Advice to a Mother on the Management of Her Children Part 19

Take of--Permanganate of Potash, pure, four grams, Water eight ounces

To make a Gargle

Or,

Take of--Powdered Alum, one drachm, Simple Syrup one ounce, Water, seven ounces

To make a Gargle

The best medicine for the first few days of the attack, is the following mixture--

Take of--Chlorate of Potash two drachms, Boiling Water seven ounces Syrup of Red Poppy one ounce

To Make a mixture. A table spoonful to be taken every four hours.

Or the chlorate of potash might be given in the form of powder--

Take of--Chlorate of Potash two scruples, Lump Sugar one drachm

Mix and divide into eight powders. One to be put into a dry tea spoon and then placed on the tongue every three hours, These powders are very useful in diphtheria; they are very cleansing to the tongue and throat. If they produce much smarting as where the mouth is very sore they sometimes do, let the patient, after taking one, drink plentifully of milk, indeed I have known these powders induce a patient to take nourishment, in the form of milk, which he otherwise would not have done, and thus to have saved him from dying of starvation, which, before taking the powders, there was every probability of his doing. An extensive experience has demonstrated to me the great value of these powders in diphtheria, but they must be put on the tongue dry.

As soon as the skin has lost its preternatural heat, beef tea and chicken broth ought to be given. Or if great prostration should supervene, in addition to the beef tea, port wine, a table spoonful every four hours, should be administered. If the child be cold, and there be great sinking of the vital powers, brandy and water should be subst.i.tuted for the port wine. Remember, in ordinary cases, port wine and brandy are not necessary, _but in cases of extreme exhaustion_ they are most valuable.

As soon as the great heat of the skin has abated and the debility has set in, one of the following mixtures will be found useful--

Take of--Wine of Iron, one ounce and a half, Sample Syrup, one ounce, Water, three ounces and a half

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

Or,

Take of--Tincture of Perchloride of Iron, one drachm Simple Syrup, one ounce, Water, three ounces

To make a Mixture. A table spoonful to be taken three times a day.

If the disease should travel downwards, it will cause all the symptoms of croup, then it must be treated as croup, with this only difference, that a blister (_Tela Vesicatoria_) must _not_ be applied, or the blistered surface may be attacked by the membrane of diphtheria, which may either cause death or hasten that catastrophe. In every other respect treat the case as croup, by giving an emetic, a tea spoonful of Ipecacuanha Wine every five minutes, until free vomiting be excited, and then administer smaller doses of Ipecacuanha Wine every two or three hours, as I recommended when conversing with you on the treatment of croup.

_What NOT to do_--Do not, on any account, apply either leeches or a blister. If the latter be applied, it is almost sure to be covered with the membrane of diphtheria, similar to that inside of the mouth and of the throat, which would be a serious complication. Do not give either calomel or emetic tartar. Do not depress the system by aperients, for diphtheria is an awfully depressing complaint of itself, the patient, in point of fact, is labouring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by faecal matter from either a privy or from a water-closet, by some horrid drain, by proximity to a pig-sty, by an overflowing privy, especially if vegetable matter be rotting at the same time in it, by bad ventilation, or by contagion. Diphtheria may generally be traced either to the one or to the other of the above causes, therefore let me urgently entreat you to look well into all these matters, and thus to stay the pestilence!

Diphtheria might long remain in a neighbourhood if active measures be not used to exterminate it.

212. _Have the goodness to describe the symptoms of Measles_?

Measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a hoa.r.s.e and peculiar ringing cough, which nurses call "measle-cough,"

and difficulty of breathing. These symptoms usually last three days before the eruption appears, on the fourth it (the eruption) generally makes its appearance, and continues for four days and then disappears, lasting altogether, from the commencement of the symptoms of cold to the decline of the eruption, seven days. It is important to bear in mind that the eruption consists of _crescent-shaped--half moon-shaped--patches_, that they usually appear first about the face and the neck, in which places they are the best marked; then on the body and on the arms; and, lastly, on the legs, and that they are slightly raised above the surface of the skin. The face is swollen, more especially the eye-lids which are sometimes for a few days closed.

Well, then, remember, _the running at the nose, the, sneezing, the peculiar hoa.r.s.e cough, and the half-moon-shaped patches_, are the leading features of the disease, and point out for a certainty that it is measles.

213. _What const.i.tutes the princ.i.p.al danger in Measles_?

The affection of the chest. The mucous or lining membrane of the bronchial tubes is always more or less inflamed, and the lungs themselves are sometimes affected.

214. _Do you recommend "surfeit water" and saffron tea to throw out the eruption in Measles_?

Certainly not. The only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "Surfeit water," saffron tea, and remedies of that cla.s.s, are hot and stimulating. The only effect they can have, will be to increase the fever and the inflammation--to add fuel to the fire.

215. _What is the treatment of Measles_?

_What to do_.--The child ought to be confined both to his room and to his bed, the room being kept comfortably warm; therefore, if it be winter time, there should be a small fire in the grate; in the summer time, a fire would be improper. The child must not be exposed to draughts; notwithstanding, from time to time, the door ought to be left a little ajar in order to change the air of the apartment; for proper ventilation, let the disease be what it may, is absolutely necessary.

Let the child, for the first few days, be kept on a low diet, such as on milk and water, arrow-root, bread and b.u.t.ter, &c.

If the attack be mild, that is to say, if the breathing be not much affected (for in measles it always is more or less affected), and if there be not much wheezing, the Acidulated Infusion of Roses' Mixture [Footnote: See page 178] will be all that is necessary.

But suppose that the breathing is short, and that there is a great wheezing, then instead of giving him the mixture just advised, give him a tea-spoonful of a mixture composed of Ipecacuanha Wine, Syrup, and Water, [Footnote: See page 161] every four hours. And if, on the following day, the breathing and the wheezing be not relieved in addition to the Ipecacuanha Mixture, apply a Tola Vesicatoria, as advised under the head of Inflammation of the Lungs.

When the child is convalescing, batter puddings, rice, and sago puddings, in addition to the milk, bread and b.u.t.ter, &c, should be given, and, a few days later, chicken, mutton chops, &c.

The child ought not, even in a mild case of measles, and in favourable weather to be allowed to leave the house under a fortnight, or it might bring on an attack of bronchitis.

_What NOT to do_--Do not give either "surfeit water" or wine. Do not apply leeches to the chest. Do not expose the child to the cold air. Do not keep the bed room very hot, but comfortably warm. Do not let the child leave the house, even under favourable circ.u.mstances, under a fortnight. Do not, while the eruption is out, give aperients. Do not, "to ease the cough," administer either emetic tartar or paregoric--the former drug is awfully depressing, the latter will stop the cough, and will thus prevent the expulsion of the phlegm.

216. _What is the difference between Scarlatina and Scarlet Fever_?

They are indeed one and the same disease, scarlatina being the Latin for scarlet fever. But, in a _popular_ sense, when the disease is mild, it is usually called scarlatina. The latter term does not sound so formidable to the ears either of patients or of parents.

217. _Will you describe the symptoms of Scarlet Fever_?

The patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. At the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself.

The scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as Dr Elliotson accurately describes it,--"the tongue looks as if it had been slightly sprinkled with Cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." The eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. There is usually, after the first few days, great itching on the surface of the body. The skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it.

There are three forms of scarlet fever;--the one where the throat is little, if at all, affected, and this is a mild form of the disease; the second, which is generally, especially at night, attended with delirium, where the throat is _much_ affected, being often greatly inflamed and ulcerated; and the third (which is, except in certain unhealthy districts, comparatively rare, and which is VERY dangerous), the malignant form.

218. _Would it be well to give a little cooling, opening physic as soon as a child begins to sicken for Scarlet Fever_?

_On no account whatever._ Aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. It is my firm conviction, that the administration of opening medicine, at such times, is one of the princ.i.p.al causes of scarlet fever being so frequently fatal. This is, of course, more applicable to the poor, and to those who are unable to procure a skilful medical man.

219. _What const.i.tutes the princ.i.p.al danger in Scarlet Fever_?

The affection of the throat, the administration of opening medicine during the first ten days, and a peculiar disease of the kidneys ending in _anasarca_ (dropsy), on which account, the medical man ought, when practicable, to be sent for at the onset, that no time may be lost in applying _proper_ remedies.

When Scarlet Fever is complicated--as it sometimes is--with diphtheria, the diphtheric membrane is very apt to travel into the wind-pipe, and thus to cause diphtheric croup, it is almost sure, when such is the case, to end in death. When a child dies from such a complication, the death might truly be said to be owing to the diphtheric croup, and not to the Scarlet Fever, for if the diphtheric croup had not occurred, the child would, in all probability, have been saved. The deaths from diphtheria are generally from diphtheric croup, if there be no croup, there is, as a rule, frequent recovery.

220. _How would you distinguish between Scarlet Fever and Measles_?

Measles commences with symptoms of a common cold, scarlet fever does not. Measles has a _peculiar hoa.r.s.e_ cough, scarlet fever has not. The eruption of measles is in patches of a half moon shape, and is slightly raised above the skin, the eruption of scarlet fever is _not_ raised above the skin at all, and is one continued ma.s.s. The colour of the eruption is much more vivid in scarlet fever than in measles. The chest is the part princ.i.p.ally affected in measles, and the throat in scarlet fever.

There is an excellent method of determining, for a certainty, whether the eruption be that of scarlatina or otherwise. I myself have, in several instances, ascertained the truth of it--"For several years M Bouchut has remarked in the eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. The phenomenon in question is a _white line_, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. On drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. In this way the diagnosis of the disease may be very distinctly written on the skin; the word 'Scarlatina' disappears as the eruption regains its uniform tint."--_Edinburgh Medical Journal._