QUINSY

Quinsy is not common in childhood. It usually follows tonsilitis when it is seen. The child complains of pain in the neck, extreme pain and difficulty upon swallowing, and inability to open the mouth as much as usual. There is a tendency to hold the head to one side. The treatment is to open the abscess at the earliest moment after pus is present.

HICCOUGH

Hiccough is, in most cases, in infancy and childhood caused by some irritation of the stomach, may be over-filled with food or gas. In these cases it is an unimportant incident and may be quickly relieved by giving the child an enema of soap-water and a laxative of rhubarb and soda.

Infrequently hiccough may be the result of cold feet, or a surface chill. Simple methods of relief are, to hold the breath, to expire, or blow the breath out as long as possible before taking the next breath; to sip water from a cup held by another person while the tips of the two fore-fingers are in the ears.

Hiccough is quite frequent in hysteria in girls, but it is of no consequence. When hiccoughs set in during the course of any serious disease it is a very unfavorable sign.

SORE MOUTH: STOMAt.i.tIS

Stomat.i.tis is an inflammation of the mucous membrane (inner lining) of the mouth. The gums and the inner surface of the lips and cheeks may be red and angry-looking. There may be small grayish spots on any part of the mouth. If the case is very bad or if it has lasted some time and has been neglected, these spots grow larger and join together forming irregular grayish plaques. A large percentage of the cases never go further than this because the proper care and attention is given them.

It is possible, however, for any case to progress further and become ulcerative. This will be observed first as a faint yellow line at the margin of the teeth and gum. Ulceration never takes place unless the child has teeth. The quant.i.ty of saliva is very greatly increased, so much so that it flows out of the mouth soiling the clothes. The saliva is intensely acid and it consequently irritates the skin, causing more or less eczema. The mouth is painful and hot. There is slight fever, but seldom any marked prostration. If, however, the ulceration should be severe, the fever may be quite high.

There is one feature of these cases that sometimes proves vexatious and annoying. Because of the soreness of the mouth, the child cannot draw strongly enough on the nipple to get a normal feeding, and as a result the nutrition of the child is poor. These children are hungry and when offered the nipple grasp it greedily, draw a few mouthfuls then stop because of the pain and begin to cry.

If the ulceration is extensive, there is usually an odor and the gums bleed easily. Sometimes the teeth fall out or have to be drawn out.

Strong, well-fed children are as likely to develop stomat.i.tis as are those who are weakly and ill fed.

The disease is caused by infection and is contagious. Just what the infection is we do not know; we do, however, know that children whose mouths are carefully cleaned after each feeding do not have sore mouths of this character. When cleaning the mouth care must be observed not to injure the tender mucous membrane.

Treatment.--As soon as the condition is observed mouth-washing should be systematically and thoroughly carried out. After each feeding the mouth should be washed with a saturated solution of boric acid in boiled water. (See page 626.)

It is not necessary to use any further treatment, as a rule. Patients recover in four to eight days. Strict attention to cleanliness, however, is imperative. The feeding bottle and nipple, or the mother's nipple, if breast fed, must be kept scrupulously clean.

The feeding of these children is sometimes a problem for a day or two, because, as stated above, of the soreness of the mouth. This is best overcome by feeding the baby with a spoon. If breast fed, it is necessary to pump the milk and then feed with the spoon. Children will take the milk better if it is fed cold. Cold boiled water is largely taken and is good for them at this time.

Treatment for Ulcers in Mouth.--The ulcers should be touched with a camel's-hair brush which has been dipped into finely powdered burnt alum. If a stronger caustic is necessary, the solid stick of nitrate of silver may be used.

A mouth wash may also be used in the ulcerative cases, composed of the peroxide of hydrogen diluted with two parts of water. If this is used wash the mouth out afterward with plain, cool, boiled water. The peroxide mouth wash can be used four or five times daily.

In addition to the mouth washing in the ulcerative cases it is advisable to use internally chlorate of potash. The druggist should be requested to make a two-ounce saturated solution, and of this you can give one-half teaspoonful, largely diluted with cool water, every hour during the day for the first twenty-four hours, then every two hours until marked improvement is shown, when it can be further reduced by lengthening the interval between doses.

SPRUE--THRUSH

Sprue is a form of sore mouth. It is seen only during the first six months of life, as a rule. It affects the mucous membrane of the mouth; it appears in the form of small white spots that look like drops of curdled milk. They are on the inner surface of the cheek and may be all over the mouth, and on the tongue. The spots are firmly attached, and if forcibly removed the mucous membrane will bleed.

The disease is caused by infection through lack of cleanliness and it invariably affects poorly nourished children, especially those who are bottle-fed.

There are no symptoms other than those of the mouth; the child frequently refuses to nurse because of evident pain and distress while nursing. The condition is not contagious. It may be cured in from six to eight days without difficulty.

Treatment.--Mouth irrigations of boracic acid are all that are necessary. They are given in the following way: Place the child on its side, roll around the index finger a piece of absorbent cotton, dip this in a saturated solution of boracic acid, and put into the mouth of the child. Let the cotton take up as much of the solution as it will hold, so that when it is lightly pressed on the tongue and cheeks it will flow out of the mouth, thus "irrigating the mouth." Repeat this a number of times, pressing the cotton to a different part each time. This should be gone through from four to six times daily.

If the child is a bottle-fed baby, care should be taken in cleaning the nipples and bottles as directed on page 264. If the patient is breast-fed, care must be taken to note that the mother's nipples are clean. They should be washed with the same solution of boracic acid and not handled. If the child cannot nurse it is necessary to feed it with a spoon.

In obstinate cases the parts may be touched with a one per cent.

solution of formalin. Mothers should particularly note not to use honey and borax, as is often recommended by women who know no better, in any disease of the mouth in children.

CHAPTER x.x.xV

DISEASES OF THE STOMACH AND GASTRO-INTESTINAL Ca.n.a.l

Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting--Acute Gastric Indigestion--Iced Champagne in Persistent Vomiting--Acute Intestinal Diseases of Children--Conditions Under Which They Exist and Suggestions as to Remedial Measures--Acute Intestinal Indigestion--Symptoms of Acute Intestinal Indigestion--Treatment of Acute Intestinal Indigestion--Children with Whom Milk Does Not Agree--Chronic or Persistent Intestinal Indigestion--Acute Ileo-colitis--Dysentery--Enteritis--Entero-colitis--Inflammatory Diarrhea--Chronic Ileo-colitis--Chronic Colitis--Summer Diarrhea--Cholera Infantum--Gastro-enteritis--Acute Gastro-enteric Infection--Gastro-enteric Intoxication--Colic Appendicitis--Jaundice in Infants--Jaundice in Older Children--Catarrhal Jaundice--Gastro-duodenitis--Intestinal Worms--Worms, Thread, Pin and Tape--Rupture

ACUTE GASTRIC INDIGESTION

Acute Inflammation of the Stomach--Acute Gastritis--Persistent Vomiting

An infant seldom has real inflammation of the stomach. Gastric, or stomach, indigestion is the better name, because it actually signifies the true condition. It is indigestion that causes a child to vomit, though it is possible to have a true inflammation caused by the taking of irritant or corrosive drugs.

Gastric indigestion causes sudden, repeated vomiting, with prostration and occasional fever. It is caused by unsuitable food, the wrong quant.i.ty of food, irregular feeding, and food the quality of which is not good.

Treatment.--The stomach should be immediately washed out. Until the physician arrives the mother can encourage the child to drink a large quant.i.ty of cool boiled water. This will be vomited and it will wash out the stomach at the same time. No further treatment may be necessary, as the vomiting may stop. All food should be withheld for at least twenty-four hours. A high rectal irrigation should now be given. It is essential to know that the bowel is absolutely clean in all vomiting cases. The normal salt solution is the best agent to use for a high enema in infants. (See page 586.)

After twelve or twenty-four hours' abstinence from food, the child can be given teaspoonful doses every twenty minutes of cooled boiled water, or barley or alb.u.men water, weak tea, or chicken broth. Cold liquids are better retained and more readily taken than those that are heated. If the liquid feedings are vomited, another twelve hours must elapse before trying stomach feedings. In these cases we must try to satisfy the thirst by giving cold colon flushings. If the case becomes protracted and we find it impossible to nourish the child by the mouth, we must wash the stomach out once every day with a five per cent. solution of bicarbonate of soda, and feed the child by the r.e.c.t.u.m. Sometimes we can feed through the stomach tube. Liquids will frequently be retained when put into the stomach through a tube when they will be vomited if swallowed.

The best food by the r.e.c.t.u.m is plain peptonized milk.

Drugs are absolutely useless. If the vomiting persists, despite the above efforts to stop it, there is nothing to be gained by experimenting. You will not only render the condition worse but you will weaken the child. Morphine given hypodermatically is the only remedy.

Given in appropriate doses, according to age, it is absolutely harmless.

It will not only stop the vomiting, but it will give the child a much-needed rest, by allowing it to go to sleep. When it wakes up it will be stronger and its stomach will most likely retain small doses of nourishment.

Great care must be exercised, in getting the child back on a normal diet, not to try to go too fast.

In cases of persistent vomiting in children I have found it advisable to use teaspoonful doses of ice-cold champagne. These children will sometimes keep this down when all other liquids will be vomited. It is absolutely necessary to keep the child lying down. If he is restless or sits up, the vomiting may begin all over again. The champagne not only is excellent nourishment for the child, but it quiets the stomach, allays irritability, and frequently favors sleep, during which time a cure very often results. The champagne must be drawn through a champagne siphon (procured in the drug store), and the bottle must be kept on ice with the mouth downward; otherwise it will get stale very quickly and be of no use. If kept as advised it will remain good to the end.

SUMMARY:--

1st. Persistent vomiting in a child means acute gastritis. Stop all food for twenty-four hours.

2nd. Encourage the child to drink large quant.i.ties of slightly warm water; this will wash the stomach out and frequently stops the vomiting.

3rd. When the child is quiet wash out the bowels.

4th. If vomiting persists, use iced champagne as directed.