Chapter IX: Part II: Childhood (4)

_The symptoms_--The child for the first few days labours 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-coloured, 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, if 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.

206. _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.

207. _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 bedroom, 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 be not above 60 degrees 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 be 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 weaned 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, &c., but, until the inflammation have 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 tea-spoonful 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_, a quarter of a sheet.

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 Vesicatorina be properly applied, and the Ipecacuanha Wine be genuine and of good quality.

If there be any difficulty in procuring _good_ Ipecacuanha Wine, the Ipecacuanha may be given in powder instead of the wine The following is a pleasant form--

Take of--Powder of Ipecacuanha, twelve grains
White Sugar thirty six grains

Mix well together and divide into twelve powders. One of the powders to be put dry on the tongue every four hours.

The Ipecacuanha Powder will keep better than the Wine--an important consideration to those living in country places, nevertheless, if the Wine can be procured fresh and good, I far prefer the Wine to the Powder.

When the bronchitis has disappeared, the diet ought gradually to be improved--rice, sago, tapioca, and light batter-pudding, &c.; 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.

208. _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 of the nostrils. This 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 wind pipe. 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 diarrhoea 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 skilful medical man.

209. _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 amongst children under ten years of age. In the Lincolnshire epidemic, in the autumn of 1858, all the deaths at Horncastle, 25 in number, occurred amongst children under twelve years of age." [Footnote: _Diphtheria_: by Ernest Hart. A valuable pamphlet on the subject. Dr Wade of Birmingham has also written an interesting and useful monograph on Diphtheria. I am indebted to the above authors for much valuable information.]

210. _What are the causes of Diphtheria_?

Bad and imperfect drainage; [Footnote: "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_, December 7, 1861.] want of ventilation; overflowing privies; low neighbourhoods in the vicinity of rivers; stagnant waters; indeed, everything 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. Bear in mind, too, that a delicate child is much more predisposed to the disease than a strong one.

211. _What is the treatment of Diptheria_?

_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 bedroom 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, &c.

Apply to his throat every four hours a warm barm and oatmeal poultice. If he be old enough to have the knowledge to use a gargle, the following will be found serviceable--

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

To make a Gargle

Or,

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

To make a Gargle

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

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

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

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

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

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

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

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

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

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

Or,

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

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

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

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

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

Measles commences with symptoms of a common cold, the patient is at first chilly, then hot and feverish, he has a running at the nose, sneezing, watering, and redness of the eyes, headache, drowsiness, a 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 eye-lids 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.

213. _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.

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

Certainly not. The only way to throw out the eruption, as it is called, is to keep the body comfortably warm, and to give the beverages ordered by the medical man, with the chill off. "Surfeit water," saffron tea, and remedies of that 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.

215. _What is the treatment of Measles_?

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

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

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

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

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

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

_What NOT to do_--Do not give either "surfeit water" or wine. Do not apply leeches to the chest. Do not expose the child to the cold air. Do not keep the bed room very hot, but comfortably warm. Do not let the child leave the house, even under favourable 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.

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

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

217. _Will you describe the symptoms of Scarlet Fever_?

The patient is generally chilly, languid, drowsy, feverish, and poorly for two days before the eruption appears. At the end of the second day, the characteristic, bright scarlet efflorescence, somewhat similar to the colour of a boiled lobster, usually first shows itself. The scarlet appearance is not confined to the skin; but the tongue, the throat, and the whites of the eyes put on the same appearance; with this only difference, that on the tongue and on the throat the scarlet is much darker; and, as Dr Elliotson accurately describes it,--"the tongue looks as if it had been slightly sprinkled with Cayenne pepper;" the tongue, at other times, looks like a strawberry; when it does, it is called "the strawberry tongue." The eruption usually declines on the fifth, and is generally indistinct on the sixth day; on the seventh it has completely faded away. There is usually, after the first few days, great itching on the surface of the body. The skin, at the end of the week, begins to peel and to dust off, making it look as though meal had been sprinkled upon it.

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

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

_On no account whatever._ Aperient medicines are, in my opinion, highly improper and dangerous both before and during the period of the eruption. It is my firm conviction, that the administration of opening medicine, at such times, is one of the 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 skilful medical man.

219. _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.

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

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

Measles commences with symptoms of a common cold, scarlet fever does not. Measles has a _peculiar 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 colour 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 eruptions of scarlatina a curious phenomenon, which serves to distinguish this eruption from that of measles, erythema, erysipelas &c., a phenomenon essentially vital, and which is connected with the excessive contractability of the capillaries. The phenomenon in question is a _white line_, which can be produced at pleasure by drawing the back of the nail along the skin where the eruption, is situated. On drawing the nail, or the extremity of a hard body (such as a pen-holder), along the eruption, the skin is observed to grow pale, and to present a white trace, which remains for one or two minutes, or longer, and then disappears. In this way the diagnosis of the disease may be very distinctly written on the skin; the word 'Scarlatina' disappears as the eruption regains its uniform tint."--_Edinburgh Medical Journal._

221. _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, &c., should be administered quite cold.

222. _Do you believe in "Hybrid" Scarlet Fever--that is to say, in a cross between Scarlet Fever and Measles_?

I never in my life saw a case of "hybrid" scarlet fever--nor do I believe in it. Scarlet fever and measles are both blood poisons, each one being perfectly separate and distinct from the other. "Hybrid" Scarlet fever is, in my opinion, an utter impossibility. In olden times, when the symptoms of diseases were not so well and carefully distinguished as now, scarlet fever and measles were constantly confounded one with the other, and was frequently said to be "hybrid"--a cross between measles and scarlet fever--to the patient's great detriment and danger, the two diseases being as distinct and separate as their treatment-and management ought to be.

223. _What is the treatment of Scarlet Fever?_ [Footnote: On the 4th of March 1856, I had the honour to read a _Paper on the Treatment of Scarlet Fever_ before the members of Queens College Medico-Chirugical Society, Birmingham--which _Paper_ was afterwards published in the _Association Journal_ (March 15 1856) and in Braithwaite's _Retrospect of Medicine_ (January--June, 1856) and in Rankings _Half Yearly Abstract of the Medical Sciences_ (July--December, 1856), besides in other publications. Moreover the _Paper_ was translated into German, and published in _Canstatts Jahresbericht_, iv 456, 1859]

_What to do_--Pray pay attention to my rules, and carry out my directions to the letter--I can then promise, _that if the scarlet fever be neither malignant nor complicated with diphtheria_, the plan I am about to advise will, with God's blessing, be usually 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 bedroom 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. [Footnote: In the _Times_ of Sept 4, 1863, 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 empanelled, 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 vide 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!]

If the weather be either intensely cold, or very damp, there is no objection to a small fire in the grate provided there be, at the same time, air--an abundance of fresh air--admitted into the room.

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 tea-cupful 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 be 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 a 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:--

Take of--Dilated Sulphuric Acid, half a drachm;
Simple Syrup, one ounce and a half;
Acid Infusion of Roses, four ounces and a half:

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

It is grateful and refreshing, it is pleasant to take, it abates fever and thirst, it cleanses 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.

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 arrowroot 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, 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 nightgown should, until the dead skin have peeled off, be now worn next to the skin, when the flannel nightgown should be discontinued. The patient ought ever after to wear, in the day time, a flannel waistcoat. [Footnote: 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 advised, 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, be not properly opened, a dose or two of syrup of senna should be given: that is to say, one or two tea-spoonfuls should be administered early in the morning, and should, if the first dose does not operate, be repeated in four hours.

In a subsequent Conversation, I shall strongly urge you not to allow your child, when convalescent, to leave the house under at least a month from the commencement of the illness; I, therefore, beg to refer you to that Conversation, and hope that you will give it your best and earnest consideration! During the last twenty years I have never had dropsy from scarlet fever, and I attribute it entirely to the plan I have just recommended, and in not allowing my patients to leave the house under the month--until, in fact, the skin that had peeled off has been renewed.

Let me now sum up the plan I adopt, and which I beg leave to designate as--Pye Chavasse's Fresh Air Treatment of Scarlet Fever:--

1. Thorough ventilation, a cool room, and scant clothes on the bed, for the first five or six days.

2. A change of temperature of the skin to be carefully regarded. As soon as the skin is cool, closing the windows, and putting additional clothing on the bed.

3. The Acidulated Infusion of Hoses with Syrup is _the_ medicine for scarlet fever.

4. Purgatives to be religiously avoided for the first ten days at least, and even afterwards, unless there be absolute necessity.

5. Leeches, blisters, emetics, cold and tepid spongings, and painting the tonsils with caustic, inadmissible in scarlet fever.

6. A strict antiphlogistic (low) diet for the first few days, during which time cold water to be given _ad libitum_.

7. The patient not to leave the house in the summer under the month; in the winter, under six weeks.

_What NOT to do._--Do not, then, apply either leeches or blisters to the throat; do not paint the tonsils with caustic; do not give aperients; do not, on any account, give either calomel or emetic tartar; do not, for the first few days of the illness, be afraid of _cold air_ to the skin, and of cold water as a beverage; do not, emphatically let me say, _do not_ let the child leave the house for at least a month from the commencement of the illness.

My firm conviction is, that purgatives, emetics, and blisters, by depressing the patient, sometimes cause ordinary scarlet fever to degenerate into malignant scarlet fever.

I am aware that some of our first authorities advocate a different plan to mine. They recommend purgatives, which I may say, in scarlet fever, are my dread and abhorrence. They advise cold and tepid spongings--a plan which I think dangerous, as it will probably drive the disease internally. Blisters, too, have been prescribed; these I consider weakening, injurious, and barbarous, and likely still more to inflame the already inflamed skin. They recommend leeches to the throat, which I am convinced, by depressing the patient, will lessen the chance of his battling against the disease, and will increase the ulceration of the tonsils. Again, the patient has not too much blood; the blood is only poisoned. I look upon scarlet fever as a specific poison of the blood, and one which will be eliminated from the system, _not_ by bleeding, _not_ by purgatives, _not_ by emetics but by a constant supply of fresh and cool air, by the acid treatment, by cold water as a beverage, and for the first few days by a strict antiphlogistic (low) diet. Sydenham says that scarlet fever is oftentimes "fatal through the officiousness of the doctor." I conscientiously believe that a truer remark was never made; and that, under a different system to the usual one adopted, scarlet fever would not be so much dreaded. [Footnote: If any of my medical brethren should do me the honour to read these pages, let me entreat them to try my plan of treating scarlet fever, as my success has been great. I have given full and minute particulars, in order that they and mothers (if mothers cannot obtain medical advice) may give my plan a fair and impartial trial. My only stipulations are that they must _begin_ with my treatment, and _not mix_ any other with it, and carry out my plan to the very letter. I then, with God's blessing, provided the cases be neither malignant nor complicated with diphtheria, shall not fear the result. If any of my _confreres_ have tried my plan of treatment of scarlet fever--and I have reason to know that many have--I should feel grateful to them if they would favour me with their opinion as to its efficacy. Address--"Pye Chavasse, 214 Hagley Road, Birmingham."]

Dr Budd, of Bristol, recommends, in the _British Medical Journal_, that the body, including the scalp, of a scarlet fever patient, should, after about the fourth day, be anointed, every night and morning, with camphorated oil; this anointing to be continued until the patient is able to take a warm bath and use disinfectant soap: this application will not only be very agreeable to the patient's feelings, as there is usually great irritation and itching of the skin, but it will, likewise, be an important means of preventing the dead skin, which is highly infectious, and which comes off partly in flakes and partly floats about the air as dust, from infecting other persons. The plan is an excellent one, and cannot be too strongly recommended.

If the case be a combination of scarlet fever and of diphtheria, as it unfortunately now frequently is, let it be treated as a case of diphtheria.

224. _I have heard of a case of Scarlet Fever, where the child, before the eruption showed itself, was suddenly struck prostrate, cold, and almost pulseless: what, in such a case, are the symptoms, and what immediate treatment do you advise_?

There is an _exceptional_ case of scarlet fever, which now and then occurs, and which requires _exceptional_ and prompt treatment, or death will quickly ensue. We will suppose a case: one of the number, where nearly all the other children of a family are labouring under scarlet fever, is quite well, when suddenly--in a few hours, or even, in some cases, in an hour--utter prostration sets in, he is very cold, and is almost pulseless, and is nearly insensible--comatose.

Having sent instantly for a judicious medical man, apply, until he arrives, hot bottles, hot bricks, hot bags of salt to the patient's feet and legs and back, wrap him in hot blankets, close the window, and give him hot brandy and water--a tablespoonful of brandy to half a tumblerful of hot water--give it him by teaspoonfuls, continuously--to keep him alive; when he is warm and restored to consciousness, the eruption will probably show itself, and he will become hot and feverish; then your tactics must, at once, be changed, and my Fresh Air Treatment, and the rest of the plan I have before advised must in all its integrity, be carried out.

We sometimes hear of a child, before the eruption comes out and within twenty-four hours of the attack, dying of scarlet fever. When such be the case it is probably owing to low vitality of the system--to utter prostration--he is struck down, as though for death, and if the plan be not adopted of, for a few hours, keeping him alive by heat, and by stimulants, until, indeed, the eruption comes out, he will never rally again, but will die from scarlet fever poisoning and from utter exhaustion. These cases are comparatively rare, but they do, from time to time, occur, and, when they do, they demand exceptional and prompt and energetic means to save them from ending in almost immediate and certain death. "To be forewarned is to be forearmed." [Footnote: I have been reminded of this _exceptional_ case of scarlet fever by a most intelligent and valued patient of mine, who had a child afflicted as above described, and whose child was saved from almost certain death, by a somewhat similar plan of treatment as advised in the text.]

225. _How soon ought a child to be allowed to leave the house after an attack of Scarlet Fever_?

He must not be allowed to go out for at least a month from the commencement of the attack, in the summer, and six weeks in the winter; and not even then without the express permission of a medical man. It might be said that this is an unreasonable recommendation: but when it is considered that the whole of the skin generally desquamates, or peels off, and consequently leaves the surface of the body exposed to cold, which cold flies to the kidneys, producing a peculiar and serious disease in them, ending in dropsy, this warning will not be deemed unreasonable.

Scarlet fever dropsy, which is really a _formidable disease, generally arises from, the carelessness, the ignorance, and the thoughtlessness of parents in allowing a child to leave the house before the new skin be properly formed and hardened._ Prevention is always better than cure.

Thus far with regard to the danger to the child himself. Now, if you please, let me show you the risk of contagion that you inflict upon families, in allowing your child to mix with others before a month at least has elapsed. Bear in mind, a case is quite as contagious, if not more so, while the skin is peeling off, as it was before. Thus, in ten days or a fortnight, there is as much risk of contagion as at the _beginning_ of the disease, and when the fever is at its height. At the conclusion of the month, the old skin has generally all peeled off, and the new skin has taken its place; consequently there will then be less fear of contagion to others. But the contagion of scarlet fever is so subtle and so uncertain in its duration, that it is impossible to fix the exact time when it ceases.

Let me most earnestly implore you to ponder well on the above important facts. If these remarks should be the means of saving only one child from death, or from broken health, my labour will not have been in vain.

226. _What means do you advise to purify a house, clothes, and furniture, from the contagion of Scarlet Fever_?

Let every room in the house, together with its contents, and clothing and dresses that cannot be washed, be well fumigated with sulphur--taking care the while to close both windows and door; let every room be _lime-washed_ and then be white-washed; if the contagion have been virulent, let every bedroom be freshly papered (the walls having been previously stripped of the old paper and then lime-washed); let the bed, the holsters, the pillows, and the mattresses be cleansed and purified; let the blankets and coverlids be thoroughly washed, and then let them be exposed to the open air--if taken into a field so much the better; let the rooms be well scoured; let the windows, top and bottom, be thrown wide open; let the drains be carefully examined; let the pump water be scrutinised, to see that it be not contaminated by faecal matter, either from the water-closet, from the privy, from the pig-stye, or from the stable; let privies be emptied of their contents--_remember this is most important advice_--then put, into the empty places, either lime and powdered charcoal or carbolic acid, for it is a well ascertained fact that it is frequently impossible to rid a house of the infection of scarlet fever without adopting such a course. "In St George's, Southwark, the medical officer reports that scarlatina 'has raged fatally, almost exclusively where privy or drain, smells are to be perceived in the houses.'" [Footnote: _Quarterly Report of the Board of Health_ upon Sickness in the Metropolis.] Let the children, who have not had, or who do not appear to be sickening for scarlet fever, be sent away from home--if to a farm house so much the better. Indeed, leave no stone unturned, no means untried, to exterminate the disease from the house and from the neighbourhood. Remember the young are more prone to catch contagious diseases than adults; for

"in the morn and liquid dew of youth
Contagious blastments are most imminent."--_Shakspeare_.

227. _Have you any further observations to offer on the precautions to be taken against the spread of Scarlet Fever_?

Great care should be taken to separate the healthy from the infected. The nurses selected for attending scarlet fever patients should be those who have previously had scarlet fever themselves. Dirty linen should be removed at once, and be put into boiling water. Very little furniture should be in the room of a scarlet fever patient--the less the better--it only obstructs the circulation of the air, and harbours the scarlet fever poison. The most scrupulous attention to cleanliness should, in these cases, be observed. A patient who has recovered from scarlet fever, and before he mixes with healthy people, should, for three or four consecutive mornings, have a warm bath, and well wash himself, while in the bath, with soap; he will, by adopting this plan, get rid of the dead skin, and thus remove the infected particles of the disease. If scarlet fever should appear in a school, the school must for a time be broken up, in order that the disease might be stamped out There must be no half measures where such a fearful disease is in question. A house containing scarlet fever patients should, by parents, be avoided as the plague; it is a folly at any time to put one's head into the lion's mouth! Chloralum and carbolic acid, and chloride of lime, and Condy's fluid, are each and all good disinfectants; but not one is to be compared to perfect cleanliness and to an abundance of fresh and pure air--the last of which may truly _par excellence_ be called God's disinfectant! Either a table-spoonful of chloralum, or two tea-spoonfuls of carbolic acid, or two tea-spoonfuls of Condy's fluid, or a tea-spoonful of chloride of lime in a pint of water, are useful to sprinkle the soiled handkerchiefs as soon as they be done with, and before the be washed, to put in the _pot-de-chambre_, and to keep in saucers about the room; but, remember, as I have said before, and cannot repeat too often, there is no preventative like the air of heaven, which should be allowed to permeate and circulate freely through the apartment and through the house: air, air, air is the best disinfectant, curative, and preventative of scarlet fever in the world!

I could only wish that my _Treatment of Scarlet Fever_ were, in all its integrity, more generally adopted; if it were, I am quite sure that thousands of children would annually be saved from broken health and from death. Time still further convinces me that my treatment is based on truth as I have every year additional proofs of its value and of its success; but error and prejudice are unfortunately ever at work, striving all they can to defeat truth and common sense. One of my principal remedies in the treatment of scarlet fever is an abundance of fresh air; but many people prefer their own miserable complicated inventions to God's grand and yet simple remedies--they pretend that they know better than the Mighty Framer of the universe!

228. _Will you describe the symptoms of Chicken pox_?

It is occasionally, but not always, ushered in with a slight shivering fit; the eruption shows itself in about twenty-four hours from the child first appearing poorly. It is a vesicular [Footnote: _Vesicles_. Small elevations of the cuticle, covering a fluid which is generally clear and colourless at first, but afterwards whitish and opaque, or pearly.--_Watson_.] disease. The eruption comes out in the form of small pimples, and principally attacks the scalp, the neck, the back, the chest, and the shoulders, but rarely the face; while in small-pox the face is generally the part most affected. The next day these pimples fill with water, and thus become vesicles; on the third day they are at maturity. The vesicles are quite separate and distinct from each other. There is a slight redness around each of them. Fresh ones, whilst the others are dying away, make their appearance. Chicken-pox is usually attended with a slight itching of the skin; when the vesicles are scratched the fluid escapes, and leaves hard pearl-like substances, which, in a few days, disappear. Chicken-pox never leaves pit marks behind. It is a child's complaint; adults scarcely, if ever, have it.

229. _Is there any danger in Chicken-pox; and what treatment do you advise_?

It is not at all a dangerous, but, on the contrary, a trivial complaint. It lasts only a few days, and requires but little medicine. The patient ought, for three or four days, to keep the house, and should abstain from animal food. On the sixth day, but not until then, a dose or two of a mild aperient is all that will be required.

230. _Is Chicken-pox infectious_?

There is a diversity of opinion on this head, but one thing is certain--it cannot be communicated by inoculation.

231. _What are the symptoms of Modified Small-pox_?