F. A. PINELES-MONTAGU, M. D., Drury, New Zealand
In September, 1901, I was called out to see Miss Aultnett, aged 19. The mother stated that her daughter had been taken ill through the night with vomiting, pains in the stomach and diarrhea. On examination I found the temperature 103°, pulse 120; complained of violent pains in the epigastric region, with great apprehension and sinking sensations; emesis after food; severe cramps of the abdominal muscles; gaseous eructations, flatulence extreme with pyrosis; tongue furred, creamy; tip and margins red; stools of the character of a diarrhea and copious; anorexia and exhaustion; menses regular. I directed that a mustard plaster be placed on the affected part for twenty minutes and bound round with a flannel bandage. Internally I prescribed
|Bismuth carbonas||drs. 2|
|Acid hydrocyanic dil.||drops. 16|
|Tr. opii||drs. 1.5|
|Aqua, q. s. ad||ozs. 8|
Mix. Sig. Two drams in sufficient water every three hours.
I ordered a cold liquid diet, milk diluted with soda water. I forgot to state that I kept my patient in bed to allow the stomach to remain in a state of rest. When I visited her the next morning, I found temperature 101°, pulse 88; very slight pains; stools not so frequent, slept fairly well. I kept her on the milk and soda water, and in addition ordered her a little corn flour and milk, tepid. When I called next day I found the temperature and pulse normal and the pains had disappeared. The stools were almost normal. The patient was hungry. I ordered for her chicken, and chicken broth, which contained a little brandy. And later, potatoes and bread and butter. On calling the following day I found my patient up and smiling, said she felt quite well but was a little weak. As a tonic with which to brace up the nervous system I gave her the phosphate of iron in solution.
This complaint chiefly occurs during the summer months, when children become predisposed to illness from the weakening effect of exposure to the sun and heat, and to errors in their diet; eating fruit; drinking impure water; especially when the body is heated, and from unknown causes.
The usual symptoms of this complaint are extreme diarrhea. The stools are usually pale, liquid and copious, there may be emesis and cramps. The stools and vomiting matter usually contain bile; and there is great thirst. The eyes become sunken and the face takes on a dusky hue, there is also anorexia and great prostration, and if not soon relieved the child dies of exhaustion. I have had great success in the treatment of this disease, and therefore write this article for others.
I always direct the mother to put the child to bed, and to bind a flannel bandage around the abdomen fairly tight. I relieve the thirst with milk and water. If there is vomiting I apply a mustard plaster over the abdomen for ten or fifteen minutes over the pit of the stomach, and I prescribe internally the following powder, which generally has the desired effect: Mercury with chalk, 3 grains; bismuth subnitrate, 9 grains; salol, 3 grains. This is thoroughly combined. For a babe one year old I divide it into 12 powders; for a two-year old child into 7 powders; for a three-year old into 5 powders; for a seven-year old into 3 powders, and for a ten or twelve-year-old child into 2 powders, and give as demanded. If the child is much exhausted you may give a little milk with brandy every hour or two as the occasion demands. Give all drinks cold. Milk, barley water and ice should be given frequently, in small quantities. When the vomiting and diarrhea has been controlled you may give frequently and in small quantities chicken or mutton broth. Be very careful that the milk is pure and fresh. I do not agree with the faculty in general, in prescribing opium or its compounds to children, especially in this disease, as it causes retention of urine and in nearly every case of this complaint the urine is diminished anyhow.
COMMENT:—In the treatment of cholera infantum the doctor makes some excellent suggestions but omits the washing out of the intestinal tract, and the use of the specific remedies for the specific indications. The use of mercury is not common among our physicians in the United States in this disease. In occasional cases we have the indications for podophyllin. Commonly ipecac for the intestinal irritation, aconite for the febrile symptoms and the arsenite of copper for its characteristic diarrhea are the remedies used. In addition to these there is a varying train of symptoms which must be met according to the indications present.
This disease may occur in children at any age. Facial paralysis may be produced either by exposure to cold, or by injury done with obstetric forceps, by an inexperienced, impulsive or rough accoucheur. Paralysis may be also temporarily caused by a pyrexia or general debility; or perhaps by sitting on a cold stone floor or step; also by dentition or worms or conditions which produce reflex irritation. Diseases of the brain and spine will also produce paralysis. Children who are born so, will be seen when older to have one of their lower limbs thinner and shorter than its fellow. However, there is one kind peculiar to children that comes on suddenly without warning. It may affect any of the limbs of the body, although the child does not quite lose all power, but the movement is very weak and imperfect, and the condition, if it receives any benefit from the treatment, which is seldom, is but partially cured. There remains a slight defect, with impairment in the growth of the limb and in its size. To diagnose this form, it is well to see that there has been no previous brain disease, nor spinal complaint, nor convulsions, nor injury.
As a rule it only affects the lower limbs, and in these cases I order the limbs to be rubbed with ammonia liniment twice daily and direct that the limbs be enclosed with cotton wool and bound with a flannel bandage, and internally I prescribe cod-liver oil, and, in addition, a wine of iron and nux vomica. The nux vomica should not be given in large enough doses to cause twitching of the limbs, else it must be at once discontinued.
In addition, I direct the nurse or mother to exercise the limb, and also to teach the child to use it. I have found that massaging the limb is very beneficial. Of course it will take a long time to improve, but both the medicine and other directions must be persevered in. Rome was not built in a day.
Acute Nephritis of Childhood
This disease is caused by exposing the child to cold, through insufficient clothing; especially climatic changes or a chill, and very often as the after effects of scarlatina. There is, as a rule, a slight pyrexia; pain in the loins which is increased by pressure, The urine is passed in small quantities frequently, and being of a dark, reddish color, shows the existence of blood. There also may be nausea, anorexia and constipation, and if relief is not soon obtained dropsy sets in. Convulsions may also occur from uremia, which may prove fatal. As a rule there is great thirst.
Put the child on a fluid diet. Milk, barley water, mutton or chicken broth, should be given, and the child should be allowed as much milk as it can drink.
Apply a hot poultice over the loins until the urine is normal. and give the child a warm bath. If the following mixture is given at the beginning of the attack it may go far to save further trouble. I prescribe
|Citrate of potassium||drs. 1.5|
|Sp. barosma crenata||drs. 3|
|Water, q. s||ozs. 4|
Mix. Sig. A teaspoonful every four or six hours according to age.
When, the active symptoms are gone and only the dropsy remains I give small doses of the tincture of iron as frequently as seems necessary. I give it mixed with a small quantity of glycerine to take off the extreme metallic taste.
Acute Articular Rheumatism
This disease occasionally attacks very young children, but more generally those who are older. There may be a state of general ill health for some time, marked by chills. These are followed by pyrexia, and soon the joints become affected. The symptoms are both general and local. There is restlessness, insomnia, anorexia and a copious perspiration, and a sour smell often pervades the whole body. There is also constipation. The urine is high colored and is generally very acid in reaction, is markedly febrile in character, and deposits urates abundantly and sometimes contains a little albumin. The pulse is generally full and strong. The tongue is thickly coated and there is great thirst. Sometimes delirium occurs. The pains early attack the joints, elbows, wrists, knees and ankles, but the other articulations are not exempt. Usually several joints are involved in succession, and the same joint may be attacked more than once in the course of the disease. The affected joint is more or less red, either uniformly or in patches. It is swollen and enlarged and hot. The heart should always be early and frequently examined in this disease, and it will be found in the majority of cases that endocarditis will be diagnosed, although pericarditis or myocarditis are not rare. Another evil of this fever is that it is likely to return. The young or inexperienced physician will be led to suspect that the heart is attacked, by the child complaining of pain in the chest, or he may notice that the breathing is quick, or that the heart beats violently or irregularly.
I keep the bowels free by administering the compound powder of rhubarb in 15 or 20-grain doses as needed.
I usually give the following:
|Sodium salicylate||drams 2|
|Specific bryonia||drops 5|
|Specific cactus||drops 30|
|Aqua q. s||ounces 4|
Mix. Sig.: One dram every three or four hours according to the age of the child.
I also paint each joint with the tincture of iodine once each day or two and wrap it in cotton wool. For sleeplessness I prescribe a dram of passiflora and ten drops of the tincture of hyoscyamus in water and give the whole at the usual bedtime. Should there be great pain over the heart a strong mustard poultice is placed over that organ for ten or fifteen minutes, and will be found of great value.
When the child is convalescent, great care must be taken against exposure to draughts or cold winds, or a relapse will occur. A tonic should always be given after an attack, but usually not until all pain has disappeared from the limbs.
I use the following with good results as a tonic:
|Quinine sulphate||grains 8|
|Hydrobromic acid, dil.,||q. s.|
|Specific cactus||drops 30|
|Syr. aurantii||ounce 1|
|Aqua, q. s||ounces 4|
Mix. Sig.: A teaspoonful three times each day.
The hydrobromic acid is an excellent solvent for the quinin and obviates a tendency to headaches.