Extermination and Prevention of Mosquitoes.—Mosquitoes require for their development standing water. They cannot arise in any other way. A single crop soon dies and disappears unless the females find water on which their eggs may be laid. In order to prevent mosquitoes, therefore, the requirement is simple.No Standing Water.—Pools of rain water, duck ponds, ice ponds, and temporary accumulations due to building; marshes, both of salt and fresh water, and road-side drains; pots, kettles, tubs, springs, barrels of water, and other back-yard collections, should be drained, filled with earth, or emptied.Running streams should have their margins carefully cleaned and covered with gravel to prevent weeds and grass at the water's edge.Lily ponds and fountain pools should, if possible, be abolished; if not, the margins should be cemented or carefully graveled, a good stock of minnows put in the water, and green slime (Algæ) regularly cleaned out, as it collects.Where tanks, cisterns, wells or springs are necessary to supply water, the openings to them should be closely covered with wire gauze (galvanized to prevent rusting), not the smallest aperture being left.When neither drainage nor covering is practicable, the surface of the standing water should be covered with a film of light fuel oil (or kerosene) which chokes and kills the larvæ. The oil may be poured on from a can or from a sprinkler. It will spread itself. One ounce of oil is sufficient to cover 15 square feet of water. The oil should be renewed once a week during warm weather.Particular attention should be paid to cess-pools. These pools when uncovered breed mosquitoes in vast numbers; if not tightly closed by a cemented top or by wire-gauze, they should be treated once a week with an excess of kerosene or light fuel oil.Certain simple precautions suffice to protect persons living in malarial districts from infection:First: Proper screening of the house to prevent the entrance of the mosquitoes (after careful search for and destruction of all those already present in the house), and screening of the bed at night. The chief danger of infection is at night (the Anopheles bite mostly at this time).Second: The screening of persons in malarial districts who are suffering from malarial fever, so that mosquitoes may not bite them and thus become infected.Third: The administration of quinine in full doses to malarial patients to destroy the malarial organisms in the blood.Fourth: The destruction of mosquitoes by one or more of the methods already described.These measures, if properly carried out, will greatly restrict the prevalence of the disease, and will prevent the occurrence of new malarial infections.It must be remembered that when a person is once infected, the organisms may remain in the body for many years, producing from time to time relapses of the fever.A case of malarial infection in a house (whether the person is actively ill or the infection is latent) in a locality where Anophele mosquitoes are present, is a constant source of danger, not only to the inmates of the house, but to the immediate neighborhood, if proper precautions are not taken. It should be noted in this connection that the mosquitoes may remain in a house through an entire winter and probably infect the inmates in the spring upon the return of the warm weather.Malarial fever is prevalent in certain boroughs of New York City, and in view of the presence of standing water resulting from the extensive excavations taking place in various parts of these boroughs, is likely to extend, if means are not taken for its prevention.
Extermination and Prevention of Mosquitoes.—Mosquitoes require for their development standing water. They cannot arise in any other way. A single crop soon dies and disappears unless the females find water on which their eggs may be laid. In order to prevent mosquitoes, therefore, the requirement is simple.
No Standing Water.—Pools of rain water, duck ponds, ice ponds, and temporary accumulations due to building; marshes, both of salt and fresh water, and road-side drains; pots, kettles, tubs, springs, barrels of water, and other back-yard collections, should be drained, filled with earth, or emptied.
Running streams should have their margins carefully cleaned and covered with gravel to prevent weeds and grass at the water's edge.
Lily ponds and fountain pools should, if possible, be abolished; if not, the margins should be cemented or carefully graveled, a good stock of minnows put in the water, and green slime (Algæ) regularly cleaned out, as it collects.
Where tanks, cisterns, wells or springs are necessary to supply water, the openings to them should be closely covered with wire gauze (galvanized to prevent rusting), not the smallest aperture being left.
When neither drainage nor covering is practicable, the surface of the standing water should be covered with a film of light fuel oil (or kerosene) which chokes and kills the larvæ. The oil may be poured on from a can or from a sprinkler. It will spread itself. One ounce of oil is sufficient to cover 15 square feet of water. The oil should be renewed once a week during warm weather.
Particular attention should be paid to cess-pools. These pools when uncovered breed mosquitoes in vast numbers; if not tightly closed by a cemented top or by wire-gauze, they should be treated once a week with an excess of kerosene or light fuel oil.
Certain simple precautions suffice to protect persons living in malarial districts from infection:
First: Proper screening of the house to prevent the entrance of the mosquitoes (after careful search for and destruction of all those already present in the house), and screening of the bed at night. The chief danger of infection is at night (the Anopheles bite mostly at this time).
Second: The screening of persons in malarial districts who are suffering from malarial fever, so that mosquitoes may not bite them and thus become infected.
Third: The administration of quinine in full doses to malarial patients to destroy the malarial organisms in the blood.
Fourth: The destruction of mosquitoes by one or more of the methods already described.
These measures, if properly carried out, will greatly restrict the prevalence of the disease, and will prevent the occurrence of new malarial infections.
It must be remembered that when a person is once infected, the organisms may remain in the body for many years, producing from time to time relapses of the fever.
A case of malarial infection in a house (whether the person is actively ill or the infection is latent) in a locality where Anophele mosquitoes are present, is a constant source of danger, not only to the inmates of the house, but to the immediate neighborhood, if proper precautions are not taken. It should be noted in this connection that the mosquitoes may remain in a house through an entire winter and probably infect the inmates in the spring upon the return of the warm weather.
Malarial fever is prevalent in certain boroughs of New York City, and in view of the presence of standing water resulting from the extensive excavations taking place in various parts of these boroughs, is likely to extend, if means are not taken for its prevention.
(In Force from March 15 to October 15.)
1. No rain-water barrel, cistern, or other receptacle for rain-water, shall be maintained without being tightly screened by netting, or so absolutely covered that no mosquito can enter.2. No cans, pails, or anything capable of holding water, shall be thrown out or allowed to remain unburied on or about any premises.3. Every uncovered cesspool or tank shall be kept in such condition that oil may be freely distributed so as to flow over the surface of the water. Covered cess-pools must have perfectly tight covers, and all openings must be screened.4. No waste or other water shall be thrown out or allowed to stand on or near premises.Information is requested as to the presence of standing water anywhere, so that the premises may be inspected and the legal remedies against the same be applied.The prompt coöperation of all persons in the enforcement of the above regulations is earnestly desired, and they are assured that in this way the breeding of mosquitoes on their premises may be prevented.Mosquitoes are, so far as known, the only means of conveying malaria.
1. No rain-water barrel, cistern, or other receptacle for rain-water, shall be maintained without being tightly screened by netting, or so absolutely covered that no mosquito can enter.
2. No cans, pails, or anything capable of holding water, shall be thrown out or allowed to remain unburied on or about any premises.
3. Every uncovered cesspool or tank shall be kept in such condition that oil may be freely distributed so as to flow over the surface of the water. Covered cess-pools must have perfectly tight covers, and all openings must be screened.
4. No waste or other water shall be thrown out or allowed to stand on or near premises.
Information is requested as to the presence of standing water anywhere, so that the premises may be inspected and the legal remedies against the same be applied.
The prompt coöperation of all persons in the enforcement of the above regulations is earnestly desired, and they are assured that in this way the breeding of mosquitoes on their premises may be prevented.
Mosquitoes are, so far as known, the only means of conveying malaria.
The following table gives all the characteristics of the rashes that accompany the eruptive fevers. The term "incubation" means the period of time which elapses between the time when the child was exposed to, or caught the disease, and the time when the child is taken sick. It is sometimes interesting to know where a child could have caught a disease; so if we know the incubation period we can tell exactly where the child was on the day, or days, when it was infected.
NameIncubationDay of RashCharacter of RashRash fadesDurationMeasles10-14days4th daySmall red like spotsresembling flea bites,first appearing on faceand forehead, formingblotches with semi-lunarborders.On the 7thday offever6-10daysScarlet1-6 daysoccasionallylonger2d day offeverBright scarlet, rapidlydiffused, first onchest and upperextremitiesOn 5th dayof fever8-9 daysChicken-pox4-12 days2d daySmall rose vesicles,which do not becomepustularSlight scab ofshort duration6-7 daysTyphoidFever10-14 days7-14 daysRose colored papuleselevated, few in number,limited to trunk,disappear on pressureFrom21-35 daysSmallpox(Variola)10-14 days3d day offeverSmall, round, redhard, papules formingvescicles then pustules,first appearing on faceand wrists9th dayscabs formand about14th dayfall off14-21days
Other Rashes.—There are so-called "stomach" rashes which are a source of much worry to mothers. These rashes may appear at any time and they may be limited to certain parts or may cover most of the body. They may be bright red, or they may be simply a general discoloration. They may appear as blotches or they may spread all over, like the rash of scarlet fever when at its height.
These rashes are of no importance, except that they indicate some derangement of the gastro-intestinal tract. As a rule they indicate indiscriminate feeding or overfeeding. Children who have had too much candy or pastries, or who have been fed things which are unsuited to their age, frequently develop rashes. Such children should have a thorough cleaning out; a dose of castor oil is probably the best cathartic to give them.
The mother may readily learn to know the difference between a rash that is unimportant and one that indicates one of the eruptive diseases, if she gives the matter a little careful thought. In the first place a child who is about to become the victim of one of the eruptive diseases will be sick, and will have a fever for two or three days before any rash appears; while on the otherhand a child may go to bed in good health and may next morning be covered with a general rash, or with large blotches, without any fever and without any evidence of ill-health, except the skin condition. In the second place, if the mother gives the child a cathartic and restricts the diet for a day the rash will disappear, and good spirits and good health will be maintained; on the other hand, the giving of a cathartic to a child who is the victim of an eruptive disease will not tend to diminish the rash, but may accentuate it.
Pimples: Blackheads (Acne).—This eruption is situated chiefly on the face. It may appear, however, on the back, shoulders, and on the chest. It is mostly seen in young men and women about the age of puberty. It appears as conical elevations of the size of a pea; they are red and tender on pressure, and have a tendency to form matter, or pus, in their center. In from four to ten days the matter is discharged but the red spots continue for some time longer.
"Blackheads"appear as slightly elevated spots of a black color out of which a small worm-like substance may be pressed. Pimples and blackheads are due to inflammation of the glands of the skin. The mouths of these glands become filled with dust which acts as a plug causing the retention of the oily matter of the gland which becomes inflamed and hence the pimples and blackheads. Certain constitutional conditions favor the development of these skin blemishes. Constipation, indigestion, bad blood from unsanitary and bad hygienic surroundings, self-abuse and bad sexual habits favor the appearance of these skin affections.
Treatment.—The patient must avoid tea, coffee, tobacco, alcohol, veal, pork, fats, candy, pastries, cheese, and all edibles that are known to disagree with the digestion of the patient. Constipation must be avoided; if necessary, laxatives may be taken to keep the bowel open. The blackheads must be squeezed out with an instrument made for the purpose, not with the finger nails. Pimples must be opened with a sterile needle. The parts should be washed three times a day with hot water and green soap, and the following mixture applied at night:—
Zinc Oxideounces1/4Powdered calamineounces1/4Lime waterounce6
Mix and shake before applying to the skin.
Convulsions are quite common in children, especially those under three years of age.
A convulsion in an infant immediately, or within three months, after its birth is the result of injury, either at birth or later (a fall for example) which seriously affects the brain itself. After the third month the cause of fits or convulsions is, in a very large percentage of the cases, to be found in errors of diet resulting in disturbances in the stomach or bowels—eating of articles of food difficult to digest, as green or overripe fruit, salads, fresh bread, pickles, cheese, etc. Children of a nervous temperament are more liable to convulsions than are others. Females are more frequently victims of fits than are male children.
In infants convulsions often result from changes in the mother's milk. Mental excitement, deep emotion, anger, frights, severe affliction and distress will so affect a woman's milk that it will cause convulsions in her child if she nurses it while under the influence of any of these conditions.
Convulsions may result from any condition that disturbs the nutrition of the child, as, for example,—exhaustion, anemia, intestinal indigestion, blood poison, and general weakness resulting from some severe sickness, especially those of the digestive organs.
Various forms of brain disease cause spasms and fits; the most common are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions may accompany certain conditions, as, the presence of worms, teething, severe burns, foreign bodies in the ear, whooping cough, pneumonia scarlet fever, malaria, sometimes measles, typhoid fever, and diphtheria. Children who are badly nourished and who live constantly in unsanitary surroundings are more apt to have convulsions than thosewho are well nourished and who live hygienically. One attack renders the patient more liable to another, and when the "habit" is established any trivial cause may incite a convulsion; persistent and systematic efforts should therefore be taken to prevent the attacks. The best preventives are:
1st. To regulate the diet and the bowels.2nd. Remove adenoids and worms, if they exist.3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper foods.4th. Guard the child against catching cold, infectious diseases and all fevers. In other words, save the child from the cause and the convulsion will not take place.
1st. To regulate the diet and the bowels.
2nd. Remove adenoids and worms, if they exist.
3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper foods.
4th. Guard the child against catching cold, infectious diseases and all fevers. In other words, save the child from the cause and the convulsion will not take place.
By regulating the bowels we mean that everything the child eats must be seen by the mother, must be with the mother's permission, and must be suited to the child's age. If there is any question about the latter it will be advisable to have a physician write out a list of articles suitable to the child. It is generally necessary to eliminate meats, pastries, candies, sugar to a large extent, gravies, salads, sauces, and all the extras of the table, as pickles, mustard, relish, etc., as well as coffee, tea, cocoa, and alcohol.
The child should live in the open air as much as possible; a daily warm bath, followed by a quick, cold sponge, is a necessity.
Children subject to fits are possessed of a highly nervous temperament. They are difficult to manage unless managed with firmness and tact. It is not necessary to be harsh, but it is imperative to be firm and decided. They must be made to realize that they are not "the master," that their will is not supreme, and the mother must exact this condition; otherwise these children will become dictators and selfish despots—ruining the discipline of the home, spoiling their own chance of physical health, and rendering unhappy everyone around them. The parents, therefore, have a definite duty to perform and it is not an easy one. The food should be so regulated that each day a natural movement of the bowels will take place. (See article on constipation, page 303.) If a day should pass without a movement the child should be given a hot rectal enema as described on page586.
The adenoids can be easily demonstrated to either exist or be absent. (See page519.) If worms are known to be present in the child they should be at once removed. If they are simply suspected, the child should receive treatment for them, just the same. (See page549.)
By going a long time without a convulsion the nervous system will recuperate itself, and become so strong and healthy that what once would cause a fit will make no impression in its new strengthened state; therefore, if you "save the child from the cause," the convulsions will cure themselves, as it were.
There are some cases of convulsions for which no satisfactory explanation can be found.
Treatment.—When a child has a convulsion, remove its clothing and put it into a mustard bath. The temperature of the bath should be 105° F. Every part of the child should be under the water except the head, which is supported in the palm of the hand. While it is in the bath its body, and especially its arms and legs, should be briskly rubbed by the hands of an assistant in order to keep the circulation active. A rectal injection of soap suds or plain salt and water (see page579) should be given while the child is in the bath, because, as explained above, a large percentage of these cases are caused by gastro-intestinal derangements. The rectal injection will likely remove the cause. An ordinary convulsion lasts from five to ten minutes. When the child is removed from the bath it should be placed in a warm, comfortable bed and kept absolutely quiet. A hot-water bottle may be put near its feet and an ice-bag or cold cloths should be kept on its head. It should be given a full dose of castor oil and allowed to go to sleep. Its diet should consist of light broths for two or three days and during this time it should not be disturbed or annoyed by too much attention. This is as far as it is wise or safe for any mother to go in the treatment of convulsions. A physician should be called in every instance, because a convulsion should never be regarded lightly. Many children have become idiots, others have been afflicted with paralysis, because of inattention at the proper time.
SUMMARY:—
1st. Convulsions must always be regarded as serious.2nd. Convulsions demand prompt treatment.3rd. Every mother should know that an English mustard bath—hot—is the first resort in convulsions.4th. While this is being done she can read the home treatment in this book and carry it out before the doctor comes.5th. If the fit is not caused by some stomach or intestinal trouble, have the physician find out the cause and tell you what to do, and do it faithfully, because if you neglect the proper treatment the child may become idiotic or paralyzed.
1st. Convulsions must always be regarded as serious.
2nd. Convulsions demand prompt treatment.
3rd. Every mother should know that an English mustard bath—hot—is the first resort in convulsions.
4th. While this is being done she can read the home treatment in this book and carry it out before the doctor comes.
5th. If the fit is not caused by some stomach or intestinal trouble, have the physician find out the cause and tell you what to do, and do it faithfully, because if you neglect the proper treatment the child may become idiotic or paralyzed.
Enuresis, or incontinence of urine, is customary in infancy. Just when urination becomes a voluntary act depends upon the development and training of the individual child. As a rule children can be taught to control this function during the day, or while awake, about the tenth month. It is not under control during sleep until a much later period, usually by the end of the second year, but lack of control should not be regarded as abnormal until the child has entered the fourth year. If the child fails to control the act of urination during the day at the end of the second year, and is addicted to habitual bed-wetting, some measures should be adopted to cure the condition.
Boys under twelve years of age seem to be affected more frequently than girls. It is wrong to assume that it is caused by negligence or laziness, as some parents do. It has generally a special cause, and the cause usually can be found if it is carefully sought for. It may be the result of bad habits: exposure to cold in the night; lying on the back; drinking too much liquid in the afternoon or at bedtime. It may be due to too much acid in the urine, and if so it will be found necessary to reduce meats and eggs the child is eating. Worms, stone in the bladder, some anatomical abnormality or deficiency, maybe responsible for it. The diet may be at fault; adenoids are supposed by some physicians to be the cause. No matter what the actual cause may be, it must be found and remedied before we can hope for a permanent cure. A very large majority of these cases are due to nervousness. These children are of a nervous temperament. They are not necessarily sickly children; they are simply of a nervous type. They are well-nourished, active, and lively. Incontinence of urine during the day and long-continued bed-wetting does not at all affect the health of the child. If they are in poor health, it is essential to treat their general condition before trying to cure the incontinence.
It is absolutely wrong to punish or to crush the spirit of these children. Constant nagging and taunting, even if done in the hope of shaming the child into a cure, will simply make a coward of him and will not aid in improving matters, but will be distinctly detrimental.
Scrupulous cleanliness must be constantly practiced or these children, if neglected, may develop ulcers and sores of a very obstinate character. The odor is also bad for the health of the child.
Treatment.—Find and remove the cause if possible. If due to general poor health, give tonics, obtain a change of air, and build the child up. Reduce the total quantity of liquids, if in excess, and be very careful not to give any liquids near bedtime. Don't cover these children too much; they should never be "too warm"; they should sleep in a well-aired room, and they should receive a quick, cool sponge bath every morning. They should be taught to sleep on their sides, never on their backs. Their diet should be light but nourishing. When bed-wetting is established it will continue, if untreated, until the child is eight or ten years of age, and it frequently lasts much longer. When treatment is undertaken it should be distinctly understood by the mother that it will take many months to cure; and during these months she must give her constant attention to the child. If she does not undertake to do this, or if she fails to do it, the treatment should not be begun at all, as it will not succeed. Various plans should be tried to keep the child from sleeping onits back. The reason of this is because it has been found that the child wets the bed only when sleeping on its back and never when sleeping on its side. The simplest method, of tying a towel or cloth around the child with a knot over the spinal column, so that it will hurt and waken it, if it turns on its back, is a very good one and should be carefully tried for some time. The nervous system of these children should never be overtaxed at home or at school. Early hours and plenty of sleep are desirable. Certain articles of diet of a stimulating character should be entirely avoided,—for example, coffee, tea, beer, candies, sugars, and pickles. The best diet for these children is one composed exclusively of milk, vegetables, fruits, meats, and cereals. Meats, however, should be given only once every two days. It is a good plan to teach the child to hold his water during the day, as long as he can, to accustom the bladder to being full. Adenoid growths, which contribute to the nervousness of a naturally nervous child, should be removed. It is a good plan to take the child up when the parents go in bed and let him urinate. This often cures the condition in itself.
Sometimes moral measures, such as the promise of a reward, will strengthen the will so that the child may overcome the tendency. Find out what the child most desires in the way of a toy, and promise it if he goes so long without wetting the bed. Aid and encourage him to make efforts to win the reward.
If drugs have to be resorted to, it is necessary to call the family physician, as the only drugs that are of any use are very powerful and have to be given with great care and caution. It is the experience of most physicians and specialists, however, that in a large majority of cases the treatment, along the lines as given above, will be effective, without drugs, if faithfully persisted in by the mother.
These children should be examined by a physician. The cause of the bed-wetting is frequently discovered to be produced by anatomical abnormalities which render circumcision imperative. In these cases no method of treatment will succeed until circumcision is performed.
Causes.—In babies, disturbed sleep is most frequently due to hunger or to indigestion. The latter is the result of overfeeding or improper feeding. Rocking the child to sleep, or feeding it during the night will cause sleeplessness. Teething, colic, or any pain will result in disturbed sleep. Nervous children are frequently poor sleepers.
In older children, some digestive disturbance is, as a rule, the cause. Chronic intestinal indigestion, worms, adenoid growths, enlarged tonsils, lack of fresh air in the bedroom, cold feet, may, however, be the cause. Overstudy in school, poor blood, poor nourishment are always accompanied by inability to sleep soundly. Too strenuous play, exciting stories read before bedtime, may cause sleeplessness.
Treatment.—The removal of the cause is absolutely necessary. In order to discover the cause it is sometimes essential to study the child's whole routine in order to be able to tell exactly just what is causing the apparent insomnia. It may be necessary to change the method of feeding, to regulate the studies and the exercises, and to suggest changes regarding the sanitary and hygienic environment of the child's life. Mothers must be warned against using drugs in the form of soothing syrups or teething mixtures. They are dangerous and absolutely forbidden under the above conditions.
The nervous disposition of the child must be taken into consideration and treated if necessary. If bad habits exist they must be stopped. Poor blood and poor nutrition must receive the treatment suggested under these headings.
In a nightmare a child wakes suddenly in a state of fright and will inform you that it has had a bad dream. His mind seems clear and he recognizes those about him. He is not easily calmed and may cry for some time; finally he goes to sleep again. The next day he will rememberthe dream and most of the incidents of the night before. Such cases are quite frequent. They are to be treated in the same way as cases of disturbed sleep, as they really have the same cause. They are mostly due to digestive disturbances and errors of diet.
Night-Terrors.—Cases under this heading form a distinct group by themselves. They are not frequent, but the condition is much more serious. The cause seems to be wholly nervous and may indicate an important nervous derangement. It seems to have some indefinite relation to such conditions as migraine, hysteria, epilepsy, and even insanity. The child wakes suddenly during the night and sits up, evidently in terror; he does not apparently regain his full consciousness. He talks of being scared, calls for his mother, trembles and shakes, cannot answer questions intelligently, and after a time goes to sleep. Next day he remembers nothing of the attack and does not seem to suffer in any way as a result of it.
I am disposed to believe that all of these attacks are not due to a nervous condition. A number of them of exactly this type have been cured by absolutely withdrawing milk from the diet.
It is a good plan to restrict the possibility of excessive play in these children. They are of the type whose play is work, and too much of it is too exhausting. Some person should sleep in the same room with these patients or in an adjoining room with the door open.
If the condition occurs frequently the child should be subjected to a thorough physical examination, because it may be one evidence of a serious ailment.
Sometimes these little patients have to be taken out of school and sent to the country, where they should remain for many months. It is far better to regard the condition as indicating an abnormality,—even though it may not have any deeper significance than that the digestive apparatus of the child is not quite right,—and make every effort to cure it, than to permit the child to go on under what really are unjust and unfavorable conditions.
Headaches are not common in little children. The most frequent ones are caused by:
1. Chronic indigestion and constipation.
2. Anemia and malnutrition.
3. Nervous disorders.
4. Diseases of the eye, nose, throat.
5. Rheumatism and gout.
6. Disturbances of the genital tract.
Those arising from anemia and poor nutrition are most frequently present in girls from ten to fifteen years of age. They may result from overcrowding of school work, which results in loss of appetite and poor sleep.
Nervous headaches may be hereditary or acquired through unhygienic surroundings. Hysteria, epilepsy, disease of the brain, neuralgia from carious teeth, may result in nervous headaches.
Headaches from disturbances of the genital tract may afflict girls about the time of puberty.
Treatment.—To remove the cause is the only plan that promises any result. Each one must be investigated by itself and dealt with accordingly. For the headache itself a hot foot bath, cold to the head, and small doses of phenacetine (one grain every hour for four doses) are perhaps the most certain of all methods of treatment.
The habit of sucking the thumb may be corrected by wearing a pair of white mittens, or gloves tied at the wrist. Should children attempt to suck the thumb with gloves on, as some do, it will be necessary to saturate the thumb and fingers of the gloves with tincture of aloes, or a solution of the bisulphate of quinine, one dram to two ounces of water.
Biting the finger nails may be stopped by the use of the same bitter remedies as are used in thumb-sucking.
Procure a soft rubber catheter,—No. 18 American is about right. It is not advisable to get too soft rubber for the reason that it will buckle when the child strains and it will be impossible to wash out the bowel. Fill half full an ordinary two-quart douche bag with water that is warm, but not too hot. Dissolve a heaping teaspoonful of table salt in a glass of hot water and add this to the water in the bag. Hang the bag about two feet above the level of the child, so that the water will not flow in with too strong a stream; otherwise the child will immediately try to eject it. If the water flows in gently, the child may not object to it to the extent of making strenuous efforts to force the catheter out.
Use the small sized nozzle that comes with the douche bag. Place the rubber catheter over this nozzle, lubricate the catheter, place the child on its back over a douche pan, insert the catheter about two inches, let the water run and as it runs in push the catheter up gently until it is all in the bowel except the end on the douche tip. The object of letting the water run while pushing in the catheter is because it floats up with the water as it distends the bowel; there is no risk then of pushing the end into the intestinal wall or hurting the child. While the water is flowing into the bowel it is a good plan to compress the buttocks together to aid in holding the water, as the child is very apt to let it run out as soon as it feels uncomfortable.
The temperature of the water for the ordinary rectal injection should be 95° F. When the child is exhausted or very weak, or when the circulation is poor, the temperature of the water may be as high as 110° F. When, on the other hand, the fever is very high, the water may be much cooler; as low as 70° F. has been given with good results on the fever. If the irrigation is given with the intention of reducing the fever, it is best to begin with water around 90° F., and reduce it to 70° F., gradually.
Indications for Irrigation of the Colon.—When it is desired to cleanse the bowel of any collection of matter a colon irrigation is indicated. This matter may be mucus, fecal substance, undigested food, or the decomposing waste products which may remain there as a result of disease or other conditions.
When it is desired to medicate by putting fluids into the bowel we adopt the colon infusion.
Every diseased condition of the bowel does not, however, indicate irrigation. If a child is having frequent loose movements every half-hour it is safe to assume that the bowel is being cleaned out sufficiently without any artificial aid. To irrigate in these cases would only irritate and would not accomplish anything. The cases which are benefited are those in which we have a fever with four or five green stools in the twenty-four hours, or where we have a high fever with no movement at all. To irrigate in these cases we not only get rid of the products of decomposition, but we prevent further decomposition and we reduce the fever, thereby contributing to the general welfare of the child.
When the child is convalescing and when there is only mucus in the stools, with no fever—as in cases of chronic ileo-colitis—the colon irrigations should be stopped, as they tend to keep up the discharge of mucus in these cases. If, however, there is a relapse with fever, which would indicate a fresh infection with more discharging mucus and possibly green stools, the irrigation must be used until the fever subsides.
Colon irrigations should always be given in every case of convulsions in infancy, first to clean out the bowel to prevent putrefaction, and second to empty the bowel on general principles because an overloaded bowel is very frequently the cause of convulsions in children.
When irrigation of the bowel is given at all it must be given thoroughly. Enough water must pass into the bowel to wash it all out. For this reason it is essential that the catheter should be all in and in the bowel—not doubled on itself two or three inches in the bowel. If it is a serious case and the mother nervous, someone else should give the washing—preferably the physician himself.If the child objects strenuously, as often happens, it must be done with greater care to be successful. Remember that a colon irrigation is never given unless it is absolutely necessary and as a consequence it is given to accomplish a certain purpose; it must, therefore, be done thoroughly. If it is not, your child may miss the chance it has of getting over some immediate difficulty and if the moment of the "chance" is wasted or lost, that moment will not return. Be thorough, therefore.
Enema.—Some physicians talk about a high enema and a low enema. A high enema is really an irrigation as described above. The following remarks apply to low enemas only.
A so-called low enema is given to clean out the rectum of constipated matter, or for the introduction of food or medicine by rectum, when for various reasons it is necessary to spare the stomach.
It may be given with the fountain syringe or with the ordinary bulb (baby) syringe. A catheter may be put on the tip of the syringe if it is thought best to inject higher up than in the rectum.
When an enema is used in infants or older children for the relief of constipation, the best medium to use is glycerine. For an infant, one teaspoonful to an ounce of water is sufficient; for older children, one tablespoonful to two ounces of water, given with the bulb syringe, will give prompt results. If the constipation is pronounced, the fecal mass very hard, an enema of sweet oil, allowed to remain in for ten minutes, will soften it and permit a movement.
Soap suds are often used. They are good but not as reliable as the glycerine or oil; if, however, neither of these two are at hand the soap suds may be given.
Enemas should be carefully given and the liquid slowly injected. If the fountain syringe is used care must be exercised in not having the bag too high. If it is too high the liquid will flow in too strongly, either injuring the bowel wall or causing the child to strain immediately and pass out the injection before it has an opportunity of accomplishing its work.
The temperature of the enema should be warm—not hot, and not cold, simply body heat.
During the course of acute illness it is frequently necessary to reduce the fever, if possible, without the use of drugs. The following means are often adopted. It is desirable that the mother should know just how to carry out these methods:
Ice-Cap.—An ice-cap is used to protect the brain when a child or adult is running a very high fever. It is put on when the fever is above 103° F. It may be used in other conditions—brain disease, or disease of the meninges or cord—in which case the physician will be in attendance and will direct what should be done.
Ice-bags are procured in the drug stores. The best one is the flat French ice-bag. Fill it three-quarters full of finely chopped ice, put the ice-bag in a towel, and place on the patient's head. There should be only one thickness of the towel between the ice-bag and the head.
It will be necessary to keep a record of the fever so that the ice-bag may be withdrawn when it falls below 103° F.
When the ice melts the bag must be at once refilled. This is often overlooked by careless mothers.
Cold Sponging.—Cold sponging is used to reduce fever or to allay nervous irritability. Equal parts of alcohol and water or vinegar and water are used. The temperature of the water should be 80° to 85° F.
Infants to be sponged should be completely undressed and laid upon a blanket. The sponging should be done for about fifteen or twenty minutes, after which the child is wrapped in a dry blanket without further clothing except the diaper. To be effective it must be done frequently.
Cold Pack.—The cold pack is used to reduce fever. It is one of the simplest and one of the best means we have. The child is undressed completely, and laid upon a blanket. It is completely covered with a small blanket (except its head) wrung out of water at 100° F. Outsideof this the child is rubbed with a piece of ice, front and back, for a sufficiently long time to render the surface cool, but not cold. Children take kindly to this means of reducing fever; there is no shock and they are quieted by it.
Just how long one will rub with the ice depends upon circumstances. From five to thirty minutes may be employed. The head should be sponged with cold water while this is being done and it is a good plan to have a hot-water bottle at the child's feet.
The Cold Bath.—To reduce fever the cold bath is used in the following way: Water at a temperature of 100° F. is put into the bath and the child is first put into this water, then the water is reduced by putting into it shaved ice until it reaches 80° F. The child's body is well rubbed while it is in the bath and cold water is applied to its head. The bath is continued for five minutes, or sometimes with a robust child to ten minutes. On removal the child should be put into a warm blanket after being thoroughly dried.
Rectal Irrigations.—These are sometimes given to reduce fever. They are very useful and very successful if they are given properly and without exciting the child too much. It is best to give water of an ordinary temperature at first and gradually reduce it to 70° F. It should be continued for ten minutes or longer. It may be repeated every three hours. (See page586.)
Every mother should know how to give any bath that may be directed by the physician.
The Mustard Bath.—Take from three to four tablespoonfuls of English mustard; mix thoroughly in about one gallon of warm water. Add to this about five gallons of plain water at a temperature of 100° F. If it is necessary to raise the temperature of the water higher it may be done by adding water until the temperature reaches 105° or 110° F.
The mustard bath is exceedingly effective in cases of shock, great sudden depression, collapse, heart failure,or in sudden congestion of the lungs or brain. The special use of the mustard bath is in the treatment of convulsions; it is also useful for nervous children who sleep badly. Two or three minutes in the mustard bath, followed by a quick rubbing, will induce refreshing sleep in these children. It is not necessary to have more than one tablespoonful of mustard in these cases.
The Hot Bath.—A bath is prepared of water at a temperature of 100° F. After the child is in the bath the temperature of the water is raised to 105°, or to 110° F. It is not safe to go above this point.
The body of the child should be well rubbed while it is in the bath. In most cases it is advisable to apply cold water to the head while the child is in the bath. A bath thermometer should be kept in the water to see that it does not rise above the temperature desired.
The hot bath, like the mustard bath, is used to promote reaction in cases of shock, collapse, etc., and in convulsions.
The Hot Pack.—Remove all clothing from the baby and envelop the body in a sheet wrung out of water at a temperature of 100° F., to 105° F., after which the body should be rolled in a thick blanket. Those hot applications may be changed every twenty minutes until free perspiration is produced. This condition may be kept up as long as is necessary.
The hot pack is used mainly in disease of the kidney.
The Hot-Air or Vapor Bath.—The child is put in bed wholly undressed with the bedclothing raised about twelve inches, and held in that position by a wicker support. The child's head is of course outside the bed clothing. Beneath the bed clothing hot air or vapor from a croup kettle is introduced. This will cause free perspiration in twenty minutes. It may be continued from twenty to thirty minutes at a time.
The vapor bath is used in diseases of the kidney, as a rule.
The Bran Bath.—In five gallons of water place a bag in which is put one quart of ordinary wheat bran. The bag is made of cheese cloth. Squeeze and manipulate the bran bag until the water resembles a thin porridge.The temperature of the water is usually about 95° F., though it may be given with any temperature of water.
The bran bath is of great value in eczema, or in rashes about the buttocks, or in delicate skin conditions when plain water would irritate.
The Tepid Bath.—This bath may be given at a temperature of 95°, or 100° F. It is of distinct advantage in extremely nervous children. To induce sleep it is often better than drugs.
The Cold Sponge or Shower Bath.—This bath should be given in the morning in a warm room. A tub should be provided with enough water in it to cover the child's feet. This water should be warm because when the feet are in warm water it prevents the shock which frequently comes when cold water is applied to any other part of the body.
A large sponge is filled with water at a temperature of from 40° to 60° F. This is squeezed a number of times over the child's chest, shoulders, and back. While the cold water is being applied the body should be well rubbed with the free hand of the mother. The bath should not last longer than half a minute. When finished take the child out quickly and stand him on a bath towel and give him a brisk rubbing with a bath towel until the skin reacts. This is an exceedingly valuable tonic for a delicate child. It should not be used on younger children than eighteen months of age. In younger children a cold plunge is preferable.
For the cold plunge water at a temperature of 55° F. is prepared. The child is lifted into this and given a single dip up to the neck. He is then briskly rubbed off as above.
There are a very few children who do not take kindly to either the cold sponge or plunge. These children do not react; they remain pale or blue and pinched for some time after. It may be necessary to discontinue the procedure or to use water of a higher temperature.
Poultices are useful in inflammation and for the relief of pain. To be of any value they should be appliedfrequently—every ten or twenty minutes—and they should be applied hot.
Ground flaxseed is the best material for poultices. It should be mixed with boiling water until the proper thickness is reached. It may be kept simmering on a fire. When one poultice is taken off it can be scraped into the pot and heated over if there is no discharge. Each poultice should be put into clean muslin, put on the part and covered with oiled silk. This will help to retain the heat and prevent the clothing or bed sheet from becoming wet.
A hot fomentation is simply a clean poultice. Several thicknesses of flannel are taken, wrung out of very hot water, covered with cotton batting, and then with oiled silk.
How to Make and How to Apply a Mustard Paste.—For infants: Take one part English mustard to six parts flour, mix with lukewarm water, and spread between two layers of cheesecloth.
For older children and adults: Take one tablespoonful English mustard to three or four tablespoonfuls of flour, and mix as above.
Mustard pastes should be made big enough. You can accomplish a great deal more by putting on a sufficiently large mustard paste than by simply putting on one the size of the palm of your hand.
It should be left on until the skin is distinctly red. The length of time will depend, of course, upon the strength of the mustard. Mustard pastes may be put on every three hours, if necessary, and they may be used for a week at this interval if the conditions demand it.
If they are used in pneumonia or other pulmonary diseases, they should be used large enough to go around the whole chest. If they are used in heart failure, they should be big enough to cover the whole trunk.
When made with the white of an egg they will not blister. Or if the part is rubbed with white vaseline before applying, it will not blister and it will be just aseffective. When a mustard paste is removed the red area should be rubbed with white vaseline and covered with a clean piece of flannel.
How to Prepare and Use the Mustard Pack.—The child is stripped and laid upon a blanket, and the trunk is surrounded by a large towel or sheet saturated with mustard water. This is prepared as follows: Take one tablespoonful of English mustard and dissolve it in one quart of water, slightly warmed. Saturate a towel in this mixture and apply to the body of the child while it is dripping. The patient is then rolled in a blanket. Keep the child in this pack for ten or fifteen minutes. The mustard pack is not as good as the mustard bath, but it is all that is necessary in a number of various conditions. The physician will, of course, decide these matters. It is simply the duty of the mother to know how to carry out the physician's instructions.
The Turpentine Stupe.—Take a piece of flannel, big enough to cover the area which it is desired to affect, wring it out of as hot water as it is possible. Upon this sprinkle twenty drops of spirits of turpentine. Place the stupe wherever it is desired and cover with a piece of oiled silk or dry flannel. The turpentine stupe is mostly used in pain of the abdominal cavity. In colic from acute indigestion it is a very convenient means of quieting the child by allaying the pain.
Care should be taken not to allow this form of application to remain on too long. Take it off when the skin is red. For continuous use it is not as good as the mustard paste.
Oiled silk is sold in the drug stores by the yard. It is one yard wide. It is used to cover any local application to prevent evaporation into the air or to prevent the clothing from absorbing the medicament. If a liniment is applied on cloth to effect a certain result, it may take some time to do its work. If the wet cloth is covered with the clothing, the clothing will absorb the medicine quicker than the body will and thereby defeat the objectin view, in addition to rendering the clothing wet and nasty. If the application is covered with oiled silk it cannot escape into the clothing, because the oiled silk is impervious. The body will be compelled to absorb the medicine and consequently results will be quicker and more certain. Many liniments are expensive; to permit them to be absorbed by the clothing is needless waste It is therefore economical to apply the oiled silk.