Advice to a Mother on the Management of Her Children Part 18

Mr Roberton, who, at my request, has kindly given me the benefit of his extensive experience in child-crowing, considers that there is no remedy, in this complaint, equal to fresh air--to dry cold winds--that the little patient ought, in fact, nearly to live, during the day, out of doors, whether the wind be in the east or in the north-east, whether it be biting cold or otherwise, provided it be dry and bracing, for "if the air be dry, the colder the better,"--taking care, of course, that he be well wrapped up. Mr Roberton, moreover, advises that the child should be sent away at once from home, either to a bracing sea-side place, such as Blackpool or Fleetwood; or to a mountainous district, such as Buxton.

As the subject is so important, let me recapitulate: the gums ought, from time to time, to be well lanced, in order to remove the irritation of painful dent.i.tion--painful dent.i.tion being the real cause of the disease. Cold sponging should be used twice or thrice daily. The diet should be carefully attended to (see Dietary of Child); and everything conducive to health should (as recommended in these Conversations) be observed. But, remember, after all that can be said about the treatment, there is nothing like change of air, of fresh air, of cold, dry pure air, and of plenty of it--the more the little fellow can inhale, during the day, the better it will be for him, it will be far better than any drug contained in the pharmacopoeia.

I have dwelt on this subject at some length--it being a most important one--as, if the above advice were more generally known and followed, nearly every child, labouring under this complaint, would be saved; while now, as coroners' inquests abundantly testify, the disease carries off yearly an immense number of victims.

204. _When is a mother to know that a cough is not a "tooth cough" but one of the symptoms of Inflammation of the lungs_?

If the child has had a s.h.i.+vering fit; if his skin be very hot and very dry; if his lips be parched; if there be great thirst; if his cheeks be flushed; if he be dull and heavy, wis.h.i.+ng to be quiet in his cot or crib; if his appet.i.te be diminished; if his tongue be furred; if his mouth be _burning_ hot and dry; [Footnote: If you put your finger into the mouth of a child labouring under inflammation of the lungs, it is like putting your finger into a hot apple pie, the heat is so great.]

if his urine be scanty and high-coloured, staining the napkin or the linen; _if his breathing be short, panting, hurried, and oppressed; if there be a hard dry cough, and if his skin be burning hot;_--then there is no doubt that inflammation of the lungs has taken place.

No time should be lost in sending for medical aid; indeed, the _hot, dry mouth and skin, and short, hurried breathing_ would be sufficient cause for your procuring _immediate_ a.s.sistance. If inflammation of the lungs were properly treated at the _onset_, a child would scarcely ever be lost by that disease. I say this advisedly, for in my own practice, _provided I am called in early, and if my plans are strictly carried out_, I scarcely ever lose a child from inflammation of the lungs.

You may ask--What are your plans? I will tell you, in case _you cannot promptly obtain medical advice,_ as delay might be death!

_The treatment of Inflammation of the Lungs, what to do._--Keep the child to one room, to his bedroom, and to his bed. Let the chamber be properly ventilated. If the weather be cool, let a small fire be in the grate; otherwise, he is better without a fire. Let him live on low diet, such as weak black tea, milk and water (in equal quant.i.ties), and toast and water, thin oatmeal gruel, arrow-root, and such like simple beverages, and give him the following mixture:--

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

Make a Mixture. A tea-spoonful of the mixture to be taken every four hours.

Be careful that you go to a respectable chemist, in order _that the totality of the Ipecacuanha Wine may be good, as the child's life may depend upon it._

If the medicine produce sickness, so much the better; continue it regularly until the short, oppressed, and hurried breathing has subsided, and has become natural.

If the attack be very severe, in addition to the above medicine, at once apply a blister, not the common blister, but _Smith's Tela Vesicatoria_ [Footnote: Manufactured by T. & H. Smith, chemists, Edinburgh, and may be procured of Southalls, chemists, Birmingham.]--a quarter of a sheet. If the child be a year old, the blister ought to be kept on for three hours, and then a piece of dry, soft linen rag should be applied for another three hours. At the end of which time--six hours--there will be a beautiful blister, which must then, with a pair of scissors, be cut, to let out the water, and then let the blister be dressed, night and morning, with simple cerate spread on lint.

If the little patient be more than one year, say two years old, let the Tela remain on for five hours, and the dry linen rag for five hours more, before the blister, as above recommended, be cut and dressed.

If in a day or two the inflammation still continue violent, let another Tela Vesicatoria be applied, not over the old blister, but let a narrow strip of it be applied on each side of the old blister, and managed in the same manner as before directed.

_I cannot speak too highly of Smith's Tela Vesicatoria._ It has, in my hands, through G.o.d's blessing, saved the lives of scores of children. It is far, very far, superior to the old fas.h.i.+oned blistering plaster. It seldom, if the above rules be strictly observed, fails to rise, it gives much less pain than the common blister, when it has had the desired effect, it readily heals, which cannot always be said of the common fly blister, more especially with children.

My sheet anchors, then, in the inflammation of the lungs of children are, Ipecacuanha Wine and Smith's _Tela Vesicatoria_. Let the greatest care, as I before advised, be observed in obtaining the Ipecacuanha Wine genuine and good. This can be only depended upon by having the medicine from a highly respectable chemist, Ipecacuanha Wine, when genuine and good, is, in many children's diseases, is one of the most valuable of medincies.

_What, in a case of inflammation of the lungs, NOT to do_--Do not, on any account, apply leeches. They draw out the life of the child, but not his disease. Avoid--_emphatically let me say so_--giving emetic tartar It is one of the most lowering and death-dealing medicines that can be administered either to an infant or to a child! If you wish to try the effect of it, take a dose yourself, and I am quite sure that you will then never be inclined to poison a child with such an abominable preparation! In olden times--many, many years ago--I myself gave it in inflammation of the lungs, and lost many children! Since leaving it off, the recoveries of patients by the Ipecacuanha treatment, combined with the external application of Smith's _Tela Vesicatoria_, have been in many cases marvellous. Avoid broths and wine, and all stimulants. Do _not_ put the child into a warm bath, it only oppresses the already oppressed breathing. Moreover, after he is out of the bath, it causes a larger quant.i.ty of blood to rush back to the lungs and to the bronchial tubes, and thus feeds the inflammation. Do not, by a large fire, keep the temperature of the room high. A small fire, in the winter time, encourages ventilation, and in such a case does good. When the little patient is on the mother's or on the nurse's lap, do not burden him either with a _heavy_ blanket or with a _thick_ shawl. Either a _thin_ child's blanket, or a _thin_ woollen shawl, in addition to his usual nightgown, is all the clothing necessary.

205. _Is Bronchitis a more frequent disease than Inflammation of the Lungs? Which is the most dangerous? What are the symptoms of Bronchitis_?

Bronchitis is a much more frequent disease than inflammation of the lungs, indeed, it is one of the most common complaints both of infants and of children, while inflammation of the lungs is comparatively a rare disease. Bronchitis is not nearly such a dangerous disease as inflammation of the lungs.

_The symptoms_--The child for the first few days labours under symptoms of a heavy cold, he has not his usual spirits. In two or three days, instead of the cold leaving him, it becomes more confirmed, he is now really poorly, fretful, and feverish, his breathing becomes rather hurried and oppressed, his cough is hard and dry, and loud, he wheezes, and if you put your ear to his naked back, between his shoulder blades, you will hear the wheezing more distinctly. If at the breast, he does not suck with his usual avidity; the cough, notwithstanding the breast is a great comfort to him, compels him frequently to loose the nipple; his urine is scanty, and rather high-coloured, staining the napkin, and smelling strongly. He is generally worse at night.

Well, then, remember if the child be feverish, if he have symptoms of a heavy cold, if he have an oppression of breathing, if he wheeze, and if he have a tight, dry, noisy cough, you may be satisfied that he has an attack of bronchitis.

206. _How can I distinguish between Bronchitis and Inflammation of the Lungs_?

In bronchitis the skin is warm, but moist; in inflammation of the lungs it is hot and dry: in bronchitis the mouth is warmer than usual, but moist; in inflammation of the lungs it is burning hot: in bronchitis the breathing is rather hurried, and attended with wheezing; in inflammation of the lungs it is very short and panting, and is unaccompanied with wheezing, although occasionally a very slight crackling sound might be heard: in bronchitis the cough is long and noisy; in inflammation of the lungs it is short and feeble: in bronchitis the child is cross and fretful; in inflammation of the lungs he is dull and heavy, and his countenance denotes distress.

We have sometimes a combination of bronchitis and of inflammation of the lungs, an attack of the latter following the former. Then the symptoms will be modified, and will partake of the character of the two diseases.

207. _How would you treat a case of Bronchitis_?

If a medical man cannot be procured, I will tell you _What to do_: Confine the child to his bedroom, and if very ill, to his bed. If it be winter time, have a little fire in the grate, but be sure that the temperature of the chamber be not above 60 degrees Fahrenheit, and let the room be properly ventilated, which may be effected by occasionally leaving the door a little ajar.

Let him lie either _outside_ the bed or on a sofa, if he be very ill, _inside_ the bed, with a sheet and a blanket only to cover him, but no thick coverlid. If he be allowed to be on the lap, it only heats him and makes him restless. If he will not lie on the bed, let him rest on a pillow placed on the lap, the pillow will cause him to lie cooler, and will more comfortably rest his weaned body. If he be at the breast, keep him to it, let him have no artificial food, unless, if he be thirsty a little toast and water. If he be weaned, let him have either milk and water, arrow root made with equal parts of milk and water, toast and water, barley water, or weak black tea, with plenty of new milk in it, &c., but, until the inflammation have subsided, neither broth nor beef tea.

Now, with regard to medicine, the best medicine is Ipecacuanha Wine, given in large doses, so as to produce constant nausea. The Ipecacuanha abates fever, acts on the skin, loosens the cough, and, in point of fact, in the majority of cases, will rapidly effect a cure. I have in a preceding Conversation given you a prescription for the Ipecacuanha Wine Mixture. Let a tea-spoonful of the mixture be taken every four hours.

If in a day or two he be no better, but worse, by all means continue the mixture, whether it produce sickness or otherwise, and put on the chest a _Tela Vesicatoria_, a quarter of a sheet.

The Ipecacuanha Wine and the Tela Vesicatoria are my sheet anchors in the bronchitis, both of infants and of children. They rarely, even in very severe cases, fail to effect a cure, provided the Tela Vesicatorina be properly applied, and the Ipecacuanha Wine be genuine and of good quality.

If there be any difficulty in procuring _good_ Ipecacuanha Wine, the Ipecacuanha may be given in powder instead of the wine The following is a pleasant form--

Take of--Powder of Ipecacuanha, twelve grains White Sugar thirty six grains

Mix well together and divide into twelve powders. One of the powders to be put dry on the tongue every four hours.

The Ipecacuanha Powder will keep better than the Wine--an important consideration to those living in country places, nevertheless, if the Wine can be procured fresh and good, I far prefer the Wine to the Powder.

When the bronchitis has disappeared, the diet ought gradually to be improved--rice, sago, tapioca, and light batter-pudding, &c.; and, in a few days, either a little chicken or a mutton chop, mixed with a well-mashed potato and crumb of bread, should be given. But let the improvement in his diet be gradual, or the inflammation might return.

_What NOT to do_.--Do not apply leeches. Do not give either emetic tartar or antimonial wine, which is emetic tartar dissolved in wine. Do not administer either paregoric or syrup of poppies, either of which would stop the cough, and would thus prevent the expulsion of the phlegm. Any fool can stop a cough, but it requires a wise man to rectify the mischief. A cough is an effort of Nature to bring up the phlegm, which would otherwise acc.u.mulate, and in the end cause death. Again, therefore, let me urge upon you the immense importance of _not_ stopping the cough of a child. The Ipecacuanha Wine will, by loosening the phlegm, loosen the cough, which is the only right way to get rid of a cough. Let what I have now said be impressed deeply upon your memory, as thousands of children in England are annually destroyed by having their coughs stopped. Avoid, until the bronchitis be relieved, giving him broths, and meat, and stimulants of all kinds. For further observations on _what NOT to do_ in bronchitis, I beg to refer you to a previous Conversation we had on _what NOT to do_ in inflammation of the lungs. That which is injurious in the one case is equally so in the other.

208. _What are the symptoms of Diphtheria, or, as it is sometimes called, Boulogne Sore-throat_?

This terrible disease, although by many considered to be a new complaint, is, in point of fact, of very ancient origin. Homer, and Hippocrates, the Father of Physic, have both described it. Diphtheria first appeared in England in the beginning of the year 1857, since which time it has never totally left our sh.o.r.es.

_The symptoms_--The little patient, before the disease really shows itself, feels poorly, and is "out of sorts." A s.h.i.+vering fit, though not severe, may generally be noticed. There is heaviness, and slight headache, princ.i.p.ally over the eyes. Sometimes, but not always, there is a mild attack of delirium at night The next day he complains of slight difficulty of swallowing. If old enough, he will complain of constriction about the swallow. On examining the throat, the tonsils will be found to be swollen and redder--more darkly red than usual. Slight specks will be noticed on the tonsils. In a day or two an exudation will cover them, the back of the swallow, the palate, the tongue, and sometimes the inside of the cheeks and of the nostrils. This exudation of lymph gradually increases until it becomes a regular membrane, which puts on the appearance of leather, hence its name diphtheria. This membrane peels off in pieces, and if the child be old and strong enough he will sometimes spit it up in quant.i.ties, the membrane again and again rapidly forming as before. The discharges from the throat are occasionally, but not always, offensive. There is danger of croup from the extension of the membrane into the wind pipe. The glands about the neck and under the jaw are generally much swollen, the skin is rather cold and clammy, the urine is scanty and usually pale, the bowels at first are frequently relaxed. This diarrhoea may, or may not, cease as the disease advances.

The child is now in a perilous condition, and it becomes a battle between his const.i.tution and the disease. If, unfortunately, as is too often the case--diphtheria being more likely to attack the weakly--the child be very delicate, there is but slight hope of recovery. The danger of the disease is not always to be measured by the state of the throat. Sometimes, when the patient appears to be getting well, a sudden change for the worse rapidly carries him off. Hence the importance of great caution, in such cases, in giving an opinion as to ultimate recovery. I have said enough to prove the terrible nature of the disease, and to show the necessity of calling in, at the earliest period of the symptoms, an experienced and skilful medical man.

209. _Is Diphtheria contagious_?

_Decidedly_. Therefore, when practicable, the rest of the children ought instantly to be removed to a distance. I say _children_, for it is emphatically a disease of childhood. When adults have it, it is the exception and not the rule: "Thus it will be seen, in the account given of the Boulogne epidemic, that of 366 deaths from this cause, 341 occurred amongst children under ten years of age. In the Lincolns.h.i.+re epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred amongst children under twelve years of age." [Footnote: _Diphtheria_: by Ernest Hart. A valuable pamphlet on the subject. Dr Wade of Birmingham has also written an interesting and useful monograph on Diphtheria. I am indebted to the above authors for much valuable information.]

210. _What are the causes of Diphtheria_?

Bad and imperfect drainage; [Footnote: "Now all my carefully conducted inquiries induce me to believe that the disease comes from drain-poison. All the cases into which I could fully inquire, have brought conviction to my mind that there is a direct law of sequence in some peculiar conditions of atmosphere between diphtheria and bad drainage; and, if this be proved by subsequent investigations, we may be able to prevent a disease which, in too many cases, our known remedies cannot cure."--W. Carr, Esq., Blackheath, _British Medical Journal_, December 7, 1861.] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything that vitiates the air, and thus depresses the system, more especially if the weather be close and muggy; poor and, improper food; and last, though not least, contagion. Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.

211. _What is the treatment of Diptheria_?

_What to do_--Examine well into the ventilation, for as diphtheria is frequently caused by deficient ventilation, the best remedy is thorough ventilation. Look well both to the drains and to the privies, and see that the drains from the water-closets and from the privies do not in any way contaminate the pump-water. If the drains be defective or the privies be full, the disease in your child will be generated, fed, and fostered. Not only so, but the disease will spread in your family and all around you.

Keep the child to his bedroom and to his bed. For the first two or three days, while the fever runs high, put him on a low diet, such as milk, tea, arrow root, &c.

Apply to his throat every four hours a warm barm and oatmeal poultice. If he be old enough to have the knowledge to use a gargle, the following will be found serviceable--