In this chapter we will consider the diseases which commonly occur during infancy and early childhood relative to digestion and the alimentary tract. Irregularity of feeding, feeding between meals, feeding too much at any given time, as well as feeding the wrong kind of food may cause stomach disturbances and intestinal troubles.

VOMITING

In a previous chapter, "The Feeding Problem," a common stomach disturbance, vomiting, was gone into quite thoroughly, and in passing to other disorders, we wish to remind the mother that vomiting should always be taken seriously. The interval between meals should usually be lengthened, the time spent in feeding shortened, and it is often necessary to withhold all milk and food of any kind for twelve or eighteen hours, giving only boiled, unsweetened water. Vomiting frequently ushers in some acute disease, and in remote cases, when it is very persistent, it may indicate inflammation of the brain. Complete rest is essential, trotting on the knee, suddenly changing the baby's position, or other quick movements must all be avoided. A physician should see the sick one and determine the cause of the trouble.

COLIC

Cases of ordinary colic are usually relieved by heat to the abdomen and feet, drinking hot water in which there has been dissolved a pinch of ordinary baking soda, or a portion of a soda mint tablet, or by the use of the photophore, as previously described. The treatment of such ordinary colic need not be given further consideration here because it has been described at length in a former chapter; but we do call the attention of the mother to a more serious form of recurring colic which so often accompanies chronic intestinal indigestion, marasmus, and malnutrition.

In most instances the food is radically at fault and should be reduced to a mixture which can more readily be digested and assimilated by the child. Often whey mixtures, peptonized foods, or buttermilk may be indicated. The weight of the baby, the age of the baby, and the color of the stools, must all be taken into account in the preparation of this easily digested food. Weak mixtures should be given at first and then gradually and carefully the quality may be strengthened until the normal formula is again used for the baby.

Injections into the bowel of water, to which has been added one level teaspoon of soda to the pint, will often give relief in this form of colic.

CHRONIC INDIGESTION

While this condition may occur at any time during babyhood days, it often makes its appearance during the last half of the first year and up to the fifth year. It is accompanied by mucus in the stools, chronic flatulence, constipation or diarrhea, or the alternating of the two, restlessness at night, distention of the abdomen ("pot bellied") accompanied by pain, a coated tongue with a fetid breath, and loss of appetite. It is a pitiable picture—the weight is usually reduced and the child gives the appearance of being decidedly undernourished. This condition is usually occasioned by errors in diet, whether it be over-feeding or feeding of the wrong element of food, and, since the diet is usually responsible for the condition, in the line of treatment diet is a prime factor.

All fats must be taken from the food, sugars should be avoided, and the amount of starchy foods, such as flour, potatoes and bread, should be greatly reduced. Buttermilk, skimmed milk, eggs, green vegetables, and fruit juices should be given. In the older child, if grains are used, they should be well toasted or baked.

JAUNDICE

It is altogether common and physiological for the newborn baby to pass through a few days of yellow skin which usually clears up in the second or third week, but it should not recur. Occasionally this yellow tint deepens, the whites of the eyes are yellow, the urine passed leaves a yellow stain on the diaper, while passages from the bowels are white or clay colored. If the child shows symptoms of ill health other than the yellow tint, it should receive medical attention. Older children troubled with jaundice should receive the following treatment: The photophore as described elsewhere should be applied to the liver and abdomen (the liver is on the right side), and this should be followed by the application of what is known as a heating compress, consisting of three layers—a cloth wrung from cold water, a mackintosh, and then two thicknesses of blanket flannel—which are all applied when the skin has been made red by the application of heat. (If the photophore is unavailable, a hot-water bottle may be applied.) The flannel is pinned snugly on the outside as the wet cloth goes next to the skin with the mackintosh between. This should remain on the abdomen for three or four hours, after which the hot application is again made to the liver and abdomen. The administration of broken doses of calomel is sometimes indicated in obstinate cases in connection with these applications of heat to the liver. Hot milk or mineral water may be taken with dry toast. In a day or two the color should clear up, the stools should be normal again, and the treatment may be discontinued.

WORMS

Irritation about the rectum which cannot be otherwise explained is usually suggestive of pinworms. These seatworms or pinworms are very much like little pieces of cotton thread—one-fourth of an inch in length. They grow and thrive in the lower part of the large bowel. Simple and effective treatment is as follows:

It is well to bathe the parts about the rectum after each bowel movement and often two or three times a day with a weak antiseptic solution. Itching may be controlled by the application of a disinfectant ointment, or the local applications of ice may serve the same purpose. After a thorough cleansing of the colon by an injection of lukewarm water containing a teaspoon of borax to the pint in order to remove the mucus, Doctor Holt suggests that after the discharge of this borated enema, infusions of quassia are very helpful (See Appendix).

Children suffering from roundworms experience a loss of appetite, varying temperature from above normal to subnormal, with colicky pains in the abdomen on coming to the table and beginning to eat. They are pale and listless, or nervous and irritable.

Roundworms very much resemble earthworms in shape and color. While their home is in the small intestines they often travel to other parts of the body. They have sometimes crawled into the stomach and have been vomited. The only definite symptom of worms is to find the eggs or the worms themselves in the stool. No worm medicine should ever be given by the mouth without being prescribed by a physician. Cases are on record where well-meaning mothers have killed their children by giving an over dose of worm medicine.

Tapeworms sometimes trouble children; their segments are found in the stool, and look like small pieces of tape line. The segments are flat and thin, one-fourth inch to one-half inch in width and three-fourths to one inch in length. They are joined together and often their number is so great the worm is many feet in length. The segments grow smaller and smaller as they approach the neck, the head of the worm being a mere point. As the worm is passing from the child it should never be pulled, as the head is easily broken off, and, on remaining in the bowel, it will grow to a full-sized worm.

Worms come from the eating of half-cooked meats; they enter the stomach as eggs or tiny worms, and pass out into the small intestines, where they begin to grow. They are a common parasite in the human family and should be suspected in all instances where digestive symptoms are masked or do not yield to treatment.

HOOKWORM DISEASE

This disease, once seen only in the southern part of the United States, is leaving its former domains as the migrating population is distributing it more or less widely everywhere. Sandy soil and country districts are infected by a tiny worm which thrives in polluted soil and enters the body through the skin of the feet. It also gets into the body through the drinking water or from the eating of uncooked vegetables, such as are used in salads.

The disease is manifested by "sallow skin, paleness, headache, swollen abdomen and sores on the legs." Little swollen places where the worm enters the skin may be seen on the flesh. The condition yields readily to treatment. If a child is discovered scratching his feet (especially in the southern part of this country), he should be taken at once to a physician.

DISORDERED STOMACH

At the first symptom of a disordered stomach take all food from the baby and give him rice water prepared by throwing a cupful of well-washed rice into a kettle of boiling water and allowing it to continue to boil for a couple of hours. The water which is strained off is rice water, ready for use after it is cooled. This may be given to the child at the meal hour in the place of his regular food. It should be kept in a glass-covered jar in the ice box. A dose of castor oil, according to the age, should be administered before the feed. The bowels should be washed out and boiled water given freely between the meals of rice water. For a day or two (twenty-four to forty-eight hours), the child should be fed only this rice water, or until the temperature returns to normal and he appears very hungry, at which time milk, which has been boiled for five minutes, may be added to the rice water, first in one-half ounce quantities and gradually increased. Each day a little more milk is added until baby is taking his regular food again.

Many a death and many acute attacks of summer complaint are avoided by the quick use of castor oil, and by withholding food and stopping the use of milk as soon as the child becomes ill.

STOMATITIS OR THRUSH

Thrush is evidenced by fretfulness or crying on attempting to nurse. On examination of the mouth it is found to be hot and very tender and covered with little white specks which, if looked at under the microscope, appear to be a fungus growth. If scratched off, the mucous membrane bleeds easily. Thrush often occurs during a fever or in connection with other diseases, and is often due to neglect and lack of cleanliness about the bottles, nipples, etc. Taken in time it is quickly cured. An immediate dose of castor oil or milk of magnesia is indicated, and the use of a mouth wash which will be prescribed by the physician. If neglected, it may become ulcerous or gangrenous, which is a very serious condition. Everything pertaining to the feeding, as well as the child's toys, hands, etc., must be kept scrupulously clean.

CONSTIPATION

In the chapter, "The Feeding Problem," constipation in bottle-fed babies was discussed. The bowels should move at least once in twenty-four hours. The passages are frequently very hard and leave the body only after a very great effort of straining. This constipation, often continuing until late childhood, should be corrected in the following manner:

In early infancy—as early as the fourth month—prune juice may be given as directed elsewhere, while in later months prune pulp or fig pulp, which has been carefully rubbed through a fine-mesh colander, may be given at meal time. By the time the baby is eleven or twelve months old, strained apple sauce may be given.

We deplore the use of the water enema as a regular daily procedure; in its place we suggest the use of the enema of oil or the introduction into the rectum of a gluten suppository or in obstinate cases a glycerine suppository. Abdominal massage should be daily administered. With a well-oiled hand, begin on the right abdomen and proceed upward to the lower border of the right ribs and across to the left side and down. This should be repeated many times at a regular hour each day. The mother should select an hour for the bowels to move, preferably after the forenoon feeding, and if the child is too small to sit upon the toilet chair, a gluten suppository may be placed into the rectum before the forenoon feed and some time during the middle of the day the bowel movement will be found in the napkin.

For the older child, before a certain meal each day, a well-vaselined piece of cotton may be inserted in the rectum; this often produces a bowel movement immediately after the meal. Laxative foods, such as bran, stewed figs, stewed prunes, or a raw apple, should be used faithfully—as repeated medication never corrects the difficulty, but usually prolongs it.

To immediately flush out the bowel, a soapsuds enema or a plain water enema may be allowed to flow into the lower colon, or a glycerine suppository inserted into the rectum will quickly bring a bowel movement. These methods are only of temporary value; a regular habit should be formed, if possible, to bring about a natural, normal bowel movement. When necessary to resort to drugs—such remedies as cascara sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as well as our old stand-by—castor oil. Regular habits must be insisted upon, and if the mother pays attention to regularity at stool in early childhood very little trouble will be met later on in adolescence and adult life.

Chronic constipation often produces abnormal conditions about the rectum such as fissures, hemorrhoids, or prolapse, which may be of serious import.

DIARRHEA

Diarrhea is a symptom of an acute illness, or it may be associated with a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipation in colitis. It is the most dangerous of all symptoms that babies develop, and in spite of all the instruction given to mothers at the present time, in spite of all the welfare stations in large cities, and in spite of all the efforts put forth by the commissioner of health, with his corps of visiting nurses—even yet, more babies die of diarrhea each summer than from any other single cause.

There are usually just two reasons for diarrhea—uncleanliness and bad milk. During the hot summer days flies multiply greatly and all manner of bacteria and germs grow in warm, moist, shadowy places, so that usually before the milk leaves the dairy farm it is seriously contaminated with disease-producing germs. If the milk is not kept at a temperature of 35 or 40 F. (which is just above the freezing point), these bacteria, particularly the manure germ, grow at such a rate that by the time the milk gets to the infant it is teeming with bacteria, and diarrhea is the sure result.

Another form of diarrhea is cholera infantum, where the stools soon become watery and colorless. The vomiting is almost incessant and there is high fever. Fortunately it is a rare disease, but when once seen it is never forgotten. One beautiful baby weighing nearly thirty pounds was reduced to sixteen within forty-eight hours, and when death came he could hardly be recognized because of the wasting from this most dreaded of infant diseases.

Another form of diarrhea is seen in an acute inflammatory condition of the intestine itself. The stools contain more or less mucus and blood. The bowel movements, which are very frequent, are accompanied by a great deal of pain and straining. This form is often seen in the more severe types of summer dysentery. We wish to impress upon the reader's mind that these diarrheas may all be avoided if the baby's food is clean and free from germs, if the apple or pear is not only washed, but thoroughly scrubbed before paring during the summer months. If all the bottles, nipples, water, toys, etc., are adequately clean, no summer diarrhea, no dysentery, no other infection due to dirt, will attack the baby. Of paramount importance is the pasteurization of milk during the summer months, as mentioned elsewhere.

TREATMENT OF DIARRHEA

Simple diarrhea in the older child of two or three years is treated as follows: Take away all solid foods. Give a big dose of castor oil, thoroughly wash out the bowel by warm water containing a level teaspoon of salt and a level teaspoon of baking soda to the pint, and put the child to bed in a quiet room. Boil all milk for ten minutes and thicken it with flour that has been browned in the oven; feed this to the child at five-hour intervals. After each bowel movement, no matter how often they come, the colon should be washed out with the salt and soda enema as before mentioned.

Bear in mind that the child is losing liquids, and so, after the bowels have moved, boiled water should be given by mouth, or a cupful of water can often be retained if it is introduced into the rectum slowly under very low pressure. Twenty-four or forty hours should clear up a case of simple diarrhea, and on returning to food it should be dry toast and boiled milk. For the younger baby, withhold all milk and give barley water or rice water for the first twenty-four hours, returning to milk very gradually and slowly.

For the more severe types, such as the dysentery containing mucus and blood, everything that has been done for the simple diarrhea should be done; the baby should be kept very quiet, while castor oil should be promptly administered. Food is withheld and the bowels are carefully irrigated after each movement with the salt and soda solutions. After the bowels have moved from the castor oil, then bismuth subnitrate, which has been dissolved in two ounces of water, should be given—one or two teaspoons every three hours. This will naturally turn the bowel movements dark.

Under no circumstances should any other medicines be given without the physician's knowledge, as it is at such times as this that many "would-be friends" advise laudanum, paregoric, and other opiates. The skin must be kept warm, and fluids must replace those that have been carried off in the many stools. Water may be given by an enema, by water drinking, and in such rare cases as cholera infantum, when water cannot be retained on the stomach, it often becomes necessary to inject it under the skin (hypodermoclysis) so that it may go at once to the wasted tissues and perhaps save the baby's life.

Give the baby ten days or two weeks to return to normal condition, and under no circumstances hurry the feeding of milk, as a second attack may occur much more readily than the first; may more profoundly overcome the baby and result in death.

RUPTURE

A protrusion of a loop or portion of intestine through a weakened abdominal muscle—which grows larger when baby cries and smaller when he is lying down in a relaxed condition—is known as rupture or hernia, and is of common occurrence in infancy. It is often seen at the navel and sometimes in the groin as early as the second week.

Hernia is always dangerous and should never be neglected. The physician will protect the navel by a special support with adhesive plaster which is carefully renewed twice a week, and if worn for several months usually entirely corrects the condition. A comfortable truss made from skeins of white yarn will amply protect a groin hernia. The condition should always be taken seriously and receive immediate treatment.

PROLAPSE OF THE BOWEL

Occasionally, as the result of severe straining in constipation, the rectum protrudes sometimes one-half inch, and in rare instances two or three inches. The placing of a young child upon a toilet chair and insisting upon severe straining sometimes results in such a protrusion of the rectum. This may be avoided by the application of vaseline to the rectum or by the use of the gluten or glycerine suppositories which cause the hardened masses to make their way out easily. Someone has suggested that if the buttocks are supported by a board placed over the toilet seat with a two-inch opening so that severe straining of the rectal muscles is impossible, the prolapse of the rectum will not recur.

The moment the mother observes the slightest protrusion of the rectum she should quickly put it back and have the child lie down and move the bowel in the diaper. Very severe cases require a physician's attention, but if prompt and quick measures are taken on the first appearance it may be quickly corrected and serious consequences be avoided.

In this connection we might mention a condition which sometimes babies are born with—the absence of the rectal opening. If the baby's bowels do not move for the first two days, surgical interference is more than likely necessary. Often the external opening alone is missing. Sometimes there is a complete closure or atresia of the lower part of the colon.

BLEEDING FROM THE NAVEL

There should be no hemorrhage from the umbilical stump after it has been properly tied, but occasionally a bit of blood is found upon the dressing and a second tying of the cord stump is necessary. The cord drops off in eight or ten days, and the umbilicus that is left may be moist or it may bleed slightly; if such is the case, great care should be exercised in bathing this ulcer that has been left behind. It simply should be touched with alcohol, a bit of boric acid powder applied, and a small piece of sterile gauze be placed over it. In the course of two or three days it will entirely heal. Care should always be exercised in washing the umbilicus. Extensive hemorrhage from this portion of the body is rare, but it does happen occasionally and is a severe condition which demands surgical attention.

If the umbilicus remains moist and foul smelling, general blood poisoning of the infant may easily follow. Thorough dusting with boric acid powder, with possibly a little oxide of zinc, will usually effect a cure promptly, but should the condition continue, which it does only in rare instances, the doctor may have to cauterize it.