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

SLEEPLESSNESS—INSOMNIA

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

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

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

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

NIGHT TERRORS

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

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

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

NERVOUSNESS

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

HEADACHE

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

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

CONVULSIONS—SPASMS

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

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

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

NERVOUS TWITCHINGS

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

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

RETENTION OF URINE

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

BED WETTING

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

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

1. The urine should be thoroughly examined.

2. The size of the bladder should be determined.

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

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

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

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

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

MENINGITIS

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

INFANTILE PARALYSIS

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

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

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

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

SAINT VITUS' DANCE

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

CONGENITAL DISORDERS

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

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

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

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

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