The Maternal Management Of Children, In Health And Disease Part 20

The clothes of the patient and the bed linen should be frequently removed, and when taken away immediately immersed in boiling water, and whilst hung up in the open air sprinkled occasionally with a weak solution of the chloride of lime. If these directions are not observed, and the clothes are closely wrapped up, they will retain and give out the disease to others at a great distance of time.

Again: as the contagious property of smallpox hangs about the child as long as any scabs remain (which indeed may be said to retain the poison in its concentrated form), a parent must be most careful that the invalid is not too early brought in contact with the healthy members of the family.

An observance of these precautions is imperatively demanded; they not only protect the healthy, but aid the infected.

Sect. VIII.--HOOPING-COUGH.

My chief inducement to notice the above disorder arises out of the well-known fact, that there is no complaint of childhood more frequently subjected to quackery and mismanagement than is this.

Indeed, there are few maladies against which a greater array and variety of means have been recommended, than against hooping-cough.

I suppose from the circ.u.mstance of the simple and mild form of the complaint being so tractable (provided it remain such) that the simplest and mildest measures effect its cure, parents are tempted to undertake its management in the more severe and complicated forms; and the result is but too often the establishment of disease dangerous to life, and sometimes fatal to it.

But although most imprudent for a parent to a.s.sume the office of the physician, her aid is essentially necessary in carrying out the measures prescribed. By her watchfulness and care the duration of the disease may not only be abridged, but, what is of much greater importance, a more serious and aggravated form of disease prevented; for although hooping-cough in itself is not a dangerous disorder, still the most simple and slight case, if neglected or mismanaged, may quickly be converted into one both complicated and dangerous.

DESCRIPTION OF THE DISEASE.--Hooping-cough commences with the symptoms of a common cold, which is more or less frequent. These symptoms continue from five days to fifteen; at the end of which time the cough changes its character, and a.s.sumes the convulsive form, which distinguishes the disorder. It occurs in paroxysms, varying with the severity of the disease from five to six in the twenty-four hours to one every ten or fifteen minutes; being generally more severe and frequent during the night than in the day.

During a paroxysm the expirations are made with such violence, and repeated in such quick succession, that the child cannot breathe, and seems in danger of suffocation. The face and neck become swollen and purple from suffusion; and the eyes prominent, injected, arid full of tears. The little one, with a forewarning of the attack, which it dreads, falls on his knees, or clings closely to any thing near him.

The paroxysm terminates with one or two long inspirations, attended with that peculiar noise, or "whoop," from which the disease has derived its designation.

Sometimes the fit of coughing is interrupted for a minute or two, so that a little rest is obtained; and is then succeeded by another fit of coughing and another hoop, until after a succession of these actions the paroxysm terminates by vomiting, or a discharge of mucus from the lungs, or both.

The disease having continued at its height for two or three weeks, it begins naturally to decline; the paroxysms become less frequent and violent; the expectoration increases; the cough loses its characteristic hoop, and gradually wears away altogether; until at length, in two or three months from the first onset of the disease, the child is restored to perfect health. Sometimes, however, particularly in the autumn, and at other seasons on the occurrence of easterly winds, the paroxysms of cough will return,--it will a.s.sume its spasmodic character, and be accompanied with the "whoop," after a month, or even two or three months, of perfect and apparent recovery.

Errors in diet will sometimes alone have a similar effect.

It is a disease which usually occurs during childhood, rarely affects the same individual twice, and is seldom seen in the very young infant.

In reference to the probable result of the disease, when it occurs in its mild and simple form in a healthy child, the termination is usually favourable; but it may at first a.s.sume this form, and afterwards become complicated, and consequently more or less dangerous, owing to injudicious management, or to various influences over which the mother has no control.

It generally appears as an epidemic, and at those seasons when catarrhal complaints are most prevalent, and affects many or several at the same time. Isolated cases, however, frequently occur, which seem to prove the disease to be infectious. Some persons deny that it is so.

Mothers and nurses, however, who have not had the disease, will often contract it from the child under such circ.u.mstances, and thus it will be quickly propagated through the family. The nursing mother will occasionally take it from the infant at her breast. The child who has caught it from others whilst at school, and brought home in consequence, will communicate it readily to his brothers and sisters, although the disease did not exist previously in the family or neighbourhood, and was brought from a distant part of the country. All these instances are surely proofs of its infectious character, and point out the necessity of caution whenever hooping-cough may present itself in a family, and the necessity which exists for an early removal of the unaffected children from the sphere of its contagious influence.

The infectious property diminishes as the disease declines.

MATERNAL MANAGEMENT.--In the mild and simple form of this disease the medical treatment is one rather of prevention than cure, and the maternal management consists in a.s.sisting, by watchfulness and care, the fulfilment of this design.

In these slighter cases little more is required of the mother during the Jirst stage of the disorder (that is, before the cough becomes spasmodic) than attention to diet, regimen, and the excretions. The diet should be farinaceous, with milk, or as may be otherwise directed.

The child must be confined to a mild equable temperature; in fact, to his apartment. It is a popular error to suppose that at this time change of air is beneficial to the disease: at a later period it certainly is so, but now injurious, and attended with great risk.

Should the weather be cold, the little patient must be warmly clad, and flannel worn next the skin; this latter precaution should always be taken in the winter, spring, and autumn. Purgatives and other medicines will be required, and ordered by the medical attendant; the chief attention, however, of the parent must be directed to any change she may observe in the symptoms, breathing, etc.; she must be all on the alert to notice the first signs of local inflammation. Of this, however, we shall speak presently.

During the early part of the second stage, that is, when the cough becomes spasmodic, a.s.suming its peculiar sound, the same diet and regimen must be continued, and the same watchfulness observed, lest any inflammatory symptoms manifest themselves.

Under the foregoing treatment the disease generally runs its course without any untoward event, and the child recovers perfectly.

Sometimes, however, although the patient is quite well, and the disease on the decline, the cough still continues. In these cases, and at this time, it is that change of air often proves so very serviceable. The sea-side is preferable, if the season of the year permit; and salt- water bathing, commencing with the warm or tepid bath, and pa.s.sing gradually to the cold-bath (if no complication forbid it), will also prove certainly and rapidly remedial.

Crying, mental irritation, or opposition, frequently bring on a fit; and even the sight of another in a paroxysm will induce it in those affected by the disease. Running or other active exercise will generally cause the fits to be more severe. Young children, too, must be carefully watched at night, and be raised up by the nurse as soon as the fit is threatened. These hints the mother should bear in mind.

So much for the simple form of the disease, and that in which it most frequently and commonly presents itself to our notice: a mild disease; and, if carefully managed and watched over, certainly not a dangerous one.

Of what, then, is a parent to be afraid, or against what is she to guard? Lest other disease insidiously come on, and advance to an irremediable degree, masked by the cough, without attracting her attention. This is the great source of danger in hooping-cough. The physician, in a case of simple hooping-cough, is not in daily attendance upon his patient, and therefore not present to notice the commencement or first symptoms of those diseases which so frequently occur at this time, and the successful treatment of which will mainly depend upon their early detection, and the decision with which they are treated. When you hear of a child or several children in a family dying of hooping-cough, it is not this disease which proves fatal; but death is caused by some disease of lungs or brain, which has been super-added to the hooping-cough. The progress of hooping-cough, then, must be closely attended to by the parent, even in the most favourable cases.

The most frequent complication with hooping-cough is inflammation of the air-tubes of the lungs. This is extremely frequent during spring and winter, especially in the months of February, March, and April, owing to the prevalence of easterly winds at this season. It is not my intention to detail the symptoms of this affection, only to point out those which will enable a parent to recognise its approach. A parent then may take warning, and fear the approach of mischief, when she observes the fits of coughing become more frequent and more distressing to the child, and the breathing hurried in the intervals of the paroxysm; when any exertion or speaking causes increased difficulty of breathing or panting; when the expectoration becomes less abundant, and difficult to get up; when there is no longer, or at all events less frequent, vomiting after the cough, and more or less febrile symptoms present.

If the lungs themselves are attacked by inflammation, most of the symptoms already pointed out will occur; the cough will be frequent, in short paroxysms; the vomiting will not take place; the breathing will be very quick and hurried; and as the disease advances the hoop will cease.

If hooping-cough attack a child whilst teething, or from six months to two or three years of age, it is very common for the brain to suffer, and convulsions and water on the head to occur, particularly if the latter disease prevails in the family. Whenever the paroxysm of cough is increased in violence, the characteristic hoop disappearing, and the face becomes very livid; the hands clenched, and the thumbs drawn into the palms; the head hot, and marked fits of drowsiness and languor; and the child, during sleep, screaming out, or grinding its teeth,-- something wrong about the head ought to be antic.i.p.ated. Of the treatment we have here nothing to say, except that the gums must be carefully examined, and scarified if they require it, and the temperature of the head reduced by cold sponging, or the application of a bag of ice when necessary. The chief duty, however, of the parent is to be alive to these symptoms, and early to detect the incipient mischief, that by a prompt application of efficient means the accession of so formidable a malady may be prevented.

To specific remedies for this disease it is scarcely necessary to allude, after what has been advanced, except by way of warning. In the simple form of the complaint such medicines are superfluous, or rather some of them, from their violent properties, most dangerous; in the complicated forms of the disease they are inadmissible.

The indiscriminate use of purgatives, also, a parent should avoid.

Bowel affections are not an infrequent attendant upon hooping-cough, and always aggravate the primary disorder.

Of external applications all that need be said is this, that if they are not violently stimulating they do no harm; if, however, they contain tartar emetic, in addition to their doing no good to the disease, they cause unnecessary suffering to the patient, and are sometimes productive of dangerous and even fatal sores.

Sect. IX.--CROUP.

This disease is one of the most formidable of childhood; sudden (generally) in its attacks, most active in its progress, and if not met by a prompt and decided treatment, fatal in its termination. Hence the paramount importance of parents being acquainted with the signs which indicate its approach, that medical aid may be secured at the very onset of the disease. Upon this early application of suitable remedies every thing depends.

SIGNS OF ITS APPROACH.--Croup may appear in one of two ways: either preceded for two or three days by the symptoms of a common cold, accompanied with hoa.r.s.eness and a rough cough; or it may attack with the most alarming suddenness, during the night for instance, although the child had been merry and well the previous evening.

Hoa.r.s.eness, however, is the premonitory and important symptom of croup; for although it is not every hoa.r.s.eness that is followed by this formidable malady, still this symptom rarely attends a common cold in young children, and therefore always deserves when present the serious attention of the mother, particularly if accompanied by a rough cough.

The symptoms or signs of the approach of this disease have been ably and graphically depicted by the late Dr. Cheyne,

"In the approach of an attack of croup, which almost always takes place in the evening, probably of a day during which the child has been exposed to the weather, and often after catarrhal symptoms have existed for several days, he may be observed to be excited; in variable spirits; more ready than usual to laugh or to cry; a little flushed; occasionally coughing, the sound of the cough being rough, like that which attends the catarrhal stage of the measles. More generally, however, the patient has been for some time in bed and asleep before the nature of the disease with which he is threatened is apparent; then, perhaps without awaking, he gives a very unusual cough, well known to any one who has witnessed an attack of the croup: it rings as if the child had coughed through a brazen trumpet; it is truly a tussis clangosa; it penetrates the walls and floors of the apartment, and startles the experienced mother--'Oh, I am afraid our child is taking the croup!' She runs to the nursery, finds her child sleeping softly, and hopes she may be mistaken. But remaining to tend him, before long the ringing cough, a single cough, is repeated again and again. The patient is roused, and then a new symptom is remarked: the sound of his voice is changed; puling, and as if the throat were swelled, it corresponds with the cough; the cough is succeeded by a sonorous inspiration, not unlike the kink in hooping-cough--a crowing noise, not so shrill, but similar to the sound emitted by a chicken in the pip (which in some parts of Scotland is called the roup, hence probably the word croup); the breathing, hitherto inaudible and natural, now becomes audible, and a little slower than common, as if the breath were forced through a narrow tube; and this is more remarkable as the disease advances," etc. etc.

It is unnecessary for me to add to the foregoing picture.

MATERNAL MANAGEMENT.--Having early obtained medical a.s.sistance attend with the strictest obedience to the directions given. And in this disease, more than any other, it is particularly important that the mother should give her personal superintendence; for the activity of the progress of the disease leaves no time to retrieve errors or atone for neglect. The pract.i.tioner may be prompt and decided in the measures he prescribes, but they will avail little, unless they are as promptly and decidedly acted upon.

The parent will have her reward; for, if timely aid has been afforded, and adequate means used, the event will be almost invariably favourable.

ITS PREVENTION.--Croup, when it has once attacked a child, is very liable to recur at any period before the thirteenth or fourteenth year of age. It may even do so several times, and after intervals of various duration. It is very desirable, therefore, that a parent should be acquainted with the means of prevention.

They consist simply in the following measures:--The careful protection of the child from cold or damp weather, particularly the north-east winds of spring following heavy rains. Croup is most prevalent in those seasons which are cold and moist, or when the alternations of temperature are sudden and remarkable. If the residence of the child is favourable to the production of croup, (for instance, near a large body of water, or in low damp spots,) he should, if possible, be removed to a healthier situation. Sponging or the shower-bath, with cold water and bay-salt, with considerable friction in drying the body, should be commenced in summer, and employed every morning upon the child's rising from bed. The clothing should be warm in the winter and spring, the neck always covered, and flannel worn next the skin throughout the year; but hot rooms, and much clothing when in bed, must be avoided.

The diet must be light and nouris.h.i.+ng; no beer or stimulant given; and the state of the bowels must be carefully watched.

The above precautions are of course particularly necessary to enforce immediately after a recovery from an attack, for there is a great tendency to relapse. If the attack takes place during the winter or spring months, the invalid must be kept, until milder weather, in the house, and in a room of an equable and moderately warm temperature. If in the summer, change of air, as soon as it can be safely effected, will be found very useful.