DISEASES OF CHILDREN, CONTINUED
Rheumatism--Malaria--Rashes of Childhood--Pimples--Acne--
Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--
Incontinence--Sleeplessness--Disturbed Sleep--Nightmare--Night Terrors--
Headache--Thumb-sucking--Biting the Finger Nails--Colon Irrigation--
How to Wash Out the Bowels--A High Enema--Enema--Methods of Reducing
Fever--Ice Cap--Cold Sponging--Cold Pack--The Cold Bath--Various Baths--
Mustard Baths--Hot Pack--Hot Bath--Hot Air, or Vapor Bath--Bran Bath--
Tepid Bath--Cold Sponge--Shower Bath--Poultices--Hot Fomentations--How
to Make and How to Apply a Mustard Paste--How to Prepare and Use the
Mustard Pack--Turpentine Stupes--Oiled Silk, What it is and Why it is
Used.
RHEUMATISM
This is a rather common disease of childhood. It occurs most frequently
between the ages of nine and thirteen years. Children can have it,
however, at any age.
The symptoms of rheumatism in children are much the same, though
somewhat milder, as when the disease is present in an adult. Children
are not quite as sick, nor is the fever as high, nor is the pain as
great as in a grown person. In children the disease does not last as
long, as a rule. Sometimes it will jump from one joint to another, and
may, as a consequence, become chronic. When a child has once had
rheumatism, it has the same disposition to recur that it has in adults.
The principal danger of rheumatism in children is its tendency to attack
the heart. Even mild attacks of the disease can do serious damage to the
heart.
Children who have the rheumatic tendency invariably suffer from
inflammatory conditions of the upper respiratory tract. They are prone
to have recurring colds, tonsilitis, and sore throats. Treatment of
conditions without regard to the underlying rheumatism is never
satisfactory. These children complain of indefinite pains, now in one
place, now in another. These pains are commonly known as "growing-pains"
and, inasmuch as they are rheumatic and not "growing pains," they should
be regarded seriously because of the heart damage they might do if
ignored, and especially so since the mildest attacks of rheumatism,
without any joint symptoms even, frequently leave the heart in very bad
shape. As a general rule it will be found that when a child has had a
number of attacks of bronchitis or asthma it is rheumatic and should
receive treatment for the rheumatic tendency.
Children with the tendency to rheumatism invariably eat too much red
meats and sugar,--the latter in the form of candy or as an excess in the
food.
Treatment of an Acute Attack.--The child should be put in bed and kept
warm. The bowels should be freely opened with citrate of magnesia. The
diet should be very light: milk and lime water or milk and vichy water,
with a piece of dry toast or zwieback, is all the child needs until the
fever is relieved. When a single joint is affected local measures may be
taken for its relief. Wraping the joints up with flannel cloths which
have been wrung out of true oil of wintergreen, and outside of this
oiled silk snugly bandaged on, is an excellent external application. The
flannel cloths should be kept moist by adding a little of the
wintergreen from time to time as it dries in. This can be done without
removing the bandage. This application is kept in place for twenty-four
hours and renewed if necessary. Such an external application will aid in
the actual cure of the disease and will quickly relieve the patient of
the pain. The oil of wintergreen used in this way should be the "true"
oil, and should be so specified when bought in the drug store.
Because of the great tendency to attack the heart a physician should
take charge of every case of acute rheumatism in a child.
To Treat the Tendency to Rheumatism.--Exclude red meats and sugar in
all forms as much as is possible. Give green vegetables freely, potatoes
boiled with the skins on, fish, eggs, and poultry. Cereals with milk,
especially well cooked Scotch oatmeal, are exceedingly good for these
children. By keeping up this diet after the acute attack has passed for
a considerable time, it is possible to cure the various other complaints
with which the child is afflicted,--tonsilitis, sore-throats, winter
coughs, head-colds, bronchitis, asthma, etc.
These children should wear woolen underwear all the year round. They
should be encouraged to drink water or vichy freely between meals.
In the treatment of an acute attack as given above it will be observed
that no drugs are mentioned. This is intentional because it would be
unjust to encourage the home treatment of a disease that is so
treacherous, even in its mildest forms. Because of its tendency to recur
and with each recurrence the danger of the heart being affected, it is
advisable to put these children on cod liver oil or iron or some other
good tonic. Every precaution should be taken to prevent these children
from getting their feet wet or being out in the rain.
SUMMARY:--
Rheumatism is a dangerous disease in children.
In its mildest forms it can affect the heart badly.
It has a distinct tendency to recur.
Rheumatic children are afflicted with a number of diseased conditions
which do not respond to treatment unless the rheumatism is treated.
Acute rheumatism should never be treated except by a physician because
of its treacherous character.
MALARIA. INTERMITTENT FEVER
Malaria occurs quite often in infants and children. As a rule the child
gives evidence of gastro-intestinal disturbance for a short period
before the malarial symptoms appear. The chilly stage is often absent.
Sometimes the hands and feet are cold and may be slightly blue and the
child may appear to be in collapse. This stage may last for an hour or
longer. The chilly stage may, however, be replaced by nervous
symptoms,--restlessness, dizziness, irritability, nausea, etc.,--or a
convulsion may take place. In the second stage the temperature may rise
quite high, the pulse may be quite rapid; the child is flushed,
restless, and cries. This period may last from half an hour to two
hours. The sweating stage is not as a rule well marked in a child. It
may be very slight or not at all.
Between the attacks some children may be entirely well; others remain
restless, have little appetite and poor digestion. Malaria in children
does not always follow a typical course. We often see children suffering
from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin
eruptions, all due to the malarial condition. This often leads to a
mistake in diagnosis. Intermittent fever is often mistaken for
pneumonia. Malaria is not a favorable disease for an infant to have. It
rapidly weakens the child and great debility and anemia follows.
Treatment.--The treatment for malaria in children is by the
administration of quinine as in adults. It must, however, be given with
care and intelligence; for this reason no mother should begin dosing her
child with it without consulting a physician.
REGARDING MOSQUITOES
The following is an extract from a circular in relation to the causation
and prevention of malaria and the life history and extermination of
mosquitoes issued by the Department of Health, City of New York:
Extermination and Prevention of Mosquitoes.--Mosquitoes require
for their development standing water. They cannot arise in any
other way. A single crop soon dies and disappears unless the
females find water on which their eggs may be laid. In order to
prevent mosquitoes, therefore, the requirement is simple.
No Standing Water.--Pools of rain water, duck ponds, ice ponds,
and temporary accumulations due to building; marshes, both of salt
and fresh water, and road-side drains; pots, kettles, tubs,
springs, barrels of water, and other back-yard collections, should
be drained, filled with earth, or emptied.
Running streams should have their margins carefully cleaned and
covered with gravel to prevent weeds and grass at the water's edge.
Lily ponds and fountain pools should, if possible, be abolished; if
not, the margins should be cemented or carefully graveled, a good
stock of minnows put in the water, and green slime (Algæ) regularly
cleaned out, as it collects.
Where tanks, cisterns, wells or springs are necessary to supply
water, the openings to them should be closely covered with wire
gauze (galvanized to prevent rusting), not the smallest aperture
being left.
When neither drainage nor covering is practicable, the surface of
the standing water should be covered with a film of light fuel oil
(or kerosene) which chokes and kills the larvæ. The oil may be
poured on from a can or from a sprinkler. It will spread itself.
One ounce of oil is sufficient to cover 15 square feet of water.
The oil should be renewed once a week during warm weather.
Particular attention should be paid to cess-pools. These pools when
uncovered breed mosquitoes in vast numbers; if not tightly closed
by a cemented top or by wire-gauze, they should be treated once a
week with an excess of kerosene or light fuel oil.
Certain simple precautions suffice to protect persons living in
malarial districts from infection:
First: Proper screening of the house to prevent the entrance of the
mosquitoes (after careful search for and destruction of all those
already present in the house), and screening of the bed at night.
The chief danger of infection is at night (the Anopheles bite
mostly at this time).
Second: The screening of persons in malarial districts who are
suffering from malarial fever, so that mosquitoes may not bite them
and thus become infected.
Third: The administration of quinine in full doses to malarial
patients to destroy the malarial organisms in the blood.
Fourth: The destruction of mosquitoes by one or more of the methods
already described.
These measures, if properly carried out, will greatly restrict the
prevalence of the disease, and will prevent the occurrence of new
malarial infections.
It must be remembered that when a person is once infected, the
organisms may remain in the body for many years, producing from
time to time relapses of the fever.
A case of malarial infection in a house (whether the person is
actively ill or the infection is latent) in a locality where
Anophele mosquitoes are present, is a constant source of danger,
not only to the inmates of the house, but to the immediate
neighborhood, if proper precautions are not taken. It should be
noted in this connection that the mosquitoes may remain in a house
through an entire winter and probably infect the inmates in the
spring upon the return of the warm weather.
Malarial fever is prevalent in certain boroughs of New York City,
and in view of the presence of standing water resulting from the
extensive excavations taking place in various parts of these
boroughs, is likely to extend, if means are not taken for its
prevention.
REGULATIONS OF THE BOARD OF HEALTH, NEW YORK CITY, IN AID OF MOSQUITO
EXTERMINATION AND THE PREVENTION OF MALARIAL FEVER
(In Force from March 15 to October 15.)
1. No rain-water barrel, cistern, or other receptacle for rain-water,
shall be maintained without being tightly screened by netting, or so
absolutely covered that no mosquito can enter.
2. No cans, pails, or anything capable of holding water, shall be thrown
out or allowed to remain unburied on or about any premises.
3. Every uncovered cesspool or tank shall be kept in such condition that
oil may be freely distributed so as to flow over the surface of the
water. Covered cess-pools must have perfectly tight covers, and all
openings must be screened.
4. No waste or other water shall be thrown out or allowed to stand on or
near premises.
Information is requested as to the presence of standing water anywhere,
so that the premises may be inspected and the legal remedies against the
same be applied.
The prompt coöperation of all persons in the enforcement of the above
regulations is earnestly desired, and they are assured that in this way
the breeding of mosquitoes on their premises may be prevented.
Mosquitoes are, so far as known, the only means of conveying malaria.
"RASHES" OF CHILDHOOD
The following table gives all the characteristics of the rashes that
accompany the eruptive fevers. The term "incubation" means the period of
time which elapses between the time when the child was exposed to, or
caught the disease, and the time when the child is taken sick. It is
sometimes interesting to know where a child could have caught a disease;
so if we know the incubation period we can tell exactly where the child
was on the day, or days, when it was infected.
-----------+------------+-----------+-----------------+----------+---------+
Name | Incubation |Day of Rash|Character of Rash|Rash fades|Duration
-----------+------------+-----------+-----------------+----------+---------+
Measles | 10-14 days | 4th day |Small red like |On the |6-10
| | |spots resembling |7th day |days
| | |flea bites, first|of fever |
| | |appearing on face| |
| | |and forehead, | |
| | |forming blotches | |
| | |with semi-lunar | |
| | |borders. | |
-----------+------------+-----------+-----------------+----------+---------+
Scarlet | 1-6 days | 2d day of |Bright scarlet, |On 5th |8-9 days
Fever |occasionally| fever |rapidly diffused,|day of |
| longer | |first on chest |fever |
| | |and upper | |
| | |extremities. | |
-----------+------------+-----------+-----------------+----------+---------+
Chicken-pox| 4-12 days | 2d day |Small rose |Slight |6-7 days
| | |vesicles, which |scab of |
| | |do not become |short |
| | |pustular |duration |
-----------+------------+-----------+-----------------+----------+---------+
Typhoid | 10-14 days | 7-14 days |Rose colored | |From
Fever | | |papules elevated,| |21-35
| | |few in number, | |days
| | |limited to trunk,| |
| | |disappear on | |
| | |pressure. | |
-----------+------------+-----------+-----------------+----------+---------+
Smallpox | 10-14 days | 3d day of |Small, round, |9th day |14-21
(Variola) | | fever |red, hard, |scabs |days
| | |papules forming |form and |
| | |vesicles then |about |
| | |pustules, first |14th day |
| | |appearing on face|fall off |
| | |and wrists. | |
-----------+------------+-----------+-----------------+----------+---------+
Other Rashes.--There are so-called "stomach" rashes which are a source
of much worry to mothers. These rashes may appear at any time and they
may be limited to certain parts or may cover most of the body. They may
be bright red, or they may be simply a general discoloration. They may
appear as blotches or they may spread all over, like the rash of scarlet
fever when at its height.
These rashes are of no importance, except that they indicate some
derangement of the gastro-intestinal tract. As a rule they indicate
indiscriminate feeding or overfeeding. Children who have had too much
candy or pastries, or who have been fed things which are unsuited to
their age, frequently develop rashes. Such children should have a
thorough cleaning out; a dose of castor oil is probably the best
cathartic to give them.
The mother may readily learn to know the difference between a rash that
is unimportant and one that indicates one of the eruptive diseases, if
she gives the matter a little careful thought. In the first place a
child who is about to become the victim of one of the eruptive diseases
will be sick, and will have a fever for two or three days before any
rash appears; while on the other hand a child may go to bed in good
health and may next morning be covered with a general rash, or with
large blotches, without any fever and without any evidence of
ill-health, except the skin condition. In the second place, if the
mother gives the child a cathartic and restricts the diet for a day the
rash will disappear, and good spirits and good health will be
maintained; on the other hand, the giving of a cathartic to a child who
is the victim of an eruptive disease will not tend to diminish the rash,
but may accentuate it.
Pimples: Blackheads (Acne).--This eruption is situated chiefly on the
face. It may appear, however, on the back, shoulders, and on the chest.
It is mostly seen in young men and women about the age of puberty. It
appears as conical elevations of the size of a pea; they are red and
tender on pressure, and have a tendency to form matter, or pus, in their
center. In from four to ten days the matter is discharged but the red
spots continue for some time longer.
"Blackheads" appear as slightly elevated spots of a black color out of
which a small worm-like substance may be pressed. Pimples and blackheads
are due to inflammation of the glands of the skin. The mouths of these
glands become filled with dust which acts as a plug causing the
retention of the oily matter of the gland which becomes inflamed and
hence the pimples and blackheads. Certain constitutional conditions
favor the development of these skin blemishes. Constipation,
indigestion, bad blood from unsanitary and bad hygienic surroundings,
self-abuse and bad sexual habits favor the appearance of these skin
affections.
Treatment.--The patient must avoid tea, coffee, tobacco, alcohol,
veal, pork, fats, candy, pastries, cheese, and all edibles that are
known to disagree with the digestion of the patient. Constipation must
be avoided; if necessary, laxatives may be taken to keep the bowel open.
The blackheads must be squeezed out with an instrument made for the
purpose, not with the finger nails. Pimples must be opened with a
sterile needle. The parts should be washed three times a day with hot
water and green soap, and the following mixture applied at night:--
Zinc Oxide ounces 1/4
Powdered calamine ounces 1/4
Lime water ounces 6
Mix and shake before applying to the skin.
CONVULSIONS. FITS. SPASMS
Convulsions are quite common in children, especially those under three
years of age.
A convulsion in an infant immediately, or within three months, after its
birth is the result of injury, either at birth or later (a fall for
example) which seriously affects the brain itself. After the third month
the cause of fits or convulsions is, in a very large percentage of the
cases, to be found in errors of diet resulting in disturbances in the
stomach or bowels--eating of articles of food difficult to digest, as
green or overripe fruit, salads, fresh bread, pickles, cheese, etc.
Children of a nervous temperament are more liable to convulsions than
are others. Females are more frequently victims of fits than are male
children.
In infants convulsions often result from changes in the mother's milk.
Mental excitement, deep emotion, anger, frights, severe affliction and
distress will so affect a woman's milk that it will cause convulsions in
her child if she nurses it while under the influence of any of these
conditions.
Convulsions may result from any condition that disturbs the nutrition of
the child, as, for example,--exhaustion, anemia, intestinal indigestion,
blood poison, and general weakness resulting from some severe sickness,
especially those of the digestive organs.
Various forms of brain disease cause spasms and fits; the most common
are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions
may accompany certain conditions, as, the presence of worms, teething,
severe burns, foreign bodies in the ear, whooping cough, pneumonia
scarlet fever, malaria, sometimes measles, typhoid fever, and
diphtheria. Children who are badly nourished and who live constantly in
unsanitary surroundings are more apt to have convulsions than those who
are well nourished and who live hygienically. One attack renders the
patient more liable to another, and when the "habit" is established any
trivial cause may incite a convulsion; persistent and systematic efforts
should therefore be taken to prevent the attacks. The best preventives
are:
1st. To regulate the diet and the bowels.
2nd. Remove adenoids and worms, if they exist.
3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries,
candies and all improper foods.
4th. Guard the child against catching cold, infectious diseases and all
fevers. In other words, save the child from the cause and the convulsion
will not take place.
By regulating the bowels we mean that everything the child eats must be
seen by the mother, must be with the mother's permission, and must be
suited to the child's age. If there is any question about the latter it
will be advisable to have a physician write out a list of articles
suitable to the child. It is generally necessary to eliminate meats,
pastries, candies, sugar to a large extent, gravies, salads, sauces, and
all the extras of the table, as pickles, mustard, relish, etc., as well
as coffee, tea, cocoa, and alcohol.
The child should live in the open air as much as possible; a daily warm
bath, followed by a quick, cold sponge, is a necessity.
Children subject to fits are possessed of a highly nervous temperament.
They are difficult to manage unless managed with firmness and tact. It
is not necessary to be harsh, but it is imperative to be firm and
decided. They must be made to realize that they are not "the master,"
that their will is not supreme, and the mother must exact this
condition; otherwise these children will become dictators and selfish
despots--ruining the discipline of the home, spoiling their own chance
of physical health, and rendering unhappy everyone around them. The
parents, therefore, have a definite duty to perform and it is not an
easy one. The food should be so regulated that each day a natural
movement of the bowels will take place. (See article on constipation,
page 303.) If a day should pass without a movement the child should be
given a hot rectal enema as described on page 586.
The adenoids can be easily demonstrated to either exist or be absent.
(See page 519.) If worms are known to be present in the child they
should be at once removed. If they are simply suspected, the child
should receive treatment for them, just the same. (See page 549.)
By going a long time without a convulsion the nervous system will
recuperate itself, and become so strong and healthy that what once would
cause a fit will make no impression in its new strengthened state;
therefore, if you "save the child from the cause," the convulsions will
cure themselves, as it were.
There are some cases of convulsions for which no satisfactory
explanation can be found.
Treatment.--When a child has a convulsion, remove its clothing and put
it into a mustard bath. The temperature of the bath should be 105° F.
Every part of the child should be under the water except the head, which
is supported in the palm of the hand. While it is in the bath its body,
and especially its arms and legs, should be briskly rubbed by the hands
of an assistant in order to keep the circulation active. A rectal
injection of soap suds or plain salt and water (see page 579) should be
given while the child is in the bath, because, as explained above, a
large percentage of these cases are caused by gastro-intestinal
derangements. The rectal injection will likely remove the cause. An
ordinary convulsion lasts from five to ten minutes. When the child is
removed from the bath it should be placed in a warm, comfortable bed and
kept absolutely quiet. A hot-water bottle may be put near its feet and
an ice-bag or cold cloths should be kept on its head. It should be given
a full dose of castor oil and allowed to go to sleep. Its diet should
consist of light broths for two or three days and during this time it
should not be disturbed or annoyed by too much attention. This is as far
as it is wise or safe for any mother to go in the treatment of
convulsions. A physician should be called in every instance, because a
convulsion should never be regarded lightly. Many children have become
idiots, others have been afflicted with paralysis, because of
inattention at the proper time.
SUMMARY:--
1st. Convulsions must always be regarded as serious.
2nd. Convulsions demand prompt treatment.
3rd. Every mother should know that an English mustard bath--hot--is the
first resort in convulsions.
4th. While this is being done she can read the home treatment in this
book and carry it out before the doctor comes.
5th. If the fit is not caused by some stomach or intestinal trouble,
have the physician find out the cause and tell you what to do, and do it
faithfully, because if you neglect the proper treatment the child may
become idiotic or paralyzed.
BED WETTING. ENURESIS--INCONTINENCE
Enuresis, or incontinence of urine, is customary in infancy. Just when
urination becomes a voluntary act depends upon the development and
training of the individual child. As a rule children can be taught to
control this function during the day, or while awake, about the tenth
month. It is not under control during sleep until a much later period,
usually by the end of the second year, but lack of control should not be
regarded as abnormal until the child has entered the fourth year. If the
child fails to control the act of urination during the day at the end of
the second year, and is addicted to habitual bed-wetting, some measures
should be adopted to cure the condition.
Boys under twelve years of age seem to be affected more frequently than
girls. It is wrong to assume that it is caused by negligence or
laziness, as some parents do. It has generally a special cause, and the
cause usually can be found if it is carefully sought for. It may be the
result of bad habits: exposure to cold in the night; lying on the back;
drinking too much liquid in the afternoon or at bedtime. It may be due
to too much acid in the urine, and if so it will be found necessary to
reduce meats and eggs the child is eating. Worms, stone in the bladder,
some anatomical abnormality or deficiency, may be responsible for it.
The diet may be at fault; adenoids are supposed by some physicians to be
the cause. No matter what the actual cause may be, it must be found and
remedied before we can hope for a permanent cure. A very large majority
of these cases are due to nervousness. These children are of a nervous
temperament. They are not necessarily sickly children; they are simply
of a nervous type. They are well-nourished, active, and lively.
Incontinence of urine during the day and long-continued bed-wetting does
not at all affect the health of the child. If they are in poor health,
it is essential to treat their general condition before trying to cure
the incontinence.
It is absolutely wrong to punish or to crush the spirit of these
children. Constant nagging and taunting, even if done in the hope of
shaming the child into a cure, will simply make a coward of him and will
not aid in improving matters, but will be distinctly detrimental.
Scrupulous cleanliness must be constantly practiced or these children,
if neglected, may develop ulcers and sores of a very obstinate
character. The odor is also bad for the health of the child.
Treatment.--Find and remove the cause if possible. If due to general
poor health, give tonics, obtain a change of air, and build the child
up. Reduce the total quantity of liquids, if in excess, and be very
careful not to give any liquids near bedtime. Don't cover these children
too much; they should never be "too warm"; they should sleep in a
well-aired room, and they should receive a quick, cool sponge bath every
morning. They should be taught to sleep on their sides, never on their
backs. Their diet should be light but nourishing. When bed-wetting is
established it will continue, if untreated, until the child is eight or
ten years of age, and it frequently lasts much longer. When treatment is
undertaken it should be distinctly understood by the mother that it will
take many months to cure; and during these months she must give her
constant attention to the child. If she does not undertake to do this,
or if she fails to do it, the treatment should not be begun at all, as
it will not succeed. Various plans should be tried to keep the child
from sleeping on its back. The reason of this is because it has been
found that the child wets the bed only when sleeping on its back and
never when sleeping on its side. The simplest method, of tying a towel
or cloth around the child with a knot over the spinal column, so that it
will hurt and waken it, if it turns on its back, is a very good one and
should be carefully tried for some time. The nervous system of these
children should never be overtaxed at home or at school. Early hours and
plenty of sleep are desirable. Certain articles of diet of a stimulating
character should be entirely avoided,--for example, coffee, tea, beer,
candies, sugars, and pickles. The best diet for these children is one
composed exclusively of milk, vegetables, fruits, meats, and cereals.
Meats, however, should be given only once every two days. It is a good
plan to teach the child to hold his water during the day, as long as he
can, to accustom the bladder to being full. Adenoid growths, which
contribute to the nervousness of a naturally nervous child, should be
removed. It is a good plan to take the child up when the parents go in
bed and let him urinate. This often cures the condition in itself.
Sometimes moral measures, such as the promise of a reward, will
strengthen the will so that the child may overcome the tendency. Find
out what the child most desires in the way of a toy, and promise it if
he goes so long without wetting the bed. Aid and encourage him to make
efforts to win the reward.
If drugs have to be resorted to, it is necessary to call the family
physician, as the only drugs that are of any use are very powerful and
have to be given with great care and caution. It is the experience of
most physicians and specialists, however, that in a large majority of
cases the treatment, along the lines as given above, will be effective,
without drugs, if faithfully persisted in by the mother.
These children should be examined by a physician. The cause of the
bed-wetting is frequently discovered to be produced by anatomical
abnormalities which render circumcision imperative. In these cases no
method of treatment will succeed until circumcision is performed.
SLEEPLESSNESS. DISTURBED SLEEP
Causes.--In babies, disturbed sleep is most frequently due to hunger
or to indigestion. The latter is the result of overfeeding or improper
feeding. Rocking the child to sleep, or feeding it during the night will
cause sleeplessness. Teething, colic, or any pain will result in
disturbed sleep. Nervous children are frequently poor sleepers.
In older children, some digestive disturbance is, as a rule, the cause.
Chronic intestinal indigestion, worms, adenoid growths, enlarged
tonsils, lack of fresh air in the bedroom, cold feet, may, however, be
the cause. Overstudy in school, poor blood, poor nourishment are always
accompanied by inability to sleep soundly. Too strenuous play, exciting
stories read before bedtime, may cause sleeplessness.
Treatment.--The removal of the cause is absolutely necessary. In order
to discover the cause it is sometimes essential to study the child's
whole routine in order to be able to tell exactly just what is causing
the apparent insomnia. It may be necessary to change the method of
feeding, to regulate the studies and the exercises, and to suggest
changes regarding the sanitary and hygienic environment of the child's
life. Mothers must be warned against using drugs in the form of soothing
syrups or teething mixtures. They are dangerous and absolutely forbidden
under the above conditions.
The nervous disposition of the child must be taken into consideration
and treated if necessary. If bad habits exist they must be stopped. Poor
blood and poor nutrition must receive the treatment suggested under
these headings.
NIGHTMARE. NIGHT TERRORS
In a nightmare a child wakes suddenly in a state of fright and will
inform you that it has had a bad dream. His mind seems clear and he
recognizes those about him. He is not easily calmed and may cry for some
time; finally he goes to sleep again. The next day he will remember the
dream and most of the incidents of the night before. Such cases are
quite frequent. They are to be treated in the same way as cases of
disturbed sleep, as they really have the same cause. They are mostly due
to digestive disturbances and errors of diet.
Night-Terrors.--Cases under this heading form a distinct group by
themselves. They are not frequent, but the condition is much more
serious. The cause seems to be wholly nervous and may indicate an
important nervous derangement. It seems to have some indefinite relation
to such conditions as migraine, hysteria, epilepsy, and even insanity.
The child wakes suddenly during the night and sits up, evidently in
terror; he does not apparently regain his full consciousness. He talks
of being scared, calls for his mother, trembles and shakes, cannot
answer questions intelligently, and after a time goes to sleep. Next day
he remembers nothing of the attack and does not seem to suffer in any
way as a result of it.
I am disposed to believe that all of these attacks are not due to a
nervous condition. A number of them of exactly this type have been cured
by absolutely withdrawing milk from the diet.
It is a good plan to restrict the possibility of excessive play in these
children. They are of the type whose play is work, and too much of it is
too exhausting. Some person should sleep in the same room with these
patients or in an adjoining room with the door open.
If the condition occurs frequently the child should be subjected to a
thorough physical examination, because it may be one evidence of a
serious ailment.
Sometimes these little patients have to be taken out of school and sent
to the country, where they should remain for many months. It is far
better to regard the condition as indicating an abnormality,--even
though it may not have any deeper significance than that the digestive
apparatus of the child is not quite right,--and make every effort to
cure it, than to permit the child to go on under what really are unjust
and unfavorable conditions.
HEADACHE
Headaches are not common in little children. The most frequent ones are
caused by:
1. Chronic indigestion and constipation.
2. Anemia and malnutrition.
3. Nervous disorders.
4. Diseases of the eye, nose, throat.
5. Rheumatism and gout.
6. Disturbances of the genital tract.
Those arising from anemia and poor nutrition are most frequently present
in girls from ten to fifteen years of age. They may result from
overcrowding of school work, which results in loss of appetite and poor
sleep.
Nervous headaches may be hereditary or acquired through unhygienic
surroundings. Hysteria, epilepsy, disease of the brain, neuralgia from
carious teeth, may result in nervous headaches.
Headaches from disturbances of the genital tract may afflict girls about
the time of puberty.
Treatment.--To remove the cause is the only plan that promises any
result. Each one must be investigated by itself and dealt with
accordingly. For the headache itself a hot foot bath, cold to the head,
and small doses of phenacetine (one grain every hour for four doses) are
perhaps the most certain of all methods of treatment.
THUMB-SUCKING
The habit of sucking the thumb may be corrected by wearing a pair of
white mittens, or gloves tied at the wrist. Should children attempt to
suck the thumb with gloves on, as some do, it will be necessary to
saturate the thumb and fingers of the gloves with tincture of aloes, or
a solution of the bisulphate of quinine, one dram to two ounces of
water.
BITING THE FINGER NAILS
Biting the finger nails may be stopped by the use of the same bitter
remedies as are used in thumb-sucking.
HOW TO WASH OUT THE BOWELS
COLON IRRIGATION. A HIGH ENEMA
Procure a soft rubber catheter,--No. 18 American is about right. It is
not advisable to get too soft rubber for the reason that it will buckle
when the child strains and it will be impossible to wash out the bowel.
Fill half full an ordinary two-quart douche bag with water that is warm,
but not too hot. Dissolve a heaping teaspoonful of table salt in a glass
of hot water and add this to the water in the bag. Hang the bag about
two feet above the level of the child, so that the water will not flow
in with too strong a stream; otherwise the child will immediately try to
eject it. If the water flows in gently, the child may not object to it
to the extent of making strenuous efforts to force the catheter out.
Use the small sized nozzle that comes with the douche bag. Place the
rubber catheter over this nozzle, lubricate the catheter, place the
child on its back over a douche pan, insert the catheter about two
inches, let the water run and as it runs in push the catheter up gently
until it is all in the bowel except the end on the douche tip. The
object of letting the water run while pushing in the catheter is because
it floats up with the water as it distends the bowel; there is no risk
then of pushing the end into the intestinal wall or hurting the child.
While the water is flowing into the bowel it is a good plan to compress
the buttocks together to aid in holding the water, as the child is very
apt to let it run out as soon as it feels uncomfortable.
The temperature of the water for the ordinary rectal injection should be
95° F. When the child is exhausted or very weak, or when the circulation
is poor, the temperature of the water may be as high as 110° F. When, on
the other hand, the fever is very high, the water may be much cooler; as
low as 70° F. has been given with good results on the fever. If the
irrigation is given with the intention of reducing the fever, it is best
to begin with water around 90° F., and reduce it to 70° F., gradually.
Indications for Irrigation of the Colon.--When it is desired to
cleanse the bowel of any collection of matter a colon irrigation is
indicated. This matter may be mucus, fecal substance, undigested food,
or the decomposing waste products which may remain there as a result of
disease or other conditions.
When it is desired to medicate by putting fluids into the bowel we adopt
the colon infusion.
Every diseased condition of the bowel does not, however, indicate
irrigation. If a child is having frequent loose movements every
half-hour it is safe to assume that the bowel is being cleaned out
sufficiently without any artificial aid. To irrigate in these cases
would only irritate and would not accomplish anything. The cases which
are benefited are those in which we have a fever with four or five green
stools in the twenty-four hours, or where we have a high fever with no
movement at all. To irrigate in these cases we not only get rid of the
products of decomposition, but we prevent further decomposition and we
reduce the fever, thereby contributing to the general welfare of the
child.
When the child is convalescing and when there is only mucus in the
stools, with no fever--as in cases of chronic ileo-colitis--the colon
irrigations should be stopped, as they tend to keep up the discharge of
mucus in these cases. If, however, there is a relapse with fever, which
would indicate a fresh infection with more discharging mucus and
possibly green stools, the irrigation must be used until the fever
subsides.
Colon irrigations should always be given in every case of convulsions in
infancy, first to clean out the bowel to prevent putrefaction, and
second to empty the bowel on general principles because an overloaded
bowel is very frequently the cause of convulsions in children.
When irrigation of the bowel is given at all it must be given
thoroughly. Enough water must pass into the bowel to wash it all out.
For this reason it is essential that the catheter should be all in and
in the bowel--not doubled on itself two or three inches in the bowel. If
it is a serious case and the mother nervous, someone else should give
the washing--preferably the physician himself. If the child objects
strenuously, as often happens, it must be done with greater care to be
successful. Remember that a colon irrigation is never given unless it is
absolutely necessary and as a consequence it is given to accomplish a
certain purpose; it must, therefore, be done thoroughly. If it is not,
your child may miss the chance it has of getting over some immediate
difficulty and if the moment of the "chance" is wasted or lost, that
moment will not return. Be thorough, therefore.
Enema.--Some physicians talk about a high enema and a low enema. A
high enema is really an irrigation as described above. The following
remarks apply to low enemas only.
A so-called low enema is given to clean out the rectum of constipated
matter, or for the introduction of food or medicine by rectum, when for
various reasons it is necessary to spare the stomach.
It may be given with the fountain syringe or with the ordinary bulb
(baby) syringe. A catheter may be put on the tip of the syringe if it is
thought best to inject higher up than in the rectum.
When an enema is used in infants or older children for the relief of
constipation, the best medium to use is glycerine. For an infant, one
teaspoonful to an ounce of water is sufficient; for older children, one
tablespoonful to two ounces of water, given with the bulb syringe, will
give prompt results. If the constipation is pronounced, the fecal mass
very hard, an enema of sweet oil, allowed to remain in for ten minutes,
will soften it and permit a movement.
Soap suds are often used. They are good but not as reliable as the
glycerine or oil; if, however, neither of these two are at hand the soap
suds may be given.
Enemas should be carefully given and the liquid slowly injected. If the
fountain syringe is used care must be exercised in not having the bag
too high. If it is too high the liquid will flow in too strongly, either
injuring the bowel wall or causing the child to strain immediately and
pass out the injection before it has an opportunity of accomplishing its
work.
The temperature of the enema should be warm--not hot, and not cold,
simply body heat.
METHODS OF REDUCING FEVER
During the course of acute illness it is frequently necessary to reduce
the fever, if possible, without the use of drugs. The following means
are often adopted. It is desirable that the mother should know just how
to carry out these methods:
Ice-Cap.--An ice-cap is used to protect the brain when a child or
adult is running a very high fever. It is put on when the fever is above
103° F. It may be used in other conditions--brain disease, or disease of
the meninges or cord--in which case the physician will be in attendance
and will direct what should be done.
Ice-bags are procured in the drug stores. The best one is the flat
French ice-bag. Fill it three-quarters full of finely chopped ice, put
the ice-bag in a towel, and place on the patient's head. There should be
only one thickness of the towel between the ice-bag and the head.
It will be necessary to keep a record of the fever so that the ice-bag
may be withdrawn when it falls below 103° F.
When the ice melts the bag must be at once refilled. This is often
overlooked by careless mothers.
Cold Sponging.--Cold sponging is used to reduce fever or to allay
nervous irritability. Equal parts of alcohol and water or vinegar and
water are used. The temperature of the water should be 80° to 85° F.
Infants to be sponged should be completely undressed and laid upon a
blanket. The sponging should be done for about fifteen or twenty
minutes, after which the child is wrapped in a dry blanket without
further clothing except the diaper. To be effective it must be done
frequently.
Cold Pack.--The cold pack is used to reduce fever. It is one of the
simplest and one of the best means we have. The child is undressed
completely, and laid upon a blanket. It is completely covered with a
small blanket (except its head) wrung out of water at 100° F. Outside
of this the child is rubbed with a piece of ice, front and back, for a
sufficiently long time to render the surface cool, but not cold.
Children take kindly to this means of reducing fever; there is no shock
and they are quieted by it.
Just how long one will rub with the ice depends upon circumstances. From
five to thirty minutes may be employed. The head should be sponged with
cold water while this is being done and it is a good plan to have a
hot-water bottle at the child's feet.
The Cold Bath.--To reduce fever the cold bath is used in the following
way: Water at a temperature of 100° F. is put into the bath and the
child is first put into this water, then the water is reduced by putting
into it shaved ice until it reaches 80° F. The child's body is well
rubbed while it is in the bath and cold water is applied to its head.
The bath is continued for five minutes, or sometimes with a robust child
to ten minutes. On removal the child should be put into a warm blanket
after being thoroughly dried.
Rectal Irrigations.--These are sometimes given to reduce fever. They
are very useful and very successful if they are given properly and
without exciting the child too much. It is best to give water of an
ordinary temperature at first and gradually reduce it to 70° F. It
should be continued for ten minutes or longer. It may be repeated every
three hours. (See page 586.)
VARIOUS BATHS
Every mother should know how to give any bath that may be directed by
the physician.
The Mustard Bath.--Take from three to four tablespoonfuls of English
mustard; mix thoroughly in about one gallon of warm water. Add to this
about five gallons of plain water at a temperature of 100° F. If it is
necessary to raise the temperature of the water higher it may be done by
adding water until the temperature reaches 105° or 110° F.
The mustard bath is exceedingly effective in cases of shock, great
sudden depression, collapse, heart failure, or in sudden congestion of
the lungs or brain. The special use of the mustard bath is in the
treatment of convulsions; it is also useful for nervous children who
sleep badly. Two or three minutes in the mustard bath, followed by a
quick rubbing, will induce refreshing sleep in these children. It is not
necessary to have more than one tablespoonful of mustard in these cases.
The Hot Bath.--A bath is prepared of water at a temperature of 100° F.
After the child is in the bath the temperature of the water is raised to
105°, or to 110° F. It is not safe to go above this point.
The body of the child should be well rubbed while it is in the bath. In
most cases it is advisable to apply cold water to the head while the
child is in the bath. A bath thermometer should be kept in the water to
see that it does not rise above the temperature desired.
The hot bath, like the mustard bath, is used to promote reaction in
cases of shock, collapse, etc., and in convulsions.
The Hot Pack.--Remove all clothing from the baby and envelop the body
in a sheet wrung out of water at a temperature of 100° F., to 105° F.,
after which the body should be rolled in a thick blanket. Those hot
applications may be changed every twenty minutes until free perspiration
is produced. This condition may be kept up as long as is necessary.
The hot pack is used mainly in disease of the kidney.
The Hot-Air or Vapor Bath.--The child is put in bed wholly undressed
with the bed clothing raised about twelve inches, and held in that
position by a wicker support. The child's head is of course outside the
bed clothing. Beneath the bed clothing hot air or vapor from a croup
kettle is introduced. This will cause free perspiration in twenty
minutes. It may be continued from twenty to thirty minutes at a time.
The vapor bath is used in diseases of the kidney, as a rule.
The Bran Bath.--In five gallons of water place a bag in which is put
one quart of ordinary wheat bran. The bag is made of cheese cloth.
Squeeze and manipulate the bran bag until the water resembles a thin
porridge. The temperature of the water is usually about 95° F., though
it may be given with any temperature of water.
The bran bath is of great value in eczema, or in rashes about the
buttocks, or in delicate skin conditions when plain water would
irritate.
The Tepid Bath.--This bath may be given at a temperature of 95°, or
100° F. It is of distinct advantage in extremely nervous children. To
induce sleep it is often better than drugs.
The Cold Sponge or Shower Bath.--This bath should be given in the
morning in a warm room. A tub should be provided with enough water in it
to cover the child's feet. This water should be warm because when the
feet are in warm water it prevents the shock which frequently comes when
cold water is applied to any other part of the body.
A large sponge is filled with water at a temperature of from 40° to 60°
F. This is squeezed a number of times over the child's chest, shoulders,
and back. While the cold water is being applied the body should be well
rubbed with the free hand of the mother. The bath should not last longer
than half a minute. When finished take the child out quickly and stand
him on a bath towel and give him a brisk rubbing with a bath towel until
the skin reacts. This is an exceedingly valuable tonic for a delicate
child. It should not be used on younger children than eighteen months of
age. In younger children a cold plunge is preferable.
For the cold plunge water at a temperature of 55° F. is prepared. The
child is lifted into this and given a single dip up to the neck. He is
then briskly rubbed off as above.
There are a very few children who do not take kindly to either the cold
sponge or plunge. These children do not react; they remain pale or blue
and pinched for some time after. It may be necessary to discontinue the
procedure or to use water of a higher temperature.
POULTICES
Poultices are useful in inflammation and for the relief of pain. To be
of any value they should be applied frequently--every ten or twenty
minutes--and they should be applied hot.
Ground flaxseed is the best material for poultices. It should be mixed
with boiling water until the proper thickness is reached. It may be kept
simmering on a fire. When one poultice is taken off it can be scraped
into the pot and heated over if there is no discharge. Each poultice
should be put into clean muslin, put on the part and covered with oiled
silk. This will help to retain the heat and prevent the clothing or bed
sheet from becoming wet.
HOT FOMENTATIONS
A hot fomentation is simply a clean poultice. Several thicknesses of
flannel are taken, wrung out of very hot water, covered with cotton
batting, and then with oiled silk.
How to Make and How to Apply a Mustard Paste.--For infants: Take one
part English mustard to six parts flour, mix with lukewarm water, and
spread between two layers of cheesecloth.
For older children and adults: Take one tablespoonful English mustard to
three or four tablespoonfuls of flour, and mix as above.
Mustard pastes should be made big enough. You can accomplish a great
deal more by putting on a sufficiently large mustard paste than by
simply putting on one the size of the palm of your hand.
It should be left on until the skin is distinctly red. The length of
time will depend, of course, upon the strength of the mustard. Mustard
pastes may be put on every three hours, if necessary, and they may be
used for a week at this interval if the conditions demand it.
If they are used in pneumonia or other pulmonary diseases, they should
be used large enough to go around the whole chest. If they are used in
heart failure, they should be big enough to cover the whole trunk.
When made with the white of an egg they will not blister. Or if the part
is rubbed with white vaseline before applying, it will not blister and
it will be just as effective. When a mustard paste is removed the red
area should be rubbed with white vaseline and covered with a clean piece
of flannel.
How to Prepare and Use the Mustard Pack.--The child is stripped and
laid upon a blanket, and the trunk is surrounded by a large towel or
sheet saturated with mustard water. This is prepared as follows: Take
one tablespoonful of English mustard and dissolve it in one quart of
water, slightly warmed. Saturate a towel in this mixture and apply to
the body of the child while it is dripping. The patient is then rolled
in a blanket. Keep the child in this pack for ten or fifteen minutes.
The mustard pack is not as good as the mustard bath, but it is all that
is necessary in a number of various conditions. The physician will, of
course, decide these matters. It is simply the duty of the mother to
know how to carry out the physician's instructions.
The Turpentine Stupe.--Take a piece of flannel, big enough to cover
the area which it is desired to affect, wring it out of as hot water as
it is possible. Upon this sprinkle twenty drops of spirits of
turpentine. Place the stupe wherever it is desired and cover with a
piece of oiled silk or dry flannel. The turpentine stupe is mostly used
in pain of the abdominal cavity. In colic from acute indigestion it is a
very convenient means of quieting the child by allaying the pain.
Care should be taken not to allow this form of application to remain on
too long. Take it off when the skin is red. For continuous use it is not
as good as the mustard paste.
OILED SILK. WHAT IT IS, AND WHY IT IS USED
Oiled silk is sold in the drug stores by the yard. It is one yard wide.
It is used to cover any local application to prevent evaporation into
the air or to prevent the clothing from absorbing the medicament. If a
liniment is applied on cloth to effect a certain result, it may take
some time to do its work. If the wet cloth is covered with the clothing,
the clothing will absorb the medicine quicker than the body will and
thereby defeat the object in view, in addition to rendering the
clothing wet and nasty. If the application is covered with oiled silk it
cannot escape into the clothing, because the oiled silk is impervious.
The body will be compelled to absorb the medicine and consequently
results will be quicker and more certain. Many liniments are expensive;
to permit them to be absorbed by the clothing is needless waste It is
therefore economical to apply the oiled silk.
DISEASES OF CHILDREN
[Illustration: By permission of Henry H. Goddard.]
The First Blight
This is one of those truly unfortunate cases which, so far as present
knowledge goes, cannot be guarded against. Eunice, age 31, mentally 2,
is a low-grade imbecile. There is not in the whole family, for
generations back, a single case of feeble-mindedness, nor of disease
that would undermine the nervous organization. Close scrutiny does not
reveal a single assignable cause. She came, as an accident, to blight an
otherwise normal family.
Such cases are few, but unfortunately they do occur. It is for Eugenics
to materially reduce the possibility of such occurrences.
* * * * *