Advice to a Mother on the Management of Her Children · Chapter 28On Disease, Etc. (4)
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232. How would you distinguish between Modified Small-pox and Chicken-pox?
Modified small-pox may readily be distinguished from chicken-pox, by the former disease being, notwithstanding its modification, much more severe and the fever much more intense before the eruption shows itself than chicken-pox; indeed, in chicken-pox there is little or no fever either before or after the eruption; by the former disease—the modified small-pox—consisting partly of pustules (containing matter), each pustule having a depression in the centre, and the favourite localities of the pustules being the wrists and the inside of the nostrils; while, in the chicken-pox, the eruption consists of vesicles (containing water), and not pustules (containing matter), and the vesicles having neither a depression in the centre, nor having any particular partiality to attack either the wrists or the inside of the nose. In modified small-pox each pustule is, as in unprotected small-pox, inflamed at the base; while in chicken-pox there is only very slight redness around each vesicle. The vesicles in chicken-pox are small—much smaller than the pustules in modified small-pox.
233. Is Hooping-cough an inflammatory disease?
Hooping-cough in itself is not inflammatory, it is purely spasmodic; but it is generally accompanied with more or less of bronchitis— inflammation of the mucous membrane of the bronchial tubes—on which account it is necessary, in all cases of hooping-cough, to consult a medical man, that he may watch the progress of the disease and nip inflammation in the bud.
234. Will you have the goodness to give the symptoms, and a brief history of, Hooping-cough?
Hooping-cough is emphatically a disease of the young; it is rare for adults to have it; if they do, they usually suffer more severely than children. A child seldom has it but once in his life. It is highly contagious, and therefore frequently runs through a whole family of children, giving much annoyance, anxiety, and trouble to the mother and the nurses; hence hooping-cough is much dreaded by them. It is amenable to treatment. Spring and summer are the best seasons of the year for the disease to occur. This complaint usually lasts from six to twelve weeks—sometimes for a much longer period, more especially if proper means are not employed to relieve it.
Hooping-cough commences as a common cold and cough. The cough, for ten days or a fortnight, increases in intensity; at about which time it puts on the characteristic "hoop." The attack of cough comes on in paroxysms. In a paroxysm, the child coughs so long and so violently, and expires so much air from the lungs without inspiring any, that at times he appears nearly suffocated and exhausted; the veins of his neck swell; his face is nearly purple; his eyes, with the tremendous exertion, almost seem to start from their sockets; at length there is a sudden inspiration of air through the contracted chink of the upper part of the wind-pipe—the glottis—causing the peculiar "hoop;" and after a little more coughing, he brings up some glairy mucus from the chest; and sometimes, by vomiting, food from the stomach; he is at once relieved, until the next paroxysm occur, when the same process is repeated, the child during the intervals, in a favourable case, appearing quite well, and after the cough is over, instantly returning either to his play or to his food. Generally, after a paroxysm he is hungry, unless, indeed, there be severe inflammation either of the chest or of the lungs. Sickness, as I before remarked, frequently accompanies hooping-cough; when it does, it might be looked upon as a good sign. The child usually knows when an attack is coming on; he dreads it, and therefore tries to prevent it; he sometimes partially succeeds; but, if he does, it only makes the attack, when it does come, more severe. All causes of irritation and excitement ought, as much as possible, to be avoided, as passion is apt to bring on a severe paroxysm.
A new-born babe—an infant of one or two months old—commonly escapes the infection; but if, at that tender age, he unfortunately catch hooping-cough, it is likely to fare harder with him than if he were older—the younger the child, the greater the risk. But still, in such a case, do not despair, as I have known numerous instances of new-born infants, with judicious care, recover perfectly from the attack, and thrive after it as though nothing of the kind had ever happened.
A new-born babe, labouring under hooping-cough, is liable to convulsions, which is in this disease one, indeed the great, source of danger. A child, too, who is teething, and labouring under the disease, is also liable to convulsions. When the patient is convalescing, care ought to be taken that he does not catch cold, or the "hoop" might return. Hooping-cough may either precede, attend, or follow an attack of measle.
235. What is the treatment of Hooping-cough?
We will divide the hooping-cough into three stages, and treat each stage separately,
What to do.—In the first stage, the commencement of hooping-cough: For the first ten days give the Ipecacuanha Wine Mixture, [Footnote: For the prescription of the Ipecacuanha Wine Mixture, see page 161.] a tea-spoonful three times a day. If the child be not weaned, keep him entirely to the breast, if he be weaned, to a milk and farinaceous diet. Confine him for the first ten days to the house, more especially if the hooping-cough be attended, as it usually is, with more or less bronchitis. But take care that the rooms be well ventilated; for good air is essential to the cure.
If the bronchitis attending the hooping-cough be severe, confine him to his bed, and treat him as though it were simply a case of bronchitis. [Footnote: For the treatment of bronchitis, see answer to 207th question.]
In the second stage, discontinue the Ipecacuanha Mixture, and give Dr Gibb's remedy—namely, Nitric Acid—which I have found to be an efficacious and valuable one in hooping-cough:—
Take of—Diluted Nitric Acid, two drachms; Compound Tincture of Cardamons, half a drachm; Simple Syrup, three ounces; Water, two ounces and a half:
Make a Mixture. One or two tea-spoonfuls, or a table-spoonful, according to the age of the child—one tea-spoonful for an infant of six months, and two tea-spoonfuls for a child of twelve months, and one table-spoonful for a child of two years, every four hours, first shaking the bottle.
Let the spine and the chest be well rubbed every night and morning either with Roche's Embrocation, or with the following stimulating liniment (first shaking the bottle):—
Take of—Oil of Cloves, one drachm; Oil of Amber, two drachms; Camphorated Oil, nine drachms:
Make a Liniment.
Let him wear a broad band of new flannel, which should extend round from his chest to his back, and which ought to be changed every night and morning, in order that it may be dried before putting on again. To keep it in its place it should be fastened by means of tapes and with shoulder-straps.
The diet ought now to be improved—he should gradually return to his usual food; and, weather permitting, should almost live in the open air—fresh air being, in such a case, one of the finest medicines.
In the third stage, that is to say, when the complaint has lasted a month, if by that time the child is not well, there is nothing like change of air to a high, dry, healthy, country place. Continue the Nitric Acid Mixture, and either the Embrocation or the Liniment to the back and the chest, and let him continue to almost live in the open air, and be sure that he does not discontinue wearing the flannel until he be quite cured, and then let it be left off by degrees.
If the hooping-cough have caused debility, give him Cod-liver Oil—a tea-spoonful twice or three times a day, giving it him on a full stomach, after his meals. But, remember, after the first three or four weeks, change of air, and plenty of it, is for hooping-cough the grand remedy.
What NOT to do.—"Do not apply leeches to the chest, for I would rather put blood into a child labouring under hooping-cough than take it out of him—hooping-cough is quite weakening enough to the system of itself without robbing him of his life's blood; do not, on any account whatever, administer either emetic tartar or antimonial wine; do not give either paregoric or syrup of white poppies; do not drug him either with calomel or with grey-powder; do not dose him with quack medicine; do not give him stimulants, but rather give him plenty of nourishment, such as milk and farinaceous food, but no stimulants; do not be afraid, after the first week or two, of his having fresh air, and plenty of it—for fresh, pure air is the grand remedy, after all that can be said and done, in hooping-cough. Although occasionally we find that, if the child to labouring under hooping-cough, and is breathing a pure country air, and is not getting well so rapidly as we could wish, change of air to a smoky gas-laden town will sometimes quickly effect a cure; indeed, some persons go so far as to say that the best remedy for an obstinate case of hooping-cough is, for the child to live, the great part of every day, in gas-works!"
236. What is to be done during a paroxysm of Hooping-cough?
If the child be old enough, let him stand up; but if he be either too young or too feeble, raise his head, and bend his body a little forward; then support his back with one hand, and the forehead with the other. Let the mucus, the moment it be within reach, be wiped with a soft handkerchief out of his mouth.
237. In an obstinate case of Hooping-cough, what is the best remedy?
Change of air, provided there be no active inflammation, to any healthy spot. A farm-house, in a high, dry, and salubrious neighbourhood, is as good a place as can be chosen. If, in a short time, he be not quite well, take him to the sea-side: the sea breezes will often, as if by magic, drive away the disease.
238. Suppose my child should have a shivering fit, is it to be looked upon as an important symptom?
Certainly. Nearly all serious illnesses commence with a shivering fit: severe colds, influenza, inflammations of different organs, scarlet fever, measles, small-pox, and very many other diseases, begin in this way. If, therefore, your child should ever have a shivering fit, instantly send for a medical man, as delay might be dangerous. A few hours of judicious treatment, at the commencement of an illness, is frequently of more avail than days and weeks, nay months, of treatment, when disease has gained a firm footing. A serious disease often steals on insidiously, and we have perhaps only the shivering fit, which might be but a slight one, to tell us of its approach.
A trifling ailment, too, by neglecting the premonitory symptom, which, at first might only be indicated by a slight shivering fit, will sometimes become a mortal disorder:—
"The little rift within the lute, That by-and-by will make the music mute, And ever widening slowly silence all." [Footnote: The above extract from Tennyson is, in my humble opinion, one of the most beautiful pieces of poetry in the English language. It is a perfect gem, and a volume in itself, so truthful, so exquisite, so full of the most valuable reflections; for instance—(1.) "The little rift within the lute,"—the little tubercle within the lung "that by-and-by will make the music mute, and ever widening slowly silence all," and the patient eventually dies of consumption. (2.) The little rent—the little rift of a very minute vessel in the brain, produces an attack of apoplexy, and the patient dies. (3.) Each and all of us, in one form or another, sooner or later, will have "the little rift within the lute." But why give more illustrations?—a little reflection will bring numerous examples to my fair reader's memory.]
239. In case of a shivering fit, perhaps you will tell me what to do?
Instantly have the bed warmed, and put the child to bed. Apply either a hot bottle or a hot brick, wrapped in flannel, to the soles of his feet. Put an extra blanket on his bed, and give him a cup of hot tea. As soon as the shivering fit is over, and he has become hot, gradually lessen the extra quantity of clothes on his bed, and take away the hot bottle or the hot brick from his feet.
What NOT to do.—Do not give either brandy or wine, as inflammation of some organ might be about taking place. Do not administer opening medicine, as there might be some "breaking out" cooling out on the skin, and an aperient might check it.
240. My child, apparently otherwise healthy, screams out in the night violently in his sleep, and nothing for a time will pacify him: what is likely to be the cause, and what is the treatment?
The causes of these violent screamings in the night are various. At one time, they proceed from teething; at another, from worms; sometimes, from night-mare; occasionally, from either disordered stomach or bowels. Each of the above causes will, of course, require a different plan of procedure; it will, therefore, be necessary to consult a medical man on the subject, who will soon, with appropriate treatment, be able to relieve him.
241. Have the goodness to describe the complaint of children called Mumps.
The mumps, inflammation of the "parotid" gland, is commonly ushered in with a slight feverish attack. After a short time, a swelling, of stony hardness, is noticed before and under the ear, which swelling extends along the neck towards the chin. This lump is exceedingly painful, and continues painful and swollen for four or five days. At the end of which time it gradually disappears, leaving not a trace behind. The swelling of mumps never gathers. It may affect one or both sides of the face. It seldom occurs but once in a lifetime. It is contagious, and has been known to run through a whole family or school; but it is not dangerous, unless, which is rarely the case, it leaves the "parotid" gland, and migrates either to the head, to the breast, or to the testicle.
242. What is the treatment of Mumps?
Foment the swelling, four or five times a day, with a flannel wrung out of hot camomile and poppy-head decoction; [Footnote: Four poppy-heads and four ounces of camomile blows to be boiled in four pints of water for half an hour, and then strained to make the decoction.] and apply, every night, a barm and oatmeal poultice to the swollen gland or glands. Debar, for a few days, the little patient from taking meat and broth, and let him live on bread and milk, light puddings, and arrow-root. Keep him in a well-ventilated room, and shut him out from the company of his brothers, his sisters, and young companions. Give him a little mild, aperient medicine. Of course, if there be the slightest symptom of migration to any other part or parts, instantly call in a medical man.
243. What is the treatment of a Boil?
One of the best applications is a Burgundy-pitch plaster spread on a soft piece of wash leather. Let a chemist spread a plaster, about the size of the hand; and, from this piece, cut small plasters, the size of a shilling or a florin (according to the dimensions of the boil), which snip around and apply to the part. Put a fresh one on daily. This plaster will soon cause the boil to break; when it does break, squeeze out the contents—the core and the matter—and then apply one of the plasters as before, which, until the boil be well, renew every day.
The old-fashioned remedy for a boil—namely, common yellow soap and brown-sugar, is a capital one for the purpose. It is made with equal parts of brown sugar and of shredded yellow soap, and mixed by means of a table-knife on a plate, with a few drops of water, until it be all well blended together, and of the consistence of thick paste; it should then be spread either on a piece of wash-leather, or on thick linen, and applied to the boil, and kept in its place by means either of a bandage or of a folded handkerchief; and should he removed once or twice a day. This is an excellent application for a boil—soothing, comforting, and drawing—and will soon effect a cure. A paste of honey and flour, spread on linen rag, is another popular and good application for a boil.
If the boils should arise from the child being in a delicate state of health, give him cod-liver oil, meat once a day, and an abundance of milk and farinaceous food. Let him have plenty of fresh air, exercise, and play.
If the boil should arise from gross and improper feeding, then keep him for a time from meat, and let him live principally on a milk and farinaceous diet.
If the child be fat and gross, cod-liver oil would he improper; a mild aperient, such as rhubarb and magnesia, would then be the best medicine.
244. What are the symptoms of Ear-ache?
A young child screaming shrilly, violently, and continuously, is oftentimes owing to ear-ache; carefully, therefore, examine each ear, and ascertain if there be any discharge; if there be, the mystery is explained.
Screaming from ear-ache may be distinguished from the screaming from bowel-ache by the former (ear-ache) being more continuous—indeed, being one continued scream, and from the child putting his hand to his head; while, in the latter (bowel-ache), the pain is more of a coming and of a going character, and he draws up his legs to his bowels. Again, in the former (ear-ache), the secretions from the bowels are natural; while, in the latter (bowel-ache), the secretions from the bowels are usually depraved, and probably offensive. But a careful examination of the ear will generally at once decide the nature of the case.
213. What is the best remedy for Ear-ache?
Apply to the ear a small flannel bag, filled with hot salt—as hot as can be comfortably borne, or foment the ear with a flannel wrung out of hot camomile and poppy head decoction. A roasted onion, inclosed in muslin applied to the ear, is an old-fashioned and favourite remedy, and may, if the bag of hot salt, or if the hot fomentation do not relieve, be tried. Put into the ear, but not very far, a small piece of cotton wool, moistened with warm olive oil. Taking care that the wool is always removed before a fresh piece be substituted, as if it be allowed to remain in any length of time, it may produce a discharge from the ear. Avoid all cold applications. If the ear-ache be severe, keep the little fellow at home, in a room of equal temperature, but well-ventilated, and give him, for a day or two, no meat.
If a discharge from the ear should either accompany or follow the ear-ache, more especially if the discharge be offensive, instantly call in a medical man, or deafness for life may be the result.
A knitted or crotcheted hat, with woollen rosettes over the ears, is, in the winter time, an excellent hat for a child subject to ear-ache. The hat may be procured at any baby-linen warehouse.
246. What are the causes and the treatment of discharges from the Ear?
Cold, measles, scarlet fever, healing up of "breakings out" behind the ear; pellets of cotton wool, which had been put in the ear, and had been forgotten to be removed, are the usual causes of discharges from the ear. It generally commences with ear-ache.
The treatment consists in keeping the parts clean, by syringing the ear every morning with warm water, by attention to food—keeping the child principally upon a milk and a farmaceous diet, and by change of air—more especially to the coast. If change of air be not practicable, great attention should be paid to ventilation. As I have before advised, in all cases of discharge from the ear call in a medical man, as a little judicious medicine is advisable—indeed, essential; and it may be necessary to syringe the ear with lotions, instead of with warm water; and, of course, it is only a doctor who has actually seen the patient who can decide these matters, and what is best to be done in each case.
247. What is the treatment of a "stye" on the eye-lid?
Bathe the eye frequently with warm milk and water, and apply, every night at bedtime, a warm white-bread poultice.
No medicine is required; but, if the child be gross, keep him for a few days from meat, and let him live on bread and milk and farinaceous puddings.
248. If a child have large bowels, what would you recommend as likely to reduce their size?
It ought to be borne in mind, that the bowels of a child are larger in proportion than those of an adult. But, if they be actually larger than they ought to be, let them be well rubbed for a quarter of an hour at a time night and morning, with soap liniment, and then apply a broad flannel belt. "A broad flannel belt worn night and day, firm but not tight, is very serviceable." [Footnote: Sir Charles Locock, in a Letter to the Author.] The child ought to be prevented from drinking as much as he has been in the habit of doing; let him be encouraged to exercise himself well in the open air; and let strict regard be paid to his diet.
249. What are the best aperients for a child?
If it be actually necessary to give him opening medicine, one or two tea-spoonfuls of Syrup of Senna, repeated, if necessary, in four hours, will generally answer the purpose; or, for a change, one or two tea-spoonfuls of Castor Oil may be substituted. Lenitive Electuary (Compound Confection of Senna) is another excellent aperient for the young, it being mild in its operation, and pleasant to take; a child fancying it is nothing more than jam, and which it much resembles both in appearance and in taste. The dose is half or one tea-spoonful early in the morning occasionally. Senna is an admirable aperient for a child, and is a safe one, which is more than can be said of many others. It is worthy of note that "the taste of Senna may be concealed by sweeting the infusion, [Footnote: Infusion of Senna may be procured of any respectable druggist. It will take about one or two table-spoonfuls, or even more, of the infusion (according to the age of the child, and the obstinacy of the bowels), to act as an aperient. Of course, you yourself will be able, from time to time, as the need arises, to add the milk and the sugar, and thus to make it palatable. It ought to be given warm, so as the more to resemble tea.] adding milk, and drinking as ordinary tea, which, when thus prepared, it much resembles" [Footnote: Waring's Manual of Practical Therapeutics.] Honey, too, is a nice aperient for a child—a tea-spoonful ought to be given either by itself, or spread on a slice of bread.
Some mothers are in the habit of giving their children jalap gingerbread. I do not approve of it, as jalap is a drastic, griping purgative; besides, jalap is very nasty to take—nothing will make it palatable.
Fluid Magnesia—Solution of Carbonate of Magnesia—is a good aperient for a child; and, as it has very little taste, is readily given, more especially if made palatable by the addition either of a little syrup or of brown sugar. The advantages which it has over the old solid form are, that it is colourless and nearly tasteless, and never forms concretions in the bowels, as the solid magnesia, if persevered in for any length of time, sometimes does. A child of two or three years old may take one or two table-spoonfuls of the fluid; either by itself or in his food, repeating it every four hours until the bowels be open. When the child is old enough to drink the draught off immediately, the addition of one or two tea-spoonfuls of Lemon Juice to each dose of the Fluid Magnesia, makes a pleasant effervescing draught, and increases its efficacy as an aperient.
Bran-bread [Footnote: One-part of bran to three parts of flour, mixed together and made into bread.] and treacle will frequently open the bowels; and as treacle is wholesome, it may be substituted for butter when the bowels are inclined to be costive. A roasted apple, eaten with raw sugar, is another excellent mild aperient for a child. Milk gruel—that is to say, milk thickened with oatmeal—forms an excellent food for him, and often keeps his bowels regular, and thus (which is a very important consideration) supersedes the necessity of giving him an aperient. An orange (taking care he does not eat the peel or the pulp), or a fig after dinner, or a few Muscatel raisins, will frequently regulate the bowels.
Stewed prunes is another admirable remedy for the costiveness of a child. The manner of stewing them is as follows:—Put a pound of prunes in a brown jar, add two table-spoonfuls of raw sugar, then cover the prunes and the sugar with cold water; place them in the oven, and let them stew for four hours. A child should every morning eat half a dozen or a dozen of them, until the bowels be relieved, taking care that he does not swallow the stones. Stewed prunes may be given in treacle—treacle increasing the aperient properties of the prunes.
A suppository is a mild and ready way of opening the bowels of a child. When he is two or three years old and upwards, a Candle suppository is better than a Soap suppository. The way of preparing it is as follows:—Cut a piece of dip-tallow candle—the length of three inches—and insert it as you would a clyster pipe, about two inches up the fundament, allowing the remaining inch to be in sight, and there let the suppository remain until the bowels be opened.
Another excellent method of opening a child's bowels is by means of an enema of warm water,—from half a tea-cupful to a tea-cupful, or even more, according to the age of the child. I cannot speak too highly of this plan as a remedy for costiveness, as it entirely, in the generality of cases, prevents the necessity of administering a particle of aperient medicine by the mouth. The fact of its doing so stamps it as a most valuable remedy—opening physic being, as a rule, most objectionable, and injurious to a child's bowels. Bear this fact—for it is a fact—in mind and let it be always remembered.
450. What are the most frequent causes of Protrusion of the lower-bowel?
The too common and reprehensible practice of a parent administering frequent aperients, especially calomel and jalap, to her child. Another cause, is allowing him to remain for a quarter of an hour or more at a time on his chair; this induces him to strain, and to force the gut down.
251. What are the remedies?
If the protrusion of the bowel have been brought on by the abase of aperients, abstain, for the future from giving them; but if medicine be absolutely required, give the mildest—such as either Syrup of Senna or Castor Oil—and the less of those the better.
If the external application of a purgative will have the desired effects it will in such cases, be better than the internal administration of aperients. Castor Oil used as a Liniment is a good one for the purpose. Let the bowels be well rubbed, every night and morning, for five minutes at a time with the oil.
A wet compress to the bowels will frequently open them, and will thus do away with the necessity of giving an aperient—a most important consideration. Fold a napkin in six thicknesses, soak it in cold water, and apply it to the bowels; over which put either a thin covering or sheet of gutta-percha, or a piece of oiled-silk; keep it in its place with a broad flannel roller; and let it remain on the bowels for three or four hours, or until they be opened.
Try what diet will do, as opening the bowels by a regulated diet is far preferable to the giving of aperients. Let him have either bran-bread or Robinson's Patent Groats, or Robinson's Pure Scotch Oatmeal made into gruel with new milk, or Du Barry's Arabica Revalenta, or a slice of Huntly and Palmer's lump gingerbread. Let him eat stewed prunes, stewed rhubarb, roasted apples, strawberries, raspberries, the inside of grapes and gooseberries, figs, &c. Give him early every morning a draught of cold water.