Pernicious Anemia.--For this condition a.r.s.enic is the one remedy needful. In all conditions of poor blood the most careful attention should be given to the general health. Colds must be guarded against.

The patients should never get their feet or their clothes wet. Muscular exercise, because of the weak condition of the heart, should be moderate, and only given on the advice of a physician. It is frequently necessary to stop all forms of exercise and in many instances we get the best results by directing complete rest in bed for a considerable part of the day or for all day if the case demands it.

CHAPTER x.x.xVII

DISEASES OF CHILDREN, CONTINUED

Rheumatism--Malaria--Rashes of Childhood--Pimples--Acne-- Blackheads--Convulsions--Fits--Spasms--Bed-wetting--Enuresis-- Incontinence--Sleeplessness--Disturbed Sleep--Nightmare--Night Terrors-- Headache--Thumb-sucking--Biting the Finger Nails--Colon Irrigation-- How to Wash Out the Bowels--A High Enema--Enema--Methods of Reducing Fever--Ice Cap--Cold Sponging--Cold Pack--The Cold Bath--Various Baths-- Mustard Baths--Hot Pack--Hot Bath--Hot Air, or Vapor Bath--Bran Bath-- Tepid Bath--Cold Sponge--Shower Bath--Poultices--Hot Fomentations--How to Make and How to Apply a Mustard Paste--How to Prepare and Use the Mustard Pack--Turpentine Stupes--Oiled Silk, What it is and Why it is Used.

RHEUMATISM

This is a rather common disease of childhood. It occurs most frequently between the ages of nine and thirteen years. Children can have it, however, at any age.

The symptoms of rheumatism in children are much the same, though somewhat milder, as when the disease is present in an adult. Children are not quite as sick, nor is the fever as high, nor is the pain as great as in a grown person. In children the disease does not last as long, as a rule. Sometimes it will jump from one joint to another, and may, as a consequence, become chronic. When a child has once had rheumatism, it has the same disposition to recur that it has in adults.

The princ.i.p.al danger of rheumatism in children is its tendency to attack the heart. Even mild attacks of the disease can do serious damage to the heart.

Children who have the rheumatic tendency invariably suffer from inflammatory conditions of the upper respiratory tract. They are p.r.o.ne to have recurring colds, tonsilitis, and sore throats. Treatment of conditions without regard to the underlying rheumatism is never satisfactory. These children complain of indefinite pains, now in one place, now in another. These pains are commonly known as "growing-pains"

and, inasmuch as they are rheumatic and not "growing pains," they should be regarded seriously because of the heart damage they might do if ignored, and especially so since the mildest attacks of rheumatism, without any joint symptoms even, frequently leave the heart in very bad shape. As a general rule it will be found that when a child has had a number of attacks of bronchitis or asthma it is rheumatic and should receive treatment for the rheumatic tendency.

Children with the tendency to rheumatism invariably eat too much red meats and sugar,--the latter in the form of candy or as an excess in the food.

Treatment of an Acute Attack.--The child should be put in bed and kept warm. The bowels should be freely opened with citrate of magnesia. The diet should be very light: milk and lime water or milk and vichy water, with a piece of dry toast or zwieback, is all the child needs until the fever is relieved. When a single joint is affected local measures may be taken for its relief. Wraping the joints up with flannel cloths which have been wrung out of true oil of wintergreen, and outside of this oiled silk snugly bandaged on, is an excellent external application. The flannel cloths should be kept moist by adding a little of the wintergreen from time to time as it dries in. This can be done without removing the bandage. This application is kept in place for twenty-four hours and renewed if necessary. Such an external application will aid in the actual cure of the disease and will quickly relieve the patient of the pain. The oil of wintergreen used in this way should be the "true"

oil, and should be so specified when bought in the drug store.

Because of the great tendency to attack the heart a physician should take charge of every case of acute rheumatism in a child.

To Treat the Tendency to Rheumatism.--Exclude red meats and sugar in all forms as much as is possible. Give green vegetables freely, potatoes boiled with the skins on, fish, eggs, and poultry. Cereals with milk, especially well cooked Scotch oatmeal, are exceedingly good for these children. By keeping up this diet after the acute attack has pa.s.sed for a considerable time, it is possible to cure the various other complaints with which the child is afflicted,--tonsilitis, sore-throats, winter coughs, head-colds, bronchitis, asthma, etc.

These children should wear woolen underwear all the year round. They should be encouraged to drink water or vichy freely between meals.

In the treatment of an acute attack as given above it will be observed that no drugs are mentioned. This is intentional because it would be unjust to encourage the home treatment of a disease that is so treacherous, even in its mildest forms. Because of its tendency to recur and with each recurrence the danger of the heart being affected, it is advisable to put these children on cod liver oil or iron or some other good tonic. Every precaution should be taken to prevent these children from getting their feet wet or being out in the rain.

SUMMARY:--

Rheumatism is a dangerous disease in children.

In its mildest forms it can affect the heart badly.

It has a distinct tendency to recur.

Rheumatic children are afflicted with a number of diseased conditions which do not respond to treatment unless the rheumatism is treated.

Acute rheumatism should never be treated except by a physician because of its treacherous character.

MALARIA. INTERMITTENT FEVER

Malaria occurs quite often in infants and children. As a rule the child gives evidence of gastro-intestinal disturbance for a short period before the malarial symptoms appear. The chilly stage is often absent.

Sometimes the hands and feet are cold and may be slightly blue and the child may appear to be in collapse. This stage may last for an hour or longer. The chilly stage may, however, be replaced by nervous symptoms,--restlessness, dizziness, irritability, nausea, etc.,--or a convulsion may take place. In the second stage the temperature may rise quite high, the pulse may be quite rapid; the child is flushed, restless, and cries. This period may last from half an hour to two hours. The sweating stage is not as a rule well marked in a child. It may be very slight or not at all.

Between the attacks some children may be entirely well; others remain restless, have little appet.i.te and poor digestion. Malaria in children does not always follow a typical course. We often see children suffering from spasms, fainting spells, neuralgias, diarrhea, vomiting, and skin eruptions, all due to the malarial condition. This often leads to a mistake in diagnosis. Intermittent fever is often mistaken for pneumonia. Malaria is not a favorable disease for an infant to have. It rapidly weakens the child and great debility and anemia follows.

Treatment.--The treatment for malaria in children is by the administration of quinine as in adults. It must, however, be given with care and intelligence; for this reason no mother should begin dosing her child with it without consulting a physician.

REGARDING MOSQUITOES

The following is an extract from a circular in relation to the causation and prevention of malaria and the life history and extermination of mosquitoes issued by the Department of Health, City of New York:

Extermination and Prevention of Mosquitoes.--Mosquitoes require for their development standing water. They cannot arise in any other way. A single crop soon dies and disappears unless the females find water on which their eggs may be laid. In order to prevent mosquitoes, therefore, the requirement is simple.

No Standing Water.--Pools of rain water, duck ponds, ice ponds, and temporary acc.u.mulations due to building; marshes, both of salt and fresh water, and road-side drains; pots, kettles, tubs, springs, barrels of water, and other back-yard collections, should be drained, filled with earth, or emptied.

Running streams should have their margins carefully cleaned and covered with gravel to prevent weeds and gra.s.s at the water's edge.

Lily ponds and fountain pools should, if possible, be abolished; if not, the margins should be cemented or carefully graveled, a good stock of minnows put in the water, and green slime (Algae) regularly cleaned out, as it collects.

Where tanks, cisterns, wells or springs are necessary to supply water, the openings to them should be closely covered with wire gauze (galvanized to prevent rusting), not the smallest aperture being left.

When neither drainage nor covering is practicable, the surface of the standing water should be covered with a film of light fuel oil (or kerosene) which chokes and kills the larvae. The oil may be poured on from a can or from a sprinkler. It will spread itself.

One ounce of oil is sufficient to cover 15 square feet of water.

The oil should be renewed once a week during warm weather.

Particular attention should be paid to cess-pools. These pools when uncovered breed mosquitoes in vast numbers; if not tightly closed by a cemented top or by wire-gauze, they should be treated once a week with an excess of kerosene or light fuel oil.

Certain simple precautions suffice to protect persons living in malarial districts from infection:

First: Proper screening of the house to prevent the entrance of the mosquitoes (after careful search for and destruction of all those already present in the house), and screening of the bed at night.

The chief danger of infection is at night (the Anopheles bite mostly at this time).

Second: The screening of persons in malarial districts who are suffering from malarial fever, so that mosquitoes may not bite them and thus become infected.

Third: The administration of quinine in full doses to malarial patients to destroy the malarial organisms in the blood.

Fourth: The destruction of mosquitoes by one or more of the methods already described.

These measures, if properly carried out, will greatly restrict the prevalence of the disease, and will prevent the occurrence of new malarial infections.

It must be remembered that when a person is once infected, the organisms may remain in the body for many years, producing from time to time relapses of the fever.

A case of malarial infection in a house (whether the person is actively ill or the infection is latent) in a locality where Anophele mosquitoes are present, is a constant source of danger, not only to the inmates of the house, but to the immediate neighborhood, if proper precautions are not taken. It should be noted in this connection that the mosquitoes may remain in a house through an entire winter and probably infect the inmates in the spring upon the return of the warm weather.

Malarial fever is prevalent in certain boroughs of New York City, and in view of the presence of standing water resulting from the extensive excavations taking place in various parts of these boroughs, is likely to extend, if means are not taken for its prevention.