General diseases in Children
-Benson.A.R,
Colds
Colds may be due to exposure, to indiscretion in diet or to infection. Usually one or the other of these causes is combined with fatigue and consequent lowered resistive power. For example, the child after some unusual exercise, perhaps after playing too hard, is exposed to a draught which ordinarily would not be noticed. The result is a cold. The same thing occurs when a tired or weakened child is exposed to the infection of some other individual who has a contagious cold. The reason why some children take cold more easily than others is because they lack the vitality which is necessary to overcome disease.
Considering these causes, it will be evident that colds are more or less preventable, and the question resolves itself into maintaining a high standard of health in the individual child. This can only be accomplished by careful attention to all the details of diet, exercise, bathing and general hygiene. Children who are subject to colds should also be carefully examined for abnormalities of the nose and throat, and if present they should be corrected.
Dress : The child should not be dressed too warmly. The lightest weight woolen garments should be worn next to the skin, and the outer garments changed according to the weather. Great care must be taken not to keep the child too warm, as this will result in perspiration and consequent sudden cooling of the surface of the body.
Bathing : The child must also be accustomed to cool, and later, cold bathing. At the start these baths are best given with bathing mits made of coarse towelling. By this means the body is sponged over with cool water and at the same time brisk friction made on the skin. With sensitive children great care should be used not to have the water too cold at the start. Lukewarm water may be used, gradually lowering the temperature. Neither is it advisable to begin with shower or tub baths. These may come later and depend entirely upon the reaction and the child's comfort. With sensitive children it may be necessary at the start to sponge only the chest and throat. These baths are best given in the morning on rising, and warm, cleansing baths should always be followed by cool sponging. After once beginning a course of cool bathing, it should be kept up, and the daily bath should never be omitted. It is quite possible to catch a cold by neglecting the morning bath after becoming accustomed to it. Children should not be allowed to over-eat, especially at night or when tired.
Treatment : To successfully treat a cold, it is necessary to use vigorous measures from the start. It has been said that neglected colds are the cause of more than half the ailments of mankind. There is no doubt that if mothers could be persuaded to put their children to bed at the first signs of a cold, and keep them there until cured, many of the serious results of colds would be prevented. It seems almost impossible to do this in the average case because of the fancied discomfort to the child. If bed treatment is impossible, the child should at least be kept in one room and isolated from the rest of the children of the family, and an effort made to regulate carefully the temperature of the room (68°), the exercise and the diet of the child. Milk, milk toast, broths, gruels, and eggs may be given to older children. The child should not be allowed to run about the room or take any exercise which will cause perspiration. If cool bathing has been practiced, it should be kept up during the cold. The child should be persuaded to drink as much water as possible between meals, and the bowels should be kept open by means of diet, or, if necessary, enemas.
Soft cloths should be used for blowing the nose, and these should be burned. The child should not be allowed to blow the nose too hard, as this frequently causes the ear to become involved. Home treatment, if begun at the first signs of a cold, will often prevent it from going to the catarrhal stage.
Aconite should be given, a teaspoonful every half hour, immediately after exposure, especially if there is dry skin, fullness in the nose and chilliness. This will oftentimes prevent the development of a cold.
Belladonna should be given, a teaspoonful every hour, when the face is flushed and hot, with throbbing headache. The voice is hoarse and the cold seems to be localizing in the throat with rawness and pain on swallowing.
Arsenicum may be given hourly if there is much sneezing with a thin watery discharge from the nose which excoriates the nostrils. The nose feels hot; there is much thirst, restlessness and all symptoms are aggravated at night.
Bryonia will be most effective where the cold is accompanied by severe, hard, dry, hacking cough. There is headache, pain in the limbs and oftentimes a darkly coated tongue. The child lies quietly and does not like to be disturbed.
Nux vomica is called for if the cold is due to indiscretion in diet. The nostrils are stopped up, or one nostril is free and the other closed. The child is apt to be constipated and all symptoms are worse in the morning.
Calcarea carb., a tablet night and morning, should be given to children who take cold easily, especially if they are fat, pale, with flabby muscles, and perspire easily on the slightest exercise.
Bronchitis
The most frequent result of neglected colds is bronchitis. In bronchitis there is a rise of temperature (99° - 102°), headache, and at first a hard, dry cough caused by inflammation of the bronchial tubes. If this inflammation is in the larger tubes the disease is less severe, but when the smaller bronchial tubes become involved, it is very difficult to distinguish between bronchitis and the bronchial form of pneumonia.
Bronchitis is a disease which needs careful medical attention, and in all cases where there is cough and even slight rise of temperature, a careful and thorough physical examination should be made.
Pneumonia
Pneumonia may exist either as broncho-pneumonia, in which small scattered areas of lung tissue are involved, or as lobar-pneumonia when a whole lobe of the lung is affected. The two forms are distinguished only by physical examination.
At its onset pneumonia is sometimes disguised by other symptoms. It may come on more or less insidiously from a cold, or during the course of one of the acute infections diseases. When it is uncomplicated, there is apt to be, at the beginning, vomiting with high temperature (103° - 104°), very rapid respiration and rapid pulse. The breathing is shallow and at the end of inspiration a "catch" is noticed. Frequently there is no cough at the beginning of the disease, and unless careful physical examination is made there may be no suspicion of inflammation of the lungs. Usually, however, the cough during the early stages is hard, dry and painful.
Treatment : Pneumonia may run a longer or shorter course, but it is a disease which taxes every resource of the physician, and no time should be lost in securing medical assistance. More than any other disease, except perhaps diphtheria, its success in treatment depends upon early diagnosis.
Upon the first suspicion of the illness, the child should be put to bed, and kept upon a liquid diet.
Aconite should be given, a teaspoonful every hour, if there is high fever, hot skin, with restlessness and thirst.
If the lungs are carefully examined at this stage of the disease and a diagnosis made, it may be possible to prevent a serious attack. Home treatment, without the advice of a physician, should not be attempted.
Mothers should remember that children are likely to complain of pain in the stomach rather than in the chest in pneumonia and other diseases of the lungs.
Spasmodic croup (false croup)
Croup usually develops suddenly in the night with symptoms which seem very alarming. The child wakens suddenly with a spasm of coughing, hard, hollow and prolonged. There is difficulty in breathing, the face becomes purple or red and the child gasps and struggles for air. During the day there is only a slight loose cough and the child seems as well as usual, or there may be slight nasal catarrh.
The condition is not ordinarily a serious one. Nearly always the spasm is short and by the time the physician arrives the child is sleeping quietly.
Treatment : Cold compresses should be applied to the neck and a few swallows of hot water taken internally.
Aconite, 8 pellets in half a glass of water, a teaspoonful every fifteen minutes, will usually relieve the spasms at once.
Spongia, 4 pellets every hour, should be given during the day to prevent recurrence.
Croup is sometimes caused by adenoids or other growths in the nose and throat, and if present, they should be removed. Great care should be used to distinguish between false croup and so-called membranous croup which is a form of diphtheria.
Tuberculosis
Tuberculosis is an infectious disease caused by the tubercle bacilli. These germs may attack any part of the body, but the lungs, joints and glands are the parts most frequently attacked. The disease is very prevalent among children, although this fact is generally overlooked, not only by mothers, but also by physicians. Its importance will be recognized when we consider that one-third of all the deaths in children's hospitals are caused by tuberculosis.
It is of the greatest importance then for mothers to be familiar, not only will the early symptoms of the disease, but also with the so-called tubercular diathesis. IN order to acquire tuberculosis, two elements are necessary. First, the germ which comes from without, and second, such a condition of the system that the germs may flourish and grow. We find such a condition in pale, thin, narrow-chested children. Such children have generally suffered from improper feeding, and in consequence they are anaemic and poorly nourished. The appetite is fickle, there is great dislike for milk, eggs and other simple foods. When we find such a child losing weight, sleeping poorly, nervous and irritable, complaining of lassitude and other vague symptoms, it is high time to take steps to prevent tubercular infection. Children of this type are apt to have very light hair, the whites of the eyes are a peculiar "bluish-white," the shoulder blades project and often there is fine hair (lanugo) on the child's back. The glands in the neck may be felt and oftentimes they increase in size, especially if the child has a cold. It is this general condition that we mean when we speak of the tubercular diathesis, and if treatment is postponed until infection has taken place, it may be too late.
Such children should be taken out of school, and if possible sent to the country, under such conditions that they can live in the open air. Their surroundings must be pleasant and they must be happy and contented. They must be taught to eat plain, simple food (milk and eggs), and this feeding must be kept up until the child is strong, healthy and vigorous and once more gaining normally in weight. The special conditions which may arise during such treatment, for example, colds, tonsillitis and cough, should receive careful medical attention. A thorough physical examination of the child should also be made at regular intervals and careful record kept of the weight.
It is easy to advise such radical treatment, but oftentimes difficult to carry it out. The results obtained, however, are worth all the trouble and expense involved and no consideration should have any weight compared to the child's future health and strength. A year of early treatment of this sort will often prevent many years of illness later in life.
Rickets (rachitis)
Rachitis is a non-infectious constitutional disease due to improper food and insufficient supply of fresh air. It occurs ordinarily in infants. The effects of the disease are shown principally in the bones. In rickety children, the lime salts which give rigidity to the bones are lacking, and the bones are soft and flexible. When the child stands, the bones of the legs are not stiff enough to support the body, and as a result they bend, and we find either bow legs or knock knees. In the same way the breast bone may project forward, the ribs may be deformed or the bones of the skull assume unusual shapes. In such children the teeth are slow in appearing and the fontanel (opening in the skull) does not close. A large percentage of the bone deformities seen in adults is due to rickets in childhood.
Treatment : Rickets may be prevented if babies are nursed, or if they are fed on carefully modified, unboiled cow's milk. They must also receive an abundance of fresh air. The disease is difficult to recognize in the early stages, but it should be suspected in children in whom the teeth are slow in appearing, where there is a tendency to the rapid taking on of fat with consequent flabby muscles. Such children perspire easily, especially about the head and neck, and the abdomen is likely to be prominent. When the disease is once established, careful dietetic and medical treatment must be carried out. Individual cases will require different treatment, and great care and judgment is necessary to prevent future deformities.
Scurvy (scorbutus)
Scurvy is a constitutional disease due to imperfect nutrition. It is frequently caused by boiled milk, condensed milk, infant foods and improperly modified milk. It occurs most frequently in the first eighteen months of life. The child becomes anaemic and gastro-intestinal disturbances (diarrhoea, colic, etc.) are present. As the disease progresses, the bones, especially at the wrists, elbows and ankles, become very sensitive, and the child cries whenever they are touched. The child lies quietly and does not wish to be moved. Later on there is marked swelling of the bones near the joints, and the gums become inflamed and congested in spots.
Treatment : The disease may be prevented by avoiding the causes mentioned above. If the disease is present, it is not only necessary to correct the diet but to add to it fresh fruit juice. The juice of one or two oranges may be given daily, diluted with one-third water. Orange juice may also be given as a preventive measure to children showing any tendency towards scurvy.
Rheumatism
Rheumatism occurs in children very frequently. It may be present as rheumatic fever or more frequently the chronic type of the disease exists. This form is rarely recognized by mothers, and the pains of which the child complains are dismissed as "growing pains." Growing pains are purely mythical, and whenever the child complains of pains in the limbs or joints, rheumatism is the probable cause.
The disease is chiefly of importance on account of its effect upon the heart. Even mild rheumatic attacks which are scarcely noticed will leave behind more or less serious heart affections which require very careful treatment. For this reason mothers should never neglect the warning which is given to them when the child complains of "growing pains."
Convulsions
Convulsions occur very frequently in infants, and from a large number of causes. Often they mark the onset of some acute disease, taking the place of the chill which occurs in older children. They are always cause for alarm and a physician should be summoned immediately. In the meantime the child should be immersed in warm water. Care should be used not to have the water too hot (not over 100° Fahrenheit), and the infant should not remain in the bath more than two or three minutes.
Cuprum met. Should be given internally, 2 pellets dissolved in a teaspoonful of water and allowed to pass slowly into the mouth.
After removing the infant from the bath, it should be well wrapped in warm blankets and not disturbed unless another convulsion occurs, when the bath may again be used. No other treatment should be given excepting under the direction of a physician.
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| General diseases in Children |
Colds may be due to exposure, to indiscretion in diet or to infection. Usually one or the other of these causes is combined with fatigue and consequent lowered resistive power. For example, the child after some unusual exercise, perhaps after playing too hard, is exposed to a draught which ordinarily would not be noticed. The result is a cold. The same thing occurs when a tired or weakened child is exposed to the infection of some other individual who has a contagious cold. The reason why some children take cold more easily than others is because they lack the vitality which is necessary to overcome disease.
Considering these causes, it will be evident that colds are more or less preventable, and the question resolves itself into maintaining a high standard of health in the individual child. This can only be accomplished by careful attention to all the details of diet, exercise, bathing and general hygiene. Children who are subject to colds should also be carefully examined for abnormalities of the nose and throat, and if present they should be corrected.
Dress : The child should not be dressed too warmly. The lightest weight woolen garments should be worn next to the skin, and the outer garments changed according to the weather. Great care must be taken not to keep the child too warm, as this will result in perspiration and consequent sudden cooling of the surface of the body.
Bathing : The child must also be accustomed to cool, and later, cold bathing. At the start these baths are best given with bathing mits made of coarse towelling. By this means the body is sponged over with cool water and at the same time brisk friction made on the skin. With sensitive children great care should be used not to have the water too cold at the start. Lukewarm water may be used, gradually lowering the temperature. Neither is it advisable to begin with shower or tub baths. These may come later and depend entirely upon the reaction and the child's comfort. With sensitive children it may be necessary at the start to sponge only the chest and throat. These baths are best given in the morning on rising, and warm, cleansing baths should always be followed by cool sponging. After once beginning a course of cool bathing, it should be kept up, and the daily bath should never be omitted. It is quite possible to catch a cold by neglecting the morning bath after becoming accustomed to it. Children should not be allowed to over-eat, especially at night or when tired.
Treatment : To successfully treat a cold, it is necessary to use vigorous measures from the start. It has been said that neglected colds are the cause of more than half the ailments of mankind. There is no doubt that if mothers could be persuaded to put their children to bed at the first signs of a cold, and keep them there until cured, many of the serious results of colds would be prevented. It seems almost impossible to do this in the average case because of the fancied discomfort to the child. If bed treatment is impossible, the child should at least be kept in one room and isolated from the rest of the children of the family, and an effort made to regulate carefully the temperature of the room (68°), the exercise and the diet of the child. Milk, milk toast, broths, gruels, and eggs may be given to older children. The child should not be allowed to run about the room or take any exercise which will cause perspiration. If cool bathing has been practiced, it should be kept up during the cold. The child should be persuaded to drink as much water as possible between meals, and the bowels should be kept open by means of diet, or, if necessary, enemas.
Soft cloths should be used for blowing the nose, and these should be burned. The child should not be allowed to blow the nose too hard, as this frequently causes the ear to become involved. Home treatment, if begun at the first signs of a cold, will often prevent it from going to the catarrhal stage.
Aconite should be given, a teaspoonful every half hour, immediately after exposure, especially if there is dry skin, fullness in the nose and chilliness. This will oftentimes prevent the development of a cold.
Belladonna should be given, a teaspoonful every hour, when the face is flushed and hot, with throbbing headache. The voice is hoarse and the cold seems to be localizing in the throat with rawness and pain on swallowing.
Arsenicum may be given hourly if there is much sneezing with a thin watery discharge from the nose which excoriates the nostrils. The nose feels hot; there is much thirst, restlessness and all symptoms are aggravated at night.
Bryonia will be most effective where the cold is accompanied by severe, hard, dry, hacking cough. There is headache, pain in the limbs and oftentimes a darkly coated tongue. The child lies quietly and does not like to be disturbed.
Nux vomica is called for if the cold is due to indiscretion in diet. The nostrils are stopped up, or one nostril is free and the other closed. The child is apt to be constipated and all symptoms are worse in the morning.
Calcarea carb., a tablet night and morning, should be given to children who take cold easily, especially if they are fat, pale, with flabby muscles, and perspire easily on the slightest exercise.
Bronchitis
The most frequent result of neglected colds is bronchitis. In bronchitis there is a rise of temperature (99° - 102°), headache, and at first a hard, dry cough caused by inflammation of the bronchial tubes. If this inflammation is in the larger tubes the disease is less severe, but when the smaller bronchial tubes become involved, it is very difficult to distinguish between bronchitis and the bronchial form of pneumonia.
Bronchitis is a disease which needs careful medical attention, and in all cases where there is cough and even slight rise of temperature, a careful and thorough physical examination should be made.
Pneumonia
Pneumonia may exist either as broncho-pneumonia, in which small scattered areas of lung tissue are involved, or as lobar-pneumonia when a whole lobe of the lung is affected. The two forms are distinguished only by physical examination.
At its onset pneumonia is sometimes disguised by other symptoms. It may come on more or less insidiously from a cold, or during the course of one of the acute infections diseases. When it is uncomplicated, there is apt to be, at the beginning, vomiting with high temperature (103° - 104°), very rapid respiration and rapid pulse. The breathing is shallow and at the end of inspiration a "catch" is noticed. Frequently there is no cough at the beginning of the disease, and unless careful physical examination is made there may be no suspicion of inflammation of the lungs. Usually, however, the cough during the early stages is hard, dry and painful.
Treatment : Pneumonia may run a longer or shorter course, but it is a disease which taxes every resource of the physician, and no time should be lost in securing medical assistance. More than any other disease, except perhaps diphtheria, its success in treatment depends upon early diagnosis.
Upon the first suspicion of the illness, the child should be put to bed, and kept upon a liquid diet.
Aconite should be given, a teaspoonful every hour, if there is high fever, hot skin, with restlessness and thirst.
If the lungs are carefully examined at this stage of the disease and a diagnosis made, it may be possible to prevent a serious attack. Home treatment, without the advice of a physician, should not be attempted.
Mothers should remember that children are likely to complain of pain in the stomach rather than in the chest in pneumonia and other diseases of the lungs.
Spasmodic croup (false croup)
Croup usually develops suddenly in the night with symptoms which seem very alarming. The child wakens suddenly with a spasm of coughing, hard, hollow and prolonged. There is difficulty in breathing, the face becomes purple or red and the child gasps and struggles for air. During the day there is only a slight loose cough and the child seems as well as usual, or there may be slight nasal catarrh.
The condition is not ordinarily a serious one. Nearly always the spasm is short and by the time the physician arrives the child is sleeping quietly.
Treatment : Cold compresses should be applied to the neck and a few swallows of hot water taken internally.
Aconite, 8 pellets in half a glass of water, a teaspoonful every fifteen minutes, will usually relieve the spasms at once.
Spongia, 4 pellets every hour, should be given during the day to prevent recurrence.
Croup is sometimes caused by adenoids or other growths in the nose and throat, and if present, they should be removed. Great care should be used to distinguish between false croup and so-called membranous croup which is a form of diphtheria.
Tuberculosis
Tuberculosis is an infectious disease caused by the tubercle bacilli. These germs may attack any part of the body, but the lungs, joints and glands are the parts most frequently attacked. The disease is very prevalent among children, although this fact is generally overlooked, not only by mothers, but also by physicians. Its importance will be recognized when we consider that one-third of all the deaths in children's hospitals are caused by tuberculosis.
It is of the greatest importance then for mothers to be familiar, not only will the early symptoms of the disease, but also with the so-called tubercular diathesis. IN order to acquire tuberculosis, two elements are necessary. First, the germ which comes from without, and second, such a condition of the system that the germs may flourish and grow. We find such a condition in pale, thin, narrow-chested children. Such children have generally suffered from improper feeding, and in consequence they are anaemic and poorly nourished. The appetite is fickle, there is great dislike for milk, eggs and other simple foods. When we find such a child losing weight, sleeping poorly, nervous and irritable, complaining of lassitude and other vague symptoms, it is high time to take steps to prevent tubercular infection. Children of this type are apt to have very light hair, the whites of the eyes are a peculiar "bluish-white," the shoulder blades project and often there is fine hair (lanugo) on the child's back. The glands in the neck may be felt and oftentimes they increase in size, especially if the child has a cold. It is this general condition that we mean when we speak of the tubercular diathesis, and if treatment is postponed until infection has taken place, it may be too late.
Such children should be taken out of school, and if possible sent to the country, under such conditions that they can live in the open air. Their surroundings must be pleasant and they must be happy and contented. They must be taught to eat plain, simple food (milk and eggs), and this feeding must be kept up until the child is strong, healthy and vigorous and once more gaining normally in weight. The special conditions which may arise during such treatment, for example, colds, tonsillitis and cough, should receive careful medical attention. A thorough physical examination of the child should also be made at regular intervals and careful record kept of the weight.
It is easy to advise such radical treatment, but oftentimes difficult to carry it out. The results obtained, however, are worth all the trouble and expense involved and no consideration should have any weight compared to the child's future health and strength. A year of early treatment of this sort will often prevent many years of illness later in life.
Rickets (rachitis)
Rachitis is a non-infectious constitutional disease due to improper food and insufficient supply of fresh air. It occurs ordinarily in infants. The effects of the disease are shown principally in the bones. In rickety children, the lime salts which give rigidity to the bones are lacking, and the bones are soft and flexible. When the child stands, the bones of the legs are not stiff enough to support the body, and as a result they bend, and we find either bow legs or knock knees. In the same way the breast bone may project forward, the ribs may be deformed or the bones of the skull assume unusual shapes. In such children the teeth are slow in appearing and the fontanel (opening in the skull) does not close. A large percentage of the bone deformities seen in adults is due to rickets in childhood.
Treatment : Rickets may be prevented if babies are nursed, or if they are fed on carefully modified, unboiled cow's milk. They must also receive an abundance of fresh air. The disease is difficult to recognize in the early stages, but it should be suspected in children in whom the teeth are slow in appearing, where there is a tendency to the rapid taking on of fat with consequent flabby muscles. Such children perspire easily, especially about the head and neck, and the abdomen is likely to be prominent. When the disease is once established, careful dietetic and medical treatment must be carried out. Individual cases will require different treatment, and great care and judgment is necessary to prevent future deformities.
Scurvy (scorbutus)
Scurvy is a constitutional disease due to imperfect nutrition. It is frequently caused by boiled milk, condensed milk, infant foods and improperly modified milk. It occurs most frequently in the first eighteen months of life. The child becomes anaemic and gastro-intestinal disturbances (diarrhoea, colic, etc.) are present. As the disease progresses, the bones, especially at the wrists, elbows and ankles, become very sensitive, and the child cries whenever they are touched. The child lies quietly and does not wish to be moved. Later on there is marked swelling of the bones near the joints, and the gums become inflamed and congested in spots.
Treatment : The disease may be prevented by avoiding the causes mentioned above. If the disease is present, it is not only necessary to correct the diet but to add to it fresh fruit juice. The juice of one or two oranges may be given daily, diluted with one-third water. Orange juice may also be given as a preventive measure to children showing any tendency towards scurvy.
Rheumatism
Rheumatism occurs in children very frequently. It may be present as rheumatic fever or more frequently the chronic type of the disease exists. This form is rarely recognized by mothers, and the pains of which the child complains are dismissed as "growing pains." Growing pains are purely mythical, and whenever the child complains of pains in the limbs or joints, rheumatism is the probable cause.
The disease is chiefly of importance on account of its effect upon the heart. Even mild rheumatic attacks which are scarcely noticed will leave behind more or less serious heart affections which require very careful treatment. For this reason mothers should never neglect the warning which is given to them when the child complains of "growing pains."
Convulsions
Convulsions occur very frequently in infants, and from a large number of causes. Often they mark the onset of some acute disease, taking the place of the chill which occurs in older children. They are always cause for alarm and a physician should be summoned immediately. In the meantime the child should be immersed in warm water. Care should be used not to have the water too hot (not over 100° Fahrenheit), and the infant should not remain in the bath more than two or three minutes.
Cuprum met. Should be given internally, 2 pellets dissolved in a teaspoonful of water and allowed to pass slowly into the mouth.
After removing the infant from the bath, it should be well wrapped in warm blankets and not disturbed unless another convulsion occurs, when the bath may again be used. No other treatment should be given excepting under the direction of a physician.
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