Chapter X: Part II: Childhood (5)

The Modified Small-pox--that is to say, small-pox that has been robbed of its virulence by the patient having been either already vaccinated, or by his having had a previous attack of small-pox--is ushered in with severe symptoms, with symptoms almost as severe as though the patient had not been already somewhat protected either by vaccination or by the previous attack of small-pox--that is to say, he has a shivering fit, great depression of spirits and debility, _malaise_, sickness, headache, and occasionally delirium. After the above symptoms have lasted about three days, the eruption shows itself. The immense value of the previous vaccination, or the previous attack of small-pox, now comes into play. In a case of _unprotected_ small-pox, the appearance of the eruption _aggravates_ all the above symptoms, and the danger begins; while in the _modified_ small-pox, the moment the eruption shows itself the patient feels better, and, as a rule, rapidly recovers. The eruption, of _modified_ small-pox varies materially from the eruption of the _unprotected_ small-pox. The former eruption assumes a varied character, and is composed, first, of vesicles (containing water); and, secondly, of pustules (containing matter), each of which pustules has a depression in the centre; and, thirdly, of several red pimples without either water or matter in them, and which sometimes assume a livid appearance. These "breakings-out" generally show themselves more upon the wrist, and sometimes up one or both of the nostrils. While in the latter disease--the _unprotected_ small-pox--the "breaking-out" is composed entirely of pustules containing matter, and which pustules are more on the face than on any other part of the body. There is generally a peculiar smell in both diseases--an odour once smelt never to be forgotten.

Now, there is one most important remark I have to make,--the _modified small-pox is contagious_. This ought to be borne in mind, as a person labouring under the disease must, if there be children in the house, either be sent away himself, or else the children ought to be banished both the house and the neighbourhood. Another important piece of advice is,--let _all_ in the house--children and adults, one and all--be vaccinated, even if any or all have been previously vaccinated.

_Treatment_.--Let the patient keep his room, and if he be very ill, his bed. Let the chamber be well ventilated. If it be winter time, a small fire in the grate will encourage ventilation. If it be summer, a fire is out of the question; indeed, in such a case, the window-sash ought to be opened, as thorough ventilation is an important requisite of cure, both in small-pox and in _modified_ small-pox. While the eruption is out, do not on any account give aperient medicine. In ten days from the commencement of the illness a mild aperient may be given. The best medicine in these cases is, the sweetened Acidulated Infusion of Roses, [Footnote: See page 178] which ought to be given from the commencement of the disease, and should be continued until the fever be abated. For the first few days, as long as the fever lasts, the patient ought not to be allowed either meat or broth, but should be kept on a low diet, such as on gruel, arrow-root, milk-puddings, &c. As soon as the fever is abated he ought gradually to resume his usual diet. When he is convalescent, it is well, where practicable, that he should have change of air for a month.

232. _How would you distinguish between Modified Small-pox and Chicken-pox_?

Modified small-pox may readily be distinguished from chicken-pox, by the former disease being, notwithstanding its modification, much more severe and the fever much more intense before the eruption shows itself than chicken-pox; indeed, in chicken-pox there is little or no fever either before or after the eruption; by the former disease--the modified small-pox--consisting _partly_ of pustules (containing matter), each pustule having a depression in the centre, and the favourite localities of the pustules being the wrists and the inside of the nostrils; while, in the chicken-pox, the eruption consists of vesicles (containing water), and _not_ pustules (containing matter), and the vesicles having neither a depression in the centre, nor having any particular partiality to attack either the wrists or the inside of the nose. In modified small-pox each pustule is, as in unprotected small-pox, inflamed at the base; while in chicken-pox there is only very slight redness around each vesicle. The vesicles in chicken-pox are small--much smaller than the pustules in modified small-pox.

233. _Is Hooping-cough an inflammatory disease_?

Hooping-cough in itself is not inflammatory, it is purely spasmodic; but it is generally accompanied with more or less of bronchitis-- inflammation of the mucous membrane of the bronchial tubes--on which account it is necessary, _in all cases_ of hooping-cough, to consult a medical man, that he may watch the progress of the disease and nip inflammation in the bud.

234. _Will you have the goodness to give the symptoms, and a brief history of, Hooping-cough_?

Hooping-cough is emphatically a disease of the young; it is rare for adults to have it; if they do, they usually suffer more severely than children. A child seldom has it but once in his life. It is highly contagious, and therefore frequently runs through a whole family of children, giving much annoyance, anxiety, and trouble to the mother and the nurses; hence hooping-cough is much dreaded by them. It is amenable to treatment. Spring and summer are the best seasons of the year for the disease to occur. This complaint usually lasts from six to twelve weeks--sometimes for a much longer period, more especially if proper means are not employed to relieve it.

Hooping-cough commences as a common cold and cough. The cough, for ten days or a fortnight, increases in intensity; at about which time it puts on the characteristic "hoop." The attack of cough comes on in paroxysms. In a paroxysm, the child coughs so long and so violently, and _expires_ so much air from the lungs without _inspiring_ any, that at times he appears nearly suffocated and exhausted; the veins of his neck swell; his face is nearly purple; his eyes, with the tremendous exertion, almost seem to start from their sockets; at length there is a sudden _inspiration_ of air through the contracted chink of the upper part of the wind-pipe--the glottis--causing the peculiar "hoop;" and after a little more coughing, he brings up some glairy mucus from the chest; and sometimes, by vomiting, food from the stomach; he is at once relieved, until the next paroxysm occur, when the same process is repeated, the child during the intervals, in a favourable case, appearing quite well, and after the cough is over, instantly returning either to his play or to his food. Generally, after a paroxysm he is hungry, unless, indeed, there be severe inflammation either of the chest or of the lungs. Sickness, as I before remarked, frequently accompanies hooping-cough; when it does, it might be looked upon as a good sign. The child usually knows when an attack is coming on; he dreads it, and therefore tries to prevent it; he sometimes partially succeeds; but, if he does, it only makes the attack, when it does come, more severe. All causes of irritation and excitement ought, as much as possible, to be avoided, as passion is apt to bring on a severe paroxysm.

A new-born babe--an infant of one or two months old--commonly escapes the infection; but if, at that tender age, he unfortunately catch hooping-cough, it is likely to fare harder with him than if he were older--the younger the child, the greater the risk. But still, in such a case, do not despair, as I have known numerous instances of new-born infants, with judicious care, recover perfectly from the attack, and thrive after it as though nothing of the kind had ever happened.

A new-born babe, labouring under hooping-cough, is liable to convulsions, which is in this disease one, indeed the great, source of danger. A child, too, who is teething, and labouring under the disease, is also liable to convulsions. When the patient is convalescing, care ought to be taken that he does not catch cold, or the "hoop" might return. Hooping-cough may either precede, attend, or follow an attack of measle.

235. _What is the treatment of Hooping-cough_?

We will divide the hooping-cough into three stages, and treat each stage separately,

_What to do.--In the first stage_, the commencement of hooping-cough: For the first ten days give the Ipecacuanha Wine Mixture, [Footnote: For the prescription of the Ipecacuanha Wine Mixture, see page 161.] a tea-spoonful three times a day. If the child be not weaned, keep him entirely to the breast, if he be weaned, to a milk and farinaceous diet. Confine him for the first ten days to the house, more especially if the hooping-cough be attended, as it usually is, with more or less bronchitis. But take care that the rooms be well ventilated; for good air is essential to the cure.

If the bronchitis attending the hooping-cough be severe, confine him to his bed, and treat him as though it were simply a case of bronchitis. [Footnote: For the treatment of bronchitis, see answer to 207th question.]

_In the second stage_, discontinue the Ipecacuanha Mixture, and give Dr Gibb's remedy--namely, Nitric Acid--which I have found to be an efficacious and valuable one in hooping-cough:--

Take of--Diluted Nitric Acid, two drachms;
Compound Tincture of Cardamons, half a drachm;
Simple Syrup, three ounces;
Water, two ounces and a half:

Make a Mixture. One or two tea-spoonfuls, or a table-spoonful, according to the age of the child--one tea-spoonful for an infant of six months, and two tea-spoonfuls for a child of twelve months, and one table-spoonful for a child of two years, every four hours, first shaking the bottle.

Let the spine and the chest be well rubbed every night and morning either with Roche's Embrocation, or with the following stimulating liniment (first shaking the bottle):--

Take of--Oil of Cloves, one drachm;
Oil of Amber, two drachms;
Camphorated Oil, nine drachms:

Make a Liniment.

Let him wear a broad band of new flannel, which should extend round from his chest to his back, and which ought to be changed every night and morning, in order that it may be dried before putting on again. To keep it in its place it should be fastened by means of tapes and with shoulder-straps.

The diet ought now to be improved--he should gradually return to his usual food; and, weather permitting, should almost live in the open air--fresh air being, in such a case, one of the finest medicines.

_In the third stage_, that is to say, when the complaint has lasted a month, if by that time the child is not well, there is nothing like change of air to a high, dry, healthy, country place. Continue the Nitric Acid Mixture, and either the Embrocation or the Liniment to the back and the chest, and let him continue to almost live in the open air, and be sure that he does not discontinue wearing the flannel until he be quite cured, and then let it be left off by degrees.

If the hooping-cough have caused debility, give him Cod-liver Oil--a tea-spoonful twice or three times a day, giving it him on a full stomach, after his meals. But, remember, after the first three or four weeks, change of air, and plenty of it, is for hooping-cough the grand remedy.

_What NOT to do_.--"Do not apply leeches to the chest, for I would rather put blood into a child labouring under hooping-cough than take it out of him--hooping-cough is quite weakening enough to the system of itself without robbing him of his life's blood; do not, on any account whatever, administer either emetic tartar or antimonial wine; do not give either paregoric or syrup of white poppies; do not drug him either with calomel or with grey-powder; do not dose him with quack medicine; do not give him stimulants, but rather give him plenty of nourishment, such as milk and farinaceous food, but _no_ stimulants; do not be afraid, after the first week or two, of his having fresh air, and plenty of it--for fresh, pure air is the grand remedy, after all that can be said and done, in hooping-cough. Although occasionally we find that, if the child to labouring under hooping-cough, and is breathing a pure country air, and is not getting well so rapidly as we could wish, change of air to a smoky gas-laden town will sometimes quickly effect a cure; indeed, some persons go so far as to say that the _best_ remedy for an _obstinate_ case of hooping-cough is, for the child to live, the great part of every day, in gas-works!"

236. _What is to be done during a paroxysm of Hooping-cough_?

If the child be old enough, let him stand up; but if he be either too young or too feeble, raise his head, and bend his body a little forward; then support his back with one hand, and the forehead with the other. Let the mucus, the moment it be within reach, be wiped with a soft handkerchief out of his mouth.

237. _In an obstinate case of Hooping-cough, what is the best remedy_?

Change of air, provided there be no active inflammation, to any healthy spot. A farm-house, in a high, dry, and salubrious neighbourhood, is as good a place as can be chosen. If, in a short time, he be not quite well, take him to the sea-side: the sea breezes will often, as if by magic, drive away the disease.

238. _Suppose my child should have a shivering fit, is it to be looked upon as an important symptom_?

Certainly. Nearly all _serious_ illnesses commence with a shivering fit: severe colds, influenza, inflammations of different organs, scarlet fever, measles, small-pox, and very many other diseases, begin in this way. If, therefore, your child should ever have a shivering fit, _instantly_ send for a medical man, as delay might be dangerous. A few hours of judicious treatment, at the commencement of an illness, is frequently of more avail than days and weeks, nay months, of treatment, when disease has gained a firm footing. A _serious_ disease often steals on insidiously, and we have perhaps only the shivering fit, which might be but a _slight_ one, to tell us of its approach.

A _trifling_ ailment, too, by neglecting the premonitory symptom, which, at first might only be indicated by a _slight_ shivering fit, will sometimes become a mortal disorder:--

"The little rift within the lute,
That by-and-by will make the music mute,
And ever widening slowly silence all." [Footnote: The above extract
from Tennyson is, in my humble opinion, one of the most beautiful
pieces of poetry in the English language. It is a perfect gem, and a
volume in itself, so truthful, so exquisite, so full of the most
valuable reflections; for instance--(1.) "The little rift within the
lute,"--the little tubercle within the lung "that by-and-by will
make the music mute, and ever widening slowly silence all," and the
patient eventually dies of consumption. (2.) The little rent--the
little rift of a very minute vessel in the brain, produces an attack
of apoplexy, and the patient dies. (3.) Each and all of us, in one
form or another, sooner or later, will have "the little rift within
the lute." But why give more illustrations?--a little reflection
will bring numerous examples to my fair reader's memory.]

239. _In case of a shivering fit, perhaps you will tell me what to do_?

_Instantly_ have the bed warmed, and put the child to bed. Apply either a hot bottle or a hot brick, wrapped in flannel, to the soles of his feet. Put an extra blanket on his bed, and give him a cup of hot tea. As soon as the shivering fit is over, and he has become hot, gradually lessen the _extra_ quantity of clothes on his bed, and take away the hot bottle or the hot brick from his feet.

_What NOT to do_.--Do not give either brandy or wine, as inflammation of some organ might be about taking place. Do not administer opening medicine, as there might be some "breaking out" cooling out on the skin, and an aperient might check it.

240. _My child, apparently otherwise healthy, screams out in the night violently in his sleep, and nothing for a time will pacify him: what is likely to be the cause, and what is the treatment_?

The causes of these violent screamings in the night are various. At one time, they proceed from teething; at another, from worms; sometimes, from night-mare; occasionally, from either disordered stomach or bowels. Each of the above causes will, of course, require a different plan of procedure; it will, therefore, be necessary to consult a medical man on the subject, who will soon, with appropriate treatment, be able to relieve him.

241. _Have the goodness to describe the complaint of children called Mumps_.

The mumps, inflammation of the "parotid" gland, is commonly ushered in with a slight feverish attack. After a short time, a swelling, of stony hardness, is noticed before and under the ear, which swelling extends along the neck towards the chin. This lump is exceedingly painful, and continues painful and swollen for four or five days. At the end of which time it gradually disappears, leaving not a trace behind. The swelling of mumps never gathers. It may affect one or both sides of the face. It seldom occurs but once in a lifetime. It is contagious, and has been known to run through a whole family or school; but it is not dangerous, unless, which is rarely the case, it leaves the "parotid" gland, and migrates either to the head, to the breast, or to the testicle.

242. _What is the treatment of Mumps_?

Foment the swelling, four or five times a day, with a flannel wrung out of hot camomile and poppy-head decoction; [Footnote: Four poppy-heads and four ounces of camomile blows to be boiled in four pints of water for half an hour, and then strained to make the decoction.] and apply, every night, a barm and oatmeal poultice to the swollen gland or glands. Debar, for a few days, the little patient from taking meat and broth, and let him live on bread and milk, light puddings, and arrow-root. Keep him in a well-ventilated room, and shut him out from the company of his brothers, his sisters, and young companions. Give him a little mild, aperient medicine. Of course, if there be the slightest symptom of migration to any other part or parts, instantly call in a medical man.

243. _What is the treatment of a Boil_?

One of the best applications is a Burgundy-pitch plaster spread on a soft piece of wash leather. Let a chemist spread a plaster, about the size of the hand; and, from this piece, cut small plasters, the size of a shilling or a florin (according to the dimensions of the boil), which snip around and apply to the part. Put a fresh one on daily. This plaster will soon cause the boil to break; when it does break, squeeze out the contents--the core and the matter--and then apply one of the plasters as before, which, until the boil be well, renew every day.

The old-fashioned remedy for a boil--namely, common yellow soap and brown-sugar, is a capital one for the purpose. It is made with equal parts of brown sugar and of shredded yellow soap, and mixed by means of a table-knife on a plate, with a few drops of water, until it be all well blended together, and of the consistence of thick paste; it should then be spread either on a piece of wash-leather, or on thick linen, and applied to the boil, and kept in its place by means either of a bandage or of a folded handkerchief; and should he removed once or twice a day. This is an excellent application for a boil--soothing, comforting, and drawing--and will soon effect a cure. A paste of honey and flour, spread on linen rag, is another popular and good application for a boil.

_If the boils should arise from the child being in a delicate state of health_, give him cod-liver oil, meat once a day, and an abundance of milk and farinaceous food. Let him have plenty of fresh air, exercise, and play.

_If the boil should arise from gross and improper feeding_, then keep him for a time from meat, and let him live principally on a milk and farinaceous diet.

_If the child be fat and gross_, cod-liver oil would he improper; a mild aperient, such as rhubarb and magnesia, would then be the best medicine.

244. _What are the symptoms of Ear-ache_?

A young child screaming shrilly, violently, and continuously, is oftentimes owing to ear-ache; carefully, therefore, examine each ear, and ascertain if there be any discharge; if there be, the mystery is explained.

Screaming from ear-ache may be distinguished from the screaming from bowel-ache by the former (ear-ache) being more continuous--indeed, being one continued scream, and from the child putting his hand to his head; while, in the latter (bowel-ache), the pain is more of a coming and of a going character, and he draws up his legs to his bowels. Again, in the former (ear-ache), the secretions from the bowels are natural; while, in the latter (bowel-ache), the secretions from the bowels are usually depraved, and probably offensive. But a careful examination of the ear will generally at once decide the nature of the case.

213. _What is the best remedy for Ear-ache_?

Apply to the ear a small flannel bag, filled with hot salt--as hot as can be comfortably borne, or foment the ear with a flannel wrung out of hot camomile and poppy head decoction. A roasted onion, inclosed in muslin applied to the ear, is an old-fashioned and favourite remedy, and may, if the bag of hot salt, or if the hot fomentation do not relieve, be tried. Put into the ear, but not very far, a small piece of cotton wool, moistened with warm olive oil. Taking care that the wool is always removed before a fresh piece be substituted, as if it be allowed to remain in any length of time, it may produce a discharge from the ear. Avoid all _cold_ applications. If the ear-ache be severe, keep the little fellow at home, in a room of equal temperature, but well-ventilated, and give him, for a day or two, no meat.

If a discharge from the ear should either accompany or follow the ear-ache, _more especially if the discharge be offensive_, instantly call in a medical man, or deafness for life may be the result.

A knitted or crotcheted hat, with woollen rosettes over the ears, is, in the winter time, an excellent hat for a child subject to ear-ache. The hat may be procured at any baby-linen warehouse.

246. _What are the causes and the treatment of discharges from the Ear_?

Cold, measles, scarlet fever, healing up of "breakings out" behind the ear; pellets of cotton wool, which had been put in the ear, and had been forgotten to be removed, are the usual causes of discharges from the ear. It generally commences with ear-ache.

The _treatment_ consists in keeping the parts clean, by syringing the ear every morning with warm water, by attention to food--keeping the child principally upon a milk and a farmaceous diet, and by change of air--more especially to the coast. If change of air be not practicable, great attention should be paid to ventilation. As I have before advised, in all cases of discharge from the ear call in a medical man, as a little judicious medicine is advisable--indeed, essential; and it may be necessary to syringe the ear with lotions, instead of with warm water; and, of course, it is only a doctor who has actually seen the patient who can decide these matters, and what is best to be done in each case.

247. _What is the treatment of a "stye" on the eye-lid_?

Bathe the eye frequently with warm milk and water, and apply, every night at bedtime, a warm white-bread poultice.

No medicine is required; but, if the child be gross, keep him for a few days from meat, and let him live on bread and milk and farinaceous puddings.

248. _If a child have large bowels, what would you recommend as likely to reduce their size_?

It ought to be borne in mind, that the bowels of a child are larger in proportion than those of an adult. But, if they be actually larger than they ought to be, let them be well rubbed for a quarter of an hour at a time night and morning, with soap liniment, and then apply a broad flannel belt. "A broad flannel belt worn night and day, firm but not tight, is very serviceable." [Footnote: Sir Charles Locock, in a _Letter_ to the Author.] The child ought to be prevented from drinking as much as he has been in the habit of doing; let him be encouraged to exercise himself well in the open air; and let strict regard be paid to his diet.

249. _What are the best aperients for a child_?

If it be _actually_ necessary to give him opening medicine, one or two tea-spoonfuls of Syrup of Senna, repeated, if necessary, in four hours, will generally answer the purpose; or, for a change, one or two tea-spoonfuls of Castor Oil may be substituted. Lenitive Electuary (Compound Confection of Senna) is another excellent aperient for the young, it being mild in its operation, and pleasant to take; a child fancying it is nothing more than jam, and which it much resembles both in appearance and in taste. The dose is half or one tea-spoonful early in the morning occasionally. Senna is an admirable aperient for a child, and is a safe one, which is more than can be said of many others. It is worthy of note that "the taste of Senna may be concealed by sweeting the infusion, [Footnote: Infusion of Senna may be procured of any respectable druggist. It will take about one or two table-spoonfuls, or even more, of the infusion (according to the age of the child, and the obstinacy of the bowels), to act as an aperient. Of course, you yourself will be able, from time to time, as the need arises, to add the milk and the sugar, and thus to make it palatable. It ought to be given warm, so as the more to resemble tea.] adding milk, and drinking as ordinary tea, which, when thus prepared, it much resembles" [Footnote: _Waring's Manual of Practical Therapeutics._] Honey, too, is a nice aperient for a child--a tea-spoonful ought to be given either by itself, or spread on a slice of bread.

Some mothers are in the habit of giving their children jalap gingerbread. I do not approve of it, as jalap is a drastic, griping purgative; besides, jalap is very nasty to take--nothing will make it palatable.

Fluid Magnesia--Solution of Carbonate of Magnesia--is a good aperient for a child; and, as it has very little taste, is readily given, more especially if made palatable by the addition either of a little syrup or of brown sugar. The advantages which it has over the old solid form are, that it is colourless and nearly tasteless, and never forms concretions in the bowels, as the _solid_ magnesia, if persevered in for any length of time, sometimes does. A child of two or three years old may take one or two table-spoonfuls of the fluid; either by itself or in his food, repeating it every four hours until the bowels be open. When the child is old enough to drink the draught off _immediately_, the addition of one or two tea-spoonfuls of Lemon Juice to each dose of the Fluid Magnesia, makes a pleasant effervescing draught, and increases its efficacy as an aperient.

Bran-bread [Footnote: One-part of bran to three parts of flour, mixed together and made into bread.] and _treacle_ will frequently open the bowels; and as treacle is wholesome, it may be substituted for butter when the bowels are inclined to be costive. A roasted apple, eaten with _raw_ sugar, is another excellent mild aperient for a child. Milk gruel--that is to say, milk thickened with oatmeal--forms an excellent food for him, and often keeps his bowels regular, and thus (_which is a very important consideration_) supersedes the necessity of giving him an aperient. An orange (taking care he does not eat the peel or the pulp), or a fig after dinner, or a few Muscatel raisins, will frequently regulate the bowels.

Stewed prunes is another admirable remedy for the costiveness of a child. The manner of stewing them is as follows:--Put a pound of prunes in a brown jar, add two table-spoonfuls of _raw_ sugar, then cover the prunes and the sugar with cold water; place them in the oven, and let them stew for four hours. A child should every morning eat half a dozen or a dozen of them, until the bowels be relieved, taking care that he does not swallow the stones. Stewed prunes may be given in treacle--treacle increasing the aperient properties of the prunes.

A suppository is a mild and ready way of opening the bowels of a child. When he is two or three years old and upwards, a _Candle_ suppository is better than a _Soap_ suppository. The way of preparing it is as follows:--Cut a piece of dip-tallow candle--the length of three inches--and insert it as you would a clyster pipe, about two inches up the fundament, allowing the remaining inch to be in sight, and there let the suppository remain until the bowels be opened.

Another excellent method of opening a child's bowels is by means of an enema of warm water,--from half a tea-cupful to a tea-cupful, or even more, according to the age of the child. I cannot speak too highly of this plan as a remedy for costiveness, as it entirely, in the generality of cases, prevents the necessity of administering a particle of aperient medicine by the mouth. The fact of its doing so stamps it as a most valuable remedy--opening physic being, as a rule, most objectionable, and injurious to a child's bowels. Bear this fact--for it is a fact--in mind and let it be always remembered.

450. _What are the most frequent causes of Protrusion of the lower-bowel_?

The too common and reprehensible practice of a parent administering frequent aperients, especially calomel and jalap, to her child. Another cause, is allowing him to remain for a quarter of an hour or more at a time on his chair; this induces him to strain, and to force the gut down.

251. _What are the remedies_?

If the protrusion of the bowel have been brought on by the abase of aperients, abstain, for the future from giving them; but if medicine be absolutely required, give the mildest--such as either Syrup of Senna or Castor Oil--_and the less of those the better._

If the _external_ application of a purgative will have the desired effects it will in such cases, be better than the _internal_ administration of aperients. Castor Oil used as a Liniment is a good one for the purpose. Let the bowels be well rubbed, every night and morning, for five minutes at a time with the oil.

A wet compress to the bowels will frequently open them, and will thus do away with the necessity of giving an aperient--_a most important consideration_. Fold a napkin in six thicknesses, soak it in _cold_ water, and apply it to the bowels; over which put either a thin covering or sheet of gutta-percha, or a piece of oiled-silk; keep it in its place with a broad flannel roller; and let it remain on the bowels for three or four hours, or until they be opened.

Try what diet will do, as opening the bowels by a regulated diet is far preferable to the giving of aperients. Let him have either bran-bread or Robinson's Patent Groats, or Robinson's Pure Scotch Oatmeal made into gruel with new milk, or Du Barry's Arabica Revalenta, or a slice of Huntly and Palmer's lump gingerbread. Let him eat stewed prunes, stewed rhubarb, roasted apples, strawberries, raspberries, the inside of grapes and gooseberries, figs, &c. Give him early every morning a draught of _cold_ water.

Let me, again, urge you _not_ to give aperients in these cases, or in any case, unless you are absolutely compelled. By following my advice you will save yourself an immense deal of trouble, and your child a long catalogue of misery. Again, I say, look well into the matter, and whenever it be practicable avoid purgatives.

Now, with regard to the best manner of returning the bowel, lay the child upon the bed on his face and bowels, with his hips a little raised; then smear lard on the forefinger of your right hand (taking care that the nail be cut close), and gently with, your fore-finger press the bowel into its proper place. Remember, if the above methods be observed, you cannot do the slightest injury to the bowel; and the sooner it be returned, the better it will be for the child; for if the bowel be allowed to remain long down, it may slough or mortify, and death may ensue. The nurse, every time he has a motion, must see that the bowel does not come down, and if it does, she ought instantly to return it. Moreover, the nurse should be careful _not_ to allow the child to remain on his chair more than two or three minutes at a time.

Another excellent remedy for the protrusion of the lower bowel, is to use every morning a cold salt and water sitz bath. There need not be more than a depth of three inches of water in the bath; a small handful of table salt should be dissolved in the water; a dash of warm water in the winter time must be added, to take off the extreme chill; and the child ought not to be allowed to sit in the bath for more than one minute, or whilst the mother can count a hundred; taking care, the while, to throw either a square of flannel or a small shawl over his shoulders. The sitz bath ought to be continued for months, or until the complaint be removed. I cannot speak in too high praise of these baths.

252. _Do you advise me, every spring and fall, to give my child brimstone to purify and sweeten his blood, and as a preventive medicine_?

Certainly not; if you wish to take away his appetite, and to weaken and depress him, give brimstone! Brimstone is not a remedy fit for a child's stomach. The principal use and value of brimstone is as an external application in itch, and as an internal remedy, mixed with other laxatives, in piles--piles being a complaint of adults. In olden times poor unfortunate children were dosed, every spring and fall, with brimstone and treacle to sweeten their blood! Fortunately for the present race, there is not so much of that folly practised, but still there is room for improvement. To dose a _healthy_ child with physic is the grossest absurdity. No, the less physic a delicate child has the better it will be for him, but physic to a healthy child is downright poison! And brimstone of all medicines! It is both weakening and depressing to the system, and by opening the pores of the skin and by relaxing the bowels, is likely to give cold, and thus to make a healthy, a sickly child. Sweeten his blood! It is more likely to weaken his blood, and thus to make his blood impure! Blood is not made pure by drugs, but by Nature's medicine; by exercise, by pure air, by wholesome diet, by sleep in a well-ventilated apartment, by regular and thorough ablution. Brimstone a preventive medicine! Preventive medicine--and brimstone especially in the guise of a preventive medicine--is "a mockery, a delusion, and a snare."

253. _When a child is delicate, and his body, without any assignable cause, is gradually wasting away, and the stomach rejects all food that is taken, what plan can be adopted likely to support his strength, and thus probably be the means of saving his life_?

I have seen, in such a case, great benefit to arise from half a tea-cupful of either strong mutton-broth or of strong beef-tea, used as an enema every four hours. [Footnote: An enema apparatus is an important requisite in every nursery; it may be procured of any respectable surgical instrument maker. The India-rubber Enema Bottle is, for a child's use, a great improvement on the old syringe, as it is not so likely to get out of order, and, moreover, is more easily used.] It should be administered slowly, in order that it may remain in the bowel. If the child be sinking, either a dessert-spoonful of brandy, or half a wine-glassful of port wine, ought to be added to each enema.

The above plan ought only to be adopted if there be _no_ diarrhoea. If there be diarrhoea, an enema must _not_ be used. Then, provided there be great wasting away, and extreme exhaustion, and other remedies having failed, it would be advisable to give, by the mouth, _raw_ beef of the finest quality, which ought to be taken from the hip bone, and should be shredded very fine. All fat and skin must be carefully removed. One or two tea-spoonfuls (according to the age of the child) ought to be given every four hours. The giving of _raw_ meat to children in exhaustive diseases, such as excessive long-standing diarrhoea, was introduced into practice by a Russian physician, a Professor Wiesse of St Petersburg. It certainly is, in these cases, a most valuable remedy, and has frequently been the means of snatching such patients from the jaws of death. Children usually take raw meat with avidity and with a relish.

254. _If a child be naturally delicate, what plan would you recommend to strengthen him_?

I should advise strict attention to the rules above mentioned, and _change of air_--more especially, if it be possible, to the coast. Change of air, sometimes, upon a delicate child, acts like magic, and may restore him to health when all other means have failed. If a girl be delicate, "carry her off to the farm, there to undergo the discipline of new milk, brown bread, early hours, no lessons, and romps in the hay-field."--_Blackwood_. This advice is, of course, equally applicable for a delicate boy, as delicate boys and delicate girls ought to be treated alike. Unfortunately in these very enlightened days there is too great a distinction made in the respective management and treatment of boys and girls.

The best medicines for a delicate child will be the wine of iron and cod-liver oil. Give them combined in the manner I shall advise when speaking of the treatment of Rickets.

In diseases of long standing, and that resist the usual remedies, there is nothing like _change of air_. Hippocrates, the father of medicine, says--

"In longis morbis solum mutare."
(In tedious diseases to change the place of residence.)

A child who, in the winter, is always catching cold, whose life during half of the year is one continued catarrh, who is in consequence, likely, if he grow up at all, to grow up a confirmed invalid, ought, during the winter months, to seek another clime; and if the parents can afford the expense, they should at the beginning of October, cause him to bend his steps to the south of Europe--Mentone being as good a place as they could probably fix upon.

255. _Do you approve of sea bathing for a delicate young child_?

No: he is frequently so frightened by it that the alarm would do him more harm than the bathing would do him good. The better plan would be to have him every morning well sponged, especially his back and loins, with sea water; and to have him as much as possible carried on the beach, in order that he may inhale the sea breezes. When he be older, and is not frightened at being dipped, sea bathing will be very beneficial to him. If bathing is to do good, either to an adult or to a child, it must be anticipated with pleasure, and neither with dread nor with distaste.

256. _What is the best method for administering medicine to a child_?

If he be old enough, appeal to his reason; for, if a mother endeavour to deceive her child, and he detect her, he will for the future suspect her. If he be too young to be reasoned with, then, if he will not take his medicine, he must be compelled. Lay him across your knees, let both his hands and his nose be tightly held, and then, by means of the patent medicine-spoon, or, if that be not at hand, by either a tea or a dessert-spoon, pour the medicine down his throat, and he will be obliged to swallow it.

It may be said that this is a cruel procedure; but it is the only way to compel an unruly child to take physic, and is much less cruel than running the risk of his dying from the medicine not having been administered. [Footnote: If any of my medical brethren should perchance read these Conversations, I respectfully and earnestly recommend them to take more pains in making medicines for children pleasant and palatable. I am convinced that, in the generality of instances, provided a little more care and thought were bestowed on the subject, it may be done; and what an amount of both trouble and annoyance it would save! It is really painful to witness the struggles and cries of a child when _nauseous_ medicine is to be given; the passion and excitement often do more harm than the medicine does good.]

257. _Ought a sick child to be roused from his sleep to give him physic, when it is time for him to take it_?

On no account, as sleep, being a natural restorative, must not be interfered with. A mother cannot be too particular in administering the medicine, at stated periods, whilst he is awake.

258. _Have you any remarks to make on the management of a sick-room, and have you any directions to give on the nursing of a child_?

In sickness select a large and lofty room; if in the town, the back of the house will be preferable--in order to keep the patient free from noise and bustle--as a sick-chamber cannot be kept too quiet. Be sure that there be a chimney in the room--as there ought to be in _every_ room in the house--and that it be not stopped, as it will help to carry off the impure air of the apartment. Keep the chamber _well ventilated_, by, from time to time, opening the window. The air of the apartment cannot be too pure; therefore, let the evacuations from the bowels be instantly removed, either to a distant part of the house, or to an out-house or to the cellar, as it might be necessary to keep them for the medical man's inspection.

Before using either the night-commode, or the _pot-de-chambre_, let a little water, to the depth of one or two inches, be put in the pan, or _pot_; in order to sweeten the motion, and to prevent the faecal matter from adhering to the vessel.

Let there be frequent change of linen, as in sickness it is even more necessary than in health, more especially if the complaint be fever. In an attack of fever, clean sheets ought, every other day, to be put on the bed; clean body-linen every day. A frequent change of linen in sickness is most refreshing.

If the complaint be fever, a fire in the grate will not be necessary. Should it be a case either of inflammation of the lungs or of the chest, a small fire in the winter time is desirable, keeping the temperature of the room as nearly as possible at 60 degrees Fahrenheit. Bear in mind that a large fire in a sick-room cannot be too strongly condemned; for if there be fever--and there are scarcely any complaints without--a large fire only increases it. Small fires, in cases either of inflammation of the lungs or of the chest, in the winter time, encourage ventilation of the apartment, and thus carry off impure air. If it be summer time, of course fires would be improper. A thermometer is an indispensable requisite in a sick-room.

In fever, free and thorough ventilation is of vital importance, more especially in scarlet fever; then a patient cannot have too much air; in scarlet fever, for the first few days the windows, be it winter or summer, must to the widest extent be opened. The fear of the patient catching cold by doing so is one of the numerous prejudices and baseless fears that haunt the nursery, and the sooner it is exploded the better it will he for human life. The valances and bed-curtains ought to be removed, and there should be as little furniture in the room as possible.

If it be a case of measles, it will be necessary to adopt a different course; then the windows ought not to be opened, but the door must from time to time be left ajar. In a case of measles, if it be winter time, a _small_ fire in the room will be necessary. In inflammation of the lungs or of the chest, the windows should not be opened, but the door ought occasionally to be left unfastened, in order to change the air and to make it pure. Remember, then, that ventilation, either by open window or by open door, is in all diseases most necessary. Ventilation is one of the best friends a doctor has.

In fever, do not load the bed with clothes; in the summer a sheet is sufficient, in winter a sheet and a blanket.

In fever, do not be afraid of allowing the patient plenty either of cold water or of cold toast and water; Nature will tell him when he has had enough. In measles, let the chill be taken off the toast and water.

In _croup_, have always ready a plentiful supply of hot water, in case a warm bath might he required.

In _child-crowing_, have always in the sick-room a supply of cold water, ready at a moment's notice to dash upon the face.

In fever, do not let the little patient lie on the lap; he will rest more comfortably on a horse-hair mattress in his crib or cot. If he have pain in the bowels, the lap is most agreeable to him; the warmth of the body, either of the mother or of the nurse, soothes him; besides, if he be on the lap, he can be turned on his stomach and on his bowels, which, often affords him great relief and comfort. If he be much emaciated, when he is nursed, place a pillow upon the lap and let him lie upon it.

In _head affections_, darken the room with a _green_ calico blind; keep the chamber more than usually quiet; let what little talking is necessary be carried on in whispers, but the less of that the better; and in _head affections_, never allow smelling salts to be applied to the nose, as they only increase the flow of blood to the head, and consequently do harm.

It is often a good sign for a child, who is seriously ill, to suddenly become cross. It is then he begins to feel his weakness and to give vent to his feelings. "Children are almost always cross when recovering from an illness, however patient they may have been during its severest moments, and the phenomenon is not by any means confined to children."--Geo. McDonald.

A sick child must _not_ be stuffed with _much_ food at a time. He will take either a table-spoonful of new milk or a table-spoonful of chicken broth every half hour with greater advantage than a tea-cupful of either the one or the other every four hours, which large quantity would very probably be rejected from his stomach, and may cause the unfortunately treated child to die of starvation!

If a sick child be peevish, attract his attention either by a toy or by an ornament; if he be cross, win him over to good humour by love, affection, and caresses, but let it be done gently and without noise. Do not let visitors see him; they will only excite, distract, and irritate him, and help to consume the oxygen of the atmosphere, and thus rob the air of its exhilarating health-giving qualities and purity; a sick-room, therefore, is not a proper place, either for visitors or for gossips.

In selecting a sick-nurse, let her be gentle, patient, cheerful, quiet, and kind, but firm withal; she ought to be neither old nor young: if she be old she is often garrulous and prejudiced, and thinks too much of her trouble; if she he young, she is frequently thoughtless and noisy; therefore choose a middle-aged woman. Do not let there be in the sick-room more than, besides the mother, one efficient nurse; a greater number can he of no service--they will only be in each other's way, and will distract the patient.

Let stillness, especially if the head be the part affected, reign in a sick-room. Creaking shoes [Footnote: Nurses at these times ought to wear slippers, and not shoes. The best slippers in sick-rooms are those manufactured by the North British Rubber Company, Edinburgh; they enable nurses to walk in them about the room without causing the slightest noise; indeed, they might truly be called "the noiseless slipper," a great desideratum in such cases, more especially in all head affections of children. If the above slippers cannot readily be obtained, then list slippers--soles and all bring made of list--will answer the purpose equally as well.] and rustling silk dresses ought not to be worn in sick-chambers--they are quite out of place there. If the child be asleep, or if he be dozing, perfect stillness must he enjoined, not even a whisper should be heard:--

"In the sick-room be calm,
More gently and with care.
Lest any jar or sudden noise,
Come sharply unaware.

You cannot tell the harm.
The mischief it may bring,
To wake the sick one suddenly,
Besides the suffering.

The broken sleep excites
Fresh pain, increased distress;
The quiet slumber undisturb'd
Soothes pain and restlessness.

Sleep is the gift of God:
Oh! bear these words at heart,
'He giveth His beloved sleep,'
And gently do thy part."

[Footnote: _Household verses on Health and Happiness._ London: Jarrold and Sons. A most delightful little volume.]

If there be other children, let them be removed to a distant part of the house; or, if the disease be of an infectious nature, let them be sent away from home altogether.

In all illnesses--and bear in mind the following is most important advice--a child must be encouraged to try and make water, whether he ask or not, at least four times during the twenty-four hours; and at any other time, if he express the slightest inclination to do so. I have known a little fellow to hold his water, to his great detriment, for twelve hours, because either the mother bad in her trouble forgotten to inquire, or the child himself was either too ill or too indolent to make the attempt.

See that the medical man's directions are, to the very letter, carried out. Do not fancy that you know better than he does, otherwise you have no business to employ him. Let him, then, have your implicit confidence and your exact obedience. What _you_ may consider to be a trifling matter, may frequently be of the utmost importance, and may sometimes decide whether the case shall end either in life or death!