DEFORMITIES AND CHRONIC DISORDERS
Reference has already been made to certain accidents of embryology
during the very early days or weeks of the formative period of the
embryo. Common illustrations of such deforming developmental accidents
are harelip, cleft palate, and club foot.
HARELIP AND CLEFT PALATE
In the case of a partial or complete failure of the two sides of the
face to come together in the median line, a deformity results which is
known as harelip--a partial or complete cleft of the upper lip. It may
be a single or a double cleft, exposing the teeth, or the cleft may
even extend up into the nose. This deformity may seriously interfere
with nursing, making it necessary to resort to feeding with a medicine
dropper and later a spoon. The success of the operation for the relief
of harelip, which should usually be performed during the early months
of life, is often very remarkable.
Should this failure to unite be in the deeper structures of the head,
then cleft palate is the result. This, too, may be partial or
complete: partial as seen in a cleft of the soft palate only; and
complete, when the hard palate also is involved. In such an instance
it is the floor of the nose that is defective; hence the nose and
mouth are one cavity.
A specially devised apparatus which assists the child in nursing may
be found on the market, for nursing is well-nigh impossible without
the closure of the roof of the mouth. The operation for cleft palate
is usually successful when performed at the proper time and by
competent hands.
In tongue-tie the weblike membrane underneath is attached too far
forward, so that the child is quite unable to protrude his tongue, and
this condition greatly interferes with sucking. The operation for the
relief of this condition is slight, and should be performed as soon as
the defect is discovered.
DEFORMED HANDS AND FEET
Occasionally there is a webbing of one or more fingers of the hand,
and there are sometimes seen too many fingers or a double thumb. It is
needless to allow such a deformity to continue; the operation for
relief is often remarkably successful and should be performed very
early.
Clubfoot results when short tendons or contracted tendons pull the
toes inward or outward with raising of the heel. Treatment must be
instituted early; braces or splints are applied; and untiring efforts
are put forth in massage and other lines to prevent a lifelong
handicap of clubfoot.
An inward rotating of the legs presents the deformity of pigeon-toe.
The normal foot naturally inclines toward "pointing in," and such a
condition should not be discouraged. Many flat feet (broken arch) are
due to shoe lasts which compel the toes to slant "out," and the
bunions which so often follow such mistreatment may be exceedingly
painful.
By all means place shoes on the pigeon-toed child that possess
straight lasts with flexible arches, and which admit of the exercise
of many muscles of the foot which otherwise remain inactive.
As the child grows older the toenails thicken, and often in their
trimming they are cut so closely at the corners that sometimes a
condition results known as ingrowing nails. Such are very painful and
must receive special attention. First of all, the nail is cut
squarely, and after scraping it thin the corner is lifted and cotton
so placed under it that the nail's downward and inward growth is
stopped.
SPINAL CURVATURE
Curvature of the spine is more common than is usually thought. The
most frequent variety of it is the lateral curvature. One shoulder is
lower than the other, and the hips are therefore uneven. Rickets,
during infancy, is the most common cause of spinal curvature.
Improper sitting at school--sitting on the edge of the seat--or
carrying heavy loads are often contributing factors to the production
of lateral curvatures. Only the muscles and ligaments enter into this
deformity, hence the treatment should be started early and should
consist of:
1. Stretching exercises.
2. Hanging from the rounds of a ladder securely fastened to the wall.
3. Certain applications of hot fomentations to the spinal muscles for
their relaxation.
4. Firm cushion placed under one or other of the hips to encourage the
re-establishment of muscular poise.
5. Special supervision of the case.
POTT'S DISEASE
Pott's disease, or tuberculosis of the bone, often results in an
angular spinal deformity. This curvature, unlike the lateral
curvature, is a sequela of an actual disease of the bones. It is
always very serious and demands early treatment from skilled hands.
Early in the disease there is a peculiar stiff, tottering gait. The
little child holds the spine rigidly, and in picking up objects from
the floor bends the knees instead of the spine. If the trouble is in
the upper spine, the shoulders are held high and the head is stiffly
poised, it is never rotated; in looking about the entire body turns.
Medical aid should be secured early. The X ray not only locates the
difficulty but also determines the extent of the process. If the spine
be put to perfect rest, outdoor life begun, a diet rich in fats
established, the results are often wonderfully successful.
Another tubercular condition is seen in the much dreaded hip-joint
disease which parents should always be on the lookout for. The
earliest symptoms are crying out in the night suddenly, unnatural
standing on one leg (to relieve the strain on the diseased hip) and
so-called "growing pains." Call in a physician very early and
institute proper treatment. A posterior curvature of the spine is
often associated with a bad case of rickets. It is of temporary
duration, and usually clears up when the symptoms of rickets have been
eradicated. It involves only the back muscles--not the vertebral
bones.
The young mother is often very much concerned over the misshapen head
of the child as a result of a prolonged labor; and it does seem quite
miraculous to see a head, more nearly resembling an egg than anything
else, become beautifully round and shapely by the end of two or three
days.
Protruding ears may be encouraged to lie more flatly by the wearing of
a specialized bonnet at night. When the babies are too young to turn
themselves they should be turned first to one side and then the other,
while care should always be exercised in properly straightening out a
curled under ear or an overlapping ear.
RHEUMATISM
While we so often regard rheumatism an adult disease, nevertheless,
children do suffer its aches and pains as well as the fever which so
often attends the inflammatory type. The so-called "growing pains" are
often of rheumatic origin.
Diseased tonsils not only are often--very often--the avenue of entry
of infectious microorganisms that cause one type of rheumatism, but
many forms of valvular heart disease are also directly traceable to
these same diseased tonsils. The treatment consists in giving proper
attention to the tonsils, even removal if necessary--and if the child
is old enough. All other possible causes should be located and
removed; the child should have absolute rest in bed with brisk
cathartics and a liquid diet (no meat broths). The diet should consist
more of alkalinizing foods as shown in the special table in the
appendix. Medicinal alkalines are often given when the urine shows a
very high acid reaction.
SCURVY
Scurvy, seen in children who subsist on "prepared foods," is
manifested by tender legs and swollen gums which have a tendency to
bleed easily. Pallor, loss of appetite, and insomnia accompany the
condition. The treatment of scurvy is change of diet from "patent
foods" to fresh cow's milk, with the addition of orange juice, daily.
In older children the food must be very nutritious; out of door life,
salt glows, friction baths (see appendix), and the taking of large
amounts of fats are all essential to the cure.
ADENITIS--ENLARGED GLANDS
Enlarged glands, or what our grandmothers used to call "kernels" in
the throat are often the result of inflammation in the mouth or
throat, and occur in connection with many of the childhood diseases,
notably diphtheria, scarlet fever, and scarlatina.
Glands appearing in the back of the neck may be occasioned by
pediculli (lice), ring worm, or eczema, while those seen in the neck
just back and below the ears may come from mastoiditis (inflammation
of the middle ear) or adenoids.
Glands felt under the arm enlarge because of trouble or infection in
the breast, hand, or arm; while glands in the groin are usually due to
some infection of the feet, legs, or abdomen.
These glands usually disappear when the general health and well-being
of the child is improved by:
1. Outdoor life.
2. Morning dry-friction rub to the skin.
3. Good liberal diet, including plenty of fats.
4. No feeding between meals.
5. The salt glow and general tonic treatment (see appendix).
6. The oil rub at night.
RICKETS
Rickets (a disease of the bones) often follows in the wake of faulty
feeding and unhygienic surroundings. The bones lack a proper amount of
lime salts and other elements. Development in general, especially that
of the bones, is greatly interfered with.
Bowlegs, prominent square brow, enlarged perspiring head, weakness,
and often tenderness of the flesh, are notable signs of the disease.
The treatment varies little from that of scurvy, and will be provided
in detail by the attending physician.
MALARIA
Children often suffer from malarial parasites. Sudden rise of fever on
regular days (sometimes daily, every two days or every three days)
should demand a careful medical examination including the examination
of the blood where the offending organism is seen in the red blood
cells. We recently saw a little girl who happened to have an earache
and was about to be operated on for ear trouble, when examination of
the blood revealed the fact that she was suffering from malaria.
TUBERCULOSIS
In the routine examination of adult patients, the X ray observations
of the lungs often reveal deposits of lime salts which tell the story
of a successful fight against tuberculosis (Fig. 16). And while it may
seem surprising, we believe beyond a doubt that most of us have had
some varying degree of tuberculosis while young--the unrecognized
battle has been fought--and these small monuments of lime salts alone
remain to tell the interesting story.
The pity of it is that whole armies of little folks fall in this
struggle against disease, for it is one of the common and fatal
diseases of childhood. Fresh-air schools, playgrounds, and free school
lunches are saving hundreds of children from the ravages of this
disease each year.
Tuberculosis is strictly a house disease, hence the little tubercular
patient must seek outdoor life. All avoidable exposure to the disease
must be denounced, and public sentiment must continue to be aroused to
the hygienic betterment of the tenement districts and basement homes.
The sanitary drinking cup and the bubble fountain must be encouraged,
as must also the proper ventilation of all places where crowds
assemble, be it the schoolroom, the theater, or the church.
SYPHILIS
While tuberculosis is known as the "great white plague," syphilis and
gonorrhea constitute the "great black plague," which seen in the
little folks is pitiable indeed, leading us to realize that surely
"the children's teeth have been set on edge" because of the careless
eating of sour grapes by the parents. Syphilitic parents who have not
been properly treated, should think many times before they take upon
themselves the awful responsibility of bringing into the world a
tainted child. Proper mercurial treatment should be instituted at once
not only for the child but also in the case of both parents.
[Illustration: Fig. 16. X ray Showing Tuberculosis of the Lung]