To the mother who has passed through the experience of bringing the child into the world is usually given that intuitiveness which helps her in caring for that child when it is well and in recognizing certain symptoms when it is sick. The newborn baby brings with him a large responsibility, but as the weeks pass by his care becomes less and less of a nervous strain, as the routine duties, so nearly alike each day of his little life, have made the task comparatively easy; but when the baby gets sick, particularly if he is under one year of age, and it is impossible for him clearly to make known his wants, and being unable to tell where it hurts or how badly it hurts, the average mother is likely to become somewhat panicky; and this confusion of mind often renders her quite unfit successfully to nurse the sick baby.
THE NURSE
It is often wise to secure the services of a trained nurse, and if the family purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will often accomplish much more than the unintentional irritability and anxious solicitude of an overworked and nervous mother.
Usually the mother not only attempts the care of the sick baby with the long night vigil—often not having the opportunity to take a bath or change her raiment day in and day out—but she often attempts to manage the entire household as well, including the getting of the meals and keeping the house cleaned, and it is not to be wondered at that her nerves become overtaxed and in an unlooked for moment she becomes irritable and cross with the sick child.
No matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continued illness of the children. Should the mother insist upon caring for the baby herself, then all household duties should be given over to outside help, and as she takes the rôle of the nurse, the same daily outing and sleep that an outside nurse would receive should be hers to enjoy.
Dr. Griffith has so ably detailed the "features of disease" that we can do no better than to quote the following:[3]
POSITION
The position assumed in sickness is a matter of importance. A child feverish or in pain is usually very restless even when asleep. When awake it desires constantly to be taken up, put down again, or carried about. Sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. In prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. It may remain like a log, scarcely breathing for days before death takes place. Perfect immobility may also be seen in children who are entirely unconscious although not exhausted.
A constant tossing off of the covers at night occurs early in rickets, but, of course, is seen in many healthy infants, especially if they are too warmly covered. A baby shows a desire to be propped up with pillows or to sit erect or to be carried in the mother's arms with its head over her shoulder whenever breathing is much interfered with, as in diphtheria of the larynx and in affections of the heart and lungs. The constant assumption of one position or the keeping of one part of the body still, may indicate paralysis. When, however, a cry attends a forcible change of position, it shows that the child was still because movement caused pain.
Sleeping with the mouth open and the head thrown back often attends chronic enlargement of the tonsils and the presence of adenoid growths in young children, although it may be seen in other affections which make breathing difficult. In inflammation of the brain the head is often drawn far back and held stiffly so. Sometimes, too, in this disease the child lies upon one side with the back arched, the knees drawn up, and the arms crossed over the chest. A constant burying of the face in the pillow or in the mother's lap occurs in severe inflammation of the eyes.
GESTURES
The gestures are often indicative of disease. Babies frequently place the hands near the seat of pain; thus in slight inflammation of the mouth they tend to put the hand in the mouth; in earache to move it to the ear; and in headache to raise it to the head. In headache or in affections of the brain they sometimes pluck at the hair or the ears, although they may often do this when there is no such trouble. Picking at the nose or at the opening of the bowel is seen in irritation of the intestine from worms or oftener from other cause. A child with a painful disease of its chest may sometimes place its hand on its abdomen, or a hungry child try to put its fists into its mouth.
In approaching convulsions the thumbs are often drawn tightly into the palms of the hands and the toes are stiffly bent or straightened. Very young babies, however, tend to do this, although healthy. The alternate doubling up and straightening of the body, with squirming movements, making of fists, kicking, and crying, are indications of colic. This is especially true if the symptoms come on suddenly and disappear as suddenly, perhaps attended by the expulsion of gas from the bowel.
SKIN COLOR
The color of the skin is often altered in disease. It is yellow in jaundice, and is bluish, especially over the face, in congenital heart disease. There is a purplish tint around the eyes and mouth, with a prominence of the veins of the face, in weakly children or in those with disordered digestion. A pale circle around the mouth accompanies nausea. The skin frequently acquires an earthy hue in chronic diarrhea, and is pale in any condition in which the blood is impoverished, as in Bright's disease, rickets, consumption, or any exhausted state. Flushing of the face accompanies fever, but besides this there is often seen a flushing without fever in older children the subjects of chronic disorders of digestion. Sudden flushing or paling is sometimes seen in disease of the brain.
FACIAL EXPRESSION
The expression of the face varies with the disease. In whooping cough and measles the face is swollen and somewhat flushed, giving the child a heavy, stupid expression. There is also swelling of the face, especially about the eyes, in Bright's disease. Repeated momentary crossing of the eyes often indicates approaching convulsions. In very severe acute diarrhea it is astonishing with what rapidity the face will become sunken and shriveled, and so covered with deep lines that the baby is almost unrecognizable. The same thing occurs more slowly in the condition commonly known as marasmus. Often the face has an expression of distress in the beginning of any serious disease. If the edges of the nostrils move in and out with breathing, we may suspect some difficulty of respiration, such as attends pneumonia. The baby sleeps with its eyes half open in exhausted conditions or when suffering pain.
THE HEAD
The head exhibits certain noteworthy features. Excessive perspiration when sleeping is an early symptom of rickets. It must be remembered, however, that any debilitated child may perspire more or less when asleep. Both in rickets and in hydrocephalus (water on the brain) the face seems small and the head large, but in the former the head is square and flat on top, while in the latter it is of a somewhat globular shape. The fontanelle is prominent and throbs forcibly in inflammation of the brain, is too large in rickets and hydrocephalus, bulges in the latter affection, and sometimes sinks in conditions with only slight debility.
THE CHEST
The chest exhibits a heaving movement with a drawing in of the spaces between the ribs in any disease in which breathing is difficult. A chicken-breasted chest is seen in Pott's disease of the spine, and to some extent in bad cases of enlargement of the tonsillar tissue; a "violin-shaped" chest in rickets; a bulging of one side in pleurisy with fluid; and a long, narrow chest, with a general flattening of the upper part, in older children predisposed to consumption.
THE ABDOMEN
The abdomen is swollen and hard in colic. It is also much distended with gas in rickets, and is constantly so in chronic indigestion in later childhood. It is usually much sunken in inflammation of the brain or in severe exhausting diarrhea or marasmus. It may be distended with liquid in some cases of dropsy.
THE CRY
The study of the cry furnishes one of the most valuable means of learning what ails a baby. A persistent cry may be produced by the intense, constant itching of eczema.
The paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. A frequent, peevish, whining cry is heard in children with general poor health or discomfort. A single shrill scream uttered now and then is often heard in inflammation of the brain. In any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. A nasal cry occurs with cold in the head.
A short cry immediately after coughing indicates that the cough hurts the chest. Crying when the bowels are moved shows that there is pain at that time. A child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. In conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. This latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. Crying when anything goes into the mouth makes one suspect some trouble there. If it occurs with swallowing, it is probable that the throat is inflamed.
With the act of crying there ought always to be tears in children over three or four months of age. If there are none, serious disease is indicated, and their reappearance is then a good sign.
COUGHING
The character of the cough is also instructive. A frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. A short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. There is a brazen, barking, "croupy" cough in spasmodic croup. In inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless.
The cough of whooping cough is so peculiar that it must be described separately when considering this disease. Then there are certain coughs which are purely nervous or dependent upon remote affections. Thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. It is not nearly so frequent as mothers suppose. Irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. Enlarged tonsils or elongated palate or throat irritation may also produce a cough.
THE BREATHING
The breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. If it becomes very decidedly so, we suspect disease, particularly of the brain. A combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "Cheyne-Stokes respiration," and is found in affections of the brain. It is one of the worst of symptoms except in infancy, and even then it is very serious.
The rate of respiration is increased in fever in proportion to the height of the temperature. It is increased also by pain in rickets, and especially in some affections of the lungs. Sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this.
Breathing is often very slow in disease of the brain, particularly tubercular meningitis. Poisoning by opiates produces the same effect. Frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. Breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. A gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious.
"Labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. Long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup.
THE PULSE
The rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. In early childhood its observation is of more service, although even then deceptive. Slight irregularity is not uncommon. Unusual irregularity is an important symptom in affections of the brain or heart. Fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. Slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in Bright's disease and jaundice.
THE TEMPERATURE
The temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes.
Even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of 103 F. or more. We do not speak of fever unless the elevation reaches 100 F. A temperature of 102 or 103 F. constitutes moderate fever, while that of 104 or 105 F. is high fever, and above 105 F. very high. A temperature of 107 F. is very dangerous, and is usually not recovered from. The danger from fever depends not only upon its height, but upon its duration also. An elevation of 105 F. may be easily borne for a short time, but it becomes alarming if much prolonged.
THE MOUTH
The tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. After this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. In scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. In the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. In thrush the tongue is covered with white patches like curdled milk. A pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. In prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef.
Grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. It generally indicates an irritated nervous system. Most often this depends upon some disturbance of digestion; less often upon the presence of worms. The symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. In some babies it appears to be only a nervous habit.
NURSING
The manner of nursing or swallowing frequently affords important information. A baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. If it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. If it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. The ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom.
THE URINE
Urine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. Sometimes the urine under these conditions is milky when first passed. In some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sandlike particles. A decidedly yellow stain on the diaper occurs when there is jaundice. A faint reddish stain seldom indicates blood. The amount of urine passed is scanty in fever, in diarrhea, and especially in acute Bright's disease. In the latter disease the urine is often of a smoky or even a muddy appearance. The possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter.
THE STOOLS
We find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino, or haematoxylon. Infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white passages. The presence of a certain amount of greenish coloration of the passages is not infrequent. This is usually an evidence of indigestion, but passages which are yellow when passed and turn to a faint pea green some time later are not an indication of disease.
3 From Griffith's Care of the Baby, copyrighted by W. B. Saunders Company.
WHEN BABY GETS SICK
When baby shows that he is sick, take his temperature as directed elsewhere, cut down the feeding to at least one half, or, if his temperature is around 102 F. give him nothing but rice water or barley water. If he is constipated give him a cleansing enema, and if hot and feverish a sponge bath may be administered. He should then be put into a bed with light covers and wait further orders which the doctor will give on his arrival. Give the baby no medicine unless ordered to do so by the physician.
Known to every physician who undertakes the care of children, is the failure of many well-meaning mothers to call him early. The mother attempts the care of the baby herself, and not until the condition gets beyond her knowledge and wisdom does she seek medical advice. In the early hours of an approaching cold, the beginning of intestinal indigestion, or at the beginning of bronchitis, if the physician can see the child early, prolonged illness may be avoided as well as unnecessary expense and many heart-breaking experiences.
FEEDING THE SICK BABY
Feeding the sick baby differs somewhat with the character of the individual disease, but in the outset of any and all diseases the intestinal tract should not be overburdened with food. At the approach of any illness, the food should at least be cut down one half; for instance, in the case of a serious acute illness accompanied by fever, not only should the strength of the food be reduced one half, but water should be given plentifully between feedings. It is better never to urge the baby to eat at such times—for the ability to digest food is very much reduced.
In cases of acute attacks with much vomiting and fever, all milk should be immediately stopped and rice water or barley water substituted. When vomiting ceases and the fever approaches normal and food is desired, begin with boiled skim milk in small amounts, well diluted with cereal water, and do not approach the normal amount of milk for twenty-four to forty-eight hours. In this way the weak digestive organs are not overtaxed and they gradually resume their usual work of good digestion. When a baby seems to have no appetite for food, lengthen the intervals from three to four or five hours, for feeding when food is not desired usually aggravates disease disturbances.
EXAMINING SICK CHILDREN
And now, above all times, the early seed sowing of teaching the child self-control, teaching him to gargle if he is sufficiently old enough, to open his mouth and allow observation without resistance, brings sure results. The great harm of making the doctor and his medicine a threat to obtain obedience also brings its harvest at this time; for the doctor, of all people, ought to be regarded as the child's best friend. When baby is sick, the doctor is needed, his daily visits must not be resisted, his medicines must not be feared—these and such other matters should be made a part of every child's early education.
Under no circumstances or conditions should we directly falsify to a child. Nothing is accomplished by telling a child it will not hurt when you know that it will hurt, or that the medicine tastes good when you know it is bad-tasting. Every physician can recall unnecessary disturbances in the office because a mother has allowed a child to acquire a wrong mental attitude toward the family physician.
One mother told her little girl in my office when I wished to make an examination for adenoids which necessitated my putting my finger back of the child's uvula, "Now Mary, the doctor won't hurt you at all, it will feel nice." I turned to the little girl and said: "Mary, it will not feel nice, it really won't hurt you, but it will feel uncomfortable." It was a grave mistake to tell her that it would feel nice. The child resisted, and, while the examination was successfully made, the greatest of tact had to be used in securing the friendship of the child after the examination.
It is far better when the throat is to be examined to wrap the child in a shawl or a sheet with his arms placed at his side, and for a member of the family to take him in her lap and hold him securely while the physician quickly makes the observation. And while we appreciate that sickness is not the time to introduce new methods of training, in instances where children have been spoiled, it is far better quietly and firmly to go about the task in a manner that you know can be carried through to a successful finish.
TREATMENT OF SICK CHILDREN
A sick child should be encouraged to lie in his bed much of the time, and the bed should be kept clean and cool. He should never be set up suddenly or laid back quickly. In the case of a broken leg, all rapid movements should be avoided. A simple story or a soothing lullaby, or the giving of a toy, will often divert attention when some painful movement must be made or some disagreeable task performed.
Both cleanliness of the body and cleanliness of the mouth are exceedingly necessary in sickness. In all instances of disease or indisposition, the mouth must receive daily care, for stomatitis or gangrene of the mouth often follows neglect. A listerine wash in proportion of one to four, or a magnesia wash, or the addition of a few drops of essence of cinnamon to the mouth wash will do much to prevent such conditions, as well as to relieve them.
Applications of medicine to the throat may be made without resistance if the tactful nurse watches her time. She should slowly introduce the tongue depressor which may be a flat stick or a spoon, when the application of medicine with a camel's-hair brush is quickly made to the rolled-out throat as the child gags, and if the nurse then quickly diverts his attention to some beautiful story or a picture or a new toy, the treatment is soon forgotten. Under no circumstances argue with or scold a sick child. Get everything ready, if possible behind his back or in another room, and then with plenty of help make the application or the observation without words, always with gentleness and firmness.
NURSING RECORDS
Whether the nurse be the mother, caretaker, practical or professional nurse, a record should always be kept of the condition of the patient. The temperature should be reported at different periods designated by the physician. The pulse should be recorded, the amount of urine passed and the time it was passed, the number of bowel movements, all feedings and the general well being of the child—whether it is restless or comfortable, sleeping or awake, together with the water that he drinks.
The record may be kept, if necessary, on a piece of common letter paper, and should read something like this:
March 26, 1916
7 a. m. Temperature 102; pulse 132; respiration 40; morning toilet; took 4 ounces of milk; 2 ounces of barley water; 1 ounce of lime water.
9 a. m. Enema given; good bowel movement; mustard paste applied to chest, front and back, and oil-silk jacket applied; drank boiled water, 4 ounces.
11 a. m. Took the juice of one orange; temperature 103; pulse 135.
12 Noon. Very listless and nervous; temperature 104. Has coughed a great deal. Gave mustard paste to chest, front and back, and wet-sheet pack.
1:30 p. m. Temperature 101.8; 4 ounces of water to drink; looks better.
3 p. m. Has slept 1-1/2 hours; temperature 102.5; pulse 134; respiration 40; 6 ounces of food given (3 ounces of milk, 2 ounces of barley water and 1 ounce of lime water).
A record like this is a great help to the physician, and such a record may be kept by anyone who can read and write. There are printed record blanks which may be procured from any medical supply house and most drug stores.
BAD-TASTING MEDICINES
Castor oil has neither a pleasant smell nor taste, and nothing is accomplished by telling the child that it does smell good or taste good. If the patient is old enough to drink from a cup, put in a layer of orange juice and then the castor oil and then another layer of orange juice, and in this way it often can be easily taken. Someone has suggested that a piece of ice held in the mouth just before the medicine is taken will often make a bad dose go down without so much forcing. A taste of currant jelly, or a bit of sweet chocolate, or the chewing of a stick of cinnamon is a great adjunct to the administration of bad-tasting medicines. All oily medicines must be kept in a cool place and should always be given in spoons or from medicine glasses that have first been dipped in very cold water. Very often the addition of sugar to bad-tasting medicines will in no wise interfere with their action, while it often facilitates the administration of the disagreeable dose. The majority of bad-tasting medicines are now put up in the form of chocolate-flavored candy tablets.
TEMPERATURES AND PULSE
The normal temperature of a baby is 98.5 to 99 F. in the rectum. After shaking the mercury of the thermometer down below the 97 mark it is well lubricated with vaseline and then carefully, gently, pushed into the rectum for about an inch and a half or two inches, and left there for three minutes before removing.
Mothers should exercise self-control in taking the temperature, for nothing is gained by allowing a panicky fear to seize you should the mercury register higher than you anticipated. Notify your physician when the temperature registers above 100 F.
The respirations of a child are fairly regular and rhythmic and occur about forty times per minute during the first month of life and about thirty times per minute during the remainder of the year. From one to two years, twenty-six to twenty-eight is the average. Breathing is somewhat irregular when the child is awake and may be a bit slower when asleep. Before the baby is born the fetal pulse is about 150. At birth it ranges from 130 to 140. During the first month the pulse is found to be from 120 to 140. By the sixth month it gets down to 120 or 130, and from that on to a year the normal pulse beat of the baby is about 120. The pulse is influenced very much by exercise and is often increased by crying or nursing or any other excitement.
FEVER
Children get fever very easily—the digestive disturbance of overeating, constipation, a slight bilious attack—all produce fever which disappears quite as suddenly as it came. The first thing to do under such circumstances is to withhold food, give plenty of water to drink, produce a brisk movement of the bowel by giving a dose of castor oil, give a cleansing enema, and treat the fever as follows:
After removing all of the clothes from the child, place him in a warm blanket and then prepare a sponge bath which may be equal parts of alcohol and water; expose one portion of the body at a time and apply the water and alcohol first to one arm and then to the other arm, the chest, one leg, the other leg, the back and then the buttocks. Do not dry the part but allow evaporation to take place, and this, accompanied by the cooling of the blood which is brought to the skin by the friction, readily reduces the fever. Another procedure which may be employed if the fever registers high is the wet-sheet pack which is administered as follows:
Three thicknesses of wool blankets are placed on the bed and a sheet as long as the baby and just enough to wrap around him once, is wrung out of cool water and spread over these blankets. With a hot-water bottle to the feet, the child is then laid down in the wet sheet which is now brought in contact with every portion of his body, then the blankets are quickly brought around, and he is allowed to warm up the sheet—which lowers his temperature.
Another valuable procedure is the cooling enema. Water the same temperature as that of the body, is allowed to enter the bowel and is then quickly cooled down to 90 or 85 F.; in this manner much heat is taken out of the body and the fever quickly reduced. (For further treatment of fevers see Appendix.)
Visitors should never be allowed in the sick room during the height of a disease, and during convalescence not more than one visitor should be allowed at one time, and the visit then should be only two or three minutes in length. The order and the quietness and the system of the sick room should be perfect. Visitors and loitering members of the family do no good and they may do much harm to the recuperating nervous system of the child.
LOCATION OF THE SICK ROOM
In these days of high rents, we realize that the greater per cent of our readers are living in apartments and homes just big enough conveniently to care for the family during health, and while it would be pleasant and convenient to have a spare room or an attic chamber that could be used in case of illness, it is the exception rather than the rule that the families to whom sickness comes have these extra apartments. When a contagious or an infectious disease comes to the family, it is of great importance that the sick child be isolated, preferably on another floor, from that used by the immediate family.
Those living in homes, more than likely can fix up a room on the attic floor for the isolation, and those living in apartments may put the sick child in one end of the apartment, while they inhabit the other end. One family under my observation not long ago had a child stricken with the measles. In the same apartment there lived a puny baby not quite two years old. Coming as it did in February, the mother of the child was apprehensive, fearing that measles would leave a severe bronchitis which might mean the death of the already too-delicate baby. She was instructed to move the baby's bed to the sun parlor in the front of the flat, while the boy with the measles was put in the parents' room in the rear end of the flat. A sheet was suspended in the middle of the hall leading from the living-room to the bedrooms. Door knobs were disinfected daily, a caretaker was put in charge of the measles patient, the mother very frequently was compelled to go back and administer a treatment, but each time she donned a large apron and completely covered her hair with a towel, she administered the treatment, took off her wrappings, thoroughly washed her face and hands—disinfected them—and returned to her baby in the front part of the house.
At night this mother slept on the floor on springs and mattress in the living-room, and to that home the measles came and departed, and the baby did not get them at all, so perfect was the isolation, so vigilant the disinfection, and so scrupulous the care to prevent contamination. So you see from this one instance that it is altogether possible to make isolation complete even on the same floor. But, mind you, the dishes that the lad ate from were all kept in his room. Food was brought to the sheet and there the caretaker held her dishes while the cook poured or lifted the food from her clean dishes to the dishes the caretaker brought from the sick room.
Whether the sick room is in the attic or whether it be the rear end of an apartment, if the principles of contagion and disinfection are understood I believe it is perfectly possible to isolate even scarlet fever without danger to the other members of the family.
NECESSARY FURNISHINGS
For slight indispositions and trifling disorders, it is not necessary to strip the room of its adornment, but it is well to clear off the dresser tops, protect them well with many thicknesses of newspapers covered over by a folded sheet so that alcohol, witch-hazel and other necessaries will not injure the mahogany or oak-top dresser. Whenever the children are sick, rob the room of anything that is going to be in your way. In instances of infectious or contagious diseases, take down all silk or wool hangings, replace them by washable curtains or inexpensive ones that can be burned if necessary, and remove valuable paintings and other bric-a-brac that later fumigation will harm or that may gather the dust during the days of illness.
Just as it is necessary for the man who mines the coal to wear suitable garments, and for the woman who does the scrubbing to dress accordingly, and for the nurse who cares for the case to wear washable clothes—so it is necessary to dress the sick room in garments that are suitable, convenient, and capable of being thoroughly disinfected, fumigated, or even burned if the occasion demands. Hence, expensive rugs should be replaced by rag carpets or no rug at all, while unnecessary articles and garments should be removed from closets, etc.
Remembering that the little fellow is to remain in this room for possibly two weeks or maybe six weeks, let us put up some bright-colored pictures that he will enjoy, bring in some books and magazines by which he may be entertained, secure a few simple toys that will not tax the brain, but serve as a help to pass away the long hours. There are many paper games that may be had, such as transfer pictures, picture puzzles, kindergarten papers, drawing pictures, as well as toys that may be put together to fashion new articles. A whole lot of fun can be gotten out of a bunch of burrs that can be stuck together to make men, animals, houses, etc. Scissors and pictures are entertaining as well as paper dolls with their wardrobes. Rubber balloons, or a target gun for the boy of six will be a great source of delight to him; as will a doll with a trunk full of clothes for the little girl during her convalescent days. A tactful nurse and a resourceful mother will think of all the rest that we have not mentioned—which will amuse, entertain and keep happy our convalescent children, help them to forget that they are "shut ins."
THE NURSERY REFRIGERATOR
It is wise in instances of the more severe childhood troubles, such as infectious and contagious diseases, to keep as many things in the sick room as possible, and so we remind our reader of the home-made ice box, described elsewhere in this book, in which may be kept the fruit juices and the fruits, as well as the milk and the buttermilk. Many medicines, particularly the oily medicines, should be kept in this home-made ice box and five cents worth of ice a day will not only make things taste better, especially during the warm months, but will protect the other members of the family, for the family ice box is a big central station which must be protected against infections and carriers of disease.
In connection with the ice box, we are reminded that it would be a great convenience to have a simple contrivance for heating bouillon, milk, or making a piece of toast, which can be readily done with an electric heater, an alcohol stove, or a small apparatus fitting over the gas jet.
SICK ROOM DISINFECTANTS
The most important thing which we are going to mention in this division of the chapter is the disinfection of the door knobs. According to the directions on the poison bottle, place an antiseptic tablet into a small amount of water which will make a solution of 1 to 1000 of bichlorid of mercury, and several times a day disinfect the door knobs, particularly in the sick end of the house—thoroughly washing and adequately rubbing with a towel moistened in this solution.
All stools and urine from the sick one will receive attention as directed by the physician. The stools from a typhoid patient should stand for one-half hour in a chamber covered with a layer of lime.
It is not at all necessary to have vessels containing disinfectant substances standing about the room and in the closet. In a room adjoining should be kept all of the dishes used by the sick patient, his tray, half a dozen napkins, knife, fork, spoon, serving dishes, drinking glass, pitcher, etc. All bedding and all linen used by the sick member should be allowed to stand in a solution of disinfectant for several hours when they may be wrung out of the solution, dropped into a bucket and carried to the laundry without any danger to other members of the family.
The nurse is not allowed to leave this room in the garments that are worn while caring for the sick. She should have her meals in an adjoining room which is also under strict isolation.
THE MEDICINE CHEST
The sick room medicine chest should be so placed on the wall that it is outside the reach of the smaller members of the family, for in it should be placed poisons for external use that are capable of producing death if taken internally. Bottles that hold these poisons—such as bichlorid of mercury, lysol, carbolic acid, laudanum, paregoric, belladonna, etc.—should be so different from the other bottles in the medicine chest that if one should reach for them with his eyes shut or in the dark he would at once recognize that he had hold of a poison bottle. This is absolutely necessary. It usually means a bit of extra expense, but when we realize what tragedies may be avoided by such slight expense, it must not be considered.
Bottles may be procured that have been molded with points of glass projecting from the outside which make them rough to the touch, or they may be covered with a wire mesh or with a wicker covering which may easily be told from the other bottles in the case.
One woman lost her life because the nurse placed two ounces of carbolic acid in the enema instead of two ounces of saline solution. Saline solution is nothing but salt and water, while carbolic acid cost the woman her life, simply because the carbolic acid was not placed in a specialized poison bottle and the attendant could not read the label in the dark.
Under no circumstances keep from one year to another the remnants of unused medicine of a former sickness, for medicines do not keep well and often lose their strength if kept longer than the physician intended.
In this medicine chest should be found the following articles:
A glass graduate marked with fluid drachms (1 teaspoon), and fluid ounces (8 teaspoons).
A medicine dropper.
Absorbent cotton.
Boric acid.
Camphorated oil.
Castor oil.
Aromatic spirits of ammonia.
Alcohol.
Olive oil.
Epsom salts.
Soda-mint tablets.
Vaseline.
Zinc ointment, together with other medicines the physician orders.
Ice bag, hot-water bottle and oiled silk.
Besides these articles, in the nursery—in readiness for emergencies and accidents—should be found the following:
Gauze bandages of various sizes.
Sterile gauze.
Boric acid crystals and powder.
Mustard.
A pocket case of instruments containing scissors, knife, dressing forceps, etc.
Syrup of ipecac.
Glycerin.
Tincture of iodine.
Package of ordinary baking soda.
Peroxid of hydrogen.
Absorbent cotton.
Needle and thread.
Lime water.
PATENT MEDICINES
Aside from the giving of castor oil and the application of vaseline to the nose, or of applying boracic acid to the eyes, no medicine should be administered to the baby without competent medical advice. There are numerous widely advertised nostrums frequently sold as soothing syrups to be used during the teething or during attacks of diarrhea, or cough spasms, croup, or worms, that contain dangerous drugs and should not be given to children. Many well-meaning but ignorant mothers are slowly but surely laying the foundations for serious nervous disorders and are often making veritable dope fiends out of their children. Patent medicines are dangerous things in the hands of the people; if we are going to give medicines to our little babies let us at least know what we are giving. Let some conscientious, scientific physician examine the baby and prescribe for its needs.
If urged to use a patent medicine, examine the label carefully, for the Federal Food and Drug Act requires the manufacturer of patent medicines to print plainly on the label of the bottle the name and amount of certain dangerous drugs which it may contain.
The drugs mentioned in this drug act and which are often used in patent medicine nostrums are, chloral hydrate, cocaine, heroin, chloroform, alpha or beta eucaine, opium, morphin, alcohol, cannabis indica, or any derivative or preparation of any such substance contained therein.
There are many other drugs sold on the market containing syrups or flavoring materials which may do harm—which may upset the baby's digestion.
Mothers avoid patent medicines. Consult your physician. Never give a baby any sort of medicine to induce sleep. Unless babies are sick or spoiled or hungry, they will go to sleep of themselves, and even in the days of a high fever a wet-sheet pack seldom ever fails to put the baby to sleep and can do no harm if properly given.
This may be as good a place as any to mention the dosage of castor oil which is as follows:
Up to three months, ½ teaspoon.
From three to six months, 1 teaspoon.
From six to nine months, 1½ teaspoons.
From nine to twelve months, 1 dessert spoon (2 teaspoons).
From twelve months on, 1 to 2 tablespoons.
AFTER THE SICKNESS IS OVER
The physician will direct when the disinfectant bath is to be given to the patient previous to his liberation from isolation. The different diseases demand different treatment, but, on the whole, it is about as follows:
The day before the boy is to be allowed to go out among the family once more he receives a soap wash, clean sheet and bedding on the bed, and puts on clean garments. The following morning, his head thoroughly shampooed, his nails manicured, a second soap wash is given followed by a weak bichlorid bath (1 to 10,000 solution) which is followed by an alcohol rub. He is then allowed to go out of the sick room which is now to be thoroughly disinfected and fumigated.
After the illness is over, the sick room and the adjoining closets and ante rooms must be thoroughly disinfected or fumigated. If you are located in a city, the health authorities will do this after an infectious or contagious disease. Away from such conveniences, use the following method:
Place two ounces of crystals of permanganate of potash in a pan and have a pint bottle of formalin near by. Everything in the room is now exposed, dresser drawers are opened, all bedding, all garments—in fact everything that is in the room—is put in such a position as to be readily exposed to the fumes which are to follow. A line should be stretched across the room over which are thrown the bedding, garments, etc. The cracks of the windows and doors, except the one door of exit, are now sealed up with paper which has been dipped in green soap, and having the paper strips and pan of green soap ready just outside the exit door, the formalin is now poured over the permanganate crystals. Fumes will immediately arise and permeate every corner, crack and crevice of the sick room. Now quickly make your exit, close the door and seal up key hole and cracks and space under the door with paper dipped in green soap. Leave the room for six hours. After this with a well-moistened cloth to the nose, rush in and throw the windows open, hurry out and allow the room to air from twelve to twenty-four hours, after which wash woodwork and painted walls or take paper off and repaper walls; recalcimine ceilings and closets; scrub closet shelves and dresser drawers, bedsteads, and other furniture thoroughly. If the mattress is old throw it away, but if not, sun it for several days following the fumigation.