The symptoms of pneumonia in children under two years of age are those of the catarrhal or lobular type; after they have passed through their first dentition they become subject to lobar pneumonia which differs in no particular from the disease which occurs in grown persons. Practice and experience make the discovery of catarrhal pneumonia possible in little children as soon as they are under observation for a little while. The most prominent sign is the rapidity of the respiration, which rises to sixty and eighty per minute instead of forty-four, the average normal respiration for the first year of infantile life.
The disease begins with a cough and more or less fever, and as it is always preceded with bronchitis, the symptoms that were enumerated when speaking of the latter disease are equally applicable to this one. Later on, when the transition of bronchial catarrh into pneumonia takes place, all the symptoms become at once aggravated. The breathing, for instance, becomes labored and increases and the nostrils dilate with each inspiration. The mouth is open, and its corners are drawn downward and outward, depicting distress and suffering, while the eyes roll anxiously about or become glassy and staring.
The treatment of pneumonia in its early stages would be the treatment of bronchitis, since every pneumonia in young children is preceded by a bronchial catarrh. The uniform temperature is of the first importance. The same remedy that was suggested for the cough in bronchitis is also here serviceable.
A systematic course of nourishment must form a part of every successful treatment for pneumonia; and as an old medical friend once told me in a consultation “if the child is kept alive long enough with nourishment it is bound to get well.” In critical cases it is surprising the large amount of whisky a little infant consumes with avidity; its eyes begging and watchingly following the teaspoon from the cup to its mouth. I attended my own child once when only three months old and although there seemed no hope, for its tiny finger tips were blue and its lips livid from deficient aeration, yet it eagerly took its teaspoonful of whisky toddy every fifteen minutes through the longest part of the night, and towards morning it took a change for the better and its life was saved. I also believe that these babies must be kept in a constant sweat; this relieves the congestion of the lungs. The nourishment must be given at regular intervals of several hours just as you would give medicine, for indeed it is a medicine at this time.
Another valuable agent to which I attribute a number of recoveries is the application of a moist girdle suggested by Professor Alfred Vogel, of the University of Dorpat, Russia. In his work on “Diseases of Children” he says: “A diaper, or large white pocket handkerchief is folded up like a cravat; the bandage thus obtained should be three or four fingers wide, and the whole length of the handkerchief. This is now dipped in warm water, and wrung out so that the cloth does not drip, and then applied like a girdle around the chest of the child. A second cloth, double the size of the first, is folded up in the same manner like it, but which must be six to eight fingers broad, and then applied dry and warm over the first. It is very advisable to interpose a piece of gutta percha or oil silk between the dry and the wet girdle by which on the one hand, the moistness of the first cloth is preserved longer, while on the other, the second does not become wet. If the water with which the fomentations are made is not too cold, the child will tolerate them very well and in a short time, a slight retardation in frequency and improvement of the respiration are indicated by less motion of the nostrils. These warm compresses should be continued for from four to six days, and it is not at all necessary, during the entire time, to remove the bandage; the oil silk is raised up a little, and a few teaspoonfuls of water are poured upon the girdle or it is moistened with a sponge. The principal thing is not to allow a cooling of the skin by evaporation to take place. To secure this object, the dry cloth should properly overlap the moist one on all sides and as it is impossible to prevent the upper cloth from becoming wet, it should be changed several times during the day. I certainly have applied this girdle many hundreds of times, and have very often seen rapid improvement ensue; nevertheless, it cannot be denied that the half of these children perish notwithstanding. If cold compresses are applied the children cry of fright in consequence, and the symptoms become worse until the cold water has become warm.” The application of blisters, cupping or leeching should not be tolerated.
CHAPTER XXX.
DISEASES PECULIAR TO CHILDREN—Continued.
(a) Indigestion in very young children is generally accompanied with diarrhœa, because that portion of the child’s food which is not thrown up or digested passes along the intestinal canal and acting as an irritant causes diarrhœa. An indigestion of only a short period of duration excites a catarrhal inflammation of the mucous membrane of the stomach, and this may be so slight that even a change or correction in the diet may be all that is required to relieve it. Children who are suffering from indigestion have stomach ache; this may be continuous or come on half an hour or an hour after nursing. The pain is due to the irritation caused by the nutriment or to the fermentation of the food and the consequent accumulation of gas within the stomach. The stomach becomes distended and sensitive to pressure. When the catarrh is severe the nutriment that the child takes into the stomach is immediately rejected or it may vomit glairy or greenish mucus from an empty stomach. At first the nutrition of the child may not be greatly interfered with, for some of the food is retained and digested in the small intestines, but in the course of time these too become irritated and then diarrhœa complicates the case and the child falls off and becomes rapidly emaciated. Children who are nourished from their mother’s breasts rarely suffer from indigestion, but those who are fed on artificial foods become victims of stomach and bowel troubles. And for this reason it is natural to suppose that the chief reliance for a successful treatment is to regulate and study the diet of the sufferer; the chapter that is especially devoted to this subject should be consulted for further information.