The Maternal Management Of Children, In Health And Disease Part 19

DESCRIPTION OF THE DISEASE.--The child infected will be observed not to be as well as usual, less active, and out of spirits; his appet.i.te will fail, and his sleep be restless and disturbed. It will soon be evident that he has apparently taken a cold in his head, and that this is accompanied by fever. His voice will be hoa.r.s.e; there will be frequent cough, headach, sneezing, running from the nose and eyes,--the eyelids being somewhat swollen, and the eyes inflamed;--the skin will be hot and dry, and he will complain of occasional chilliness. In the course of the next two or three days, these symptoms will increase in severity, and perhaps be accompanied by oppression at the chest and hurried breathing, and towards evening by slight delirium.

On the fourth day, the rash will appear, but the symptoms will be little, if at all, mitigated; indeed, they will sometimes increase in severity. The eruption will first be perceived about the head and face, in the form of small red spots, at first distinct from each other, but soon coalescing, and forming patches of an irregular crescent-like or semilunar figure, of a dull red colour, and slightly elevated (giving a sensation of hardness to the finger), while portions of the skin intervening between them will retain their natural appearance. At this time the eruption will also be found on the inside of the mouth and throat, and the hoa.r.s.eness will consequently increase.

On the fifth day, the rash usually covers the whole surface of the body, with the exception of the legs and feet; and is now very vivid on the face, which is not unfrequently so much swelled, especially the eyelids, that the eyes are quite closed up, as in small-pox. On the sixth day, it is fully out on the extremities, and is beginning to fade on the face. On the eighth, it is fading from all parts; on the ninth, it is hardly perceptible; and has entirely disappeared on the tenth day from the commencement of the fever, or the sixth from its own first appearance. As the fading proceeds, the spots drop off in the form of little branny scales, which are sometimes, from their minuteness, scarcely perceptible. They leave a slight discolouration on the skin, with considerable itching.

Such is the ordinary course of this disease; occasionally, however, deviations are met with.

CHARACTER OF MEASLES COMPARED WITH SCARLET FEVER AND SMALL-POX.--Under the description given of Scarlet Fever, are noticed several signs by which that disease may be distinguished from measles: to these may be added the absence of cough, of water flowing from the eyes, and of redness and swelling of the eyelids as in measles. Again, in measles, the eruption is more pointed, of a crimson instead of a scarlet hue, and does not appear until two days later than in scarlet fever.

In small-pox, the fever abates as soon as the eruption makes its appearance. In scarlet fever, this is by no means the case; and as little so in measles: the vomiting, indeed, subsides; but the cough, fever, and headach grow more violent; and the difficulty of breathing, weakness of the eyes, and, indeed, all the catarrhal symptoms, remain without any abatement till the eruption has all but completed its course.

MATERNAL MANAGEMENT.--Measles, in its ordinary and simple form, is a mild, and by no means dangerous, disease: it is sometimes, however, accompanied or immediately followed by symptoms of a very serious character, and which, it is to be feared, in many instances, owe their origin to the carelessness of the attendants in the sick chamber. A mother's superintendence, therefore, is much required at this time to insure a careful attention to the medical directions, as also to those general points of management upon which the well-doing of her child much depend, of which the following are the most important:--

VENTILATION OF THE BED-ROOM, ETC.--The child must be kept in bed from the onset of the attack. He must have so much clothing only as will secure his comfort, avoiding equally too much heat or exposure to cold.

To these points the parent's attention must be particularly directed.

It is the practice with some nurses, in the belief that a breath of cool air is most pernicious, to keep the child constantly enveloped in a smothering heap of bed-clothes, with curtains closely drawn, and the room well heated by fire, by which means the fever and all its concomitant dangers are greatly augmented. It is equally a popular error (and yet by many it is still held and acted upon) to suppose that because in small-pox exposure to cold is useful, that therefore it must be of equal advantage in measles. It cannot be too generally known that the nature of the fevers accompanying the two diseases are widely different, and that the adoption of this error is productive of the most serious consequences; for it would most likely produce in measles inflammation of the lungs, which, in truth, is commonly the result of carelessness upon this point.

The bed-room should be large and airy; free from currents of cold, but well ventilated, and not hot. The room, also, must be darkened, on account of the tenderness of the eyes; all noise excluded, and mental excitement or irritation carefully avoided.

REGIMEN.--Little or no food must be allowed, and whatever is taken must be of the simplest kind, and in a liquid form. Mild mucilaginous drinks, and warm, may be given liberally; as barley-water, or thin gruel, etc.

SPONGING, ETC.--The face, chest, arms, and hands should be sponged occasionally with vinegar and warm water (one fourth and three fourths). This will be productive of great comfort to the little patient; it removes the heat, dryness, and itching of the skin, which are often very distressing; and is especially useful at night in relieving wakefulness. If the cough be troublesome, it will be useful for the child to breathe the steam of warm water; not through an inhaler, but over a large basin, with the head covered with flannel large enough to hang over its edges. By this means the tender and inflamed eyes will at the same time derive advantage from the soothing effect of the vapour.

CAUTIONS.--Whenever the measles is known to be prevalent in a neighbourhood, and a child manifests symptoms of cold in the head and fever, it should at once be a reason for carefulness on the part of the parent. The diet should be light, cooling, and scanty; and the child should be carefully kept in doors.

It has been before remarked, that in its ordinary course measles is a disease unaccompanied with danger, but that the mildest form may be speedily converted into the most dangerous. That is to say, a sudden change may lake place in the symptoms, arising out of circ.u.mstances which could not have been foreseen, and therefore unavoidable; or may be produced by improper management on the part of the nurse, such as the giving of stimulants, by too much heat, or by exposure to cold. Now it is for the parent early to notice any change which may occur from the first source, and by her watchfulness to guard against the possibility of its arising from either of the second.

In reference to the first, if the child should complain at any period of the disease of severe headach, with piercing pain through the temples, and if this is accompanied by wandering of mind, great increase of suffusion of the eyes, as also intolerance of light, the immediate attention of the medical man is demanded. So, if towards the dose of the eruption, that is, from the seventh to the ninth day, the breathing should again become hurried (this symptom is very generally present during the height of the eruption, and is not necessarily connected with disease of the lungs), with pain and oppression felt at the chest, the cough becoming hacking and incessant, etc. (all symptoms cognizable by the mother, and indicative of inflammation of the lungs), no time must be lost in seeking medical aid.

With regard to the last cause (improper management), it may be well, in reference to it, to observe, that it sometimes happens that the rash comes out imperfectly, or, having appeared properly, suddenly retrocedes and disappears; and that under such circ.u.mstances the nurse will almost certainly, if not well watched, give the child "a good dose of sulphur in diluted spirit, or a gla.s.s of punch containing saffron," which are considered specifics for bringing out the eruption.

Nothing can be more injurious than such remedies, for generally the disappearance of the rash will be dependent upon the existence of some internal inflammation, or of too high a fever; for the removal of which the medical man ought to be instantly applied to. Sometimes, however, it may be fairly traced to a careless exposure to cold: under such circ.u.mstances the child should be instantly, and without hesitation, put into the warm bath.

Measles are frequently followed by cough, and deranged bowels; and there is always great susceptibility about the child for some time. On this account he should be carefully screened from a cold or damp atmosphere; the diet should be carefully regulated; and flannel worn next to the skin. If the cough should continue, it must not be neglected on the supposition that it will wear off; for it demands the skilful and careful attention of the medical man.

In conclusion, it may be remarked that very frequently during infancy and childhood, and particularly during the period of teething, eruptions very similar in appearance to this disease occur; unless, however, they are accompanied by the specific fever, and run the regular course, they may at once be decided upon as not being the measles.

Sect. VII.--SMALL-POX.

This disease, the most dreaded of all eruptive fevers, is not so commonly met with in the present day as formerly; thanks to that Providence which led to the discovery of Jenner. But although its occurrence is not so frequent, it still does occasionally present itself; when it will a.s.sume either a mild or severe form. If it attack a child that has not previously been vaccinated, it is called natural small-pox; and the chances are that the disorder will be severe in character;--if, on the other hand, it occur in the vaccinated, the disease will generally be much modified in its symptoms; the attack will be mild, and without danger.

NATURAL SMALL-POX.--The infection of small-pox having been received into the system of a child that has not been vaccinated, fourteen days (on an average) will transpire before the commencement of the febrile symptoms, or eruptive fever. A distinct rigor or s.h.i.+vering fit then takes place, accompanied by pain in the back or in the stomach, with sickness, giddiness, or headach; as also great drowsiness. And if an infant be the subject of the disease, a convulsive fit will sometimes take place, or several in succession.

At the end of eight-and-forty hours from the occurrence of the rigor (in the majority of cases), the eruption comes out; and shows itself first on the face and neck in minute flea-bite spots. In the course of the next four-and-twenty hours in some cases, and in others not until the expiration of two or three days, it completely covers the body; not being confined exclusively to the skin, but frequently extending to the mouth and throat, and even to the external membrane of the eye.

In the course of two or three days from their first appearance the little pimples, increasing in size, will be found to contain a thin transparent fluid, to pit or become depressed in their centre, and the skin in the s.p.a.ces between them will be found red. On the seventh or eighth day from the commencement of the fever, the fluid contained in the pimples will be no longer transparent, but opaque; and they will consequently appear white, or of a light straw colour. Each pimple or pock will be no longer depressed in its centre, but will become raised and pointed, being more fully distended by the increased quant.i.ty of fluid within; and the skin around each pock will now be of a bright crimson. The head, face, hands, and wherever else the eruption shows itself, gradually swell; and the eyelids are often so much distended as to close the eyes and produce temporary blindness. There will always at this time be some degree of fever present, and its amount will vary with the circ.u.mstances of each individual ease. The skin too will be very tender, so much so sometimes as greatly to hara.s.s and distress the child.

On the eleventh day the swelling and inflam of the skin of the body and face subside; the pimples upon these parts dry up and form scabs, which fall off about the fourteenth or fifteenth day. Those on the hands, as they come out later, commonly continue a short time longer.

The eruption leaves behind, in some cases, the peculiar marks of the disease; and in others merely discoloured spots, which disappear in the progress of a short time.

The natural small-pox is sometimes much more severe in its character than the foregoing, and what is called confluent small-pox is said to exist. This form will be marked by great const.i.tutional disturbance, and the eruption coming out earlier than in the milder form; instead of being distinct, that is, each pimple standing distinct and separate one from the other, they will coalesce, and appear flat and doughy, not prominent: they will more particularly run into each other on the face, where they will form one continuous bag, which soon becoming a sore, will discharge copiously.

SMALL-POX IN THE VACCINATED.--When small-pox occurs to those that have been formerly vaccinated, the disease, in almost every instance, is much altered or modified in its character. Indeed in children, in whom of course vaccination has been but comparatively lately performed, small-pox when it occurs will, in the majority of cases, be so mild that the real nature of the disease will be with difficulty determined: so mild, that again and again has a parent been heard to exclaim, "Surely these few scattered pimples cannot be the small-pox!" If, however, as the pimples progress, they are narrowly watched, and are seen to become depressed in their centre; if there has been the precursory rigor, etc.; and if the source of the disorder can be traced to some case of undoubted small-pox, the child in fact having been exposed to contagion, no doubt ought to exist in reference to the nature of such a case, however slight may be the character of the disease.

The usual progress, however, of small-pox modified by vaccination is as follows. The first stage is the same usually as in the natural form of the disease. As soon, however, as the eruption appears, the modifying power of the vaccination becomes apparent. The eruption will be found to be generally both less in quant.i.ty and more limited in its extent; or if even it should come out profusely, and cover a large extent of the surface of the body, still the controuling power of the vaccination will immediately show itself after its appearance,--first, in the complete subsidence of all the febrile symptoms which will now take place; and, secondly, in reference to the eruption, part of which will die away at once, and the remainder will by the fifth day be filled with the opaque yellowish fluid, then dry up, becoming hard and h.o.r.n.y, and falling off will leave a mottled red appearance of the skin, and now and then slight pitting.

Such is the usual progress of the disease: subsequent to vaccination, it is a mild and tractable disorder. It is right, however, to mention that small-pox has occurred even to the vaccinated in almost as severe a form as the confluent natural small-pox, and running its regular course unaltered or unmodified. Such instances, however, are extremely rare, and form the exceptions to the general rule; for "no reasonable doubt can be entertained, from the abundance of facts now before the world, that such modification is the law of the animal economy, and that the regular or natural progress is the exception."

MATERNAL MANAGEMENT.--The grand principle in the treatment of small-pox is to moderate and keep under the fever; and however the plans adopted by different medical men may vary in particular points to accomplish this purpose, they uniformly make this principle their chief aim and object. To carry out this intention, however, the medical adviser is greatly dependent upon the aid and a.s.sistance of a judicious parent, and without this it is impossible to hope for a successful issue to the case. A clear knowledge, therefore, of those points of general management in which in fact a great part of the above principle consists (few and simple as these directions are), it must be all-important for the mother to be acquainted with: for the rest, she must and ought to look to the medical man.

In the more rare and severe form of this disease, viz. the confluent small-pox, although in some instances it runs the same course as the milder form, the distinct or natural small-pox, still, usually, the const.i.tutional symptoms are much more aggravated, and the medical and general treatment required will so much depend upon the character of the individual case, that we do not think it well to notice it here.

BED AND BED-ROOM.--It will not be necessary at first for the child to be confined to his bed, but generally about the third or fourth day he will gladly resort to it; and if he does not, it will be prudent to keep him there. He must not, however, be loaded with bed-clothes, but lightly covered; and the bed and body linen should be changed daily, if possible.

The bed-room should be capacious and well ventilated; fresh air frequently admitted; and if the season of the year permit, and there is no dampness of atmosphere, a window should be constantly open during the day: it is also desirable to keep the chamber darkened in all cases, as there is always a tendency to inflammation of the eyes.

If these directions are not regarded, and a great heat of the apartment is permitted, with abundance of bed-clothes heaped upon the child, the hot bath is used, and hot and stimulating regimen given (upon the old and erroneous notion of bringing out the eruption), the mildest case will inevitably be converted into one of the most severe and dangerous. Facts have abundantly shown that such measures invariably prove the most effectual means of exasperating the disease, and endangering life.

REGIMEN.--This must be most sparing. Cold water may be given whenever the child asks for it. Lemonade should form the common drink during the fever; and gruel, barley-water, and roasted apples are all else that is required during this period, and not until the disease is going off must any change be made in the diet.

The above period having arrived, mildly nutritious food should be given, as chicken or mutton broth, beef-tea, arrow-root, tapioca, or sago; to be followed in a few days by the wing of a chicken or a mutton chop; remembering always, that solid animal food must at first be given cautiously and sparingly. Wine or stimulants must be positively forbidden; unless, indeed, ordered by the medical man, for circ.u.mstances may arise which render them advisable.

The state of the bowels must be carefully attended to at this time.

THE ERUPTION.--In the natural and mild form of this disorder the pustules generally break from the sixth to the eighth day; dry scabs succeed; and in about nine or ten days the parts heal perfectly, requiring no treatment. In the more aggravated cases, however, in which the pustules are very numerous, running one into the other, and, bursting, discharge greatly, the whole surface of the body should be frequently and liberally dusted over with dried flour, or, what is better, starch powder. The sores in this instance are always tedious in healing, and followed by the well-known pits or marks: these arise from a loss of substance in the true skin, and occur more particularly on the face, from the great vascularity of this part causing the pustules to be more numerous here than elsewhere. It is a popular error to suppose that by wearing masks of fine linen or cambric illined with particular ointments, these scars or pits may be prevented: it is impossible to prevent them; and any local application, except a little cold cream or oil of almonds applied to the scabs when they harden, will prove more injurious than useful. The child's hands, however, should always be m.u.f.fled to prevent its scratching or breaking the sores, for otherwise he will not be kept from thus attempting to allay the excessive itching which they occasion.

The hair should be closely cut at an early period of the disease, and so kept throughout its continuance. This will contribute very much to the comfort of the child, by preventing the hair becoming matted together with the discharge from the pustules when they break, which gives rise to great pain and irritation. In the confluent and worst forms of this disease, this measure it is particularly necessary to attend to, as also to the application of cold lotions to the head when hot and dry (with other remedial means), as there is always a tendency in these cases to the formation of abscesses, the healing of which is troublesome and attended with difficulty.

CAUTIONS, ETC.--It has already been stated that a free ventilation of the bed-room is necessary to the well-doing of the patient. This measure, however, must not be confined to the chamber of the sick, but acted upon through the whole house.

In conjunction with ventilation, fumigations by means of aromatic substances kept slowly burning should be resorted to. A solution of the chloride of lime too, a most powerful disinfectant, should be used to purify the different apartments. This is best accomplished by steeping in the solution pieces of linen, and hanging them about the rooms, as also frequently and freely sprinkling the walls themselves; and as soon as the invalid is removed, the chamber should be white-washed, the various articles of furniture well scoured with soap and water, and the room be well and freely ventilated prior to its being again occupied.