The Mother's Manual of Children's Diseases

by Charles West

All cases, indeed, are not equally severe, but all require careful and gentle treatment, the cool and darkened room, the quiet, the cold to the head, the tepid bath, and on the part of everyone the care not to allow the apparently serious condition of the child to urge them to those active measures which will here be out of place, and destroy the hopes which would revive after a few hours of patience and gentle means.

Really acute inflammation of the brain is of so rare occurrence except as the result of accident or injury, and its symptoms are of so serious a character, even from the first, that medical advice is obviously needed at once. I shall, therefore, pass it over here, and endeavour to describe two forms of inflammation of the brain which are much more frequent, and at their commencement more likely to be overlooked.

Water on the Brain.—One of these is the form of inflammation commonly known as water on the brain, a term which, though incorrect medically, has the advantage of being well understood. This, now, is not a simple disease, occurring in a previously healthy child, but it is a disease dependent on the same state of constitution as gives rise in other children to consumption, or scrofula, or disease of the mesenteric glands.

It is this circumstance which renders the disease so serious, and recovery from it so extremely rare. This it is also which makes it so desirable to become acquainted with its symptoms, both that you may be alive to the approach of danger, and also not indulge in needless alarm when brain symptoms occur from other causes which have no relation whatever to those which give rise to water on the brain.

The disease comparatively seldom comes on in a child who had previously seemed in perfect health; a state of vague ailing usually precedes its outbreak. The child loses flesh and strength, and the look of health, and the lustre of the eye, and the silky softness of the hair. The appetite becomes uncertain, the bowels irregular, with a tendency to constipation; there are little feverish attacks for a few hours, subsiding of their own accord. The sleep is not sound, the temper uncertain, the child tires even of its favourite toys; the brightness of the little face is changed for a strange, weird, wistful look—an unnatural earnestness; the child sits for moments gazing upward on vacancy, as though it saw, or sought something beyond.

By degrees these vague premonitions, which may continue for weeks, become more and more marked till they pass into what may be called the first stage of the affection, in which there are signs of congestion of the brain, such as I have already described, coupled with general irregular attacks of feverishness. The child becomes more gloomy, more pettish, and slower in its movements, and is little pleased by its usual amusements. Or, at other times, its spirits are very variable; it will sometimes cease suddenly in the midst of its play, and run to hide its head in its mother's lap, putting its hands to its head, and complaining of headache, or saying merely that it is tired and sleepy, and wants to go to bed. Sometimes, too, it will turn dizzy, as you will know, not so much from its complaint of dizziness as from its suddenly standing still, gazing around for a moment as if lost, and then either beginning to cry at the strange sensation, or seeming to awake from a reverie, and at once returning to its play. The infant in its nurse's arms betrays the same sensation by a sudden look of alarm, a momentary cry, and a hasty clinging to its nurse. If the child can walk it may be observed to drag one leg, halting in its gait, though but slightly, and seldom as much at one time as at another, so that both the parents and the medical attendant may be disposed to attribute it to an ungainly habit which the child has contracted. The appetite is usually bad, though sometimes very variable; and the child, when apparently busy at play, may all at once throw down its toys and beg for food, then refuse what is offered; or taking a hasty bite may seem to nauseate the half-tasted morsel, may open its mouth, stretch out its tongue, and heave as if about to vomit. The thirst is seldom considerable, and sometimes there is an actual aversion to drink as well as to food, apparently from its exciting or increasing the sickness. The stomach, however, seldom rejects everything; but the same food as occasions sickness at one time is retained at another. Sometimes the child vomits only after taking food, at other times, even when the stomach is empty, it brings up some greenish phlegm without much effort, and with no relief. These attacks of vomiting seldom occur oftener than two or three times a day, but they may return for several days together, the child's head probably growing heavier, and its headache more severe. The bowels during this time are disordered, generally constipated from the very first, though their condition in this respect sometimes varies at the commencement of the disease. The evacuations are usually scanty, sometimes pale, often of different colours, almost always deficient in bile, frequently mud-coloured and very offensive. The tongue is not dry, generally rather red at the tip and edges, coated with white fur in the centre and yellowish towards the root, but occasionally very moist, and uniformly coated with white fur. The skin is harsh, but not very hot, the temperature seldom above 100° Fahr., varying causelessly, but usually higher towards evening than in the daytime. The nostrils are dry, the eyes lustreless, and the child sheds no tears. It is drowsy, and will sometimes want to be put to bed two or three times in a day; but it is restless, sleeps ill, grinds its teeth in sleep, lies with its eyes partially open, awakes with the slightest noise, or even starts up in alarm without any apparent cause. At night, too, the existence of intolerance of light is often first noticed in consequence of the child's complaints about the presence of the candle in the room.

I have purposely dwelt long on this preliminary stage because it is only in it that treatment is likely to be of any service, while the very indefiniteness of the symptoms constantly leads to their being overlooked, or referred to teething, or thought at any rate to be a mere temporary ailment for which it is not worth while to call in the doctor.

After four or five days, however, the illness of the child becomes too marked to escape notice. All cheerfulness has fled, the eyes are closed to shut out the light, the child lies apparently dozing, but answers questions rationally, in a short quick manner in as few words as possible, and from time to time complains of its head, or utters a short, sharp lamentable cry. The night brings with it no other change than an increase of restlessness, attended sometimes with noisy cries, or with the wandering talk of delirium. Sickness often diminishes, but the bowels continue constipated, and it is to be noted that whereas in fevers the bowels are distended with wind, here all wind has disappeared and the belly is sunken to a striking degree.

Next comes the last stage. Each stage is distinguished by peculiarities of the pulse which tell the expert what is passing; quick and regular in the first stage; irregular and slower in the second; quick, variable, irregular from time to time in the third; growing more rapid and more feeble as the end arrives. Squinting, stupor, dilated pupil, difficulty of swallowing, tremulous limbs, convulsions, profound insensibility, such are the series of occurrences which bring on death usually within a fortnight, always within three weeks from the appearance of the first decided symptoms.

What are you to do in these cases? Above all save yourselves the heartbreak of feeling that you have overlooked the premonitory symptoms of the disease. Guard with special care the health of any child in whose family a disposition to consumptive disease has ever shown itself, and keep it at any cost from the risk of catching the hooping cough or measles. Since, too, it is not in early infancy, but after the age of one year, and in the majority of instances between the ages of three and six years that this disease occurs, that is to say, at the time when the brain begins to be most actively exercised, when the new world on which the child is just entering brings with it new wonders every day; be very careful not to over-stimulate its intelligence, over-excite its imagination, or over-strain its mental powers. After the age of ten the great danger is over; up to that time it is the health of the body which requires care; not fuss, not rearing like a hothouse plant, but the healthy training that may fortify the system.