The Mother's Manual of Children's Diseases

by Charles West

On the other hand, when the cough becomes complicated with bronchitis, it ceases to recur in distinct fits which leave behind them intervals of comparative, or of absolute ease. The hurried breathing which precedes and follows a fit of coughing never entirely subsides, while each returning cough aggravates the irritation and inflammation of the air-tubes, and the child's condition becomes the very dangerous one of hooping-cough complicated with bronchitis.

So long as a child seems pretty well in the intervals between the fits of coughing, as the hurried breathing subsides after each to a natural frequency, as a long loud hoop follows each cough, as vomiting takes place only after a fit of coughing and never in the intervals, as the child becomes flushed only and not livid during a cough, and recovers itself perfectly afterwards, as it does not complain of constant headache, nor spits blood, nor has nose-bleeding, nor is feverish, nor depressed, nor drowsy, you may feel happy about it. When any of the symptoms just enumerated show themselves you have reason for grave solicitude, and the child requires daily medical watching.

One word in conclusion. A child who has recently had hooping-cough is more liable than another to be attacked by chicken-pox or measles; and, moreover, imperfect recovery from hooping-cough is apt, especially if there is any tendency to consumption in the family, to be followed by consumptive disease.

Asthma.—Asthma, attended by distress of breathing quite as considerable as in the grown person, is by no means unusual in the child. Recovery from it is far more likely to take place in the latter, since it is almost always independent of those diseases of the heart or lungs, which in the former occasion or aggravate it. It belongs to the class of what has been termed nervous asthma and is observed with special frequency in children who, when younger, had been liable to catarrhal croup; spasm of the air-tubes having taken the place of the previous spasm of the windpipe. Independently of that antecedent it comes on sometimes about the time of the second teething in nervous and impressionable children, in whom an attack may be produced by indigestion, constipation, or over-fatigue. It is also by no means rare in children in whom that skin affection, eczema, of which I have already spoken, outlasts the time of infancy, and becomes general and severe. The improper performance of the functions of the skin seems to cause a peculiar sensitiveness of the air-tubes, and to render them liable to the occasional occurrence of that spasm which produces asthma. These cases are less hopeful than others, and the liability to the attacks ceases only when the skin-affection has been completely cured; a reason this for not neglecting eczema in infancy and early childhood. Sometimes, too, it follows frequently-recurring attacks of bronchitis, and, though less often than might be expected, it succeeds severe hooping-cough, and in these two conditions the prospects of recovery are less hopeful than in the others.

When asthma occurs in childhood, the first point is to ascertain the cause on which the attack depends; and it is worth any amount of care to discover and remove it; for if what may be called the asthmatic habit is not formed, the attacks will, in the majority of instances, cease between the ages of twelve and fifteen. Bad habits of the body are, however, as difficult to get rid of as bad habits of the mind, and the boy who grows up an asthmatic youth is very unlikely to get rid of the disorder in later life.

It is in that form of asthma which succeeds to frequent attacks of catching cold, and in which bronchitis precedes or accompanies each seizure, that change of climate is most useful. In the majority of instances a moderately sheltered seaside place, with a sandy soil such as Bournemouth, is the best, and a few years' residence there not infrequently overcomes every disposition to asthma through the whole remainder of the patient's life. To this, however, there are exceptions, and I have seen instances in which residence at Bournemouth and in the Riviera have failed, but where a perfect cure has been wrought by the cold, still air of Davos.

Diseases of the Heart.—Malformed Heart.—Every now and then one sees a little babe, carefully wrapped up in its nurse's arms to shield it, even on a warm day, from the air; and, on removing the shawl which covered it, one is struck by the sight of a little pale pinched face, with a livid ring around the mouth, and a blue instead of a rosy tint of lips and fingertips, as though perished with cold. The babe wakes on being disturbed, and gives a faint short cry of distress; the livid hue of its surface deepens, it struggles feebly, its mouth twitches as though convulsions might be coming on. Soon, however, these symptoms subside, the babe smiles again, is cheerful, and save for the tints of its face and lips, it looks like other infants, but frailer.

This condition has a name in medical writings, from a Greek word expressive of the blue tint which characterises it, and is called cyanosis. It depends on the blood not having undergone completely those changes in the lungs which take place in the healthy state. The blood, as it returns through the veins to the right side of the heart, is of a deep purple hue. The right side of the heart contracting sends it to the lungs, where, in the minute vessels of the air-cells, it is purified, and returns vivified by the oxygen a bright scarlet stream, to be distributed by the arteries over the whole body; and thence to return once more for fresh purification to the right side of the heart. Before birth, the blood does not run the same course, but is purified within the mother's body, the blood running through channels which close with the first breath the infant draws. The previously existing communication between the two sides of the heart ceases at the same time as the new channels are opened, by the shutting of a thin valve which had hitherto allowed the blood to pass from one side to the other.

Sometimes this closure fails to take place, or takes place but imperfectly; sometimes, in addition, the channels which should be disused after birth remain open still; and sometimes also the heart is otherwise imperfectly formed, and a large communication exists between the two sides of the heart, which long before birth ought to have been firmly partitioned off from each other.

According to the freedom of communication between the two sides of the heart, there is more or less ready intermingling of the impure blood with that which is already purified; and this is betokened by the greater or less severity of the symptoms which I have described. When the heart is very malformed, and the blood consequently is very impure, life is but a short agony which ends in a few weeks; some slight movement, some little accidental cold deranging altogether the imperfect machinery, and bringing it to a sudden standstill. Between this and the slightest cases there are all shades of difference, till, in the latter, a smaller power to maintain warmth, a less rapid growth, a smaller muscular development, a feebler power, a hurry of breathing on exertion, or in ascending a hill, or in going up a staircase, are all, except the sounds which the educated ear detects of the blood passing through its devious course, that tell of nature having, in this instance, ill done her handiwork.