removed, and when taken away immediately immersed in boiling water, and
whilst hung up in the open air sprinkled occasionally with a weak
solution of the chloride of lime. If these directions are not observed,
and the clothes are closely wrapped up, they will retain and give out
the disease to others at a great distance of time.
Again: as the contagious property of smallpox hangs about the child as
long as any scabs remain (which indeed may be said to retain the poison
in its concentrated form), a parent must be most careful that the
invalid is not too early brought in contact with the healthy members of
the family.
An observance of these precautions is imperatively demanded; they not
only protect the healthy, but aid the infected.
Sect. VIII.--HOOPING-COUGH.
My chief inducement to notice the above disorder arises out of the
well-known fact, that there is no complaint of childhood more
frequently subjected to quackery and mismanagement than is this.
Indeed, there are few maladies against which a greater array and
variety of means have been recommended, than against hooping-cough.
I suppose from the circumstance of the simple and mild form of the
complaint being so tractable (provided it remain such) that the
simplest and mildest measures effect its cure, parents are tempted to
undertake its management in the more severe and complicated forms; and
the result is but too often the establishment of disease dangerous to
life, and sometimes fatal to it.
But although most imprudent for a parent to assume the office of the
physician, her aid is essentially necessary in carrying out the
measures prescribed. By her watchfulness and care the duration of the
disease may not only be abridged, but, what is of much greater
importance, a more serious and aggravated form of disease prevented;
for although hooping-cough in itself is not a dangerous disorder, still
the most simple and slight case, if neglected or mismanaged, may
quickly be converted into one both complicated and dangerous.
DESCRIPTION OF THE DISEASE.--Hooping-cough commences with the symptoms
of a common cold, which is more or less frequent. These symptoms
continue from five days to fifteen; at the end of which time the cough
changes its character, and assumes the convulsive form, which
distinguishes the disorder. It occurs in paroxysms, varying with the
severity of the disease from five to six in the twenty-four hours to
one every ten or fifteen minutes; being generally more severe and
frequent during the night than in the day.
During a paroxysm the expirations are made with such violence, and
repeated in such quick succession, that the child cannot breathe, and
seems in danger of suffocation. The face and neck become swollen and
purple from suffusion; and the eyes prominent, injected, arid full of
tears. The little one, with a forewarning of the attack, which it
dreads, falls on his knees, or clings closely to any thing near him.
The paroxysm terminates with one or two long inspirations, attended
with that peculiar noise, or "whoop," from which the disease has
derived its designation.
Sometimes the fit of coughing is interrupted for a minute or two, so
that a little rest is obtained; and is then succeeded by another fit
of coughing and another hoop, until after a succession of these actions
the paroxysm terminates by vomiting, or a discharge of mucus from the
lungs, or both.
The disease having continued at its height for two or three weeks, it
begins naturally to decline; the paroxysms become less frequent and
violent; the expectoration increases; the cough loses its
characteristic hoop, and gradually wears away altogether; until at
length, in two or three months from the first onset of the disease, the
child is restored to perfect health. Sometimes, however, particularly
in the autumn, and at other seasons on the occurrence of easterly
winds, the paroxysms of cough will return,--it will assume its
spasmodic character, and be accompanied with the "whoop," after a
month, or even two or three months, of perfect and apparent recovery.
Errors in diet will sometimes alone have a similar effect.
It is a disease which usually occurs during childhood, rarely affects
the same individual twice, and is seldom seen in the very young infant.
In reference to the probable result of the disease, when it occurs in
its mild and simple form in a healthy child, the termination is usually
favourable; but it may at first assume this form, and afterwards become
complicated, and consequently more or less dangerous, owing to
injudicious management, or to various influences over which the mother
has no control.
It generally appears as an epidemic, and at those seasons when
catarrhal complaints are most prevalent, and affects many or several at
the same time. Isolated cases, however, frequently occur, which seem to
prove the disease to be infectious. Some persons deny that it is so.
Mothers and nurses, however, who have not had the disease, will often
contract it from the child under such circumstances, and thus it will
be quickly propagated through the family. The nursing mother will
occasionally take it from the infant at her breast. The child who has
caught it from others whilst at school, and brought home in
consequence, will communicate it readily to his brothers and sisters,
although the disease did not exist previously in the family or
neighbourhood, and was brought from a distant part of the country. All
these instances are surely proofs of its infectious character, and
point out the necessity of caution whenever hooping-cough may present
itself in a family, and the necessity which exists for an early removal
of the unaffected children from the sphere of its contagious influence.
The infectious property diminishes as the disease declines.
MATERNAL MANAGEMENT.--In the mild and simple form of this disease the
medical treatment is one rather of prevention than cure, and the
maternal management consists in assisting, by watchfulness and care,
the fulfilment of this design.
In these slighter cases little more is required of the mother during
the Jirst stage of the disorder (that is, before the cough becomes
spasmodic) than attention to diet, regimen, and the excretions. The
diet should be farinaceous, with milk, or as may be otherwise directed.
The child must be confined to a mild equable temperature; in fact, to
his apartment. It is a popular error to suppose that at this time
change of air is beneficial to the disease: at a later period it
certainly is so, but now injurious, and attended with great risk.
Should the weather be cold, the little patient must be warmly clad, and
flannel worn next the skin; this latter precaution should always be
taken in the winter, spring, and autumn. Purgatives and other medicines
will be required, and ordered by the medical attendant; the chief
attention, however, of the parent must be directed to any change she
may observe in the symptoms, breathing, etc.; she must be all on the
alert to notice the first signs of local inflammation. Of this,
however, we shall speak presently.
During the early part of the second stage, that is, when the cough
becomes spasmodic, assuming its peculiar sound, the same diet and
regimen must be continued, and the same watchfulness observed, lest
any inflammatory symptoms manifest themselves.
Under the foregoing treatment the disease generally runs its course
without any untoward event, and the child recovers perfectly.
Sometimes, however, although the patient is quite well, and the disease
on the decline, the cough still continues. In these cases, and at this
time, it is that change of air often proves so very serviceable. The
sea-side is preferable, if the season of the year permit; and salt-
water bathing, commencing with the warm or tepid bath, and passing
gradually to the cold-bath (if no complication forbid it), will also
prove certainly and rapidly remedial.
Crying, mental irritation, or opposition, frequently bring on a fit;
and even the sight of another in a paroxysm will induce it in those
affected by the disease. Running or other active exercise will
generally cause the fits to be more severe. Young children, too, must
be carefully watched at night, and be raised up by the nurse as soon as
the fit is threatened. These hints the mother should bear in mind.
So much for the simple form of the disease, and that in which it most
frequently and commonly presents itself to our notice: a mild disease;
and, if carefully managed and watched over, certainly not a dangerous
one.
Of what, then, is a parent to be afraid, or against what is she to
guard? Lest other disease insidiously come on, and advance to an
irremediable degree, masked by the cough, without attracting her
attention. This is the great source of danger in hooping-cough. The
physician, in a case of simple hooping-cough, is not in daily
attendance upon his patient, and therefore not present to notice the
commencement or first symptoms of those diseases which so frequently
occur at this time, and the successful treatment of which will mainly
depend upon their early detection, and the decision with which they are
treated. When you hear of a child or several children in a family dying
of hooping-cough, it is not this disease which proves fatal; but death
is caused by some disease of lungs or brain, which has been super-added
to the hooping-cough. The progress of hooping-cough, then, must be
closely attended to by the parent, even in the most favourable cases.
The most frequent complication with hooping-cough is inflammation of
the air-tubes of the lungs. This is extremely frequent during spring
and winter, especially in the months of February, March, and April,
owing to the prevalence of easterly winds at this season. It is not my
intention to detail the symptoms of this affection, only to point out
those which will enable a parent to recognise its approach. A parent
then may take warning, and fear the approach of mischief, when she
observes the fits of coughing become more frequent and more distressing
to the child, and the breathing hurried in the intervals of the
paroxysm; when any exertion or speaking causes increased difficulty of
breathing or panting; when the expectoration becomes less abundant, and
difficult to get up; when there is no longer, or at all events less
frequent, vomiting after the cough, and more or less febrile symptoms
present.
If the lungs themselves are attacked by inflammation, most of the
symptoms already pointed out will occur; the cough will be frequent,
in short paroxysms; the vomiting will not take place; the breathing
will be very quick and hurried; and as the disease advances the hoop
will cease.
If hooping-cough attack a child whilst teething, or from six months to
two or three years of age, it is very common for the brain to suffer,
and convulsions and water on the head to occur, particularly if the
latter disease prevails in the family. Whenever the paroxysm of cough
is increased in violence, the characteristic hoop disappearing, and the
face becomes very livid; the hands clenched, and the thumbs drawn into
the palms; the head hot, and marked fits of drowsiness and languor; and
the child, during sleep, screaming out, or grinding its teeth,--
something wrong about the head ought to be anticipated. Of the
treatment we have here nothing to say, except that the gums must be
carefully examined, and scarified if they require it, and the
temperature of the head reduced by cold sponging, or the application of
a bag of ice when necessary. The chief duty, however, of the parent is
to be alive to these symptoms, and early to detect the incipient
mischief, that by a prompt application of efficient means the accession
of so formidable a malady may be prevented.
To specific remedies for this disease it is scarcely necessary to
allude, after what has been advanced, except by way of warning. In the
simple form of the complaint such medicines are superfluous, or rather
some of them, from their violent properties, most dangerous; in the
complicated forms of the disease they are inadmissible.
The indiscriminate use of purgatives, also, a parent should avoid.
Bowel affections are not an infrequent attendant upon hooping-cough,
and always aggravate the primary disorder.
Of external applications all that need be said is this, that if they
are not violently stimulating they do no harm; if, however, they
contain tartar emetic, in addition to their doing no good to the
disease, they cause unnecessary suffering to the patient, and are
sometimes productive of dangerous and even fatal sores.
Sect. IX.--CROUP.
This disease is one of the most formidable of childhood; sudden
(generally) in its attacks, most active in its progress, and if not
met by a prompt and decided treatment, fatal in its termination. Hence
the paramount importance of parents being acquainted with the signs
which indicate its approach, that medical aid may be secured at the
very onset of the disease. Upon this early application of suitable
remedies every thing depends.
SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either
preceded for two or three days by the symptoms of a common cold,
accompanied with hoarseness and a rough cough; or it may attack with
the most alarming suddenness, during the night for instance, although
the child had been merry and well the previous evening.
Hoarseness, however, is the premonitory and important symptom of
croup; for although it is not every hoarseness that is followed by
this formidable malady, still this symptom rarely attends a common cold
in young children, and therefore always deserves when present the
serious attention of the mother, particularly if accompanied by a rough
cough.
The symptoms or signs of the approach of this disease have been ably
and graphically depicted by the late Dr. Cheyne,
"In the approach of an attack of croup, which almost always takes
place in the evening, probably of a day during which the child has been
exposed to the weather, and often after catarrhal symptoms have existed
for several days, he may be observed to be excited; in variable
spirits; more ready than usual to laugh or to cry; a little flushed;
occasionally coughing, the sound of the cough being rough, like that
which attends the catarrhal stage of the measles. More generally,
however, the patient has been for some time in bed and asleep before
the nature of the disease with which he is threatened is apparent;
then, perhaps without awaking, he gives a very unusual cough, well
known to any one who has witnessed an attack of the croup: it rings as
if the child had coughed through a brazen trumpet; it is truly a tussis
clangosa; it penetrates the walls and floors of the apartment, and
startles the experienced mother--'Oh, I am afraid our child is taking
the croup!' She runs to the nursery, finds her child sleeping softly,
and hopes she may be mistaken. But remaining to tend him, before long
the ringing cough, a single cough, is repeated again and again. The
patient is roused, and then a new symptom is remarked: the sound of his
voice is changed; puling, and as if the throat were swelled, it
corresponds with the cough; the cough is succeeded by a sonorous
inspiration, not unlike the kink in hooping-cough--a crowing noise, not
so shrill, but similar to the sound emitted by a chicken in the pip
(which in some parts of Scotland is called the roup, hence probably the
word croup); the breathing, hitherto inaudible and natural, now becomes
audible, and a little slower than common, as if the breath were forced
through a narrow tube; and this is more remarkable as the disease
advances," etc. etc.
It is unnecessary for me to add to the foregoing picture.
MATERNAL MANAGEMENT.--Having early obtained medical assistance attend
with the strictest obedience to the directions given. And in this
disease, more than any other, it is particularly important that the
mother should give her personal superintendence; for the activity of
the progress of the disease leaves no time to retrieve errors or atone
for neglect. The practitioner may be prompt and decided in the measures
he prescribes, but they will avail little, unless they are as promptly
and decidedly acted upon.
The parent will have her reward; for, if timely aid has been afforded,
and adequate means used, the event will be almost invariably favourable.
ITS PREVENTION.--Croup, when it has once attacked a child, is very
liable to recur at any period before the thirteenth or fourteenth year
of age. It may even do so several times, and after intervals of various
duration. It is very desirable, therefore, that a parent should be
acquainted with the means of prevention.
They consist simply in the following measures:--The careful protection
of the child from cold or damp weather, particularly the north-east
winds of spring following heavy rains. Croup is most prevalent in those
seasons which are cold and moist, or when the alternations of
temperature are sudden and remarkable. If the residence of the child is
favourable to the production of croup, (for instance, near a large body
of water, or in low damp spots,) he should, if possible, be removed to
a healthier situation. Sponging or the shower-bath, with cold water and
bay-salt, with considerable friction in drying the body, should be
commenced in summer, and employed every morning upon the child's rising
from bed. The clothing should be warm in the winter and spring, the
neck always covered, and flannel worn next the skin throughout the
year; but hot rooms, and much clothing when in bed, must be avoided.
The diet must be light and nourishing; no beer or stimulant given; and
the state of the bowels must be carefully watched.
The above precautions are of course particularly necessary to enforce
immediately after a recovery from an attack, for there is a great
tendency to relapse. If the attack takes place during the winter or
spring months, the invalid must be kept, until milder weather, in the
house, and in a room of an equable and moderately warm temperature. If
in the summer, change of air, as soon as it can be safely effected,
will be found very useful.
Sect. X.--WATER IN THE HEAD.
Water in the head is a formidable disease, and not unfrequent in its
occurrence. It is often destructive to life, and the instances are
numerous in which it has appeared again and again in the same family,
carrying off one child after another, as they have successively arrived
at the same age.
But notwithstanding its frequency and fearful character, a mother may
do much to overcome a constitutional predisposition to this disease,
and thus prevent its appearance; as also she may assist greatly in
promoting its cure, when it does occur. Hence it is most important that
a mother should be acquainted with the measures of prevention; and
also, when it does manifest itself, that clear and accurate information
should be possessed, upon what may be said to constitute the maternal
management of the disorder.
ITS PREVENTION.--Whenever there is found to exist in a family a
predisposition to this malady, one or more children having suffered
from it, a mother must make up her mind, and in the strictest sense of
the word, to be the guardian of the health of any child she may
subsequently give birth to. And not only during the period of infancy,
but during that of childhood also, must she continue the same careful
and vigilant superintendence.
The infant must be brought up on the breast, and if the mother is not
of a decidedly healthy and robust constitution, she must obtain a
wet-nurse possessing such qualifications. The breast-milk, and nothing
beside, must form the nutriment of the child for at least nine months;
and if the infant is delicate or strumous, it will be prudent to
continue it even six months longer. When the period arrives for the
substitution of artificial food, it must be carefully selected; it must
be appropriate to the advancing age of the child; nutritious and
unirritating. Good air and daily exercise, and the bath or sponging,
are of much importance; in short, all those general measures which have
a tendency to promote and maintain the tone and general health of the
system, and thus induce a vigorous and healthy constitution, and to
which reference has been so fully made in the first chapter of this
work, must be strictly regarded and followed out by the parent.
The condition of the digestive organs must be the mother's especial
care. Costiveness must be guarded against; and if at any time the
secretions from the bowels indicate the presence of derangement, the
medical attendant must be applied to, that appropriate remedies may
without delay be exhibited. Their disordered condition is frequently
productive of head-disease. Again and again have I clearly traced the
origin of the complaint, of which I am now writing, as more
immediately resulting from disorder of the digestive apparatus. To a
child thus predisposed to water in the head, the healthy state of these
organs is not only of first consequence, but any deviation from health
to be dreaded, to be immediately attended to, and guarded against in
future; and, as there is a great liability to these attacks at the time
of weaning, the above remarks especially apply to that period, when due
attention must be particularly paid to the plan of diet adopted.
During teething the mother must be especially watchful, for it is at
this time that the disease so commonly appears; the irritation produced
by this process being a frequent exciting cause. Every thing,
therefore, that will tend to allay excitement of the system, must be
strictly enforced, as well as all causes avoided, which would produce
derangement of the stomach and bowels. The head should be kept cool.
For this purpose it must be sponged night and morning throughout the
whole period of teething; a horse-hair pillow used in the cot; and
nothing but a light straw hat should be worn, except in winter, The
diet should be moderate, and carefully regulated after leaving the
breast, and the child should be as much as possible in the open air.
The mouth must be occasionally examined, and if the gums become hot or
distended, they must be scarified or lanced, as may be advised. If the
parent finds at any time an unusual heat about the head, the medical
man must be at once consulted; or if there is watchfulness or
indisposition to sleep at the proper periods, or frequent startings in
the sleep, irritability of temper, and much crying, danger should be
apprehended, and prompt and judicious means employed.