The Mother's Manual of Children's Diseases Part 8

Two or three more cautions may still be of service. Do not keep a child out of bed, and force it to try to exert itself when the movements are very severe; continued movement, voluntary or involuntary, fatigues. Let the child lie in bed; it rests there, and the movements, which always cease during sleep, become at once greatly lessened. So important indeed is it to avoid the exhaustion caused by incessant violent movement, that in bad cases it is sometimes necessary to swathe the limbs in flannel bandages, and so to confine them to splints in order to restrain them.

Next, do not become over-anxious because the child grows stupid and ceases to talk; intelligence and the power of speech will certainly come back again. And, lastly, do not be impatient and think your medical adviser incompetent because the disorder lasts so long. An average duration of seventy days implies that while sometimes it ceases sooner, in others it lasts much longer than the two weary months of watching and waiting with which in any case you must lay your account.

=Paralysis, or Palsy.=--When speaking of St. Vitus's dance I said that there was a partial loss of power in the limbs as well as an inability to control their movements. After a fit of convulsions, or an epileptic seizure, power over some limb is often lost for a time which may vary from a few minutes to some hours. In the course of some serious diseases of the brain, one of the manifestations of the mischief is the impairment or the loss of power over one arm or leg, rarely over both; and lastly, that terrible disease diphtheria is often followed by a paralysis so general that the patient is sometimes for days unable to move even a finger, although the condition may eventually pa.s.s away.

There is, however, a very _real paralysis_ which occurs sometimes in infants and young children. It comes on for the most part quite suddenly, often unaccompanied by any sign of brain disorder, but tending nevertheless to issue in great permanent impairment of the power over the affected limb or limbs, and eventually to interfere with their growth and thus to produce serious deformity.

It is in general impossible to a.s.sign any distinct exciting cause for the affection, though the fact that in two-thirds of the cases it occurs between the ages of six months and three years, proves it to be in some way intimately a.s.sociated with teething. The oldest child in whom I have ever seen it was aged between seven and eight years, and the youngest a little under six months. It is of excessive rarity for the arm alone to be affected, but it is by no means unusual for the legs alone to be paralysed; though in the majority of instances power is lost on one side only, the leg and arm being both involved.

A child goes to bed quite well, or at the worst having seemed slightly ailing and feverish for a day or two, and on waking in the morning it is suddenly discovered that power is lost over one leg or both, or over both arm and leg of one side. The loss of power is at first seldom complete, though neither arm nor leg can be used to any good purpose, and during the ensuing twenty-four hours the palsy often grows worse, and sometimes affects one or both limbs of the opposite side. After that time recovery in general begins. It is now and then speedy, so that in three or four days all trace of the paralysis may have disappeared.

This, however, is a fortunate exception to the general rule, which is that amendment is very tardy, showing itself first in the arm, afterwards in the leg, and, if both sides have been affected, more on one side than on the other. Unless the improvement is very rapid, it is almost always only partial, and the palsied limb, though it does not lose sensation, regains but little power; it grows much more slowly than the other, is always colder and wastes considerably, while, some muscles still retaining more power than others, it becomes twisted out of shape, and requires all the skill of the orthopaedic surgeon to remedy or at least to lessen the consequent deformity.

It has been ascertained that this form of palsy depends on a state of congestion, or overfilling of the minute blood-vessels of the spinal marrow. When the child gets well the congestion has pa.s.sed away; but it does this speedily, and recovery is then rapid as well as complete. If it does not soon pa.s.s away, other changes take place in the spinal marrow, and recovery is then slow, incomplete, or even does not take place at all.

Remedies are unfortunately of little avail here, but it is evident that when the palsy is quite recent all movement of the limb must be mischievous, and that the congestion of the spinal marrow to which it is due will be most likely to abate under the influence of perfect quiet, rest in bed, and soothing or fever medicines, or of such as are calculated to overcome constipation, or to correct any fault of digestion, while the importance of teething, and the possible expediency of lancing the gums must not be forgotten.

Afterwards comes the time for exercise of the paralysed limb, for friction, for shampooing, for galvanism; all continued perhaps for months or years with unwearied patience, and I must add with reasonable expectations as to the result. The only additional remark which I have to make is this, that to gain any real good from galvanism, a battery must be procured under the direction of some medical man specially skilled in the use of electricity, and the mode of employing it must be learned thoroughly from him. It is merely idle to purchase a toy machine, and, giving it to the nurse to turn the handle for ten minutes twice a day, to fancy that you are making a serious trial of the effects of galvanism. As a mere money question, a costly machine, and several fees paid in order to be thoroughly instructed in the way to use it, is much cheaper than a cripple child.

A few words may not be out of place with reference to cases in which paralysis is mistakenly supposed to exist. Much anxiety is sometimes expressed by parents concerning children who have long pa.s.sed the usual age without making any attempt to walk; or who having once walked seem to have lost that power. Now it often happens that after any weakening illness a child ceases for some weeks to walk, just as it ceases to talk. The power in both cases was newly acquired, it called for effort which, when strength is regained, will be put forth once more. The same applies to other instances in which children are late in learning to walk; or who, having once walked, leave off walking when a back tooth, or when one of the eye teeth is coming near the surface of the gum, and regaining the power lose it again, or lose at least the desire to exert it more than once during the active progress of teething. But, holding the child under its arms, you have but to put its feet to the ground, and at once it will draw up its legs though it will make no other movement; or take it on your lap and tickle the soles of its feet, and laughing or crying, as the mood takes it, it will move its legs about as freely as you could wish and show that the power is still there, though for the present the child will not take the trouble to exert it.

Gradual loss of power over one or other leg, especially if attended with pain either in the back or in the knee or hip, should always call for attention, and induce you to seek at once for medical advice. Such cases generally occur later in childhood than the conditions of which I spoke in the former paragraph, and may depend on disease of the spine or of the hip-joint, two serious conditions which it needs the medical expert to discover and to treat.

=Neuralgia and Headache.=--In the grown person neuralgia, as many of us know to our cost, is by no means infrequent; in the child it is very rare, and when a child complains of severe pain in the head, or of severe pain to the knee or hip apart from rheumatism, it is almost invariably the sign of disease of the brain in the one case, of the hip-joint in the other. To this rule there are indeed exceptions, but it will always be well to leave it to the doctor to determine--no easy matter by the bye--whether any given case is one of the rare exceptions or not.

There is, however, one form of real _neuralgic headache_ which is by no means rare in children after the commencement of the second dent.i.tion, and which sometimes goes on into early manhood or womanhood, when it becomes what is commonly known as sick headache. It is essentially an ailment of development, incidental to the time when the brain is first called on for the performance of its higher functions.

It does not by any means always depend on over-study, though I do not remember meeting with it in children who had not yet gone into the school-room; and I have frequently found it dependent on too continuous application, though the number of hours devoted to study in the course of the day may not have been by any means excessive.

The child's brain soon tires, and the arrangement, so convenient to parents of morning lessons and afternoon play, works far less well for it than if the time were more equally divided between the two.

The attacks not infrequently come on on waking in the morning, and rapidly become worse, the pain, which is almost always referred to the forehead, being attended with much intolerance of light and sound, with nausea, and often with actual vomiting. Like the vomiting of sea-sickness, however, previous stomach disorder has no necessary share in its production, and I may add, indeed, that it is often difficult to a.s.sign any special exciting cause for the attack. The suffering is more often relieved by warm or tepid than by cold applications, and not infrequently pressure or a tight bandage greatly mitigates it. In no case does the attack last more than twelve hours--usually not more than half that time; it pa.s.ses off with sleep, and leaves the patient weak and with a degree of tenderness of the head to the touch.

Such attacks may occur every fortnight, ten days, or even oftener, but their very frequent return, instead of increasing apprehension, should diminish anxiety. A first attack, indeed, may seem as though it threatened mischief, till it is seen how speedily and completely it pa.s.ses off, and when afterwards a second or a third attack comes on with the same severity of onset, the same rapid worsening, and the same quick pa.s.sing away, you will feel convinced that the symptoms have no grave meaning.

There is a headache of quite a different kind to which I must for a moment refer, that, namely, which depends entirely on imperfect vision, and for which spectacles are the remedy, not physic. The infirmity is not noticed during the first few years of life, but in later childhood, when a tolerably close attention to study has become necessary. Some of the minor degrees of short-sightedness, and want of power of adaptation of the eyes, such as exists in the aged, soon begin to interfere sensibly with the child's comfort, and the strain to which the eyes are subject produces a constant pain over the brow, the cause of which is often unsuspected.[13]

In all cases, therefore, in which a child complains of constant pain over the brow for which there is no obvious cause, it is well to take the opinion of an oculist, who can best ascertain the power of _reading at different distances_ and with each eye separately, and the real cause of symptoms which had occasioned much anxiety is thus often brought to light.

=Night Terrors.=--Before taking leave of the disorders of the nervous system, I must briefly mention the Nightmare, or Night Terrors of children, which often cause a degree of alarm quite out of proportion to their real importance.

It happens sometimes that a child who has gone to bed apparently well, and who has slept soundly for a short time, awakes suddenly with a sharp and piercing cry. The child will be found sitting up in bed, crying out as if in an agony of fear, 'Oh dear! Oh dear! take it away! father!

mother!' while terror is depicted on its countenance, and it does not recognise its parents, who, alarmed by the shrieks, have come into its room, but seems wholly occupied by the fearful impression that has roused it from sleep. By degrees consciousness returns; the child now clings to its mother or its nurse, sometimes wants to be taken up and carried about the room, and by degrees, sometimes in ten minutes, sometimes in half-an-hour, it grows quiet and falls asleep; and then usually the rest of the night is pa.s.sed undisturbed, though sometimes a second or even a third attack may occur before daybreak.

Seizures of this kind may come on in a great variety of circ.u.mstances, and may either happen only two or three times, or may continue to recur at intervals for several weeks. The great point, however, to bear in mind is that they depend invariably on some disorder of the stomach or bowels, and are never an evidence of the commencement of real disease of the brain.

FOOTNOTES:

[11] Reports of the Registrar-General, as quoted at p. 30 of my _Lectures on Diseases of Children_. The actual numbers are 9,350 under five years old, out of a total of 16,258.

[12] Figures deduced from the 44th Report of the Registrar-General.

[13] Before I called attention to this form of headache in the last edition of my lectures, it had already been noticed without my knowledge, by a friend of mine, Dr. Blache, of Paris, in a very valuable essay on the headaches which occur during the period of growth.

CHAPTER VII.

THE DISORDERS AND DISEASES OF THE CHEST.

In speaking of the ailments which occur during the first month after birth, I have already noticed the peculiarities of breathing in early infancy, and the difficulties that sometimes attend the complete filling of the air-cells of the lungs, and the readiness with which when once filled they become emptied of air and collapse.

On this ground it is therefore needless for me again to enter, and I may pa.s.s at once to consider those ailments which rise in increasing importance from a simple cold or catarrh to inflammation of the air-tubes or bronchitis, inflammation of the lung substance, as pneumonia, and inflammation of the membrane which lines the chest and covers the lungs, or pleurisy.

=Catarrh.=--A common cold or _catarrh_ is not one of the ailments of very early infancy. The watery eyes, the sneezing, the cough, the slight feverishness and the heavy head are scarcely met with until after the age of three months; nor, indeed, are they often seen till the child is old enough to run about, to go out for a walk, and to encounter in consequence all the variations of temperature and of damp or dryness inseparable from the English climate.

This, however, is not entirely due to the greater exposure of the child to these influences as it grows older, but in part also to the fact that the lining of the air-tubes is less sensitive in early infancy than it afterwards becomes. The young babe if it catches cold gets _snuffles_, or stoppage of the nostrils, which first become dry, and then pour out an abundant discharge, which sometimes dries and forms crusts, and causes the child to suck with difficulty, and to breathe uncomfortably and with open mouth. In a few days, however, at the worst this discomfort pa.s.ses away; and the only additional remark I have to make is, that since obstinate snuffles are sometimes a const.i.tutional disease, the doctor's advice should always be sought if they last longer than a week.

It is needless to describe a cold, but it is much more to the purpose to say how its occurrence is to be prevented, and nine times out of ten the observance of two simple rules will suffice for this. First, take care that there is no great difference between the temperature of the day and of the night nursery. The one should never be above 60, nor the other below 50, and the undressing and the bath should always take place in the warmer room. Second, never let the child wear the same shoes or boots in the house as it does out of doors. The change should be as much a matter of routine as the taking off its hat or its bonnet.

The domestic management of a cold is simple enough. The usual error is the overdoing precautions, the keeping the room too hot, or overloading the child with extra garments, or its bed with extra covering, by which it is kept in a state of feverishness, or of needlessly profuse perspiration.

If, for the first two days of a bad cold, the child is kept in bed, the room being at a temperature of 60, with no extra covering on the bed, but a flannel jacket for the child to wear when it sits up in bed to play, a few drops of ipecacuanha wine several times a day, a warm bath, a linseed poultice to the chest, and a little paregoric at night, with a light diet of rice, and arrowroot, and milk, and a roasted apple, and some orange juice; nine times out of ten, or nineteen out of twenty, the cold will pa.s.s away with small discomfort to the child and no anxiety to the parents.

Often a child objects to stop all day in its little cot, but move it to its mother's or nurse's big bed; and with a large tray of toys before it, and a little of the tact which love teaches, the day will pa.s.s in unclouded content and cheerfulness.

It must of course be borne in mind that measles set in with all the symptoms of a bad cold, followed on the fourth day by the appearance of the eruption; and, moreover, watchfulness must always be alive to detect increase of fever, hurry of breathing, hardness or extreme frequency of cough, the sign of the irritation of the larger air-tubes having extended and become more severe, the evidence that the case from simple catarrh has become one of bronchitis.

=Bronchitis and Pneumonia.=--It is impossible to enable persons who have not received a medical education to distinguish between a case of bronchitis and one of pneumonia. Neither, indeed, is it of much importance that they should do so, for in both the dangers are of a similar kind, and both call equally for the advice of a skilful doctor.

In _bronchitis_ inflammation affects the lining of the air-tubes, travelling from the larger towards the smaller, and in bad cases extending even to their termination in the minute air-cells. The inflammation leads to the pouring out of a secretion, which by degrees becomes thick like matter, or even very tenacious, almost as tough as though it were a thin layer of skin. If this is very extensive, and reaches to the small air-cells, it is evident that air cannot enter, while that elasticity of the lung which I have already spoken of tends to drive out from the cells the small quant.i.ty of air they contained, and the child dies suffocated, partly from the difficulty in the entrance of air, partly from the collapse of air-cells from which the air has been slowly expelled.

In _pneumonia_ or inflammation of the lung-substance the process is different. A portion of one or other lung, sometimes of both, becomes overfilled with blood, or congested, and though the air-tubes themselves are not the special seat of the congestion, yet the air-cells are pressed on by the surrounding swollen substance, and the entrance of air into them is impeded. If the mischief goes further the substance becomes solid and impervious to air, and lastly it becomes softened, its structure destroyed, and infiltrated with matter; the affected part becomes really an abscess, though not bounded by the distinct limits which would shut in an abscess of the hand or the foot. Inflammation, and the formation of an abscess anywhere is, as we know, attended by fever and much general illness, and inflammation of the lung is of course attended by fever and general illness in proportion to the importance of the organ affected. To these, too, must be added all the disturbance inseparable from any ailment which gravely interferes with breathing.

In the great majority of instances inflammation of the lung-substance does not go on to the last stage, and recovery is not only possible, but probable, from congestion and solidification of the organ. Pneumonia, too, usually attacks only a portion of one lung, while in bronchitis the air-tubes of both are always involved. Hence of the two, serious bronchitis is more to be dreaded than serious pneumonia.

Bronchitis is always developed out of previous catarrh, though there is a wide difference between the duration of the preliminary stage and the occurrence of serious symptoms in different cases; while it may be laid down as a general rule that the severity and danger of an attack are in proportion to the rapidity of its onset. An attack of pneumonia, or inflammation of the lung-substance sets in, as a rule, more suddenly, with fever, a temperature of 103 to 105, general distress, headache, not unfrequently delirium; the urgency of which symptoms, the hurried breathing and the short, dry, hacking cough, and the tearless eyes are too often misinterpreted, and the state of the chest not examined.

The doctor, of course, skilled in auscultation, will listen to the chest and give to all these symptoms their true signification. The lesson for the parent to bear in mind is never to neglect in a child the symptoms of what may seem to be but a common cold, but to seek for advice the moment the cough shows any disposition to become hard, or the breathing hurried. Next, when any sudden illness sets in with very high temperature and much general ailing, not to let the disorder of the head, or the delirium, make you shut your eyes to the import of the short cough, the dry eyes, the hurried breathing; and lastly, to remember that, grave though the symptoms may be, the tendency in pneumonia is to eventual recovery, and that in early life bronchitis is the graver of the two diseases.

A caution may not be out of place with reference to cases which may occur during the epidemic prevalence of _influenza_. A child is sometimes struck down by it, just as grown persons are sometimes, with great depression, extreme rapidity of breathing, and very high fever, which, pa.s.sing off in a couple of days, leave a state of great exhaustion behind. It is well to bear in mind that such symptoms have no such grave meaning when influenza is prevalent as they would have at another time; and the knowledge of this fact may serve in some degree to control your anxiety.

=Pleurisy.=--It is not possible for anyone, without medical experience, to discriminate between pneumonia, or inflammation of the substance of the lung, and pleurisy, or inflammation of its covering. Some degree of the latter, indeed, very often accompanies the former, and this accounts for the pain which interferes with every attempt of the child to draw a deep breath. When pleurisy comes on independent of affection of the lung-substance, it generally sets in suddenly with severe pain in the chest, and a short hacking cough which causes so much pain that the child tries as much as possible to suppress it. After a few hours the severity of the pain usually subsides, but fever, hurried breathing, and cough continue, and the child, though usually it looks heavy and seems drowsy, yet becomes extremely restless at intervals--cries and struggles as if in pain, and violently resists any attempt to alter its position, since every movement brings on an increase of its sufferings. The posture which it selects varies much; sometimes its breathing seems disturbed in any other position than sitting straight up in bed; at other times it lies on its back, or one side; but whatever be the posture, any alteration of it causes much distress, and is sure to be resisted by the child.

The variations of posture depend on the seat of the inflammation; the pain depends on the two inflamed surfaces of the membrane rubbing against each other, and accordingly is relieved not merely by the abatement of the inflammation, but also when either the two surfaces become, as they often do, adherent to each other, or when fluid is poured out into the cavity of the chest, and thus keeps them asunder.

I dwell on this, because when fluid is poured out, the most distressing symptoms greatly abate, or even disappear, and parents sometimes put off in consequence sending for the doctor, while yet, if unattended to, the fluid may increase to so large a quant.i.ty as to press upon the lung, and so interfere with the entrance of air, or it may, if the mischief is not checked, change into matter, and then have to be let out by tapping the chest, for just the same reason as it may be necessary to open an abscess in any other situation.