REGULATIONS OF THE BOARD OF HEALTH, NEW YORK CITY, IN AID OF MOSQUITO EXTERMINATION AND THE PREVENTION OF MALARIAL FEVER

(In Force from March 15 to October 15.)

1. No rain-water barrel, cistern, or other receptacle for rain-water, shall be maintained without being tightly screened by netting, or so absolutely covered that no mosquito can enter.

2. No cans, pails, or anything capable of holding water, shall be thrown out or allowed to remain unburied on or about any premises.

3. Every uncovered cesspool or tank shall be kept in such condition that oil may be freely distributed so as to flow over the surface of the water. Covered cess-pools must have perfectly tight covers, and all openings must be screened.

4. No waste or other water shall be thrown out or allowed to stand on or near premises.

Information is requested as to the presence of standing water anywhere, so that the premises may be inspected and the legal remedies against the same be applied.

The prompt cooperation of all persons in the enforcement of the above regulations is earnestly desired, and they are a.s.sured that in this way the breeding of mosquitoes on their premises may be prevented.

Mosquitoes are, so far as known, the only means of conveying malaria.

"RASHES" OF CHILDHOOD

The following table gives all the characteristics of the rashes that accompany the eruptive fevers. The term "incubation" means the period of time which elapses between the time when the child was exposed to, or caught the disease, and the time when the child is taken sick. It is sometimes interesting to know where a child could have caught a disease; so if we know the incubation period we can tell exactly where the child was on the day, or days, when it was infected.

-----------+------------+-----------+-----------------+----------+---------+ Name | Incubation |Day of Rash|Character of Rash|Rash fades|Duration -----------+------------+-----------+-----------------+----------+---------+ Measles | 10-14 days | 4th day |Small red like |On the |6-10 | | |spots resembling |7th day |days | | |flea bites, first|of fever | | | |appearing on face| | | | |and forehead, | | | | |forming blotches | | | | |with semi-lunar | | | | |borders. | | -----------+------------+-----------+-----------------+----------+---------+ Scarlet | 1-6 days | 2d day of |Bright scarlet, |On 5th |8-9 days Fever |occasionally| fever |rapidly diffused,|day of | | longer | |first on chest |fever | | | |and upper | | | | |extremities. | | -----------+------------+-----------+-----------------+----------+---------+ Chicken-pox| 4-12 days | 2d day |Small rose |Slight |6-7 days | | |vesicles, which |scab of | | | |do not become |short | | | |pustular |duration | -----------+------------+-----------+-----------------+----------+---------+ Typhoid | 10-14 days | 7-14 days |Rose colored | |From Fever | | |papules elevated,| |21-35 | | |few in number, | |days | | |limited to trunk,| | | | |disappear on | | | | |pressure. | | -----------+------------+-----------+-----------------+----------+---------+ Smallpox | 10-14 days | 3d day of |Small, round, |9th day |14-21 (Variola) | | fever |red, hard, |scabs |days | | |papules forming |form and | | | |vesicles then |about | | | |pustules, first |14th day | | | |appearing on face|fall off | | | |and wrists. | | -----------+------------+-----------+-----------------+----------+---------+

Other Rashes.--There are so-called "stomach" rashes which are a source of much worry to mothers. These rashes may appear at any time and they may be limited to certain parts or may cover most of the body. They may be bright red, or they may be simply a general discoloration. They may appear as blotches or they may spread all over, like the rash of scarlet fever when at its height.

These rashes are of no importance, except that they indicate some derangement of the gastro-intestinal tract. As a rule they indicate indiscriminate feeding or overfeeding. Children who have had too much candy or pastries, or who have been fed things which are unsuited to their age, frequently develop rashes. Such children should have a thorough cleaning out; a dose of castor oil is probably the best cathartic to give them.

The mother may readily learn to know the difference between a rash that is unimportant and one that indicates one of the eruptive diseases, if she gives the matter a little careful thought. In the first place a child who is about to become the victim of one of the eruptive diseases will be sick, and will have a fever for two or three days before any rash appears; while on the other hand a child may go to bed in good health and may next morning be covered with a general rash, or with large blotches, without any fever and without any evidence of ill-health, except the skin condition. In the second place, if the mother gives the child a cathartic and restricts the diet for a day the rash will disappear, and good spirits and good health will be maintained; on the other hand, the giving of a cathartic to a child who is the victim of an eruptive disease will not tend to diminish the rash, but may accentuate it.

Pimples: Blackheads (Acne).--This eruption is situated chiefly on the face. It may appear, however, on the back, shoulders, and on the chest.

It is mostly seen in young men and women about the age of p.u.b.erty. It appears as conical elevations of the size of a pea; they are red and tender on pressure, and have a tendency to form matter, or pus, in their center. In from four to ten days the matter is discharged but the red spots continue for some time longer.

"Blackheads" appear as slightly elevated spots of a black color out of which a small worm-like substance may be pressed. Pimples and blackheads are due to inflammation of the glands of the skin. The mouths of these glands become filled with dust which acts as a plug causing the retention of the oily matter of the gland which becomes inflamed and hence the pimples and blackheads. Certain const.i.tutional conditions favor the development of these skin blemishes. Constipation, indigestion, bad blood from unsanitary and bad hygienic surroundings, self-abuse and bad s.e.xual habits favor the appearance of these skin affections.

Treatment.--The patient must avoid tea, coffee, tobacco, alcohol, veal, pork, fats, candy, pastries, cheese, and all edibles that are known to disagree with the digestion of the patient. Constipation must be avoided; if necessary, laxatives may be taken to keep the bowel open.

The blackheads must be squeezed out with an instrument made for the purpose, not with the finger nails. Pimples must be opened with a sterile needle. The parts should be washed three times a day with hot water and green soap, and the following mixture applied at night:--

Zinc Oxide ounces 1/4 Powdered calamine ounces 1/4 Lime water ounces 6

Mix and shake before applying to the skin.

CONVULSIONS. FITS. SPASMS

Convulsions are quite common in children, especially those under three years of age.

A convulsion in an infant immediately, or within three months, after its birth is the result of injury, either at birth or later (a fall for example) which seriously affects the brain itself. After the third month the cause of fits or convulsions is, in a very large percentage of the cases, to be found in errors of diet resulting in disturbances in the stomach or bowels--eating of articles of food difficult to digest, as green or overripe fruit, salads, fresh bread, pickles, cheese, etc.

Children of a nervous temperament are more liable to convulsions than are others. Females are more frequently victims of fits than are male children.

In infants convulsions often result from changes in the mother's milk.

Mental excitement, deep emotion, anger, frights, severe affliction and distress will so affect a woman's milk that it will cause convulsions in her child if she nurses it while under the influence of any of these conditions.

Convulsions may result from any condition that disturbs the nutrition of the child, as, for example,--exhaustion, anemia, intestinal indigestion, blood poison, and general weakness resulting from some severe sickness, especially those of the digestive organs.

Various forms of brain disease cause spasms and fits; the most common are meningitis, tumors, hemorrhage, abscesses and injuries. Convulsions may accompany certain conditions, as, the presence of worms, teething, severe burns, foreign bodies in the ear, whooping cough, pneumonia scarlet fever, malaria, sometimes measles, typhoid fever, and diphtheria. Children who are badly nourished and who live constantly in unsanitary surroundings are more apt to have convulsions than those who are well nourished and who live hygienically. One attack renders the patient more liable to another, and when the "habit" is established any trivial cause may incite a convulsion; persistent and systematic efforts should therefore be taken to prevent the attacks. The best preventives are:

1st. To regulate the diet and the bowels.

2nd. Remove adenoids and worms, if they exist.

3rd. Avoid the use of alcohol, coffee, tea, fresh bread, pastries, candies and all improper foods.

4th. Guard the child against catching cold, infectious diseases and all fevers. In other words, save the child from the cause and the convulsion will not take place.

By regulating the bowels we mean that everything the child eats must be seen by the mother, must be with the mother's permission, and must be suited to the child's age. If there is any question about the latter it will be advisable to have a physician write out a list of articles suitable to the child. It is generally necessary to eliminate meats, pastries, candies, sugar to a large extent, gravies, salads, sauces, and all the extras of the table, as pickles, mustard, relish, etc., as well as coffee, tea, cocoa, and alcohol.

The child should live in the open air as much as possible; a daily warm bath, followed by a quick, cold sponge, is a necessity.

Children subject to fits are possessed of a highly nervous temperament.

They are difficult to manage unless managed with firmness and tact. It is not necessary to be harsh, but it is imperative to be firm and decided. They must be made to realize that they are not "the master,"

that their will is not supreme, and the mother must exact this condition; otherwise these children will become dictators and selfish despots--ruining the discipline of the home, spoiling their own chance of physical health, and rendering unhappy everyone around them. The parents, therefore, have a definite duty to perform and it is not an easy one. The food should be so regulated that each day a natural movement of the bowels will take place. (See article on constipation, page 303.) If a day should pa.s.s without a movement the child should be given a hot rectal enema as described on page 586.

The adenoids can be easily demonstrated to either exist or be absent.

(See page 519.) If worms are known to be present in the child they should be at once removed. If they are simply suspected, the child should receive treatment for them, just the same. (See page 549.)

By going a long time without a convulsion the nervous system will recuperate itself, and become so strong and healthy that what once would cause a fit will make no impression in its new strengthened state; therefore, if you "save the child from the cause," the convulsions will cure themselves, as it were.

There are some cases of convulsions for which no satisfactory explanation can be found.

Treatment.--When a child has a convulsion, remove its clothing and put it into a mustard bath. The temperature of the bath should be 105 F.

Every part of the child should be under the water except the head, which is supported in the palm of the hand. While it is in the bath its body, and especially its arms and legs, should be briskly rubbed by the hands of an a.s.sistant in order to keep the circulation active. A rectal injection of soap suds or plain salt and water (see page 579) should be given while the child is in the bath, because, as explained above, a large percentage of these cases are caused by gastro-intestinal derangements. The rectal injection will likely remove the cause. An ordinary convulsion lasts from five to ten minutes. When the child is removed from the bath it should be placed in a warm, comfortable bed and kept absolutely quiet. A hot-water bottle may be put near its feet and an ice-bag or cold cloths should be kept on its head. It should be given a full dose of castor oil and allowed to go to sleep. Its diet should consist of light broths for two or three days and during this time it should not be disturbed or annoyed by too much attention. This is as far as it is wise or safe for any mother to go in the treatment of convulsions. A physician should be called in every instance, because a convulsion should never be regarded lightly. Many children have become idiots, others have been afflicted with paralysis, because of inattention at the proper time.

SUMMARY:--

1st. Convulsions must always be regarded as serious.

2nd. Convulsions demand prompt treatment.

3rd. Every mother should know that an English mustard bath--hot--is the first resort in convulsions.

4th. While this is being done she can read the home treatment in this book and carry it out before the doctor comes.

5th. If the fit is not caused by some stomach or intestinal trouble, have the physician find out the cause and tell you what to do, and do it faithfully, because if you neglect the proper treatment the child may become idiotic or paralyzed.

BED WETTING. ENURESIS--INCONTINENCE