Advice to a Mother on the Management of Her Children Part 17

ON DISEASE, ETC.

198. _Do you think it important that I should be made acquainted with the symptoms of the SERIOUS diseases of children_?

Certainly I am not advocating the doctrine of a mother _treating serious_ diseases; far from it, it is not her province, except in certain cases of extreme urgency, where a medical man cannot be procured, and where delay might be death; but I do insist upon the necessity of her knowing the _symptoms_ of disease. My belief is, that if parents were better informed on such subjects, many children's lives might be saved, much suffering averted, and sorrow spared. The fact is, the knowledge of the symptoms of disease is, to a mother, almost a sealed book. If she were better acquainted with these matters, how much more useful would she be in a sick-room, and how much more readily would she enter into the plans and views of the medical man! By her knowledge of the symptoms, and by having his advice in time, she would nip disease in the bud, and the fight might end in favour of life, for "sickness is just a fight between life and death."--_Geo. M'Donald._

It is really lamentable to contemplate the amount of ignorance that still exists among mothers in all that appertains to the diseases of children; although, fortunately, they are beginning to see and to feel the importance of gaining instruction on such subjects; but the light is only dawning. A writer of the _Medical Times and Gazette_ makes the following remarks, which somewhat bear on the subject in question. He observes--"In spite of the knowledge and clear views possessed by the profession on all that concerns the management of children, no fact is more palpable than that the most grievous ignorance and incompetency prevail respecting it among the public. We want some means of making popular the knowledge which is now almost restricted to medical men, or, at most, to the well-educated cla.s.ses."

In the earlier editions of this work I did not give the _treatment_ of any serious diseases, however urgent. In the eight last editions, I have been induced, for reasons I will presently state, to give the _treatment_ of some of the more urgent _serious_ diseases, when a medical man cannot instantly be procured, and where delay might be death.

Sir CHARLES LOc.o.c.k, who has taken a kind interest in this little work, has given me valid reasons why a mother should be so enlightened. The following extracts are from a letter which I received from Sir CHARLES on the subject, and which he has courteously allowed me to publish. He says,--"As an old physician of some experience in complaints of infants and children, I may perhaps be allowed to suggest that in a future edition you should add a few words on the actual treatment of some of the more urgent infantile diseases. It is very right to caution parents against superseding the doctor, and attempting to manage serious illness themselves, but your advice, with very small exceptions, always being 'to lose no tune in sending for a medical man,' much valuable and often irremediable time may be lost _when a medical man is not to be had_. Take, for instance, a case of croup there are no directions given at all, except to send for a medical man, and always to keep medicines in the house which he may have directed. But how can this apply to a first attack? You state that a first attack is generally the worst. But why is it so? Simply because it often occurs when the parents do not recognise it, and it is allowed to get a worse point than in subsequent attacks, when they are thoroughly alive to it. As the very best remedy, and often the only essential one, if given early, is a full emetic, surely it is better that you should give some directions as to this in a future edition, and I can speak from my own experience when I say that an emetic, _given in time_, and repeated to free vomiting, will cut short _any_ case of croup. In nine cases out of ten the attack takes place in the evening or early night, and when vomiting is effected the dinner of that day is brought up nearly undigested, and the seventy of the symptoms at once cut short. Whenever any remedy is valuable, the more by its being administered _in time_, it is surely wiser to give directions as to its use, although, as a general rule, it is much better to advise the sending for medical advice."

The above reasons, coming from such a learned and experienced physician as Sir Charles Loc.o.c.k, are conclusive, and have decided me to comply with his advice, to enlighten a mother on the _treatment_ of some of the more urgent diseases of infants and of children. In a subsequent letter addressed to myself, Sir Charles has given me the names of those _urgent_ diseases, which he considers may be treated by a mother "where a medical man cannot be procured quickly, or not at all." They are Croup: Inflammation of the Lungs; Diptheria; Dysentry; Diarrhoea; Hooping Cough, in its various stages; and Shivering Fit. Sir Charles sums up his letter to me by saying, "Such a book ought to be made as complete as possible, and the objections to medical treatment being so explained as to induce mothers to try to avoid medical men is not so serious as that of leaving them without any guide in those instances where every delay is dangerous, and yet where medical a.s.sistance is not to be obtained or not to be had quickly."

In addition to the above I shall give you the _treatment_ of Bronchitis, Measles, and Scarlet Fever. Bronchitis is one of the most common diseases incidental to childhood, and, with judicious treatment, is, in the absence of the medical man, readily managed by a sensible mother. Measles is very submissive to treatment. Scarlet Fever, _if it be not malignant_, and, _if it be not complicated with diphtheric-croup_, and if certain rules be strictly followed, is also equally amenable to treatment.

I have been fortunate in treating Scarlet Fever, and I therefore think it desirable to enter fully into the _treatment_ of a disease which is looked upon by many parents, and, according to the usual mode of treatment, with just cause, with great consternation and dread. By giving my plan of treatment, fully and simply, and without the slightest reservation, I am fully persuaded, through G.o.d's blessing, that I may be the humble means of saving the lives of numbers of children.

The diseases that might be treated by a mother, in the absence of a medical man, will form the subject of future Conversations.

I think it right to promise that in all the prescriptions for a child I have for the use of a mother given, I have endeavoured to make them as simple as possible, and have, whenever practicable, avoided to recommend powerful drugs. Complicated prescriptions and powerful medicines might, as a rule, to be seldom given; and when they are, should only be administered by a judicious medical man: a child requiring much more care and gentleness in his treatment than an adult: indeed, I often think it would be better to leave a child to nature rather than to give him powerful and large doses of medicines. A remedy--calomel, for instance--has frequently done more mischief than the disease itself; and the misfortune of it is, the mischief from that drug has oftentimes been permanent, while the complaint might, if left alone, have only been temporary.

199. _At what age does Water in the Brain usually occur, and how is a mother to know that her child is about to labour under that disease_?

Water on the brain is, as a rule, a disease of childhood: after a child is seven years old it is comparatively rare. It more frequently attacks delicate children--children who have been dry nursed (especially if they have been improperly fed), or who have been suckled too long, or who have had consumptive mothers, or who have suffered severely from toothing, or who are naturally of a feeble const.i.tution. Water on the brain sometimes follows an attack of inflammation of the lungs, more especially if depressing measures (such as excessive leeching and the administration of emetic tartar) have been adopted. It occasionally follows in the train of contagious eruptive diseases, such as either small-pox or scarlatina. We may divide the symptoms of water on the brain into two stages. The first--the premonitory stage--which lasts for or five days, in which medical aid might be of great avail: the second--the stage of drowsiness and of coma--which usually ends in death.

I shall dwell on the first--the premonitory stage--in order that a mother may see the importance without loss of time of calling in a medical man:--

If her child be feverish and irritable, if his stomach be disordered, if he have urgent vomitings, if he have a foul breath, if his appet.i.te be capricious and bad, if his nights be disturbed (screaming out in his sleep), if his bowels be disordered, more especially if they be constipated, if he be more than usually excited, if his eye gleam with unusual brilliancy, if his tongue run faster than it is wont, if his cheek be flushed and his head be hot, and if he be constantly putting his hand to his head; there is cause for suspicion. If to these symptoms be added, a more than usual carelessness in tumbling about, in hitching his foot in the carpet, or in dragging one foot after the other; if, too, he has complained of darting, shooting, lancinating pains in his head, it may then be known that the _first_ stage of inflammation (the forerunner of water on the brain) either has taken, or is about taking place. Remember no time ought to be lost in obtaining medical aid; for the _commencement_ of the disease is the golden opportunity, when life might probably be saved.

200. _At what age, and in what neighbourhood, is a child most liable to croup, and when is a mother to know that it is about to take place_?

It is unusual for a child until he be twelve months old to have croup: but, from that time until the age of two years, he is more liable to it than at any other period. The liability after two years, gradually, until he be ten years old, lessens, after which time it is rare.

A child is more liable to croup in a low and damp, than in a high and dry neighbourhood; indeed, in some situations, croup is almost an unknown disease; while in others it is only too well understood. Croup is more likely to prevail when the wind is either easterly or north-easterly.

There is no disease that requires more prompt treatment than croup, and none that creeps on more insidiously. The child at first seems to be labouring under a slight cold, and is troubled with a little _dry_ cough, he is hot and fretful, and hoa.r.s.e when he cries. Hoa.r.s.eness is one of the earliest symptoms of croup, and it should be borne in mind that a young child, unless he be going to have croup, is seldom hoa.r.s.e, if, therefore, your child be hoa.r.s.e, he should be carefully watched, in order that, as soon as croup be detected, not a moment be lost in applying the proper remedies.

His voice at length becomes gruff, he breathes as though it were through muslin, and the cough becomes crowing. These three symptoms prove that the disease is now fully formed. These latter symptoms sometimes come on without any previous warning, the little fellow going to bed apparently quite well, until the mother is awakened, perplexed and frightened, in the middle of the night, by finding him labouring under the characteristic cough and the other symptoms of croup. If she delay either to send for a.s.sistance, _or if proper medicines be not instantly given_, in a few hours it will probably be of no avail, and in a day or two the little sufferer will be a corpse.

When once a child has had croup the after attacks are generally milder. If he has once had an attack of croup, I should advise you always to have in the house medicine--a 4 oz. bottle of Ipecacuanha Wine, to fly to at a moments notice, [Footnote: In case of a sudden attack of croup, _instantly_ give a teaspoonful of Ipecacuanha Wine, and repeat it every fire minutes natal free vomiting be excited.] but never omit, where practicable, in a case of croup, whether the case be severe or mild to send _immediately_ for medical aid. There is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death.

201. _But suppose a medical man is not IMMEDIATELY to be procured, what then am I to do? more especially, as you say, that delay might be death_?

_What to do_.--I never, in my life, lost a child with croup with catarrhal croup where I was called in at the _commencement_ of the disease, and where my plans were carried out to the very letter. Let me begin by saying, look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. What medicine! _Ipecacuanha Wine!_ At the earliest dawn of the disease give a few spoonful of Ipecacuanha Wine every five minutes, until free vomiting be exerted. In croup, then, before he be safe, free vomiting _must_ be established, and that without loss of time. If, _after_ the expiration of an hour, the Ipecacuanha Wine (having given during that hour one or two tea-spoonfuls of it every five minutes) be not sufficiently powerful for the purpose--although it generally is so--(_if the Ipecacuanha Wine be good_)--then let the following mixture be subst.i.tuted--

Take of--Powdered Ipecacuanha, one scruple, Wine of Ipecacuanha, one ounce and a half

Make a mixture. One or two tea spoonfuls to be given every five minutes, until free vomiting be excited, first well shaking the bottle.

After the vomiting, place the child for a quarter of an hour in a warm bath. [Footnote: See "Warm Baths"--directions and precautions to be observed.] When out of the bath give him small doses of Ipecacuanha Wine every two or three hours. The following is a palatable form for the mixture--

Take of--Wine of Ipecacuanha, three drachms; Simple syrup, three drachms, Water, six drachms

Make a Mixture. A tea-spoonful to be taken every two or three hours.

But remember the emetic which is given at _first_ is _pure Ipecacuanha Wine, without a drop of either water or of syrup._

A large sponge dipped out of very hot water, and applied to the throat, and frequently renewed, oftentimes affords great relief in croup, and ought during the time the emetic is being administered in all cases to be adopted.

If it be a _severe_ case of croup, and does not in the course of two hours yield to the free exhibition of the Ipecacuanha Emetic, apply a narrow strip of _Smith's Tela Vesicularia_ to the throat, prepared in the same way as for a case of inflammation of the lungs (see the Conversation on the _treatment_ of inflammation of the lungs). With this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. If a child has a very short, fat neck, there may not be room for the _Tela_, then you ought to apply it to the _upper_ part of the chest--just under the collar-bones.

Let it be understood, the the _Tela Vesicularia_ is not a severe remedy, that the _Tela_ produces very little pain--not nearly so much as the application of leeches; although, in its action, it is much more beneficial, and is not nearly so weakening to the system.

Keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrowroot, &c.; and let the room be, if practicable, at a temperate heat--60 deg. Fahrenheit, and be well ventilated.

So you see that the _treatment_ of croup is very simple, and the the plan might be carried out by an intelligent mother. Notwithstanding which, it is your duty, where practicable, to send, at the very _onset_ of the disease, for a medical man.

Let me again reiterate that, if your child is to be saved, the _Ipecacuanha Wine must be genuine and good_. This can only be effected by having the medicine from a highly respectable chemist. Again, if ever your child has had croup, let me again urge you _always_ to have in the house a 4 oz. bottle of Ipecacuanha Wine, that you may resort to at a moment's notice, in case there be the slightest return of the disease.

Ipecacuanha Wine, unfortunately, is not a medicine that keeps well, therefore, every three or four months a fresh bottle ought to be procured, either from a medical man or from a chemist. As long as the Ipecacuanha Wine remains _clear_, it is good; but as soon as it becomes _turbid_, it is bad, and ought to be replaced by a fresh supply. An intelligent correspondent of mine makes the following valuable remarks on the preservation of Ipecacuanha Wine:--"Now, I know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a _perfectly full_ bottle. If so, would it not be a valuable suggestion if the Apothecaries' Hall, or some other London firm of _undoubted_ reliability, would put up 1 oz. phials of Ipecacuanha Wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. By their keeping a few such ounce bottles in an unopened state in one's house, one might rely in being ready for any emergency. If you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, I think, be adding another most valuable item to an already invaluable book."

The above suggestion of preserving Ipecacuanha Wine in ounce bottles, quite full, and hermetically sealed, is a very good one. The best way of hermetically sealing the bottle would be, to cut the cork level with the lip of the bottle, and to cover the cork with sealing-wax, in the same manner wine merchants serve some kinds of their wines, and then to lay the bottles on their sides in sawdust in the cellar. I have no doubt, if such a plan were adopted, the Ipecacuanha Wine would for a length of time keep good. Of course, if the Wine of Ipecacuanha be procured from the Apothecaries' Hall Company, London (as suggested by my correspondent), there can be no question as to the genuineness of the article.

_What NOT to do_--Do not give emetic tartar, do not apply leeches, do not keep the room very warm, do not give stimulants, do not omit to have always in the house either a 4 oz. bottle, or three or four 1 oz. bottles, of Ipecacuanha Wine.

202. _I have heard Child crowing mentioned as a formidable disease, would you describe the symptoms_?

Child-crowing, or spasm of the glottis, or _spurious croup_, as it is sometimes called, is occasionally mistaken for _genuine croup_. It is a more frequent disorder than the latter, and requires a different plan of treatment Child crowing is a disease that invariably occurs only during dent.i.tion, and is _most perilous_, indeed, painful dent.i.tion is _the_ cause--_the_ only cause--of child crowing. But, if a child labouring under it can fortunately escape suffocation until he have cut the whole of his first set of teeth--twenty--he is then safe.

Child-crowing comes on in paroxysms. The breathing during the intervals is quite natural--indeed, the child appears perfectly well, hence, the dangerous nature of the disease is either overlooked, or is lightly thought of, until perhaps a paroxysm worse than common takes place, and the little patient dies of suffocation, overwhelming the mother with terror, with confusion, and dismay.

The _symptoms_ in a paroxysm of child-crowing are as follows--The child suddenly loses and fights for his breath, and in doing so, makes a noise very much like that of crowing, hence the name child-crowing.

The face during the paroxysm becomes bluish or livid. In a favourable case, after either a few seconds, or even, in some instances, a minute, and a frightful straggle to breathe, he regains his breath, and is, until another paroxysm occurs, perfectly well. In an unfavourable case, the upper part (c.h.i.n.k) of the windpipe--the glottis--remains for a minute or two closed, and the child, not being able to breathe, drops a corpse in his nurse's arms! Many children, who are said, to have died of fits, hare really died of child-crowing.

Child-crowing is very apt to cause convulsions, which complication, of course, adds very much to the danger. Such a complication requires the constant supervision of an experienced and skilful medical man.

I have entered thus rather fully into the subject, as nearly every life might be saved, if a mother knew the nature and the treatment of the complaint, and of the _great necessity during the paroxysm of prompt and proper measures_. For, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent himself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting such information, in a _popular_ style, in conversations of this kind.

203. _What treatment, then, during a paroxysm of Child-crowing should you advise_?

The first thing, of course, to be done, is to send _immediately_ for a medical man. Have a plentiful supply of cold and of hot water always at hand, ready at a moment's notice for use. The instant the paroxysm is upon the child, plentifully and perseveringly dash _cold_ water upon his head and face. Put his foot and legs in _hot_ salt, mustard, and water; and, if necessary, place him up to his neck in a hot bath, still dashing water upon his face and head. If he does not quickly come round, sharply smack his back and b.u.t.tocks.

In every severe paroxysm of child-crowing, put your fore-finger down the throat of the child, and pull his tongue forward. This plan of pulling the tongue forward opens the epiglottis (the lid of the glottis), and thus admits air (which is so sorely needed) into the glottis and into the lungs, and thus staves off impending suffocation. If this plan were generally known and adopted, many precious lives might be saved. [Footnote: An intelligent correspondent first drew my attention to the efficacy of pulling forward the tongue in every severe paroxysm of child-crowing.]

There is nothing more frightfully agonising to a mother's feelings than to see her child strangled,--as it were,--before her eyes, by a paroxysm of child crowing.

As soon as a medical man arrives, he will lose no time in thoroughly lancing the gums, and in applying other appropriate remedies.

Great care and attention ought, during the intervals, to be paid to his diet. If the child be breathing a smoky, close atmosphere, he should be immediately removed to a pure one. In this disease, indeed, there is no remedy equal to a change of air--to a dry, bracing neighbourhood. Change of air, even if it be winter, is the best remedy, either to the coast or to a healthy mountainous district. I am indebted to Mr Roberton of Manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject [Footnote: See the end of the volume of "Physiology and Diseases of Women," &c. Churchill, 1851.]) for the knowledge of this fact. Where, in a case of this kind, it is not practicable to send a child _from_ home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. I am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and princ.i.p.al remedy. Cold sponging of the body too is useful.