In very bad cases, where a young child cannot catch his breath and gets blue in the face—which, fortunately, is uncommon—he should be slapped in the face with a towel wet in cold water; or, he may be lifted into a tub of warm water, then quickly in cold water, then back into the warm, etc. Hygienic measures should prevail, such as keeping the bowels open, the skin clean, and the use of the usual throat gargles and nasal sprays. Do not be misguided by the old-time thought that whooping cough must run its course; for, if medical aid is promptly secured, the disease may often be cut short and the severe paroxysms greatly lessened.

EYE INFECTIONS

Not long ago while in North Dakota near Canada, we took a trip one day just over the border to visit several villages of Russian peasants. We found the boys and girls of nearly the entire village suffering from trachoma—a dangerous, infectious disease of the eyes which spreads alarmingly from one child to another.

We saw the disease in all of its varying degrees among the children. Some of them had swollen, reddened lids. A discharge of pus was coming from the eyes of others, and they could not look toward a light or the sun. This disease is spread in a hundred different ways—through the common use of wash basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., and that is the reason why these isolated villages of foreign people who could neither read nor write the English language were nearly all so sorely afflicted.

The ordinary condition of "catching cold in the eye" ("pink eye") is just as infectious as the trachoma which we have mentioned, although it is more of an acute disorder and nothing like so serious.

In all such cases a physician is to be called immediately, isolate the patient, and give strict attention to carrying out the doctor's orders.

Another form of inflammation of the eye which was mentioned in a previous chapter, is the inflammation of the eye of the newborn.

In most civilized districts at the present, especially where the cases are attended by a physician, the eyes of all newborn babies are treated with either argyrol or silver nitrate. Just as soon as defective sight is discovered in the child the eyes should be examined at once and proper glasses fitted. While the glimmer and shimmer of moving pictures may seriously interfere with the child's vision, on the other hand, this very thing often discovers the defect in the eyesight earlier than it would otherwise be found out.

RUNNING EARS

Inflammation of the ears was fully covered in our discussion of adenoids and tonsils, but we would like to add at this time that under no circumstances should a running ear be regarded lightly. A chronic mastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. The attention of a specialist should be called to it and his instructions most carefully carried out; for, when we have a sudden stopping of the discharge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost.



CHAPTER XXIX

RESPIRATORY DISEASES

Next to digestive disturbances, babies suffer more frequently from respiratory disorders—colds, bronchitis, and pneumonia. In fact, during very early infancy, pneumonia heads the list of infant deaths, only to be displaced a few months later by that most dreaded summer disease—diarrhea.

Little tiny babies are so helpless—they are so dependent upon their seniors for life itself—that our responsibility is indeed great. We should put forth our best endeavor to avoid and prevent common colds. Among all the common maladies that afflict the human race "colds" probably head the list; and, in the case of babies and the younger children, the common colds often go on into coughs, croup, bronchitis, and even pneumonia.

WHY BABIES CATCH COLD

1. Someone has brought the infection to him. 2. Somebody coughed in his face. 3. Germ-laden hands have handled the baby. 4. He has drunk from an "infected" glass. 5. There was not enough moisture in the air. 6. Somebody wiped his face with an infected towel. 7. Baby was allowed to play on the cold floor. 8. Baby's lowered vitality could not stand the combined strain of overeating and clogged up bowels. 9. Baby was kissed in the mouth by a "cold-germ" carrier. 10. Baby was dressed too warmly—and then taken out. 11. Somebody carelessly breathed in baby's face. 12. He slept in a stuffy room. 13. His extremities got chilled. 14. Baby has adenoids or diseased tonsils.

Babies should not be allowed to sit or play on cold, drafty floors. They may play on mother's bed whose open side is protected with high-back chairs, or they may play in their own bed whose raised sides are sheltered by blankets.

It is possible for a mother so to disinfect her hands, and so garb herself with clean, washable garments, that, although she may be suffering from an acute cold, she may continue to care for her baby and the baby need not contract the cold.

CORYZA—COLD IN THE HEAD

This most annoying ailment, a cold in the head, is particularly hard on babies because the obstruction of the nasal passages not only makes breathing difficult, but renders nursing well-nigh impossible.

The throat end of the eustachium tube (the ear tube) is found in the upper and back part of the throat, just behind the nose. The infection of the cold extends from both the nose and throat and there results a spreading inflammatory process on through these ear tubes into the middle ear itself. Now if this tube swells so much that it entirely closes, as so often happens in cases of "cold in the head" as well as in constant irritation from adenoids, then may follow a vast train of difficulties—earache, mastoiditis, etc.—with the result that the tiny bones in the middle ear which vibrate so exquisitely may become ankylosed (stiffened) and deafness often follow. Everything known must be done to prevent baby's catching "cold in the head." If the sinuses become infected it may also lead to serious consequences.

When the nose becomes clogged it may be opened up by repeatedly disinfecting the inside of the nose with oily sprays such as simple albolene or camphorated-albolene spray.

The bowels should be quickly opened by castor oil, and the feedings should be cut down at least two-thirds or one-half.

Public drinking cups should always be avoided and kissing the baby be tabooed.

GRIPPE

The treatment of influenza in infancy and childhood is to avoid contact with an older person suffering with the grippe. Ordinarily, the so-called "grippe" is a common, mixed infection—not true influenza. Coryza and cough are the chief respiratory symptoms which attend these widespread epidemics. Often vomiting and diarrhea are seen in the young sufferers.

In cases of grippe put the child to bed and call the doctor. In the case of the older children, the treatment and care to be recommended has been fully outlined by the author in the little work entitled The Cause and Cure of Colds.

Complications from the grippe are very frequent in children—such as severe diarrhea, enlarged glands of the neck, running ears, bronchitis, pneumonia, and sometimes tuberculosis.

Every effort should be put forth to isolate and quarantine the first member of the family to be stricken with grippe so that the remaining members may, if possible, escape an uncomfortable and unhappy siege.

SORE THROAT

The danger of permanent deafness which so often follows a sore throat as well as a cold in the head, should cause every mother or caretaker earnestly to begin treatment at the very first sign of a sore throat. When a little baby gulps or cries on swallowing, a sore throat should always be suspected and remedial measures promptly instituted.

A most convenient article with which to examine an infant's throat is a small pocket flashlight. The pillars of the throat or the tonsils or both may be much inflamed, and since tonsillitis, diphtheria, and scarlet fever all begin with a sore throat, it is wise early to seek medical counsel in order that the differential diagnosis may be promptly made. We urge the mother, as a rule, not to attempt to diagnose severe cases of sore throat. Send for the physician.

Tonsillitis is a severe form of sore throat which, fortunately, rarely troubles tiny infants; but for every sore throat, while waiting for medical help to arrive, lay your plans to empty the bowels, diminish the quantity of the food, swab or spray the throat, and later closely follow the physician's advice concerning the general treatment of the child.

ADENOIDS

Adenoid growths appear as grape-like lymphoid formations located in the upper and posterior-nasal pharynx. These adenoids secrete a very toxic, thickened fluid, which slowly makes its way down along the back wall of the throat, and reddens and inflames first the anterior and posterior pillars of the throat and then often inflames and enlarges the tonsils.

Adenoids not only obstruct the respiratory passage way to the throat and lungs, but they also exert a harmful influence on the general physical and mental development of the child.

It is nothing less than criminal for heedless parents to allow adenoid growths to remain in the child's post-nasal pharynx. The little fellow's face is disfigured, more or less for life, his mentality dulled, while he is compelled to breathe through his mouth.

An almost miraculous change often follows the complete removal of these obstructive adenoids—the child takes a renewed interest in everything about him. More oxygen finds its way to the tissues, his face takes on better color, he gains in weight, in fact, there appears to be a complete rejuvenation mentally and physically.

The signs or symptoms of adenoids are mouth breathing, restlessness at night, snoring, recurring colds, nasal discharge, swelling of the glands of the neck, poor nutrition, loss of appetite, bed wetting, impaired hearing, lack of attention, and mental dullness. The removal of adenoids is neither a serious or difficult procedure, and they may safely be removed at any age.

DISEASED TONSILS

Tonsils which remain permanently enlarged and show signs of disease and debilitation—filled crypts—may be removed as early as the fourth or fifth year, if necessary. If proper treatment does not improve the tonsils as the child grows older, their removal should seriously be considered. The tonsils may serve some special secretory or defensive function during the first few years of life and we think best, therefore, not to advise their removal—except in extreme cases—until the child is at least four or five years old.

When it is necessary to attack the tonsils, they should be thoroughly dissected out—not merely burned or clipped off. If they are properly removed, the danger of heart trouble, rheumatism, and many other infections may be considered as greatly lessened.

After five years of age the normal tonsils should begin to shrink, and at about the beginning of adolescence they should be no larger than a small lima bean, hidden almost completely out of sight behind the pillars of the throat. While healthy tonsils may serve some useful purpose even in the adult, it is almost universally conceded that the thoroughly bad and diseased tonsil is utterly useless to the body—only an open gateway for the entrance of infection.

BRONCHITIS

A very common disorder of early infancy and childhood is bronchitis—an inflammation of the bronchial tubes—accompanied by severe coughing. Its tendency to pass into pneumonia renders it a disease for skilled hands to treat—a disorder hardly safe for even the well-meaning mother to undertake to manage without medical advice and help. And since bronchitis is usually accompanied by alarming symptoms of high fever, weakened heart, embarrassed breathing, mottled or blue skin, green stools, troublesome cough, disturbed sleep, "stopped up nose," and "choked up throat," it is of utmost importance not only to seek medical aid early, but also that the mother, herself, should have definite ideas concerning the proper manner of doing the following things in the line of treatment:

1. Making and applying a mustard paste. 2. The fashioning of an oil-silk jacket. 3. Improvising a steam tent. 4. Flushing out the colon, and a score of other things which the watchful doctor may want given any moment.

Mustard Pastes are prepared by mixing one part of mustard and six parts of flour in warm water and applying to the chest between two pieces of thin muslin. It is left on just seven minutes and then talcum powder is thickly sprinkled on the moist, reddened skin; this powder quickly absorbs all the moisture and leaves the skin in a good condition—ready for another paste in three hours if it is so ordered.

The Oil-Silk Jacket, or pneumonia jacket, consists of three layers—the inside of cheesecloth, an inner thin sheet of cotton wadding, and an outside layer of oil silk (procurable at any drug store). It should open on the shoulder and under the arm on the same side. It is worn constantly (change for fresh cheesecloth and cotton every day) during the inflammatory stage; it is removed only during the mustard pastes.

A Steam Tent may be prepared by placing a sheet over the infant's crib and allowing steam to enter from a large paper funnel placed in the nose of a tea kettle of boiling water kept hot on a small stove of some sort.

The mattress and bedding are covered with rubber sheeting and the infant's clothes protected from moisture. The baby should remain in this steamy atmosphere ten minutes at a time.

Another method is to hold baby in arms near the large end of a big funnel placed in a tea kettle on the gas stove or range, and then have an assistant help hold a sheet tent over both the mother and babe. Or the baby carriage may be placed over a small tub of water into which are dropped several hot bricks. A sheet canopy spread over the carriage holds the steam in and baby reaps the benefits of the warm moisture.

Colonic Flushing is necessary when green stools accompany bronchitis. A well-lubricated end of a large Davidson's syringe is inserted into the rectum, and with the hips of the baby brought to the edge of a basin (the heels held in the hands of the assistant), water is forced into the rectum. Not more than one ordinary cup of water should be introduced at any one time. After expulsion, another may be gently injected.

The diet in bronchitis is always reduced so that no extra work will be thrown on the already overtaxed constitution of the child.

Absolute rest is necessary and perfect quiet should prevail. The humidity of the room should not be lower than 50 at any time, while the air should be moderately cool and fresh.

Numerous other details which may be necessary in the management of bronchitis will be directed by the physicians and nurses in charge of the case.

SPASMODIC CROUP

It is believed that children with enlarged tonsils and adenoids are much more subject to croup than others. Although very sudden in its onset and very alarming, spasmodic croup, fortunately, is seldom dangerous. A little child goes to bed in apparently normal condition and wakes up suddenly with a coarse metallic cough, difficult breathing, and with a distressed expression on the face.

Alternate hot and cold compresses should be applied to the throat—first the hot cloths (wrung from very hot water) being applied over the throat, which should be covered with a single thickness of dry flannel. Then after three minutes of the hot cloths a very cold cloth is applied to the skin itself for one half minute; then more of the hot compress, followed again by the short cold, until five such changes have been made. A bronchitis tent should be quickly improvised so that the child can be "steamed."

Vomiting must be produced by kerosene (three or four drops on sugar), alum and molasses, or ipecac (ten drops every fifteen minutes). Some remedy must be administered continuously until free vomiting occurs. A good dose of castor oil should be given after the spasm. Suitable treatment should be administered through the day to prevent a recurrence of the attack the next night.

The general vital resistance should be raised by outdoor life, improved circulation, good food; adenoids if present, should be removed.

Medical advice should be sought in every case of severe croup, for membraneous croup usually is indicative of diphtheria, and the diagnosis is important, as on it hangs the determination of the administration of antitoxin.

PNEUMONIA

Pneumonia is always a serious disease. It is accompanied by high fever, painful, very short cough, and rapid breathing with a moving in and out of the edges of the nose as well as the spaces between the ribs. The possibilities of complications are always great—the dangers are many—so that the combined watchfulness of both the mother and a proficient trained nurse are required; not to mention the skill of the physician.

The steam tent, the mustard paste, the oil-silk jacket and the colonic flushing (described earlier in this chapter) may all be asked for by the physician in his untiring efforts to prevent dangerous complications during the course of the disease.

Plenty of moderately cool, fresh air (without drafts) is of great benefit. Never allow blue finger tips, or cold ear tips to exist; send at once for the doctor and administer a hot bath, or wrap in a sheet dipped in hot mustard water while awaiting his arrival. No mother should think of attempting to carry her baby through an attack of bronchitis or pneumonia without the best medical help available.



CHAPTER XXX

THE NERVOUS CHILD

While each child possesses an individuality all its own, nevertheless, there are certain general principles of psychologic conduct and family discipline which are more or less applicable to all children. The so-called nervous child, in addition to the usual methods of child culture, stands in need of special attention as concerns its early discipline and training. This chapter will, therefore, be devoted to special suggestions with regard to the management and training of those children who are by heredity predisposed to nervousness, over-excitability, and who possess but a minimum of self-control.

HEREDITARY NERVOUSNESS

The so-called nervous child—all things equal—is the child who is born into the world with an unbalanced or inefficiently controlled nervous system; and while it is all too true that the common nursery methods of "spoiling the child" are often equally to blame with heredity for the production of an erratic disposition and an uncontrolled temper, nevertheless, it is now generally recognized that the foundation of the difficulties of the nervous child reaches back into its immediate and remote ancestral heredity.

I no longer doubt but that many of these babies with a bad nervous heredity, who are born predisposed to Saint Vitus' dance, bad temper, chronic worry, neurasthenia, and hysteria could be spared much of their early troubles and later miseries by prompt and proper methods of early nursery discipline.

These nervous babies are born into the world with an abnormal lack of self-control. Their "inhibition control" over the natural and spontaneous tendency of the nervous system to manifest its inherent impulses and passing whims is decidedly deficient. The child is unduly sensitive, whines, hollers, or flies into a violent rage when its will is crossed in the least degree. Such a child sometimes keeps its mother living in constant terror because, when its will is crossed in any particular, it will scream and hold its breath until it turns black in the face and sometimes actually goes into a convulsion.

In dealing with these unfortunate little ones, fathers and mothers, while they should be firm and persistent in their methods of correction, should also be kind and patient; fully recognizing that whatever undesirable traits the little ones manifest they have come by honestly—these naughty tendencies being the result either of heredity or spoiling, for both of which the parents stand responsible.

EARLY TRAINING

One of the very first things that a child, especially the nervous child, should learn is that crying and other angerful manifestations accomplish absolutely nothing. The greatest part of the successful training of the nervous child should take place before it is three and one-half years of age. It should early learn to lie quietly in its little bed and be entirely happy without receiving any attention or having any fuss made over it. It should not become the center of a circle of admiring and indulgent family friends and caretakers who will succeed in effectually destroying what little degree of self-control it may be fortunate enough to possess.

When the little one is discovered to be nervous, fretful, impatient, and easily irritated early in the morning, it should be left alone in its bed or in the nursery until it quiets down. If it has a good, healthy crying spell, leave it alone. Let it early get used to living with itself—teach the little fellow to get along with the world as it is—and you will do a great deal toward preventing a host of neurasthenic miseries and a flood of hysterical sorrows later on in life.

You must not expect to train the nervous child by the simple and easy methods which are successful in the case of a normal child; that is, you cannot repeat a simple discipline two or three times and have the child learn the lesson. In the case of the high-strung nervous child it requires "line upon line and precept upon precept;" for, whereas a normal child will respond to a certain discipline after it is repeated a half dozen times, the nervous child will require the persistent repetition of such a discipline from twenty-five to one hundred times before the lesson sinks into his consciousness sufficiently to enable him to gain control of his erratic and unbalanced nervous mechanism.

SPOILING THE CHILD

As bad as all spoiling methods are in child culture, they are decidedly disastrous—almost fatal—in the case of the nervous child; and yet it is these delicate, sensitive, cute little things that are the very ones who are most frequently the worst spoiled. Nervous children simply must not be played with all the time. They must be by themselves a great deal, at least this is true in their earlier years.

The nervous baby must early learn absolute respect for authority, so that what it lacks in its own nervous control may be partially made up for by parental suggestion and discipline. Of course, as suggested in a later chapter, the more ideal methods of suggestion, education, and persuasion should be employed in your efforts to secure obedience and promote self-control; but, when through either the deep-rooted incorrigibility of a child, or the inefficiency of the parent's efforts in the employment of suggestion—no matter what the cause of the failure of your ideal methods to control temper, stop crying, or otherwise put down the juvenile rebellion, whether the child has been spoiled on account of company, sickness or through your carelessness—when you cannot effectively and immediately enforce your will any other way, do not hesitate to punish; spank promptly and vigorously and spank repeatedly if necessary to accomplish your purpose. You must not fail in the case of the nervous child to accomplish exactly what you start out to do.

When the little fellow wakes up in the night and cries, see if he needs anything and administer to him. If you have previously tried the method of letting him "cry it out," which is usually entirely sufficient in the case of a normal child, and if such treatment does not seem to cure him, then speak to him firmly, give him to understand that he must stop crying, and if he does not, turn him over and administer a good spanking—and repeat if necessary to get results. In dealing with a nervous child we must follow the directions on the bottle of the old-fashioned liniment "rub in until relief is obtained."

No "spoiling practices" should be countenanced in the case of nervous children. They should be taught to sleep undisturbed in a room in the presence of usual noises. They should not be allowed to grow up with a sleeping-room always darkened by day and a light to sleep by at night. They should be taught to sleep on without being disturbed even if someone does enter the room; they should be taught to sleep normally without having to quiet and hush the whole neighborhood.

PLAYMATES

The early play of nervous children should be carefully supervised and organized. Under no circumstance should they be allowed exclusively to play with children younger than themselves. They must not be allowed to dictate and control their playmates; it is far better that they should play at least a part of the time with older children who will force them to occupy subordinate roles in their affairs of play; in this way much may be accomplished toward preventing the development of a selfish, headstrong, and intolerant attitude. When the nervous child is miffed or peeved at play and wants to quit because he cannot have his way, see to it that he quickly takes his place back in the ranks of his playfellows, and thus early teach him how to react to defeat and disappointment. The nervous child must not be allowed to grow up with a disposition that will in some later crisis cause him to "get mad and quit."

If the nervous baby has older brothers and sisters, see to it that he does not, through pet and peeve and other manifestations of temper, control the family and thus dictate the trend of all the children's play. Early train him to be manly, to play fair, and when his feelings are hurt or things do not go just to his liking, teach him, in the language of the street, to be "game." It is equally important that the little girls be taught in the same way how to take disappointment and defeat without murmur or complaint.

TEACHING SELF-CONTROL

When nervous children grow up, especially if their parents are well to do, and they are not forced to work for a living, they are prone to develop into erratic, neurasthenic, and hysterical women, and worrying, inefficient, and nervous men; and in later years they throng the doctor's offices with both their real and imaginary complaints. These patients always feel that they are different from other people, that something terrible is the matter with them or that something awful is about to happen to them. Their brains constantly swarm with fears and premonitions of disease, disaster, and despair, while their otherwise brilliant intellects are confused and handicapped because of these "spoiled" and "hereditary" nervous disturbances—with the result that both their happiness and usefulness in life is largely destroyed.

The fundamental abnormal characteristic of that great group of nerve-patients who throng the doctor's office is sensitiveness, suggestibility, and lack of self-control. Sensitiveness is nothing more or less than a refined form of selfishness, while lack of self-control is merely the combined end-product of heredity and childhood spoiling. I am a great believer in, and practitioner of, modern methods of psychological child culture, but let me say to the fond parent who has a nervous child, when you have failed to teach the child self-control by suggestive methods, do not hesitate to punish, for of all cases it is doubly true of the nervous child that if you "spare the rod" you are sure to "spoil the child."

Let me urge parents to secure this self-control and enforce this discipline before the child is three or four years of age; correct the child at a time when your purpose can be accomplished without leaving in his subconscious mind so many vivid memories of these personal and, sometimes, more or less brutal physical encounters. Every year you put off winning the disciplinary fight with your offspring, you enormously increase the danger and likelihood of alienating his affections and otherwise destroying that beautiful and sympathetic relationship which should always exist between a child and his parents. In other words, the older the child, the less the good you accomplish by discipline and the more the personal resentment toward the parent is aroused on the part of the child.

CRIME AND INTEMPERANCE

While it is generally admitted that feeble-mindedness lies at the foundation of most crime, we must also recognize that failure on the part of parents to teach their children self-control is also responsible for many otherwise fairly normal youths falling into crime and intemperance. The parents of a nervous child must recognize that they will in all probability be subject to special danger along these lines as they grow up. The nervous child, as it grows up, is quite likely to be erratic, emotional, indecisive, and otherwise easily influenced by his associates and environment.

Nervous children are more highly suggestible than others, and if they have not been taught to control their appetites and desires, their wants and passions, they are going to form an especially susceptible class of society from which may be recruited high-class criminals, dipsomaniacs, and other unfortunates.

It is true that any spoiled child, however normal its heredity, may turn out bad in these respects if it is not properly trained; but what we are trying to accomplish here is to emphasize to parents that the nervous child is doubly prone to go wrong and suffer much sorrow in after life if he is not early and effectively taught self-control.

UNSPOILING THE CHILD

If the child of nervous tendencies forms the habit of crying, sulking, or otherwise misbehaving when it is denied its desires, or when something it wants done is not immediately attended to, it will be found an excellent plan simply to stand still and let the little fellow have it out with himself, in the meanwhile kindly reminding him to say, "please mamma," "please papa," etc. I well remember one nervous little girl who would yell at the top of her voice and become black in the face the moment she wanted a door opened or anything else. A few weeks of patience and firmness on the part of the mother entirely cured her of this unbecoming trait.

As a rule, it will be found best not to argue with the nervous child. The moment your commands are not heeded, when you have admonished the child once or twice without effect, take him quickly to the crib or the nursery and there leave him alone, isolated, until he is in a state of mind to manifest a kindly spirit and an obedient disposition. It is an excellent plan quietly and quickly to deprive such children of their pleasures temporarily, in order to produce thoughtfulness; and these methods are often more efficacious than the infliction of varying degrees of pain under the guise of punishment.

Nervous children must be taught to go to sleep by themselves. They are not to be rocked or allowed to hold the hand of the mother or the caretaker. The nervous baby should not be encouraged to exhibit its cuteness for the delectation of the family or the amusement of strangers and visitors. He should be especially trained in early and regular habits, taking particular pains to see that bed wetting and similar bad habits are early overcome; otherwise, he may drag along through early life and become the cause of great embarrassment both to himself and his parents.

The control of these nervous habits is somewhat like the management of the slipping of the wheels of a locomotive when the track is wet and slippery. The little folks ofttimes endeavor to apply the brakes, but they are minus the sand which keeps the wheels from slipping. The parent, with his well-planned discipline, is able to supply this essential element, and thus the child is enabled to gain a sufficient amount of self-control to prevent him making a continuous spectacle of himself.

When nervous children do not walk or talk early, let them alone. Of course, if later on it is discovered that they are manifestly backward children, something must be done about it; but if the nervous child is encouraged to talk too soon there is great danger of his developing into a stutterer or a stammerer.

PREVENTING HYSTERIA

Every year we have pass through our hands men and women, especially women, who possess beautiful characters, who have noble intellects, and who have high aims and holy ambitions in life, but whose careers have been well-nigh ruined, almost shattered, because of the hysterical tendency which ever accompanies them, and which, just as soon as the stress and strain of life reaches a certain degree of intensity, unfailingly produces its characteristic breakdown; the patient is seized with confusion, is overcome by feeling, indulges in an emotional sprawl, is flooded with terrible apprehensions and distracting sensations, may even go into a convulsive fit, and, in extreme cases, even become unconscious and rigidly stiff.

Now, in the vast majority of cases, if this nervous patient, when a baby, had been thoroughly disciplined and taught proper self-control before it was four years of age, it would have developed into quite a model little citizen; and while throughout life it would have borne more or less of a hysteria stigma, nevertheless it would have possessed a sufficient amount of self-control to have gotten along with dignity and success; in fact, the possibilities are so tremendous, the situation is so terrible in the case of these nervous babies, that we might almost say that, in the majority of such, success and failure in life will be largely determined by the early and effective application of these methods of preventive discipline.

I was recently consulted by a patient whose nervous system was in a deplorable state, who had lost almost complete mental control of herself, and who really presented a pathetic spectacle as she told of the fears and worries that enthralled her. In an effort to get to the bottom of this patient's heredity I had a conference with her father, and I learned that this woman, in her childhood days, had been constantly humored—allowed to have everything she wanted. She was a delicate and sensitive little thing and the parents could not bear to hear her cry, it made her sick, it gave her convulsions, it produced sleepless nights, it destroyed her appetite, and so she grew up in this pampered way. The father recognized the greatness of his mistake and he told me with tears in his eyes how, when the ringing of the school bell disturbed his little girl baby, he saw the school directors and had them stop ringing the bell, and he even stopped the ringing of the church bells. He was an influential citizen and could even stop the blowing of the whistles if it disturbed his precious little daughter.

And so this woman has grown up with this nervous system naturally weakened by heredity and further weakened by "spoiling"; and fortunate indeed she will be if off and on the most of her life she is not seeking the advice of a physician in her efforts to gain that self-control which her parents could have so easily put in her possession at the time she was three or four years of age, if they had only spent a few hours then, instead of the many months and years that subsequently have been devoted to medical attention.

METHODS OF DISCIPLINE

We run into many snags when we undertake to discipline the nervous baby. The first is that it will sometimes cry so hard that it will get black in the face and may even have a convulsion; occasionally a small blood vessel may be ruptured on some part of the body, usually the face. When you see the little one approaching this point, turn it over and administer a sound spanking and it will instantly catch its breath. This will not have to be repeated many times until that particular difficulty will be largely under control.

It will be discovered when you undertake to break a bad habit in the case of a spoiled child who is of a nervous temperament, that your discipline interferes with the child's appetite and nutrition. The delicate little creature who has perhaps already given you no end of trouble regarding its feeding, will begin to lose in weight, and even the doctor often becomes so alarmed that he advises against all further methods of discipline. We think this is usually a mistake. Both the nutrition and discipline should be kept in mind and carried harmoniously through to a successful finish. It will be necessary during such troublous times to conserve both the physical and nervous strength of the child; it should not be allowed to run about and over-play, as such high strung children often do. It should be given a reasonable amount of physical exercise, and two or three times a day should have short periods of complete isolation in the nursery, where it may quietly play with its blocks and toys, sing and croon or talk as the case may be, but should be left entirely alone.

Wise efforts should be put forth to keep the feeding up to the proper number of calories, and to see, if the child does not gain during this disciplinary struggle, that at least it does not lose; and I give it as my experience that I have yet to see a case in which both the child's nutrition and discipline cannot be efficiently maintained at one and the same time, though it does sometimes require adroit scientific and artistic management. But the game we are playing is worth the effort—the battle must be fought—and it can be fought with the least suffering and sorrowing the earlier the conflict is waged to a successful issue.

I am decidedly opposed to allowing these young nervous children to over-play and thus wear themselves out unduly. This over exhaustion sometimes renders the training of the child much more difficult, as it is a well-known fact that we are all much more irritable and lacking in self-control when we are tired, more especially when we are over-tired and fatigued.

Let me emphasize the importance and value of proper periods of isolation—complete rest and partial physical relaxation. You can take a child who has gotten up wrong in the morning, whose nerves are running away with him, who is irritable, crying at everything that happens, who even rejects the food prepared for him, and who, when spoken to and commanded to stop crying, yells all the louder—I say you can take such a little one back to its crib, place it in the bed and smilingly walk out of the room. After a transient outburst of crying, within a very few minutes you can return to find a perfect little angel, winsome and smiling, happy and satisfied, presenting an entirely different picture from the little culprit so recently incarcerated as a punishment for his unseemly conduct.

But let me repeat that while such methods of discipline often work like magic on normal children, they must be repeated again and again in the case of one who is nervous in order to establish new association groups in the brain and to form new habit grooves in his developing nervous system.

RESPECT FOR AUTHORITY

There are just two things the nervous child must grow up to respect; one is authority and the other is the rights and privileges of his associates. The nervous child needs early to learn to reach a conclusion and to render a decision—to render a decision without equivocation—to move forward in obedience to that decision without quibbling and without question; that is the thing the nervous man and woman must learn in connection with the later conquest of their own nerves; and a foundation for such a mastery of one's unruly nerves is best laid early in life—by teaching the child prompt and unquestioning obedience to parental commands. At the same time, endeavor so to raise the child that it acquires the faculty of quickly and agreeably adapting itself to its environment, at the same time cheerfully recognizing the rights of its fellows.

It is a crime against the nervous child to allow it to hesitate, to debate, or to falter about any matter that pertains to the execution of parental commands. Let your rule be—speak once, then spank. Never for a moment countenance anything resembling dilatoriness or procrastination, let the child grow up to recognize these as its greatest dangers, never to be tolerated for one moment.

FALSE SYMPATHY

We are aware that many good people in perusing this chapter will think that some of the advice here given is both cruel and hard hearted; but we can safely venture the opinion that those who have reared many children, at least if they have had some nervous little ones, will be able to discern the meaning and significance of most of our suggestions. Sympathy is a beautiful and human trait and we want nothing in this chapter in any way to interfere with that characteristic sympathy of a parent for its offspring—the proverbial "as a father pitieth his children"—nevertheless, there is a great deal of sympathy that is utterly false, that is of the nature of a disastrous compromise, for the time being making it easy for both parent and child, but making things unutterably more difficult later on in life when both (or perhaps the child alone) must face the calamitous consequences of this failure early to inculcate the principles of self-control and self-mastery on the mind and character of the nervous child.

We so often hear "mother love" eulogized. It is a wonderful and self-denying human trait; but, as a physician, I have been led to believe that "mother loyalty" is of almost equal or even greater value. All mothers love their children more or less, but only a few mothers possess that superb loyalty which is able to rise above human sympathy and maternal love, which qualifies the mother to stand smilingly by the side of the crib and watch her little one in a fit of anger—yelling at the top of its voice—and yet never touch the child, allow the little fellow to come to himself, to wake up to the fact that all his yelling, his emotion, his anger, and his resentment are absolutely powerless to move his mother. Thus has the mother—by her loyalty to the little fellow—taught him a new lesson in self-control, and thus has she added one more strong link in the chain of character which parent and child are forging day by day, and which finally must determine both the child's temporal and eternal destiny.

SYSTEM AND ORDER

System and order are desirable acquisitions for all children, but they are absolutely indispensable to the successful rearing of the nervous child, who should be taught to have a place for everything and everything in its place. When he enters the house his clothes must not be thoughtlessly thrown about. Every garment must be put in its proper place. These little folks must be taught a systematic and regular way of doing things.

Nervous children must not be allowed to procrastinate. They must not be allowed to put off until tomorrow anything which can be done today. They must be taught how to keep the working decks of life clear—caught right up to the minute. They should be taught proper methods of analysis—how to go to the bottom of things—how to render a decision, execute it, and then move forward quickly to the next task of life. When they come home from school with home work to do it would be best, as a rule, first to do the school work before engaging in play. In fact, all the methods which are needful for the proper discipline of the ordinary child are more than doubly needful for the training of the nervous child; while more than fourfold persistence is needed on the part of parents to make them really effective.

EMOTIONAL RUNAWAYS

Whether the child be two years of age or ten years of age, when the parent discovers that the nervous system is "losing its head," that the child is embarking on a nervous runaway, or that it is about to indulge in an emotional sprawl, it is best to interfere suddenly and spectacularly. Lay a firm hand on him and bring things to a sudden stop. Speak to him calmly and deliberately, but firmly. Set him on a chair, put him in the bed, or take him to a room and isolate him.

In the case of the older children, tell them a story of the horse which becomes frightened, loses self-control, and tears off down the highway, wrecking the vehicle and throwing out its occupants. Explain to them that many of the mistakes of life are made during the times of these emotional runaways, these passing spells of lost self-control. Tell the little folks that you have perfect confidence in them if they will only take time to stop and think before they talk or act. Explain to them that since you saw that they were rapidly approaching a foolish climax you thought it was your duty to call a halt, to stop them long enough to enable them to collect their wits and indulge in some sober thinking.

Personally, we have found it to be a good plan not to be too arbitrary with the little folks, like putting them on a chair and saying, "You must sit there one hour by the clock." They usually begin to indulge in resentful thoughts and a situation is often produced akin to that of the stern father who felt compelled to go back and thrash his boy three different times during his hour on the chair, because of what he was satisfied was going through the boy's mind. No, that is not usually the best way. Put them on the chair with an indeterminate sentence. I prefer to carry it out something like this: "Now, son, this will never do; you are running away with yourself. Stop for a moment and think. Now I am going to ask you to sit down in that chair there and think this over quietly. I will be in the next room. Whenever you think you have got control of yourself and have thought this thing out so you can talk with me, you may get up from the chair and come into the room to me." Sometimes five minutes, sometimes fifteen minutes, and the little fellow will walk in and talk to you in a very satisfactory manner. He will give you his viewpoint and you will be able to adjust the matter in a spirit of conference which will be satisfactory to both parent and child, without doing the least violence to the responsibility of the one or the individuality of the other.

Very little is to be accomplished, when the child starts to indulge in an emotional runaway, if the parent contracts the same spirit, begins to talk fast and loud, to gesticulate wildly, grabs the child, begins to slap and shake it—that is merely an exhibition on the part of the parent of the very same weakness he is trying to correct in his offspring. I am afraid it is entirely too true that for every time you shake one demon out of a child in anger, you shake in seven worse devils. When all other methods fail and you must resort to punishment, do it with kindness, deliberation, and dignity. Never punish a child in haste and anger.

THE FINAL REWARD

The advice offered in this chapter is not mere theory. It has been successfully used by many parents in the management of their nervous children, and while all principles of child culture must be carefully wrought out and made applicable to the particular child in question, nevertheless, the methods of repeated and firm discipline herein set forth will enable you to take many a child who has been born into this world almost neurologically bankrupt, and, by this training and discipline, enable him in adult life to draw such dividends of self-control and self-mastery as will far exceed the outward results obtained in the case of many children who are born with sound nervous systems, but who were early spoiled and allowed to grow up without that discipline which is so essential to later self-control and dignity of character.



CHAPTER XXXI

NERVOUS DISEASES

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

SLEEPLESSNESS—INSOMNIA

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

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

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

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

NIGHT TERRORS

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

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

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

NERVOUSNESS

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

HEADACHE

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

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

CONVULSIONS—SPASMS

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

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

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

NERVOUS TWITCHINGS

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

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

RETENTION OF URINE

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

BED WETTING

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

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

1. The urine should be thoroughly examined.

2. The size of the bladder should be determined.

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

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

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

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

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

MENINGITIS

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

INFANTILE PARALYSIS

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

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

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

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

SAINT VITUS' DANCE

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

CONGENITAL DISORDERS

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

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

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

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

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



CHAPTER XXXII

SKIN TROUBLES

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

CHAFING

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

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

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

VULVOVAGINITIS

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

ECZEMA

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

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

ECZEMA TREATMENT

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

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

HIVES AND FRECKLES

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

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

RINGWORM

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

BOILS

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

FEVER BLISTERS

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

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

WARTS

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

BIRTHMARKS

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

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

ERYSIPELAS

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

SCABIES AND LICE

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

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



CHAPTER XXXIII

DEFORMITIES AND CHRONIC DISORDERS

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

HARELIP AND CLEFT PALATE

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

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

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

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

DEFORMED HANDS AND FEET

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

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

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

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