment.--The diet should be cut down in quantity and should consist
of rare meat, fruit, and a small quantity of milk. If vomiting continues
the milk may diluted with lime water or vichy water. The child should
drink water or vichy water freely. No starchy foods, or fats, or sugars
should be allowed. The bowels should be kept open with calomel,
one-tenth of a grain every hour until ten are taken, to be followed by
citrate of magnesia every morning. If the pain is severe it may be
relieved by a mustard paste or a turpentine poultice. The child should
be given acid hydrochloric diluted, eight drops in one-half glass of
water, ten minutes before each meal--and kept on it for at least one
month.
INTESTINAL WORMS
There are three types of intestinal worms; they are known as the
round-worm, the thread-worm, and the tape worm.
Round-Worm.--The round-worm is usually found in children of the
run-about age. It is never seen in infancy. It occupies the small or
upper intestine, and is from four to ten inches long. If there are
round-worms in the bowel, there are usually a number of them and there
may be hundreds.
Symptoms.--Round-worms give no definite symptoms. The only possible
way to tell if they are present is actually to see them in the stools of
the child. They are of a light gray color.
It is reasonable to expect that a child suffering from worms will have
symptoms of abdominal distress from time to time; indigestion with colic
and much gas may be present; children lose their appetites and are
nervous and restless; sleep is disturbed; they may grind their teeth and
talk in their sleep, and they may pick their noses unnecessarily during
the day. These symptoms may, however, accompany other conditions when no
worms are present in the bowel. My observation has been that in children
in whom worms were present the nervous symptoms were distinctly
accentuated. They are unreliable children; they seem well to-day and
peevish to-morrow; they complain of headaches, dizziness, and chilly
feelings. They are hysterical, noisy, uncontrollable. A child with these
symptoms should be suspected of having worms and if no cause can be
found to explain his temperamental vagaries he should be treated for
worms. I have cured a number of children of excessive nervousness by
giving them medicine for worms when no worms were present. Such results
can only be explained on the assumption that these children were
suffering from intestinal auto-toxemia or self-poisoning, and the
thorough disinfection of the bowel apparently stopped the process by
ridding the child's system of a mass of bacteria, which were undoubtedly
causing the auto-toxemia and consequent nervousness.
Treatment.--The most efficient remedy for removing round-worms is
Santonin. The quantity necessary for the various ages is as follows:
Two to four years 2 grains.
Four to six years 3 grains.
Six to ten years 3-1/2 grains.
The best way to give it is in divided doses, with an equal quantity of
sugar of milk. For a child of six years the formula would therefore be,
3-1/2 grains of Santonin, mixed with the same quantity of sugar of milk
divided into three powders. These powders are given four hours apart in
the following way. The child is given a light supper the evening before
and one-half glass citrate of magnesia the following morning and the
first powder one-half hour later; no breakfast being given. A light
lunch, of milk and crackers, may be taken about noon. The second powder
is given four hours after the first, and the third four hours after the
second. Half an hour after the last powder, a dose of castor oil (one
tablespoonful) is given. In a few moments the bowels will move; usually
there are no worms in this movement. A little later they will move
freely again and if worms are present they will be discharged in this
movement.
Thread-Worm, or Pin-Worm.--A thread-worm looks just like a little
piece of white thread. They are found in the lower part of the bowel and
in the rectum. They are usually present, if present at all, in large
numbers.
Symptoms.--The chief symptom is itching. It may be limited to the anus
or it may involve the neighboring parts. Thread-worms may find their
way out of the anus and in female children may find their way into the
vagina. In these instances the child is tormented with itching of the
privates and may establish the habit of self-abuse as a result of the
constant itching and scratching. The itching is more intense at night
soon after the child goes to bed. As a result of the local irritation in
the lower part of the bowel and rectum there is set up a catarrh of the
bowel which produces large quantities of mucus.
Treatment.--The only medication by the mouth that is of any use is
turpentine in one drop doses after meals, given in a teaspoonful of
sugar. The best treatment, and in most cases the only treatment that is
effective, is the use of rectal injections. The procedure is as
follows:--The child first gets a cleaning injection of two quarts of
warm water into which a teaspoonful of borax has been put. This will
wash away any mucus or fecal matter that may have collected. This
injection is best given with a No. 18 rectal catheter which is pushed
into the rectum for about 10 inches, the water being allowed to run away
as it enters. From six to eight ounces of the infusion of quassia is
then passed, as high up as the catheter will reach. It is intended that
the quassia will remain in as long as possible, for at least half an
hour. In order to assure this there are two features that should be kept
in mind: first, the water should be allowed to flow in slowly,
consequently hold the bag low, not higher than two feet above the level
of the bed on which the patient lies; second, after the water is all in
remove the catheter very slowly and keep the child absolutely quiet.
This treatment is repeated every second night for a week, then twice a
week for four weeks.
A solution of garlic is a very effective remedy and may be tried if the
quassia fails, which is not likely if the treatment is carried out
effectively and if the parts are kept scrupulously clean.
Tape Worms.--Tape worms are obtained from eating raw meat, pork or
sausage, rarely from fish, and from playing with cats and dogs.
Symptoms.--No definite symptoms accompany the presence of tape worm.
The children may have pains in the abdomen, diarrhea, a capricious
appetite, foul breath, and they may suffer from anemia, sometimes quite
severely. The only positive symptoms is the presence of links of the
worm in the stools.
Treatment.--Give a dose of castor oil at bed time. Two hours after
breakfast next morning give one-half dram of the oleoresin of male-fern
in emulsion or capsule. Very light nourishment should be taken during
the day, composed of gruels and soups. When the worm is passed it should
be examined to find if the head is present; if not, the treatment should
be repeated in twenty-four hours.
RUPTURE
Rupture of any description is not a condition that any mother should
attempt to treat. A physician should be called in every case. Any
misdirected effort at manipulation or pressure may result in irreparable
injury to the parts. External applications are useless and may be
injurious.
All ordinary forms of rupture in infancy and early childhood are curable
if properly treated.
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