The respirations vary between 60 and 80 per minute, though they may be much more frequent than this. The child breathes with apparent difficulty, the soft parts of the cheeks and nose rising and falling as it breathes.

The prostration becomes, as the disease progresses, more and more marked, until the child looks profoundly sick.

Cough is a constant and incessant symptom. It disturbs rest and sleep and may cause frequent vomiting. There is no expectoration.

A strong cough is a good symptom; if it stops it is a bad symptom.

Pain is seldom present.

Blueness of the skin is a bad sign and indicates failure of respiration and suggests constant and careful watching.

Delirium may be present during the disease. It is not necessarily a bad sign. Accompanying stomach troubles are frequent if the patient is very young, and are very important. The bowels may be loose; they may be green in color and contain much mucus. Large quant.i.ties of gas may acc.u.mulate in the intestines and may cause much distress and convulsions. Death may occur at any time or the process may be arrested and recovery take place at any stage of the disease. Broncho-pneumonia is not necessarily a fatal disease in a fairly healthy child. It is, however, always a serious disease.

Various complications may occur in the course of the disease. The most frequent are: pleurisy, emphysema, abscess of the lung, meningitis, heart disease, stomach troubles, thrush, intestinal disease.

How to Tell When a Child Has Broncho-Pneumonia.--If a child develops a high fever, breathes rapidly, coughs, and is content to lie in bed because of the degree of prostration, broncho-pneumonia is almost certain to be the disease present. If in addition to these symptoms there is any blueness of the fingers or around the mouth it is more strongly suggestive of pneumonia.

If the child has been suffering with bronchitis it is sometimes difficult to tell just when the pneumonia begins. The child will appear more profoundly sick, the fever will go higher, and the respiration will be more frequent when pneumonia sets in on top of bronchitis.

Treatment.--The nursing of a little patient with pneumonia is the most important part. He must get plenty of fresh air; consequently he should be kept in a well-ventilated room. It is an excellent plan to change the patient twice daily from the sick room into another which has previously been thoroughly aired. While he is in this room the sick room should be as thoroughly aired as is possible. Keep this plan up all through the disease; change the position of the patient in bed every two hours. He should never be allowed to lie on his back for hours at a time. In this way the different parts of the lungs get a chance to air themselves,--the air cells expand and the oxygen in the air and the fresh blood tend to heal the parts more quickly.

It would be distinctly wrong to go into the detailed symptomatic treatment of broncho-pneumonia in a book of this character. Inasmuch as this is one of the most serious diseases of infancy, no mother should attempt to treat it alone. A physician is absolutely necessary and the most the mother can hope to do is to follow out his directions to the letter.

He may direct the use of mustard pastes but it is essential to know where to apply them. If he should request the use of the cotton jacket, the height and character of the fever must regulate its use. Stimulants are always necessary, whisky and strychnine being given in every case, but if given at the wrong time they may do more harm than good. Cough mixtures may be necessary, but frequently they are contra-indicated.

Drugs and cold sponging may be used to reduce the fever, but they are dangerous if used when conditions do not justify their use.

Complications must be diagnosed when they occur, and the correct methods of treatment promptly inst.i.tuted. A competent physician alone can a.s.sume the responsibility of these various phases of the disease.

Every mother should appreciate, however, that pneumonia is frequently the result of carelessness. It is a well-known fact that pneumonia is an infrequent disease among children of the well-to-do, because the hygienic surroundings of these children are better and because they receive competent attention if suffering with colds and bronchitis.

Bronchitis is quite common in all cla.s.ses of children, but in the lower walks of life it is the custom to allow children to run around while they give every sign of having a heavy cold, and a beginning bronchitis.

These children should receive treatment and should be kept indoors and in bed if they have even a slight fever, as pneumonia is frequently the inevitable outcome. They should be carefully fed, and all signs of stomach or intestinal troubles attended to at once.

[Ill.u.s.tration: By permission of Henry H. G.o.ddard

A Grim Result

Isaac is 16, although mentally 10. He is a high-grade moron.

This is one of those all too frequent instances[A] "of a feeble-minded woman with a husband who is alcoholic and the offspring either feeble-minded or miscarriages."

"Isaac is exceedingly dangerous. He is a potential criminal or bad man, or under the best conditions would at least marry and probably become the father of defectives like himself."

This and the succeeding pictures in this volume contrast vividly with the frontispiece. Terrible are the results when we disregard the inevitable laws of nature, and so mate ourselves that our children will be parasites on society.]

[A] "Feeble-mindedness; Its Causes and Consequences", G.o.ddard, The Macmillan Company.

The After-Treatment of Pneumonia is important, and every detail has a distinct bearing on the ultimate recovery and establishment of good health. Careful feeding, a good tonic, and the proper attention to exercise, fresh air and bathing are requisite. A change of air after the fever is gone is more important than all other measures put together. A dry, warm climate where patients can be kept in the open air is preferable. The danger of allowing a slow, long drawn-out convalescence after pneumonia is the development of tuberculosis.

ADENOIDS

Adenoids are very common, almost popular, in childhood. The condition is one that causes more real trouble and discomfort than any other childhood affliction. Adenoids are a.s.sociated with, and are responsible for, many of the ailments of childhood. They may be a.s.sociated with enlarged tonsils or they may be independent of them. They may be present at birth or develop any time thereafter, though they are more frequent between the ages of two and six years. Children who have adenoids invariably suffer from chronic "head-colds" with a discharge from the nose. These chronic colds are caused by the adenoids. Nearly every disease, and every diseased, or abnormal, condition of the nose, throat, larynx, and lungs can be directly caused by the presence of adenoids.

They are also responsible for numerous other conditions of very grave importance in the growing child. The accompanying "head-colds" may develop into a bronchitis which may keep the child indoors for a long period. Adenoids always interfere with respiration, thereby depriving the child of a normal quant.i.ty of oxygen, thus rendering the blood less pure, and, as a consequence, seriously interfering with the nourishment and general health. The impaired nourishment and poor health thus produced, as a direct result of adenoids, renders the child more liable to disease; he may thus acquire ailments that may affect his whole subsequent life. The mental side of a child's development is also affected by the presence of adenoids, so much so that actual statistics prove that these children cannot keep up with their cla.s.ses in the public school.

We must therefore regard the presence of adenoids as a serious menace to the health and comfort of the patient. It has already been pointed out in discussing other diseases that before a cure of these diseases could be permanently accomplished it would be absolutely necessary to remove the adenoids, which were, no doubt, the actual cause, or an important contributing cause, of the disease. Such conditions as catarrhal laryngitis, croup, chronic recurring winter coughs, acute catarrhal rhinitis, "snuffles", "cold in the head", chronic catarrh, bronchial asthma, incontinence of urine, "bed-wetting", "nose-bleeding", headaches in growing children, anemia, deafness, night terrors, defective speech, diphtheria, consumption, are frequently caused by the presence of adenoids.

These patients contract certain diseases easier than other children, and when they do, they have them more severely; such diseases are diphtheria, tuberculosis, scarlet fever, measles, and whooping cough.

Adenoid children are, as a rule, in better health during the warm, equable, summer weather than during the changeable, uncertain weather we have in the winter months. If the case is neglected, and if the adenoids have existed for a long time, the growth of the child is impaired. He remains small and stunted, and the expression of the face is dull and stupid. The temperament and disposition are affected also; such children are languid, listless and depressed.

How to Tell When a Child Has Adenoids.--Children with well-developed adenoids are "mouth-breathers." Instead of breathing through the nose they breathe with the mouth open, especially when sound asleep. If a child has a discharge from its nose and a chronic cough, both of which resist treatment, and if in addition it is a mouth-breather, it is safe to investigate the naso-pharynx for adenoids. If a child with these symptoms is not in good health, is listless and depressed, looks stupid, snores at night, has difficulty in breathing and cannot blow its nose satisfactorily, is troubled occasionally with "nose bleeds" and headaches, we may be satisfied that the child has adenoids, as no other condition could produce such a picture.

Adenoids, like enlarged tonsils, are dangerous, apart from the physical distress and disease which they cause, owing to the fact that they harbor deadly bacteria, and from these bacteria, which find a lodgment in the adenoids and tonsils, a fatal attack of diphtheria or consumption may have its beginning.

Treatment of Adenoids.--Absolute removal is the only justifiable treatment. This is rendered imperative for so many reasons that it is unnecessary to go into details in justification of the procedure.

The physical well-being, the mental development, the life of the child depend upon it. Any parent who would wittingly interpose an objection to the removal of his or her child's adenoids, after they have been demonstrated to exist, would be guilty of a grave crime.

The operation itself is not at all dangerous. It is over in a few moments and the child is well in an hour or two, so far as any pain or suffering is concerned.

Physicians are frequently asked if adenoids "grow" again after removal.

The answer is, "Yes," they sometimes do. In a very small percentage of the cases they do return. The older the child is when they are removed the less chance there is of a recurrence. A child operated on before it is two years of age is more liable to a recurrence than a child operated on at six years of age. This must not, however, be construed as an excuse for putting an operation off, because if a child needs an operation at two years and it is postponed till later, its health will be permanently injured before it is four years of age.

SUMMARY:--

1. Adenoids cause more trouble and more actual disease than any other condition during childhood.

2. It is a crime for a parent to refuse operation if the presence of adenoids has been proved.

3. Removal is the only treatment and it should be done in every case as soon as possible.

4. The operation is a trivial one and is free from danger.

NASAL HEMORRHAGE--"NOSE BLEEDS"

A hemorrhage from the nose may occur at any time from birth on. It depends upon the rupture of one or more blood vessels. The great majority of "nose-bleeds" are caused by adenoids, or by a small ulcer in the nose, or by an injury, such as a blow or fall. A nasal hemorrhage, however, may be caused by other, more serious conditions, and for that reason may justify a careful inquiry into the cause, especially if bleeding should occur a number of times, or be of a serious character the first time.

Of the more common causes as given above, the adenoids should be removed, and the chronic catarrh which is invariably the cause of the ulcer should be cured.

Treatment of an Acute Attack.--Have the patient sit erect; loosen all tight clothing around neck; fold the hands over the head; apply cold to the back of the neck and the nose. Pieces of ice can be put into the nostril and the ice bag to the nape of the neck, or a piece of ice can be put into a folded napkin and held on the back of the neck. Taking a long breath and holding it as long as possible and repeating it while the ice is being applied is an aid. Placing the feet in hot mustard water is of decided use. Another excellent expedient is to wrap absorbent cotton round a smooth probe (piece of whalebone, for example), dip the cotton in an alum-water mixture (half teaspoonful powdered alum in a half cupful of water), and then push it into the bleeding nostril as far as you can with gentle force. A valuable remedy is Peroxide of Hydrogen used full strength and freely dropped into the nostril. If these measures fail, send for a physician at once.

SUMMARY:--

1st. Nose bleeds may be caused by some serious condition.

2nd. If they occur a number of times have the child examined.

3rd. If the treatment outlined above does not stop the bleeding in a few moments send immediately for a physician.