Do Not Pick the Ears.--Do not put cotton in the ears unless ordered to do so by a reputable physician. Do not syringe the ears without the doctor's orders. Put no poultices in the ears. Do not put drops of any kind in the ears unless prescribed by a doctor. Above all, do not use the advertised ear cures, as most of them are harmful. Never blow into a child's ear, never douche the nose without the doctor's orders, as this may wash germs into the tubes leading to the ears and bring about a serious condition.

Riding in tunnels, especially in tunnels under water where the air pressure varies, has, through some recent investigation, been found to be injurious to the ears of a great many people.

Conductors and other trainmen who run through many tunnels are apt to have ear trouble, as are the men who work underground a great depth where they are in motion, such as miners running underground trains.

If you have an earache that continues for any length of time, take no chances, but consult a physician. And remember to care for the throat and nose, as ill conditions in those places result in ear troubles. Do not blow your nose too hard; it merely injures the inner sides of the ear drums. Adenoids in children frequently bring about a bad ear trouble. Even seasickness is due in a great measure to ear disturbances.

If you have a running ear, attend to it at once by visiting a doctor. So serious is this that life insurance companies will not insure people in that condition.

Earache.--When a child complains of earache its ear should be examined. In nearly every case of earache it is necessary to treat the throat, as this is, as a rule, the seat of the trouble. An antiseptic gargle of equal parts of Borolyptol and warm water is an excellent mixture. It should be used freely every two hours. Children suffering from earache should be kept indoors. If the examination should show that it is not necessary to lance the ear drum, some local measure may be adopted to allay the pain. Putting the child in bed with the head resting on a hot-water bottle may be all that will be necessary. The following procedure may be carried out, but only after a physician has made an examination and according to his directions: A hot water douche, given by means of a douche bag, is quite effective. The water should be 110 F.; the bag should be held about two feet above the level of the child's head, and the irrigating point should not be pushed into the ear, but held so that the water will find its own way into the ear.

When the earache does not respond to the above methods the ear should be closely watched and examined at intervals so that it may be opened at the right moment. This is very essential because, if it is neglected, the pus may find its way into the mastoid cells and set up the dangerous disease, mastoiditis. This disease may cause abscess of the brain and death. The moment a child develops fever in the course of an earache the ear should be examined and opened at once, if found necessary.

Inflammation of the Ear. Acute Ot.i.tis.--Inflammation of the ear seldom occurs in childhood, unless as a complication, or as a result of some infectious disease. Any disease which affects the throat in any way may be the cause of the inflammation of the ear. Such diseases are, "cold in the head," tonsilitis, grippe, "sore throat," or pharyngitis, measles, scarlet fever. It is much more common in children than in adults. The younger the child, the more liable it is to develop ear trouble when suffering from any of the above diseases. The presence of adenoids favors the development of ear complications.

Symptoms.--There is one symptom present in all cases of inflammation of the ear; that is, fever. Pain may or may not be present; it is present in a majority of the cases. Children with inflammation of the ear are exceedingly restless and do not sleep long at a time nor do they sleep soundly.

Treatment.--The treatment is to open the drum membrane, at the right time, which of course will always be done by a physician who has had some experience in this work.

After Treatment.--The after treatment consists of washing or syringing the ear every three hours with eight or twelve ounces of a 1:10,000 solution of corrosive sublimate. This will be kept up for four days; then the intervals between the washing will be extended to five hours, and kept up until the drum membrane closes. If the corrosive sublimate solution should cause any eruption around the ear, a normal salt solution (see page 627) may be used in the same way, and in the same quant.i.ty as above. A running ear will run for from three to six weeks.

It may heal up at any time after ten days. If the discharge should suddenly stop and the fever rise, it indicates that the opening has become plugged or healed too quickly. In either case it will have to be opened again. As soon as the ear begins running again the symptoms will disappear. After syringing the ear it should be dried thoroughly with pieces of sterile absorbent cotton.

The best syringe to use for washing out the ear is a one-ounce hard-rubber ear syringe with a soft rubber tip. An ordinary douche bag will do if a syringe of the above character cannot be obtained. The douche bag should not be held higher than two feet above the patient's head. The double-current ear irrigator is an excellent device for this purpose. The child should be on its back on a table. Its arms should be fastened down by its side. A basin can be placed under its ear and the irrigating done without causing any pain or discomfort.

Any child addicted to disease of the ear should be closely watched and examined for tuberculosis. Scrofula may accompany this condition. These children need careful attention in every little detail, they need good nourishment, fresh air night and day, and they should not be pushed at school. During the winter they should be protected from "catching colds;" it is a good plan to put them on a cod-liver-oil mixture for the entire cold season. During the summer they should have a radical change of climate.

SUMMARY:

1st. Inflammation of the ear is frequently a complication of or follows some other disease which affects the throat.

2nd. If a child with one of these diseases becomes restless, sleepless and feverish, be on the look-out for ear trouble.

3rd. The ear must be lanced immediately when necessary.

4th. The after treatment is very important, because the hearing of the child depends upon it.

SWOLLEN GLANDS. ACUTE ADENITIS

Swollen glands in infancy and childhood are usually seen below and behind the ear, less frequently in the groin. Their cause is, as a rule, local disturbance in the mouth or throat, as decayed teeth, enlarged tonsils, cold in the head, catarrh, adenoids, or some form of infection of the mouth, or throat, or scalp. They occasionally accompany scarlet fever, diphtheria, measles, and influenza. They seldom suppurate.

Symptoms.--A swelling is noticed just below the angle of the jaw; it does not grow rapidly. There is a slight temperature and the child is more or less irritable. If the patient is an infant, the fever may be quite high and there may be considerable prostration. The trouble lasts from four to eight weeks.

Treatment.--An ice-bag constantly applied is the best treatment. This not only relieves pain, but it prevents the possibility of the gland breaking down and suppurating. It is sometimes difficult to keep an ice-bag on an infant, in which case cold compresses should be applied.

These are made by taking several layers of old linen or cheese cloth and laying them on ice. They should be applied frequently to the swollen gland. The following ointment may be applied, though the ice-bag is the better and more certain treatment: Ichthyol 25 per cent., Adeps Lanae one ounce. This is applied on cloth and renewed every six hours.

This ointment is black and stains the clothing. For that reason it is advised to use oiled silk over the cloth to avoid staining the pillow or clothing.

Children suffering from adenitis should use a spray of Dobell's solution in the nose and throat three or four times daily. If the cause of the swollen glands is known, treatment for its cure should be promptly inst.i.tuted.

In the event of pus forming the gland must be opened and drained.

Swollen glands in the groin of a child are caused most frequently by some inflammatory condition of the privates, which should be discovered and treated.

BOILS

In some delicate children and in some children who do not seem to be delicate, repeated crops of boils may appear from time to time.

It is necessary to open them as soon as pus is present. They should be pressed out and a gauze dressing, wet with a saturated solution of boric acid, bound over them. The dressing should be kept moist.

I have in a number of instances successfully rid a child of the tendency to boils by the use of the following formula, which I can recommend highly as one of the best tonics I have ever used in the treatment of delicate and poorly nourished children: Tinct. Nux Vomica 4 drops, Acid Phosphoric Dilute 8 drops, Syrup Hypophosphites, 1 teaspoonful. Make a two-ounce mixture and give to children over four years of age one teaspoonful after each meal; to younger children, one-half teaspoonful after each meal.

It is necessary in these cases to keep the bowels open daily.

HIVES. NETTLE-RASH

Cause.--Contact with different plants, bites of insects, irritation from clothing, use of certain drugs. Certain articles of food, such as tomatoes, strawberries, oatmeal, buckwheat, have all been said to cause hives.

Dent.i.tion during warm weather and the presence of worms and chronic malarial poisoning have been known to cause hives.

It is most frequently caused, however, in childhood by some disturbance in the stomach or bowels.

It causes severe itching and loss of sleep and as a result of these the general health suffers.

Treatment.--If caused by any external irritant, remove it. If it is caused by any special article of diet, prohibit its use. If no cause is apparent, give the child one tablespoonful of castor oil, and put it on the mildest diet possible of soups, broths, and dried stale bread. Give no milk. Use the following treatment on the erupted parts: Menthol, ten grains in one ounce of cold cream. Keep the bowels open.

It is sometimes necessary to advise a change of air before complete cure results.

p.r.i.c.kLY HEAT

This is a very common complaint in children during the summer months. It is so common that it is well known and easily recognized. It consists of a bright red eruption, composed of little papules, close together.

The rash comes out quickly, so much so that mothers may be surprised and frightened by observing an angry looking rash on their baby some morning when none was there the night before. It most frequently appears upon the neck, back, chest, and forehead. It is exceedingly itchy and a child may scratch itself and cause extensive harm. Eczema, of a very obstinate type, frequently results from scratching.

The rash of p.r.i.c.kly heat is easily diagnosed from other rashes because it is accompanied by no other symptom, such as fever, which would suggest a more serious disease. The rash of p.r.i.c.kly heat resembles the rash of scarlet fever more than any other rash, but it is quickly noted that when a child has scarlet fever it has every symptom of being profoundly sick, while p.r.i.c.kly heat has no symptom other than the itch and discomfort. It is caused by overfeeding, being overclothed, and sweating in hot weather.

Treatment.--Steps should be taken to prevent p.r.i.c.kly heat in an infant. Use light, seasonable clothing, bathe frequently, and use plenty of good toilet powder. When the child actually has an attack, open its bowels freely with citrate of magnesia, and give some sweet spirits of niter, according to age. Protect the skin from the irritating underwear by interposing a soft piece of linen. In order to reduce the inflammation and cure the condition apply equal parts of starch and boric acid powder freely. Keep the patient on a light fluid diet. The bran bath is advisable if the little patient is addicted to these skin eruptions.

RINGWORM OF THE SCALP

Children of all ages are liable to "catch" ringworm of the scalp. It particularly affects those who are untidy, dirty, and badly cared for, though any child is apt to get it while attending the public schools.

If a mother discovers scaly patches in the scalp, with loss of hair, ringworm should be immediately suspected. It is not, however, always easy to diagnose the condition, especially if the case is a mild one. If it is a severe attack, there is, as a rule, quite a little inflammation, and this may render the condition obscure for some time. The disease may be mistaken for dandruff, but dandruff covers a large area of the scalp, while ringworm is limited and sharply defined. Dandruff may cause a loss of hair; if it does, the hairs come out clean, while in ringworm they break off near the scalp.