BRONCHITIS

Bronchitis is one of the commonest diseases of childhood. It is the cause of many deaths. Exposure during inclement weather is as a rule the cause of it. It occurs in all cla.s.ses and conditions of children. Poorly nourished and badly clothed children are more liable to get it than are others. It is more dangerous in young children and infants than in older children. A young child or an infant will get bronchitis quicker than those older and stronger under the same conditions.

Bronchitis is often present while children are suffering from other diseases, measles, influenza, scarlet fever, typhoid fever, pneumonia, diphtheria, whooping-cough, for example. It may accompany any disease of childhood, however.

Symptoms.--In infants bronchitis usually follows a "cold in the head," with running nose and a cough. The child is indisposed and peevish because of the cold. In a few days the cough becomes worse, fever develops, the breathing is quicker, and the baby looks and acts sick. The cough may be constant and severe; sometimes the cough does not seem to bother the baby, although this is exceptional. The breathing is quite rapid and is accompanied with a moist, rattling sound in the chest. The baby is restless and if the cough is severe it becomes exhausted. Vomiting or diarrhea may be present.

Bronchitis in Older Children.--Bronchitis in older children comes on abruptly, with fever and cough. The child may complain of headache and pains in the chest or other parts of the body. It may begin with a chill or chilly feelings. These children "raise" with the cough. The expectoration may be quite profuse; at first it is a white, frothy mucus, then yellow, and later a yellowish green; it may be slightly tinged with blood.

There is a mild form of bronchitis in these older children where the serious symptoms are absent. The children are not sick enough to go to bed, but they appear to have a "heavy cold" with, at first, a tight, hard cough, which is usually worse at night. Later the cough turns loose and the same expectoration occurs as in the severe type. It is these cases of mild bronchitis which do not receive the proper care and treatment that develop into the so-called "winter cough," which lasts for months.

Treatment.--(See page 497 under heading, "Catching Colds.") Children who acquire bronchitis easily and frequently, should be built up. Cod liver oil should be given all winter. The sleeping apartment of these children should not be too cold, but it should be well aired through the day and well ventilated throughout the night. Flannel night clothes should be worn and the feet should be kept warm always. Mild attacks of "cold in the head" should be treated vigorously and not neglected.

The following "Don'ts" may be profitably studied when your child or baby has bronchitis:--

Don't keep the windows tightly closed; fresh air and good ventilation are absolutely necessary to the patient.

Don't use a cotton jacket or oil silk.

Don't wrap the child up in blankets and shawls.

Don't carry the child around; keep it in bed.

Don't dose the child with syrupy cough mixtures.

Don't overheat the room.

Don't let friends bother or annoy the baby.

Don't reduce the diet unnecessarily.

The child should be put to bed. The temperature of the room should be 70 degrees F. all the time. The windows should be opened top and bottom according to the weather, and the room should be well aired every day, the patient being taken to another room while it is being done. The child should have its usual night clothes on, nothing more. If the child is not very sick and insists on sitting up, a bath robe can be worn but it should be always removed when it sleeps. It is advisable to change the position of the baby from time to time. Have it rest on one side, then on the other, as well as on the back. Give a dose of castor oil at the beginning of the sickness and keep the bowels open during the disease.

Diet.--The diet will depend upon the severity of the disease. If the fever is high and the cough persistent, the strength of the food of nursing infants should be reduced. We can reduce the strength of the food by giving the child a drink of cool boiled water before each feeding and shortening the length of each feeding. Older children may be given toast, milk with lime water, cocoa with milk, broths, gruels, custards, cereals and fruit juices.

Inhalations.--The value of inhalations in bronchitis is very great.

The ordinary croup kettle, which can be bought in any good drug store, is the best method of giving them. Full directions come with each kettle as to the best way to use it. The best drug to use in the kettle is creosote (beechwood). Ten drops are added to one quart of boiling water and the steaming continued for thirty minutes. The interval between steaming is two hours and a half in bad cases day and night. In mild cases the night treatments can be dispensed with. Sheets rigged up over the top and sides of the crib, in the form of a tent, is the most desirable way to give the inhalations.

External Applications.--Counter-irritation by means of mustard pastes are the best applications. They should be put back and front--one on back and one on the chest, overlapping at the sides beneath the arms.

They should cover the entire body from the waist line to the neck. These pastes are made as follows:--Mix the mustard (English) and the flour in the following proportions, using a quant.i.ty according to the size of child and area to be covered; one tablespoonful mustard to three tablespoonfuls of flour. Mix with lukewarm water until a paste is formed, not too thick and not too thin. Spread on a cloth (put plenty on) and cover with one layer of cheesecloth and place the cheesecloth side next the skin. In order to guard against burning the skin it is advisable to rub the skin with vaseline, before and after putting on the paste. The paste should be left on until the skin is uniformly red. It may be applied from two to four times in the twenty-four hours according to the severity of the case. Mustard pastes are most effective during the first two or three days of the disease.

Drugs.--Drugs are of very little value in the treatment of bronchitis.

In the first stage of the disease, when the cough is hard and dry, small doses of castor oil and syrup of ipecac may be given to good advantage.

The following dosage should be followed closely: 1st year, 2 drops castor oil, 2 drops syrup of ipecac, every two hours; 3rd year, 3 drops castor oil, 3 drops syrup of ipecac, every two hours; over 3 years, 4 drops castor oil, 4 drops syrup of ipecac, every two hours.

The benefits from this treatment will be obtained in the first two or three days, when it should be discontinued. The cough under this treatment and the use of the mustard paste and inhalations of creosote will be soft and loose in two or three days and the fever will be distinctly on the mend. The disease lasts from five to ten days. It may, however, last much longer according to the condition of the child, etc.

There are other drugs that can be given, with good effect, but when other remedies are indicated a physician should be called to prescribe them according to indications.

SUMMARY:--

Bronchitis is one of the commonest diseases of childhood.

It is the cause of many deaths.

A large number of children have a tendency to bronchitis.

These children need careful attention and "building up."

Do not neglect a "little" cold. It means trouble.

Chronic or Recurrent Bronchitis.--Bronchitis becomes chronic when the treatment of an acute attack fails to cure the condition. The failure usually is dependent upon the condition of the child. It may be suffering with some disease resulting from poor nourishment or poor sanitary and hygienic surroundings or both. The bronchitis, in other words, is dependent upon some other condition, and will not get wholly better until the cause is cured. These children should lead an active outdoor life when the weather is favorable. Their sleeping-room should be well aired and ventilated. Red meats are allowed twice a week only.

Sugar is cut down to the lowest limit. Skimmed milk only should be taken--the cream being too rich for them. They can eat freely of fruits in season, green vegetables and cereals. The bowels must move freely every day. Patients must be given a lukewarm bath, followed by a brief spray of cold water, daily. The cold spray should not be too cold; about 60 degrees F. is the suitable temperature of the water.

An absolute change of climate, to a warmer inland atmosphere, is imperative before some of these patients will begin to improve.

SUMMARY:--

A child with chronic bronchitis, or with frequent attacks of bronchitis (or chronic colds), is usually suffering from some other diseased condition.

The bronchitis, or the cold, will not get better until you find out what that "other diseased condition" is.

It takes a physician to find that out.

Having found the cause, cure it, and the bronchitis will disappear and the general health of the child will immediately improve.

PNEUMONIA

Pneumonia is a very common disease in childhood. It is the most frequent complication of the various acute infectious diseases. Pneumonia is an exceedingly important factor in the mortality of infancy.

There are two kinds of pneumonia:--

1. Broncho-pneumonia.

2. Lobar-pneumonia.

Acute Broncho-Pneumonia.--Up to the fourth year this is the form of pneumonia always present. It is the form that always complicates other diseases all through childhood.

It is most apt to occur during the spring and winter months.

It affects all cla.s.ses, but especially those whose hygienic surroundings are poor. Catching cold is the exciting cause in a large percentage of primary pneumonias.

Symptoms.--Broncho-pneumonia has no regular course. It may or it may not follow a cold or an attack of bronchitis. As a rule it begins suddenly with a high fever, frequently accompanied by vomiting, rapid respiration, cough, and prostration.

The child does not maintain a high fever continuously; it varies considerably throughout each twenty-four hours. It lasts from one to three weeks, and subsides gradually.