Advice to a Mother on the Management of Her Children Part 20

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.

222. _Do you believe in "Hybrid" Scarlet Fever--that is to say, in a cross between Scarlet Fever and Measles_?

I never in my life saw a case of "hybrid" scarlet fever--nor do I believe in it. Scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "Hybrid"

Scarlet fever is, in my opinion, an utter impossibility. In olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"--a cross between measles and scarlet fever--to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be.

223. _What is the treatment of Scarlet Fever?_ [Footnote: On the 4th of March 1856, I had the honour to read a _Paper on the Treatment of Scarlet Fever_ before the members of Queens College Medico-Chirugical Society, Birmingham--which _Paper_ was afterwards published in the _a.s.sociation Journal_ (March 15 1856) and in Braithwaite's _Retrospect of Medicine_ (January--June, 1856) and in Rankings _Half Yearly Abstract of the Medical Sciences_ (July--December, 1856), besides in other publications. Moreover the _Paper_ was translated into German, and published in _Canstatts Jahresbericht_, iv 456, 1859]

_What to do_--Pray pay attention to my rules, and carry out my directions to the letter--I can then promise, _that if the scarlet fever be neither malignant nor complicated with diphtheria_, the plan I am about to advise will, with G.o.d's blessing, be usually successful.

What is the first thing to be done? Send the child to bed, throw open the windows, be it winter or summer, and have a thorough ventilation, for the bedroom must be kept cool, I may say cold. Do not be afraid of fresh air, for fresh air, for the first few days, is essential to recovery. _Fresh air, and plenty of it, in scarlet fever, is the best doctor_ a child can have let these words be written legibly on your mind. [Footnote: In the _Times_ of Sept 4, 1863, is the following copied from the _Bridgewater Mercury_--

GROSS SUPERSt.i.tION--In one of the streets of Taunton, there resides a man and his wife who have the care of a child This child was attacked with scarlatina, and to all appearance death was inevitable. A jury of matrons was as it were empanelled, and to prevent the child 'dying hard' all the doors in the house all the drawers, all the boxes all the cupboards were thrown wide open, the keys taken out and the body of the child placed under a beam, whereby a sure, certain, and easy pa.s.sage into eternity could be secured. Watchers held their vigils throughout the weary night, and in the morning the child, to the surprise of all, did not die, and is now gradually recovering.

These old women--this jury of matrons--stumbled on the right remedy, "all the doors in the house....were thrown vide open," and thus they thoroughly ventilated the apartment. What was the consequence? The child who, just before the opening of the doors, had all the appearances "that death was inevitable," as soon as fresh air was let in showed symptoms of recovery, "and in the morning the child, to the surprise of all, did not die, and is now gradually recovering." There is nothing wonderful--there is nothing surprising to my mind--in all this. Ventilation--thorough ventilation--is the grand remedy for scarlatina! Oh, that there were in scarlet fever cases a good many such old women's--such a "jury of matrons'"--remedies! We should not then be horrified, as we now are, at the fearful records of death, which the Returns of the Registrar General disclose!]

If the weather be either intensely cold, or very damp, there is no objection to a small fire in the grate provided there be, at the same time, air--an abundance of fresh air--admitted into the room.

Take down the curtains of the bed, remove the valances. If it be summer time, let the child be only covered with a sheet. If it be winter time, in addition to the sheet, he should have one blanket over him.

Now for the throat--The best _external_ application is a barm and oatmeal poultice How ought it to be made, and how applied? Put half a tea-cupful of barm into a saucepan, put it on the fire to boil; as soon as it boils, take it off the fire, and stir oatmeal into it, until it be of the consistence of a nice soft poultice; then place it on a rag, and apply it to the throat, carefully fasten it on with a bandage, two or three turns of the bandage going round the throat, and two or three over the crown of the head, so as nicely to apply the poultice where it is wanted--that is to say, to cover the tonsils.

Tack the bandage: do not pin it. Let the poultice be changed three times a day. The best medicine is the Acidulated Infusion of Roses, sweetened with syrup:--

Take of--Dilated Sulphuric Acid, half a drachm; Simple Syrup, one ounce and a half; Acid Infusion of Roses, four ounces and a half:

To make a Mixture. A table-spoonful to be taken every four hours.

It is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleanses the throat and tongue of mucus, and is peculiarly efficacious in scarlet fever; as soon as the fever is abated it gives an appet.i.te. My belief is that the sulphuric acid in the mixture is a specific in scarlet fever, as much as quinine is in ague, and sulphur in itch. I have reason to say so, for, in numerous cases I have seen its immense value.

Now, with regard to food.--If the child be at the breast, keep him entirely to it. If he be weaned, and under two years old, give him milk and water, and cold water to drink. If he be older, give him toast and water, and plain water from the pump, as much as he chooses; let it be quite cold--the colder the better. Weak black tea, or thin gruel, may be given, but not caring, unless he be an infant at the breast, if he take nothing but _cold_ water. If the child be two years old and upwards, roasted apples with sugar, and grapes, will be very refreshing, and will tend to cleanse both the mouth and the throat Avoid broths and stimulants.

When the appet.i.te returns, you may consider the patient to be safe. The diet ought now to be gradually improved. Bread and b.u.t.ter, milk and water, and arrowroot made with equal parts of new milk and water, should for the first two or three days be given. Then a light batter or rice pudding may be added, and in a few days, either a little chicken or a mutton chop.

The essential remedies, then, in scarlet fever, are, for the first few days--(1) plenty of fresh air and ventilation, (2) plenty of cold water to drink, (3) barm poultices to the throat, and (4) the Acidulated Infusion of Roses Mixture as a medicine.

Now, then, comes very important advice. After the first few days, probably five or six, sometimes as early as the fourth day--_watch carefully and warily, and note the time, the skin will suddenly become cool_, the child will say that he feels chilly; then is the time you must now change your tactics--_instantly close the windows and put extra clothing_, a blanket or two, on his bed. A flannel nightgown should, until the dead skin have peeled off, be now worn next to the skin, when the flannel nightgown should be discontinued. The patient ought ever after to wear, in the day time, a flannel waistcoat.

[Footnote: On the importance--the vital importance--of the wearing of flannel next to the skin, see "Flannel Waistcoats."] His drinks must now be given with the chill off; he ought to have a warm cup of tea, and gradually his diet should, as I have previously advised, be improved.

There is one important caution I wish to impress upon you,--_do not give opening medicine during the time the eruption is out_. In all probability the bowels will be opened: if so, all well and good; but do not, on any account, for the first ten days, use artificial means to open them. It is my firm conviction that the administration of purgatives in scarlet fever is a fruitful source of dropsy, of disease, and death. When we take into consideration the sympathy there is between the skin and the mucous membrane, I think that we should pause before giving irritating medicines, such as purgatives. The irritation of aperients on the mucous membrane may cause the poison of the skin disease (for scarlet fever is a blood-poison) to be driven internally to the kidneys, to the throat, to the pericardium (bag of the heart), or to the brain. You may say, Do you not purge if the bowels be not open for a week? I say emphatically, No!

I consider my great success in the treatment of scarlet fever to be partly owing to my avoidance of aperients during the first ten days of the child's illness.

If the bowels, after the ten days, be not properly opened, a dose or two of syrup of senna should be given: that is to say, one or two tea-spoonfuls should be administered early in the morning, and should, if the first dose does not operate, be repeated in four hours.

In a subsequent Conversation, I shall strongly urge you not to allow your child, when convalescent, to leave the house under at least a month from the commencement of the illness; I, therefore, beg to refer you to that Conversation, and hope that you will give it your best and earnest consideration! During the last twenty years I have never had dropsy from scarlet fever, and I attribute it entirely to the plan I have just recommended, and in not allowing my patients to leave the house under the month--until, in fact, the skin that had peeled off has been renewed.

Let me now sum up the plan I adopt, and which I beg leave to designate as--Pye Chava.s.se's Fresh Air Treatment of Scarlet Fever:--

1. Thorough ventilation, a cool room, and scant clothes on the bed, for the first five or six days.

2. A change of temperature of the skin to be carefully regarded. As soon as the skin is cool, closing the windows, and putting additional clothing on the bed.

3. The Acidulated Infusion of Hoses with Syrup is _the_ medicine for scarlet fever.

4. Purgatives to be religiously avoided for the first ten days at least, and even afterwards, unless there be absolute necessity.

5. Leeches, blisters, emetics, cold and tepid spongings, and painting the tonsils with caustic, inadmissible in scarlet fever.

6. A strict antiphlogistic (low) diet for the first few days, during which time cold water to be given _ad libitum_.

7. The patient not to leave the house in the summer under the month; in the winter, under six weeks.

_What NOT to do._--Do not, then, apply either leeches or blisters to the throat; do not paint the tonsils with caustic; do not give aperients; do not, on any account, give either calomel or emetic tartar; do not, for the first few days of the illness, be afraid of _cold air_ to the skin, and of cold water as a beverage; do not, emphatically let me say, _do not_ let the child leave the house for at least a month from the commencement of the illness.

My firm conviction is, that purgatives, emetics, and blisters, by depressing the patient, sometimes cause ordinary scarlet fever to degenerate into malignant scarlet fever.

I am aware that some of our first authorities advocate a different plan to mine. They recommend purgatives, which I may say, in scarlet fever, are my dread and abhorrence. They advise cold and tepid spongings--a plan which I think dangerous, as it will probably drive the disease internally. Blisters, too, have been prescribed; these I consider weakening, injurious, and barbarous, and likely still more to inflame the already inflamed skin. They recommend leeches to the throat, which I am convinced, by depressing the patient, will lessen the chance of his battling against the disease, and will increase the ulceration of the tonsils. Again, the patient has not too much blood; the blood is only poisoned. I look upon scarlet fever as a specific poison of the blood, and one which will be eliminated from the system, _not_ by bleeding, _not_ by purgatives, _not_ by emetics but by a constant supply of fresh and cool air, by the acid treatment, by cold water as a beverage, and for the first few days by a strict antiphlogistic (low) diet. Sydenham says that scarlet fever is oftentimes "fatal through the officiousness of the doctor." I conscientiously believe that a truer remark was never made; and that, under a different system to the usual one adopted, scarlet fever would not be so much dreaded. [Footnote: If any of my medical brethren should do me the honour to read these pages, let me entreat them to try my plan of treating scarlet fever, as my success has been great. I have given full and minute particulars, in order that they and mothers (if mothers cannot obtain medical advice) may give my plan a fair and impartial trial. My only stipulations are that they must _begin_ with my treatment, and _not mix_ any other with it, and carry out my plan to the very letter. I then, with G.o.d's blessing, provided the cases be neither malignant nor complicated with diphtheria, shall not fear the result. If any of my _confreres_ have tried my plan of treatment of scarlet fever--and I have reason to know that many have--I should feel grateful to them if they would favour me with their opinion as to its efficacy. Address--"Pye Chava.s.se, 214 Hagley Road, Birmingham."]

Dr Budd, of Bristol, recommends, in the _British Medical Journal_, that the body, including the scalp, of a scarlet fever patient, should, after about the fourth day, be anointed, every night and morning, with camphorated oil; this anointing to be continued until the patient is able to take a warm bath and use disinfectant soap: this application will not only be very agreeable to the patient's feelings, as there is usually great irritation and itching of the skin, but it will, likewise, be an important means of preventing the dead skin, which is highly infectious, and which comes off partly in flakes and partly floats about the air as dust, from infecting other persons. The plan is an excellent one, and cannot be too strongly recommended.

If the case be a combination of scarlet fever and of diphtheria, as it unfortunately now frequently is, let it be treated as a case of diphtheria.

224. _I have heard of a case of Scarlet Fever, where the child, before the eruption showed itself, was suddenly struck prostrate, cold, and almost pulseless: what, in such a case, are the symptoms, and what immediate treatment do you advise_?

There is an _exceptional_ case of scarlet fever, which now and then occurs, and which requires _exceptional_ and prompt treatment, or death will quickly ensue. We will suppose a case: one of the number, where nearly all the other children of a family are labouring under scarlet fever, is quite well, when suddenly--in a few hours, or even, in some cases, in an hour--utter prostration sets in, he is very cold, and is almost pulseless, and is nearly insensible--comatose.

Having sent instantly for a judicious medical man, apply, until he arrives, hot bottles, hot bricks, hot bags of salt to the patient's feet and legs and back, wrap him in hot blankets, close the window, and give him hot brandy and water--a tablespoonful of brandy to half a tumblerful of hot water--give it him by teaspoonfuls, continuously--to keep him alive; when he is warm and restored to consciousness, the eruption will probably show itself, and he will become hot and feverish; then your tactics must, at once, be changed, and my Fresh Air Treatment, and the rest of the plan I have before advised must in all its integrity, be carried out.

We sometimes hear of a child, before the eruption comes out and within twenty-four hours of the attack, dying of scarlet fever. When such be the case it is probably owing to low vitality of the system--to utter prostration--he is struck down, as though for death, and if the plan be not adopted of, for a few hours, keeping him alive by heat, and by stimulants, until, indeed, the eruption comes out, he will never rally again, but will die from scarlet fever poisoning and from utter exhaustion. These cases are comparatively rare, but they do, from time to time, occur, and, when they do, they demand exceptional and prompt and energetic means to save them from ending in almost immediate and certain death. "To be forewarned is to be forearmed."

[Footnote: I have been reminded of this _exceptional_ case of scarlet fever by a most intelligent and valued patient of mine, who had a child afflicted as above described, and whose child was saved from almost certain death, by a somewhat similar plan of treatment as advised in the text.]

225. _How soon ought a child to be allowed to leave the house after an attack of Scarlet Fever_?

He must not be allowed to go out for at least a month from the commencement of the attack, in the summer, and six weeks in the winter; and not even then without the express permission of a medical man. It might be said that this is an unreasonable recommendation: but when it is considered that the whole of the skin generally desquamates, or peels off, and consequently leaves the surface of the body exposed to cold, which cold flies to the kidneys, producing a peculiar and serious disease in them, ending in dropsy, this warning will not be deemed unreasonable.

Scarlet fever dropsy, which is really a _formidable disease, generally arises from, the carelessness, the ignorance, and the thoughtlessness of parents in allowing a child to leave the house before the new skin be properly formed and hardened._ Prevention is always better than cure.

Thus far with regard to the danger to the child himself. Now, if you please, let me show you the risk of contagion that you inflict upon families, in allowing your child to mix with others before a month at least has elapsed. Bear in mind, a case is quite as contagious, if not more so, while the skin is peeling off, as it was before. Thus, in ten days or a fortnight, there is as much risk of contagion as at the _beginning_ of the disease, and when the fever is at its height. At the conclusion of the month, the old skin has generally all peeled off, and the new skin has taken its place; consequently there will then be less fear of contagion to others. But the contagion of scarlet fever is so subtle and so uncertain in its duration, that it is impossible to fix the exact time when it ceases.

Let me most earnestly implore you to ponder well on the above important facts. If these remarks should be the means of saving only one child from death, or from broken health, my labour will not have been in vain.

226. _What means do you advise to purify a house, clothes, and furniture, from the contagion of Scarlet Fever_?

Let every room in the house, together with its contents, and clothing and dresses that cannot be washed, be well fumigated with sulphur--taking care the while to close both windows and door; let every room be _lime-washed_ and then be white-washed; if the contagion have been virulent, let every bedroom be freshly papered (the walls having been previously stripped of the old paper and then lime-washed); let the bed, the holsters, the pillows, and the mattresses be cleansed and purified; let the blankets and coverlids be thoroughly washed, and then let them be exposed to the open air--if taken into a field so much the better; let the rooms be well scoured; let the windows, top and bottom, be thrown wide open; let the drains be carefully examined; let the pump water be scrutinised, to see that it be not contaminated by faecal matter, either from the water-closet, from the privy, from the pig-stye, or from the stable; let privies be emptied of their contents--_remember this is most important advice_--then put, into the empty places, either lime and powdered charcoal or carbolic acid, for it is a well ascertained fact that it is frequently impossible to rid a house of the infection of scarlet fever without adopting such a course. "In St George's, Southwark, the medical officer reports that scarlatina 'has raged fatally, almost exclusively where privy or drain, smells are to be perceived in the houses.'" [Footnote: _Quarterly Report of the Board of Health_ upon Sickness in the Metropolis.] Let the children, who have not had, or who do not appear to be sickening for scarlet fever, be sent away from home--if to a farm house so much the better. Indeed, leave no stone unturned, no means untried, to exterminate the disease from the house and from the neighbourhood. Remember the young are more p.r.o.ne to catch contagious diseases than adults; for

"in the morn and liquid dew of youth Contagious blastments are most imminent."--_Shakspeare_.