causes rickets, and makes him crooked. A horse-hair mattress is the
best for a child to lie on. The pillow, too, should be made of
horse-hair. A _feather_ pillow often causes the bead to be bathed in
perspiration, thus enervating the child, and making him liable to
catch cold. If he be at all rickety, if he be weak in the neck, if he
be inclined to stoop, or if he be at all crooked, let him, by all
means, lie without a pillow.
186. _Do you recommend a child, in the middle of the day, to be put to
sleep_?
Let him be put on his mattress _awake_, that he may sleep for a couple
of hours before dinner, then he will rise both refreshed and
strengthened for the remainder of the day. I said, let him be put down
_awake_. He might, for the first few times, cry, but, by perseverance,
he will without any difficulty fall to sleep. The practice of sleeping
before dinner ought to be continued until he be three years old, and,
if he can be prevailed upon, even longer. For if he do not have sleep
in the middle of the day, he will all the afternoon and the evening be
cross; and when he does go to bed, he will probably be too tired to
sleep, or his nerves having been exhausted by the long wakefulness, he
will fall into a troubled, broken slumber, and not into that sweet,
soft, gentle repose, so characteristic of healthy, happy childhood!
187. _At what hour ought a child to be put to bed in the evening_?
At six in the winter, and at seven o'clock in the summer. _Regularity_
ought to be observed, _as regularity is very conducive to health._ It
is a reprehensible practice to keep a child up until nine or ten
o'clock at night. If this be done, he will, before his time, become
old, and the seeds of disease will be sown,
As soon as he can run, let him be encouraged, for half an hour before
he goes to bed, to race either about the hall, or the landing, or a
large room, which will be the best means of warming his feet, of
preventing chilblains, and of making him sleep soundly.
188. _Have you any directions to give me at to the placing of my child
in his bed_?
If a child lie alone, place him fairly on his aide in the middle of
the bed; if it be winter time, see that his arms and hands be covered
with the bed-clothes; if it be summer, his hands might be allowed to
be outside the clothes. In putting him down to sleep, you should
ascertain that his face be not covered with the bedclothes; if it be,
he will he poisoned with his own breath--the breath constantly giving
off carbonic acid gas; which gas must, if his face be smothered in the
clothes; be breathed--carbonic acid gas being highly poisonous.
You can readily prove the existence of carbonic and gas in the
breathing, by simply breathing into a little lime-water; after
breathing for a few seconds into it, a white film will form on the
top; the carbonic acid gas from the breath unites with the lime of the
lime-water and the product of the white film is carbonate of lime.
189. _Do you advise a bedroom to be darkened at night_?
Certainly: a child sleeps sounder and sweeter in a dark than in a
light room. There is nothing better for the purpose of darkening a
bedroom, than Venetian blinds. Remember, then, a well-ventilated, but
a darkened, chamber at night. The cot or the crib ought _not_ to face
the window, "as the light is best behind." [Footnote: Sir Charles
Locock in a Letter to the Author. ]
190. _Which is the beat position for a child when sleeping--on his
back, or on his side_?
His side: he ought to be accustomed to change about on the right side
one night, on the left another; and occasionally, for a change, he
should lie on his back. By adopting this plan, you will not only
improve his figure, but likewise his health. Lying, night after night,
in one position, would be likely to make him crooked.
191. _Do you advise, in the winter time, that there should be a fire
in the night nursery_?
Certainly not, unless the weather be intensely cold. I dislike fires
in bedrooms, especially for children; they are very enervating, and
make a child liable to catch cold. Cold weather is very bracing,
particularly at night "Generally speaking," says the _Siecle_, "during
winter, apartments are too much heated. The temperature in them ought
not to exceed 16 deg. Centigrade (59 deg. Fahrenheit); and even in periods of
great cold scientific men declare that 12 deg. or 14 deg. had better not be
exceeded. In the wards of hospitals, and in the chambers of the sick,
care is taken not to have greater heat than 15 deg.. Clerks in offices,
and other persons of sedentary occupations, when rooms in which they
sit are too much heated, are liable to cerebral [brain] congestion and
to pulmonary [lung] complaints. In bedrooms, and particularly those of
children, the temperature ought to be maintained rather low; it is
even prudent only rarely to make fires in them, especially during the
night"
If "a cold stable make a healthy horse," I am quite sure that a
moderately cold and well-ventilated bedroom helps to make a healthy
child. But, still, in the winter time, if the weather be biting cold,
a _little_ fire in the bedroom grate is desirable. In bringing up
children, we must never run into extremes--the coddling system and the
hardening system are both to be deprecated; the coddling system will
make the strong child weakly, while the hardening system will probably
kill a delicate one.
A child's bed ought, of course, to be comfortably clothed with
blankets--I say blankets, as they are much superior to coverlids; the
perspiration will more readily pass through a blanket than a
coverlid. A _thick_ coverlid ought never to be used; there is nothing
better, for a child's bed, than the old-fashioned patchwork coverlid,
as the perspiration will easily escape through it.
192. _Should a child be washed and dressed_ AS SOON AS HE AWAKE _in
the morning_?
He ought, if he awake in anything like reasonable time; for if he doze
after he be once awake, such slumber does him more harm than good. He
should be up every morning as soon as it is light If, as a child, he
be taught to rise early, it will make him an early riser for life, and
will tend greatly to prolong both his existence and his happiness.
_Never awake a child from his sleep_ to dress him, to give him
medicine, or for any other purpose; _let him always sleep as long as
he can;_ but the moment he awakes let him be held out, and then let
him be washed and dressed, and do not wait, as many a silly nurse
does, until he have wet his bed, until his blood be chilled, and until
he be cross, miserable, and uncomfortable! How many babes are made
ill by such foolish practices!
The moment he leaves his bed, turn back to the fullest extent the
clothes, in order that they may be thoroughly ventilated and
sweetened. They ought to be exposed to the air for at least an hour
before the bed be made. As soon as he leaves his room, be it winter or
summer, throw open the windows.
193. _Ought a child to lie alone_?
He should, after he is weaned. He will rest more comfortably, and his
sleep will be more refreshing.
194. _Supposing a child should not sleep well, what ought to be done?
Would you give him a dose of composing medicine_?
Certainly not. Try the effects of exercise. Exercise in the open air
is the best composing medicine in the world. Let the little fellow be
well tired out, and there will be little fear of his not sleeping.
195. _Have you any further observations to make on the subject of
sleep_?
Send a child joyful to bed. Do not, if you can possibly help it, let
him go to bed crying. Let the last impressions he has at night be of
his happy home, and of his loving father and mother and let his last
thoughts be those of joy and gladness. He will sleep all the sounder
if he be sent to bed in such a frame of mind, and he will be more
refreshed and nourished in the morning by his sleep.
196. _What are the usual causes of a child walking in his sleep, and
what measures during such times, ought to be adopted to prevent his
injuring himself_?
A disordered stomach, in a child of nervous temperament, or worms, are
usually the causes. The means to be adopted to prevent his throwing
himself out of the window, are to have bars to his chamber present,
and if that be not practicable, to have either nails or screws driven
into the window sash to allow the window to open only for a sufficient
space for ventilation, and to have a screw window fastening, in order
that he cannot, without difficulty, open the window, to have a trusty
person to sleep in his room, who should have directions given not to
rouse him from his sleep, but to gently lead him back to his bed,
which may frequently be done without awaking him, and to consult a
medical man, who will adopt means to destroy the worms, to put his
stomach into order, to brace his nerves, and to strengthen his general
system. A trip to the coast and sea bathing, in such a case, is often
of great service.
SECOND DENTITION.
197. _When does a child commence to cut his SECOND set of teeth_?
Generally at seven years old. He _begins to cut_ them at about that
time: but it should be borne in mind (so wonderful are the works of
God) that the _second_ crop of teeth, _in embryo_, is actually bred
and formed from the very commencement of his life, _under_ the first
tier of teeth, but which remain in abeyance for years, and do not come
into play until the _first_ teeth, having done their duty, loosen and
fall out, and thus make room for the more numerous, larger, stronger,
and more permanent teeth, which latter have to last for the remainder
of his existence. The _first_ set is sometimes cut with a great deal
of difficulty, and produces various diseases; the _second_, or
permanent teeth, come easily, and are unaccompanied with any disorder.
The following is the process:--One after another of the _first_ set
gradually loosen, and either drop out, or with little pain are readily
pulled out; under these, the _second_--the permanent--teeth make their
appearance, and fill up the vacant spaces. The fang of the tooth that
has dropped out is nearly all absorbed or eaten away, leaving little
more than the crown. The _first_ set consists of twenty; the _second_
(including the wise-teeth, which are not, generally cut until after
the the age of twenty-seven) consists of thirty-two.
I would recommend you to pay particular attention to the teeth of your
children; for, besides their being ornamental, their regularity and
soundness are of great importance to the present as well as to the
future health of your offspring. If there be any irregularity in the
appearance of the _second_ set, lose no time in consulting an
experienced and respectable dentist.
ON DISEASE, ETC.
198. _Do you think it important that I should be made acquainted with
the symptoms of the SERIOUS diseases of children_?
Certainly I am not advocating the doctrine of a mother _treating
serious_ diseases; far from it, it is not her province, except in
certain cases of extreme urgency, where a medical man cannot be
procured, and where delay might be death; but I do insist upon the
necessity of her knowing the _symptoms_ of disease. My belief is, that
if parents were better informed on such subjects, many children's
lives might be saved, much suffering averted, and sorrow spared. The
fact is, the knowledge of the symptoms of disease is, to a mother,
almost a sealed book. If she were better acquainted with these
matters, how much more useful would she be in a sick-room, and how
much more readily would she enter into the plans and views of the
medical man! By her knowledge of the symptoms, and by having his
advice in time, she would nip disease in the bud, and the fight might
end in favour of life, for "sickness is just a fight between life and
death."--_Geo. M'Donald._
It is really lamentable to contemplate the amount of ignorance that
still exists among mothers in all that appertains to the diseases of
children; although, fortunately, they are beginning to see and to feel
the importance of gaining instruction on such subjects; but the light
is only dawning. A writer of the _Medical Times and Gazette_ makes the
following remarks, which somewhat bear on the subject in question. He
observes--"In spite of the knowledge and clear views possessed by the
profession on all that concerns the management of children, no fact is
more palpable than that the most grievous ignorance and incompetency
prevail respecting it among the public. We want some means of making
popular the knowledge which is now almost restricted to medical men,
or, at most, to the well-educated classes."
In the earlier editions of this work I did not give the _treatment_ of
any serious diseases, however urgent. In the eight last editions, I
have been induced, for reasons I will presently state, to give the
_treatment_ of some of the more urgent _serious_ diseases, when a
medical man cannot instantly be procured, and where delay might be
death.
Sir CHARLES LOCOCK, who has taken a kind interest in this little work,
has given me valid reasons why a mother should be so enlightened. The
following extracts are from a letter which I received from Sir CHARLES
on the subject, and which he has courteously allowed me to publish. He
says,--"As an old physician of some experience in complaints of
infants and children, I may perhaps be allowed to suggest that in a
future edition you should add a few words on the actual treatment of
some of the more urgent infantile diseases. It is very right to
caution parents against superseding the doctor, and attempting to
manage serious illness themselves, but your advice, with very small
exceptions, always being 'to lose no tune in sending for a medical
man,' much valuable and often irremediable time may be lost _when a
medical man is not to be had_. Take, for instance, a case of croup
there are no directions given at all, except to send for a medical
man, and always to keep medicines in the house which he may have
directed. But how can this apply to a first attack? You state that a
first attack is generally the worst. But why is it so? Simply because
it often occurs when the parents do not recognise it, and it is
allowed to get a worse point than in subsequent attacks, when they are
thoroughly alive to it. As the very best remedy, and often the only
essential one, if given early, is a full emetic, surely it is better
that you should give some directions as to this in a future edition,
and I can speak from my own experience when I say that an emetic,
_given in time_, and repeated to free vomiting, will cut short _any_
case of croup. In nine cases out of ten the attack takes place in the
evening or early night, and when vomiting is effected the dinner of
that day is brought up nearly undigested, and the seventy of the
symptoms at once cut short. Whenever any remedy is valuable, the more
by its being administered _in time_, it is surely wiser to give
directions as to its use, although, as a general rule, it is much
better to advise the sending for medical advice."
The above reasons, coming from such a learned and experienced
physician as Sir Charles Locock, are conclusive, and have decided me
to comply with his advice, to enlighten a mother on the _treatment_ of
some of the more urgent diseases of infants and of children. In a
subsequent letter addressed to myself, Sir Charles has given me the
names of those _urgent_ diseases, which he considers may be treated by
a mother "where a medical man cannot be procured quickly, or not at
all." They are Croup: Inflammation of the Lungs; Diptheria; Dysentry;
Diarrhoea; Hooping Cough, in its various stages; and Shivering
Fit. Sir Charles sums up his letter to me by saying, "Such a book
ought to be made as complete as possible, and the objections to
medical treatment being so explained as to induce mothers to try to
avoid medical men is not so serious as that of leaving them without
any guide in those instances where every delay is dangerous, and yet
where medical assistance is not to be obtained or not to be had
quickly."
In addition to the above I shall give you the _treatment_ of
Bronchitis, Measles, and Scarlet Fever. Bronchitis is one of the most
common diseases incidental to childhood, and, with judicious
treatment, is, in the absence of the medical man, readily managed by a
sensible mother. Measles is very submissive to treatment. Scarlet
Fever, _if it be not malignant_, and, _if it be not complicated with
diphtheric-croup_, and if certain rules be strictly followed, is also
equally amenable to treatment.
I have been fortunate in treating Scarlet Fever, and I therefore think
it desirable to enter fully into the _treatment_ of a disease which is
looked upon by many parents, and, according to the usual mode of
treatment, with just cause, with great consternation and dread. By
giving my plan of treatment, fully and simply, and without the
slightest reservation, I am fully persuaded, through God's blessing,
that I may be the humble means of saving the lives of numbers of
children.
The diseases that might be treated by a mother, in the absence of a
medical man, will form the subject of future Conversations.
I think it right to promise that in all the prescriptions for a child
I have for the use of a mother given, I have endeavoured to make them
as simple as possible, and have, whenever practicable, avoided to
recommend powerful drugs. Complicated prescriptions and powerful
medicines might, as a rule, to be seldom given; and when they are,
should only be administered by a judicious medical man: a child
requiring much more care and gentleness in his treatment than an
adult: indeed, I often think it would be better to leave a child to
nature rather than to give him powerful and large doses of
medicines. A remedy--calomel, for instance--has frequently done more
mischief than the disease itself; and the misfortune of it is, the
mischief from that drug has oftentimes been permanent, while the
complaint might, if left alone, have only been temporary.
199. _At what age does Water in the Brain usually occur, and how is a
mother to know that her child is about to labour under that disease_?
Water on the brain is, as a rule, a disease of childhood: after a
child is seven years old it is comparatively rare. It more frequently
attacks delicate children--children who have been dry nursed
(especially if they have been improperly fed), or who have been
suckled too long, or who have had consumptive mothers, or who have
suffered severely from toothing, or who are naturally of a feeble
constitution. Water on the brain sometimes follows an attack of
inflammation of the lungs, more especially if depressing measures
(such as excessive leeching and the administration of emetic tartar)
have been adopted. It occasionally follows in the train of contagious
eruptive diseases, such as either small-pox or scarlatina. We may
divide the symptoms of water on the brain into two stages. The
first--the premonitory stage--which lasts for or five days, in which
medical aid might be of great avail: the second--the stage of
drowsiness and of coma--which usually ends in death.
I shall dwell on the first--the premonitory stage--in order that a
mother may see the importance without loss of time of calling in a
medical man:--
If her child be feverish and irritable, if his stomach be disordered,
if he have urgent vomitings, if he have a foul breath, if his appetite
be capricious and bad, if his nights be disturbed (screaming out in
his sleep), if his bowels be disordered, more especially if they be
constipated, if he be more than usually excited, if his eye gleam with
unusual brilliancy, if his tongue run faster than it is wont, if his
cheek be flushed and his head be hot, and if he be constantly putting
his hand to his head; there is cause for suspicion. If to these
symptoms be added, a more than usual carelessness in tumbling about,
in hitching his foot in the carpet, or in dragging one foot after the
other; if, too, he has complained of darting, shooting, lancinating
pains in his head, it may then be known that the _first_ stage of
inflammation (the forerunner of water on the brain) either has taken,
or is about taking place. Remember no time ought to be lost in
obtaining medical aid; for the _commencement_ of the disease is the
golden opportunity, when life might probably be saved.
200. _At what age, and in what neighbourhood, is a child most liable
to croup, and when is a mother to know that it is about to take
place_?
It is unusual for a child until he be twelve months old to have croup:
but, from that time until the age of two years, he is more liable to
it than at any other period. The liability after two years, gradually,
until he be ten years old, lessens, after which time it is rare.
A child is more liable to croup in a low and damp, than in a high and
dry neighbourhood; indeed, in some situations, croup is almost an
unknown disease; while in others it is only too well understood. Croup
is more likely to prevail when the wind is either easterly or
north-easterly.
There is no disease that requires more prompt treatment than croup,
and none that creeps on more insidiously. The child at first seems to
be labouring under a slight cold, and is troubled with a little _dry_
cough, he is hot and fretful, and hoarse when he cries. Hoarseness is
one of the earliest symptoms of croup, and it should be borne in mind
that a young child, unless he be going to have croup, is seldom
hoarse, if, therefore, your child be hoarse, he should be carefully
watched, in order that, as soon as croup be detected, not a moment be
lost in applying the proper remedies.
His voice at length becomes gruff, he breathes as though it were
through muslin, and the cough becomes crowing. These three symptoms
prove that the disease is now fully formed. These latter symptoms
sometimes come on without any previous warning, the little fellow
going to bed apparently quite well, until the mother is awakened,
perplexed and frightened, in the middle of the night, by finding him
labouring under the characteristic cough and the other symptoms of
croup. If she delay either to send for assistance, _or if proper
medicines be not instantly given_, in a few hours it will probably be
of no avail, and in a day or two the little sufferer will be a corpse.
When once a child has had croup the after attacks are generally
milder. If he has once had an attack of croup, I should advise you
always to have in the house medicine--a 4 oz. bottle of Ipecacuanha
Wine, to fly to at a moments notice, [Footnote: In case of a sudden
attack of croup, _instantly_ give a teaspoonful of Ipecacuanha Wine,
and repeat it every fire minutes natal free vomiting be excited.] but
never omit, where practicable, in a case of croup, whether the case be
severe or mild to send _immediately_ for medical aid. There is no
disease in which time is more precious than in croup, and where the
delay of an hour may decide either for life or for death.
201. _But suppose a medical man is not IMMEDIATELY to be procured,
what then am I to do? more especially, as you say, that delay might be
death_?
_What to do_.--I never, in my life, lost a child with croup with
catarrhal croup where I was called in at the _commencement_ of the
disease, and where my plans were carried out to the very letter. Let
me begin by saying, look well to the goodness and purity of the
medicine, for the life of your child may depend upon the medicine
being genuine. What medicine! _Ipecacuanha Wine!_ At the earliest dawn
of the disease give a few spoonful of Ipecacuanha Wine every five
minutes, until free vomiting be exerted. In croup, then, before he be
safe, free vomiting _must_ be established, and that without loss of
time. If, _after_ the expiration of an hour, the Ipecacuanha Wine
(having given during that hour one or two tea-spoonfuls of it every
five minutes) be not sufficiently powerful for the purpose--although
it generally is so--(_if the Ipecacuanha Wine be good_)--then let the
following mixture be substituted--
Take of--Powdered Ipecacuanha, one scruple,
Wine of Ipecacuanha, one ounce and a half
Make a mixture. One or two tea spoonfuls to be given every five
minutes, until free vomiting be excited, first well shaking the
bottle.
After the vomiting, place the child for a quarter of an hour in a warm
bath. [Footnote: See "Warm Baths"--directions and precautions to be
observed.] When out of the bath give him small doses of Ipecacuanha
Wine every two or three hours. The following is a palatable form for
the mixture--
Take of--Wine of Ipecacuanha, three drachms;
Simple syrup, three drachms,
Water, six drachms
Make a Mixture. A tea-spoonful to be taken every two or three hours.
But remember the emetic which is given at _first_ is _pure Ipecacuanha
Wine, without a drop of either water or of syrup._
A large sponge dipped out of very hot water, and applied to the
throat, and frequently renewed, oftentimes affords great relief in
croup, and ought during the time the emetic is being administered in
all cases to be adopted.
If it be a _severe_ case of croup, and does not in the course of two
hours yield to the free exhibition of the Ipecacuanha Emetic, apply a
narrow strip of _Smith's Tela Vesicularia_ to the throat, prepared in
the same way as for a case of inflammation of the lungs (see the
Conversation on the _treatment_ of inflammation of the lungs). With
this only difference, let it be a narrower strip, only one-half the
width there recommended, and apply it to the throat instead of to the
chest. If a child has a very short, fat neck, there may not be room
for the _Tela_, then you ought to apply it to the _upper_ part of the
chest--just under the collar-bones.
Let it be understood, the the _Tela Vesicularia_ is not a severe
remedy, that the _Tela_ produces very little pain--not nearly so much
as the application of leeches; although, in its action, it is much
more beneficial, and is not nearly so weakening to the system.
Keep the child from all stimulants; let him live on a low diet, such
as milk and water, toast and water, arrowroot, &c.; and let the room
be, if practicable, at a temperate heat--60 deg. Fahrenheit, and be well
ventilated.
So you see that the _treatment_ of croup is very simple, and the the
plan might be carried out by an intelligent mother. Notwithstanding
which, it is your duty, where practicable, to send, at the very
_onset_ of the disease, for a medical man.
Let me again reiterate that, if your child is to be saved, the
_Ipecacuanha Wine must be genuine and good_. This can only be effected
by having the medicine from a highly respectable chemist. Again, if
ever your child has had croup, let me again urge you _always_ to have
in the house a 4 oz. bottle of Ipecacuanha Wine, that you may resort
to at a moment's notice, in case there be the slightest return of the
disease.
Ipecacuanha Wine, unfortunately, is not a medicine that keeps well,
therefore, every three or four months a fresh bottle ought to be
procured, either from a medical man or from a chemist. As long as the
Ipecacuanha Wine remains _clear_, it is good; but as soon as it
becomes _turbid_, it is bad, and ought to be replaced by a fresh
supply. An intelligent correspondent of mine makes the following
valuable remarks on the preservation of Ipecacuanha Wine:--"Now, I
know that there are some medicines and chemical preparations which,
though they spoil rapidly when at all exposed to the air, yet will
keep perfectly good for an indefinite time if hermetically sealed up
in a _perfectly full_ bottle. If so, would it not be a valuable
suggestion if the Apothecaries' Hall, or some other London firm of
_undoubted_ reliability, would put up 1 oz. phials of Ipecacuanha Wine
of guaranteed purity, sealed up so as to keep good so long as
unopened, and sent out in sealed packages, with the guarantee of their
name. By their keeping a few such ounce bottles in an unopened state
in one's house, one might rely in being ready for any emergency. If
you think this suggestion worth notice, and could induce some
first-rate house to carry it out, and mention the fact in a subsequent
edition of your book, you would, I think, be adding another most
valuable item to an already invaluable book."
The above suggestion of preserving Ipecacuanha Wine in ounce bottles,
quite full, and hermetically sealed, is a very good one. The best way
of hermetically sealing the bottle would be, to cut the cork level
with the lip of the bottle, and to cover the cork with sealing-wax, in
the same manner wine merchants serve some kinds of their wines, and
then to lay the bottles on their sides in sawdust in the cellar. I
have no doubt, if such a plan were adopted, the Ipecacuanha Wine would
for a length of time keep good. Of course, if the Wine of Ipecacuanha
be procured from the Apothecaries' Hall Company, London (as suggested
by my correspondent), there can be no question as to the genuineness
of the article.
_What NOT to do_--Do not give emetic tartar, do not apply leeches, do
not keep the room very warm, do not give stimulants, do not omit to
have always in the house either a 4 oz. bottle, or three or four 1
oz. bottles, of Ipecacuanha Wine.
202. _I have heard Child crowing mentioned as a formidable disease,
would you describe the symptoms_?
Child-crowing, or spasm of the glottis, or _spurious croup_, as it is
sometimes called, is occasionally mistaken for _genuine croup_. It is
a more frequent disorder than the latter, and requires a different
plan of treatment Child crowing is a disease that invariably occurs
only during dentition, and is _most perilous_, indeed, painful
dentition is _the_ cause--_the_ only cause--of child crowing. But, if
a child labouring under it can fortunately escape suffocation until he
have cut the whole of his first set of teeth--twenty--he is then safe.
Child-crowing comes on in paroxysms. The breathing during the
intervals is quite natural--indeed, the child appears perfectly well,
hence, the dangerous nature of the disease is either overlooked, or is
lightly thought of, until perhaps a paroxysm worse than common takes
place, and the little patient dies of suffocation, overwhelming the
mother with terror, with confusion, and dismay.
The _symptoms_ in a paroxysm of child-crowing are as follows--The
child suddenly loses and fights for his breath, and in doing so, makes
a noise very much like that of crowing, hence the name child-crowing.
The face during the paroxysm becomes bluish or livid. In a favourable
case, after either a few seconds, or even, in some instances, a
minute, and a frightful straggle to breathe, he regains his breath,
and is, until another paroxysm occurs, perfectly well. In an
unfavourable case, the upper part (chink) of the windpipe--the
glottis--remains for a minute or two closed, and the child, not being
able to breathe, drops a corpse in his nurse's arms! Many children,
who are said, to have died of fits, hare really died of child-crowing.
Child-crowing is very apt to cause convulsions, which complication, of
course, adds very much to the danger. Such a complication requires
the constant supervision of an experienced and skilful medical man.
I have entered thus rather fully into the subject, as nearly every
life might be saved, if a mother knew the nature and the treatment of
the complaint, and of the _great necessity during the paroxysm of
prompt and proper measures_. For, too frequently, before a medical man
has had time to arrive, the child has breathed his last, the parent
himself being perfectly ignorant of the necessary treatment; hence the
vital importance of the subject, and the paramount necessity of
imparting such information, in a _popular_ style, in conversations of
this kind.
203. _What treatment, then, during a paroxysm of Child-crowing should
you advise_?
The first thing, of course, to be done, is to send _immediately_ for a
medical man. Have a plentiful supply of cold and of hot water always
at hand, ready at a moment's notice for use. The instant the paroxysm
is upon the child, plentifully and perseveringly dash _cold_ water
upon his head and face. Put his foot and legs in _hot_ salt, mustard,
and water; and, if necessary, place him up to his neck in a hot bath,
still dashing water upon his face and head. If he does not quickly
come round, sharply smack his back and buttocks.
In every severe paroxysm of child-crowing, put your fore-finger down
the throat of the child, and pull his tongue forward. This plan of
pulling the tongue forward opens the epiglottis (the lid of the
glottis), and thus admits air (which is so sorely needed) into the
glottis and into the lungs, and thus staves off impending
suffocation. If this plan were generally known and adopted, many
precious lives might be saved. [Footnote: An intelligent correspondent
first drew my attention to the efficacy of pulling forward the tongue
in every severe paroxysm of child-crowing.]
There is nothing more frightfully agonising to a mother's feelings
than to see her child strangled,--as it were,--before her eyes, by a
paroxysm of child crowing.
As soon as a medical man arrives, he will lose no time in thoroughly
lancing the gums, and in applying other appropriate remedies.
Great care and attention ought, during the intervals, to be paid to
his diet. If the child be breathing a smoky, close atmosphere, he
should be immediately removed to a pure one. In this disease, indeed,
there is no remedy equal to a change of air--to a dry, bracing
neighbourhood. Change of air, even if it be winter, is the best
remedy, either to the coast or to a healthy mountainous district. I am
indebted to Mr Roberton of Manchester (who has paid great attention to
this disease, and who has written a valuable essay on the subject
[Footnote: See the end of the volume of "Physiology and Diseases of
Women," &c. Churchill, 1851.]) for the knowledge of this fact. Where,
in a case of this kind, it is not practicable to send a child _from_
home, then let him be sent out of doors the greater part of every day;
let him, in point of fact, almost live in the open air. I am quite
sure, from an extensive experience, that in this disease, fresh air,
and plenty of it, is the best and principal remedy. Cold sponging of
the body too is useful.
Mr Roberton, who, at my request, has kindly given me the benefit of
his extensive experience in child-crowing, considers that there is no
remedy, in this complaint, equal to fresh air--to dry cold winds--that
the little patient ought, in fact, nearly to live, during the day, out
of doors, whether the wind be in the east or in the north-east,
whether it be biting cold or otherwise, provided it be dry and
bracing, for "if the air be dry, the colder the better,"--taking care,
of course, that he be well wrapped up. Mr Roberton, moreover, advises
that the child should be sent away at once from home, either to a
bracing sea-side place, such as Blackpool or Fleetwood; or to a
mountainous district, such as Buxton.
As the subject is so important, let me recapitulate: the gums ought,
from time to time, to be well lanced, in order to remove the
irritation of painful dentition--painful dentition being the real
cause of the disease. Cold sponging should be used twice or thrice
daily. The diet should be carefully attended to (see Dietary of
Child); and everything conducive to health should (as recommended in
these Conversations) be observed. But, remember, after all that can
be said about the treatment, there is nothing like change of air, of
fresh air, of cold, dry pure air, and of plenty of it--the more the
little fellow can inhale, during the day, the better it will be for
him, it will be far better than any drug contained in the
pharmacopoeia.
I have dwelt on this subject at some length--it being a most important
one--as, if the above advice were more generally known and followed,
nearly every child, labouring under this complaint, would be saved;
while now, as coroners' inquests abundantly testify, the disease
carries off yearly an immense number of victims.
204. _When is a mother to know that a cough is not a "tooth cough" but
one of the symptoms of Inflammation of the lungs_?
If the child has had a shivering fit; if his skin be very hot and very
dry; if his lips be parched; if there be great thirst; if his cheeks
be flushed; if he be dull and heavy, wishing to be quiet in his cot or
crib; if his appetite be diminished; if his tongue be furred; if his
mouth be _burning_ hot and dry; [Footnote: If you put your finger into
the mouth of a child labouring under inflammation of the lungs, it is
like putting your finger into a hot apple pie, the heat is so great.]
if his urine be scanty and high-coloured, staining the napkin or the
linen; _if his breathing be short, panting, hurried, and oppressed; if
there be a hard dry cough, and if his skin be burning hot;_--then
there is no doubt that inflammation of the lungs has taken place.
No time should be lost in sending for medical aid; indeed, the _hot,
dry mouth and skin, and short, hurried breathing_ would be sufficient
cause for your procuring _immediate_ assistance. If inflammation of
the lungs were properly treated at the _onset_, a child would scarcely
ever be lost by that disease. I say this advisedly, for in my own
practice, _provided I am called in early, and if my plans are strictly
carried out_, I scarcely ever lose a child from inflammation of the
lungs.
You may ask--What are your plans? I will tell you, in case _you cannot
promptly obtain medical advice,_ as delay might be death!
_The treatment of Inflammation of the Lungs, what to do._--Keep the
child to one room, to his bedroom, and to his bed. Let the chamber be
properly ventilated. If the weather be cool, let a small fire be in
the grate; otherwise, he is better without a fire. Let him live on low
diet, such as weak black tea, milk and water (in equal quantities),
and toast and water, thin oatmeal gruel, arrow-root, and such like
simple beverages, and give him the following mixture:--
Take of--Wine of Ipecacuanha, three drachms;
Simple Syrup, three drachms;
Water, six drachms;
Make a Mixture. A tea-spoonful of the mixture to be taken every four
hours.
Be careful that you go to a respectable chemist, in order _that the
totality of the Ipecacuanha Wine may be good, as the child's life may
depend upon it._
If the medicine produce sickness, so much the better; continue it
regularly until the short, oppressed, and hurried breathing has
subsided, and has become natural.
If the attack be very severe, in addition to the above medicine, at
once apply a blister, not the common blister, but _Smith's Tela
Vesicatoria_ [Footnote: Manufactured by T. & H. Smith, chemists,
Edinburgh, and may be procured of Southalls, chemists, Birmingham.]--a
quarter of a sheet. If the child be a year old, the blister ought to
be kept on for three hours, and then a piece of dry, soft linen rag
should be applied for another three hours. At the end of which
time--six hours--there will be a beautiful blister, which must then,
with a pair of scissors, be cut, to let out the water, and then let
the blister be dressed, night and morning, with simple cerate spread
on lint.
If the little patient be more than one year, say two years old, let
the Tela remain on for five hours, and the dry linen rag for five
hours more, before the blister, as above recommended, be cut and
dressed.
If in a day or two the inflammation still continue violent, let
another Tela Vesicatoria be applied, not over the old blister, but let
a narrow strip of it be applied on each side of the old blister, and
managed in the same manner as before directed.
_I cannot speak too highly of Smith's Tela Vesicatoria._ It has, in my
hands, through God's blessing, saved the lives of scores of
children. It is far, very far, superior to the old fashioned
blistering plaster. It seldom, if the above rules be strictly
observed, fails to rise, it gives much less pain than the common
blister, when it has had the desired effect, it readily heals, which
cannot always be said of the common fly blister, more especially with
children.
My sheet anchors, then, in the inflammation of the lungs of children
are, Ipecacuanha Wine and Smith's _Tela Vesicatoria_. Let the greatest
care, as I before advised, be observed in obtaining the Ipecacuanha
Wine genuine and good. This can be only depended upon by having the
medicine from a highly respectable chemist, Ipecacuanha Wine, when
genuine and good, is, in many children's diseases, is one of the most
valuable of medincies.
_What, in a case of inflammation of the lungs, NOT to do_--Do not, on
any account, apply leeches. They draw out the life of the child, but
not his disease. Avoid--_emphatically let me say so_--giving emetic
tartar It is one of the most lowering and death-dealing medicines that
can be administered either to an infant or to a child! If you wish to
try the effect of it, take a dose yourself, and I am quite sure that
you will then never be inclined to poison a child with such an
abominable preparation! In olden times--many, many years ago--I myself
gave it in inflammation of the lungs, and lost many children! Since
leaving it off, the recoveries of patients by the Ipecacuanha
treatment, combined with the external application of Smith's _Tela
Vesicatoria_, have been in many cases marvellous. Avoid broths and
wine, and all stimulants. Do _not_ put the child into a warm bath, it
only oppresses the already oppressed breathing. Moreover, after he is
out of the bath, it causes a larger quantity of blood to rush back to
the lungs and to the bronchial tubes, and thus feeds the
inflammation. Do not, by a large fire, keep the temperature of the
room high. A small fire, in the winter time, encourages ventilation,
and in such a case does good. When the little patient is on the
mother's or on the nurse's lap, do not burden him either with a
_heavy_ blanket or with a _thick_ shawl. Either a _thin_ child's
blanket, or a _thin_ woollen shawl, in addition to his usual
nightgown, is all the clothing necessary.
205. _Is Bronchitis a more frequent disease than Inflammation of the
Lungs? Which is the most dangerous? What are the symptoms of
Bronchitis_?
Bronchitis is a much more frequent disease than inflammation of the
lungs, indeed, it is one of the most common complaints both of infants
and of children, while inflammation of the lungs is comparatively a
rare disease. Bronchitis is not nearly such a dangerous disease as
inflammation of the lungs.
_The symptoms_--The child for the first few days labours under
symptoms of a heavy cold, he has not his usual spirits. In two or
three days, instead of the cold leaving him, it becomes more
confirmed, he is now really poorly, fretful, and feverish, his
breathing becomes rather hurried and oppressed, his cough is hard and
dry, and loud, he wheezes, and if you put your ear to his naked back,
between his shoulder blades, you will hear the wheezing more
distinctly. If at the breast, he does not suck with his usual avidity;
the cough, notwithstanding the breast is a great comfort to him,
compels him frequently to loose the nipple; his urine is scanty, and
rather high-coloured, staining the napkin, and smelling strongly. He
is generally worse at night.
Well, then, remember if the child be feverish, if he have symptoms of
a heavy cold, if he have an oppression of breathing, if he wheeze, and
if he have a tight, dry, noisy cough, you may be satisfied that he has
an attack of bronchitis.
206. _How can I distinguish between Bronchitis and Inflammation of the
Lungs_?
In bronchitis the skin is warm, but moist; in inflammation of the
lungs it is hot and dry: in bronchitis the mouth is warmer than usual,
but moist; in inflammation of the lungs it is burning hot: in
bronchitis the breathing is rather hurried, and attended with
wheezing; in inflammation of the lungs it is very short and panting,
and is unaccompanied with wheezing, although occasionally a very
slight crackling sound might be heard: in bronchitis the cough is long
and noisy; in inflammation of the lungs it is short and feeble: in
bronchitis the child is cross and fretful; in inflammation of the
lungs he is dull and heavy, and his countenance denotes distress.
We have sometimes a combination of bronchitis and of inflammation of
the lungs, an attack of the latter following the former. Then the
symptoms will be modified, and will partake of the character of the
two diseases.
207. _How would you treat a case of Bronchitis_?
If a medical man cannot be procured, I will tell you _What to do_:
Confine the child to his bedroom, and if very ill, to his bed. If it
be winter time, have a little fire in the grate, but be sure that the
temperature of the chamber be not above 60 degrees Fahrenheit, and let
the room be properly ventilated, which may be effected by occasionally
leaving the door a little ajar.
Let him lie either _outside_ the bed or on a sofa, if he be very ill,
_inside_ the bed, with a sheet and a blanket only to cover him, but no
thick coverlid. If he be allowed to be on the lap, it only heats him
and makes him restless. If he will not lie on the bed, let him rest on
a pillow placed on the lap, the pillow will cause him to lie cooler,
and will more comfortably rest his weaned body. If he be at the
breast, keep him to it, let him have no artificial food, unless, if he
be thirsty a little toast and water. If he be weaned, let him have
either milk and water, arrow root made with equal parts of milk and
water, toast and water, barley water, or weak black tea, with plenty
of new milk in it, &c., but, until the inflammation have subsided,
neither broth nor beef tea.
Now, with regard to medicine, the best medicine is Ipecacuanha Wine,
given in large doses, so as to produce constant nausea. The
Ipecacuanha abates fever, acts on the skin, loosens the cough, and, in
point of fact, in the majority of cases, will rapidly effect a cure. I
have in a preceding Conversation given you a prescription for the
Ipecacuanha Wine Mixture. Let a tea-spoonful of the mixture be taken
every four hours.
If in a day or two he be no better, but worse, by all means continue
the mixture, whether it produce sickness or otherwise, and put on the
chest a _Tela Vesicatoria_, a quarter of a sheet.
The Ipecacuanha Wine and the Tela Vesicatoria are my sheet anchors in
the bronchitis, both of infants and of children. They rarely, even in
very severe cases, fail to effect a cure, provided the Tela
Vesicatorina be properly applied, and the Ipecacuanha Wine be genuine
and of good quality.
If there be any difficulty in procuring _good_ Ipecacuanha Wine, the
Ipecacuanha may be given in powder instead of the wine The following
is a pleasant form--
Take of--Powder of Ipecacuanha, twelve grains
White Sugar thirty six grains
Mix well together and divide into twelve powders. One of the powders
to be put dry on the tongue every four hours.
The Ipecacuanha Powder will keep better than the Wine--an important
consideration to those living in country places, nevertheless, if the
Wine can be procured fresh and good, I far prefer the Wine to the
Powder.
When the bronchitis has disappeared, the diet ought gradually to be
improved--rice, sago, tapioca, and light batter-pudding, &c.; and, in
a few days, either a little chicken or a mutton chop, mixed with a
well-mashed potato and crumb of bread, should be given. But let the
improvement in his diet be gradual, or the inflammation might return.
_What NOT to do_.--Do not apply leeches. Do not give either emetic
tartar or antimonial wine, which is emetic tartar dissolved in
wine. Do not administer either paregoric or syrup of poppies, either
of which would stop the cough, and would thus prevent the expulsion of
the phlegm. Any fool can stop a cough, but it requires a wise man to
rectify the mischief. A cough is an effort of Nature to bring up the
phlegm, which would otherwise accumulate, and in the end cause
death. Again, therefore, let me urge upon you the immense importance
of _not_ stopping the cough of a child. The Ipecacuanha Wine will, by
loosening the phlegm, loosen the cough, which is the only right way to
get rid of a cough. Let what I have now said be impressed deeply upon
your memory, as thousands of children in England are annually
destroyed by having their coughs stopped. Avoid, until the bronchitis
be relieved, giving him broths, and meat, and stimulants of all
kinds. For further observations on _what NOT to do_ in bronchitis, I
beg to refer you to a previous Conversation we had on _what NOT to do_
in inflammation of the lungs. That which is injurious in the one case
is equally so in the other.
208. _What are the symptoms of Diphtheria, or, as it is sometimes
called, Boulogne Sore-throat_?
This terrible disease, although by many considered to be a new
complaint, is, in point of fact, of very ancient origin. Homer, and
Hippocrates, the Father of Physic, have both described it. Diphtheria
first appeared in England in the beginning of the year 1857, since
which time it has never totally left our shores.
_The symptoms_--The little patient, before the disease really shows
itself, feels poorly, and is "out of sorts." A shivering fit, though
not severe, may generally be noticed. There is heaviness, and slight
headache, principally over the eyes. Sometimes, but not always, there
is a mild attack of delirium at night The next day he complains of
slight difficulty of swallowing. If old enough, he will complain of
constriction about the swallow. On examining the throat, the tonsils
will be found to be swollen and redder--more darkly red than
usual. Slight specks will be noticed on the tonsils. In a day or two
an exudation will cover them, the back of the swallow, the palate, the
tongue, and sometimes the inside of the cheeks and of the
nostrils. This exudation of lymph gradually increases until it becomes
a regular membrane, which puts on the appearance of leather, hence its
name diphtheria. This membrane peels off in pieces, and if the child
be old and strong enough he will sometimes spit it up in quantities,
the membrane again and again rapidly forming as before. The discharges
from the throat are occasionally, but not always, offensive. There is
danger of croup from the extension of the membrane into the wind
pipe. The glands about the neck and under the jaw are generally much
swollen, the skin is rather cold and clammy, the urine is scanty and
usually pale, the bowels at first are frequently relaxed. This
diarrhoea may, or may not, cease as the disease advances.
The child is now in a perilous condition, and it becomes a battle
between his constitution and the disease. If, unfortunately, as is
too often the case--diphtheria being more likely to attack the
weakly--the child be very delicate, there is but slight hope of
recovery. The danger of the disease is not always to be measured by
the state of the throat. Sometimes, when the patient appears to be
getting well, a sudden change for the worse rapidly carries him
off. Hence the importance of great caution, in such cases, in giving
an opinion as to ultimate recovery. I have said enough to prove the
terrible nature of the disease, and to show the necessity of calling
in, at the earliest period of the symptoms, an experienced and skilful
medical man.
209. _Is Diphtheria contagious_?
_Decidedly_. Therefore, when practicable, the rest of the children
ought instantly to be removed to a distance. I say _children_, for it
is emphatically a disease of childhood. When adults have it, it is the
exception and not the rule: "Thus it will be seen, in the account
given of the Boulogne epidemic, that of 366 deaths from this cause,
341 occurred amongst children under ten years of age. In the
Lincolnshire epidemic, in the autumn of 1858, all the deaths at
Horncastle, 25 in number, occurred amongst children under twelve years
of age." [Footnote: _Diphtheria_: by Ernest Hart. A valuable pamphlet
on the subject. Dr Wade of Birmingham has also written an interesting
and useful monograph on Diphtheria. I am indebted to the above authors
for much valuable information.]
210. _What are the causes of Diphtheria_?
Bad and imperfect drainage; [Footnote: "Now all my carefully conducted
inquiries induce me to believe that the disease comes from
drain-poison. All the cases into which I could fully inquire, have
brought conviction to my mind that there is a direct law of sequence
in some peculiar conditions of atmosphere between diphtheria and bad
drainage; and, if this be proved by subsequent investigations, we may
be able to prevent a disease which, in too many cases, our known
remedies cannot cure."--W. Carr, Esq., Blackheath, _British Medical
Journal_, December 7, 1861.] want of ventilation; overflowing privies;
low neighbourhoods in the vicinity of rivers; stagnant waters; indeed,
everything that vitiates the air, and thus depresses the system, more
especially if the weather be close and muggy; poor and, improper food;
and last, though not least, contagion. Bear in mind, too, that a
delicate child is much more predisposed to the disease than a strong
one.
211. _What is the treatment of Diptheria_?
_What to do_--Examine well into the ventilation, for as diphtheria is
frequently caused by deficient ventilation, the best remedy is
thorough ventilation. Look well both to the drains and to the privies,
and see that the drains from the water-closets and from the privies do
not in any way contaminate the pump-water. If the drains be defective
or the privies be full, the disease in your child will be generated,
fed, and fostered. Not only so, but the disease will spread in your
family and all around you.
Keep the child to his bedroom and to his bed. For the first two or
three days, while the fever runs high, put him on a low diet, such as
milk, tea, arrow root, &c.
Apply to his throat every four hours a warm barm and oatmeal
poultice. If he be old enough to have the knowledge to use a gargle,
the following will be found serviceable--
Take of--Permanganate of Potash, pure, four grams,
Water eight ounces
To make a Gargle
Or,
Take of--Powdered Alum, one drachm,
Simple Syrup one ounce,
Water, seven ounces
To make a Gargle
The best medicine for the first few days of the attack, is the
following mixture--
Take of--Chlorate of Potash two drachms,
Boiling Water seven ounces
Syrup of Red Poppy one ounce
To Make a mixture. A table spoonful to be taken every four hours.
Or the chlorate of potash might be given in the form of powder--
Take of--Chlorate of Potash two scruples,
Lump Sugar one drachm
Mix and divide into eight powders. One to be put into a dry tea spoon
and then placed on the tongue every three hours, These powders are
very useful in diphtheria; they are very cleansing to the tongue and
throat. If they produce much smarting as where the mouth is very sore
they sometimes do, let the patient, after taking one, drink
plentifully of milk, indeed I have known these powders induce a
patient to take nourishment, in the form of milk, which he otherwise
would not have done, and thus to have saved him from dying of
starvation, which, before taking the powders, there was every
probability of his doing. An extensive experience has demonstrated to
me the great value of these powders in diphtheria, but they must be
put on the tongue dry.
As soon as the skin has lost its preternatural heat, beef tea and
chicken broth ought to be given. Or if great prostration should
supervene, in addition to the beef tea, port wine, a table spoonful
every four hours, should be administered. If the child be cold, and
there be great sinking of the vital powers, brandy and water should be
substituted for the port wine. Remember, in ordinary cases, port wine
and brandy are not necessary, _but in cases of extreme exhaustion_
they are most valuable.
As soon as the great heat of the skin has abated and the debility has
set in, one of the following mixtures will be found useful--
Take of--Wine of Iron, one ounce and a half,
Sample Syrup, one ounce,
Water, three ounces and a half
To make a Mixture. A table spoonful to be taken every four hours.
Or,
Take of--Tincture of Perchloride of Iron, one drachm
Simple Syrup, one ounce,
Water, three ounces
To make a Mixture. A table spoonful to be taken three times a day.
If the disease should travel downwards, it will cause all the symptoms
of croup, then it must be treated as croup, with this only difference,
that a blister (_Tela Vesicatoria_) must _not_ be applied, or the
blistered surface may be attacked by the membrane of diphtheria, which
may either cause death or hasten that catastrophe. In every other
respect treat the case as croup, by giving an emetic, a tea spoonful
of Ipecacuanha Wine every five minutes, until free vomiting be
excited, and then administer smaller doses of Ipecacuanha Wine every
two or three hours, as I recommended when conversing with you on the
treatment of croup.
_What NOT to do_--Do not, on any account, apply either leeches or a
blister. If the latter be applied, it is almost sure to be covered
with the membrane of diphtheria, similar to that inside of the mouth
and of the throat, which would be a serious complication. Do not give
either calomel or emetic tartar. Do not depress the system by
aperients, for diphtheria is an awfully depressing complaint of
itself, the patient, in point of fact, is labouring under the
depressing effects of poison, for the blood has been poisoned either
by the drinking water being contaminated by faecal matter from either a
privy or from a water-closet, by some horrid drain, by proximity to a
pig-sty, by an overflowing privy, especially if vegetable matter be
rotting at the same time in it, by bad ventilation, or by
contagion. Diphtheria may generally be traced either to the one or to
the other of the above causes, therefore let me urgently entreat you
to look well into all these matters, and thus to stay the pestilence!
Diphtheria might long remain in a neighbourhood if active measures be
not used to exterminate it.
212. _Have the goodness to describe the symptoms of Measles_?
Measles commences with symptoms of a common cold, the patient is at
first chilly, then hot and feverish, he has a running at the nose,
sneezing, watering, and redness of the eyes, headache, drowsiness, a
hoarse and peculiar ringing cough, which nurses call "measle-cough,"
and difficulty of breathing. These symptoms usually last three days
before the eruption appears, on the fourth it (the eruption) generally
makes its appearance, and continues for four days and then disappears,
lasting altogether, from the commencement of the symptoms of cold to
the decline of the eruption, seven days. It is important to bear in
mind that the eruption consists of _crescent-shaped--half
moon-shaped--patches_, that they usually appear first about the face
and the neck, in which places they are the best marked; then on the
body and on the arms; and, lastly, on the legs, and that they are
slightly raised above the surface of the skin. The face is swollen,
more especially the eye-lids which are sometimes for a few days
closed.
Well, then, remember, _the running at the nose, the, sneezing, the
peculiar hoarse cough, and the half-moon-shaped patches_, are the
leading features of the disease, and point out for a certainty that it
is measles.
213. _What constitutes the principal danger in Measles_?
The affection of the chest. The mucous or lining membrane of the
bronchial tubes is always more or less inflamed, and the lungs
themselves are sometimes affected.
214. _Do you recommend "surfeit water" and saffron tea to throw out
the eruption in Measles_?
Certainly not. The only way to throw out the eruption, as it is
called, is to keep the body comfortably warm, and to give the
beverages ordered by the medical man, with the chill off. "Surfeit
water," saffron tea, and remedies of that class, are hot and
stimulating. The only effect they can have, will be to increase the
fever and the inflammation--to add fuel to the fire.
215. _What is the treatment of Measles_?
_What to do_.--The child ought to be confined both to his room and to
his bed, the room being kept comfortably warm; therefore, if it be
winter time, there should be a small fire in the grate; in the summer
time, a fire would be improper. The child must not be exposed to
draughts; notwithstanding, from time to time, the door ought to be
left a little ajar in order to change the air of the apartment; for
proper ventilation, let the disease be what it may, is absolutely
necessary.
Let the child, for the first few days, be kept on a low diet, such as
on milk and water, arrow-root, bread and butter, &c.
If the attack be mild, that is to say, if the breathing be not much
affected (for in measles it always is more or less affected), and if
there be not much wheezing, the Acidulated Infusion of Roses' Mixture
[Footnote: See page 178] will be all that is necessary.
But suppose that the breathing is short, and that there is a great
wheezing, then instead of giving him the mixture just advised, give
him a tea-spoonful of a mixture composed of Ipecacuanha Wine, Syrup,
and Water, [Footnote: See page 161] every four hours. And if, on the
following day, the breathing and the wheezing be not relieved in
addition to the Ipecacuanha Mixture, apply a Tola Vesicatoria, as
advised under the head of Inflammation of the Lungs.
When the child is convalescing, batter puddings, rice, and sago
puddings, in addition to the milk, bread and butter, &c, should be
given, and, a few days later, chicken, mutton chops, &c.
The child ought not, even in a mild case of measles, and in favourable
weather to be allowed to leave the house under a fortnight, or it
might bring on an attack of bronchitis.
_What NOT to do_--Do not give either "surfeit water" or wine. Do not
apply leeches to the chest. Do not expose the child to the cold
air. Do not keep the bed room very hot, but comfortably warm. Do not
let the child leave the house, even under favourable circumstances,
under a fortnight. Do not, while the eruption is out, give
aperients. Do not, "to ease the cough," administer either emetic
tartar or paregoric--the former drug is awfully depressing, the latter
will stop the cough, and will thus prevent the expulsion of the
phlegm.
216. _What is the difference between Scarlatina and Scarlet Fever_?
They are indeed one and the same disease, scarlatina being the Latin
for scarlet fever. But, in a _popular_ sense, when the disease is
mild, it is usually called scarlatina. The latter term does not sound
so formidable to the ears either of patients or of parents.
217. _Will you describe the symptoms of Scarlet Fever_?
The patient is generally chilly, languid, drowsy, feverish, and poorly
for two days before the eruption appears. At the end of the second
day, the characteristic, bright scarlet efflorescence, somewhat
similar to the colour of a boiled lobster, usually first shows itself.
The scarlet appearance is not confined to the skin; but the tongue,
the throat, and the whites of the eyes put on the same appearance;
with this only difference, that on the tongue and on the throat the
scarlet is much darker; and, as Dr Elliotson accurately describes
it,--"the tongue looks as if it had been slightly sprinkled with
Cayenne pepper;" the tongue, at other times, looks like a strawberry;
when it does, it is called "the strawberry tongue." The eruption
usually declines on the fifth, and is generally indistinct on the
sixth day; on the seventh it has completely faded away. There is
usually, after the first few days, great itching on the surface of the
body. The skin, at the end of the week, begins to peel and to dust
off, making it look as though meal had been sprinkled upon it.
There are three forms of scarlet fever;--the one where the throat is
little, if at all, affected, and this is a mild form of the disease;
the second, which is generally, especially at night, attended with
delirium, where the throat is _much_ affected, being often greatly
inflamed and ulcerated; and the third (which is, except in certain
unhealthy districts, comparatively rare, and which is VERY dangerous),
the malignant form.
218. _Would it be well to give a little cooling, opening physic as
soon as a child begins to sicken for Scarlet Fever_?
_On no account whatever._ Aperient medicines are, in my opinion,
highly improper and dangerous both before and during the period of the
eruption. It is my firm conviction, that the administration of opening
medicine, at such times, is one of the principal causes of scarlet
fever being so frequently fatal. This is, of course, more applicable
to the poor, and to those who are unable to procure a skilful medical
man.
219. _What constitutes the principal danger in Scarlet Fever_?
The affection of the throat, the administration of opening medicine
during the first ten days, and a peculiar disease of the kidneys
ending in _anasarca_ (dropsy), on which account, the medical man
ought, when practicable, to be sent for at the onset, that no time may
be lost in applying _proper_ remedies.
When Scarlet Fever is complicated--as it sometimes is--with
diphtheria, the diphtheric membrane is very apt to travel into the
wind-pipe, and thus to cause diphtheric croup, it is almost sure, when
such is the case, to end in death. When a child dies from such a
complication, the death might truly be said to be owing to the
diphtheric croup, and not to the Scarlet Fever, for if the diphtheric
croup had not occurred, the child would, in all probability, have been
saved. The deaths from diphtheria are generally from diphtheric croup,
if there be no croup, there is, as a rule, frequent recovery.
220. _How would you distinguish between Scarlet Fever and Measles_?
Measles commences with symptoms of a common cold, scarlet fever does
not. Measles has a _peculiar hoarse_ cough, scarlet fever has not. The
eruption of measles is in patches of a half moon shape, and is
slightly raised above the skin, the eruption of scarlet fever is _not_
raised above the skin at all, and is one continued mass. The colour of
the eruption is much more vivid in scarlet fever than in measles. The
chest is the part principally affected in measles, and the throat in
scarlet fever.
There is an excellent method of determining, for a certainty, whether
the eruption be that of scarlatina or otherwise. I myself have, in
several instances, ascertained the truth of it--"For several years M
Bouchut has remarked in the eruptions of scarlatina a curious
phenomenon, which serves to distinguish this eruption from that of
measles, erythema, erysipelas &c., a phenomenon essentially vital,
and which is connected with the excessive contractability of the
capillaries. The phenomenon in question is a _white line_, which can
be produced at pleasure by drawing the back of the nail along the skin
where the eruption, is situated. On drawing the nail, or the extremity
of a hard body (such as a pen-holder), along the eruption, the skin is
observed to grow pale, and to present a white trace, which remains for
one or two minutes, or longer, and then disappears. In this way the
diagnosis of the disease may be very distinctly written on the skin;
the word 'Scarlatina' disappears as the eruption regains its uniform
tint."--_Edinburgh Medical Journal._
221. _Is it of so much importance, then, to distinguish between
Scarlet fever and Measles_?
It is of great importance, as in measles the patient ought to be kept
_moderately_ warm, and the drinks should be given with the chill off;
while in scarlet fever the patient ought to be kept cool--indeed, for
the first few days, _cold_--and the beverages, such as spring-water,
toast and water, &c., should be administered quite cold.
222. _Do you believe in "Hybrid" Scarlet Fever--that is to say, in a
cross between Scarlet Fever and Measles_?
I never in my life saw a case of "hybrid" scarlet fever--nor do I
believe in it. Scarlet fever and measles are both blood poisons, each
one being perfectly separate and distinct from the other. "Hybrid"
Scarlet fever is, in my opinion, an utter impossibility. In olden
times, when the symptoms of diseases were not so well and carefully
distinguished as now, scarlet fever and measles were constantly
confounded one with the other, and was frequently said to be
"hybrid"--a cross between measles and scarlet fever--to the patient's
great detriment and danger, the two diseases being as distinct and
separate as their treatment-and management ought to be.
223. _What is the treatment of Scarlet Fever?_ [Footnote: On the 4th
of March 1856, I had the honour to read a _Paper on the Treatment of
Scarlet Fever_ before the members of Queens College Medico-Chirugical
Society, Birmingham--which _Paper_ was afterwards published in the
_Association Journal_ (March 15 1856) and in Braithwaite's _Retrospect
of Medicine_ (January--June, 1856) and in Rankings _Half Yearly
Abstract of the Medical Sciences_ (July--December, 1856), besides in
other publications. Moreover the _Paper_ was translated into German,
and published in _Canstatts Jahresbericht_, iv 456, 1859]
_What to do_--Pray pay attention to my rules, and carry out my
directions to the letter--I can then promise, _that if the scarlet
fever be neither malignant nor complicated with diphtheria_, the plan
I am about to advise will, with God's blessing, be usually successful.
What is the first thing to be done? Send the child to bed, throw open
the windows, be it winter or summer, and have a thorough ventilation,
for the bedroom must be kept cool, I may say cold. Do not be afraid of
fresh air, for fresh air, for the first few days, is essential to
recovery. _Fresh air, and plenty of it, in scarlet fever, is the best
doctor_ a child can have let these words be written legibly on your
mind. [Footnote: In the _Times_ of Sept 4, 1863, is the following
copied from the _Bridgewater Mercury_--
GROSS SUPERSTITION--In one of the streets of Taunton, there resides a
man and his wife who have the care of a child This child was attacked
with scarlatina, and to all appearance death was inevitable. A jury of
matrons was as it were empanelled, and to prevent the child 'dying
hard' all the doors in the house all the drawers, all the boxes all
the cupboards were thrown wide open, the keys taken out and the body
of the child placed under a beam, whereby a sure, certain, and easy
passage into eternity could be secured. Watchers held their vigils
throughout the weary night, and in the morning the child, to the
surprise of all, did not die, and is now gradually recovering.
These old women--this jury of matrons--stumbled on the right remedy,
"all the doors in the house....were thrown vide open," and thus they
thoroughly ventilated the apartment. What was the consequence? The
child who, just before the opening of the doors, had all the
appearances "that death was inevitable," as soon as fresh air was let
in showed symptoms of recovery, "and in the morning the child, to the
surprise of all, did not die, and is now gradually recovering." There
is nothing wonderful--there is nothing surprising to my mind--in all
this. Ventilation--thorough ventilation--is the grand remedy for
scarlatina! Oh, that there were in scarlet fever cases a good many
such old women's--such a "jury of matrons'"--remedies! We should not
then be horrified, as we now are, at the fearful records of death,
which the Returns of the Registrar General disclose!]
If the weather be either intensely cold, or very damp, there is no
objection to a small fire in the grate provided there be, at the same
time, air--an abundance of fresh air--admitted into the room.
Take down the curtains of the bed, remove the valances. If it be
summer time, let the child be only covered with a sheet. If it be
winter time, in addition to the sheet, he should have one blanket over
him.
Now for the throat--The best _external_ application is a barm and
oatmeal poultice How ought it to be made, and how applied? Put half a
tea-cupful of barm into a saucepan, put it on the fire to boil; as
soon as it boils, take it off the fire, and stir oatmeal into it,
until it be of the consistence of a nice soft poultice; then place it
on a rag, and apply it to the throat, carefully fasten it on with a
bandage, two or three turns of the bandage going round the throat, and
two or three over the crown of the head, so as nicely to apply the
poultice where it is wanted--that is to say, to cover the tonsils.
Tack the bandage: do not pin it. Let the poultice be changed three
times a day. The best medicine is the Acidulated Infusion of Roses,
sweetened with syrup:--
Take of--Dilated Sulphuric Acid, half a drachm;
Simple Syrup, one ounce and a half;
Acid Infusion of Roses, four ounces and a half:
To make a Mixture. A table-spoonful to be taken every four hours.
It is grateful and refreshing, it is pleasant to take, it abates fever
and thirst, it cleanses the throat and tongue of mucus, and is
peculiarly efficacious in scarlet fever; as soon as the fever is
abated it gives an appetite. My belief is that the sulphuric acid in
the mixture is a specific in scarlet fever, as much as quinine is in
ague, and sulphur in itch. I have reason to say so, for, in numerous
cases I have seen its immense value.
Now, with regard to food.--If the child be at the breast, keep him
entirely to it. If he be weaned, and under two years old, give him
milk and water, and cold water to drink. If he be older, give him
toast and water, and plain water from the pump, as much as he chooses;
let it be quite cold--the colder the better. Weak black tea, or thin
gruel, may be given, but not caring, unless he be an infant at the
breast, if he take nothing but _cold_ water. If the child be two years
old and upwards, roasted apples with sugar, and grapes, will be very
refreshing, and will tend to cleanse both the mouth and the throat
Avoid broths and stimulants.
When the appetite returns, you may consider the patient to be
safe. The diet ought now to be gradually improved. Bread and butter,
milk and water, and arrowroot made with equal parts of new milk and
water, should for the first two or three days be given. Then a light
batter or rice pudding may be added, and in a few days, either a
little chicken or a mutton chop.
The essential remedies, then, in scarlet fever, are, for the first few
days--(1) plenty of fresh air and ventilation, (2) plenty of cold
water to drink, (3) barm poultices to the throat, and (4) the
Acidulated Infusion of Roses Mixture as a medicine.
Now, then, comes very important advice. After the first few days,
probably five or six, sometimes as early as the fourth day--_watch
carefully and warily, and note the time, the skin will suddenly become
cool_, the child will say that he feels chilly; then is the time you
must now change your tactics--_instantly close the windows and put
extra clothing_, a blanket or two, on his bed. A flannel nightgown
should, until the dead skin have peeled off, be now worn next to the
skin, when the flannel nightgown should be discontinued. The patient
ought ever after to wear, in the day time, a flannel waistcoat.
[Footnote: On the importance--the vital importance--of the wearing of
flannel next to the skin, see "Flannel Waistcoats."] His drinks must
now be given with the chill off; he ought to have a warm cup of tea,
and gradually his diet should, as I have previously advised, be
improved.
There is one important caution I wish to impress upon you,--_do not
give opening medicine during the time the eruption is out_. In all
probability the bowels will be opened: if so, all well and good; but
do not, on any account, for the first ten days, use artificial means
to open them. It is my firm conviction that the administration of
purgatives in scarlet fever is a fruitful source of dropsy, of
disease, and death. When we take into consideration the sympathy there
is between the skin and the mucous membrane, I think that we should
pause before giving irritating medicines, such as purgatives. The
irritation of aperients on the mucous membrane may cause the poison of
the skin disease (for scarlet fever is a blood-poison) to be driven
internally to the kidneys, to the throat, to the pericardium (bag of
the heart), or to the brain. You may say, Do you not purge if the
bowels be not open for a week? I say emphatically, No!
I consider my great success in the treatment of scarlet fever to be
partly owing to my avoidance of aperients during the first ten days of
the child's illness.
If the bowels, after the ten days, be not properly opened, a dose or
two of syrup of senna should be given: that is to say, one or two
tea-spoonfuls should be administered early in the morning, and should,
if the first dose does not operate, be repeated in four hours.
In a subsequent Conversation, I shall strongly urge you not to allow
your child, when convalescent, to leave the house under at least a
month from the commencement of the illness; I, therefore, beg to refer
you to that Conversation, and hope that you will give it your best and
earnest consideration! During the last twenty years I have never had
dropsy from scarlet fever, and I attribute it entirely to the plan I
have just recommended, and in not allowing my patients to leave the
house under the month--until, in fact, the skin that had peeled off
has been renewed.
Let me now sum up the plan I adopt, and which I beg leave to designate
as--Pye Chavasse's Fresh Air Treatment of Scarlet Fever:--
1. Thorough ventilation, a cool room, and scant clothes on the bed,
for the first five or six days.
2. A change of temperature of the skin to be carefully regarded. As
soon as the skin is cool, closing the windows, and putting additional
clothing on the bed.
3. The Acidulated Infusion of Hoses with Syrup is _the_ medicine for
scarlet fever.
4. Purgatives to be religiously avoided for the first ten days at
least, and even afterwards, unless there be absolute necessity.
5. Leeches, blisters, emetics, cold and tepid spongings, and painting
the tonsils with caustic, inadmissible in scarlet fever.
6. A strict antiphlogistic (low) diet for the first few days, during
which time cold water to be given _ad libitum_.
7. The patient not to leave the house in the summer under the month;
in the winter, under six weeks.
_What NOT to do._--Do not, then, apply either leeches or blisters to
the throat; do not paint the tonsils with caustic; do not give
aperients; do not, on any account, give either calomel or emetic
tartar; do not, for the first few days of the illness, be afraid of
_cold air_ to the skin, and of cold water as a beverage; do not,
emphatically let me say, _do not_ let the child leave the house for at
least a month from the commencement of the illness.
My firm conviction is, that purgatives, emetics, and blisters, by
depressing the patient, sometimes cause ordinary scarlet fever to
degenerate into malignant scarlet fever.
I am aware that some of our first authorities advocate a different
plan to mine. They recommend purgatives, which I may say, in scarlet
fever, are my dread and abhorrence. They advise cold and tepid
spongings--a plan which I think dangerous, as it will probably drive
the disease internally. Blisters, too, have been prescribed; these I
consider weakening, injurious, and barbarous, and likely still more to
inflame the already inflamed skin. They recommend leeches to the
throat, which I am convinced, by depressing the patient, will lessen
the chance of his battling against the disease, and will increase the
ulceration of the tonsils. Again, the patient has not too much blood;
the blood is only poisoned. I look upon scarlet fever as a specific
poison of the blood, and one which will be eliminated from the system,
_not_ by bleeding, _not_ by purgatives, _not_ by emetics but by a
constant supply of fresh and cool air, by the acid treatment, by cold
water as a beverage, and for the first few days by a strict
antiphlogistic (low) diet. Sydenham says that scarlet fever is
oftentimes "fatal through the officiousness of the doctor." I
conscientiously believe that a truer remark was never made; and that,
under a different system to the usual one adopted, scarlet fever would
not be so much dreaded. [Footnote: If any of my medical brethren
should do me the honour to read these pages, let me entreat them to
try my plan of treating scarlet fever, as my success has been great. I
have given full and minute particulars, in order that they and mothers
(if mothers cannot obtain medical advice) may give my plan a fair and
impartial trial. My only stipulations are that they must _begin_ with
my treatment, and _not mix_ any other with it, and carry out my plan
to the very letter. I then, with God's blessing, provided the cases be
neither malignant nor complicated with diphtheria, shall not fear the
result. If any of my _confreres_ have tried my plan of treatment of
scarlet fever--and I have reason to know that many have--I should feel
grateful to them if they would favour me with their opinion as to its
efficacy. Address--"Pye Chavasse, 214 Hagley Road, Birmingham."]
Dr Budd, of Bristol, recommends, in the _British Medical Journal_,
that the body, including the scalp, of a scarlet fever patient,
should, after about the fourth day, be anointed, every night and
morning, with camphorated oil; this anointing to be continued until
the patient is able to take a warm bath and use disinfectant soap:
this application will not only be very agreeable to the patient's
feelings, as there is usually great irritation and itching of the
skin, but it will, likewise, be an important means of preventing the
dead skin, which is highly infectious, and which comes off partly in
flakes and partly floats about the air as dust, from infecting other
persons. The plan is an excellent one, and cannot be too strongly
recommended.
If the case be a combination of scarlet fever and of diphtheria, as it
unfortunately now frequently is, let it be treated as a case of
diphtheria.
224. _I have heard of a case of Scarlet Fever, where the child, before
the eruption showed itself, was suddenly struck prostrate, cold, and
almost pulseless: what, in such a case, are the symptoms, and what
immediate treatment do you advise_?
There is an _exceptional_ case of scarlet fever, which now and then
occurs, and which requires _exceptional_ and prompt treatment, or
death will quickly ensue. We will suppose a case: one of the number,
where nearly all the other children of a family are labouring under
scarlet fever, is quite well, when suddenly--in a few hours, or even,
in some cases, in an hour--utter prostration sets in, he is very cold,
and is almost pulseless, and is nearly insensible--comatose.
Having sent instantly for a judicious medical man, apply, until he
arrives, hot bottles, hot bricks, hot bags of salt to the patient's
feet and legs and back, wrap him in hot blankets, close the window,
and give him hot brandy and water--a tablespoonful of brandy to half a
tumblerful of hot water--give it him by teaspoonfuls, continuously--to
keep him alive; when he is warm and restored to consciousness, the
eruption will probably show itself, and he will become hot and
feverish; then your tactics must, at once, be changed, and my Fresh
Air Treatment, and the rest of the plan I have before advised must in
all its integrity, be carried out.
We sometimes hear of a child, before the eruption comes out and within
twenty-four hours of the attack, dying of scarlet fever. When such be
the case it is probably owing to low vitality of the system--to utter
prostration--he is struck down, as though for death, and if the plan
be not adopted of, for a few hours, keeping him alive by heat, and by
stimulants, until, indeed, the eruption comes out, he will never rally
again, but will die from scarlet fever poisoning and from utter
exhaustion. These cases are comparatively rare, but they do, from
time to time, occur, and, when they do, they demand exceptional and
prompt and energetic means to save them from ending in almost
immediate and certain death. "To be forewarned is to be forearmed."
[Footnote: I have been reminded of this _exceptional_ case of scarlet
fever by a most intelligent and valued patient of mine, who had a
child afflicted as above described, and whose child was saved from
almost certain death, by a somewhat similar plan of treatment as
advised in the text.]
225. _How soon ought a child to be allowed to leave the house after an
attack of Scarlet Fever_?
He must not be allowed to go out for at least a month from the
commencement of the attack, in the summer, and six weeks in the
winter; and not even then without the express permission of a medical
man. It might be said that this is an unreasonable recommendation: but
when it is considered that the whole of the skin generally
desquamates, or peels off, and consequently leaves the surface of the
body exposed to cold, which cold flies to the kidneys, producing a
peculiar and serious disease in them, ending in dropsy, this warning
will not be deemed unreasonable.
Scarlet fever dropsy, which is really a _formidable disease, generally
arises from, the carelessness, the ignorance, and the thoughtlessness
of parents in allowing a child to leave the house before the new skin
be properly formed and hardened._ Prevention is always better than
cure.
Thus far with regard to the danger to the child himself. Now, if you
please, let me show you the risk of contagion that you inflict upon
families, in allowing your child to mix with others before a month at
least has elapsed. Bear in mind, a case is quite as contagious, if not
more so, while the skin is peeling off, as it was before. Thus, in ten
days or a fortnight, there is as much risk of contagion as at the
_beginning_ of the disease, and when the fever is at its height. At
the conclusion of the month, the old skin has generally all peeled
off, and the new skin has taken its place; consequently there will
then be less fear of contagion to others. But the contagion of scarlet
fever is so subtle and so uncertain in its duration, that it is
impossible to fix the exact time when it ceases.
Let me most earnestly implore you to ponder well on the above
important facts. If these remarks should be the means of saving only
one child from death, or from broken health, my labour will not have
been in vain.
226. _What means do you advise to purify a house, clothes, and
furniture, from the contagion of Scarlet Fever_?
Let every room in the house, together with its contents, and clothing
and dresses that cannot be washed, be well fumigated with
sulphur--taking care the while to close both windows and door; let
every room be _lime-washed_ and then be white-washed; if the contagion
have been virulent, let every bedroom be freshly papered (the walls
having been previously stripped of the old paper and then
lime-washed); let the bed, the holsters, the pillows, and the
mattresses be cleansed and purified; let the blankets and coverlids be
thoroughly washed, and then let them be exposed to the open air--if
taken into a field so much the better; let the rooms be well scoured;
let the windows, top and bottom, be thrown wide open; let the drains
be carefully examined; let the pump water be scrutinised, to see that
it be not contaminated by faecal matter, either from the water-closet,
from the privy, from the pig-stye, or from the stable; let privies be
emptied of their contents--_remember this is most important
advice_--then put, into the empty places, either lime and powdered
charcoal or carbolic acid, for it is a well ascertained fact that it
is frequently impossible to rid a house of the infection of scarlet
fever without adopting such a course. "In St George's, Southwark, the
medical officer reports that scarlatina 'has raged fatally, almost
exclusively where privy or drain, smells are to be perceived in the
houses.'" [Footnote: _Quarterly Report of the Board of Health_ upon
Sickness in the Metropolis.] Let the children, who have not had, or
who do not appear to be sickening for scarlet fever, be sent away from
home--if to a farm house so much the better. Indeed, leave no stone
unturned, no means untried, to exterminate the disease from the house
and from the neighbourhood. Remember the young are more prone to catch
contagious diseases than adults; for
"in the morn and liquid dew of youth
Contagious blastments are most imminent."--_Shakspeare_.
227. _Have you any further observations to offer on the precautions to
be taken against the spread of Scarlet Fever_?
Great care should be taken to separate the healthy from the
infected. The nurses selected for attending scarlet fever patients
should be those who have previously had scarlet fever themselves.
Dirty linen should be removed at once, and be put into boiling
water. Very little furniture should be in the room of a scarlet fever
patient--the less the better--it only obstructs the circulation of the
air, and harbours the scarlet fever poison. The most scrupulous
attention to cleanliness should, in these cases, be observed. A
patient who has recovered from scarlet fever, and before he mixes with
healthy people, should, for three or four consecutive mornings, have a
warm bath, and well wash himself, while in the bath, with soap; he
will, by adopting this plan, get rid of the dead skin, and thus remove
the infected particles of the disease. If scarlet fever should appear
in a school, the school must for a time be broken up, in order that
the disease might be stamped out There must be no half measures where
such a fearful disease is in question. A house containing scarlet
fever patients should, by parents, be avoided as the plague; it is a
folly at any time to put one's head into the lion's mouth! Chloralum
and carbolic acid, and chloride of lime, and Condy's fluid, are each
and all good disinfectants; but not one is to be compared to perfect
cleanliness and to an abundance of fresh and pure air--the last of
which may truly _par excellence_ be called God's disinfectant! Either
a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid,
or two tea-spoonfuls of Condy's fluid, or a tea-spoonful of chloride
of lime in a pint of water, are useful to sprinkle the soiled
handkerchiefs as soon as they be done with, and before the be washed,
to put in the _pot-de-chambre_, and to keep in saucers about the room;
but, remember, as I have said before, and cannot repeat too often,
there is no preventative like the air of heaven, which should be
allowed to permeate and circulate freely through the apartment and
through the house: air, air, air is the best disinfectant, curative,
and preventative of scarlet fever in the world!
I could only wish that my _Treatment of Scarlet Fever_ were, in all
its integrity, more generally adopted; if it were, I am quite sure
that thousands of children would annually be saved from broken health
and from death. Time still further convinces me that my treatment is
based on truth as I have every year additional proofs of its value and
of its success; but error and prejudice are unfortunately ever at
work, striving all they can to defeat truth and common sense. One of
my principal remedies in the treatment of scarlet fever is an
abundance of fresh air; but many people prefer their own miserable
complicated inventions to God's grand and yet simple remedies--they
pretend that they know better than the Mighty Framer of the universe!
228. _Will you describe the symptoms of Chicken pox_?
It is occasionally, but not always, ushered in with a slight shivering
fit; the eruption shows itself in about twenty-four hours from the
child first appearing poorly. It is a vesicular [Footnote:
_Vesicles_. Small elevations of the cuticle, covering a fluid which
is generally clear and colourless at first, but afterwards whitish and
opaque, or pearly.--_Watson_.] disease. The eruption comes out in the
form of small pimples, and principally attacks the scalp, the neck,
the back, the chest, and the shoulders, but rarely the face; while in
small-pox the face is generally the part most affected. The next day
these pimples fill with water, and thus become vesicles; on the third
day they are at maturity. The vesicles are quite separate and distinct
from each other. There is a slight redness around each of them. Fresh
ones, whilst the others are dying away, make their appearance.
Chicken-pox is usually attended with a slight itching of the skin;
when the vesicles are scratched the fluid escapes, and leaves hard
pearl-like substances, which, in a few days, disappear. Chicken-pox
never leaves pit marks behind. It is a child's complaint; adults
scarcely, if ever, have it.
229. _Is there any danger in Chicken-pox; and what treatment do you
advise_?
It is not at all a dangerous, but, on the contrary, a trivial
complaint. It lasts only a few days, and requires but little
medicine. The patient ought, for three or four days, to keep the
house, and should abstain from animal food. On the sixth day, but not
until then, a dose or two of a mild aperient is all that will be
required.
230. _Is Chicken-pox infectious_?
There is a diversity of opinion on this head, but one thing is
certain--it cannot be communicated by inoculation.
231. _What are the symptoms of Modified Small-pox_?
The Modified Small-pox--that is to say, small-pox that has been robbed
of its virulence by the patient having been either already vaccinated,
or by his having had a previous attack of small-pox--is ushered in
with severe symptoms, with symptoms almost as severe as though the
patient had not been already somewhat protected either by vaccination
or by the previous attack of small-pox--that is to say, he has a
shivering fit, great depression of spirits and debility, _malaise_,
sickness, headache, and occasionally delirium. After the above
symptoms have lasted about three days, the eruption shows itself. The
immense value of the previous vaccination, or the previous attack of
small-pox, now comes into play. In a case of _unprotected_ small-pox,
the appearance of the eruption _aggravates_ all the above symptoms,
and the danger begins; while in the _modified_ small-pox, the moment
the eruption shows itself the patient feels better, and, as a rule,
rapidly recovers. The eruption, of _modified_ small-pox varies
materially from the eruption of the _unprotected_ small-pox. The
former eruption assumes a varied character, and is composed, first, of
vesicles (containing water); and, secondly, of pustules (containing
matter), each of which pustules has a depression in the centre; and,
thirdly, of several red pimples without either water or matter in
them, and which sometimes assume a livid appearance. These
"breakings-out" generally show themselves more upon the wrist, and
sometimes up one or both of the nostrils. While in the latter
disease--the _unprotected_ small-pox--the "breaking-out" is composed
entirely of pustules containing matter, and which pustules are more on
the face than on any other part of the body. There is generally a
peculiar smell in both diseases--an odour once smelt never to be
forgotten.
Now, there is one most important remark I have to make,--the _modified
small-pox is contagious_. This ought to be borne in mind, as a person
labouring under the disease must, if there be children in the house,
either be sent away himself, or else the children ought to be banished
both the house and the neighbourhood. Another important piece of
advice is,--let _all_ in the house--children and adults, one and
all--be vaccinated, even if any or all have been previously
vaccinated.
_Treatment_.--Let the patient keep his room, and if he be very ill,
his bed. Let the chamber be well ventilated. If it be winter time, a
small fire in the grate will encourage ventilation. If it be summer, a
fire is out of the question; indeed, in such a case, the window-sash
ought to be opened, as thorough ventilation is an important requisite
of cure, both in small-pox and in _modified_ small-pox. While the
eruption is out, do not on any account give aperient medicine. In ten
days from the commencement of the illness a mild aperient may be
given. The best medicine in these cases is, the sweetened Acidulated
Infusion of Roses, [Footnote: See page 178] which ought to be given
from the commencement of the disease, and should be continued until
the fever be abated. For the first few days, as long as the fever
lasts, the patient ought not to be allowed either meat or broth, but
should be kept on a low diet, such as on gruel, arrow-root,
milk-puddings, &c. As soon as the fever is abated he ought gradually
to resume his usual diet. When he is convalescent, it is well, where
practicable, that he should have change of air for a month.
232. _How would you distinguish between Modified Small-pox and
Chicken-pox_?
Modified small-pox may readily be distinguished from chicken-pox, by
the former disease being, notwithstanding its modification, much more
severe and the fever much more intense before the eruption shows
itself than chicken-pox; indeed, in chicken-pox there is little or no
fever either before or after the eruption; by the former disease--the
modified small-pox--consisting _partly_ of pustules (containing
matter), each pustule having a depression in the centre, and the
favourite localities of the pustules being the wrists and the inside
of the nostrils; while, in the chicken-pox, the eruption consists of
vesicles (containing water), and _not_ pustules (containing matter),
and the vesicles having neither a depression in the centre, nor having
any particular partiality to attack either the wrists or the inside of
the nose. In modified small-pox each pustule is, as in unprotected
small-pox, inflamed at the base; while in chicken-pox there is only
very slight redness around each vesicle. The vesicles in chicken-pox
are small--much smaller than the pustules in modified small-pox.
233. _Is Hooping-cough an inflammatory disease_?
Hooping-cough in itself is not inflammatory, it is purely spasmodic;
but it is generally accompanied with more or less of bronchitis--
inflammation of the mucous membrane of the bronchial tubes--on which
account it is necessary, _in all cases_ of hooping-cough, to consult a
medical man, that he may watch the progress of the disease and nip
inflammation in the bud.
234. _Will you have the goodness to give the symptoms, and a brief
history of, Hooping-cough_?
Hooping-cough is emphatically a disease of the young; it is rare for
adults to have it; if they do, they usually suffer more severely than
children. A child seldom has it but once in his life. It is highly
contagious, and therefore frequently runs through a whole family of
children, giving much annoyance, anxiety, and trouble to the mother
and the nurses; hence hooping-cough is much dreaded by them. It is
amenable to treatment. Spring and summer are the best seasons of the
year for the disease to occur. This complaint usually lasts from six
to twelve weeks--sometimes for a much longer period, more especially
if proper means are not employed to relieve it.
Hooping-cough commences as a common cold and cough. The cough, for ten
days or a fortnight, increases in intensity; at about which time it
puts on the characteristic "hoop." The attack of cough comes on in
paroxysms. In a paroxysm, the child coughs so long and so violently,
and _expires_ so much air from the lungs without _inspiring_ any, that
at times he appears nearly suffocated and exhausted; the veins of his
neck swell; his face is nearly purple; his eyes, with the tremendous
exertion, almost seem to start from their sockets; at length there is
a sudden _inspiration_ of air through the contracted chink of the
upper part of the wind-pipe--the glottis--causing the peculiar "hoop;"
and after a little more coughing, he brings up some glairy mucus from
the chest; and sometimes, by vomiting, food from the stomach; he is at
once relieved, until the next paroxysm occur, when the same process is
repeated, the child during the intervals, in a favourable case,
appearing quite well, and after the cough is over, instantly returning
either to his play or to his food. Generally, after a paroxysm he is
hungry, unless, indeed, there be severe inflammation either of the
chest or of the lungs. Sickness, as I before remarked, frequently
accompanies hooping-cough; when it does, it might be looked upon as a
good sign. The child usually knows when an attack is coming on; he
dreads it, and therefore tries to prevent it; he sometimes partially
succeeds; but, if he does, it only makes the attack, when it does
come, more severe. All causes of irritation and excitement ought, as
much as possible, to be avoided, as passion is apt to bring on a
severe paroxysm.
A new-born babe--an infant of one or two months old--commonly escapes
the infection; but if, at that tender age, he unfortunately catch
hooping-cough, it is likely to fare harder with him than if he were
older--the younger the child, the greater the risk. But still, in such
a case, do not despair, as I have known numerous instances of new-born
infants, with judicious care, recover perfectly from the attack, and
thrive after it as though nothing of the kind had ever happened.
A new-born babe, labouring under hooping-cough, is liable to
convulsions, which is in this disease one, indeed the great, source of
danger. A child, too, who is teething, and labouring under the
disease, is also liable to convulsions. When the patient is
convalescing, care ought to be taken that he does not catch cold, or
the "hoop" might return. Hooping-cough may either precede, attend, or
follow an attack of measle.
235. _What is the treatment of Hooping-cough_?
We will divide the hooping-cough into three stages, and treat each
stage separately,
_What to do.--In the first stage_, the commencement of hooping-cough:
For the first ten days give the Ipecacuanha Wine Mixture, [Footnote:
For the prescription of the Ipecacuanha Wine Mixture, see page 161.] a
tea-spoonful three times a day. If the child be not weaned, keep him
entirely to the breast, if he be weaned, to a milk and farinaceous
diet. Confine him for the first ten days to the house, more especially
if the hooping-cough be attended, as it usually is, with more or less
bronchitis. But take care that the rooms be well ventilated; for good
air is essential to the cure.
If the bronchitis attending the hooping-cough be severe, confine him
to his bed, and treat him as though it were simply a case of
bronchitis. [Footnote: For the treatment of bronchitis, see answer to
207th question.]
_In the second stage_, discontinue the Ipecacuanha Mixture, and give
Dr Gibb's remedy--namely, Nitric Acid--which I have found to be an
efficacious and valuable one in hooping-cough:--
Take of--Diluted Nitric Acid, two drachms;
Compound Tincture of Cardamons, half a drachm;
Simple Syrup, three ounces;
Water, two ounces and a half:
Make a Mixture. One or two tea-spoonfuls, or a table-spoonful,
according to the age of the child--one tea-spoonful for an infant of
six months, and two tea-spoonfuls for a child of twelve months, and
one table-spoonful for a child of two years, every four hours, first
shaking the bottle.
Let the spine and the chest be well rubbed every night and morning
either with Roche's Embrocation, or with the following stimulating
liniment (first shaking the bottle):--
Take of--Oil of Cloves, one drachm;
Oil of Amber, two drachms;
Camphorated Oil, nine drachms:
Make a Liniment.
Let him wear a broad band of new flannel, which should extend round
from his chest to his back, and which ought to be changed every night
and morning, in order that it may be dried before putting on again. To
keep it in its place it should be fastened by means of tapes and with
shoulder-straps.
The diet ought now to be improved--he should gradually return to his
usual food; and, weather permitting, should almost live in the open
air--fresh air being, in such a case, one of the finest medicines.
_In the third stage_, that is to say, when the complaint has lasted a
month, if by that time the child is not well, there is nothing like
change of air to a high, dry, healthy, country place. Continue the
Nitric Acid Mixture, and either the Embrocation or the Liniment to the
back and the chest, and let him continue to almost live in the open
air, and be sure that he does not discontinue wearing the flannel
until he be quite cured, and then let it be left off by degrees.
If the hooping-cough have caused debility, give him Cod-liver Oil--a
tea-spoonful twice or three times a day, giving it him on a full
stomach, after his meals. But, remember, after the first three or four
weeks, change of air, and plenty of it, is for hooping-cough the grand
remedy.
_What NOT to do_.--"Do not apply leeches to the chest, for I would
rather put blood into a child labouring under hooping-cough than take
it out of him--hooping-cough is quite weakening enough to the system
of itself without robbing him of his life's blood; do not, on any
account whatever, administer either emetic tartar or antimonial wine;
do not give either paregoric or syrup of white poppies; do not drug
him either with calomel or with grey-powder; do not dose him with
quack medicine; do not give him stimulants, but rather give him plenty
of nourishment, such as milk and farinaceous food, but _no_
stimulants; do not be afraid, after the first week or two, of his
having fresh air, and plenty of it--for fresh, pure air is the grand
remedy, after all that can be said and done, in hooping-cough.
Although occasionally we find that, if the child to labouring under
hooping-cough, and is breathing a pure country air, and is not getting
well so rapidly as we could wish, change of air to a smoky gas-laden
town will sometimes quickly effect a cure; indeed, some persons go so
far as to say that the _best_ remedy for an _obstinate_ case of
hooping-cough is, for the child to live, the great part of every day,
in gas-works!"
236. _What is to be done during a paroxysm of Hooping-cough_?
If the child be old enough, let him stand up; but if he be either too
young or too feeble, raise his head, and bend his body a little
forward; then support his back with one hand, and the forehead with
the other. Let the mucus, the moment it be within reach, be wiped with
a soft handkerchief out of his mouth.
237. _In an obstinate case of Hooping-cough, what is the best remedy_?
Change of air, provided there be no active inflammation, to any
healthy spot. A farm-house, in a high, dry, and salubrious
neighbourhood, is as good a place as can be chosen. If, in a short
time, he be not quite well, take him to the sea-side: the sea breezes
will often, as if by magic, drive away the disease.
238. _Suppose my child should have a shivering fit, is it to be looked
upon as an important symptom_?
Certainly. Nearly all _serious_ illnesses commence with a shivering
fit: severe colds, influenza, inflammations of different organs,
scarlet fever, measles, small-pox, and very many other diseases, begin
in this way. If, therefore, your child should ever have a shivering
fit, _instantly_ send for a medical man, as delay might be
dangerous. A few hours of judicious treatment, at the commencement of
an illness, is frequently of more avail than days and weeks, nay
months, of treatment, when disease has gained a firm footing. A
_serious_ disease often steals on insidiously, and we have perhaps
only the shivering fit, which might be but a _slight_ one, to tell us
of its approach.
A _trifling_ ailment, too, by neglecting the premonitory symptom,
which, at first might only be indicated by a _slight_ shivering fit,
will sometimes become a mortal disorder:--
"The little rift within the lute,
That by-and-by will make the music mute,
And ever widening slowly silence all." [Footnote: The above extract
from Tennyson is, in my humble opinion, one of the most beautiful
pieces of poetry in the English language. It is a perfect gem, and a
volume in itself, so truthful, so exquisite, so full of the most
valuable reflections; for instance--(1.) "The little rift within the
lute,"--the little tubercle within the lung "that by-and-by will
make the music mute, and ever widening slowly silence all," and the
patient eventually dies of consumption. (2.) The little rent--the
little rift of a very minute vessel in the brain, produces an attack
of apoplexy, and the patient dies. (3.) Each and all of us, in one
form or another, sooner or later, will have "the little rift within
the lute." But why give more illustrations?--a little reflection
will bring numerous examples to my fair reader's memory.]
239. _In case of a shivering fit, perhaps you will tell me what to
do_?
_Instantly_ have the bed warmed, and put the child to bed. Apply
either a hot bottle or a hot brick, wrapped in flannel, to the soles
of his feet. Put an extra blanket on his bed, and give him a cup of
hot tea. As soon as the shivering fit is over, and he has become hot,
gradually lessen the _extra_ quantity of clothes on his bed, and take
away the hot bottle or the hot brick from his feet.
_What NOT to do_.--Do not give either brandy or wine, as inflammation
of some organ might be about taking place. Do not administer opening
medicine, as there might be some "breaking out" cooling out on the
skin, and an aperient might check it.
240. _My child, apparently otherwise healthy, screams out in the night
violently in his sleep, and nothing for a time will pacify him: what
is likely to be the cause, and what is the treatment_?
The causes of these violent screamings in the night are various. At
one time, they proceed from teething; at another, from worms;
sometimes, from night-mare; occasionally, from either disordered
stomach or bowels. Each of the above causes will, of course, require
a different plan of procedure; it will, therefore, be necessary to
consult a medical man on the subject, who will soon, with appropriate
treatment, be able to relieve him.