DISEASES PECULIAR TO CHILDREN—CONTINUED.
(_a_) INDIGESTION in very young children is generally accompanied
with diarrhœa, because that portion of the child’s food which is not
thrown up or digested passes along the intestinal canal and acting as
an irritant causes diarrhœa. An indigestion of only a short period of
duration excites a catarrhal inflammation of the mucous membrane of the
stomach, and this may be so slight that even a change or correction in
the diet may be all that is required to relieve it. Children who are
suffering from indigestion have stomach ache; this may be continuous
or come on half an hour or an hour after nursing. The pain is due to
the irritation caused by the nutriment or to the fermentation of the
food and the consequent accumulation of gas within the stomach. The
stomach becomes distended and sensitive to pressure. When the catarrh
is severe the nutriment that the child takes into the stomach is
immediately rejected or it may vomit glairy or greenish mucus from an
empty stomach. At first the nutrition of the child may not be greatly
interfered with, for some of the food is retained and digested in the
small intestines, but in the course of time these too become irritated
and then diarrhœa complicates the case and the child falls off and
becomes rapidly emaciated. Children who are nourished from their
mother’s breasts rarely suffer from indigestion, but those who are
fed on artificial foods become victims of stomach and bowel troubles.
And for this reason it is natural to suppose that the chief reliance
for a successful treatment is to regulate and study the diet of the
sufferer; the chapter that is especially devoted to this subject should
be consulted for further information.
(_b_) Diarrhœa is a derangement of the stools in which they loose their
semi-solid, pap-like consistence and become watery liquid alone, or
watery liquid in which indigested particles of food and fecal matter
remain suspended. The quantity of alvine matter that is evacuated
greatly exceeds that which passes in the normal state. The stools have
an alkaline or acrid nature which irritates and often inflames the anus
and the surrounding integument. “The normal form of the infantile feces
in the first year of life is the pappy; the color is yellow like that
of the yolk of egg; the smell is feebly acid, never putrid, and only in
children who are fed upon a meat diet as repulsively pungent as in the
adult; in later years they are no longer distinguished from the adult.”
The passages of diarrhœa may be simply softer, but yellowish and
increased in quantity, or they may be bright yellow and so watery as to
squeeze out from the anus as from a syringe and soak through diapers
and bedclothes, or the stools may be green, or bilious, and slimy.
When children teethe they often have a diarrhœa for several days; this
intestinal derangement has no connection with improper feeding, yet it
requires to be watched lest it become serious and uncontrollable. There
is still another kind of diarrhœa which is foamy and contains large
quantities of mucus and little or no coloring matter. For the different
varieties one and the same remedy will answer, and that which I here
submit has never disappointed my expectation:—
Take: Subnitrate of Bismuth 1 dram
Powdered Kino 16 grains
Rubbed thoroughly with Glycerine 1 dram
Paregoric. 2 drams
Chalk Mixture, sufficient to make 2 ounces
Shake the mixture thoroughly before using, and the dose can be
regulated between ten drops for an infant to a teaspoonful for a child
three or four years old.
(_c_) Dysentery or Flux is an inflammation of the mucous membrane of
the large intestine, or colon, extending down to the rectum. Children
under one year of age are not as liable to this affection as those who
are older, and it is during their first dentition that the affection
shows itself. In hot summer months, at the season of unripe fruits,
the disease often becomes epidemic. The loss of strength and flesh is
very rapid, and when children do not perish during the first few days
of their sickness, they may succumb later when the disease has assumed
a chronic form. Dysentery is extremely liable to become complicated
with pneumonia, anæmia, pyæmia, perforations and strictures of the
intestines, jaundice and abscess of the liver, and in proportion that
these complications become developed life becomes seriously threatened.
The symptoms of dysentery are striking and can hardly be mistaken for
anything else. There is always pain over the abdomen, but on touching
the abdomen near the navel and over the course of the colon the pain is
greater than elsewhere.
Tenesmus is a characteristic symptom of dysentery. This is a straining
sensation as if the bowels wanted to move, yet notwithstanding the
violent bearing down, only a little mucus often streaked with pus or
blood is discharged. The straining causes the lower folds of the rectum
to protrude, and this portion of the bowel presents a livid red color;
the sufferer is tormented a great deal by this fruitless bearing down,
and the bowels should be anointed with pure zinc ointment and returned.
The stools of the child are characteristic of this disease. Every
passage contains glairy mucus formed into lumps resembling granules of
boiled starch, streaked with blood and associated with a creamy looking
substance which is purulent matter. If the disease has progressed to
the formation of ulcers the evacuations become grayish red or assume a
dirty ashen color, and the odor is putrescent. Portions of the mucous
membrane slough off and large quantities of pus are discharged from the
ulcerating surfaces so that the stools present sometimes nothing but
purulent and bloody matter.
The treatment for this disease must be prompt and directed to the
point; reliance must not be placed upon one single remedy, but a
combination of expedients must be resorted to.
The greatest annoyance and source of pain is the straining and
tenesmus, and to relieve this steps must at once be taken. There is
hardly any use to give injections for this purpose for the irritable
condition of the rectum makes it impossible for the child to retain
them long enough to do any good. Use suppositories instead, and if need
be, retain them by holding a soft compress of cloth over the anus, for
ten to fifteen minutes until they are dissolved. For example, to a
child one year old I employ the following suppository:—
Take: Laudanum 1 drop
Cocaine 1/30 grain
Bismuth Subnitrate 10 grains
Cocoa Butter 10 grains
Make into one long suppository and roll in powdered bismuth, dip it
first into oil or vaseline and insert into the rectum every three or
four hours until the soreness and straining have subsided. If the child
is not very sensitive nor very ill an injection of a teaspoonful of
boiled liquid starch to which a few drops of laudanum have been added,
may be used instead and as often as may be necessary. Cold drinks
aggravate the pains, therefore give everything warm.
Cow’s milk should be dispensed with in artificially fed children,
and broths substituted to which a portion of a fresh egg is added,
previously thoroughly beaten with an egg beater; in very young
children the yolk alone should be used. A little whisky is always
good for this class of patients, either in their broth, or given as
a toddy in teaspoonful doses for the children are generally always
thirsty and feverish. When children lose their appetites and refuse
nourishment they must be coaxed and even forced to take food at regular
intervals, otherwise they cannot rally and will perish from inanition.
The medicine that I recommended for diarrhœa is also very useful for
dysentery.
(_d_) Colic is the result of an abnormal accumulation of gas,
_flatulency_, in the small intestine. There is always more or less
gas in both stomach and bowels, but usually this passes off and there
is no pain felt from it. It is when the quantity increases so as to
distend the bowels that the walls of the intestines become the seat
of pain. The pain comes on in paroxysms, or fits at short intervals,
and increasing in violence. Children suffering from colic have the
abdomen swollen or bloated, giving rise to that condition termed
meteorismus or tympanites. Those who are under one year old are the
most liable to colicky pains, for it is during this period of life that
digestive disturbances are the most frequent, and these constitute the
chief cause. Whenever the vermicular motion of the intestines becomes
lessened or suspended, the gas is not expelled from the anus, and the
accumulation causes the characteristic pains under consideration. In
perfectly healthy digestion there is always more or less gas developed,
and even then there may be colicky pains. The same pains originate
with every diarrhœa that is due to improper food or feeding, and in
dysentery too they are generally present. Infants who nurse at their
mother’s breasts are less liable, but not altogether exempt, for
mothers’ milk is very sensitive to impressions of purely physical
exertions, or to emotions of fear or fright, thus her milk may become
unhealthy for her child; or through her own digestion, suffering from
temporary or permanent derangement, her milk may transmit a similar
condition to her child; the mother may have eaten green fruit, or too
much of a variety, or it may be too highly seasoned, or too fatty. Many
mothers and nurses look upon the colic cry as a hunger cry, and hasten
to feed the little one, and sometimes a few teaspoonfuls of milk or
broth will relieve the cry for a few minutes, then the pain returns
severer than ever, and the baby cries louder than ever. I have seen
very nervous children thrown into convulsions from severe colicky pains.
My rule has been for years to nurse infants for the first two months
not oftener than once in two hours; after that until they are six
months old, every three hours, and from six to twelve months every
four hours; between times the babies cry, of course, not because they
are hungry, but because they have either pain or are thirsty. The old
German household remedy for this is _fennel seed tea_; there is nothing
as useful; it expels the gas and it quenches the thirst from which
colicky children suffer, at least while they have the colic. This tea
should be given regularly between times, and until they are twelve or
fifteen months old; it is soothing, and what is of equal importance, it
prevents overfeeding, which is the bane of artificially-fed children.
The latter, bottle-fed babies, are all more or less colicky, and for
these the fennel seed tea, between bottle time is indeed a balm. If
the fennel seed tea does not relieve the child at once, or if the pain
seems severe, then add a few drops of paregoric to the fennel seed tea,
and give an injection of German chamomile tea, rubbing the bowels at
the same time with a mixture of turpentine and sweet oil, and I believe
that every case will be relieved. Permanent relief must be sought in
ferreting out the cause and removing it. This may be due to improper
food, or feeding, to indigestible contents in the stomach or bowels,
and indeed, very often to constipation. When the stomach is overloaded,
a dose of syrup of ipecac may give relief, and if due to constipation,
the Femina laxative syrup is the most appropriate remedy.
(_e_) Convulsions, or spasms in children have long been well known to
the laity, and from their frequent occurrence they make an important
class of children’s diseases. If there is one thing more frightful to
behold than another, to the young and inexperienced mother, it is to
see her baby’s eyes unsteadily rolling, or turned up so as to show
only the white of the eyeballs, or may be the eyes steadily fixed in
a stare while the child becomes completely unconscious. A painful
smile may play over its face, or an expression of fear or anger may
distort the facial expression, while the muscles of the face twitch
convulsively. The jaws are sometimes set, then again there is gnashing
of the teeth, alternating with relaxation of muscles and ligaments.
The child cannot swallow, and fluids poured into the mouth flow out
again. The other muscles of the body also participate in the spasmodic
contractions; those of the back contract and relax, and those of the
extremities are involved in lively twitchings, or perform acts of
thrashing, striking or twisting. The breathing becomes very irregular,
and from the spasms of the muscles of the larynx or throat it may
become entirely suspended, and if the spasm does not subside in two or
three minutes the child may die. The skin becomes livid or congested
and loses its sensibility so that blisters or irritants make no painful
impression. Sometimes the child bleeds from the nose or mouth; the
latter is generally due to the tongue having been caught between the
teeth during the paroxysm. Frothy saliva wells up from the mouth and
the urine and stools are involuntarily discharged.
All convulsive attacks have not every symptom above enumerated, some of
them are usually absent and an attack may be quite mild, and last only
a few moments; if convulsions last longer they are not only dangerous,
but indicate serious disease, either of the brain or in which the brain
or spinal cord is seriously complicated.
The period of the child’s life at which convulsions are most frequent
is from the time they are born up to the completion of the first
dentition. Nervous children who had convulsions while they were
teething are susceptible to violent attacks at the commencement of
various diseases or during the developmental stage of the eruptive
fevers. Perhaps the most frequent cause of convulsions in children is
the eruption of teeth. The irritation which a growing tooth causes in
the gums also irritates its nerve and this irritability is reflected
on the brain, and this causes the spasm. An overloaded stomach, worms
and digestive disturbances that accompany teething irritate the bowels
and from this too convulsions ensue. The treatment for convulsions
naturally resolves itself into first giving instant relief during the
paroxysm, and secondly, finding out the cause of the attack. The latter
is not always easy at first sight, and as the cause may be serious
a competent physician should be sent for. But instructions that are
serviceable while the convulsion is on are of the greatest importance
to mother and child. The old and familiar remedy of giving the child a
hot bath as soon as possible is certainly the best thing that can be
done. The child should be undressed as quickly as possible so as to
relieve it from all constriction and so that nothing can interfere with
the respiration and circulation.
A towel wrung out of cold water should be placed over the child’s head
and its body immersed in hot water that is not so hot as to scald; the
hands on which the child is supported while in the water must be well
able to stand the heat. When the spasm has subsided, the child should
be transferred to a previously warmed woolen blanket in which it is to
be wrapped with its head softly elevated. If the bowels are constipated
an enema of warm water and a little castile soap should be administered.
(_f_) Worms of different species infest the human organism; they get
into the system from the outside world, with the food we eat and drink.
Their abiding place seems to be the mucous membrane of the intestinal
canal with the exception of the _trichinæ_ which penetrate the mucous
membrane and make their way to the different muscles throughout the
body; the voluntary muscles seem to be their permanent dwelling place.
These parasites are peculiar to the meat of the hog and as very young
children do not eat this meat, they are so far totally exempt from
them.
Tapeworms are rarely found in children under one year of age; it is
when they get older and especially when they eat hog’s meat, for this
too is the home of the embryo tapeworm, that they become infected.
The roundworm, however, is peculiar to childhood. It is a yellowish
or whitish worm resembling the earthworm, from one to twelve inches
in length. The body is round, tapering toward each extremity. This
worm inhabits the small intestine, but by acts of vomiting they are
frequently ejected from the mouth or they may find their way into other
cavities. On the Pacific slope these worms are not as frequently met
with as on the other side of the Rockies. It is propagated by _ova_ and
taken into the system by means of drinking water containing them. The
number varies greatly in different cases; sometimes there are only a
few and again there may be dozens or hundreds coiled together so as to
form balls or masses. They are most common between the ages of three
and ten years. I do not believe that they ever exist in early infancy.
The symptoms denoting the presence of these parasites are on the whole
obscure and depend somewhat on the temperament of the individual.
A nervous child may be thrown into fits or convulsions from them.
My first case of these worms in a child seven years old was rather
exceptional and remarkable. The child was suddenly taken with a severe
attack of spasmodic croup, for which I prescribed remedies without much
relief. After the second day the child passed five large roundworms,
the croup subsided, and while I claimed no credit that my remedies did
not cure the croup it was generally conceded that they killed the worms.
The usual symptoms are colic pains, impaired appetite, diarrhœa,
itching of the nose, swollen abdomen, puffy features, offensive odor of
breath, dreaming sleep and grinding the teeth during sleep or twitching
of the muscles.
The expulsion of the parasite is generally effected with simple
remedies. Five to ten drops of spirits of turpentine in half to one
tablespoonful of castor oil is a reliable remedy. The oil of wormseed
is another convenient remedy in the same dose on a lump of sugar or
mixed with oil; a cupful of tansy tea early three or four mornings
on an empty stomach serves a useful purpose; pinkroot and senna
administered as a tea has also a well-deserved popularity.
The thread, pin, spring or mawworm inhabits the large intestine
and chiefly the rectum. It is a thin yellowish-white parasite from
one-twelfth to one-third inch in length; the female has a straight,
awl-like, pointed tail, the male has a strongly curved tail. It rarely,
if ever, enters the small intestines. The worms occur chiefly in young
children, but there is no period of life that is exempt from them. They
cause pain and an itching sensation at the anus. This is particularly
troublesome when the children lie in warm beds. The sexual organs are
apt to become excited from the irritation and the habit of masturbation
be thus formed. In girls the worms may travel into the vagina and
leucorrhœa in children is often accounted for in this way; around the
anus there may be pimply redness.
From the loss of appetite and sleep the general health of the child
may become impaired; but the only possible evidence of the presence
of worms is to examine the stools. If worms of the above description
cannot be seen, yet the symptoms make their existence suspected, a dose
of some of the remedies above suggested should be given and afterwards
the stools again examined. Some children have a peculiar predisposition
to pinworms, and although you seem to give them relief for the time
being, in a short time afterwards the same symptoms return and the
worms are as numerous as ever. In these cases a course of continual
treatment becomes necessary to eradicate the morbid habit; for this
course I recommend:
Take: Powdered wormseed,
Powdered chocolate,
Milk of sulphur, of each equal parts.
Mix and give half to one teaspoonful every night at bedtime.
(_g_) Constipation is the bane of artificially reared children and if
the sagacity of mother or nurse does not correct the evil it often
causes serious complications. Sometimes those who are nursed on the
breast suffer from constipation, especially when the mothers or wet
nurses are troubled with similar derangements. Children under one year
of age should have two evacuations, and those from one to three years
should have at least one passage a day; when this does not occur the
feces become solid and constipation is the result. In most febrile
affections constipation is caused by a loss of moisture through the
skin and an increased urinary secretion. Certain foods constipate,
especially the starchy or farinaceous variety, as soups containing
corn starch, rice, sago, etc., and in older children certain dishes
consisting of peas, beans, and wheaten bread. A great many medicines
are constipating, for instance, most cough mixtures, for they contain
opium in some form, also preparations of iron, lead, alum, bismuth,
chalk, and vegetable remedies that contain astringents or tannin.
It must be laid down as a RULE never to be violated, that every child
must have at least one passage a day from the day it is born, and it is
the imperative duty of mother or nurse to see that it is accomplished.
The infant of only a few days or weeks old may require only a few drops
of olive oil, but if that delays in its effect it may become necessary
to give relief at once, and for this purpose we have in a small warm
water enema a most decided and effectual remedy. Soapsuds should never
be used, except in very urgent cases, for I have known a diarrhoea to
ensue from the irritation it caused which was very hard to control.
If the feces are not very hard a soap suppository may be used with
good advantage, and in the following manner: Take a piece of soap and
pare it to a point the thickness of a lead pencil and about an inch
long, moisten this and introduce carefully into the rectum; if the
straining bring only the soap away it may be well to use the water
enema afterward. If the constipation continues to be habitual a slight
modification of the diet becomes necessary; starchy foods must not be
given as often, and thinner than formerly; the milk too should be more
diluted; broth or beef tea substituted once or twice each day will
often have a good effect. When children are old enough to eat mixed
food the diet can often be so regulated as to materially contribute
towards opening the bowels. The children should be encouraged to drink
a great deal of water; from the lack of that alone some children become
constipated. Graham bread and boiled German prunes are especially to
be recommended; so are ripe raw fruits, grapes, strawberries, apples,
pears, etc. Children require fresh air and outdoor exercise to be well
and robust; they run and jump more when in the open air, all of which
gives tone and strength to the general system. If diet and outdoor
exercise alone does not remedy the evil, then the Femina laxative syrup
should be administered; it is efficient in its action, and pleasant to
take, and unlike most laxative or aperient remedies, there is no danger
of forming a habit of using purgatives.
(_h_) Whooping cough is the name of an affection deriving its
significance from a characteristic which is peculiar to this cough. It
commences like an ordinary bronchitis such as is the result of taking
cold; there is the usual hoarseness, tickling in the throat, dry cough,
sneezing, running from the nose; the eyes are red and watery, and
there is more or less fever. Sometimes the cough is ordinary, but at
other times it has a sharp metallic clang from the beginning. Owing
to certain marked periods in the course of the affection it has been
found convenient to divide it into three stages which may usually be
distinguished, although in a certain proportion of cases the first
stage (comprising some of the symptoms that have been enumerated above)
may be submerged into the second or whooping stage. The first stage
may last from four to five days to as many weeks. The second stage is
when the peculiar sound or whoop begins; it consists of a great number
of violent paroxysms, rapidly-recurring spasmodic coughs, until most of
the air in the lungs is expired; there is then a sense of suffocation
and the child becomes bluish red over the entire head and face, from
which the German designation _blue cough_ has originated. During this
spell the face swells and the eyeballs become congested and bulge
from their orbits and the nose often begins to bleed, while the urine
and feces are often involuntarily ejected and the contents of the
stomach thrown up from the violent contraction of the diaphragm. In
a few moments the spell is broken by a protracted, whistling croupy
inspiration, and this constitutes the whoop.
The whooping generally grows worse the first two or three weeks, after
which time in favorable cases the cough gradually becomes milder, but
this is not the rule by any means. I have had it in my own family to
last, in two instances, six months, and in another eight months before
the children had fully recovered.
Laughing or crying, swallowing dry, irritating morsels of food or cold
and impure air will bring on a paroxysm of cough. When several children
are affected together, the coughing of one will make the others cough.
The third stage is when the cough is wearing off and has lost
its severity. The expectoration consists now of a yellowish or
green-colored mucus; in otherwise healthy children this lasts only a
few weeks, but in weakly or scrofulous ones it may last for several
months. This disease is not as yet thoroughly understood. It is an
epidemic, contagious bronchial catarrh, involving the nerves of
respiration and attacks an individual but once. When complications
arise the affection becomes exceedingly dangerous and the most common
of these is pneumonia.
There is no specific cure for whooping cough; it has got to run its
course, which may be either short or long. I have tried every agent
so far known to scientific medicine, and there is none that will give
prompt relief in every instance. Whooping cough being a bronchitis plus
something else, it seems rational that the same precautions that are
observed in a case of bronchitis should be followed here. Children with
this affection must not be exposed to drafts or rough winds lest they
get cold, which might seriously complicate matters. In summer when the
weather is warm, outdoor life is beneficial in hastening recovery. Some
children have the cough so light, that no extra precautions seem to
be necessary; they have no fever, eat, feel and sleep well. But those
who are feverish, who vomit freely, and whose appetite is capricious,
require every attention. Their diet should be especially guarded, so
that all dry, irritating nutriments are prohibited, and so that the
diet consists principally of liquid nourishment. Warm drinks have a
favorable influence on the disease; a plentiful supply of warm milk,
first thoroughly beaten with an egg beater is the most suitable and
convenient. The milk punch is often borne well, and the little whisky
that enters into its composition is a needed stimulant to the sufferer;
broths may be given for a change, and to these the yolk of an egg can
be added with advantage. A great many remedies might be suggested, but
the one which has served my purpose the best, is the following:
Take: Deodorized tincture, of opium ½ dram
Fluid extract, of belladonna 4 drops
Fluid extract, of ipecac. 10 drops
Simple syrup 2 ounces
For a child five years old, give a teaspoonful three or four times a
day; older or younger children in proportion. If the cough is hard
and dry, ten to twenty drops of syrup of ipecac alone should be given
instead of the mixture, and when the cough is loosened, the mixture
can be again administered. When in the course of the affection the
breathing suddenly becomes labored, and the fever increases, it is fair
to presume that the case is complicated with pneumonia.
(_i_) Eruptive fevers, as their name implies, are characterized by an
eruption or exanthema. The most virulent of this class is smallpox. The
eruption of this disease is of the nature of vesicles, or pustules,
while that of measles, scarlatina, and rose rash is dry, and is
properly called a _rash_. Chickenpox, however, has also vesicles and
pustules, and for this reason it is very liable in times of an epidemic
of smallpox to be mistaken for a mild form of the latter disease.
For obvious reasons it is not proper to consider smallpox in this
connection; its gravity and its management require experience, and
further, it generally comes under special quarantine regulations of the
proper constituted authorities.
The eruptive fevers are all divided into three stages, namely: a stage
of invasion or development; a second stage when the eruption appears,
and while it lasts; and a third stage, that of _desquamation_, when the
eruption begins to fade or exfoliate in branny scales.
(_j_) Measles is generally a mild and not serious disease, and only
attacks the individual but once in a lifetime; only through gross
carelessness the disease becomes complicated, and then it may become a
very dangerous affection. It begins with all the symptoms of a common
cold. There is frequent sneezing, and an acrid muco-serous discharge
from the nostrils. The eyes are irritable, reddened and watery, and
there is more or less intolerance of light. The voice becomes hoarse
and there is always a bronchitis present which is characterized by
a dry, harsh cough. The patient is generally feverish, alternating
with chilly sensations or shivering; the appetite is poor or absent
and in some cases there is nausea and vomiting. The children feel
drowsy; they complain of pain in the head and limbs and want to lounge
around. The bowels may be constipated, but diarrhœa supervenes in
a certain proportion of cases. In nervous children convulsions may
occur; bleeding from the nose and false croup are not infrequently met
with in the development of this disease. The duration of the first
stage varies greatly in different individuals, and comprises a period
extending from one to seven days. The eruption begins generally on the
temples and forehead, whence it extends over the head and neck, thence
down the back and over the entire body, occupying in its development
from thirty-six to forty-eight hours. The eruption bears a resemblance
to flea bites at first; it appears as minute red specks which gradually
enlarge and become slightly elevated and arrange themselves in circular
clusters. The portions of the skin that are free from the eruption
retain their white appearance; the face is more or less swollen and the
eyelids puffed. In some patients there is considerable annoyance from
itching in the skin. The cough and bronchitis continue to be prominent
symptoms, and the expectoration, consisting of yellowish sputa becomes
abundant. In some children the fever runs very high in this stage and
they become delirious and restless, but this is only temporary, for it
generally diminishes with the eruption on the third or fourth day.
When the eruption begins to fade the third stage of the affection is
inaugurated, and when there exist no complications, the patient may now
be considered on the way to recovery which takes from four to eight
days longer.
The treatment in measles should consist in good nursing, rather than
in medication. Owing to the inflammation of the membranes of the
eyes, the patient should be kept in a darkened chamber, and the eyes
occasionally bathed with a solution of borax, by dissolving half a
teaspoonful in a tumblerful of water. Good judgment forbids that the
patient should be sweltered, but that he should be kept comfortably
warm and never allowed to cool off suddenly is also very important.
When the eruption is slow to develop a good sweat will often bring it
out; so will undue exposure, to cold drafts and the transportation out
of a warm bed into a cold one or drinking immoderately of cold drinks
either delay the development of the eruption or drive it back, and
from this undoubtedly dangerous complications arise, like pneumonia,
diphtheritic croup, and convulsions. A mouthful of cold water now and
then is harmless, but on the whole the drinks should be quite warm; the
cough and bronchitis alone would require that.
Warm milk thoroughly beaten is the most suitable form of diet; broths
and soups may be given for a change, so can a mixture of equal parts of
weak hot tea and milk. The bowels should be moved with a mild laxative
and if the fever runs very high, ten to fifteen drops of the sweet
spirits of nitre, for a child five years old, in half wineglass of
water every few hours will generally reduce the temperature. For the
itching, the skin should be rubbed with equal parts of glycerine and
warm water. The cough is generally the most troublesome feature, and
the only symptom requiring regular medication; for this a good general
cough mixture will serve every purpose, such as:
Take: Compound mixture of liquorice,
Syrup of wild cherry, of each 2 ounces
Mix and give to a child four years old a teaspoonful every four hours;
older or younger children in proportion.
(_k_) Rose rash, sometimes called false or German measles is a
comparatively trivial affection and of very little importance, for
it never has any serious complications and lasts only twenty-four or
forty-eight hours in the majority of cases. It is often mistaken for
measles, and one attack affords no protection against recurrences. The
eruption appears in small rose-colored spots or patches which are not
elevated. It does not commence on the head, but appears on different
parts of the body. The eruption may be preceded by headache, loss of
appetite, occasionally vomiting, and more or less fever or chilly
sensations.
The affection of the eyes and air passages, especially the bronchitis
which is characteristic of measles, are wanting in rose rash, and when
we hear of children having had measles several times it is reasonable
to presume that it was rose rash instead. This eruption hardly calls
for treatment, but a mild laxative and a regulated diet would fulfill
all requirements.
(_l_) Scarlet fever or scarlatina has received its name from the
color of its eruption. This affection presents itself differently in
different cases. It may be so mild in its attack that it constitutes a
trifling ailment and again it may be so severe that life is seriously
threatened, and destroyed in a few days. This has formed the basis of
dividing scarlatina into three varieties, namely: simple scarlatina,
diphtheritic scarlatina and malignant scarlatina.
The fever, as a rule, is notably higher than in other eruptive fevers.
The attack may begin with a chill, nausea and vomiting and headache.
There is also bleeding from the nose in a certain proportion of cases.
The most constant sign is redness and more or less swelling of the
throat, either with or without a sense of soreness and pain in the
act of swallowing. The stage of development lasts in the average
twenty-four hours, although exceptionally it may appear in a few hours
after the first symptoms of the disease have appeared. The eruption
often begins on the back first, and from there rapidly spreads over the
entire body in twenty-four hours. It greatly differs from the eruption
in measles in not allowing any healthy or white skin to intervene
between the red specks, but the entire skin has a reddish blush.
This has given rise to the expression _boiled lobster_ appearance
in scarlatina, and indeed nothing could illustrate the color of the
skin better than by comparing the one with the other. The eruption
is sometimes accompanied with a great deal of itching and burning
and reaches its fullest development on the third day after its first
appearance; it lasts from four to six days.
The extent and redness of the eruption varies greatly in different
individuals, in some it is very slight and transient while in others
there is not a spot as large as a dime which is not covered. Yet a very
light attack in one patient when communicated to another individual may
develop in that one a most malignant form. One attack secures against a
recurrence.
The throat affection seems to modify the eruption of the skin for in
some instances in which the throat is very bad, the skin eruption is
comparatively slight. There may be simply a little redness over the
tonsils, extending more or less over the soft palate, or on the other
hand, the disease in the throat may become in every respect equal to if
not identical with the worst type of diphtheria. Some writers consider
the sore throat of scarlatina and that of diphtheria identical, and
from a practical point of view there is certainly no difference, and
the very best results are obtained when all severe sore throats of
scarlatina are treated precisely as if they were diphtheria; this has
always been my practice.
The tongue is quite distinctive of the affection; early in the
development of the disease it is generally furred, but later the
coating peels off in patches, and these spots present the appearance of
a ripe _strawberry_; sometimes the entire surface of the tongue looks
as if cayenne pepper or red sand had been sprinkled on it.
The fever generally increases during the eruptive stage, and the skin
becomes very dry and hot. The pulse may run up to 130 to 140 per
minute, while the temperature runs up as high as 106° Fahrenheit; this
state of affairs places the patient in imminent danger, he now may
become restless and even delirious. In a certain proportion of cases
the kidneys become involved and albuminuria is a result, but this
usually passes off with the improvement and recovery of the patient.
In the third stage the cuticle begins to exfoliate in the form of
branny scales. In the absence of serious complications this stage marks
the beginning of convalescence; the fever subsides, the appetite
returns, and the soreness and redness of the throat disappear.
The treatment of this affection always depends upon the nature of the
case. Simple scarlatina requires no medical treatment; the precaution
and intelligence which are comprised in good nursing supply everything
that is required. There is not the same danger of the eruption striking
in with scarlatina as there is with measles, and the patient need not
be kept so warmly covered. When the fever runs very high, sponging the
surface with cool water is very grateful and reduces the temperature.
After the eruption has thoroughly developed, the water for sponging off
may be very cold without the least danger, and this may be repeated
as often as comfort or the high temperature demands. To relieve the
burning and itching of the skin, the entire body should be rubbed
over with glycerine night and morning; this relieves the system and
makes the skin moist and supple. If the throat is only reddened, a
teaspoonful of chlorate of potash dissolved in a cupful of hot water
and when cold used as a gargle and a teaspoonful of the solution
swallowed at the same time every two hours is all that is necessary.
The diphtheritic scarlatina is treated precisely similar to and
according to the instructions laid down for diphtheria in another part
of this work. Move the bowels freely with the Femina laxative syrup.
(_m_) Chickenpox has neither distressing symptoms nor is it significant
as regards danger. It is an eruptive fever which occasionally affects
adults, but for the most part children. The eruption is generally
preceded by a slight fever and nausea, and appears first on the body
and afterwards on the scalp where it is usually more abundant. There
always remains healthy white skin between the vesicles, which at first
contain a transparent liquid, hence called by the Germans waterpox,
which afterward becomes cloudy or opaline. The eruption begins to dry
up from the fifth to the seventh day forming granular crusts that are
sometimes followed by pitting. The disease is contagious and develops
twelve to seventeen days after the exposure. Chickenpox claims no
treatment; its only point of interest is its resemblance to varioloid,
but as a successful vaccination guarantees against the latter, and as
the vesicles of varioloid have a central depression while those of
chickenpox have not, the individuality of the affection is readily
established.