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:

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:

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?

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:

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:

To make a Gargle.

The best medicine for the first few days of the attack, is one of the following mixtures:

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

Or,

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:

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

Or,

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.”

These old women—this jury of matrons—stumbled on the right remedy, “all the doors in the house ... were thrown wide open,” and thus they thoroughly ventilated the apartment. What was the consequence? The child who, just before the opening of the doors, had all the appearances “that death was inevitable,” as soon as fresh air was let in, showed symptoms of recovery, “and in the morning the child, to the surprise of all, did not die, and is now gradually recovering.” There is nothing wonderful—there is nothing surprising to my mind—in all this. Ventilation—thorough ventilation—is the grand remedy for scarlatina! Oh, that there were in scarlet fever cases a good many such old women’s—such a “jury of matrons”—remedies! We should not then be horrified, as we now are, at the fearful records of death, which the Returns of the Registrar-General disclose!

Take down the curtains of the bed; remove the valances. If it be summer time, let the child be only covered with a sheet: if it be winter time, in addition to the sheet, he should have one blanket over him.

Now for the throat.—The best external application is a barm and oatmeal poultice. How ought it to be made, and how applied? Put half a teacupful of barm into a saucepan, put it on the fire to boil; as soon as it boils take it off the fire, and stir oatmeal into it, until it is of the consistence of a nice soft poultice; then place it on a rag, and apply it to the throat; carefully fasten it on with bandage, two or three turns of the bandage going round the throat, and two or three over the crown of the head, so as nicely to apply the poultice where it is wanted—that is to say, to cover the tonsils. Tack the bandage: do not pin it. Let the poultice be changed three times a day. The best medicine is the acidulated infusion of roses, sweetened with syrup. [For the prescription of the acidulated infusion of roses with syrup, see question 209.] It is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleans the throat and tongue of mucus, and is peculiarly efficacious in scarlet fever; as soon as the fever is abated it gives an appetite. My belief is that the sulphuric acid in the mixture is a specific in scarlet fever, as much as quinine is in ague, and sulphur in itch. I have reason to say so, for, in numerous cases, I have seen its immense value.

Now, with regard to food.—If the child be at the breast, keep him entirely to it. If he be weaned, and under two years old, give him milk and water, and cold water to drink. If he be older, give him toast and water, and plain water from the pump, as much as he chooses; let it be quite cold—the colder the better. Weak black tea, or thin gruel, may be given, but not caring, unless he be an infant at the breast, if he take nothing but cold water. If the child be two years old and upwards, roasted apples with sugar, and grapes will be very refreshing, and will tend to cleanse both the mouth and the throat. Avoid broths and stimulants of every kind.

When the appetite returns, you may consider the patient to be safe. The diet ought now to be gradually improved. Bread and butter, milk and water, and arrow-root made with equal parts of new milk and water, should for the first two or three days be given. Then a light batter or rice pudding may be added, and in a few days afterward, either a little chicken or a mutton-chop.

The essential remedies, then, in scarlet fever, are, for the first few days—(1) plenty of fresh air and ventilation, (2) plenty of cold water to drink, (3) barm poultices to the throat, and (4) the acidulated infusion of roses’ mixture as a medicine.

Now, then, comes very important advice. After the first few days, probably five or six, sometimes as early as the fourth day, watch carefully and warily, and note the time, the skin will suddenly become cool, the child will say that he feels chilly; then is the time you must now change your tactics—instantly close the windows, and put extra clothing, a blanket or two on his bed. A flannel night-gown should, until the dead skin has peeled off, be now worn next to the skin, when the flannel night-gown should be discontinued. The patient ought ever after to wear, in the daytime, a flannel waistcoat. On the importance, the vital importance, of the wearing of flannel next to the skin, see Flannel Waistcoats. His drinks must now be given with the chill off; he ought to have a warm cup of tea, and gradually his diet should, as I have previously recommended, be improved.

There is one important caution I wish to impress upon you,—do not give opening medicine during the time the eruption is out. In all probability the bowels will be opened: if so, all well and good; but do not, on any account, for the first ten days, use artificial means to open them. It is my firm conviction that the administration of purgatives in scarlet fever is a fruitful source of dropsy, of disease and death. When we take into consideration the sympathy there is between the skin and the mucous membrane, I think that we should pause before giving irritating medicines, such as purgatives. The irritation of aperients on the mucous membrane may cause the poison of the skin disease (for scarlet fever is a blood poison) to be driven internally to the kidneys, to the throat, to the pericardium (bag of the heart), or to the brain. You may say, Do you not purge if the bowels be not open for a week? I say emphatically, No!

I consider my great success in the treatment of scarlet fever to be partly owing to my avoidance of aperients during the first ten days of the child’s illness.

If the bowels, after the ten days, are not properly opened, a dose or two of the following mixture should be given: