When any signs such as I have described indicate the threatening of disease, do not look on them as within the scope of domestic management, but place the child at once under the watchful care of a skilful doctor. I have seen but one recovery in all my life, after the disease had fully set in, and that was a recovery almost worse than death.
=Earache.=--There is another form of inflammation of the brain which is likewise oftenest met with in children who are of weakly constitution, or of scrofulous habit, or in whom scarlet fever has left behind that very troublesome ailment, discharge from the ear. This is so tedious, so difficult to cure, so apt to return under the influence of very slight causes, that people are too ready to put up with it as an inconvenience which it is useless to try to remedy.
In addition, however, to the risk of the child's hearing being impaired by the extension of the mischief to the internal ear, there is another still greater danger, namely, that of the _disease passing from the ear to the brain_, and producing inflammation of its membranes, or even abscess of its substance.
It is therefore of the greatest moment that every case of chronic discharge from the ear should be looked on as important, and that no pains be spared to bring about its cure; and further, that during its continuance the slightest sign of disturbance of the brain--headache, sickness, feverishness, and dulness--should at once be noticed, and the advice of a competent doctor be immediately sought for.
These dangers, however, follow almost entirely on long-continued discharges from the ear, but do not attend that acute inflammation of the passage to the ear which is often met with in childhood, and the symptoms of which sometimes cause needless fear, from being taken for those of inflammation of the brain. Attacks of _earache_ are most frequent before the first set of teeth have been cut, and are by no means rare in young children, who are perfectly unable to point out the seat of their sufferings. The attack sometimes comes on quite suddenly, but usually the child is languid and fretful for a period varying from a few hours to one or two days before acute pain is experienced. In this premonitory stage, however, it will often cry if tossed or moved briskly; noise seems unpleasant to it, and it does not care to be played with; while children who are still at the breast show a disinclination to suck, though they will take food from a spoon. The infant seeks to rest its head on its mother's shoulder, or, if lying in its cot, moves its head uneasily from side to side, and then buries its face in the pillow. If you watch closely, you will see that it is always the same side of the head which it seeks to bury in the pillow, or to rest on its nurse's arm, and that no other position seems to give any ease, except this one, which, after much restlessness, the child will take up, and to which, if disturbed, it will always return. The gentle support to the ear seems to soothe the little patient: it cries itself to sleep, but after a short doze, some fresh twinge of pain arouses it, or some accidental movement disturbs it, and it awakes crying aloud, and refusing to be pacified, and may continue so for hours together. Sometimes the ear is red, and the hand is often put to the affected side of the head, but neither of these symptoms is constant. The intensity of the pain seldom lasts for more than a few hours, when, in many instances a copious discharge of matter takes place from the ear, and the child is well. In some instances, indeed, the subsidence of the disease on one side is followed by a similar attack on the opposite side, and the same acute suffering is once more gone through, and terminates in the same manner. Sometimes, too, this complete cure does not take place, but the earache abates, or altogether ceases, for a day or two, and then returns; no discharge, or but a very scanty discharge, taking place, while, for weeks together, the child has but few intervals of perfect ease. In infants, earache seldom follows this chronic course, but it does sometimes in older children, and is then of the more importance, since it shows that the disease is no longer confined to the external passage, but has extended to the internal ear.