The pain and tenderness are not referred to the region of the appendix but are more centrally located. If, however, the finger point is pressed over the appendix, distinct tenderness will be elicited in inflammation of that region. Constipation is the rule in appendicitis, but diarrhea occasionally accompanies it.

The abdominal muscles may be rigid, that is, the abdomen does not feel soft as is usual; there is a feeling if they are pressed, as if they were hard and unyielding.

Treatment.--Put the child in bed and send for the family physician at once. The condition is too serious and too uncertain to delay, or for a parent to make any effort at treatment. Appendicitis is a much more serious condition in infancy and childhood than it is in an adult.

JAUNDICE IN INFANTS

There are two types of jaundice in infants that deserve brief consideration.

1st. There is a form of jaundice caused by a defect in the development of the bile or gall tubes. These infants develop jaundice a day or two after birth and become intensely jaundiced within a very brief time.

They lose flesh and strength to a marked degree and die in a few weeks.

It is not possible to affect this condition favorably by any method of treatment. This type of jaundice is not very common.

2nd. There is a type of jaundice that appears between the second and fifth day of life that is very common. It lasts from one to two weeks and then disappears. It is never fatal and is not serious. It requires no treatment.

JAUNDICE IN OLDER CHILDREN--CATARRHAL JAUNDICE--GASTRO DUODENITIS

Symptoms.--This form of jaundice begins like an attack of ordinary indigestion. There are, as a rule, pain, fever, vomiting, and prostration. The pain is located in the upper part of the abdomen and may be quite severe. The vomiting may continue for a number of days. The bowels are usually constipated. After a few days the jaundice sets in and may be quite intense. After the jaundice is established the stools are gray or white in color and there is much gas in the bowel. The urine is very dark and may be yellow or yellowish-green in color. The child complains of headache, is dull and listless, and appears sick and weak.

The condition lasts about two weeks, but the jaundice may last much longer. It is not a serious disease.

Treatment.--The diet should be cut down in quant.i.ty and should consist of rare meat, fruit, and a small quant.i.ty of milk. If vomiting continues the milk may diluted with lime water or vichy water. The child should drink water or vichy water freely. No starchy foods, or fats, or sugars should be allowed. The bowels should be kept open with calomel, one-tenth of a grain every hour until ten are taken, to be followed by citrate of magnesia every morning. If the pain is severe it may be relieved by a mustard paste or a turpentine poultice. The child should be given acid hydrochloric diluted, eight drops in one-half gla.s.s of water, ten minutes before each meal--and kept on it for at least one month.

INTESTINAL WORMS

There are three types of intestinal worms; they are known as the round-worm, the thread-worm, and the tape worm.

Round-Worm.--The round-worm is usually found in children of the run-about age. It is never seen in infancy. It occupies the small or upper intestine, and is from four to ten inches long. If there are round-worms in the bowel, there are usually a number of them and there may be hundreds.

Symptoms.--Round-worms give no definite symptoms. The only possible way to tell if they are present is actually to see them in the stools of the child. They are of a light gray color.

It is reasonable to expect that a child suffering from worms will have symptoms of abdominal distress from time to time; indigestion with colic and much gas may be present; children lose their appet.i.tes and are nervous and restless; sleep is disturbed; they may grind their teeth and talk in their sleep, and they may pick their noses unnecessarily during the day. These symptoms may, however, accompany other conditions when no worms are present in the bowel. My observation has been that in children in whom worms were present the nervous symptoms were distinctly accentuated. They are unreliable children; they seem well to-day and peevish to-morrow; they complain of headaches, dizziness, and chilly feelings. They are hysterical, noisy, uncontrollable. A child with these symptoms should be suspected of having worms and if no cause can be found to explain his temperamental vagaries he should be treated for worms. I have cured a number of children of excessive nervousness by giving them medicine for worms when no worms were present. Such results can only be explained on the a.s.sumption that these children were suffering from intestinal auto-toxemia or self-poisoning, and the thorough disinfection of the bowel apparently stopped the process by ridding the child's system of a ma.s.s of bacteria, which were undoubtedly causing the auto-toxemia and consequent nervousness.

Treatment.--The most efficient remedy for removing round-worms is Santonin. The quant.i.ty necessary for the various ages is as follows:

Two to four years 2 grains.

Four to six years 3 grains.

Six to ten years 3-1/2 grains.

The best way to give it is in divided doses, with an equal quant.i.ty of sugar of milk. For a child of six years the formula would therefore be, 3-1/2 grains of Santonin, mixed with the same quant.i.ty of sugar of milk divided into three powders. These powders are given four hours apart in the following way. The child is given a light supper the evening before and one-half gla.s.s citrate of magnesia the following morning and the first powder one-half hour later; no breakfast being given. A light lunch, of milk and crackers, may be taken about noon. The second powder is given four hours after the first, and the third four hours after the second. Half an hour after the last powder, a dose of castor oil (one tablespoonful) is given. In a few moments the bowels will move; usually there are no worms in this movement. A little later they will move freely again and if worms are present they will be discharged in this movement.

Thread-Worm, or Pin-Worm.--A thread-worm looks just like a little piece of white thread. They are found in the lower part of the bowel and in the r.e.c.t.u.m. They are usually present, if present at all, in large numbers.

Symptoms.--The chief symptom is itching. It may be limited to the a.n.u.s or it may involve the neighboring parts. Thread-worms may find their way out of the a.n.u.s and in female children may find their way into the v.a.g.i.n.a. In these instances the child is tormented with itching of the privates and may establish the habit of self-abuse as a result of the constant itching and scratching. The itching is more intense at night soon after the child goes to bed. As a result of the local irritation in the lower part of the bowel and r.e.c.t.u.m there is set up a catarrh of the bowel which produces large quant.i.ties of mucus.

Treatment.--The only medication by the mouth that is of any use is turpentine in one drop doses after meals, given in a teaspoonful of sugar. The best treatment, and in most cases the only treatment that is effective, is the use of rectal injections. The procedure is as follows:--The child first gets a cleaning injection of two quarts of warm water into which a teaspoonful of borax has been put. This will wash away any mucus or fecal matter that may have collected. This injection is best given with a No. 18 rectal catheter which is pushed into the r.e.c.t.u.m for about 10 inches, the water being allowed to run away as it enters. From six to eight ounces of the infusion of qua.s.sia is then pa.s.sed, as high up as the catheter will reach. It is intended that the qua.s.sia will remain in as long as possible, for at least half an hour. In order to a.s.sure this there are two features that should be kept in mind: first, the water should be allowed to flow in slowly, consequently hold the bag low, not higher than two feet above the level of the bed on which the patient lies; second, after the water is all in remove the catheter very slowly and keep the child absolutely quiet.

This treatment is repeated every second night for a week, then twice a week for four weeks.

A solution of garlic is a very effective remedy and may be tried if the qua.s.sia fails, which is not likely if the treatment is carried out effectively and if the parts are kept scrupulously clean.

Tape Worms.--Tape worms are obtained from eating raw meat, pork or sausage, rarely from fish, and from playing with cats and dogs.

Symptoms.--No definite symptoms accompany the presence of tape worm.

The children may have pains in the abdomen, diarrhea, a capricious appet.i.te, foul breath, and they may suffer from anemia, sometimes quite severely. The only positive symptoms is the presence of links of the worm in the stools.

Treatment.--Give a dose of castor oil at bed time. Two hours after breakfast next morning give one-half dram of the oleoresin of male-fern in emulsion or capsule. Very light nourishment should be taken during the day, composed of gruels and soups. When the worm is pa.s.sed it should be examined to find if the head is present; if not, the treatment should be repeated in twenty-four hours.

RUPTURE

Rupture of any description is not a condition that any mother should attempt to treat. A physician should be called in every case. Any misdirected effort at manipulation or pressure may result in irreparable injury to the parts. External applications are useless and may be injurious.

All ordinary forms of rupture in infancy and early childhood are curable if properly treated.

CHAPTER x.x.xVI

DISEASES OF CHILDREN, CONTINUED

Mast.i.tis or Inflammation of the b.r.e.a.s.t.s in Infancy--Mast.i.tis in Young Girls--Let Your Ears Alone--Never Box a Child's Ears--Do Not Pick the Ears--Earache--Inflammation of the Ear--Acute Ot.i.tis--Swollen Glands--Acute Adenitis--Swollen Glands in the Groin--Boils--Hives--Nettle Rash--p.r.i.c.kly Heat--Ringworm in the Scalp--Eczema--Poor Blood--Simple Anemia--Chlorosis--Severe Anemia--Pernicious Anemia

MASt.i.tIS, OR INFLAMMATION OF THE b.r.e.a.s.t.s IN INFANCY

There are a few drops of a milky secretion in the b.r.e.a.s.t.s of infants when born. Occasionally the amount will be in excess of the normal quant.i.ty, and the b.r.e.a.s.t.s, around the nipple, may be swollen and slightly inflamed. Should this condition persist, it may be relieved by painting the parts with the tincture of belladonna. Under no circ.u.mstances should the b.r.e.a.s.t.s be manipulated or rubbed, as this is very apt to cause an inflammatory condition, and to result in mast.i.tis.

Mast.i.tis begins, as a rule, during the second week of life. The breast becomes red, swollen, painful, and shows inflammatory changes. It may terminate without the formation of an abscess, or it may go on to suppuration. The child becomes extremely restless and irritable, it is disinclined to nurse, and suffers from loss of sleep and nourishment. It is possible for such a condition, in the female, to injure the breast to the extent of arresting its development and to render it useless in the future. If the suppuration is extensive the process may terminate fatally.

Mast.i.tis in infants is caused by unnecessary interference and manipulation and by want of cleanliness. When it occurs the parts should be kept absolutely clean and should not be handled in any way. Ichthyol 25 per cent., Zinc Oxide Ointment, enough to make one ounce, spread upon old, clean, soft linen, and laid over the parts and changed every six hours, is an excellent healing application. A piece of oiled silk may be put outside the linen to prevent the ointment staining the clothing, and over this a layer of absorbent cotton and a binder, applied without pressure.

If an abscess develops in spite of treatment, it must be freely opened and freely drained, and the general health of the patient supported by regular nourishment and tonics.

Mast.i.tis in Young Girls.--Pain and swelling of the b.r.e.a.s.t.s are sometimes complained of by girls between the twelfth and fifteenth years, though it may occur at an earlier or later date. If left alone the condition will invariably subside without treatment. Should bacteria find an entrance through the nipple at this time, an abscess may result.

The whole breast is involved and it will be exceedingly painful and much swollen. There may be moderate fever, headache, and a p.r.o.nounced feeling of indisposition. These patients should be given a laxative,--citrate of magnesia, or Pluto Water, and kept on a very light diet. An ice-bag should be kept constantly at the breast during the day, and a moist dressing of 1:5000 bichloride of mercury during the night.

It may take a week before recovery takes place.

LET YOUR EARS ALONE

Never Box a Child's Ears.--A single blow may make a child deaf; repeated blows on their ears will certainly injure children's hearing.

Thomas A. Edison, our greatest inventor, was made deaf when a lad by a surly brakeman, who soundly boxed his ears for some trivial or fancied offense.

Boxing a child's ears is but one of a great many things you should never do to the ears. In fact, there are far more things you should not do to safeguard the hearing, than there are things you can do to benefit your ears.