Pediatrics

“ Known to every physician who undertakes the care of children, is the failure of many well-meaning mothers to call him early. The mother attempts the care of the baby herself, and not until the condition gets beyond her knowledge and wisdom does she seek medical advice. In the early hours of an approaching cold, the beginning of intestinal indigestion, or at the beginning of bronchitis, if the physician can see the child early, prolonged illness may be avoided as well as unnecessary expense and many heart-breaking experiences. ”

“ Even to-day we have to concern ourselves with child-protection. The physician must not refuse to treat his patient because the means available for treatment will not suffice to cure. The wise physician does indeed endeavour to discover and to remove the causes of disease, but he does not neglect the symptoms. He is well aware that the disappearance of the symptoms does not indicate the cure of the disease. Nevertheless, he holds it to be his duty to prescribe certain remedies which do no more than relieve symptoms. ”

“ Rest, quiet, cleanliness and warmth are what the children need to restore them to health. The right kind of physician when acting as adviser to intelligent parents who wish to do the best by their children will see to it that there is little or no disease.
If the parents do not know what to do, the most economical procedure is to consult a physician who has understanding of and confidence in nature. Pay no attention to the women of many words who give advice "because they have had many children and have buried them all." ”

“ But if he be disposed, as many are, to make capital out of the anxieties of his employers, he will say that the child is very sick, and perhaps that ‘it is well you have called me so soon,’ or, ‘I wish that you had called me before, but I think on the whole that the little one can be relieved.’ Every physician knows how readily the imagination of a parent may be excited in relation to the symptoms of disease in a darling child. ”

“ Teachers have simply found physical defects an impediment to the pupil's school progress and desire their removal. The school doctor spends some three to six minutes in the examination of each pupil, looking only for the gross and external symptoms of defectiveness. Having strictly the point of view of the physician, his search is for disease. His training has not fitted him to scent out delicate, incipient deviations from the normal nor to see the necessity of doing so. He does not have a biological conception of the functions of child hygiene. ”

“ It is wiser to call the doctor at first, when symptoms of illness appear, than to incur severe sickness and greater cost by delay. A severely sick child needs a trained nurse. Children have less resistance than adults, and succumb more easily, therefore they need prompt, intelligent treatment.
Every woman who has the care of a little child should learn the following from the physician or nurse: use of clinical thermometer, bedpan, giving of enema, massage, dressing and bathing of bed patient, bandaging, first aid in serious cuts, fractures, broken limbs, drowning. ”

“ Too many people, and especially too many parents, think of the child as merely a small man or woman. This is far from a true conception of the child. Just as the physical organs of the child work in a manner different from what we find in the adult, so the mind of the child works along in a way peculiar to its stage of development. If a physician should use the same formulas for treating children's ailments as he uses with adults, simply reducing the size of the dose, we should consider his methods rather crude. ”

“ It is often the case that when we need our physician the most, he is busy with another patient and cannot come, or perhaps an automobile accident detains the man of the hour. The hospital delivery always possesses this advantage over the home—physicians are always on hand. We deem it wise to relate in detail the method of procedure during the rapid birth of a child; that the husband or nurse may give intelligent and clean service.
After the patient has been given the enema and has been shaved and the bath has been administered as previously directed, the helper most vigorously "scrubs up." ”

“ In early infancy, as in advanced old age, the hold on life is slight, normal and abnormal are soon interchanged, and there is needed not only more knowledge on the part of mothers and nurses, and even of physicians, of the hygienic side of medicine as applied to the physiological life of the mother and her infant, but also personal care and assistance to enable the mother to apply the useful information and advice given by the public health nurse. ”

“ As an old physician of some experience in complaints of infants and children, I may perhaps be allowed to suggest that in a future edition you should add a few words on the actual treatment of some of the more urgent infantile diseases. It is very right to caution parents against superseding the doctor, and attempting to manage serious illness themselves; but your advice, with very small 172exceptions, always being to ‘to lose no time in sending for a medical man,’ much valuable and often irremediable time may be lost when a medical man is not to be had. ”

“ The school physician's discovery of defects and diseases is of little use if the result is only the entering of the fact on the record card or the exclusion of the child from school. The notice sent to parents telling of the child's condition and advising that the family physician be consulted, represents wasted effort if the parents fail to realize the import of the notification or if there be no family physician to consult. If the physical examination has for its only result the entering of words upon record cards, then pediculosis and tuberculosis are of precisely equal importance. ”

“ But it is not less certain that these are cases of which no mother or nurse ought to attempt the treatment. As a general rule, where the child is well managed, medicine of any kind is very rarely required; and if disease were more generally regarded in its true light, not as some394thing thrust into the system, which requires to be expelled by force, but as an aberration from a natural mode of action, produced by some external cause, we should be in less haste to attack it by medicine, and more watchful in its prevention. ”

“ The records of our medical examinations of school children bring out the same fact, and emphasize the necessity not only for school clinics on an immensely larger scale than at present, but also for additional medical and nursing care in connection with child-bearing and during the pre-school period, which would discover defects and disease at an earlier stage, and would secure the provision not only of early preventive treatment, but also of more systematic improvement of the sanitary environment of maternity and childhood. ”

“ It is hoped that enough has been said to draw the parent's attention to the subject of the teeth, to prevent their neglect, and yet at the same time to induce a cautious management.
CHAP. IV. HINTS FOR THE EARLY DETECTION OF DISEASE IN THE CHILD BY THE MOTHER. Life is soon extinguished in infancy. At this epoch any disease is formidable, and must be met most promptly. It is either sudden and active in its assaults, or comes with slow and insidious approach. ”

“ It is therefore highly important that a mother should possess such information as will enable her to detect disease at its first appearance, and thus insure for her child timely medical assistance. This knowledge it will not be difficult for her to obtain. She has only to bear in mind what are the indications which constitute health, and she will at once see that all deviations from it must denote the presence of disorder, if not of actual disease. ”

“ To-day, babies are quiet; it is marvelous to go through the infant ward in the Obstetrical Clinic of Rome; absolute silence reigns there, and yet if we lift up the white curtains of the cribs, we see the little ones lying with their eyes wide open. A deeper knowledge than was formerly had of the hygiene of the child has enabled us to interpret his needs, and when these are satisfied, the child is tranquil. ”

“ My business is, as I have said more than once, the endeavour to describe the symptoms of disease, to explain their nature, to indicate the principles to be observed in attempting their cure, and not to lay down definite rules for their treatment, with the idle expectation that I could thus enable every mother to be her children's doctor. ”

“ No endeavour should be spared by nurse or parent, or by the doctor himself, to render his visit popular in the nursery. Three-fourths of the difficulties which attend the administration of medicine are commonly the result of previous bad management of the child, of foolish over-indulgence, or of still more foolish want of truthfulness. It may answer once to tell a child that medicine is nice when really it is nasty, but the trick will scarcely succeed a second time, and the one success will increase your difficulties ever after. ”

“ It is far better when the throat is to be examined to wrap the child in a shawl or a sheet with his arms placed at his side, and for a member of the family to take him in her lap and hold him securely while the physician quickly makes the observation. And while we appreciate that sickness is not the time to introduce new methods of training, in instances where children have been spoiled, it is far better quietly and firmly to go about the task in a manner that you know can be carried through to a successful finish. ”

“ Upon visiting the school he found one child on the playground proudly showing the other children how he could take flakes of skin from his arm. No one expects teachers to be expert diagnosticians, but any teacher should acquaint herself with the more common indications of childish diseases, and should act promptly when her suspicion is aroused, even though she prove to be wrong in half the cases. If anything is wrong, eliminate the child from the group, suggest that a physician be consulted, and await developments: this is the only safe rule. ”

“ We believe this caution is generally omitted by the American physician, though it is one which accords with the plainest dictates of common sense. Who of us has not experienced the pain of emerging suddenly from the darkness of a cellar to the ordinary light of day? The strongest eyes of the adult are scarcely able to bear the transition. How much more painful to the tender organs of the new-born infant must be the change to which it is so frequently subjected? ”

“ Equally serious is the absence of any system of medical advice or treatment for the cases in which physical defect or disease has been notified. For these and other reasons it is highly desirable that the factory medical service, so far as it relates to juveniles, should be absorbed in the School Medical Service, which for nearly ten years has been doing such good work in the detection and to some extent the treatment of pathological conditions among school children. ”

“ The view that proper study or treatment of pediatric illness and injury must include an assessment of the child's functional capacity to perform age-appropriate activities is well accepted in the medical community. ”

“ Nor have physicians themselves been sufficiently attentive to the management of children: this has been generally considered as the sole province of old women, while men of the first character in physic have refused to visit infants even when sick. Such conduct in the faculty has not only caused this branch of medicine to be neglected, but has also encouraged the other sex to assume an absolute title to prescribe for children in the most dangerous diseases. 6The consequence is, that a physician is seldom called till the good women have exhausted all their skill ”

“ Neither has it the worse than idle pretence of telling people how to treat their children's illnesses, without the help of a doctor. Its object is to give a description of the diseases of early life, such as may help a mother to understand something of their nature and symptoms, to save her from needless anxiety as to their issue, and to enable her wisely to second the doctor in his endeavours for their cure. ”

“ The physician's training does not qualify him for the many sided tosh of adapting the program and environment of the school to the health and growth needs of the pupil. The main purpose of this article is to suggest tentatively and somewhat roughly some of the more important lines of professional preparation necessary for those who are to work in any field of child hygiene in the public schools. ”

“ When disease attacks the child, the mother has then a part to perform, which it is especially important during the epochs of infancy and childhood should be done well. I refer to those duties which constitute the maternal part of the management of disease.
Medical treatment, for its successful issue, is greatly dependent upon a careful, pains-taking, and judicious maternal superintendence. No medical treatment can avail at any time, if directions be only partially carried out, or be negligently attended to ”

“ The last Caution I shall give to Parents relative to Health, is, the Danger of Nostrums and Quack-Medicines. I believe there is not a Physician nor an Apothecary in the Kingdom but what has seen the Lives of People, particularly of Children, sacrificed to this Practice. What is it that constitutes the Physician, that proves the Man of Judgment, but the varying his Prescriptions, not only according to different Diseases, but according to the different Circumstances of the same Disease? ”

“ TREATMENT.—The management of the infant in this case is very simple, and seldom calls for the interference of the medical attendant. The child ought to be much in the open air, and well exercised: the bowels should be kept freely open with castor oil; and be always gently relaxed at this time. Cold sponging employed daily, and the surface of the body rubbed dry with as rough a flannel as the delicate skin of the child will bear; friction being very useful. The breast should be given often, but not for long at a time ”