The Mother and Her Child

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THE NURSERY REFRIGERATOR

It is wise in instances of the more severe childhood troubles, such as
infectious and contagious diseases, to keep as many things in the sick
room as possible, and so we remind our reader of the home-made ice
box, described elsewhere in this book, in which may be kept the fruit
juices and the fruits, as well as the milk and the buttermilk. Many
medicines, particularly the oily medicines, should be kept in this
home-made ice box and five cents worth of ice a day will not only make
things taste better, especially during the warm months, but will
protect the other members of the family, for the family ice box is a
big central station which must be protected against infections and
carriers of disease.

In connection with the ice box, we are reminded that it would be a
great convenience to have a simple contrivance for heating bouillon,
milk, or making a piece of toast, which can be readily done with an
electric heater, an alcohol stove, or a small apparatus fitting over
the gas jet.

SICK ROOM DISINFECTANTS

The most important thing which we are going to mention in this
division of the chapter is the disinfection of the door knobs.
According to the directions on the poison bottle, place an antiseptic
tablet into a small amount of water which will make a solution of 1 to
1000 of bichlorid of mercury, and several times a day disinfect the
door knobs, particularly in the sick end of the house--thoroughly
washing and adequately rubbing with a towel moistened in this
solution.

All stools and urine from the sick one will receive attention as
directed by the physician. The stools from a typhoid patient should
stand for one-half hour in a chamber covered with a layer of lime.

It is not at all necessary to have vessels containing disinfectant
substances standing about the room and in the closet. In a room
adjoining should be kept all of the dishes used by the sick patient,
his tray, half a dozen napkins, knife, fork, spoon, serving dishes,
drinking glass, pitcher, etc. All bedding and all linen used by the
sick member should be allowed to stand in a solution of disinfectant
for several hours when they may be wrung out of the solution, dropped
into a bucket and carried to the laundry without any danger to other
members of the family.

The nurse is not allowed to leave this room in the garments that are
worn while caring for the sick. She should have her meals in an
adjoining room which is also under strict isolation.

THE MEDICINE CHEST

The sick room medicine chest should be so placed on the wall that it
is outside the reach of the smaller members of the family, for in it
should be placed poisons for external use that are capable of
producing death if taken internally. Bottles that hold these
poisons--such as bichlorid of mercury, lysol, carbolic acid, laudanum,
paregoric, belladonna, etc.--should be so different from the other
bottles in the medicine chest that if one should reach for them with
his eyes shut or in the dark he would at once recognize that he had
hold of a poison bottle. This is absolutely necessary. It usually
means a bit of extra expense, but when we realize what tragedies may
be avoided by such slight expense, it must not be considered.

Bottles may be procured that have been molded with points of glass
projecting from the outside which make them rough to the touch, or
they may be covered with a wire mesh or with a wicker covering which
may easily be told from the other bottles in the case.

One woman lost her life because the nurse placed two ounces of
carbolic acid in the enema instead of two ounces of saline solution.
Saline solution is nothing but salt and water, while carbolic acid
cost the woman her life, simply because the carbolic acid was not
placed in a specialized poison bottle and the attendant could not read
the label in the dark.

Under no circumstances keep from one year to another the remnants of
unused medicine of a former sickness, for medicines do not keep well
and often lose their strength if kept longer than the physician
intended.

In this medicine chest should be found the following articles:

A glass graduate marked with fluid drachms (1 teaspoon),
and fluid ounces (8 teaspoons).
A medicine dropper.
Absorbent cotton.
Boric acid.
Camphorated oil.
Castor oil.
Aromatic spirits of ammonia.
Alcohol.
Olive oil.
Epsom salts.
Soda-mint tablets.
Vaseline.
Zinc ointment, together with other medicines the physician
orders.
Ice bag, hot-water bottle and oiled silk.

Besides these articles, in the nursery--in readiness for emergencies
and accidents--should be found the following:

Gauze bandages of various sizes.
Sterile gauze.
Boric acid crystals and powder.
Mustard.
A pocket case of instruments containing scissors, knife, dressing
forceps, etc.
Syrup of ipecac.
Glycerin.
Tincture of iodine.
Package of ordinary baking soda.
Peroxid of hydrogen.
Absorbent cotton.
Needle and thread.
Lime water.

PATENT MEDICINES

Aside from the giving of castor oil and the application of vaseline to
the nose, or of applying boracic acid to the eyes, no medicine should
be administered to the baby without competent medical advice. There
are numerous widely advertised nostrums frequently sold as soothing
syrups to be used during the teething or during attacks of diarrhea,
or cough spasms, croup, or worms, that contain dangerous drugs and
should not be given to children. Many well-meaning but ignorant
mothers are slowly but surely laying the foundations for serious
nervous disorders and are often making veritable dope fiends out of
their children. Patent medicines are dangerous things in the hands of
the people; if we are going to give medicines to our little babies let
us at least know what we are giving. Let some conscientious,
scientific physician examine the baby and prescribe for its needs.

If urged to use a patent medicine, examine the label carefully, for
the Federal Food and Drug Act requires the manufacturer of patent
medicines to print plainly on the label of the bottle the name and
amount of certain dangerous drugs which it may contain.

The drugs mentioned in this drug act and which are often used in
patent medicine nostrums are, chloral hydrate, cocaine, heroin,
chloroform, alpha or beta eucaine, opium, morphin, alcohol, cannabis
indica, or any derivative or preparation of any such substance
contained therein.

There are many other drugs sold on the market containing syrups or
flavoring materials which may do harm--which may upset the baby's
digestion.

Mothers avoid patent medicines. Consult your physician. Never give a
baby any sort of medicine to induce sleep. Unless babies are sick or
spoiled or hungry, they will go to sleep of themselves, and even in
the days of a high fever a wet-sheet pack seldom ever fails to put the
baby to sleep and can do no harm if properly given.

This may be as good a place as any to mention the dosage of castor oil
which is as follows:

Up to three months, 1/2 teaspoon.
From three to six months, 1 teaspoon.
From six to nine months, 11/2 teaspoons.
From nine to twelve months, 1 dessert spoon (2 teaspoons).
From twelve months on, 1 to 2 tablespoons.

AFTER THE SICKNESS IS OVER

The physician will direct when the disinfectant bath is to be given to
the patient previous to his liberation from isolation. The different
diseases demand different treatment, but, on the whole, it is about as
follows:

The day before the boy is to be allowed to go out among the family
once more he receives a soap wash, clean sheet and bedding on the bed,
and puts on clean garments. The following morning, his head thoroughly
shampooed, his nails manicured, a second soap wash is given followed
by a weak bichlorid bath (1 to 10,000 solution) which is followed by
an alcohol rub. He is then allowed to go out of the sick room which is
now to be thoroughly disinfected and fumigated.

After the illness is over, the sick room and the adjoining closets and
ante rooms must be thoroughly disinfected or fumigated. If you are
located in a city, the health authorities will do this after an
infectious or contagious disease. Away from such conveniences, use the
following method:

Place two ounces of crystals of permanganate of potash in a pan and
have a pint bottle of formalin near by. Everything in the room is now
exposed, dresser drawers are opened, all bedding, all garments--in
fact everything that is in the room--is put in such a position as to
be readily exposed to the fumes which are to follow. A line should be
stretched across the room over which are thrown the bedding, garments,
etc. The cracks of the windows and doors, except the one door of exit,
are now sealed up with paper which has been dipped in green soap, and
having the paper strips and pan of green soap ready just outside the
exit door, the formalin is now poured over the permanganate crystals.
Fumes will immediately arise and permeate every corner, crack and
crevice of the sick room. Now quickly make your exit, close the door
and seal up key hole and cracks and space under the door with paper
dipped in green soap. Leave the room for six hours. After this with a
well-moistened cloth to the nose, rush in and throw the windows open,
hurry out and allow the room to air from twelve to twenty-four hours,
after which wash woodwork and painted walls or take paper off and
repaper walls; recalcimine ceilings and closets; scrub closet shelves
and dresser drawers, bedsteads, and other furniture thoroughly. If the
mattress is old throw it away, but if not, sun it for several days
following the fumigation.

CHAPTER XXVII

DIGESTIVE DISORDERS

In this chapter we will consider the diseases which commonly occur
during infancy and early childhood relative to digestion and the
alimentary tract. Irregularity of feeding, feeding between meals,
feeding too much at any given time, as well as feeding the wrong kind
of food may cause stomach disturbances and intestinal troubles.

VOMITING

In a previous chapter, "The Feeding Problem," a common stomach
disturbance, vomiting, was gone into quite thoroughly, and in passing
to other disorders, we wish to remind the mother that vomiting should
always be taken seriously. The interval between meals should usually
be lengthened, the time spent in feeding shortened, and it is often
necessary to withhold all milk and food of any kind for twelve or
eighteen hours, giving only boiled, unsweetened water. Vomiting
frequently ushers in some acute disease, and in remote cases, when it
is very persistent, it may indicate inflammation of the brain.
Complete rest is essential, trotting on the knee, suddenly changing
the baby's position, or other quick movements must all be avoided. A
physician should see the sick one and determine the cause of the
trouble.

COLIC

Cases of ordinary colic are usually relieved by heat to the abdomen
and feet, drinking hot water in which there has been dissolved a pinch
of ordinary baking soda, or a portion of a soda mint tablet, or by the
use of the photophore, as previously described. The treatment of such
ordinary colic need not be given further consideration here because
it has been described at length in a former chapter; but we do call
the attention of the mother to a more serious form of recurring colic
which so often accompanies chronic intestinal indigestion, marasmus,
and malnutrition.

In most instances the food is radically at fault and should be reduced
to a mixture which can more readily be digested and assimilated by the
child. Often whey mixtures, peptonized foods, or buttermilk may be
indicated. The weight of the baby, the age of the baby, and the color
of the stools, must all be taken into account in the preparation of
this easily digested food. Weak mixtures should be given at first and
then gradually and carefully the quality may be strengthened until the
normal formula is again used for the baby.

Injections into the bowel of water, to which has been added one level
teaspoon of soda to the pint, will often give relief in this form of
colic.

CHRONIC INDIGESTION

While this condition may occur at any time during babyhood days, it
often makes its appearance during the last half of the first year and
up to the fifth year. It is accompanied by mucus in the stools,
chronic flatulence, constipation or diarrhea, or the alternating of
the two, restlessness at night, distention of the abdomen ("pot
bellied") accompanied by pain, a coated tongue with a fetid breath,
and loss of appetite. It is a pitiable picture--the weight is usually
reduced and the child gives the appearance of being decidedly
undernourished. This condition is usually occasioned by errors in
diet, whether it be over-feeding or feeding of the wrong element of
food, and, since the diet is usually responsible for the condition, in
the line of treatment diet is a prime factor.

All fats must be taken from the food, sugars should be avoided, and
the amount of starchy foods, such as flour, potatoes and bread, should
be greatly reduced. Buttermilk, skimmed milk, eggs, green vegetables,
and fruit juices should be given. In the older child, if grains are
used, they should be well toasted or baked.

JAUNDICE

It is altogether common and physiological for the newborn baby to pass
through a few days of yellow skin which usually clears up in the
second or third week, but it should not recur. Occasionally this
yellow tint deepens, the whites of the eyes are yellow, the urine
passed leaves a yellow stain on the diaper, while passages from the
bowels are white or clay colored. If the child shows symptoms of ill
health other than the yellow tint, it should receive medical
attention. Older children troubled with jaundice should receive the
following treatment: The photophore as described elsewhere should be
applied to the liver and abdomen (the liver is on the right side), and
this should be followed by the application of what is known as a
heating compress, consisting of three layers--a cloth wrung from cold
water, a mackintosh, and then two thicknesses of blanket
flannel--which are all applied when the skin has been made red by the
application of heat. (If the photophore is unavailable, a hot-water
bottle may be applied.) The flannel is pinned snugly on the outside as
the wet cloth goes next to the skin with the mackintosh between. This
should remain on the abdomen for three or four hours, after which the
hot application is again made to the liver and abdomen. The
administration of broken doses of calomel is sometimes indicated in
obstinate cases in connection with these applications of heat to the
liver. Hot milk or mineral water may be taken with dry toast. In a day
or two the color should clear up, the stools should be normal again,
and the treatment may be discontinued.

WORMS

Irritation about the rectum which cannot be otherwise explained is
usually suggestive of pinworms. These seatworms or pinworms are very
much like little pieces of cotton thread--one-fourth of an inch in
length. They grow and thrive in the lower part of the large bowel.
Simple and effective treatment is as follows:

It is well to bathe the parts about the rectum after each bowel
movement and often two or three times a day with a weak antiseptic
solution. Itching may be controlled by the application of a
disinfectant ointment, or the local applications of ice may serve the
same purpose. After a thorough cleansing of the colon by an injection
of lukewarm water containing a teaspoon of borax to the pint in order
to remove the mucus, Doctor Holt suggests that after the discharge of
this borated enema, infusions of quassia are very helpful (See
Appendix).

Children suffering from roundworms experience a loss of appetite,
varying temperature from above normal to subnormal, with colicky pains
in the abdomen on coming to the table and beginning to eat. They are
pale and listless, or nervous and irritable.

Roundworms very much resemble earthworms in shape and color. While
their home is in the small intestines they often travel to other parts
of the body. They have sometimes crawled into the stomach and have
been vomited. The only definite symptom of worms is to find the eggs
or the worms themselves in the stool. No worm medicine should ever be
given by the mouth without being prescribed by a physician. Cases are
on record where well-meaning mothers have killed their children by
giving an over dose of worm medicine.

Tapeworms sometimes trouble children; their segments are found in the
stool, and look like small pieces of tape line. The segments are flat
and thin, one-fourth inch to one-half inch in width and three-fourths
to one inch in length. They are joined together and often their number
is so great the worm is many feet in length. The segments grow smaller
and smaller as they approach the neck, the head of the worm being a
mere point. As the worm is passing from the child it should never be
pulled, as the head is easily broken off, and, on remaining in the
bowel, it will grow to a full-sized worm.

Worms come from the eating of half-cooked meats; they enter the
stomach as eggs or tiny worms, and pass out into the small intestines,
where they begin to grow. They are a common parasite in the human
family and should be suspected in all instances where digestive
symptoms are masked or do not yield to treatment.

HOOKWORM DISEASE

This disease, once seen only in the southern part of the United
States, is leaving its former domains as the migrating population is
distributing it more or less widely everywhere. Sandy soil and country
districts are infected by a tiny worm which thrives in polluted soil
and enters the body through the skin of the feet. It also gets into
the body through the drinking water or from the eating of uncooked
vegetables, such as are used in salads.

The disease is manifested by "sallow skin, paleness, headache, swollen
abdomen and sores on the legs." Little swollen places where the worm
enters the skin may be seen on the flesh. The condition yields readily
to treatment. If a child is discovered scratching his feet (especially
in the southern part of this country), he should be taken at once to a
physician.

DISORDERED STOMACH

At the first symptom of a disordered stomach take all food from the
baby and give him rice water prepared by throwing a cupful of
well-washed rice into a kettle of boiling water and allowing it to
continue to boil for a couple of hours. The water which is strained
off is rice water, ready for use after it is cooled. This may be given
to the child at the meal hour in the place of his regular food. It
should be kept in a glass-covered jar in the ice box. A dose of castor
oil, according to the age, should be administered before the feed. The
bowels should be washed out and boiled water given freely between the
meals of rice water. For a day or two (twenty-four to forty-eight
hours), the child should be fed only this rice water, or until the
temperature returns to normal and he appears very hungry, at which
time milk, which has been boiled for five minutes, may be added to the
rice water, first in one-half ounce quantities and gradually
increased. Each day a little more milk is added until baby is taking
his regular food again.

Many a death and many acute attacks of summer complaint are avoided by
the quick use of castor oil, and by withholding food and stopping the
use of milk as soon as the child becomes ill.

STOMATITIS OR THRUSH

Thrush is evidenced by fretfulness or crying on attempting to nurse.
On examination of the mouth it is found to be hot and very tender and
covered with little white specks which, if looked at under the
microscope, appear to be a fungus growth. If scratched off, the mucous
membrane bleeds easily. Thrush often occurs during a fever or in
connection with other diseases, and is often due to neglect and lack
of cleanliness about the bottles, nipples, etc. Taken in time it is
quickly cured. An immediate dose of castor oil or milk of magnesia is
indicated, and the use of a mouth wash which will be prescribed by the
physician. If neglected, it may become ulcerous or gangrenous, which
is a very serious condition. Everything pertaining to the feeding, as
well as the child's toys, hands, etc., must be kept scrupulously
clean.

CONSTIPATION

In the chapter, "The Feeding Problem," constipation in bottle-fed
babies was discussed. The bowels should move at least once in
twenty-four hours. The passages are frequently very hard and leave the
body only after a very great effort of straining. This constipation,
often continuing until late childhood, should be corrected in the
following manner:

In early infancy--as early as the fourth month--prune juice may be
given as directed elsewhere, while in later months prune pulp or fig
pulp, which has been carefully rubbed through a fine-mesh colander,
may be given at meal time. By the time the baby is eleven or twelve
months old, strained apple sauce may be given.

We deplore the use of the water enema as a regular daily procedure; in
its place we suggest the use of the enema of oil or the introduction
into the rectum of a gluten suppository or in obstinate cases a
glycerine suppository. Abdominal massage should be daily administered.
With a well-oiled hand, begin on the right abdomen and proceed upward
to the lower border of the right ribs and across to the left side and
down. This should be repeated many times at a regular hour each day.
The mother should select an hour for the bowels to move, preferably
after the forenoon feeding, and if the child is too small to sit upon
the toilet chair, a gluten suppository may be placed into the rectum
before the forenoon feed and some time during the middle of the day
the bowel movement will be found in the napkin.

For the older child, before a certain meal each day, a well-vaselined
piece of cotton may be inserted in the rectum; this often produces a
bowel movement immediately after the meal. Laxative foods, such as
bran, stewed figs, stewed prunes, or a raw apple, should be used
faithfully--as repeated medication never corrects the difficulty, but
usually prolongs it.

To immediately flush out the bowel, a soapsuds enema or a plain water
enema may be allowed to flow into the lower colon, or a glycerine
suppository inserted into the rectum will quickly bring a bowel
movement. These methods are only of temporary value; a regular habit
should be formed, if possible, to bring about a natural, normal bowel
movement. When necessary to resort to drugs--such remedies as cascara
sagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, as
well as our old stand-by--castor oil. Regular habits must be insisted
upon, and if the mother pays attention to regularity at stool in early
childhood very little trouble will be met later on in adolescence and
adult life.

Chronic constipation often produces abnormal conditions about the
rectum such as fissures, hemorrhoids, or prolapse, which may be of
serious import.

DIARRHEA

Diarrhea is a symptom of an acute illness, or it may be associated
with a chronic condition such as chronic intestinal indigestion,
tuberculosis of the bowel, or may occur alternately with constipation
in colitis. It is the most dangerous of all symptoms that babies
develop, and in spite of all the instruction given to mothers at the
present time, in spite of all the welfare stations in large cities,
and in spite of all the efforts put forth by the commissioner of
health, with his corps of visiting nurses--even yet, more babies die
of diarrhea each summer than from any other single cause.

There are usually just two reasons for diarrhea--uncleanliness and bad
milk. During the hot summer days flies multiply greatly and all manner
of bacteria and germs grow in warm, moist, shadowy places, so that
usually before the milk leaves the dairy farm it is seriously
contaminated with disease-producing germs. If the milk is not kept at
a temperature of 35 or 40 F. (which is just above the freezing point),
these bacteria, particularly the manure germ, grow at such a rate that
by the time the milk gets to the infant it is teeming with bacteria,
and diarrhea is the sure result.

Another form of diarrhea is cholera infantum, where the stools soon
become watery and colorless. The vomiting is almost incessant and
there is high fever. Fortunately it is a rare disease, but when once
seen it is never forgotten. One beautiful baby weighing nearly thirty
pounds was reduced to sixteen within forty-eight hours, and when death
came he could hardly be recognized because of the wasting from this
most dreaded of infant diseases.

Another form of diarrhea is seen in an acute inflammatory condition of
the intestine itself. The stools contain more or less mucus and blood.
The bowel movements, which are very frequent, are accompanied by a
great deal of pain and straining. This form is often seen in the more
severe types of summer dysentery. We wish to impress upon the reader's
mind that these diarrheas may all be avoided if the baby's food is
clean and free from germs, if the apple or pear is not only washed,
but thoroughly scrubbed before paring during the summer months. If all
the bottles, nipples, water, toys, etc., are adequately clean, no
summer diarrhea, no dysentery, no other infection due to dirt, will
attack the baby. Of paramount importance is the pasteurization of milk
during the summer months, as mentioned elsewhere.

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