Treatment.—In the treatment of cholera infantum it must not be forgotten that the dangerous element is the poisoning of the system that is constantly going on. It is difficult for the non-medical mind to estimate the importance of this element. It is, of course, caused by the bacteria present in the gastro-intestinal canal. There are numberless millions of bacteria in the normal healthy bowel. A very large percentage of those germs are good for us, are there for a beneficent purpose, and can and do protect us from other germs which occasionally find their way into the bowel and whose purpose is not a peaceful one. When the bowel condition changes, as during an attack of summer diarrhea, it is invaded by multitudes of evil-intentioned germs. These germs find conditions in the diseased bowel exceedingly favorable to them, so they begin work in an active, energetic way. The result of their activity is highly poisonous, and, as the good germs are virtually out of business and are consequently not working in our interest, we are absolutely in the hands of the enemy. There is soon manufactured, by these invading germs, enough poison to poison the entire system of the child. It is this feature that we must combat in summer diarrhea.

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

If it is a city child that is affected and it does not show decided improvement in three or four days, it should, if possible, be sent to the 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 as convalescence permits. The seashore is preferable to the mountains in all intestinal cases.

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

Feeding must be stopped at once. No food of any kind should be given for at least twenty-four hours, or until the tendency to vomit subsides. The thirst must be allayed, however, so we give frequently small quantities of thin barley water or albumen water or cold boiled water. If these are vomited we must stop giving them altogether for twenty-four hours. If the fever is high and the skin dry, the child should be given a cool pack, 85 deg. to 90 deg. F., which can be moistened every half hour with water at 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's circulation poor, the skin blue and cold, a hot-water bath at 108 deg. 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-hour intervals.

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

If the patient is artificially fed and is not over four months old, a substitute for the milk must be found. The best substitutes are rice or barley water, either plain or dextrinized, the malted foods, chicken or beef 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 while there is any vomiting. When vomiting stops begin with small quantities of beef broth, or chicken, or veal broth. Later kumyss or matzoon can be tried, and finally thin gruels made with milk.

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

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

Irrigation of the bowel is an exceedingly effective way of cleaning out the poison-laden large intestine. It should be done in every instance unless the movements are watery and of such frequency as to render irrigation unnecessary. Once or twice daily will be sufficient in even the worst cases. The irrigation should be given at the temperature of 100 deg. F, and should be the normal saline solution; a long rectal tube is used to give the irrigation.

SUMMARY:—

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

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

3rd. Give a large dose of castor oil and withhold all nourishment until the doctor sees the little patient in every case of diarrhea during the warm 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 be short, sharp, and decisive. Don't pave the way for regrets afterward. Do everything while you have the chance.

COLIC

Colic is a common condition in infancy. Very few children escape more or less colic during the first few months of life. It does not seem to injure permanently some infants; they go on growing according to standard, eat and sleep, and seem contented and happy despite occasional severe attacks of colic. Other children suffer seriously; the degree of indigestion is considerable, and the nutrition of the child is interfered with.

Colic is much more frequent in bottle-fed infants than in those fed on breast milk. Cow's milk, no matter how skillfully it is prepared for their use, is at best an unsuitable diet and taxes the digestive ability of robust children. It is quite natural for an infant whose digestive organs are not strong to develop colic and intestinal indigestion if put on artificial food. Any condition that causes indigestion may likewise cause colic. Those children who are always overfeeding,—taking too much milk, too strong milk, or who are fed irregularly,—are the colicky babies.

Constipation is frequently associated with colic and may be the actual cause. A daily movement of the bowel does not necessarily mean that the bowels are emptying themselves satisfactorily. Despite the daily movement, there may be considerable fecal matter left in the bowel which undergoes decomposition. This results in the evolution of large quantities of gas and severe attacks of colic. Indigestion is very often caused by conditions which effect the stability of the child's nervous organism; such conditions are fright, anger, fatigue, exhaustion, excitement.

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

Symptoms.—A baby having an attack of colic will cry loudly from time to time and whine during the interval; it will pull up its legs and bear down. Its abdomen is tense and hard and distended with gas. With the expulsion of the gas the pain ceases and the child falls asleep. If the attack is very severe the prostration and exhaustion is marked; the feet are cold and the body is bathed in perspiration.

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

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

Treatment.—Find out the cause of the colic if possible. If the cause is 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. The best and quickest means to effect this is to apply massage or give a rectal injection. An injection of two ounces of cold water in which a half or one teaspoonful of glycerine has been put, will act quickly. Dry heat applied to the abdomen in the form of the hot-water bottle or woolen cloths will aid in the expulsion of the gas. The feet should be kept warm.

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

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

To relieve the acute attack, three drops of Hoffman's anodyne may be given in two teaspoonfuls of warm water and repeated in ten-minute intervals until relieved, to a baby under one year of age. From five to ten drops of gin, given in three teaspoonfuls of warm water, and repeated in fifteen minutes, is also satisfactory and harmless. A very good remedy which may be used with the above for quick relief, and to stop the child from crying, is the following: Fold a piece of flannel cloth (two thicknesses) the size of the baby's abdomen; wring out of very hot water and drop ten drops of turpentine over the surface,—at different spots,—of the flannel and lay on abdomen,—turpentine side next skin. Cover this with another piece of flannel,—two or three thicknesses, that has been dry-heated and allow to remain in place for about ten minutes.

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

APPENDICITIS

Appendicitis is mentioned here merely to acquaint mothers with its prominent symptoms.

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

The pain and tenderness are not referred to the region of the appendix but are more centrally located. If, however, the finger point is pressed over the appendix, distinct tenderness will be elicited in inflammation of that region. Constipation is the rule in appendicitis, but diarrhea occasionally accompanies it.

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

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

JAUNDICE IN INFANTS

There are two types of jaundice in infants that deserve brief consideration.

1st. There is a form of jaundice caused by a defect in the development of the bile or gall tubes. These infants develop jaundice a day or two after 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 of treatment. This type of jaundice is not very common.

2nd. There is a type of jaundice that appears between the second and fifth day of life that is very common. It lasts from one to two weeks and then disappears. It is never fatal and is not serious. It requires no treatment.

JAUNDICE IN OLDER CHILDREN—CATARRHAL JAUNDICE—GASTRO DUODENITIS

Symptoms.—This form of jaundice begins like an attack of ordinary indigestion. There are, as a rule, pain, fever, vomiting, and prostration. The pain is located in the upper part of the abdomen and may be quite severe. The vomiting may continue for a number of days. The bowels are usually constipated. After a few days the jaundice sets in and may be quite intense. After the jaundice is established the stools are gray or white in color and there is much gas in the bowel. The urine is very dark and may be yellow or yellowish-green in color. The child complains of headache, is dull and listless, and appears sick and weak. The condition lasts about two weeks, but the jaundice may last much longer. It is not a serious disease.

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

INTESTINAL WORMS

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

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

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

It is reasonable to expect that a child suffering from worms will have symptoms of abdominal distress from time to time; indigestion with colic and much gas may be present; children lose their appetites and are nervous and restless; sleep is disturbed; they may grind their teeth and talk in their sleep, and they may pick their noses unnecessarily during the day. These symptoms may, however, accompany other conditions when no worms are present in the bowel. My observation has been that in children in whom worms were present the nervous symptoms were distinctly accentuated. They are unreliable children; they seem well to-day and peevish to-morrow; they complain of headaches, dizziness, and chilly feelings. They are hysterical, noisy, uncontrollable. A child with these symptoms should be suspected of having worms and if no cause can be found to explain his temperamental vagaries he should be treated for worms. I have cured a number of children of excessive nervousness by giving them medicine for worms when no worms were present. Such results can only be explained on the assumption that these children were suffering from intestinal auto-toxemia or self-poisoning, and the thorough disinfection of the bowel apparently stopped the process by ridding the child's system of a mass of bacteria, which were undoubtedly causing the auto-toxemia and consequent nervousness.

Treatment.—The most efficient remedy for removing round-worms is Santonin. 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 of sugar 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 milk divided into three powders. These powders are given four hours apart in the following way. The child is given a light supper the evening before and one-half glass citrate of magnesia the following morning and the first powder one-half hour later; no breakfast being given. A light lunch, of milk and crackers, may be taken about noon. The second powder is given four hours after the first, and the third four hours after the second. Half an hour after the last powder, a dose of castor oil (one tablespoonful) is given. In a few moments the bowels will move; usually there are no worms in this movement. A little later they will move freely again and if worms are present they will be discharged in this movement.

Thread-Worm, or Pin-Worm.—A thread-worm looks just like a little piece of white thread. They are found in the lower part of the bowel and in the rectum. They are usually present, if present at all, in large numbers.

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

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

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

Tape Worms.—Tape worms are obtained from eating raw meat, pork or sausage, 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 capricious appetite, foul breath, and they may suffer from anemia, sometimes quite severely. The only positive symptoms is the presence of links of the worm in the stools.

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

RUPTURE

Rupture of any description is not a condition that any mother should attempt to treat. A physician should be called in every case. Any misdirected effort at manipulation or pressure may result in irreparable injury to the parts. External applications are useless and may be injurious.

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

* * * * *

CHAPTER XXXVI

DISEASES OF CHILDREN, CONTINUED

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

MASTITIS, OR INFLAMMATION OF THE BREASTS IN INFANCY

There are a few drops of a milky secretion in the breasts of infants when born. Occasionally the amount will be in excess of the normal quantity, and the breasts, around the nipple, may be swollen and slightly inflamed. Should this condition persist, it may be relieved by painting the parts with the tincture of belladonna. Under no circumstances should the breasts be manipulated or rubbed, as this is very apt to cause an inflammatory condition, and to result in mastitis.

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

Mastitis in infants is caused by unnecessary interference and manipulation and by want of cleanliness. When it occurs the parts should be kept absolutely clean and should not be handled in any way. Ichthyol 25 per cent., Zinc Oxide Ointment, enough to make one ounce, spread upon old, clean, soft linen, and laid over the parts and changed every six hours, is an excellent healing application. A piece of oiled silk may be put outside the linen to prevent the ointment staining the clothing, 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 opened and freely drained, and the general health of the patient supported by regular nourishment and tonics.

Mastitis in Young Girls.—Pain and swelling of the breasts are sometimes complained of by girls between the twelfth and fifteenth years, though it may occur at an earlier or later date. If left alone the condition will invariably subside without treatment. Should bacteria find an entrance through the nipple at this time, an abscess may result. The whole breast is involved and it will be exceedingly painful and much swollen. There may be moderate fever, headache, and a pronounced feeling of indisposition. These patients should be given a laxative,—citrate of magnesia, or Pluto Water, and kept on a very light diet. An ice-bag should be kept constantly at the breast during the day, and a moist dressing 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 a surly brakeman, who soundly boxed his ears for some trivial or fancied offense.

Boxing a child's ears is but one of a great many things you should never do to the ears. In fact, there are far more things you should not do to safeguard the hearing, than there are things you can do to benefit your ears.

Do Not Pick the Ears.—Do not put cotton in the ears unless ordered to do so by a reputable physician. Do not syringe the ears without the doctor's orders. Put no poultices in the ears. Do not put drops of any kind in the ears unless prescribed by a doctor. Above all, do not use the advertised ear cures, as most of them are harmful. Never blow into a child's ear, never douche the nose without the doctor's orders, as this may wash germs into the tubes leading to the ears and bring about a serious condition.

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

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

If you have an earache that continues for any length of time, take no chances, but consult a physician. And remember to care for the throat and nose, as ill conditions in those places result in ear troubles. Do not blow your nose too hard; it merely injures the inner sides of the ear drums. Adenoids in children frequently bring about a bad ear trouble. 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. So serious is this that life insurance companies will not insure people in that condition.

Earache.—When a child complains of earache its ear should be examined. In nearly every case of earache it is necessary to treat the throat, as this is, as a rule, the seat of the trouble. An antiseptic gargle of equal parts of Borolyptol and warm water is an excellent mixture. It should be used freely every two hours. Children suffering from earache should be kept indoors. If the examination should show that it is not necessary to lance the ear drum, some local measure may be adopted to allay the pain. Putting the child in bed with the head resting on a hot-water bottle may be all that will be necessary. The following procedure may be carried out, but only after a physician has made an examination and according to his directions: A hot water douche, given by means of a douche bag, is quite effective. The water should be 110 deg. F.; the bag should be held about two feet above the level of the child's head, and the irrigating point should not be pushed into the ear, 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 be closely watched and examined at intervals so that it may be opened at the 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 dangerous disease, mastoiditis. This disease may cause abscess of the brain and death. The moment a child develops fever in the course of an earache the ear should be examined and opened at once, if found necessary.

Inflammation of the Ear. Acute Otitis.—Inflammation of the ear seldom occurs in childhood, unless as a complication, or as a result of some infectious disease. Any disease which affects the throat in any way may be the cause of the inflammation of the ear. Such diseases are, "cold in the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles, scarlet fever. It is much more common in children than in adults. The younger the child, the more liable it is to develop ear trouble when suffering from any of the above diseases. The presence of adenoids favors the development of ear complications.

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

Treatment.—The treatment is to open the drum membrane, at the right time, which of course will always be done by a physician who has had some experience in this work.

After Treatment.—The after treatment consists of washing or syringing the ear every three hours with eight or twelve ounces of a 1:10,000 solution 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 sublimate solution should cause any eruption around the ear, a normal salt solution (see page 627) may be used in the same way, and in the same quantity 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 should suddenly stop and the fever rise, it indicates that the opening has become plugged or healed too quickly. In either case it will have to be opened again. As soon as the ear begins running again the symptoms will disappear. After syringing the ear it should be dried thoroughly with pieces of sterile absorbent cotton.

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

Any child addicted to disease of the ear should be closely watched and examined for tuberculosis. Scrofula may accompany this condition. These children need careful attention in every little detail, they need good nourishment, fresh air night and day, and they should not be pushed at school. During the winter they should be protected from "catching colds;" it is a good plan to put them on a cod-liver-oil mixture for the entire cold season. During the summer they should have a radical change of climate.

SUMMARY:

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

2nd. If a child with one of these diseases becomes restless, sleepless and 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 the child depends upon it.

SWOLLEN GLANDS. ACUTE ADENITIS

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

Symptoms.—A swelling is noticed just below the angle of the jaw; it does not grow rapidly. There is a slight temperature and the child is more or less irritable. If the patient is an infant, the fever may be quite high and there may be considerable prostration. The trouble lasts from four to eight weeks.

Treatment.—An ice-bag constantly applied is the best treatment. This not only relieves pain, but it prevents the possibility of the gland breaking down and suppurating. It is sometimes difficult to keep an ice-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 and laying them on ice. They should be applied frequently to the swollen gland. The following ointment may be applied, though the ice-bag is the better and more certain treatment: Ichthyol 25 per cent., Adeps Lanae one ounce. This is applied on cloth and renewed every six hours.

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

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

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 by some inflammatory condition of the privates, which should be discovered and treated.

BOILS

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

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

I have in a number of instances successfully rid a child of the tendency to boils by the use of the following formula, which I can recommend highly as one of the best tonics I have ever used in the treatment of delicate and poorly nourished children: Tinct. Nux Vomica 4 drops, Acid Phosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make a two-ounce mixture and give to children over four years of age one teaspoonful after each meal; to younger children, one-half teaspoonful after 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, irritation from clothing, use of certain drugs. Certain articles of food, such as tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause hives.

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

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

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

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

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

PRICKLY HEAT

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

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

The rash of prickly heat is easily diagnosed from other rashes because it is accompanied by no other symptom, such as fever, which would suggest a more serious disease. The rash of prickly heat resembles the rash of scarlet fever more than any other rash, but it is quickly noted that when a child has scarlet fever it has every symptom of being profoundly sick, while prickly heat has no symptom other than the itch and discomfort. It is caused by overfeeding, being overclothed, and sweating in hot weather.

Treatment.—Steps should be taken to prevent prickly heat in an infant. Use light, seasonable clothing, bathe frequently, and use plenty of good toilet powder. When the child actually has an attack, open its bowels freely with citrate of magnesia, and give some sweet spirits of niter, according to age. Protect the skin from the irritating underwear by interposing a soft piece of linen. In order to reduce the inflammation and cure the condition apply equal parts of starch and boric acid powder freely. Keep the patient on a light fluid diet. The bran bath is advisable if the little patient is addicted to these skin eruptions.

RINGWORM OF THE SCALP

Children of all ages are liable to "catch" ringworm of the scalp. It particularly 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, always easy to diagnose the condition, especially if the case is a mild one. If it 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 may be mistaken for dandruff, but dandruff covers a large area of the scalp, while ringworm is limited and sharply defined. Dandruff may cause a loss of hair; if it does, the hairs come out clean, while in ringworm they break off near the scalp.

Treatment.—Ringworm is always curable, provided the patient is watched and treatment carried out thoroughly. It is always absolutely necessary to treat the condition, because it will not get better of itself, and the longer it is permitted to last, the worse it gets, and the more difficult it is to cure. If treatment is begun at once, it may take two months to cure it. If the case has lasted for some time, or if it has been neglected and not treated thoroughly, it will take from six months to one year to cure it. These facts are stated so that parents may not become discouraged.

The first thing to do is to cut the hair as close to the scalp as possible, wherever the ringworm is, and for about an inch outside, and all around it. The entire scalp should be thoroughly washed three times a 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 may spread the disease to other parts of the scalp. Every child with ringworm of the scalp should wear a cap of muslin or one lined with paper, so that others may not be infected. These caps can be burned when dirty and new ones made. One of the best remedies to apply to the affected area is the following: Bichloride of mercury, 2 grains; olive oil, 2 teaspoonfuls; kerosene, 2 teaspoonfuls. This is rubbed in every day until the parts are sore and tender. It is a good plan to apply this mixture to the entire scalp every fourth day, to guard against other parts becoming infected. It is not necessary to rub it in when using it where there is no ringworm.

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

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

ECZEMA

Eczema is the most important skin disease of babyhood. It is probably the 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 natural tenderness, or delicacy, of the skin. These children, because of the extreme sensitiveness of the skin, develop an eczema from a very slight degree of external irritation, or a trifling disturbance of digestion. Children of rheumatic or gouty parents are more liable to be victims of eczema than are others. Eczema of the face is quite common in children who are apparently healthy and fat. It does not seem to matter whether they are breast-fed or bottle-fed. The following conditions may be regarded as contributory to eczema:

Exposure to winds; cold, dry air; heat; the use of hard water or strong soaps; lack of cleanliness, and the irritation of clothing. It frequently accompanies chronic constipation, indigestion, and other conditions of the intestinal canal; overfeeding; too early or too excessive 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 the neck. It begins on the cheeks as small red papules. These join together and form a mass of moist, exuding crusts. They dry in time and may be so thick as to form a mask on the face. The skin may be much swollen. When the crusts are removed the face looks red and angry and bleeds easily. It is exceedingly itchy. It causes restlessness, loss of sleep, and it may affect the appetite, though, as a rule, the health remains good. Eczema of the face is exceedingly chronic; it improves from time to time, but it is cured with great difficulty only.

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

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

There exists in the minds of the laity, and in some physicians also, an idea that it is wrong, or dangerous, to cure, or "dry up," an eczema. It is never dangerous, but highly desirable, to cure an eczema, whenever possible. It is always wise, because it is always necessary, to get the child in perfect condition before you treat the eczema. Cure the constipation, or indigestion, or cold, or whatever is the matter with the child; then treat the eczema. This is the only plan that offers any success. It is not a simple matter to find out why a nursing child is having indigestion. The most minute care must be exercised to find out the 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 of the 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 in older children. Sometimes to cure the constipation means an immediate cure of the eczema.

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

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

The use of external remedies is imperative, as frequently the cause is mostly external, and in other cases it must be used in addition to the general treatment. Before external treatment is instituted, the crusts should 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 much inflammation, or if the face looks angry, a very good application is Lassar's paste.

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

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

When an external remedy is applied to any eczematous surface it is necessary 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 well to remember that the real cause of the eczema may be in the mother. If the mother is constipated, or if her diet is too liberal, if she is drinking beer, or an excess of coffee, or is not taking exercise, the eczema 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 poor blood during infancy and childhood. The explanation of this anomalous condition is, that the tax or strain put upon the blood to provide for the growth of the child is severe, and is in addition to the great demands made upon it in the exercise of its regular duties. We must, therefore, always take this special duty into consideration, when the question of recuperation, convalescence, feeding, and the administration of blood foods and tonics comes up.

It is not necessary to specify the diseases from which a child may suffer and recover, in an anemic condition. Any disease may leave a child with temporarily poor blood. The conditions which most frequently produce anemia in childhood are improper feeding and unhealthy surroundings. It is not fully appreciated how seriously these conditions can affect the health of growing children. There is one condition that every mother should be warned against, namely, the possibility of unduly prolonging breast-feeding. Children should be weaned at the end of the tenth month. By prolonging the breast-feeding a mother can undermine the vitality and strength of her baby and so impoverish its blood as to invite disease. A bottle-fed baby should be put upon a mixed diet at the same time. To continue feeding a child exclusively on milk for a year or two after weaning, simply because "it will not take anything else," is criminal. Any woman guilty of such stupidity should never have become a mother. Once again it must be emphasized that every child must have an abundance of fresh air, must not be confined in close, hot, unsanitary rooms, and must have a daily, satisfactory movement of the bowels to be a 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 of headache, pains, disturbed sleep, are nervous and irritable. They tire quickly, 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 may have attacks of nose-bleeding and of bed-wetting.

Chlorosis.—Chlorosis is that form of anemia, of poor blood, which occurs in young girls about the time their sickness begins. It is most frequently seen between the fourteenth and seventeenth years, and more often in blondes than in brunettes. The cause is not known. It is thought to be due to constipation. Any occupation which is deleterious to health has a distinct influence on the condition. Employment in factories, confinement in badly ventilated rooms, bad or insufficient food, great grief, care, or a bad fright, mental strain, overstudy, may all 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 a peculiar 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 have various nervous disturbances, such as headache, pains in various parts of the body, neuralgia, especially over the eyes, hysterical attacks, and sometimes cholera. Ulcer of the stomach is sometimes seen in this condition.

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



Warren is feeble-minded. His family said it was due to "a serious fall of 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, The Macmillan Company.

Severe Anemia: Pernicious Anemia.—This is the most severe form of anemia, or the condition in which we have the poorest blood. While this condition frequently results in death the others rarely ever do. This condition is not common in childhood.

Symptoms.—There is intense weakness and prostration. The skin is very pale, the mucous membranes are bluish white. The breath is markedly short and there is often dropsy of the limbs and feet. Fever is often present and quite high. The disease lasts a number of months; the patient often feels better for a time, then relapses into a more serious condition than before.

TREATMENT OF THE VARIOUS FORMS OF ANEMIA

Simple Anemia.—Find the cause and stop it. In infancy special attention should be given to diet and hygiene, giving the child plenty of fresh air, and a change of air to the country or seashore if necessary. The general treatment is more important than any benefit that may 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 give iron. Change of air and change of scene are of special importance in these cases and will frequently cure. The general condition of course must not be overlooked. The diet, exercise, bowels, habits, should receive careful attention. Iron should be continued for a number of months after all traces of the anemia have disappeared.

Pernicious Anemia.—For this condition arsenic is the one remedy needful. In all conditions of poor blood the most careful attention should be given to the general health. Colds must be guarded against. The patients should never get their feet or their clothes wet. Muscular exercise, because of the weak condition of the heart, should be moderate, and only given on the advice of a physician. It is frequently necessary to stop all forms of exercise and in many instances we get the best results by directing complete rest in bed for a considerable part of 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 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.

RHEUMATISM

This is a rather common disease of childhood. It occurs most frequently between 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, though somewhat milder, as when the disease is present in an adult. Children are not quite as sick, nor is the fever as high, nor is the pain as great as in a grown person. In children the disease does not last as long, as a rule. Sometimes it will jump from one joint to another, and may, as a consequence, become chronic. When a child has once had rheumatism, it has the same disposition to recur that it has in adults. The principal danger of rheumatism in children is its tendency to attack the heart. Even mild attacks of the disease can do serious damage to the heart.

Children who have the rheumatic tendency invariably suffer from inflammatory conditions of the upper respiratory tract. They are prone to have recurring colds, tonsilitis, and sore throats. Treatment of conditions without regard to the underlying rheumatism is never satisfactory. These children complain of indefinite pains, now in one place, now in another. These pains are commonly known as "growing-pains" and, inasmuch as they are rheumatic and not "growing pains," they should be regarded seriously because of the heart damage they might do if ignored, and especially so since the mildest attacks of rheumatism, without any joint symptoms even, frequently leave the heart in very bad shape. As a general rule it will be found that when a child has had a number of attacks of bronchitis or asthma it is rheumatic and should receive treatment for the rheumatic tendency.

Children with the tendency to rheumatism invariably eat too much red meats and sugar,—the latter in the form of candy or as an excess in the food.

Treatment of an Acute Attack.—The child should be put in bed and kept warm. The bowels should be freely opened with citrate of magnesia. The diet 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 the fever is relieved. When a single joint is affected local measures may be taken for its relief. Wraping the joints up with flannel cloths which have been wrung out of true oil of wintergreen, and outside of this oiled silk snugly bandaged on, is an excellent external application. The flannel cloths should be kept moist by adding a little of the wintergreen from time to time as it dries in. This can be done without removing the bandage. This application is kept in place for twenty-four hours and renewed if necessary. Such an external application will aid in the actual cure of the disease and will quickly relieve the patient of the 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 should take charge of every case of acute rheumatism in a child.

To Treat the Tendency to Rheumatism.—Exclude red meats and sugar in all forms as much as is possible. Give green vegetables freely, potatoes boiled with the skins on, fish, eggs, and poultry. Cereals with milk, especially well cooked Scotch oatmeal, are exceedingly good for these children. By keeping up this diet after the acute attack has passed for a considerable time, it is possible to cure the various other complaints with which the child is afflicted,—tonsilitis, sore-throats, winter coughs, head-colds, bronchitis, asthma, etc.

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

In the treatment of an acute attack as given above it will be observed that no drugs are mentioned. This is intentional because it would be unjust to encourage the home treatment of a disease that is so treacherous, even in its mildest forms. Because of its tendency to recur and with each recurrence the danger of the heart being affected, it is advisable to put these children on cod liver oil or iron or some other good tonic. Every precaution should be taken to prevent these children from 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 conditions which do not respond to treatment unless the rheumatism is treated.

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

MALARIA. INTERMITTENT FEVER

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

Between the attacks some children may be entirely well; others remain restless, have little appetite and poor digestion. Malaria in children does not always follow a typical course. We often see children suffering from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin eruptions, all due to the malarial condition. This often leads to a mistake in diagnosis. Intermittent fever is often mistaken for pneumonia. Malaria is not a favorable disease for an infant to have. It rapidly weakens the child and great debility and anemia follows.

Treatment.—The treatment for malaria in children is by the administration of quinine as in adults. It must, however, be given with care and intelligence; for this reason no mother should begin dosing her child with it without consulting a physician.

REGARDING MOSQUITOES

The following is an extract from a circular in relation to the causation and prevention of malaria and the life history and extermination of mosquitoes 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 (Algae) 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 larvae. 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 MOSQUITO EXTERMINATION 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 so absolutely covered that no mosquito can enter.

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

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

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

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

The prompt cooeperation of all persons in the enforcement of the above regulations is earnestly desired, and they are assured that in this way the 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 that accompany the eruptive fevers. The term "incubation" means the period of time which elapses between the time when the child was exposed to, or caught the disease, and the time when the child is taken sick. It is sometimes interesting to know where a child could have caught a disease; so if we know the incubation period we can tell exactly where the child was 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 days Fever 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 From Fever 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 source of much worry to mothers. These rashes may appear at any time and they may be limited to certain parts or may cover most of the body. They may be bright red, or they may be simply a general discoloration. They may appear as blotches or they may spread all over, like the rash of scarlet fever when at its height.

These rashes are of no importance, except that they indicate some derangement of the gastro-intestinal tract. As a rule they indicate indiscriminate feeding or overfeeding. Children who have had too much candy or pastries, or who have been fed things which are unsuited to their age, frequently develop rashes. Such children should have a thorough cleaning out; a dose of castor oil is probably the best cathartic to give them.

The mother may readily learn to know the difference between a rash that is unimportant and one that indicates one of the eruptive diseases, if she gives the matter a little careful thought. In the first place a child who is about to become the victim of one of the eruptive diseases will be sick, and will have a fever for two or three days before any rash appears; while on the other hand a child may go to bed in good health and may next morning be covered with a general rash, or with large blotches, without any fever and without any evidence of ill-health, except the skin condition. In the second place, if the mother gives the child a cathartic and restricts the diet for a day the rash will disappear, and good spirits and good health will be maintained; on the other hand, the giving of a cathartic to a child who is 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 the face. 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. It appears as conical elevations of the size of a pea; they are red and tender on pressure, and have a tendency to form matter, or pus, in their center. In from four to ten days the matter is discharged but the red spots continue for some time longer.

"Blackheads" appear as slightly elevated spots of a black color out of which a small worm-like substance may be pressed. Pimples and blackheads are due to inflammation of the glands of the skin. The mouths of these glands become filled with dust which acts as a plug causing the retention of the oily matter of the gland which becomes inflamed and hence the pimples and blackheads. Certain constitutional conditions favor 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 skin affections.

Treatment.—The patient must avoid tea, coffee, tobacco, alcohol, veal, pork, fats, candy, pastries, cheese, and all edibles that are known to disagree with the digestion of the patient. Constipation must be avoided; if necessary, laxatives may be taken to keep the bowel open. The blackheads must be squeezed out with an instrument made for the purpose, not with the finger nails. Pimples must be opened with a sterile needle. The parts should be washed three times a day with hot water 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 three years of age.

A convulsion in an infant immediately, or within three months, after its birth is the result of injury, either at birth or later (a fall for example) which seriously affects the brain itself. After the third month the cause of fits or convulsions is, in a very large percentage of the cases, to be found in errors of diet resulting in disturbances in the stomach or bowels—eating of articles of food difficult to digest, as green or overripe fruit, salads, fresh bread, pickles, cheese, etc. Children of a nervous temperament are more liable to convulsions than are others. Females are more frequently victims of fits than are male children.

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

Convulsions may result from any condition that disturbs the nutrition of the 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 common are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions may accompany certain conditions, as, the presence of worms, teething, severe burns, foreign bodies in the ear, whooping cough, pneumonia scarlet fever, malaria, sometimes measles, typhoid fever, and diphtheria. Children who are badly nourished and who live constantly in unsanitary surroundings are more apt to have convulsions than those who are well nourished and who live hygienically. One attack renders the patient more liable to another, and when the "habit" is established any trivial cause may incite a convulsion; persistent and systematic efforts should therefore be taken to prevent the attacks. The best preventives are:

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 all fevers. In other words, save the child from the cause and the convulsion will not take place.

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

The child should live in the open air as much as possible; a daily warm bath, 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. It is not necessary to be harsh, but it is imperative to be firm and decided. They must be made to realize that they are not "the master," that their will is not supreme, and the mother must exact this condition; otherwise these children will become dictators and selfish despots—ruining the discipline of the home, spoiling their own chance of physical health, and rendering unhappy everyone around them. The parents, therefore, have a definite duty to perform and it is not an easy one. The food should be so regulated that each day a natural movement of the bowels will take place. (See article on constipation, page 303.) If a day should pass without a movement the child should be given 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 they should be at once removed. If they are simply suspected, the child should receive treatment for them, just the same. (See page 549.)

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

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

Treatment.—When a child has a convulsion, remove its clothing and put it into a mustard bath. The temperature of the bath should be 105 deg. F. Every part of the child should be under the water except the head, which is 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 hands of an assistant in order to keep the circulation active. A rectal injection of soap suds or plain salt and water (see page 579) should be given while the child is in the bath, because, as explained above, a large percentage of these cases are caused by gastro-intestinal derangements. The rectal injection will likely remove the cause. An ordinary convulsion lasts from five to ten minutes. When the child is removed from the bath it should be placed in a warm, comfortable bed and kept absolutely quiet. A hot-water bottle may be put near its feet and an ice-bag or cold cloths should be kept on its head. It should be given a full dose of castor oil and allowed to go to sleep. Its diet should consist of light broths for two or three days and during this time it should not be disturbed or annoyed by too much attention. This is as far as it is wise or safe for any mother to go in the treatment of convulsions. A physician should be called in every instance, because a convulsion should never be regarded lightly. Many children have become idiots, others have been afflicted with paralysis, because of inattention 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 the first resort in convulsions.

4th. While this is being done she can read the home treatment in this book 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 it faithfully, because if you neglect the proper treatment the child may become idiotic or paralyzed.

BED WETTING. ENURESIS—INCONTINENCE

Enuresis, or incontinence of urine, is customary in infancy. Just when urination becomes a voluntary act depends upon the development and training of the individual child. As a rule children can be taught to control this function during the day, or while awake, about the tenth month. 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 be regarded as abnormal until the child has entered the fourth year. If the child fails to control the act of urination during the day at the end of the second year, and is addicted to habitual bed-wetting, some measures should be adopted to cure the condition.

Boys under twelve years of age seem to be affected more frequently than girls. It is wrong to assume that it is caused by negligence or laziness, as some parents do. It has generally a special cause, and the cause usually can be found if it is carefully sought for. It may be the result 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 due to too much acid in the urine, and if so it will be found necessary to reduce 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 be the cause. No matter what the actual cause may be, it must be found and remedied before we can hope for a permanent cure. A very large majority of these cases are due to nervousness. These children are of a nervous temperament. They are not necessarily sickly children; they are simply of a nervous type. They are well-nourished, active, and lively. Incontinence of urine during the day and long-continued bed-wetting does not 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 cure the incontinence.

It is absolutely wrong to punish or to crush the spirit of these children. Constant nagging and taunting, even if done in the hope of shaming the child into a cure, will simply make a coward of him and will not 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 obstinate character. The odor is also bad for the health of the child.

Treatment.—Find and remove the cause if possible. If due to general poor health, give tonics, obtain a change of air, and build the child up. Reduce the total quantity of liquids, if in excess, and be very careful not to give any liquids near bedtime. Don't cover these children too much; they should never be "too warm"; they should sleep in a well-aired room, and they should receive a quick, cool sponge bath every morning. They should be taught to sleep on their sides, never on their backs. Their diet should be light but nourishing. When bed-wetting is established it will continue, if untreated, until the child is eight or ten years of age, and it frequently lasts much longer. When treatment is undertaken it should be distinctly understood by the mother that it will take many months to cure; and during these months she must give her constant 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, as it will not succeed. Various plans should be tried to keep the child from sleeping on its back. The reason of this is because it has been found that the child wets the bed only when sleeping on its back and never when sleeping on its side. The simplest method, of tying a towel or cloth around the child with a knot over the spinal column, so that it will hurt and waken it, if it turns on its back, is a very good one and should be carefully tried for some time. The nervous system of these children should never be overtaxed at home or at school. Early hours and plenty of sleep are desirable. Certain articles of diet of a stimulating character should be entirely avoided,—for example, coffee, tea, beer, candies, sugars, and pickles. The best diet for these children is one composed exclusively of milk, vegetables, fruits, meats, and cereals. Meats, however, should be given only once every two days. It is a good plan to teach the child to hold his water during the day, as long as he can, to accustom the bladder to being full. Adenoid growths, which contribute to the nervousness of a naturally nervous child, should be removed. It is a good plan to take the child up when the parents go in bed and let him urinate. This often cures the condition in itself.

Sometimes moral measures, such as the promise of a reward, will strengthen the will so that the child may overcome the tendency. Find out what the child most desires in the way of a toy, and promise it if he goes so long without wetting the bed. Aid and encourage him to make efforts to win the reward.

If drugs have to be resorted to, it is necessary to call the family physician, as the only drugs that are of any use are very powerful and have to be given with great care and caution. It is the experience of most physicians and specialists, however, that in a large majority of cases 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 the bed-wetting is frequently discovered to be produced by anatomical abnormalities which render circumcision imperative. In these cases no method of treatment will succeed until circumcision is performed.

SLEEPLESSNESS. DISTURBED SLEEP

Causes.—In babies, disturbed sleep is most frequently due to hunger or to indigestion. The latter is the result of overfeeding or improper feeding. Rocking the child to sleep, or feeding it during the night will cause sleeplessness. Teething, colic, or any pain will result in disturbed 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, enlarged tonsils, lack of fresh air in the bedroom, cold feet, may, however, be the cause. Overstudy in school, poor blood, poor nourishment are always accompanied by inability to sleep soundly. Too strenuous play, exciting stories read before bedtime, may cause sleeplessness.

Treatment.—The removal of the cause is absolutely necessary. In order to discover the cause it is sometimes essential to study the child's whole routine in order to be able to tell exactly just what is causing the apparent insomnia. It may be necessary to change the method of feeding, to regulate the studies and the exercises, and to suggest changes regarding the sanitary and hygienic environment of the child's life. Mothers must be warned against using drugs in the form of soothing syrups or teething mixtures. They are dangerous and absolutely forbidden under the above conditions.