Part 14

Water on the brain is, as a rule, a disease of childhood; after a child is seven years old it is comparatively rare. It more frequently attacks delicate children—children who have been dry-nursed (especially if they have been improperly fed), or who have been suckled too long, or who have had consumptive mothers, or who have suffered severely from teething, or who are naturally of a feeble constitution. Water on the brain sometimes follows an attack of inflammation of the lungs, more especially if depressing measures (such as excessive leeching and the administration of emetic tartar) have been adopted. It occasionally follows in the train of contagious eruptive diseases, such as either small-pox or scarlatina. We may divide the symptoms of water on the brain into two stages. The first—the premonitory stage—which lasts four or five days, in which medical aid might be of great avail; the second—the stage of drowsiness and of coma—which usually ends in death.

I shall dwell on the first—the premonitory stage—in order that a mother may see the importance without loss of time of calling in a medical man:

If her child be feverish and irritable, if his stomach be disordered, if he have urgent vomitings, if he have a foul breath, if his appetite be capricious and bad, if his nights be disturbed (screaming out in his sleep), if his bowels be disordered, more especially if they be constipated, if he be more than usually excited, if his eye gleam with unusual brilliancy, if his tongue run faster than it is wont, if his cheek be flushed and his head be hot, and if he be constantly putting his hand to his head, there is cause for suspicion. If to these symptoms be added, a more than usual carelessness in tumbling about, in hitching his foot in the carpet, or in dragging one foot after the other; if, too, he has complained of darting, shooting, lancinating pains in his head, it may then be known that the _first_ stage of inflammation (the forerunner of water on the brain) either has taken or is about taking place. Remember, no time ought to be lost in obtaining medical aid; for the _commencement_ of the disease is the golden opportunity, when life might probably be saved.

198. _At what age, and in what neighborhood, is a child most liable to Croup, and when is a mother to know that it is about to take place?_

It is unusual for a child until he be twelve months old to have croup; but, from that time until the age of two years, he is more liable to it than at any other period. The liability after two years gradually, until he be ten years old, lessens, after which time it is rare.

A child is more liable to croup in a low and damp, than in a high and dry neighborhood; indeed, in some situations, croup is almost an unknown disease; while in others it is only too well understood. Croup is more likely to prevail when the wind is either easterly or northeasterly.

There is no disease that requires more prompt treatment than croup, and none that creeps on more insidiously. The child at first seems to be laboring under a slight cold, and is troubled with a little _dry_ cough; he is hot and fretful, and _hoarse_ when he cries. Hoarseness is one of the earliest symptoms of croup; and it should be borne in mind that a young child, unless he be going to have croup, is seldom hoarse; if, therefore, your child be hoarse, he should be carefully watched, in order that, as soon as croup be detected, not a moment be lost in applying the proper remedies.

His voice at length becomes gruff, he breathes as though it were through muslin, and the cough becomes crowing. These three symptoms prove that the disease is now fully formed. These latter symptoms sometimes come on without any previous warning, the little fellow going to bed apparently quite well, until the mother is awakened, perplexed, and frightened, in the middle of the night, by finding him laboring under the characteristic cough and the other symptoms of croup. If she delay either to send for assistance, _or if proper medicines be not instantly given_, in a few hours it will probably be of no avail, and in a day or two the little sufferer will be a corpse!

When once a child has had croup the after-attacks are generally milder. If he has once had an attack of croup, I should advise you always to have in the house medicine—a 4 oz. bottle of ipecacuanha wine, to fly to at a moment’s notice; but never omit, where practicable, in a case of croup, whether the attack be severe or mild, to send _immediately_ for medical aid. In case of a sudden attack of croup, _instantly_ give a teaspoonful of ipecacuanha wine, and repeat it every five minutes until free vomiting be excited. There is no disease in which time is more precious than in croup, and where the delay of an hour may decide either for life or for death.

199. _But suppose a medical man is not_ IMMEDIATELY _to be procured, what then am I to do? more especially, as you say, that delay might be death_.

_What to do._—I never in my life lost a child with croup where I was called in at the _commencement_ of the disease, and where my plans were carried out to the very letter. Let me begin by saying, Look well to the goodness and purity of the medicine, for the life of your child may depend upon the medicine being genuine. What medicine? _Ipecacuanha wine!_ At the earliest dawn of the disease give a teaspoonful of ipecacuanha wine every five minutes, until free vomiting be excited. In croup, before he is safe, free vomiting _must_ be established, and that without loss of time. If, after the expiration of an hour, the ipecacuanha wine (having given during that hour a teaspoonful of it every five minutes) is not sufficiently powerful for the purpose—although it generally is so (if the ipecacuanha wine be good)—then let the following mixture be substituted:

Take of—Powdered Ipecacuanha, one scruple; Wine of Ipecacuanha, one ounce and a half:

Make a Mixture. A teaspoonful to be given every five minutes, until free vomiting be excited, first _well_ shaking the bottle.

After the vomiting, place the child for a quarter of an hour in a warm bath. (See “Warm baths”—directions and precautions to be observed.) When out of the bath give him small doses of ipecacuanha wine every two or three hours. The following is a palatable form for the mixture:

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

Make a Mixture. A teaspoonful to be taken every two or three hours.

But remember, the emetic which is given at _first_ is _pure ipecacuanha wine, without a drop of either water or of syrup_.

A large sponge dipped out of very hot water, and applied to the throat, and frequently renewed, oftentimes affords great relief in croup, and ought during the time the emetic is being administered in all cases to be adopted.

If it be a _severe_ case of croup, and does not in the course of two hours yield to the free exhibition of the ipecacuanha emetic, apply a narrow strip of _Smith’s tela vesicatoria_ to the throat, prepared in the same way as for a case of inflammation of the lungs (see the Conversation on the _treatment_ of inflammation of the lungs). With this only difference, let it be a narrower strip, only one-half the width there recommended, and apply it to the throat instead of to the chest. If a child has a very short, fat neck, there may not be room for the _tela_, then you ought to apply it to the _upper_ part of the chest—just under the collar-bones.

Let it be understood that the _tela vesicatoria_ is not a severe remedy, that the _tela_ produces very little pain—not nearly so much as the application of leeches; although, in its action, it is much more beneficial, and is not nearly so weakening to the system.

Keep the child from all stimulants; let him live on a low diet, such as milk and water, toast and water, arrow-root, etc.; and let the room be, if practicable, at a temperate heat—60° Fahrenheit, and be well ventilated.

So you see that the _treatment_ of croup is very simple, and that the plan might be carried out by an intelligent mother. Notwithstanding which, it is your duty, where practicable, to send at the very _onset_ of the disease for a medical man.

Let me again reiterate that if your child is to be saved the _ipecacuanha wine must be genuine and good_. This can only be effected by having the medicine from a highly respectable chemist. Again, if ever your child has had croup, let me again urge you _always_ to have in the house a 4 oz. bottle of ipecacuanha wine, that you may resort to at a moment’s notice in case there be the slightest return of the disease.

Ipecacuanha wine, unfortunately, is not a medicine that keeps well; therefore, every three or four months a fresh bottle ought to be procured either from a medical man or from a chemist. As long as the ipecacuanha wine remains _clear_, it is good; but as soon as it becomes _turbid_ it is bad, and ought to be replaced by a fresh supply.

An intelligent correspondent of mine makes the following valuable remarks on the preservation of ipecacuanha wine: “Now, I know that there are some medicines and chemical preparations which, though they spoil rapidly when at all exposed to the air, yet will keep perfectly good for an indefinite time if hermetically sealed up in a _perfectly full_ bottle. If so, would it not be a valuable suggestion if the Apothecaries’ Hall, or some other London firm of _undoubted_ reliability, would put up 1 oz. phials of ipecacuanha wine of guaranteed purity, sealed up so as to keep good so long as unopened, and sent out in sealed packages, with the guarantee of their name. By keeping a few such ounce bottles in an unopened state in one’s house, one might rely on being ready for any emergency. If you think this suggestion worth notice, and could induce some first-rate house to carry it out, and mention the fact in a subsequent edition of your book, you would, I think, be adding another most valuable item to an already invaluable book.”

The above suggestion of preserving ipecacuanha wine in ounce bottles, quite full, and hermetically sealed, is a very good one. The best way of hermetically sealing the bottle would be to cut the cork level with the lip of the bottle, and to cover the cork with sealing-wax, in the same manner wine merchants serve some kinds of their wines, and then to lay the bottles on their sides in sawdust in the cellar. I have no doubt, if such a plan were adopted, the ipecacuanha wine would for a length of time keep good. Of course, if the wine of ipecacuanha be procured from the Apothecaries’ Hall Company, London (as suggested by my correspondent), there can be no question as to the genuineness of the article.

_What_ NOT _to do_.—Do not give emetic tartar; do not apply leeches; do not keep the room very warm; do not give stimulants; do not omit to have always in the house either a 4 oz. bottle, or three or four 1 oz. bottles of ipecacuanha wine.

200. _I have heard Child-crowing mentioned as a formidable disease; would you describe the symptoms?_

Child-crowing, or _spurious croup_, as it is sometimes called, is occasionally mistaken for _genuine croup_. It is a more frequent disorder than the latter, and requires a different plan of treatment. Child-crowing is a disease that almost invariably occurs only during dentition, and is _most perilous_. But if a child laboring under it can fortunately escape suffocation until he has cut the whole of his first set of teeth—twenty—he is then, as a rule, safe.

Child-crowing comes on in paroxysms. The breathing during the intervals is quite natural—indeed, the child appears perfectly well; hence the dangerous nature of the disease is either overlooked, or is lightly thought of, until perhaps a paroxysm worse than common takes place, and the little patient dies of suffocation, overwhelming the mother with terror, with confusion, and dismay.

The _symptoms_ in a paroxysm of child-crowing are as follows: The child suddenly loses and fights for his breath, and in doing so makes a noise very much like that of crowing; hence the name child-crowing. The face during the paroxysm becomes bluish or livid. In a favorable case, after either a few seconds, or even, in some instances, a minute, and a frightful struggle to breathe, he regains his breath, and is, until another paroxysm occurs, perfectly well. In an unfavorable case, the upper part (chink) of the windpipe remains for a minute or two closed, and the child, not being able to breath, drops a corpse in his nurse’s arms. Many children, who are said to have died of fits, have really died of child-crowing.

I have entered thus rather fully into the subject, as many lives might be saved if a mother knew the nature of the complaint, and the _great necessity, during the paroxysms, of prompt and proper measures_. For, too frequently, before a medical man has had time to arrive, the child has breathed his last, the parent herself being perfectly ignorant of the necessary treatment; hence the vital importance of the subject, and the paramount necessity of imparting information, in a _popular_ style, in a work of this kind.

201. _What treatment, then, during a paroxysm of Child-crowing should you advise?_

The first thing, of course, to be done is to send _immediately_ for a medical man. Have a plentiful supply of cold and of hot water always at hand, ready at a moment’s notice for use. The instant the paroxysm is upon the child, plentifully and perseveringly dash _cold_ water upon his head and face. Put his feet and legs in _hot_ salt, mustard, and water; and, if necessary, place him up to his neck in a hot bath, still dashing water upon his face and head. If he does not quickly come round, sharply smack his back and buttocks.

As soon as a medical man arrives, he will lose no time in thoroughly lancing the gums and in applying other appropriate remedies.

Great care and attention ought, during the intervals, to be paid to the diet. If the child is breathing a smoky, close atmosphere, he should be immediately removed to a pure one. In this disease, indeed, there is no remedy equal to a change of air—to a dry, bracing neighborhood. Change of air, even if it be winter, is the best remedy, either to the coast or to a healthy farm-house. I am indebted to Mr. Roberton, of Manchester (who has paid great attention to this disease, and who has written a valuable essay on the subject), for the knowledge of this fact. Where, in a case of this kind, it is not practicable to send a child _from_ home, then let him be sent out of doors the greater part of every day; let him, in point of fact, almost live in the open air. I am quite sure, from an extensive experience, that in this disease, fresh air, and plenty of it, is the best and principal remedy.

202. _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 shivering 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, wishing to be quiet in his cot or crib; if his appetite be diminished; if his tongue be furred; if his mouth be _burning_ hot and dry; if his urine be scanty and high-colored, 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. If you put your finger into the mouth of a child laboring under inflammation of the lungs, it is like putting your finger into a hot apple-pie, the heat is _so_ great.

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_ assistance. 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 bed-room, 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, 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 teaspoonful of the mixture to be taken every four hours.

Be careful that you go to a respectable chemist, in order _that the quality of the ipecacuanha wine may be good, as the child’s life may depend upon it_.

If the medicine produces 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_—a quarter of a sheet, which ought to be fastened on to a piece of sticking-plaster, taking care to apply the tela vesicatoria (which is on paper) to the warmed plaster, so as to securely fasten the tela vesicatoria on the sticking-plaster. The plaster should be rather larger than the blister, so as to leave a margin. Any respectable chemist will understand the above directions, and will prepare the tela ready for use. 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 slip of it, on sticking-plaster, 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 God’s blessing, saved the lives of scores of children. It is far, very far superior to the old-fashioned 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 only be depended upon by having the medicine from a highly respectable chemist. Ipecacuanha wine, when genuine and good, is, in many children’s diseases, one of the most valuable of medicines.

_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 baby 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 marvelous. 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 quantity 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 child’s _thin_ blanket, or a thin _woolen_ shawl, in addition to his usual night-gown, is all the clothing necessary.

203. _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 labors 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-colored, 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, or 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.

204. _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.

205. _How would you treat a case of Bronchitis?_