The course of mumps is usually favorable, but there is a possibility of an abscess forming, and this may break directly outward, or burrow backwards and burst into the ear, perforating the ear drum, causing lifelong deafness. I have had one case in which the disease went to the brain; the little boy, a child of seven, died. The patient who has mumps must be kept warm; over the swelling apply hot poultices for three or four days, and besides wrap the entire head and neck in flannel. If the swelling is painful, and the child in robust health, a few leeches applied to the swelling will relieve the pain and have a good effect on the cause of the disease. Belladonna ointment is a valuable remedy for older children, but with babies it must be used with extreme care. The diet must be bland and light; bread and milk, or gruel, is the most appropriate. Give a little paregoric at night to soothe the restlessness, and open the bowels with the Femina laxative syrup.
(e) Tonsilitis or quinsy sore throat is often mistaken for the mumps, but to the experienced practitioner or nurse there is no resemblance, and to mistake one for the other is almost impossible. In tonsilitis the cheek never swells, the swelled tonsils being felt only behind the jaw and quite below the ear. Tonsilitis occurs oftener than mumps, and unlike the latter affection, when the patient has had one attack of quinsy he is likely to have a recurrence whenever he gets a fresh cold. The disease begins with difficult deglutition, pain, heat and dryness in the throat, and always more or less fever, from which some children become quite delirious. The affected tonsils become as large as pigeon eggs, and can be readily felt beneath the angle of the lower jaw. The swollen tonsils are red and dotted with yellowish spots, which is due to the suppuration of the follicles of which the gland is composed. If both swell at the same time so that they touch each other, symptoms of suffocation may ensue. The writer suffered from tonsilitis when he was a student, and the pain was indeed excruciating for a time. The pain is sometimes greater in swallowing fluids than solids. In examining the mouth a little skill is required. Some children are so well trained that they will respond at once, and then by means of a spoon handle the tongue is depressed, and the tonsils come into view. Others again have their own sweet will about these things, and simply will not voluntarily open their mouths. Then it takes two persons to manage them in the following manner: while one person holds the child in his lap, its back and head braced against his chest and the hands held down, the other person slides the handle of a teaspoon along the tongue until he touches the soft palate; this makes the child gag, and at that moment the tonsils are brought plainly into view.
The treatment for tonsilitis should be prompt and active; that is, when the disease is recognized, something should be done at once to relieve it. If the bowels are constipated give a laxative at once, and over the painful tonsils apply a flaxseed poultice, keeping the neck and head wrapped up well at the same time. For the fever give a dose of antifebrine in the forenoon and at bedtime; for a child one year old, one grain for a dose; at the age of three or four, give two grains at once, and at eight to twelve years, three grains can be given. Chlorate of potassa is the best remedy for a gargle, and for internal use also. Make a solution of chlorate of potassa by dissolving one teaspoonful in a teacupful of hot water, and when cooled off, have the child gargle every hour or two, and swallow a half to a teaspoonful of the solution at the same time.
(f) Diphtheria of the throat is eminently an epidemic disease and of a highly contagious and infectious nature. Of late years, the disease occurs in every season of the year, and independently of any epidemic or contagious influence, but it is presumed that the contagion or spores are cultivated in improper sanitary conditions arising from defective sewerage and filthy accumulations. The disease invariably begins with fever, a marked increase of the pulse, increase of the temperature of the skin, and general depression. There is first a difficulty of swallowing, a snuffling voice and stiffness in the neck; the first two signs are due to the swelling and diphtheritic coating of the tonsils, palate and nasal passages, while the last symptom is due to a swelling of the lymphatic glands of the neck which is never absent in genuine diphtheria. If the throat is examined in the early stage, the white membrane is first seen in the tonsils and as the disease progresses it spreads to the palate, the pharynx and the nasal passages. The color of the membrane also changes; after several days it passes into a yellowish-white or grayish-white tint. It has another peculiar feature that distinguishes this membrane from the exudation of ordinary tonsilitis, which the practical eye at once detects; the membrane of diphtheria makes the impression of having eaten into the tonsil or as though it was pressed into the tissue by the finger. And that is really so too, because as a scientific fact it is no membrane at all, but a death or slough of the mucous membrane which may extend down into the tissue beneath the membrane. To treat diphtheria successfully is simple enough but it requires great skill and experience, and I will outline what I consider the proper thing to do and which in my hands saved those lives that were intrusted to my care.
The treatment resolves itself into perfect cleanliness or disinfection, stimulating nourishment and internal medication.
Everything must be kept clean around the patient, and a vessel must be provided, containing a little chloride of lime into which he spits or hawks the phlegm from his throat. The membrane or slough in the throat or nose must be thoroughly disinfected and the only evidence that this has been successfully accomplished is when all offensive odor has disappeared. For this purpose as a local application I employ the following preparation: Solution of subsulphate of iron (Monsel’s solution) 3 drams, glycerine 5 drams; mix and pour ten to twenty drops into a saucer and by means of a camel’s hair brush apply to the diphtheritic membrane until the character and odor of it is destroyed; this application repeat every four hours. Should the nasal passages be also affected mix a teaspoonful of the preparation to a teacupful of warm water and by means of a syringe wash the nasal passages out several times a day. Give the patient internal medicine to disinfect the stomach and for its alterative action on the blood: for this purpose use tincture of iron 4 drams, simple syrup, add to make 4 ounces. To a child seven to ten years old give a teaspoonful, ten or fifteen minutes each time, after the brushing. Between the times of brushing and giving the medicine, that is two hours afterwards, give the nourishment and stimulant; this consists of milk punch. A child seven to ten years old should take no less than a tablespoonful of whisky, with or without a little sugar, in a half to a teacupful of milk beaten thoroughly together with an egg beater; this is to be taken for a meal and drank at once, and repeated every four hours. No other food or nourishment must be given for a number of days, and if the child is thirsty between times allow it to drink sweetened water and whisky. Sometimes the glands of the neck and the tonsils swell and become very painful; for this the Belladonna ointment applied with gentle friction night and morning and the neck enveloped in cotton batting are certain to give relief. The efficiency of this treatment depends upon the intelligence and faithfulness with which it is used.
(g) Croup is a term derived from the German Kropf the crop or craw of the bird; this disease is known by a great many different names, but on account of its shortness, croup has received the preference. The disease has to do with an affection of the organ of the voice, the larynx, which is the upper part of the air passage, and situated between the trachea and base of the tongue at the upper and front part of the neck where it forms a projection in the middle line which is prominent above and called the pomum Adami or Adam’s apple. The larynx contains the vocal cords, running from before backwards on both sides; these form the narrow fissure or chink, the rima glottidis, through which we breathe. Like all other air passages this too is lined with mucous membrane. The symptoms that foreshadow croup are not particularly significant, for they simply indicate that the child has a cold. The children have a cough, they sneeze, and their appetite is capricious for a few days; they are not as lively as usual and are more or less feverish. In a certain proportion of cases there is nothing noticeable before the croup develops, for the children may go to bed perfectly well and sleep calmly the first few hours of the night, when suddenly they are awakened with a barking cough, which greatly frightens young children and they begin to cry. The cough may repeat itself at short intervals, the voice become hoarse and husky and lower and lower, so that in the morning a well marked croup is developed. The voice finally disappears so completely that it is not heard above a whisper, and the greatest pain and harassing symptoms of suffocation do not enable the child to utter a loud sound. The respiration becomes labored in proportion to the swelling of the vocal cords and other obstructions to the passage of air through the larynx. Croup has vagaries that cannot be foretold. One child may have symptoms of so threatening a nature that one believes it will suffocate at any moment, yet, with a few simple remedies, the symptoms will gradually lessen and it recovers in a few days, while another may be suffering comparatively little and from appearances one would imagine that there is little or no danger, but at once it will change and grow worse so rapidly that it will die in a few hours. For this simple reason no case of croup should be carelessly or lightly considered. When a child has croup it should be put at once into a warm room; a big fire should be kept up, and the child given hot drinks or a cupful of hot tea so as to make it sweat. The front part of the neck should be rubbed with equal parts of turpentine and sweet oil until it feels warm and the skin reddens. If the child has eaten a good supper, a teaspoonful of syrup of ipecac should be given every half hour until it vomits; otherwise vomiting should be omitted. The following mixture always gives relief and with other precautions is all that is usually required.
| Take: | Bicarbonate of potassa | 2 drams |
| Water | 1 ounce | |
| Hive syrup, | ||
| Paregoric, of each | ½ ounce |
Mix and give half to one teaspoonful every two hours until relieved; then every four to six hours.
What we have considered thus far is also called spasmodic, catarrhal or false croup, to distinguish it from another variety that is described under the name of membranous or diphtheritic croup.