Advice to a Mother on the Management of Her Children · Chapter 26On Disease, Etc. (2)
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If the little patient be more than one year, say two years old, let the Tela remain on for five hours, and the dry linen rag for five hours more, before the blister, as above recommended, be cut and dressed.
If in a day or two the inflammation still continue violent, let another Tela Vesicatoria be applied, not over the old blister, but let a narrow strip of it be applied on each side of the old blister, and managed in the same manner as before directed.
I cannot speak too highly of Smith's Tela Vesicatoria. It has, in my hands, through God's blessing, saved the lives of scores of children. It is far, very far, superior to the old fashioned blistering plaster. It seldom, if the above rules be strictly observed, fails to rise, it gives much less pain than the common blister, when it has had the desired effect, it readily heals, which cannot always be said of the common fly blister, more especially with children.
My sheet anchors, then, in the inflammation of the lungs of children are, Ipecacuanha Wine and Smith's Tela Vesicatoria. Let the greatest care, as I before advised, be observed in obtaining the Ipecacuanha Wine genuine and good. This can be only depended upon by having the medicine from a highly respectable chemist, Ipecacuanha Wine, when genuine and good, is, in many children's diseases, is one of the most valuable of medincies.
What, in a case of inflammation of the lungs, NOT to do—Do not, on any account, apply leeches. They draw out the life of the child, but not his disease. Avoid—emphatically let me say so—giving emetic tartar It is one of the most lowering and death-dealing medicines that can be administered either to an infant or to a child! If you wish to try the effect of it, take a dose yourself, and I am quite sure that you will then never be inclined to poison a child with such an abominable preparation! In olden times—many, many years ago—I myself gave it in inflammation of the lungs, and lost many children! Since leaving it off, the recoveries of patients by the Ipecacuanha treatment, combined with the external application of Smith's Tela Vesicatoria, have been in many cases marvellous. Avoid broths and wine, and all stimulants. Do not put the child into a warm bath, it only oppresses the already oppressed breathing. Moreover, after he is out of the bath, it causes a larger quantity of blood to rush back to the lungs and to the bronchial tubes, and thus feeds the inflammation. Do not, by a large fire, keep the temperature of the room high. A small fire, in the winter time, encourages ventilation, and in such a case does good. When the little patient is on the mother's or on the nurse's lap, do not burden him either with a heavy blanket or with a thick shawl. Either a thin child's blanket, or a thin woollen shawl, in addition to his usual nightgown, is all the clothing necessary.
205. Is Bronchitis a more frequent disease than Inflammation of the Lungs? Which is the most dangerous? What are the symptoms of Bronchitis?
Bronchitis is a much more frequent disease than inflammation of the lungs, indeed, it is one of the most common complaints both of infants and of children, while inflammation of the lungs is comparatively a rare disease. Bronchitis is not nearly such a dangerous disease as inflammation of the lungs.
The symptoms—The child for the first few days labours under symptoms of a heavy cold, he has not his usual spirits. In two or three days, instead of the cold leaving him, it becomes more confirmed, he is now really poorly, fretful, and feverish, his breathing becomes rather hurried and oppressed, his cough is hard and dry, and loud, he wheezes, and if you put your ear to his naked back, between his shoulder blades, you will hear the wheezing more distinctly. If at the breast, he does not suck with his usual avidity; the cough, notwithstanding the breast is a great comfort to him, compels him frequently to loose the nipple; his urine is scanty, and rather high-coloured, staining the napkin, and smelling strongly. He is generally worse at night.
Well, then, remember if the child be feverish, if he have symptoms of a heavy cold, if he have an oppression of breathing, if he wheeze, and if he have a tight, dry, noisy cough, you may be satisfied that he has an attack of bronchitis.
206. How can I distinguish between Bronchitis and Inflammation of the Lungs?
In bronchitis the skin is warm, but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful; in inflammation of the lungs he is dull and heavy, and his countenance denotes distress.
We have sometimes a combination of bronchitis and of inflammation of the lungs, an attack of the latter following the former. Then the symptoms will be modified, and will partake of the character of the two diseases.
207. How would you treat a case of Bronchitis?
If a medical man cannot be procured, I will tell you What to do: Confine the child to his bedroom, and if very ill, to his bed. If it be winter time, have a little fire in the grate, but be sure that the temperature of the chamber be not above 60 degrees Fahrenheit, and let the room be properly ventilated, which may be effected by occasionally leaving the door a little ajar.
Let him lie either outside the bed or on a sofa, if he be very ill, inside the bed, with a sheet and a blanket only to cover him, but no thick coverlid. If he be allowed to be on the lap, it only heats him and makes him restless. If he will not lie on the bed, let him rest on a pillow placed on the lap, the pillow will cause him to lie cooler, and will more comfortably rest his weaned body. If he be at the breast, keep him to it, let him have no artificial food, unless, if he be thirsty a little toast and water. If he be weaned, let him have either milk and water, arrow root made with equal parts of milk and water, toast and water, barley water, or weak black tea, with plenty of new milk in it, &c., but, until the inflammation have subsided, neither broth nor beef tea.
Now, with regard to medicine, the best medicine is Ipecacuanha Wine, given in large doses, so as to produce constant nausea. The Ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases, will rapidly effect a cure. I have in a preceding Conversation given you a prescription for the Ipecacuanha Wine Mixture. Let a tea-spoonful of the mixture be taken every four hours.
If in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise, and put on the chest a Tela Vesicatoria, a quarter of a sheet.
The Ipecacuanha Wine and the Tela Vesicatoria are my sheet anchors in the bronchitis, both of infants and of children. They rarely, even in very severe cases, fail to effect a cure, provided the Tela Vesicatorina be properly applied, and the Ipecacuanha Wine be genuine and of good quality.
If there be any difficulty in procuring good Ipecacuanha Wine, the Ipecacuanha may be given in powder instead of the wine The following is a pleasant form—
Take of—Powder of Ipecacuanha, twelve grains White Sugar thirty six grains
Mix well together and divide into twelve powders. One of the powders to be put dry on the tongue every four hours.
The Ipecacuanha Powder will keep better than the Wine—an important consideration to those living in country places, nevertheless, if the Wine can be procured fresh and good, I far prefer the Wine to the Powder.
When the bronchitis has disappeared, the diet ought gradually to be improved—rice, sago, tapioca, and light batter-pudding, &c.; and, in a few days, either a little chicken or a mutton chop, mixed with a well-mashed potato and crumb of bread, should be given. But let the improvement in his diet be gradual, or the inflammation might return.
What NOT to do.—Do not apply leeches. Do not give either emetic tartar or antimonial wine, which is emetic tartar dissolved in wine. Do not administer either paregoric or syrup of poppies, either of which would stop the cough, and would thus prevent the expulsion of the phlegm. Any fool can stop a cough, but it requires a wise man to rectify the mischief. A cough is an effort of Nature to bring up the phlegm, which would otherwise accumulate, and in the end cause death. Again, therefore, let me urge upon you the immense importance of not stopping the cough of a child. The Ipecacuanha Wine will, by loosening the phlegm, loosen the cough, which is the only right way to get rid of a cough. Let what I have now said be impressed deeply upon your memory, as thousands of children in England are annually destroyed by having their coughs stopped. Avoid, until the bronchitis be relieved, giving him broths, and meat, and stimulants of all kinds. For further observations on what NOT to do in bronchitis, I beg to refer you to a previous Conversation we had on what NOT to do in inflammation of the lungs. That which is injurious in the one case is equally so in the other.
208. What are the symptoms of Diphtheria, or, as it is sometimes called, Boulogne Sore-throat?
This terrible disease, although by many considered to be a new complaint, is, in point of fact, of very ancient origin. Homer, and Hippocrates, the Father of Physic, have both described it. Diphtheria first appeared in England in the beginning of the year 1857, since which time it has never totally left our shores.
The symptoms—The little patient, before the disease really shows itself, feels poorly, and is "out of sorts." A shivering fit, though not severe, may generally be noticed. There is heaviness, and slight headache, principally over the eyes. Sometimes, but not always, there is a mild attack of delirium at night The next day he complains of slight difficulty of swallowing. If old enough, he will complain of constriction about the swallow. On examining the throat, the tonsils will be found to be swollen and redder—more darkly red than usual. Slight specks will be noticed on the tonsils. In a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and of the nostrils. This exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather, hence its name diphtheria. This membrane peels off in pieces, and if the child be old and strong enough he will sometimes spit it up in quantities, the membrane again and again rapidly forming as before. The discharges from the throat are occasionally, but not always, offensive. There is danger of croup from the extension of the membrane into the wind pipe. The glands about the neck and under the jaw are generally much swollen, the skin is rather cold and clammy, the urine is scanty and usually pale, the bowels at first are frequently relaxed. This diarrhoea may, or may not, cease as the disease advances.
The child is now in a perilous condition, and it becomes a battle between his constitution and the disease. If, unfortunately, as is too often the case—diphtheria being more likely to attack the weakly—the child be very delicate, there is but slight hope of recovery. The danger of the disease is not always to be measured by the state of the throat. Sometimes, when the patient appears to be getting well, a sudden change for the worse rapidly carries him off. Hence the importance of great caution, in such cases, in giving an opinion as to ultimate recovery. I have said enough to prove the terrible nature of the disease, and to show the necessity of calling in, at the earliest period of the symptoms, an experienced and skilful medical man.
209. Is Diphtheria contagious?
Decidedly. Therefore, when practicable, the rest of the children ought instantly to be removed to a distance. I say children, for it is emphatically a disease of childhood. When adults have it, it is the exception and not the rule: "Thus it will be seen, in the account given of the Boulogne epidemic, that of 366 deaths from this cause, 341 occurred amongst children under ten years of age. In the Lincolnshire epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred amongst children under twelve years of age." [Footnote: Diphtheria: by Ernest Hart. A valuable pamphlet on the subject. Dr Wade of Birmingham has also written an interesting and useful monograph on Diphtheria. I am indebted to the above authors for much valuable information.]
210. What are the causes of Diphtheria?
Bad and imperfect drainage; [Footnote: "Now all my carefully conducted inquiries induce me to believe that the disease comes from drain-poison. All the cases into which I could fully inquire, have brought conviction to my mind that there is a direct law of sequence in some peculiar conditions of atmosphere between diphtheria and bad drainage; and, if this be proved by subsequent investigations, we may be able to prevent a disease which, in too many cases, our known remedies cannot cure."—W. Carr, Esq., Blackheath, British Medical Journal, December 7, 1861.] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air, and thus depresses the system, more especially if the weather be close and muggy; poor and, improper food; and last, though not least, contagion. Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.
211. What is the treatment of Diptheria?
What to do—Examine well into the ventilation, for as diphtheria is frequently caused by deficient ventilation, the best remedy is thorough ventilation. Look well both to the drains and to the privies, and see that the drains from the water-closets and from the privies do not in any way contaminate the pump-water. If the drains be defective or the privies be full, the disease in your child will be generated, fed, and fostered. Not only so, but the disease will spread in your family and all around you.
Keep the child to his bedroom and to his bed. For the first two or three days, while the fever runs high, put him on a low diet, such as milk, tea, arrow root, &c.
Apply to his throat every four hours a warm barm and oatmeal poultice. If he be old enough to have the knowledge to use a gargle, the following will be found serviceable—
Take of—Permanganate of Potash, pure, four grams, Water eight ounces
To make a Gargle
Or,
Take of—Powdered Alum, one drachm, Simple Syrup one ounce, Water, seven ounces
To make a Gargle
The best medicine for the first few days of the attack, is the following mixture—
Take of—Chlorate of Potash two drachms, Boiling Water seven ounces Syrup of Red Poppy one ounce
To Make a mixture. A table spoonful to be taken every four hours.
Or the chlorate of potash might be given in the form of powder—
Take of—Chlorate of Potash two scruples, Lump Sugar one drachm
Mix and divide into eight powders. One to be put into a dry tea spoon and then placed on the tongue every three hours, These powders are very useful in diphtheria; they are very cleansing to the tongue and throat. If they produce much smarting as where the mouth is very sore they sometimes do, let the patient, after taking one, drink plentifully of milk, indeed I have known these powders induce a patient to take nourishment, in the form of milk, which he otherwise would not have done, and thus to have saved him from dying of starvation, which, before taking the powders, there was every probability of his doing. An extensive experience has demonstrated to me the great value of these powders in diphtheria, but they must be put on the tongue dry.
As soon as the skin has lost its preternatural heat, beef tea and chicken broth ought to be given. Or if great prostration should supervene, in addition to the beef tea, port wine, a table spoonful every four hours, should be administered. If the child be cold, and there be great sinking of the vital powers, brandy and water should be substituted for the port wine. Remember, in ordinary cases, port wine and brandy are not necessary, but in cases of extreme exhaustion they are most valuable.
As soon as the great heat of the skin has abated and the debility has set in, one of the following mixtures will be found useful—
Take of—Wine of Iron, one ounce and a half, Sample Syrup, one ounce, Water, three ounces and a half
To make a Mixture. A table spoonful to be taken every four hours.
Or,
Take of—Tincture of Perchloride of Iron, one drachm Simple Syrup, one ounce, Water, three ounces
To make a Mixture. A table spoonful to be taken three times a day.
If the disease should travel downwards, it will cause all the symptoms of croup, then it must be treated as croup, with this only difference, that a blister (Tela Vesicatoria) must not be applied, or the blistered surface may be attacked by the membrane of diphtheria, which may either cause death or hasten that catastrophe. In every other respect treat the case as croup, by giving an emetic, a tea spoonful of Ipecacuanha Wine every five minutes, until free vomiting be excited, and then administer smaller doses of Ipecacuanha Wine every two or three hours, as I recommended when conversing with you on the treatment of croup.
What NOT to do—Do not, on any account, apply either leeches or a blister. If the latter be applied, it is almost sure to be covered with the membrane of diphtheria, similar to that inside of the mouth and of the throat, which would be a serious complication. Do not give either calomel or emetic tartar. Do not depress the system by aperients, for diphtheria is an awfully depressing complaint of itself, the patient, in point of fact, is labouring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by faecal matter from either a privy or from a water-closet, by some horrid drain, by proximity to a pig-sty, by an overflowing privy, especially if vegetable matter be rotting at the same time in it, by bad ventilation, or by contagion. Diphtheria may generally be traced either to the one or to the other of the above causes, therefore let me urgently entreat you to look well into all these matters, and thus to stay the pestilence! Diphtheria might long remain in a neighbourhood if active measures be not used to exterminate it.
212. Have the goodness to describe the symptoms of Measles?
Measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a hoarse and peculiar ringing cough, which nurses call "measle-cough," and difficulty of breathing. These symptoms usually last three days before the eruption appears, on the fourth it (the eruption) generally makes its appearance, and continues for four days and then disappears, lasting altogether, from the commencement of the symptoms of cold to the decline of the eruption, seven days. It is important to bear in mind that the eruption consists of crescent-shaped—half moon-shaped—patches, that they usually appear first about the face and the neck, in which places they are the best marked; then on the body and on the arms; and, lastly, on the legs, and that they are slightly raised above the surface of the skin. The face is swollen, more especially the eye-lids which are sometimes for a few days closed.
Well, then, remember, the running at the nose, the, sneezing, the peculiar hoarse cough, and the half-moon-shaped patches, are the leading features of the disease, and point out for a certainty that it is measles.
213. What constitutes the principal danger in Measles?
The affection of the chest. The mucous or lining membrane of the bronchial tubes is always more or less inflamed, and the lungs themselves are sometimes affected.
214. Do you recommend "surfeit water" and saffron tea to throw out the eruption in Measles?
Certainly not. The only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "Surfeit water," saffron tea, and remedies of that class, are hot and stimulating. The only effect they can have, will be to increase the fever and the inflammation—to add fuel to the fire.
215. What is the treatment of Measles?
What to do.—The child ought to be confined both to his room and to his bed, the room being kept comfortably warm; therefore, if it be winter time, there should be a small fire in the grate; in the summer time, a fire would be improper. The child must not be exposed to draughts; notwithstanding, from time to time, the door ought to be left a little ajar in order to change the air of the apartment; for proper ventilation, let the disease be what it may, is absolutely necessary.
Let the child, for the first few days, be kept on a low diet, such as on milk and water, arrow-root, bread and butter, &c.
If the attack be mild, that is to say, if the breathing be not much affected (for in measles it always is more or less affected), and if there be not much wheezing, the Acidulated Infusion of Roses' Mixture [Footnote: See page 178] will be all that is necessary.
But suppose that the breathing is short, and that there is a great wheezing, then instead of giving him the mixture just advised, give him a tea-spoonful of a mixture composed of Ipecacuanha Wine, Syrup, and Water, [Footnote: See page 161] every four hours. And if, on the following day, the breathing and the wheezing be not relieved in addition to the Ipecacuanha Mixture, apply a Tola Vesicatoria, as advised under the head of Inflammation of the Lungs.
When the child is convalescing, batter puddings, rice, and sago puddings, in addition to the milk, bread and butter, &c, should be given, and, a few days later, chicken, mutton chops, &c.
The child ought not, even in a mild case of measles, and in favourable weather to be allowed to leave the house under a fortnight, or it might bring on an attack of bronchitis.
What NOT to do—Do not give either "surfeit water" or wine. Do not apply leeches to the chest. Do not expose the child to the cold air. Do not keep the bed room very hot, but comfortably warm. Do not let the child leave the house, even under favourable circumstances, under a fortnight. Do not, while the eruption is out, give aperients. Do not, "to ease the cough," administer either emetic tartar or paregoric—the former drug is awfully depressing, the latter will stop the cough, and will thus prevent the expulsion of the phlegm.
216. What is the difference between Scarlatina and Scarlet Fever?
They are indeed one and the same disease, scarlatina being the Latin for scarlet fever. But, in a popular sense, when the disease is mild, it is usually called scarlatina. The latter term does not sound so formidable to the ears either of patients or of parents.
217. Will you describe the symptoms of Scarlet Fever?
The patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. At the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself. The scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as Dr Elliotson accurately describes it,—"the tongue looks as if it had been slightly sprinkled with Cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." The eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. There is usually, after the first few days, great itching on the surface of the body. The skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it.
There are three forms of scarlet fever;—the one where the throat is little, if at all, affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is much affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is VERY dangerous), the malignant form.
218. Would it be well to give a little cooling, opening physic as soon as a child begins to sicken for Scarlet Fever?
On no account whatever. Aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. It is my firm conviction, that the administration of opening medicine, at such times, is one of the principal causes of scarlet fever being so frequently fatal. This is, of course, more applicable to the poor, and to those who are unable to procure a skilful medical man.
219. What constitutes the principal danger in Scarlet Fever?
The affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in anasarca (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying proper remedies.
When Scarlet Fever is complicated—as it sometimes is—with diphtheria, the diphtheric membrane is very apt to travel into the wind-pipe, and thus to cause diphtheric croup, it is almost sure, when such is the case, to end in death. When a child dies from such a complication, the death might truly be said to be owing to the diphtheric croup, and not to the Scarlet Fever, for if the diphtheric croup had not occurred, the child would, in all probability, have been saved. The deaths from diphtheria are generally from diphtheric croup, if there be no croup, there is, as a rule, frequent recovery.
220. How would you distinguish between Scarlet Fever and Measles?
Measles commences with symptoms of a common cold, scarlet fever does not. Measles has a peculiar hoarse cough, scarlet fever has not. The eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is not raised above the skin at all, and is one continued mass. The colour of the eruption is much more vivid in scarlet fever than in measles. The chest is the part principally affected in measles, and the throat in scarlet fever.
There is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. I myself have, in several instances, ascertained the truth of it—"For several years M Bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. The phenomenon in question is a white line, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. On drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. In this way the diagnosis of the disease may be very distinctly written on the skin; the word 'Scarlatina' disappears as the eruption regains its uniform tint."—Edinburgh Medical Journal.
221. Is it of so much importance, then, to distinguish between Scarlet fever and Measles?
It is of great importance, as in measles the patient ought to be kept moderately warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool—indeed, for the first few days, cold—and the beverages, such as spring-water, toast and water, &c., should be administered quite cold.