Meningitis - "Wasting a Very Serious Symptom - Possibility of Cure - Diet - How to Prepare Raw-meat - A Representative Dietary - Value of the Open Air Life t is during the first five years of life that I tubercular disease is most fatal to children. The school child is practically free from the risk of contracting fatal tuberculosis. It is the more curable type of the disease which affects the glands and bones that is then met with.

Meningitis is one form of tuberculosis affecting early childhood, whilst tuberculosis of the lungs may follow upon bronchitis, measles, or other acute fevers. Tubercular disease of the abdominal organs shows itself in wasting, enlargement of the abdomen, and very often pain. The child is subject to alternative constipation and diarrhoea. During the school age swelling of the glands is a common symptom. The glands of the neck, for example, may become swollen and hard. The joints may be affected by tubercular disease, especially the hip joints, the ankle, or knee; whilst abscesses in connection with the bones and other tissues often appear.

The unfortunate thing is, in most cases, that the presence of the disease is not recognised until a late stage. The one symptom which should make a mother suspect the presence of tubercular disease in the body is wasting. It may be, of course, that wasting is due to some simple cause, such as defective feeding; but the symptoms should never be neglected. Any lameness or

Medical swelling of the joints, any enlargement of the glands, especially about the neck, should also serve as warnings to the observant mother that the child's health should be investigated. Tuberculosis can be prevented and cured. When the child has a tendency to the disease special care has to be exercised. After measles and other fevers also,tuberculosis can be prevented by careful nursing, and by guarding the child against chill. Good food and fresh air are the main things to consider, and whenever a tubercular person is present in a household containing children every precaution must be taken to prevent infection. The Question of Diet

The food ought to be liberal, and, at the same time, easily digested, as a tubercular child's digestion is easily upset, which is a serious matter when there is any wasting. Four meals will be found sufficient in most cases, but if the child wakens very early in the morning he should have some food if breakfast is not for an hour or two. The ordinary nursery menu may be supplemented by raw meat or meat juice.

The child of two, three, or four years should be able to take from a half to two ounces of raw meat in the twenty-four hours. The best way to serve this is to mince it very finely, and spread it in thin sandwiches. Meat juice is made by pounding fresh raw steak, and mixing a little of the juice with breadcrumbs. The child of five years should be able to take from two to four ounces in the twenty-four hours. When he gets tired of this supplementary diet it should be given up for a week or two, and cod-liver oil given in its place. The child should have from one to two table-spoonfuls of cod-liver oil in a day, given in large teaspoonful doses. Well boiled porridge made with flour of leguminosae makes an excellent breakfast dish served with cream; whilst such food as fish, sweetbreads, purees of lentils, etc., provide a nourishing and varied diet. Yolk of egg is a very valuable food when there is any tendency to consumption. The young child can quite easily take two yolks of egg a day; whilst milk should be given as liberally as possible.

Diet can be carried out on the same lines up to the age of seven or eight, when the child is able to take more meat and larger quantities at each meal.

A Model Menu

For the school child who is inclined to be tubercular diet has to be more ample. The following menu is given on the diet chart for the children of from nine to thirteen years at the Lyons Open Air Municipal School.

The daily ration comprises:

Bread, 13 ounces; meat (weighed raw), 5 to 7 ounces; dry vegetables, 1/2 ounce; green vegetables, 1 ounce; wine, 1 fluid ounce; milk, 2 pints; cheese, 1/2 ounce; jam, 1 ounce; rice, etc., 1/2 ounce.

The meals consist of:

Breakfast: Ten ounces of milk or coffee and milk, or chocolate, with bread at will.

Second Meal (10 a.m.): One egg, bread-and-milk, or 10 ounces of milk.

Third Meal (midday): Meat, green vegetables, cheese, dessert, a tablespoonful of wine. On Sundays and Thursdays a sardine in addition.

Fourth Meal (4 p.m.): Ten ounces of milk, or 5 ounces of bread with cheese, butter, chocolate, jam, or fruit; or porridge with 7 ounces of milk, or cocoa.

Fifth Meal (7 p.m.): Soup, eggs, fruit, jam, or cheese, a tablespoonful of wine.

This dietary is intended for children who are not very ill, but who are threatened with con sumption, or who have glandular swellings. The so-called breakfast in this diet chart should consist in the case of English children, of a cup of milk on awakening; the second meal with us would form breakfast proper at nine; whilst the third meal would be not until one o'clock. Such a dietary is a very good guide for mothers, but they must remember that cheese, if it is to be served to children, must either be grated, or be given as cream cheese, the harder forms being indigestible unless very carefully chewed.

When children are tubercular they must practically live in the open air, and take all their meals either out of doors or at an open window. Sleeping-rooms must be very carefully ventilated, the child supplied with warm blankets and a woollen sleeping suit, so that plenty of fresh air can be introduced to the room by night. Moderate, gentle exercise out of doors is neces-sary, but nothing in the" way of strain or fatigue should be permitted, as excessive exercise may mean a rise of temperature, or even a chill.

The tubercular child is, as a rule, quick at lessons and fond of learning, and so long as he is prevented from overstraining himself his school work need not be interfered with. The ideal plan, of course, is to have the child in an open air school. Open Air Schooling

It has been found that children taught in the open air (in County Council schools and elsewhere) improve in physique, health, and mental ability. The movement for organising open air schools is gaining ground. These should be situated in a healthy neighbourhood. The seaside school sanatorium is best for the tubercular child.

But, granted that it is impossible to send a child to an open air school, what practical measures can the mother adopt so as to interfere as little as may be with educational progress? The teacher should be interviewed, and asked to pay special attention to the provision of plenty of pure air. Breathing exercises should form a daily part of any physical culture or gymnastics arranged. A child with a tubercular tendency showing any sign of listlessness or lassitude needs medical attention.

Lessons can sometimes be given in a verandah or playground, with an awning over one corner, in private schools, and this is, of course, a great advantage when children are delicate. Home work must be conducted under strict hygienic conditions. A child enjoys working "out of doors" in the country, and a comfortable corner can sometimes be arranged in a summer-house or verandah or a shady corner of the garden for study. The feet must be protected from any risk of damp by strong boots and a cork mat.

Lastly, do not let a mother get depressed because one of her children shows a tendency to consumption. In the days before hygiene was understood, when every current of fresh air was excluded from the house, and a child was over-coddled and overclothed there was every likelihood of developing consumptive diseases. But we know better nowadays. We know that the important points to attend to are:

1. Give abundance of fresh air day and night.

2. Give nourishing food.

3. Make the child lead a healthy, happy life.

4. Consult the doctor early, and follow his directions carefully.

If you do that there is every hope the child will grow up healthy, and as well as his brothers and sisters.

6 Health And Hygiene In The Nursery The Tubercular 700233