Part 15

If a medical man cannot be procured, I will tell you _what to do_: Confine the child to his bed-room, 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 is not above 60° 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 lie 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 wearied 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, etc.; but, until the inflammation has 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 teaspoonful 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_, prepared and applied as I recommended when treating of inflammation of the lungs.

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 vesicatoria 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, etc.; 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 accumulate, 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.

206. _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 shores.

_The symptoms._—The little patient, before the disease really shows itself, feels poorly, and is “out of sorts.” A shivering fit, though not severe, may generally be noticed. There is heaviness, and slight headache, principally 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 the nostrils. The 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 quantities, 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 windpipe. 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 diarrhœa may or may not cease as the disease advances.

The child is now in a perilous condition, and it becomes a battle between his constitution 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 skillful medical man.

207. _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 among children under ten years of age. In the Lincolnshire epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred among children under twelve years of age.”

208. _What are the causes of Diphtheria?_

Bad and imperfect drainage; want of ventilation; overflowing privies; low neighborhoods in the vicinity of rivers; stagnant waters; indeed, every thing 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. “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._ Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.

209. _What is the treatment of Diphtheria?_

_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 bed-room 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, etc.

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:

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 one of the following mixtures:

Take of—Chlorate of Potash, two drachms; Boiling Water, seven ounces and a half; Syrup of Red Poppy, half an ounce:

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

Or,

Take of—Diluted Sulphuric Acid, one drachm; Simple Syrup, one ounce and a half; Infusion of Roses, four ounces and a half;

To make a Mixture. A tablespoonful to be given every four hours.

Let the infusion of roses be made merely with the rose-leaves and boiling water.

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 tablespoonful 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 substituted 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; Simple Syrup, one ounce; Water, three ounces and a half:

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

Or,

Take of—Muriated Tincture of Iron, half a drachm; Simple Syrup, one ounce; Water, three ounces:

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

If the disease should travel downward, 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 teaspoonful 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 laboring under the depressing effects of poison, for the blood has been poisoned either by the drinking water being contaminated by fecal 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 neighborhood if active measures be not used to exterminate it.

210. _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 hoarse 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 eyelids, which are sometimes for a few days closed.

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

211. _What constitutes the principal 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.

212. _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 class, 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.

213. _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 butter, etc.

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 will be all that is necessary. (See question 209.)

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 teaspoonful of a mixture composed of ipecacuanha wine, syrup, and water, every four hours. (See question 202.) And if, on the following day, the breathing and the wheezing be not relieved, in addition to the ipecacuanha mixture, apply a tela 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 butter, etc., should be given; and, a few days later, chicken, mutton-chops, etc.

The child ought not, even in a mild case of measles, and in favorable 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 favorable circumstances, 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.

214. _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.

215. _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 color 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 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.

216. _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 principal 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 skillful medical man.

217. _What constitutes the principal 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.

218. _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 hoarse_ 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 mass. The color of the eruption is much more vivid in scarlet fever than in measles. The chest is the part principally 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 eruption of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas, etc., 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._

219. _Is it of so much importance, then, to distinguish between Scarlet Fever and Measles?_

It is of great importance, as in measles the patient ought to be kept _moderately_ warm, and the drinks should be given with the chill off; while in scarlet fever the patient ought to be kept cool—indeed, for the first few days, _cold_; and the beverages, such as spring water, toast and water, etc., should be administered quite cold.

I had the honor to read a _Paper on the Treatment of Scarlet Fever_ before the members of Queen’s College Medico-Chirurgical Society, Birmingham,—which _Paper_ was afterwards published in the _Association Journal_; and in Braithwaite’s _Retrospect of Medicine_; and in Ranking’s _Half-Yearly Abstract of the Medical Sciences_; besides in other publications. Moreover, the _Paper_ was translated into German, and published in _Canstatt’s Jahresbericht_, iv. 456.

220. _What is the treatment of Scarlet Fever?_

_What to do._—Pray pay particular attention to my rules, and carry out my directions to the very letter—as I can then promise you _that if the scarlet fever be not malignant_, the plan I am about to recommend will, with God’s blessing, be generally successful.

What is the first thing to be done? Send the child to bed; throw open the windows, be it winter or summer, and have a thorough ventilation; for the bed-room must be kept cool, I may say cold. Do not be afraid of fresh air, for fresh air, for the first few days is essential to recovery. _Fresh air, and plenty of it, in scarlet fever, is the best doctor_ a child can have: let these words be written legibly on your mind. In the _Times_, is the following, copied from the _Bridgewater Mercury_:—

“GROSS SUPERSTITION.—In one of the streets of Taunton there resides a man and his wife who have the care of a child. This child was attacked with scarlatina, and to all appearance death was inevitable. A jury of matrons was, as it were, impaneled, and, to prevent the child ‘dying hard,’ all the doors in the house, all the drawers, all the boxes, all the cupboards were thrown wide open, the keys taken out, and the body of the child placed under a beam, whereby a sure, certain, and easy passage into eternity could be secured. Watchers held their vigils throughout the weary night, and in the morning the child, to the surprise of all, did not die, and is now gradually recovering.”