quality of the ipecacuanha wine may be good, as the child’s life may
depend upon it_.
If the medicine produces 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_—a quarter of a sheet, which ought to be fastened on to a
piece of sticking-plaster, taking care to apply the tela vesicatoria
(which is on paper) to the warmed plaster, so as to securely fasten the
tela vesicatoria on the sticking-plaster. The plaster should be rather
larger than the blister, so as to leave a margin. Any respectable
chemist will understand the above directions, and will prepare the tela
ready for use. 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
slip of it, on sticking-plaster, 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 only be depended upon by having the medicine
from a highly respectable chemist. Ipecacuanha wine, when genuine and
good, is, in many children’s diseases, one of the most valuable of
medicines.
_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 baby 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 marvelous. 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 child’s
_thin_ blanket, or a thin _woolen_ shawl, in addition to his usual
night-gown, is all the clothing necessary.
203. _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 labors 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-colored, 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, or 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.
204. _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.
205. _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 bed-room, 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 is not above 60° 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 lie 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 wearied 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, etc.; but, until the inflammation has 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 teaspoonful 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_, prepared and applied as I recommended when
treating of inflammation of the lungs.
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 vesicatoria
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, etc.; 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.
206. _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 the nostrils. The 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 windpipe. 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 diarrhœa 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 skillful medical man.
207. _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 among children under ten years of age. In the Lincolnshire
epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in
number, occurred among children under twelve years of age.”
208. _What are the causes of Diphtheria?_
Bad and imperfect drainage; want of ventilation; overflowing privies;
low neighborhoods in the vicinity of rivers; stagnant waters; indeed,
every thing 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. “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._ Bear in mind, too,
that a delicate child is much more predisposed to the disease than a
strong one.
209. _What is the treatment of Diphtheria?_
_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 bed-room 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, etc.
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—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 one of the
following mixtures:
Take of—Chlorate of Potash, two drachms;
Boiling Water, seven ounces and a half;
Syrup of Red Poppy, half an ounce:
To make a Mixture. A tablespoonful to be taken every four hours.
Or,
Take of—Diluted Sulphuric Acid, one drachm;
Simple Syrup, one ounce and a half;
Infusion of Roses, four ounces and a half;
To make a Mixture. A tablespoonful to be given every four hours.
Let the infusion of roses be made merely with the rose-leaves and
boiling water.
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 tablespoonful 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;
Simple Syrup, one ounce;
Water, three ounces and a half:
To make a Mixture. A tablespoonful to be taken every four hours.
Or,
Take of—Muriated Tincture of Iron, half a drachm;
Simple Syrup, one ounce;
Water, three ounces:
To make a Mixture. A tablespoonful to be taken three times a day.
If the disease should travel downward, 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 teaspoonful 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 laboring under the depressing effects of poison, for
the blood has been poisoned either by the drinking water being
contaminated by fecal 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 neighborhood if
active measures be not used to exterminate it.
210. _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 eyelids, 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.
211. _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.
212. _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.
213. _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, etc.
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
will be all that is necessary. (See question 209.)
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 teaspoonful of a mixture composed of ipecacuanha wine, syrup, and
water, every four hours. (See question 202.) And if, on the following
day, the breathing and the wheezing be not relieved, in addition to the
ipecacuanha mixture, apply a tela 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, etc., should be
given; and, a few days later, chicken, mutton-chops, etc.
The child ought not, even in a mild case of measles, and in favorable
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 favorable 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.
214. _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.
215. _Will you describe the symptoms of Scarlet Fever?_