separation of the invalid from the rest of the family; and, when it is
practicable, the children should be removed to a distance. This measure
is imperatively called for, when the form of the disease is very severe
in its character.
Great caution must also be exercised, after the convalescence of the
patient, that the other children are not brought into too early contact
with him: for infection may be thus produced, though several weeks may
have elapsed from the period of the peeling off of the skin.
The period at which the disease shows itself after the exposure of an
individual to sources of contagion, is exceedingly various. One child
will be seized within a few hours; another, not for some days; and now
and then (though rarely), five or six weeks have intervened between the
period of exposure and the manifestation of the disease.
When this disease is rife in a family, it will frequently affect the
individuals composing it very differently. Some escape altogether;--
others have the mild form of the complaint;--others the severe;--and,
again, the attendant in the sick room may be attacked with the sore
throat and fever only, both of which may subside without any appearance
of a rash.
In conclusion, this disease is a complaint of infancy and childhood,
rather than of adult age; generally affects the same individual but
once during his life; and, though examples of a second attack have
occurred, such a circumstance is extremely rare.
Sect. VI.--MEASLES.
Measles consists of a fever, in which the mucous lining of the air-
passages is principally affected, and which, after about three days'
duration, results in an eruption of a red rash over the surface.
It depends upon a specific contagion;--occurs most frequently during
childhood and adolescence, though no age is exempt from it;--and affects
the system but once; a peculiarity to which an exception is very rare,
proved by the few instances of the kind which have been recorded.
The period at which the disease manifests itself after infection is
various,--generally about the ninth day; it has, however, been delayed
until the sixteenth.
DESCRIPTION OF THE DISEASE.--The child infected will be observed not to
be as well as usual, less active, and out of spirits; his appetite
will fail, and his sleep be restless and disturbed. It will soon be
evident that he has apparently taken a cold in his head, and that this
is accompanied by fever. His voice will be hoarse; there will be
frequent cough, headach, sneezing, running from the nose and eyes,--the
eyelids being somewhat swollen, and the eyes inflamed;--the skin will be
hot and dry, and he will complain of occasional chilliness. In the
course of the next two or three days, these symptoms will increase in
severity, and perhaps be accompanied by oppression at the chest and
hurried breathing, and towards evening by slight delirium.
On the fourth day, the rash will appear, but the symptoms will be
little, if at all, mitigated; indeed, they will sometimes increase in
severity. The eruption will first be perceived about the head and face,
in the form of small red spots, at first distinct from each other, but
soon coalescing, and forming patches of an irregular crescent-like or
semilunar figure, of a dull red colour, and slightly elevated (giving a
sensation of hardness to the finger), while portions of the skin
intervening between them will retain their natural appearance. At this
time the eruption will also be found on the inside of the mouth and
throat, and the hoarseness will consequently increase.
On the fifth day, the rash usually covers the whole surface of the
body, with the exception of the legs and feet; and is now very vivid on
the face, which is not unfrequently so much swelled, especially the
eyelids, that the eyes are quite closed up, as in small-pox. On the
sixth day, it is fully out on the extremities, and is beginning to fade
on the face. On the eighth, it is fading from all parts; on the ninth,
it is hardly perceptible; and has entirely disappeared on the tenth day
from the commencement of the fever, or the sixth from its own first
appearance. As the fading proceeds, the spots drop off in the form of
little branny scales, which are sometimes, from their minuteness,
scarcely perceptible. They leave a slight discolouration on the skin,
with considerable itching.
Such is the ordinary course of this disease; occasionally, however,
deviations are met with.
CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under
the description given of Scarlet Fever, are noticed several signs by
which that disease may be distinguished from measles: to these may be
added the absence of cough, of water flowing from the eyes, and of
redness and swelling of the eyelids as in measles. Again, in measles,
the eruption is more pointed, of a crimson instead of a scarlet hue,
and does not appear until two days later than in scarlet fever.
In small-pox, the fever abates as soon as the eruption makes its
appearance. In scarlet fever, this is by no means the case; and as
little so in measles: the vomiting, indeed, subsides; but the cough,
fever, and headach grow more violent; and the difficulty of breathing,
weakness of the eyes, and, indeed, all the catarrhal symptoms, remain
without any abatement till the eruption has all but completed its
course.
MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a
mild, and by no means dangerous, disease: it is sometimes, however,
accompanied or immediately followed by symptoms of a very serious
character, and which, it is to be feared, in many instances, owe their
origin to the carelessness of the attendants in the sick chamber. A
mother's superintendence, therefore, is much required at this time to
insure a careful attention to the medical directions, as also to those
general points of management upon which the well-doing of her child
much depend, of which the following are the most important:--
VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from
the onset of the attack. He must have so much clothing only as will
secure his comfort, avoiding equally too much heat or exposure to cold.
To these points the parent's attention must be particularly directed.
It is the practice with some nurses, in the belief that a breath of
cool air is most pernicious, to keep the child constantly enveloped in
a smothering heap of bed-clothes, with curtains closely drawn, and the
room well heated by fire, by which means the fever and all its
concomitant dangers are greatly augmented. It is equally a popular
error (and yet by many it is still held and acted upon) to suppose that
because in small-pox exposure to cold is useful, that therefore it
must be of equal advantage in measles. It cannot be too generally known
that the nature of the fevers accompanying the two diseases are widely
different, and that the adoption of this error is productive of the
most serious consequences; for it would most likely produce in measles
inflammation of the lungs, which, in truth, is commonly the result of
carelessness upon this point.
The bed-room should be large and airy; free from currents of cold, but
well ventilated, and not hot. The room, also, must be darkened, on
account of the tenderness of the eyes; all noise excluded, and mental
excitement or irritation carefully avoided.
REGIMEN.--Little or no food must be allowed, and whatever is taken must
be of the simplest kind, and in a liquid form. Mild mucilaginous
drinks, and warm, may be given liberally; as barley-water, or thin
gruel, etc.
SPONGING, ETC.--The face, chest, arms, and hands should be sponged
occasionally with vinegar and warm water (one fourth and three
fourths). This will be productive of great comfort to the little
patient; it removes the heat, dryness, and itching of the skin, which
are often very distressing; and is especially useful at night in
relieving wakefulness. If the cough be troublesome, it will be useful
for the child to breathe the steam of warm water; not through an
inhaler, but over a large basin, with the head covered with flannel
large enough to hang over its edges. By this means the tender and
inflamed eyes will at the same time derive advantage from the soothing
effect of the vapour.
CAUTIONS.--Whenever the measles is known to be prevalent in a
neighbourhood, and a child manifests symptoms of cold in the head and
fever, it should at once be a reason for carefulness on the part of the
parent. The diet should be light, cooling, and scanty; and the child
should be carefully kept in doors.
It has been before remarked, that in its ordinary course measles is a
disease unaccompanied with danger, but that the mildest form may be
speedily converted into the most dangerous. That is to say, a sudden
change may lake place in the symptoms, arising out of circumstances
which could not have been foreseen, and therefore unavoidable; or may
be produced by improper management on the part of the nurse, such as
the giving of stimulants, by too much heat, or by exposure to cold. Now
it is for the parent early to notice any change which may occur from
the first source, and by her watchfulness to guard against the
possibility of its arising from either of the second.
In reference to the first, if the child should complain at any period
of the disease of severe headach, with piercing pain through the
temples, and if this is accompanied by wandering of mind, great
increase of suffusion of the eyes, as also intolerance of light, the
immediate attention of the medical man is demanded. So, if towards the
dose of the eruption, that is, from the seventh to the ninth day, the
breathing should again become hurried (this symptom is very generally
present during the height of the eruption, and is not necessarily
connected with disease of the lungs), with pain and oppression felt at
the chest, the cough becoming hacking and incessant, etc. (all symptoms
cognizable by the mother, and indicative of inflammation of the
lungs), no time must be lost in seeking medical aid.
With regard to the last cause (improper management), it may be well,
in reference to it, to observe, that it sometimes happens that the rash
comes out imperfectly, or, having appeared properly, suddenly
retrocedes and disappears; and that under such circumstances the nurse
will almost certainly, if not well watched, give the child "a good
dose of sulphur in diluted spirit, or a glass of punch containing
saffron," which are considered specifics for bringing out the eruption.
Nothing can be more injurious than such remedies, for generally the
disappearance of the rash will be dependent upon the existence of some
internal inflammation, or of too high a fever; for the removal of
which the medical man ought to be instantly applied to. Sometimes,
however, it may be fairly traced to a careless exposure to cold: under
such circumstances the child should be instantly, and without
hesitation, put into the warm bath.
Measles are frequently followed by cough, and deranged bowels; and
there is always great susceptibility about the child for some time. On
this account he should be carefully screened from a cold or damp
atmosphere; the diet should be carefully regulated; and flannel worn
next to the skin. If the cough should continue, it must not be
neglected on the supposition that it will wear off; for it demands the
skilful and careful attention of the medical man.
In conclusion, it may be remarked that very frequently during infancy
and childhood, and particularly during the period of teething,
eruptions very similar in appearance to this disease occur; unless,
however, they are accompanied by the specific fever, and run the
regular course, they may at once be decided upon as not being the
measles.
Sect. VII.--SMALL-POX.
This disease, the most dreaded of all eruptive fevers, is not so
commonly met with in the present day as formerly; thanks to that
Providence which led to the discovery of Jenner. But although its
occurrence is not so frequent, it still does occasionally present
itself; when it will assume either a mild or severe form. If it attack
a child that has not previously been vaccinated, it is called natural
small-pox; and the chances are that the disorder will be severe in
character;--if, on the other hand, it occur in the vaccinated, the
disease will generally be much modified in its symptoms; the attack
will be mild, and without danger.
NATURAL SMALL-POX.--The infection of small-pox having been received
into the system of a child that has not been vaccinated, fourteen days
(on an average) will transpire before the commencement of the febrile
symptoms, or eruptive fever. A distinct rigor or shivering fit then
takes place, accompanied by pain in the back or in the stomach, with
sickness, giddiness, or headach; as also great drowsiness. And if an
infant be the subject of the disease, a convulsive fit will sometimes
take place, or several in succession.
At the end of eight-and-forty hours from the occurrence of the rigor
(in the majority of cases), the eruption comes out; and shows itself
first on the face and neck in minute flea-bite spots. In the course of
the next four-and-twenty hours in some cases, and in others not until
the expiration of two or three days, it completely covers the body; not
being confined exclusively to the skin, but frequently extending to the
mouth and throat, and even to the external membrane of the eye.
In the course of two or three days from their first appearance the
little pimples, increasing in size, will be found to contain a thin
transparent fluid, to pit or become depressed in their centre, and the
skin in the spaces between them will be found red. On the seventh or
eighth day from the commencement of the fever, the fluid contained in
the pimples will be no longer transparent, but opaque; and they will
consequently appear white, or of a light straw colour. Each pimple or
pock will be no longer depressed in its centre, but will become raised
and pointed, being more fully distended by the increased quantity of
fluid within; and the skin around each pock will now be of a bright
crimson. The head, face, hands, and wherever else the eruption shows
itself, gradually swell; and the eyelids are often so much distended as
to close the eyes and produce temporary blindness. There will always at
this time be some degree of fever present, and its amount will vary
with the circumstances of each individual ease. The skin too will be
very tender, so much so sometimes as greatly to harass and distress the
child.
On the eleventh day the swelling and inflam of the skin of the body
and face subside; the pimples upon these parts dry up and form scabs,
which fall off about the fourteenth or fifteenth day. Those on the
hands, as they come out later, commonly continue a short time longer.
The eruption leaves behind, in some cases, the peculiar marks of the
disease; and in others merely discoloured spots, which disappear in the
progress of a short time.
The natural small-pox is sometimes much more severe in its character
than the foregoing, and what is called confluent small-pox is said to
exist. This form will be marked by great constitutional disturbance,
and the eruption coming out earlier than in the milder form; instead of
being distinct, that is, each pimple standing distinct and separate
one from the other, they will coalesce, and appear flat and doughy, not
prominent: they will more particularly run into each other on the face,
where they will form one continuous bag, which soon becoming a sore,
will discharge copiously.
SMALL-POX IN THE VACCINATED.--When small-pox occurs to those that have
been formerly vaccinated, the disease, in almost every instance, is
much altered or modified in its character. Indeed in children, in whom
of course vaccination has been but comparatively lately performed,
small-pox when it occurs will, in the majority of cases, be so mild
that the real nature of the disease will be with difficulty determined:
so mild, that again and again has a parent been heard to exclaim,
"Surely these few scattered pimples cannot be the small-pox!" If,
however, as the pimples progress, they are narrowly watched, and are
seen to become depressed in their centre; if there has been the
precursory rigor, etc.; and if the source of the disorder can be traced
to some case of undoubted small-pox, the child in fact having been
exposed to contagion, no doubt ought to exist in reference to the
nature of such a case, however slight may be the character of the
disease.
The usual progress, however, of small-pox modified by vaccination is
as follows. The first stage is the same usually as in the natural form
of the disease. As soon, however, as the eruption appears, the
modifying power of the vaccination becomes apparent. The eruption will
be found to be generally both less in quantity and more limited in its
extent; or if even it should come out profusely, and cover a large
extent of the surface of the body, still the controuling power of the
vaccination will immediately show itself after its appearance,--first,
in the complete subsidence of all the febrile symptoms which will now
take place; and, secondly, in reference to the eruption, part of which
will die away at once, and the remainder will by the fifth day be
filled with the opaque yellowish fluid, then dry up, becoming hard and
horny, and falling off will leave a mottled red appearance of the skin,
and now and then slight pitting.
Such is the usual progress of the disease: subsequent to vaccination,
it is a mild and tractable disorder. It is right, however, to mention
that small-pox has occurred even to the vaccinated in almost as severe
a form as the confluent natural small-pox, and running its regular
course unaltered or unmodified. Such instances, however, are extremely
rare, and form the exceptions to the general rule; for "no reasonable
doubt can be entertained, from the abundance of facts now before the
world, that such modification is the law of the animal economy, and
that the regular or natural progress is the exception."
MATERNAL MANAGEMENT.--The grand principle in the treatment of small-pox
is to moderate and keep under the fever; and however the plans adopted
by different medical men may vary in particular points to accomplish
this purpose, they uniformly make this principle their chief aim and
object. To carry out this intention, however, the medical adviser is
greatly dependent upon the aid and assistance of a judicious parent,
and without this it is impossible to hope for a successful issue to
the case. A clear knowledge, therefore, of those points of general
management in which in fact a great part of the above principle
consists (few and simple as these directions are), it must be
all-important for the mother to be acquainted with: for the rest,
she must and ought to look to the medical man.
In the more rare and severe form of this disease, viz. the confluent
small-pox, although in some instances it runs the same course as the
milder form, the distinct or natural small-pox, still, usually, the
constitutional symptoms are much more aggravated, and the medical and
general treatment required will so much depend upon the character of
the individual case, that we do not think it well to notice it here.
BED AND BED-ROOM.--It will not be necessary at first for the child to
be confined to his bed, but generally about the third or fourth day he
will gladly resort to it; and if he does not, it will be prudent to
keep him there. He must not, however, be loaded with bed-clothes, but
lightly covered; and the bed and body linen should be changed daily, if
possible.
The bed-room should be capacious and well ventilated; fresh air
frequently admitted; and if the season of the year permit, and there is
no dampness of atmosphere, a window should be constantly open during
the day: it is also desirable to keep the chamber darkened in all
cases, as there is always a tendency to inflammation of the eyes.
If these directions are not regarded, and a great heat of the
apartment is permitted, with abundance of bed-clothes heaped upon the
child, the hot bath is used, and hot and stimulating regimen given
(upon the old and erroneous notion of bringing out the eruption), the
mildest case will inevitably be converted into one of the most severe
and dangerous. Facts have abundantly shown that such measures
invariably prove the most effectual means of exasperating the disease,
and endangering life.
REGIMEN.--This must be most sparing. Cold water may be given whenever
the child asks for it. Lemonade should form the common drink during the
fever; and gruel, barley-water, and roasted apples are all else that is
required during this period, and not until the disease is going off
must any change be made in the diet.
The above period having arrived, mildly nutritious food should be
given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or
sago; to be followed in a few days by the wing of a chicken or a mutton
chop; remembering always, that solid animal food must at first be given
cautiously and sparingly. Wine or stimulants must be positively
forbidden; unless, indeed, ordered by the medical man, for
circumstances may arise which render them advisable.
The state of the bowels must be carefully attended to at this time.
THE ERUPTION.--In the natural and mild form of this disorder the
pustules generally break from the sixth to the eighth day; dry scabs
succeed; and in about nine or ten days the parts heal perfectly,
requiring no treatment. In the more aggravated cases, however, in which
the pustules are very numerous, running one into the other, and,
bursting, discharge greatly, the whole surface of the body should be
frequently and liberally dusted over with dried flour, or, what is
better, starch powder. The sores in this instance are always tedious in
healing, and followed by the well-known pits or marks: these arise from
a loss of substance in the true skin, and occur more particularly on
the face, from the great vascularity of this part causing the pustules
to be more numerous here than elsewhere. It is a popular error to
suppose that by wearing masks of fine linen or cambric illined with
particular ointments, these scars or pits may be prevented: it is
impossible to prevent them; and any local application, except a little
cold cream or oil of almonds applied to the scabs when they harden,
will prove more injurious than useful. The child's hands, however,
should always be muffled to prevent its scratching or breaking the
sores, for otherwise he will not be kept from thus attempting to allay
the excessive itching which they occasion.
The hair should be closely cut at an early period of the disease, and
so kept throughout its continuance. This will contribute very much to
the comfort of the child, by preventing the hair becoming matted
together with the discharge from the pustules when they break, which
gives rise to great pain and irritation. In the confluent and worst
forms of this disease, this measure it is particularly necessary to
attend to, as also to the application of cold lotions to the head when
hot and dry (with other remedial means), as there is always a tendency
in these cases to the formation of abscesses, the healing of which is
troublesome and attended with difficulty.
CAUTIONS, ETC.--It has already been stated that a free ventilation of
the bed-room is necessary to the well-doing of the patient. This
measure, however, must not be confined to the chamber of the sick, but
acted upon through the whole house.
In conjunction with ventilation, fumigations by means of aromatic
substances kept slowly burning should be resorted to. A solution of the
chloride of lime too, a most powerful disinfectant, should be used to
purify the different apartments. This is best accomplished by steeping
in the solution pieces of linen, and hanging them about the rooms, as
also frequently and freely sprinkling the walls themselves; and as soon
as the invalid is removed, the chamber should be white-washed, the
various articles of furniture well scoured with soap and water, and the
room be well and freely ventilated prior to its being again occupied.