When the child is convalescing and when there is only mucus in the stools, with no fever--as in cases of chronic ileo-colitis--the colon irrigations should be stopped, as they tend to keep up the discharge of mucus in these cases. If, however, there is a relapse with fever, which would indicate a fresh infection with more discharging mucus and possibly green stools, the irrigation must be used until the fever subsides.

Colon irrigations should always be given in every case of convulsions in infancy, first to clean out the bowel to prevent putrefaction, and second to empty the bowel on general principles because an overloaded bowel is very frequently the cause of convulsions in children.

When irrigation of the bowel is given at all it must be given thoroughly. Enough water must pa.s.s into the bowel to wash it all out.

For this reason it is essential that the catheter should be all in and in the bowel--not doubled on itself two or three inches in the bowel. If it is a serious case and the mother nervous, someone else should give the washing--preferably the physician himself. If the child objects strenuously, as often happens, it must be done with greater care to be successful. Remember that a colon irrigation is never given unless it is absolutely necessary and as a consequence it is given to accomplish a certain purpose; it must, therefore, be done thoroughly. If it is not, your child may miss the chance it has of getting over some immediate difficulty and if the moment of the "chance" is wasted or lost, that moment will not return. Be thorough, therefore.

Enema.--Some physicians talk about a high enema and a low enema. A high enema is really an irrigation as described above. The following remarks apply to low enemas only.

A so-called low enema is given to clean out the r.e.c.t.u.m of constipated matter, or for the introduction of food or medicine by r.e.c.t.u.m, when for various reasons it is necessary to spare the stomach.

It may be given with the fountain syringe or with the ordinary bulb (baby) syringe. A catheter may be put on the tip of the syringe if it is thought best to inject higher up than in the r.e.c.t.u.m.

When an enema is used in infants or older children for the relief of constipation, the best medium to use is glycerine. For an infant, one teaspoonful to an ounce of water is sufficient; for older children, one tablespoonful to two ounces of water, given with the bulb syringe, will give prompt results. If the constipation is p.r.o.nounced, the fecal ma.s.s very hard, an enema of sweet oil, allowed to remain in for ten minutes, will soften it and permit a movement.

Soap suds are often used. They are good but not as reliable as the glycerine or oil; if, however, neither of these two are at hand the soap suds may be given.

Enemas should be carefully given and the liquid slowly injected. If the fountain syringe is used care must be exercised in not having the bag too high. If it is too high the liquid will flow in too strongly, either injuring the bowel wall or causing the child to strain immediately and pa.s.s out the injection before it has an opportunity of accomplishing its work.

The temperature of the enema should be warm--not hot, and not cold, simply body heat.

METHODS OF REDUCING FEVER

During the course of acute illness it is frequently necessary to reduce the fever, if possible, without the use of drugs. The following means are often adopted. It is desirable that the mother should know just how to carry out these methods:

Ice-Cap.--An ice-cap is used to protect the brain when a child or adult is running a very high fever. It is put on when the fever is above 103 F. It may be used in other conditions--brain disease, or disease of the meninges or cord--in which case the physician will be in attendance and will direct what should be done.

Ice-bags are procured in the drug stores. The best one is the flat French ice-bag. Fill it three-quarters full of finely chopped ice, put the ice-bag in a towel, and place on the patient's head. There should be only one thickness of the towel between the ice-bag and the head.

It will be necessary to keep a record of the fever so that the ice-bag may be withdrawn when it falls below 103 F.

When the ice melts the bag must be at once refilled. This is often overlooked by careless mothers.

Cold Sponging.--Cold sponging is used to reduce fever or to allay nervous irritability. Equal parts of alcohol and water or vinegar and water are used. The temperature of the water should be 80 to 85 F.

Infants to be sponged should be completely undressed and laid upon a blanket. The sponging should be done for about fifteen or twenty minutes, after which the child is wrapped in a dry blanket without further clothing except the diaper. To be effective it must be done frequently.

Cold Pack.--The cold pack is used to reduce fever. It is one of the simplest and one of the best means we have. The child is undressed completely, and laid upon a blanket. It is completely covered with a small blanket (except its head) wrung out of water at 100 F. Outside of this the child is rubbed with a piece of ice, front and back, for a sufficiently long time to render the surface cool, but not cold.

Children take kindly to this means of reducing fever; there is no shock and they are quieted by it.

Just how long one will rub with the ice depends upon circ.u.mstances. From five to thirty minutes may be employed. The head should be sponged with cold water while this is being done and it is a good plan to have a hot-water bottle at the child's feet.

The Cold Bath.--To reduce fever the cold bath is used in the following way: Water at a temperature of 100 F. is put into the bath and the child is first put into this water, then the water is reduced by putting into it shaved ice until it reaches 80 F. The child's body is well rubbed while it is in the bath and cold water is applied to its head.

The bath is continued for five minutes, or sometimes with a robust child to ten minutes. On removal the child should be put into a warm blanket after being thoroughly dried.

Rectal Irrigations.--These are sometimes given to reduce fever. They are very useful and very successful if they are given properly and without exciting the child too much. It is best to give water of an ordinary temperature at first and gradually reduce it to 70 F. It should be continued for ten minutes or longer. It may be repeated every three hours. (See page 586.)

VARIOUS BATHS

Every mother should know how to give any bath that may be directed by the physician.

The Mustard Bath.--Take from three to four tablespoonfuls of English mustard; mix thoroughly in about one gallon of warm water. Add to this about five gallons of plain water at a temperature of 100 F. If it is necessary to raise the temperature of the water higher it may be done by adding water until the temperature reaches 105 or 110 F.

The mustard bath is exceedingly effective in cases of shock, great sudden depression, collapse, heart failure, or in sudden congestion of the lungs or brain. The special use of the mustard bath is in the treatment of convulsions; it is also useful for nervous children who sleep badly. Two or three minutes in the mustard bath, followed by a quick rubbing, will induce refreshing sleep in these children. It is not necessary to have more than one tablespoonful of mustard in these cases.

The Hot Bath.--A bath is prepared of water at a temperature of 100 F.

After the child is in the bath the temperature of the water is raised to 105, or to 110 F. It is not safe to go above this point.

The body of the child should be well rubbed while it is in the bath. In most cases it is advisable to apply cold water to the head while the child is in the bath. A bath thermometer should be kept in the water to see that it does not rise above the temperature desired.

The hot bath, like the mustard bath, is used to promote reaction in cases of shock, collapse, etc., and in convulsions.

The Hot Pack.--Remove all clothing from the baby and envelop the body in a sheet wrung out of water at a temperature of 100 F., to 105 F., after which the body should be rolled in a thick blanket. Those hot applications may be changed every twenty minutes until free perspiration is produced. This condition may be kept up as long as is necessary.

The hot pack is used mainly in disease of the kidney.

The Hot-Air or Vapor Bath.--The child is put in bed wholly undressed with the bed clothing raised about twelve inches, and held in that position by a wicker support. The child's head is of course outside the bed clothing. Beneath the bed clothing hot air or vapor from a croup kettle is introduced. This will cause free perspiration in twenty minutes. It may be continued from twenty to thirty minutes at a time.

The vapor bath is used in diseases of the kidney, as a rule.

The Bran Bath.--In five gallons of water place a bag in which is put one quart of ordinary wheat bran. The bag is made of cheese cloth.

Squeeze and manipulate the bran bag until the water resembles a thin porridge. The temperature of the water is usually about 95 F., though it may be given with any temperature of water.

The bran bath is of great value in eczema, or in rashes about the b.u.t.tocks, or in delicate skin conditions when plain water would irritate.

The Tepid Bath.--This bath may be given at a temperature of 95, or 100 F. It is of distinct advantage in extremely nervous children. To induce sleep it is often better than drugs.

The Cold Sponge or Shower Bath.--This bath should be given in the morning in a warm room. A tub should be provided with enough water in it to cover the child's feet. This water should be warm because when the feet are in warm water it prevents the shock which frequently comes when cold water is applied to any other part of the body.

A large sponge is filled with water at a temperature of from 40 to 60 F. This is squeezed a number of times over the child's chest, shoulders, and back. While the cold water is being applied the body should be well rubbed with the free hand of the mother. The bath should not last longer than half a minute. When finished take the child out quickly and stand him on a bath towel and give him a brisk rubbing with a bath towel until the skin reacts. This is an exceedingly valuable tonic for a delicate child. It should not be used on younger children than eighteen months of age. In younger children a cold plunge is preferable.

For the cold plunge water at a temperature of 55 F. is prepared. The child is lifted into this and given a single dip up to the neck. He is then briskly rubbed off as above.

There are a very few children who do not take kindly to either the cold sponge or plunge. These children do not react; they remain pale or blue and pinched for some time after. It may be necessary to discontinue the procedure or to use water of a higher temperature.

POULTICES

Poultices are useful in inflammation and for the relief of pain. To be of any value they should be applied frequently--every ten or twenty minutes--and they should be applied hot.

Ground flaxseed is the best material for poultices. It should be mixed with boiling water until the proper thickness is reached. It may be kept simmering on a fire. When one poultice is taken off it can be sc.r.a.ped into the pot and heated over if there is no discharge. Each poultice should be put into clean muslin, put on the part and covered with oiled silk. This will help to retain the heat and prevent the clothing or bed sheet from becoming wet.

HOT FOMENTATIONS

A hot fomentation is simply a clean poultice. Several thicknesses of flannel are taken, wrung out of very hot water, covered with cotton batting, and then with oiled silk.