CHAPTER XIVNURSERY EMERGENCIES

CONTAGIOUS DISEASES: SYMPTOMS, TREATMENT AND QUARANTINE—CROUP AND ITS TREATMENT—CONVULSIONS—WHEN PALLS ARE DANGEROUS—BURNS AND CUTS—POISONS AND THEIR ANTIDOTES

Themodern mother is prepared to meet emergencies in the nursery far more capably than was your mother or mine. The open discussion, in the public press, of contagion and of accidents and their treatment, has educated the modern woman to cope with them. Thus women are learning how to provide against emergencies, how to protect their children from contagion, and how to guard against accident.

Most of us can look back to the day when the child was expected to “catch” a certain number of contagious diseases; it was part of normal development, like the cutting of teeth and the learning to walk; and the sooner they had them and got over them the better for all concerned. We have learned that a child can grow up without having a single contagious disease, and that menand women live and thrive and attain a ripe old age without contracting measles, scarlet fever, whooping-cough, any more than they must necessarily have pneumonia or typhoid.

Contagious disease is not a normal feature of a child’s growth. It is an emergency, and as such it is placed in this chapter. With each disease under consideration I am giving the period of quarantine prescribed by the Health Board of New York City. Every mother should respect these tables, whether she lives in a city, where quarantine is enforced, or in the country districts where it is not even recognized. None of us has the right to spread disease just because we have had it in our own household.

Immediately a mother discovers symptoms of contagious disease in her child she must quarantine the little patient, no matter what sacrifice this may entail on herself or on other members of the household. The room should be located in a remote corner of the house, provided this is one of the big, old-fashioned homes which are peculiar to the suburban or country town. In a smaller house or in an apartment it should be the most quiet room and the one farthest removed from family activities. This insures quiet for the patient, and less danger of contagion for the other members of the family. The room should be sunny and well ventilated.

For some contagious diseases it is not necessaryto strip the room to what may be termed hospital conditions. Doctors hold that measles and whooping-cough cannot be carried on fabrics; but the germ of scarlet fever has been known to live in hangings, rugs, and clothing for many months, even years. So, after all, as the change involves little trouble, it is just as well to take up carpets, and remove the hangings and curtains. Washable rugs may be used. The bureau should be stripped of fancy fittings to make room for the practical equipment required by the nurse. There should be no upholstered furniture, especially with scarlet fever; and the cushions used on wicker or wooden chairs should be covered with washable material.

There should be a screen to surround the bed while the room is being aired; and, above all things, the bed must be so placed that the sun will not strike in the child’s eyes at any time. There should be a comfortable cot for the mother or trained nurse or member of the family assigned to the care of the invalid. No visitors or other members of the family should be admitted. Their presence cannot lessen the danger of the child, and it may endanger their lives and the lives of other people.

If possible, there should be separate dishes, and a complete outfit for rinsing out clothing in this room. If the room is small these conveniences should be placed in an adjoining roomwhich, like the sick room, should be barred to other members of the family. Remember that some contagions can be carried on cotton clothes. The mother’s or the nurse’s outer garments, aprons, towels, and bedding, all should be soaked in a solution of carbolic acid—one-half ounce to each gallon of water—before they are sent any place else to be laundered. After they have been soaked in this solution they can be washed by any one without danger of contagion. Nevertheless, it is better to have all the laundry work done separately.

The three most common contagious diseases in the nursery are whooping-cough, measles, and scarlet fever. In infancy the most dreaded disease is whooping-cough. A normal, healthy baby under six months of age can hardly survive this disease; and there is nothing more pitiful than to see the family baby, who has caught this racking ailment from older children, slowly but surely choke up as it becomes too weak even to cough. I regard it as nothing short of criminal to expose a healthy baby to whooping-cough. As many babies die of whooping-cough, in New York City, as from measles, scarlet fever and diphtheria combined. Never allow any child with a cough to come near your baby.

The cause of whooping-cough has never been discovered. In older children it consists of terrible paroxysms of coughing, marked with a soundwhich can be described only by the word “whoop.” The little sufferer struggles for breath, the face turns red, the food is often vomited, and the paroxysm is followed by great prostration. Young infants are not strong enough to whoop, as the doctors express it, but they cough and hold their breath in a most distressing fashion; the face becomes blue, and the baby may have convulsions.

No cure for whooping-cough has ever been found; and no mother should administer patent medicines exploited for that purpose. The family physician may prescribe sedatives which will give the little patient relief, but the disease will generally run its course of six to twelve weeks. It is no respecter of seasons, and an epidemic in a certain neighborhood will be just as bad in summer as in winter.

The patient should have plenty of fresh air day and night; and should be given regular, nourishing meals, for he will require all the strength he can command to combat the paroxysms of coughing.

The child should be quarantined as long as it coughs, and should not be permitted to mingle with other children until the family physician has given his permission.

Measles is one of the most contagious of juvenile diseases, and it is carried by clothing, toys, and animals. It appears about ten to fourteen days after exposure. The first symptom is redness and running of the eyes. The child seeksa dark corner, claiming that the light hurts his eyes. There is a discharge from the nose; and the child appears to have a severe cold with a dry cough. He is not hungry; and his temperature may rise from 100° to 104° F. A rash appears on the face and behind the ears about the third or fourth day. It consists of groups of small, dull red, raised spots, accompanied by itching, and lasts about three or four days in the average case.

Upon the appearance of the first symptoms the baby should be given a hot bath and be put to bed in a well ventilated room. The shades must be drawn, for the eyes are extremely sensitive to the glare of sunlight. Artificial light should be carefully shaded. The eyes must be bathed three or four times a day with warm boric acid solution—one-half teaspoonful of the boric acid to one pint of water. The bottle-fed baby will need to have his milk diluted. The baby who is eating solid food should be placed on a fluid diet. The bowels must be kept open. If the temperature is very high, an ice-cap or a wet compress may be applied to the head. A doctor should be asked to look the child over; but he generally prescribes nothing more than a simple cathartic and the remedies named above. The chief danger from measles, in little babies, is the complication of pneumonia. Therefore, the child should be kept in bed at least three days after the temperaturehas dropped to normal. Quarantine should last for two weeks after the temperature becomes normal.

Scarlet fever is another contagious disease which can be carried by clothing or any article that has been in contact with a patient. The child exposed to this contagion may be taken ill within a few hours after coming in contact with it, or not for a week. The symptoms of scarlet fever are more violent than in measles. There is immediate loss of appetite, with vomiting, constipation, restlessness, sleeplessness, and headache. The breathing is hurried; the temperature runs up to 103°, 104°, or 105° F.; the throat is sore and shows inflammation; there is difficulty in swallowing; the tongue is coated in the center but red at the tip and edges. The rash, which appears within twenty-four hours on the neck and chest, spreads rapidly all over the body. It starts with small red points, which may be isolated or blended into a dull red flush. It lasts from five days to a week; then the skin peels off in fine flakes, which are seen especially on the palms of the hands and the soles of the feet. This peeling, which marks the most contagious stage of the disease, may last from two to six weeks, during which time nobody must be permitted to come in contact with the patient except the nurse and the doctor. The doctor only is qualified to raise the quarantine in the case of scarlet fever.

As inflammation of the kidneys and of the ears is apt to follow scarlet fever, a physician should be in constant attendance. No mother should attempt to treat scarlet fever without the help of a doctor.

Chickenpox is a less serious contagious disease, but may make a child most uncomfortable. The rash varies greatly in size, starting with red spots, developing into pimples, small blisters, and, finally, blackish crusts. The temperature rarely goes beyond 102° F. The child suffers from loss of appetite. The little patient should be kept in bed for a few days until the rash passes. Mild cathartics should be administered. Cotton undergarments should be used instead of woolen to relieve the itching, which can also be allayed by the use of carbolated ointment. If possible, keep the child from scratching the eruption, in order to prevent scars from forming.

Last, but not least, in this list of contagious ailments, may be mentioned the mumps—a disease which affects the salivary glands. The first symptom is nausea, followed by chill, drowsiness, and high temperature; the latter varies from 100° to 103° F. The child complains of pain in the mouth and the jaw; the face looks distorted. Soon a swelling appears below and in front of one ear, pushing the lobe outward. Sometimes this swelling attacks both ears. It usually lasts about a week. The child should be kept in bed to preventtaking cold. Mild cathartics will do no harm; and a fluid or semi-fluid diet should be supplied while there is temperature. The swelling can be covered by an ordinary cotton-batting bandage, unless the pain is very severe, when it can be soothed by hot compresses. Quarantine should be maintained for three weeks from the appearance of the swelling.

Among the nursery emergencies which are not contagious croup may be mentioned first, because it is the most common. This is the spasmodic contraction of the larynx, and may accompany a severe cold or may manifest its presence before the mother realizes that the child has taken cold. Some babies go through their nursery days without a single attack of this terrifying malady. Others are subject to it.

Usually the patient wakes suddenly, gasping for breath. The mother who has once heard the sound never fails to recognize it in its first stages. The breathing is slow, noisy, and heavy. The patient is greatly distressed. Sometimes there is a metallic, barking cough; again this may be missing.

Mothers who are experienced in handling this ailment keep on hand what is known as a croup-kettle, which can be purchased either at houses which deal in physicians’ supplies or through first-class druggists or house-furnishers. Whenthe mother does not have this convenient utensil at hand she can use other forms of treatment.

First, take a piece of soft cloth, cotton or linen, wring it out very dry in cold water about 60° F., and fold it in six or eight thicknesses. Lay this under the chin, covering the neck from ear to ear. Cover it with a strip of very heavy waxed paper, or a piece of oiled silk, and tie it all on with a big handkerchief. Change this in half an hour, when it will be found that the folds of cloth are hot. Have ready fresh folds of cloth dipped in cold water. If the attack of croup is light this treatment will generally control it. If not, the mother or nurse must rig up a croup-kettle.

A sheet must be arranged over the crib or bed like the top of a tent. Close to the crib, so that the spout will be under the improvised tent, rig up your tea-kettle, filled with water and kept at the boiling point by an alcohol or gas stove. The stove can be set on a table beside the bed. The steam pouring out of the spout of the kettle relieves the croup. The child begins to feel easier immediately this steaming process starts. But the mother must be very careful not to have the stove near enough to set fire to the bed clothing. If she will bear in mind that croup is not a very serious ailment and that it seldom results fatally, she will be clear-headed enough to relieve her baby in a very short time.

If neither the cold compresses nor the steamingprocess bring relief, then the mother may give syrup of ipecac—from one to two teaspoonfuls, according to the age of the child. This will cause vomiting. It is especially effective if the ordinary croup is accompanied by indigestion, as it is frequently. The next day the mother should have a doctor look the child over and decide on what treatment she shall use during another attack.

There is no emergency so terrorizing to a mother as convulsions. As the child becomes unconscious the mother, who has never seen a child pass through convulsions, believes that her baby is dying. In reality convulsions are a symptom rather than a disease, and the cause is easily traced and removed. They represent, first, an irritation of the nervous system. Back of this may lie disturbances of the digestive organs, rickets, and, in boys, tight foreskin. They occur with whooping-cough, and sometimes indicate the approach of an acute fever, such as accompanies pneumonia, scarlet fever, etc. Though it is commonly supposed that both teething and worms will cause convulsions, they can rarely be traced to such causes. If they occur during teething they are due not to the normal process of teething but to indigestion from which the child suffers, regardless of teething.

Convulsions have no preliminary symptoms and give the mother little warning. The first changein the child’s appearance is a sudden rigidity, with the hands clenched. The face turns pale; the eyes roll up or back and are fixed; and, although the child is apparently unconscious, the muscles of the face, arms, and body twitch in a way that horrifies the mother. The convulsion may pass in a few seconds or it may last several minutes. In the latter case the child breathes feebly; the lips take on a ghastly bluish tone; the forehead is moist and chill. After the convulsion passes the child is greatly exhausted; and often before it has time to react and become normal a second convulsion follows.

To prevent this the first convulsion should be treated promptly; and it is especially essential that in this emergency the mother maintain her self-control. Many a child in no real danger from a light convulsion has been seriously burned by the frightened mother’s plunging it into hot water. A physician should be summoned immediately; but in the meantime the mother will act for herself.

A hot bath should be prepared, with water at a temperature of 105° F. If there is no thermometer the mother must test the water by thrusting her bared elbow into it. If she cannot bear the heat of the water she may be sure that her child will suffer if immersed in water of such high temperature. If she uses the ordinary bathtub made for infants she should add to thewarm water a tablespoonful of dry mustard, dissolved in a cup of warm water. If there is no small bathtub and she uses the family bathtub, the water should be six inches high, and the same amount of mustard should be added to it. The little patient should then be held under the water from five to ten minutes, the water being kept at the same temperature. While the mother rubs his body and limbs under the water, her assistant should dip a small towel or piece of old linen in cold water and lay it on the top of the child’s head and forehead.

After the bath he should be patted, not rubbed, dry; wrapped in warm blankets; and tucked into bed, with a hot-water bottle or bag near the feet. Be very careful that the hot-water bag is not hot enough to blister the flesh. The baby, in the state of prostration which follows the convulsion, will not know enough even to withdraw his feet from the surface of the bag or bottle.

If the convulsion is a symptom of illness like scarlet fever, where the temperature is high, the baby cannot be put in a hot bath. A cold compress is laid on his head, and the body and limbs are sponged gently with cool water—not hot. If, after the sponging, the feet are cold, a hot-water bottle may be placed near them. If the child is fully dressed when the convulsion comes on, be sure to loosen the clothes, and take off the shoes and stockings. If there is an ice-cap in the houseuse that in place of the cold compress for the head.

If the convulsion comes from indigestion give an enema of warm soapsuds, and as soon as the child is able to swallow give him a large dose of castor-oil.

When a baby has a fall this may or may not attain the dignity of a nursery emergency. A child can escape real injury in what may first appear to the mother as a very bad fall. The effect of a fall most to be dreaded is injury to the spine or brain. I recall one particular case where a child was dropped by its nurse and it made very little outcry; in fact, it became listless, dull, and apathetic. It dozed, off and on, for twenty-four hours; and then suddenly the mother discovered that the child had lost the use of its legs. The blow to the spine had caused paralysis.

When a child strikes the head in falling, and develops listlessness and drowsiness, or makes no outcry, does not even talk, the mother should have it examined by a physician, even though the baby may not become unconscious. There are cases on record where children of three and four years were counted as defective and idiots, when a surgical examination developed the fact that a bit of bone was pressing on the brain and making all the trouble. The fracture could be traced to a fall during infancy, to which no attention had been paid. The pressure removed, the child hasregained the use of its faculties and developed into a normal being. The mother who suspects that the brain is even slightly affected by a fall should have her baby examined immediately.

Where the arm or leg is hurt the child may stop crying and resume its playing in a short time, merely shielding the injured member. If, at the end of several hours, he continues to play without using the hand or foot affected, the mother will do well to have him looked over by a doctor. An astonishing number of children will resume playing despite a broken arm, leg, collar-bone, or rib.

One of the common emergencies of childhood is the burn. I know of nothing which will make a child cry more terrifyingly or give the mother more alarm than a burn, whether from actual flame or from steam or boiling water. Too much care cannot be taken to ward off this emergency. Hot water should not be left standing around where a child can tumble or dip into it. Lamps, candles, etc., should be placed beyond reach. Matches should never be left where a child can strike them. However, careful as the mother may be, children will burn themselves, and a mother should be prepared for the emergency.

Keep on hand gauze bandages in several widths and a bottle of sweet-oil and lime water in equal proportion. This is effective if the skin is merely reddened or inflamed. If the burn destroys the first layer of skin, causing blisters to arise, thereis danger of infection. Cover the burn with a piece of gauze soaked in a weak antiseptic solution—one teaspoonful of creolin to one quart of water.

The same antiseptic treatment may be used for the more severe burns where the flesh is actually seared. In that case, after applying the antiseptic solution and gauze, the child should immediately have the care of a physician.

Infection, lockjaw, and intense suffering, if not death, may result from a neglected burn.

When a child chokes never strike it on the back while in an upright position. Turn it over on your lap, head downward, or even let it hang by its heels, when slapping it on the back.

A cut is never too slight to require the attention of the mother. The ordinary cut should be washed at once with warm water, using absorbent cotton or old, soft, clean linen. Unless the cut is very deep and bleeds so profusely as to exhaust the child, or unless an artery is cut, cleaning it and binding it up with sterile gauze is sufficient. But when the wound comes from broken glass or wood, and the mother is not sure that she has removed all the splinters, and especially if it comes from a rusted nail, she should take the child to a doctor and have the wound sterilized. If a doctor is not at hand she should wash out the wound with hot antiseptic solution. This may be made by dissolving one corrosive sublimate tablet or oneteaspoonful of creolin to one quart of water. A piece of sterile gauze, soaked with the same solution, is then laid over the wound, and it is bandaged, and left undisturbed until the wound is healed; unless on the arrival of the physician he thinks it necessary to investigate, and treat the wound.

In case of slight hemorrhage a piece of sterile gauze should be bound tightly over the cut with the bandage. In case of a serious hemorrhage from a wound on the leg or arm, make a tourniquet of a rope or a strip of strong cloth twisted tightly around the leg or arm at a point between the wound and the body. It must be held firmly until the bleeding stops or until the physician arrives to take charge of the case.

Acute nose-bleed is not a common emergency in the nursery. It is more apt to be slight and habitual, in which case it indicates adenoids or ulcerations on the inside of the nose. These should receive treatment at the hands of a specialist. In case of acute and serious nose-bleed, which exhausts the child, try to keep him quiet in an upright position, with a piece of ice held at the back of the neck. The mother can also hold the child’s nose firmly between her thumb and forefinger.

When a child thrusts some small object like a bean or a pebble into the ear or nose, the mother must be very careful not to try to remove the foreign body with her finger. In case of the noseshe may press the empty nostril firmly with her finger and induce the child to blow his nose vigorously. In most cases the foreign body will be expelled. If not, she should send for a doctor.

In the case of the ear, unless the obstruction can be easily seized with the finger-tips, it should be permitted to remain until a physician arrives with the proper instruments to remove it. In a mother’s effort to dislodge it, she may push it farther against the canal or drum of the ear.

Earache is one of the most trying emergencies in the nursery. It is an exquisite form of torture. It keeps both mother and child awake. It may be accompanied by fever; and in the infant who cannot locate the pain for the mother, it is indicated by irritation, restlessness and drowsiness, loss of appetite and nausea. The child tosses the head from side to side, not restlessly but violently, according to the intensity of the pain. The tiny hands make constant but futile efforts to reach the seat of the pain. If the attack is recurrent a specialist should be consulted, as sometimes an incision of the drum is necessary to relieve the pain. This does not affect the hearing of the child if properly done.

In the meantime, heat may give some small relief. This may be applied with hot compresses, a bag containing hot salt, or even a hot-water bottle wrapped in flannel. The ear may be irrigated with hot boric acid solution in the proportion ofone teaspoonful of boric acid to a pint of water. This may be poured into a fountain syringe, which is held two feet above the child’s head, the small nozzle of the syringe may then be held from one-quarter to one-half inch from the opening in the ear. It should never be pressed far enough into the ear to touch the drum. This warm water injection may be repeated every three or four hours, and where the ear discharges, either because of the incision made by the doctor or when the drum has burst of its own accord, the injection should be given three times a day as long as the discharge lasts.

The best solution of the poison emergency in the nursery is to keep poisons of every kind out of the reach of children. This includes Rough-on-Rats, corrosive sublimate tablets, carbolic acid, oxalic acid, laudanum, and strychnine.

Rough-on-Rats is full of arsenic.

Oxalic acid is kept in the house to take out stains, particularly of ink; carbolic acid and corrosive sublimate for disinfecting; laudanum for toothache.

They should all be plainly marked for the protection of adults, and should be placed absolutely beyond the reach of baby hands.

If, however, a child does swallow any of these, use the following antidotes:

Carbolic acid: If taken internally, give epsomsalts in large doses, soap; but no sweet-oil or castor-oil. For external burns apply alcohol.

Oxalic acid: Give an emetic, such as tepid mustard water, followed by a dose of chalk or whiting or vinegar. Follow this with soothing drinks, like warm milk. Never give potash or soda in any form.

Ammonia: Children have been known to drink ammonia with fatal results. Give vinegar or lemon juice, immediately followed by warm milk or sweet-oil.

Rough-on-RatsorParis Green: Give an emetic of mustard water, chloride of iron, or magnesia, or baking soda, or water of ammonia. Follow this with white of egg, sweet-oil, or milk. Later give castor-oil to keep the bowels open.

Corrosive sublimate: Administer emetic of mustard water, followed by white of egg or milk. Castor-oil to open the bowels. Try first the emetic of mustard water. If it does not work send to the nearest druggist for permanganate of potash, diluted. Give a dose of four or five grains with strong coffee.

Matches: Give the emetic; and then permanganate of potash, diluted, four or five grains; following this with epsom salts or magnesia to open the bowels. Never give milk, sweet-oil, castor-oil to a child who has eaten matches.

In order to meet these various emergencies, themother should have the following supplies in or near the nursery:

Package of sterile gauze (5 yards).Sterile gauze bandages—½ dozen in assorted lengths.1 lb. absorbent cotton, in small rolls.1 bottle corrosive sublimate tablets (7½ grains).1 bottle of creolin.1 bottle of sweet-oil.1 bottle of castor-oil.1 jar of vaseline, or lard.Mustard flour for making an emetic.The various antidotes mentioned in connection with poisons.

This represents a comparatively small investment, yet it is invaluable for the mother to use while waiting for the arrival of the physician.

One of the real terrors of the nursery is the realization that the baby has swallowed something more or less dangerous to his digestive organs—safety-pins, tacks, pennies, buttons, etc. Nature provides to a certain extent for carrying such things off. Food and juices form a coating around these foreign objects. Do not make the mistake of administering drastic cathartics. It is far better to give the child coarse food, such as bran, whole wheat, graham-flour bread, oatmeal, and other coarse cereals, and plenty of potatoes. Watch the stools, and if an object, like a safety-pin or a tack, does not pass within a reasonable time, take the baby to an X-Ray specialist and the foreign body will be located. This does notalways mean an operation. Very frequently, if the object is not passed off in the bowels, it is located in some part of the child’s anatomy where it will do no harm.

The most careful of mothers have to face nursery emergencies in raising their children. The most important thing to remember is that coolness and courage are as useful in saving the child’s life as the remedies named in this chapter. This is particularly true in cases like croup, convulsions, or poisons, when, in the excitement of the moment, the mother may scald her child, or give what she thinks is an antidote but which in reality hastens the fatal action of the poison.

Children pass successfully through many of these emergencies; the mother should never give up hope until the family physician has told her that there is nothing more to be done.

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