In this chapter we will consider the diseases which commonly occur during infancy and early childhood relative to digestion and the alimentary tract. Irregularity of feeding, feeding between meals, feeding too much at any given time, as well as feeding the wrong kind of food may cause stomach disturbances and intestinal troubles.
VOMITING
In a previous chapter, "The Feeding Problem," a common stomach disturbance, vomiting, was gone into quite thoroughly, and in passing to other disorders, we wish to remind the mother that vomiting should always be taken seriously. The interval between meals should usually be lengthened, the time spent in feeding shortened, and it is often necessary to withhold all milk and food of any kind for twelve or eighteen hours, giving only boiled, unsweetened water. Vomiting frequently ushers in some acute disease, and in remote cases, when it is very persistent, it may indicate inflammation of the brain. Complete rest is essential, trotting on the knee, suddenly changing the baby's position, or other quick movements must all be avoided. A physician should see the sick one and determine the cause of the trouble.
COLIC
Cases of ordinary colic are usually relieved by heat to the abdomen and feet, drinking hot water in which there has been dissolved a pinch of ordinary baking soda, or a portion of a soda mint tablet, or by the use of the photophore, as previously described. The treatment of such ordinary colic need not be given further consideration here because it has been described at length in a former chapter; but we do call the attention of the mother to a more serious form of recurring colic which so often accompanies chronic intestinal indigestion, marasmus, and malnutrition.
In most instances the food is radically at fault and should be reduced to a mixture which can more readily be digested and assimilated by the child. Often whey mixtures, peptonized foods, or buttermilk may be indicated. The weight of the baby, the age of the baby, and the color of the stools, must all be taken into account in the preparation of this easily digested food. Weak mixtures should be given at first and then gradually and carefully the quality may be strengthened until the normal formula is again used for the baby.
Injections into the bowel of water, to which has been added one level teaspoon of soda to the pint, will often give relief in this form of colic.
CHRONIC INDIGESTION
While this condition may occur at any time during babyhood days, it often makes its appearance during the last half of the first year and up to the fifth year. It is accompanied by mucus in the stools, chronic flatulence, constipation or diarrhea, or the alternating of the two, restlessness at night, distention of the abdomen ("pot bellied") accompanied by pain, a coated tongue with a fetid breath, and loss of appetite. It is a pitiable picture—the weight is usually reduced and the child gives the appearance of being decidedly undernourished. This condition is usually occasioned by errors in diet, whether it be over-feeding or feeding of the wrong element of food, and, since the diet is usually responsible for the condition, in the line of treatment diet is a prime factor.
All fats must be taken from the food, sugars should be avoided, and the amount of starchy foods, such as flour, potatoes and bread, should be greatly reduced. Buttermilk, skimmed milk, eggs, green vegetables, and fruit juices should be given. In the older child, if grains are used, they should be well toasted or baked.
JAUNDICE
It is altogether common and physiological for the newborn baby to pass through a few days of yellow skin which usually clears up in the second or third week, but it should not recur. Occasionally this yellow tint deepens, the whites of the eyes are yellow, the urine passed leaves a yellow stain on the diaper, while passages from the bowels are white or clay colored. If the child shows symptoms of ill health other than the yellow tint, it should receive medical attention. Older children troubled with jaundice should receive the following treatment: The photophore as described elsewhere should be applied to the liver and abdomen (the liver is on the right side), and this should be followed by the application of what is known as a heating compress, consisting of three layers—a cloth wrung from cold water, a mackintosh, and then two thicknesses of blanket flannel—which are all applied when the skin has been made red by the application of heat. (If the photophore is unavailable, a hot-water bottle may be applied.) The flannel is pinned snugly on the outside as the wet cloth goes next to the skin with the mackintosh between. This should remain on the abdomen for three or four hours, after which the hot application is again made to the liver and abdomen. The administration of broken doses of calomel is sometimes indicated in obstinate cases in connection with these applications of heat to the liver. Hot milk or mineral water may be taken with dry toast. In a day or two the color should clear up, the stools should be normal again, and the treatment may be discontinued.
WORMS
Irritation about the rectum which cannot be otherwise explained is usually suggestive of pinworms. These seatworms or pinworms are very much like little pieces of cotton thread—one-fourth of an inch in length. They grow and thrive in the lower part of the large bowel. Simple and effective treatment is as follows:
It is well to bathe the parts about the rectum after each bowel movement and often two or three times a day with a weak antiseptic solution. Itching may be controlled by the application of a disinfectant ointment, or the local applications of ice may serve the same purpose. After a thorough cleansing of the colon by an injection of lukewarm water containing a teaspoon of borax to the pint in order to remove the mucus, Doctor Holt suggests that after the discharge of this borated enema, infusions of quassia are very helpful (See Appendix).
Children suffering from roundworms experience a loss of appetite, varying temperature from above normal to subnormal, with colicky pains in the abdomen on coming to the table and beginning to eat. They are pale and listless, or nervous and irritable.
Roundworms very much resemble earthworms in shape and color. While their home is in the small intestines they often travel to other parts of the body. They have sometimes crawled into the stomach and have been vomited. The only definite symptom of worms is to find the eggs or the worms themselves in the stool. No worm medicine should ever be given by the mouth without being prescribed by a physician. Cases are on record where well-meaning mothers have killed their children by giving an over dose of worm medicine.
Tapeworms sometimes trouble children; their segments are found in the stool, and look like small pieces of tape line. The segments are flat and thin, one-fourth inch to one-half inch in width and three-fourths to one inch in length. They are joined together and often their number is so great the worm is many feet in length. The segments grow smaller and smaller as they approach the neck, the head of the worm being a mere point. As the worm is passing from the child it should never be pulled, as the head is easily broken off, and, on remaining in the bowel, it will grow to a full-sized worm.
Worms come from the eating of half-cooked meats; they enter the stomach as eggs or tiny worms, and pass out into the small intestines, where they begin to grow. They are a common parasite in the human family and should be suspected in all instances where digestive symptoms are masked or do not yield to treatment.
HOOKWORM DISEASE
This disease, once seen only in the southern part of the United States, is leaving its former domains as the migrating population is distributing it more or less widely everywhere. Sandy soil and country districts are infected by a tiny worm which thrives in polluted soil and enters the body through the skin of the feet. It also gets into the body through the drinking water or from the eating of uncooked vegetables, such as are used in salads.
The disease is manifested by "sallow skin, paleness, headache, swollen abdomen and sores on the legs." Little swollen places where the worm enters the skin may be seen on the flesh. The condition yields readily to treatment. If a child is discovered scratching his feet (especially in the southern part of this country), he should be taken at once to a physician.
DISORDERED STOMACH
At the first symptom of a disordered stomach take all food from the baby and give him rice water prepared by throwing a cupful of well-washed rice into a kettle of boiling water and allowing it to continue to boil for a couple of hours. The water which is strained off is rice water, ready for use after it is cooled. This may be given to the child at the meal hour in the place of his regular food. It should be kept in a glass-covered jar in the ice box. A dose of castor oil, according to the age, should be administered before the feed. The bowels should be washed out and boiled water given freely between the meals of rice water. For a day or two (twenty-four to forty-eight hours), the child should be fed only this rice water, or until the temperature returns to normal and he appears very hungry, at which time milk, which has been boiled for five minutes, may be added to the rice water, first in one-half ounce quantities and gradually increased. Each day a little more milk is added until baby is taking his regular food again.
Many a death and many acute attacks of summer complaint are avoided by the quick use of castor oil, and by withholding food and stopping the use of milk as soon as the child becomes ill.
STOMATITIS OR THRUSH
Thrush is evidenced by fretfulness or crying on attempting to nurse. On examination of the mouth it is found to be hot and very tender and covered with little white specks which, if looked at under the microscope, appear to be a fungus growth. If scratched off, the mucous membrane bleeds easily. Thrush often occurs during a fever or in connection with other diseases, and is often due to neglect and lack of cleanliness about the bottles, nipples, etc. Taken in time it is quickly cured. An immediate dose of castor oil or milk of magnesia is indicated, and the use of a mouth wash which will be prescribed by the physician. If neglected, it may become ulcerous or gangrenous, which is a very serious condition. Everything pertaining to the feeding, as well as the child's toys, hands, etc., must be kept scrupulously clean.
CONSTIPATION
In the chapter, "The Feeding Problem," constipation in bottle-fed babies was discussed. The bowels should move at least once in twenty-four hours. The passages are frequently very hard and leave the body only after a very great effort of straining. This constipation, often continuing until late childhood, should be corrected in the following manner:
In early infancy—as early as the fourth month—prune juice may be given as directed elsewhere, while in later months prune pulp or fig pulp, which has been carefully rubbed through a fine-mesh colander, may be given at meal time. By the time the baby is eleven or twelve months old, strained apple sauce may be given.
We deplore the use of the water enema as a regular daily procedure; in its place we suggest the use of the enema of oil or the introduction into the rectum of a gluten suppository or in obstinate cases a glycerine suppository. Abdominal massage should be daily administered. With a well-oiled hand, begin on the right abdomen and proceed upward to the lower border of the right ribs and across to the left side and down. This should be repeated many times at a regular hour each day. The mother should select an hour for the bowels to move, preferably after the forenoon feeding, and if the child is too small to sit upon the toilet chair, a gluten suppository may be placed into the rectum before the forenoon feed and some time during the middle of the day the bowel movement will be found in the napkin.
For the older child, before a certain meal each day, a well-vaselined piece of cotton may be inserted in the rectum; this often produces a bowel movement immediately after the meal. Laxative foods, such as bran, stewed figs, stewed prunes, or a raw apple, should be used faithfully—as repeated medication never corrects the difficulty, but usually prolongs it.
To immediately flush out the bowel, a soapsuds enema or a plain water enema may be allowed to flow into the lower colon, or a glycerine suppository inserted into the rectum will quickly bring a bowel movement. These methods are only of temporary value; a regular habit should be formed, if possible, to bring about a natural, normal bowel movement. When necessary to resort to drugs—such remedies as cascara sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as well as our old stand-by—castor oil. Regular habits must be insisted upon, and if the mother pays attention to regularity at stool in early childhood very little trouble will be met later on in adolescence and adult life.
Chronic constipation often produces abnormal conditions about the rectum such as fissures, hemorrhoids, or prolapse, which may be of serious import.
DIARRHEA
Diarrhea is a symptom of an acute illness, or it may be associated with a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipation in colitis. It is the most dangerous of all symptoms that babies develop, and in spite of all the instruction given to mothers at the present time, in spite of all the welfare stations in large cities, and in spite of all the efforts put forth by the commissioner of health, with his corps of visiting nurses—even yet, more babies die of diarrhea each summer than from any other single cause.
There are usually just two reasons for diarrhea—uncleanliness and bad milk. During the hot summer days flies multiply greatly and all manner of bacteria and germs grow in warm, moist, shadowy places, so that usually before the milk leaves the dairy farm it is seriously contaminated with disease-producing germs. If the milk is not kept at a temperature of 35 or 40 F. (which is just above the freezing point), these bacteria, particularly the manure germ, grow at such a rate that by the time the milk gets to the infant it is teeming with bacteria, and diarrhea is the sure result.
Another form of diarrhea is cholera infantum, where the stools soon become watery and colorless. The vomiting is almost incessant and there is high fever. Fortunately it is a rare disease, but when once seen it is never forgotten. One beautiful baby weighing nearly thirty pounds was reduced to sixteen within forty-eight hours, and when death came he could hardly be recognized because of the wasting from this most dreaded of infant diseases.
Another form of diarrhea is seen in an acute inflammatory condition of the intestine itself. The stools contain more or less mucus and blood. The bowel movements, which are very frequent, are accompanied by a great deal of pain and straining. This form is often seen in the more severe types of summer dysentery. We wish to impress upon the reader's mind that these diarrheas may all be avoided if the baby's food is clean and free from germs, if the apple or pear is not only washed, but thoroughly scrubbed before paring during the summer months. If all the bottles, nipples, water, toys, etc., are adequately clean, no summer diarrhea, no dysentery, no other infection due to dirt, will attack the baby. Of paramount importance is the pasteurization of milk during the summer months, as mentioned elsewhere.
TREATMENT OF DIARRHEA
Simple diarrhea in the older child of two or three years is treated as follows: Take away all solid foods. Give a big dose of castor oil, thoroughly wash out the bowel by warm water containing a level teaspoon of salt and a level teaspoon of baking soda to the pint, and put the child to bed in a quiet room. Boil all milk for ten minutes and thicken it with flour that has been browned in the oven; feed this to the child at five-hour intervals. After each bowel movement, no matter how often they come, the colon should be washed out with the salt and soda enema as before mentioned.
Bear in mind that the child is losing liquids, and so, after the bowels have moved, boiled water should be given by mouth, or a cupful of water can often be retained if it is introduced into the rectum slowly under very low pressure. Twenty-four or forty hours should clear up a case of simple diarrhea, and on returning to food it should be dry toast and boiled milk. For the younger baby, withhold all milk and give barley water or rice water for the first twenty-four hours, returning to milk very gradually and slowly.
For the more severe types, such as the dysentery containing mucus and blood, everything that has been done for the simple diarrhea should be done; the baby should be kept very quiet, while castor oil should be promptly administered. Food is withheld and the bowels are carefully irrigated after each movement with the salt and soda solutions. After the bowels have moved from the castor oil, then bismuth subnitrate, which has been dissolved in two ounces of water, should be given—one or two teaspoons every three hours. This will naturally turn the bowel movements dark.
Under no circumstances should any other medicines be given without the physician's knowledge, as it is at such times as this that many "would-be friends" advise laudanum, paregoric, and other opiates. The skin must be kept warm, and fluids must replace those that have been carried off in the many stools. Water may be given by an enema, by water drinking, and in such rare cases as cholera infantum, when water cannot be retained on the stomach, it often becomes necessary to inject it under the skin (hypodermoclysis) so that it may go at once to the wasted tissues and perhaps save the baby's life.
Give the baby ten days or two weeks to return to normal condition, and under no circumstances hurry the feeding of milk, as a second attack may occur much more readily than the first; may more profoundly overcome the baby and result in death.
RUPTURE
A protrusion of a loop or portion of intestine through a weakened abdominal muscle—which grows larger when baby cries and smaller when he is lying down in a relaxed condition—is known as rupture or hernia, and is of common occurrence in infancy. It is often seen at the navel and sometimes in the groin as early as the second week.
Hernia is always dangerous and should never be neglected. The physician will protect the navel by a special support with adhesive plaster which is carefully renewed twice a week, and if worn for several months usually entirely corrects the condition. A comfortable truss made from skeins of white yarn will amply protect a groin hernia. The condition should always be taken seriously and receive immediate treatment.
PROLAPSE OF THE BOWEL
Occasionally, as the result of severe straining in constipation, the rectum protrudes sometimes one-half inch, and in rare instances two or three inches. The placing of a young child upon a toilet chair and insisting upon severe straining sometimes results in such a protrusion of the rectum. This may be avoided by the application of vaseline to the rectum or by the use of the gluten or glycerine suppositories which cause the hardened masses to make their way out easily. Someone has suggested that if the buttocks are supported by a board placed over the toilet seat with a two-inch opening so that severe straining of the rectal muscles is impossible, the prolapse of the rectum will not recur.
The moment the mother observes the slightest protrusion of the rectum she should quickly put it back and have the child lie down and move the bowel in the diaper. Very severe cases require a physician's attention, but if prompt and quick measures are taken on the first appearance it may be quickly corrected and serious consequences be avoided.
In this connection we might mention a condition which sometimes babies are born with—the absence of the rectal opening. If the baby's bowels do not move for the first two days, surgical interference is more than likely necessary. Often the external opening alone is missing. Sometimes there is a complete closure or atresia of the lower part of the colon.
BLEEDING FROM THE NAVEL
There should be no hemorrhage from the umbilical stump after it has been properly tied, but occasionally a bit of blood is found upon the dressing and a second tying of the cord stump is necessary. The cord drops off in eight or ten days, and the umbilicus that is left may be moist or it may bleed slightly; if such is the case, great care should be exercised in bathing this ulcer that has been left behind. It simply should be touched with alcohol, a bit of boric acid powder applied, and a small piece of sterile gauze be placed over it. In the course of two or three days it will entirely heal. Care should always be exercised in washing the umbilicus. Extensive hemorrhage from this portion of the body is rare, but it does happen occasionally and is a severe condition which demands surgical attention.
If the umbilicus remains moist and foul smelling, general blood poisoning of the infant may easily follow. Thorough dusting with boric acid powder, with possibly a little oxide of zinc, will usually effect a cure promptly, but should the condition continue, which it does only in rare instances, the doctor may have to cauterize it.
Never under any circumstances knowingly expose a child to any of the so-called "childhood diseases." The old method of "have the child get them as quickly as possible and get over them," has laid the foundation for many chronic disorders later in life. For instance, eye troubles and running ears are often the sequelae of measles; chronic coughs, tuberculosis and bronchitis frequently follow in the wake of whooping cough; heart disorders follow diphtheria, while kidney disease often follows in the course of scarlet fever.
CATCHING DISEASE
Under all circumstances keep the children away from these dangerous childhood diseases. When a contagious disease breaks out in a school and the little fellow has, along with the other pupils, been exposed to it, begin at once systematically to keep the nose and throat very clean with such well-known sprays as the champhor-menthol-albolene spray, which should be used in the nose morning, noon, and night. Throat gargles, such as listerine, or equal parts of alcohol and water, help to keep the throat in condition to resist the microbic invasion.
During this anxious time of patient waiting the bowels should move every day and the food should be cut down at least a third. In other words, moderate eating and a clean bowel tract go a long way toward keeping a child well and preparing him for an attack of disease. The skin at this time should be kept well bathed and free from the accumulated skin secretions which clog up the sweat glands and otherwise lower the vitality.
Stuffy, close rooms, where the ventilation is poor, not only harbor disease germs, but also lower the vitality of the child. Never take your child into a household where there is any form of sickness, for it may turn out to be a contagious disease—no matter how it began, it must be remembered that many contagious diseases, in their earlier stages, much resemble a simple cold.
Measles come on rather gradually, and one might suspect that the child was simply suffering from a severe cold in the head.
Scarlet fever usually begins with a sore throat, while chickenpox has very few initial symptoms; usually the first thing noted is the rash itself. Diphtheria begins with a sore throat, while whooping cough begins very insidiously.
The most important thing is to keep children away from people who are sick, and if a contagious or infectious disease is prevalent in the neighborhood discourage the mingling of the children in hot, illy ventilated rooms. Put a stop to "parties" and all similar gatherings. Let the little folks have good books, plenty of toys, in a well-ventilated room, and the more they keep to themselves at this particular time the better they are off.
THE SPREAD OF CONTAGION
It is possible to "stamp out" any known disease if only proper cooperation takes place and certain sanitary regulations are maintained. It is within the memory of most of our readers when yellow fever was put to flight and the cause of malaria discovered. We learned to screen our camps and no longer did our soldiers contract the fever; while the simple covering of stagnant pools with oil, together with proper screenage, stopped the ravages of malaria.
Likewise, many of the woeful tragedies of infant summer diarrhea and dysenteries have been tracked to the so-called "innocent house fly." We have all learned—only recently—that if we move the manure pile once in seven days the hatching of the maggots may be prevented, and so millions, yes trillions, of these carriers of disease may never be born.
If there is one sweet morsel above another for this fly pest it is tubercular sputum or feces, and from these feasts they go directly to walk over baby's hands, crawl over his cheek, and wash their feet in his milk. Proper screenage will prevent such contamination of food, such opportunities for carrying disease.
Sunshine, hot water, soap, and fresh air, are the best ordinary every-day disinfectants. It is possible so to conduct the treatment of a contagious or infectious disease that no other member of the family may contract it. A few simple but very important hints are:
1. Door knobs are one of the very greatest avenues of contagion—disinfect them.
2. Cleanse the hands both before and after attending to the sick; first, scrub with stiff brush, soap and water, then dip in alcohol.
3. An epidemic of sore eyes may be stopped by absolute "hand disinfection" and using separate towels.
4. Do not go visiting when you have a "common cold."
5. Kissing is one of the best ways of spreading many diseases.
6. In cases of contagious and infectious diseases completely cover all excretions from the body with lime.
7. Country homes would be as healthy as city homes if the privies and stables were screened.
8. In the country, the well water should be boiled; one infected well may be the cause of the death of a score of beautiful children.
INCUBATION PERIODS
The incubation period of scarlet fever is from one to seven days.
Measles, ten to twenty days.
Whooping cough, from one to two weeks.
Chicken-pox, fourteen to sixteen days.
German measles, seven to twenty-one days.
Diphtheria, any time from one to twelve days.
Mumps, from one week to three weeks.
Of all the diseases, measles and chicken-pox are probably the most contagious. In scarlet fever and diphtheria, close contact is necessary for exposure, while whooping cough can actually be contracted in the open air, young babies being particularly susceptible.
TYPHOID FEVER
Typhoid fever is a disease of the small intestine. Typhoid germs accumulate in the little lymph nodes of the small intestines and that is the reason why we often have so many hemorrhages from the bowel—actual ulcerations take place—and if an ulcer is situated in the neighborhood of a blood vessel hemorrhage may result.
Typhoid fever begins rather insidiously with a slight debility and loss of appetite, but if a temperature record is kept the fever will be found to rise from one-half to a degree higher each day. A steady climb in the temperature curve is noted until the end of the first week, when it remains for a week, possibly 103 or 104 F. After one week it begins slowly to decrease and, if all goes well, the early part of the fourth week usually finds the temperature about normal. It is exceedingly important that the child be kept in bed during the entire course of the disease. The bed pan must be used at each bowel movement or urination.
First Week Treatment. During this week the child may feel quite well, but he should be kept in bed and sustaining treatments begun—such as wet-sheet packs and cold frictions to the skin (during which time there should always be external heat to the feet). The diet must be full and nourishing, but all pastries and "knicknacks" should be avoided. Abundance of fresh fruit that has been well washed before paring, eggs, pasteurized milk, baked potatoes, and toasted bread may be taken at regular periods—with an interval of not less than five hours between meals.
The bowels should be opened in the beginning of the disease with a liberal dose of castor oil, after which daily colonic irrigations should be employed. These enemas should be given at least once a day, the temperature being about that of the body, with a smaller terminal enema about five degrees cooler at the close of each bowel cleansing.
Second Week Treatment. The normal temperature at this time is no longer 98.6, it is 101.5 F. This fever is essential to the curative and defensive processes of the body; and while we do not care to have the fever fall below 101.5, at the same time nothing is to be gained by allowing the fever to go up much above 102.5 or 103 degrees F. And so, during the second week, while the disease is at its height, we make frequent use of the wet-sheet pack, always remembering that the extremities must be kept warm and never permitting the skin to become blue or mottled while the cold treatment is being administered. Since the real disease is localized in the small intestine, we will now describe a very important treatment for the diseased bowel—and one which is also very useful in combating high temperature.
The Cooling Enema. The temperature of this enema begins one degree higher than that of the body (supposing the body temperature to be 103, the temperature of the enema would start at 104 F.). This is allowed to flow into the colon and out again, under low pressure, without disturbing the patient, by means of a glass tube connection (See Fig. 15). The temperature is quickly brought down to 100, then to 98, then to 90, usually finishing up at 80 or 85 F. The water is allowed to enter the rectum slowly through a soft rubber catheter (not a hard rectal point), and as it comes out it will be noted that the water is very warm, sometimes registering 105, and it is needless to add that if the water goes in at 80 and comes out at 105 F., much heat has been taken from the body; and so, of all the treatments we have to suggest for typhoid fever, the one just mentioned is possibly the most important. When it is necessary to keep up this enema for an hour or two, the cool water may cramp the bowels, but this may be entirely obviated by applying hot compresses to the abdomen.
Another treatment of great importance in this second week is the cold abdominal compress. Much fever is occasioned in the abdomen because it is the seat of disease, and the much dreaded hemorrhages which often cause the death of the patient are usually avoided by the use of abdominal compresses—wrung out of water at 55 F.—the temperature of ordinary well water—and changed every twenty minutes.
I recall one mother in my dispensary practice who was so poor she could not afford a nurse, her only helper being a son twelve years old. A nurse went to the house twice each day and taught this lad of twelve years to give his mother the cooling colonic irrigation; he was also taught to warm up the abdomen by a hot application and afterwards to apply the cold compresses. The mother made a good recovery.
During this second week the diet should be sustaining. It should consist of boiled milk, eggs, fresh fruit and fresh fruit juices, dextrinized grains (hard toast, toasted corn flakes, shredded wheat biscuits, etc.). The mouth should be kept scrupulously clean, for in all the infectious and contagious diseases there is always the possibility of gangrene in the mouth if it is neglected.
Third Week Treatment. This is the week we look for hemorrhage from the bowel unless the abdomen has been well treated during the second week; and even so, the cool compresses to the abdomen will be continued well into the third week—also the daily or semi-daily enema. The skin is kept in good condition with soap washing and friction baths, and a fairly liberal diet is maintained. During the whole course of the disease the skin is never allowed to get blue or mottled, being quickly restored to the normal red color by the mustard sheet bath, the short hot-blanket pack, or the dry-blanket pack with hot-water bottles. Under no circumstances let the child leave the room or his bed for at least another week.
MUMPS
Infants are rarely affected with mumps. It is a disease of the salivary glands and (as a rule) is usually preceded by pain between the ear and the angle of the jaw, accompanied in a short time by swelling and temperature. It is distinctly contagious even during the incubation period. There is much tenderness on pressure, and chewing is difficult and may be impossible. It usually occurs on the face and only one side may be affected. The bowels should be kept open, the mouth should be kept clean, and the side of the face should be protected by a layer of cotton held in place by bandages.
Hot fomentations may be applied if the pain is severe. The electric light bulb on an extension cord, that was mentioned in connection with earache, is very comforting in this condition.
Isolation should be maintained for ten days or two weeks after all symptoms have disappeared.
SCARLET FEVER
Scarlet fever is one of childhood's most dreaded diseases because of, first, its long quarantine; second, its terrible possibilities of contagion; and, third, its sequelae.
Absolute quarantine is necessary until ten days after the last signs of desquamation have disappeared.
This disease is always alarming because of the possibilities of its sequelae—the danger of pneumonia, inflammation of the ears, abscesses of the glands of the neck, and nephritis (inflammation of the kidneys).
Scarlet fever is highly contagious at any time during its onset and course. Among the first symptoms of the disease are sore throat, swollen glands, fever, etc. Vomiting on a street car or at the movie may spread the disease to more than one child who might otherwise have escaped. One child who may have only a very light form of the disease may give it to another child in the most severe form. Any such group of classic symptoms—vomiting, fever, rapid pulse, and sore throat—should cause any parent immediately to isolate the little sufferer for several days—awaiting the "rash"—which usually puts in its appearance after three or four days of increasing temperature.
This rash has an appearance "all of its own," unlike any other. Because the fine "meal-like" red points are in such close proximity, the skin assumes a smooth "lobster red" color that is never to be forgotten. After three days of increasing redness, the color begins slowly to fade, and after four or five days of this fading a peculiar peeling takes place, whose scales vary in size from a small fleck to casts of the whole of the soles of the feet and the palms of the hands.
During the height of the disease, the throat is very red, the tonsils are not only inflamed, but covered over with white patches, the head aches and the tongue possesses a peculiar coating through which peep the red points of the swollen papillae, presenting the classic "strawberry tongue" of scarlet fever.
After ten days the fever disappears and the "real sick" stage of the disease is in the past.
Each morning of the ten previous days a small dose of Epsom salts is usually administered and the itching, which so often accompanies the rash, is relieved by carbolized-water sponge baths.
The nose, throat, and ears receive daily care—sprays to the nose and gargles to the throat, as well as special swabbing to the tonsils.
The physician in charge of the case will note the urinary findings, guard the heart and kidneys, prevent the spreading of the scales of desquamation by frequent rubbing of the skin with oil, and otherwise work for the future well-being of the patient.
MEASLES
Measles, one of the most common diseases of childhood, is not to be regarded lightly, for very often its sequelae—running ears, weak eyes, and bronchial coughs—may prove very serious and troublesome. Tuberculosis of the lungs not infrequently follows in the wake of measles. The early symptoms of measles are so mild that often the child is out of doors, at school, or about his usual play, until the second or third day of the fever. He was supposed merely to be suffering from a simple "cold in the head."
On the third or fourth day the patient begins heavy sneezing and wears a stupid expression; and it is then that the mother ascertains that his temperature is perhaps 101 to 102 F. He is put to bed and the next day the rash usually appears. The rash is peculiar to itself, not usually mistaken for anything else, being a purplish red, slightly elevated, flattened papule, about the size of a split pea. The coughing, which is very annoying, usually remains until about the seventh or eighth day—at which time the fever also disappears.
The bowels must be kept open; a daily bath be given—in which has been dissolved a small amount of bicarbonate of soda (simple baking soda)—after which an oil rub should be administered. The nose should be frequently sprayed with three per cent camphor-menthol-alboline spray, while the throat is gargled with equal parts of alcohol and water. The feet should be kept warm by external heat, while the physician in charge may order additional attention to the chest, such as a pneumonia jacket, etc.
Care should be taken to guard against "catching cold," for bronchitis or pneumonia is quite likely to develop in many cases of measles. The eyes should be protected by goggles and the room should be darkened; under no circumstances should the little patient be allowed to read. Carelessness in this respect may mean weakened eyesight all the rest of his life. Until two weeks after the rash has disappeared, the little fellow should be kept by himself, for the desquamation keeps up almost continuously during this time.
The food during the course of the disease is a liquid and soft diet. Children should never be allowed to go to a party or gathering with a cold in the head; the mothers of a group of small children will never forget the time that one certain mother allowed her little fellow to attend a party with "simply a cold in the head." He laughed, talked, and sneezed during the afternoon and when he went home the rash appeared that night, while eight of the ten exposed children came down with measles during the next two weeks.
CHICKENPOX
The incubation period of chickenpox is from ten to seventeen days. It is a mild disease, with a troublesome rash consisting of widely scattered pimples appearing over the scalp, face, and body. These pimples soon became vesicles (small blisters), which in turn quickly become pustular, afterwards drying up with heavy crust formation. Severe itching which attends these pustules may be greatly allayed by either the daily carbolic-acid-water bath or a baking-soda bath. The itching must be relieved by proper measures, for if the crust is removed from the top of the blebs by scratching, a scar usually results. The bowels should be kept open, the diet should be soft. Rigidly isolate, for chickenpox is highly contagious.
SMALLPOX
This disease occurs oftenest during the cold season. It spares no one unless vaccinated, attacking children and adults alike. The early symptoms are: headache, pain in the back, high fever, vomiting, and general lassitude. In many respects these resemble the symptoms of the grippe, while on the third day the eruption appears. The pimples are hard and feel like shot under the skin. Within a day or two these shotlike pimples have grown and pushed themselves beyond the skin into little conical vesicles which soon turn to pus. By the eighth or ninth day crusts are formed over the vesicle, beginning to fall off about the fifteenth day.
Patients are quarantined usually eight weeks and when a case of smallpox in the home breaks out everyone in the family should be revaccinated. The strictest isolation is important from the first of the disease.
We will not enter into the treatment of smallpox, for medical aid is sought at once and usually the patient is removed to a special isolation hospital.
VACCINATION
The history of the change brought about in the Philippines since vaccination has been introduced is an argument of itself which ought to convince the most skeptical of the value of vaccination. By all means, every child in a fair degree of health should be vaccinated. It is wise to vaccinate babies before the teething period—from the third to the sixth month. Babies with any skin trouble or suffering from malnutrition, but not living in a smallpox district, should be vaccinated during the second year. In young babies, under six months, the leg is the proper place to receive the vaccination.
If proper surgical cleanliness is practiced and ample protection is afforded in after dressing, vaccination need not be a taxing process. The child suffers from general lassitude—a little drowsiness with loss of appetite and a small amount of fever—but this passes off in a reasonable length of time, especially if he is not overfed and his bowels are looked after. On the second or third day after vaccination a red papule appears which soon grows larger, and, after five or six days, it becomes filled with a watery fluid. By the tenth day it has the appearance of a pustule about the size of a ten-cent piece, surrounded by a red areola about three inches in diameter. At the end of two weeks the pustule has dried down to a good crust or scab, in another week it falls off, leaving a pitted white scar.
If the vaccination does not take, it should be repeated after an interval of two months.
DIPHTHERIA
Diphtheria is a disease much dreaded during childhood and adolescence. It may attack any age—even little babies are susceptible. It begins with a general feeling of heavy, drowsy lassitude with a sore throat. White spots appear on the tonsils which may resemble a simple follicular tonsillitis, while in a short time white patches spread over the throat and tonsils.
It is not at all uncommon for this membrane to attack the nose, producing a bloody, pustular discharge; and when it does attack the nose, it is none the less contagious and must be regarded just as seriously. A physician is called at once, and, not only to the child, but to the other members of the family, antitoxin is immediately administered. The disease runs a regular course and its most dangerous complication is the membrane which forms in the larynx and threatens to suffocate the child unless prompt intubation is performed—the slipping of a silver tube in the larynx to prevent suffocation and death. The early use of antitoxin greatly lessens all these serious complications.
Care must be exercised to prevent sudden heart failure; and this is done by raising the child to an upright position with the utmost care; while you insist upon him lying quietly upon his back or his side, long after the disease has left his throat. While the throat or nose is the seat of disease, the toxins from these most dreaded diphtheritic microbes spread through the lymph channels and the blood vessels to the heart itself—so weakening that organ that it sometimes suddenly fails, or becomes more or less crippled for life. These serious results are to be prevented by the science of good nursing and the prompt use of antitoxin. In these days the "Schick test" may be administered for the purpose of ascertaining whether one is susceptible to contracting diphtheria.
A physician is always in charge of diphtheria, and he will supply directions for the bowels, the diet, and the sprays for the nose and throat, and the general well-being of the suffering child. Isolation and quarantine should continue for two weeks, and in bad cases three weeks, after the membrane has disappeared from the throat.
WHOOPING COUGH
A child suffering from a continuous cough, particularly if it is accompanied by a whoop or a condition which is so often seen in children who cough—not able to stop—should not be taken to church, nor to the movies, nor allowed to go to school; neither should he be allowed to leave his own yard. The average duration of the disease is usually six weeks. The child should have an abundance of fresh air, should spend much of his time out of doors, and while in the house should avoid dust of every kind; at night he should not be exposed to drafts. Call the physician early in the case and he may attempt to thwart the progress of the disease by certain administrations of vaccine medication.
In very bad cases, where a young child cannot catch his breath and gets blue in the face—which, fortunately, is uncommon—he should be slapped in the face with a towel wet in cold water; or, he may be lifted into a tub of warm water, then quickly in cold water, then back into the warm, etc. Hygienic measures should prevail, such as keeping the bowels open, the skin clean, and the use of the usual throat gargles and nasal sprays. Do not be misguided by the old-time thought that whooping cough must run its course; for, if medical aid is promptly secured, the disease may often be cut short and the severe paroxysms greatly lessened.
EYE INFECTIONS
Not long ago while in North Dakota near Canada, we took a trip one day just over the border to visit several villages of Russian peasants. We found the boys and girls of nearly the entire village suffering from trachoma—a dangerous, infectious disease of the eyes which spreads alarmingly from one child to another.
We saw the disease in all of its varying degrees among the children. Some of them had swollen, reddened lids. A discharge of pus was coming from the eyes of others, and they could not look toward a light or the sun. This disease is spread in a hundred different ways—through the common use of wash basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., and that is the reason why these isolated villages of foreign people who could neither read nor write the English language were nearly all so sorely afflicted.
The ordinary condition of "catching cold in the eye" ("pink eye") is just as infectious as the trachoma which we have mentioned, although it is more of an acute disorder and nothing like so serious.
In all such cases a physician is to be called immediately, isolate the patient, and give strict attention to carrying out the doctor's orders.
Another form of inflammation of the eye which was mentioned in a previous chapter, is the inflammation of the eye of the newborn.
In most civilized districts at the present, especially where the cases are attended by a physician, the eyes of all newborn babies are treated with either argyrol or silver nitrate. Just as soon as defective sight is discovered in the child the eyes should be examined at once and proper glasses fitted. While the glimmer and shimmer of moving pictures may seriously interfere with the child's vision, on the other hand, this very thing often discovers the defect in the eyesight earlier than it would otherwise be found out.
RUNNING EARS
Inflammation of the ears was fully covered in our discussion of adenoids and tonsils, but we would like to add at this time that under no circumstances should a running ear be regarded lightly. A chronic mastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. The attention of a specialist should be called to it and his instructions most carefully carried out; for, when we have a sudden stopping of the discharge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost.