in attempting more than what has been laid down here for her guidance.
It is believed that the few and plain common-sense directions given, if
followed, will do much to prevent disease, and even to relieve it in
its milder forms; they will not, however, cure disease itself when
really established: and again I would repeat, let the mother recollect
that to prevent disease is her province--to cure it, is the physician's.
Sect. III.--COSTIVENESS.
1. IN INFANCY.
The principle to act upon in the management of the infant's bowels is
this,--that they should be kept free, and by the mildest and least
irritating means.
If therefore they become accidentally confined (less than two stools
in the four-and-twenty hours), and the infant is suckled, the mother
may ascertain whether an aperient taken by herself will render her milk
of a sufficiently purgative quality to act upon the bowels of her
child. This is the mildest mode of all.
If, however, this does not answer, or is not practicable from the
child being fed artificially, then the mildest aperient medicines must
be chosen to accomplish this purpose. The kind of medicine to be
selected, and the doses in which to be adminstered, will be found in
the section on "Aperient Medicine."[FN#39]
[FN#39] See page 97.
If, however, the bowels of the infant are disposed to be habitually
confined, it should be ascertained whether this may not be dependent
upon its diet. The same food that agrees perfectly well with one child
will frequently cause costiveness in another. An intelligent and
observing mother will soon discover whether this is the source of the
mischief, or not. Boiled milk, for instance, will invariably cause
confined bowels in some children; the same result will follow sago
boiled in beef tea, with others; whilst, on the other hand, the bowels
may frequently be brought into regular order, and their confined state
overcome, by changing the food to Leman's tops and bottoms steeped in
hot water, and a small quantity of unboiled milk added; or prepared
barley, mixed in warm water and unboiled milk, will have the same
effect.
Sometimes children are constitutionally costive, that is, the bowels
are relieved every third or fourth day, not oftener, and yet perfect
health is enjoyed. This occasionally will happen in large families, all
the children, though perfectly healthy and robust, being similarly
affected. When such is found by a mother to be really the habit of her
child, it would be very unwise, because injurious to its health, to
attempt by purgatives to obtain more frequent relief. At the same time
it will be prudent and necessary for her to watch that the regular time
is not exceeded. This condition seldom occurs to the very young infant.
2. IN CHILDHOOD.
Children of sound health, who are judiciously fed, and have sufficient
exercise, very seldom need aperient medicine. Errors in diet, a want of
proper attention to the state of the skin, insufficiency of air and
exercise, in fine, a neglect of those general principles which have
been laid down for the management of health, and upon the observance of
which the due and healthy performance of every function of the body
depends, are the sources of bowel derangements, and particularly, at
this age, of costiveness.
I feel assured, however, that some children are more troubled with
costiveness than others, from the simple but important circumstance of
their not being early taught the habit of relieving the bowels daily,
and at a certain hour. There is a natural tendency to this periodical
relief of the system, and it exists at the earliest age. And if the
mother only cause this habit to be fairly established in infancy, she
will do much towards promoting regularity of her child's bowels
throughout life. The recollection of this fact, and the mother's acting
upon it, is of the greatest importance to the future health and comfort
of her children.
If the bowels are accidentally confined at this age, castor oil is
certainly the best aperient that can be given: it acts mildly but
efficiently, clearing out the bowels without irritating them. The dose
must be regulated by the age, as also by the effect that aperients
generally have upon the individual. Great care must in future be taken
to avoid the cause or accidental circumstance which produced the
irregularity.
When the bowels are habitually costive, much care and judgment is
necessary for their relief and future management. Fortunately this
condition is very rare in youth. The activity and exposure to the air,
usual at this period of life, render purgatives unnecessary, unless,
indeed (as just mentioned), some error in diet, or some unusual
circumstance, render them accidentally confined. Should, however, the
foregoing state exist, medicine alone will avail little; there are
certain general measures which must also be acted up to, and most
strictly, if the end is to be accomplished. They consist, principally,
in an observance of great regularity with respect to the time of taking
food, its quality, quantity, and due mastication; regular and
sufficient exercise, horse exercise being particularly serviceable; the
shower-bath, or daily ablution; early rising (the indulgence in the
habit of lying in bed always predisposing to constipation); and,
lastly, the patient habituating himself to evacuate the bowels at a
certain hour of the day. After breakfast appears to be the time when
the bowels are more disposed to act than at any other part of the day;
this is the time, then, that should be chosen.
All these points must be sedulously observed, and upon the principles
laid down in the various chapters upon these subjects, if habitual
costiveness is expected to be overcome.
SECT. IV.--WORMS.
NOT SO FREQUENT AS POPULARLY SUPPOSED; AN ERROR PRODUCTIVE OF
MISCHIEF.--Almost all diseases have been, at one time or other,
attributed to the generation of worms in the intestines. And at the
present day it is not at all an uncommon occurrence for medical men to
be called in to prescribe for children, to whom the strongest purgative
quack medicines have been previously exhibited by parents, for the
removal of symptoms which, upon investigation, are found in no way
connected with or produced by worms. The results of such errors are
always, more or less, mischievous, and sometimes of so serious a nature
as to lay the foundation of disease which ultimately proves fatal. This
observation, moreover, it behoves a mother carefully to regard, since
the symptoms, popularly supposed to indicate the existence of worms,
are so deceptive, (and none more so than that which is usually so much
depended upon--the picking of the nose,) that it may be positively
asserted to be impossible for an unprofessional person to form a
correct and sound opinion in any of these cases.
It was at one time imagined, and the idea is still popularly current,
that worms were the occasion of a troublesome and lingering species of
fever, which was therefore designated worm-fever. This notion is now
entirely exploded; for if worms be present under such circumstances, it
is a mere accidental complication; the fever referred to being
generally of a remitting character, and neither caused by or causing
the generation of worms. The symptoms of this fever, however, have led
and continue to lead very many astray. This is not surprising, since
they so closely resemble those which characterise the presence of
worms, that an unprofessional person is almost sure to be misled by
them. Amongst other symptoms, there is the picking of the nose and
lips, offensive breath, occasional vomiting, deranged bowels, pain in
the head and belly, with a tumid and swollen condition of the latter, a
short dry cough, wasting of the flesh, etc.; symptoms continually
attendant upon the disorder now under consideration. These cases have
hitherto been perpetually looked upon by mothers as worm-cases, and
after having been treated by them as such, by the use of the popular
worm-powders of the day, have, as perpetually, presented themselves to
the physician greatly and grievously aggravated by such injudicious
treatment. It is folly, at any time, for an unprofessional person to
prescribe for a case where worms are actually known to exist: surely
where there is any doubt upon the latter point it must be greater folly
still.
The infant at the breast is seldom, if ever, the subject of this
disorder, whilst an artificial diet, or bringing up by hand,
predisposes to it. Worms most frequently occur, however, during
childhood; much more so at this epoch than in adult age. They do not
invariably occasion indisposition, for they are now and then passed
without pain or distress by children who are in the enjoyment of
perfect health, and in whom previously there was not the slightest
suspicion of their existence. The idea, formerly so prevalent, of their
being attended with danger, is without foundation; for unless the case
be mismanaged, they rarely give rise to serious consequences.
HOW PRODUCED, AND HOW BEST PREVENTED.--The causes of worms it is not
very easy to explain; at the same time it is very certain that some
known circumstances favour their production.
If the general health of a child be enfeebled, particularly if the
child be strumous, such a condition will favour the generation of these
animals. The protracted use of unwholesome and innutritious articles of
food, or a deficient supply of salt (the most necessary stimulant to
the digestive organs), or other condiments, predisposes to worms. This
observation is strikingly illustrated by an occurrence which formerly
took place in Holland, where an ancient law existed forbidding salt in
the bread of certain criminals; they were in consequence horribly
infested with worms, and quickly died. Sugar, too, whilst a necessary
condiment for the food of children, if given in the form of sweetmeats,
and their indulgence, long persisted in, may so enfeeble the organs of
digestion as to cause worms. And, lastly, (though many other causes
might be referred to) the injudicious means occasionally employed to
effect the removal of these animals, by the debility produced in the
intestinal canal, favours not only their re-appearance but their
increase.
These, then, are so many causes which may occasion worms in the child,
and of course the best and most effectual method to prevent their
production is their avoidance. A mother, therefore, should at all times
be careful in the regulation of the diet and general management of her
child's habits and health, even if no stronger obligations existed than
the dread of this disorder; and she must be more than ordinarily
vigilant on this head, when the slightest disposition to such disorder
is manifested. Again; she must not forget that the symptoms so commonly
ascribed as characteristic of worms are much more frequently caused by
other diseases; that at no time, therefore, is she justified in giving
worm powders, or strong doses of medicine for such symptoms; for if
they do exist, their use is always attended with risk, and if they do
not, the debility which they occasion in the stomach and bowels may
itself become the source of their production.
Sect. V. SCARLET FEVER.
There are several varieties of this disease; it will be more
perspicuous, however, for our purpose to speak of it under the two
following forms:--
Mild scarlet fever;
Scarlet fever, with sore throat.
MILD SCARLET FEVER.--In this form of the disease there is only the rash
with fever.
SYMPTOMS.--The anticipating symptoms are those of fever: they precede
the eruption. The degree of fever, however, is variable; for the
symptoms are sometimes so moderate as scarcely to attract attention,
slight and irregular shivering, nausea, perhaps vomiting, thirst, and
heat of skin; whilst, at others, there is considerable constitutional
disturbance, indicated by pungent heat of skin, flushing of the face,
suffusion of the eyes, pain in the head, great anxiety and
restlessness, and occasionally slight delirium.
These symptoms are followed on the second day (in the majority of
instances) by the rash. This first appears in numerous specks or minute
patches of a vivid red colour on the face, neck, and chest. In about
four-and-twenty hours it becomes gradually diffused over the whole
trunk. On the following day (the third) it extends to the upper and
lower extremities, so that at this period the whole surface of the body
is of a bright red colour, hot and dry. The efflorescence, too, is not
always confined to the skin, but occasionally tinges the inside of the
lips, cheeks, palate, throat, nostrils, and even the internal surface
of the eyelids. Sometimes the efflorescence is continuous and
universal; but more generally on the trunk of the body there are
intervals of a natural hue between the patches, with papulous dots
scattered over them, the colour being most deep on the loins and
neighbouring parts, at the flexure of the joints, and upon those parts
of the body which are subjected to pressure. It is also generally most
vivid in the evening, gradually becoming paler towards morning.
The eruption is at its height on the fourth day;--it begins to decline
on the fifth, when the interstices widen, and the florid hue fades;--on
the sixth, the rash is very indistinct; and on the eighth day it is
wholly gone.
The various symptoms with which the eruption is accompanied, gradually
disappear with the efflorescence; but the tongue still remains morbidly
red and clean. The peeling off of the cuticle (the outer layer of the
skin), which begins about the end of the fifth day on the parts on
which the eruption first appeared, proceeds; so that about the eighth
or ninth, portions of the cuticle are thrown off, the thickest and
largest being those detached from the skin of the hands and feet.
SCARLET FEVER, WITH SORE THROAT.--In this form of the disease, the
fever and rash are accompanied with inflammation of the throat.
SYMPTOMS.--The symptoms are more severe than in the mild form of this
disease, and, in the majority of instances, the inflammation of the
throat appears with the eruption, and goes through its progress of
increase and decline with the cutaneous eruption. Sometimes, however,
it precedes the fever; whilst at others it does not appear until the
rash is at its height.
It is generally in the course of the second day that the child
complains of considerable stiffness in the muscles of the neck,
extending to the lower jaw, and under the ears;--of a roughness of the
throat, and difficulty in swallowing;--and some degree of hoarseness
will be noticed: all so many indications that the throat is affected.
Very shortly, an increased secretion of the mucus of these parts
occurs, and, collecting about the tonsils, aggravates the child's
sufferings, from the frequent and ineffectual efforts made to expel it.
If the inflammatory action be more severe, exudations of lymph will
also be poured out, and intermingling with the mucus, greatly augment
the difficulty of swallowing. At this time the lining membrane of the
mouth, as also the tongue, assume a florid red colour; the red points
of the latter becoming much elongated.
The febrile symptoms are severe from the first; amongst others, there
will be headach, sometimes accompanied by slight delirium, nausea,
intense heat of skin, languor, and considerable inquietude and anxiety:
and as the inflammation approaches its height, the fever increases, the
pulse rises, the breathing becomes oppressed, the skin becomes more
pungently hot and dry, and the thirst urgent. All these symptoms being
increased towards evening, when the febrile restlessness is often
succeeded by delirium.
The rash is seldom perceptible before the third day, and then comes
out in irregular patches on various parts of the body, particularly
about the elbows and wrists; thus differing as to the time and mode of
its appearance, from the mild form of the disease. It frequently
recedes, or entirely vanishes, the day after it first comes out, and
then reappears partially, and at uncertain times. This generally
protracts the duration of the disorder, without, however, producing any
perceptible change in the other symptoms. On the fifth or sixth day of
the disease, the fever and inflammation of the throat begin to abate;
at the same time the rash declines, and the peeling off of the cuticle
soon follows.
This is the ordinary course of scarlet fever with sore throat; but in
many cases the symptoms run still higher, and the disease is alarmingly
dangerous from its commencement. In some instances, there is an acrid
discharge from the nostrils or ears, often accompanied with deafness;
as also enlargements of the glands in the neck, followed by the
formation of abscesses in their immediate neighbourhood. It is
unnecessary, however, to follow out the symptoms of scarlet fever more
fully; as all that has been attempted here, has been so to sketch out
the more prominent symptoms of this disease, that the directions upon
the parental management may be readily comprehended: they will be very
brief, but a strict attention thereto will be found all-important to
the well-doing and comfort of the child.
CHARACTER OF SCARLET FEVER COMPARED WITH THAT OF MEASLES.--It will be
seldom difficult to distinguish this disease from other acute eruptive
disorders. The one to which it bears the greatest resemblance is the
measles; but from this it is readily distinguished by the absence of
the cough, the inflamed and watery eye, running at the nose and
sneezing, which are the predominant symptoms in the early stage of the
measles; but which do not usually attend on scarlet fever--at least, in
any high degree. In measles, also, there is an absence of that
restlessness, anxiety, and depression of spirits, by which scarlet
fever is peculiarly distinguished.--The rash, too, in measles, does not
appear till two or three days later than that of scarlet fever. It also
differs in its characters. In scarlet fever, the eruption consists of
innumerable minute dots or points, diffused in patches with uneven
edges of various sizes and forms; and gives to those portions of the
skin on which it appears, a diffused bright red colour. In measles, the
rash comes out in irregular semi-lunar or crescentic shaped patches,
distinctly elevated; the spots being of a deeper red in the centre
than in the circumference, and leaving intervening spaces in which the
skin retains its natural pale colour.
MATERNAL MANAGEMENT.--The chief points to which the parent's attention
must be directed, irrespective of a strict attention to the more
immediate medical treatment directed by the physician, are the
following:--
VENTILATION OF THE BED-ROOM.--Even in the mildest cases, the child must
be kept in bed from the first accession of the fever. He must not be
loaded, however, as was formerly the practice, with a quantity of
bed-clothes, in order to encourage the fever and increase the quantity
of eruption. A moderate quantity of clothing is all that is required,
adapted to the heat of skin and feelings of the patient.
The bed-room must be kept cool and well ventilated. This is of
importance in the mildest cases; but in the more severe forms of this
disease, in which the throat is much affected, the constant and free
admission of pure air will have a most decided and marked good effect
upon the symptoms. The air should be renewed, therefore, from time to
time. The linen, both of the bed and the patient, should also be
frequently changed daily,--if practicable.
However mild the symptoms of this disease may be at the commencement,
the child must always be carefully and vigilantly watched by the
parent, as inflammation of some internal organ may suddenly arise
(which is generally indicated by symptoms sufficiently obvious), and
thus change an apparently mild form of this disease into one of an
alarming character.
COLD SPONGING.--Whenever the skin is pungently hot and dry, the whole
surface of the body should be sponged with cold water, or with vinegar
and water. The heat is by this means rapidly abstracted, and the child
refreshed; and this may again and again be resorted to, as the heat
again returns. By this application alone, "the pulse has been
diminished in frequency, the thirst has abated, the tongue has become
moist, a general free per spiration has broken forth, the skin has
become soft and cool, and the eyes have brightened; and these
indications of relief have been speedily followed by a calm and
refreshing sleep. In all these respects, the condition of the patient
presented a complete contrast to that which preceded the cold washing;
and his languor was exchanged for a considerable share of vigour. The
morbid heat, it is true, when thus removed, is liable to return, and
with it the distressing symptoms; but a repetition of the remedy is
followed by the same beneficial effects as at first."[FN#40]
[FN#40] Bateman's Practical Synopsis of Cutaneous Diseases.
GARGLES AND THE INHALATION OF WARM WATER.--When the throat is affected,
gargles are sometimes ordered; but the pain and inconvenience which
their employment gives rise to, frequently precludes their use: and
children seldom understand how to employ them, even if the state of the
throat permitted it. Under these circumstances, the inhalation of the
steam of hot water, or hot vinegar and water, may be substituted, and
with decided benefit. Mudge's inhaler is a good contrivance to effect
this.
When the throat is found by the mother to be early affected, an
immediate application to the medical adviser is especially important.
For, if he be called upon to treat this form of scarlet fever at its
very commencement, by judicious treatment, the duration and violence of
the disease may be both shortened and greatly mitigated.
REGIMEN.--Cooling drinks, as plain water, toast and water, barley water
flavoured with lemon peel, fresh whey, lemonade, and thin gruel, may
all be resorted to in their turn. The child may also be allowed
oranges, grapes, or lemons sweetened with sugar, particularly when the
mouth is foul and dry; but care must be taken that neither the pulp nor
the stones are swallowed. These will both refresh and feed the patient
as much as is necessary until the decline of the disease. The parent
must strictly forbid the attendants in the sick chamber giving, at this
period, any heating or stimulating fluid, as also animal food; and this
injunction must be strictly regarded, even in the mildest form of the
disease.
When the child is convalescent, mild nourishment will be required,
such as arrow-root, tapioca, chicken or mutton broth, beef tea,
jellies, and roasted apples; and by and by a mutton chop. Wine is
seldom necessary, except under circumstances of unusual debility after
a protracted illness, when its moderate use tends much to assist the
convalescence; but, if given unadvisedly, there will be great hazard of
exciting internal inflammatory disease.
Relapses are sometimes caused by the child getting about too soon, and
by indulgence of the appetite, particularly for food: a proper degree
of restraint, therefore, must be placed upon the child by the parent,
who cannot too strictly carry out the directions of the medical
attendant upon the diet and regimen during this period.
Great attention must still be paid to the state of the bowels, and,
indeed, to all the secretions and excretions.
PEELING OFF OF THE CUTICLE, AND FALLING OFF OF THE HAIR.--To promote
the more easy separation of the cuticle from the surface of the body, a
warm or tepid bath may be usefully employed at the close of the
disease. It will, moreover, greatly contribute to the comfort of the
child, and induce a more healthy condition of the skin. Occasionally
the cuticle of the whole hand and fingers will peel off unbroken, when
it will resemble precisely a glove in shape.
As is the case in all fevers, more or less, so particularly after
scarlet fever, there is a great tendency to the falling off of the
hair. It will be always well, therefore, to shave the head at this
time, and exhibit daily a tepid shower bath, as early as the strength
of the child will permit.