Advice to a Mother on the Management of Her Children Part 21

227. _Have you any further observations to offer on the precautions to be taken against the spread of Scarlet Fever_?

Great care should be taken to separate the healthy from the infected. The nurses selected for attending scarlet fever patients should be those who have previously had scarlet fever themselves.

Dirty linen should be removed at once, and be put into boiling water. Very little furniture should be in the room of a scarlet fever patient--the less the better--it only obstructs the circulation of the air, and harbours the scarlet fever poison. The most scrupulous attention to cleanliness should, in these cases, be observed. A patient who has recovered from scarlet fever, and before he mixes with healthy people, should, for three or four consecutive mornings, have a warm bath, and well wash himself, while in the bath, with soap; he will, by adopting this plan, get rid of the dead skin, and thus remove the infected particles of the disease. If scarlet fever should appear in a school, the school must for a time be broken up, in order that the disease might be stamped out There must be no half measures where such a fearful disease is in question. A house containing scarlet fever patients should, by parents, be avoided as the plague; it is a folly at any time to put one's head into the lion's mouth! Chloralum and carbolic acid, and chloride of lime, and Condy's fluid, are each and all good disinfectants; but not one is to be compared to perfect cleanliness and to an abundance of fresh and pure air--the last of which may truly _par excellence_ be called G.o.d's disinfectant! Either a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid, or two tea-spoonfuls of Condy's fluid, or a tea-spoonful of chloride of lime in a pint of water, are useful to sprinkle the soiled handkerchiefs as soon as they be done with, and before the be washed, to put in the _pot-de-chambre_, and to keep in saucers about the room; but, remember, as I have said before, and cannot repeat too often, there is no preventative like the air of heaven, which should be allowed to permeate and circulate freely through the apartment and through the house: air, air, air is the best disinfectant, curative, and preventative of scarlet fever in the world!

I could only wish that my _Treatment of Scarlet Fever_ were, in all its integrity, more generally adopted; if it were, I am quite sure that thousands of children would annually be saved from broken health and from death. Time still further convinces me that my treatment is based on truth as I have every year additional proofs of its value and of its success; but error and prejudice are unfortunately ever at work, striving all they can to defeat truth and common sense. One of my princ.i.p.al remedies in the treatment of scarlet fever is an abundance of fresh air; but many people prefer their own miserable complicated inventions to G.o.d's grand and yet simple remedies--they pretend that they know better than the Mighty Framer of the universe!

228. _Will you describe the symptoms of Chicken pox_?

It is occasionally, but not always, ushered in with a slight shivering fit; the eruption shows itself in about twenty-four hours from the child first appearing poorly. It is a vesicular [Footnote: _Vesicles_. Small elevations of the cuticle, covering a fluid which is generally clear and colourless at first, but afterwards whitish and opaque, or pearly.--_Watson_.] disease. The eruption comes out in the form of small pimples, and princ.i.p.ally attacks the scalp, the neck, the back, the chest, and the shoulders, but rarely the face; while in small-pox the face is generally the part most affected. The next day these pimples fill with water, and thus become vesicles; on the third day they are at maturity. The vesicles are quite separate and distinct from each other. There is a slight redness around each of them. Fresh ones, whilst the others are dying away, make their appearance.

Chicken-pox is usually attended with a slight itching of the skin; when the vesicles are scratched the fluid escapes, and leaves hard pearl-like substances, which, in a few days, disappear. Chicken-pox never leaves pit marks behind. It is a child's complaint; adults scarcely, if ever, have it.

229. _Is there any danger in Chicken-pox; and what treatment do you advise_?

It is not at all a dangerous, but, on the contrary, a trivial complaint. It lasts only a few days, and requires but little medicine. The patient ought, for three or four days, to keep the house, and should abstain from animal food. On the sixth day, but not until then, a dose or two of a mild aperient is all that will be required.

230. _Is Chicken-pox infectious_?

There is a diversity of opinion on this head, but one thing is certain--it cannot be communicated by inoculation.

231. _What are the symptoms of Modified Small-pox_?

The Modified Small-pox--that is to say, small-pox that has been robbed of its virulence by the patient having been either already vaccinated, or by his having had a previous attack of small-pox--is ushered in with severe symptoms, with symptoms almost as severe as though the patient had not been already somewhat protected either by vaccination or by the previous attack of small-pox--that is to say, he has a shivering fit, great depression of spirits and debility, _malaise_, sickness, headache, and occasionally delirium. After the above symptoms have lasted about three days, the eruption shows itself. The immense value of the previous vaccination, or the previous attack of small-pox, now comes into play. In a case of _unprotected_ small-pox, the appearance of the eruption _aggravates_ all the above symptoms, and the danger begins; while in the _modified_ small-pox, the moment the eruption shows itself the patient feels better, and, as a rule, rapidly recovers. The eruption, of _modified_ small-pox varies materially from the eruption of the _unprotected_ small-pox. The former eruption a.s.sumes a varied character, and is composed, first, of vesicles (containing water); and, secondly, of pustules (containing matter), each of which pustules has a depression in the centre; and, thirdly, of several red pimples without either water or matter in them, and which sometimes a.s.sume a livid appearance. These "breakings-out" generally show themselves more upon the wrist, and sometimes up one or both of the nostrils. While in the latter disease--the _unprotected_ small-pox--the "breaking-out" is composed entirely of pustules containing matter, and which pustules are more on the face than on any other part of the body. There is generally a peculiar smell in both diseases--an odour once smelt never to be forgotten.

Now, there is one most important remark I have to make,--the _modified small-pox is contagious_. This ought to be borne in mind, as a person labouring under the disease must, if there be children in the house, either be sent away himself, or else the children ought to be banished both the house and the neighbourhood. Another important piece of advice is,--let _all_ in the house--children and adults, one and all--be vaccinated, even if any or all have been previously vaccinated.

_Treatment_.--Let the patient keep his room, and if he be very ill, his bed. Let the chamber be well ventilated. If it be winter time, a small fire in the grate will encourage ventilation. If it be summer, a fire is out of the question; indeed, in such a case, the window-sash ought to be opened, as thorough ventilation is an important requisite of cure, both in small-pox and in _modified_ small-pox. While the eruption is out, do not on any account give aperient medicine. In ten days from the commencement of the illness a mild aperient may be given. The best medicine in these cases is, the sweetened Acidulated Infusion of Roses, [Footnote: See page 178] which ought to be given from the commencement of the disease, and should be continued until the fever be abated. For the first few days, as long as the fever lasts, the patient ought not to be allowed either meat or broth, but should be kept on a low diet, such as on gruel, arrow-root, milk-puddings, &c. As soon as the fever is abated he ought gradually to resume his usual diet. When he is convalescent, it is well, where practicable, that he should have change of air for a month.

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 c.h.i.n.k 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 pa.s.sion 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 ill.u.s.trations?--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_ quant.i.ty 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.