How to Disinfect the Bed Clothing and Clothes.--The surest way is to boil them for half an hour; otherwise they may be left in the room while it is being disinfected. Spraying the clothes with a spray of formaldehyde is an effective way of disinfecting them.

MUMPS: EPIDEMIC PAROt.i.tIS

Mumps is a contagious disease. It is most common between the fourth and sixth years. Infants are rarely affected. The disease is not very contagious, direct contact being necessary to communicate it. Every case should be isolated for a period of three weeks from the beginning of the disease.

The seat of the affection is the parotid gland which is located in front of and on a level with the ear. One or both glands may be affected at the same time or one may follow the other in succ.u.mbing. The duration of the disease from the time the swelling becomes noticeable is about ten days. It is contagious for a week after the swelling subsides. The period of incubation is from one to three weeks.

Symptoms.--In the majority of cases the first symptom is the swelling and the discomfort which it causes. In more severe cases the child feels sick and is listless for from twenty-four to forty-eight hours. There may be a headache, vomiting, pains in the back and limbs, and fever.

There is pain in the swelling which is increased by movement of the jaws and by pressure. The degree of the swelling varies with the severity of the attack. It may be very little or it may be so great as to completely distort, and render unrecognizable, the face. It must be remembered that, though mumps is not regarded as an important or dangerous disease, it may a.s.sume dangerous characteristics.

We sometimes see distressing complications with mumps. In boys, orchitis, or inflammation of the t.e.s.t.i.c.l.es, occasionally occur. In girls, ovaritis, or inflammation of the ovaries may be present. These complications may be avoided by keeping the patients in bed.

Treatment.--Keep the child in bed until the fever is gone. Keep him in the house for one week after the swelling has entirely subsided. He should be put on a liquid diet while the fever lasts. The bowels should move each day.

The mouth should be kept clean by an antiseptic mouth wash. If there is much pain in the swollen gland, warm, wet dressings give the best results. Sometimes it is advisable to paint the gland with belladonna ointment. If it is not very painful, the most comfortable way to dress the gland is simply to place over it a large pad of absorbent cotton held in place by a broad strip of flannel cloth.

CHICKEN POX. VARICELLA

Chicken pox is an affection almost entirely special to children, in whom it may be observed from their first year, although it is especially frequent from the ages of two to six. It appears often in the epidemical form and spreads by contagion.

Some doctors are inclined to regard varicella as a very attenuated form of smallpox, hence the name "chicken pox," by which it is popularly known. This opinion is based merely on the a.n.a.logy between the two types of skin eruptions and the coincidence sometimes observed between two epidemics of smallpox and chicken pox. But the theory falls on considering that, on the one hand, chicken pox offers no safeguard against infection by smallpox and does not prevent the effects of vaccination, and, on the other hand the disease may occur in children who have been vaccinated or who have had smallpox. Chicken pox, too, differs essentially from smallpox in the course of its development.

After a period of incubation, extending over a fortnight, chicken pox becomes apparent by such symptoms as slight shivering, extreme fatigue and a general but not very intense condition of fever. In less than twenty-four hours small pink spots will appear on the skin, and these after a few hours are topped by a vesicle, and the next day the whole rash shows a vesiculous appearance.

The vesicles are sometimes small and pointed, sometimes more voluminous and globular in form. They are filled with a limpid or a slightly yellowish liquid. Their base is sometimes surrounded by an inflammatory ring. By the third day the contents of the vesicle has become thicker and tends to become purulent. On the fourth day desiccation commences, and the vesicles shrivel and shrink in and form small brownish scabs, which fall about the eighth day. Frequently the child will scratch them off with the finger nails before they are entirely desiccated. The vesicles leave small reddish spots, which generally disappear gradually, almost always without a scar.

An eruption of chicken pox does not burst out all over the body at once, but appears in successive rashes. It is not confined to any special parts of the body. It may begin and spread at the same time from the face, the trunk of the body or the limbs. A dozen pimples may be seen the first day, while three or even ten times as many may be visible the next day, and so on for several days in succession.

Sometimes the vesicles appear on mucous membrane at different parts--the mouth, tongue, soft palate and tonsils--and may also invade the conjunctiva and cornea, or the larynx, where they will set up laryngitis.

Owing to the very contagious nature of chicken pox, the first thing to be done is to provide for the complete isolation during a period of twelve to fifteen days of all patients attacked by the disease.

The treatment of the disease is solely a matter of hygiene. The more severe the fever the stricter the diet should be, and in the case of great fever, the diet should be restricted to broth and milk. If there is no fever the child need not be placed on any special diet.

If the intestines are sluggish, they may be stimulated by administering a dose of castor oil. It is advisable to make the patient rinse his mouth two or three times a day with a mouth wash. It is also well to apply a lotion around the eyes and face, consisting of two per cent.

boracic acid solution with the chill taken off. Finally, in order to prevent the child scratching the sores and the consequent danger of inoculation by the finger nails, it is a good practice to rub a small amount of carbolated vaseline over the itching parts. It is frequently found necessary to have the little patient wear white woolen gloves to prevent scratching and infecting the sores. If a child scratches the sores on the face it will leave an unsightly mark which will stay for the rest of its life.

The child, of course, should not be allowed to rejoin his playmates without having had a good bath, and having had his clothes completely disinfected.

INFLUENZA: LA GRIPPE

The most important feature with reference to influenza in children is its very active tendency to develop complications. These complications generally affect the respiratory tract. So we find in children suffering from grippe an easy disposition to get bronchitis or broncho-pneumonia.

The younger the child the greater the danger.

The disease itself, so long as it remains an uncomplicated influenza, is not of much importance or severity. The lesson to be learned, therefore, is to treat the disease with respect and take every precaution to avoid the possibility of developing a complication.

La Grippe is a highly contagious disease. It prevails epidemically, and after an active epidemic it may remain in the vicinity for a number of years. It is more frequently seen in the late winter months and early spring. The poison of the disease clings to clothing and apartments as well as to railroad and street cars. The germ is found in the sputum and in the nasal secretions.

Sneezing is one of its symptoms and it is one of the ways by which the disease is spread around. Children should never be brought near an adult suffering from influenza. One attack does not render the patient immune to a subsequent attack as is the case with most of the contagious diseases. The reverse is the rule with La Grippe because one attack favors the development of another attack. It is a common experience for many people to have influenza every winter or spring.

Symptoms.--If a child "catches" grippe, it becomes quite sick abruptly. There is usually chilliness, pains in the muscles all over the body, more or less fever, sometimes nausea and vomiting. If the attack is a more severe one, the prostration is more marked, the temperature higher and the signs of shock and poisoning of the system are more in evidence. A child a few months old can get influenza so severely as to cause collapse and death in thirty-six hours. As a rule the type of grippe most common in infancy is of a very mild character. It lasts about a week. Children may be a little slow in convalescing and it may be three or four weeks before they regain their health.

Complications.--As has been intimated, the most frequent complication is bronchitis and the most fatal one is broncho-pneumonia.

A congestion of the entire mucous membrane of the respiratory tract, producing a nasal discharge, a sore and inflamed throat, pains and a feeling of compression, with a cough in the chest, may accompany the disease.

Gastric symptoms, with vomiting, intestinal disturbance, diarrhea, with or without mucus and blood, are quite common in some epidemics.

Not infrequently we have numerous cases in which the ear seems to be the vulnerable part. As a consequence running ears have to receive most of our attention. When the ears are affected, the glands of the neck become inflamed. They swell up and add considerable to the discomfort of the little patient.

Treatment.--Cases of influenza should be isolated. Children should be put in a room by themselves and the other children of the family should not be permitted to see them. The rooms should be disinfected after the case is over. As complications are the dangerous element in grippe, we should try to prevent them. This can be best done by promptly putting the child in bed, making him comfortable, opening his bowels by castor oil or calomel. He should be made to drink hot lemonade. He should be kept on a light diet from which meat and vegetables are excluded.

The above treatment will usually suffice in the ordinary uncomplicated grippe. If complications arise they must be treated according to the conditions.

It is well to remember that the degree of prostration following a rather severe attack of grippe is out of all proportion to the extent of the disease. These little patients sometimes suffer considerably and do not regain their strength promptly. Experience has taught us that the best thing to do is to send them away. A change of climate will do wonders for them, more quickly and more thoroughly than all the medicine we can give them at home. The seash.o.r.e is particularly good for them.

DIPHTHERIA

Diphtheria is an acute, specific, infectious, communicable disease. It affects the tonsils, throat, nose, or larynx. It is most frequently seen in children between the ages of two and five years, though it may appear at any time during life. The two s.e.xes are equally liable to it. The same person may have the disease twice or more times at different ages.

Children suffering from disease of the nose or throat are more likely to get it than are others. Such diseases are cold in the head with running nose, catarrh of the nose and throat, inflammation of the mucous membranes of the nose or throat.

Diphtheria may occur at any time of the year, though it is more frequent during the cold months. The incubation, or the length of time between exposure to the disease and the development of the symptoms, is between two and five days. In its mild form the disease may be present without giving any const.i.tutional symptoms. In its severe form, however, it is one of the most dangerous diseases of childhood. In large cities it is present all the year round with more or less frequent outbreaks in the form of local epidemics. In the country it is only seen in its epidemic form. It does not arise without a cause, that is, there is always a preceding case from which an epidemic springs, though it is not always easy to trace the connection. The child inhales the bacilli which cause the disease with the air it breathes. The bacilli may lodge on toys or other articles from which the child gets them. Direct infection is usually the mode of communication through which a child obtains the disease. The saliva and mucus from the nose contain the bacilli in large quant.i.ties and if a patient coughs or sneezes they are expelled in this way and infect others. Frequently a child suffering from a mild form of diphtheria may attend school and infect others without it being known that the child has the disease.

Symptoms.--The symptoms vary with the severity of the attack. There are mild cases, as has been stated, that give no const.i.tutional symptoms. There may be a small amount of local disturbance in the throat or nose and there may be some membrane present, but, for some reason, there does not seem to be any absorption of the poison into the system and the child escapes the systemic disturbance. Even as a local condition these cases vary. There is always a fever at the beginning, but the child never seems sick enough to go to bed. If the throat is examined it will be found to be red and slightly inflamed, there may be spots on the tonsils, or there may be a gray film over them. There is no discharge from the nose and the child does not complain of an excess of mucus from the throat. The spots may last for a week and then disappear.

These cases are difficult to diagnose without making a culture, and if the physician insists upon keeping the child confined to bed while apparently well the family as a rule object, though it is absolutely necessary. These are the cases that do great harm in school, and no mother should object if the physician insists in taking preventative measures to stop an epidemic if the bacilli have been found in the child's throat. She should rather feel thankful that the child escaped so easily.

Since the introduction of ant.i.toxin we do not see the severe cases now, so that a description of them would not be of any use in a book of this character. Mothers should, however, know that it is absolutely criminal to take any chances with a "sore throat." Ant.i.toxin is a prompt and an absolute remedy if used soon after the onset of the disease. It is more sure if used the first or second day, still reliable the third day, but its efficacy diminishes the longer we postpone its use from the date of the onset of the disease. When, therefore, a child complains of being sick and states that its throat hurts, medical aid should be at once sought.

The disease may develop in one of two ways. It may begin as a slight indisposition for a day or two, and perhaps some soreness of the throat.

The fever may be slight. The child will continue to be sick despite any treatment given and will get slowly worse until the fourth or fifth day, when it will be impossible to mistake the condition.

At other times the disease begins abruptly. The child complains of being sick. It may vomit, or suffer from headache, chilly feelings, and a fever. The glands in the neck may swell and cause considerable disturbance. There is, as a rule, an abundant discharge from the nose and there is an excess of mucus in the throat. Membrane is seen in the throat. It may cover the tonsils and spread over the entire throat cavity, or it may extend up into the nose and over the roof of the mouth. All the parts are much swollen and breathing is interfered with, sometimes seriously. If the attack is very severe there is an active absorption of poison going on from the throat which soon renders the little patient intensely sick. There is marked weakness and prostration, the circulation becomes poor, the pulse rapid and the child falls into a stupor.

The physician will, of course, have taken complete charge of the case before the patient has gone thus far. The nursing of the case, which may fall to the mother if no trained nurse is present, is most important.

She should preserve absolute cleanliness of herself and of the sick room. She should never eat or sleep in the same room with the patient, and should use a gargle, which the physician should prescribe, frequently during the day. She should dress simply, so that whatever is worn can be changed often and washed easily. Every article of furniture must be taken out of the sick room that is not absolutely essential in the care of the case. If toys are allowed they should be burned as soon as the child is tired of them, never left around the house after the case is over. The room should be a large one and it should be thoroughly aired each day. The floor should be washed each day with a solution of bichloride of mercury, and all dusting should be done with a wet cloth.

The bed linen and any rags or handkerchiefs used should be treated as in scarlet fever. All vessels in which the patient expectorates should have an antiseptic in them. The room must be disinfected after the case is over.

The patient must be kept in bed during the entire attack. He must not be allowed to even sit up in bed until the physician gives him permission.

This is a very important essential in the treatment of this disease, and the nurse must be held responsible for the conduct of the patient in this respect. Because of the character of the poison, there is a tendency to paralysis of the heart, and frequently children have been allowed to sit up too soon only to fall back dead in bed. The same thing has occurred later in the disease when children have been allowed to play too heartily before the poison had an opportunity to completely eliminate itself. Nursing children should be fed on breast milk pumped from the mother, but they must not nurse it themselves. Older children can take milk and should depend upon it mostly. The physician will give any other special directions that he may think necessary, the duty of the mother being to see that they are faithfully carried out.

WHOOPING-COUGH

Whooping-cough is usually seen in young children. It may, however, affect a person at any age. It is contagious. During infancy it is one of the most fatal diseases. During adult life it is a dangerous condition, while in childhood it is simply regarded as a mildly contagious disease.