DISEASES PECULIAR TO CHILDREN.

The diseases of children that I propose to inquire into, are not those of so serious a nature as to require the skill of a physician, but rather those trivial ailments which are common among children of tender age and which neither good care nor healthy surroundings seem to be able to ward off. And for this reason, mothers and nurses should familiarize themselves with these ailments and their appropriate treatment, for trivial as they may seem to begin with, if permitted to go on uncontrolled, they often lead to more serious and perhaps fatal consequences.

A coated tongue in children is not always a sign of digestive disturbance, for most nurslings have a white coated tongue in the first three or four weeks of their lives. With the ancients, and even up to within a recent period, the tongue was considered the mirror of the stomach; this was a delusion because nothing definite or of great importance can be deciphered in any case from the appearance of the tongue alone, but this superstition became so deeply rooted in the minds of the public, that even now a medical examination is considered incomplete unless the physician says put your tongue out, for the purpose of a physical inspection.

When the child loses its appetite and the stomach and bowels become deranged, the tongue generally becomes coated. Children who are overfed and in whom the food is not digested, may have a thick fur over the tongue, but as a rule only on the back of the tongue there is a whitish coat. In diseases of the mouth that are purely local, the tongue is sometimes coated, quite independently of any disease of the stomach, as for instance in thrush, in catarrhal inflammation of the mouth, diphtheria, burns and other injuries.

(a) Catarrh of the mouth is an inflammation of the mucous membrane and is recognized by redness and increased secretion. It is most intense on the tongue, which presents the appearance as though it were coated with raspberry syrup. Sometimes the redness is most on the inside of the cheeks and soft palate, while the tongue is covered with soft fur. The inflammation of the mucous membrane of the mouth, extends in aggravated cases to the throat and nasal passages and along the Eustachian tube into the ear. There is many a baby suffering, no one knows from what, when it has an earache due to this cause. When the catarrh has existed for some time, clear, minute water-vesicles rise upon the tongue, gums and mucous membrane of the lips and cheeks. These burst and leave behind them small, flat ulcers, which in the first few days run together and present large, flat, ulcerated surfaces. The children become feverish and refuse to eat and drink for days, partly because to do so, pains them and partly from a loss of appetite.

The most common cause is the eruption of the teeth. Mothers of experience know that when the baby drools, it is teething, and if she examines a little closer she will discover the catarrhal condition described. Another cause is the old-fashioned sugar teat with its souring contents; so is the nursing food, when either too hot or too cold, and in older children irregular or improper food has the same effect, for instance, sour ripe fruit eaten in excess.

The treatment for catarrh of the mouth is simple and successful if directed to the removal of the causes that we have enumerated. The mouth should be cleansed every few hours with a little borax water, and the febrile symptoms generally subside with a dose of mild laxative.

(b) Putrid sore mouth is an aggravated stage of the above affection; it begins on the borders of the gums as inflamed patches coated with a thin layer of yellow mucus. The slightest touch of the ulcerated places causes bleeding, and the affection can be recognized at quite a distance from the mouth by the sense of smell. The disease is contagious and may be imparted from one child to another. Carious teeth are the predisposing agents; mercury or calomel in repeated and large doses produces a similar effect. A very simple and efficient remedy for this affection is a saturated solution of chlorate of potassa, in the proportion of a teaspoonful to a teacupful of boiling water; with this solution wash the mouth out every two hours, and allow a little to be swallowed at the same time; children under one year of age can swallow ten drops; under two years, twenty drops; under three, thirty drops, and larger ones can take a teaspoonful.

(c) Thrush, sprue, or soor is another type of sore mouth that falls to the lot of some children. It resembles catarrh of the mouth, but must be considered a different disease, inasmuch that it is proven to be due to a fungus growth. The disease begins with a change of color from the natural bright red, to a livid, dark red color; the entire mucous membrane of the mouth is uniformly discolored; the discoloration never occurs in spots, and the surface presents the appearance as if a thick coat of raspberry syrup had been smeared upon it. The mucous membrane becomes dry and sticky and the secretion of the mouth is acid. On inspecting the mouth the fungi can be seen, at first as small white points if only existing a few hours, but their growth is very rapid, and they soon form large white patches, which may run together and cover the entire mouth. The treatment is directed towards removing the cause in the first place; if the child has been using the sugar teat that must be discontinued, and even a milk diet should be suspended for a few days, on account of its containing sugar and cheesy matter, and instead the child should be fed with a little thickening of arrow root or wheaten flour. The mouth must be kept sweet and clean with a solution of borax applied with a small camel’s hair brush; if the disease is obstinate, dissolve the borax in creosote water obtained from a druggist, and apply this every hour or two as above.

(d) Parotitis, or mumps, is an inflammation of the parotid or salivary gland. The disease shows itself as a swelling between the angle of the lower jaw and the ear. Several days before the swelling and pain begin, the children feel tired, ill-humored, feverish, lose their appetite, lounge around or voluntarily take to bed. Nervous children show brain symptoms; they complain of headache, are delirious and have convulsions. After two or three days they begin to feel pain behind the jaw, and when they open the mouth, masticate, or on slight pressure, the pain becomes aggravated. The swelling over the corresponding cheek extends to the lower eyelid and back to the neck. The skin over the swelling becomes inflamed and red. In males the swelling may suddenly move from the neck to the testes, while in the female it may strike on the mammÆ.

The course of mumps is usually favorable, but there is a possibility of an abscess forming, and this may break directly outward, or burrow backwards and burst into the ear, perforating the ear drum, causing lifelong deafness. I have had one case in which the disease went to the brain; the little boy, a child of seven, died. The patient who has mumps must be kept warm; over the swelling apply hot poultices for three or four days, and besides wrap the entire head and neck in flannel. If the swelling is painful, and the child in robust health, a few leeches applied to the swelling will relieve the pain and have a good effect on the cause of the disease. Belladonna ointment is a valuable remedy for older children, but with babies it must be used with extreme care. The diet must be bland and light; bread and milk, or gruel, is the most appropriate. Give a little paregoric at night to soothe the restlessness, and open the bowels with the Femina laxative syrup.

(e) Tonsilitis or quinsy sore throat is often mistaken for the mumps, but to the experienced practitioner or nurse there is no resemblance, and to mistake one for the other is almost impossible. In tonsilitis the cheek never swells, the swelled tonsils being felt only behind the jaw and quite below the ear. Tonsilitis occurs oftener than mumps, and unlike the latter affection, when the patient has had one attack of quinsy he is likely to have a recurrence whenever he gets a fresh cold. The disease begins with difficult deglutition, pain, heat and dryness in the throat, and always more or less fever, from which some children become quite delirious. The affected tonsils become as large as pigeon eggs, and can be readily felt beneath the angle of the lower jaw. The swollen tonsils are red and dotted with yellowish spots, which is due to the suppuration of the follicles of which the gland is composed. If both swell at the same time so that they touch each other, symptoms of suffocation may ensue. The writer suffered from tonsilitis when he was a student, and the pain was indeed excruciating for a time. The pain is sometimes greater in swallowing fluids than solids. In examining the mouth a little skill is required. Some children are so well trained that they will respond at once, and then by means of a spoon handle the tongue is depressed, and the tonsils come into view. Others again have their own sweet will about these things, and simply will not voluntarily open their mouths. Then it takes two persons to manage them in the following manner: while one person holds the child in his lap, its back and head braced against his chest and the hands held down, the other person slides the handle of a teaspoon along the tongue until he touches the soft palate; this makes the child gag, and at that moment the tonsils are brought plainly into view.

The treatment for tonsilitis should be prompt and active; that is, when the disease is recognized, something should be done at once to relieve it. If the bowels are constipated give a laxative at once, and over the painful tonsils apply a flaxseed poultice, keeping the neck and head wrapped up well at the same time. For the fever give a dose of antifebrine in the forenoon and at bedtime; for a child one year old, one grain for a dose; at the age of three or four, give two grains at once, and at eight to twelve years, three grains can be given. Chlorate of potassa is the best remedy for a gargle, and for internal use also. Make a solution of chlorate of potassa by dissolving one teaspoonful in a teacupful of hot water, and when cooled off, have the child gargle every hour or two, and swallow a half to a teaspoonful of the solution at the same time.

(f) Diphtheria of the throat is eminently an epidemic disease and of a highly contagious and infectious nature. Of late years, the disease occurs in every season of the year, and independently of any epidemic or contagious influence, but it is presumed that the contagion or spores are cultivated in improper sanitary conditions arising from defective sewerage and filthy accumulations. The disease invariably begins with fever, a marked increase of the pulse, increase of the temperature of the skin, and general depression. There is first a difficulty of swallowing, a snuffling voice and stiffness in the neck; the first two signs are due to the swelling and diphtheritic coating of the tonsils, palate and nasal passages, while the last symptom is due to a swelling of the lymphatic glands of the neck which is never absent in genuine diphtheria. If the throat is examined in the early stage, the white membrane is first seen in the tonsils and as the disease progresses it spreads to the palate, the pharynx and the nasal passages. The color of the membrane also changes; after several days it passes into a yellowish-white or grayish-white tint. It has another peculiar feature that distinguishes this membrane from the exudation of ordinary tonsilitis, which the practical eye at once detects; the membrane of diphtheria makes the impression of having eaten into the tonsil or as though it was pressed into the tissue by the finger. And that is really so too, because as a scientific fact it is no membrane at all, but a death or slough of the mucous membrane which may extend down into the tissue beneath the membrane. To treat diphtheria successfully is simple enough but it requires great skill and experience, and I will outline what I consider the proper thing to do and which in my hands saved those lives that were intrusted to my care.

The treatment resolves itself into perfect cleanliness or disinfection, stimulating nourishment and internal medication.

Everything must be kept clean around the patient, and a vessel must be provided, containing a little chloride of lime into which he spits or hawks the phlegm from his throat. The membrane or slough in the throat or nose must be thoroughly disinfected and the only evidence that this has been successfully accomplished is when all offensive odor has disappeared. For this purpose as a local application I employ the following preparation: Solution of subsulphate of iron (Monsel’s solution) 3 drams, glycerine 5 drams; mix and pour ten to twenty drops into a saucer and by means of a camel’s hair brush apply to the diphtheritic membrane until the character and odor of it is destroyed; this application repeat every four hours. Should the nasal passages be also affected mix a teaspoonful of the preparation to a teacupful of warm water and by means of a syringe wash the nasal passages out several times a day. Give the patient internal medicine to disinfect the stomach and for its alterative action on the blood: for this purpose use tincture of iron 4 drams, simple syrup, add to make 4 ounces. To a child seven to ten years old give a teaspoonful, ten or fifteen minutes each time, after the brushing. Between the times of brushing and giving the medicine, that is two hours afterwards, give the nourishment and stimulant; this consists of milk punch. A child seven to ten years old should take no less than a tablespoonful of whisky, with or without a little sugar, in a half to a teacupful of milk beaten thoroughly together with an egg beater; this is to be taken for a meal and drank at once, and repeated every four hours. No other food or nourishment must be given for a number of days, and if the child is thirsty between times allow it to drink sweetened water and whisky. Sometimes the glands of the neck and the tonsils swell and become very painful; for this the Belladonna ointment applied with gentle friction night and morning and the neck enveloped in cotton batting are certain to give relief. The efficiency of this treatment depends upon the intelligence and faithfulness with which it is used.

(g) Croup is a term derived from the German Kropf the crop or craw of the bird; this disease is known by a great many different names, but on account of its shortness, croup has received the preference. The disease has to do with an affection of the organ of the voice, the larynx, which is the upper part of the air passage, and situated between the trachea and base of the tongue at the upper and front part of the neck where it forms a projection in the middle line which is prominent above and called the pomum Adami or Adam’s apple. The larynx contains the vocal cords, running from before backwards on both sides; these form the narrow fissure or chink, the rima glottidis, through which we breathe. Like all other air passages this too is lined with mucous membrane. The symptoms that foreshadow croup are not particularly significant, for they simply indicate that the child has a cold. The children have a cough, they sneeze, and their appetite is capricious for a few days; they are not as lively as usual and are more or less feverish. In a certain proportion of cases there is nothing noticeable before the croup develops, for the children may go to bed perfectly well and sleep calmly the first few hours of the night, when suddenly they are awakened with a barking cough, which greatly frightens young children and they begin to cry. The cough may repeat itself at short intervals, the voice become hoarse and husky and lower and lower, so that in the morning a well marked croup is developed. The voice finally disappears so completely that it is not heard above a whisper, and the greatest pain and harassing symptoms of suffocation do not enable the child to utter a loud sound. The respiration becomes labored in proportion to the swelling of the vocal cords and other obstructions to the passage of air through the larynx. Croup has vagaries that cannot be foretold. One child may have symptoms of so threatening a nature that one believes it will suffocate at any moment, yet, with a few simple remedies, the symptoms will gradually lessen and it recovers in a few days, while another may be suffering comparatively little and from appearances one would imagine that there is little or no danger, but at once it will change and grow worse so rapidly that it will die in a few hours. For this simple reason no case of croup should be carelessly or lightly considered. When a child has croup it should be put at once into a warm room; a big fire should be kept up, and the child given hot drinks or a cupful of hot tea so as to make it sweat. The front part of the neck should be rubbed with equal parts of turpentine and sweet oil until it feels warm and the skin reddens. If the child has eaten a good supper, a teaspoonful of syrup of ipecac should be given every half hour until it vomits; otherwise vomiting should be omitted. The following mixture always gives relief and with other precautions is all that is usually required.

Mix and give half to one teaspoonful every two hours until relieved; then every four to six hours.

What we have considered thus far is also called spasmodic, catarrhal or false croup, to distinguish it from another variety that is described under the name of membranous or diphtheritic croup.

This form of croup as its name indicates is characterized by a membrane which forms upon the surface of the inflamed mucous membrane of the larynx as an exudation, and sometimes the croupous membrane extends down into the windpipe or trachea.

This variety of croup begins just like the simple or catarrhal form only as the disease progresses the symptoms gradually grow worse, and remain persistent. It is fortunately a very rare disease and almost always fatal when it does occur. An ordinary or catarrhal croup may, when neglected, run into the membranous form and for that reason children who are croupous, no matter how light it may appear, should be carefully nursed until the symptoms have passed off. The treatment for membranous croup has been on the whole very unsatisfactory; the membrane which forms in the larynx and windpipe is the cause of suffocating the child, and the question how to remove this has never as yet been answered. Of course a great many remedies have been suggested and used but at times all have disappointed. The successful case of membranous croup that I treated many years ago was cured by giving the little patient inhalations of lime water with a steam atomizer and besides giving whisky and milk as nourishment; how much of the success in this case was due to the child’s vigorous constitution and how much to the treatment will always remain a mystery. In the commencement, the same treatment that was recommended for false croup is advisable; later on the skill of a good physician is required.

(h) Bronchitis or catarrh of the bronchial tubes is generally the cause of the ordinary cough due to exposure or taking cold. Its danger depends upon the severity of the bronchial inflammation and upon the age of the patient; the younger the child the more dangerous the disease. In older children or adults there is no connection between a bronchitis and a pneumonia, but in infants or children under two years of age who are suffering from bronchitis the tendency toward a complication with pneumonia is ever present; in fact, in children of this age, pneumonia usually begins in that way.

Cough is the most prominent symptom and it is always present from the commencement of the affection, and apprehensive of this the parents seek medical assistance. The expectoration in young children is generally swallowed after each paroxysm of cough, hence the nature of it can rarely be seen. In the first part of the night the cough is always more severe than during the day, and the paroxysms may last from half to one minute, recurring several times in the hour. Some children are less disturbed in their sleep than others, for they sleep on, notwithstanding the cough, while others always awaken, become annoyed from the disturbance and cry. These interruptions in their night’s rest reduce them in strength and flesh. Children who cough more when laid on one or the other side than when they lie on their back and who distort their face when coughing or, when old enough, complain of pain during or after coughing have something more than a simple bronchitis; they have a complication of pleurisy or a pneumonia. There is always fever and this may run very high, so that the child becomes delirious; even before the fever becomes very pronounced or the cough very annoying, their little hands and faces feel hot to the touch, indicating that they are not well.

Infants require good nursing when they are suffering from bronchitis, and it is not good to let them lie on their backs all of the time; when they have a coughing spell take them up quickly and lay them across the knees, with their faces downwards; this gives the mucus a chance to run out of the bronchial tubes and mouth which is better than swallowing it. The most important feature in the treatment of bronchitis is a warm room of even temperature night and day. If the temperature is allowed to go down during the night and the child inhales cold air into the lungs it will often bring on a relapse or aggravate the disease. When children have a cough and cold they must be kept warm in order to get well; this is no time for trying to harden them. A thermometer should be in every house and certainly in every bedchamber, so that the temperature of a room may be gauged to a certainty. In ordinary cases the temperature should not fall below seventy degrees Fahrenheit, and when the child coughs very much and the bronchitis is very bad it is best to keep the temperature of the room around eighty degrees night and day for several days, and as the patient improves, it is advisable to gradually drop to seventy.

The application of oil and spirits of turpentine is advisable in all cases of cold in the chest; it does good and one can hardly explain how and why. For the cough an infant can take with great advantage three or four drops of syrup of ipecac together with the same amount of paregoric, every four hours; older children take larger doses in proportion. When scrofula or tuberculosis is at the bottom of the bronchitis, a reliable preparation of cod liver oil emulsion should also be administered.

(i) Pneumonia is the technical term for inflammation of the lungs or lung fever. It consists of an inflammation, involving the air cells and smallest air tubules of the lungs; in other words, it is an inflammation of the substance or tissues of the lungs.

It is altogether a more serious affection than bronchitis, and in very small children exceedingly dangerous. The inflammation may affect either a small circumscribed portion of the lung, lobular pneumonia, or it may compromise an entire lobe or all the lobes of the lung, and is then called lobar pneumonia. Pneumonia is dangerous in proportion to the extent of lung tissue involved and the symptoms become correspondingly aggravated. The disease occurs extremely often in children, but it is altogether different from that which occurs in the adult. In children it is of a bronchial nature, that is, the ordinary bronchial catarrh has a tendency to extend to the very small bronchial tubes (capillary bronchitis), thence into the air cells of the lungs. In this variety of pneumonia the lungs do not become inflamed in their entirety, but here and there patches of lung tissue become the seat of lobular pneumonia. In the nursling, catarrhal pneumonia is an extremely frequent affection and I believe that it is principally due to the carelessness and promiscuous bathing of infants to which I have already referred. In foundling hospitals this disease destroys a great many children, and the chief cause has been attributed to their lying both night and day in a horizontal posture.

It has been statistically proven that many more children suffer from the disease in winter than in summer, and further, that in those parts of the lung that are inflamed the bronchial tubes which lead to them are also found to be inflamed. This relation of catarrhal pneumonia to bronchitis may be accounted for by the play of a mechanical force and thus illustrates the relation of cause and effect. The secretion of bronchitis not being expectorated, gravitates into the region in which the inflamed bronchial tubes terminate, namely, the air cells of the lungs, and by irritating and blocking or filling the air cells, a catarrhal pneumonia is developed.

The symptoms of pneumonia in children under two years of age are those of the catarrhal or lobular type; after they have passed through their first dentition they become subject to lobar pneumonia which differs in no particular from the disease which occurs in grown persons. Practice and experience make the discovery of catarrhal pneumonia possible in little children as soon as they are under observation for a little while. The most prominent sign is the rapidity of the respiration, which rises to sixty and eighty per minute instead of forty-four, the average normal respiration for the first year of infantile life.

The disease begins with a cough and more or less fever, and as it is always preceded with bronchitis, the symptoms that were enumerated when speaking of the latter disease are equally applicable to this one. Later on, when the transition of bronchial catarrh into pneumonia takes place, all the symptoms become at once aggravated. The breathing, for instance, becomes labored and increases and the nostrils dilate with each inspiration. The mouth is open, and its corners are drawn downward and outward, depicting distress and suffering, while the eyes roll anxiously about or become glassy and staring.

The treatment of pneumonia in its early stages would be the treatment of bronchitis, since every pneumonia in young children is preceded by a bronchial catarrh. The uniform temperature is of the first importance. The same remedy that was suggested for the cough in bronchitis is also here serviceable.

A systematic course of nourishment must form a part of every successful treatment for pneumonia; and as an old medical friend once told me in a consultation “if the child is kept alive long enough with nourishment it is bound to get well.” In critical cases it is surprising the large amount of whisky a little infant consumes with avidity; its eyes begging and watchingly following the teaspoon from the cup to its mouth. I attended my own child once when only three months old and although there seemed no hope, for its tiny finger tips were blue and its lips livid from deficient aeration, yet it eagerly took its teaspoonful of whisky toddy every fifteen minutes through the longest part of the night, and towards morning it took a change for the better and its life was saved. I also believe that these babies must be kept in a constant sweat; this relieves the congestion of the lungs. The nourishment must be given at regular intervals of several hours just as you would give medicine, for indeed it is a medicine at this time.

Another valuable agent to which I attribute a number of recoveries is the application of a moist girdle suggested by Professor Alfred Vogel, of the University of Dorpat, Russia. In his work on “Diseases of Children” he says: “A diaper, or large white pocket handkerchief is folded up like a cravat; the bandage thus obtained should be three or four fingers wide, and the whole length of the handkerchief. This is now dipped in warm water, and wrung out so that the cloth does not drip, and then applied like a girdle around the chest of the child. A second cloth, double the size of the first, is folded up in the same manner like it, but which must be six to eight fingers broad, and then applied dry and warm over the first. It is very advisable to interpose a piece of gutta percha or oil silk between the dry and the wet girdle by which on the one hand, the moistness of the first cloth is preserved longer, while on the other, the second does not become wet. If the water with which the fomentations are made is not too cold, the child will tolerate them very well and in a short time, a slight retardation in frequency and improvement of the respiration are indicated by less motion of the nostrils. These warm compresses should be continued for from four to six days, and it is not at all necessary, during the entire time, to remove the bandage; the oil silk is raised up a little, and a few teaspoonfuls of water are poured upon the girdle or it is moistened with a sponge. The principal thing is not to allow a cooling of the skin by evaporation to take place. To secure this object, the dry cloth should properly overlap the moist one on all sides and as it is impossible to prevent the upper cloth from becoming wet, it should be changed several times during the day. I certainly have applied this girdle many hundreds of times, and have very often seen rapid improvement ensue; nevertheless, it cannot be denied that the half of these children perish notwithstanding. If cold compresses are applied the children cry of fright in consequence, and the symptoms become worse until the cold water has become warm.” The application of blisters, cupping or leeching should not be tolerated.