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General Treatment of Children in Disease

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When a child is suspected or seen to be unwell there are certain steps that ought to be taken at once, no matter what may be the nature of the illness, steps which, if taken immediately, will, in many cases, be able to convert into a short and slight illness what, if neglected, might become a long and serious one, and which may even be sufficient to arrest the illness altogether.

As soon as the child is supposed to be ill it should be stripped, bathed, and put to bed, if possible in a quiet room, not in a noisy, much frequented apartment. The bed should be fresh and clean, not closed in, and freed entirely from hangings and curtains. The room should be well ventilated, but free from draughts. A fire secures a continuous supply of good air to a consider able extent, besides warming the room, which should be kept as much as possible at a regular temperature—a moderate one (62° Fahrenheit), —which is most easily managed by the aid of a thermometer kept hanging in the room.

At once attention is to be directed to (1) the diet of the child and (2) the state of the bowels. (1) The whole trouble may have arisen from overfeeding or improper feeding. The child is, therefore, to be put on milk diet entirely (see the directions given under MANAGEMENT OF CHILDREN, p. 565). The quantity is to be kept strictly moderate, small quantities given in frequent but regular intervals being better than large quantities at one time. Irregular feeding must be avoided, and no solid food whatever given. (2) If the bowels have not been properly moved for some time a moderate dose of castor-oil or of fluid magnesia, or similar mild purgative, may be given. This is, gen erally speaking, all that should be done on the mother's or nurse's sole responsibility, when the services of a medical man are at all obtain able. When such services can be obtained they should be at once sent for, as very slight symp toms may be the forerunners of very serious disease. The medical man being in attendance, his advice, and none other, should be strictly, promptly, and conscientiously followed.

But it will often happen that medical aid is not within immediate reach ; that, owing to distance or some other case, it may be many hours before the doctor can arrive. Meanwhile the child seems highly fevered, is very restless in its sleep, seems to be wandering, or the mother fears convulsions. What is to be donel This, at any rate, must not be done: the mother or nurse must not seek to quiet the child by "soothing syrups" of any description. Espe

cially in nervous conditions is a great deal of harm possible by their means. There are, how ever, two things the mother may do without the least fear, tivo things beside what has been already advised. First an injection into the bowel should be given for the purpose of pro ducing at once a full clearing-out of the lower bowel. The fact that castor-oil or some other opening medicine has been already given does not stand in the way of the injection, if it seems needed, for the injection will clear out the lower part of the bowel, while the medicine sweeps everything down from the upper end.

Mode of Injection. — An enema-syringe should be used (as represented on Plate XXXII.). It is an oval elastic bag, with an opening at each end of the oval ; from each opening pro ceeds an elastic tube. One tube ends in a long ivory nozzle for insertion into the bowel. The other end dips into a bowl of water. When the bag is compressed by the hand, anything it contains is forced out through the nozzle ; when it is allowed to expand it sucks up a fresh sup ply of water by the other tube, the movement of the water being directed by valves. Take a small bowl of tepid water, work the syringe for a little time till it is found to be in good work ing order, expelling a steady stream of water, unmixed with air, from the nozzle with each compression of the bag. Now oil the nozzle, and by a twisting movement gently pass it up into the child's bowel, using no force, and directing the point slightly backwards and to the left, the child lying on its left side in bed or in the nurse's lap. An ivory plate prevents it being pushed too far. Then gently but steadily squeeze the bag till the water has all passed into the bowel ; then relax and let it refill ; gently press again. Take care that all the time the other tube—the inlet tube—is dipping below the surface of the water in the bowl, so that no air is sucked in. Even in the case of quite a young child the quantity injected by two or three compressions of the bag is not too much, when it is desired to act well and quickly. With older children a small bowlful of water may be injected with perfect safety. Instead of water, pure olive-oil, gently warmed, may be injected, from 2 to 5 ounces, that is from less than a half to a whole tea-cupful. When an enema-syringe cannot be obtained, a brass one with ivory point may be used. Glass syringes are rather to be avoided, and, if used, great care must be taken that the point is quite round and not sharp, and that it is not broken in the bowel.

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