In the second class of cases the urgent thing is to find the source of the irritation, and when it has been found, the means of its removal will be probably apparent.
The moment, however, when the child is actually in a fit is not the time to hunt up and down to discover to what class it belongs, unless one fit is following another with little interval. The immediate question is how to deal with the attack.
But the following procedure will cover the most of the cases, and the explanations just given will make the purpose of that procedure intelligible :— 1. The child should immediately be un dressed, and be kept warm in a half-blanket or warm 2. Au injection should immediately be pre pared and gently passed into the bowel to sweep out all offending material. The best for this purpose is the oil, glycerine, and soapy water, noted on p. 606, but plain tepid water will do if nothing else is available. or plain warm water with the addition of a table-spoon ful of salt.
The object of the injection must be secured, that is, the complete empty ing of the lower bowel.
3. Meantime a warm bath should be pre pared. Instead of three or four persons run ning distractedly about, getting in one an other's way, and undoing one another's work, as one has often seen, whenever several people are about, let one prepare the injection, while another prepares the bath.
There is risk that in the hurry the bath be made too hot. Its temperature should not be above 98° Fahr.
The child should be immersed gently, not plumped in, and should be supported by the hand and arm of the nurse or person holding it, being so placed that the hand is spread over the lower part of the child's back, and the child reclines, as it were, on the arm. The heat of the bath should be maintained by the addition from time to time of a little hot water to the side. The relaxation of the child's rigid muscles, the restoration of its colour, the quiet ing down of its movements, will indicate im provement. As soon as it has been restored to comfort, and its consciousness is returning, the child should be removed, quickly dried, and, no time being wasted on dressing, it should be loosely wrapped in a warm blanket, and put to bed and lightly covered.
4. In a short time, the attack not having recurred, and the child being quiet, it would be well to administer a full dose of castor-oil to sweep down any offending material from the stomach and upper bowel. But this must be done with caution, and must not be per sisted in, if the child resists in any way, lest struggle provoke another fit.
5. If these measures have all proved fruit less, or have only procured brief intervals of quiet, a solution of bromide of potassium should be injected into the bowel. The dose for an infant is 5 grains dissolved in one table spoonful of tepid water, and it should be in jected slowly by means of a glass syringe, no air being introduced. A child one year old
may have 10 grains, and the dose may be re peated every hour if necessary for four doses. With older children, rather than give larger doses, one may repeat them oftener, every half hour till four doses have been given. The addition to each injection of one grain of hydrate of chloral greatly increases the effect of the bromide, but it is too powerful a drug to be administered by an unqualified person, except in grave emergency, when no medical man is available.
6. The application of cold to the head, or an ice cap (pp. 337, 338), and wrapping round feet and legs a piece of flannel, wrung out of warm mustard and water (a tea-spoonful of mustard to a tumbler of warm—not hot—water), will help to maintain the soothing effect of the bath.
It is when the immediate urgency is over that the search for sources of irritation should be quietly made, should the material brought away from the bowel not have revealed it.
in which a child. starts up from sleep shrieking and in a state of extreme terror, are commonly caused by irritation through undigested or indigestible food. Care in the management of food, already so often advised, and attention to the bowels, will pre vent their recurrence. If this is insufficient a dose of 5 grains bromide of potassium with 2 of antipyrin may be given the child at bed-time in a table-spoonful of water.
Spasm at the head of the Windpipe Child-crowing—False Croup.—The child is suddenly seized, and frequently during sleep, with spasm that prevents the entrance of air to the lungs; the face becomes swollen, red, and then bluish, owing to the great difficulty of breathing. The child is extremely agitated, and there seems a tendency to convulsions. In a short time the spasm yields, the air rushes in with a long crowing noise, and the child falls back pale and exhausted, and becomes in a short time composed as if nothing had hap pened. The fit may recur, and may, if pro longed, cause death by suffocation. It is a nervous disease, and occurs owing to nervous irritability. The irritation may be from teeth ing, or the child may be so excitable that a slight fright may occasion it.
Dash cold water over the child's chest. A hot foot-bath with mustard, or a warm bath for the whole body, is also useful. While the child is in the fit, forcibly open the mouth and pull forward the tongue, grasping it by a hand kerchief between fingers and thumb. As a preventive, bromide of potassium, in doses from 2 to 5 grains, with 5 drops spirits of ether or tincture of valerian, is useful. Examine the teeth and ears, and watch the bowels, so that any cause of irritation may be removed.
St. Vitus' Dance or Chorea is discussed on p. 182.
is considered on pp. 155 and 156.
Paralysis as it sometimes attacks children is discussed on p. 179.