|Diseases of the alimentary canal|
SORE MOUTH (Sprue, Stomatitis, etc.) : In a large majority of cases, sore mouth is caused by a lack of cleanliness in the care of the bottle or the nipple, or by too vigorous cleansing of the infant’s mouth. The disease is characterized by small white spots on the child’s tongue, or on the inside of the cheeks and lips. These spots sometimes bleed. They are painful and if neglected go on to ulceration. If taken at the start, they can usually be cured by hygienic measures alone. Scrupulous care in cleansing the bottles and nipples as previously directed (see page 72) is necessary. The nipples must be changed if too large or too hard, and after each feeding the mouth must be rinsed with warm water, using a soft cloth, and not the finger, for the purpose. The disease is more likely to be present in poorly nourished infants. It may be prevented by the measures mentioned and by keeping the infant in good physical condition.
SORE THROAT (Tonsillitis, Quinsy) : Tonsillitis is of frequent occurrence in childhood. It sometimes follows a bad cold, or more often is the result of exposure in damp weather or when there is melting snow. Attacks of tonsillitis are usually accompanied by high fever (103° – 104°), restlessness, sometimes vomiting, and soreness of the throat internally. There is tenderness when pressure is made over the tonsils, and when the throat is examined the tonsils appear large, red and inflamed; and sometimes with white dots. It is always difficult to distinguish between simple tonsillitis and the onset of diphtheria. In such cases it is wise to make a bacterial culture from the throat. If the case is one of true diphtheria, the child’s life may depend upon early diagnosis. Scarlet fever in its onset is also very similar to simple tonsillitis. In all cases of illness where the cause is not perfectly clear, the throat should be carefully examined.
Treatment : If the case is one of simple tonsillitis, the child should be kept in bed and only milk given. Cold compressed should be applied to the throat externally, as above directed. The throat may be rinsed with hot salt solution (1/2 teaspoonful of salt to a glass of water), but not oftener than three times a day, and gargling should not be allowed. Cool applications may be used for the head, and cool sponging at night will relieve the restlessness and fever.
Aconite should be given, a teaspoonful every half hour, at the first indication of the illness, even before the throat symptoms become localized.
Belladonna should be given in place of Aconite as soon as the throat symptoms develop.
The tendency in tonsillitis is towards the formation of abscesses. These can often be prevented by the proper administration of remedies. Tonsillitis is a communicable disease, and other children in the family should be kept away from the patient. Adults should not kiss the child or come in intimate contact.
Repeated attacks of tonsillitis are sometimes due to enlarged tonsils and a weakened constitutional condition of the child. Such children require persistent and careful treatment. The operation for the removal of the tonsils is to be advised only when all other means have failed, and the tonsils are so large that they interfere with the act of swallowing. In a large majority of cases, careful constitutional treatment will prevent the necessity of tonsillotomy.
DENTITION (Teething) : The growth of the teeth is a physiological process dependent largely upon the nourishment which the child receives. When the teeth are delayed in appearing, there is something wrong with the dietary or constitution. Oftentimes the teeth will be cut by the baby with very little discomfort. There is no definite rule, and this trouble is quite as likely to come with later teeth as with the first.
In general, the symptoms of teething are somewhat as follows. The baby has a high temperature (103° – 104°), the face is hot and flushed, it is restless and wants to be walked with an carried, and cries in a peculiar whining way from pain. Oftentimes the pain is reflex and affects the ear, in which case the cry is much more vigorous, like the crying in colic. The gums become sore and inflamed and the troublesome tooth will often be seen under the surface of the mucous membrane. The child is especially likely at this time to have digestive disturbances, such as vomiting of food and diarrhoea with green stools containing undigested food. There is usually marked loss of weight while the tooth is being cut, but this is rapidly recovered later.
Treatment : As dentition is a natural process, we must direct our efforts towards making the infant as comfortable as possible during this period. In order to prevent indigestion, the food should be diluted one-half, or if necessary, only barley water should be given for 24 hours.
The infant should be kept as quiet as possible. This period is not one for the exercise of discipline, and if the baby is more quiet lying in the nurse’s arms, it should be allowed to remain. Cool water may be given from a teaspoon frequently. In case there is earache, the affected side of the head may rest upon a hot water bag or a hot salt bag. The gums should not be rubbed and the finger should not be placed in the mouth at all. The custom of feeling the child’s gums for the teeth not only adds to its discomfort, but frequently is the means of introducing disease germs to the sensitive membranes. If the child is held in the arms with the head slightly lowered, it is usually easy to see the gums, which will give all the information necessary. Teething rings and “pacifiers” are disease carriers and should never be allowed.
It should be remembered that diseases frequently occur at the time of teething, and their symptoms are disguised by the teething symptoms. Cough at this time should always be regarded as suspicious, and frequently bronchitis and pneumonia are allowed to exist without being suspected, because their symptoms are laid to teething.
The average length of time for cutting a tooth is from one to two days, and symptoms lasting a longer time may arise from some other cause.
Chamomilla may be given when the child is cross and irritable, desires to be carried in the nurse’s arms, and especially if there is diarrhoea with greenish yellow stools.
Belladonna will be more useful if the head is hot, cheeks brightly flushed, if the child wakes suddenly and frequently from its sleep, and if the pain causes violent spasmodic crying. If should be given in cases in which the ear is affected.
Calcarea carb. may be given night and morning for those cases in which dentition is delayed.
It should be remembered that in addition to the danger of the existence of other diseases during the period of dentition, there is also danger that the ear may become infected, and suppuration with rupture of the ear drum follow. Whenever the ear symptoms are not relieved in a few hours, a physician should make a careful examination. Many cases of deafness in adults are due to neglect of the parents or physician during this period of teething.
ACUTE INDIGESTION : Acute indigestion is caused by improper food. It may be from milk which has become tainted or soured, and it may be from too rich milk, or in older children from other unsuitable food. There is a rapid rise of temperature, with the usual symptoms accompanying fever, and vomiting of food. There is often acute pain with the attack. Sometimes not even water will be retained. In such cases it should be remembered that the stomach is in an extremely irritable condition and requires absolute rest. It is best to stop all food for 12 to 24 hours. During this period of fasting, water may be given very cautiously, half a teaspoonful at a time, and if this is retained, toast water may be given in the same way. If the stomach is able to retain this and the fever has dropped, barley water may be given, also in very small quantities and frequently (rather than the usual amount at the usual nursing periods). If this is well retained for 24 hours, the usual milk formula may be given diluted one-half with water. It may be gradually strengthened from day to day until the required strength is reached. During this period of returning to the normal feeding, the infant must be watched very carefully, and at the first indication of a return of the trouble the food must be stopped entirely or diluted.
Vigorous dietetic treatment of this sort will usually nip in the bud an attack of indigestion, and perhaps prevent it from becoming serious intestinal trouble.
In older children where solid food is the cause of the disease it is sufficient to stop all food for 12 hours, and then give plain milk or gruel in small quantities until the stomach is normal.
Treatment : Ipecac should be given, in water, a teaspoonful after each vomiting attack until the vomiting has ceased. It should be given in the same way if there is nausea with ineffectual attempts at vomiting.
Arsenicum, a teaspoonful every hour, should be given in place of Ipecac if the former does not relieve, if there is high fever, restlessness, hot skin, great thirst, with vomiting even of small quantities of water.
It must be remembered that many serious diseases resemble in their onset acute indigestion. Where the temperature remains high for 24 hours, or if there is no history of improper food, we must suspect that the symptoms are caused by other than gastric disturbances. Meningitis, scarlet fever, diphtheria, and pneumonia, as well as other diseases, simulate very closely acute indigestion in the early stages, and it is wise to take no chances as to the diagnosis.
DIARRHOEA (Enteritis, Summer Complaint, etc.) : This condition is sometimes the result of neglected indigestion which has caused inflammation of the mucous membrane of the stomach, which in turns has extended into the intestines. In other cases, the stomach succeeds in passing the poisonous food into the intestine and the first indications of trouble are loose watery movements.
These movements may consist simply of thin fecal matter; they may contain curds or undigested food, or, in the severer forms, mucus, pus and blood may be found. They are yellow, brown, or green, and are thin and watery. In mild attacks there may be from 2 to 4 movements daily, while in the severe forms, stools may be as frequent as every 15 minutes.
This condition is a very serious one, and should never be neglected. Intestinal diseases are the cause of more deaths in infants than any other disease. It is especially serious during the hot weather, not only on account of the infant’s lowered resistance, but also because of the contamination of the milk supply at that time.
The movements are usually accompanied by much pain, and if the stomach is involved there will also be vomiting. There is usually fever, although not as high as in acute indigestion (100° – 102°). If the condition is allowed to continue, there is rapid emaciation, pallor of the skin, extreme weakness, all of which are due to the loss of fluids from the body. In weak babies, death may result from such attacks in 2 or 3 days.
Dietetic Treatment : The dietetic treatment is the same as that given above for acute indigestion, except that even more caution must be used in returning to the normal food. In cases where there is a suspicion as to the purity of the milk supply, the milk should be boiled before being used. Older children may be fed on browned flour or arrowroot gruel or meat broths until the symptoms have disappeared.
The condition is a serious one – the younger the child, the more serious. All the resources of the physician will be taxed, and no attempt at home treatment should be made except in rare emergencies when a physician cannot be secured. It is sometimes necessary to wash out the intestine as previously directed, and hot salt injections may be necessary to replace the loss of fluids. These measures are, however, rarely necessary if the case is treated carefully and intelligently at the first signs of the trouble.
Remedies : Cuprum should be given, a teaspoonful after each movement of the bowels, if there is sharp pain, if the stools are greenish and contain undigested food. If given early it will prevent a serious attack.
Arsenicum should be given in the same way if the stools are liquid and brownish or yellow, if they irritate the skin around the buttocks, and if there is much thirst for small quantities of water.
Nursing : In nursing a case of diarrhoea special attention should be paid to the quality and quantity of the air supply. While the child must not be allowed to take cold, yet if the disease occurs in the summer, as it frequently does, it will be well to have the bed by the window or if possible out of doors. The greatest cleanliness must be observed. The buttocks and thighs must be kept clean without the use of too much soap or rubbing. Dusting powder should be used sparingly in this region. It must be remembered that the stools are loaded with bacteria and are highly contagious. For this reason, the soiled napkins, if they are not burned, must be boiled or otherwise disinfected, and the nurse’s hands must be scrubbed in soap and water and alcohol after touching the napkins.
CONSTIPATION : Constipation in children is usually due to improper feeding. In addition to the general measures given in the section on feeding, the following remedies may be mentioned :
Nux vomica when there is desire for movement which is ineffectual.
Bryonia when the stools are small, hard, dark in color as if burnt.
Calcarea carb. when the stools are light colored, in fat children in whom the development of the bony structures is delayed.
These remedies are to be administered 8 pellets in half a glass of cold water before each meal and before retiring. In infants one pellet may be dissolved in a teaspoonful of water and given night and morning.
These remedies are not cathartics and must be given for several days to obtain results. After the normal movements are resumed the remedy should be gradually discontinued. Too much cannot be said against the indiscriminate use of cathartics by mothers and nurses. When diet and exercise are not sufficient to cure the case, home treatment should cease. Many an adult is a slave to cathartics owing to the ignorance or carelessness in the use of these drugs during childhood. Pure olive oil only, a teaspoonful to a tablespoonful, may be used without harm.
Immediate relief, when necessary, can always be obtained by the use of enemas, given as previously directed, or by the insertion in the rectum of a gluten suppository.