VOL. XIV. No. 20.

REPORTS ON PROGRESS.

1.

DISEASES OF CHILDREN.

BY I. N. LOVE, M. D.

TERMS: $3.50 A YEAR.

tal disturbances misnamed hysteria, gastrointestinal disorders, and evidences of malnutrition. The child will probably become languid, suffer with frontal headache, become peculiar in her disposition, and show fits of temper, shun society of other children,

4. THE BEST SUBSTITUTE FOR MOTHER'S MILK.-Jour. Amer. Med. Assn.

5. OFFENSIVE DIARRHEA IN CHILDREN.Therapeutic Gazette.

lation and deficient oxygenation.

Such cases present two types, the one essentially nervous, just described, the other the so-called strumous or lymphatic, in whom the want of proper assimilation is shown by a large amount of stored fat, and the anemia

In the issue of Oct. 23, of the Med. & Surg. Reporter, Dr. John M. Keating writes in his usually interesting and practical way regarding this subject which is frequently handled in popular magazines, but not sufficiently written about by the observing physician.

He says: We all recognize the very great importance of impressing upon mothers the value of all that tends toward muscular development in growing girls. They should be symmetrically developed; should have full chests, straight backs and strong limbs. We should also urge the importance of clothing of light weight and loose fitting, the principal strain being upon the shoulders, not on the waist and hips; and also the evil results of cramped, stooped positions in the school rooms, eye strain and bad ventilation.

Certain forms of various disorders occur about the time of second dentition. These are manifested either as a chorea, nervous excitement, such as night terrors and various men

In the first case, the mother will tell you at once that her child cannot take iron, that she has frequent nose bleeds, and that she feels confident that if iron could be given it would be of great service. The nervous system seems to run riot, but this very excitement in itself is an evidence of the demand on the part of nature for a blood supply which is nutritious and well oxygenated. All the exercise in the world, all the most nutritious and sustaining of foods, will have no effect, until the digestive organs are made to perform. their normal functions. If you examine the tongue you will find it coated, the breath is heavy, the bowels are sluggish, the appetite is perverted, the child craves extraordinary articles of food, especially acids and sweets. She has a disgust for her regular meals. There is flatulence, cardiac palpitation, asthma after exertion. The urine is either scanty and high colored, or very copious and of low specific gravity. If the menses have been established they are scanty, colorless, and ir

As far as the general treatment is concerned, the little patient should be sponged every morning with tepid water, she should stand in a tub, and have a pitcher of it poured down her spine from the nape of her neck, and then be thoroughly rubbed with a soft Turkish towel into a glow. The breakfast should consist of milk warm, or cocoa, a softboiled egg, or rare pieces of steak or chop, either oatmeal, cracked wheat, grits, or Indian meal alternating; bread and butter, with hot cakes. For dinner soup, rare meat, fresh vegetables, very little water.

For supper,

stewed fruits, bread and butter, warm milk or cocoa, with tea, not coffee. She should retire early, and not be permitted to read at night. The supply of oxygen should come from outdoor exercise, not an over-indulgence in walks or games that fatigue; let the school hours be limited to the early part of the day, and avoid that abomination of preparing

lessons in the afternoon or evening for next day's recitations.

In about a week's time the girl will be able to bear the iron alone, and the tincture of the chloride can be given in ten or fifteen drop doses for some time, or a chalybeate water can be given with arsenic. The digestive organs will now also tolerate milk in large quantities, provided in it is of medium richness, is fresh and given warm.

But this not all. There are very many cases of a highly nervous type, which, despite the most careful treatment, will not improve at home. The constant association with parents of like temperament, however solicitous they may be in carrying out instructions, is of itself a cause of nervous irritation.

It may be necessary to send such children from home, either to some relative, living possibly in the country or some distant city, or perhaps to some suburban or country boarding school, where a thorough change of air and scene, the association with girls of a different temperament, will work wonders.

For the strumous type, the same preparatory treatment may be instituted, and for such I would not hesitate to push the iron, phosphates, cod-liver oil as soon as possible. Change of air to the sea-shore is advisable. There is little trouble in the home treatment in these latter cases; there is rarely a conflict of authority in such families.

Although I have intimated that the ovaries have little or nothing to do with the production of these conditions, I feel satisfied that the weakness, constipation, faulty clothing, eye strain, or dental pressure, will eventually tend to the production of uterine derangements-anemia being the cause, due to defi cient assimilation, from digestive disturb ances, want of fresh air and healthful exercise, reflex irritation, and afterwards uterine disorders follow-post hoc instead of propter hoc.

[This is a practical presentation of a class of cases which come under the observation of every physician. Particularly do we recall the type referred to as "lymphatic" in whom the want of proper assimilation is shown by

a large amount of stored fat" accompanied by perverted appetite and impaired digestion; a never absent foul tongue, frequent nausea and headache.

An accumulation of fat is at no time an evidence of good nutrition. The storing of fat in the connective tissue is usually a robbery of the nerves and muscles, and if it occur during the formative or growing period of life something is radically wrong.

Unquestionably the key to the situation is the unlocking of the secretions, the unloading of the sewers of the body, the improving of the digestion, assimilation and nutrition, the growth and development of muscle, bone and nerve, and the disappearance of the stored up and unappropriated food in the form of fat. The remedies as suggested are admirable along with the muscular exercise, physical training and occasional change of surroundings, if this can be accomplished without a separation of the daughter from the mother at this critical period, unless she be in such a nervous condition herself as to render the separation desirable. Every intelligent mother should so guard her own health as to be in a condition to serve as counsellor, companion and friend to her child at a period when she needs her above all other times, not by any manner of means excepting early infancy, for a wet nurse or hireling can be secured at this time, but no being on earth can take the place of a calm, intelligent judicious mother at the adolescent period of her daughter and thefamily physician should make his it business to impress this fact upon the mothers under his care.]

ANOMALOUS CASE OF SCARLET FEVER.

back of the neck. I could trace no error in diet nor presence of worms to account for it. I sent her home, and called next day, and very carefully took her temperature, which I found to be normal. I gave her some alkaline medicine, and she went on well, the rash disappearing next day. Her mother told me that she was feverish, and complained of sore throat on August 22, and she gave her a cooling aperient, which dissipated the attack. On September 20, I was sent for to see a younger child, whom I found to be suffering from a pronounced attack of scarlet fever, the rash well out, and the temperature 103°. On examining the elder child, I found coarse, heavy desquamation on the cheeks and neck. This has continued over the entire surface of the body; the hands and feet are now desquamat. ing.

[Every now and then we all have unique cases of the various diseases incident to childhood, which differ so materially from the usual run of such cases as for a time to mislead us in the making of our diagnosis. It is only by the most careful watching of individual cases from their inception to their termination along with a steady and close scrutiny of their surroundings and associations that we are enabled to arrive at correct conclusions. In no disease do we find greater variations dependent upon idiosyncrasy and local surroundings than in searlet fever.]

DEEP BREATHING.

The lungs seem in a sense to be scavengers -as one of the products of decomposition, carbonic acid appears, as we know in the tis sues of the body; from them it is taken up by the blood, carried to the lungs and exhaled from the pulmonary mucous membrane as a The expired air contains four per cent of its volume of carbonic acid and a series of experiments made by French scientists proved that this amount varied in different indviduals, depending upon the lung capacity. It fol lows then that since every part of the organism is susceptible of culture, the capacity of the lungs can be increased, not only as to the

amount of air they can inhale, but also the length of time that air can be retained in the lungs. Of course an increasing time is given for the interchange of gases, there is a more prolonged inter-communication between the "residual" and the inhaled air, the carbonic acid is necessarily exhaled in a greater quantity, and since the lungs cannot in a state of health remain empty, the cells are richer in oxygen and the blood by contact becomes purer.

Oxygenized blood is as essential to health and to growth, as it is inimical to disease. The object of sanitation as of medicine is to make the fluid upon which life's processes depend better fitted for its function, as a natural sequence of perfectly healthy blood is nutrition and growth of the body.

Careful observation of 100 moderately healthy children between seven and fourteen years will afford proof of the statement, that not more than 10 per cent, if as many, use their lungs to their full capacity, few have perfectly erect carriage, many have varied degrees of round shoulders, while not a few carry the head in advance of the body.

It would seem to be one of the duties of the family physician to call the mother's attention to this need of the child, and by instruction in the meaning of the few rules here suggested, the little one may be taught to get the very most out of the air with which she is urrounded.

To Practice Deep Breathing.

of pure oxygen and the muscles have exercise).

6. Hold the breath as long as possible, and meanwhile use the ordinary calisthenic exercises.

7. Never exercise except with the chest well expanded with air.

8. Exhale slowly, enunciating the vowel sounds as the air passes the lips.

It is well to call attention to the fact that when the child begins these lessons she makes many mistakes. The lungs are not half filled, the exercises are nervously executed, and of course are imperfect, and she catches her breath between the vowel sounds. Sometimes she inhales with undue force, holds the breath until the face is flushed, and dizziness is complained of; but do not let her be discouraged. Vires acquirit eundo. In a fortnight the rules are acquired, and practice produces the desired results.

The habit of deep breathing once fixed, the proper development of the voice will come in its order, and besides being conducive to health, the wise use of the respiratory organs will be an aid in acquiring that most delightful accomplishment for our daughters, reading and speaking well.

[There can be no doubt that there is great advantage to the growing child in properly training him in the direction of deep breathing, as it not only oxygenates the blood and tissues to better advantage but develops the chest, muscles and stimulates the child in the direction of increased energy physical and mental. The remark that has very properly been made regarding beer drinkers, "drink

2. Shoulders and head in natural position. 3. Hands lying tightly on the abdomen, the fingers pointing to the umbilicus. (Compliance with this rule enables the child to be sure she is using the abdominal as well as the pectoral muscles in respiration.)

ply in this connection: breath deeply good pure air and think deeply good pure thoughts.

In addition to teaching the importance of this subject the family physician should impress upon the minds of the patients under his care the importance of breathing through the nose rather than through the mouth. Nature

5. Inhale slowly through the nostrils using abdominal as well as chest muscles. (The lungs thus receive the utmost possible amount

as a smelling one, in fact the latter function is adjunct to the first, as, warned by the sense of smell, the air which contains offensive and injurious odors can be avoided.