CHAPTER III.

CARE OF THE ADOLESCENT GIRL IN SICKNESS.

If measured by the death-rate the period of adolescence should cause us little anxiety, but a careful examination into the state of health of children of school age shows us that it is a time in which disorders of health abound, and that although these disorders are not necessarily, nor even generally, fatal, they are frequent, they spoil the child's health, and inevitably bear fruit in the shape of an injurious effect on health in after life.

That the health of adolescents should be unstable is what we ought to expect from the general instability of the organism due to the rapidity of growth and the remarkable developmental changes that are crowded into these few years. Rapidity of growth and increase of weight are very generally recognised, although their effects upon health are apt to be overlooked. On the other hand, the still more remarkable development that occurs in adolescence is very generally ignored.

As a general rule the infectious fevers, the so-called childish diseases - such as measles, chicken-pox, and whooping-cough - are less common in adolescence than they are in childhood, while the special diseases of internal organs due to their overwork, or to their natural tendency to degeneration, is yet far in the future. The chief troubles of adolescents appear to be due to overstress which accompanies rapid development, to the difficulty of the whole organism in adapting itself to new functions and altered conditions, and no doubt in some measure to the unwisdom both of the young people and of their advisers.

This is not the place for a general treatise on the diseases of adolescents, but a few of the commonest and most obvious troubles should be noted.

The Teeth. - It is quite surprising to learn what a very large percentage of young soldiers are refused enlistment in the army on account of decayed or defective teeth, and anyone who has examined the young women candidates for the Civil Service and for Missionary Societies must have recognised that their teeth are in no way better than those of the young men. In addition to several vacancies in the dental series, it is by no means unusual to find that a candidate has three or even five teeth severely decayed. The extraordinary thing is that not only the young people and their parents very generally fail to recognise the gravity of this condition, but that even their medical advisers have frequently acquiesced in a state of things that is not only disagreeable but dangerous. A considerable proportion of people with decayed teeth have also suppuration about the margins of the gums and around the roots of the teeth. This pyorrhoea alveolaris, as it is called, constitutes a very great danger to the patient's health, the purulent discharge teems with poisonous micro-organisms, which being constantly swallowed are apt to give rise to septic disease in various organs. It is quite probable that some cases of gastric ulcer are due to this condition, so too are some cases of appendicitis, it has been known to cause a peculiarly fatal form of heart disease, and it is also responsible for the painful swelling of the joints of the fingers, with wasting of the muscles and general weakness which goes by the name of rheumatoid arthritis. In addition to this there are many local affections, such as swollen glands in the neck, that may be due to this poisonous discharge. One would think that the mere knowledge that decayed teeth can cause all this havoc would lead to a grand rush to the dentist, but so far from being the case, doctors find it extremely difficult to induce their patients to part with this unsightly, evil-smelling, and dangerous decayed tooth.

The Throat. - Some throat affections, such as diphtheria and quinsy, are well known and justly dreaded; and although many a child's life has been sacrificed to the slowness of its guardians to procure medical advice and the health-restoring antitoxin, yet on the whole the public conscience is awake to this duty. Far otherwise is it with chronic diseases of the tonsils: they may be riddled with small cysts, they may be constantly in a condition of subacute inflammation dependent on a septic condition, but no notice is taken except when chill, constipation, or a general run-down state of health aggravates the chronic into a temporary acute trouble. And yet it is perhaps not going too far to say that for one young girl who is killed or invalided rapidly by diphtheria there are hundreds who are condemned to a quasi-invalid life owing to this persistent supply of poison to the system.

Another condition of the throat which causes much ill-health is well known to the public under the name of adenoids. Unfortunately, however, many people have an erroneous idea that children will "grow out of adenoids." Even if this were true it is extremely unwise to wait for so desirable an event. Adenoids may continue to grow, and during the years that they are present they work great mischief. Owing to the blocking of the air-passages the mouth is kept constantly open, greatly to the detriment of the throat and lungs. Owing to the interference with the circulation at the back of the nose and throat, a considerable amount both of apparent and real stupidity is produced, the brain works less well than it ought, and the child's appearance is ruined by the flat, broad bridge of the nose and the gaping mouth. The tale of troubles due to adenoids is not even yet exhausted; a considerable amount of discharge collects about them which it is not easy to clear away, it undergoes very undesirable changes, and is then swallowed to the great detriment of the stomach and the digestion. The removal of septic tonsils and of adenoids is most urgently necessary, and usually involves little distress or danger. The change in the child's health and appearance that can thus be secured is truly wonderful, especially if it be taught, as it should be, to keep its mouth shut and to breathe through the nose. In the course of a few months the complexion will have cleared, the expression will have regained its natural intelligence, digestion will be well performed, and the child's whole condition will be that of alert vigour instead of one of listless and sullen indifference.

Errors of Digestion. - From the consideration of certain states of the nose, mouth, and throat, it is easy to turn to what is so often their consequence. Many forms of indigestion are due to the septic materials swallowed. It would not, however, be fair to say that all indigestion is thus caused; not infrequently indigestion is due to errors of diet, and here the blame must be divided between the poverty and ignorance of many parents and the self-will of adolescents. The foods that are best for young people - such as bread, milk, butter, sugar, and eggs - are too frequently scarce in their dietaries owing to their cost; and again, in the case of many girls whose parents are able and willing to provide them with a thoroughly satisfactory diet-sheet, dyspepsia is caused by their refusal to take what is good for them, and by their preference for unsuitable and indigestible viands.

A further cause of indigestion must be sought in the haste with which food is too often eaten. The failure to rise at the appointed time leads to a hasty breakfast, and this must eventually cause indigestion. The food imperfectly masticated and not sufficiently mixed with saliva enters the stomach ill-prepared, and the hasty rush to morning school or morning work effectually prevents the stomach from dealing satisfactorily with the mass so hastily thrust into it.

There is an old saying that "Those whom the gods will destroy they first make mad," and in many instances young people who fall victims to the demon of dyspepsia owe their sorrows, if not to madness, at any rate to ignorance and want of consideration. The defective teeth, septic tonsils, discharging adenoids, poverty of their parents and their own laziness, all conspire to cause digestive troubles which bear a fruitful crop of further evils, for thus are caused such illnesses as anæmia and gastric ulcer.

Constipation claims a few words to itself. And here again we ought to consider certain septic processes. The refuse of the food should travel along the bowels at a certain rate, but if owing to sluggishness of their movements or to defects in the quality and amount of their secretion, the refuse is too long retained the masses become unduly dry, and, constantly shrinking in volume, are no longer capable of being urged along the tube at the proper rate. In consequence of this the natural micro-organisms of the intestine cease to be innocent and become troublesome; they lead in the long run to a peculiar form of blood-poisoning, and to so many diseased conditions that it is impossible to deal with them at the present moment. The existence of constipation is too often a signal for the administration of many doses of medicine. The wiser, the less harmful, and the more effectual method of dealing with it would be to endeavour to secure the natural action of the bowels by a change in the diet, which should contain more vegetable and less animal constituents. The patient should also be instructed to drink plenty of water, either hot or cold, a large glassful on going to bed and one on first awaking, and also if necessary an hour before each meal. Steady exercise is also of very great service, and instead of starting so late as to have no time for walking to school or work, a certain portion of the daily journey should be done on foot. Further, in all cases where it is possible, team games, gymnastics, and dancing should be called in to supplement the walk.

Headache. - Headache may be due to so many different causes that it would be impossible in this little book to adequately consider them, but it would not be fair to omit to mention that in many cases the headache of young people is due to their want of spectacles. The idea that spectacles are only required by people advanced in life is by this time much shaken, but even now not only many parents object to their children enjoying this most necessary assistance to imperfect vision, but also employers may be found so foolish and selfish as to refuse to employ those persons who need to wear glasses. The folly as well as selfishness of this objection is demonstrated by the far better work done by a person whose vision has been corrected, and the absolute danger incurred by all who have to deal with machinery if vision is imperfect. Among other causes for headache are the defects of mouth, throat, stomach, and bowels already described, because in all of them there is a supply of septic material to the blood which naturally causes headache and other serious symptoms.

Abnormalities of Menstruation. - The normal period should occur at regular intervals about once a month. Its duration and amount vary within wide limits, but in each girl it should remain true to her individual type, and it ought not to be accompanied by pain or distress. As a rule the period starts quite normally, and it is not until the girl's health has been spoiled by over-exertion of body or mind, by unwise exertion during the period, or by continued exposure to damp or cold, that it becomes painful and abnormal in time or in amount.

One of the earliest signs of approaching illness - such as consumption, anæmia, and mental disorder - is to be found in the more or less sudden cessation of the period. This should always be taken as a danger-signal, and as indicating the need of special medical advice.

Another point that should enter into intimate talk with girls is to make them understand the co-relation of their own functions to the great destiny that is in store. A girl is apt to be both shocked and humiliated when she first hears of menstruation and its phenomena. Should this function commence before she is told about it, she will necessarily look upon it with disgust and perhaps with fear. It is indeed a most alarming incident in the case of a girl who knows nothing about it, but if, before the advent of menstruation, it be explained to her that it is a sign of changes within her body that will gradually, after the lapse of some years, fit her also to take her place amongst the mothers of the land, her shame and fear will be converted into modest gladness, and she will readily understand why she is under certain restrictions, and has at times to give up work or pleasure in order that her development may be without pain, healthy, and complete.