BIRTHMARKS

A red or purplish patch on the skin is the result, as mentioned in an earlier chapter, of an embryological accident in which one or more embryonic cells slipped out of place in the early days of skin formation. These accidental markings may occur on the face, the scalp, or on any other portion of the body, and they should be let alone, unless they show a tendency to grow, when it may prove best to give them proper surgical attention.

A mole is also a birthmark, and if found upon the neck or shoulders where it is likely to disfigure, it may be removed by the high-frequency spark, or by surgery, in the same way as warts. Never tamper with moles. Leave them alone or turn them over to the surgeon.

ERYSIPELAS

Erysipelas is a much-dreaded disease which is the result of infection with the blood-poisoning germ--streptococcus. It usually occurs about a wound, and is due to infection by this microbe. If it follows circ.u.mcision, it is due, of course, to infection, and may be very serious, even causing death. It attacks persons of any age and is oftenest seen on the face. In appearance, the skin is a bright and shiny red, with a definite line of demarcation slightly raised at the edges because of the swollen tissues underneath. On pressure, the redness disappears but reappears immediately upon relieving the pressure. The inflammation, pain, and fever often continues a number of days, during which the child should be isolated from all other members of the family. The bowels should be freely opened, and the diet should be liquid and soft; while local treatment is cared for by the physician who should always be called. Should erysipelas develop on a very young baby it is very important that he should be removed at once from the mother. As stated before, the disease is produced by the blood-poisoning germ which is very much to be avoided in any and all stages of obstetrics. One attack in no way renders the patients immune. They may have repeated attacks of erysipelas. The treatments should be started early and kept up most rigidly.

SCABIES AND LICE

In thickly settled districts among the poor and uneducated, where filth and untidiness reign, the "itch" is a very prominent disease. It is caused by the itch mite, a parasite which burrows underneath the skin leaving behind its eggs in little irregularly shaped, bluish tinted ridges. Such a profound itching is set up by this burrowing and depositing of eggs that the child cannot resist scratching, and all taken together produces the typical itch-rash. The common site for this rash is on the sides and between the fingers and toes; on arm pits and b.u.t.tocks of the child, as well as at the waistline. The treatment is usually beyond home remedies. A physician should have charge of the case who will conduct a line of treatment which, if diligently followed, will rid the body of this scourge within a week or ten days.

Along with the itch are often found parasites of the head, or lice (pediculi). It is not at all infrequent to find them in the heads of uncared for children; but if a much-cared-for child is brought in contact with an infected head he will probably "catch" the infection.

A most intense and disagreeable itching is set up at once. The treatment consists in getting the head clean by the use of a very fine comb, thus endeavoring to remove the adult parasites as well as the eggs or "nits." However, great care should be taken to avoid injuring the scalp. Perhaps the simplest and most effective treatment known is the kerosene bath which should be applied at night, the hair being done up in a bandage until morning, when the kerosene is washed off with soap and water and then the hair given a vigorous vinegar shampoo in order to destroy the "nits." Tincture of larkspur, or an ointment made from the seeds, may also be used. It is applied several days in succession and then washed out.

CHAPTER x.x.xIII

DEFORMITIES AND CHRONIC DISORDERS

Reference has already been made to certain accidents of embryology during the very early days or weeks of the formative period of the embryo. Common ill.u.s.trations of such deforming developmental accidents are harelip, cleft palate, and club foot.

HARELIP AND CLEFT PALATE

In the case of a partial or complete failure of the two sides of the face to come together in the median line, a deformity results which is known as harelip--a partial or complete cleft of the upper lip. It may be a single or a double cleft, exposing the teeth, or the cleft may even extend up into the nose. This deformity may seriously interfere with nursing, making it necessary to resort to feeding with a medicine dropper and later a spoon. The success of the operation for the relief of harelip, which should usually be performed during the early months of life, is often very remarkable.

Should this failure to unite be in the deeper structures of the head, then cleft palate is the result. This, too, may be partial or complete: partial as seen in a cleft of the soft palate only; and complete, when the hard palate also is involved. In such an instance it is the floor of the nose that is defective; hence the nose and mouth are one cavity.

A specially devised apparatus which a.s.sists the child in nursing may be found on the market, for nursing is well-nigh impossible without the closure of the roof of the mouth. The operation for cleft palate is usually successful when performed at the proper time and by competent hands.

In tongue-tie the weblike membrane underneath is attached too far forward, so that the child is quite unable to protrude his tongue, and this condition greatly interferes with sucking. The operation for the relief of this condition is slight, and should be performed as soon as the defect is discovered.

DEFORMED HANDS AND FEET

Occasionally there is a webbing of one or more fingers of the hand, and there are sometimes seen too many fingers or a double thumb. It is needless to allow such a deformity to continue; the operation for relief is often remarkably successful and should be performed very early.

Clubfoot results when short tendons or contracted tendons pull the toes inward or outward with raising of the heel. Treatment must be inst.i.tuted early; braces or splints are applied; and untiring efforts are put forth in ma.s.sage and other lines to prevent a lifelong handicap of clubfoot.

An inward rotating of the legs presents the deformity of pigeon-toe.

The normal foot naturally inclines toward "pointing in," and such a condition should not be discouraged. Many flat feet (broken arch) are due to shoe lasts which compel the toes to slant "out," and the bunions which so often follow such mistreatment may be exceedingly painful.

By all means place shoes on the pigeon-toed child that possess straight lasts with flexible arches, and which admit of the exercise of many muscles of the foot which otherwise remain inactive.

As the child grows older the toenails thicken, and often in their tr.i.m.m.i.n.g they are cut so closely at the corners that sometimes a condition results known as ingrowing nails. Such are very painful and must receive special attention. First of all, the nail is cut squarely, and after sc.r.a.ping it thin the corner is lifted and cotton so placed under it that the nail's downward and inward growth is stopped.

SPINAL CURVATURE

Curvature of the spine is more common than is usually thought. The most frequent variety of it is the lateral curvature. One shoulder is lower than the other, and the hips are therefore uneven. Rickets, during infancy, is the most common cause of spinal curvature.

Improper sitting at school--sitting on the edge of the seat--or carrying heavy loads are often contributing factors to the production of lateral curvatures. Only the muscles and ligaments enter into this deformity, hence the treatment should be started early and should consist of:

1. Stretching exercises.

2. Hanging from the rounds of a ladder securely fastened to the wall.

3. Certain applications of hot fomentations to the spinal muscles for their relaxation.

4. Firm cushion placed under one or other of the hips to encourage the re-establishment of muscular poise.

5. Special supervision of the case.

POTT'S DISEASE

Pott's disease, or tuberculosis of the bone, often results in an angular spinal deformity. This curvature, unlike the lateral curvature, is a sequela of an actual disease of the bones. It is always very serious and demands early treatment from skilled hands.

Early in the disease there is a peculiar stiff, tottering gait. The little child holds the spine rigidly, and in picking up objects from the floor bends the knees instead of the spine. If the trouble is in the upper spine, the shoulders are held high and the head is stiffly poised, it is never rotated; in looking about the entire body turns.

Medical aid should be secured early. The X ray not only locates the difficulty but also determines the extent of the process. If the spine be put to perfect rest, outdoor life begun, a diet rich in fats established, the results are often wonderfully successful.

Another tubercular condition is seen in the much dreaded hip-joint disease which parents should always be on the lookout for. The earliest symptoms are crying out in the night suddenly, unnatural standing on one leg (to relieve the strain on the diseased hip) and so-called "growing pains." Call in a physician very early and inst.i.tute proper treatment. A posterior curvature of the spine is often a.s.sociated with a bad case of rickets. It is of temporary duration, and usually clears up when the symptoms of rickets have been eradicated. It involves only the back muscles--not the vertebral bones.

The young mother is often very much concerned over the misshapen head of the child as a result of a prolonged labor; and it does seem quite miraculous to see a head, more nearly resembling an egg than anything else, become beautifully round and shapely by the end of two or three days.

Protruding ears may be encouraged to lie more flatly by the wearing of a specialized bonnet at night. When the babies are too young to turn themselves they should be turned first to one side and then the other, while care should always be exercised in properly straightening out a curled under ear or an overlapping ear.

RHEUMATISM

While we so often regard rheumatism an adult disease, nevertheless, children do suffer its aches and pains as well as the fever which so often attends the inflammatory type. The so-called "growing pains" are often of rheumatic origin.

Diseased tonsils not only are often--very often--the avenue of entry of infectious microorganisms that cause one type of rheumatism, but many forms of valvular heart disease are also directly traceable to these same diseased tonsils. The treatment consists in giving proper attention to the tonsils, even removal if necessary--and if the child is old enough. All other possible causes should be located and removed; the child should have absolute rest in bed with brisk cathartics and a liquid diet (no meat broths). The diet should consist more of alkalinizing foods as shown in the special table in the appendix. Medicinal alkalines are often given when the urine shows a very high acid reaction.

SCURVY

Scurvy, seen in children who subsist on "prepared foods," is manifested by tender legs and swollen gums which have a tendency to bleed easily. Pallor, loss of appet.i.te, and insomnia accompany the condition. The treatment of scurvy is change of diet from "patent foods" to fresh cow's milk, with the addition of orange juice, daily.

In older children the food must be very nutritious; out of door life, salt glows, friction baths (see appendix), and the taking of large amounts of fats are all essential to the cure.