The Diary of a Doctor Who Tells

Evening Star, Issue 23379, 23 September 1939, Page 3

The Diary of a Doctor Who Tells

Those “ Delicate ” Children

Monday, September 18. “ lie’s always been such a delicate child, doctor,” said a new patient, Mrs irelin, this afternoon, speaking of her eight-year-old Harold. “ We’ve had to take tho greatest care of him. He picks up every cold that goes around.” I could find nothing wrong with Harold, except that ho looked a bit undernourished. 1 finally informed his mother of tho fact and was rewarded with a horrified and annoyed gasp. “ Doctor . . . you don’t mean to suggest ” she began. “ No,” I said, “ t don’t mean to infer that you are deliberately starving him. I do suggest, however, that he probably doesn’t drink milk and isn’t very fond of vegetables or eggs. And I’ll also risk a bet that he doesn’t like going to bed early.” Milk’s nasty,” put in Harold stolidly. I suppose you’re not very fond ol lollies, either,” 1 said. “ Yes, I am,” said Harold, briefly. “ Yes,” assented his mother. “He likes sweet things. All boys do.” An examination of Harold’s diet Revealed that he ate very few of what are commonly called tho “ protective ” foods (milk, butter, eggs, vegetables, and fruit), that he despised cod liver oil, and hated the sight of liver and bacon. It was also obvious that his hours of rest were seldom longer than nine hours a night, in my opinion at least two hours too few for a child of eight.

I have a patient aged 87 who has been “ delicate ” all her life ... or so she says. Personally i don’t believe it. There is no such medical textbook condition as “ delicacy ” of constitution. There are septic tonsils, under-nourishment, defective lungs and hearts, and so on. There are bilious children, allergic children, bronchial children, and tubercular or diabetic children. There ’are “ difficult ” children, neurasthenic children, and children with definite complexes. But I can’t remember having met “ delicate ” children. (And 1 can’t remember having met one of those wonder children whose “ dear little brain is too active for his darling little body.”) If a child is “ delicate ” a thorough examination is urgently required Modern medicine has gone past the day when a vague generalisation is an adequate substitute for scientific description.

Tuesday, September 19. There was a time when all irritability, fretfulness, and voracious appetite was put down to worms. Nowadays we know that these symptoms are found in a multitude of troubles, from psycho-neurosis to diabetes. I was reminded of this this evening when the ■ Turnwrights brought their six-year-old along to explain the cause of his night wakefulness persistent tendency to scratch. They reported having noticed little pieces or threadlike material. Rightly _ they lelt that this combination of signs and symptoms might indicate the presence of that quite common parasite, the thread-worm, and a quick search confirmed its presence. I explained that extra cleanliness was an essential part of the treatment, and recommended a sit-hath at appropriate times at least twice a day. Because reinfection is so common, J also recommended frequent washing 6t the hands and scrubbing of the finger nails in, hot water and soap. The final suggestion was that mild salt and water enema might be tried for two nights, after which progress should he reported. w ,

1 like the story of the men who asked the waiter for two bad eggs, some burnt toast, and a rotten tomato. The waiter expressed mild surprise. “ Oh, it’s all right,” said the diner. “ I’ve got worms and anything's good enough for them.” Wednesday, September 20. “ I think it’s narcolepsy,” 1 said. ‘‘Does that mean I’m finished? said Edward Skyington quietly. “ Far from that,” 1 said. However 1 can’t pretend to be an expert on everything, and I’m certainly not one on, that sort of thing. Pm going to give you a note to someone who knows much more about it than I do.” Skyington nodded assent, and 1 sat down and wrote to a specialist as follows :

“ Edward Skyington tells me that he is subject to attacks of irresistible

sleepiness. He is liable to drop off at any time, especially after a meal or after any little emotional disturbance. He can be aroused as from normal sleep, but he says he just can’t stop himself falling to sleep. Ho works near a machine, so he is naturally very worried about it all. Tho attacks occur many times a day, though they might last only a few minutes or even seconds. ”My patient also suffers a little from rather vivid halucinations, more especially as ho is falling asleep. They are rather frightening, and sometimes take the form of ghosts chasing him.” Narcolepsy is one of those many curious disorders to which the brain is subject, and despite which there is no suggestion of mental disease as the term is ordinarily understood. 1 once had a patient who suffered from it and who was a highly intelligent and skilled workman.

Is there any brain peculiarity more strange than catalepsy, that condition in which all consciousness is lost and a state of “ trance ” is created? You may place the limbs of these patients in any position at all and they will not move for hours at a stretch. A condition somewhat similar is called cataplexy, and in it the .patient suddenly and temporarily’ loses all power of movement or speech, despite which he is acutely conscious of everything going on around.

Thursday, September 21. The romance between Edna Lyard and George Winnel received a sorb blow this time two years ago when only a week before the projected wedding day I discovered that Edna had tuberculosis. George came and asked about it straight away. “It won’t stop the marriage,” he said. “My love would not be worth much if it did. I have a good job. She can have a couple of servants to help her. If We have to wait for six months till she picks up before we set up home, well, that’s all right.” “ If you’re interested in the question of infection.” J said. “I’m not,” he said briefly. “Still, I’ll tell .you,” I replied. “ Many doctors think that married couples do not infect one another atall. _ The rate of tuberculosis among marriage partners is no higher than the ordinary. At the same time it would be foolish not to look after yourself and especially be particular to take good food and reasonable rest.” “About family?” asked George. “ Not till the disease is conquered,” I said. “'Hie strain of pregnancy is an undesirable risk for a tubercular woman to take, in my opinion.”

Two months ago a baby arrived and Edna is going down the hill again. A pity . . -but then babies and marriage arc not a rare association. Friday, September 22. 1 The few sunny days this month have tempted early bathers, among them being Gordon Hellen, who arrived this evening with deafness. Patricia, the secretary, held a kidney dish under his ear while I forced jets of warm water into it by means of a powerful engine known as an ear syringe. We removed large masses of wax which the water had caused to swell and obstruct the ear canal. Gordon was covered with confusion at what he obviously thought was a reflection on his personal cleanliness. Patricia was looking her pretti-' est (which is not an unattractive sight) and George obviously felt that he had sealed his fate for all time. ‘‘Your ears secrete a good deal >of wax,” I told him. “ People like you, no matter how clean they keep themselves, generally get an aggregation that wants a minute or two’s attention every now and again. I think it mightn’t do any harm to come and see me before every surfing season.” George agreed and Patricia rewarded him with a slight relaxation from rigidity.

Ears can be affected by swimming. High divers might do worse than putting a rubber ping in each ear for instance. If deafness occurs when leaving the water and hopping on one leg doesn’t relieve it, a hot water bottle to the ear sometimes works. If that fails it is time some deserving family physician earned half a guinea. Names in this Diary are fictitious. (Copyright.)