XLI. Inflammation of the Mouth. (Stomatitis).
SYMPTOMS. Heat, redness, dryness, and ulceration of the mucous membrane of the mouth; foetid breath and salivation may also be present.
REMEDIES. Mercurius. Slight cases; or foetid breath, and abundant flow of saliva.
Kali Chloricum. When mercury has been administered in excess, or when there is great soreness, bad-smelling breath, and ulceration.
Hydrastis. Swelling, dark, redness, and soreness of the tongue, gums, and cheek; ulceration of the lips and tongue; sticky mucus in the mouth.
China. When the acute symptoms have subsided.
ACCESSORY MEANS. The most frequent causes being want of cleanliness and errors in diet, the first care should be to remove these causes. The food should be principally milk, or milk and soda-water. When there is prostration, beef-tea, or good animal broth is requisite.
XLII. Thrush. Sore Mouth (Aphthae)
SYMPTOMS. There is generally some febrile disturbance; the child is fretful, often refuses the breath; there is usually vomiting, and a watery diarrhoea. The local symptoms consist of innumerable white specks, like little bits of curd, which sometimes form a continuous dirty covering over the tongue, gums, palate, and inside of the cheeks and lips. In severe cases the buttocks become roughened and tender by the harsh secretions.
CAUSES. Unhealthy character of, or insufficient breast-milk; unsuitable food in infants fed with the bottle or spoon (especially sour milk, and imperfectly washed feeding-bottles), neglect of general cleanliness, bad drainage, etc. The disease may also occur during the course of Measles, Enteric Fever, and Consumption; it is then generally indicative of a fatal issue.
LOCAL TREATMENT. Borax. The mouth should be washed with a weak solution of Borax (ten grains to one ounce of water), by means of a soft brush. Or Borax and Glycerine may be used, half a drachm of the former to one ounce of the latter. Before using the Borax, the infant’s mouth should be well cleansed.
Sulphurous Acid. This is a valuable local remedy; may be applied by means of the spray-producer, two or three minutes at a time, twice a day; or a solution of Sulphite of Soda (I drachm to I oz. of water): the acid is generated in the mouth, and destroys the minute plants in one or two days.
Kali Permang. A solution of three grains to the ounce of water may be used for bad-smelling breath.
Soothing Fluids. Infusion of Linseed, thin solution of Borax and honey, etc., are grateful and useful. Vinegar, carbolic acid, etc., diluted with water, are also recommended.
When Thrush is associated with constitutional symptoms, one of the following remedies should be administrated:
Mercurius. Diarrhoea, offensive breath, dribbling saliva, etc.
ACCESSORY MEANS. If Thrush be distinctly traceable to any disease in the mother which cannot be quickly cured, the infant should be at once provided with a wet-nurse, or weaned, and fed with Sugar-of-milk, or cow’s milk, diluted with water, till the seventh or eighth month, when the teeth usually begin to appear; at this time some prepared food through the feeding-bottle is the best diet.
But before the above time, every variety of starch-food is unsuitable, and nothing but breast-milk, sugar-of-milk, or cow’s milk mixed with a little warm water, should be used.
Strict cleanliness is necessary. After each meal the mouth should be washed, to prevent the accumulation of milk about the gums. This simple measure will often prevent Thrush. In like manner, the mother’s nipple should be cleansed each time after giving it to the infant.
XLIII. Disorders of Teething.
There are two sets of teeth; the first, the milk-teeth, generally appear in the following order: About the sixth month the two middle front teeth of the lower jaw, followed by the corresponding ones of the upper jaw; next the two outside cutting teeth of the lower jaw, and soon after those of the upper; after another interval, the first four double-teeth, then the eye- teeth, and lastly, four other double teeth. If the teeth are not all cut before eighteen months, or if only one or two appear by that time, there is some constitutional failing which requires attention. (See ” Rickets,” “Struma,” etc.). For feverishness, sleeplessness, etc. during teething, consult the Sections treating of those derangements.
XLIV. Toothache (Odontalgia)
The most frequent causes are sudden changes of temperature, Indigestion, ill-health, and irritation of the bared nerve by food or sweets.
REMEDIES. Aconitum. Toothache brought on by cold, or accompanied by fever-symptoms.
Belladonna. Burning, throbbing pain, extending to the temples, particularly the right.
Chamomilla. Unbearable fits of pain; nightly aggravation; redness of one cheek and paleness of the other.
Mercurius. Pain starting from loose or decayed teeth, occurring in the night; pain extending to the ears.
Kreasotum. Decayed teeth, with red and painful gums, offensive breath, etc.
Pulsatilla. Pain from indigestible food, fat, pastry, etc.; on the left side of the face.
Bryonia. Pain aggravated by hot or cold food, the cheek being tender to the touch.
Arsenicum. Intermittent toothache; burning or cutting pains; general prostration.
ACCESSORY TREATMENT. The application of heat sometimes gives relief; in other cases, when the temple throbs, a small stream of cold water eases the pain. The digestive organs often require attention, and the bowels should be regulated; very hot or very cold food should be avoided.
XLV. Hiccough (Singultus).
This common affection is of no grave import in children, and may therefore be generally left alone. Should it become troublesome, a draught of cold water will frequently stay the annoyance. This falling, recourse may be had to one of the following:
REMEDIES. Ignatia. Simple cases.
Nux vomica or Pulse. When due to Indigestion.
Sambucus. From exposure to cold, and when it appears to cause a momentary suffocation.
Antim tart. Hiccough, with rattling of mucus in the bronchial tubes.
XLVI. Indigestion (Dyspepsia).
SYMPTOMS. Loss of appetite; flatulence; pain and spasm in the stomach; nausea; furred tongue; hiccough, etc. The symptoms vary in different cases, and, unless corrected, are apt to become chronic.
CAUSES. Irregular feeding; unsuitable food; insufficient out-of- door air and exercise; worms, etc.
REMEDIES. Nux Vomica. Pain after eating; sallow skin; constipation.
Pulsatilla. Brownish furred tongue; heartburn; bad taste; mucous Diarrhoea.
Antimonium Crud. Loss of appetite; white furred tongue; pimples on the face.
Bryonia. Diarrhoea and constipation in turns; pain; nausea and eructations after food.
Carbo Veg. Much flatulence.
ACCESSORY MEANS. Regulation of the diet as pointed out in the sections on “Vomiting” and “Diarrhoea,” especially removing any known cause of the disorder. Daily out-of-door recreation and bathing are indispensable.
XLVII. Simple Vomiting.
When the milk is rejected immediately after nursing or feeling, the milk being curdled, it is due either to the too-frequent feeding or over-distension of the stomach. Vomiting of uncurdled milk indicates debility of the stomach, and requires a carefully- regulated diet; smaller quantities of food being given, and at shorter intervals.
CAUSES. Improper, starchy, or badly-prepared food; too early weaning. Wet-nurses have been known to make up a deficiency of breast-milk by arrow-root, baked flour and other indigestible food. The microscope reveals starch particles, and thus enable us to detect the cause of the derangement. Impure air, too little sunlight, want of cleanliness, and other unhealthy surroundings, may be causes. The crowding of a whole family, or of many children in one room, is not an uncommon cause.
REMEDIES. Pulsatilla. Simple Vomiting from indigestible food, or debility of the stomach.
Ipecacuanha. Aversion to food, and Vomiting of mucus; disagreement of the breast-milk.
Antimonium Crudum. Thickly-furred, white tongue; great thirst; painfulness of the stomach to pressure; nausea; eructations.
Nux Vomica. Aversion to food and drink; vomiting of green bilious matter; Constipation.
ACCESSORY TREATMENT. A change of diet is generally the first consideration, and a change of the mother’s diet, or of her habits, in the case of infants fed by the breast. They should be nursed at regular periods, and not permitted to suck too long at one time. In some cases a wet-nurse should be provided, or feeding with Sugar-of-milk, or with cows’ milk and lime-water, given in such quantities as can be retained. In the case of older children much care is often necessary. When a disposition to sickness has been excited, the stomach will only bear small quantities of food at time, while warm food is often much better tolerated than cold. Small pieces of ice ten to allay Vomiting, and are usually very grateful. After some rest, a teaspoonful of cold water may be given, and followed in ten or fifteen minutes by a very little cold milk-and-water, or whatever else may be suitable. During sickness children should not be moved hastily or roughly to administer food; indeed, no more than is just necessary for the purpose. As soon as possible, out-of-door air, sunlight, cold or tepid bathing, etc., will help to bring about great improvement. They should be warmly but no excessively clad, and the feet especially kept warm.
XLVIII. Chronic Vomiting.
SYMPTOMS. Chronic vomiting generally comes on slowly, and without fever. At first the child vomits curdled milk of a strong-sour smell, showing by its yellow or green tinge the presence of bile. After a time, the matters vomited look like clear water mixed with food. The belly is full, hard, and tender; sour of foetid eructations occur; the bowels are obstinately constipated, and the spaces between the bones of the skull sink considerably. Occasionally Diarrhoea sets in, then leaves the bowels as obstinate as ever; the motions consisting of light- coloured, hard, round lumps, covered with tongue mucus. The tongue is now coated with dirty-yellow fur, and dry; the breath smells sour, the lips are red and lack moisture; the mouth is clammy, and the lips appear to project.
In the next stage, Vomiting occurs much more frequently, and is occasioned by the slightest movement; wasting progresses rapidly, the skin becomes harsh, dry, and loose.
The temperature sinks very low, the child lies with the eyes half-closed in a half-stupor; Thrush appears, and the worn-out sufferer sinks to rest.
CAUSES. Too early weaning; the too early use of starchy food; and other conditions stated under “Chronic Diarrhoea.”
TREATMENT. Arsenicum. Dryness of the Mouth, with disagreeable odour; Thrush; ulcerated, coated, or cracked tongue; Vomiting after food of watery fluid; great tenderness and Colic; prostration and wasting; watery Diarrhoea.
Kreasotum. Obstinate Vomiting, with general ill-health.
Calcarea Carb. Chronic Vomiting, with swelling and hardness of the bowels, and constipated or offensive motions.
Veratrum Alb. Excessive Vomiting; nightly Diarrhoea; faintness; coldness of the face, tongue, and extremities.
Pulsatilla. Tongue covered with whitish mucus; Vomiting of mucus or bile; mucous Diarrhoea.
Nux Vomica. This is an excellent remedy in some forms of Chronic Vomiting.
ACCESSORY TREATMENT. The child should be sponged twice a day with tepid water, and afterwards rubbed with olive-oil. The greatest cleanliness should be observed, and all vomited matters or soiled clothes removed immediately. ( See also preceding Section.) A change of diet, as recommended in the former Section, is generally the first point of be attended to.
XLIX. Acute Infantile Diarrhoea.
The frequency of Diarrhoea in early childhood, especially during teething, its hurtful effected on the constitution if unchecked, and its large contribution to infantile mortality, especially in summer and autumn, render the subject one of great importance.
VARIETIES. Diarrhoea has been described under numerous headings simple, catarrhal, non-inflammatory, choleraic, inflammatory, and dysenteric. Simple Diarrhoea, when sudden, profuse, and frequent, becomes choleraic. When mucus from the large intestine accompanied the bowel-discharge, it becomes inflammatory; and if straining be superadded, it is termed dysenteric.
CAUSES. Improper food, especially farinaceous, which is often unwisely given almost as soon as the child is able to swallow. Sour milk is a frequent cause, so is an inferior quality of mother’s milk, as in women in whom the monthly period has returned, or whose milk is otherwise deprived, of its nourishment. Sugar is also hurtful, particularly when given too freely. The late Dr. Lade writes: “I find the milk of the cow, without the addition of sugar, far preferable to the two together.” Giving castor-oil, or butter-and-sugar; also contaminated water, the emanations from drains or decaying refuse, are causes. Further, atmospheric conditions, especially in summer and autumn, tend to develop or increase Diarrhoea.
SYMPTOMS. These vary extremely, even in recent and acute attacks, from a slight, painless increase in the quantity, frequency, and altered form of the evacuations, to violent, painful and frequent purging; watery evacuations. perhaps several times every hour, being ejected with spasmodic force. In the more severe stage they are sometimes streaked with blood, and mixed with mucus. There is also generally sickness, thirst, and an interruption in the nourishing processes. The eyes are sunken, the features pinched and darkish; the pulse rapid, feeble, and nearly imperceptible; and the legs and hands cold and shrunken.
TREATMENT. Slight attacks may be left to themselves; the relaxation may be beneficial, and cease of itself in a day or two. As soon, however, as it begins to act injuriously, corrective measures should be begun.
Iris. Bilious evacuations, with sickness.
Chamomilla. Diarrhoea during teething, or from cold, with fretfulness of restlessness; colicky pains; greenish, watery, frothy, and offensive evacuations; yellowness of the whites-of- the-eyes, and sallow skin.
Ipecacuanha. Simple diarrhoea, or blood-streaked, with sickness, the latter symptoms being more marked than the Diarrhoea.
Rheum. Sour swelling, copious motions.
Mercurius Dulcis. Stools green, whitish, clay-coloured, watery, or mixed with mucus; straining, nausea, and thirst.
Mercurius Cor. Evacuations containing blood, and passed with excessive straining.
Veratrum Album. Frequent copious, watery discharges, occurring in gushes, and accompanied by excessive Vomiting and prostration; cold sweat on the forehead, and coldness of the abdomen.
Arsenicum. Neglected or advanced cases, in which there is aggravation at night, and unquenchable thirst; when other measures seem useless, and the pale, sunken face gives evidence that the disease is making serious inroads.
Podophyllin. Profuse, sudden, foetid, exhausting discharges,. worse in the morning and forenoon; drowsiness; rolling and perspiration of the head; moaning and restlessness.
ACCESSORY MEANS. In the first place, an attempt should be made to correct Diarrhoea by the removal of its cause. (See “Acute Vomiting.”) Cold milk and lime-water will often suffice to arrest an attack. When sickness is superadded to the Diarrhoea, and is troublesome, all preparations of milk may have to be suspended for a few hours, and water, or barley-water, substituted; and this, again, followed by beef-tea, or other animal broths.
In grave cases, with tendency to failure of the pulse and sudden extreme prostration, small dose of brandy are necessary. Ten to twenty drops with milk, or milk-and-lime-water, may be given every thirty to sixty minutes. The feet and abdomen should be kept warm. Cleanliness and fresh air aid recovery.
L. Chronic Infantile Diarrhoea.
Chronic Infantile Diarrhoea is generally much milder than the acute, but none the less grave on that account. It is often overlooked till the loss of flesh and strength are so far advanced as to force a conviction that some secret disease has been eating away the system. Fever is absent from the first; the motions may be three of four daily, about the colour and firmness of putty, consisting partly of undigested food, and accompanied with pain and straining. The motions often smell sour and offensive, while the child looks dull and pale, but otherwise well. This form may continue for weeks, or even months; the additional symptoms being loss of flesh, colour, and activity. At length the stools become watery, slimy, clay-coloured, or grass- green, and have an increasingly offensive odour. At this stage, variations are almost constant, often varying with atmospheric changes. The emaciation advances; the food, eagerly taken, seems to pass immediately in an undigested state; the child lies listless and helpless, or cries plaintively, and draws up his legs from the accumulation of gas in the abdomen.
The skin is now dry and harsh, the features old and pinched, the bones projecting and the child appears a mere skeleton, loosely covered with wrinkled skin. The appetite becomes whimsical, or is altogether absent; the stools become excessively frequent fifteen or twenty in the twenty-four hours; Thrush, and soreness of the buttocks follow, and death may shortly take place.
Should the stools, however, become more solid, and covered with bile; should the patient also put on a more active, fretful, and tearful temperament, hopes of recovery may be entertained. Diminished foetor of the stools, Constipation, and increase of flesh and strength, are additional grounds for hoping for a favourable end.
CAUSES. Chronic Diarrhoea is generally traceable to three sets of causes, viz. unhealthy conditions, atmospheric influences, and acute disease.
The younger the child, the more easily is it affected by neglect of cleanliness, want of proper food, fresh air and sunlight. The bad habit of giving newly-born infants castor-oil and boluses of sugar-and-butter by old-fashioned nurses, is also a frequent cause. Diarrhoea, often follows Measles, Small-pox, Scarlatina, Inflammation of the lungs, Enteric Fever, Croup, Bronchitis, and Pleurisy.
If the disease date from a few days of the child’s birth, or if its commencement coincide with weaning, or the use of unsuitable food, it is probably a simple bowel catarrh.
If the motions become thicker and more uniform, a favourable result may be anticipated. Amongst the favourable signs may be included continuance of the progress of teething, the appearance of tears, and the occurrence of any eruption (unconnected, of course, with any of the eruptive fevers.).
EPITOME OF TREATMENT.
From errors in diet. Pulsatilla, Ant.-Crud., Mercurius, Croton Tig.
From exposure to cold. Aconite, Mercurius, Bryonia,
From exposure top heat. Bryonia, China., Iris.
From worms. Cina., Mercurius, Calcarea carb., Ant.-Crud.
With inflammation of the bowels. Arsenicum, Mercurius-Cor., Coloc., Aconite, Podoph
SPECIAL INDICATIONS. Calcarea Carbonica. Diarrhoea in weakly, pale-faced, wasted children, liable to glandular swellings; undigested, sour, pappy, frothy, bad-smelling or involuntary stools; thread-worms, pains during a motion, and faintness afterwards.
Mercurius Iodatus. Chronic Diarrhoea, with hardness, enlargement, and a knotty feeling of the abdomen.
Croton Tiglium. Thin, yellowish-brown, putrid evacuations, expelled suddenly, and induced by eating; involuntary stool during sleep.
Iodium. Thin, foetid diarrhoea, with distension of the bowels; emaciation; hectic symptoms.
Arsenicum. Diarrhoea worse after food, especially after midnight; frequent and scanty motions; weakness and wasting; excessive, unquenchable thirst; vomiting.
Phosphorus. Chronic Diarrhoea in children having a consumptive tendency; yellow tinge of the eyes and skin.
Mercurius Sol. Frequent evacuations of frothy mucus, or whitish green, offensive, or bloody stools; soreness of the anus; violent pain; Jaundice. If there is severe straining, with other Dysenteric symptoms, Mercurius-Cor. is preferable.
ACCESSORY MEANS. For children two or more years old, mutton, chicken, game, pigeon, white fish, and old rice freshly cooked in milk, are excellent; also beef-tea in which rice has been stewed. Animal broths in small quantities, and raw eggs beaten up or eggs lightly boiled, are necessary; also tepid abdominal compresses, and frictions over the whole body. An abdominal belt of flannel is often preventive or curative. Cod-liver-oil is frequently advantageous.
LI. Prolapsus Ani (Prolapsio Ani) Falling of the Bowel.
DEFINITION. A prostration of the mucous lining of the rectum through the anal orifice, after the action of the bowel, which goes back of itself, or is easily replaced.
CAUSES. Constipation or Diarrhoea; purgatives; straining excited by worms, or stone in the bladder; laxity and delicacy of constitution, or being allowed to sit too long at stool.
REMEDIES. Ignatia is often specific.
Podophyllin. Prolapsus accompanying Diarrhoea, with straining and offensive stools; irritation from teething, etc.
Mercurius. Prolapsus, with itching, discharge of a yellowish mucus, and Diarrhoea; hard, swollen abdomen.
Lycopodium. Obstinate cases, and when other remedies only partially cure.
Sulph., Calcarea, Sepia,. and Arsenicum are sometimes required.
ACCESSORY MEANS. When Prolapsus occurs, the protrusion should be returned by placing the child across the lap, and making pressure on the part with the fingers, previously lubricated, and carried beyond the ring of the anus. Bathing the parts with cold water every morning, and injections of water are useful. The action of the bowel in the evening, just before going to bed, should be encouraged.
LII. Worms. (Entozoa).
The worms that most commonly infest children are the thread- worm, the round worm, and occasionally the tape-worm.
Thread-worms are from one to three quarters of an inch in length, white and thread-like, moving rapidly. They cause great irritation.
The round-worm is from six to fifteen inches long, similar to the common earth-worm, but of a paler colour.
The tape-worm is white, flat, and jointed, varying in length from a few feet to several yards.
SYMPTOMS. Itching and irritation about the anus, especially troublesome in the evening; depraved or irregular appetite, offensive breath, straining at stool, falling of the bowel, disturbed sleep, and general restlessness (Thread-worms). When Round -worms exist in numbers, there may be pain and swelling of the abdomen; slimy stools; tenesmus; chronic Diarrhoea, most troublesome at night, with thin, scanty, and offensive motions; pallid countenance, dilated pupils, grinding of the teeth in the sleep, Convulsions, etc.
The symptoms of Tape-worm are less marked; sensations of weight or gnawing in the abdomen; enlargement about the navel; great appetite, and increasing wasting.
CAUSE. The predisposing cause of worms is an unhealthy, slimy condition of the intestines, often due to improper feeding.
TREATMENT. Injections. When there is much irritation an injection of salt-and-water ( a tea-spoonful to half-a-pint) may be used at bed-time for several days. Or lime-water injections may be used, or a little sweet oil.
1. Constitutional Remedies. Calcarea carb., Mercurius, Sulphur, Silicea, Arsenicum, Ant.-Crud.
2. Remedies to expel the Worms. Cina, Santonine, Teucrium, Mercurius, Urtica Urens (Thread or Round Worms); Oil of Filix Mas., xx.–xl. drops, in mucilage and syrup, half an ounce of each, as a draught to be taken on an empty stomach early in the morning (Tape worm).