The Mother's Manual of Children's Diseases

by Charles West

When any signs such as I have described indicate the threatening of disease, do not look on them as within the scope of domestic management, but place the child at once under the watchful care of a skilful doctor. I have seen but one recovery in all my life, after the disease had fully set in, and that was a recovery almost worse than death.

Earache.—There is another form of inflammation of the brain which is likewise oftenest met with in children who are of weakly constitution, or of scrofulous habit, or in whom scarlet fever has left behind that very troublesome ailment, discharge from the ear. This is so tedious, so difficult to cure, so apt to return under the influence of very slight causes, that people are too ready to put up with it as an inconvenience which it is useless to try to remedy.

In addition, however, to the risk of the child's hearing being impaired by the extension of the mischief to the internal ear, there is another still greater danger, namely, that of the disease passing from the ear to the brain, and producing inflammation of its membranes, or even abscess of its substance.

It is therefore of the greatest moment that every case of chronic discharge from the ear should be looked on as important, and that no pains be spared to bring about its cure; and further, that during its continuance the slightest sign of disturbance of the brain—headache, sickness, feverishness, and dulness—should at once be noticed, and the advice of a competent doctor be immediately sought for.

These dangers, however, follow almost entirely on long-continued discharges from the ear, but do not attend that acute inflammation of the passage to the ear which is often met with in childhood, and the symptoms of which sometimes cause needless fear, from being taken for those of inflammation of the brain. Attacks of earache are most frequent before the first set of teeth have been cut, and are by no means rare in young children, who are perfectly unable to point out the seat of their sufferings. The attack sometimes comes on quite suddenly, but usually the child is languid and fretful for a period varying from a few hours to one or two days before acute pain is experienced. In this premonitory stage, however, it will often cry if tossed or moved briskly; noise seems unpleasant to it, and it does not care to be played with; while children who are still at the breast show a disinclination to suck, though they will take food from a spoon. The infant seeks to rest its head on its mother's shoulder, or, if lying in its cot, moves its head uneasily from side to side, and then buries its face in the pillow. If you watch closely, you will see that it is always the same side of the head which it seeks to bury in the pillow, or to rest on its nurse's arm, and that no other position seems to give any ease, except this one, which, after much restlessness, the child will take up, and to which, if disturbed, it will always return. The gentle support to the ear seems to soothe the little patient: it cries itself to sleep, but after a short doze, some fresh twinge of pain arouses it, or some accidental movement disturbs it, and it awakes crying aloud, and refusing to be pacified, and may continue so for hours together. Sometimes the ear is red, and the hand is often put to the affected side of the head, but neither of these symptoms is constant. The intensity of the pain seldom lasts for more than a few hours, when, in many instances a copious discharge of matter takes place from the ear, and the child is well. In some instances, indeed, the subsidence of the disease on one side is followed by a similar attack on the opposite side, and the same acute suffering is once more gone through, and terminates in the same manner. Sometimes, too, this complete cure does not take place, but the earache abates, or altogether ceases, for a day or two, and then returns; no discharge, or but a very scanty discharge, taking place, while, for weeks together, the child has but few intervals of perfect ease. In infants, earache seldom follows this chronic course, but it does sometimes in older children, and is then of the more importance, since it shows that the disease is no longer confined to the external passage, but has extended to the internal ear.

In children who are too young to express their sufferings by words, the violence of their cries, coupled with the absence of any sign of disease in the chest or the bowels, naturally leads to the suspicion of something being wrong in the head. There are several facts, however, which may satisfy you that the case is not one of water on the brain—the child does not vomit, its bowels are not constipated, there is but little fever, the cries are loud and passionate, and are attended with shedding tears. If you watch closely, you will notice the dread of movement and the evident relief afforded by resting one side of the head, and always the same side, while often the movement of the hand to the head, and the redness of the ear, with the swelling at its entrance, will all serve to point to that organ as the source of the trouble. Sometimes, when in doubt, you will be able to satisfy yourselves that the cause of the suffering is in the ear by pressing the gristle of the organ slightly inwards, which will produce very evident pain on the affected side, while on the other side it will not occasion any suffering.

The treatment of this painful affection is very simple. In many instances the suffering is greatly relieved by warm fomentations, or by applying to the ear a poultice of hot bran or camomile flowers, while at the same time a little warm oil and laudanum are dropped into the ear. When these means do not bring relief, a leech applied on the bone directly behind the ear seldom fails to give ease; while the disposition to the frequent return of the attack is often controlled by a series of small blisters, not larger than a sixpence, behind the ear. As soon as the tendency has sufficiently abated to admit of it, the ear should be syringed out twice a day with warm water, or with equal parts of warm water and Goulard lotion; but if pain or discharge still continues, medical advice must in all cases be sought for.

Chronic Water on the Brain.—There is still another form of inflammation of the brain, concerning which a few words will suffice. It constitutes what is termed chronic water on the brain, and in this instance the term is a correct one, for the disease usually depends on a slow form of inflammation of the lining membrane of the cavities of the brain, often beginning before, still oftener very soon after, birth, which ends in the pouring out of a quantity of fluid into them sufficient to enlarge the head to three or four times its natural dimensions.

Such cases are very sad and very hopeless, and the great resource, which is sometimes adopted by medical men, of puncturing the head and letting out the fluid, is very seldom successful.

But there are more hopeful cases sometimes met with, those namely of children in whom, either from simple weakness, or from that constitutional disorder called rickets, bone formation has been backward, and the head has consequently long remained unclosed. If such children, either from the irritation of teething, or from the straining during paroxysms of hooping cough, suffer from congestion of the brain, fluid may be poured out, which, not being compressed by the too yielding skull, may in consequence enlarge it. These cases, however, may be distinguished from the other more serious ones by the date of their commencement, which is always much later than that of the other form, by the symptoms which attend them being less severe, and by the enlargement of the skull being far slighter.