TREATMENT.- In the early state the symptoms are usually those common cold, and point to Aconite and then to Ipecac., which medicines may be given alternately, or otherwise, as the case may demand. When the spasmodic and peculiarly characteristic “hoop” is decided, Drosera should be administered – a dose every three hours.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Aconitum.- Febrile symptoms, dry cough, burning pain in larynx.
Belladonna.- Dry Cough, spasmodic contraction of larynx, sore throat, flushed face, suffused eyes, convulsions.
Cuprum.- Paroxysms attended with threatened suffocation, vomiting, rattling noise in bronchial tubes, Convulsions.
Drosera.- Similar to Cuprum, but without Convulsions.
Ipecacuanha.- Dry-cough; vomiting, especially in the early stage of the disease.
ADDITIONAL REMEDIES.- Antim tart. (Bronchitis, with much sputa); Bryonia (Pleuritis); Carbol. Ac. (Premonitory Catarrh); Coral.- Rub. (fully developed symptoms, return of cough after it has apparently left the patient); Cina (cough, with gastric derangement, Worms); Dulcam. (aggravated by damp); Kali bichromicum (Bronchitis, with stringy mucus); Phosph. (Pneumonia). Ammonium- Bromium-Drs. Harley and Gibbs regard this remedy as almost specific, and many cures by it are reported.
ACCESSORIES.- In warm, fine weather the patient may take exercise in the open air during portions of each day; indeed, a reasonable degree of exposure to open air, in the absence of unfavourable conditions, is one of the most essential aids towards recovery. But damp and draughts should be strictly avoided, as the skin is generally relaxed, sensitive to cold, and after a paroxysm bathed in perspiration. Warm clothing is therefore necessary. Fits of anger add to the frequency and violence of the paroxysms. Infants must be watched day and night, taken up as soon as a fit comes on, and placed in a favourable posture. “Balcony” treatment, or its equivalent, is of the utmost value, and is only contra-indicated by strong winds and fog. In obstinate cases, change of air, if only at a short distance, often proves a great utility.
Another means of relief is to rub the chest and back of the little sufferer with oil for a few minutes every morning and night. Spinal friction is also of service.
DIET.- Light digestive food only, in moderate quantities, frequently given; in the convulsive stage it should be highly nutritious and if there is much vomiting, it should be given immediately after a paroxysm. toast-and-water, barley-water, or gum-water are grateful and soothing; but a too exclusive slop- diet often aggravates the vomiting. Cod-liver oil should be given in convalescence.
26. Mumps (Parotitis).
DEFINITION.- Inflammatory swelling of the salivary (parotid) glands beneath and in front of the ear, frequently with pain, soreness, and difficulty in moving the jaws. The glands sometimes attain a very large size; the enlargement generally commences on one side, and as it diminishes shows itself on the other side.
CAUSE.- A specific germ of uncertain identity, communicated by direct contact. It often occurs as an epidemic, particularly in cold, damp weather; is more incident to children after the fifth year than to adults; and only occasionally attacks the same person twice. It is very infectious; children take it from their playmates and school fellows.
SYMPTOMS.- At first there is a feeling of stiffness and soreness on moving the jaw, and the child complains of the discomfort of eating; indeed, the pain caused by eating or even drinking is sometimes agonizing. The swelling first appears in the hollow under one ear and spreads downwards in the neck and forwards on to the face; two or three days later the parotid gland on the opposite side of the face begins to swell. The glands continue to be sore and painful, with more or less fever and headache, for about a week. There is little danger, but there are one or two unfortunate possible complications, such as Deafness, Orchitis (inflammation of the testicles – this, however, seldom occurs before puberty), and pancreatitis (severe epigastric pain, vomiting, and collapse).
TREATMENT.- Give Aconite every two or three hours for three or four times, then Mercurius-Sol. 6 every three hours.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Aconitum.- Pain and fever
Belladonna.- Pain, erysipelatous redness of the skin, tendency to metastasis of the brain.
Mercurius Sol.- Foul tongue, increased flow of saliva.
Pulsatilla.- When metastasis takes place to the testicles or mammae.
ACCESSORY MEANS.- The child should be kept in a warm room, but not confined to bed. The parts may be fomented with hot water several times a day, and in the intervals covered with a flannel bandage. The patient should be protected from cold, damp, and excitement. In this disease, as also in Quinsy, semi-liquid food is swallowed with much less suffering that either liquid or solid food, and hence should be chiefly used.
CHAPTER II CONSTITUTIONAL DISEASES
27. Rheumatism of Children
RHEUMATISM is a very common disease in children, and owing in particular to its effect upon the heart, it is productive of a great deal of ill-health, chronic invalidism, and premature death. The adult type of acute Articular Rheumatism (Rheumatic fever) is seldom seen in children. Rather is the condition subacute, and indeed often a febrile. Whereas in adults the force of the disease expends itself on the joints, in children there is comparatively little of rheumatic pain, and when present it is not severe, but the disease takes terrible toll of the heart and nervous system.
DEFINITION.- A microbic infection constitutionally causing a low range of fever and an often profound anaemia and locally affecting the joints, the fibrous and muscular tissues, the throat, the tissues of the hear, and the cortex of the brain.
CAUSATION.- The real cause is almost certainly a micro-organism, which probably in most cases gets access into the body through the tonsils. Hence the Tonsillitis, which is an early manifestation often repeated through the course of the disease. Exciting causes are chill and damp and insufficiency of warm clothing. Low-lying soil which keeps the damp and garments improperly “aired” – or garments sat in when they are damp, all make a heavy contribution to the sum-total of Rheumatism. The influence of food as a causative factor is probably negligible. The “acidity” of Rheumatism is not due to uric acid, as is so commonly supposed, but rather to lactic acid, manufactured in the muscles through the activity of the specific microbe.
SYMPTOMS.- The main manifestations of Rheumatism in children are Tonsillitis, slight and fugitive pains in joints and muscles (favourite sites are the back of the knee and the heel), nodules on the exposed bony surfaces and prominences (e.g. elbow, ulna, wrist, vertebrae, Carditis (inflammation of the heart – Peri-, Myo-, and Endo-carditis), Chorea (St.Vitus’s Dance (see Section 38), minor nervous systems (e.g. night-terrors, incontinence of urine, teeth-grinding, etc.), erythematous rashes, Rheumatic Anaemia, and the symptoms of Rheumatic Carditis.
In this last- named condition there is usually some fever, though it may be slight, and there are vague and inconstant physical sings (enlargement of the heart, murmurs, etc.), but often an increase in the pulse rate is the chief and most reliable guide to the condition. In a rheumatic child, perhaps suffering from some of the other troubles of Rheumatism, an increase of pulse-rate, not otherwise accounted for, signifies that the heart has been attached. Other suspicious signs are restlessness, pallor, and anaemia. The appearance of “rheumatic nodules” nearly always means that the heart has been involved. Pericarditis alone of the cardiac affections always has marked physical signs – considerable enlargement of the heart’s area and the typical to- and-for rub heard over some part of the heart.
TREATMENT.- Bryonia, rhus Tox., and MercuriusSol.. are given for rheumatic pains and tonsillitis.
Spigelia, Arsenicum-Iodium, Kalmia, and Cactus are given for the rheumatic heart. For the constitutional condition, the chronic enlargement of the tonsils, and the anaemia, Calcarea-Phosphorus is often of the greatest service.
INDICATIONS FOR THE ABOVE AND OTHER REMEDIES.
Aconitum.- Pain and fever. Suitable at outset of Rheumatic fever. Often well given in alternation with Bryonia.
Arsenicum.- Acute Rheumatism with Pericarditis and effusion.
Arsen.-Iodium- Rheumatic Carditis.
Bryonia.- Heat and swelling of joints. All pain worse by movement.
Cactus.- Rheumatic Carditis.
Calcarea-Phosphorus- Enlarged tonsils. Adenoids Flatulence and acidity. Chalky pallor. Stiffness, pain, and chilliness, worse from change of weather.
Cimicifuga.- Muscular Rheumatism, especially in back and neck. Chorea.
Colchicum.- Shifting Rheumatism, worse at night and in hot weather. Dysenteric stools. Great nausea from smell of cooking food. Heart trouble, especially Pericarditis.
Dulcamara.- Rheumatism from damp and wet, worse by every cold change. Accompanied by Diarrhoea from damp cold weather.