The Mother and Her Child

In this chapter we shall consider a number of the more common diseases which are associated with the nervous system of the child. Some of these so-called nervous diseases are hereditary or congenital, while others are the result of infection and environment.

SLEEPLESSNESS—INSOMNIA

There are many conditions which cause sleeplessness or insomnia in a child aside from disturbance of the mental state or nervous system. For instance, late romping, too hearty and too late a dinner, lack of outdoor life during the day, illy ventilated sleeping rooms, too much bedding, too little bedding which causes cold extremities, too much sleep during the day, too much excitement (movies or receptions), intestinal indigestion which is associated with accumulation of gas, and constipation—any or all of these are causes of sleeplessness. Some peculiarly nervous children—those with an hereditary strain of nervousness—are easily upset or disturbed by any of the conditions above mentioned.

The treatment of insomnia consists, first, in finding the cause and removing it. Children with a nervous tendency should be let alone as nearly as possible, and just allowed to grow up as the little lambs and calves grow up. They should be fed, watered, kept clean and dry, and allowed to live their lives undisturbed and without excitement.

The medicinal remedies on the market for insomnia are all harmful if used too long or in excess, and we most earnestly urge the mother not to seek drug-store information concerning remedies for sleeplessness. The neutral bath is beneficial in ninety per cent of these cases. It is administered as follows: Enough water is allowed to run into the bath tub to cover the child. The temperature should be 99 to 100 F. It should be taken accurately—and should be maintained. Bath tub thermometers may be purchased at any drug store. The restless child, after the bowels have been freely moved, is placed in the water, and, without whispering, talking, or laughing, he remains there for at least twenty minutes, after which he is carefully lifted out, wrapped in a sheet and very gently dried off with soothing strokes and placed at once into his night clothes. As before said, ninety per cent of restless children will go at once to sleep after such a treatment.

Another method of treating sleeplessness is by the wet-sheet pack. Three single woolen blankets are placed on the bed and a sheet large enough to wrap the child in is wrung from warm water, about 100 F. The child is stripped and this sheet is brought in contact with every portion of his body, quickly followed by bringing the flannel blankets about him and he is allowed to remain there for twenty minutes—if he does not fall asleep before the lapse of that time. With witch-hazel or alcohol, the body is sponged off, night clothes are put on and a restful night usually follows. If fresh air is lacking, open the windows. If there is too much bedding, remove some of it. Talcum powder the sweaty back and neck and make the child perfectly comfortable. Give a small drink of water and turn out the light.

NIGHT TERRORS

Night terrors are probably due to some digestive disturbance, with a coexisting highly nervous temperament. They oftentimes, in older children, follow the reading of thrilling stories or a visit to an exciting moving-picture show. The child goes to sleep and gets along nicely for two or three hours and then suddenly jumps up out of bed and rushes to its mother with little or no explanation for the act. In his dreams the thoughts and the imaginations of his waking moments are all confounded and alarming.

We recall one little fellow who constantly feared big, black birds coming in the window and attacking him—he had been reading about Sinbad the Sailor and his experiences with the big bird. He so feared this big, black bird that he could not go to sleep. For a number of nights he did not have the courage to tell his parents that it was the fear of the big bird that kept him from going to sleep, but finally he confided in his mother and told her of his fear. The mother and father both entered into a conversation with him through an open door which connected the two rooms, after the lights were out; they laughed and talked about the big bird, they openly talked of it and allowed their imagination to work with the child's imagination in planning how he could combat with the bird, should it really come, asking him how big it really was and what color he thought its eyes were and how big an object he thought its feet could carry. They all three planned a fairy story they might write which would rival the fairy stories of the Arabian Nights. In a very short time—possibly a week or ten days—the little fellow felt quite equal to these imaginary assaults, his fears were quieted and his slumbers were no more disturbed by visions of the big, black bird.

Everything should be done to relieve the stomach and intestines of laborious work during the sleeping hours, hence let the evening meal be light and eaten early enough to be out of the way, as far as digestion is concerned, by bed time.

NERVOUSNESS

During the formative period of the nervous system—the first few years—under no circumstances should the children be played with late at night, when they are tired and sleepy, or hungry, for it is at such times that the nervous system is so easily excited and irritated. When the baby is to be played with, if at all, it should be in the morning or after the mid-day nap. Rest and peaceful surroundings are of paramount importance to the nervous child, and he should be left alone to amuse himself several hours each day. It is a deplorable fact that the nervous child—the very one that should be left alone—is the very child that usually receives the most attention, the very one who is most petted, indulged, and pacified; all of which only tends to increase his lack of self-control and to multiply the future sorrows of his well-meaning but indulgent parents.

HEADACHE

Headache attacks old and young alike, and the young infant that is unable to tell us he has a headache manifests it by rolling the head from side to side, putting his hand to his head, or by wrinkling up his brow. Headaches may be occasioned by disorders of the brain and spinal column, such as meningitis. It nearly always accompanies fever, and is often a result of constipation, intestinal indigestion, overeating, as well as eating the wrong kind of food.

The treatment of headache in children (aside from removing any known cause) consists of a hot foot bath, a brief mustard paste to the back of the neck, a light diet—sometimes nothing but water—and the administration of a laxative.

CONVULSIONS—SPASMS

In the very young, convulsions are easily produced. That which will produce but a headache in an adult will often produce a convulsion in the child. Aside from diseases of the nervous system such as epilepsy, etc., convulsions frequently accompany gas on the bowels, intestinal indigestion, disordered dentition, an acute illness, intestinal parasites (worms), irritation about the genitals such as the need of circumcision, an adherent clitoris, adenoids and enlarged tonsils, inflammation of the ears, and poor nutrition of any sort such as rickets.

The convulsion picture is a stiffening of the body—sometimes arching backwards—rolling or staring of the eye-balls, blueness of the skin, a drooling mouth (often foamy mucus at the mouth), clinched hands, biting the teeth—if there are teeth—and even biting the tongue. There is at first a succession of quick, jerking, convulsive movements of the body which in a few moments grow less and less violent and finally cease. The child begins to cry and then soon goes off into a deep sleep, while the body seems more heavy and logy than usual. In extreme cases, the child relaxes but for a moment of time, when he goes off into another convulsion, sometimes going from one fit into another until death relieves him.

Treatment for convulsions must be instituted at once. Do not wait entirely to undress the child—pull off his shoes, place him at once into a good warm bath, temperature about 100 to 102 F. An ice cap should be placed to his head (cracked ice done up in a towel), and while in the bath or immediately upon taking him out, give a warm soapsuds enema. The bath that the child is placed in should be always tested with the bared elbow. A half cupful of mustard may be added to the bath. Just as soon as the child is able to swallow, give a teaspoon of syrup of ipecac. Enema after enema should be given until the water comes back clear. Undue excitement after the bath only predisposes to repeated attacks, and while the mother may be very happy that the child is himself again, under no circumstances should she caress and fondle him. Put the little one to bed and allow his nervous system to calm down; let him rest quietly and undisturbed.

NERVOUS TWITCHINGS

Habit spasms or "tics" are common in childhood, and are caused by an over irritability of the nerves supplying certain groups of muscles. It is not at all uncommon to see a child nervously blink the eyes, twitch the nasal muscles, shrug the shoulders, constantly open and close the hand, and execute a score of other minor habit-spasms; which, day by day, wear deeper and deeper paths into his nervous system as a result of their constant repetition. These minor habit-spasms of childhood are but telltales of an unstable nervous system, of a nervous heredity lacking poise and balance; and, mind you, if this nervous system is studied, treated, and properly harnessed with self-understanding and self-control, much may be accomplished; the habit may be more or less completely eradicated. If left to itself, unchecked, the habit deepens the "spasm-groove," and the "energy-leaks" grow bigger and bigger until finally, in later, adult life, all that is necessary to convert such persons into first-class neurasthenics or hysterics is some bad news, a few worries, or a sudden shock.

By all means study to nip all childhood twitchings in the bud; remembering all the while that childhood—the formative period for the nervous system of the child—presents the golden opportunity to prevent and abort the more grave neuroses of later life. There may be a special contraction of one or more muscles of the eyeball which produces either a "cross-eye," when the contraction is convergent, or a turning of one eye outward when the contraction is divergent. It is not possible for the mother to correct this condition. The one important thing for her to do is to take the child to a skilled ophthalmologist early in his life, that treatment may be instituted for the correction of the difficulty.

RETENTION OF URINE

Not an unusual condition during childhood is a temporary retention of urine. It may follow an attack of colic or accompany any acute illness. Increase the water drinking, and, after seven or eight hours, hot cloths should be applied over the bladder; a large enema (enema bag should be hung low) should also be given, retaining as much as is possible. These simple measures usually relieve the condition. If retention follows circumcision, due to swelling of the parts, the surgeon should be notified.

BED WETTING

Nocturnal enuresis (bed wetting) usually is found to "run in families." It is seldom the case to find that both the father and the mother escaped bed wetting during childhood when the child is sorely afflicted.

Early bad habits may be the prime factor in this distressing and humiliating difficulty. A little child that has been compelled to lie in wet diapers for hours at a time gradually becomes accustomed to "being wet," and the desire to urinate is not under the keen control of a will that has been trained by untiring patience to "sit on a chair" at regular intervals throughout the day. This lack of training in a child who possesses an unstable nervous system, creates the proper environment for the habit of bed wetting—which often marches steadily on until puberty. In the treatment of bed wetting give attention to the following:

1. The urine should be thoroughly examined.

2. The size of the bladder should be determined.

3. The last meal of the day should not be after four o'clock in the afternoon.

4. All during the day, in young children, systematic training should be begun—put the child on the chair every hour, then every hour and a half, then every two hours. Let the work be done most painstakingly and much will be accomplished toward training the bladder to "hold its contents" during the night. For a time it will be necessary to set an alarm clock to ring every three hours during the night, that the bladder may be relieved at regular intervals.

5. No liquids whatever are allowed after four p. m.; even the four o'clock meal should be very light.

6. In older children the habit is often broken by appealing to the pride—by requesting or demanding the child to rinse out the bed linen and hang it up to dry himself.

Usually at puberty the trouble ends, and while no amount of whipping will correct the difficulty, the promise of rewards, an appeal to the pride, correction of dietetic errors, the establishment of regular times to empty the bladder, the removal of all reflex causes such as adenoids, need of circumcision, worms, etc.—these combined influences—will bring results in the end, if they are faithfully and intelligently applied.

MENINGITIS

Cerebro-spinal meningitis is not highly contagious. Children old enough to complain of symptoms usually first complain of an intense headache with frequent vomiting and very high fever. Great prostration is seen, the pulse is weak, the respirations are irregular, the child may have convulsions, or it may have chills and fever, and rigidity of the body may be present. The position of the child is very characteristic. It does not want to lie on its back but usually rests on one side, with the spine more or less arched. It is a very serious disease and demands the early attention of a physician. Some cases are very mild and others are exceedingly grave. If the physician is secured early, and special remedies administered that are known today, many of the children may be saved.

INFANTILE PARALYSIS

Infantile paralysis is a serious disease of the spinal cord which comes on very suddenly and is associated with vomiting, pain in the legs, and a high temperature. After these symptoms have lasted a day or two the paralysis is discovered. There may be convulsions. The paralysis is progressive, and the wasting of the muscles increases until by the end of a couple of months one limb is considerably shorter than the other. Sometimes the baby goes to bed at night in apparent good health and wakes up in the morning paralyzed.

In this disease the attention of the best physician in your community should be called to the case at once, for there are being developed in our large research laboratories special vaccines for this condition as well as for spinal meningitis. But what is done must be done very, very early, so let there be no delay in calling in medical counsel.

There are other forms of spinal paralysis which, associated with tuberculosis of the spine and other spinal diseases, result in loss of power to one or more groups of muscles. The only treatment that can be given in the home is to keep all of the paralytic portions of the body very warm by external heat, care being taken to avoid burning, and secure medical advice. Often, later in the course of the disease, by the aid of crutches and braces, the child can be taught to go to school and to get around the house about his little duties.

The slight facial paralysis which is so often seen in babies that have been delivered with forceps, usually clears up in a few days or at the latest in a few weeks or months.

SAINT VITUS' DANCE

Saint Virus' dance (chorea) is a peculiar disorder seen in nervous children, and which usually clears up in a few weeks or months under proper treatment. It is characterized by irregular jerkings pretty much all over the body, so that the child staggers as he walks, drops his food at the table, and executes many other noticeably abnormal movements. The child should be taken out of school at once and removed from association with children who might make sport of him or otherwise annoy him and thus increase these irregular jerkings. He should at once be put under the direction of competent medical authority. Simple food, colon hygiene, more or less complete rest, and freedom from annoying circumstances, will usually bring about a speedy recovery.

CONGENITAL DISORDERS

Water on the Brain is characterized by an enlarged head due to an increased accumulation of fluid within the cranium. While the face remains small the head greatly increases in size so that oftentimes it must be braced while the child is compelled to remain in a wheel chair. The mentality is usually fairly normal, but the enormous weight of the head compels the life-long occupancy of a wheel chair.

Deaf-Mutism. The child born deaf pays no attention whatever to sounds. An intellectual expression is seen on his face and by six months he is able to do all that a normal baby can do with the exception of hearing. The child should early be taken to an ear specialist in the endeavor, if possible, to correct the defect of hearing. Such little ones who are destined to a life without sound, should be given every opportunity to learn to read the lips and to secure a good education—to be taught a vocation where eyesight is of more value than hearing. Special institutions are in existence today which can take these deaf mutes when small and so teach them to make audible sounds that they can make themselves understood—at least partially. Lip reading is a wonderful improvement over the deaf and dumb alphabet, and should be taught early.

Congenital Blindness. Perhaps not until the child is six months old can the observer distinguish between blindness and idiocy. The blind child of course will not fix his eyes upon any object; but the general lassitude and the inability to hold up its head, while seen in idiocy, is not present in blindness.

Feeble Mindedness. A baby that is born with a weak mind is found to be very backward in all the normal developmental attainments of the growing child. A normal baby holds up its head at four months and should be able to sit erect at six months. The weak-minded baby will not do this, and often as late as two years it will not make any attempt to walk or to talk. There is an unnatural expression—a vacant look—to the face, while there is often much dribbling at the mouth.

Early Training should be Instituted. It is necessary to call the attention of a physician to these facts, that the parents may be instructed in regard to the early training which is so essential in all these weak-minded little folk. In our opinion it is best to remove these children early to special institutions, where their education can be superintended by those thoroughly accomplished and accustomed to dealing with this class. There are varying grades of feeble mindedness—the backward child who requires a longer time to learn things, and the child who is slow at school and possibly cannot get through more than the fourth or fifth grade—but as soon as weak mindedness is discovered, it is best to transfer the child to some special institution.

One of the earliest skin troubles that the average normal child suffers from is prickly heat—a tiny, red-pointed rash always accompanied by sweating and usually resulting from over-dressing, stuffy rooms, and other conditions that make the child too warm. Prickly heat produces more or less discomfort but usually little or no itching. Ordinarily, a sponge bath followed by the application of talcum powder is sufficient to give relief in mild cases; but severe or neglected cases should be treated by means of bran baths, a cupful of bran being tied up in a gauze bag and suspended in water until the water assumes a milky color. Soda baths, two tablespoons to a gallon of water, are also very soothing. A baby should never receive any friction with a towel after such baths, but should be rolled up in a clean linen towel and simply patted dry.

CHAFING

Great care should be exercised in the choice of baby's soaps. Among a number of soaps that might be mentioned castile soap is, perhaps, as good as any. Frequent sponging is required to wash off the irritating perspiration; cool clothing, plenty of talcum powder, a dose of calcined magnesia, and a regulated diet are necessary to clear up the trouble.

Chafed skin, particularly between the buttocks or in other folds and creases, should be kept free from soap. Either the starch or bran bath may be tried, while olive oil should be frequently and lightly rubbed over the chafed part. A bit of sterile cotton placed between the folds to prevent friction is often all that is necessary to correct the difficulty.

Dandruff or milk crust which is often seen on young babies' scalps has been described in detail elsewhere. It should early receive the vaseline rub at night which will often loosen up the hardened crusts. It may be gently removed in the morning with soap and water unless the case has gone on to great severity. In such neglected cases the mother should not undertake to correct the difficulty alone. Taken early, when the scalp is covered with tiny flakes known as milk crust, it can be quickly relieved.

VULVOVAGINITIS

Vulvovaginitis is a very contagious disease, and before the days of hospital asepsis, which is so perfectly maintained today in our large institutions, this disease used to go right through a children's ward because of carelessness in the handling of soiled diapers, etc. The sign of this disease is a yellow-white vaginal discharge, while the surrounding skin covering the inside of the thighs and buttocks may be very much reddened. The baby should be taken at once to the physician at the first appearance of these symptoms. Only rigid isolation can possibly prevent other children from getting it—essentials are separate towels, wash towels, soap (in the case of the older children), and, in the case of the baby, separate diapers and rigid scrubbing of the attendant's hands—in this way only can this infection be held in check. The infected child should sleep by herself, and utmost care must be exercised in preventing her fingers from first touching the itching vulva and then placing them to the eyes or to the mother's eyes. A vulva pad must be worn as long as the disease lasts. The physician will give you the proper medicines to be used in these cases, and if no physician is within reach, you are perfectly safe in dropping into the spread apart vulva a few drops of twenty-per-cent argyrol and then applying the vulva pad. After each treatment the hands of the mother or nurse must be most rigidly cleansed.

ECZEMA

Eczema is a very troublesome disease, particularly in infants; there are so many forms of it that there is neither time nor space in this volume to describe them individually. This disease may be produced in children by either internal or external causes—from friction on the skin, from coarse, rough woolen clothes, or from starched garments, or from lace or starched bonnet strings which rub into the folds of the skin. Irritating soap, the contact of soiled diapers, cheap toilet powders, and discharges from the nose and ears may also be responsible for the disease. The particular internal causes are over-feeding, digestive disturbances, the too early use of starches which create fermentation in the intestinal tract. In the most frequent form of eczema the skin becomes red and then there appear tiny vesicles (water blisters) which soon rupture and "weep." This fluid which oozes from these tiny, ruptured vesicles, in connection with the perspiration and exfoliation of old skin, forms heavy crusts upon the face which are both unsightly and annoying.

Another form of eczema is simply a very badly chafed condition accompanied by intense itching, and commonly known as "dry eczema." A very disagreeable form is the pustular variety. One poor little sufferer that was once brought to us had so many pustules on his head that one could not put a ten cent piece on his scalp without touching a pustule. The treatment of these cases, in order to be effective and leave the child's head in normal condition, must be administered with the utmost patience every day for weeks. A doctor's help is always required in combating this sort of skin trouble. If the cause is external, then the clothes should be changed. All irritation should be removed—the clothing must not be allowed to scratch the skin. The child must not scratch himself. If necessary, little splints may be placed on the inside of his arms to prevent his bending the elbows if the eczema is on the face, while the little sleeves may be pinned to the side of the dress to resist the movement of the arms.

ECZEMA TREATMENT

The diet should be most carefully looked into. The nursing mother will earnestly look into every article of food she herself is eating, and carefully avoid all foods that produce fermentation or decomposition. The mother's urine should be examined and its acidity noted; if it is above normal she should take some alkalines such as ordinary baking soda or calcined magnesia. If it is a bottle-fed baby, any form of flour should be removed from the food and the quantity of the milk reduced. All this, of course, is done under the direction of the physician. Repeated doses of castor oil may be given.

The name of the medicinal agents that have been used in the treatment of eczema, is legion. Perhaps one of the most widely used is the early varnishing of the affected skin with ichthyol (one part ichthyol, one part distilled water), which is swabbed on after the skin has been cleansed with olive oil. Allow this to almost dry, and then sprinkle on talcum powder which smooths over the dry varnish of ichthyol. This is worn every night and during the day, in bad cases, even when the eczema is on the face. It is renewed each day, and is preceded by the olive-oil bath. No water or soap is ever used in eczema. Fortunately, the Eskimo has taught us that the skin really can be cleansed with oil as well as with water. In the appendix will be found two prescriptions, number one and number two, that have proved very beneficial in some of the most severe forms of eczema.

HIVES AND FRECKLES

Hives, a crop of little raised red papules closely resembling lesions caused by the sting of a mosquito, may make their appearance upon the skin of the child, remain a few hours, and then disappear. Hives are usually due to digestive disturbances and may be caused by such foods as strawberries, nuts, pastries, pineapple, certain sea foods, mushrooms, etc. A good cathartic, the taking of alkalines, such as baking soda or calcined magnesia, with a bran or starch bath, or possibly a soda bath, will usually correct the difficulty. The same treatment may be used in nettle rash or prickly heat.

Freckles seem to run in families. Broad-brimmed hats or sunbonnets may be worn, but under no circumstance should a little girl be bidden to remain in the house and shun the beautiful, sunshiny outdoors just because she freckles easily. Do not apply any lotions to the freckled face without medical advice, for great harm may be done the tender skin of the child.

RINGWORM

Often upon the scalps of young children may be seen circles—rather, patches—which are slightly rough to the touch, and which cause the hair to fall out and the spots to remain bald. They are known as ringworms of the scalp. The affection may likewise appear on the body or the face, presenting a ring of reddened skin with a scaly border. Ringworm on the scalp is hard to treat and medical help should be secured, for, in spite of all that can be done, the disease often runs its course, leaving round bald spots over the head. Ringworm of the face, taken early, is helped by carefully painting with tincture of iodine. The mother should constantly bear in mind that ringworm is a "catching" disease, so that all handkerchiefs, towels, and clothes are to be kept separate. The disease known as mange which so often attacks dogs, is nothing more than ringworm, and children often contract the disease from dogs. Ringworm, whether it be on children or dogs, may be greatly helped by the use of tincture of iodine and other appropriate remedies.

BOILS

The much poulticing of boils has done an untold amount of mischief. Many children and adults are in their graves today because of improper treatment of boils. Blood poisoning which so often follows the careless poulticing, as well as the uncleanly opening of boils, can all be avoided. Before touching a boil, the surrounding skin should be thoroughly washed with sterile cotton and laundry soap and then disinfected with alcohol. Then, with a scalpel or a surgeon's knife which has been either boiled for twenty minutes or allowed to remain in pure carbolic acid two minutes and then in alcohol two minutes, it should be thoroughly opened down to the core so that the pus may come out. It is very much better for the trained hands of a physician to do this than for any member of the family to undertake such an operation—where the danger of blood poisoning is always present. The only treatment of skin eruptions containing pus which is justifiable for the home folks to undertake is to simply paint them with iodine. Under no circumstance should poultices be used.

FEVER BLISTERS

It is not at all uncommon for small children to develop a group of fever blisters on the lips when suffering with any disease, or experiencing a high fever. Even a simple cold or a spell of indigestion may be accompanied by fever blisters. They appear not only on the lips but also on the edges of the nose and may even be seen on the chin.

Early in their first appearance they may be treated with spirits of camphor or plain alcohol, which sometimes tends to abort them; but they usually run their course, and when they are fully developed they may be treated with zinc oxide, simple borated vaseline, or ichthyol.

WARTS

Very often children's hands are disfigured by warts. They appear suddenly, develop rapidly, and many times disappear just about as suddenly as they appeared. Every child suffering from warts usually passes through the stage of charms and lingoes which are popularly used to remove these disagreeable growths. We hardly see any efficacy in "bean-ie, bean-ie take this wart away," or any particular virtue in stealing mother's dishcloth, cutting it up into as many pieces as there are warts on the hand and rubbing each wart with a separate piece of the cloth; but you will find people in every town or village who will assure you that their warts were driven away by one of these charms or lingoes. Warts are either better left alone or removed by a physician with the high-frequency spark or some other reliable method.

BIRTHMARKS

A red or purplish patch on the skin is the result, as mentioned in an earlier chapter, of an embryological accident in which one or more embryonic cells slipped out of place in the early days of skin formation. These accidental markings may occur on the face, the scalp, or on any other portion of the body, and they should be let alone, unless they show a tendency to grow, when it may prove best to give them proper surgical attention.

A mole is also a birthmark, and if found upon the neck or shoulders where it is likely to disfigure, it may be removed by the high-frequency spark, or by surgery, in the same way as warts. Never tamper with moles. Leave them alone or turn them over to the surgeon.

ERYSIPELAS

Erysipelas is a much-dreaded disease which is the result of infection with the blood-poisoning germ—streptococcus. It usually occurs about a wound, and is due to infection by this microbe. If it follows circumcision, it is due, of course, to infection, and may be very serious, even causing death. It attacks persons of any age and is oftenest seen on the face. In appearance, the skin is a bright and shiny red, with a definite line of demarcation slightly raised at the edges because of the swollen tissues underneath. On pressure, the redness disappears but reappears immediately upon relieving the pressure. The inflammation, pain, and fever often continues a number of days, during which the child should be isolated from all other members of the family. The bowels should be freely opened, and the diet should be liquid and soft; while local treatment is cared for by the physician who should always be called. Should erysipelas develop on a very young baby it is very important that he should be removed at once from the mother. As stated before, the disease is produced by the blood-poisoning germ which is very much to be avoided in any and all stages of obstetrics. One attack in no way renders the patients immune. They may have repeated attacks of erysipelas. The treatments should be started early and kept up most rigidly.

SCABIES AND LICE

In thickly settled districts among the poor and uneducated, where filth and untidiness reign, the "itch" is a very prominent disease. It is caused by the itch mite, a parasite which burrows underneath the skin leaving behind its eggs in little irregularly shaped, bluish tinted ridges. Such a profound itching is set up by this burrowing and depositing of eggs that the child cannot resist scratching, and all taken together produces the typical itch-rash. The common site for this rash is on the sides and between the fingers and toes; on arm pits and buttocks of the child, as well as at the waistline. The treatment is usually beyond home remedies. A physician should have charge of the case who will conduct a line of treatment which, if diligently followed, will rid the body of this scourge within a week or ten days.

Along with the itch are often found parasites of the head, or lice (pediculi). It is not at all infrequent to find them in the heads of uncared for children; but if a much-cared-for child is brought in contact with an infected head he will probably "catch" the infection. A most intense and disagreeable itching is set up at once. The treatment consists in getting the head clean by the use of a very fine comb, thus endeavoring to remove the adult parasites as well as the eggs or "nits." However, great care should be taken to avoid injuring the scalp. Perhaps the simplest and most effective treatment known is the kerosene bath which should be applied at night, the hair being done up in a bandage until morning, when the kerosene is washed off with soap and water and then the hair given a vigorous vinegar shampoo in order to destroy the "nits." Tincture of larkspur, or an ointment made from the seeds, may also be used. It is applied several days in succession and then washed out.

Reference has already been made to certain accidents of embryology during the very early days or weeks of the formative period of the embryo. Common illustrations of such deforming developmental accidents are harelip, cleft palate, and club foot.

HARELIP AND CLEFT PALATE

In the case of a partial or complete failure of the two sides of the face to come together in the median line, a deformity results which is known as harelip—a partial or complete cleft of the upper lip. It may be a single or a double cleft, exposing the teeth, or the cleft may even extend up into the nose. This deformity may seriously interfere with nursing, making it necessary to resort to feeding with a medicine dropper and later a spoon. The success of the operation for the relief of harelip, which should usually be performed during the early months of life, is often very remarkable.

Should this failure to unite be in the deeper structures of the head, then cleft palate is the result. This, too, may be partial or complete: partial as seen in a cleft of the soft palate only; and complete, when the hard palate also is involved. In such an instance it is the floor of the nose that is defective; hence the nose and mouth are one cavity.

A specially devised apparatus which assists the child in nursing may be found on the market, for nursing is well-nigh impossible without the closure of the roof of the mouth. The operation for cleft palate is usually successful when performed at the proper time and by competent hands.

In tongue-tie the weblike membrane underneath is attached too far forward, so that the child is quite unable to protrude his tongue, and this condition greatly interferes with sucking. The operation for the relief of this condition is slight, and should be performed as soon as the defect is discovered.

DEFORMED HANDS AND FEET

Occasionally there is a webbing of one or more fingers of the hand, and there are sometimes seen too many fingers or a double thumb. It is needless to allow such a deformity to continue; the operation for relief is often remarkably successful and should be performed very early.

Clubfoot results when short tendons or contracted tendons pull the toes inward or outward with raising of the heel. Treatment must be instituted early; braces or splints are applied; and untiring efforts are put forth in massage and other lines to prevent a lifelong handicap of clubfoot.

An inward rotating of the legs presents the deformity of pigeon-toe. The normal foot naturally inclines toward "pointing in," and such a condition should not be discouraged. Many flat feet (broken arch) are due to shoe lasts which compel the toes to slant "out," and the bunions which so often follow such mistreatment may be exceedingly painful.

By all means place shoes on the pigeon-toed child that possess straight lasts with flexible arches, and which admit of the exercise of many muscles of the foot which otherwise remain inactive.

As the child grows older the toenails thicken, and often in their trimming they are cut so closely at the corners that sometimes a condition results known as ingrowing nails. Such are very painful and must receive special attention. First of all, the nail is cut squarely, and after scraping it thin the corner is lifted and cotton so placed under it that the nail's downward and inward growth is stopped.

SPINAL CURVATURE

Curvature of the spine is more common than is usually thought. The most frequent variety of it is the lateral curvature. One shoulder is lower than the other, and the hips are therefore uneven. Rickets, during infancy, is the most common cause of spinal curvature.

Improper sitting at school—sitting on the edge of the seat—or carrying heavy loads are often contributing factors to the production of lateral curvatures. Only the muscles and ligaments enter into this deformity, hence the treatment should be started early and should consist of:

1. Stretching exercises.
2. Hanging from the rounds of a ladder securely fastened to the wall.
3. Certain applications of hot fomentations to the spinal muscles for their relaxation.
4. Firm cushion placed under one or other of the hips to encourage the re-establishment of muscular poise.
5. Special supervision of the case.

POTT'S DISEASE

Pott's disease, or tuberculosis of the bone, often results in an angular spinal deformity. This curvature, unlike the lateral curvature, is a sequela of an actual disease of the bones. It is always very serious and demands early treatment from skilled hands. Early in the disease there is a peculiar stiff, tottering gait. The little child holds the spine rigidly, and in picking up objects from the floor bends the knees instead of the spine. If the trouble is in the upper spine, the shoulders are held high and the head is stiffly poised, it is never rotated; in looking about the entire body turns.

Medical aid should be secured early. The X ray not only locates the difficulty but also determines the extent of the process. If the spine be put to perfect rest, outdoor life begun, a diet rich in fats established, the results are often wonderfully successful.

Another tubercular condition is seen in the much dreaded hip-joint disease which parents should always be on the lookout for. The earliest symptoms are crying out in the night suddenly, unnatural standing on one leg (to relieve the strain on the diseased hip) and so-called "growing pains." Call in a physician very early and institute proper treatment. A posterior curvature of the spine is often associated with a bad case of rickets. It is of temporary duration, and usually clears up when the symptoms of rickets have been eradicated. It involves only the back muscles—not the vertebral bones.

The young mother is often very much concerned over the misshapen head of the child as a result of a prolonged labor; and it does seem quite miraculous to see a head, more nearly resembling an egg than anything else, become beautifully round and shapely by the end of two or three days.

Protruding ears may be encouraged to lie more flatly by the wearing of a specialized bonnet at night. When the babies are too young to turn themselves they should be turned first to one side and then the other, while care should always be exercised in properly straightening out a curled under ear or an overlapping ear.

RHEUMATISM

While we so often regard rheumatism an adult disease, nevertheless, children do suffer its aches and pains as well as the fever which so often attends the inflammatory type. The so-called "growing pains" are often of rheumatic origin.

Diseased tonsils not only are often—very often—the avenue of entry of infectious microorganisms that cause one type of rheumatism, but many forms of valvular heart disease are also directly traceable to these same diseased tonsils. The treatment consists in giving proper attention to the tonsils, even removal if necessary—and if the child is old enough. All other possible causes should be located and removed; the child should have absolute rest in bed with brisk cathartics and a liquid diet (no meat broths). The diet should consist more of alkalinizing foods as shown in the special table in the appendix. Medicinal alkalines are often given when the urine shows a very high acid reaction.

SCURVY

Scurvy, seen in children who subsist on "prepared foods," is manifested by tender legs and swollen gums which have a tendency to bleed easily. Pallor, loss of appetite, and insomnia accompany the condition. The treatment of scurvy is change of diet from "patent foods" to fresh cow's milk, with the addition of orange juice, daily. In older children the food must be very nutritious; out of door life, salt glows, friction baths (see appendix), and the taking of large amounts of fats are all essential to the cure.

ADENITIS—ENLARGED GLANDS

Enlarged glands, or what our grandmothers used to call "kernels" in the throat are often the result of inflammation in the mouth or throat, and occur in connection with many of the childhood diseases, notably diphtheria, scarlet fever, and scarlatina.

Glands appearing in the back of the neck may be occasioned by pediculli (lice), ring worm, or eczema, while those seen in the neck just back and below the ears may come from mastoiditis (inflammation of the middle ear) or adenoids.

Glands felt under the arm enlarge because of trouble or infection in the breast, hand, or arm; while glands in the groin are usually due to some infection of the feet, legs, or abdomen.

These glands usually disappear when the general health and well-being of the child is improved by:

1. Outdoor life.
2. Morning dry-friction rub to the skin.
3. Good liberal diet, including plenty of fats.
4. No feeding between meals.
5. The salt glow and general tonic treatment (see appendix).
6. The oil rub at night.

RICKETS

Rickets (a disease of the bones) often follows in the wake of faulty feeding and unhygienic surroundings. The bones lack a proper amount of lime salts and other elements. Development in general, especially that of the bones, is greatly interfered with.

Bowlegs, prominent square brow, enlarged perspiring head, weakness, and often tenderness of the flesh, are notable signs of the disease. The treatment varies little from that of scurvy, and will be provided in detail by the attending physician.

MALARIA

Children often suffer from malarial parasites. Sudden rise of fever on regular days (sometimes daily, every two days or every three days) should demand a careful medical examination including the examination of the blood where the offending organism is seen in the red blood cells. We recently saw a little girl who happened to have an earache and was about to be operated on for ear trouble, when examination of the blood revealed the fact that she was suffering from malaria.

TUBERCULOSIS

In the routine examination of adult patients, the X ray observations of the lungs often reveal deposits of lime salts which tell the story of a successful fight against tuberculosis (Fig. 16). And while it may seem surprising, we believe beyond a doubt that most of us have had some varying degree of tuberculosis while young—the unrecognized battle has been fought—and these small monuments of lime salts alone remain to tell the interesting story.

The pity of it is that whole armies of little folks fall in this struggle against disease, for it is one of the common and fatal diseases of childhood. Fresh-air schools, playgrounds, and free school lunches are saving hundreds of children from the ravages of this disease each year.

Tuberculosis is strictly a house disease, hence the little tubercular patient must seek outdoor life. All avoidable exposure to the disease must be denounced, and public sentiment must continue to be aroused to the hygienic betterment of the tenement districts and basement homes. The sanitary drinking cup and the bubble fountain must be encouraged, as must also the proper ventilation of all places where crowds assemble, be it the schoolroom, the theater, or the church.