For instance, it may be due to irritation of the stomach by too much, or badly prepared, food, or improper food, or food that has gone sour or is tainted and undergoing chemical change. But it may also occur when there is no irritation of the stomach itself, the irritation being in some other organ. Thus it is a fre quent occurrence in tubercular disease of the brain in its earliest stages, and it is a constant symptom in obstruction of the bowel. In such cases the stomach is made to empty itself by a reflex nervous action starting from the distant organ which is the real seat of the irritation. But how is a mother or nurse to distinguish between the simple and the serious condition? The answer is that the mother or nurse should not try to do so if she is within reach of com petent medical advice. The risks are too great. Delay is too dangerous. In the serious con dition twelve hours' delay may make all the difference between successful treatment and a hopeless situation.
But this book, it is is primarily meant for those who are far from proper medi cal help, or for those to whom the summoning of the nearest but yet distant doctor is a serious financial consideration if only a trifling ailment is concerned.
Persons who are in such circumstances should be in some measure prepared, if they have chil dren to care for. They should be provided with a thermometer and know how to use it. The temperature in such cases should always be taken in the bowel (see p. 38).
The vomit should be carefully inspected as to its general appearance, and specially its colour, and any motion similarly inspected.
A child, then, is seized with an attack of vomiting, under circumstances which render medical aid impossible for many hours; what is the mother or nurse to do? The child should be stripped, put to bed, and its temperature taken in the bowel, and the amount and hour when taken noted down in black and white.
All food and even water is to be stopped for a time, and the bowels are to be cleared by a water or oil enema (see p. 592); no drugs are to be given.
If medical help has been sent for and will arrive in an hour or two, the doctor's arrival should be awaited and nothing else done.
But we shall assume no medical help is near. The person in charge is compelled to try to come to some sort of conclusion.
If the temperature is normal, or below it, that is in the bowel, or lower, no conclusion can be drawn, but if the temperature is above this level, something is wrong somewhere. The temperature should be taken at regular inter vals, say every three hours, and carefully noted.
If a temperature, at first below normal, in an hour or two rises to normal, and remains there, not going above, the probability is the disturb ance has been trifling and is over, but if it is found above normal, or, originally low, goes above normal and remains so, there is mischief going on, and great care must be exercised.
The temperature having been taken, the next thing the person in charge should do is to uncover the child's belly, the child lying on its back, and carefully to note whether it is any where unduly bulging or unduly rigid. The warmed hand should then be gently laid flat on the child's belly and moved gently over it, in the endeavour to discover whether there is any place painful to pressure. The unskilled person cannot be expected to learn much, but often will be able to make out that the child is uneasy, or cries or wriggles, when the hand presses over one particular place. If the child is old enough to do so, it will say where there is. pain, though one must be on one's guard against being misled by a nervous child. But if the child is old enough, it should be asked to put its baud on the painful place. After it has done so, the child's attention should be drawn to something else, and then, after a minute or two, it should be again asked to lay its hand on the painful place. This manoeuvre may be several times repeated, in order to discover whether the child always lays its band exactly on the same place. If it does so, the mother or nurse should then try whether gentle but firm pressure with the points of two fingers over this place causes complaint by the child.
More or less persistent vomiting, accompanied by a raised temperature, however little, and by a painful area or spot in the belly, is strongly suggestive of appendicitis (see p. 247), intussus ception (p. 604), or obstruction (p. 253), while if the belly is prominent and tender all over, peritonitis is to be feared (p. 265).
Vomiting, temperature, and pain in the belly, when associated in a child, are symptoms of the gravest kind that must never be treated lightly.
The paragraphs dealing with each of these ailments should be referred to for further information.
The cases in which vomiting is a symptom of very grave character have been referred to first to emphasize the warning meant to be conveyed. But, of course, such cases, though every now and again occurring in most unex pected fashion, are few in comparison with the multitude of cases of vomiting due merely to some error of diet.