Transcriber's notes: Obvious typographical errors have been correctedand a few punctuation usages have been normalized. 

[Illustration: Courtesy of New York World

More Babies Like These

These nine little tots are all sound, healthy stock. The generationsbehind them had unconsciously been practicing Eugenics through theprocess of natural selection. By luck, as it were, no strain was bredinto the several families that would have caused these children to beunsound mentally, morally, or physically. 

It is through Eugenics that we shall have more babies like these, andshall eliminate the possibility of children like those shown in theother illustrations to this volume. ]

TheEugenic Marriage

A Personal Guide to theNew Science of BetterLiving and Better Babies

By W. GRANT HAGUE, M. D. 

College of Physicians and Surgeons (ColumbiaUniversity), New York; Member of County MedicalSociety, and of the American Medical Association

In Four Volumes

VOLUME IV

New YorkTHE REVIEW OF REVIEWS COMPANY1914

Copyright, 1913, byW. GRANT HAGUE

Copyright, 1914, byW. GRANT HAGUE

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TABLE OF CONTENTS

ACCIDENTS AND EMERGENCIES

CHAPTER XXXIV

COMMON DISEASES OF THE NOSE, MOUTH AND CHEST

 PAGE

"Catching cold"--Sitting on the floor--Kicking the bedclothes off--Inadequate head covering--Subjecting baby to different temperatures suddenly--Wearing rubbers--Direct infection--Acute nasal catarrh--Acute coryza--Acute rhinitis--"Cold in the head"--"Snuffles"--Treatment of acute nasal catarrh, or rhinitis, or coryza, or "cold in the head, " or "snuffles"--Chronic nasal catarrh--Chronic rhinitis--Chronic discharge from the nose--Nervous or persistent cough--Adenoids as a cause of persistent cough--Croup--Acute catarrhal laryngitis--Spasmodic croup--False croup--Tonsilitis--Angina--Sore throat--Symptoms of tonsilitis--Treatment of tonsilitis--Bronchitis in infants--Bronchitis in older children--"Don'ts" in bronchitis--Diet in bronchitis--Inhalations in bronchitis-- External applications in bronchitis--Drugs in bronchitis-- Chronic or recurrent bronchitis--Pneumonia--Acute broncho-pneumonia--Symptoms of broncho-pneumonia--How to tell when a child has broncho-pneumonia--Treatment of broncho-pneumonia--The after treatment of broncho-pneumonia--Adenoids--How to tell when a child has adenoids--Treatment of adenoids--Nasal hemorrhage-- "Nose-bleeds"--Treatment of nose-bleeds--Quinsy--Hiccough-- Sore-mouth--Stomatitis--Treatment of ulcers of the mouth-- Sprue--Thrush 497

CHAPTER XXXV

DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL

Inflammation of the stomach--Acute gastritis--Persistent vomiting--Acute gastric indigestion--Iced champagne in persistent vomiting--Acute intestinal diseases of children-- Conditions under which they exist and suggestions as to remedial measures--Acute intestinal indigestion--Symptoms of acute intestinal indigestion--Treatment of acute intestinal indigestion--Children with whom milk does not agree--Chronic, or persistent intestinal indigestion-- Acute ileo-colitis--Dysentery--Enteritis--Enter-colitis-- Inflammatory diarrhea--Chronic ileo-colitis--Chronic colitis--Summer diarrhea--Cholera infantum--Gastro-enteritis-- Acute gastro-enteric infection--Gastro-enteric intoxication--Colic--Appendicitis--Jaundice in infants--Jaundice in older children--Catarrhal jaundice--Gastro-duodenitis--Intestinal worms--Worms, thread, pin and tape--Rupture 527

CHAPTER XXXVI

DISEASES OF CHILDREN (continued)

PAGE

Mastitis, or inflammation of the breasts in infancy--Mastitis in young girls--Let your ears alone--Never box a child's ears--Do not pick the ears--Earache--Inflammation of the ear--Acute otitis--Swollen glands--Acute adenitis-- Swollen glands in the groin--Boils--Hives--Nettle rash-- Prickly Heat--Ringworm in the scalp--Eczema--Poor blood--Simple anemia--Chlorosis--Severe anemia--Pernicious anemia 553

CHAPTER XXXVII

DISEASES OF CHILDREN (continued)

Rheumatism--Malaria--Rashes of childhood--Pimples--Acne-- Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis-- Incontinence--Sleeplessness--Disturbed sleep--Nightmare-- Night terrors--Headache--Thumb sucking--Biting the finger nails--Colon irrigation--How to wash out the bowels--A high enema--Enema--Methods of reducing fever--Ice cap--Cold sponging--Cold pack--The cold bath--Various baths--mustard baths--Hot pack--Hot bath--Hot air, or vapor bath--Bran bath--Tepid bath--Cold sponge--Shower bath--Poultices--Hot fomentations--How to make and how to apply a mustard paste--How to prepare and use the mustard pack--Turpentine stupes--Oiled silk, what it is and why it is used 569

DISEASES OF CHILDREN

CHAPTER XXXVIII

INFECTIOUS OR CONTAGIOUS DISEASES

Rules to be observed in the treatment of contagious diseases-- What isolation means--The contagious sick room--Conduct and dress of the nurse--Feeding the patient and nurse--How to disinfect the clothing and linen--How to disinfect the urine and feces--How to disinfect the hands--Disinfection of the room necessary--How to disinfect the mouth and nose--How to disinfect the throat--Receptacle for the sputum--Care of the skin in contagious diseases--Convalescence after a contagious disease--Disinfecting the sick chamber--The after treatment of a disinfected room--How to disinfect the bed clothing and clothes--Mumps--Epidemic parotitis--Chicken pox-- Varicella--La Grippe--Influenza--Diphtheria--Whooping Cough--Pertussis--Measles--Koplik's spots--Department of health rules in measles--Scarlet fever--Scarlatina-- Typhoid fever--Various solutions--Boracic acid solution--Normal salt solution--Carron oil--Thiersch's solution--Solution of bichloride of mercury--How to make various solutions 599

ACCIDENTS AND EMERGENCIES

CHAPTER XXXIX

ACCIDENTS AND EMERGENCIES

Accidents and emergencies--Contents of the family medicine chest--Foreign bodies in the eye--Foreign bodies in the ear--Foreign bodies in the nose--Foreign bodies in the throat--A bruise or contusion--Wounds--Arrest of hemorrhage--Removal of foreign bodies from a wound--Cleansing a wound--Closing and dressing wounds--The condition of shock--Dog bites--Sprains--Dislocations--Wounds of the scalp--Run-around--Felon--Whitlow--Burns and scalds 629

MISCELLANEOUS

CHAPTER XL

MISCELLANEOUS

The dangerous housefly--Diseases transmitted by flies--Homes should be carefully screened and protected--The breeding places of flies--Special care should be given to stables, privy vaults, garbage, vacant lots, foodstuffs, water fronts, drains--Precautions to be observed--How to kill flies--Moths--What physicians are doing--Radium--X-Ray treatment and X-Ray diagnosis--Aseptic surgery--New anesthetics--Vaccine in typhoid fever--"606"--Transplanting the organs of dead men into the living--Bacteria that make soil barren or productive--Anti-meningitis serum--A serum for malaria in sight 645

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ACCIDENTS AND EMERGENCIES

CHAPTER XXXIV

COMMON DISEASES OF THE NOSE, MOUTH, AND CHEST

"Catching Cold"--Sitting on the Floor--Kicking the Bed ClothesOff--Inadequate Head Covering--Subjecting Baby to DifferentTemperatures Suddenly--Wearing Rubbers--Direct Infection--AcuteNasal Catarrh--Acute Coryza--Acute Rhinitis--"Cold in theHead"--"Snuffles"--Treatment of Acute Nasal Catarrh, or Rhinitis, or Coryza, or "Cold in the Head, " or "Snuffles"--Chronic NasalCatarrh--Chronic Rhinitis--Chronic Discharge from the Nose--Nervousor Persistent Cough--Adenoids as a Cause of PersistentCough--Croup--Acute Catarrhal Laryngitis--Spasmodic Croup--FalseCroup--Tonsilitis--Angina--Sore Throat--Symptoms ofTonsilitis--Treatment of Tonsilitis--Bronchitis inInfants--Bronchitis in Older Children--"Don'ts" in Bronchitis--Dietin Bronchitis--Inhalations in Bronchitis--External Applications inBronchitis--Drugs in Bronchitis--Chronic or RecurrentBronchitis--Pneumonia--Acute Broncho-pneumonia--Symptoms ofBroncho-pneumonia--How to Tell When a Child hasBroncho-pneumonia--Treatment of Broncho-pneumonia--TheAfter-treatment of Broncho-pneumonia--Adenoids--How to Tell When aChild has Adenoids--Treatment of Adenoids--NasalHemorrhage--"Nose-bleeds"--Treatment ofNose-bleeds--Quinsy--Hiccough--Sore Mouth--Stomatitis--Treatment ofUlcers of the Mouth--Sprue--Thrush. 

"CATCHING COLDS"

Mothers frequently wonder where their children get colds. Briefly wewill point out some of the sources from which these apparentlyinexplicable colds may come. 

A. Sitting on the Floor. --Children should not be allowed to sit orcrawl upon the floor at any season of the year, but especially duringthe winter months. There is always a draught of cold air near the floor. It is a bad habit to begin allowing a child to play with its toys on thefloor. Use the bed or a sofa or a platform raised a foot from thefloor. 

B. Kicking the Bed Clothes Off During the Night. --The bedclothes should be securely pinned to the mattress by large safety pins. When it is established as a habit a child who kicks off the bed clothesshould wear a combination night suit with "feet, " made of flannel duringthe winter and of cotton during the summer. 

C. Inadequate Head Covering. --Professor Kerley states that this is oneof the "most frequent causes of disease of the respiratory tract in theyoung. " He calls attention to the fact that "mothers carefully clothethe baby with ample coats, blankets, leggings, etc. , before they takehim out for the daily walk. They dress him in a warm room taking plentyof time to put on the extra clothes, during which time the baby fretsand perspires. When all is ready they place upon the hot, almost baldhead of the baby a light artistically decorated airy creation which issold in the shops as children's caps. The child is then taken out ofdoors and because of the inadequate covering of the hot perspiring head, catches cold and the mother never knows how it came. " Every baby andchild should wear under such caps a skull cap of thin flannel, especially in cold weather. In summer or windy day a light silkhandkerchief folded under the cap is a very excellent protection. 

D. Subjecting a Baby to Different Temperatures Suddenly, is liable tobe followed by a cold--for example, taking the child from a warm room toa cold room, or through a cold hall, holding the child at an open windowfor a few moments. 

E. The Practice of Wearing Rubbers Needs Some Consideration. --Theyshould never be worn indoors for even five minutes. They should nottherefore be kept on in school, nor should they be worn by women instores when they go shopping. When it is actually raining, or snowing, or when there is slush or wet mud they are needful; but they should notbe worn simply because the weather is threatening or damp. Childrenshould not put them on to play--worn for any length of time when activethey are harmful. If worn to and from school they should be taken off atonce when in school or at home. Wearing rubbers prevents freeevaporation of the natural secretion of the skin, keeps thefeet moist and invites colds and catarrh. In damp weather, or whenchildren play during winter months, they should be shod with stout shoeswith cork insoles. 

The same argument applies to storm coats of rubber, water-proofmaterial. They should not be worn as overcoats all day, but only whengoing to and from school or business when it is actually storming. 

Underclothing or hosiery should not be heavy enough to cause moisture ofthe skin. Health demands a dry skin at all times. The necessary degreeof body heat should be attained by the quality of the outer clothing, not by the quantity of the underclothing. Many men and women wear heavyunderclothing which causes moisture when indoors, with the result thatthey get surface chills when they go outside if the weather is cold andas a result catch cold. The underclothing should be just heavy enough tobe comfortable indoors and the extra warmth necessary when outsideshould be supplied by a good overcoat or furs. 

F. Direct Infection. --A baby may catch cold if kissed or "hugged" byan adult who has a cold. 

Catching cold while bathing is possible, but scarcely probable, ifordinary precautions are taken. It is very bad practice to permitchildren to use one another's handkerchiefs or the handkerchief of anadult. Certain children are predisposed to attacks of "cold in the head"or acute coryza or nasal catarrh (these being the medical names for thiscondition). Sometimes this is an inherited characteristic. There is nodoubt, however, that most of these children acquire the habit by badsanitary and hygienic surroundings. These children do not as a rule getenough fresh air. They are kept indoors most of the time in stuffy, overheated, badly ventilated rooms, unless the weather is absolutelyperfect. The windows in their bedrooms are always kept closed, becausethey are "liable to catch cold. " They are overdressed and perspireeasily and as a result "catch cold. " These conditions all tend to createan unhealthy condition of the nasal mucous membrane and of the throat, and this is rendered worse if the child lives in a damp, changeable climate, such as that of New York City. In these susceptiblechildren the exciting cause of an attack may be trivial; exposure, coldor wet feet, inadequate head covering (as already pointed out), adraught of cold air even may excite sneezing and a nasal discharge;hence we have:

Acute Nasal Catarrh (Acute Coryza, Acute Rhinitis, "Cold in the Head", "Snuffles"). --Acute nasal catarrh may accompany measles, diphtheria, influenza, and whooping cough. 

Symptoms. --The onset is sudden with sneezing, and difficulty inbreathing through the nose. In a few hours, or it may be not for a dayor two, a mucous, watery, nasal discharge appears. There are redness andslight swelling of the nose and upper lip, caused by the discharge. There is no fever as a general rule except in very young infants, inwhom the fever may be very high. The discharge interferes with thenursing and the child suffers from lack of nourishment. The inflammationmay extend to the eyes and ears, causing painful complications, or tothe throat and bronchi, causing hoarseness and cough. Less frequently wehave disturbances of the digestive tract with vomiting, or diarrhea. 

The mild form of the disease lasts for two or three days, the severeform from one to two weeks. 

Repeated attacks are said to contribute to the production of adenoidgrowths. 

An acute attack of this disease is seldom a serious affliction in olderchildren; it may be, however, very serious and even dangerous in veryyoung infants. The tendency of the disease to extend downward, causingbronchitis or pneumonia, explains in part the possible danger to a baby. Another reason is because it may seriously interfere with suckling andwith breathing in these little patients. It may even cause suddenattacks of strangulation. An infant, therefore, suffering with an acuteattack of rhinitis requires constant attention. It may be necessary tofeed it with a spoon, and if necessary mother's milk should be so fed. Plenty of fresh air should be provided. It may be essential to keep themouth open in order that it may get enough fresh air. Every effortshould be made to keep the nostrils open. The secretions must beremoved from time to time. Causing the child to sneeze by tickling thenose with a camel's hair brush will clear the nose for the time being. The physician may be compelled to use a solution of cocaine for thispurpose. 

Treatment of Acute Rhinitis ("Taking Cold", Nasal Catarrh, AcuteCoryza, "Snuffles"). --A child suffering with an acute attack of "coldin the head" should be kept indoors in a room with a constant, uniformtemperature; the particular reason for this is, that, if a child isexposed to cold at any time during an attack of "cold in the head, " itmay cause the disease to invade the chest, --a tendency which it has atall times. The bowels must be kept open; if they do not move every dayof their own accord they must be made to move by means of an enema ofsweet oil or of soap-suds. The amount of food should be reduced to suitthe circumstances and the condition of the patient. 

We treat the local condition in the nose with a menthol mixture. Thefollowing is a very good one: Menthol, 30 grains; Camphor, 30 grains;White Vaseline, 1 ounce. Put some of this on the end of the finger andpush it gently into each nostril. When the nostrils become blocked andthe child cannot breathe through the nose, tickle the nose with afeather until it sneezes; this will clear the passage. Immediately afterthe sneeze place the menthol mixture in each nostril. When the child isabout to sneeze place a handkerchief before the nose, as this dischargeis full of germs and will infect others when dry. Internal remediesshould not be used unless the child is distinctly sick and is running afever, in which case a physician should look the child over andprescribe whatever is called for. 

The upper lip and the nostrils of the child should be protected, becausethe discharge very quickly irritates the parts and renders them raw andpainful. Vaseline or cold cream is very suitable for this purpose. 

Mothers should not wash out the nose of a child with any solutionadvised for this purpose where force is used, as, for example, with asyringe. Any forceful irrigation of the nose is dangerous, because itwould carry the infection into the deeper parts and set up a moreserious condition. 

If the above treatment is carefully carried out and the childunexposed to a fresh cold, two or three days will be sufficient tocure the disease. 

It is not, however, the treatment of an acute attack of "cold in thehead" that is important; it is intelligently to follow out a plan whichwill prevent these attacks from repeating themselves that is ofconsequence. The tendency to take cold is a real condition in childhoodand a very common one. When mothers appreciate that it is possible toprevent this condition and to cure it when it is seemingly anestablished habit, more interest will undoubtedly be taken in thesubject. Too frequently it is looked upon as an unfortunate affliction, but it is never regarded as a condition that is caused by neglect andignorance. 

It is an exceedingly common occurence to find a mother worrying over herchild's cold, dosing it with cod liver oil or some other unnecessarytonic, rubbing it with camphorated oil or plastering it over withcertain useless patent plasters, dressing it with extra pieces offlannel on its chest and extra clothes pinned snugly around it, thenshutting it up in a warm, stuffy, unsanitary, ill-smelling room, inorder to keep it from "catching a fresh cold. " Can you imagine anythingelse she could do to defeat her purpose?

No quantity of cod liver oil, no medicine, no coddling, will remove thetendency to "catch cold. " The child's life must be lived amidst sanitarysurroundings and hygienic conditions first; then other expedients may beutilized if necessary. These children must be kept out of doors most ofthe time, unless during the severest wet weather. They should sleep in aroom the windows of which are open at the top and bottom every night inthe year. They should not, however, be in a draught. The rooms in whichthey live should be of a uniform temperature, never too hot and nevertoo cold, between 68° and 70° F. These delicate catarrhal childrenshould be accustomed to light clothing on their beds. Chest protectors, mufflers, cotton pads, and heavy wraps of any description should beabsolutely prohibited. It is advisable to use flannel underwear winterand summer, light in summer and a medium weight in winter. During the summer months the mother should begin cold sponging of theface, throat, chest, and spine every morning and carry it into thewinter. The entire process need take only a moment or two. Always drythoroughly with a fairly rough towel. If the cold sponging is begun inthe warm summer time the child will become so accustomed to it that noobjection will be made when the cold weather comes. 

If the child continues to be "catarrhal, " despite a course of thistreatment, it would be well to investigate whether any adenoids oradenoid tissue exist in the naso-pharynx. If adenoids are found notreatment will be successful until they are removed. 

It is a wise plan to place a flannel cap on an infant who has an acuteattack of "cold in the head" (snuffles). This will prevent catching afresh cold and it will aid in the speedy cure of the attack from whichit is suffering when it is put on. 

CHRONIC NASAL CATARRH--CHRONIC RHINITIS CHRONIC DISCHARGE FROM THENOSE

Some children have a nasal discharge during all of their childhood. Itis usually worse during the winter months. It may be a thin, waterydischarge or a thick, nasty, yellow discharge. 

It is a condition that is very frequently neglected even by the familyphysician. This is unfortunate because it may lead to serious disease, permanent damage sometimes being done to the hearing, the speech, thesmell, and to the lungs of the child. 

It may be caused by adenoids; disease of the bones or tissues in thenose; foreign bodies in the nose; or it may occur in children whosenutrition is bad. It may result from frequent acute attacks of "cold inthe head. " It also occurs in other less important conditions. Theforeign bodies which usually cause a chronic nasal dischargeare, --buttons, peas, beans, beads, paper balls, flies and bugs, cherry-stones, small pieces of coal, or stone, cork or other material. Achild gets hold of a shoe-button for example and pushes it into itsnostrils. In the effort to get it out the child pushes itfurther in. It may or may not cause pain at the time, and it may beoverlooked, but shortly the mother will notice a discharge from onenostril. This discharge becomes thick and foul and when an investigationis made the button is found embedded firmly in the nose. It is sometimesquite difficult to get the button out and this should always be done bya physician. 

Treatment. --Remove the cause first then treat the catarrh. If it is aproduct of a constitutional disease that causes general poor health, such as tuberculosis, syphilis, or scrofula, the child will need"building up" and a decided change of climate. Foreign bodies must beremoved, adenoids taken out, large tonsils excised, and malformations ofthe nasal bones operated upon. The catarrh will in many cases be curedby removing its cause; if, however, it should persist it must be treatedfor some time with appropriate solutions. These solutions and thedirections as to the method of giving them must be given by a physician, because there is great danger of carrying the disease to deeperstructures if given wrongly. 

SUMMARY:--

1st. --A chronic discharge from the nose is a sign that something iswrong and should be carefully and thoroughly investigated. 

2nd. --The cause can usually be found out and the proper treatment willcure it. 

3rd. --If the condition is neglected it may ruin the health of the childfor the whole period of its life. 

NERVOUS OR PERSISTENT COUGH

Cough in an infant or growing child is usually the result of a cold andthe structure affected is some part of the nose, throat or bronchi. Itis a comparatively simple matter to discover just where the trouble isand to prescribe the appropriate remedy and effect a cure. 

There is another type of cough, however, that is of quite a differentcharacter. This cough will begin as an ordinary cough and itwill only be discovered that it is not an ordinary cough because nothingwill apparently cure it. We mean that the child is given cough remediesthat usually cure a cold, is kept in the house and carefully watched fora sufficiently long period to justify a cure, and yet, despite this careand attention, the cough remains the same. The child is not sick, theappetite is good, there is no fever, it plays and seems to enjoy goodhealth, yet for weeks and frequently for months the annoying cough hangson. It is as a rule worse at night. It begins soon after the child fallsasleep and spoils the entire night's rest or a great part of it. It maybe a dry, hard, hacking cough, or a croupy, harsh bark. It may come inspells with a considerable interval between them, during which time thechild falls asleep, or it may be almost constant, not quite severeenough to rouse the child, but bad enough to spoil the child's rest andthe rest of the mother. If this condition lasts for a long time, as itoccasionally does, the health of the little patient is apt to sufferfrom loss of sleep. 

Treatment. --These children should be taken to a good physician andthoroughly examined. Special care should be devoted to investigating thecondition of the nose, throat, ear, stomach, heart, and lungs. 

A very large majority of these coughs are caused by adenoid growths inthe back part of the nose. The child may not look like an adenoid child, nor may it breathe through its mouth when asleep, and it may have hadits adenoids removed, yet in spite of these contra-indications it mayhave enough loose adenoid tissue in its nose to cause this kind ofpersistent cough. This has been proved many times. 

It is not only useless but positively harmful to give these childrencough remedies. The cause of the cough must be found and treated. Thecough may be indirectly caused by anemia (poor blood) or heart orstomach trouble, or it may have a number of other causes. Whatever it isit must be found by a careful physical examination or a number ofcareful physical examinations, because these cases are as a rule obscureand difficult to diagnose, and even the most expert examinercannot always tell where the trouble is without seeing the child anumber of times. The parents must therefore have patience and confidencein the physician and must aid him all they can by watching and reportingall the symptoms, etc. , to him. (See article on Adenoids). 

SUMMARY:--

Coughs that resist careful treatment are not "ordinary coughs. "

Coughs of this type require special medical care. 

The usual cough medicines are not only useless in these coughs, butdangerous. Don't give them. 

ACUTE CATARRHAL LARYNGITIS: SPASMODIC CROUP: FALSE CROUP

Croup is one of the common diseases of childhood. It usually follows acatarrhal "cold in the head" with a cough. Croup is most frequentlyassociated with large tonsils and adenoids. It may come on gradually orit may occur suddenly. There is always fever with croup. One of thefirst symptoms is a hard, dry, croupy, barking cough, which gets worsetoward night. If it occurs suddenly, the child will wake about midnightwith the characteristic croupy cough. The disease may go no further thanthis and under the proper treatment is well in a few days. In othercases, however, there develops marked interference with breathing. Everyinspiration is accompanied by a loud hissing or "crowing" sound. Thisfeature of the disease is one that frightens the parents, though itseldom means anything serious. The child sits up in bed, frightened, andstruggles for breath. It may clutch its throat with its hands as ifsomething was tied round its neck. The lips may become slightly blue andthe perspiration appears upon the child's brow. After some time, --it maybe two or three hours, --the attack wears away and the child goes tosleep. Next morning it wakes up apparently well except for the croupycough. The attack may repeat itself the next night and mildly on thethird night. 

Treatment. --The object of treatment during an acute attack, whenthe child is struggling for breath, is to relax quickly the spasm of thelarynx which interferes with the breathing. The simplest way is to givethe child a teaspoonful of the fresh syrup of ipecac. If the child doesnot vomit in fifteen minutes, give another teaspoonful and keep ongiving it every fifteen minutes till the child vomits. One or two dosesis usually enough, but it must be given till the child vomits. 

If the attack comes suddenly during the night and there is no syrup ofipecac in the house, the physician should be sent for at once andinformed that the child probably has croup, so he may know what to takewith him. While waiting for the physician the mother should apply overthe front of the neck (in the region of Adam's apple), hot applications. These are best made of flannel wrung out of quite hot water every two orthree minutes: also a hot mustard foot bath. When the physician takescharge of the case he will also direct the treatment for the followingday in order that the attack of the next night may be a very mild one, if it should came at all. 

Children who have a tendency to frequent attacks of croup should receivethe same attention as the children do who are subject to attacks oftonsilitis and acute catarrhal rhinitis. 

SUMMARY:--

1st. Spasmodic Croup always requires prompt and efficient treatment. 

2nd. It is called "false" croup, because "true" croup is alwaysdiphtheritic and is a very serious disease. 

3rd. For that reason a physician should always be called because if itis "true" croup antitoxin must be given at once. 

4th. Don't worry unnecessarily because, though "spasmodic croup" canmake the child look exceedingly sick for a very short time, anuncomplicated case in a healthy child is seldom if ever dangerous. 

TONSILITIS: ANGINA: "SORE THROAT"

This is one of the frequent diseases of childhood. We rarely see it ininfants. It is caused by inhaling air which contains poisonous germs. These germs quickly develop when conditions are favorable. They lodge inthe pores or follicles of the tonsils and set up an active inflammation. The tonsils swell up and the follicles exude a thick fluid which lookslike curdled cream. This fluid sticks in the mouths of the folliclesforming spots. If enough of this fluid is coming out, these spots jointogether forming patches, and the patches may join together formingmembrane. This is why it is sometimes so difficult to tell whether thecase is one of tonsilitis or diphtheria. 

Conditions are favorable to the development of tonsilitis if the childis not in good health when he happens to inhale the infection, when thefeet are wet or cold, or when the child is allowed out during inclementweather and it becomes chilled or numbed from cold, when the child has acold in the head and a running nose, or when its stomach is out oforder. Any condition in which the child should be carefully watched andtended to, rather than allowed further liberties, or risks, conduces tosore throat of some kind. 

Some children have the disease a number of times; they seem to bepredisposed toward a sore throat. These are children who have largetonsils or who are rheumatic. The tonsils should be removed in the onecase, and the tendency to rheumatism should be the main treatment in theother case. 

These children should be encouraged to cleanse the throat and nosemorning and night with a warm salt solution (half a teaspoonful ofordinary table salt to three-quarters of a cup of warm water). This willhelp greatly to prevent these chronic sore throats. 

Symptoms of Tonsilitis. --The disease begins suddenly. The child mayhave a chill or be seized with sudden vomiting or diarrhea. A very younginfant may have a convulsion. The usual way is for the child to developa fever quickly, to complain of being sick and tired. Muscular pains allover the body and a severe headache are constant symptoms. Thefever is usually high from the beginning. The child will tell you itsthroat is sore, but there is as a rule very little pain in the throat. The little spots or patches can be seen on one or both tonsils. Thegeneral symptoms are more pronounced than the local throat symptoms. Theamount of physical depression that is caused by a tonsilitis is out ofall proportion to the seriousness of the disease. 

Tonsilitis lasts three days usually. The throat symptoms may take a dayor two longer to clear up, and the patients feel more or less weak forsome time after all the symptoms have disappeared. 

Tonsilitis is medically regarded as one of the mild diseases ofchildhood. It is, however, of very great importance because of itslikeness to diphtheria, and inasmuch as a positive diagnosis must bepromptly made, in the interest of the patient, it is given closeattention and treated with considerable respect by the medicalprofession. The chief differences between the two diseases are asfollows:

Tonsilitis begins abruptly with pronounced prostration and a high feverthe first day. The patient feels distinctly sick all over. The secondday the patient feels somewhat better, the fever is lower and theprostration and pain are not so marked. The third day he feels betterstill, and but for a little weakness would feel well. Diphtheria beginsslowly and insidiously, with very little prostration and a very lowfever the first day. The patient scarcely feels sick. The second daymore prostration is present, the fever climbs upward a little more, andthe patient begins to feel sick. On the third day the prostration ismuch more profound, the fever is higher, and all the evidences of aserious sickness are present. Two very different pictures: The onebegins bad and ends easy, the other begins easy and may end bad. 

The important fact, however, so far as the similarity of the twodiseases is concerned, is, that we must make the diagnosis positive onthe first or second day, because if we are dealing with a case ofdiphtheria we must give antitoxin at once. This is essential, becausethe efficacy of antitoxin is greatest when given early in the disease. By "early" we mean the first or second day of the disease. Whenantitoxin is given late (the third or fourth day of the disease) it ismuch less efficacious and must be given in relatively larger doses. Theneed, therefore, of a quick, positive diagnosis is a real one. 

Another important element involved in a speedy diagnosis is, that wemust not take any chances of infecting other children. So important arethese conditions that it is the proper treatment to give antitoxin atonce in every case of tonsilitis that in the slightest way resemblesdiphtheria. An examination of the throat contents, --a culture of whichis taken during the first visit of the physician, --will, of course, reveal the true condition and dictate the future use of the antitoxin. Antitoxin is absolutely harmless when given to a patient who has nodiphtheria. Every case of tonsilitis should be quarantined when thereare other children in the house. 

The local condition of the throat helps in the diagnosis: In tonsilitis(as the name implies) the disease is limited to the tonsils and on thetonsils (one or both) do we find the spots or patches. In diphtheria, onthe other hand, the membrane is not limited to the tonsils, but maycover every part of the throat and extend into the nose and mouth. Intonsilitis it is spots or patches we see in the throat. In diphtheria itis membrane we see always. The difficulty here again is that if we waittill the diphtheritic membrane covers the whole throat, antitoxin willnot be of much use. 

In diphtheria we have a characteristic odor, in tonsilitis we have nocharacteristic odor. 

The practical lesson to be learned from this uncertainty is, immediatelyto get a physician as soon as you find spots in the throat of your sickchild, unless you are absolutely sure that the condition is notdiphtheria and you are willing to take that chance. 

Treatment of an Acute Attack of Tonsilitis. --Put the child in bed atonce and keep him on a light diet during the fever. Give him all thecool boiled water he wants to drink. If the fever is very high it can becontrolled by sponging the body with cool water. If the patient is aninfant the food should be reduced to one-half strength. Tonsilitisis a disease that runs a certain course and gets better, or the patientdevelops some other more serious conditions as a result of neglect orcarelessness. We therefore try to make the patient comfortable and letthe disease take care of itself. 

The throat can be gargled or sprayed with any mild antiseptic liquid, orit can be painted with tincture of iodine or 10 per cent. Solution ofsilver nitrate. As a rule the gargles do not aid in the cure of thedisease, though they contribute to the comfort of the patient. 

A cold compress made of half a dozen thicknesses of cloth, such as atable napkin, and put under the jaw (not round the neck), and coveredwith oiled silk and held in place with a bandage that meets and is tiedon the top of the head, is of distinct usefulness. 

When it is known that the child is rheumatic, the heart must becarefully watched during the fever and anti-rheumatic remedies dependedupon to effect a cure. 

SUMMARY:--

Tonsilitis, because of its likeness to diphtheria, must be promptly andcarefully diagnosed. 

A physician only is capable of making a diagnosis. 

Any sore throat in a child with spots or membrane is deserving ofserious and immediate attention. 

A mistake may mean death. Don't take a chance. 

BRONCHITIS

Bronchitis is one of the commonest diseases of childhood. It is thecause of many deaths. Exposure during inclement weather is as a rule thecause of it. It occurs in all classes and conditions of children. Poorlynourished and badly clothed children are more liable to get it than areothers. It is more dangerous in young children and infants than in olderchildren. A young child or an infant will get bronchitis quicker thanthose older and stronger under the same conditions. 

Bronchitis is often present while children are suffering from otherdiseases, measles, influenza, scarlet fever, typhoid fever, pneumonia, diphtheria, whooping-cough, for example. It may accompany any disease ofchildhood, however. 

Symptoms. --In infants bronchitis usually follows a "cold in thehead, " with running nose and a cough. The child is indisposed andpeevish because of the cold. In a few days the cough becomes worse, fever develops, the breathing is quicker, and the baby looks and actssick. The cough may be constant and severe; sometimes the cough does notseem to bother the baby, although this is exceptional. The breathing isquite rapid and is accompanied with a moist, rattling sound in thechest. The baby is restless and if the cough is severe it becomesexhausted. Vomiting or diarrhea may be present. 

Bronchitis in Older Children. --Bronchitis in older children comes onabruptly, with fever and cough. The child may complain of headache andpains in the chest or other parts of the body. It may begin with a chillor chilly feelings. These children "raise" with the cough. Theexpectoration may be quite profuse; at first it is a white, frothymucus, then yellow, and later a yellowish green; it may be slightlytinged with blood. 

There is a mild form of bronchitis in these older children where theserious symptoms are absent. The children are not sick enough to go tobed, but they appear to have a "heavy cold" with, at first, a tight, hard cough, which is usually worse at night. Later the cough turns looseand the same expectoration occurs as in the severe type. It is thesecases of mild bronchitis which do not receive the proper care andtreatment that develop into the so-called "winter cough, " which lastsfor months. 

Treatment. --(See page 497 under heading, "Catching Colds. ") Childrenwho acquire bronchitis easily and frequently, should be built up. Codliver oil should be given all winter. The sleeping apartment of thesechildren should not be too cold, but it should be well aired through theday and well ventilated throughout the night. Flannel night clothesshould be worn and the feet should be kept warm always. Mild attacks of"cold in the head" should be treated vigorously and not neglected. 

The following "Don'ts" may be profitably studied when your child or babyhas bronchitis:--

Don't keep the windows tightly closed; fresh air and good ventilationare absolutely necessary to the patient. 

Don't use a cotton jacket or oil silk. 

Don't wrap the child up in blankets and shawls. 

Don't carry the child around; keep it in bed. 

Don't dose the child with syrupy cough mixtures. 

Don't overheat the room. 

Don't let friends bother or annoy the baby. 

Don't reduce the diet unnecessarily. 

The child should be put to bed. The temperature of the room should be 70degrees F. All the time. The windows should be opened top and bottomaccording to the weather, and the room should be well aired every day, the patient being taken to another room while it is being done. Thechild should have its usual night clothes on, nothing more. If the childis not very sick and insists on sitting up, a bath robe can be worn butit should be always removed when it sleeps. It is advisable to changethe position of the baby from time to time. Have it rest on one side, then on the other, as well as on the back. Give a dose of castor oil atthe beginning of the sickness and keep the bowels open during thedisease. 

Diet. --The diet will depend upon the severity of the disease. If thefever is high and the cough persistent, the strength of the food ofnursing infants should be reduced. We can reduce the strength of thefood by giving the child a drink of cool boiled water before eachfeeding and shortening the length of each feeding. Older children may begiven toast, milk with lime water, cocoa with milk, broths, gruels, custards, cereals and fruit juices. 

Inhalations. --The value of inhalations in bronchitis is very great. The ordinary croup kettle, which can be bought in any good drug store, is the best method of giving them. Full directions come with each kettleas to the best way to use it. The best drug to use in the kettle iscreosote (beechwood). Ten drops are added to one quart of boiling waterand the steaming continued for thirty minutes. The interval betweensteaming is two hours and a half in bad cases day and night. In mildcases the night treatments can be dispensed with. Sheets rigged up overthe top and sides of the crib, in the form of a tent, is the mostdesirable way to give the inhalations. 

External Applications. --Counter-irritation by means of mustard pastesare the best applications. They should be put back and front--one onback and one on the chest, overlapping at the sides beneath the arms. They should cover the entire body from the waist line to the neck. Thesepastes are made as follows:--Mix the mustard (English) and the flour inthe following proportions, using a quantity according to the size ofchild and area to be covered; one tablespoonful mustard to threetablespoonfuls of flour. Mix with lukewarm water until a paste isformed, not too thick and not too thin. Spread on a cloth (put plentyon) and cover with one layer of cheesecloth and place the cheeseclothside next the skin. In order to guard against burning the skin it isadvisable to rub the skin with vaseline, before and after putting on thepaste. The paste should be left on until the skin is uniformly red. Itmay be applied from two to four times in the twenty-four hours accordingto the severity of the case. Mustard pastes are most effective duringthe first two or three days of the disease. 

Drugs. --Drugs are of very little value in the treatment of bronchitis. In the first stage of the disease, when the cough is hard and dry, smalldoses of castor oil and syrup of ipecac may be given to good advantage. The following dosage should be followed closely: 1st year, 2 dropscastor oil, 2 drops syrup of ipecac, every two hours; 3rd year, 3 dropscastor oil, 3 drops syrup of ipecac, every two hours; over 3 years, 4drops castor oil, 4 drops syrup of ipecac, every two hours. 

The benefits from this treatment will be obtained in the first two orthree days, when it should be discontinued. The cough under thistreatment and the use of the mustard paste and inhalations of creosotewill be soft and loose in two or three days and the fever will bedistinctly on the mend. The disease lasts from five to ten days. It may, however, last much longer according to the condition of the child, etc. 

There are other drugs that can be given, with good effect, but whenother remedies are indicated a physician should be called toprescribe them according to indications. 

SUMMARY:--

Bronchitis is one of the commonest diseases of childhood. 

It is the cause of many deaths. 

A large number of children have a tendency to bronchitis. 

These children need careful attention and "building up. "

Do not neglect a "little" cold. It means trouble. 

Chronic or Recurrent Bronchitis. --Bronchitis becomes chronic when thetreatment of an acute attack fails to cure the condition. The failureusually is dependent upon the condition of the child. It may besuffering with some disease resulting from poor nourishment or poorsanitary and hygienic surroundings or both. The bronchitis, in otherwords, is dependent upon some other condition, and will not get whollybetter until the cause is cured. These children should lead an activeoutdoor life when the weather is favorable. Their sleeping-room shouldbe well aired and ventilated. Red meats are allowed twice a week only. Sugar is cut down to the lowest limit. Skimmed milk only should betaken--the cream being too rich for them. They can eat freely of fruitsin season, green vegetables and cereals. The bowels must move freelyevery day. Patients must be given a lukewarm bath, followed by a briefspray of cold water, daily. The cold spray should not be too cold; about60 degrees F. Is the suitable temperature of the water. 

An absolute change of climate, to a warmer inland atmosphere, isimperative before some of these patients will begin to improve. 

SUMMARY:--

A child with chronic bronchitis, or with frequent attacks of bronchitis(or chronic colds), is usually suffering from some other diseasedcondition. 

The bronchitis, or the cold, will not get better until you findout what that "other diseased condition" is. 

It takes a physician to find that out. 

Having found the cause, cure it, and the bronchitis will disappear andthe general health of the child will immediately improve. 

PNEUMONIA

Pneumonia is a very common disease in childhood. It is the most frequentcomplication of the various acute infectious diseases. Pneumonia is anexceedingly important factor in the mortality of infancy. 

There are two kinds of pneumonia:--

 1. Broncho-pneumonia. 2. Lobar-pneumonia. 

Acute Broncho-Pneumonia. --Up to the fourth year this is the form ofpneumonia always present. It is the form that always complicates otherdiseases all through childhood. 

It is most apt to occur during the spring and winter months. 

It affects all classes, but especially those whose hygienic surroundingsare poor. Catching cold is the exciting cause in a large percentage ofprimary pneumonias. 

Symptoms. --Broncho-pneumonia has no regular course. It may or it maynot follow a cold or an attack of bronchitis. As a rule it beginssuddenly with a high fever, frequently accompanied by vomiting, rapidrespiration, cough, and prostration. 

The child does not maintain a high fever continuously; it variesconsiderably throughout each twenty-four hours. It lasts from one tothree weeks, and subsides gradually. 

The respirations vary between 60 and 80 per minute, though they may bemuch more frequent than this. The child breathes with apparentdifficulty, the soft parts of the cheeks and nose rising and falling asit breathes. 

The prostration becomes, as the disease progresses, more and moremarked, until the child looks profoundly sick. 

Cough is a constant and incessant symptom. It disturbs rest and sleepand may cause frequent vomiting. There is no expectoration. A strong cough is a good symptom; if it stops it is a bad symptom. 

Pain is seldom present. 

Blueness of the skin is a bad sign and indicates failure of respirationand suggests constant and careful watching. 

Delirium may be present during the disease. It is not necessarily a badsign. Accompanying stomach troubles are frequent if the patient is veryyoung, and are very important. The bowels may be loose; they may begreen in color and contain much mucus. Large quantities of gas mayaccumulate in the intestines and may cause much distress andconvulsions. Death may occur at any time or the process may be arrestedand recovery take place at any stage of the disease. Broncho-pneumoniais not necessarily a fatal disease in a fairly healthy child. It is, however, always a serious disease. 

Various complications may occur in the course of the disease. The mostfrequent are: pleurisy, emphysema, abscess of the lung, meningitis, heart disease, stomach troubles, thrush, intestinal disease. 

How to Tell When a Child Has Broncho-Pneumonia. --If a child develops ahigh fever, breathes rapidly, coughs, and is content to lie in bedbecause of the degree of prostration, broncho-pneumonia is almostcertain to be the disease present. If in addition to these symptomsthere is any blueness of the fingers or around the mouth it is morestrongly suggestive of pneumonia. 

If the child has been suffering with bronchitis it is sometimesdifficult to tell just when the pneumonia begins. The child will appearmore profoundly sick, the fever will go higher, and the respiration willbe more frequent when pneumonia sets in on top of bronchitis. 

Treatment. --The nursing of a little patient with pneumonia is the mostimportant part. He must get plenty of fresh air; consequently he shouldbe kept in a well-ventilated room. It is an excellent plan to change thepatient twice daily from the sick room into another which has previouslybeen thoroughly aired. While he is in this room the sick room should beas thoroughly aired as is possible. Keep this plan up all through thedisease; change the position of the patient in bed every twohours. He should never be allowed to lie on his back for hours at atime. In this way the different parts of the lungs get a chance to airthemselves, --the air cells expand and the oxygen in the air and thefresh blood tend to heal the parts more quickly. 

It would be distinctly wrong to go into the detailed symptomatictreatment of broncho-pneumonia in a book of this character. Inasmuch asthis is one of the most serious diseases of infancy, no mother shouldattempt to treat it alone. A physician is absolutely necessary and themost the mother can hope to do is to follow out his directions to theletter. 

He may direct the use of mustard pastes but it is essential to knowwhere to apply them. If he should request the use of the cotton jacket, the height and character of the fever must regulate its use. Stimulantsare always necessary, whisky and strychnine being given in every case, but if given at the wrong time they may do more harm than good. Coughmixtures may be necessary, but frequently they are contra-indicated. Drugs and cold sponging may be used to reduce the fever, but they aredangerous if used when conditions do not justify their use. Complications must be diagnosed when they occur, and the correct methodsof treatment promptly instituted. A competent physician alone can assumethe responsibility of these various phases of the disease. 

Every mother should appreciate, however, that pneumonia is frequentlythe result of carelessness. It is a well-known fact that pneumonia is aninfrequent disease among children of the well-to-do, because thehygienic surroundings of these children are better and because theyreceive competent attention if suffering with colds and bronchitis. Bronchitis is quite common in all classes of children, but in the lowerwalks of life it is the custom to allow children to run around whilethey give every sign of having a heavy cold, and a beginning bronchitis. These children should receive treatment and should be kept indoors andin bed if they have even a slight fever, as pneumonia is frequently theinevitable outcome. They should be carefully fed, and all signs ofstomach or intestinal troubles attended to at once. 

[Illustration: By permission of Henry H. Goddard

A Grim Result

Isaac is 16, although mentally 10. He is a high-grade moron. 

 This is one of those all too frequent instances[A] "of a feeble-minded woman with a husband who is alcoholic and the offspring either feeble-minded or miscarriages. "

 "Isaac is exceedingly dangerous. He is a potential criminal or bad man, or under the best conditions would at least marry and probably become the father of defectives like himself. "

This and the succeeding pictures in this volume contrast vividly withthe frontispiece. Terrible are the results when we disregard theinevitable laws of nature, and so mate ourselves that our children willbe parasites on society. ]

[A] "Feeble-mindedness; Its Causes and Consequences", Goddard, TheMacmillan Company. 

The After-Treatment of Pneumonia is important, and every detailhas a distinct bearing on the ultimate recovery and establishment ofgood health. Careful feeding, a good tonic, and the proper attention toexercise, fresh air and bathing are requisite. A change of air after thefever is gone is more important than all other measures put together. Adry, warm climate where patients can be kept in the open air ispreferable. The danger of allowing a slow, long drawn-out convalescenceafter pneumonia is the development of tuberculosis. 

ADENOIDS

Adenoids are very common, almost popular, in childhood. The condition isone that causes more real trouble and discomfort than any otherchildhood affliction. Adenoids are associated with, and are responsiblefor, many of the ailments of childhood. They may be associated withenlarged tonsils or they may be independent of them. They may be presentat birth or develop any time thereafter, though they are more frequentbetween the ages of two and six years. Children who have adenoidsinvariably suffer from chronic "head-colds" with a discharge from thenose. These chronic colds are caused by the adenoids. Nearly everydisease, and every diseased, or abnormal, condition of the nose, throat, larynx, and lungs can be directly caused by the presence of adenoids. They are also responsible for numerous other conditions of very graveimportance in the growing child. The accompanying "head-colds" maydevelop into a bronchitis which may keep the child indoors for a longperiod. Adenoids always interfere with respiration, thereby deprivingthe child of a normal quantity of oxygen, thus rendering the blood lesspure, and, as a consequence, seriously interfering with the nourishmentand general health. The impaired nourishment and poor health thusproduced, as a direct result of adenoids, renders the child more liableto disease; he may thus acquire ailments that may affect his wholesubsequent life. The mental side of a child's development is alsoaffected by the presence of adenoids, so much so that actual statisticsprove that these children cannot keep up with their classes in thepublic school. 

We must therefore regard the presence of adenoids as a seriousmenace to the health and comfort of the patient. It has already beenpointed out in discussing other diseases that before a cure of thesediseases could be permanently accomplished it would be absolutelynecessary to remove the adenoids, which were, no doubt, the actualcause, or an important contributing cause, of the disease. Suchconditions as catarrhal laryngitis, croup, chronic recurring wintercoughs, acute catarrhal rhinitis, "snuffles", "cold in the head", chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting", "nose-bleeding", headaches in growing children, anemia, deafness, nightterrors, defective speech, diphtheria, consumption, are frequentlycaused by the presence of adenoids. 

These patients contract certain diseases easier than other children, andwhen they do, they have them more severely; such diseases arediphtheria, tuberculosis, scarlet fever, measles, and whooping cough. 

Adenoid children are, as a rule, in better health during the warm, equable, summer weather than during the changeable, uncertain weather wehave in the winter months. If the case is neglected, and if the adenoidshave existed for a long time, the growth of the child is impaired. Heremains small and stunted, and the expression of the face is dull andstupid. The temperament and disposition are affected also; such childrenare languid, listless and depressed. 

How to Tell When a Child Has Adenoids. --Children with well-developedadenoids are "mouth-breathers. " Instead of breathing through the nosethey breathe with the mouth open, especially when sound asleep. If achild has a discharge from its nose and a chronic cough, both of whichresist treatment, and if in addition it is a mouth-breather, it is safeto investigate the naso-pharynx for adenoids. If a child with thesesymptoms is not in good health, is listless and depressed, looks stupid, snores at night, has difficulty in breathing and cannot blow its nosesatisfactorily, is troubled occasionally with "nose bleeds" andheadaches, we may be satisfied that the child has adenoids, as no othercondition could produce such a picture. 

Adenoids, like enlarged tonsils, are dangerous, apart from thephysical distress and disease which they cause, owing to the fact thatthey harbor deadly bacteria, and from these bacteria, which find alodgment in the adenoids and tonsils, a fatal attack of diphtheria orconsumption may have its beginning. 

Treatment of Adenoids. --Absolute removal is the only justifiabletreatment. This is rendered imperative for so many reasons that it isunnecessary to go into details in justification of the procedure. 

The physical well-being, the mental development, the life of the childdepend upon it. Any parent who would wittingly interpose an objection tothe removal of his or her child's adenoids, after they have beendemonstrated to exist, would be guilty of a grave crime. 

The operation itself is not at all dangerous. It is over in a fewmoments and the child is well in an hour or two, so far as any pain orsuffering is concerned. 

Physicians are frequently asked if adenoids "grow" again after removal. The answer is, "Yes, " they sometimes do. In a very small percentage ofthe cases they do return. The older the child is when they are removedthe less chance there is of a recurrence. A child operated on before itis two years of age is more liable to a recurrence than a child operatedon at six years of age. This must not, however, be construed as anexcuse for putting an operation off, because if a child needs anoperation at two years and it is postponed till later, its health willbe permanently injured before it is four years of age. 

SUMMARY:--

1. Adenoids cause more trouble and more actual disease than any othercondition during childhood. 

2. It is a crime for a parent to refuse operation if the presence ofadenoids has been proved. 

3. Removal is the only treatment and it should be done in every case assoon as possible. 

4. The operation is a trivial one and is free from danger. 

NASAL HEMORRHAGE--"NOSE BLEEDS"

A hemorrhage from the nose may occur at any time from birth on. Itdepends upon the rupture of one or more blood vessels. The greatmajority of "nose-bleeds" are caused by adenoids, or by a small ulcer inthe nose, or by an injury, such as a blow or fall. A nasal hemorrhage, however, may be caused by other, more serious conditions, and for thatreason may justify a careful inquiry into the cause, especially ifbleeding should occur a number of times, or be of a serious characterthe first time. 

Of the more common causes as given above, the adenoids should beremoved, and the chronic catarrh which is invariably the cause of theulcer should be cured. 

Treatment of an Acute Attack. --Have the patient sit erect; loosen alltight clothing around neck; fold the hands over the head; apply cold tothe back of the neck and the nose. Pieces of ice can be put into thenostril and the ice bag to the nape of the neck, or a piece of ice canbe put into a folded napkin and held on the back of the neck. Taking along breath and holding it as long as possible and repeating it whilethe ice is being applied is an aid. Placing the feet in hot mustardwater is of decided use. Another excellent expedient is to wrapabsorbent cotton round a smooth probe (piece of whalebone, for example), dip the cotton in an alum-water mixture (half teaspoonful powdered alumin a half cupful of water), and then push it into the bleeding nostrilas far as you can with gentle force. A valuable remedy is Peroxide ofHydrogen used full strength and freely dropped into the nostril. Ifthese measures fail, send for a physician at once. 

SUMMARY:--

1st. Nose bleeds may be caused by some serious condition. 

2nd. If they occur a number of times have the child examined. 

3rd. If the treatment outlined above does not stop the bleeding in a fewmoments send immediately for a physician. 

QUINSY

Quinsy is not common in childhood. It usually follows tonsilitis when itis seen. The child complains of pain in the neck, extreme pain anddifficulty upon swallowing, and inability to open the mouth as much asusual. There is a tendency to hold the head to one side. The treatmentis to open the abscess at the earliest moment after pus is present. 

HICCOUGH

Hiccough is, in most cases, in infancy and childhood caused by someirritation of the stomach, may be over-filled with food or gas. In thesecases it is an unimportant incident and may be quickly relieved bygiving the child an enema of soap-water and a laxative of rhubarb andsoda. 

Infrequently hiccough may be the result of cold feet, or a surfacechill. Simple methods of relief are, to hold the breath, to expire, orblow the breath out as long as possible before taking the next breath;to sip water from a cup held by another person while the tips of the twofore-fingers are in the ears. 

Hiccough is quite frequent in hysteria in girls, but it is of noconsequence. When hiccoughs set in during the course of any seriousdisease it is a very unfavorable sign. 

SORE MOUTH: STOMATITIS

Stomatitis is an inflammation of the mucous membrane (inner lining) ofthe mouth. The gums and the inner surface of the lips and cheeks may bered and angry-looking. There may be small grayish spots on any part ofthe mouth. If the case is very bad or if it has lasted some time and hasbeen neglected, these spots grow larger and join together formingirregular grayish plaques. A large percentage of the cases never gofurther than this because the proper care and attention is given them. It is possible, however, for any case to progress further and becomeulcerative. This will be observed first as a faint yellow lineat the margin of the teeth and gum. Ulceration never takes place unlessthe child has teeth. The quantity of saliva is very greatly increased, so much so that it flows out of the mouth soiling the clothes. Thesaliva is intensely acid and it consequently irritates the skin, causingmore or less eczema. The mouth is painful and hot. There is slightfever, but seldom any marked prostration. If, however, the ulcerationshould be severe, the fever may be quite high. 

There is one feature of these cases that sometimes proves vexatious andannoying. Because of the soreness of the mouth, the child cannot drawstrongly enough on the nipple to get a normal feeding, and as a resultthe nutrition of the child is poor. These children are hungry and whenoffered the nipple grasp it greedily, draw a few mouthfuls then stopbecause of the pain and begin to cry. 

If the ulceration is extensive, there is usually an odor and the gumsbleed easily. Sometimes the teeth fall out or have to be drawn out. 

Strong, well-fed children are as likely to develop stomatitis as arethose who are weakly and ill fed. 

The disease is caused by infection and is contagious. Just what theinfection is we do not know; we do, however, know that children whosemouths are carefully cleaned after each feeding do not have sore mouthsof this character. When cleaning the mouth care must be observed not toinjure the tender mucous membrane. 

Treatment. --As soon as the condition is observed mouth-washing shouldbe systematically and thoroughly carried out. After each feeding themouth should be washed with a saturated solution of boric acid in boiledwater. (See page 626. )

It is not necessary to use any further treatment, as a rule. Patientsrecover in four to eight days. Strict attention to cleanliness, however, is imperative. The feeding bottle and nipple, or the mother's nipple, ifbreast fed, must be kept scrupulously clean. 

The feeding of these children is sometimes a problem for a day or two, because, as stated above, of the soreness of the mouth. This is bestovercome by feeding the baby with a spoon. If breast fed, it isnecessary to pump the milk and then feed with the spoon. Children willtake the milk better if it is fed cold. Cold boiled water is largelytaken and is good for them at this time. 

Treatment for Ulcers in Mouth. --The ulcers should be touched with acamel's-hair brush which has been dipped into finely powdered burntalum. If a stronger caustic is necessary, the solid stick of nitrate ofsilver may be used. 

A mouth wash may also be used in the ulcerative cases, composed of theperoxide of hydrogen diluted with two parts of water. If this is usedwash the mouth out afterward with plain, cool, boiled water. Theperoxide mouth wash can be used four or five times daily. 

In addition to the mouth washing in the ulcerative cases it is advisableto use internally chlorate of potash. The druggist should be requestedto make a two-ounce saturated solution, and of this you can giveone-half teaspoonful, largely diluted with cool water, every hour duringthe day for the first twenty-four hours, then every two hours untilmarked improvement is shown, when it can be further reduced bylengthening the interval between doses. 

SPRUE--THRUSH

Sprue is a form of sore mouth. It is seen only during the first sixmonths of life, as a rule. It affects the mucous membrane of the mouth;it appears in the form of small white spots that look like drops ofcurdled milk. They are on the inner surface of the cheek and may be allover the mouth, and on the tongue. The spots are firmly attached, and ifforcibly removed the mucous membrane will bleed. 

The disease is caused by infection through lack of cleanliness and itinvariably affects poorly nourished children, especially those who arebottle-fed. 

There are no symptoms other than those of the mouth; the childfrequently refuses to nurse because of evident pain and distress whilenursing. The condition is not contagious. It may be cured in from six toeight days without difficulty. 

Treatment. --Mouth irrigations of boracic acid are all that arenecessary. They are given in the following way: Place the child on itsside, roll around the index finger a piece of absorbent cotton, dip thisin a saturated solution of boracic acid, and put into the mouth of thechild. Let the cotton take up as much of the solution as it will hold, so that when it is lightly pressed on the tongue and cheeks it will flowout of the mouth, thus "irrigating the mouth. " Repeat this a number oftimes, pressing the cotton to a different part each time. This should begone through from four to six times daily. 

If the child is a bottle-fed baby, care should be taken in cleaning thenipples and bottles as directed on page 264. If the patient isbreast-fed, care must be taken to note that the mother's nipples areclean. They should be washed with the same solution of boracic acid andnot handled. If the child cannot nurse it is necessary to feed it with aspoon. 

In obstinate cases the parts may be touched with a one per cent. Solution of formalin. Mothers should particularly note not to use honeyand borax, as is often recommended by women who know no better, in anydisease of the mouth in children. 

 * * * * *

CHAPTER XXXV

DISEASES OF THE STOMACH AND GASTRO-INTESTINAL CANAL

Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting--AcuteGastric Indigestion--Iced Champagne in Persistent Vomiting--AcuteIntestinal Diseases of Children--Conditions Under Which They Exist andSuggestions as to Remedial Measures--Acute IntestinalIndigestion--Symptoms of Acute Intestinal Indigestion--Treatment ofAcute Intestinal Indigestion--Children with Whom Milk Does NotAgree--Chronic or Persistent Intestinal Indigestion--AcuteIleo-colitis--Dysentery--Enteritis--Entero-colitis--InflammatoryDiarrhea--Chronic Ileo-colitis--Chronic Colitis--SummerDiarrhea--Cholera Infantum--Gastro-enteritis--Acute Gastro-entericInfection--Gastro-enteric Intoxication--Colic Appendicitis--Jaundice inInfants--Jaundice in Older Children--CatarrhalJaundice--Gastro-duodenitis--Intestinal Worms--Worms, Thread, Pin andTape--Rupture

ACUTE GASTRIC INDIGESTION

Acute Inflammation of the Stomach--Acute Gastritis--PersistentVomiting

An infant seldom has real inflammation of the stomach. Gastric, orstomach, indigestion is the better name, because it actually signifiesthe true condition. It is indigestion that causes a child to vomit, though it is possible to have a true inflammation caused by the takingof irritant or corrosive drugs. 

Gastric indigestion causes sudden, repeated vomiting, with prostrationand occasional fever. It is caused by unsuitable food, the wrongquantity of food, irregular feeding, and food the quality of which isnot good. 

Treatment. --The stomach should be immediately washed out. Until thephysician arrives the mother can encourage the child to drink a largequantity of cool boiled water. This will be vomited and it will wash outthe stomach at the same time. No further treatment may be necessary, asthe vomiting may stop. All food should be withheld for at leasttwenty-four hours. A high rectal irrigation should now be given. It isessential to know that the bowel is absolutely clean in all vomitingcases. The normal salt solution is the best agent to use for a highenema in infants. (See page 586. )

After twelve or twenty-four hours' abstinence from food, the child canbe given teaspoonful doses every twenty minutes of cooled boiled water, or barley or albumen water, weak tea, or chicken broth. Cold liquids arebetter retained and more readily taken than those that are heated. Ifthe liquid feedings are vomited, another twelve hours must elapse beforetrying stomach feedings. In these cases we must try to satisfy thethirst by giving cold colon flushings. If the case becomes protractedand we find it impossible to nourish the child by the mouth, we mustwash the stomach out once every day with a five per cent. Solution ofbicarbonate of soda, and feed the child by the rectum. Sometimes we canfeed through the stomach tube. Liquids will frequently be retained whenput into the stomach through a tube when they will be vomited ifswallowed. 

The best food by the rectum is plain peptonized milk. 

Drugs are absolutely useless. If the vomiting persists, despite theabove efforts to stop it, there is nothing to be gained byexperimenting. You will not only render the condition worse but you willweaken the child. Morphine given hypodermatically is the only remedy. Given in appropriate doses, according to age, it is absolutely harmless. It will not only stop the vomiting, but it will give the child amuch-needed rest, by allowing it to go to sleep. When it wakes up itwill be stronger and its stomach will most likely retain small doses ofnourishment. 

Great care must be exercised, in getting the child back on a normaldiet, not to try to go too fast. 

In cases of persistent vomiting in children I have found it advisable touse teaspoonful doses of ice-cold champagne. These children willsometimes keep this down when all other liquids will be vomited. It isabsolutely necessary to keep the child lying down. If he isrestless or sits up, the vomiting may begin all over again. Thechampagne not only is excellent nourishment for the child, but it quietsthe stomach, allays irritability, and frequently favors sleep, duringwhich time a cure very often results. The champagne must be drawnthrough a champagne siphon (procured in the drug store), and the bottlemust be kept on ice with the mouth downward; otherwise it will get stalevery quickly and be of no use. If kept as advised it will remain good tothe end. 

SUMMARY:--

1st. Persistent vomiting in a child means acute gastritis. Stop all foodfor twenty-four hours. 

2nd. Encourage the child to drink large quantities of slightly warmwater; this will wash the stomach out and frequently stops the vomiting. 

3rd. When the child is quiet wash out the bowels. 

4th. If vomiting persists, use iced champagne as directed. 

ACUTE INTESTINAL DISEASES OF CHILDREN

The large infant mortality that results from intestinal diseases duringthe summer months is deserving of the most careful consideration, bothof the physician and the parent. 

Apart from the excessive heat of the summer, there is no doubt that anunfavorable environment, which means bad hygienic surroundings, badsanitary conditions, bad food and home influences, contributes largelyto the enormous number of these serious cases. Education, while it maybe expected to influence favorably the sanitary and other conditions inthe home, cannot change the home location. The child must continue tolive in the same environment. It is in this class of cases that thesesummer diseases are so very fatal. Children in better circumstances cantake advantage of conditions which are denied to the tenement child. Thediseases must therefore be faced and treated under these existingconditions. 

In addition to the climate and the environment, there are certainfactors that occur in all classes which result in intestinalderangement. If the stomach or bowels are not performing their functionproperly, or if the food or method of feeding is wrong, these, plus veryhot, humid weather, invariably result in serious intestinal disease. Themother must be taught to interpret properly the meaning of a green, loose stool in the summertime; she must appreciate that it is the dangersignal and must be regarded seriously. 

The very best preventive against summer diseases of the intestine is toguard particularly against any trouble with the child's stomach at allseasons of the year. A healthy stomach and bowel will resist disease, even in very hot weather. 

The most important food product which has a direct relationship to thisclass of diseases is milk. In a large city like New York it will remainimpossible to solve the milk problem, despite the splendid efforts ofthe Health Department and the members of the medical profession, untilthe city itself shall establish milk depots and ice stations where safemilk, and ice to keep it safe, may be obtained at a nominal cost, orfree, if the parents cannot afford to buy it. We, therefore, mustrecognize that the vast majority of children to-day are taking milk thatis not suited to them, that is really not fit as a food for children. The mothers do not know this and no steps are taken to render the milkmore safe for them to feed to their children. These mothers are willingto do what is essential in the interest of their children, but they donot know what should be done. These people cannot afford a physician ora nurse to teach them, nor do they even know that their methods arewrong or that they need any instruction. We must carry the informationand the explanation to them. We must show them the need for a change ofmethods. This is the work for those charitably disposed women who desiresome worthy purpose in life, who really wish to do some real good. Allthe equipment they need is good common sense. They will tell thesemothers why it is necessary to pasteurize the milk before feeding it tothe baby. They will show how to keep the nursing bottles clean, and the nipples sweet and fresh. They will instruct them how to dressthe baby in the hot weather and impress them with the need of giving itall the cool, fresh air possible. In short, they will gain theconfidence and the good will of these mothers in a tactful anddiplomatic way, and they will tell them all they know in language whichthey will understand regarding the care of the baby. In every city inthe country this work is needed and is waiting for the missionaries whowill volunteer. To teach mothers the need for boiled water as anecessary drink for baby and older children is alone a worthy avocation. To impress upon one of these willing but ignorant mothers the absolutenecessity for washing her hands before she prepares her baby's food, that she must keep a covered vessel in which the soiled napkins areplaced until washed, that she should frequently sponge her baby in thehot weather, and explain thoroughly why these are important details, isa work of true religious charity. They should be specially taught toimmediately discontinue milk at the first sign of intestinal trouble, togive a suitable dose of castor oil and to put the child on barley wateras a food until the danger is passed. They should be taught to know thesignificance of a green, watery stool, they should know that is the onedanger signal in the summer time that no mother can ignore withoutwilfully risking the life of her baby. They should be taught to preparespecial articles of diet when they are needed. If every mother wereeducated to the extent as indicated in the above outline the appallinginfant mortality would fall into insignificance. It is not a difficulttask nor would it take a long time to carry it out; it is the work forwilling women who have time and who perhaps spend that time in lessdesirable but more dramatic ways. 

It is the knowledge that aids in catching disease in its inception thatcounts. The worst infections begin as a mild condition and prompttreatment robs them of their sting. When treatment is delayed and thechild is fed for twenty-four hours too long on milk, the condition whichin the beginning could have been stopped promptly has developed and itbecomes a fight for life. 

It will be seen from the above that all we need is education. Education of the mother primarily, but education of the missionary, thenurse, the physician, the municipality, and the State, eachco-operating, each willing to work in the interest of a great cause, forthe benefit of the human race and for the brotherhood of man. 

ACUTE INTESTINAL INDIGESTION

Causes. --Overfeeding, unsuitable and improper food, irregular andindiscriminate feeding, sudden change from one food to another, as atweaning time, a change from a poor quality to a rich food, or viceversa. Conditions affecting the health of the child, especially thenervous system, such as hot weather, extreme cold, fatigue, or at thebeginning of any of the acute diseases. Children sometimes arepredisposed to attacks of intestinal indigestion; these children aredelicate in health and have weak digestive ability. The slightestirregularity or error in diet will cause an attack in these children. 

Symptoms. --The attack may come on suddenly or it may develop slowly. The important constitutional symptoms are fever, prostration, and ageneral nervous irritability. The child is seized with pain in theabdomen. The pain is referred to the region around the navel. It issharp, colicky, and severe, causing the child to cry out and draw up itslegs in an effort to lessen its severity. The child is exceedinglyrestless and acts as if it were on the verge of a dangerous illness. Gasin the bowel is not present as a rule as frequently as it is in infantsunder the same circumstances. In a few hours diarrhea sets in, thestools may number from four to twelve or more in twenty-four hours. Thestools are acid, sour, and the odor may be very foul. They are thinnerthan usual and frothy from the presence of gas. 

In very young infants suffering from a sudden attack of intestinalindigestion, the stomach, as well as the bowels, is invariably upset. Ifthe indigestion is the result of a slower process, the stomach does notparticipate in the process. The color of the stools in infancy is yellow, then yellowish-green, and later grass-green. Undigested food isalways present and in infants the curdled casein of the milk appearsas white specks or lumps in the movements. 

The fever is high in the sudden cases and lower in the cases of gradualonset. The prostration is more severe when the onset is sudden and ininfants may be very marked. 

The termination of the disease depends upon the cause, the treatment, and the previous health of the child. In healthy children promptly andproperly treated it may be all over in a week. In delicate, poorlynourished children, and especially in the summer time, it may be thebeginning of trouble that may eventuate in death. 

Treatment. --There is no condition in the whole realm of diseases ofchildhood where the knowledge of the mother may have such importantresults as this condition. The most effective time to treat these casesof intestinal indigestion is before the physician is called. There arefew diseases in which time is so valuable, so far as final results areconcerned, as it is here. Every mother should know the significance of aloose, green stool. She should be taught that it means danger andconsequently demands prompt treatment. The first indication is to empty, thoroughly, the bowel. The best means for this purpose, if it isimmediately procurable, is calomel. If calomel is not procurable at oncegive castor oil, two teaspoonfuls to an infant, one tablespoonful to anolder child. Calomel should be given in one-eighth-grain doses, repeatedevery three-quarters of an hour for eight or twelve doses, until thebowel is thoroughly cleaned out. Don't be afraid of a few extramovements at the beginning. Better clean out thoroughly at the startthan to be compelled to do it all over again after the child is weak andsuffering from the poison of the disease. The next important thing to dois to stop milk at once. The thirst is usually intense and if vomitingis not present it can be moderately relieved by giving small quantitiesfrequently of cool boiled water or mineral water or strained albumen orbarley water. We quite often have to stop all food and liquids by themouth for twenty-four hours. 

If the prostration is very great and the child looks as though itmight collapse, it can be given brandy in cracked ice from time to time. 

After the bowels have been thoroughly cleaned out, never before, somemedicinal agent may be given to stop the unnecessary diarrhea. In a verylarge number of promptly and properly treated cases this is not needed. If it is thought best to use it the physician will select the agentaccording to the conditions present and prescribe it. 

Breast-fed infants rarely have intestinal diseases of a severe type. Ifthey should develop diarrhea they must be taken off the mother's milkfor twenty-four hours. They should be given a dose of castor oil orcalomel and fed on barley water in the interval. The feedings should bereduced in quantity and the interval doubled. The two-hour interval willbecome a four-hour feeding: the three or four ounces at each feeding canbe reduced to two ounces. The intention is to simply give as little aspossible while the diarrhea is under way. 

The mother's breasts must be pumped at the regular feeding time in orderto preserve the flow, release the pressure, and keep the milk fresh. 

It is sometimes a problem to renew feedings of milk without exciting arelapse of the diarrhea. It should not be tried until the stools arenormal in color and consistency. This may not be for three or four days. In resuming the milk it should be given in smaller amounts and dilutedwith lime water or barley water for the first day. Gruels may be givento which skimmed milk may be added: later add the ordinary milk. If itis well digested and does not cause any return of the diarrhea, thequantity of milk can be slowly increased until the former feedings areresumed. It is often of very great advantage to boil the milk for sometime. Peptonized milk is safe and can be used in bottle-fed infantsafter diarrhea. In older children, meat, broths, eggs, boiled milk, anddry toast bread may be used sparingly for some time. Cereals, vegetables, fruits, should be withheld for a considerable time andwatched carefully when resumed. Kumyss, buttermilk, matzoon, bacillac, and other fermented milks are better borne than plain milk. All ofthese children need rest, fresh air, change of air, frequent bathing, and tonics, as an attack of this kind leaves them depressed, weak, languid, and anemic. 

SUMMARY:--

1st. When a child complains of sharp, colicky, severe pains in theabdomen, around navel, which are shortly followed by foul, sour, frothydiarrhea, --greenish in color, it has acute intestinal indigestion. 

2nd. Every mother should know that a green stool means danger. Sheshould know to give at once a cathartic, --castor oil is good, but give agood large dose--then stop all food for twenty-four hours. If she learnsthis lesson she will have time to wait for the doctor; meantime, she mayhave saved her child's life. 

CHILDREN WITH WHOM MILK DOES NOT AGREE

Contrary to the general belief, there are quite a large number ofchildren in whom milk seems to act as a poison. These children are notnecessarily constipated. They suffer, however, from a slow, continuousintestinal toxemia or poison. The symptoms of this condition areheadache, disorders of speech, habitual sleep-talking, sleep-walking, and general nervous irritability without cause: they are listless, languid, and constantly tired. They may be bright in the morning andsleepy in the afternoon. They are irritable and cross and touchy. 

Treatment. --Milk must be wholly discontinued. Eggs must be restrictedto one every second day, and meat but once daily. The use of greenvegetables is particularly suitable and should be given daily. Cerealsand fruit also are good. Malted milk, kumyss, or matzoon may be given inplace of milk. If constipation is present, rhubarb and soda mixture isan excellent laxative in these cases. A tonic should be prescribed forall these children. 

DYSENTERY--ENTERITIS--ENTERO-COLITIS--INFLAMMATORY DIARRHEA

Cause. --Any cause which has been mentioned as a cause of ordinarydiarrhea may result in this disease. It may occur at any time of theyear and at any age. It may follow the infectious diseases. It mayfollow any other disease of the intestines. 

Symptoms. --It may begin like an ordinary attack of acute intestinalindigestion. There is usually vomiting, fever, pain, and frequent yellowor green stools. The passages may be blood-stained and there may belittle or much mucus. The stools at the beginning have no odor as arule. The bowels move very frequently, often with little or nothing topass. There may be pain with each movement. The blood may disappear in afew days, but the mucus remains, often in large quantity in each stool. 

At the beginning the fever is high, but it soon falls and remains lowduring the attack. The child loses weight, is irritable, has noappetite, and looks and acts sick. When the attack is over thesechildren do not gain their strength as readily as we would like;recovery is slow. 

The acute symptoms usually last about one week, after this time thechild begins to recover, but the process is a tedious one and one inwhich much care has to be exercised. It is an encouraging sign to notethe disappearance of the blood in the stools and the return of themovements to the normal brown color. When these favorable signs arewanting the bowel is probably ulcerated and it will take a much longertime to return to normal and to be free from blood and mucus. 

The above is the ordinary form of this disease and it ends in recoveryas a rule. There is a more severe form, however, which differs from theabove in the following way:

The fever is high and remains high; the stools are more frequent andthere is more blood and more mucus in them; the child is much moreirritable and is more profoundly sick. Death may occur at any time fromthe second day. If the little patient survives, the return to health isa very slow process; it often takes months and frequently years before areasonable degree of strength is regained. Relapses are common, andthey are very difficult to treat and care for. In some cases the childnever wholly regains its former strength. 

There are children who have been the victims of other intestinaldiseases or conditions who develop colitis. The colitis in these casesmay come on suddenly with vomiting and high fever, or it begins slowly, with no vomiting and with little fever. Their appetite is poor, theirdigestion is feeble, their prostration is pronounced. They lose fleshrapidly and may be emaciated to a remarkable degree. Very few of thesecases recover completely. Serious and sometimes fatal relapses may takeplace. The feeding of these children is a difficult task and thegreatest care must be constantly taken; a very little mistake may costthe life of the child. 

Treatment. --All diseases of the intestine in childhood should bepromptly and efficiently treated. If any form of diarrhea is neglected, it may result in the development of ileo-colitis with all its risks anduncertainty. When a child is seized with sudden bowel trouble, no matterwhat variety it is, it should be treated with the greatest care because"sudden" bowel trouble usually means plenty of trouble if it isneglected. 

Fresh air is essential in all these cases. A change of air is of decidedvalue as soon as the immediate symptoms have abated. The diet is thesame as for children who have gastro-enteric intoxication. Later, muchdifficulty will be met because these patients have absolutely noappetite, --peptonized skimmed milk is always good, beef broths are oftenwell borne, liquid beef peptonoids may be tried. The food should begiven every three hours. Boiled water and stimulants may be givenbetween the feedings. Later in older children, raw beef, eggs, boiledmilk, kumyss, or matzoon and gruels may be given. Great care has to betaken for months after an attack; relapses may be caused by changes oftemperature, by fatigue, and, of course, by improper feeding. Thesechildren should avoid potatoes, tomatoes, fruits, corn, oatmeal, and agreat many other things which an intelligent mother would not give anysick child, as candy, cakes, pastries, etc. 

Cases which begin with free vomiting, thin stools; and fever should betreated at once. The bowels must be thoroughly cleaned out, the colonshould be thoroughly irrigated, and all food should be stopped. Whenthere are bloody stools with mucus and pain we must depend upon castoroil, irrigations of the colon, and opium and bismuth by the mouth. Agood big dose of oil at the beginning is always necessary. If, however, the stomach is irritable and will not tolerate castor oil, we maysubstitute calomel in one-fourth-grain doses every hour for six doses, to be followed by citrate of magnesium. Irrigation of the colon in thesecases is one of the essential means of successful treatment; it shouldbe done twice a day during the first few days of the disease. 

Stimulants are needed in all the cases. They help the heart, act as afood, and tend to quiet the general nervousness by favoring sleep. Goodbrandy given in boiled cool water is the best stimulant. 

After the child is over the worst of the acute symptoms all medicineshould be withdrawn and the proper kind of food given. Tonics will aidin restoring the strength. Cod Liver Oil during the following winter isa very good plan to aid in building up the vitality of the weakenedbowel, but it must not be given too soon. 

CHRONIC ILEO-COLITIS--CHRONIC COLITIS

Chronic Ileo-colitis fellows the acute variety. Cases which areunusually severe or which have been badly managed are likely to becomechronic. A child suffering from this disease presents the followingpicture: The patient is emaciated, the abdomen is usually enlarged withgas, the feet are cold, the circulation of the blood is poor, the feveris low or absent altogether except when the child is having a relapse, when it jumps up suddenly. The bowels are loose and contain mucus, frequently in large quantities. The mucus may stop for a few days; thenit appears again with a rise of temperature accompanied with loosestools with foul odor. These children are exceedingly nervous andirritable and are very poor sleepers. 

Parents should be told it will be impossible to effect a rapid cure ofthese cases. It often takes months to get them started on the safe road. The slightest mistake or change in the weather will upset the progressof the cure and it will be necessary to begin all over again. The entirehope of cure rests with the mother. She must be faithful, patient, andmust carry out the physician's instructions implicitly. The managementconsists in diet, change of climate, and such other treatment as thephysician finds necessary in each individual case. 

Treatment. --In children under one year of age the only hope is breastmilk, which must be given in small quantities. They do not do well onany starch food for a considerable period. 

Where breast milk is not available the whites of two or three eggs maybe given daily. They may be beaten up and given in skimmed milk, or inplain water with a little salt added. Zwieback or bread crumbs may begiven in small quantities. They should be fed at four-hour intervals. 

Older children may take skimmed milk, raw scraped beef, junket, andcoddled white of egg or raw egg, bread crumbs, toasted, or zwieback. 

A rectal enema must be given every twenty-four hours if the bowels havenot moved. If constipation is the habit a laxative should be given; thearomatic fluid extract of cascara sagrada or magnesia are suitable. Atleast one free movement every day is essential to success. 

Colon irrigations are only to be used when there is a rise oftemperature, irrespective of whether the bowels have moved or not. 

When convalescence is established these children should be given amaximum of fresh air and should be treated as recommended in cases ofmalnutrition. 

SUMMER DIARRHEA

As the name implies, this is the form of diarrhea that is so common, especially in cities, in summer. It is always preceded by some mildercondition which paves the way for the more serious diarrhea. Acuteindigestion is, as a general rule, the forerunner of cholera infantum. The influence of hot weather must always be kept in mind as theunderlying factor which no doubt conduces to gastro-intestinal diseaseof infancy and childhood. The depression incident to a spell of hot andpossibly humid weather tends to interfere with the digestive process ofbabies and children. When this function is carried on imperfectly, thestrength and vitality of the child fails, and if immediate steps are nottaken to check the process, diarrhea makes its appearance. If thesechildren are improperly fed, or if their surroundings are not sanitary;if they are not getting fresh air enough, or if they suffer because oflack of attention, and have at the same time a little indigestion, it isonly a step further to develop a full-fledged cholera infantum. 

The outcome of any case of summer diarrhea is questionable. It is notsafe to make any promise. An apparently mild attack may prove quicklyfatal. Much depends upon the previous history of the child. If it hasbeen a strong, healthy child it has a very good chance if treatedenergetically and correctly. If it has previously suffered from badnutrition, is not robust, has had trouble with its stomach, etc. , thechances are against it. 

The one lesson to be learned by all mothers is, as stated above, to actquickly; to be on the watch all through the summer months for anytrouble with the baby's stomach or bowels. It is much easier to treatand cure a little trouble than to battle against an establishedgastro-enteric intoxication. Overfeeding and indiscriminate feeding mustbe religiously avoided, --they are the two most prolific causes ofstomach and intestinal troubles in childhood. 

Symptoms. --The onset is sudden and pronounced. The child begins tovomit and continues vomiting and retching persistently. The bowels areloose, and large, watery, greenish stools are frequent. The prostrationis very marked, the child looks seriously sick, respiration is quick andshallow, the eyes sunken, the skin becomes ashen gray in color, and thepulse is soft and very rapid. The fever may be very high or it mayremain low. The low febrile cases are the worst. 

If taken in hand quickly and if the treatment is energetic and if thechild reacts, the case may go rapidly on to recovery and the child bewholly well in a few days; or it may not react, but be overwhelmed bythe poison and sink and die in twenty-four hours. 

Treatment. --In the treatment of cholera infantum it must not beforgotten that the dangerous element is the poisoning of the system thatis constantly going on. It is difficult for the non-medical mind toestimate the importance of this element. It is, of course, caused by thebacteria present in the gastro-intestinal canal. There are numberlessmillions of bacteria in the normal healthy bowel. A very largepercentage of those germs are good for us, are there for a beneficentpurpose, and can and do protect us from other germs which occasionallyfind their way into the bowel and whose purpose is not a peaceful one. When the bowel condition changes, as during an attack of summerdiarrhea, it is invaded by multitudes of evil-intentioned germs. Thesegerms find conditions in the diseased bowel exceedingly favorable tothem, so they begin work in an active, energetic way. The result oftheir activity is highly poisonous, and, as the good germs are virtuallyout of business and are consequently not working in our interest, we areabsolutely in the hands of the enemy. There is soon manufactured, bythese invading germs, enough poison to poison the entire system of thechild. It is this feature that we must combat in summer diarrhea. 

It is absolutely essential to keep these cases as much in the open freshair as possible. No matter how sick they may be, this rule must beobserved. Light clothing is advisable. 

If it is a city child that is affected and it does not show decidedimprovement in three or four days, it should, if possible, be sent tothe country. There is always distinct danger of a relapse in every case, so the little victim should be given a change of air as soon asconvalescence permits. The seashore is preferable to the mountains inall intestinal cases. 

In the care of these patients cleanliness is an important factor andcounts much in the ultimate cure. The child, as well as the clothing, should be kept scrupulously clean. Napkins as soon as soiled should beremoved and put into a disinfecting solution. The buttocks should bewell powdered after each movement to prevent sores developing. 

Feeding must be stopped at once. No food of any kind should be given forat least twenty-four hours, or until the tendency to vomit subsides. Thethirst must be allayed, however, so we give frequently small quantitiesof thin barley water or albumen water or cold boiled water. If these arevomited we must stop giving them altogether for twenty-four hours. Ifthe fever is high and the skin dry, the child should be given a coolpack, 85° to 90° F. , which can be moistened every half hour with waterat this temperature; this will often control the fever satisfactorily. Hot-water bottles should be placed at the feet if they are cold. 

If, on the other hand, the fever is very low (below normal), the child'scirculation poor, the skin blue and cold, a hot-water bath at 108° F. , for five minutes (rubbing the surface of the body while in the bath), will be of very great service. The bath may be repeated at half-hourintervals. 

If the patient is a breast-fed infant it can be allowed to nurse afterthe twenty-four-hour rest. The length of time it is permitted to stay atthe breast should be about one-quarter of the time it was allowed beforethe attack began. If it does not vomit, the nursing can be repeatedevery four hours. As the case progresses toward recovery the intervalbetween feedings can be shortened. Care, however, must be taken not toshorten the interval too rapidly. 

If the patient is artificially fed and is not over four months old, asubstitute for the milk must be found. The best substitutes are rice orbarley water, either plain or dextrinized, the malted foods, chicken orbeef broths, liquid peptonoids or bovinine. Water (boiled and cooled)may be allowed at all times if not vomited. 

Older children are treated in the same way. All food is withheld whilethere is any vomiting. When vomiting stops begin with small quantitiesof beef broth, or chicken, or veal broth. Later kumyss or matzoon can betried, and finally thin gruels made with milk. 

If vomiting persists the stomach must be washed out; this can be done bygiving the infant or child a large drink of cool boiled water. This willbe immediately vomited and it will clean the stomach at the same time. The stomach-pump may be used to better advantage. One washing is usuallysufficient. The vomiting will stop after the stomach has been washed outand the patient may then be given, frequently, small quantities of coldalbumen water or barley water. 

The bowel should be thoroughly cleaned out at the beginning of everysummer diarrhea. Castor oil or calomel are the two best cathartics forthis purpose. If the stomach is not upset use castor oil. If the stomachis upset use calomel; one-fourth of a grain every hour for eight doseswill be sufficient. Give enough, however, --there is no danger at thebeginning of the attack of too free movements of the bowel. Whatevercathartic is given, it should produce green, watery stools. 

Irrigation of the bowel is an exceedingly effective way of cleaning outthe poison-laden large intestine. It should be done in every instanceunless the movements are watery and of such frequency as to renderirrigation unnecessary. Once or twice daily will be sufficient in eventhe worst cases. The irrigation should be given at the temperature of100° F, and should be the normal saline solution; a long rectal tube isused to give the irrigation. 

SUMMARY:--

1st. Cholera infantum is one of the most dangerous, one of the mosttreacherous, and one of the quickest acting diseases of childhood. 

2nd. Don't temporize, don't delay, don't regard lightly any diarrheaduring the summer time. 

3rd. Give a large dose of castor oil and withhold all nourishment untilthe doctor sees the little patient in every case of diarrhea during thewarm weather. 

4th. Keep the child in a cool, quiet place and don't handle or annoy it. 

5th. Follow, your doctor's directions implicitly. The fight may beshort, sharp, and decisive. Don't pave the way for regrets afterward. Doeverything while you have the chance. 

COLIC

Colic is a common condition in infancy. Very few children escape more orless colic during the first few months of life. It does not seem toinjure permanently some infants; they go on growing according tostandard, eat and sleep, and seem contented and happy despite occasionalsevere attacks of colic. Other children suffer seriously; the degree ofindigestion is considerable, and the nutrition of the child isinterfered with. 

Colic is much more frequent in bottle-fed infants than in those fed onbreast milk. Cow's milk, no matter how skillfully it is prepared fortheir use, is at best an unsuitable diet and taxes the digestive abilityof robust children. It is quite natural for an infant whose digestiveorgans are not strong to develop colic and intestinal indigestion if puton artificial food. Any condition that causes indigestion may likewisecause colic. Those children who are always overfeeding, --taking too muchmilk, too strong milk, or who are fed irregularly, --are the colickybabies. 

Constipation is frequently associated with colic and may be the actualcause. A daily movement of the bowel does not necessarily mean that thebowels are emptying themselves satisfactorily. Despite the dailymovement, there may be considerable fecal matter left in the bowel whichundergoes decomposition. This results in the evolution of largequantities of gas and severe attacks of colic. Indigestion is very oftencaused by conditions which effect the stability of the child's nervousorganism; such conditions are fright, anger, fatigue, exhaustion, excitement. 

The origin of the colic in breast-fed children is very often caused bysome nervous condition of the mother that affects her milk. Constipationin the mother may cause colic in the child. 

Symptoms. --A baby having an attack of colic will cry loudly from timeto time and whine during the interval; it will pull up its legs and beardown. Its abdomen is tense and hard and distended with gas. With theexpulsion of the gas the pain ceases and the child falls asleep. If theattack is very severe the prostration and exhaustion is marked; the feetare cold and the body is bathed in perspiration. 

If the colic is constant the child may be fretful and restless most ofthe time, being seemingly comfortable for only an hour or two in thetwenty-four. 

In older children who cry because of severe pain in the abdomen thepossibility of appendicitis must not be forgotten. 

Treatment. --Find out the cause of the colic if possible. If the causeis located in the mother, the remedy naturally must affect her. Regulation of her bowel, restriction of her diet, and proper exercise, may be sufficient to effect a cure of the colic in the infant. 

The object of treatment is to help the child get rid of the gas. Thebest and quickest means to effect this is to apply massage or give arectal injection. An injection of two ounces of cold water in which ahalf or one teaspoonful of glycerine has been put, will act quickly. Dryheat applied to the abdomen in the form of the hot-water bottle orwoolen cloths will aid in the expulsion of the gas. The feet should bekept warm. 

In cases of habitual colic in breast-fed babies the cause may be in thequality of the mother's milk. It should be examined and if found toostrong should be diluted. This can be done by giving the child an ounceof plain boiled water or barley water before each feeding. If the childgets an ounce of liquid before each feeding he will not want as much ofthe breast milk; so we shall have the same total quantity, but a reducedquality, which may cure the colic at once. 

It is necessary, in order to cure colic, that the bowels move every dayin a satisfactory manner. If any aid is needed, milk of magnesia is thebest laxative. It may be given in teaspoonful doses in water previous toa feeding. Aromatic cascara sagrada in from ten to thirty-drop doses isa very good laxative, if a stronger remedy is needed. 

To relieve the acute attack, three drops of Hoffman's anodyne may begiven in two teaspoonfuls of warm water and repeated in ten-minuteintervals until relieved, to a baby under one year of age. From five toten drops of gin, given in three teaspoonfuls of warm water, andrepeated in fifteen minutes, is also satisfactory and harmless. A verygood remedy which may be used with the above for quick relief, and tostop the child from crying, is the following: Fold a piece of flannelcloth (two thicknesses) the size of the baby's abdomen; wring out ofvery hot water and drop ten drops of turpentine over the surface, --atdifferent spots, --of the flannel and lay on abdomen, --turpentine sidenext skin. Cover this with another piece of flannel, --two or threethicknesses, that has been dry-heated and allow to remain in place forabout ten minutes. 

Colic, as a rule, disappears completely about the third month. 

APPENDICITIS

Appendicitis is mentioned here merely to acquaint mothers with itsprominent symptoms. 

When a child has what seems to be an attack of indigestion, butcomplains of pain and tenderness in the abdomen, vomits, and develops afever, and is constipated, appendicitis may be suspected. 

The pain and tenderness are not referred to the region of the appendixbut are more centrally located. If, however, the finger point is pressedover the appendix, distinct tenderness will be elicited in inflammationof that region. Constipation is the rule in appendicitis, but diarrheaoccasionally accompanies it. 

The abdominal muscles may be rigid, that is, the abdomen does not feelsoft as is usual; there is a feeling if they are pressed, as if theywere hard and unyielding. 

Treatment. --Put the child in bed and send for the family physician atonce. The condition is too serious and too uncertain to delay, or for aparent to make any effort at treatment. Appendicitis is a much moreserious condition in infancy and childhood than it is in an adult. 

JAUNDICE IN INFANTS

There are two types of jaundice in infants that deserve briefconsideration. 

1st. There is a form of jaundice caused by a defect in the developmentof the bile or gall tubes. These infants develop jaundice a day or twoafter birth and become intensely jaundiced within a very brief time. They lose flesh and strength to a marked degree and die in a few weeks. It is not possible to affect this condition favorably by any method oftreatment. This type of jaundice is not very common. 

2nd. There is a type of jaundice that appears between the second andfifth day of life that is very common. It lasts from one to two weeksand then disappears. It is never fatal and is not serious. It requiresno treatment. 

JAUNDICE IN OLDER CHILDREN--CATARRHAL JAUNDICE--GASTRO DUODENITIS

Symptoms. --This form of jaundice begins like an attack of ordinaryindigestion. There are, as a rule, pain, fever, vomiting, andprostration. The pain is located in the upper part of the abdomen andmay be quite severe. The vomiting may continue for a number of days. Thebowels are usually constipated. After a few days the jaundice sets inand may be quite intense. After the jaundice is established the stoolsare gray or white in color and there is much gas in the bowel. The urineis very dark and may be yellow or yellowish-green in color. The childcomplains of headache, is dull and listless, and appears sick and weak. The condition lasts about two weeks, but the jaundice may last muchlonger. It is not a serious disease. 

Treatment. --The diet should be cut down in quantity and should consistof rare meat, fruit, and a small quantity of milk. If vomiting continuesthe milk may diluted with lime water or vichy water. The child shoulddrink water or vichy water freely. No starchy foods, or fats, or sugarsshould be allowed. The bowels should be kept open with calomel, one-tenth of a grain every hour until ten are taken, to be followed bycitrate of magnesia every morning. If the pain is severe it may berelieved by a mustard paste or a turpentine poultice. The child shouldbe given acid hydrochloric diluted, eight drops in one-half glass ofwater, ten minutes before each meal--and kept on it for at least onemonth. 

INTESTINAL WORMS

There are three types of intestinal worms; they are known as theround-worm, the thread-worm, and the tape worm. 

Round-Worm. --The round-worm is usually found in children of therun-about age. It is never seen in infancy. It occupies the small orupper intestine, and is from four to ten inches long. If there areround-worms in the bowel, there are usually a number of them and theremay be hundreds. 

Symptoms. --Round-worms give no definite symptoms. The only possibleway to tell if they are present is actually to see them in the stools ofthe child. They are of a light gray color. 

It is reasonable to expect that a child suffering from worms will havesymptoms of abdominal distress from time to time; indigestion with colicand much gas may be present; children lose their appetites and arenervous and restless; sleep is disturbed; they may grind their teeth andtalk in their sleep, and they may pick their noses unnecessarily duringthe day. These symptoms may, however, accompany other conditions when noworms are present in the bowel. My observation has been that in childrenin whom worms were present the nervous symptoms were distinctlyaccentuated. They are unreliable children; they seem well to-day andpeevish to-morrow; they complain of headaches, dizziness, and chillyfeelings. They are hysterical, noisy, uncontrollable. A child with thesesymptoms should be suspected of having worms and if no cause can befound to explain his temperamental vagaries he should be treated forworms. I have cured a number of children of excessive nervousness bygiving them medicine for worms when no worms were present. Such resultscan only be explained on the assumption that these children weresuffering from intestinal auto-toxemia or self-poisoning, and thethorough disinfection of the bowel apparently stopped the process byridding the child's system of a mass of bacteria, which were undoubtedlycausing the auto-toxemia and consequent nervousness. 

Treatment. --The most efficient remedy for removing round-worms isSantonin. The quantity necessary for the various ages is as follows:

 Two to four years 2 grains. Four to six years 3 grains. Six to ten years 3-1/2 grains. 

The best way to give it is in divided doses, with an equal quantity ofsugar of milk. For a child of six years the formula would therefore be, 3-1/2 grains of Santonin, mixed with the same quantity of sugar of milkdivided into three powders. These powders are given four hours apart inthe following way. The child is given a light supper the evening beforeand one-half glass citrate of magnesia the following morning and thefirst powder one-half hour later; no breakfast being given. A lightlunch, of milk and crackers, may be taken about noon. The second powderis given four hours after the first, and the third four hours after thesecond. Half an hour after the last powder, a dose of castor oil (onetablespoonful) is given. In a few moments the bowels will move; usuallythere are no worms in this movement. A little later they will movefreely again and if worms are present they will be discharged in thismovement. 

Thread-Worm, or Pin-Worm. --A thread-worm looks just like a littlepiece of white thread. They are found in the lower part of the bowel andin the rectum. They are usually present, if present at all, in largenumbers. 

Symptoms. --The chief symptom is itching. It may be limited to the anusor it may involve the neighboring parts. Thread-worms may find theirway out of the anus and in female children may find their way into thevagina. In these instances the child is tormented with itching of theprivates and may establish the habit of self-abuse as a result of theconstant itching and scratching. The itching is more intense at nightsoon after the child goes to bed. As a result of the local irritation inthe lower part of the bowel and rectum there is set up a catarrh of thebowel which produces large quantities of mucus. 

Treatment. --The only medication by the mouth that is of any use isturpentine in one drop doses after meals, given in a teaspoonful ofsugar. The best treatment, and in most cases the only treatment that iseffective, is the use of rectal injections. The procedure is asfollows:--The child first gets a cleaning injection of two quarts ofwarm water into which a teaspoonful of borax has been put. This willwash away any mucus or fecal matter that may have collected. Thisinjection is best given with a No. 18 rectal catheter which is pushedinto the rectum for about 10 inches, the water being allowed to run awayas it enters. From six to eight ounces of the infusion of quassia isthen passed, as high up as the catheter will reach. It is intended thatthe quassia will remain in as long as possible, for at least half anhour. In order to assure this there are two features that should be keptin mind: first, the water should be allowed to flow in slowly, consequently hold the bag low, not higher than two feet above the levelof the bed on which the patient lies; second, after the water is all inremove the catheter very slowly and keep the child absolutely quiet. This treatment is repeated every second night for a week, then twice aweek for four weeks. 

A solution of garlic is a very effective remedy and may be tried if thequassia fails, which is not likely if the treatment is carried outeffectively and if the parts are kept scrupulously clean. 

Tape Worms. --Tape worms are obtained from eating raw meat, pork orsausage, rarely from fish, and from playing with cats and dogs. 

Symptoms. --No definite symptoms accompany the presence of tape worm. The children may have pains in the abdomen, diarrhea, a capriciousappetite, foul breath, and they may suffer from anemia, sometimes quiteseverely. The only positive symptoms is the presence of links of theworm in the stools. 

Treatment. --Give a dose of castor oil at bed time. Two hours afterbreakfast next morning give one-half dram of the oleoresin of male-fernin emulsion or capsule. Very light nourishment should be taken duringthe day, composed of gruels and soups. When the worm is passed it shouldbe examined to find if the head is present; if not, the treatment shouldbe repeated in twenty-four hours. 

RUPTURE

Rupture of any description is not a condition that any mother shouldattempt to treat. A physician should be called in every case. Anymisdirected effort at manipulation or pressure may result in irreparableinjury to the parts. External applications are useless and may beinjurious. 

All ordinary forms of rupture in infancy and early childhood are curableif properly treated. 

 * * * * *

CHAPTER XXXVI

DISEASES OF CHILDREN, CONTINUED

Mastitis or Inflammation of the Breasts in Infancy--Mastitis in YoungGirls--Let Your Ears Alone--Never Box a Child's Ears--Do Not Pick theEars--Earache--Inflammation of the Ear--Acute Otitis--SwollenGlands--Acute Adenitis--Swollen Glands in theGroin--Boils--Hives--Nettle Rash--Prickly Heat--Ringworm in theScalp--Eczema--Poor Blood--Simple Anemia--Chlorosis--SevereAnemia--Pernicious Anemia

MASTITIS, OR INFLAMMATION OF THE BREASTS IN INFANCY

There are a few drops of a milky secretion in the breasts of infantswhen born. Occasionally the amount will be in excess of the normalquantity, and the breasts, around the nipple, may be swollen andslightly inflamed. Should this condition persist, it may be relieved bypainting the parts with the tincture of belladonna. Under nocircumstances should the breasts be manipulated or rubbed, as this isvery apt to cause an inflammatory condition, and to result in mastitis. 

Mastitis begins, as a rule, during the second week of life. The breastbecomes red, swollen, painful, and shows inflammatory changes. It mayterminate without the formation of an abscess, or it may go on tosuppuration. The child becomes extremely restless and irritable, it isdisinclined to nurse, and suffers from loss of sleep and nourishment. Itis possible for such a condition, in the female, to injure the breast tothe extent of arresting its development and to render it useless in thefuture. If the suppuration is extensive the process may terminatefatally. 

Mastitis in infants is caused by unnecessary interference andmanipulation and by want of cleanliness. When it occurs the parts shouldbe kept absolutely clean and should not be handled in any way. Ichthyol25 per cent. , Zinc Oxide Ointment, enough to make one ounce, spreadupon old, clean, soft linen, and laid over the parts and changed everysix hours, is an excellent healing application. A piece of oiled silkmay be put outside the linen to prevent the ointment staining theclothing, and over this a layer of absorbent cotton and a binder, applied without pressure. 

If an abscess develops in spite of treatment, it must be freely openedand freely drained, and the general health of the patient supported byregular nourishment and tonics. 

Mastitis in Young Girls. --Pain and swelling of the breasts aresometimes complained of by girls between the twelfth and fifteenthyears, though it may occur at an earlier or later date. If left alonethe condition will invariably subside without treatment. Should bacteriafind an entrance through the nipple at this time, an abscess may result. The whole breast is involved and it will be exceedingly painful and muchswollen. There may be moderate fever, headache, and a pronounced feelingof indisposition. These patients should be given a laxative, --citrate ofmagnesia, or Pluto Water, and kept on a very light diet. An ice-bagshould be kept constantly at the breast during the day, and a moistdressing of 1:5000 bichloride of mercury during the night. 

It may take a week before recovery takes place. 

LET YOUR EARS ALONE

Never Box a Child's Ears. --A single blow may make a child deaf;repeated blows on their ears will certainly injure children's hearing. 

Thomas A. Edison, our greatest inventor, was made deaf when a lad by asurly brakeman, who soundly boxed his ears for some trivial or fanciedoffense. 

Boxing a child's ears is but one of a great many things you should neverdo to the ears. In fact, there are far more things you should not do tosafeguard the hearing, than there are things you can do to benefit yourears. 

Do Not Pick the Ears. --Do not put cotton in the ears unless ordered todo so by a reputable physician. Do not syringe the ears without thedoctor's orders. Put no poultices in the ears. Do not put drops of anykind in the ears unless prescribed by a doctor. Above all, do not usethe advertised ear cures, as most of them are harmful. Never blow into achild's ear, never douche the nose without the doctor's orders, as thismay wash germs into the tubes leading to the ears and bring about aserious condition. 

Riding in tunnels, especially in tunnels under water where the airpressure varies, has, through some recent investigation, been found tobe injurious to the ears of a great many people. 

Conductors and other trainmen who run through many tunnels are apt tohave ear trouble, as are the men who work underground a great depthwhere they are in motion, such as miners running underground trains. 

If you have an earache that continues for any length of time, take nochances, but consult a physician. And remember to care for the throatand nose, as ill conditions in those places result in ear troubles. Donot blow your nose too hard; it merely injures the inner sides of theear drums. Adenoids in children frequently bring about a bad eartrouble. Even seasickness is due in a great measure to ear disturbances. 

If you have a running ear, attend to it at once by visiting a doctor. Soserious is this that life insurance companies will not insure people inthat condition. 

Earache. --When a child complains of earache its ear should beexamined. In nearly every case of earache it is necessary to treat thethroat, as this is, as a rule, the seat of the trouble. An antisepticgargle of equal parts of Borolyptol and warm water is an excellentmixture. It should be used freely every two hours. Children sufferingfrom earache should be kept indoors. If the examination should show thatit is not necessary to lance the ear drum, some local measure may beadopted to allay the pain. Putting the child in bed with the headresting on a hot-water bottle may be all that will be necessary. Thefollowing procedure may be carried out, but only after a physician hasmade an examination and according to his directions: A hot water douche, given by means of a douche bag, is quite effective. The water should be110° F. ; the bag should be held about two feet above the level of thechild's head, and the irrigating point should not be pushed into theear, but held so that the water will find its own way into the ear. 

When the earache does not respond to the above methods the ear should beclosely watched and examined at intervals so that it may be opened atthe right moment. This is very essential because, if it is neglected, the pus may find its way into the mastoid cells and set up the dangerousdisease, mastoiditis. This disease may cause abscess of the brain anddeath. The moment a child develops fever in the course of an earache theear should be examined and opened at once, if found necessary. 

Inflammation of the Ear. Acute Otitis. --Inflammation of the ear seldomoccurs in childhood, unless as a complication, or as a result of someinfectious disease. Any disease which affects the throat in any way maybe the cause of the inflammation of the ear. Such diseases are, "cold inthe head, " tonsilitis, grippe, "sore throat, " or pharyngitis, measles, scarlet fever. It is much more common in children than in adults. Theyounger the child, the more liable it is to develop ear trouble whensuffering from any of the above diseases. The presence of adenoidsfavors the development of ear complications. 

Symptoms. --There is one symptom present in all cases of inflammationof the ear; that is, fever. Pain may or may not be present; it ispresent in a majority of the cases. Children with inflammation of theear are exceedingly restless and do not sleep long at a time nor do theysleep soundly. 

Treatment. --The treatment is to open the drum membrane, at the righttime, which of course will always be done by a physician who has hadsome experience in this work. 

After Treatment. --The after treatment consists of washing or syringingthe ear every three hours with eight or twelve ounces of a 1:10, 000solution of corrosive sublimate. This will be kept up for four days;then the intervals between the washing will be extended to five hours, and kept up until the drum membrane closes. If the corrosive sublimatesolution should cause any eruption around the ear, a normal saltsolution (see page 627) may be used in the same way, and in the samequantity as above. A running ear will run for from three to six weeks. It may heal up at any time after ten days. If the discharge shouldsuddenly stop and the fever rise, it indicates that the opening hasbecome plugged or healed too quickly. In either case it will have to beopened again. As soon as the ear begins running again the symptoms willdisappear. After syringing the ear it should be dried thoroughly withpieces of sterile absorbent cotton. 

The best syringe to use for washing out the ear is a one-ouncehard-rubber ear syringe with a soft rubber tip. An ordinary douche bagwill do if a syringe of the above character cannot be obtained. Thedouche bag should not be held higher than two feet above the patient'shead. The double-current ear irrigator is an excellent device for thispurpose. The child should be on its back on a table. Its arms should befastened down by its side. A basin can be placed under its ear and theirrigating done without causing any pain or discomfort. 

Any child addicted to disease of the ear should be closely watched andexamined for tuberculosis. Scrofula may accompany this condition. Thesechildren need careful attention in every little detail, they need goodnourishment, fresh air night and day, and they should not be pushed atschool. During the winter they should be protected from "catchingcolds;" it is a good plan to put them on a cod-liver-oil mixture for theentire cold season. During the summer they should have a radical changeof climate. 

SUMMARY:

1st. Inflammation of the ear is frequently a complication of or followssome other disease which affects the throat. 

2nd. If a child with one of these diseases becomes restless, sleeplessand feverish, be on the look-out for ear trouble. 

3rd. The ear must be lanced immediately when necessary. 

4th. The after treatment is very important, because the hearing of thechild depends upon it. 

SWOLLEN GLANDS. ACUTE ADENITIS

Swollen glands in infancy and childhood are usually seen below andbehind the ear, less frequently in the groin. Their cause is, as a rule, local disturbance in the mouth or throat, as decayed teeth, enlargedtonsils, cold in the head, catarrh, adenoids, or some form of infectionof the mouth, or throat, or scalp. They occasionally accompany scarletfever, diphtheria, measles, and influenza. They seldom suppurate. 

Symptoms. --A swelling is noticed just below the angle of the jaw; itdoes not grow rapidly. There is a slight temperature and the child ismore or less irritable. If the patient is an infant, the fever may bequite high and there may be considerable prostration. The trouble lastsfrom four to eight weeks. 

Treatment. --An ice-bag constantly applied is the best treatment. Thisnot only relieves pain, but it prevents the possibility of the glandbreaking down and suppurating. It is sometimes difficult to keep anice-bag on an infant, in which case cold compresses should be applied. These are made by taking several layers of old linen or cheese cloth andlaying them on ice. They should be applied frequently to the swollengland. The following ointment may be applied, though the ice-bag is thebetter and more certain treatment: Ichthyol 25 per cent. , Adeps Lanaeone ounce. This is applied on cloth and renewed every six hours. 

This ointment is black and stains the clothing. For that reason it isadvised to use oiled silk over the cloth to avoid staining the pillow orclothing. 

Children suffering from adenitis should use a spray of Dobell's solutionin the nose and throat three or four times daily. If the cause of theswollen glands is known, treatment for its cure should be promptlyinstituted. 

In the event of pus forming the gland must be opened and drained. 

Swollen glands in the groin of a child are caused most frequently bysome inflammatory condition of the privates, which should be discoveredand treated. 

BOILS

In some delicate children and in some children who do not seem to bedelicate, repeated crops of boils may appear from time to time. 

It is necessary to open them as soon as pus is present. They should bepressed out and a gauze dressing, wet with a saturated solution of boricacid, bound over them. The dressing should be kept moist. 

I have in a number of instances successfully rid a child of the tendencyto boils by the use of the following formula, which I can recommendhighly as one of the best tonics I have ever used in the treatment ofdelicate and poorly nourished children: Tinct. Nux Vomica 4 drops, AcidPhosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make atwo-ounce mixture and give to children over four years of age oneteaspoonful after each meal; to younger children, one-half teaspoonfulafter each meal. 

It is necessary in these cases to keep the bowels open daily. 

HIVES. NETTLE-RASH

Cause. --Contact with different plants, bites of insects, irritationfrom clothing, use of certain drugs. Certain articles of food, such astomatoes, strawberries, oatmeal, buckwheat, have all been said to causehives. 

Dentition during warm weather and the presence of worms and chronicmalarial poisoning have been known to cause hives. 

It is most frequently caused, however, in childhood by some disturbancein the stomach or bowels. 

It causes severe itching and loss of sleep and as a result of these thegeneral health suffers. 

Treatment. --If caused by any external irritant, remove it. If it iscaused by any special article of diet, prohibit its use. If no cause isapparent, give the child one tablespoonful of castor oil, and put it onthe mildest diet possible of soups, broths, and dried stale bread. Giveno milk. Use the following treatment on the erupted parts: Menthol, tengrains in one ounce of cold cream. Keep the bowels open. 

It is sometimes necessary to advise a change of air before complete cureresults. 

PRICKLY HEAT

This is a very common complaint in children during the summer months. Itis so common that it is well known and easily recognized. It consists ofa bright red eruption, composed of little papules, close together. 

The rash comes out quickly, so much so that mothers may be surprised andfrightened by observing an angry looking rash on their baby some morningwhen none was there the night before. It most frequently appears uponthe neck, back, chest, and forehead. It is exceedingly itchy and a childmay scratch itself and cause extensive harm. Eczema, of a very obstinatetype, frequently results from scratching. 

The rash of prickly heat is easily diagnosed from other rashes becauseit is accompanied by no other symptom, such as fever, which wouldsuggest a more serious disease. The rash of prickly heat resembles therash of scarlet fever more than any other rash, but it is quickly notedthat when a child has scarlet fever it has every symptom of beingprofoundly sick, while prickly heat has no symptom other than the itchand discomfort. It is caused by overfeeding, being overclothed, andsweating in hot weather. 

Treatment. --Steps should be taken to prevent prickly heat in aninfant. Use light, seasonable clothing, bathe frequently, and use plentyof good toilet powder. When the child actually has an attack, open itsbowels freely with citrate of magnesia, and give some sweet spirits ofniter, according to age. Protect the skin from the irritating underwearby interposing a soft piece of linen. In order to reduce theinflammation and cure the condition apply equal parts of starch andboric acid powder freely. Keep the patient on a light fluid diet. Thebran bath is advisable if the little patient is addicted to these skineruptions. 

RINGWORM OF THE SCALP

Children of all ages are liable to "catch" ringworm of the scalp. Itparticularly affects those who are untidy, dirty, and badly cared for, though any child is apt to get it while attending the public schools. 

If a mother discovers scaly patches in the scalp, with loss of hair, ringworm should be immediately suspected. It is not, however, alwayseasy to diagnose the condition, especially if the case is a mild one. Ifit is a severe attack, there is, as a rule, quite a little inflammation, and this may render the condition obscure for some time. The disease maybe mistaken for dandruff, but dandruff covers a large area of the scalp, while ringworm is limited and sharply defined. Dandruff may cause a lossof hair; if it does, the hairs come out clean, while in ringworm theybreak off near the scalp. 

Treatment. --Ringworm is always curable, provided the patient iswatched and treatment carried out thoroughly. It is always absolutelynecessary to treat the condition, because it will not get better ofitself, and the longer it is permitted to last, the worse it gets, andthe more difficult it is to cure. If treatment is begun at once, it maytake two months to cure it. If the case has lasted for some time, or ifit has been neglected and not treated thoroughly, it will take from sixmonths to one year to cure it. These facts are stated so that parentsmay not become discouraged. 

The first thing to do is to cut the hair as close to the scalp aspossible, wherever the ringworm is, and for about an inch outside, andall around it. The entire scalp should be thoroughly washed three timesa week. The scales should be kept soft by the use of carbolic soap. 

The hair should not be brushed at all, because brushing the hair mayspread the disease to other parts of the scalp. Every child withringworm of the scalp should wear a cap of muslin or one lined withpaper, so that others may not be infected. These caps can be burned whendirty and new ones made. One of the best remedies to apply to theaffected area is the following: Bichloride of mercury, 2 grains; oliveoil, 2 teaspoonfuls; kerosene, 2 teaspoonfuls. This is rubbed in everyday until the parts are sore and tender. It is a good plan to apply thismixture to the entire scalp every fourth day, to guard against otherparts becoming infected. It is not necessary to rub it in when using itwhere there is no ringworm. 

When the scalp becomes sore from the application it can be stopped for aday or two, or until better; then begin again and repeat the treatmentright along. If the kerosene in the above mixture is objected to, a verygood mixture is bichloride of mercury, 2 grains, and tincture of iodine, 1 ounce. This may be rubbed vigorously enough to produce a rash. If thedisease shows a tendency to spread under this treatment it is best toapply the latter mixture to the entire scalp. 

Ringworm on any other part of the body is effectually treated byapplying tincture of iodine. It should be painted on every day until theskin begins to peel, when the ringworm will disappear with the skin. 

ECZEMA

Eczema is the most important skin disease of babyhood. It is probablythe most frequent skin disease of infancy. Any baby may develop eczema. There are, however, some babies who seem to be very susceptible to it. The reason of this susceptibility seems to be due to the naturaltenderness, or delicacy, of the skin. These children, because of theextreme sensitiveness of the skin, develop an eczema from a very slightdegree of external irritation, or a trifling disturbance of digestion. Children of rheumatic or gouty parents are more liable to be victims ofeczema than are others. Eczema of the face is quite common in childrenwho are apparently healthy and fat. It does not seem to matter whetherthey are breast-fed or bottle-fed. The following conditions may beregarded as contributory to eczema:

Exposure to winds; cold, dry air; heat; the use of hard water or strongsoaps; lack of cleanliness, and the irritation of clothing. Itfrequently accompanies chronic constipation, indigestion, and otherconditions of the intestinal canal; overfeeding; too early or tooexcessive use of starchy foods. 

Eczema of the Face:--Eczema Rubrum. --This is the most frequent form. It affects the cheeks, scalp, forehead, and sometimes the ears and theneck. It begins on the cheeks as small red papules. These join togetherand form a mass of moist, exuding crusts. They dry in time and may be sothick as to form a mask on the face. The skin may be much swollen. Whenthe crusts are removed the face looks red and angry and bleeds easily. It is exceedingly itchy. It causes restlessness, loss of sleep, and itmay affect the appetite, though, as a rule, the health remains good. Eczema of the face is exceedingly chronic; it improves from time totime, but it is cured with great difficulty only. 

Infants suffering with eczema of the face begin to improve about themiddle of the second year and may be entirely cured about this time. Thereason of this is the greater amount of exercise the child is getting atthis period. If the disease continues longer it is because of theunnecessary amount of fat that the child has. 

Treatment. --Eczema is a notoriously tedious disease. There is verylittle tendency for it to improve, if left to itself. The age, theseverity, and just how much you can rely upon the mother, or nurse, faithfully to carry out directions--upon these its cure depends. Atbest, the treatment may have to be carried out for months. If the eczemais accompanied with constipation and indigestion in infancy, very littlecan be done with the eczema until these conditions are removed. 

There exists in the minds of the laity, and in some physicians also, anidea that it is wrong, or dangerous, to cure, or "dry up, " an eczema. Itis never dangerous, but highly desirable, to cure an eczema, wheneverpossible. It is always wise, because it is always necessary, to get thechild in perfect condition before you treat the eczema. Cure theconstipation, or indigestion, or cold, or whatever is the matter withthe child; then treat the eczema. This is the only plan that offers anysuccess. It is not a simple matter to find out why a nursing child ishaving indigestion. The most minute care must be exercised to find outthe element in the milk that is causing the eczema. It would, however, be foolish, and a waste of time, to apply pastes, etc. , to an eczema ofthe face, while the real cause that produced it was still in existence. It will frequently be found necessary to change the food entirely. Strict attention to the bowels is essential, both in infants and inolder children. Sometimes to cure the constipation means an immediatecure of the eczema. 

If the child is anemic, poorly nourished, and flabby, tonics areadvisable. Cod liver oil is of use in quite a number of these cases. Eczematous children should not be taken out when the weather is verycold or when there are high winds. They should not be washed with plainwater, or with castile soap and water. When washing is necessary, do itwith milk and water, to which one teaspoonful of borax is added. Theclothing must not be too heavy. 

In eczema of the face, the child must either wear a mask or heavy woolengloves, so that he will not scratch the parts. Frequently these fail, and it will be necessary to restrain the child from scratching the faceby the use of some mechanical device. A piece of strong pasteboardbandaged on the elbows, so as to prevent the child from bending them, isall that is necessary. If the child cannot bend the elbows he cannotscratch his face, yet he has the free use of his hands. 

The use of external remedies is imperative, as frequently the cause ismostly external, and in other cases it must be used in addition to thegeneral treatment. Before external treatment is instituted, the crustsshould be softened by applying olive oil to them for twenty-four hours, after which they can be removed with soap and water. If there is muchinflammation, or if the face looks angry, a very good application isLassar's paste. 

Later, when the inflammation has subsided and the itching is severe, amixture of tar ointment, 3 teaspoonfuls; zinc oxide, 1-1/2 teaspoonfuls;rose water ointment, 6 teaspoonfuls has proved to be one of the verybest. 

When the eczema on the face is of the weeping, or moist, variety, theapplication of bassorin paste gives splendid results. 

When an external remedy is applied to any eczematous surface it isnecessary to apply it on a cloth. Simply to smear it on will do no good. 

In the treatment of eczema, when the children are breast-fed, it is wellto remember that the real cause of the eczema may be in the mother. Ifthe mother is constipated, or if her diet is too liberal, if she isdrinking beer, or an excess of coffee, or is not taking exercise, theeczema may be caused by one or other or all of these. 

For eczema of the scalp the remedy to use is white-precipitate ointment, 1 part; vaseline, 4 parts. Mix together and apply. 

POOR BLOOD. SIMPLE ANEMIA

Causes. --There is what may be termed an unnatural tendency toward poorblood during infancy and childhood. The explanation of this anomalouscondition is, that the tax or strain put upon the blood to provide forthe growth of the child is severe, and is in addition to the greatdemands made upon it in the exercise of its regular duties. We must, therefore, always take this special duty into consideration, when thequestion of recuperation, convalescence, feeding, and the administrationof blood foods and tonics comes up. 

It is not necessary to specify the diseases from which a child maysuffer and recover, in an anemic condition. Any disease may leave achild with temporarily poor blood. The conditions which most frequentlyproduce anemia in childhood are improper feeding and unhealthysurroundings. It is not fully appreciated how seriously these conditionscan affect the health of growing children. There is one condition thatevery mother should be warned against, namely, the possibility of undulyprolonging breast-feeding. Children should be weaned at the end of thetenth month. By prolonging the breast-feeding a mother can undermine thevitality and strength of her baby and so impoverish its blood as toinvite disease. A bottle-fed baby should be put upon a mixed diet at thesame time. To continue feeding a child exclusively on milk for a yearor two after weaning, simply because "it will not take anything else, "is criminal. Any woman guilty of such stupidity should never have becomea mother. Once again it must be emphasized that every child must have anabundance of fresh air, must not be confined in close, hot, unsanitaryrooms, and must have a daily, satisfactory movement of the bowels to bea healthy child with good blood in its body. 

Symptoms. --Children suffering from poor blood are flabby, constipated, hungry, weak specimens of childhood. They are under weight, complain ofheadache, pains, disturbed sleep, are nervous and irritable. They tirequickly, are short of breath, and may have a tendency to faint easily. The hands and feet are cold, the pulse is small and irregular. They mayhave attacks of nose-bleeding and of bed-wetting. 

Chlorosis. --Chlorosis is that form of anemia, of poor blood, whichoccurs in young girls about the time their sickness begins. It is mostfrequently seen between the fourteenth and seventeenth years, and moreoften in blondes than in brunettes. The cause is not known. It isthought to be due to constipation. Any occupation which is deleteriousto health has a distinct influence on the condition. Employment infactories, confinement in badly ventilated rooms, bad or insufficientfood, great grief, care, or a bad fright, mental strain, overstudy, mayall produce, or contribute to the production of chlorosis. 

Symptoms. --The symptoms of chlorosis resemble those of simple anemia. Children suffering from anemia are pale; girls with chlorosis have apeculiar greenish yellow tint in the skin. They are short of breath, they have vertigo, palpitation, disturbances of digestion, constipation, cold hands and feet, and scanty or arrested monthly periods. They havevarious nervous disturbances, such as headache, pains in various partsof the body, neuralgia, especially over the eyes, hysterical attacks, and sometimes cholera. Ulcer of the stomach is sometimes seen in thiscondition. 

The disease lasts for a year or longer; it frequently lasts a number ofyears. Relapses are frequent. 

[Illustration: By permission of Henry H. Goddard

"A Misfortune at Birth"]

Warren is feeble-minded. His family said it was due to "a serious fallof the mother. "

 [A]"The family history is, however, exceedingly interesting. 

 "The paternal grandfather, whom we have called Nick, was of good family, although he himself was totally different from the rest. He was weak in every way, and to be considered feeble-minded. He married into a family that was much lower socially than his own, although we have no proof that it was a defective family. The children of this couple were all mentally defective and low-grade, morally as well as intellectually. 

 "Warren's father, Jake, a thoroughly disgraceful character, married Sal, a woman somewhat older than he. 

 "The immorality of this family beggars description. A girl named Moll was fifteen years old when Jake brought her into his home: his wife, Sal, was so feeble-minded that she allowed the illicit relations between these two. Moll's child was born in the hospital after the mother had been sent away from one Home because of her horrible syphilitic condition--from which she finally died. 

 "Our boy Warren's sister Liz with whom the father lived in incestuous relations, was also allowed to live illicitly with a man who worked for her father. She was so simple that she talked openly about her relations with her father and with this man. When a child was to be born the man married her. 

 "This is not all, but enough: and sufficient to show what feeble-mindedness leads to when it takes the direction of sexual abuses. "

[A] "Feeble-mindedness: Its Causes and Consequences, Goddard, TheMacmillan Company. 

Severe Anemia: Pernicious Anemia. --This is the most severe form ofanemia, or the condition in which we have the poorest blood. While thiscondition frequently results in death the others rarely ever do. Thiscondition is not common in childhood. 

Symptoms. --There is intense weakness and prostration. The skin is verypale, the mucous membranes are bluish white. The breath is markedlyshort and there is often dropsy of the limbs and feet. Fever is oftenpresent and quite high. The disease lasts a number of months; thepatient often feels better for a time, then relapses into a more seriouscondition than before. 

TREATMENT OF THE VARIOUS FORMS OF ANEMIA

Simple Anemia. --Find the cause and stop it. In infancy specialattention should be given to diet and hygiene, giving the child plentyof fresh air, and a change of air to the country or seashore ifnecessary. The general treatment is more important than any benefit thatmay be derived from drugs. The rules laid down in the articles on"Malnutrition" must be closely followed in these children. 

Chlorosis. --In this form of anemia, or poor blood, it is best to giveiron. Change of air and change of scene are of special importance inthese cases and will frequently cure. The general condition of coursemust not be overlooked. The diet, exercise, bowels, habits, shouldreceive careful attention. Iron should be continued for a number ofmonths after all traces of the anemia have disappeared. 

Pernicious Anemia. --For this condition arsenic is the one remedyneedful. In all conditions of poor blood the most careful attentionshould be given to the general health. Colds must be guarded against. The patients should never get their feet or their clothes wet. Muscularexercise, because of the weak condition of the heart, should bemoderate, and only given on the advice of a physician. It is frequentlynecessary to stop all forms of exercise and in many instances we get thebest results by directing complete rest in bed for a considerable partof the day or for all day if the case demands it. 

 * * * * *

CHAPTER XXXVII

DISEASES OF CHILDREN, CONTINUED

Rheumatism--Malaria--Rashes of Childhood--Pimples--Acne--Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis--Incontinence--Sleeplessness--Disturbed Sleep--Nightmare--Night Terrors--Headache--Thumb-sucking--Biting the Finger Nails--Colon Irrigation--How to Wash Out the Bowels--A High Enema--Enema--Methods of ReducingFever--Ice Cap--Cold Sponging--Cold Pack--The Cold Bath--Various Baths--Mustard Baths--Hot Pack--Hot Bath--Hot Air, or Vapor Bath--Bran Bath--Tepid Bath--Cold Sponge--Shower Bath--Poultices--Hot Fomentations--Howto Make and How to Apply a Mustard Paste--How to Prepare and Use theMustard Pack--Turpentine Stupes--Oiled Silk, What it is and Why it isUsed. 

RHEUMATISM

This is a rather common disease of childhood. It occurs most frequentlybetween the ages of nine and thirteen years. Children can have it, however, at any age. 

The symptoms of rheumatism in children are much the same, thoughsomewhat milder, as when the disease is present in an adult. Childrenare not quite as sick, nor is the fever as high, nor is the pain asgreat as in a grown person. In children the disease does not last aslong, as a rule. Sometimes it will jump from one joint to another, andmay, as a consequence, become chronic. When a child has once hadrheumatism, it has the same disposition to recur that it has in adults. The principal danger of rheumatism in children is its tendency to attackthe heart. Even mild attacks of the disease can do serious damage to theheart. 

Children who have the rheumatic tendency invariably suffer frominflammatory conditions of the upper respiratory tract. They are proneto have recurring colds, tonsilitis, and sore throats. Treatment ofconditions without regard to the underlying rheumatism is neversatisfactory. These children complain of indefinite pains, now in oneplace, now in another. These pains are commonly known as "growing-pains"and, inasmuch as they are rheumatic and not "growing pains, " they shouldbe regarded seriously because of the heart damage they might do ifignored, and especially so since the mildest attacks of rheumatism, without any joint symptoms even, frequently leave the heart in very badshape. As a general rule it will be found that when a child has had anumber of attacks of bronchitis or asthma it is rheumatic and shouldreceive treatment for the rheumatic tendency. 

Children with the tendency to rheumatism invariably eat too much redmeats and sugar, --the latter in the form of candy or as an excess in thefood. 

Treatment of an Acute Attack. --The child should be put in bed and keptwarm. The bowels should be freely opened with citrate of magnesia. Thediet should be very light: milk and lime water or milk and vichy water, with a piece of dry toast or zwieback, is all the child needs until thefever is relieved. When a single joint is affected local measures may betaken for its relief. Wraping the joints up with flannel cloths whichhave been wrung out of true oil of wintergreen, and outside of thisoiled silk snugly bandaged on, is an excellent external application. Theflannel cloths should be kept moist by adding a little of thewintergreen from time to time as it dries in. This can be done withoutremoving the bandage. This application is kept in place for twenty-fourhours and renewed if necessary. Such an external application will aid inthe actual cure of the disease and will quickly relieve the patient ofthe pain. The oil of wintergreen used in this way should be the "true"oil, and should be so specified when bought in the drug store. 

Because of the great tendency to attack the heart a physician shouldtake charge of every case of acute rheumatism in a child. 

To Treat the Tendency to Rheumatism. --Exclude red meats and sugar inall forms as much as is possible. Give green vegetables freely, potatoesboiled with the skins on, fish, eggs, and poultry. Cereals with milk, especially well cooked Scotch oatmeal, are exceedingly good for thesechildren. By keeping up this diet after the acute attack has passed fora considerable time, it is possible to cure the various other complaintswith which the child is afflicted, --tonsilitis, sore-throats, wintercoughs, head-colds, bronchitis, asthma, etc. 

These children should wear woolen underwear all the year round. Theyshould be encouraged to drink water or vichy freely between meals. 

In the treatment of an acute attack as given above it will be observedthat no drugs are mentioned. This is intentional because it would beunjust to encourage the home treatment of a disease that is sotreacherous, even in its mildest forms. Because of its tendency to recurand with each recurrence the danger of the heart being affected, it isadvisable to put these children on cod liver oil or iron or some othergood tonic. Every precaution should be taken to prevent these childrenfrom getting their feet wet or being out in the rain. 

SUMMARY:--

Rheumatism is a dangerous disease in children. 

In its mildest forms it can affect the heart badly. 

It has a distinct tendency to recur. 

Rheumatic children are afflicted with a number of diseased conditionswhich do not respond to treatment unless the rheumatism is treated. 

Acute rheumatism should never be treated except by a physician becauseof its treacherous character. 

MALARIA. INTERMITTENT FEVER

Malaria occurs quite often in infants and children. As a rule the childgives evidence of gastro-intestinal disturbance for a short periodbefore the malarial symptoms appear. The chilly stage is often absent. Sometimes the hands and feet are cold and may be slightly blue and thechild may appear to be in collapse. This stage may last for an hour orlonger. The chilly stage may, however, be replaced by nervoussymptoms, --restlessness, dizziness, irritability, nausea, etc. , --or aconvulsion may take place. In the second stage the temperature may risequite high, the pulse may be quite rapid; the child is flushed, restless, and cries. This period may last from half an hour to twohours. The sweating stage is not as a rule well marked in a child. Itmay be very slight or not at all. 

Between the attacks some children may be entirely well; others remainrestless, have little appetite and poor digestion. Malaria in childrendoes not always follow a typical course. We often see children sufferingfrom spasms, fainting spells, neuralgias, diarrhea, vomiting, and skineruptions, all due to the malarial condition. This often leads to amistake in diagnosis. Intermittent fever is often mistaken forpneumonia. Malaria is not a favorable disease for an infant to have. Itrapidly weakens the child and great debility and anemia follows. 

Treatment. --The treatment for malaria in children is by theadministration of quinine as in adults. It must, however, be given withcare and intelligence; for this reason no mother should begin dosing herchild with it without consulting a physician. 

REGARDING MOSQUITOES

The following is an extract from a circular in relation to the causationand prevention of malaria and the life history and extermination ofmosquitoes issued by the Department of Health, City of New York:

 Extermination and Prevention of Mosquitoes. --Mosquitoes require for their development standing water. They cannot arise in any other way. A single crop soon dies and disappears unless the females find water on which their eggs may be laid. In order to prevent mosquitoes, therefore, the requirement is simple. 

 No Standing Water. --Pools of rain water, duck ponds, ice ponds, and temporary accumulations due to building; marshes, both of salt and fresh water, and road-side drains; pots, kettles, tubs, springs, barrels of water, and other back-yard collections, should be drained, filled with earth, or emptied. 

 Running streams should have their margins carefully cleaned and covered with gravel to prevent weeds and grass at the water's edge. 

 Lily ponds and fountain pools should, if possible, be abolished; if not, the margins should be cemented or carefully graveled, a good stock of minnows put in the water, and green slime (Algæ) regularly cleaned out, as it collects. 

 Where tanks, cisterns, wells or springs are necessary to supply water, the openings to them should be closely covered with wire gauze (galvanized to prevent rusting), not the smallest aperture being left. 

 When neither drainage nor covering is practicable, the surface of the standing water should be covered with a film of light fuel oil (or kerosene) which chokes and kills the larvæ. The oil may be poured on from a can or from a sprinkler. It will spread itself. One ounce of oil is sufficient to cover 15 square feet of water. The oil should be renewed once a week during warm weather. 

 Particular attention should be paid to cess-pools. These pools when uncovered breed mosquitoes in vast numbers; if not tightly closed by a cemented top or by wire-gauze, they should be treated once a week with an excess of kerosene or light fuel oil. 

 Certain simple precautions suffice to protect persons living in malarial districts from infection:

 First: Proper screening of the house to prevent the entrance of the mosquitoes (after careful search for and destruction of all those already present in the house), and screening of the bed at night. The chief danger of infection is at night (the Anopheles bite mostly at this time). 

 Second: The screening of persons in malarial districts who are suffering from malarial fever, so that mosquitoes may not bite them and thus become infected. 

 Third: The administration of quinine in full doses to malarial patients to destroy the malarial organisms in the blood. 

 Fourth: The destruction of mosquitoes by one or more of the methods already described. 

 These measures, if properly carried out, will greatly restrict the prevalence of the disease, and will prevent the occurrence of new malarial infections. 

 It must be remembered that when a person is once infected, the organisms may remain in the body for many years, producing from time to time relapses of the fever. 

 A case of malarial infection in a house (whether the person is actively ill or the infection is latent) in a locality where Anophele mosquitoes are present, is a constant source of danger, not only to the inmates of the house, but to the immediate neighborhood, if proper precautions are not taken. It should be noted in this connection that the mosquitoes may remain in a house through an entire winter and probably infect the inmates in the spring upon the return of the warm weather. 

 Malarial fever is prevalent in certain boroughs of New York City, and in view of the presence of standing water resulting from the extensive excavations taking place in various parts of these boroughs, is likely to extend, if means are not taken for its prevention. 

REGULATIONS OF THE BOARD OF HEALTH, NEW YORK CITY, IN AID OF MOSQUITOEXTERMINATION AND THE PREVENTION OF MALARIAL FEVER

(In Force from March 15 to October 15. )

1. No rain-water barrel, cistern, or other receptacle for rain-water, shall be maintained without being tightly screened by netting, or soabsolutely covered that no mosquito can enter. 

2. No cans, pails, or anything capable of holding water, shall be thrownout or allowed to remain unburied on or about any premises. 

3. Every uncovered cesspool or tank shall be kept in such condition thatoil may be freely distributed so as to flow over the surface of thewater. Covered cess-pools must have perfectly tight covers, and allopenings must be screened. 

4. No waste or other water shall be thrown out or allowed to stand on ornear premises. 

Information is requested as to the presence of standing water anywhere, so that the premises may be inspected and the legal remedies against thesame be applied. 

The prompt coöperation of all persons in the enforcement of the aboveregulations is earnestly desired, and they are assured that in this waythe breeding of mosquitoes on their premises may be prevented. 

Mosquitoes are, so far as known, the only means of conveying malaria. 

"RASHES" OF CHILDHOOD

The following table gives all the characteristics of the rashes thataccompany the eruptive fevers. The term "incubation" means the period oftime which elapses between the time when the child was exposed to, orcaught the disease, and the time when the child is taken sick. It issometimes interesting to know where a child could have caught a disease;so if we know the incubation period we can tell exactly where the childwas on the day, or days, when it was infected. 

-----------+------------+-----------+-----------------+----------+---------+Name | Incubation |Day of Rash|Character of Rash|Rash fades|Duration-----------+------------+-----------+-----------------+----------+---------+Measles | 10-14 days | 4th day |Small red like |On the |6-10 | | |spots resembling |7th day |days | | |flea bites, first|of fever | | | |appearing on face| | | | |and forehead, | | | | |forming blotches | | | | |with semi-lunar | | | | |borders. | |-----------+------------+-----------+-----------------+----------+---------+Scarlet | 1-6 days | 2d day of |Bright scarlet, |On 5th |8-9 daysFever |occasionally| fever |rapidly diffused, |day of | | longer | |first on chest |fever | | | |and upper | | | | |extremities. | |-----------+------------+-----------+-----------------+----------+---------+Chicken-pox| 4-12 days | 2d day |Small rose |Slight |6-7 days | | |vesicles, which |scab of | | | |do not become |short | | | |pustular |duration |-----------+------------+-----------+-----------------+----------+---------+Typhoid | 10-14 days | 7-14 days |Rose colored | |FromFever | | |papules elevated, | |21-35 | | |few in number, | |days | | |limited to trunk, | | | | |disappear on | | | | |pressure. | |-----------+------------+-----------+-----------------+----------+---------+Smallpox | 10-14 days | 3d day of |Small, round, |9th day |14-21(Variola) | | fever |red, hard, |scabs |days | | |papules forming |form and | | | |vesicles then |about | | | |pustules, first |14th day | | | |appearing on face|fall off | | | |and wrists. | |-----------+------------+-----------+-----------------+----------+---------+

Other Rashes. --There are so-called "stomach" rashes which are a sourceof much worry to mothers. These rashes may appear at any time and theymay be limited to certain parts or may cover most of the body. They maybe bright red, or they may be simply a general discoloration. They mayappear as blotches or they may spread all over, like the rash of scarletfever when at its height. 

These rashes are of no importance, except that they indicate somederangement of the gastro-intestinal tract. As a rule they indicateindiscriminate feeding or overfeeding. Children who have had too muchcandy or pastries, or who have been fed things which are unsuited totheir age, frequently develop rashes. Such children should have athorough cleaning out; a dose of castor oil is probably the bestcathartic to give them. 

The mother may readily learn to know the difference between a rash thatis unimportant and one that indicates one of the eruptive diseases, ifshe gives the matter a little careful thought. In the first place achild who is about to become the victim of one of the eruptive diseaseswill be sick, and will have a fever for two or three days before anyrash appears; while on the other hand a child may go to bed in goodhealth and may next morning be covered with a general rash, or withlarge blotches, without any fever and without any evidence ofill-health, except the skin condition. In the second place, if themother gives the child a cathartic and restricts the diet for a day therash will disappear, and good spirits and good health will bemaintained; on the other hand, the giving of a cathartic to a child whois the victim of an eruptive disease will not tend to diminish the rash, but may accentuate it. 

Pimples: Blackheads (Acne). --This eruption is situated chiefly on theface. It may appear, however, on the back, shoulders, and on the chest. It is mostly seen in young men and women about the age of puberty. Itappears as conical elevations of the size of a pea; they are red andtender on pressure, and have a tendency to form matter, or pus, in theircenter. In from four to ten days the matter is discharged but the redspots continue for some time longer. 

"Blackheads" appear as slightly elevated spots of a black color out ofwhich a small worm-like substance may be pressed. Pimples and blackheadsare due to inflammation of the glands of the skin. The mouths of theseglands become filled with dust which acts as a plug causing theretention of the oily matter of the gland which becomes inflamed andhence the pimples and blackheads. Certain constitutional conditionsfavor the development of these skin blemishes. Constipation, indigestion, bad blood from unsanitary and bad hygienic surroundings, self-abuse and bad sexual habits favor the appearance of these skinaffections. 

Treatment. --The patient must avoid tea, coffee, tobacco, alcohol, veal, pork, fats, candy, pastries, cheese, and all edibles that areknown to disagree with the digestion of the patient. Constipation mustbe avoided; if necessary, laxatives may be taken to keep the bowel open. The blackheads must be squeezed out with an instrument made for thepurpose, not with the finger nails. Pimples must be opened with asterile needle. The parts should be washed three times a day with hotwater and green soap, and the following mixture applied at night:--

 Zinc Oxide ounces 1/4 Powdered calamine ounces 1/4 Lime water ounces 6

Mix and shake before applying to the skin. 

CONVULSIONS. FITS. SPASMS

Convulsions are quite common in children, especially those under threeyears of age. 

A convulsion in an infant immediately, or within three months, after itsbirth is the result of injury, either at birth or later (a fall forexample) which seriously affects the brain itself. After the third monththe cause of fits or convulsions is, in a very large percentage of thecases, to be found in errors of diet resulting in disturbances in thestomach or bowels--eating of articles of food difficult to digest, asgreen or overripe fruit, salads, fresh bread, pickles, cheese, etc. Children of a nervous temperament are more liable to convulsions thanare others. Females are more frequently victims of fits than are malechildren. 

In infants convulsions often result from changes in the mother's milk. Mental excitement, deep emotion, anger, frights, severe affliction anddistress will so affect a woman's milk that it will cause convulsions inher child if she nurses it while under the influence of any of theseconditions. 

Convulsions may result from any condition that disturbs the nutrition ofthe child, as, for example, --exhaustion, anemia, intestinal indigestion, blood poison, and general weakness resulting from some severe sickness, especially those of the digestive organs. 

Various forms of brain disease cause spasms and fits; the most commonare meningitis, tumors, hemorrhage, abscesses and injuries. Convulsionsmay accompany certain conditions, as, the presence of worms, teething, severe burns, foreign bodies in the ear, whooping cough, pneumoniascarlet fever, malaria, sometimes measles, typhoid fever, anddiphtheria. Children who are badly nourished and who live constantly inunsanitary surroundings are more apt to have convulsions than those whoare well nourished and who live hygienically. One attack renders thepatient more liable to another, and when the "habit" is established anytrivial cause may incite a convulsion; persistent and systematic effortsshould therefore be taken to prevent the attacks. The best preventivesare:

1st. To regulate the diet and the bowels. 

2nd. Remove adenoids and worms, if they exist. 

3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper foods. 

4th. Guard the child against catching cold, infectious diseases and allfevers. In other words, save the child from the cause and the convulsionwill not take place. 

By regulating the bowels we mean that everything the child eats must beseen by the mother, must be with the mother's permission, and must besuited to the child's age. If there is any question about the latter itwill be advisable to have a physician write out a list of articlessuitable to the child. It is generally necessary to eliminate meats, pastries, candies, sugar to a large extent, gravies, salads, sauces, andall the extras of the table, as pickles, mustard, relish, etc. , as wellas coffee, tea, cocoa, and alcohol. 

The child should live in the open air as much as possible; a daily warmbath, followed by a quick, cold sponge, is a necessity. 

Children subject to fits are possessed of a highly nervous temperament. They are difficult to manage unless managed with firmness and tact. Itis not necessary to be harsh, but it is imperative to be firm anddecided. They must be made to realize that they are not "the master, "that their will is not supreme, and the mother must exact thiscondition; otherwise these children will become dictators and selfishdespots--ruining the discipline of the home, spoiling their own chanceof physical health, and rendering unhappy everyone around them. Theparents, therefore, have a definite duty to perform and it is not aneasy one. The food should be so regulated that each day a naturalmovement of the bowels will take place. (See article on constipation, page 303. ) If a day should pass without a movement the child should begiven a hot rectal enema as described on page 586. 

The adenoids can be easily demonstrated to either exist or be absent. (See page 519. ) If worms are known to be present in the child theyshould be at once removed. If they are simply suspected, the childshould receive treatment for them, just the same. (See page 549. )

By going a long time without a convulsion the nervous system willrecuperate itself, and become so strong and healthy that what once wouldcause a fit will make no impression in its new strengthened state;therefore, if you "save the child from the cause, " the convulsions willcure themselves, as it were. 

There are some cases of convulsions for which no satisfactoryexplanation can be found. 

Treatment. --When a child has a convulsion, remove its clothing and putit into a mustard bath. The temperature of the bath should be 105° F. Every part of the child should be under the water except the head, whichis supported in the palm of the hand. While it is in the bath its body, and especially its arms and legs, should be briskly rubbed by the handsof an assistant in order to keep the circulation active. A rectalinjection of soap suds or plain salt and water (see page 579) should begiven while the child is in the bath, because, as explained above, alarge percentage of these cases are caused by gastro-intestinalderangements. The rectal injection will likely remove the cause. Anordinary convulsion lasts from five to ten minutes. When the child isremoved from the bath it should be placed in a warm, comfortable bed andkept absolutely quiet. A hot-water bottle may be put near its feet andan ice-bag or cold cloths should be kept on its head. It should be givena full dose of castor oil and allowed to go to sleep. Its diet shouldconsist of light broths for two or three days and during this time itshould not be disturbed or annoyed by too much attention. This is as faras it is wise or safe for any mother to go in the treatment ofconvulsions. A physician should be called in every instance, because aconvulsion should never be regarded lightly. Many children have becomeidiots, others have been afflicted with paralysis, because ofinattention at the proper time. 

SUMMARY:--

1st. Convulsions must always be regarded as serious. 

2nd. Convulsions demand prompt treatment. 

3rd. Every mother should know that an English mustard bath--hot--is thefirst resort in convulsions. 

4th. While this is being done she can read the home treatment in thisbook and carry it out before the doctor comes. 

5th. If the fit is not caused by some stomach or intestinal trouble, have the physician find out the cause and tell you what to do, and do itfaithfully, because if you neglect the proper treatment the child maybecome idiotic or paralyzed. 

BED WETTING. ENURESIS--INCONTINENCE

Enuresis, or incontinence of urine, is customary in infancy. Just whenurination becomes a voluntary act depends upon the development andtraining of the individual child. As a rule children can be taught tocontrol this function during the day, or while awake, about the tenthmonth. It is not under control during sleep until a much later period, usually by the end of the second year, but lack of control should not beregarded as abnormal until the child has entered the fourth year. If thechild fails to control the act of urination during the day at the end ofthe second year, and is addicted to habitual bed-wetting, some measuresshould be adopted to cure the condition. 

Boys under twelve years of age seem to be affected more frequently thangirls. It is wrong to assume that it is caused by negligence orlaziness, as some parents do. It has generally a special cause, and thecause usually can be found if it is carefully sought for. It may be theresult of bad habits: exposure to cold in the night; lying on the back;drinking too much liquid in the afternoon or at bedtime. It may be dueto too much acid in the urine, and if so it will be found necessary toreduce meats and eggs the child is eating. Worms, stone in the bladder, some anatomical abnormality or deficiency, may be responsible for it. The diet may be at fault; adenoids are supposed by some physicians to bethe cause. No matter what the actual cause may be, it must be found andremedied before we can hope for a permanent cure. A very large majorityof these cases are due to nervousness. These children are of a nervoustemperament. They are not necessarily sickly children; they are simplyof a nervous type. They are well-nourished, active, and lively. Incontinence of urine during the day and long-continued bed-wetting doesnot at all affect the health of the child. If they are in poor health, it is essential to treat their general condition before trying to curethe incontinence. 

It is absolutely wrong to punish or to crush the spirit of thesechildren. Constant nagging and taunting, even if done in the hope ofshaming the child into a cure, will simply make a coward of him and willnot aid in improving matters, but will be distinctly detrimental. 

Scrupulous cleanliness must be constantly practiced or these children, if neglected, may develop ulcers and sores of a very obstinatecharacter. The odor is also bad for the health of the child. 

Treatment. --Find and remove the cause if possible. If due to generalpoor health, give tonics, obtain a change of air, and build the childup. Reduce the total quantity of liquids, if in excess, and be verycareful not to give any liquids near bedtime. Don't cover these childrentoo much; they should never be "too warm"; they should sleep in awell-aired room, and they should receive a quick, cool sponge bath everymorning. They should be taught to sleep on their sides, never on theirbacks. Their diet should be light but nourishing. When bed-wetting isestablished it will continue, if untreated, until the child is eight orten years of age, and it frequently lasts much longer. When treatment isundertaken it should be distinctly understood by the mother that it willtake many months to cure; and during these months she must give herconstant attention to the child. If she does not undertake to do this, or if she fails to do it, the treatment should not be begun at all, asit will not succeed. Various plans should be tried to keep the childfrom sleeping on its back. The reason of this is because it has beenfound that the child wets the bed only when sleeping on its back andnever when sleeping on its side. The simplest method, of tying a towelor cloth around the child with a knot over the spinal column, so that itwill hurt and waken it, if it turns on its back, is a very good one andshould be carefully tried for some time. The nervous system of thesechildren should never be overtaxed at home or at school. Early hours andplenty of sleep are desirable. Certain articles of diet of a stimulatingcharacter should be entirely avoided, --for example, coffee, tea, beer, candies, sugars, and pickles. The best diet for these children is onecomposed exclusively of milk, vegetables, fruits, meats, and cereals. Meats, however, should be given only once every two days. It is a goodplan to teach the child to hold his water during the day, as long as hecan, to accustom the bladder to being full. Adenoid growths, whichcontribute to the nervousness of a naturally nervous child, should beremoved. It is a good plan to take the child up when the parents go inbed and let him urinate. This often cures the condition in itself. 

Sometimes moral measures, such as the promise of a reward, willstrengthen the will so that the child may overcome the tendency. Findout what the child most desires in the way of a toy, and promise it ifhe goes so long without wetting the bed. Aid and encourage him to makeefforts to win the reward. 

If drugs have to be resorted to, it is necessary to call the familyphysician, as the only drugs that are of any use are very powerful andhave to be given with great care and caution. It is the experience ofmost physicians and specialists, however, that in a large majority ofcases the treatment, along the lines as given above, will be effective, without drugs, if faithfully persisted in by the mother. 

These children should be examined by a physician. The cause of thebed-wetting is frequently discovered to be produced by anatomicalabnormalities which render circumcision imperative. In these cases nomethod of treatment will succeed until circumcision is performed. 

SLEEPLESSNESS. DISTURBED SLEEP

Causes. --In babies, disturbed sleep is most frequently due to hungeror to indigestion. The latter is the result of overfeeding or improperfeeding. Rocking the child to sleep, or feeding it during the night willcause sleeplessness. Teething, colic, or any pain will result indisturbed sleep. Nervous children are frequently poor sleepers. 

In older children, some digestive disturbance is, as a rule, the cause. Chronic intestinal indigestion, worms, adenoid growths, enlargedtonsils, lack of fresh air in the bedroom, cold feet, may, however, bethe cause. Overstudy in school, poor blood, poor nourishment are alwaysaccompanied by inability to sleep soundly. Too strenuous play, excitingstories read before bedtime, may cause sleeplessness. 

Treatment. --The removal of the cause is absolutely necessary. In orderto discover the cause it is sometimes essential to study the child'swhole routine in order to be able to tell exactly just what is causingthe apparent insomnia. It may be necessary to change the method offeeding, to regulate the studies and the exercises, and to suggestchanges regarding the sanitary and hygienic environment of the child'slife. Mothers must be warned against using drugs in the form of soothingsyrups or teething mixtures. They are dangerous and absolutely forbiddenunder the above conditions. 

The nervous disposition of the child must be taken into considerationand treated if necessary. If bad habits exist they must be stopped. Poorblood and poor nutrition must receive the treatment suggested underthese headings. 

NIGHTMARE. NIGHT TERRORS

In a nightmare a child wakes suddenly in a state of fright and willinform you that it has had a bad dream. His mind seems clear and herecognizes those about him. He is not easily calmed and may cry for sometime; finally he goes to sleep again. The next day he will remember thedream and most of the incidents of the night before. Such cases arequite frequent. They are to be treated in the same way as cases ofdisturbed sleep, as they really have the same cause. They are mostly dueto digestive disturbances and errors of diet. 

Night-Terrors. --Cases under this heading form a distinct group bythemselves. They are not frequent, but the condition is much moreserious. The cause seems to be wholly nervous and may indicate animportant nervous derangement. It seems to have some indefinite relationto such conditions as migraine, hysteria, epilepsy, and even insanity. The child wakes suddenly during the night and sits up, evidently interror; he does not apparently regain his full consciousness. He talksof being scared, calls for his mother, trembles and shakes, cannotanswer questions intelligently, and after a time goes to sleep. Next dayhe remembers nothing of the attack and does not seem to suffer in anyway as a result of it. 

I am disposed to believe that all of these attacks are not due to anervous condition. A number of them of exactly this type have been curedby absolutely withdrawing milk from the diet. 

It is a good plan to restrict the possibility of excessive play in thesechildren. They are of the type whose play is work, and too much of it istoo exhausting. Some person should sleep in the same room with thesepatients or in an adjoining room with the door open. 

If the condition occurs frequently the child should be subjected to athorough physical examination, because it may be one evidence of aserious ailment. 

Sometimes these little patients have to be taken out of school and sentto the country, where they should remain for many months. It is farbetter to regard the condition as indicating an abnormality, --eventhough it may not have any deeper significance than that the digestiveapparatus of the child is not quite right, --and make every effort tocure it, than to permit the child to go on under what really are unjustand unfavorable conditions. 

HEADACHE

Headaches are not common in little children. The most frequent ones arecaused by:

 1. Chronic indigestion and constipation. 

 2. Anemia and malnutrition. 

 3. Nervous disorders. 

 4. Diseases of the eye, nose, throat. 

 5. Rheumatism and gout. 

 6. Disturbances of the genital tract. 

Those arising from anemia and poor nutrition are most frequently presentin girls from ten to fifteen years of age. They may result fromovercrowding of school work, which results in loss of appetite and poorsleep. 

Nervous headaches may be hereditary or acquired through unhygienicsurroundings. Hysteria, epilepsy, disease of the brain, neuralgia fromcarious teeth, may result in nervous headaches. 

Headaches from disturbances of the genital tract may afflict girls aboutthe time of puberty. 

Treatment. --To remove the cause is the only plan that promises anyresult. Each one must be investigated by itself and dealt withaccordingly. For the headache itself a hot foot bath, cold to the head, and small doses of phenacetine (one grain every hour for four doses) areperhaps the most certain of all methods of treatment. 

THUMB-SUCKING

The habit of sucking the thumb may be corrected by wearing a pair ofwhite mittens, or gloves tied at the wrist. Should children attempt tosuck the thumb with gloves on, as some do, it will be necessary tosaturate the thumb and fingers of the gloves with tincture of aloes, ora solution of the bisulphate of quinine, one dram to two ounces ofwater. 

BITING THE FINGER NAILS

Biting the finger nails may be stopped by the use of the same bitterremedies as are used in thumb-sucking. 

HOW TO WASH OUT THE BOWELS

COLON IRRIGATION. A HIGH ENEMA

Procure a soft rubber catheter, --No. 18 American is about right. It isnot advisable to get too soft rubber for the reason that it will bucklewhen the child strains and it will be impossible to wash out the bowel. Fill half full an ordinary two-quart douche bag with water that is warm, but not too hot. Dissolve a heaping teaspoonful of table salt in a glassof hot water and add this to the water in the bag. Hang the bag abouttwo feet above the level of the child, so that the water will not flowin with too strong a stream; otherwise the child will immediately try toeject it. If the water flows in gently, the child may not object to itto the extent of making strenuous efforts to force the catheter out. 

Use the small sized nozzle that comes with the douche bag. Place therubber catheter over this nozzle, lubricate the catheter, place thechild on its back over a douche pan, insert the catheter about twoinches, let the water run and as it runs in push the catheter up gentlyuntil it is all in the bowel except the end on the douche tip. Theobject of letting the water run while pushing in the catheter is becauseit floats up with the water as it distends the bowel; there is no riskthen of pushing the end into the intestinal wall or hurting the child. While the water is flowing into the bowel it is a good plan to compressthe buttocks together to aid in holding the water, as the child is veryapt to let it run out as soon as it feels uncomfortable. 

The temperature of the water for the ordinary rectal injection should be95° F. When the child is exhausted or very weak, or when the circulationis poor, the temperature of the water may be as high as 110° F. When, onthe other hand, the fever is very high, the water may be much cooler; aslow as 70° F. Has been given with good results on the fever. If theirrigation is given with the intention of reducing the fever, it is bestto begin with water around 90° F. , and reduce it to 70° F. , gradually. 

Indications for Irrigation of the Colon. --When it is desired tocleanse the bowel of any collection of matter a colon irrigation isindicated. This matter may be mucus, fecal substance, undigested food, or the decomposing waste products which may remain there as a result ofdisease or other conditions. 

When it is desired to medicate by putting fluids into the bowel we adoptthe colon infusion. 

Every diseased condition of the bowel does not, however, indicateirrigation. If a child is having frequent loose movements everyhalf-hour it is safe to assume that the bowel is being cleaned outsufficiently without any artificial aid. To irrigate in these caseswould only irritate and would not accomplish anything. The cases whichare benefited are those in which we have a fever with four or five greenstools in the twenty-four hours, or where we have a high fever with nomovement at all. To irrigate in these cases we not only get rid of theproducts of decomposition, but we prevent further decomposition and wereduce the fever, thereby contributing to the general welfare of thechild. 

When the child is convalescing and when there is only mucus in thestools, with no fever--as in cases of chronic ileo-colitis--the colonirrigations should be stopped, as they tend to keep up the discharge ofmucus in these cases. If, however, there is a relapse with fever, whichwould indicate a fresh infection with more discharging mucus andpossibly green stools, the irrigation must be used until the feversubsides. 

Colon irrigations should always be given in every case of convulsions ininfancy, first to clean out the bowel to prevent putrefaction, andsecond to empty the bowel on general principles because an overloadedbowel is very frequently the cause of convulsions in children. 

When irrigation of the bowel is given at all it must be giventhoroughly. Enough water must pass into the bowel to wash it all out. For this reason it is essential that the catheter should be all in andin the bowel--not doubled on itself two or three inches in the bowel. Ifit is a serious case and the mother nervous, someone else should givethe washing--preferably the physician himself. If the child objectsstrenuously, as often happens, it must be done with greater care to besuccessful. Remember that a colon irrigation is never given unless it isabsolutely necessary and as a consequence it is given to accomplish acertain purpose; it must, therefore, be done thoroughly. If it is not, your child may miss the chance it has of getting over some immediatedifficulty and if the moment of the "chance" is wasted or lost, thatmoment will not return. Be thorough, therefore. 

Enema. --Some physicians talk about a high enema and a low enema. Ahigh enema is really an irrigation as described above. The followingremarks apply to low enemas only. 

A so-called low enema is given to clean out the rectum of constipatedmatter, or for the introduction of food or medicine by rectum, when forvarious reasons it is necessary to spare the stomach. 

It may be given with the fountain syringe or with the ordinary bulb(baby) syringe. A catheter may be put on the tip of the syringe if it isthought best to inject higher up than in the rectum. 

When an enema is used in infants or older children for the relief ofconstipation, the best medium to use is glycerine. For an infant, oneteaspoonful to an ounce of water is sufficient; for older children, onetablespoonful to two ounces of water, given with the bulb syringe, willgive prompt results. If the constipation is pronounced, the fecal massvery hard, an enema of sweet oil, allowed to remain in for ten minutes, will soften it and permit a movement. 

Soap suds are often used. They are good but not as reliable as theglycerine or oil; if, however, neither of these two are at hand the soapsuds may be given. 

Enemas should be carefully given and the liquid slowly injected. If thefountain syringe is used care must be exercised in not having the bagtoo high. If it is too high the liquid will flow in too strongly, eitherinjuring the bowel wall or causing the child to strain immediately andpass out the injection before it has an opportunity of accomplishing itswork. 

The temperature of the enema should be warm--not hot, and not cold, simply body heat. 

METHODS OF REDUCING FEVER

During the course of acute illness it is frequently necessary to reducethe fever, if possible, without the use of drugs. The following meansare often adopted. It is desirable that the mother should know just howto carry out these methods:

Ice-Cap. --An ice-cap is used to protect the brain when a child oradult is running a very high fever. It is put on when the fever is above103° F. It may be used in other conditions--brain disease, or disease ofthe meninges or cord--in which case the physician will be in attendanceand will direct what should be done. 

Ice-bags are procured in the drug stores. The best one is the flatFrench ice-bag. Fill it three-quarters full of finely chopped ice, putthe ice-bag in a towel, and place on the patient's head. There should beonly one thickness of the towel between the ice-bag and the head. 

It will be necessary to keep a record of the fever so that the ice-bagmay be withdrawn when it falls below 103° F. 

When the ice melts the bag must be at once refilled. This is oftenoverlooked by careless mothers. 

Cold Sponging. --Cold sponging is used to reduce fever or to allaynervous irritability. Equal parts of alcohol and water or vinegar andwater are used. The temperature of the water should be 80° to 85° F. 

Infants to be sponged should be completely undressed and laid upon ablanket. The sponging should be done for about fifteen or twentyminutes, after which the child is wrapped in a dry blanket withoutfurther clothing except the diaper. To be effective it must be donefrequently. 

Cold Pack. --The cold pack is used to reduce fever. It is one of thesimplest and one of the best means we have. The child is undressedcompletely, and laid upon a blanket. It is completely covered with asmall blanket (except its head) wrung out of water at 100° F. Outsideof this the child is rubbed with a piece of ice, front and back, for asufficiently long time to render the surface cool, but not cold. Children take kindly to this means of reducing fever; there is no shockand they are quieted by it. 

Just how long one will rub with the ice depends upon circumstances. Fromfive to thirty minutes may be employed. The head should be sponged withcold water while this is being done and it is a good plan to have ahot-water bottle at the child's feet. 

The Cold Bath. --To reduce fever the cold bath is used in the followingway: Water at a temperature of 100° F. Is put into the bath and thechild is first put into this water, then the water is reduced by puttinginto it shaved ice until it reaches 80° F. The child's body is wellrubbed while it is in the bath and cold water is applied to its head. The bath is continued for five minutes, or sometimes with a robust childto ten minutes. On removal the child should be put into a warm blanketafter being thoroughly dried. 

Rectal Irrigations. --These are sometimes given to reduce fever. Theyare very useful and very successful if they are given properly andwithout exciting the child too much. It is best to give water of anordinary temperature at first and gradually reduce it to 70° F. Itshould be continued for ten minutes or longer. It may be repeated everythree hours. (See page 586. )

VARIOUS BATHS

Every mother should know how to give any bath that may be directed bythe physician. 

The Mustard Bath. --Take from three to four tablespoonfuls of Englishmustard; mix thoroughly in about one gallon of warm water. Add to thisabout five gallons of plain water at a temperature of 100° F. If it isnecessary to raise the temperature of the water higher it may be done byadding water until the temperature reaches 105° or 110° F. 

The mustard bath is exceedingly effective in cases of shock, greatsudden depression, collapse, heart failure, or in sudden congestion ofthe lungs or brain. The special use of the mustard bath is in thetreatment of convulsions; it is also useful for nervous children whosleep badly. Two or three minutes in the mustard bath, followed by aquick rubbing, will induce refreshing sleep in these children. It is notnecessary to have more than one tablespoonful of mustard in these cases. 

The Hot Bath. --A bath is prepared of water at a temperature of 100° F. After the child is in the bath the temperature of the water is raised to105°, or to 110° F. It is not safe to go above this point. 

The body of the child should be well rubbed while it is in the bath. Inmost cases it is advisable to apply cold water to the head while thechild is in the bath. A bath thermometer should be kept in the water tosee that it does not rise above the temperature desired. 

The hot bath, like the mustard bath, is used to promote reaction incases of shock, collapse, etc. , and in convulsions. 

The Hot Pack. --Remove all clothing from the baby and envelop the bodyin a sheet wrung out of water at a temperature of 100° F. , to 105° F. , after which the body should be rolled in a thick blanket. Those hotapplications may be changed every twenty minutes until free perspirationis produced. This condition may be kept up as long as is necessary. 

The hot pack is used mainly in disease of the kidney. 

The Hot-Air or Vapor Bath. --The child is put in bed wholly undressedwith the bed clothing raised about twelve inches, and held in thatposition by a wicker support. The child's head is of course outside thebed clothing. Beneath the bed clothing hot air or vapor from a croupkettle is introduced. This will cause free perspiration in twentyminutes. It may be continued from twenty to thirty minutes at a time. 

The vapor bath is used in diseases of the kidney, as a rule. 

The Bran Bath. --In five gallons of water place a bag in which is putone quart of ordinary wheat bran. The bag is made of cheese cloth. Squeeze and manipulate the bran bag until the water resembles a thinporridge. The temperature of the water is usually about 95° F. , thoughit may be given with any temperature of water. 

The bran bath is of great value in eczema, or in rashes about thebuttocks, or in delicate skin conditions when plain water wouldirritate. 

The Tepid Bath. --This bath may be given at a temperature of 95°, or100° F. It is of distinct advantage in extremely nervous children. Toinduce sleep it is often better than drugs. 

The Cold Sponge or Shower Bath. --This bath should be given in themorning in a warm room. A tub should be provided with enough water in itto cover the child's feet. This water should be warm because when thefeet are in warm water it prevents the shock which frequently comes whencold water is applied to any other part of the body. 

A large sponge is filled with water at a temperature of from 40° to 60°F. This is squeezed a number of times over the child's chest, shoulders, and back. While the cold water is being applied the body should be wellrubbed with the free hand of the mother. The bath should not last longerthan half a minute. When finished take the child out quickly and standhim on a bath towel and give him a brisk rubbing with a bath towel untilthe skin reacts. This is an exceedingly valuable tonic for a delicatechild. It should not be used on younger children than eighteen months ofage. In younger children a cold plunge is preferable. 

For the cold plunge water at a temperature of 55° F. Is prepared. Thechild is lifted into this and given a single dip up to the neck. He isthen briskly rubbed off as above. 

There are a very few children who do not take kindly to either the coldsponge or plunge. These children do not react; they remain pale or blueand pinched for some time after. It may be necessary to discontinue theprocedure or to use water of a higher temperature. 

POULTICES

Poultices are useful in inflammation and for the relief of pain. To beof any value they should be applied frequently--every ten or twentyminutes--and they should be applied hot. 

Ground flaxseed is the best material for poultices. It should be mixedwith boiling water until the proper thickness is reached. It may be keptsimmering on a fire. When one poultice is taken off it can be scrapedinto the pot and heated over if there is no discharge. Each poulticeshould be put into clean muslin, put on the part and covered with oiledsilk. This will help to retain the heat and prevent the clothing or bedsheet from becoming wet. 

HOT FOMENTATIONS

A hot fomentation is simply a clean poultice. Several thicknesses offlannel are taken, wrung out of very hot water, covered with cottonbatting, and then with oiled silk. 

How to Make and How to Apply a Mustard Paste. --For infants: Take onepart English mustard to six parts flour, mix with lukewarm water, andspread between two layers of cheesecloth. 

For older children and adults: Take one tablespoonful English mustard tothree or four tablespoonfuls of flour, and mix as above. 

Mustard pastes should be made big enough. You can accomplish a greatdeal more by putting on a sufficiently large mustard paste than bysimply putting on one the size of the palm of your hand. 

It should be left on until the skin is distinctly red. The length oftime will depend, of course, upon the strength of the mustard. Mustardpastes may be put on every three hours, if necessary, and they may beused for a week at this interval if the conditions demand it. 

If they are used in pneumonia or other pulmonary diseases, they shouldbe used large enough to go around the whole chest. If they are used inheart failure, they should be big enough to cover the whole trunk. 

When made with the white of an egg they will not blister. Or if the partis rubbed with white vaseline before applying, it will not blister andit will be just as effective. When a mustard paste is removed the redarea should be rubbed with white vaseline and covered with a clean pieceof flannel. 

How to Prepare and Use the Mustard Pack. --The child is stripped andlaid upon a blanket, and the trunk is surrounded by a large towel orsheet saturated with mustard water. This is prepared as follows: Takeone tablespoonful of English mustard and dissolve it in one quart ofwater, slightly warmed. Saturate a towel in this mixture and apply tothe body of the child while it is dripping. The patient is then rolledin a blanket. Keep the child in this pack for ten or fifteen minutes. The mustard pack is not as good as the mustard bath, but it is all thatis necessary in a number of various conditions. The physician will, ofcourse, decide these matters. It is simply the duty of the mother toknow how to carry out the physician's instructions. 

The Turpentine Stupe. --Take a piece of flannel, big enough to coverthe area which it is desired to affect, wring it out of as hot water asit is possible. Upon this sprinkle twenty drops of spirits ofturpentine. Place the stupe wherever it is desired and cover with apiece of oiled silk or dry flannel. The turpentine stupe is mostly usedin pain of the abdominal cavity. In colic from acute indigestion it is avery convenient means of quieting the child by allaying the pain. 

Care should be taken not to allow this form of application to remain ontoo long. Take it off when the skin is red. For continuous use it is notas good as the mustard paste. 

OILED SILK. WHAT IT IS, AND WHY IT IS USED

Oiled silk is sold in the drug stores by the yard. It is one yard wide. It is used to cover any local application to prevent evaporation intothe air or to prevent the clothing from absorbing the medicament. If aliniment is applied on cloth to effect a certain result, it may takesome time to do its work. If the wet cloth is covered with the clothing, the clothing will absorb the medicine quicker than the body will andthereby defeat the object in view, in addition to rendering theclothing wet and nasty. If the application is covered with oiled silk itcannot escape into the clothing, because the oiled silk is impervious. The body will be compelled to absorb the medicine and consequentlyresults will be quicker and more certain. Many liniments are expensive;to permit them to be absorbed by the clothing is needless waste It istherefore economical to apply the oiled silk. 

DISEASES OF CHILDREN

[Illustration: By permission of Henry H. Goddard. ]

The First Blight

This is one of those truly unfortunate cases which, so far as presentknowledge goes, cannot be guarded against. Eunice, age 31, mentally 2, is a low-grade imbecile. There is not in the whole family, forgenerations back, a single case of feeble-mindedness, nor of diseasethat would undermine the nervous organization. Close scrutiny does notreveal a single assignable cause. She came, as an accident, to blight anotherwise normal family. 

Such cases are few, but unfortunately they do occur. It is for Eugenicsto materially reduce the possibility of such occurrences. 

 * * * * *

CHAPTER XXXVIII

INFECTIOUS OR CONTAGIOUS DISEASES

Rules to be Observed in the Treatment of Contagious Diseases--WhatIsolation Means--The Contagious Sick Room--Conduct and Dress of theNurse--Feeding the Patient and Nurse--How to Disinfect the Clothing andLinen--How to Disinfect the Urine and Feces--How to Disinfect theHands--Disinfection of the Room Necessary--How to Disinfect the Mouthand Nose--How to Disinfect the Throat--Receptacle for the Sputum--Careof the Skin in Contagious Diseases--Convalescence After a ContagiousDisease--Disinfecting the Sick Chamber--The After Treatment of aDisinfected Room--How to Disinfect the Bed Clothing andClothes--Mumps--Epidemic Parotitis--Chicken Pox--Varicella--LaGrippe--Influenza--Diphtheria--WhoopingCough--Pertussis--Measles--Koplik's Spots--Department of Health Rules inMeasles--Scarlet Fever--Scarlatina--Typhoid Fever--VariousSolutions--Boracic Acid Solution--Normal Salt Solution--CarronOil--Thiersch's Solution--Solution of Bichloride of Mercury--How to MakeVarious Solutions. 

RULES TO BE OBSERVED IN THE TREATMENT OF CONTAGIOUS DISEASES

Every mother should know the elementary principles involved in thetreatment of contagious diseases. They are contagious because they maybe conveyed from one individual to another or because a person nursing avictim of a contagious disease may carry that disease to another personwithout having the disease herself. For this reason, certain rules havebeen established by the medical profession, which experience has taughtare necessary in order to preserve the health of the community when suchdiseases are prevalent. 

The very first rule to which the physician will direct the mother'sattention, when there is a contagious disease, will be that the childmust be "isolated. "

What Isolation Means. --Isolation means the complete seclusion of thepatient in a room by himself, so that no one will see him or come incontact with him except the physician and the nurse or mother who willtend him during the entire course of the disease. Isolation implies morethan it would seem to mean. It implies that every article used duringthe sickness will be thoroughly disinfected before it leaves the room inwhich the patient himself is isolated. Mothers must always remember thatevery article used by the patient may carry the germs of the disease tosome other member of the family or to some other individual. Thesearticles are the clothing of the child, the bedclothes, napkins, handkerchiefs, towels, dishes, knives and spoons, rags, the variousdischarges--sputum, urine, and bowel passages--and, we may add to thislist, flies, insects, and domestic animals. Every precaution must, therefore, be taken to safeguard any dissemination of the disease bymeans of these articles. 

Thorough isolation also implies that the nurse shall frequently batheand disinfect her person and her clothing, and that the sick-room itselfshall be carefully dusted with a moist cloth and disinfected from timeto time. 

The Contagious Sick-Room. --The contagious sick-room will be preparedin exactly the same way as the ordinary sick-room which has beenpreviously described. In addition, however, it will be safeguarded inthe following manner. A wet sheet will be hung up outside the door. Thissheet will be kept constantly moistened with a solution of chloride oflime. One-half pound to an ordinary house-pail of water is the strengthof the solution to use. Every window must be effectively screened toprevent the ingress and egress of flies and other insects. 

Conduct and Dress of the Nurse. --She will remain in the sick-room allthe time unless when she takes outdoor exercise. Her dress will consistof a long gown which will entirely cover her person from the neck to theshoes and will be of plain, white, easily washed material, without tucksor ruffles or adornment of any kind. She should wear an ordinary pair ofhouse slippers made of light leather. Her cap will be large enough tocover and include her hair and head. When she leaves the room, she willremove her cap, gown, and slippers, disinfect her hands in adisinfecting solution and wash her face, neck, and hands in soap andwater. She should go directly out and in, without coming in contact withany occupant of the home. 

Feeding the Patient and Nurse. --The meals for the patient and nurseshould be left on a table outside the door of the sick-room, from whichplace the nurse will then take them into the room. The utensils used forthese meals should not be used by other members of the family during theentire sickness. After the patient and nurse have eaten, the utensilsshould be placed in a chloride of lime solution for disinfection. If anyof the food is left over it should be put into a jar in which it may bedisinfected and rendered harmless before being disposed of. 

How to Disinfect the Clothing and Linen. --All bed and body linen, towels, handkerchiefs, napkins, etc. , should be immediately put into alarge receptacle--a wash boiler, or tub, will answer the purposeadmirably--containing a five per cent. Solution of carbolic acid inwhich an adequate quantity of soft soap has been dissolved. They shouldremain in this mixture for two hours, after which they may be wrung outand taken to the laundry. 

How to Disinfect the Urine and Feces. --The urine and the stools shouldbe passed into vessels containing a solution of four ounces of carbolicacid to the gallon of water. This vessel should be covered and themixture allowed to stand for one hour, after which time it may be thrownout. 

How to Disinfect the Hands. --Any of the following solutions may beused for disinfection of the nurse's hands: Creolin, one teaspoonful tothe quart of water; chloride of lime, one-half pound to a pail of water;formalin, thirty-two drops to a quart of water. A basin containing oneof the above solutions should be constantly kept standing for thefrequent disinfection of the nurse's hands. After disinfection, thehands should be washed in plain water and soap. 

Disinfection of Room Necessary. --The room in which a contagiouspatient is confined requires systematic attention on the part of thenurse. Every other day all flat or projecting surfaces should bedisinfected. Mantels, window-sills, door knobs, picture moldings, furniture, chairs, and bed-railings, should be wiped with clothsmoistened in a disinfecting solution. A suitable solution for thispurpose is one containing one ounce of carbolic acid to the quart ofwater. 

How to Disinfect the Mouth and Nose. --In the course of all contagiousdiseases the mouth and throat of the patient and nurse should bethoroughly disinfected as a matter of routine. It should be done atleast twice daily unless more frequent disinfection is called forbecause of the nature of the disease. In measles and diphtheria, forexample, the nasal and throat conditions will undoubtedly call for morefrequent and more thorough disinfection than twice daily. This may alsoapply to scarlet fever if the throat is involved as is often the case. 

Pocket handkerchiefs should never be used by a patient suffering from acontagious disease. The nose and mouth should be wiped with pieces ofgauze or cheesecloth, cut into small squares for this purpose. Theseshould be immediately burned after being used. 

To disinfect the throat, a solution of formalin, six drops to six ouncesof water, is effective. To disinfect the nose, a solution ofGlyco-Thymoline is suitable. These applications should be made by meansof an atomizer, a different atomizer being used for the patient andnurse. 

Receptacle for the Sputum. --A cuspidor, or basin, should be constantlykept at the side of the bed in which the patient may convenientlyexpectorate. This utensil should contain the chloride of lime solutionpreviously mentioned. 

Care of the Skin in Contagious Diseases. --As in all other sickconditions, the skin of the patient should be bathed frequently with analcoholic solution. In the later stages of measles and scarlet fever itis essential to anoint the skin while the patient is scaling. This maybe done with carbolated vaseline. Mothers should understand why this isnecessary. These diseases have a distinct rash or eruption. Thiseruption practically kills the skin cells and at a certain period thesecells are cast off by the new growth of skin underneath. This process iscalled scaling. In measles the scales are small, and are cast off in theform of bran like dust. In scarlet fever, the cells adhere together andare cast off in large scales. These scales are contagious. They are verylight and will float in the air if dry. The movement of the patient, changing the bed clothing, etc. , will waft a multitude of thesecontagious scales into the air of the room and infect every article theymay land on. This would make the disinfection of the room difficult andtedious. In order to obviate this tendency experience has taught us thatmuch of the difficulty and nearly all of the risk of contagion may beovercome by rubbing some oily or sticky substance on the skin. By thismethod the dust and scales are rendered heavier than the air, sticktogether and will not float. During the scaling period there is aconstant itch present which irritates the little patient. By usingcarbolated vaseline to anoint the skin we accomplish two purposes. Thecarbolic acid in the vaseline relieves the itch, and the vaseline itselfgreases the skin so that the scales remain in the bed. Each day thenurse changes the bed-sheet, gathers the scales in the sheet and putsall in the disinfecting solution. 

Convalescence After a Contagious Disease. --Complete isolation must bekept up until all danger from contagion is passed. In diphtheria thisperiod is not reached until the examination of the throat contents underthe microscope is returned negative. In diseases Which have a rash thisperiod is not reached until all scaling is completed. Even then, and fora number of days or weeks, the patient may be taken out for exercisedaily, but must not be allowed to play with other children until hisstrength justifies active exercise. It takes a much longer period to ridthe system of the poison of a contagious disease than most mothersappreciate. Many children have died from heart failure after they wereconsidered well simply because the active exercise overtaxed the heartbefore the system was wholly free from the poison of the disease. 

Before the child is removed from the sick-room for the first time heshould have a disinfecting bath. This bath should be in a solution ofbichloride of mercury, the strength of which should be one part to fivethousand parts of water. The towels used to dry the patient after thebath should be fresh and should not have been in the sick-room. Heshould then be dressed in clothing which has never been in thesick-room. 

DISINFECTING THE SICK-CHAMBER

How to Disinfect a Room. --The most efficient way to disinfect a roomis by means of formaldehyde gas. This, however, requires a specialapparatus which can only be used by one familiar with the process. Inall large cities the Department of Health usually undertakes thedisinfection of rooms after any contagious disease. The next best methodis by sulphur. 

When sulphur is employed it should be used in the form of powder or insmall pieces. This is placed in a shallow iron pan set on a couple ofboards in a tub partly filled with water. The sulphur is moistened withalcohol before it is set on fire. 

It is always necessary, of course, before disinfecting by any process tomake the room as nearly air tight as is possible. To accomplish this thewindows must be tightly closed, the doors locked, and the cracks andkeyhole sealed with pieces of paper or adhesive paper. The room shouldremain closed for six or eight hours, after which it should bethoroughly aired for several days. 

The After Treatment of a Disinfected Room. --The walls, ceiling, andall flat surfaces, such as mantels, window-sills, etc. , should be washedwith a fresh chloride of lime solution. The floor should be scrubbedwith a four per cent. Soda solution. All carpets and curtains, if any, should be removed, taken to a vacant lot and thoroughly beaten and thenexposed to direct sunlight for a number of hours. The room should thenbe well aired again for a couple of days before it is again occupied. 

How to Disinfect the Bed Clothing and Clothes. --The surest way is toboil them for half an hour; otherwise they may be left in the room whileit is being disinfected. Spraying the clothes with a spray offormaldehyde is an effective way of disinfecting them. 

MUMPS: EPIDEMIC PAROTITIS

Mumps is a contagious disease. It is most common between the fourth andsixth years. Infants are rarely affected. The disease is not verycontagious, direct contact being necessary to communicate it. Every caseshould be isolated for a period of three weeks from the beginning of thedisease. 

The seat of the affection is the parotid gland which is located in frontof and on a level with the ear. One or both glands may be affected atthe same time or one may follow the other in succumbing. The duration ofthe disease from the time the swelling becomes noticeable is about tendays. It is contagious for a week after the swelling subsides. Theperiod of incubation is from one to three weeks. 

Symptoms. --In the majority of cases the first symptom is the swellingand the discomfort which it causes. In more severe cases the child feelssick and is listless for from twenty-four to forty-eight hours. Theremay be a headache, vomiting, pains in the back and limbs, and fever. There is pain in the swelling which is increased by movement of the jawsand by pressure. The degree of the swelling varies with the severity ofthe attack. It may be very little or it may be so great as to completelydistort, and render unrecognizable, the face. It must be rememberedthat, though mumps is not regarded as an important or dangerous disease, it may assume dangerous characteristics. 

We sometimes see distressing complications with mumps. In boys, orchitis, or inflammation of the testicles, occasionally occur. Ingirls, ovaritis, or inflammation of the ovaries may be present. Thesecomplications may be avoided by keeping the patients in bed. 

Treatment. --Keep the child in bed until the fever is gone. Keep himin the house for one week after the swelling has entirely subsided. Heshould be put on a liquid diet while the fever lasts. The bowels shouldmove each day. 

The mouth should be kept clean by an antiseptic mouth wash. If there ismuch pain in the swollen gland, warm, wet dressings give the bestresults. Sometimes it is advisable to paint the gland with belladonnaointment. If it is not very painful, the most comfortable way to dressthe gland is simply to place over it a large pad of absorbent cottonheld in place by a broad strip of flannel cloth. 

CHICKEN POX. VARICELLA

Chicken pox is an affection almost entirely special to children, in whomit may be observed from their first year, although it is especiallyfrequent from the ages of two to six. It appears often in the epidemicalform and spreads by contagion. 

Some doctors are inclined to regard varicella as a very attenuated formof smallpox, hence the name "chicken pox, " by which it is popularlyknown. This opinion is based merely on the analogy between the two typesof skin eruptions and the coincidence sometimes observed between twoepidemics of smallpox and chicken pox. But the theory falls onconsidering that, on the one hand, chicken pox offers no safeguardagainst infection by smallpox and does not prevent the effects ofvaccination, and, on the other hand the disease may occur in childrenwho have been vaccinated or who have had smallpox. Chicken pox, too, differs essentially from smallpox in the course of its development. 

After a period of incubation, extending over a fortnight, chicken poxbecomes apparent by such symptoms as slight shivering, extreme fatigueand a general but not very intense condition of fever. In less thantwenty-four hours small pink spots will appear on the skin, and theseafter a few hours are topped by a vesicle, and the next day the wholerash shows a vesiculous appearance. 

The vesicles are sometimes small and pointed, sometimes more voluminousand globular in form. They are filled with a limpid or a slightlyyellowish liquid. Their base is sometimes surrounded by an inflammatoryring. By the third day the contents of the vesicle has become thickerand tends to become purulent. On the fourth day desiccation commences, and the vesicles shrivel and shrink in and form small brownish scabs, which fall about the eighth day. Frequently the child will scratch themoff with the finger nails before they are entirely desiccated. Thevesicles leave small reddish spots, which generally disappear gradually, almost always without a scar. 

An eruption of chicken pox does not burst out all over the body at once, but appears in successive rashes. It is not confined to any specialparts of the body. It may begin and spread at the same time from theface, the trunk of the body or the limbs. A dozen pimples may be seenthe first day, while three or even ten times as many may be visible thenext day, and so on for several days in succession. 

Sometimes the vesicles appear on mucous membrane at different parts--themouth, tongue, soft palate and tonsils--and may also invade theconjunctiva and cornea, or the larynx, where they will set uplaryngitis. 

Owing to the very contagious nature of chicken pox, the first thing tobe done is to provide for the complete isolation during a period oftwelve to fifteen days of all patients attacked by the disease. 

The treatment of the disease is solely a matter of hygiene. The moresevere the fever the stricter the diet should be, and in the case ofgreat fever, the diet should be restricted to broth and milk. If thereis no fever the child need not be placed on any special diet. 

If the intestines are sluggish, they may be stimulated by administeringa dose of castor oil. It is advisable to make the patient rinse hismouth two or three times a day with a mouth wash. It is also well toapply a lotion around the eyes and face, consisting of two per cent. Boracic acid solution with the chill taken off. Finally, in order toprevent the child scratching the sores and the consequent danger ofinoculation by the finger nails, it is a good practice to rub a smallamount of carbolated vaseline over the itching parts. It is frequentlyfound necessary to have the little patient wear white woolen gloves toprevent scratching and infecting the sores. If a child scratches thesores on the face it will leave an unsightly mark which will stay forthe rest of its life. 

The child, of course, should not be allowed to rejoin his playmateswithout having had a good bath, and having had his clothes completelydisinfected. 

INFLUENZA: LA GRIPPE

The most important feature with reference to influenza in children isits very active tendency to develop complications. These complicationsgenerally affect the respiratory tract. So we find in children sufferingfrom grippe an easy disposition to get bronchitis or broncho-pneumonia. The younger the child the greater the danger. 

The disease itself, so long as it remains an uncomplicated influenza, isnot of much importance or severity. The lesson to be learned, therefore, is to treat the disease with respect and take every precaution to avoidthe possibility of developing a complication. 

La Grippe is a highly contagious disease. It prevails epidemically, andafter an active epidemic it may remain in the vicinity for a number ofyears. It is more frequently seen in the late winter months and earlyspring. The poison of the disease clings to clothing and apartments aswell as to railroad and street cars. The germ is found in the sputum andin the nasal secretions. 

Sneezing is one of its symptoms and it is one of the ways by which thedisease is spread around. Children should never be brought near an adultsuffering from influenza. One attack does not render the patient immuneto a subsequent attack as is the case with most of the contagiousdiseases. The reverse is the rule with La Grippe because one attackfavors the development of another attack. It is a common experience formany people to have influenza every winter or spring. 

Symptoms. --If a child "catches" grippe, it becomes quite sickabruptly. There is usually chilliness, pains in the muscles all over thebody, more or less fever, sometimes nausea and vomiting. If the attackis a more severe one, the prostration is more marked, the temperaturehigher and the signs of shock and poisoning of the system are more inevidence. A child a few months old can get influenza so severely as tocause collapse and death in thirty-six hours. As a rule the type ofgrippe most common in infancy is of a very mild character. It lastsabout a week. Children may be a little slow in convalescing and it maybe three or four weeks before they regain their health. 

Complications. --As has been intimated, the most frequent complicationis bronchitis and the most fatal one is broncho-pneumonia. 

A congestion of the entire mucous membrane of the respiratory tract, producing a nasal discharge, a sore and inflamed throat, pains and afeeling of compression, with a cough in the chest, may accompany thedisease. 

Gastric symptoms, with vomiting, intestinal disturbance, diarrhea, withor without mucus and blood, are quite common in some epidemics. 

Not infrequently we have numerous cases in which the ear seems to be thevulnerable part. As a consequence running ears have to receive most ofour attention. When the ears are affected, the glands of the neck becomeinflamed. They swell up and add considerable to the discomfort of thelittle patient. 

Treatment. --Cases of influenza should be isolated. Children should beput in a room by themselves and the other children of the family shouldnot be permitted to see them. The rooms should be disinfected after thecase is over. As complications are the dangerous element in grippe, weshould try to prevent them. This can be best done by promptly puttingthe child in bed, making him comfortable, opening his bowels by castoroil or calomel. He should be made to drink hot lemonade. He should bekept on a light diet from which meat and vegetables are excluded. 

The above treatment will usually suffice in the ordinary uncomplicatedgrippe. If complications arise they must be treated according to theconditions. 

It is well to remember that the degree of prostration following a rathersevere attack of grippe is out of all proportion to the extent of thedisease. These little patients sometimes suffer considerably and do notregain their strength promptly. Experience has taught us that the bestthing to do is to send them away. A change of climate will do wondersfor them, more quickly and more thoroughly than all the medicine we cangive them at home. The seashore is particularly good for them. 

DIPHTHERIA

Diphtheria is an acute, specific, infectious, communicable disease. Itaffects the tonsils, throat, nose, or larynx. It is most frequently seenin children between the ages of two and five years, though it may appearat any time during life. The two sexes are equally liable to it. Thesame person may have the disease twice or more times at different ages. Children suffering from disease of the nose or throat are more likely toget it than are others. Such diseases are cold in the head with runningnose, catarrh of the nose and throat, inflammation of the mucousmembranes of the nose or throat. 

Diphtheria may occur at any time of the year, though it is more frequentduring the cold months. The incubation, or the length of time betweenexposure to the disease and the development of the symptoms, is betweentwo and five days. In its mild form the disease may be present withoutgiving any constitutional symptoms. In its severe form, however, it isone of the most dangerous diseases of childhood. In large cities it ispresent all the year round with more or less frequent outbreaks in theform of local epidemics. In the country it is only seen in its epidemicform. It does not arise without a cause, that is, there is always apreceding case from which an epidemic springs, though it is not alwayseasy to trace the connection. The child inhales the bacilli which causethe disease with the air it breathes. The bacilli may lodge on toys orother articles from which the child gets them. Direct infection isusually the mode of communication through which a child obtains thedisease. The saliva and mucus from the nose contain the bacilli in largequantities and if a patient coughs or sneezes they are expelled in thisway and infect others. Frequently a child suffering from a mild form ofdiphtheria may attend school and infect others without it being knownthat the child has the disease. 

Symptoms. --The symptoms vary with the severity of the attack. Thereare mild cases, as has been stated, that give no constitutionalsymptoms. There may be a small amount of local disturbance in the throator nose and there may be some membrane present, but, for some reason, there does not seem to be any absorption of the poison into the systemand the child escapes the systemic disturbance. Even as a localcondition these cases vary. There is always a fever at the beginning, but the child never seems sick enough to go to bed. If the throat isexamined it will be found to be red and slightly inflamed, there may bespots on the tonsils, or there may be a gray film over them. There is nodischarge from the nose and the child does not complain of an excess ofmucus from the throat. The spots may last for a week and then disappear. These cases are difficult to diagnose without making a culture, and ifthe physician insists upon keeping the child confined to bed whileapparently well the family as a rule object, though it is absolutelynecessary. These are the cases that do great harm in school, and nomother should object if the physician insists in taking preventativemeasures to stop an epidemic if the bacilli have been found in thechild's throat. She should rather feel thankful that the child escapedso easily. 

Since the introduction of antitoxin we do not see the severe cases now, so that a description of them would not be of any use in a book of thischaracter. Mothers should, however, know that it is absolutely criminalto take any chances with a "sore throat. " Antitoxin is a prompt and anabsolute remedy if used soon after the onset of the disease. It is moresure if used the first or second day, still reliable the third day, butits efficacy diminishes the longer we postpone its use from the date ofthe onset of the disease. When, therefore, a child complains of beingsick and states that its throat hurts, medical aid should be at oncesought. 

The disease may develop in one of two ways. It may begin as a slightindisposition for a day or two, and perhaps some soreness of the throat. The fever may be slight. The child will continue to be sick despite anytreatment given and will get slowly worse until the fourth or fifth day, when it will be impossible to mistake the condition. 

At other times the disease begins abruptly. The child complains of beingsick. It may vomit, or suffer from headache, chilly feelings, and afever. The glands in the neck may swell and cause considerabledisturbance. There is, as a rule, an abundant discharge from the noseand there is an excess of mucus in the throat. Membrane is seen in thethroat. It may cover the tonsils and spread over the entire throatcavity, or it may extend up into the nose and over the roof of themouth. All the parts are much swollen and breathing is interfered with, sometimes seriously. If the attack is very severe there is an activeabsorption of poison going on from the throat which soon renders thelittle patient intensely sick. There is marked weakness and prostration, the circulation becomes poor, the pulse rapid and the child falls into astupor. 

The physician will, of course, have taken complete charge of the casebefore the patient has gone thus far. The nursing of the case, which mayfall to the mother if no trained nurse is present, is most important. She should preserve absolute cleanliness of herself and of the sickroom. She should never eat or sleep in the same room with the patient, and should use a gargle, which the physician should prescribe, frequently during the day. She should dress simply, so that whatever isworn can be changed often and washed easily. Every article of furnituremust be taken out of the sick room that is not absolutely essential inthe care of the case. If toys are allowed they should be burned as soonas the child is tired of them, never left around the house after thecase is over. The room should be a large one and it should be thoroughlyaired each day. The floor should be washed each day with a solution ofbichloride of mercury, and all dusting should be done with a wet cloth. The bed linen and any rags or handkerchiefs used should be treated as inscarlet fever. All vessels in which the patient expectorates should havean antiseptic in them. The room must be disinfected after the case isover. 

The patient must be kept in bed during the entire attack. He must not beallowed to even sit up in bed until the physician gives him permission. This is a very important essential in the treatment of this disease, andthe nurse must be held responsible for the conduct of the patient inthis respect. Because of the character of the poison, there is atendency to paralysis of the heart, and frequently children have beenallowed to sit up too soon only to fall back dead in bed. The same thinghas occurred later in the disease when children have been allowed toplay too heartily before the poison had an opportunity to completelyeliminate itself. Nursing children should be fed on breast milk pumpedfrom the mother, but they must not nurse it themselves. Older childrencan take milk and should depend upon it mostly. The physician will giveany other special directions that he may think necessary, the duty ofthe mother being to see that they are faithfully carried out. 

WHOOPING-COUGH

Whooping-cough is usually seen in young children. It may, however, affect a person at any age. It is contagious. During infancy it is oneof the most fatal diseases. During adult life it is a dangerouscondition, while in childhood it is simply regarded as a mildlycontagious disease. 

It is most contagious during the catarrhal stage, --the first ten days. Children suffering from whooping-cough should not be allowed to mix orplay with other children for two months. After an exposure to thedisease it takes about fourteen days for a case to develop. The dangerof whooping-cough is the tendency to develop pneumonia or bronchitis. 

Symptoms. --During the first ten days the child acts as if sufferingfrom an ordinary catarrhal cold with cough. This is called the catarrhalstage. There is no way of telling that whooping-cough is present untilthe child whoops. Most children do not whoop until the expiration of thecatarrhal stage, though a very few do from the beginning of the disease. If a child is treated for an ordinary cold with cough and does notrespond to treatment, and whooping-cough is epidemic, it is fair toassume that whooping-cough has been contracted. When the cough shows adistinct tendency to be worse at night it is further proof of thisassumption. 

When they begin to cough in paroxysms, and whoop, the second, orspasmodic stage begins. These fits of paroxysmal coughing are much moresevere than spells of ordinary coughing. These may only be three or fourattacks daily, or the child may have from forty to fifty such attacks. When children feel these attacks coming on they seek support, holding onto chairs or they stand by the mother's knee. The coughing is explosive, rapid, and forceful, the child fails to catch its breath and iscompelled to take a deep inspiration, which is the whoop; it then goeson coughing more. The face may become purple, the eyes protrude, and theveins of the face swell up. Near the end of the attack the child raises, or vomits a mass of stringy, glutinous mucus. After it is over the childis exhausted, there is a more or less profuse perspiration, and he maybe quite dazed. These attacks are, as a rule, more frequent and moresevere during the night. This stage lasts about one month and is thenfollowed by the stage of decline, during which the disease subsides intowhat appears as an ordinary bronchial cold. 

It is quite common for these children to get relapses, especially duringinclement winter weather, and go on whooping for two or three monthslonger. Their vitality suffers because their sleep and nourishment isinterfered with, and they become nervous and difficult to manage. 

Treatment. --Inasmuch as there is no remedy known that will curewhooping-cough, the best we can do is to render the patient physicallyefficient to stand the severe strain of coughing, which is the worstfeature of the disease. Experience has taught us that those children dobest who spend their entire time out of doors. We, therefore, adviseparents to encourage their children to play in the open air. There is noexception to this rule, even in winter weather, unless it isparticularly inclement. If the weather is wet or raw, or if the childhas bronchitis, or is running a fever, it would be more safe to keep thechild indoors, in a well-aired room, until the temporary conditions passover, when they could again resume the open-air treatment. 

Naturally delicate children if under two years of age should not riskstaying out of doors too much in very cold or raw weather, even if notsuffering from any of the above complications. 

The bedrooms of children suffering from whooping-cough should be largeand thoroughly aired day and night. 

The nourishment in these cases is of great importance. They should becarefully fed, and if they vomit with the paroxysms of coughing, theyshould be fed small quantities frequently. Any form of digestivedisturbance is very apt to accentuate the frequency of coughing. A fluiddiet of milk is the best. Milk punches aid in keeping up the strength;malted milk and eggs beaten in milk are nutritious and easily digested. 

So far as internal medication is concerned, I have found pertussin to bethe most efficacious remedy. If it is begun early and in sufficientdosage, it not only favors an early termination of the disease, but itlessens the frequency and the severity of the paroxysms. If it issuspected that the child has been exposed to whooping-cough, pertussinmay be given during the catarrhal stage with the advantage that it willrender the whole course of the disease milder. If it is given during thecourse of an ordinary catarrhal cold, it will in most cases be aseffectual as any ordinary cough remedy. The dosage should be largeenough to produce results. I have found a teaspoonful every two hoursto a child of three years to be the average dose. In older children Igive two teaspoonfuls every three hours. It is necessary to continue itsuse throughout the disease. The taste of pertussin is pleasant and youngchildren take it willingly. 

When the disease is inclined to a protracted course, or when the coughdoes not subside, especially during unfavorable weather, it is of greatimportance to send the child away. A change of climate, preferably tothe seashore, even for a short time, will act like a charm, and willcure the cough of whooping-cough quicker than any other possiblemeasure. 

MEASLES

Measles is the most widely prevalent, eruptive, contagious disease. Withfew exceptions, every human being "gets" measles. As an uncomplicateddisease it is never fatal, and is not even regarded as dangerous. Because of this characteristic, however, parents are neglectful andcomplications occur, and these frequently prove fatal. One attackrenders the patient immune. It is very highly contagious and spreadswith great rapidity among those who have never had it. It is notpossible to carry the disease any great distance by a third person or bymeans of living objects. It does not, however, cling to clothing orother objects as long as scarlet fever. Its period of incubation is fromeleven to fourteen days. 

Symptoms. --The symptoms develop gradually. A severe cold in the headis the first and most characteristic symptom of the disease. There is adischarge from the nose, swollen and watery eyes, sneezing and a hoarse, harsh cough. The patient may complain of the throat being painful andexamination will reveal a general congestion of the parts. There arealso headache, lassitude, pains in the back, and there may be vomitingand diarrhea. Children in the early stages of measles are tired andsleepy. 

Koplik's Spots. --Three or four days, in rare cases somewhat longer, before the appearance of the rash there appears on the mucous membraneof the cheeks small, bluish white, or yellowish white points, the sizeof a small pin head. These points are surrounded with reddened areaswhich give the appearance of a general rash with fine white points uponit. These points resemble milk particles. They adhere firmly to themucous membrane and when an effort is made to remove them it is foundthat the underlying surface is ulcerated and excoriated. 

The Koplik spots are not of much value to the mother other than thatthey may be relied upon to indicate the coming disease with which theychild is affected. Physicians look for them as an aid in diagnosisbefore the rash would of itself indicate the disease. 

The rash appears on the third, fourth, or fifth day of the disease. Fromthe day of the infection to the outbreak of the rash about thirteen daysintervene. It is seen first at the roots of the hair on the forehead, behind the ears or on the neck. It may be seen first on the cheeks. Thebeginning rash appears as small, dark red, dull spots. At first thereare only a few, but they soon become more numerous, they join together, and soon the surface looks inflamed as if entirely covered with therash. The rash covers the entire body, including the soles and palms. Intwenty-four hours it is at its height on the face. It spreads downwardlike a wave, first the face, then the neck and chest, then the abdomenand later the legs. By the time it invades the legs it has begun to fadeon the face. It fades slowly in the order of its appearance. Itsduration is about four days. 

The skin is swollen; it burns and itches. The eyes are swollen and redand intensely sensitive to light. There is usually a muco-pus dischargefrom them. The cough is invariably an annoying feature. The fever ishigh and reaches its highest point when the rash is at its height. Asthe rash fades the fever subsides. 

When the rash fades, the patient begins to "scale. " The scales ofmeasles are fine, like bran, never in large patches like the scales ofscarlet fever. The amount of the scaling varies. It may be quiteconsiderable or it may be so small as to be overlooked. 

Complications. --The most important and by far the most frequentcomplication of measles is broncho-pneumonia. There may be variousconditions affecting the stomach, bowels, throat, ears, bronchi, and thenervous system, which may accompany the disease but are seldom of aserious or important character. 

Treatment. --Measles runs a certain course and will run that course, nomatter what we may or may not do. We cannot stop it, or shorten it, orlessen its severity. We can only hope to make the patient comfortableand to prevent the development of complications. 

The child should be put in bed and kept comfortably warm but not toowarm. The room should be kept at the ordinary temperature of the sickroom, 68° to 70° F. It should be darkened but not dark. The food shouldbe fluid and given regularly. The child may be given all the cool, --notcold, --water it wants to drink. The bowels should be kept open daily. Ifconstipation occurs an enema may be given. The eyes must be carefullywatched and washed every hour or two during the day with a boracic acidsolution. If the cough is distressing, it may be rendered lessdistressing, though we cannot hope to stop it until the disease has runits course. The restlessness, headache and general discomfort can bemuch modified by suitable remedies. If the itching is acute, the bodycan be rubbed with carbolated vaseline. When the rash subsides and thepatient is free from fever a daily warm bath should be given in order tofacilitate scaling. 

Should complications arise they should be promptly cared for by theattending physician. 

SUMMARY:--

 1. Measles is the most prevalent infectious disease of childhood. 

 2. The danger of measles has been and is underestimated. Because of its prevalency many mothers treat it with less respect than they should, with the result that fatal complications occur, or the future health of the child is permanently injured. 

 3. Children with measles should be put in bed and kept in bed and treated as directed above. 

The following rules have been formulated by the Department of Health ofNew York City, with reference to measles, and embody precautions thatshould find general observance:

 1. All children in the family must be promptly excluded from school attendance. 

 2. Careful and continued isolation of the patient must be enforced until the case is terminated and fumigation has been ordered by the medical inspector of the Department. 

 3. All secondary cases must be reported even if the first case is still under surveillance of the Department of Health. 

 4. Suspected cases must be treated as contagious cases until a sufficiently long observation has shown that the patient has a non-contagious disease. All cases will be considered as measles, if so reported. Any change in the original diagnosis must be made in writing to the Department of Health and must be confirmed by a diagnostician. 

 5. Physicians must not order the removal of patients to the contagious disease hospital, or elsewhere, in cabs or other vehicles, but must notify the Department of Health and the removal will be effected by a coupé or ambulance of the Department. 

 6. Whenever there is a case of measles in rooms in the rear of, or communicating with, a store, the inspector is required to have the store closed at once, or to report the case for immediate removal to the hospital. 

 7. A case of measles must not be removed from one house to another, or even to a different apartment in the same house, without the permission of the Department. Such removal is in direct violation of the provisions of the Sanitary Code. 

 8. No case of measles shall be discharged from observation until the Department has been notified, the case examined by an inspector to see if desquamation is entirely completed, and the premises ordered fumigated. This examination by the inspector is necessary because the Department of Health must have official information as to the completion of desquamation before a child is dismissed from observation. Other people with children demand this protection. At no other time is the inspector allowed to examine the patient. In any case, however, where isolation has not been maintained and it becomes necessary to remove the patient to the hospital, a diagnostician will make an examination. 

 It is recommended that physicians provide a special washable gown for each case of measles. This gown should be put on before entering the sick-room and taken off outside the sick-room as soon as the visit is completed. The gown should be kept in a closet or suitable place, separate from all other clothing, and the gown, and the closet should be fumigated after the termination of the case. 

 10. In private houses only fumigation may be performed under the supervision of the attending physician; provided he follow accurately the directions given in the following rules and regulations. Upon request a blank will be provided upon which he must state the manner and extent of the work performed under his orders and supervision. If satisfactory to the Department, this will be accepted in place of fumigation by the Department. It is essential, however, that he should know that the disinfection has been efficiently carried out. 

In every case of fumigation the following regulations must be compliedwith:

 All cracks or crevices in rooms to be fumigated must be sealed or calked, to prevent the escape of the disinfectant, and one of the following disinfectants used in the quantities named:

 a. Sulphur, 4 lbs. , for every 1, 000 cubic feet of air space, 8 hours' exposure. 

 b. Formaline, 6 oz. For every 1, 000 cubic feet of air space, 4 hours' exposure. 

 c. Paraform, 1, 000 grains for every 1, 000 cubic feet of air space, 6 hours' exposure. 

 The following disinfecting solutions may be used for goods, which are afterwards to be washed:

 a. Carbolic acid, 2 to 5 per cent. 

 b. Bichloride of mercury, 1-1, 000. 

SCARLET FEVER. SCARLATINA. 

Scarlet fever is an acute, contagious disease. It begins abruptly. Thechild may have a severe attack and be quite sick from the beginning, orhe may have a mild attack and not be very sick. Usually the fever risesrapidly, the child vomits and complains of a sore throat. If the attackis very mild the throat symptoms may not cause any distress. Frequently, about the third day, there are patches on the tonsils. Prostration maybe profound if the fever is very high. Convulsions and diarrhea aresometimes present in very young patients. It takes from two to six daysto develop scarlet fever from the time the child is exposed to it. Thedisease may be caught at any time, but it is most contagious during thetime the patient is scaling. It is not as contagious as measles. Somechildren seem to escape even though directly exposed to it. It is morefrequent in the fall and during the winter, and it is more severe duringthe latter months. 

Eruption. --The eruption appears at any time after twelve hours. It maynot, however, appear before the third or fourth day. It lasts from threeto seven days, and only takes a few hours to cover the whole body afterit is first seen. The rash is first seen on the neck or chest; itappears as a red, uniform blush, but, when examined closely, smallreddish spots may be seen all over it. If the rash is very faint and ofa doubtful character a hot bath may bring it out. A bright red, well-developed rash is a sign of good heart action. In the event ofheart failure, the rash fades quickly. Itching is a constant symptomafter the rash is fully out. 

About the eighth day the rash begins to scale or desquamate. It beginson the neck and chest. It takes from one to three weeks to scalecompletely, from the time it begins to peel. The hands and feet are thelast spots to scale. 

It must always be kept in mind that mild cases are just as contagious assevere cases, and that a mild case may cause in another person a verysevere attack. 

The throat may be mildly affected or it may be the most troublesomefeature of the case. It is red and swollen and the child complains ofpain during the act of swallowing. Patches may be seen on the tonsils onthe third day. There is usually a discharge from the nose and thisdischarge may be contagious. While the fever is high, the child isrestless, complains of thirst, and may be slightly delirious. 

One attack is usually all a child has during life, though there areexceptions to this rule. Complications are quite frequent with scarletfever. Inflammation of the ears and kidneys is most often met. 

Measures to be Taken to Prevent Spread of Disease. --Every case, nomatter how mild, should be isolated for four weeks. Many cases must beisolated longer, --until scaling is complete. Children should not playor sleep with other children for three or four weeks after all symptomshave been absent. Other children in the family, who have not beenexposed, should be sent away. All clothing should be changed and washedin soap and water and then boiled in a carbolic solution. The nurseshould not mix freely with other members of the family. The sick roomshould be kept clean, and well aired. It should be dusted with a wetcloth, and this should afterwards be burned. There should be nofurniture, or hangings, or pictures in the room other than areabsolutely necessary. The room should not be used after the case is overuntil it is thoroughly and completely disinfected. 

During the period of scaling the patient should be rubbed all over withcarbolated vaseline. This allays itching and prevents the scales flyingaround. The bed sheet can be taken off daily with the scales in it, andimmediately put in carbolic water and boiled. 

Treatment. --Inasmuch as scarlet fever is one of the most dangerous andone of the most treacherous diseases of childhood, we cannot afford totake any chances with it. Every child with scarlet fever should be putin bed, and kept there during the entire illness, --that is, from four tosix weeks. Light, and the free circulation of fresh air are absolutelynecessary for the proper care of a scarlet fever case. The child shouldbe clothed only with the usual night gown and a light undershirt. Noextra wraps or blankets are required. 

The diet should be reduced in quantity and strength. The bowels shouldmove daily. If anything is necessary to accomplish this, citrate ofmagnesia is quite satisfactory. There is no special medicine for thetreatment of this disease. Often it is not necessary to give any. Goodnursing is more essential, and with proper attention to the bowels, diet, fresh air, clothing, sleep, and quiet, all will, as a rule, resultfavorably. Quiet is essential. Consequently, two persons at a timeshould never be allowed in the room with the little patient. 

The family physician will prescribe whatever medicine is necessary inhis judgment, and will meet any complication as it arises. 

TYPHOID FEVER

Typhoid fever is an acute infectious disease. It is rare in infancy. After the fifth year it is more common. It is caused by drinkinginfected water or milk. It is not a serious disease in childhood, rarelybeing fatal. 

Symptoms. --It may begin suddenly or it may come on slowly. Ifsuddenly, the child develops what appears to be an attack ofindigestion, has fever, vomiting, and is prostrated. In cases developingslowly the child complains of being tired, has a headache, nausea, andfever. Vomiting is the suggestive and important symptom. 

Diarrhea is usually present. Constipation, however, may accompany theentire illness. Children may not complain of an excess of gas as doadults. The abdomen is tender. The typhoid eruption is rarely seen inchildren. They lose flesh steadily and then strength diminishes rapidly. Headache and delirium at night are quite common, and the child is dulland indifferent, and often in a state of semi-stupor. 

In order to tell definitely whether the child has typhoid, it isnecessary to make a blood examination. There are so many intestinalconditions in children that simulate typhoid, that a blood examinationis imperative. 

Treatment. --The patient should remain in bed during the time fever ispresent and for a few days after. A fluid diet, preferably milk, is themost suitable means of nourishing the child. It may be diluted or givenplain according to the age of the patient. Water is essential and shouldbe given freely. 

The discharges of the patient should be thoroughly disinfected in asolution of carbolic acid, 1-20. All clothing and bed linen should beboiled for two hours. If the fever remains high cold sponging isadvisable. The attending physician should instruct regarding thisfeature, as some children do not stand cold applications well. 

The average duration of the disease is about six weeks. 

How to Keep From Getting and Spreading Typhoid Fever. --Typhoid feveris a communicable disease, but, if certain precautions are taken, itscontraction and spread can almost certainly be prevented. 

The disease is caused by a specific germ known as the typhoid bacillus. These germs are found in the excreta (stools and urine) of persons illwith typhoid fever. 

Failure to properly disinfect these excreta and carelessness in the careof persons ill with typhoid fever lead to the transmission of thedisease from the sick to the well by the infection of water, milk orfood with the typhoid bacillus or by direct contact. 

The disease is contracted by taking into the mouth in some form thedischarges from some previous case. There is no other way. It is, therefore, a disease of filth and someone is at fault somewhere forevery case of typhoid fever that occurs. 

Bad sanitary conditions, such as lack of drainage, open cess-pools, sewer gas, decaying vegetable matter, etc. , may favor the contraction ofthe disease, but cannot cause it unless the specific germ, the typhoidbacillus, is present. 

The water supply of a community becomes infected by the entrance into itof the excreta (stools and urine) of persons suffering from typhoidfever. 

Milk (in which typhoid bacilli grow and multiply very rapidly) usuallybecomes infected by washing out milk cans with water in which thesebacilli are present, or from the presence of the bacilli on the hands orpersons of those handling milk. Oysters spread the disease when theyhave been "freshed" in water rich in sewage and containing the typhoidbacillus. Flies, whose bodies have become foul with typhoid excreta, mayinfect food, milk, etc. Those who take care of typhoid patients maycontract the disease if they do not at once disinfect their hands afterhandling the patient, or clothing or bedding which has become soiledwith the discharges. 

How to Keep From Getting Typhoid Fever. --If the chance of infection isto be reduced to a minimum, all drinking water, concerning the characterof which there may be the slightest doubt, should be boiled, and allmilk, the handling and care of which is not absolutely beyond suspicion, should be pasteurized or boiled. All food supplies (meat, milk, vegetables, etc. ), should be carefully protected against flies, andflies should not be permitted access to the sick-room, the kitchen norto the room in which the meals are eaten. Bathing at all beaches whichhave sewers emptying in their immediate vicinity should be strictlyavoided. In the majority of cases it is probable that the system must beslightly below par in order that the disease may be contracted;therefore, all indigestible food, green fruit, etc. , which may set upindigestion or diarrhea, and so render the system more susceptible toinfection, should be avoided. In addition, the elementary rules ofcleanliness and hygiene, both as to the house and person, should be moststrictly observed. No member of a household in which a case of typhoidfever occurs should take food in any form without previously washing thehands. 

Typhoid bacilli enter the body only through the mouth. If sufficientcare be taken to prevent their entrance, the contraction of the diseasecan be absolutely prevented. 

How to Keep From Spreading the Disease. --In order to protectthemselves and others in the household, persons caring for or in any waycoming into contact with a case of typhoid fever must constantly bear inmind that the secretions and excretions (urine, stools, etc. ), of thepatient contain typhoid bacilli and are capable of transmitting thedisease to others. The person who nurses the patient should not do thecooking for the family. The bedding used by the patient should be washedseparately from that used by others. Special dishes, plates, knives, forks, etc. , should be kept for the use of the patient alone, and shouldbe washed separately and thoroughly. Particular attention should be paidto immediate disinfection of the stools and urine of the patients untilthe restoration of health is complete. 

The urine is especially dangerous. It may look entirely normal and yetcontain typhoid bacilli for some time after recovery is apparentlycomplete. In a few instances the typhoid bacilli may persist in thestools for weeks or months after recovery. Such persons are called"typhoid carriers, " and constitute a grave menace to the health of thecommunity. The best disinfectants are carbolic acid and freshly slackedlime; both are effectual, cheap and easily obtained. Urine or stools towhich has been added one-third of their volume of a solution of one partof carbolic acid to twenty parts of water are, as a rule, sufficientlydisinfected in half an hour, provided the mass of the stool is broken upand thoroughly mixed with the solutions. The best method is to keep theurinal of bed-pan partly filled with the disinfecting solution at alltimes. In this way any germs present in the urine or stools are almostinstantly destroyed. Stools and urine should never be thrown out on theground. If no system of drainage is at hand, they should be verythoroughly disinfected and emptied into a hole in the ground and coveredwith earth. All persons nursing or handling the patient in any wayshould be careful to wash their hands very thoroughly with soap andwater before leaving the sick-room. They should never, while in thesick-room, touch any article of food or put their hands to their mouths. Careful observation of the above suggestions and precautions will almostcertainly prevent contraction of typhoid fever or the spread of thedisease. 

VARIOUS SOLUTIONS

Boracic Acid Solution. --In the previous pages mothers are frequentlytold to use "a saturated solution of boracic acid. " A saturated solutionmeans that the water in the solution has dissolved all of the productthat is put into it that it is capable of dissolving. When boracic acidis put into water, the water will dissolve it up to a certain point; ifyou add more the boracic acid will not dissolve; it will float if it isin the form of powder, or it will remain at the bottom of the glass ifit is crystal--in other words the water is saturated to its limit andthe solution is known as a saturated solution. 

The strength of a saturated solution of boracic acid is as follows:--

 Boracic Acid Ounces 1-1/2 Hot Sterile Water Pints 2

which means that 2 pints of hot water will completely dissolve 1-1/2ounces of boracic acid. If any more boracic acid is added the waterwill not dissolve it because it is already "saturated. " Inasmuch, however, as boracic acid is harmless, it is perfectly safe to use theliquid part of a solution which contains some undissolved acid. 

A saturated solution is used in the eyes after it is strained. 

Normal Salt Solution. --A normal salt solution is made in the followingproportions:--

 Sodium Chloride (ordinary table salt) Grains 128 Sterile Water Pints 2

Normal salt solution is much used in irrigating the bowel. A mother maysafely use it in the proportion of one heaping teaspoonful to two quartsof water--two quarts being the size of the ordinary fountain syringe. 

Carron Oil. --Lime water and raw linseed oil, equal parts. This mixtureis much used in burns. It should be made fresh. 

Thiersch's Solution:--

 Salicylic Acid Drams 1/2 Boracic Acid Drams 3 Sterile Water Pints 2

Thiersch's solution is a good, mild antiseptic solution, or wash. 

Solution of Bichloride of Mercury (1 to 1000):--

 Bichloride of Mercury Grains 15 Common Salt Grains 15 Sterile Water Pints 2

Bichloride of mercury is one of the most powerful and poisonous drugs. Solutions made from it should never be used without special directionsfrom a physician. In much weaker solutions than the above it is one ofthe best antiseptic washes known. It is used to disinfect wounds, fordouches, and for various other purposes, but always by special directionof a physician. 

Other solutions. --Frequently mothers are directed to use solutions inthe proportion of 1 to 500, or 1 to 1000. 

This means that there will be one part of the drug, or of the liquidmedicine, to 500, or 1000 parts of water. For example if you were askedto make up a solution of bichloride of mercury in the strength of 1 to4000, you would use one ounce of bichloride of mercury to four thousandounces of water, or one grain of the mercury to four thousand drops ofwater, --one grain being equivalent to one drop. 

Sometimes solutions are made up on the percentage basis. For example, afive per cent. Solution of carbolic acid. In this case it would benecessary to take five ounces of carbolic to one hundred ounces ofwater, or five drops of carbolic to one hundred drops of water. 

 * * * * *

CHAPTER XXXIX

ACCIDENTS AND EMERGENCIES

Accidents and Emergencies--Contents of the Family MedicineChest--Foreign Bodies in the Eye--Foreign Bodies in the Ear--ForeignBodies in the Nose--Foreign Bodies in the Throat--A Bruise orContusion--Wounds--Arrest of Hemorrhage--Removal of Foreign Bodies froma Wound--Cleansing a Wound--Closing and Dressing Wounds--The Conditionof Shock--Dog Bites--Sprains--Dislocations--Wounds of theScalp--Run-around--Felon--Whitlow--Burns and Scalds

Contents of the Family Medicine Chest. --The family medicine cabinetshould contain the following articles: a graduate, medicine droppers, hot water bags, a flat ice bag, a fountain syringe, a Davidson'ssyringe, a baby syringe, sterile gauze, absorbent cotton, gauze bandagesof various widths, a yard of oiled silk, one roll of one inch "Z O"adhesive plaster, a bottle of Pearson's creolin, hydrogen peroxide(fresh), one ounce tincture of iodine in an air-tight bottle, a can ofColman's mustard, two ounces of syrup of ipecac, a bottle of castor oil(fresh), one pound of boracic acid powder, one pound of boracic acidcrystal, a bottle of glycerine, a bottle of white vaseline, a baththermometer, some good whisky or brandy, aromatic spirits of ammonia, smelling salts, pure sodium bicarbonate, oil of cloves for an aching gumor toothache, a bottle of alkolol for mouth wash and gargle, and oneounce of the following ointment for use in the various emergencies whichoccur in all homes, --

 Bismuth subnitrate dram one Zinc oxide dram one Phenol (95%) drops twelve Resinol ointment to make ounce one

This ointment may be applied to all cuts, bruises, skin eruptions, chafings and sores of minor importance. It is one of the bestapplications for chafing of the skin in babies. 

The medicine chest should also contain a small jar of Unguentine forburns; one-tenth grain calomel tablets for a cathartic for baby to beused as explained in the text of the book, or as advised by thephysician. It may also contain tablets for colds and for other purposesas suggested by the family physician. It should never contain medicinesthe use of which is not thoroughly understood by the mother. It is awrong practice for mothers to keep medicines to use for the same ailmentat a subsequent time. The ailment may not be the same and frequently themedicine itself deteriorates, or it may get stronger with age. Manymedicines are made with alcohol in them. If kept for some time thealcohol evaporates and leaves a concentrated mixture which, if given inthe dose meant for the fresh preparation, may poison a child. Such casesof poisoning are on record. The same argument applies to powders. Certain drugs lose their strength, some absorb moisture, others changetheir chemical strength if kept mixed with other chemicals. They shouldbe thrown away after the case is over if they have not been used. It isa dangerous practice to keep medicines around if there are children inthe family. 

Foreign Bodies in the Eye. --Particles which accidentally lodge in theeye are usually located on the under surface of the upper lid. They aresometimes, however, found on the ball of the eye or on the inner aspectof the lower lid. Foreign bodies which are propelled into the eye withgreat force, as iron specks which railroad men frequently get sometimesimbed themselves into the eye-ball and have to be cut out or dug out. The entrance of the foreign particle is always accompanied by a flow oftears which is nature's way of removing them. The offending object mayescape through the tear duct into the nose, or it may be simply washedout with the flow of tears. Rubbing the well eye will cause a flow oftears in both eyes and may facilitate removal of the foreign matter. Blowing the nose may force the particle into the tear duct. The use ofthe eye cup may help in ridding the eye of the body. The same object maybe accomplished if the eyes are immersed in a basin of water and openedwide. Then by moving the eyes around the particle may be washed out. Ifthe particle is located on the under surface of the upper lid it may bepromptly removed by pulling the upper lid forcibly down and over thelower lid. The eyelashes of the lower lid act as a brush and as a rulequickly remove the irritant if the procedure is carried out adroitly. Everting the upper lid is a means of locating the body and in makingpossible its removal by a small camel's hair brush or corner of ahandkerchief. To evert the upper lid it is necessary to employ a guide. A match stem may be used in an emergency. This is laid across the middleof the upper lid, the eye lashes are grasped with the fingers of theother hand and the lid is bent over the match stem and turned up thuseverting or turning inside out the entire upper lid. The procedure maybe facilitated if the patient is instructed to look down while theoperator is drawing the eye-lid upward. 

If the particle cannot be easily removed by any of the above methods itis not safe for an uninstructed individual to go any further. The eye isan exceedingly delicate organ and may be permanently injured byunnecessary irritation. It is always safer and it may be cheaper in thelong run to consult a competent oculist in such cases. 

After the removal of any object from the eye, it is desirable tofrequently wash it out with a saturated solution of boracic acid. Thismixture will allay any inflammation and will tend to restore the normalcondition more quickly and more satisfactorily than if the eye were leftto heal itself. 

Foreign Bodies in the Ear. --When a foreign body gets into the earmothers are unnecessarily alarmed because of a failure to appreciatethat the ear is a closed passage. It is impossible for any object to getinto the ear itself; the depth of the external passage is only about oneinch in an adult. At this point the passage is completely closed by thedrum membrane. Most of the harm is done by ignorant meddling, not by theobject itself. 

Children frequently put foreign bodies in the ear, as, buttons, pebbles, beans, cherry stones, coffee, etc. The very first thing for the motherto do when she learns that her child has put "something" in its ear isto keep cool, and try to find out what the something is. It isessential to know what the article is because different articles aretreated differently. For example if we try to remove a bean or pea witha syringe, the liquid will cause the pea or bean to swell and result inwedging it in so firmly that it will be impossible to dislodge it inthis way. 

If the object is hard, as a marble, button, pebble, bead, the greatestcare must be exercised. Try to make the object fall out. To effect this, turn the child's head downward with the injured ear toward the floor. Then pull the lobe of the ear outward and backward so as to straightenthe canal. A teaspoonful of olive oil poured into the ear will aid inits expulsion. If after the oil is poured in, the head is suddenlyturned as above described the object will fall out. A very effective wayto remove a hard object is to take a small camel's hair brush and coatthe end with glue, or any other adhesive substance, then place it incontact with the object and permit it to remain long enough to becomefirmly attached after which it may be gently pulled out with the objectattached. Never employ an instrument in the ear to remove a foreignbody. 

When a live insect or fly enters the ear a number of safe methods may bedeveloped. If the ear is immediately turned to a bright light the insectmay come out of its own accord. It may be floated out with salt water, or it may be smothered with sweet oil or castor oil after which it maybe floated or syringed out. If it is necessary to employ a syringe thisshould be used gently. A foreign body may remain in the ear for days orweeks without doing any harm. This suggests that any unnecessary pokingor prying should not be undertaken, because this may wedge it in tighterand to injure the drum membrane. 

Foreign Bodies in the Nose. --Children may put any of these articlesinto the nose. Very often they do, and do not know enough to tell. Ifsuch is the case the first symptom calling attention to the fact thatsomething is wrong is the appearance of a thick foul discharge from onenostril or some obstruction to breathing on the same side. 

When the foreign body may be seen the child should be made to blow thenose, first closing the well side with the finger. If this does notexpel the object the child should be made to sneeze by tickling the freenostril with a feather or by taking snuff. The mother should neverpermit the use of instruments by one unskilled in an effort to rid thenose of an obstruction. There is great danger of seriously injuring thedelicate structure of the nose in this way or of pushing the object sofar in that it may necessitate an operation to extract it. It is muchsafer to seek medical aid before any damage is effected. It seldom doesharm to wait until the right assistance is at hand; it often doesserious harm to be too smart in these little matters. 

Foreign Bodies in the Throat. --If the foreign body is in the upperpart of the throat and can be seen it may be removed with any instrumentthat can grasp it. The child may be immediately held up by its feet whenthe article may be shaken out. If it is further back or in the airpassages the child should be made to vomit by tickling the throat with afeather or with the finger held in the throat till it does vomit. 

When the object interferes with breathing a physician should be sent forin a hurry. In the meantime the family may try to dislodge it by havingthe child bend forward or by holding it with the head downward and, while in this position, sharply striking the back with each cough. Striking the chest when in this position may effect the same purpose. Ifno success follows this procedure try the reverse position. Have thechild bend backward over the arm of a sofa, for example, or put him inbed with the body hanging out of the bed face upward. If none of theseeffect relief you must depend upon the skill of the physician. 

A Bruise or Contusion. --A bruise or contusion is an injury to thetissues underneath the skin, but this does not imply that the skinitself is opened or damaged. In every bruise the small blood vessels areruptured, and the blood collects in the tissues causing distention, swelling and pain. The blood is held in the tissues, it is stagnant, becomes dark in color and so produces the bluish discoloration that wesee in all bruises. The color varies according to the extent of thecollected blood. At first it is red and inflamed looking, then purple, then black, then greenish and finally citron. The so-called "black-eye"is a typical example of this degree of bruise. After a bruise the partsswell from the collection of blood and from the accompanyinginflammation. This causes pain which persists for a day although thespot may be sore and tender for a week or more. 

In all mild varieties home remedies may suffice, but in the more seriousand extensive bruises it is advisable to seek medical assistance. It isessential to completely put the part to rest and to elevate it. Thiswill relieve the pain and favor the absorption of the exuded blood. Ifthe bruise is on the foot, the leg should be elevated until the foot ishigher than the hip. If, on the hand, it should be so held that it willbe higher than the elbow and it may frequently be held higher than theshoulder to relieve the throbbing and the pain. 

As a rule, cold should be applied as soon after the injury as possible, cloths wrung out of ice water, or a piece of ice may be bound on thepart for a short time. The object of the cold is to stop the internalbleeding. If the injury is slight, as are most of the injuries of thehousehold, the mother may apply repeated cloths wrung out of very hotwater. This procedure tends to aid the immediate absorption of the bloodand prevents a discoloration of the part. If there is great pain reliefmay be afforded by applying a firm bandage saturated in the lead-waterand laudanum mixture which may be obtained in the drug store under thename of lead and opium wash. The bruised part should be massaged everyday and a simple ointment may be applied to soften the inflamed area. 

If any complication arises in the treatment of a bruise, it will benecessary to consult a physician. 

Wounds. --A wound implies an injury to the skin in addition to injuryto the underlying parts to a lesser or greater extent. The skin may beopened by cutting, or stabbing wounds; or it may be punctured, torn, contused, or bruised open. These injuries are effected in various ways. We speak of machinery or mechanical wounds, or gunshot wounds, bites, cuts, stabs and other varieties of wounds. 

It is very important to know exactly how a wound is produced and thenature of the instrument which opened the skin. We try to obtain thisinformation in order to estimate the probable degree of poison that mayor may not have entered into the wound. 

The first thing to do in treating wounds is to stop the bleeding. If thepatient is suffering from shock he should be given active treatment forthis condition as described elsewhere. If the wound contains any foreignbodies these should be removed. The wound should then be cleansed, closed and dressed and kept at rest. If the wound is poisoned, or ifthere is any fear that lockjaw may arise, or if the wound has beencaused by a mad dog it will require special treatment. 

It is far better not to interfere if you do not know what to do than todo harm. One should offer no advice if they are not qualified to giveadvice. Much harm has resulted from doing the wrong thing in thesecases. The instruction in the following pages is given so that theaverage mother may know what to do in emergency but not with theintention that she may regard her knowledge as sufficient to dispensewith the aid of the physician. 

Arrest of Hemorrhage. --When there is a wound there is always bleeding;this means that some blood vessels have been cut or torn open allowingblood to escape. The character of the hemorrhage will determine thenature of the treatment to be employed. On general principles, the firstthing to do in the presence of bleeding is to elevate the part, if thatis possible. If there is simply a general oozing of blood, it may becontrolled and arrested by pressure. This pressure should be steady andprolonged. It is best accomplished by wetting a clean handkerchief or apad of gauze in ice cold water, placing this on the part and binding iton firmly with a bandage. 

If the discharge of blood flows in a steady stream and is rather darkthe hemorrhage is coming from a vein. We know that veins carry bloodtoward the heart so that any pressure or constriction employed to stop avenous hemorrhage should be tied on the side of the wound furtherremoved from the heart. Inasmuch as veins have soft walls the right kindof pressure will in most instances stop the bleeding. The part should beelevated after the pad is adjusted in place. Any tight band on the limbas a garter or sleeve band should be removed as they tend to interruptthe return circulation. 

If the hemorrhage is from an artery the blood is bright red. It spurtsout forcibly, is difficult to control and demands immediate attention. Arteries carry the blood from the heart to the extremities. They beatwith every pulsation of the heart so that blood coming from an arteryspurts with every pulse beat. Even a small artery may be responsible fora very considerable hemorrhage in a very short time. Whatever is donemust be done quickly. The parts should be freed from all clothing and ifpossible elevated. Pressure may be tried, if it succeeds it must bestrong and steady pressure. The point to press must be on the heart sideof the bleeding artery since the blood stream is coming that way--thisthe mother will note is the reverse from treating bleeding from a veinas previously explained. The artery at this point may be felt beating. It is frequently necessary to clamp the whole limb to stop an arterialhemorrhage. This may be done in the following manner. Take a strongpiece of cloth or bandage and tie above the bleeding point. Insert ashort piece of stick between the bandage and the limb and twist arounduntil the bleeding stops. This should not be kept on longer than onehour. A tourniquet of this character shuts off all the blood in the limband if kept on too long the parts may mortify. The best means to stop ahemorrhage of this character is by means of a rubber bandage sold forthe purpose. It is applied by stretching at every turn. It exertsuniform pressure and in this way does no injury to the parts. All thesemeasures are, of course, only temporary expedients as the artery willfinally have to be caught and tied by a physician. 

Removal of Foreign Bodies From a Wound. --When the foreign bodies arelarge enough to be seen they may be picked out with the fingers afterthe hands have been rendered sterile. Smaller bodies may be picked upwith forceps, or they may be washed out with water that has been boiledand cooled slightly, or a bichloride of mercury solution in the strengthof 1 to 2000 may be used; or a normal salt solution may be used. As ageneral rule the physician should be allowed to undertake this procedureso that you may not be blamed for something that may come up later. 

Cleansing a Wound. --The simplest way, and the most effective, tocleanse a wound, no matter how caused, is to procure a brush and paintit thoroughly with tincture of iodine. The iodine should be paintedright into the raw wound, it is then bound up and left if it is smalland does not need any stitching. When the physician comes he can attendto any further procedure that may be necessary. 

Closing and Dressing Wounds. --If the wound is small, its edges may bedrawn together with narrow strips of adhesive bandage after it has beenpainted with iodine. It is then bound up and kept at rest. It should beinspected the following day to see if it is healing properly. 

If the wound is large or torn, it should be seen by a physician anddressed and closed by him. All wounds do better if they are kept atrest. 

The Condition of Shock. --When a person suffers a serious injury, losesa large quantity of blood, or is subjected to a profound emotion, itaffects the vital powers to such an extent that the individual is saidto be suffering from shock. Shock expresses itself in varying degrees ofapathy. The patient may or may not be conscious. If conscious he givesno evidence of feeling, he is silent and motionless although he willrespond to directions and may answer questions. The eyes are dull andlistless, the face pale and pinched, and the general expression isapathetic. The skin is cold and there may be perspiration; the pulse isfeeble and irregular, and the breathing is shallow. The whole attitudeof the victim is one of indifference and apparent inability toappreciate the seriousness of the situation and a seeming immunity topain or discomfort. 

When this condition exists it must always be regarded as serious becausethe patient may die as a direct result of the condition of shock. Thevarious symptoms depend upon a temporary paralysis of the blood vesselswhich deprives the brain of blood. There is always a certain degree ofshock with all injuries. Mothers should know what to do in these casesbefore the physician comes. The general treatment in all cases is tokeep the patient warm and quiet, and to use stimulants carefully. 

The patient should be put in bed or on a flat surface with the feethigher than the head. If raising the feet should cause the face tobecome blue it will be advisable to restore the patient to thehorizontal posture. Artificial heat must be applied to the patient'sbody and extremities by means of hot water bags, bottles, bricks, plates, or any other handy device. Blankets should be put around thepatient and every possible means resorted to, to maintain body heat. Mustard plasters may be put to the heart, spine and shins. Stimulantsare necessary, such as hot black coffee if possible or hot water, inwhich a small portion of brandy may be put. If brandy is not obtainablethe patient may take aromatic spirits of ammonia in hot water everytwenty minutes for a number of doses. In every case of shock a physicianshould be sent for immediately. 

Dog Bites. --When a child is bit by a dog every effort should be madeto get the dog. It should be kept in a safe place for a week so that itmay be definitely known whether it is sick or not. If the dog dieswithin a few days after biting anyone it may be assumed that he hadrabies. Its head should be sent to the local health authorities who cantell after examination if it was mad. If there is any reason to assumethat the dog was infected, the child should receive the Pasteurtreatment. This treatment will, if conducted under favorablecircumstances, absolutely prevent hydrophobia. 

The mother should sterilize the wound as thoroughly as possible. Thismay be done by using pure hydrogen peroxide. A little piece of absorbentcotton is wound round the end of a tooth-pick or match, dipped in theperoxide and the incision thoroughly rubbed clean. This may be done anumber of times to ensure thorough cleansing. No effort should be madeto cauterize the wound. It is not considered proper to employ thismethod with dog bites. When the physician examines the wound he may ormay not open it further for more extensive inspection and sterilization. 

Mothers should remember that there are thousands of bites by dogs thatnever cause any trouble, and if it is known that the dog is healthy noworry need trouble the family. It is also wrong to inform the child ofthe probability of hydrophobia. The child may worry himself sick withfear and if the mother is nervous and excitable he is apt to be madesick with the dread of what may follow. It is better, therefore, toremain quiet, to keep cool, and not to excite the little patient at all. 

Sprains. --Every joint is held together by ligaments which are attachedto the bones forming the joint. If these ligaments are subjected to asudden twist in a direction in which the joint is not constructed tomove, the resulting injury is known as a sprain. The ligaments arestretched, though they may be torn apart and even small pieces of thebone may be split off if the wrench is great enough. The injury is anexceedingly painful one and frequently renders the limb useless for sometime. It is always accompanied with some degree of swelling and more orless inflammation. 

A sprained joint should be immediately put at absolute rest. The bestdressing is the lead and opium wash. Two pints of it may be obtained atthe drug store. Pour into a large bowl, saturate a large piece of thickabsorbent cotton, wrap around the joint and bind in place. This dressingmay be repeated as often as the cotton becomes dry. When the swellinghas disappeared and the pain is gone, it is desirable to have the jointsupported with strips of adhesive bandage. These must be put on in acertain way in order to properly support the joint. Consequently aphysician should put them on. If a sprain is not attended to effectivelythere is danger of the joint being more or less incapacitated for life. 

Dislocations. --A dislocated joint is one that has been put out ofplace. It is best to allow a physician to treat a dislocation. Unskilledhandling of a dislocated joint may not only increase the damage but itmay permanently put the joint out of business. Until the physicianarrives the part should be kept absolutely at rest. 

Wounds of the Scalp. --Children frequently get injuries of the scalp. These wounds bleed freely and as a rule they occasion a great deal ofunnecessary worry and apprehension. Usually they are not of muchimportance. We must keep in mind, however, the probability of fractureas a consequence of severe injury. The first thing to do when there isbleeding from the scalp is to cut or shave away the hair surrounding thewound. This should be done for an inch around the wound so that thoroughdisinfection may be possible. The wound should now be cleansed aspreviously instructed and an effort made to stop the bleeding. The bestmethod is to first apply pads of gauze wrung out of very hot water. Whensuccess is evident a pad made of boiled cotton should be placed on thewound and held tightly in place for some time. If the wound is of such acharacter as to demand stitches a physician should of course put themin. 

Run-Around: Felon: Whitlow. --When pus germs enter around a finger nailand lodge in the soft tissue a "run-around" is the result. It isaccompanied with pain, swelling, redness and inflammation. The loss ofthe nail may follow. 

A felon or Whitlow is a more extensive and a more serious condition. Itis not always possible to trace the cause of a felon. The fact thatgerms gain an entrance, however, is soon established. Sometimes abruise, or scratch, or a wound is the primary cause. The last joint ofany of the fingers may be the seat of a felon. A end of the fingerbecomes hot, tense, swollen and very painful; the pain is intense if thehand is held down. The surface may or may not be red. There is as a rulesome fever. If the felon is on the little finger or thumb the conditionis worse than on the others as a rule, --the inflammation extending tothe hand and often into the arm. The condition affects the palmarsurface of the fingers. If the felon results in the "death" of the bone, the last joint will have to be taken off and the hand may be distorted, crippled, and rendered permanently disabled. Blood poison may set in anddeath is possible as a result of this complication. 

Treatment. --Every effort should be made to abort a felon. Continuousapplication of equal parts of alcohol and water night and day may abortit. Tincture of iodine applied to the entire end of the finger may beeffective. The hand must be at rest, carried in a sling during the dayand slung over the head to the bed-board at night. If these efforts arenot successful after twenty-four hours hot poultices should be resortedto, but they must be changed every twenty minutes. If, at the end ofanother twenty-four hours, there is no improvement the finger must befreely cut open by a surgeon and the poultices continued. 

Treatment of "Run-Around. "--Apply iodine freely, cold applications, and if the inflammation persists use poultices. It is frequentlynecessary to incise the run-around. Patients suffering from either ofthese conditions need general tonic treatment and should be under thecare of a physician. 

Burns and Scalds. --Burns result from undue exposure to dry heat. Scalds are produced by the action of hot liquids and steam. 

There are always produced two results from a burn or a scald. First thelocal effect, and, second, the general effect. The general effect mayproduce shock, the symptoms of which have been described in the previouspages. The degree of shock depends upon the extent of the local injuryand may be severe enough to result in death. If the local injury coversmore than two-thirds of the body death as a rule takes place within twodays. 

How to Extinguish Burning Clothing. --The thought to keep in mind is tosmother the flames effectively. If we deprive the flame of all air oroxygen it will immediately subside. This may be done quickly by wrappingthe burning part in a carpet, rug, blanket, overcoat or any large woolenmaterial at hand. If none of these articles are at hand the victim mayroll on the floor and try to smother the flame by pressure, aided by thehands. It is a good plan to throw water on the patient immediately afterthe fire has been put out, so as to extinguish the smoldering fire. 

When a person is scalded by steam or boiling water or other liquid, itis advisable to pour cold water freely over the wound. 

How to Remove the Clothing. --When it is necessary to remove theclothing it is essential to be gentle in order not to do greater injury. The clothing must not be pulled. The garment should be cut so that theyfall off. If any part sticks to the skin, it must be left, not tornaway. Later, it may be removed by moistening it with salt water. 

Treatment of Scalds and Burns. --All slight burns or scalds may beeffectively treated with Unguentine. This substance may be obtained inany drug store. It is spread on a cloth and applied directly to theinjured part, bound securely on and renewed every day until the wound ishealed. If Unguentine is not readily obtainable the part may be coveredwith any of the following mixtures or oils: carbolated vaseline, equalparts of linseed oil and lime water, olive oil, castor oil or kerosene, cloths soaked in a solution of baking soda, or a solution of phenolsodique. 

In severe burns or scalds the mother should not attempt to treat thechild. A physician should be summoned at once. The child may be given alittle whisky or brandy in warm water, and if the pain is great a doseof laudanum may be given. The dose of laudanum is one drop for each yearof life. If the child has a chill he may be put into a warm bath of100°F. It is not wise to cut a burn blister. The water may be let out bypuncturing with a sterile needle, but the skin must be left intact untilthe new skin is grown. The treatment of burns must be done with thegreatest cleanliness because if infected with germs they may proveserious. 

 * * * * *

MISCELLANEOUS

CHAPTER XL

MISCELLANEOUS

The Dangerous House Fly--Diseases Transmitted by Flies--Homes Should beCarefully Screened and Protected--The Breeding Places of Flies--SpecialCare Should be Given to Stables, Privy Vaults, Garbage, Vacant Lots, Foodstuffs, Water Fronts, Drains--Precautions to be Observed--How toKill Flies--Moths--What Physicians are Doing--Radium--X-Ray Treatmentand X-Ray Diagnosis--Aseptic Surgery--New Anesthetics--Vaccine inTyphoid Fever--"606"--Transplanting the Organs of Dead Men into theLiving--Bacteria that Make Soil Barren or Productive--Anti-meningitisSerum--A Serum for Malaria in Sight. 

THE DANGEROUS HOUSE FLY

Mothers should become thoroughly acquainted with the grave consequenceswhich may result from fly-infected foods, and from the possible carriageof disease by means of flies, even where foods are carefully protected. The transmission of the following diseases by means of flies has beenconclusively proven: typhoid fever, tuberculosis, cholera, Orientalplague, inflammation of the eyelids, serious infection of wounds. Summerdiarrhea of children is also transmitted in this way. 

Typhoid fever and summer diarrhea of children in this country, andcholera and Oriental plague in the countries in which those diseasesexist, may be transmitted through the various foods that are eaten in anuncooked state, if infected by flies, through cooked foods infected byflies after the process of cooking, through drinking water which hasbeen infected by flies, and through milk similarly infected. Fruits areespecially likely to be infected by the small fruit fly commonly foundaround markets and stands. Fish may be infected by flies, and inconsequence will undergo rapid decomposition. Decomposition caused inthis way has resulted in many cases of diarrhea and dysentery. What iscommonly known as fly speck is the excreta of the fly, and frequentlycontains virulent disease germs. These specks are often found onfoodstuffs that have not been properly protected. 

Transmission of disease may also occur by the infection of open woundsthrough contact with infected flies. This is true of all pus formationin wounds. The simple contact of a fly infected with the disease maycause Oriental plague, sore eyes, and possibly granular eyelids. A flyinfected with dysentery or typhoid fever may cause either of thesediseases by simply coming in contact with the lips of susceptiblepersons. 

The fly in the house should be relentlessly pursued and destroyed. Thehouse which is carefully screened and protected from flies is infinitelysafer than one not so protected. In the spring of the year the house flybegins to take on life. Eggs which were laid the preceding fall begin tohatch. At first the fly is only a little worm wriggling in some pile offilth. The eggs are usually laid and the grub developed in a manure pileor some mass of garbage or other filth. Before the grub develops intothe fly it is easily destroyed. If everything in and about the housewere kept scrupulously clean, and if every manure pile were keptcarefully screened or covered so as to protect it from flies, therewould be no difficulty in preventing the fly nuisance. The mosteffective way to accomplish this is to destroy the breeding places. Theimportance of this may be seen when it is considered that one flyproduces one hundred and twenty-five millions or more of its kind in oneseason. 

Stables. --Manure is by far the commonest material in which the flylays her eggs. All stables should be kept scrupulously clean. No manureshould be allowed to accumulate where it will be exposed to flies foreven a few minutes. Immediately after it is dropped by an animal, itshould be removed and covered. Manure may be treated with considerablequantities of lime without interfering with its fertilizing value, andin this way the development of the eggs laid in it by the flies can bepractically prevented. The floors of stables should be thoroughlyflushed with water at least once in every twenty-four hours. 

Privy Vaults. --Human excrement also affords an excellent breedingplace for flies. In army camps the latrines are the points from whichmuch infection is transmitted to troops, and thousands of the men havelost their lives by contracting typhoid fever transmitted in thismanner. During the summer time all open vaults and dry closets should betreated continuously with lime, crude creolin or crude carbolic acid, and they should be carefully cleaned out at frequent intervals. 

Garbage. --As a medium for the development of flies, garbage may beconsidered next in importance to excreta. The eggs of the fly hatch inabout twenty-four hours, and garbage which is retained in the kitchenfor that length of time may contain flies in the grub stage. To preventthis development, all garbage should be covered and pails should beemptied as often as possible. In country districts garbage should beburned in the kitchen or buried in the garden at frequent intervals, twenty-four hours being the maximum time it should be retained. 

Vacant Lots. --Vacant lots frequently contain appreciable quantities oforganic matter in a state of decomposition, affording favorable breedingplaces for flies. These vacant areas should be maintained in a state ofscrupulous cleanliness. 

Foodstuffs. --In order to prevent contamination of foodstuffs, allfoods that are eaten in the raw state and all foods that are exposed forsale after having been cooked should be carefully protected from contactwith flies, by screens or covers. 

A point where rapid development of flies takes place is along the city'swater front. This is due to the fact that many of the sewers do notdischarge below the level of the water. All open drains should beeliminated, whether they be sewers, private house drains or drains fromcess-pools. 

Precautions to be Observed. --Keep the house free from flies. Every flyshould be considered a possible disease carrier and should be destroyed. 

Keep the windows of the house, especially the kitchen windows, carefully screened during the spring, summer and autumn. 

Protect children from exposure to flies, particularly children who areill, and do not allow nursing bottles to be exposed to flies. 

Protect milk and other foodstuffs from contact with flies. 

Keep the garbage outside of the house, carefully covered. 

Abolish open drains near dwelling places. 

Stable manure should be frequently sprinkled with lime and kept covered. 

Earth closets and privy vaults should be treated with lime, crudecreolin or crude carbolic acid at frequent intervals. 

Earth closets and privy vaults should be cleaned frequently in order toprevent excrement accumulating to an undue extent. 

To Kill Flies. --Dissolve one dram of bichromate of potash in twoounces of water, add a little sugar to this solution and put some of itin shallow dishes and place about the house. Sticky fly paper and flytraps may also be used. 

To clean the room where there are many flies, burn pyrethrum powder(Persian insect powder). This stupefies the flies and in this conditionthey may be swept up and burned. 

Probably the best and simplest fly killer is a weak solution offormaldehyde in water (two teaspoonfuls to the pint). This solutionshould be placed in plates or saucers throughout the house. Ten cents'worth of formaldehyde, obtained in the drug store, will last an ordinaryfamily all summer. Don't smell formaldehyde in the pure state; it isvery pungent and strong. In the solution of the strength used for fliesit has no offensive smell. It is fatal to disease organisms, and ispractically non-poisonous except to insects. Flies will not stay in thehouse when this solution is around. 

Moths. --Late spring and early summer is the time to guard againstmoths and beetles. Many of these fabric-destroying insects are broughtinto the house on flowers. 

May and June are especially bad months, as both moths and beetles areonly dangerous to fabrics in their young or grub stage. 

These insects will destroy almost anything from coarse rugs to thefinest of ball gowns and dress suits. Carpets that are rarely swept andgarments that are seldom disturbed are most liable to damage. 

The substitution of the frequently removed and easily cleaned rugs forcarpets will greatly lessen the danger from the destructive moth andbeetle grubs. Carpets laid on tight floors are much less liable toinjury than where numerous cracks furnish safe retreats for the insects. Tarred paper under a carpet is an excellent preventive. 

All clothes presses should be thoroughly cleaned at frequent intervals. The garments should be removed, aired and vigorously brushed. Any larvæwhich are not dislodged in this way should be destroyed. It is a badplan to keep odds and ends of woolen or other materials in attics wherethese pests can breed and thus spread to more valuable articles. 

Spraying with benzine two or three times during hot weather is a goodway of preventing injury to furniture or carriage upholstery and otherarticles which are in storage or not in use for a long time. If you arecertain that woolens and furs are free from the pests they may be storedin safety by placing them in tight paste board boxes and sealing thecovers firmly with gummed paper. 

Both moths and carpet beetles are harmless at a temperature of 40degrees Fahrenheit--a fact very well known to advantage by the large furstorage companies. They cannot survive furthermore a temperature of 120decrees if subjected to it for about twenty minutes. 

What Physicians are Doing. --It is desirable that the ordinarynon-medical individual should know what the science of medicine is doingand what it is accomplishing. 

During the past fifteen years the art of curing and preventing diseasehas taken on giant strides. The man or woman most ready to question theaccomplishments and the ability of the humble family physician or themotive of the science of medicine, is the one who appreciates least thatit is due to the skill and intelligence of the medical men of to-daythat he owes his comfort, his health, and his freedom from pestilence, plague and disease. Unthinking people laud and praise some upstart whoseability lies in his faculty to fool the gullible, or they will rush toseek the false aid of some nondescript science, because it is popularand well advertised, while they pass by or ignore the men whose laborshave made the world what it is, and who alone possess the ability tointelligently wage the battle in the interest of humanity againstdisease. 

The medical profession has repeatedly pointed out that there are, on anaverage, six hundred thousand lives lost every year in the United Statesfrom preventable disease and accidents. Six hundred thousand lives whichmedical science has at hand the remedy to save, but which the medicalprofession sacrificed because of inadequate legislation. Few people cancomprehend just what six hundred thousand lives mean. Let us put it inanother way. There are destroyed by preventable disease and accidentsevery day American lives equal in number to the crews of two battleships, equal in three months to more than the total combined numbers ofthe Army and Navy of the United States; equal in one year to more thanthe total number of lives lost in all our wars since the Declaration ofIndependence. 

The Titanic disaster shocked the public for a moment, and seemed toimpress them as though it was a terrible and unheard of waste of goodhuman lives. Yet in the loss of life due to preventable causes we havein this country every day in the year a destruction of our citizensexceeding in magnitude that which occurred when the Titanic sank. Think of it! A Titanic disaster a day, and yet the public does notrise up and demand in a spirit of anger and determination that steps betaken at once to put an end to this appalling and unnecessary waste oflives. 

Under modern hygienic conditions, the average length of existence for anindividual in Great Britain has increased ten years in the last halfcentury. Among all the enlightened and advanced nations, the expectationof the individual for long survival is greater. Since the appearance ofuncheckable and epidemic disorders is less frequent and the percentageof cures is greater. 

Since quarantine has been regularly established and the sewage systemmade efficient in large cities, and since the sanitary plumbing lawshave been made compulsory, the general death rate has decreasedenormously. These regulations have been the product of regularlyeducated medical or sanitary experts. No 'ism or 'ology has everestablished any scientific principle which has contributed to thegeneral welfare of the people. We no longer fear the plague, or typhusor yellow fever, cholera, diphtheria, typhoid, consumption, and otherdiseases which once were a constant menace to the race. The plague, forexample, is practically limited to the Far East, where modern methodscannot evidently be introduced efficiently. At one time it periodicallydevastated Europe, where it cannot now get a foothold because of theintroduction of sanitary systems and hygienic principles. 

Tetanus or lockjaw and hydrophobia are now amenable to cure whileformerly all cases were practically fatal. The mortality of diphtheriahas been reduced more than fifty per cent. Antiseptic precautions insurgical cases, first introduced by the famous surgeon, Lord Lister, have made possible and successful operations that formerly could not beundertaken, thus broadening the whole field of surgical possibilities. The Boer war and the war with Spain proved this truth in a way thatcould not be denied. Smallpox is almost a medical curiosity in New YorkCity, where it once was a scourge. The mortality of childbirth has beenreduced to about one-fifth of what it was by the introduction ofantiseptics and anesthetics. The new methods of making and preparingdrugs, the sterilization and inspection of milk, the methods devised forthe care of and preparation of infant foods have all enormouslycontributed to checking disease, to preventing disease, and toincreasing the length of life and its happiness. 

These are all facts which may be proved by any one, no matter howincompetent they may be. If we were to give up all these hard earnedvictories, cease to investigate or experiment, deny the existence ofdisease, and depend upon the questionable methods of hystericalemotionalists we would soon find ourselves facing all the horrors of thepast. Can we afford to lose the priceless benefits we have achieved andare attaining? Can we sit still and permit the profession of medicine, which has always contained the best of the race in its membership, thebest intellects, the most sympathetic and unselfish characters, thenoblest and most steadfast souls, to be maligned and assailed, to haveits means of well-doing assaulted and threatened, when we know that itshould be supported and protected for the sake of all it has done in thepast in the interest of humanity?

Every mother should be acquainted with these facts so that she may lendher influence in behalf of honest effort and honest inquiry. 

The following summary comprises a brief review of what medicine has beendoing in the recent past:

Radium. --This element was discovered about fifteen years ago byProfessor and Mme. Curie. It possesses the wonderful property of givingout inexhaustible stores of energy. It virtually possesses the propertyof perpetual motion. Professor Becquerel was the first one to suggestthat it might possess therapeutic or healing powers. The suggestion cameto him in a curious way. He carried a tube of radium in his vest pocketand was severely burnt as a consequence. The incident suggested to himthat, if radium could attack healthy tissue in such a short time, itshould be able to similarly attack diseased tissue. Experiments weresoon instituted, and are still being conducted to exactly define itscurative value and scope. 

It was hailed as a cure for cancer and other serious conditions, but wehave found that it is not a cure for these ailments. It is, however, exceedingly valuable in the treatment of certain skin diseases. Inlupus, epithelial tumors, ulcers, papillomata, angiomata and pruritus, it is being widely and successfully used. It was later discovered thatit can quickly kill disease-producing bacteria. It is also well knownthat it will efficiently purify water. 

X-Ray Treatment and X-Ray Diagnosis. --Professor Roentgen gave to theworld an exceedingly valuable discovery in the X-Ray. He discoveredthat a certain form of electrical energy, when applied in a certain way, would produce shadows that differentiated between a certain degrees ofopacity. For example, it would, if directed upon the human hand, produceshadows that clearly indicated whether the substance through which therays passed was bone or muscle. The chief value of the X-Rays has beenfound to be this property rather than any healing value which has beenattributed to them. The fact that these shadows can be photographed hasrendered them of supreme value in surgery and medicine. Previously itwas essential that the surgeon should depend upon his own diagnosis, upon what he could learn from his sense of touch and from surroundingconditions. With the X-Rays at his disposal he can quite eliminate thepersonal equation. His pictures are precise and mathematically accurate;he can prove the truth of his diagnosis before he cuts. We can takepictures of fractured bones and from what we learn we can immediatelytell how they should be set to attain the very best results. We canactually tell if there is a stone in the kidney before we subject thepatient to a serious operation. We can actually take pictures of thestomach at various stages of digestion and tell what disease affects theindividual with a degree of precision that was not possible before theX-Rays were introduced. These examples only suggest its use. There are amultiplicity of uses for these as yet unknown rays which have greatlyaided in diagnosis and consequently in successful treatment. 

Aseptic Surgery. --The utility of the aseptic principle in surgery wasdemonstrated by the Japanese army surgeons during the war with Russia in1904-1905. Their success in preventing deaths from suppurating woundsamazed the world. Their method was to discard the use of antiseptics andto depend upon absolutely clean instruments, dressings and hands. Themost terrible wounds healed under this method without festering. Thisis, of course, the method in vogue to-day all over the civilized world. The Japanese did not discover aseptic surgery, but they were the firstto put it to actual test in a large way. The old method was to dependupon drugs to kill the germs which might find their way into wounds andoperations. To-day we prevent the germs from getting into the wound anddepend upon nature to do the rest. 

New Anesthetics. --Several important advances have been made in methodsof giving anesthetics and in the nature of the products used. Temporaryunconsciousness with electricity was induced in 1909 by Dr. StephaneLeduc. Stovaine was invented by Dr. Jonnesco, of Bucharest. He injectedit into the spinal cord after the method made famous by Biers withcocaine in 1899. Dr. W. S. Schley invented novocaine for the samepurpose. Temporary unconsciousness was accomplished by the use of epsomsalts injected into the spinal cord by Dr. Samuel J. Meltzer. All ofthese efforts to discover a harmless anesthetic by spinal injection weremade possible by investigations and experiments of Dr. J. LeonardCorning, of New York, who worked along this line as far back as 1885. The most revolutionary discovery, however, was that of Dr. S. J. Meltzerat the Rockefeller Institute, New York, when he inserted a tube into thewindpipe, through which he pumped the anesthetic into the lungs. Whiledoing this he at the same time pumped oxygen to aerate the blood, thusensuring the patient against possible accident during the course ofdifficult and tedious operations on the lungs and heart. 

Vaccine in Typhoid Fever. --Inasmuch as typhoid fever has played animportant part in the conduct of all wars, it has always been a sourceof much careful study by military and naval surgeons in every civilizedcountry in the world. We had not, however, reached a stage when it waspossible to hope for its extermination until medical science began toappreciate the possibilities of vaccine therapy. The Cuban, Boer andRussian wars, because of the terrible experiences of the soldiers withtyphoid in each of them, stimulated inquiry along the line ofdiscovering a serum of vaccine that would be effectual against it. American, British, French and Japanese military and naval surgeonsinstituted experiments simultaneously to discover an anti-typhoidvaccine. In the fall of 1909, American army surgeons were experimentingwith a serum at Washington and on Governor's Island with success, butthe first public announcement of an absolutely successful vaccine wasmade by Captain Vincent of the French navy on June 20th, 1910, beforethe Académie de Medicine in Paris. The final success of the anti-typhoidserum has been conclusively proved by elaborate tests upon soldiers andsailors in many nations. 

It is difficult for the ordinary individual to appreciate thesignificance and importance of a discovery of this character andmagnitude. When one thinks calmly of the thousands and thousands of menwho have lost their lives during wars because of typhoid epidemics, andof the thousands of others who have returned home practically invalidedfor life from the same cause, it is possible to, at least, conceive ofthe benefit to the race such a discovery promises. And when we learnthat the discovery is a product of the same principle or method whichgave to the world a cure for smallpox, diphtheria and syphilis, we mustbegin to believe that the medical profession is on the path which isunlimited in its field of promise so far as efficient treatment isconcerned. Yet to-day we have people who do not believe in vaccinationor in anti-diphtheritic serum. We may not live to see the time, but itis not far distant in the opinion of men qualified to speak withauthority, when every disease will be amenable to the serum therapy, andwhen drugs will virtually be discarded by the human race. 

"606. "--One of the most important discoveries in the history ofmedicine was recently given to the world by Dr. Paul Ehrlich. 

He called it "606, " because it was the 606th experiment he had made withthe same end in view. It was designed with the purpose of curing themost terrible disease known to man, syphilis. The name of the remedy issalvarsan. That it will do all that was first claimed for it is stilldoubtful, but salvarsan and its improvements, neosalvarsan, etc. , areaccepted by the profession as by far the best treatment yet devised forthis dread disease. It points the way for improvement along the sameline to an ultimate specific. 

Transplanting the Organs of Dead Men Into Living Men. --To take from arecently dead individual a kidney, or a bone, or an artery, and byimmersing them in certain fluids thereby keeping them aliveindefinitely, and later transplanting them in the body of a livingindividual so that they will continue to live and perform their functionin the new environment, is a revolutionary and a seemingly incredibleperformance. Yet Dr. Alexis Carrel of the Rockefeller Institute, NewYork, has accomplished this wonderful task. The smallest imagination canpicture the possibilities of this kind of surgery, but, inasmuch as thediscovery is so recent and the opportunities for testing it upon humanbeings are so relatively few, that time alone can tell how far it may bepossible to go. 

Anti-Meningitis Serum. --Another important discovery that has emanatedfrom the Rockefeller Institute is the Anti-Meningitis serum. The deathrate from spinal meningitis, before the introduction of the serum, was70 per cent. , the use of the serum has reduced this percentage to 30. Weowe this important contribution to Dr. Simon Flexner. 

A Serum for Malaria Now Possible. --Dr. C. C. Bass, of TulaneUniversity, has succeeded in extracting malaria-producing parasites fromhuman blood and keeping them alive in test tubes. This feat had beenlong attempted but never before with success. The significance of thisachievement is that it is the first step toward preparing a serum thatwill give immunity to malaria.